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Sample records for renal pelvic diameter

  1. Frequency of postnatal hydronephrosis in infants with a renal anterior-posterior pelvic diameter > 4 mm on midtrimester ultrasound.

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    Chou, Ching-Yu; Chen, Li-Ching; Cheong, Mei-Leng; Tsai, Ming-Song

    2015-10-01

    To examine the association of antenatal renal pelvic dilatation observed on midtrimester ultrasound screening with the presence of hydronephrosis in newborn infants. The records of patients who received fetal ultrasound examination at 18-28 weeks' gestation from May 2008 to March 2012 were retrospectively reviewed. A fetal renal pelvic anterior-posterior (AP) diameter > 4 mm was considered abnormal and ≤ 4 mm was considered normal. On postnatal ultrasound, a renal pelvic AP diameter > 3 mm was considered to indicate hydronephrosis and ≤ 3 mm was considered normal. The association of postnatal hydronephrosis with prenatal pelvic AP diameter was determined using binary logistic regression analysis. The study comprised 1310 newborn infants: 684 (52.2%) male and 626 (47.8%) female. Multivariate analysis showed a right or left prenatal AP renal pelvic diameter > 4 mm was associated with a higher risk of postnatal hydronephrosis compared with a right and left prenatal AP renal pelvic diameter ≤ 4 mm. Boys had a higher risk for postnatal hydronephrosis than girls (odds ratio = 2.42, p 4 mm on midtrimester ultrasound is predictive of postnatal hydronephrosis. Copyright © 2015. Published by Elsevier B.V.

  2. Frequency of postnatal hydronephrosis in infants with a renal anterior–posterior pelvic diameter > 4 mm on midtrimester ultrasound

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    Ching-Yu Chou

    2015-10-01

    Results: The study comprised 1310 newborn infants: 684 (52.2% male and 626 (47.8% female. Multivariate analysis showed a right or left prenatal AP renal pelvic diameter > 4 mm was associated with a higher risk of postnatal hydronephrosis compared with a right and left prenatal AP renal pelvic diameter ≤ 4 mm. Boys had a higher risk for postnatal hydronephrosis than girls (odds ratio = 2.42, p  4 mm on midtrimester ultrasound is predictive of postnatal hydronephrosis.

  3. Association of left renal vein variations and pelvic varices in abdominal MDCT

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    Koc, Zafer [Baskent University, Adana Teaching and Medical Research Center, Department of Radiology, Adana (Turkey); Baskent Universitesi Adana Hastanesi, Adana (Turkey); Ulusan, Serife; Oguzkurt, Levent [Baskent University, Adana Teaching and Medical Research Center, Department of Radiology, Adana (Turkey)

    2007-05-15

    The aim of this study was to determine whether left renal vein (LRV) variation is associated with pelvic varices and left ovarian vein (LOV) reflux. Routine abdominal multidetector-row computed tomography scans of 324 women without symptoms of pelvic congestion syndrome were analyzed. Presence and type of LRV variants (circumaortic [CLRV] or retroaortic [RLRV]) were recorded. Diameters of the LRV, ovarian veins (OVs), and parauterine veins were measured and a specific LRV diameter ratio was calculated for each patient. Presence and severity of pelvic varices and LOV reflux were noted. Pelvic varices were detected in 59 (18%) of the total of 324 women, in 7 (37%) of the 19 women with RLRVs, in 7 (29%) of the 24 women with CLRVs, and in 45 (16%) of the 281 women with normal LRVs. The frequency of pelvic varices in the women with LRV variation was significantly higher than that in the group with normal LRV anatomy (33 vs. 16%; p=0.009). The frequency of pelvic varices in the women with RLRVs was also significantly higher than that in the group with normal LRV anatomy (p=0.02). LRV diameter ratio was correlated with presence of pelvic varices and presence of LOV reflux (p=0.0001 for both). This study revealed an association between pelvic varices and LRV variations in a population of predominantly multiparous women. (orig.)

  4. Association of left renal vein variations and pelvic varices in abdominal MDCT

    International Nuclear Information System (INIS)

    Koc, Zafer; Ulusan, Serife; Oguzkurt, Levent

    2007-01-01

    The aim of this study was to determine whether left renal vein (LRV) variation is associated with pelvic varices and left ovarian vein (LOV) reflux. Routine abdominal multidetector-row computed tomography scans of 324 women without symptoms of pelvic congestion syndrome were analyzed. Presence and type of LRV variants (circumaortic [CLRV] or retroaortic [RLRV]) were recorded. Diameters of the LRV, ovarian veins (OVs), and parauterine veins were measured and a specific LRV diameter ratio was calculated for each patient. Presence and severity of pelvic varices and LOV reflux were noted. Pelvic varices were detected in 59 (18%) of the total of 324 women, in 7 (37%) of the 19 women with RLRVs, in 7 (29%) of the 24 women with CLRVs, and in 45 (16%) of the 281 women with normal LRVs. The frequency of pelvic varices in the women with LRV variation was significantly higher than that in the group with normal LRV anatomy (33 vs. 16%; p=0.009). The frequency of pelvic varices in the women with RLRVs was also significantly higher than that in the group with normal LRV anatomy (p=0.02). LRV diameter ratio was correlated with presence of pelvic varices and presence of LOV reflux (p=0.0001 for both). This study revealed an association between pelvic varices and LRV variations in a population of predominantly multiparous women. (orig.)

  5. Computerized tomography for diagnosis and staging of renal pelvic tumor

    International Nuclear Information System (INIS)

    Fukuoka, Hiroshi; Goto, Akihiko; Kitamura, Hajime

    1985-01-01

    Although we have no definite criteria available yet for clinical staging of renal pelvic tumor, the preoperative staging of this disease is nevertheless important in view of the current tendency that the necessity for renal conservative operation is considered. CT is now a routine work also for diagnosing renal pelvic tumor. The present study was performed in order to validate its usefulness for diagnosing and staging the disease. Our series consisted of 8 patients with renal pelvic tumor, in 6 of whom a definite diagnosis was established after demonstrating filling defect on pyelogram, but in the remaining two with extensive infiltration, and squamous cell carcinoma associated with staghorn calculus respectively, CT failed to provide a definite diagnosis. CT findings of an extension of the mass in the renal pelvis or renal calyces into adipose tissue of the renal sinus or renal parenchyma were judged to indicate an invasive type (Stage III), while a non-invasive type (Stage I or II) was defined on the basis of otherwise CT findings. Consistency with pathological stages was noted in 7 of the 8 cases (87.5 %). It was difficult to differentiate Stage I and Stage II on CT findings. CT was considered to be extremely useful tool for preoperative staging of renal pelvic tumor. (author)

  6. Internal validation of the renal pelvic score: a novel marker of renal pelvic anatomy that predicts urine leak after partial nephrectomy.

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    Tomaszewski, Jeffrey J; Smaldone, Marc C; Cung, Bic; Li, Tianyu; Mehrazin, Reza; Kutikov, Alexander; Canter, Daniel J; Viterbo, Rosalia; Chen, David Y T; Greenberg, Richard E; Uzzo, Robert G

    2014-08-01

    To internally validate the renal pelvic score (RPS) in an expanded cohort of patients undergoing partial nephrectomy (PN). Our prospective institutional renal cell carcinoma database was used to identify all patients undergoing PN for localized renal cell carcinoma from 2007 to 2013. Patients were classified by RPS as having an intraparenchymal or extraparenchymal renal pelvis. Multivariate logistic regression models were used to examine the relationship between RPS and urine leak. Eight hundred thirty-one patients (median age, 60 ± 11.6 years; 65.1% male) undergoing PN (57.3% robotic) for low (28.9%), intermediate (56.5%), and high complexity (14.5%) localized renal tumors (median size, 3.0 ± 2.3 cm; median nephrometry score, 7.0 ± 2.6) were included. Fifty-four patients (6.5%) developed a clinically significant or radiographically identified urine leak. Seventy-two of 831 renal pelvises (8.7%) were classified as intraparenchymal. Intrarenal pelvic anatomy was associated with a markedly increased risk of urine leak (43.1% vs 3.0%; P renal pelvis; odds ratio [OR], 24.8; confidence interval [CI], 11.5-53.4; P Renal pelvic anatomy as measured by the RPS best predicts urine leak after open and robotic partial nephrectomy. Although external validation of the RPS is required, preoperative identification of patients at increased risk for urine leak should be considered in perioperative management and counseling algorithms. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Antenatal renal pelvic dilatation; the long-term outlook

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    Duncan, K.A. [Royal Aberdeen Children' s Hospital and Aberdeen Maternity Hospital, Foresterhill, Aberdeen (United Kingdom)]. E-mail: k.duncan@nhs.net

    2007-02-15

    Aim: The purpose of this study was twofold: first to provide data for more accurate counselling of parents with regard to prognosis, and second, to ensure that by following a policy of selective micturating cystourethography (MCUG), significant pathology is not missed, in particular vesicoureteric reflux (VUR). (MCUG is only undertaken if the renal pelvic diameter (RPD) is {>=} 10 mm or if there is calyceal or ureteric dilatation.) Material and methods: Data were collected prospectively over a 6-year period. Pre and postnatal imaging findings were collected for all infants in whom a RPD of {>=} 5 mm was identified at any gestational age. The imaging records of all patients were reviewed in 2005 for evidence of pathology detected after re-presentation with symptoms. The age range at review varied from 2-8 years. Results: Complete data were available in 527 infants. The risk of significant pathology was related to the degree of antenatal renal pelvic dilatation varying from 6% for a RPD of 5 mm at 20 weeks gestation to 38% at 10mm. At 28-33 weeks gestation the risk varied from 5% at 5 mm to 15% at 10 mm. Subsequent imaging record review revealed only one patient with grade II VUR in the study population not picked up by our selective MCUG policy. Conclusion: The present study provides prognostic information that can be given to parents both antenatally and postnatally, and reassurance that a selective MCUG policy is appropriate.

  8. Antenatal renal pelvic dilatation; the long-term outlook

    International Nuclear Information System (INIS)

    Duncan, K.A.

    2007-01-01

    Aim: The purpose of this study was twofold: first to provide data for more accurate counselling of parents with regard to prognosis, and second, to ensure that by following a policy of selective micturating cystourethography (MCUG), significant pathology is not missed, in particular vesicoureteric reflux (VUR). (MCUG is only undertaken if the renal pelvic diameter (RPD) is ≥ 10 mm or if there is calyceal or ureteric dilatation.) Material and methods: Data were collected prospectively over a 6-year period. Pre and postnatal imaging findings were collected for all infants in whom a RPD of ≥ 5 mm was identified at any gestational age. The imaging records of all patients were reviewed in 2005 for evidence of pathology detected after re-presentation with symptoms. The age range at review varied from 2-8 years. Results: Complete data were available in 527 infants. The risk of significant pathology was related to the degree of antenatal renal pelvic dilatation varying from 6% for a RPD of 5 mm at 20 weeks gestation to 38% at 10mm. At 28-33 weeks gestation the risk varied from 5% at 5 mm to 15% at 10 mm. Subsequent imaging record review revealed only one patient with grade II VUR in the study population not picked up by our selective MCUG policy. Conclusion: The present study provides prognostic information that can be given to parents both antenatally and postnatally, and reassurance that a selective MCUG policy is appropriate

  9. Endoluminal isoproterenol reduces renal pelvic pressure during semirigid ureterorenoscopy

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    Jakobsen, Jørn S; Jung, Helene U; Gramsbergen, Jan B

    2009-01-01

    OBJECTIVE To investigate the effects on the pressure-flow relation of renal pelvic pressure during semirigid ureterorenoscopy and endoluminal perfusion of isoproterenol (ISO) 0.1 microg/mL, with emphasis on local effects and cardiovascular side-effects, as topically administered ISO effectively...... and dose-dependently causes relaxation of the upper urinary tract in pigs with no concomitant cardiovascular side-effects. MATERIALS AND METHODS In anaesthetized female pigs (60 kg), 16 macroscopically normal upper urinary tract systems were subjected to ureterorenoscopy. Via a subcostal incision a 6-F...... catheter was placed in the renal pelvis for pressure measurements, and a semirigid ureteroscope (7.8 F) was inserted retrogradely in the renal pelvis, through which the pelvis was perfused. The blood pressure and heart rate were recorded. The increase in renal pelvic pressure was examined with increasing...

  10. Radiological and cytological detection of renal pelvic transitional-cell carcinoma

    International Nuclear Information System (INIS)

    Paeivaensalo, M.; Merikanto, J.; Myllylae, V.; Hellstroem, P.; Kallionen, M.; Jalovaara, P.; Oulu Univ.; Oulu Univ.

    1990-01-01

    We evaluated US, CT, intraveneous urography, arteriography, retrograde pyelography and urine cytology results in a series of 23 patients with renal pelvic transitional-cell carcinomas, 14 of whom underwent US, 17 i.v. urography, 8 CT, 15 arteriography, 9 retrograde pyelography, and 17 patients urine cytology. A tumour was identified in 5 patients (36%) at US, in 11 patients (61%) at urography, in 7 (88%) at CT, in 10 patients (67%) at arteriography, and in 8 (89%) at retrograde pyelography. Urine cytology was assessed as showing changes consistent with Papanicolaou class III-V in 15 (88%) of 17 patients. When renal pelvic cancer is suspected, intravenous urography should be performed as the initial radiological examination and followed by CT, which may also identify tumour spread. Arteriography and retrograde pyelography are sometimes complementary investigations. Repeated urinary cytology is mandatory. Our results show that US alone is unreliable in detecting renal pelvic cancer. (orig.) [de

  11. Laparoscopic bilateral nephroureterectomy and bladder cuff excision for native renal pelvic and ureteral transitional cell carcinoma after renal transplantation.

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    Chen C

    2003-01-01

    Full Text Available A 37-years-old female who was suffering from end-stage renal disease for about 6 years received allograft renal transplantation 4 years ago. She has been receiving 50mg of Cyclosporin A orally daily for immuno-suppression since then. Gross haematuria was noted and computerised tomography showed native left renal pelvic and ureteral multi-focal transitional cell carcinoma with severe hydronephrosis. Laparoscopic bilateral nephroureterectomy and bladder cuff excision were performed. In the past, history of previous operation was considered a relative contraindication for laparoscopic surgery. To our knowledge, we present the first case of laparoscopic treatment for native renal pelvic and ureteral transitional cell carcinoma after renal allograft transplantation without a hand-assisted device. This case shows the feasibility of laparoscopic bilateral nephroureterectomy in patients with transplanted kidneys.

  12. Renal pelvic anatomy is associated with incidence, grade, and need for intervention for urine leak following partial nephrectomy.

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    Tomaszewski, Jeffrey J; Cung, Bic; Smaldone, Marc C; Mehrazin, Reza; Kutikov, Alexander; Viterbo, Rosalia; Chen, David Y T; Greenberg, Richard E; Uzzo, Robert G

    2014-11-01

    Although the effect of tumor complexity on perioperative outcome measures is well established, the impact of renal pelvic anatomy on perioperative outcomes remains poorly defined. To evaluate renal pelvic anatomy as an independent predictor of urine leak in moderate- and high-complexity tumors undergoing nephron-sparing surgery. Patients undergoing open partial nephrectomy (PN) for localized RCC were stratified into intermediate- and high-complexity groups using a nephrometry score (7-9 and 10-12, respectively). A renal pelvic score (RPS) was defined by the percentage of renal pelvis contained inside the volume of the renal parenchyma. On this basis, patients were categorized as having an intraparenchymal (>50%) or extraparenchymal (renal pelvis. Characteristics of patients with and without an intraparenchymal renal pelvic anatomy were compared. Inclusion criteria were met by 255 patients undergoing PN for intermediate (73.6%) and complex (26.4%) localized renal tumors (mean size: 4.6±2.9cm). Twenty-four (9.6%) renal pelves were classified as completely intraparenchymal. Following stratification by RPS, groups differed with respect to Charlson comorbidity index, body mass index, and largest tumor size, while no differences were observed between hospital length of stay, nephrometry score, estimated blood loss, operative time, and age. Intrarenal pelvic anatomy was associated with a markedly increased risk of urine leak (75% vs 6.5%; p=0.001), secondary intervention (37.5% vs 3.9%; prenal pelvic anatomy is an uncommon anatomic variant associated with an increased rate of urine leak following PN. Elevated pressures within a small intraparenchymal renal pelvis might explain the increased risk. Preoperative imaging characteristics suggestive of increased risk for urine leak should be considered in perioperative management algorithms. Copyright © 2013. Published by Elsevier B.V.

  13. Percutaneous nephrolithotomy vs. extracorporeal shockwave lithotripsy for treating a 20-30 mm single renal pelvic stone.

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    Hassan, Mohammed; El-Nahas, Ahmed R; Sheir, Khaled Z; El-Tabey, Nasr A; El-Assmy, Ahmed M; Elshal, Ahmed M; Shokeir, Ahmed A

    2015-09-01

    To compare the efficacy, safety and cost of extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL) for treating a 20-30 mm single renal pelvic stone. The computerised records of patients who underwent PNL or ESWL for a 20-30 mm single renal pelvic stone between January 2006 and December 2012 were reviewed retrospectively. Patients aged PNL. The re-treatment rate (75% vs. 5%), the need for secondary procedures (25% vs. 4.7%) and total number of procedures (three vs. one) were significantly higher in the ESWL group (P PNL group (95% vs. 75%, P PNL (US$ 1120 vs. 490; P PNL was more effective than ESWL for treating a single renal pelvic stone of 20-30 mm. However, ESWL was associated with fewer complications and a lower cost.

  14. Double intervention in management of acute obstructive renal failure due to pelvic malignancies

    International Nuclear Information System (INIS)

    Wang Jingbing; Wang Han; An Xiao; Wang Linchuan; Gao Liqiang; Zhang Guixiang

    2008-01-01

    Objective: To evaluate the clinical value and safety of combined percutaneous nephrostomy and antegrade double-pigtail stenting with regional intrarterial infusion chemotherapy in the management of acute obstructive renal failure secondary to pelvic primary malignant tumor and metastasis. Methods: Percutaneous unilateral nephrostomy and stenting were done in 18 cases of acute malignant obstructive renal failure due to bilateral ureteral obstruction. Regional TAIs with routine drug dosage were performed after 3 to 5 days of restoration of normal renal function. Results: Seventeen procedures were all successful in the first attempt, except 1 was interrupted due to massive left perirenal hematoma which was controlled by segemental renal arterial embolization with gelform particals and secondary successful PCN was performed in right kidney 5 days later. No other serious complications occurred. The levels of pretreatment serum creatinine were 175.40 μmol/L to 1040.70 μmol/L, with bleeding tendency in 6 cases, and all returned to normal from 2 to 7 days after successful PCN. Follow-up was taken from 3 months to 15 months, averaging 7 months. Conclusion: The combined percutaneous nephrostomy and antegrade double-pigtail stenting with regional intraarterial infusion chemotherapy in the management of acute obstructive renal failure secondary to pelvic malignant tumors is safe, feasible, less complications, providing the prolongation of patient's survival span. (authors)

  15. Retroperitoneal laparoscopic pyelolithotomy in renal pelvic stone versus open surgery - a comparative study.

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    Singal, Rikki; Dhar, Siddharth

    2018-01-01

    The introduction of endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy have led to a revolution in the the management of urinary stone disease. The indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. To study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy in retroperitoneal renal stone. We compared the results of laparoscopic and open surgery in terms of easy accessibility, operative period, renal injuries, and early recovery. This prospective study was conducted on renal pelvic stone cases from January 2009 to February 2016 in Suchkhand Hospital, Agra, India. The study included a total of 1700 cases with the diagnosis of solitary renal pelvic stones. In group A - 850 cases - retroperitoneal laparoscopic pyelolithotomy was performed, while group B - 850 cases - underwent open pyelolithotomy. The mean operative time was less in group B than group A (74.83 min vs. 94.43 min) which was significant (p<0.001). The blood loss was less in the laparoscopic group than in the open group (63 mL vs. 103mL). There were statistically significant differences in the post-operative pain scores, and postoperative complications compared to group B (p<0.001). The mean hospital stay was less in group A (p<0.03), which was significant. Laparoscopic surgery reduces analgesic requirements, hospital stay, and blood loss. The disadvantages include the reduced working space, the cost of equipment and the availability of a trained surgeon.

  16. Has the pelvic renal stone position inside the upper loop of JJ stent any influence on the extracorporeal shock wave lithotripsy results?

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    Pricop, Catalin; Serban, Dragomir N; Serban, Ionela Lacramioara; Cumpanas, Alin-Adrian; Gingu, Constantin-Virgil

    2016-01-01

    JJ stents are often encountered in patients with pelvic renal stones referred for shock wave lithotripsy, most of them being placed either for obstructive renal pelvic stones or for ureteric stones mobilized retrograde during the JJ stent insertion. The aim of the study was to determine whether the relative stone position in the upper loop of the JJ stent during extracorporeal shock wave lithotripsy (SWL) influences the efficiency of the procedure. The study was designed as a prospective cohort study on 162 patients addressing the same urological department, with single renal pelvic stone (primary or mobilized to the renal pelvis during the insertion of JJ stent), smaller than 15 mm, with JJ stent, treated by SWL using a second generation spark gap lithotripter, 18 kV, 3000 waves/session. Patients were divided in three groups according to the relative position of the stone to the upper loop of the JJ stent as appears on plain X-ray: stone-inside-loop, loop-crossing-stone and stone-outside the loop. The SWL success rate was the primary outcome of the study. p Value, Chi square and Kruskal-Wallis tests were used for statistical analysis. For stone-inside-loop cases, SWL efficiency was 22.7 versus 42 % for all the other cases (p = 0.002). Other factors for decreased SWL success rate were: higher stone radio-opacity, larger JJ of stent and obese patients. Study limitation is represented by the relative small study group and by the evaluation of stone density using plain X-ray instead of computer tomography. For pelvic renal stones having the same density characteristics studied by plain X-ray, the SWL efficiency is lower in stone-inside-loop cases comparing with the other positions. The overall stone free rate for renal pelvic stones could be explained by the second generation lithotripter used for all procedures.

  17. Right ovarian vein drainage variant: Is there a relationship with pelvic varices?

    International Nuclear Information System (INIS)

    Koc, Zafer; Ulusan, Serife; Oguzkurt, Levent

    2006-01-01

    Objective: To correlate right ovarian vein (ROV) variations that drain into the right renal vein (RRV) with the presence of pelvic varices. Materials and methods: Routine abdominal multidetector-row computed tomography scans of 324 women were analyzed for the presence and type of ROV variations in this retrospective study. The subjects were divided into 2 groups: those with ROV variations and those without such variations. The diameters of the subjects' ROV, left ovarian vein (LOV), and parauterine veins were measured. Pelvic varices and the presence and degree of ovarian vein reflux were noted and compared between the 2 groups. The χ 2 -test and the Pearson correlation test were used for statistical analysis. Results: Thirty-two (9.9%) of 324 women studied exhibited ROV variant that drained into the right renal vein, and the remaining subjects (90.1%) exhibited a normal pattern of ROV drainage that flowed directly into the inferior vena cava. Pelvic varices were identified in 59 (18%) of the subjects. Reflux was not observed in any patient without pelvic varices. Fifty-seven of 59 women exhibited ovarian vein reflux. In 56 of those 57 individuals, reflux occurred only in the LOV, and in 1 subject, reflux was noted predominantly in the ROV. No significant relationship between the presence of an ROV that drained into the right renal vein and pelvic varices was noted. Conclusion: Although right-sided pelvic varices associated with right ovarian vein drainage variations are rare, anatomic variations of the right ovarian vein are not. This study did not find an association between the presence of right ovarian vein and pelvic varices

  18. Right ovarian vein drainage variant: Is there a relationship with pelvic varices?

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    Koc, Zafer [Baskent Universitesi, Adana Hastanesi, Radyoloji Boeluemue, Serin Evler 39, Sok. No. 6 Yueregir, Adana (Turkey)]. E-mail: koczafer@gmail.com; Ulusan, Serife [Baskent Universitesi, Adana Hastanesi, Radyoloji Boeluemue, Serin Evler 39, Sok. No. 6 Yueregir, Adana (Turkey); Oguzkurt, Levent [Baskent Universitesi, Adana Hastanesi, Radyoloji Boeluemue, Serin Evler 39, Sok. No. 6 Yueregir, Adana (Turkey)

    2006-09-15

    Objective: To correlate right ovarian vein (ROV) variations that drain into the right renal vein (RRV) with the presence of pelvic varices. Materials and methods: Routine abdominal multidetector-row computed tomography scans of 324 women were analyzed for the presence and type of ROV variations in this retrospective study. The subjects were divided into 2 groups: those with ROV variations and those without such variations. The diameters of the subjects' ROV, left ovarian vein (LOV), and parauterine veins were measured. Pelvic varices and the presence and degree of ovarian vein reflux were noted and compared between the 2 groups. The {chi}{sup 2}-test and the Pearson correlation test were used for statistical analysis. Results: Thirty-two (9.9%) of 324 women studied exhibited ROV variant that drained into the right renal vein, and the remaining subjects (90.1%) exhibited a normal pattern of ROV drainage that flowed directly into the inferior vena cava. Pelvic varices were identified in 59 (18%) of the subjects. Reflux was not observed in any patient without pelvic varices. Fifty-seven of 59 women exhibited ovarian vein reflux. In 56 of those 57 individuals, reflux occurred only in the LOV, and in 1 subject, reflux was noted predominantly in the ROV. No significant relationship between the presence of an ROV that drained into the right renal vein and pelvic varices was noted. Conclusion: Although right-sided pelvic varices associated with right ovarian vein drainage variations are rare, anatomic variations of the right ovarian vein are not. This study did not find an association between the presence of right ovarian vein and pelvic varices.

  19. Significance of lower-pole pelvicaliceal anatomy on stone clearance after shockwave lithotripsy in nonobstructive isolated renal pelvic stones.

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    Sozen, Sinan; Kupeli, Bora; Acar, Cenk; Gurocak, Serhat; Karaoglan, Ustunol; Bozkirli, Ibrahim

    2008-05-01

    To investigate the probable effect of lower-pole pelvicaliceal anatomy on stone clearance after shockwave lithotripsy (SWL) in patients with nonobstructive renal pelvic stones. The clinical records of patients with isolated renal pelvic stones who underwent SWL between 1996 and 2005 were reviewed. After excluding patients with obstruction leading to dilatation, major anatomic abnormalities, noncalcium stones, metabolic abnormalities, history of recurrent stone disease, multiple stones, and previous renal surgery, 153 patients were enrolled in the study. Lower pole infundibulopelvic angle (IPA) and infundibular length and width were measured from intravenous urography. Patients were classified into three groups according to stone burden (group 1, renal pelvis, and both in 50 (32.6%), 29 (18.9%), and 8 (5.2%) patients, respectively. There was no statistically significant difference in pelvicaliceal anatomic features except narrower IPA (P=0.02) in group 1 patients with residual stones. The falling of stone fragments to the lower calix in spite of the ureter whether clinically significant or not after SWL of pelvic stones initially seems to be related to stone burden rather than lower caliceal anatomy. However, existence of a more narrow IPA in group 1 patients with residual fragments led us to believe that lower-pole IPA can play a role in stone clearance, especially for smaller stones, probably because of smaller residual fragment size or the more mobile nature of the primary stone.

  20. CT differentiation of periappendiceal inflammation with appendicitis and pelvic inflammatory disease in woman with right lower quadrant pain

    International Nuclear Information System (INIS)

    Wang, Hyun Hye; Kim, Mi Young; Kim, Jung Eun; Kim, Youn Jeong; Suh, Chang Hae

    2006-01-01

    We wanted to determine the usefulness of the computed tomography (CT) findings for making the diagnosis between periappendiceal inflammation (PAI) with appendicitis and pelvic inflammatory disease (PID) for the women presenting with right lower quadrant pain. We retrospectively analyzed the CT findings of 83 women with right lower quadrant pain: PAI in 36 and PID in 47 patients. We reviewed the CT images, including the appendiceal diameter and the enhancing wall thickening, the cecal thickening, the location of the appendix, thickening of the right anterior renal fascia, abscess, mesenteric fatty infiltration, ascites, heterogeneous uterine enhancement and paralytic ileus. Statistical analysis was performed by using the t-test for the diameter of appendix, and the x 2 test or Fisher's exact test for the CT findings. The mean diameter of the appendix was 11.0 ± 3.4 mm for the PAI subjects and it was 6.7 ± 2.0 mm for the PID subjects (ρ < 0.0001). Wall thickening of the appendix was more commonly detected in PAI (25 subjects, 69%) than in PID (15 subjects, 32%) (ρ = 0.0007). Thickening of the right anterior renal fascia was more commonly detected in PAI (18 subjects, 50%) than in PID (7 subjects, 15%). Cecal thickening, ascitis, heterogeneous uterine enhancement and paralytic ileus were not significantly different between PAI and PID. Abscess and mesenteric fatty infiltration were more frequently detected in the RLQ and in the abdomen or pelvic cavity in PAI and PID, respectively (ρ < 0.05). There was no significant difference in the distribution of ascites between the diseases. The CT findings of the appendiceal diameter, enhancing wall thickening and thickening of the right anterior renal fascia are useful for making the diagnosis of PAI. The abdominal and pelvic distributions of abscess and mesenteric fatty infiltration are highly suggestive findings of PID

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

    NARCIS (Netherlands)

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

    2012-01-01

    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

  2. EFFECTIVENESS AND SAFETY OF EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY FOR UNCOMPLICATED PELVIC CONCREMENTS

    Directory of Open Access Journals (Sweden)

    A. V. Khasigov

    2017-01-01

    Full Text Available Introduction. Extracorporeal shockwave lithotripsy (ESWL allowed to improve the treatment results for patients suffering from the kidney stone disease (KSD, decrease the number of complications, optimize the nearest and distant therapy results; however, its success depends on the initial size and shape of the stone. Purpose of the study. Тo examine the clinical effectiveness and safety of electromagnetic ESWL used on simple renal calculi taking their sizes into account. Materials and methods. The survey included 110 patients with simple renal calculi who passed electromagnetic ESWL procedures. The first group consisted of 75 patients with calculi ≤ 15 mm in diameter, the second group included 35 patients with stones > 15 mm. Results. Complete disintegration of stones ≤ 15 mm was accomplished in 74,7% of cases in 1-2 lithotripsy sessions, and after 3 months residual fragments were found in 4% of cases only. Elimination of stones > 15 mm from the renal collecting system takes considerably longer, all patients require more than 1 lithotripsy session. In 3 months following the ESWL residual stones were found in 17,2% of analysed cases. Stone sizes had no bearing on the pain syndrome frequency and severity as well as activation of urinary infection. Macrohematuria, renal haematomas, and an increase of blood creatinine level compared with the original value were more frequent in patients with stones > 15 mm. Conclusions. Electromagnetic ESWL is an efficient and safe method for monotherapy of patients with uncomplicated pelvic concrements. Clinical ESWL effectiveness for stones ≤15 mm by the 3rd month of monitoring reaches 96,0%, for stones > 15 mm it is 82,8% (р<0,05. The level and severity of complications is higher in case of pelvic stones >15 mm compared with the stones < 15 mm in diameter (р<0,05.

  3. Does the type of renal artery anatomic variant determine the diameter of the main vessel supplying a kidney? A study based on CT data with a particular focus on the presence of multiple renal arteries.

    Science.gov (United States)

    Majos, Marcin; Stefańczyk, Ludomir; Szemraj-Rogucka, Zofia; Elgalal, Marcin; De Caro, Raffaele; Macchi, Veronica; Polguj, Michał

    2018-04-01

    An in-depth knowledge of renal vascular anatomy is essential when planning many surgical procedures; however, a few data exists regarding renal artery diameter. The aim of this study was to assess this morphological feature and to investigate whether a correlation exists between renal artery diameter and the type of arterial supply, with a particular emphasis on variant anatomy and the presence of multiple renal arteries. Computed tomography angiography (CTA) studies of 248 patients, i.e., a total of 496 kidneys, were evaluated. The mean age of the patients was 66.4 ± 15.01 years. Renal artery diameter was measured based on the type of arterial blood supply. The frequency of occurrence of three anatomic variants of renal arterial supply was established: single renal artery (RA) 43.35%, single artery with prehilar branching (pRA) 37.30%, and multiple renal artery (mRA) 19.35%. The diameter of single renal arteries, with either prehilar or hilar branching, was significantly larger than when multiple arteries were present. A detailed analysis of just the mRA variant demonstrated that the diameter of the renal arteries in men was larger (p = 0.012) than those in women and that there was no difference in diameter with regard to the side of the body (p = 0.219). The classification described in our study containing a detailed description of renal artery diameter. It may be helpful in clinical practice, especially for transplantologists, surgeons, and vascular surgeons.

  4. Comparing the difference of measured GFR of ectopic pelvic kidney between anterior and posterior imaging processing in renal dynamic imaging

    International Nuclear Information System (INIS)

    Li Baojun; Zhao Deshan

    2014-01-01

    Objective: To compare and analyze the difference of measured glomerular filtration rate (GFR) of ectopic pelvic kidney between anterior and posterior imaging processing in renal dynamic imaging. Methods: There were 10 patients collected retrospectively, with ectopic kidneys in pelvic cavity confirmed by ultrasound, CT, renal dynamic imaging and other imaging modalities. All images of ectopic kidneys in renal dynamic imaging were processed by anterior and posterior methods respectively. The ectopic kidney was only processed in anterior imaging, ectopic kidney and contralateral normal kidney were processed in posterior imaging. Total GFR equalled the sum of GFR of normal kidney in posterior imaging and GFR of ectopic kidney in anterior imaging, was compared with total GFR of two kidneys in posterior imaging and GFR in two-sample method. All correlation analysis were completed between GFRs from three methods and all patients were followed up. Statistically paired t-test and bivariate correlation analysis test were used. Results: The mean GFR of ectopic kidney in anterior imaging equal to (27.48±12.24) ml/(min · 1.73 m 2 ). It was more than GFR [(10.71 ±4.74) ml/ (min · 1.73 m 2 )] in posterior imaging above 46% (t=5.481, P<0.01). There was no significant difference (t=-2.238, P>0.05), but better correlation (r=0.704, P<0.05) between total GFR in anterior imaging and GFR in two-sample method. There was significant difference (t=4.629, P<0.01)and worse correlation (r=0.576, P>0.05) between total GFR in posterior imaging and GFR in two-sample method. Conclusion: Comparing with GFR in posterior imaging, GFR in anterior imaging can more truly reflect function condition of ectopic pelvic kidney in renal dynamic imaging. (authors)

  5. Renal pelvic calculi and neoplasm. New indication for treatment of asymptomatic renal pelvic calculi?

    DEFF Research Database (Denmark)

    Vibitis, H; Jørgensen, J B

    1990-01-01

    Metaplasia of the renal pelvis caused by chronic irritation, calculi, infection is a reversible pre-malignant condition. The application of ESWL on renal calculi as a safe treatment in relation to metaplasia is discussed and a case history is presented.......Metaplasia of the renal pelvis caused by chronic irritation, calculi, infection is a reversible pre-malignant condition. The application of ESWL on renal calculi as a safe treatment in relation to metaplasia is discussed and a case history is presented....

  6. Differential diagnosis between fetal extrarenal pelvis and obstructive uropathy on fetal ultrasonogram

    Energy Technology Data Exchange (ETDEWEB)

    Han, Byoung Hee; Cho, Jeong Yeon; Cho, Byung Jae; Lee, Kyung Sang [Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2003-03-15

    To establish the standard guideline for differentiating the extrarenal pelvis from obstructive uropathy on fetal ultrasonogram (US) to avoid unnecessary postnatal follow-up and other additional examinations. From July 2000 to July 2001, Thirty-four kidneys with hydronephrosis diagnosed on fetal ultrasonogram performed during the third trimester of pregnancy were included in this study. Hydronephrosis was defined as the pelvic anteroposterior (AP) diameter being 4 mm or greater before 33 weeks of gestation while 7 mm or greater at or after 33 weeks of gestation. The size of the renal pelvis was measured at intrarenal, intra-extrarenal junctional and extrarenal portions in every kidney on the transverse view of the fetal renal hiluin. Postnatally, all neonates underwent renal ultrasonogram 2 to 8 days after birth, and renal pelvic diameters were measured using the same method as the fetal US in 28 kidneys. We then compared the extrarenal-intrarenal ratio (E/I ratio) of pelvic diameter between fetal and neoatal kidneys. We presumed that the extrarenal pelvis in fetal US was the pelvis showing the normal intrarenal pelvic diameter accompanied by the most dilated exrtarenal pelvic diameter. Follow-up ultrasonograms were measured using the same method as the fetal US in 28 kidneys. We then compared the extrarenal intrarenal ratio (E/I ratio) of pelvic diameter between fetal and neonatal kidneys. We presumed that the extrarenal pelvis on fetal US was the pelvis showing the normal intrarenal pelvic diameter accompanied by the most dilated extrarenal pelvic diameter. Follow-up ultrasonograms were performed in 12 of 17 neonates who had the maximal diameter at extrarenal portion on fetal ultrasonogram. VCUG and IVU were taken in 2 patients with a persistent dilatation of the renal pelvis on follow-up ultrasonograms. On fetal US, 17/34 kidneys showed the extrarenal portion with the most dilatation while in 12/34 kidneys, the intra-extra renal junction portion was the most

  7. Differential diagnosis between fetal extrarenal pelvis and obstructive uropathy on fetal ultrasonogram

    International Nuclear Information System (INIS)

    Han, Byoung Hee; Cho, Jeong Yeon; Cho, Byung Jae; Lee, Kyung Sang

    2003-01-01

    To establish the standard guideline for differentiating the extrarenal pelvis from obstructive uropathy on fetal ultrasonogram (US) to avoid unnecessary postnatal follow-up and other additional examinations. From July 2000 to July 2001, Thirty-four kidneys with hydronephrosis diagnosed on fetal ultrasonogram performed during the third trimester of pregnancy were included in this study. Hydronephrosis was defined as the pelvic anteroposterior (AP) diameter being 4 mm or greater before 33 weeks of gestation while 7 mm or greater at or after 33 weeks of gestation. The size of the renal pelvis was measured at intrarenal, intra-extrarenal junctional and extrarenal portions in every kidney on the transverse view of the fetal renal hiluin. Postnatally, all neonates underwent renal ultrasonogram 2 to 8 days after birth, and renal pelvic diameters were measured using the same method as the fetal US in 28 kidneys. We then compared the extrarenal-intrarenal ratio (E/I ratio) of pelvic diameter between fetal and neoatal kidneys. We presumed that the extrarenal pelvis in fetal US was the pelvis showing the normal intrarenal pelvic diameter accompanied by the most dilated exrtarenal pelvic diameter. Follow-up ultrasonograms were measured using the same method as the fetal US in 28 kidneys. We then compared the extrarenal intrarenal ratio (E/I ratio) of pelvic diameter between fetal and neonatal kidneys. We presumed that the extrarenal pelvis on fetal US was the pelvis showing the normal intrarenal pelvic diameter accompanied by the most dilated extrarenal pelvic diameter. Follow-up ultrasonograms were performed in 12 of 17 neonates who had the maximal diameter at extrarenal portion on fetal ultrasonogram. VCUG and IVU were taken in 2 patients with a persistent dilatation of the renal pelvis on follow-up ultrasonograms. On fetal US, 17/34 kidneys showed the extrarenal portion with the most dilatation while in 12/34 kidneys, the intra-extra renal junction portion was the most

  8. Is decreased diameter of renal pelvis in prone position an indicator of successful pyeloplasty?

    International Nuclear Information System (INIS)

    Sharma, Gyanendra; Sharma, Anshu; Leung, Vivian Yee-Fong; Chu, Winnie Chiu-Wing

    2016-01-01

    To evaluate patients who had undergone pyeloplasty for pelviureteric junction obstruction, by measuring the anteroposterior diameter (APD) of the renal pelvis in supine and prone positions, and determine whether a decrease in APD in prone position can exclude obstruction in dilated renal system. From January 2012 to December 2013, patients who had undergone pyeloplasty were evaluated by ultrasound in two centers. The difference of APD of the renal pelvis in supine and prone positions was obtained. Correlation was made with the pre- and post-pyeloplasty renal function by radionuclide renogram. There were 42 patients (31 males, 11 females; age range 5 months to 18 years). Residual hydronephrosis was detected in 41 patients of whom 35 patients (85%) showed decrease in APD by >10% in prone position. These patients and the one without hydronephrosis showed either no deterioration or improvement in renal function. Six patients (15%) showed either no change or increase in APD in prone position. Three patients (7.5%) were confirmed to have decrease in renal function indicating obstruction. Three patients (7.5%) showed no deterioration of renal function, but sluggish drainage on radionuclide renogram. Demonstration of decreased APD of renal pelvis in prone position by ultrasound is useful to differentiate obstructed from non-obstructed dilated renal system, and it correctly identified 85% candidates with successful pyeloplasty. In patients with no decrease or increase in APD at prone position, further follow-up is recommended to rule out obstruction

  9. Individual renal function study using dynamic computed tomography

    International Nuclear Information System (INIS)

    Fukuda, Yutaka; Kiya, Keiichi; Suzuki, Yoshiharu

    1990-01-01

    Dynamic CT scans of individual kindneys were obtained after an intravenous bolus injection of contrast agent. Time-density curves measured from the renal cortex, medulla and pelvis revealed the changes in density produced by the contrast agent reflecting the differential phase of renal function. Renal cortical density increased rapidly after bolus administration and then renal medullary and pelvic density increased continuously. In analyzing time-density curve, the cortico-medullary junction time, which is the time when the cortical and medullary curves cross was 57±8 seconds in patients with normal renal function. The cortico-medullary junction time was delayed in patient with decreased glomerular filtration rate. The cortico-pelvic junction time, which is the time when the cortical and pelvic curves cross was 104±33 seconds in patients with normal renal function. The cortico-pelvic junction time was delayed in patients with declined urinary concentrating capacity. In patients with unilateral renal agenesis and patients who were treated surgically by ureteral sprits, the relationship between individual renal functions and these junction times was examined. As a result of study there were inversely significant correlations between C-M junction time and unilateral GFR and between C-P junction time and urinary concentrating capacity. These studies indicate that dynamic CT scanning is an effective way that individual renal function can be monitored and evaluated. (author)

  10. The outcome of extracorporeal shockwave lithotripsy for renal pelvic stone with and without JJ stent--a comparative study.

    Science.gov (United States)

    Mohayuddin, Nazim; Malik, Hamad Afzal; Hussain, Manzoor; Tipu, Salman Ahmed; Shehzad, Asad; Hashmi, Altaf; Naqvi, Syed Ali Anwar; Rizvi, Syed Adibul Hasan

    2009-03-01

    To compare the outcome of Extra corporeal shockwave lithotripsy for a renal pelvic stone with and without JJ stent. A comparative cross sectional study was carried out at Sindh Institute of Urology and Transplantation from January 2007 to January 2008. Eighty patients with renal pelvic stone measuring 2cm +/- 2mm were selected for treatment with Extra Corporeal Shockwave Lithotripsy (ESWL). All of these patients were adults with normal renal function and had unilateral renal stones with negative urine cultures. Patients with renal failure and children were excluded. They were divided into two groups of 40 each. Group A patients underwent ESWL without a JJ stent and in Group B a JJ stent was placed before ESWL. SLX F2 electromagnetic ESWL machine was used to impart shock waves. 3000 shockwaves were given in a session. Both the groups were compared for renal colic, steinstrasse, fever, lower urinary tract symptoms (LUTS) emergency room visits and hospital admissions, stone clearance, number of ESWL sessions, auxilliary procedures, (percutaneous nephrostomy or ureterorenoscopy) and cost. Ureteric colic occurred in 13 (32.5%) patients in group A and in 3 (7.5%) patient in group B. Steinstrasse developed in 4 (10%) patients with out JJ stent and in 3 (7.5%) patients with JJ stent. Fever was encountered in 1 (2.5%) patient in group A and in 3 (7.5%) patient in group B. Mean emergency room visits were 2.1 per patient in group A and 0.7 per patient in group B. Stone clearance occurred in 33 (82.5%) patients in group A and 31 (77.5%) in group B. In group B lower urinary tract symptoms were found in 50% versus 20% in group A. Auxillary procedure was performed in one (2.5%) patient each in both groups. Pre ESWL JJ stenting for a 2 cm +/- 2 mm renal stone was not beneficial in terms of steinstrasse, fever, stone clearance and number of ESWL sessions. However ureteric colic was significantly less in the stented group. Lower urinary tract symptoms (LUTS) was also significantly

  11. Idiopathic retroperitoneal fibrosis involving a unilateral renal sinus: A case report and literature review

    International Nuclear Information System (INIS)

    Lee, Seul Bi; Yoon, Jung Hee; Kim, Seung Ho; Lee, Ye Daum; Kim, Suk Jung; Lim, Yun Jung; Jung, Hyun Kyung; Lee, Jin Soo

    2016-01-01

    Idiopathic retroperitoneal fibrosis (RPF) is a rare disease entity and its etiology is uncertain. We report two similar cases which showed an uncommon presentation of idiopathic RPF. A 66-year-old woman and an 80-year-old man presented with incidental findings of left renal pelvic mass-like lesions. Computed tomography revealed a soft tissue density mass replacing the left renal pelvis, which was suspicious for renal pelvic cancer, and the diagnosis of idiopathic RPF was surgically confirmed. To the best of our knowledge, a few cases of idiopathic RPF presenting with features of a localized unilateral renal pelvic mass mimicking renal pelvic cancer have been reported

  12. Idiopathic retroperitoneal fibrosis involving a unilateral renal sinus: A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seul Bi; Yoon, Jung Hee; Kim, Seung Ho; Lee, Ye Daum; Kim, Suk Jung; Lim, Yun Jung; Jung, Hyun Kyung; Lee, Jin Soo [Dept. of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

    2016-06-15

    Idiopathic retroperitoneal fibrosis (RPF) is a rare disease entity and its etiology is uncertain. We report two similar cases which showed an uncommon presentation of idiopathic RPF. A 66-year-old woman and an 80-year-old man presented with incidental findings of left renal pelvic mass-like lesions. Computed tomography revealed a soft tissue density mass replacing the left renal pelvis, which was suspicious for renal pelvic cancer, and the diagnosis of idiopathic RPF was surgically confirmed. To the best of our knowledge, a few cases of idiopathic RPF presenting with features of a localized unilateral renal pelvic mass mimicking renal pelvic cancer have been reported.

  13. Application of 80-kVp scan and raw data-based iterative reconstruction for reduced iodine load abdominal-pelvic CT in patients at risk of contrast-induced nephropathy referred for oncological assessment: effects on radiation dose, image quality and renal function.

    Science.gov (United States)

    Nagayama, Yasunori; Tanoue, Shota; Tsuji, Akinori; Urata, Joji; Furusawa, Mitsuhiro; Oda, Seitaro; Nakaura, Takeshi; Utsunomiya, Daisuke; Yoshida, Eri; Yoshida, Morikatsu; Kidoh, Masafumi; Tateishi, Machiko; Yamashita, Yasuyuki

    2018-05-01

    To evaluate the image quality, radiation dose, and renal safety of contrast medium (CM)-reduced abdominal-pelvic CT combining 80-kVp and sinogram-affirmed iterative reconstruction (SAFIRE) in patients with renal dysfunction for oncological assessment. We included 45 patients with renal dysfunction (estimated glomerular filtration rate  60 ml per lmin per 1.73 m 2 ) who underwent standard oncological abdominal-pelvic CT (600 mgI kg -1 , 120-kVp, filtered-back projection) were included as controls. CT attenuation, image noise, and contrast-to-noise ratio (CNR) were compared. Two observers performed subjective image analysis on a 4-point scale. Size-specific dose estimate and renal function 1-3 months after CT were measured. The size-specific dose estimate and iodine load of 80-kVp protocol were 32 and 41%,, respectively, lower than of 120-kVp protocol (p 0.05). No significant kidney injury associated with CM administration was observed. 80-kVp abdominal-pelvic CT with SAFIRE yields diagnostic image quality in oncology patients with renal dysfunction under substantially reduced iodine and radiation dose without renal safety concerns. Advances in knowledge: Using 80-kVp and SAFIRE allows for 40% iodine load and 32% radiation dose reduction for abdominal-pelvic CT without compromising image quality and renal function in oncology patients at risk of contrast-induced nephropathy.

  14. Sonographic findings of renal tuberculosis

    International Nuclear Information System (INIS)

    Yoon, Chong Hyun; Lee, Chang Joon; Kim, Seung Hyun

    1990-01-01

    In order to determine sonographic characteristic of renal tuberculosis, we retrospectively collected 27 cases during a 5 year period. Infected kidneys showed large size (52%) and lobulating contour (76%). In 19 cases of increased parenchymal echogenicity, most of them (16 cases) showed decreased parenchymal thickness. We divided hydronephrotic patterns into 4 categories; predominant calyceal dilatation with mild or no pelvic dilatation (67%), focal calyectasis without pelvic dilation (15%), parenchymal cavitation without hydronephrosis (11%) and proportional hydronephrosis with calyceal deformity (7%). Our findings suggest that disproportional hydronephrosis would be the characteristic finding of renal tuberculosis

  15. CNS sites activated by renal pelvic epithelial sodium channels (ENaCs) in response to hypertonic saline in awake rats.

    Science.gov (United States)

    Goodwill, Vanessa S; Terrill, Christopher; Hopewood, Ian; Loewy, Arthur D; Knuepfer, Mark M

    2017-05-01

    In some patients, renal nerve denervation has been reported to be an effective treatment for essential hypertension. Considerable evidence suggests that afferent renal nerves (ARN) and sodium balance play important roles in the development and maintenance of high blood pressure. ARN are sensitive to sodium concentrations in the renal pelvis. To better understand the role of ARN, we infused isotonic or hypertonic NaCl (308 or 500mOsm) into the left renal pelvis of conscious rats for two 2hours while recording arterial pressure and heart rate. Subsequently, brain tissue was analyzed for immunohistochemical detection of the protein Fos, a marker for neuronal activation. Fos-immunoreactive neurons were identified in numerous sites in the forebrain and brainstem. These areas included the nucleus tractus solitarius (NTS), the lateral parabrachial nucleus, the paraventricular nucleus of the hypothalamus (PVH) and the supraoptic nucleus (SON). The most effective stimulus was 500mOsm NaCl. Activation of these sites was attenuated or prevented by administration of benzamil (1μM) or amiloride (10μM) into the renal pelvis concomitantly with hypertonic saline. In anesthetized rats, infusion of hypertonic saline but not isotonic saline into the renal pelvis elevated ARN activity and this increase was attenuated by simultaneous infusion of benzamil or amiloride. We propose that renal pelvic epithelial sodium channels (ENaCs) play a role in activation of ARN and, via central visceral afferent circuits, this system modulates fluid volume and peripheral blood pressure. These pathways may contribute to the development of hypertension. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Factors associated with changes in vaginal length and diameter during pelvic radiotherapy for cervical cancer.

    Science.gov (United States)

    Martins, Jumara; Vaz, Ana Francisca; Grion, Regina Celia; Esteves, Sérgio Carlos Barros; Costa-Paiva, Lúcia; Baccaro, Luiz Francisco

    2017-12-01

    This study reports the incidence and factors associated with vaginal stenosis and changes in vaginal dimensions after pelvic radiotherapy for cervical cancer. A descriptive longitudinal study with 139 women with cervical cancer was conducted from January 2013 to November 2015. The outcome variables were vaginal stenosis assessed using the Common Terminology Criteria for Adverse Events (CTCAE v3.0) and changes in vaginal diameter and length after the end of radiotherapy. Independent variables were the characteristics of the neoplasm, clinical and sociodemographic data. Bivariate analysis was carried out using χ 2 , Kruskal-Wallis and Mann-Whitney's test. Multiple analysis was carried out using Poisson regression and a generalized linear model. Most women (50.4%) had stage IIIB tumors. According to CTCAE v3.0 scale, 30.2% had no stenosis, 69.1% had grade 1 and 0.7% had grade 2 stenosis after radiotherapy. Regarding changes in vaginal measures, the mean variation in diameter was - 0.6 (± 1.7) mm and the mean variation in length was - 0.6 (± 1.3) cm. In the final statistical model, having tumoral invasion of the vaginal walls (coefficient + 0.73, p vaginal stenosis and lower reduction of vaginal dimensions. Advanced clinical stage (coefficient + 1.44; p = 0.02) and receiving brachytherapy/teletherapy (coefficient - 1.17, p vaginal dimensions. Most women had mild vaginal stenosis with slight reductions in both diameter and length of the vaginal canal. Women with tumoral invasion of the vagina have an increase in vaginal length soon after radiotherapy due to a reduction in tumoral volume.

  17. Contribution of 99mTc-DTPA dynamic renal scintigraphy with furosemide test in the exploration of low grade urethra-pelvic junction syndrome. Report of 17 cases

    International Nuclear Information System (INIS)

    Ghfir, I.; Ben Rais, N.

    2009-01-01

    Introduction The renal scintigraphy using 99m Tc-DTPA with furosemide test constitutes a noninvasive and functional method that is of appreciable interest in the exploration of the upper urinary tract and in the evaluation of the separate renal function. It distinguishes the functional character of dilation from organic obstruction needing surgery or endoscopic treatment. Material and methods We report, through this work, the observations of 17 patients with a low grade urethra-pelvic junction syndrome detect by intravenous urography (I.V.U.). 99m Tc-DTPA renal scintigraphy with furosemide test was carried out among all our patients by means of a gamma-camera with large field equipped with a low energy high-resolution parallel collimator. The evaluation of images obtained consisted of analysis of urethra-pelvic permeability taking into account the semiquantitative parameters of time-activity curve or isotopic nephrogram (I.N.) obtained after digital reconstruction of sequential images. Results On the 17 studied cases, the sex-ratio was equal to 1.83; the average age was 18.92 years with extremes spanning from 4 years to 70 years. Renal scintigraphy categorized four patients groups. Group I: two patients (11.76%) with normal aspect of I.N.; group II; seven patients (41.17% of cases) with functional dilation; group III: five patients (29.41%) with organic obstruction and a group IV: three patients (17.64%) with intermediate response. Discussion 99m Tc-DTPA renal scintigraphy with furosemide test allowed, through our study, to obviate the limits of IVU and manometric explorations to distinguish functional dilation of organic obstruction. It permits the improvement of treatment with a favourable dosimetry. (authors)

  18. Relationship Between Adult Renal Dimensions and Biometric ...

    African Journals Online (AJOL)

    We measured renal dimensions sonographically and correlated the values obtained with some anthropometric parameters in order to identify the best estimate of renal size in a clinical setting. The renal dimensions of 200 adult subjects referred for abdomino-pelvic scan at University of Nigeria Teaching Hospital, Enugu ...

  19. Renal streaky artifact during contrast-enhanced abdominal and pelvic CT: Comparison of high versus low osmolality contrast media

    International Nuclear Information System (INIS)

    Kim, Dae Hong; Kim, Jong Chul; Lee, Chung Keun; Shin, Kyoung Suk

    1994-01-01

    Introduction of low osmolality contrast agent(LOCA) has allowed safer, more comfortable contrast-enhanced CT examination, but there has been significant increase in image degradation when evaluating the kidneys due to streaky artifact. The authors reviewed findings of contrast- enhanced abdominal and pelvic computed tomography(CT) to know the difference of renal streaky artifact between a high osmolality contrast agent (HOCA) and LOCA. This study included two hundred contrast-enhanced CT in 200 patients, 100 performed with HOCA(meglumine ioglicate, 150 ml) and 100 performed with LOCA (iopromide,150 ml). The severity of renal streaky artifact was compared between HOCA and LOCA groups. Of the scans performed with HOCA, 40 had no artifact, 52 had grade I artifact, 6 had grade II artifact, and 2 had grade III artifact. Of the scans preformed with LOCA, 23 had no artifact, 44 had grade I artifact, 29 had grade II artifact, and 4 had grade III artifact. There was significant difference in the degree of the streaky artifact depending upon the osmolality of the contrast media used(by χ 2 -test, P=.0001). The results of this study revealed a statistically significant increased incidence of artifacts and distortions of renal image with LOCA when compared with HOCA

  20. Bilateral Malrotation and a Congenital Pelvic Kidney with Varied Vasculature and Altered Hilar Anatomy

    Directory of Open Access Journals (Sweden)

    J. Singh

    2015-01-01

    Full Text Available Variations of structure and position of the kidney along with variations of renal vessels are most frequently reported. Rotational variations form a rare entity that are not cited in most embryology textbooks. During an educational cadaveric dissection of a 42-year-old male, a complex picture of bilateral anatomical variants was encountered. Malrotation of both kidneys and a left lobulated ectopic kidney along with open hilum was observed. The left kidney showed a pelvic position in front of sacral promontory with three renal arteries retaining its embryological aortoiliac branches and two renal veins draining into right common iliac vein. These variations have an embryological base. Pelvic kidney with rotational variation though comparatively rare assumes great importance in view of present-day surgical procedures like laparoscopic radical nephrectomy, percutaneous nephrectomy, and renal transplantation.

  1. Congenital seminal vesicle cyst accompanying with ipsilateral renal agenesis in an adolescent patient: A pediatric radiologist approach to Zinner’s syndrome

    Directory of Open Access Journals (Sweden)

    Mehmet Burak Özkan

    2015-12-01

    Full Text Available A fifteen-year-old boy who had complaints of left sided pelvic pain with known ipsilateral left renal agenesia was referred to pediatric radiology department. Incidentally, his sonography examination revealed a dilated tubular structure located in the retro-vesicular region from cephalic to prostate. Contrast enhanced pelvic MRI showed a huge seminal vesicle cyst which is over 6 cm without a mass effect near the aspect border of the prostate and bladder. The patient was diagnosed with Zinner syndrome. The patient doesn’t have new complaint with no definite increase in the diameter of the cyst. In this case presentation we are discussing the Zinner syndrome’s imaging findings from a pediatric radiologist approach with a brief review of the literature.

  2. Conservative management of a grade V injury to an ectopic pelvic kidney following blunt trauma to the lower abdomen: a case report

    Directory of Open Access Journals (Sweden)

    Becker Adam M

    2010-07-01

    Full Text Available Abstract Introduction Ectopic pelvic kidneys represent an anatomic variant that remains clinically asymptomatic in most patients. While there is some literature to suggest that ectopic kidneys may be more predisposed to blunt trauma injuries, there are few examples to guide the management of these injuries. To our knowledge, we present the first case of a grade V renal injury to an ectopic pelvic kidney managed successfully with conservative measures. Case Presentation We present a case of grade V renal injury to an ectopic pelvic kidney in a 21 year-old African-American male. The clinical and radiographic findings are presented, along with the patient's conservative hospital course. Conclusion We suggest that management of grade V renal injuries to ectopic pelvic kidneys can be treated similarly to that of kidneys in normal anatomic position. Conservative measures may be considered in properly selected patients.

  3. Endourological Evaluation and Management of Leukoplakia of the Renal Pelvis

    Directory of Open Access Journals (Sweden)

    Hidehiro Kakizaki

    1996-01-01

    Full Text Available Since August 1989, we have seen 4 patients with leukoplakia of the renal pelvis associated with a longstanding renal stone. In 2 of them, excretory or retrograde pyelography revealed multiple filling defects in the left renal pelvis as well as a renal stone, although urine cytological examination was negative. One of the other 2 patients underwent extracorporeal shock wave lithotripsy (ESWL for the renal stone, but this was not followed by the passage of stone fragments. The renal stone in the remaining patient was associated with staghorn calculi. For stone extraction as well as endoscopic evaluation of the intrapelvic lesion, percutaneous nephroscopy was performed. A small to large amount of tissue-like white debris in sheets characteristic of leukoplakia was found in the renal pelvis with stones embedded in it and was removed directly by forceps or suction and then by irrigating with saline. We propose that 1 the endourological approach should be recommended for patients with renal pelvic lesions associated with longstanding renal stones or for patients who show difficulty in passing stone fragments after ESWL and 2 this entity of leukoplakia should be kept in mind for the differential diagnosis of renal pelvic lesions associated with renal stones.

  4. Leiomyosarcoma of the renal pelvis

    Directory of Open Access Journals (Sweden)

    Dhamne Sagar

    2009-10-01

    Full Text Available Leiomyosarcomas are rare malignant tumors of the kidney. They may arise from the renal capsule, renal vein, renal pelvic musculature or renal parenchyma. Renal pelvis is an uncommon site of occurrence, with around 10 cases reported in the literature so far. Here we present a 60-year-old male who presented with increased urinary frequency, lower limb weakness, anorexia and weight loss. Imaging showed a right renal mass. A renal cell carcinoma was suspected clinically. A right nephrectomy was performed, which showed a large circumscribed mass in the hilar region. Histology revealed a tumor mass arising from the renal pelvis. The tumor was composed of spindle cells arranged in fascicles. Immunohistochemistry showed tumor cells to be positive for smooth muscle actin (SMA and desmin (Des and negative for cytokeratin (CK, HMB 45, CD117 (C-kit, and CD34. That confirmed the diagnosis of leiomyosarcoma.

  5. The grade of vesicoureteral reflux in voiding cystourethrography: comparison with ultrasonography and Tc99m-DMSA renal scintigraphy

    International Nuclear Information System (INIS)

    1998-01-01

    To evaluate the prevalence of abnormalities seen on sonography and renal scintigraphy, according to the grade of vesicoureteral reflux (VUR) on in voiding cystourethrography(VCUG). One hundred and forty-nine patients (age range: 1 months-10 years) with urinary tract infection underwent sonography, VCUG, and renal scans, and 32 showed VUR on VCUG. We retrospectively evaluated the frequency and characteristic findings of sonographic abnormalities according to the grade of VUR, and also the frequency of cortical defects seen on renal scans of 32 patients with VUR. The remaining 117 patients without VUR were also evaluated for the frequency of abnormal findings seen on sonography and renal scans. Among 32 patients (49 kidneys) with VUR, abnormal findings were not detected in 17 (29 kidneys) on sonography; thus, findings were abnormal in 15 (20 kidneys, 41%). Among these 20 kidneys, renal calyceal and/or pelvic dilatation and dilatation of distal ureter were seen in 11, all of which were grade 4-5 VUR. Renal pelvic dilatation only was noted in eight kidneys; two were grade 1-3 and six were grade 4-5 VUR. Nineteen patients (24 kidneys, 49%) showed focal cortical defects on renal scintigraphy. Six kidneys were grade 1-3, and 18 kidneys were grade 4-5 VUR. Of 117 patients without VUR, 34 patients (29%) showed renal pelvic dilatation on sonography and in 14 patients (12%), cortical defects were seen on renal scintigraphy. Among 32 patients with VUR, 41% showed abnormal sonographic findings and in 49%, cortical defects were seen on renal scintigraphy. With a higher grade of VUR, the prevalence of abnormalities increased on both sonography and renal scintigraphy. Sonographic demonstration of renal caliceal and/or pelvic dilatation associated with ipsilateral distal ureteric dilatation was the characteristic finding in high grade VUR.=20

  6. Stent sizing strategies in renal artery stenting: the comparison of conventional invasive renal angiography with renal computed tomographic angiography.

    Science.gov (United States)

    Kadziela, Jacek; Michalowska, Ilona; Pregowski, Jerzy; Janaszek-Sitkowska, Hanna; Lech, Katarzyna; Kabat, Marek; Staruch, Adam; Januszewicz, Andrzej; Witkowski, Adam

    2016-01-01

    Randomized trials comparing invasive treatment of renal artery stenosis with standard pharmacotherapy did not show substantial benefit from revascularization. One of the potential reasons for that may be suboptimal procedure technique. To compare renal stent sizing using two modalities: three-dimensional renal computed tomography angiography (CTA) versus conventional angiography. Forty patients (41 renal arteries), aged 65.1 ±8.5 years, who underwent renal artery stenting with preprocedural CTA performed within 6 months, were retrospectively analyzed. In CTA analysis, reference diameter (CTA-D) and lesion length (CTA_LL) were measured and proposed stent diameter and length were recorded. Similarly, angiographic reference diameter (ANGIO_D) and lesion length (ANGIO_LL) as well as proposed stent dimensions were obtained by visual estimation. The median CTA_D was 0.5 mm larger than the median ANGIO_D (p < 0.001). Also, the proposed stent diameter in CTA evaluation was 0.5 mm larger than that in angiography (p < 0.0001). The median CTA_LL was 1 mm longer than the ANGIO_LL (p = NS), with significant correlation of these variables (r = 0.66, p < 0.0001). The median proposed stent length with CTA was equal to that proposed with angiography. The median diameter of the implanted stent was 0.5 mm smaller than that proposed in CTA (p < 0.0005) and identical to that proposed in angiography. The median length of the actual stent was longer than that proposed in angiography (p = 0.0001). Renal CTA has potential advantages as a tool adjunctive to angiography in appropriate stent sizing. Careful evaluation of the available CTA scans may be beneficial and should be considered prior to the planned procedure.

  7. Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Robert Marcovich

    2003-06-01

    Full Text Available Introduction of minimally invasive techniques has revolutionized the surgical management of renal calculi. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are now both well-established procedures. Each modality has advantages and disadvantages, and the application of each should be based on well-defined factors. These variables include stone factors such as number, size, and composition; factors related to the stone's environment, including the stone's location, spatial anatomy of the renal collecting system, presence of hydronephrosis, and other anatomic variables, such as the presence of calyceal diverticula and renal anomalies; and clinical or patient factors like morbid obesity, the presence of a solitary kidney, and renal insufficiency. The morbidity of each procedure in relation to its efficacy should be taken in to account. This article will review current knowledge and suggest an algorithm for the rational management of renal calculi with shock wave lithotripsy and percutaneous nephrolithotomy.

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

    Science.gov (United States)

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

    2016-01-01

    Nephrolitiasis, once considered an adult disease, has become increasingly prevalent in children, with na 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. 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. 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. Retroperitoneoscopic pielolithotomy is a feasible and safe procedure in children, with same outcomes of the procedure for adult population. Copyright® by the International Brazilian Journal of Urology.

  9. Diuretic 99mTc DTPA renography in assessment of renal function and drainage in infants with antenatally detected hydronephrosis.

    Science.gov (United States)

    Radulović, Marija; Pucar, Dragan; Jauković, Ljiljana; Sisić, Marija; Krstić, Zoran; Ajdinović, Boris

    2015-12-01

    The controversy over the postnatal management of infants with antenataly detected hydronephrosis (ANH) still exists. We presented the results of diuretic 99mTc diethylenetriamine pentaacetic acid (DTPA) renography in 30 infants with the antenatal diagnosis of unilateral renal pelvic dilatation. The aim of this study was to assess the renal function determined by the pattern of drainage and split renal function (SRF) on diuretic renography and to correlate these findings with anteroposterior pelvic diameter (APD) estimated by ultrasonography. A total of 30 infants with 60 renal units (RU) (25 boys and 5 girls, median age 6.0 months, range 2-24) presented with unilateral hydronephrosis on ultrasound in the newborn period, underwent DTPA diuretic renal scintigraphy (F+15 protocol). The median APD evaluated on perinatal ultrasound was 15 mm (range 5-30). The postnatal associated clinical diagnosis were pelviureteric junction obstruction (PUJ), simple hydronephrosis, megaureter, vesicoureteral reflux (VUR) and posterior urethral valves in 11, 10, 6, 2 and 1 infant, respectively. Images and Tmax/2 after diuretic stimulation on the background subtracted renographic curves were used as the criteria for classifying the drainage as good, partial, and poor or no drainage. The SRF was calculated with the integral method. Good drainage was shown in 36/60, partial drainage in 13/60 and poor or no drainage in 11/60 RU. The SRF > 40% was observed in 55/60 RU, with no RU showing SRF lower than 23.5%. In infants with severe ANH the obstruction was not excluded in 94.1%. Diuretic renography in antenatally detected hydronephrosis should be a useful tool in postnatal follow up, especially in differentiating nonobstructive hydronephrosis from obstructive. It is also importanat to assess and monitor the SRF. Our results suggest that even in the presence of partial or no drainage, SRF may not be significantly impaired.

  10. Laparoscopic assisted percutaneous nephrolithotomy in chronic kidney disease patients with ectopic pelvic kidney

    Directory of Open Access Journals (Sweden)

    Sujata K Patwardhan

    2017-01-01

    Conclusion: Although laparoscopic assisted PCNL is an option in the management of patients with stone disease in ectopic pelvic kidney, prolonged time for healing of tract may increase postoperative morbidity in these patients with impaired renal function.

  11. [Ultrasonography in acute pelvic pain].

    Science.gov (United States)

    Kupesić, Sanja; Aksamija, Alenka; Vucić, Niksa; Tripalo, Ana; Kurjak, Asim

    2002-01-01

    Acute pelvic pain may be the manifestation of various gynecologic and non-gynecologic disorders from less alarming rupture of the follicular cyst to life threatening conditions such as rupture of ectopic pregnancy or perforation of inflamed appendix. In order to construct an algorithm for differential diagnosis we divide acute pelvic pain into gynecologic and non-gynecologic etiology, which is than subdivided into gastrointestinal and urinary causes. Appendicitis is the most common surgical emergency and should always be considered in differential diagnosis if appendix has not been removed. Apart of clinical examination and laboratory tests, an ultrasound examination is sensitive up to 90% and specific up to 95% if graded compression technique is used. Still it is user-depended and requires considerable experience in order to perform it reliably. Meckel's diverticulitis, acute terminal ileitis, mesenteric lymphadenitis and functional bowel disease are conditions that should be differentiated from other causes of low abdominal pain by clinical presentation, laboratory and imaging tests. Dilatation of renal pelvis and ureter are typical signs of obstructive uropathy and may be efficiently detected by ultrasound. Additional thinning of renal parenchyma suggests long-term obstructive uropathy. Ruptured ectopic pregnancy, salpingitis and hemorrhagic ovarian cysts are three most commonly diagnosed gynecologic conditions presenting as an acute abdomen. Degenerating leiomyomas and adnexal torsion occur less frequently. For better systematization, gynecologic causes of acute pelvic pain could be divided into conditions with negative pregnancy test and conditions with positive pregnancy test. Pelvic inflammatory disease may be ultrasonically presented with numerous signs such as thickening of the tubal wall, incomplete septa within the dilated tube, demonstration of hyperechoic mural nodules, free fluid in the "cul-de-sac" etc. Color Doppler ultrasound contributes to more

  12. Iliac renal ectopia explored by {sup 99m}Tc-DTPA and {sup 99m}Tc-DMSA scintigraphy. Report of one case; Ectopie renale iliaque exploree par scintigraphie au {sup 99m}Tc-DTPA et au {sup 99m}Tc-DMSA. A propos d'un cas

    Energy Technology Data Exchange (ETDEWEB)

    Ghfir, I.; Ben Rais, N. [Hopital Ibn Sina, CHU de Rabat, Service de Medecine Nucleaire de Rabat (Morocco)

    2008-11-15

    Introduction Renal ectopia is a malposition by anomaly of migration during the embryonic development. It can be high, low or crossed. Association with an obstructive malformation is rather frequent. The objective of this work is to highlight the interest of {sup 99m}Tc-DTPA and {sup 99m}Tc-DMSA scintigraphy in the exploration of this type of malformation through the observation of a patient presenting an iliac right renal ectopia associated with an ureteral-pelvic junction syndrome. Observation A 38-year-old patient with an ureteral-pelvic junction syndrome on a right iliac renal ectopia revealed by intravenous urography. The dynamic renal scintigraphy using {sup 99m}Tc-DTPA with furosemide test evidenced an organic obstruction in the right urinary tract with a right renal function estimated at 40% on the {sup 99m}Tc-DMSA scintigraphy. A right pyelo-plasty was carried out. The evolution was marked by the disappearance of pain and a remarkable improvement of the permeability of the right urinary tract on the follow-up scintigraphy. Discussion Renal ectopia is not an unfrequent urinary malformation. It is generally low, pelvic or iliac. Association with an ureteral-pelvic junction obstruction is rather frequent. In this purpose, renal scintigraphy intervenes as a means of functional exploration, with low ionizing radiation and non-invasive to assess the permeability of the urinary tracts of the ectopic kidney and to appreciate the relative renal function. This contributes to the orientation of diagnosis and the improvement of therapeutic strategy.

  13. Menstruation. A hazard in radionuclide renal transplant evaluation

    International Nuclear Information System (INIS)

    Orzel, J.A.; Jaffers, G.J.

    1986-01-01

    Serial Tc-99m DTPA studies were performed to evaluate renal transplant blood flow and function in a 34-year-old woman. A hypervascular pelvic mass with increased blood pool activity was intermittently identified. This hypervascular lesion suggested a pathologic condition of the pelvis, and its blood pool simulated bladder activity, confusing interpretation of renal function. This perplexing vascular lesion was the uterus, with varying degrees of blood flow and blood pool activity depending on the timing of the renal study in relation to the menstrual cycle

  14. Menstruation. A hazard in radionuclide renal transplant evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Orzel, J.A.; Jaffers, G.J.

    1986-06-01

    Serial Tc-99m DTPA studies were performed to evaluate renal transplant blood flow and function in a 34-year-old woman. A hypervascular pelvic mass with increased blood pool activity was intermittently identified. This hypervascular lesion suggested a pathologic condition of the pelvis, and its blood pool simulated bladder activity, confusing interpretation of renal function. This perplexing vascular lesion was the uterus, with varying degrees of blood flow and blood pool activity depending on the timing of the renal study in relation to the menstrual cycle.

  15. The Number of Positive Pelvic Lymph Nodes and Multiple Groups of Pelvic Lymph Node Metastasis Influence Prognosis in Stage IA-IIB Cervical Squamous Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Yu Liu

    2015-01-01

    Full Text Available Background: Pelvic lymph node metastasis (LNM is an important prognostic factor in cervical cancer. Cervical squamous cell carcinoma accounts for approximately 75-80% of all cervical cancers. Analyses of the effects of the number of positive lymph nodes (LNs, unilateral versus bilateral pelvic LNM and a single group versus multiple groups of pelvic LNM on survival and recurrence of cervical squamous cell carcinoma are still lacking. The study aimed to analyze the effects of the number of positive pelvic LNs and a single group versus multiple groups of pelvic LNM on survival and recurrence. Methods: We performed a retrospective review of 296 patients diagnosed with Stage IA-IIB cervical squamous cell carcinoma who received extensive/sub-extensive hysterectomy with pelvic lymphadenectomy/pelvic LN sampling at Peking University People′s Hospital from November 2004 to July 2013. Ten clinicopathological variables were evaluated as risk factors for pelvic LNM: Age at diagnosis, gravidity, clinical stage, histological grade, tumor diameter, lymph-vascular space involvement (LVSI, depth of cervical stromal invasion, uterine invasion, parametrial invasion, and neoadjuvant chemotherapy. Results: The incidence of pelvic LNM was 20.27% (60/296 cases. Pelvic LNM (P = 0.00 was significantly correlated with recurrence. Pelvic LNM (P = 0.00, the number of positive pelvic LNs (P = 0.04 and a single group versus multiple groups of pelvic LNM (P = 0.03 had a significant influence on survival. Multivariate analysis revealed that LVSI (P = 0.00, depth of cervical stromal invasion (P = 0.00 and parametrial invasion (P = 0.03 were independently associated with pelvic LNM. Conclusions: Patients with pelvic LNM had a higher recurrence rate and poor survival outcomes. Furthermore, more than 2 positive pelvic LNs and multiple groups of pelvic LNM appeared to identify patients with worse survival outcomes in node-positive IA-IIB cervical squamous cell carcinoma. LVSI

  16. Nutcracker Syndrome Accompanying Pelvic Congestion Syndrome; Color Doppler Sonography and Multislice CT Findings: A Case Report

    International Nuclear Information System (INIS)

    Inal, Mikail; Karadeniz Bilgili, Mihrace Yasemin; Sahin, Safa

    2014-01-01

    Nutcracker syndrome (NCS) is a rare pathology, caused by compression of the left renal vein (LRV) between the abdominal aorta (AA) and the superior mesenteric artery (SMA), due to reduction of the angle between AA and SMA. This leads to LRV varices, left gonadal vein varices and therefore, the pelvic congestion syndrome. For this reason, coexistence of NCS and pelvic congestion syndrome has been described. It manifests by hematuria, proteinuria, and nonspecific pelvic pain secondary to pelvic congestion, dyspareunia and persistent genital arousal. We report a 27-year-old woman who experienced hematuria and left flank pain. The diagnosis of NCS accompanied by pelvic congestion syndrome was missed initially, but later on the diagnosis was made by color Doppler ultrasound, abdominal computed tomography (CT) and CT angiography that were later performed. She refused interventional and surgical treatments, and was lost to follow up

  17. The birth canal: correlation between the pubic arch angle, the interspinous diameter, and the obstetrical conjugate: a computed tomography biometric study in reproductive age women.

    Science.gov (United States)

    Perlman, Sharon; Raviv-Zilka, Lisa; Levinsky, Denis; Gidron, Ayelet; Achiron, Reuven; Gilboa, Yinon; Kivilevitch, Zvi

    2018-04-22

    Assessment of pelvic configuration is an important factor in the prediction of a successful vaginal birth. However, manual evaluation of the pelvis is practically a vanishing art, and imaging techniques are not available as a real-time bed-side tool. Unlike the obstetrical conjugate diameter (OC) and inter spinous diameter (ISD), the pubic arch angle (PAA) can be easily measured by transperineal ultrasound. Three-dimensional computed tomography bone reconstructions were used to measure the three main birth canal diameters, evaluate the correlation between them, and establish the normal reference range for the inlet, mid-, and pelvic outlet. Measurements of the PAA, obstetric conjugate (OC), and ISD were performed offline using three-dimensional post processing reconstruction in bone algorithm application of the pelvis on examinations performed for suspected renal colic in nonpregnant reproductive age woman. The mean of two measurements was used for statistical analysis which included reproducibility of measurements, regression curve estimation between PAA, OC, and ISD, and calculation of the respective reference range centiles for each PAA degree. Two hundred ninety-eight women comprised the study group. The mean ± SD of the PAA, ISD, and OC were 104.9° (±7.4), 103.8 mm (±7.3), and 129.9 mm (±8.3), respectively. The intra- and interobserver agreement defined by the intraclass correlation coefficient (ICC) was excellent for all parameters (range 0.905-0.993). A significant positive correlation was found between PAA and ISD and between PAA and OCD (Pearson's correlation = 0.373 (p correlation between the three pelvic landmarks with greatest impact on the prediction of a successful vaginal delivery: the PAA which is easily measured sonographically and the ISD and OC which are not measurable by ultrasound. This correlation may serve as a basis for future studies to assess its utility and prognostic value for a safe vaginal delivery.

  18. Longitudinal comparison study of pelvic floor function between women with and without stress urinary incontinence after vaginal delivery.

    Science.gov (United States)

    Yoshida, Mikako; Murayama, Ryoko; Haruna, Megumi; Matsuzaki, Masayo; Yoshimura, Kenichi; Murashima, Sachiyo; Kozuma, Shiro

    2013-04-01

    To compare the pelvic floor function between women with and without stress urinary incontinence after vaginal delivery. Seventeen women (age 35.5 ± 3.5) were prospectively studied at about 6 weeks, 3 months, and 6 months after vaginal delivery. Urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire - Short Form. Pelvic floor function was assessed by antero-posterior diameter of the levator hiatus using transperineal ultrasound. Five of 17 women experienced postpartum stress urinary incontinence. The antero-posterior diameter of the levator hiatus at rest was significantly longer in stress urinary incontinent women than in continent women until 3 months after delivery (p continent women and stress urinary incontinent women. Regardless of urinary incontinence, the antero-posterior diameter of the levator hiatus at rest shortened at 6 months postpartum, compared to 6 weeks postpartum (p continent women by 6 months postpartum (p = 0.02). The extended pelvic floor may be a cause of stress urinary incontinence in the postpartum period. Therefore, treatment to improve the extended pelvic floor should be developed for the prevention of stress urinary incontinence.

  19. Evaluation of magnetization transfer ratio in ascites and pelvic cystic masses

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Susumu [Nippon Medical School, Inba, Chiba (Japan). Chiba-Hokuso Hospital; Kato, Tomoyasu; Yamashita, Takashi [and others

    1997-12-01

    To investigate the feasibility of magnetization transfer contrast (MTC) in characterization of pelvic cystic masses and ascites, in vitro studies were performed. Cystic fluids were taken from operative specimens of ten ovarian cystic masses (five mucinous cystadenomas, one cystadenocarcinoma, two serous cystadenocarcinomas, two clear cell carcinomas) and three non-ovarian pelvic cysts (one paraovarian cyst, one pseudomyxoma peritonei, one pelvic abscess). Samples of ascitic flied were drawn by peritoneal puncture in twenty patients (thirteen with peritonitis carcinomatosa, five with liver dysfunction, two with renal dysfunction). Total protein content in ascitic fluids was measured. Magnetization transfer ratio (MTR) was calculated by the signal intensities under the gradient echo sequence with and without the application of off-resonance pulses. The relative signal intensities (RSI) relative to water in T{sub 1} and T{sub 2} weighted images were obtained using spin echo sequence. There was no correlation between histological type of pelvic mass and MTR and RSI. Good correlation (R{sup 2}=0.761) was obtained between MTR and protein content in ascitic fluids, whereas no correlation was noted between RSI and protein content in ascitic fluids. These results suggest that MTC is not useful in the characterization of pelvic masses but is applicable in the differentiation between exudative ascites and transudative ascites. (author)

  20. Non-contrast magnetic resonance angiography in renal transplantation and renal donation

    DEFF Research Database (Denmark)

    Blankholm, Anne Dorte

    2015-01-01

    for this purpose, including US, CTA and CEMRA. CTA is based on x-ray technology, and the applied iodine-based contrast agent can cause nephropathy and, in rare cases, severe allergic reactions. Allergic reactions to Gd used in CEMRA are extremely rare. Thus, CEMRA was often used for preoperative examination before...... renal transplantation. In 2006, it was realised that the Gd used in CEMRA could cause NSF, which prompted the Danish National Board of Health to produce guidelines for the use of contrast agents in patients with severe renal disease. This thesis discusses different preoperative imaging methods without...... contrast agents before kidney transplantation and kidney donation. Study I is a review of NCMRA techniques and clinical applications. In study II, we searched for an NCMRA method with consistently good image quality for the examination of the pelvic vessels in patients with severe renal disease. Five...

  1. The Role of Non-Steroidal Anti-Inflammatory Drugs in Renal Colic

    Directory of Open Access Journals (Sweden)

    Elizabeth Waine

    2010-04-01

    Full Text Available NSAIDs provide optimal analgesia in renal colic due to the reduction in glomerular filtration and renal pelvic pressure, ureteric peristalsis and ureteric oedema. Prevention of glomerular afferent arteriolar vasodilatation renders these patients at risk of renal impairment. NSAIDs have the additional benefit of reducing the number of new colic episodes and preventing subsequent readmission to hospital. Despite recent work promoting the use of pharmacological agents to improve stone passage rates, NSAIDs do not appear to reduce the time to stone passage or increase the likelihood of stone passage in renal colic.

  2. Renal and perirenal non-Hodgkin's lymphoma: CT findings

    International Nuclear Information System (INIS)

    Lee, Seon Kyu; Kim, Seung Hyup; Lee, Goo; Choi, Byeung In; Han, Man Chung

    1992-01-01

    CT findings of 19 kidneys in 12 patients with renal and perirenal non-Hodgkin's lymphoma were retrospectively reviewed to determine distinguishing characteristic and specific findings. CT manifestation of the renal and perirenal lymphoma included multiple nodules in five kidneys(26.3%), trans-capsular infiltration in three kidneys(15.8%), trans-sinus infiltration in nine kidneys(47.4%) and diffuse infiltration in two kidneys(10.5%). Perirenal changes were thickening of the renal fascia in ten kidneys(52.6%) and crescent lesion of low attenuation in the subcapsular area in five kidneys(26.3%) Retroperitoneal lymphadenopathy was evident in eleven patient(57.9%). Renal calyceal dilatation without renal pelvic dilatation(selective calycelal dilatation) was noted in three kidneys. Familiarity with these CT findings of renal and perirenal lymphoma may be helpful in the diagnosis and management of patient with non-Hodgkin's lymphoma

  3. Anatomic features involved in technical complexity of partial nephrectomy.

    Science.gov (United States)

    Hou, Weibin; Yan, Weigang; Ji, Zhigang

    2015-01-01

    Nephrometry score systems, including RENAL nephrometry, preoperative aspects and dimensions used for an anatomical classification system, C-index, diameter-axial-polar nephrometry, contact surface area score, calculating resected and ischemized volume, renal tumor invasion index, surgical approach renal ranking score, zonal NePhRO score, and renal pelvic score, have been reviewed. Moreover, salient anatomic features like the perinephric fat and vascular variants also have been discussed. We then extract 7 anatomic characteristics, namely tumor size, spatial location, adjacency, exophytic/endophytic extension, vascular variants, pelvic anatomy, and perinephric fat as important features for partial nephrectomy. For novice surgeons, comprehensive and adequate anatomic consideration may help them in their early clinical practice. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Massive postpartum right renal hemorrhage.

    Science.gov (United States)

    Kiracofe, H L; Peterson, N

    1975-06-01

    All reported cases of massive postpartum right renal hemorrhage have involved healthy young primigravidas and blacks have predominated (4 of 7 women). Coagulopathies and underlying renal disease have been absent. Hematuria was painless in 5 of 8 cases. Hemorrhage began within 24 hours in 1 case, within 48 hours in 4 cases and 4 days post partum in 3 cases. Our first case is the only report in which hemorrhage has occurred in a primipara. Failure of closure or reopening of pyelovenous channels is suggested as the pathogenesis. The hemorrhage has been self-limiting, requiring no more than 1,500 cc whole blood replacement. Bleeding should stop spontaneously, and rapid renal pelvic clot lysis should follow with maintenance of adequate urine output and Foley catheter bladder decompression. To date surgical intervention has not been necessary.

  5. What is the best option for 10-20mm renal pelvic stones undergoing ESWL in the pediatric population: stenting, alpha blockers or conservative follow-up?

    Science.gov (United States)

    Telli, Onur; Gokce, Mehmet Ilker; Ozturk, Erdem; Suer, Evren; Mermerkaya, Murat; Afandiyev, Faraj; Ozcan, Cihat; Guclu, Adil Gucal; Soygur, Tarkan; Burgu, Berk

    2015-09-01

    In this study we aimed to identify the effect of three different modalities (stenting, doxazosin and conservative follow-up) on stone free rates and complication rates for 10-20mm renal pelvic stones in pediatric patients who underwent shock wave lithotripsy. In this study data from 241 renal units (RUs) of 195 consecutive patients with 10-20mm renal pelvis stones were analyzed retrospectively. There were 3 groups in the study; 56 (23.2%) RUs with ureteral stenting were categorized as group 1, and 39 (16.2%) RUs that received doxazosin were categorized as group 2. The remaining 146 (60.6%) RUs without history of ureteral stenting or alpha-blockers usage were categorized as group 3. Patient demographics, stone characteristics, stone free rates (SFRs), time to stone expulsion and complications were documented and compared in each group. Mean age of the population was 6.6 years and mean stone size was 13.8 ± 2.9 mm. Demographic characteristics of the 3 groups were not significantly different. SFRs of the three groups were 89.2%, 87.1% and 82.1% (p = 0.275). Mean time to stone expulsion for groups 1 and 2 were 17.4 and 21.8 days respectively and significantly lower than that in group 3 (31.3 days). Ureteral stenting or doxazosin for shockwave lithotripsy (SWL) is not superior to watchful waiting in terms of SFR and complications however both modalities shorten the stone expulsion time for 10-20mm renal pelvis stones in the pediatric population. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Anatomic and hemodynamic evaluation of renal venous flow in varicocele formation using color Doppler sonography with emphasis on renal vein entrapment syndrome.

    Science.gov (United States)

    Unlu, Murat; Orguc, Sebnem; Serter, Selim; Pekindil, Gokhan; Pabuscu, Yuksel

    2007-01-01

    To investigate the anatomic and hemodynamic properties of testicular venous drainage and its effects on varicocele formation and reflux using color Doppler ultrasound (US) with emphasis on renal vein entrapment syndrome. Upper abdominal and scrotal US examinations of 35 varicocele patients and 35 healthy male subjects were performed in the supine position during rest, during a Valsalva maneuver and in the erect position. The aortomesenteric angle and distance (AMA and AMD, respectively), peak mean velocities (PVs) and diameters of different segments of renal veins, testicular vein diameters and duration of flow inversion were measured. In the varicocele group, the lateral segment of the left renal vein (LRV) had a larger diameter and slower PV, and the medial segment of the LRV had a smaller diameter and faster PV. The diameter of the dominant draining vein correlated with the PV of the medial and lateral segments of the LRV, whereas there was no correlation between the diameter of the dominant draining vein and the diameters of the right renal vein (RRV) and the lateral segment of the LRV or the PV of the RRV. The duration of flow inversion correlated with the diameter and PV of the medial segment of the LRV. No correlation between the diameters and PVs of the RRV and the lateral segment of the LRV was detected. The decreases in the AMA, AMD, diameter of the medial segment of the LRV and PV of the lateral segment of the LRV, and the increases in the PV of the medial segment of the LRV and the diameter of the lateral segment of the LRV in varicocele patients in all positions suggest the entrapment or impingement of the left renal vein between the aorta and the superior mesenteric artery. This has been defined as the "nutcracker phenomenon", which is known to affect varicocele formation.

  7. Transvaginal ultrasound examination of women with and without pelvic venous congestion

    International Nuclear Information System (INIS)

    Halligan, Steve; Campbell, Deidre; Bartram, Clive I.; Rogers, Vera; El-Haddad, Cadria; Patel, Sujata; Beard, Richard W.

    2000-01-01

    AIM: To determine if transvaginal ultrasound, including power Doppler examination, can distinguish between women with and without pelvic congestion. MATERIALS AND METHODS: Thirty-six women with pelvic congestion were prospectively examined using transvaginal ultrasonography and standard uterine and ovarian measurements made. Additionally, planimetric measurements of each ovary were taken using an image analysis program to determine the cross-sectional area of ovarian stroma and follicles, if any. Power Doppler images of adnexal vessels were obtained and planimetric estimates of surface area calculated. A congestion score was assigned to each patient, based on vein number, diameter and morphology on grey-scale scanning. Identical measurements were obtained from 19 asymptomatic women and results compared. RESULTS: There was no significant difference between women with pelvic congestion and controls with respect to power Doppler or grey-scale images of adnexal vessels, or congestion score. However, women with pelvic congestion had significantly larger and multicystic ovaries when compared to controls. CONCLUSIONS: Transvaginal ultrasound measurements of adnexal vasculature, including power Doppler measurements, cannot reliably distinguish women with pelvic congestion from controls. However, ultrasound may remain useful for diagnosis of pelvic congestion, predominantly because it is able to visualize multi-cystic ovaries in these patients. Halligan, S. (2000).Clinical Radiology 55 , 954-958

  8. Contribution of {sup 99m}Tc-DTPA dynamic renal scintigraphy with furosemide test in the exploration of low grade urethra-pelvic junction syndrome. Report of 17 cases; Apport de la scintigraphie renale dynamique au {sup 99m}Tc-DTPA avec epreuve au furosemide dans l'exploration du syndrome de la jonction pyelo-uretrale a minima. A propos de 17 cas

    Energy Technology Data Exchange (ETDEWEB)

    Ghfir, I.; Ben Rais, N. [Hopital Ibn Sina, CHU de Rabat, Service de Medecine Nucleaire, Rabat (Morocco)

    2009-10-15

    Introduction The renal scintigraphy using {sup 99m}Tc-DTPA with furosemide test constitutes a noninvasive and functional method that is of appreciable interest in the exploration of the upper urinary tract and in the evaluation of the separate renal function. It distinguishes the functional character of dilation from organic obstruction needing surgery or endoscopic treatment. Material and methods We report, through this work, the observations of 17 patients with a low grade urethra-pelvic junction syndrome detect by intravenous urography (I.V.U.). {sup 99m}Tc-DTPA renal scintigraphy with furosemide test was carried out among all our patients by means of a gamma-camera with large field equipped with a low energy high-resolution parallel collimator. The evaluation of images obtained consisted of analysis of urethra-pelvic permeability taking into account the semiquantitative parameters of time-activity curve or isotopic nephrogram (I.N.) obtained after digital reconstruction of sequential images. Results On the 17 studied cases, the sex-ratio was equal to 1.83; the average age was 18.92 years with extremes spanning from 4 years to 70 years. Renal scintigraphy categorized four patients groups. Group I: two patients (11.76%) with normal aspect of I.N.; group II; seven patients (41.17% of cases) with functional dilation; group III: five patients (29.41%) with organic obstruction and a group IV: three patients (17.64%) with intermediate response. Discussion {sup 99m}Tc-DTPA renal scintigraphy with furosemide test allowed, through our study, to obviate the limits of IVU and manometric explorations to distinguish functional dilation of organic obstruction. It permits the improvement of treatment with a favourable dosimetry. (authors)

  9. [Case report of rare co-occurrence of renal cell carcinoma and crossed renal dystopia (L-shaped kidney)].

    Science.gov (United States)

    Bakov, V N; Los, M S

    2017-10-01

    L-shaped kidney refers to a rare anomaly of the relative kidney positioning. Due to low prevalence, the literature on the co-occurrence of this anomaly with malignancy is lacking. And, if the diagnosis of a renal anomaly does not present difficulties, if a tumor is detected in such a kidney, even MSCT does not always help differentiate a pelvic tumor from a tumor of the renal parenchyma spreading to the pelvicalyceal system. This has important implications for choosing an appropriate surgical strategy. A feature of the presented clinical observation is the co-occurrence of the rare anomaly of kidney position and locally advanced renal cell carcinoma spreading to the renal pelvis. Due to the massive spread of the tumor, an organ-sparing surgery was not feasible. Due to the suspicion of tumor spread to the renal pelvis, the patient underwent nephrureterectomy of the L-shaped kidney. Introduction to renoprival state with transfer to chronic hemodialysis became the only option to maintain homeostasis and extend the patients life. Histological examination revealed clear cell renal cell carcinoma with invasion of the pelvis and renal capsule, with no clear demarcation between the fused kidneys.

  10. Renal artery anatomy assessed by quantitative analysis of selective renal angiography in 1,000 patients with hypertension.

    Science.gov (United States)

    Lauder, Lucas; Ewen, Sebastian; Tzafriri, Abraham Rami; Edelman, Elazer Reuven; Lüscher, Thomas Felix; Blankenstijn, Peter J; Dörr, Oliver; Schlaich, Markus; Sharif, Faisal; Voskuil, Michiel; Zeller, Thomas; Ukena, Christian; Scheller, Bruno; Böhm, Michael; Mahfoud, Felix

    2018-05-20

    With increasing attention to renovascular causes and targets for hypertension there arises a critical need for more detailed knowledge of renal arterial anatomy. However, a standardised nomenclature is lacking. The present study sought to develop a standardised nomenclature for renal anatomy considering the complexity and variation of the renal arterial tree and to assess the applicability of the nomenclature. One thousand hypertensive patients underwent invasive selective renal artery angiography in nine centres. Further, renovasography was performed in 249 healthy swine as a surrogate for normotensive anatomy. Anatomical parameters were assessed by quantitative vascular analysis. Patients' mean blood pressure was 168/90±26/17 mmHg. The right main renal artery was longer than the left (41±15 mm vs. 35±13 mm, prenal arteries and renal artery disease were documented in 22% and 9% of the patients, respectively. Other than exhibiting a longer left main renal artery in uncontrolled hypertensives (+2.7 mm, p=0.034) there was no anatomical difference between patients with controlled and uncontrolled hypertension. Main renal artery mean diameter was smaller in patients with impaired kidney function (GFR Renal arterial anatomy differs between sides but shows no difference between patients with and without blood pressure control. Impaired GFR was associated with small main renal artery diameter.

  11. Treatment outcomes of open pelvic fractures associated with extensive perineal injuries.

    Science.gov (United States)

    Hasankhani, Ebrahim Ghayem; Omidi-Kashani, Farzad

    2013-12-01

    The main causes of death in patients with open pelviperineal injuries are uncontrollable bleeding and pelvic sepsis. The aim of this study was to evaluate the management outcomes of open pelvic fractures associated with extensive perineal injuries. We retrospectively studied 15 cases with open pelvic fractures associated with extensive perineal injuries (urethral and anal canal laceration) admitted between August 2006 and September 2010. Mechanism of injury, Injury Severity Score, associated injuries, hemodynamic status on arrival, resuscitation and transfusion requirements, operative techniques, intra- and postoperative complications, length of intensive care unit and hospital stay, and mortality were recorded in a computerised database for further evaluation and analysis. The male to female ratio was 12:3 with an average age of 38.6 years (ranged, 11 to 65 years). The average packed red blood cell units used were 8 units (ranged, 4 to 21 units). All patients were initially transferred to the operating room for colostomy, radical debridement and fixation of the pelvic fracture by an external fixator. One patient had acute renal failure, which improved with medical treatment and 2 patients (13.3%) died, one with type III anteroposterior compression fracture due to hemorrhagic shock and the other due to septicemia. Open pelvic fractures with extensive perineal injuries are associated with high mortality rates. Early diagnosis and appropriate treatment, including reanimation, colostomy, cystostomy, vigorous and repeated irrigation and debridement, and fixation by an external fixator can improve the outcomes and reduce the mortality rate.

  12. Is Tamsulosin Effective after Shock Wave Lithotripsy for Pediatric Renal Stones? A Randomized, Controlled Study.

    Science.gov (United States)

    Shahat, Ahmed; Elderwy, Ahmad; Safwat, Ahmed S; Abdelkawi, Islam F; Reda, Ahmed; Abdelsalam, Yasser; Sayed, Mohamed; Hammouda, Hisham

    2016-04-01

    We assessed the effect of tamsulosin as an adjunctive therapy after shock wave lithotripsy for pediatric single renal pelvic stones. A total of 120 children with a unilateral single renal pelvic stone were included in a prospective randomized, controlled study. All children were randomized to 2 equal groups. Group 1 received tamsulosin (0.01 mg/kg once daily) as adjunctive therapy after shock wave lithotripsy in addition to paracetamol while group 2 received paracetamol only. Stone clearance was defined as no renal stone fragments or fragments less than 3 mm and no pelvicalyceal system dilatation. Our study included 69 boys and 51 girls with a median age of 3.5 years and a median stone size of 1.2 cm. There was no statistically significant difference between groups 1 and 2 in stone or patient criteria. Of the children 99 (82.5%) achieved stone clearance after the first session, including 50 in group 1 and 49 in group 2. All children in each group were cleared of stones after the second session. The overall complication rate was 14.2%. There was no statistically significant difference between single session stone clearance rates (p = 0.81) and complications rates (p = 0.432) in either group. On multivariate analysis using logistic regression smaller stone size (p = 0.016) and radiopaque stones (p = 0.019) were the only predictors of stone clearance at a single shock wave lithotripsy session. Tamsulosin therapy did not affect stone clearance (p = 0.649). Tamsulosin does not seem to improve renal stone clearance. Smaller and radiopaque renal stones have more chance of clearance after shock wave lithotripsy for pediatric single renal pelvic stones. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  13. [An exceptional mimicker of ovarian tumors: cancer in a pelvic horseshoe kidney].

    Science.gov (United States)

    Ortiz-Mendoza, Carlos Manuel

    2013-01-01

    although the horseshoe kidney is a frequent congenital abnormality, the likelihood of it being the cause of a malignant tumor that looks like an ovarian neoplasm has not been reported. a 53-year-old female came to the hospital with a pelvic tumor. The patient had a history of a simple hysterectomy due to uterine myomatosis. At abdominal physical examination we identified a rounded hypogastric tumor, 20 cm diameter, firm, and fixed. On pelvic examination the mass was easily palpated through the vaginal fornix. The diagnosis of a probable ovarian neoplasm, caused by a residual ovary syndrome was made, therefore she was admitted to the gynecology service. Computed tomography scans showed a tumor located in the right side of a deformed pelvic kidney. Hence, the gynecology service sent the patient to the surgical oncology department, where the assumption was confirmed. The analysis of the RX studies showed a possible neoplasm from a pelvic horseshoe kidney. The patient underwent an exploratory abdominal surgery, and a 19 cm tumor was excised. The pathology department reported a chromophobe cell carcinoma. tumors in the pelvic horseshoe kidney may simulate an ovarian neoplasms in females.

  14. Direct pelvic access percutaneous nephrolithotomy in management of ectopic kidney stone: a case report and literature review.

    Science.gov (United States)

    Mehmet, Rifaioglu Murat; Rustu, Yalcinkaya Fatih; Hanefi, Bayarogullari; Mursel, Davarci; Fusun, Aydogan; Mehmet, Inci

    2013-01-01

    Percutaneous nephrolithotomy (PNL) is an effective procedure for the treatment of patients with large or complex stones. PNL is challenging in anomalous kidneys, certain patients, such as those with renal ectopia. It is unable to undergo PNL in conventional technique safely in these cases. We presented a case report of laparoscopic-assisted PNL via direct pelvic puncture in a pelvic kidney stone and discussed previous published literature. A 49-year-old man presented with right lower quadrant pain and hematuria. Intravenous pyelography and three-dimensional computerized tomography revealed an opaque 2.7 × 1.7 cm pelvis renalis stone in a right side ectopic pelvic kidney with grade III hydronephrosis. Laparoscopic-assisted tubeless PNL was performed to remove the calculus. Laparoscopic-assisted PNL as a minimally invasive therapy in ectopic kidney has many advantages. Our case showed that, in pelvic ectopic kidney with pelvic stones greater than 1.5 cm in size, laparoscopic-assisted PNL via direct pelvis puncture is a safe and effective technique.

  15. COMPARATIVE STUDY OF CULTURE AND SENSITIVITY PATTERNS OF PRE OPERATIVE MID STREAM URINE WITH RENAL PELVIC URINE AND STONE TO PREDICT UROSEPSIS FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY: A PROSPECTIVE CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Bhargava Vardhana Reddy

    2015-11-01

    Full Text Available INTRODUCTION : Percutaneous nephrolithotomy (PCNL is the most frequently performed surgery for stone disease at our institution. Nearly 100 PCNL procedures are being performed in a year at our institution. Septicemia following PCNL can be catastrophic despite sterile preoperative urine and prophylactic antibiotics. Infected stones, obstructed kidneys , and comorbidit y have been held responsible. In this study we analyzed various culture specimens, namely Mid - stream urine (MSU, renal pelvic urine and crushed stones. MATERIALS AND METHODS : We performed a prospective clinical study in all our patients undergoing PCNL b etween January 2013 and December 2014. MSU was sent for culture and sensitivity testing (C&S one day prior to surgery. Percutaneous access into the ipsilateral pelvicaliceal system is achieved under image intensification using a fine, 14 gauge Kellet need le. Urine from the pelvicaliceal system is first aspirated and sent as pelvic urine C&S. Stone fragments are collected to be proces0sed for C&S. The data collected were divided into 3 main groups, that is MSU C&S, pelvic urine C&S and stone C&S. RESULTS : A total of 83 patients were included in the study, of this MSU C&S was positive in 9/83 (10.8% patients, Pelvic C&S in 10 /73 (13.7% patients and Stone C&S in 25/83 (30.1% patients. Out of 25 cases of stone culture positive patients 17 patients develope d Systemic Inflammatory Response Syndrome (SIRS but only 2 patients developed SIRS in MSU C & S positive patients. CONCLUSIONS: The results of our study suggest that positive stone C&S is the better predictor of potential urosepsis than MSU. Stone cultur e is available only after surgery but appears to be the best guide for antibiotic therapy in case of sepsis. So the routine collection of stone for C&S will be beneficial

  16. Uterus bicornis bicollis, imperforate hemivagina and ipsilateral renal agenesis: case report and literature review.

    Science.gov (United States)

    DaCosta, V; Christie, L; Wynter, S; Harriott, J; Frederick, J

    2009-09-01

    We present a case of a patient with Uterus bicornis bicollis, imperforate hemivagina and ipsilateral renal agenesis. This group of congenital malformations is often asymptomatic until puberty, when it presents as cyclic dysmenorrhoea, leucorrhoea or a pelvic mass. Magnetic resonance imaging is becoming the preferred modality for delineation of uterine malformations. When congenital abnormalities of the reproductive tract are encountered, a search should also be made for renal anomalies. Patients with Uterus bicornis bicollis and unilateral imperforate vagina are often seen with pain severe enough to mimic an acute abdomen. It is important to keep this unusual congenital malformation in mind in the differential diagnosis of vaginal discharge, pelvic mass and/or abdominopelvic pain in young women so as to avoid inappropriate surgical procedures.

  17. Anatomic Patterns of Renal Arterial Sympathetic Innervation: New Aspects for Renal Denervation.

    Science.gov (United States)

    Imnadze, Guram; Balzer, Stefan; Meyer, Baerbel; Neumann, Joerg; Krech, Rainer Horst; Thale, Joachim; Franz, Norbert; Warnecke, Henning; Awad, Khaled; Hayek, Salim S; Devireddy, Chandan

    2016-12-01

    Initial studies of catheter-based renal arterial sympathetic denervation to lower blood pressure in resistant hypertensive patients renewed interest in the sympathetic nervous system's role in the pathogenesis of hypertension. However, the SYMPLICITY HTN-3 study failed to meet its prespecified blood pressure lowering efficacy endpoint. To date, only a limited number of studies have described the microanatomy of renal nerves, of which, only two involve humans. Renal arteries were harvested from 15 cadavers from the Klinikum Osnabruck and Schuchtermann Klinik, Bad Rothenfelde. Each artery was divided longitudinally in equal thirds (proximal, middle, and distal), with each section then divided into equal superior, inferior, anterior, and posterior quadrants, which were then stained. Segments containing no renal nerves were given a score value = 0, 1-2 nerves with diameter 4 nerves or nerve diameter ≥600 µm a score = 3. A total of 22 renal arteries (9 right-sided, 13 left-sided) were suitable for examination. Overall, 691 sections of 5 mm thickness were prepared. Right renal arteries had significantly higher mean innervation grade (1.56 ± 0.85) compared to left renal arteries (1.09 ± 0.87) (P renal artery has significantly higher innervation scores than the left. The anterior and superior quadrants of the renal arteries scored higher in innervation than the posterior and inferior quadrants did. The distal third of the renal arteries are more innervated than the more proximal segments. These findings warrant further evaluation of the spatial innervation patterns of the renal artery in order to understand how it may enhance catheter-based renal arterial denervation procedural strategy and outcomes. The SYMPLICITY HTN-3 study dealt a blow to the idea of the catheter-based renal arterial sympathetic denervation. We investigated the location and patterns of periarterial renal nerves in cadaveric human renal arteries. To quantify the density of the

  18. Experimental research on local renal injury of dog with microwave ablation guided by DSA

    International Nuclear Information System (INIS)

    Lin Jianping; Xian Zhengyuan; Shi Rongshu; Zhang Gaofeng; Li Xianlang

    2008-01-01

    Objective: To explore the efficiency, complications and probability of preserving part renal function by local renal microwave ablation. Methods: The fresh pig renal pelvis full filled with 30% diatrizoate meglumine and the dogs kidney taken arterial pyelography were both ablated with microwave. Dogs were divided into three groups: measuring temperature after ablation group, single point ablation both on the two kidneys group and double points ablation on unilateral kidney group. In measuring temperature after ablation group, DSA and pathology were performed immediately after ablation. In the other groups, DSA with blood and urine samplings were taken for routine tests including renal function right after the ablation and 10 days later. Results: Experiment in vitro showed conspicuous renal pelvic contraction and convolution. The group under power rate of 70, 3 min produced urine leak easily. Preliminary test in vivo with DSA showed the disappearance of local kidney blood supply. The residual renal function was related to areas of necrosis. Acute stage pathology revealed acute renal cortex medulla and pelvic cells injury. DSA of chronic stage showed no change in size of the area of ablation. The blood supply of necrotic areas was not restored. The residual kidney possessed the excretion contrast medium with no urine leaks. Upper pole of right kidney adhered with adjacent tissue, together with thickened covering. Pathology revealed fibrous proliferation around the coagulative necrosis. Conclusion: Microwave ablation can inactivate the local renal tissue, and, effectively preserve the big blood vessels and function of residual kidney. No urine leaks occurred in chronic stage but easily to produce adhesions with adjacent tissue. (authors)

  19. Swine as a model in renal physiology and nephrology: an overview

    International Nuclear Information System (INIS)

    Terris, J.M.

    1986-01-01

    Swine have become an important animal model in many areas of biomedical research for a variety of reasons. They are suited for studies in nephrology and renal physiology because they are the only mammal, with the exception of the dwarf water buffalo, which has been shown to have kidneys morphologically similar to the human. Maturational characteristics of fetal and neonatal kidney are similar to those of the newborn human infant. Therefore, studies to evaluate the pyeloureteral dynamics of human like multipapillary kidneys or developmental studies related to the newborn human cannot be conducted adequately in any other mammal. The following overview addresses the morphology and pelvic and ureteral dynamics of swine and human kidneys, maturation of renal hemodynamics in the neonate, renal function and the effects of anesthesia and diruetics on renal function in the pig. Additionally, the use of swine in other areas of interest to the nephrologist and renal physiologist are considered, eg, renal response to exercise, irradiation therapy, kidney preservation and renal transplantation

  20. Renal artery origins: best angiographic projection angles.

    Science.gov (United States)

    Verschuyl, E J; Kaatee, R; Beek, F J; Patel, N H; Fontaine, A B; Daly, C P; Coldwell, D M; Bush, W H; Mali, W P

    1997-10-01

    To determine the best projection angles for imaging the renal artery origins in profile. A mathematical model of the anatomy at the renal artery origins in the transverse plane was used to analyze the amount of aortic lumen that projects over the renal artery origins at various projection angles. Computed tomographic (CT) angiographic data about the location of 400 renal artery origins in 200 patients were statistically analyzed. In patients with an abdominal aortic diameter no larger than 3.0 cm, approximately 0.5 mm of the proximal part of the renal artery and origin may be hidden from view if there is a projection error of +/-10 degrees from the ideal image. A combination of anteroposterior and 20 degrees and 40 degrees left anterior oblique projections resulted in a 92% yield of images that adequately profiled the renal artery origins. Right anterior oblique projections resulted in the least useful images. An error in projection angle of +/-10 degrees is acceptable for angiographic imaging of the renal artery origins. Patients sex, site of interest (left or right artery), and local diameter of the abdominal aorta are important factors to consider.

  1. Pelvic floor muscle function in women with pelvic floor dysfunction

    DEFF Research Database (Denmark)

    Tibaek, Sigrid; Dehlendorff, Christian

    2014-01-01

    The objectives of this study were to investigate the level of pelvic floor muscle (PFM) function in women with pelvic floor dysfunction (PFD) referred by gynaecologists and urologists for in-hospital pelvic floor muscle training (PFMT), and to identity associated factors for a low level of PFM...

  2. Paraparesis secondary to erratic migration of Dioctophyma renale in a dog

    Directory of Open Access Journals (Sweden)

    Fernando Swiech Bach

    2016-05-01

    Full Text Available ABSTRACT: A 4 years old mongrel stray bitch, weighing 16kg was submitted to physical examination to demonstrated inability of locomotion with the pelvic limbs. Extradural spinal cord compression was observed in myelotomography of the thoracolumbar segment. The patient was submitted to exploratory hemilaminectomy of T13-L1 and L1-L2, in an attempt to decompress the medullar segments. During the surgery was observed one adult parasite, identified as Dioctophyma renale , located in the extradural space and causing spinal cord compression. The patient was submitted to postoperative physical therapy, presenting clinical improvement 15 days after surgery, remaining on prone position and able to move the pelvic limbs, but not yet able to walk unassisted. It started walking naturally 60 days after the surgery. With the present clinical report, the erratic migration of the parasite Dioctophyma renale should be added to the list of differential diagnoses for patients with paraparesis and extramedullary lesion pattern, especially in endemic areas.

  3. Pelvic Muscle Rehabilitation: A Standardized Protocol for Pelvic Floor Dysfunction

    Directory of Open Access Journals (Sweden)

    Rodrigo Pedraza

    2014-01-01

    Full Text Available Introduction. Pelvic floor dysfunction syndromes present with voiding, sexual, and anorectal disturbances, which may be associated with one another, resulting in complex presentation. Thus, an integrated diagnosis and management approach may be required. Pelvic muscle rehabilitation (PMR is a noninvasive modality involving cognitive reeducation, modification, and retraining of the pelvic floor and associated musculature. We describe our standardized PMR protocol for the management of pelvic floor dysfunction syndromes. Pelvic Muscle Rehabilitation Program. The diagnostic assessment includes electromyography and manometry analyzed in 4 phases: (1 initial baseline phase; (2 rapid contraction phase; (3 tonic contraction and endurance phase; and (4 late baseline phase. This evaluation is performed at the onset of every session. PMR management consists of 6 possible therapeutic modalities, employed depending on the diagnostic evaluation: (1 down-training; (2 accessory muscle isolation; (3 discrimination training; (4 muscle strengthening; (5 endurance training; and (6 electrical stimulation. Eight to ten sessions are performed at one-week intervals with integration of home exercises and lifestyle modifications. Conclusions. The PMR protocol offers a standardized approach to diagnose and manage pelvic floor dysfunction syndromes with potential advantages over traditional biofeedback, involving additional interventions and a continuous pelvic floor assessment with management modifications over the clinical course.

  4. 后腹腔镜下肾窦内肾盂切开取石术%Retroperitoneal laparoscopic pyelolithotomy in the treatment of intrarenal pelvic calculi

    Institute of Scientific and Technical Information of China (English)

    林超; 时少显; 李海涛; 吕共生; 和学强; 陈家旺

    2008-01-01

    Objective To evaluate the clinical efficacy and safety of retroperitoneal laparoscopic pyelolithotomy in the treatment of intrarenal pelvic staghorn calculus or multiple renal calculi. Methods Fifteen patients(9 males and 6 females)with average age of 40 years old were treated. The diameters of the calculi were from 1.5 cm to 3.7 cm. Three trocars were used in this procedure as rou-tine. The renal sinus was exposed by separating the pelvis from outside to inside until reaching the in-fundibulum of the renal calyx. Then the renal calyx was cut open and the calculus was taken out. Double J stent was placed in the ureter and the incision of pelvis was closed by 3-0 absorbable suture. The drainage tube was pulled out 3-4 d post-operatively according to the drainage quantity. Double J stent was then pulled out 2 weeks after surgery. Results All the 15 procedures were successfully completed. The average operation time was 170 min and the average post-operative hospital stay was 7 d. During the 3-15 months' follow-up, 2 patients had calculus remnants with the size of 0. 2-0.5cm in diameter. Conclusions Retroperitoneal laparoscopic pyelolithotomy provides a minimally inva-sive treatment option in patients with intrarenal pelvic staghorn calculus or multiple renal calculi. It has the advantages of good exposure, little bleeding, small incision and fast recovery.%目的 探讨后腹腔镜下肾窦内肾盂切开取石治疗肾鹿角状及多发性结石的疗效. 方法肾多发及鹿角状结石患者15例.男9例,女6例.平均年龄40岁.结石直经1.5~3.7 cm.常规用3个穿刺器,建立气腹于腹膜后间隙,紧贴肾盂外膜向肾窦内分离,暴露出肾盏漏斗部,切开取石,输尿管内置入双J管,3-0可吸收线缝合肾盂切口.冲洗、放置引流管.术后3~4 d拔出引流管.2周左右拔出双J管. 结果 15例手术均获成功,平均手术时间170 rain.术后平均住院7 d.随访3~15个月,2例有0.2~0.5 cm结石残留. 结论 后腹腔镜下肾窦内肾盂切开取石提供了微创的新途径,暴露好、出血少、创伤小、恢复快.

  5. The Role of Pelvic Floor Muscles in Male Sexual Dysfunction and Pelvic Pain.

    Science.gov (United States)

    Cohen, Deborah; Gonzalez, Joshua; Goldstein, Irwin

    2016-01-01

    Sexual function is essential to good health and well-being in men. The relationship between male sexual function, pelvic floor function, and pelvic pain is complex and only beginning to be appreciated. The objectives of the current review are to examine these complex relationships, and to demonstrate how pelvic floor physical therapy can potentially improve the treatment of various male sexual dysfunctions, including erectile dysfunction and dysfunction of ejaculation and orgasm. Contemporary data on pelvic floor anatomy and function as they relate to the treatment of various male sexual dysfunctions were reviewed. Examination of evidence supporting the association between the male pelvic floor and erectile dysfunction, ejaculatory/orgasmic dysfunction, and chronic prostatitis/chronic pelvic pain syndrome, respectively. Evidence suggests a close relationship between the pelvic floor and male sexual dysfunction and a potential therapeutic benefit from pelvic floor therapy for men who suffer from these conditions. Pelvic floor physical therapy is a necessary tool in a more comprehensive bio-neuromusculoskeletal-psychosocial approach to the treatment of male sexual dysfunction and pelvic pain. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

  6. Treatment of Pelvic Venous Spur (May-Thurner Syndrome) with Self-Expanding Metallic Endoprostheses

    International Nuclear Information System (INIS)

    Binkert, Christoph A.; Schoch, Eric; Stuckmann, Gerd; Largiader, Jon; Wigger, Pius; Schoepke, Wolfdietrich; Zollikofer, Christoph L.

    1998-01-01

    Purpose: The application of self-expanding metallic endoprostheses (stents) to treat symptomatic pelvic venous spurs as an alternative to surgery. Methods: Wallstents with a diameter from 14 to 16 mm and one Cragg stent were placed in the left common iliac vein of eight patients (seven women, one man; mean age 42 years) with a symptomatic pelvic venous spur (left deep venous thrombosis or post-thrombotic leg swelling). Four patients had surgical thrombectomy prior to stent placement. Results: Technical success with immediate reduction of left leg circumference was achieved in all eight patients. A primary patency rate of 100% was observed during an average follow-up of 3 years (range 10-121 months). There were no procedural or stent-related complications. Conclusion: The percutaneous transfemoral placement of self-expanding metallic stents is an effective minimally invasive alternative to surgery in the treatment of symptomatic pelvic venous spur

  7. Contribution of pelvic floor muscles to stiffness of the pelvic ring

    NARCIS (Netherlands)

    Pool-Goudzwaard, A.L.; Hoek van Dijke, G; van Gurp, M; Mulder, P; Snijders, C.J.; Stoeckart, R.

    2004-01-01

    STUDY DESIGN: A biomechanical study in embalmed specimens, on the relation between applied tension in the pelvic floor muscles, stiffness of the pelvic ring and generation of movement in the sacroiliac joints. OBJECTIVE: To gain insight into the effect of tension in the pelvic floor muscles on

  8. Application of single-incision transvaginal mesh in a woman undergoing peritoneal dialysis and suffering from refractory advanced stage pelvic organ prolapse

    OpenAIRE

    Sun, Yi-Hung; Kan, Wei-Chih; Wu, Ming-Ping

    2016-01-01

    Objective: We would like to provide an option of minimal invasive surgical intervention for a patient with end-stage renal disease undergoing continuous ambulatory peritoneal dialysis, who was at the advanced-stage pelvic organ prolapse (POP) and who also failed to be treated conservatively. Materials and method: We present a case of uterine prolapse stage IV in a woman who underwent continuous ambulatory peritoneal dialysis due to end-stage renal disease. Her severity of POP had only limi...

  9. Renal function and urological complications after radical hysterectomy with postoperative radiotherapy and platinum-based chemotherapy for cervical cancer.

    Science.gov (United States)

    Okadome, Masao; Saito, Toshiaki; Kitade, Shoko; Ariyoshi, Kazuya; Shimamoto, Kumi; Kawano, Hiroyuki; Minami, Kazuhito; Nakamura, Motonobu; Shimokawa, Mototsugu; Okushima, Kazuhiro; Kubo, Yuichiro; Kunitake, Naonobu

    2018-02-01

    We aimed to clarify renal functional changes long term and serious urological complications in women with cervical cancer who undergo radical hysterectomy followed by pelvic radiotherapy and/or platinum-based chemotherapy to treat the initial disease. Data on 380 women who underwent radical hysterectomy at the National Kyushu Cancer Center from January 1997 to December 2013 were reviewed. Main outcome measures were the estimated glomerular filtration rate (eGFR) and monitored abnormal urological findings. Postoperative eGFR was significantly lower than preoperative eGFR in 179 women with surgery alone and in 201 women with additional pelvic radiotherapy and/or chemotherapy (both P types of univariate analyses for eGFR reduction in women after treatment showed that older age, advanced stage, pelvic radiotherapy, and platinum-based chemotherapy were significant variables on both analyses. Two types of multivariate analyses showed that platinum-based chemotherapy or pelvic radiotherapy were associated with impaired renal function (odds ratio 1.96, 95% confidence interval 1.08-3.54 and odds ratio 2.85, 95% confidence interval 1.12-7.24, for the respective analyses). There was a higher rate of bladder wall thickening in women with pelvic radiotherapy had than those without it (17.4% vs. 2.7%, P chemotherapy and/or postoperative pelvic radiotherapy. Serious and life-threatening urological complications are rare, but surgeons should be aware of the possibility during the long follow-up. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. Evaluation of renal artery and renal masses using enhanced dynamic MRI. Three-dimensional volumetric interpolated breath-hold examination

    International Nuclear Information System (INIS)

    Ishikawa, Aimi; Kakizaki, Dai; Ito, Naoki; Shindou, Hiroaki; Ozuki, Taizou; Abe, Kimihiko; Sasaki, Kazuyoshi; Katsuyama, Hiroaki

    2003-01-01

    The purpose of this study was to evaluate of three-dimensional volumetric interpolated breathhold examination (3D-VIBE) for imaging renal arteries in renal tumor surgery. Twenty four patients to evaluate renal arteries, and 30 patients for staging of renal tumors. For evaluation of renal arteries, the number of renal arteries and secondary branches, and the RA ratio (renal artery diameter per aorta diameter) were investigated. For tumor evaluation, we investigated T factor and presence and condition of tumor capsule, 3D-VIBE was performed with a MAGNETOM Symphony (Siemens, Erlangen, Germany). Before the dynamic study, we measured renal artery acquisition time with 1 ml of contrast material (Gd-DTPA) and 20 ml of physiological saline solution injected into a hand vein at a rate of 3 ml/sec using an automatic injector. The first phase was set for arrival of the Gd-DTPA at the renal artery, the 2nd for 40 sec after the 1st phase, and the 3rd 180 sec after injection. Then we started scanning with 19 ml of Gd-DTPA and 20 ml of physiological saline solution. Maximum intensity projection (MIP) and multiplanar reconstruction (MFR) were reconstructed by the image data set. All renal arteries were correctly counted In one case, a branch of the superior mesenteric artery (SMA) was mistaken for a renal artery, but correctly identified using a stereo view. The rate of depiction of secondary branches was 86% compared with RA ratio which was significantly smaller than on aortic angiography (p<0.05). The findings for 5 tumors were confirmed by CT, but differed pathologically. We believe 3D-VIBE is useful dynamic CT for evaluation of renal arteries and preoperative classification of renal tumors. (author)

  11. Intra-pelvic pressure changes after pelvic fracture: A cadaveric study quantifying the effect of a pelvic binder and limb bandaging over a bolster.

    Science.gov (United States)

    Morris, Rhys; Loftus, Andrew; Friedmann, Yasmin; Parker, Paul; Pallister, Ian

    2017-04-01

    Unstable pelvic fractures can be life-threatening due to catastrophic haemorrhage. Non-invasive methods of reducing and stabilising these injuries include pelvic binder application and also lower limb bandaging over a knee-flexion bolster. Both of these methods help close the pelvic ring and should tamponade bleeding. This study aimed to quantify the intra-pelvic pressure changes that occurred with 3 different manoeuvres: lower limb bandaging over a bolster; a Trauma Pelvic Orthotic Device (T-POD) pelvic binder, and a combination of both. Following a pilot study with 2 soft embalmed cadavers, a formal study with 6 unembalmed cadavers was performed. For each specimen an unstable pelvic injury was created (OA/OTA 61-C1) by dividing the pelvic ring anteriorly and posteriorly. A 3-4cm manometric water-filled balloon was placed in the retropubic space and connected to a 50ml syringe and water manometer via a 3-way tap. A baseline pressure of 8cmH 2 O (equating to the average central venous pressure) was used for each cadaver. Steady intra-pelvic pressures (more reliably reflecting the pressures achieved following an intervention) were used in the subsequent statistical analysis, using R statistical language and Rstudio. Paired t-test or Wilcoxon's rank sum test were used (depending on the normality of the dataset) to determine the impact of each intervention on the intra-pelvic pressure. The mean steady intra-pelvic pressures were significantly greater than the baseline pressure for each intervention. The binder and limb bandaging over a bolster alone increased the mean steady pelvic pressures significantly to 24 (SE=5) (plower limb bandaging over a bolster and pelvic binder application significantly increased intra-pelvic pressure above the baseline pressure. This was further increased through combining these interventions, which could be useful clinically to augment haemorrhage control in these fractures. Lower-limb bandaging over a bolster, and pelvic binder

  12. Ultrasonographically determined renal values and comparisons to serum biochemistry renal variables in aged semi-captive cheetahs (Acinonyx jubatus).

    Science.gov (United States)

    Kirberger, Robert M; Tordiffe, Adrian S W

    2017-11-06

    Cheetahs in captivity have a high prevalence of chronic renal diseases. We ultrasonographically evaluated the renal volumes, a variety of renal dimensions, interarcuate artery resistive indices (RI) as well as aortic diameters and the length of the ventral aspect of the 6th lumbar vertebrae in 27 aged semi-captive anesthetized cheetahs. Renal size, dimensions and ratios were compared to urine specific gravity, serum creatinine and urea values. There were minimal differences for all values between left and right kidneys. Mean kidney length was 65.1 mm (range 55.2-76.9) with left kidney length ratios to L6 length being 1.60 (range 1.27-2.06) and to the aortic diameter 7.69 (range 4.54-10.72). Significant correlations between left renal length as well as length:L6 ratio to creatinine values were found ((r - 0.66) and (r - 0.60) respectively). The mean RI values of the different sedation/anesthetic protocols ranged from 0.46-0.55. Left renal length and L6 ventral vertebral body length as well as left kidney RI values should be routinely measured in all cheetah abdominal ultrasound examinations. These measurements, together with serum creatinine, urea and urine specific gravity values may be relatively sensitive indicators of early renal pathology in the absence of gross ultrasonographic changes.

  13. Retrospective study of renal images on whole bone scanning

    International Nuclear Information System (INIS)

    Yanagisawa, Munetoshi; Machida, Toyohei; Miki, Makoto; Ohishi, Yukihiko; Ueda, Masataka

    1978-01-01

    One hundred and twenty-seven cases were surveyed by sup(99m)Tc-pyrophosphate at Jikei hospital. Renal images on whole-bone scanning were observed in all cases; 75% of all renal images were normal and 25% were abnormal. Thirteen percent of these abnormal images were symmetric and 87% were asymmetric. Four of the symmetric renal images were bilaterally bad. Three of the four bilaterally bad renal images involved prostate carcinomas with general metastases and the last involved serious bilateral hydronephrosis. The reason for the high percentage of asymmetric renal images was that the materials involved many urogenital cases. Asymmetric renal images other than the urogenital cases, were recognised in 8% of all cases. This percentage is consistent with Hattner's report. Unilateral abnormal renal images involved 8 hydronephrosis cases, 2 unilateral nonfunctioning kidneys and one malrotation kidney. Among the hydronephrosis cases, serious cases gave low uptake and mild cases gave high uptake. The reason for this phenomenon was, presumably, that there were differences in renal uptake, renal excretion and renal pelvic accumulation. In nine cases, one kidney was not visualized on whole-bone scanning, 8 of them involved nephrectomy and the remainining one unilateral nonfunctioning kidney. Six cases presented locally abnormal renal images on whole-bone scanning, three of them suffered renal cell carcinomas and the rest renal solitary cyst. Eighty-eight percent of the abnormal renal images agreed with IVP findings. The renal images of whole-bone scanning faithfully reflected the original renal lesion. Two cases of renal carcinoma and renal solitary cyst recognized on whole-bone scanning are presented, to indicate the usefulness of renal images on whole-bone scanning. (auth.)

  14. An Unexpected Cause of Pelvic Pain in a Pubertal Case: Herlyn-Werner-Wunderlich Syndrome

    Directory of Open Access Journals (Sweden)

    Yasemin Kayadibi

    2014-03-01

    Full Text Available Uterovaginal duplication with imperforated hemivagina is a rare type of Mullerian anomaly. If ipsilateral renal agenesis is associated with this complex genital malformation, it is called Herlyn-Werner-Wunderlich syndrome. Clinical presentations of this syndrome include pelvic pain and mass effect due to obstructed hemivagina in pubertal adolescents and adults. Hematocolpos, even after menstruation period, leads to misdiagnosis. Laparotomy is the gold standard for the diagnosis, however, magnetic resonance imaging has an accuracy upto 100% in evaluating uterovajinal anatomy. In this article, we aimed to present ultrasonographic and magnetic resonance imaging findings in a patient with Herlyn-Werner-Wun derlich syndrome who presented with cyclic pelvic pain. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 60-3

  15. A Rare Renal Epithelial Tumor: Mucinous Cystadenocarcinoma Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Abdulkadir Tepeler

    2011-01-01

    Full Text Available Primary renal mucinous cystadenocarcinoma is a very rare lesion of kidney which originates from the metaplasia of the renal pelvic uroepithelium. Only one case with primary mucinous cystadenocarcinoma has been reported in the English literature. We report second case of mucinous cystadenocarcinoma which was radiologically classified as type-IIF Bosniak cyst in peripheral localization. We aimed to present this extreme and unusual entity with its radiological, surgical, and pathologic aspects under the light of literature.

  16. Renal Metastasis from Primary Cervical Cancer: A Case Report

    International Nuclear Information System (INIS)

    Jeon, Seong Woo; Kim, See Hyung; Kwon, Sun Young

    2013-01-01

    Metastasis of malignant tumors to the kidney is clinically rare and often discovered by autopsy. Primary lymphoma and lung cancer are known that can metastasize to the kidney. Other malignant tumor metastasis to the kidney is very unusual. Primary cervical cancer metastasis to adjacent pelvic organs and lymph nodes are well known followed by abdominal solid organs such as the liver and adrenal glands. However, reported primary cervical cancer metastasis to the kidney is extremely rare and mostly appeared as bilateral multiple renal masses. We report here on a rare case of unilateral single renal metastasis from primary cervical cancer after concur- rent chemoradiotherapy.

  17. Computed tomography angiogram. Accuracy in renal surgery

    International Nuclear Information System (INIS)

    Rabah, Danny M.; Al-Hathal, Naif; Al-Fuhaid, Turki; Raza, Sayed; Al-Yami, Fahad; Al-Taweel, Waleed; Alomar, Mohamed; Al-Nagshabandi, Nizar

    2009-01-01

    The objective of this study was to determine the sensitivity and specificity of computed tomography angiogram (CTA) in detecting number and location of renal arteries and veins as well as crossing vessels causing uretero-pelvic junction obstruction (UPJO), and to determine if this can be used in decision-making algorithms for treatment of UPJO. A prospective study was carried out in patients undergoing open, laparoscopic and robotic renal surgery from April 2005 until October 2006. All patients were imaged using CTA with 1.25 collimation of arterial and venous phases. Each multi-detector CTA was then read by one radiologist and his results were compared prospectively with the actual intra-operative findings. Overall, 118 patients were included. CTA had 93% sensitivity, 77% specificity and 90% overall accuracy for detecting a single renal artery, and 76% sensitivity, 92% specificity and 90% overall accuracy for detecting two or more renal arteries (Pearson χ 2 =0.001). There was 95% sensitivity, 84% specificity and 85% overall accuracy for detecting the number of renal veins. CTA had 100% overall accuracy in detecting early dividing renal artery (defined as less than 1.5 cm branching from origin), and 83.3% sensitivity, specificity and overall accuracy in detecting crossing vessels at UPJ. The percentage of surgeons stating CTA to be helpful as pre-operative diagnostic tool was 85%. Computed tomography angiogram is simple, quick and can provide an accurate pre-operative renal vascular anatomy in terms of number and location of renal vessels, early dividing renal arteries and crossing vessels at UPJ. (author)

  18. Effect of pelvic floor rehabilitation technique in preventing the postpartum pelvic floor dysfunction

    Directory of Open Access Journals (Sweden)

    Shi-Qiong Li

    2017-04-01

    Full Text Available Objective: To explore the effect of pelvic floor rehabilitation technique in preventing the postpartum pelvic floor dysfunction and on the sexual life quality. Methods: A total of 286 puerpera with pelvic floor dysfunction who were admitted in our hospital from May, 2014 to May, 2015 42 d after delivery were included in the study, and randomized into the treatment group and the control group with 143 cases in each group. After guidance, the puerpera in the control group were given pelvic floor muscle training by themselves at home. On this basis, the puerpera in the treatment group were treated by the pelvic floor rehabilitation apparatus. The puerpera in the two groups were treated for 4 weeks. The pelvic floor function before treatment, 6 months and 1 year after delivery was detected. The color Doppler ultrasound apparatus was used to detect BSD, PUVA, UVJ-M, and BND 3 months after delivery. Results: BND, PUVA-R, PUVA-S, and UVJ-M 3 months after delivery in the treatment groups were significantly lower than those in the control group, while BSD-S was significantly higher than that in the control group. The improvement of type I and II muscle fiber fatigue (%, POP-Q degree, AP indication point (cm, and vaginal dynamic pressure (cmH2O was significantly superior to that in the control group. The comparison of pelvic floor muscle strength classification before treatment between the two groups was not statistically significant. After treatment, the pelvic floor muscle in the two groups was significantly strengthened, and the proportion of V grade patients was significantly increased when compared with before treatment. Conclusions: The postpartum early pelvic floor rehabilitation technique can effectively enhance the pelvic floor function, and prevent the postpartum pelvic floor dysfunction, with an accurate efficacy; therefore, it deserves to be widely recommended in the clinic.

  19. Chronic pelvic pain.

    Science.gov (United States)

    Stein, Sharon L

    2013-12-01

    Chronic pelvic pain is pain lasting longer than 6 months and is estimated to occur in 15% of women. Causes of pelvic pain include disorders of gynecologic, urologic, gastroenterologic, and musculoskeletal systems. The multidisciplinary nature of chronic pelvic pain may complicate diagnosis and treatment. Treatments vary by cause but may include medicinal, neuroablative, and surgical treatments. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Pelvic Actinomycosis

    Directory of Open Access Journals (Sweden)

    Alejandra García-García

    2017-01-01

    Full Text Available Introduction. Actinomycosis is a chronic bacterial infection caused by Actinomyces, Gram-positive anaerobic bacteria. Its symptomatology imitates some malignant pelvic tumours, tuberculosis, or nocardiosis, causing abscesses and fistulas. Actinomycoses are opportunistic infections and require normal mucous barriers to be altered. No epidemiological studies have been conducted to determine prevalence or incidence of such infections. Objective. To analyse the clinical cases of pelvic actinomycosis reported worldwide, to update the information about the disease. Methods. A systematic review of worldwide pelvic actinomycosis cases between 1980 and 2014 was performed, utilising the PubMed, Scopus, and Google Scholar databases. The following information was analysed: year, country, type of study, number of cases, use of intrauterine device (IUD, final and initial diagnosis, and method of diagnosis. Results. 63 articles met the search criteria, of which 55 reported clinical cases and 8 reported cross-sectional studies. Conclusions. Pelvic actinomycosis is confusing to diagnose and should be considered in the differential diagnosis of pelvic chronic inflammatory lesions. It is commonly diagnosed through a histological report, obtained after a surgery subsequent to an erroneous initial diagnosis. A bacterial culture in anaerobic medium could be useful for the diagnosis but requires a controlled technique and should be performed using specialised equipment.

  1. Validation of the Pelvic Floor Distress Inventory-20 and the Pelvic Floor Impact Questionnaire-7 in Danish women with pelvic organ prolapse

    DEFF Research Database (Denmark)

    Due, Ulla; Brostrøm, Søren; Lose, Gunnar

    2013-01-01

    To translate the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) and to evaluate their psychometric properties in Danish women with symptomatic pelvic organ prolapse....

  2. Conservative management of small renal tumors

    International Nuclear Information System (INIS)

    Matsuzaki, Masato; Kawano, Yoshiyuki; Morikawa, Hirofumi; Shiga, Yoshiyuki; Murata, Hirokatsu; Komatsu, Hideki

    2007-01-01

    With the widespread use of imaging modalities, incidentally discovered small renal cell carcinomas have increased. Some patients, however, are too old or weak due to various diseases to undergo surgery and other patients occasionally refuse surgery. To investigate the natural history of small renal cell carcinoma, we retrospectively reviewed patients with small renal tumors suggestive of carcinoma. We retrospectively reviewed 15 patients with contrast-enhancing renal masses less than 4.0 cm in diameter who were observed without treatment. The mean follow-up period was 38 months (range, 8-91). The average patient age was 67 years (range, 44-87). The initial average tumor diameter was 2.2 cm (range, 1.0-3.9). The average growth rate was 0.06 cm per year (range, -0.09-0.28). Only 4 tumors grew obviously during the follow-up period. Three tumors were removed surgically by radical nephrectomy, and all tumors were pathologically diagnosed as renal cell carcinoma. None of the patients developed metastases during the follow-up period or after surgery. Two patients died of other causes. Nonsurgical watchful waiting may be an acceptable treatment option for elderly or severely comorbid patients; however, it is not known whether this conservative management can he applied to young or otherwise healthy patients. (author)

  3. Pelvic and acetabular fractures

    International Nuclear Information System (INIS)

    Mears, D.C.; Rubash, H.E.

    1986-01-01

    This treatise focuses primarily on the clinical aspects of diagnosis and treatments of pelvic and acetabular fractures. However, considerable attention is also paid to the radiographic diagnosis of trauma and postoperative effects. The book begins with a succinct review of pelvic and acetabular anatomy and pelvic biomechanics. It continues with a radiographic classification of pelvic injury, which will represent the major source of the book's interest for radiologists. The remainder of the book is concerned with clinical management of pelvic and acetabular trauma, including preoperative planning, surgical approaches, techniques of reduction, internal fixation, eternal fixation, post-operative care, and late problems. Even throughout this later portion of the book there are extensive illustrations, including plain radiographs, computed tomographic (CT) scans, reconstructed three-dimensional CT scans, and schematic diagrams of diverse pelvic and acetabular fractures and the elementary surgical techniques for their repair

  4. Classification of tubulo-papillary renal cortical tumours using estimates of nuclear volume

    DEFF Research Database (Denmark)

    Brooks, B; Sørensen, Flemming Brandt; Olsen, S

    1993-01-01

    The classification of renal cortical tumours is problematic, with no clear division of benign from malignant tumours. Unbiased stereological estimates of volume-weighted nuclear volume (nuclear vv) were obtained by point sampling of nuclear intercepts in a retrospective study of 36 variably sized...... = 241 microns 3) and 15 tumours classified as renal cell carcinomas with diameters > 3 cm, or aggressive histological pattern (average nuclear vv = 229 microns 3) (2p = 0.68). In this subtype of renal cortical tumours, estimates of nuclear vv do not support the historical convention of using a 3 cm...... tumour diameter as the dividing line between adenomas and carcinomas, but support the theory of a single group of tumours. As most of the truly incidental renal cortical tumours are less than 1 cm in diameter, this limit could be considered. Such small benign cortical nodules have never been reported...

  5. Retrograde intrarenal surgery versus percutaneous lithotripsy to treat renal stones 2-3 cm in diameter.

    Science.gov (United States)

    Zengin, Kursad; Tanik, Serhat; Karakoyunlu, Nihat; Sener, Nevzat Can; Albayrak, Sebahattin; Tuygun, Can; Bakirtas, Hasan; Imamoglu, M Abdurrahim; Gurdal, Mesut

    2015-01-01

    Retrograde intrarenal surgery (RIRS) performed using a flexible ureterorenoscope marked the beginning of a new era in urology. Today, even staghorn stones are successfully treated via RIRS. The recommended treatment for larger stones is percutaneous nephrolithotomy (PNL). However, the question of whether PNL or RIRS should be the first-line treatment option for larger stones remains controversial. In this study, we contribute to the debate by comparing the success and complication rates of PNL and RIRS that were used to treat renal pelvis stones 2-3 cm in diameter. The medical records of 154 patients (74 PNL, 80 RIRS) were retrospectively evaluated. PNL patients were placed in Group 1 and RIRS patients in Group 2. The complete stone-free rates were 95.5% in the PNL group and 80.6% in the RIRS group 1 month postoperatively (P = 0.061). The respective complication rates (evaluated using the Clavien system) were 13.5% and 8.8% (P = 0.520). RIRS affords a comparable success rate, causes fewer complications than PNL, and seems to be a promising alternative to PNL when larger stones are to be treated. Prospective randomized controlled trials are needed to confirm these findings.

  6. Bilateral Malrotation and a Congenital Pelvic Kidney with Varied Vasculature and Altered Hilar Anatomy

    OpenAIRE

    Singh, J.; Singh, N.; Kapoor, K.; Sharma, M.

    2015-01-01

    Variations of structure and position of the kidney along with variations of renal vessels are most frequently reported. Rotational variations form a rare entity that are not cited in most embryology textbooks. During an educational cadaveric dissection of a 42-year-old male, a complex picture of bilateral anatomical variants was encountered. Malrotation of both kidneys and a left lobulated ectopic kidney along with open hilum was observed. The left kidney showed a pelvic position in front of...

  7. Prevalence of myofascial chronic pelvic pain and the effectiveness of pelvic floor physical therapy.

    Science.gov (United States)

    Bedaiwy, Mohamed A; Patterson, Betsy; Mahajan, Sangeeta

    2013-01-01

    To determine the prevalence of myofascial pain and the outcome of transvaginal pelvic floor physical therapy for the treatment of chronic pelvic pain caused by myofascial pelvic pain in a tertiary care facility. A retrospective chart review was performed on all women who presented to our facility between January 2005 and December 2007. Those diagnosed with myofascial pelvic pain and referred for transvaginal pelvic floor physical therapy over this 3-year period were evaluated. Participants with an initial pain score of > or = 4, myofascial pelvic pain on examination, and who attended 2 or more physician visits were included in the analysis. Patient physical examination findings, symptoms, and verbal pain ratings were reviewed. In all, 146 (13.2%) of 1,106 initially screened patients were diagnosed with myofascial pain. Seventy-five (51%) of the 146 patients who were referred for physical therapy were included, and 75% had an initial pain score of > or = 7. Pain scores significantly improved proportional to the number of physical therapy visits completed, with 63% of patients reporting significant pain improvement. Transvaginal physical therapy is an effective treatment for chronic pelvic pain resulting from myofascial pelvic pain.

  8. Renal transitional cell carcinoma: a sonographic and radiological correlation

    International Nuclear Information System (INIS)

    Prando, A.; Marins, J.L.C.; Prando, D.; Pereira, R.M.

    1984-01-01

    A sonographic study was performed on nine patients with renal transitional cell carcinoma and the findings correlated with those of excretory urography, retrograde and/or antegrade pyelography. In six patients the correct diagnosis was considered mainly by the radiological features. In the remaining three patients, due to its unusual manifestations, this diagnosis was accomplished only by sonography. A small echogenic mass at the peryphery of a chronic hydronephrotic kidney, a huge complex mass due to a multiple arborescent papilary tumor and a demonstration of a mass in a presumptive renal pelvic inflammatory disease, respectively, represented these uncommon aspects. The spectrum of features of this entity and the related differential diagnosis are also presented. (Author) [pt

  9. Percutaneous thermal ablation of renal neoplasms

    International Nuclear Information System (INIS)

    Tacke, J.; Mahnken, A.H.; Guenther, R.W.

    2005-01-01

    Due to modern examination techniques such as multidetector computed tomography and high-field magnetic resonance imaging, the detection rate of renal neoplasms is continually increasing. Even though tumors exceeding 4 cm in diameter rarely metastasize, all renal lesions that are possible neoplasms should be treated. Traditional treatment techniques include radical nephrectomy or nephron-sparing resection, which are increasingly performed laparoscopically. Modern thermal ablation techniques such as hyperthermal techniques like radiofrequency ablation RFA, laser induced thermal ablation LITT, focused ultrasound FUS and microwave therapy MW, as well as hypothermal techniques (cryotherapy) may be a useful treatment option for patients who are unfit for or refuse surgical resection. Cryotherapy is the oldest and best known thermal ablation technique and can be performed laparoscopically or percutaneously. Since subzero temperatures have no antistyptic effect, additional maneuvers must be performed to control bleeding. Percutaneous cryotherapy of renal tumors is a new and interesting method, but experience with it is still limited. Radiofrequency ablation is the most frequently used method. Modern probe design allows volumes between 2 and 5 cm in diameter to be ablated. Due to hyperthermal tract ablation, the procedure is deemed to be safe and has a low complication rate. Although there are no randomized comparative studies to open resection, the preliminary results for renal RFA are promising and show RFA to be superior to other thermal ablation techniques. Clinical success rates are over 90% for both, cryo- and radiofrequency ablation. Whereas laser induced thermal therapy is established in hepatic ablation, experience is minimal with respect to renal application. For lesions of more than 2 cm in diameter, additional cooling catheters are required. MR thermometry offers temperature control during ablation. Microwave ablation is characterized by small ablation volumes

  10. Evaluation of the normal thoracic and abdominal aorta diameters by computerized tomography

    International Nuclear Information System (INIS)

    Lucarelli, Claudio Luiz

    1995-01-01

    The study was undertaken to evaluate, through computerized tomography, the diameters of the normal thoracic and abdominal aorta, as well as they are connected to gender, age and body surface area; and the ratio between measurements obtained at the ascending and descending limbs of the thoracic aorta, and between the abdominal aortic diameters. For that reason, we measured the widest anteroposterior diameters of the thoracic aortas at the levels of the arch, the root, the pulmonary artery, and the thoracic-abdominal transition, as well as the level of the emergence of the superior mesenteric artery, of the renal hila and just cephalad to the bifurcation of the abdominal aortas of 350 patients without cardiovascular diseases who had undergone computerized tomography of the thorax and/or abdomen for any other reasons. Observation and statistic analyses led us to conclude that: 1) both the thoracic and abdominal aortic diameters are reduced from their proximal to their distal portions; 2) the body surface influences the size of the aorta, although only extreme variations alter the vessel's caliber; 3) vessel diameter was observed to gradually increase with age; 4) men were found to have larger diameters than age matched women; 5) the ratio between the ascending and descending aortic diameters varies according to gender and age; 6) the relations between abdominal aortic diameters measured at the level of renal hila and cephalad to the bifurcation are independent from gender and age. But the relation between those measured at the level of the superior mesenteric artery and cephalad to the bifurcation are linked to gender, but not to age. (author)

  11. Chronic female pelvic pain

    Directory of Open Access Journals (Sweden)

    Gaurab Maitra

    2013-01-01

    Full Text Available Chronic pelvic pain (CPP is defined as nonmalignant pain perceived in the structures related to the pelvis that has been present for more than 6 months or a non acute pain mechanism of shorter duration. Pain in the pelvic region can arise from musculoskeletal, gynaecological, urologic, gastrointestinal and or neurologic conditions. Key gynaecological conditions that contribute to CPP include pelvic inflammatory disease (PID, endometriosis, adnexa pathologies (ovarian cysts, ovarian remnant syndrome, uterine pathologies (leiomyoma, adenomyosis and pelvic girdle pain associated with pregnancy. Several major and minor sexually transmitted diseases (STD can cause pelvic and vulvar pain. A common painful condition of the urinary system is Interstitial cystitis(IC. A second urologic condition that can lead to development of CPP is urethral syndrome. Irritable bowel syndrome (IBS is associated with dysmenorrhoea in 60% of cases. Other bowel conditions contributing to pelvic pain include diverticular disease,Crohn′s disease ulcerative colitis and chronic appendicitis. Musculoskeletal pathologies that can cause pelvic pain include sacroiliac joint (SIJ dysfunction, symphysis pubis and sacro-coccygeal joint dysfunction, coccyx injury or malposition and neuropathic structures in the lower thoracic, lumbar and sacral plexus. Prolonged pelvic girdle pain, lasting more than 6 months postpartum is estimated in 3% to 30% of women. Nerve irritation or entrapment as a cause of pelvic pain can be related to injury of the upper lumbar segments giving rise to irritation of the sensory nerves to the ventral trunk or from direct trauma from abdominal incisions or retractors used during abdominal surgical procedures. Afflictions of the iliohypogastric, ilioinguinal, genitofemoral, pudendal and obturator nerves are of greatest concern in patients with pelvic pain. Patient education about the disease and treatment involved is paramount. A knowledge of the differential

  12. Didelphic uterus with imperforate unilateral vagina and ipsilateral renal agenesis: Magnetic resonance

    International Nuclear Information System (INIS)

    Rodrigo, R.M.; Saez, F.; Astigarraga, E.; Rodriguez, O.

    1993-01-01

    We present two cases of didelphic uterus with the clinical appearance of a pelvic mass produced by the hematometra-hematocolpos retained by an imperforate unilateral hemivagina. In both cases, this anomaly was accompanied by ipsilateral renal agenesis. We basically review the diagnosis of this disorder, focusing on magnetic resonance as the technique of choice. (Author) 10 refs

  13. Normal renal arterial anatomy assessed by multidetector CT angiography: are there differences between men and women?

    Science.gov (United States)

    Turba, Ulku Cenk; Uflacker, Renan; Bozlar, Ugur; Hagspiel, Klaus D

    2009-03-01

    The purpose of this study was to determine renal arterial anatomy and gender differences in adults without renovascular disease using multidetector computed tomography angiography (MDCTA). MDCTA datasets of 399 patients were retrospectively reviewed. Measurements of the aortorenal diameters, the angulation of the renal ostia and pedicles as well as the distance between the origins of the renal arteries were measured. Differences in measurements between genders were tested for statistical significance using analysis of variance (ANOVA) and Pearson's Chi-Square tests. A total of 798 renal arteries were available for analysis in 207 female (mean age = 52.91 years) and 192 male patients (mean age = 53.04 years). Female patients were found to have smaller aortae (at the level of the right renal ostium) and bilateral renal arteries than males (mean aortic diameter M/F = 18.33/15.89 mm, mean right renal artery ostial diameter M/F = 5.06/4.59 mm, mean left ostial renal diameter M/F = 5.14/4.66 mm) (p renal ostia level in relation to the vertebrae and the majority of renal arteries originated at the L1 and L2 levels. The longitudinal distance between right and left renal artery ostia ranged from 0 to 32 mm (mean = 4,6 mm, median = 5mm). The mean anteroposterior orientation of the right renal ostia was M/F = 29.45 degrees/28.20 degrees , and M/F = -7.96 degrees/-11.14 degrees for left renal artery ostia. The mean anteroposterior orientation of the right renal pedicle was M/F = 41.37 degrees/44.34 degrees and M/F = 42.31 degrees/43.95 degrees for the left pedicle. There are some differences in normal renal arterial anatomy between genders. Normal renal arterial information is useful not only for planning and performing of endovascular and laparoscopic urologic procedures, but also for medical device development. Copyright 2009 Wiley-Liss, Inc.

  14. Correction of Pelvic Tilt and Pelvic Rotation in Cup Measurement after THA - An Experimental Study.

    Science.gov (United States)

    Schwarz, Timo Julian; Weber, Markus; Dornia, Christian; Worlicek, Michael; Renkawitz, Tobias; Grifka, Joachim; Craiovan, Benjamin

    2017-09-01

    Purpose  Accurate assessment of cup orientation on postoperative pelvic radiographs is essential for evaluating outcome after THA. Here, we present a novel method for correcting measurement inaccuracies due to pelvic tilt and rotation. Method  In an experimental setting, a cup was implanted into a dummy pelvis, and its final position was verified via CT. To show the effect of pelvic tilt and rotation on cup position, the dummy was fixed to a rack to achieve a tilt between + 15° anterior and -15° posterior and 0° to 20° rotation to the contralateral side. According to Murray's definitions of anteversion and inclination, we created a novel corrective procedure to measure cup position in the pelvic reference frame (anterior pelvic plane) to compensate measurement errors due to pelvic tilt and rotation. Results  The cup anteversion measured on CT was 23.3°; on AP pelvic radiographs, however, variations in pelvic tilt (± 15°) resulted in anteversion angles between 11.0° and 36.2° (mean error 8.3°± 3.9°). The cup inclination was 34.1° on CT and ranged between 31.0° and 38.7° (m. e. 2.3°± 1.5°) on radiographs. Pelvic rotation between 0° and 20° showed high variation in radiographic anteversion (21.2°-31.2°, m. e. 6.0°± 3.1°) and inclination (34.1°-27.2°, m. e. 3.4°± 2.5°). Our novel correction algorithm for pelvic tilt reduced the mean error in anteversion measurements to 0.6°± 0.2° and in inclination measurements to 0.7° (SD± 0.2). Similarly, the mean error due to pelvic rotation was reduced to 0.4°± 0.4° for anteversion and to 1.3°± 0.8 for inclination. Conclusion  Pelvic tilt and pelvic rotation may lead to misinterpretation of cup position on anteroposterior pelvic radiographs. Mathematical correction concepts have the potential to significantly reduce these errors, and could be implemented in future radiological software tools. Key Points   · Pelvic tilt and rotation influence cup

  15. Assessment of a semiautomated pelvic floor measurement model for evaluating pelvic organ prolapse on MRI.

    Science.gov (United States)

    Onal, S; Lai-Yuen, S; Bao, P; Weitzenfeld, A; Greene, K; Kedar, R; Hart, S

    2014-06-01

    The objective of this study was to assess the performance of a semiautomated pelvic floor measurement algorithmic model on dynamic magnetic resonance imaging (MRI) images compared with manual pelvic floor measurements for pelvic organ prolapse (POP) evaluation. We examined 15 MRIs along the midsagittal view. Five reference points used for pelvic floor measurements were identified both manually and using our semiautomated measurement model. The two processes were compared in terms of accuracy and precision. The semiautomated pelvic floor measurement model provided highly consistent and accurate locations for all reference points on MRI. Results also showed that the model can identify the reference points faster than the manual-point identification process. The semiautomated pelvic floor measurement model can be used to facilitate and improve the process of pelvic floor measurements on MRI. This will enable high throughput analysis of MRI data to improve the correlation analysis with clinical outcomes and potentially improve POP assessment.

  16. Pelvic exenteration for locally advanced primary and recurrent pelvic neoplasm: a series of 54 resectable cases

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    Sergio Renato Pais Costa

    2008-09-01

    Full Text Available Objective: To report on a series of 54 patients with pelvic neoplasms submitted to curative pelvic exenteration at a tertiary hospital and describe the results (morbidity, mortality, and long-term survival. Methods: The complete data of 54 patients submitted to pelvic exenteration between 1999 and 2007 were evaluated. Sixteen men and 38 women with a mean age of 65 years and median age of 66 years (36 to 77 were studied. Surgical procedures included total pelvic exenteration (n = 26, anterior pelvic exenteration(n = 5, and posterior pelvic exenteration (n = 23. Rresults: The mean operative time was 402 minutes (280 to 585. The average volume of intraoperative bleeding was 2,013 ml (300 to 5,800. Postoperative mortality was 5% (n = 3. The overall morbidity rate was 46%(n = 25. Histological evaluation demonstrated that 47 resections were R0 (87% while seven were R1 (13%. The overall survival rate in five years was 23.5% (n = 12. Cconclusions: Despite its aggressive nature and high morbidity, pelvic exenteration is still justified in locally advanced pelvic neoplasms or even in isolated pelvic recurrence, since it affords a greater long-term control of the neoplasm.

  17. A Case of Squamous Cell Carcinoma of the Renal Pelvis in association with Schistosoma hematobium

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    Muhammad A. A. Khan

    2012-01-01

    Full Text Available A 72-year-old man presented with painless frank haematuria. Investigations included intravenous urogram and abdominal/pelvic CT which revealed a marked focal thickening of the wall of the inferior aspect of the left renal pelvis extending into the lower pole calyx and into the pelviureteric junction resulting in left hydronephrosis. Urine cytology demonstrated clusters of malignant keratinised squamous cells and schistosome ova. He underwent left laparoscopic radical nephroureterectomy and histology revealed moderately differentiated keratinising squamous cell carcinoma in the renal pelvis.

  18. [Functional aspects of pelvic floor surgery].

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    Wagenlehner, F M E; Gunnemann, A; Liedl, B; Weidner, W

    2009-11-01

    Pelvic floor dysfunctions are frequently seen in females. The human pelvic floor is a complex structure and heavily stressed throughout female life. Recent findings in the functional anatomy of the pelvic floor have led to a much better understand-ing, on the basis of which enormous improvements in the therapeutic options have arisen. The pelvic floor activity is regulated by three main muscular forces that are responsible for vaginal tension and suspension of the pelvic floor -organs, bladder and rectum. For different reasons laxity in the vagina or its supporting ligaments as a result of altered connective tissue can distort this functional anatomy. A variety of symptoms can derive from these pelvic floor dysfunctions, such as urinary urge and stress incontinence, abnormal bladder emptying, faecal incontinence, obstructive bowel disease syndrome and pelvic pain. Pelvic floor reconstruction is nowadays driven by the concept that in the case of pelvic floor symptoms restoration of the anatomy will translate into restoration of the physiology and ultimately improve the patients' symptoms. The exact surgical reconstruction of the anatomy is there-fore almost exclusively focused on the restoration of the lax pelvic floor ligaments. An exact identification of the anatomic lesions preoperatively is eminently necessary, to allow for an exact anatomic reconstruction with respect to the muscular forces of the pelvic floor. Georg Thieme Verlag Stuttgart * New York.

  19. Polyuria due to vasopressin V2 receptor antagonism is not associated with increased ureter diameter in ADPKD patients.

    Science.gov (United States)

    Casteleijn, Niek F; Messchendorp, A Lianne; Bae, Kyong T; Higashihara, Eiji; Kappert, Peter; Torres, Vicente; Meijer, Esther; Leliveld, Anna M

    2017-06-01

    Tolvaptan, a vasopressin V2 receptor antagonist, has been shown to reduce the rates of growth in total kidney volume (TKV) and renal function loss in ADPKD patients, but also leads to polyuria because of its aquaretic effect. Prolonged polyuria can result in ureter dilatation with consequently renal function loss. Therefore, we aimed to investigate the effect of tolvaptan-induced polyuria on ureter diameter in ADPKD patients. 70 ADPKD patients were included (51 were randomized to tolvaptan and 19 to placebo). At baseline and after 3 years of treatment renal function was measured (mGFR) and MRI was performed to measure TKV and ureter diameter at the levels of renal pelvis and fifth lumbar vertebral body (L5). In these patients [65.7 % male, age 41 ± 9 years, mGFR 74 ± 27 mL/min/1.73 m 2 and TKV 1.92 (1.27-2.67) L], no differences were found between tolvaptan and placebo-treated patients in 24-h urine volume at baseline (2.5 vs. 2.5 L, p = 0.8), nor in ureter diameter at renal pelvis and L5 (4.0 vs. 4.2 mm, p = 0.4 and 3.0 vs. 3.1 mm, p = 0.3). After 3 years of treatment 24-h urine volume was higher in tolvaptan-treated patients when compared to placebo (4.7 vs. 2.3 L, p polyuria did not lead to an increase in ureter diameter, suggesting that tolvaptan is a safe therapy from a urological point of view.

  20. An unusual localization of seven months delayed pelvic lymphocele following radical retropubic prostatectomy: Case report and literature review

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    Berk Hazır

    Full Text Available Introduction: A pelvic lymphocele is a collection of lymphatic fluid that develops after extensive lymphadenectomies in surgeries such as urological malignancies or renal transplantation. Pelvic lymphoceles may cause complications such as fever, abdominal pain, leg swelling, genital swelling and flank pain. This report summarizes the management of a pelvic lymphocele after open radical retropubic prostatectomy with bilateral lymphadenectomy. Presentation of case: Herein, we present a case in which a pelvic lymphocele developed seven months post-radical open retropubic prostatectomy and through this patient we discussed the lymphocele following radical prostatectomy. The pelvic lymphocele occurred along the sciatic nerve from the sciatica foramen to the intergluteal muscles. The patient was treated with three drainage catheters. This localization is an atypical and unusual for lymphocele after radical retropubic prostatectomy. Discussion: Lymphocele formation that leads to major complications after radical prostatectomy is rare. Lymphocele formation is most commonly seen in the early postoperative period, but it should be considered in patients with fever, abdominal pain or leg swelling during the late postoperative period. Lymphocele formation was the most common cause of hospital readmission after radical prostatectomy. Conclusion: Lymphocele formation can be seen in atypical regions and can lead to unexpected complications after radical prostatectomy. Therefore, it should be brought to mind when complaints such as fever and lower extremity swelling occurred in patients underwent extensive lymph node dissection. Surgical treatment options are available, but percutaneous interventions can also be used. Keywords: Radical retropubic prostatectomy, Pelvic lymphocele, Percutaneous drainage, Prostate cancer, Case-report

  1. Pelvic denervation procedures for dysmenorrhea.

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    Ramirez, Christina; Donnellan, Nicole

    2017-08-01

    Chronic pelvic pain and dysmenorrhea are common conditions affecting reproductive-age women. Surgical pelvic denervation procedures may be a treatment option for women with midline dysmenorrhea, in which medical management is declined by the patient, ineffective at managing symptoms, or medically contraindicated. This review describes the surgical techniques and complications associated with pelvic denervation procedures as well as the current evidence for these procedures in women with primary dysmenorrhea and dysmenorrhea secondary to endometriosis. Presacral neurectomy is the preferred pelvic denervation procedure in patients with primary dysmenorrhea and midline chronic pelvic pain associated with endometriosis. In patients with endometriosis presacral neurectomy is a useful adjunct to excision or ablation of all endometrial lesions to improve postoperative pain relief. There is no additional patient benefit of performing combined presacral neurectomy and uterine nerve ablation procedures. Pelvic denervation procedures can be performed safely and quickly with a low risk of complication if the surgeon is knowledgeable and skilled in operating in the presacral space. Patients should be adequately counseled on expected success rates and potential complications associated with pelvic denervation procedures.

  2. [Anatomy character of renal artery and treatment of living-donor renal transplantation].

    Science.gov (United States)

    Zhang, Lei; Fei, Ji-guang; Chen, Li-zhong; Wang, Chang-xi; Deng, Su-xiong; Qiu, Jiang; Li, Jun; Chen, Guo-dong; Huang, Gang

    2009-12-15

    To study the anatomy characters of renal artery and the treatment of multiple arteries in living donor renal grafts. Records of 142 living donors were analyzed in our center. We analyzed the anatomic structure of renal arteries by DSA and CTA pre-transplantation. Thirty-one kidneys with multiple arteries were transplanted after reconstruction. Then clinical effects were compared between multiple-renal-arteries group (n=31) and single-renal-artery group (n=111). The incidence of multiple renal artery was 30.99%, and there was no difference between both sides (left kidney 22.54%, right kidney 22.13%). If the multiple artery occurred in left or right kidney, the incidence of the multiple artery occurred in the other side was 56.25% and 60.00%, respectively. The diameter of left main renal artery was more magnanimous (P=0.001) and the first branch was more closed to abdominal aorta (P=0.004). Operation time and warm/cool ischemia time were longer in the multiple-renal-arteries group. However, estimated blood loss, delayed graft function, acute rejection and flow rate of arcuate artery were similar in both groups, the same as serum creatinine and serum creatinine clearance rate on day 7, 1 month and 3 month post-operation. It was shown by repeated measures ANOVA that graft with multiple arteries didn't affect the tendency of renal function at early time post-operation. Comprehending the character of renal artery and accurate treatment of multiple artery anastomosis are critical for the effect of the living kidney transplantation.

  3. Retrograde Intrarenal Surgery versus Percutaneous Lithotripsy to Treat Renal Stones 2-3 cm in Diameter

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    Kursad Zengin

    2015-01-01

    Full Text Available Objective. Retrograde intrarenal surgery (RIRS performed using a flexible ureterorenoscope marked the beginning of a new era in urology. Today, even staghorn stones are successfully treated via RIRS. The recommended treatment for larger stones is percutaneous nephrolithotomy (PNL. However, the question of whether PNL or RIRS should be the first-line treatment option for larger stones remains controversial. In this study, we contribute to the debate by comparing the success and complication rates of PNL and RIRS that were used to treat renal pelvis stones 2-3 cm in diameter. Materials and Methods. The medical records of 154 patients (74 PNL, 80 RIRS were retrospectively evaluated. PNL patients were placed in Group 1 and RIRS patients in Group 2. Results. The complete stone-free rates were 95.5% in the PNL group and 80.6% in the RIRS group 1 month postoperatively (P=0.061. The respective complication rates (evaluated using the Clavien system were 13.5% and 8.8% (P=0.520. Conclusions. RIRS affords a comparable success rate, causes fewer complications than PNL, and seems to be a promising alternative to PNL when larger stones are to be treated. Prospective randomized controlled trials are needed to confirm these findings.

  4. Clinical Significance of Renal Pelvic Dilatation less than 10 mm in Neonates: Correlation with Urinary Tract Infection and Vesicoureteral Reflux

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    Lee, Woong Hee; Kim, Young Tong; Jo, Sung Sik; Kim, Sang Won; Shin, Hyung Cheol; Kim, Il Young [Cheonan Hospital, Soonchunhyang University, Cheonan (Korea, Republic of)

    2009-12-15

    We wanted to evaluate the correlation of mild renal pelvic dilatation (RPD) that is observed to be less than 10 mm on ultrasound (US) with urinary tract infection (UTI) and vesicoureteral reflux (VUR) in neonates. We reviewed 137 kidneys of 107 neonates who had RPD less than 10 mm on US. All the kidneys were divided into two groups: Group I (RPD <= 5.0 mm) and Group II (RPD > 5.0 mm), and we statistically analyzed the RPD change according to UTI and VUR. Seven neonates had VUR (5.1%), and there was no statistical significance between Group I (6 neonates, 5.6%) and Group II (1 neonate, 3.3%). Thirty seven cases (27%) had UTI and there was no statistical significance between Group I (30 cases, 28.0%) and Group II (7 cases, 23.3%). The RPD did not change in 81.8% of the cases, it increased in 4.4% of the cases and it decreased in 13.9% of the cases on follow up US. The incidence of VUR and UTI were not different according to the change of RPD. There were no statistical differences between the changes of RPD and the incidences of UTI and VUR in neonates with mild RPD less than 10 mm. Most of RPD did not change on the follow up US

  5. Clinical Significance of Renal Pelvic Dilatation less than 10 mm in Neonates: Correlation with Urinary Tract Infection and Vesicoureteral Reflux

    International Nuclear Information System (INIS)

    Lee, Woong Hee; Kim, Young Tong; Jo, Sung Sik; Kim, Sang Won; Shin, Hyung Cheol; Kim, Il Young

    2009-01-01

    We wanted to evaluate the correlation of mild renal pelvic dilatation (RPD) that is observed to be less than 10 mm on ultrasound (US) with urinary tract infection (UTI) and vesicoureteral reflux (VUR) in neonates. We reviewed 137 kidneys of 107 neonates who had RPD less than 10 mm on US. All the kidneys were divided into two groups: Group I (RPD ≤ 5.0 mm) and Group II (RPD > 5.0 mm), and we statistically analyzed the RPD change according to UTI and VUR. Seven neonates had VUR (5.1%), and there was no statistical significance between Group I (6 neonates, 5.6%) and Group II (1 neonate, 3.3%). Thirty seven cases (27%) had UTI and there was no statistical significance between Group I (30 cases, 28.0%) and Group II (7 cases, 23.3%). The RPD did not change in 81.8% of the cases, it increased in 4.4% of the cases and it decreased in 13.9% of the cases on follow up US. The incidence of VUR and UTI were not different according to the change of RPD. There were no statistical differences between the changes of RPD and the incidences of UTI and VUR in neonates with mild RPD less than 10 mm. Most of RPD did not change on the follow up US

  6. Tuberculosis of the genitourinary system-Urinary tract tuberculosis: Renal tuberculosis-Part II

    International Nuclear Information System (INIS)

    Merchant, Suleman; Bharati, Alpa; Merchant, Neesha

    2013-01-01

    This article reviews the computed tomography and magnetic resonance imaging (MRI) features of renal tuberculosis (TB), including TB in transplant recipients and immunocompromised patients. Multi detector computed tomography (MDCT) forms the mainstay of cross-sectional imaging in renal TB. It can easily identify calcification, renal scars, mass lesions, and urothelial thickening. The combination of uneven caliectasis, with urothelial thickening and lack of pelvic dilatation, can also be demonstrated on MDCT. MRI is a sensitive modality for demonstration of features of renal TB, including tissue edema, asymmetric perinephric fat stranding, and thickening of Gerota's fascia, all of which may be clues to focal pyelonephritis of tuberculous origin. Diffusion-weighted MR imaging with apparent diffusion coefficient (ADC) values may help in differentiating hydronephrosis from pyonephrosis. ADC values also have the potential to serve as a sensitive non-invasive biomarker of renal fibrosis. Immunocompromised patients are at increased risk of renal TB. In transplant patients, renal TB, including tuberculous interstitial nephritis, is an important cause of graft dysfunction. Renal TB in patients with HIV more often shows greater parenchymal affection, with poorly formed granulomas and relatively less frequent findings of caseation and stenosis. Atypical mycobacterial infections are also more common in immunocompromised patients

  7. Pelvic floor physical therapy in urogynecologic disorders.

    Science.gov (United States)

    Kotarinos, Rhonda K

    2003-08-01

    Physical therapists are uniquely qualified to treat pelvic floor dysfunction with conservative management techniques. Techniques associated with incontinence and support functions of the pelvic floor include bladder training and pelvic floor rehabilitation: pelvic floor exercises, biofeedback therapy, and pelvic floor electrical stimulation. Pain associated with mechanical pelvic floor dysfunction can be treated by physical therapists utilizing various manual techniques and modalities. Research documents that conservative management is effective in treating many conditions associated with pelvic floor dysfunction. Research should be conducted to determine if addressing diastasis recti and contracture of the pelvic floor musculature should be a component of the standard physical therapy protocol.

  8. Awareness and timing of pelvic floor muscle contraction, pelvic exercises and rehabilitation of pelvic floor in lifelong premature ejaculation: 5 years experience

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    Giuseppe La Pera

    2014-06-01

    Full Text Available Objectives: To assess the cure rate of patients with premature ejaculation who underwent a treatment involving: 1 awareness of the pelvic floor muscles 2 learning the timing of execution and maintenance of contraction of the pelvic floor muscles during the sensation of the pre-orgasmic phase 3 pelvic floor rehabilitation (bio feed back, pelvic exercises and electrostimulation. Materials and methods: We recruited 78 patients with lifelong premature ejaculation who completed the training. The patients were informed of the role of the pelvic floor. They were taught to carry out the execution and maintenance of contraction of the pelvic floor muscles during the sensation of the pre-orgasmic phase to control the ejaculatory reflex. In order to improve the awareness, the tone and the endurance of the pelvic floor muscles, patients were treated with the rehabilitation of pelvic floor (RPF consisting mainly in biofeedback, pelvic exercises and in some cases also in electro-stimulation (ES. The training was carried out for a period of about 2-6 months with an average of 2-5 visits per cycle. Results: 54% of patients who completed the training were cured of premature ejaculation and learned over time to be able to postpone the ejaculation reflex. In a subgroup of 26 patients was also measured the IELT which on the average increased from < 2 minutes to >10 minutes. The best results occurred mainly in patients aged less than 35 where the cure rate was 65%. There were no side effects. Conclusions: In this study, approximately half of patients with premature ejaculation were cured after applying the above treatment.This therapy, necessitates a fairly long period of time (2-6 months and a great commitment on the part of the patient, nevertheless it can be a valid and effective treatment for patients with premature ejaculation. This treatment makes the patient independent in that he is not bound to specific times for taking medication. Furthermore there are no

  9. Anorectal and Pelvic Pain.

    Science.gov (United States)

    Bharucha, Adil E; Lee, Tae Hee

    2016-10-01

    Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacological, behavioral, and physical therapy. Opioids should be avoided, and surgical treatment has a limited role, primarily in refractory interstitial cystitis. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  10. Effect of apricot seeds on renal structure of rabbits

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    Anna Kolesárová

    2017-01-01

    Full Text Available Amygdalin is the major cyanogenic glycoside present in apricot seeds and is degraded to cyanide by chewing or grinding. The animal data available did not provide a suitable basis for acute human health hazard. The apricot seeds are potentially useful in human nutrition and for treatment of several diseases especially cancer. The present study demonstrates the potential effect of short-term oral application of apricot seeds on renal structure of rabbit as a biological model. Meat line P91 Californian rabbits from the experimental farm of the Animal Production Research Centre Nitra (Slovak Republic were used in the experiments. The animals were randomly divided into the three groups (C-control, P1, P2 - experimental groups leading to 8 rabbits in each group. The control group received no apricot seeds while the experimental groups P1 and P2 received a daily dose 60 and 300 mg.kg-1 b.w. of crushed apricot seeds mixed with feed during 28 days, respectively. After 28 days all animals were slaughtered and kidney tissue was processed by standard histopathological techniques. Tissue sections were observed under an optical microscope with camera Olympus CX41 (Olympus, Japan at a magnification of 10 x 0.40. The basic morphometric criteria of the preparations were quantified using image program MeasurIT (Olympus, Japan. From each sample (n = 24 three histological sections with five different fields of view in each section were analysed and followed parameters were analysed: diameter of renal corpuscles (RC, diameter of glomeruli (G, diameter of tubules (T and the height of epithelial tubules (E. In our study, we observed a slight increase in the most frequent occurrence parenchyma dystrophy experimental animals. These changes were more pronounced in the experimental group (P2 rabbits received a daily dose of 300 mg.kg-1 of body weight of apricot seeds. Most often, we have found enlarged glomeruli filling the entire space of the capsule, and also glomerular

  11. Analysis of radiological features relative to pathology in pelvic chondrosarcoma

    International Nuclear Information System (INIS)

    Zhou Jianjun; Ding Jianguo; Wang Jianhua; Zeng Mengsu; Yan Fuhua; Zhou Kangrong; Ji Yuan

    2008-01-01

    Objective: To Explore the imaging features relative to pathology of pelvic chondrosarcoma and to evaluate the clinical value. Methods: All 12 cases patients with primary pelvic chondrosarcoma confirmed by pathological examination underwent radiography, spiral CT plain scanning, MR SE-T 1 WI, FSE-T 2 WI and SE-T 1 WI enhancement scanning before operation. The imaging data was reviewed and analyzed retrospectively to compare with surgical and pathological results. Results: Eleven conventional chondrosarcoma and one dedifferentiated chondrosarcoma were located in different parts of pelvis. The diameters of the tumors ranged from 4.7 to 17.0 cm with one case less than 5.0 cm, 6 cases being 5.0-10.0 cm and 5 cases more than 10.0 cm. The CT value of 5 eases was identical or inferior to muscle with mild to moderate 'ring-and-arc' mineralization and soft mass. MR imaging depict the high water content of these lesions as very high signal intensity was detected on T 2 WI. Six cases showed typical 'ting- and-arc' fibrous tissue which enhanced persistently. Aggressive features of deep endosteal scalloping and soft-tissue extension was also found in these cases. Conclusions: Radiographic findings can suggest the diagnosis of pelvic chondrosarcoma when there is typical 'ring-and-arc' fibrous tissue, mineralization, aggressive features of deep endosteal scalloping and large soft-tissue extension. MR imaging reflect directly this pathologic structure, superior to that of CT and radiography. CT is optimal to detect the matrix mineralization, particularly when it is subtle or when the lesion is located in anatomically complex pelvic areas. (authors)

  12. Rare calcium oxalate monohydrate calculus attached to the wall of the renal pelvis.

    Science.gov (United States)

    Grases, Felix; Costa-Bauza, Antonia; Prieto, Rafael M; Saus, Carlos; Servera, Antonio; García-Miralles, Reyes; Benejam, Joan

    2011-04-01

    Most renal calculi can be classified using well-established criteria in a manner that reflects both composition and fine structure under specific pathophysiological conditions. However, when a large patient population is considered, rare renal calculi invariably appear, some of which have never been classified; careful study is required to establish stone etiology in such cases. The patient in the present case report formed two types of calculi. One was attached on the wall of the renal pelvis near the ureter and part of the calculus was embedded inside pelvic renal tissue. The calculus developed on an ossified calcification located in the pelvis tissue. Current knowledge on the development of calcification in soft tissues suggests a pre-existing injury as an inducer of its development. A mechanism of calculus formation is proposed. The second stone was a typical jack-stone calculus. © 2011 The Japanese Urological Association.

  13. A comparison between stabilization exercises and pelvic floor muscle training in women with pelvic organ prolapse

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    Nuriye Özengin

    2015-03-01

    Full Text Available Objective: This study aimed to compare the effectiveness of stabilization exercises and pelvic floor muscle training in women with stage 1 and 2 pelvic organ prolapse. Materials and Methods: In a total 38 women with pelvic organ prolapse whose average age was 45.60 years, pelvic floor muscles were evaluated with electromyography, and prolapse with pelvic organ prolapse quantification system, and the quality of life with prolapse quality of life questionnaire. Afterwards, the subjects were divided into two groups; stabilization exercise group (n=19 and pelvic floor muscle training group (n=19. Stabilization exercise group were given training for 8 weeks, 3 times a week. Pelvic floor muscle training group were given eight-week home exercises. Each group was assessed before training and after eight weeks. Results: An increase was found in the pelvic muscle activation response in the 2 groups (p≤0.05. There was no difference in EMG activity values between the groups (p>0.05. A difference was found in the values Aa, Ba and C in subjects of each group (p≤0.05, and the TVL, Ap, Bp and D values of subjects in pelvic floor muscle training group (p≤0.05 in the before and after pelvic organ prolapse quantification system assessment, however, no difference was found between the groups (p≤0.05. A positive difference was found in the effect of prolapse sub parameter in each of the two groups, and in general health perception sub parameter in subjects of stabilization exercise group (p<0.05 in the prolapse quality of life questionnaire. Conclusions: It was concluded that both training programs increased the pelvic floor muscle strength, provided a decline in prolapse stages. Stabilization exercise has increased general health perception unlike home training, thus, these exercises can be added to the treatment of women with prolapse.

  14. Distal renal tubular acidosis as a cause of osteomalacia in a patient with primary Sjögren's syndrome

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    Jovelić Aleksandra

    2005-01-01

    Full Text Available Background. One half of the patients with primary Sjögren’s syndrome has extraglandular manifestations, including renal involvement. The most frequent renal lesion is tubulo-interstitial nephritis, which manifests clinically as distal tubular acidosis and may result in the development of osteomalacia. Case report. In a 29 - year-old female patient, with bilateral nephrolithiasis, the diagnosis of primary Sjögren’s syndrome, tubulo-interstitial nephritis, distal renal tubular acidosis, and hypokalemia were established. She was treated for hypokalemia. Two years later she developed bone pains and muscle weakness, she wasn’t able to walk, her proximal muscles and pelvic bones were painful, with radiological signs of pelvic bones osteopenia and pubic bones fractures. The diagnosis of osteomalacia was established and the treatment started with Schol’s solution, vitamin D and calcium. In the following two months, acidosis was corrected, and the patient started walking. Conclusion. In our patient with primary Sjögren’s syndrome and interstitial nephritis, osteomalacia was a result of the long time decompensate acidosis, so the correction of acidosis, and the supplementation of vitamin D and calcium were the integral part of the therapy.

  15. Frequency and factors effecting non clearance of lower pole renal stones

    International Nuclear Information System (INIS)

    Ullah, A.; Zubair, M.; Khan, N.; Malik, A.

    2015-01-01

    Renal stone disease is a major health hazard in Pakistan and extra-corporeal shockwave lithotripsy is one of comprehensive method used to treat these stones. The aim of this study is to determine the frequency of factors affecting the non-clearance of stone fragments of lower pole renal stone after extra corporeal shockwave lithotripsy. The study was done with the objective to determine the frequency the spatial anatomical factors which can influence the non-clearance of lower pole stone fragments after ESWL. Methods: One and nineteen (119) patients with lower pole renal stone less than 10 mm were subjected to maximum 3 sessions of extracorporeal shock wave lithotripsy. KUB radiographs, ultrasonography and intravenous urography were used as investigative tools for lower pole renal calyceal anatomy. X ray KUB and ultrasound were done after a week for clearance. Data was analysed with the help of SPSS version 10.0 and presented in the forms of tables and graphs. Results: There were 77 (64.71%) males and 42 (35.29%) females. Infundibulo-pelvic angle (IPA)>40 degree was present in 93 (78.15%), Infundibular length (IL) <22 mm in 107 (89.92%) and Infundibular width (IW) >4 mm was present in 100 (84.03%) patients. The frequency of stone non clearance was noted in 31 (26.05%). Infundibulo-pelvic angle (IPA)>40 degree (p=0.000), Infundibular length (IL)<22 mm (p=0.001) and Infundibular width (IW)>4 mm (p=0.046) were significant variables affecting stone clearance. Conclusion: The frequency of non-clearance of lower calyx of kidney stone is 26.05%. The clearance of fragments of the lower calyx kidney stones is affected by three spatial anatomical factors, i.e., Infundibulopelvic angle, Infundibular width and infundibular length. (author)

  16. Percutaneous nephrolithotomy of bilateral staghorn renal calculi in pediatric patients: 12 years experience in a tertiary care centre.

    Science.gov (United States)

    Purkait, Bimalesh; Kumar, Manoj; Sokhal, Ashok Kumar; Bansal, Ankur; Sankhwar, Satya Narayan; Gupta, Ashok Kumar

    2017-08-01

    To assess the outcomes of percutaneous nephrolithotomy (PCNL) in bilateral staghorn calculi in pediatric patients, we have performed a retrospective analysis. Staghorn calculus is defined as stone that fills a greater part of the pelvic-caliceal system. Still, in developing countries, patients may present with staghorn calculus. PCNL is the preferred treatment modality for staghorn calculus both in adult and children. Our study included fifty-one pediatric patients (calculus in children needs expertise. PCNL in B/L staghorn renal calculus in children is safe and effective. B/L staghorn renal calculi with compromised renal function have higher chance of complications including bleeding.

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

    International Nuclear Information System (INIS)

    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

    2008-01-01

    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

  18. Multidetector row computed tomography evaluation of the micropig kidney as a potential renal donor.

    Science.gov (United States)

    Yoon, Woong; Lee, Min Young; Ryu, Jung Min; Moon, Yong Ju; Lee, Sang Hun; Park, Jae Hong; Yun, Seung Pil; Jang, Min Woo; Park, Sung Su; Han, Ho Jae

    2010-03-01

    Multidetector row computed tomography (MDCT) provides anatomical information about the kidney and other internal organs. Presently, the suitability of 64-channel MDCT to assess the kidney of healthy micropigs was evaluated. Morphological evaluations of the kidney and the major renal vessels of six healthy micropigs were carried out using MDCT, recording kidney volume and the diameter and length of renal arteries and veins. The mean diameters and lengths of the renal artery were 0.44 +/- 0.05 and 4.51 +/- 0.55 cm on the right side and 0.46 +/- 0.06 and 3.36 +/- 0.27 cm on the left side, respectively. The mean diameters and lengths of the renal vein were 1.44 +/- 0.52 and 4.22 +/- 1.29 cm on the right side and 1.38 +/- 0.17 and 5.15 +/- 0.87 cm on the left side, respectively. The mean volume of the right kidney was 79.3 +/- 14.5 mL and of the left kidney was 78.0 +/- 13.9 mL. The data presented in this study suggest that the MDCT offers a noninvasive, rapid, and accurate method for the evaluation of the renal anatomy in living kidney donors. It also provides sufficient information about extra-renal anatomy important for donor surgery and determination of organ suitability.

  19. Post Pelvic Radiotherapy Bony Changes

    Energy Technology Data Exchange (ETDEWEB)

    Huh, Seung Jae [Samsung Medical Center, Seoul (Korea, Republic of)

    2009-03-15

    There has been recent interest in radiation-induced bone injury in clinical conditions, especially for pelvic insufficiency fracture (PIF). A PIF is caused by the effect of normal or physiological stress on bone with demineralization and decreased elastic resistance. Pelvic radiotherapy (RT) can also contribute to the development of a PIF. A PIF has been regarded as a rare complication with the use of megavoltage equipment. However, recent studies have reported the incidence of PIFs as 8.2{approx}20% after pelvic RT in gynecological patients, an incidence that was higher than previously believed. The importance of understanding a PIF lies in the potential for misdiagnosis as a bony metastasis. If patients complain of pelvic pain after whole-pelvis radiation therapy, the presence of a PIF must be considered in the differential diagnosis. The use of multibeam arrangements and conformal RT to reduce the volume and dose of irradiated pelvic bone can be helpful to minimize the risk of fracture. In addition to a PIF, osteonecrosis and avascular necrosis of the femoral head can develop after radiation therapy. Osteoradionecrosis of the pelvic bone is a clinical diagnostic challenge that must be differentiated from an osseous metastasis. A post-radiation bone sarcoma can result as a long-term sequela of pelvic irradiation for uterine cervical cancer.

  20. Normal differential renal function does not indicate a normal kidney after partial ureteropelvic obstruction and subsequent relief in 2-week-old piglets

    Energy Technology Data Exchange (ETDEWEB)

    Dissing, Thomas H.; Mikkelsen, Mette Marie; Pedersen, Michael; Froekiaer, Joergen; Djurhuus, Jens Christian [University of Aarhus, Institute of Clinical Medicine, Aarhus (Denmark); Eskild-Jensen, Anni [Aarhus University Hospital, Department of Nuclear Medicine, Aarhus Sygehus, Aarhus (Denmark); Gordon, Isky [University College London, Institute of Child Health, London (United Kingdom); University College London, Radiology and Physics Unit, Institute of Child Health, London (United Kingdom)

    2008-09-15

    We investigated the functional consequences of relieving ureteric obstruction in young pigs with experimental hydronephrosis (HN) induced by partial unilateral ureteropelvic obstruction. Three groups of animals were followed from the age of 2 weeks to the age of 14 weeks: Eight animals had severe or grades 3-4 HN throughout the study. Six animals had relief of the obstruction after 4 weeks. Six animals received sham operations at both ages. Morphological and functional examinations were performed at age 6 weeks and again at age 14 weeks and consisted of magnetic resonance imaging (MRI), technetium-diethylenetriaminepentaaceticacid ({sup 99m}Tc-DTPA) renography, renal technetium-dimercaptosuccinicacid ({sup 99m}Tc-DMSA) scintigraphy, and glomerular filtration rate (GFR) measurement. After relief of the partial obstruction, there was reduction of the pelvic diameter and improvement of urinary drainage. Global and relative kidney function was not significantly affected by either obstruction or its relief. Renal {sup 99m}Tc-DMSA scintigraphy showed a change in both the appearance of the kidney and a change in the distribution within kidneys even after relief of obstruction. This study shows that partial ureteric obstruction in young pigs may be associated with little effect on global and differential kidney function. However, even after relief of HN, the distribution of {sup 99m}Tc-DMSA in the kidney remains abnormal suggesting that a normal differential renal function may not represent a normal kidney. (orig.)

  1. Gradient field echo imaging and Gd-DTPA for the assessment of renal function in humans

    International Nuclear Information System (INIS)

    Von Schulthess, G.K.; Kikinis, R.; Durr, R.; Bino, M.; Jager, P.; Kubler, O.

    1986-01-01

    To evaluate renal parenchymal function, 1.5 T gradient field echo imaging using a sequence of repetitive 10-second scans was performed in apneic patients after injection of Gd-DTPA (0.1 mmol/kg body weight). During the 10-second pauses the patients were allowed to breathe. Angled coronal images (TR=40 msec, TE =20 msec, flip angle = 40 0 ) were obtained in four volunteers and four patients with hydronephrosis. Image quality was excellent, suggesting unprecedented spatial resolution for renal function studies. Initially, cortical perfusion was observed. Then the papilae became isointense; after 70 seconds they became hypointense; and finally the renal pelvic signal dropped. No papillary signal drop was seen in hydronephrosis, as confirmed by region-of-interest analysis. These results strongly suggest that in MR renal ''function'' studies with Gd-DTPA, T1 and T2 paramagnetic effects are operative

  2. An Unusual Course of Segmental Renal Artery Displays a Rare Case of Hilar Nutcracker Phenomenon

    Directory of Open Access Journals (Sweden)

    Devendra A. Sawant

    2015-01-01

    Full Text Available Nutcracker phenomenon or renal vein entrapment is classically seen as a compression of renal vein in between abdominal aorta and superior mesenteric artery with patients being asymptomatic or clinically manifested in the form of nutcracker syndrome as proteinuria, hematuria, flank pain, pelvic congestion in women, and varicocele in men. In this report, we are presenting a case of rare variant of nutcracker phenomenon along with brief review of anatomy, pathophysiology, public health, and clinical significance of nutcracker syndrome. On a routine dissection of an adult male cadaver, we noticed an unusual arrangement of the structures at the hilum of the left kidney showing entrapment of renal vein between left anterior inferior and posterior segmental renal arteries. The variation in the course of left anterior inferior segmental renal artery leads to compression of left renal vein at renal hilum. Therefore, we have named this rare abnormal anatomical entity as hilar nutcracker phenomenon. The structures in the right renal hilum are normal. The objective of this paper is to report an unusual but important variant of nutcracker phenomenon and also give collective knowledge of such anatomical variations in renal vasculature that will help in diagnosing and treating such rare renal disorder.

  3. Anatomical and procedural determinants of ambulatory blood pressure lowering following catheter-based renal denervation using radiofrequency.

    Science.gov (United States)

    Lauder, Lucas; Ewen, Sebastian; Tzafriri, Abraham R; Edelman, Elazer R; Cremers, Bodo; Kulenthiran, Saarraaken; Ukena, Christian; Linz, Dominik; Kindermann, Ingrid; Tsioufis, Costas; Scheller, Bruno; Böhm, Michael; Mahfoud, Felix

    2018-03-02

    Catheter-based renal sympathetic denervation (RDN) has been introduced to lower blood pressure (BP) and sympathetic activity in patients with uncontrolled hypertension with at best equivocal results. It has been postulated that anatomic and procedural elements introduce unaccounted variability and yet little is known of the impact of renal anatomy and procedural parameters on BP response to RDN. Anatomical parameters such as length and diameter were analyzed by quantitative vascular analysis and the prevalence of accessory renal arteries and renal artery disease were documented in 150 patients with resistant hypertension undergoing bilateral RDN using a mono-electrode radiofrequency catheter (Symplicity Flex, Medtronic). Accessory renal arteries and renal artery disease were present in 56 (37%) and 14 patients (9%), respectively. At 6-months, 24 h-ambulatory BP was reduced by 11/6 mm Hg (p renal arteries (p = 0.543) or renal artery disease (p = 0.598). Patients with at least one main renal artery diameter ≤ 4 mm had a more pronounced reduction of 24 h-ambulatory SBP compared to patients where both arteries were >4 mm (-19 vs. -10 mmHg; p = 0.038). Neither the length of the renal artery nor the number of RF ablations influenced 24 h-ambulatory BP reduction at 6 months. 24 h-ambulatory BP lowering was most pronounced in patients with smaller renal artery diameter but not related to renal artery length, accessory arteries or renal artery disease. Further, there was no dose-response relationship observed with increasing number of ablations. Because little is known of the impact of renal anatomy and procedural parameters on blood pressure (BP) response to renal denervation (RDN), anatomical and procedural data were analyzed in 150 patients undergoing bilateral RDN. BP lowering was most pronounced in patients with smaller renal artery diameter but not related to renal artery length, the presence of renal artery disease or accessory renal

  4. Correction of differential renal function for asymmetric renal area ratio in unilateral hydronephrosis.

    Science.gov (United States)

    Aktaş, Gul Ege; Sarıkaya, Ali

    2015-11-01

    Children with unilateral hydronephrosis are followed up with anteroposterior pelvic diameter (APD), hydronephrosis grade, mercaptoacetyltriglycine (MAG-3) drainage pattern and differential renal function (DRF). Indeterminate drainage preserved DRF in higher grades of hydronephrosis, in some situations, complicating the decision-making process. Due to an asymmetric renal area ratio, falsely negative DRF estimations can result in missed optimal surgery times. This study was designed to assess whether correcting the DRF estimation according to kidney area could reflect the clinical situation of a hydronephrotic kidney better than a classical DRF calculation, concurrently with the hydronephrosis grade, APD and MAG-3 drainage pattern. We reviewed the MAG-3, dimercaptosuccinic acid (DMSA) scans and ultrasonography (US) of 23 children (6 girls, 17 boys, mean age: 29 ± 50 months) with unilateral hydronephrosis. MAG-3 and DMSA scans were performed within 3 months (mean 25.4 ± 30.7 days). The closest US findings (mean 41.5 ± 28.2 days) were used. DMSA DRF estimations were obtained using the geometric mean method. Secondary calculations were performed to correct the counts (the total counts divided by the number of pixels in ROI) according to kidney area. The renogram patterns of patients were evaluated and separated into subgroups. The visual assessment of DMSA scans was noted and the hydronephrotic kidney was classified in comparison to the normal contralateral kidney's uptake. The correlations of the DRF values of classical and area-corrected methods with MAG-3 renogram patterns, the visual classification of DMSA scan, the hydronephrosis grade and the APD were assessed. DRF estimations of two methods were statistically different (p: 0.001). The categories of 12 hydronephrotic kidneys were changed. There were no correlations between classical DRF estimations and the hydronephrosis grade, APD, visual classification of the DMSA scan and uptake evaluation. The DRF

  5. A Rare Case of Atypical Renal Arteries Arrangement with Ectopic Kidneys in a Guinea Pig

    Directory of Open Access Journals (Sweden)

    Maženský D.

    2016-12-01

    Full Text Available We recorded a very rare case of atypical renal arteries arrangement in a guinea pig using the corrosion technique in the study of the arterial system. The right renal artery originated from the ventral wall of the abdominal aorta at the level of the caudal aspect of the 5th lumbar vertebra. The left renal artery originated from the left common iliac artery approximately 12 mm caudally to the aortic bifurcation. The right kidney was located ventral to the aortic bifurcation and the left kidney inside the pelvic cavity between the common iliac arteries. According to the vascular pattern, we determined that the ectopic kidneys in this guinea pig were unusual. This is the first case describing bilateral ectopic kidneys in a guinea pig.

  6. Oxidative stress and hemoglobin-cholesterol adduct in renal patients with different LDL phenotypes.

    Science.gov (United States)

    Miljkovic, Milica; Kotur-Stevuljevic, Jelena; Stefanovic, Aleksandra; Zeljkovic, Aleksandra; Vekic, Jelena; Gojkovic, Tamara; Bogavac-Stanojevic, Natasa; Nikolic, Milan; Simic-Ogrizovic, Sanja; Spasojevic-Kalimanovska, Vesna; Jelic-Ivanovic, Zorana

    2016-10-01

    Unfavorable lipid profile is a major risk factor for cardiovascular disease in renal pathology. In this study, we compared chronic renal patients and healthy controls with different LDL phenotypes (A or B) in respect of various biochemical parameters related to cardiovascular disease. Oxidative stress and anti-oxidative defense parameters [thiobarbituric acid-reacting substances (TBARS), total oxidative status (TOS), total anti-oxidative status (TAS), total protein sulfhydryl (-SH) groups], as well as red blood cell cholesterol distribution were assessed in 40 renal patients and 40 control subjects by standardized assays. LDL particle diameters were determined by polyacrylamide gradient gel electrophoresis. LDL particles are subdivided according to their size into large LDL A phenotype (diameter >25.5 nm) and small LDL B phenotype (diameter ≤25.5 nm). Renal patients with LDL A phenotype had increased oxidative stress (TOS: p LDL phenotype. A notable decrease in hemoglobin-cholesterol adduct was detected in patients with LDL A phenotype (p LDL B phenotype (p LDL B phenotype was characterized with increased TBARS (p LDL A phenotype in control group. Increased oxidative stress, decreased anti-oxidative defense followed with unfavorable changes in hemoglobin-cholesterol binding capacity, could have important influence on cardiovascular disease risk in renal patients regardless of LDL phenotype.

  7. Evaluation of late redislocation in patients who underwent open reduction and pelvic osteotomy as treament for developmental dysplasia of the hip.

    Science.gov (United States)

    Tuhanioğlu, Ümit; Cicek, Hakan; Ogur, Hasan U; Seyfettinoglu, Firat; Kapukaya, Ahmet

    2017-10-16

    The goal in the treatment of developmental dysplasia of the hip (DDH) is to achieve a stable and concentric reduction and to create a congruent relationship between the femoral head and the acetabulum. This study discusses the causes of loss of reduction in DDH patients who had a concentrically reduced hip at the time of removal of the hip spica cast and cessation of brace use and who later appeared with hip redislocation after mobilisation and ambulation. In addition, the possible interventions in such cases are also discussed. A retrospective evaluation was made of 13 patients diagnosed with DDH who developed redislocation following primary surgery. 6 of them had undergone the 1st surgery in our department between 2008 and 2016 and 7 had udergone surgery in another centre. For comparison reasons a 2nd group was formed of 13 demographically and clinically matched patients who had no loss of reduction. The groups were compared in terms of acetabular index, pelvic length, pelvic width, abduction degree of plaster, ossifying nucleus diameter, acetabular depth, and acetabular volume parameters. The average age of the patients was 23 months at initial surgery and 29 months at the time of revision surgery. No significant difference was found between the groups in terms of acetabular inclination angle, ossifying nucleus diameter, pelvic size, pelvic width, centre edge angle, acetabular volume, and depth. Contracted inferomedial capsule was found in 1 patient who underwent revision surgery and intact transverse acetabular ligament was seen in 1 patient. The loss of reduction in the remaining 11 patients was associated with high total anteversion of the femoral head and acetabulum. Correction of increased combined anteversion by femoral osteotomy can create a safe zone in terms of redislocation and can significantly contribute to the stability provided by capsulorrhaphy and pelvic osteotomy.

  8. Carcinoma of the renal pelvis and ureter

    Directory of Open Access Journals (Sweden)

    Fernando Korkes

    2006-12-01

    Full Text Available OBJECTIVE: To assess the occurrence of upper urinary tract urothelial tumors (UUTT in Brazil. MATERIALS AND METHODS: We performed a clinical and histopathologic study of 33 patients who were diagnosed with a malignant neoplasm in the renal pelvis or ureter in the period of 1994 to 2004, in a single institution. RESULTS: Among the patients with upper urinary tract carcinoma, 70% were males and 30% females, with mean age of 65 ± 16 years (ranging from 31 to 91 years. Nineteen patients presented renal pelvis tumor (58%, 9 ureteral tumor (27% and 5 synchronic pelvic and ureteral tumors (15%. Renal pelvis tumors represented 2.8% of all the urothelial neoplasms, and 11.4% of all renal neoplasms treated in the same period. Ureteral tumors represented 1.6% of all the urothelial malignancies surgically managed in these 11 years. Tobacco smoking was the most common risk factor, and analgesic abuse was not reported by those patients. Most carcinomas were high-grade and muscle-invasive. Mean time to diagnosis was 7 months, being hematuria the most common symptom. CONCLUSIONS: A high association was also found between UUTT and bladder urothelial carcinoma. UUTT were mostly seen in men in their seventies and related to a high overall and cancer-related mortality rate. The overall disease-specific survival was 40%, much lower than found in most of the reported series.

  9. Patients with Pelvic Floor Muscle Spasm Have a Superior Response to Pelvic Floor Physical Therapy at Specialized Centers.

    Science.gov (United States)

    Polackwich, Alan Scott; Li, Jianbo; Shoskes, Daniel A

    2015-10-01

    Chronic prostatitis/chronic pelvic pain syndrome is a common condition that often requires multimodal therapy. Patients with chronic pelvic pain syndrome have a high incidence of pelvic floor spasm, which can be treated with pelvic floor physical therapy. However, this is a specialized skill. We compared outcomes of pelvic floor physical therapy as part of multimodal therapy in patients with chronic pelvic pain syndrome between those treated at our institution and elsewhere. We identified patients from our chronic pelvic pain syndrome registry with pelvic floor spasm who were seen between 2010 and 2014 for more than 1 visit. Patient phenotype was assessed with the UPOINT system and symptom severity was determined by the National Institutes of Health CPSI. A 6-point decrease in CPSI was used to define patient improvement. A total of 82 patients fit the study criteria. Mean age was 41.6 years (range 19 to 75) and median symptom duration was 24 months (range 3 to 240). Mean CPSI was 26.8 (range 10 to 41), the median number of positive UPOINT domains was 3 (range 1 to 6) and 27 patients (32.9%) were treated locally. At followup 9 patients had refused pelvic floor physical therapy, and 24 and 48 had undergone pelvic floor physical therapy elsewhere and at CCF, respectively. The mean change in CPSI was 1.11 ± 4.1 in patients who refused, -3.46 ± 6.7 in those treated elsewhere and -11.3 ± 7.0 in those treated at CCF (p physical therapy at CCF (OR 4.23, p = 0.002) and symptom duration (OR 0.52, p = 0.03) predicted improvement. Pelvic floor physical therapy can be effective for chronic pelvic pain syndrome in patients with pelvic floor spasm. However, the outcome depends on specialty training and experience of therapists. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  10. Spontaneous rupture of renal pelvis secondary to ureteral obstruction by urothelial tumor

    Energy Technology Data Exchange (ETDEWEB)

    Fernandes, Daniel Alvarenga; Palma, Ana Laura Gatti; Kido, Ricardo Yoshio Zanetti; Barros, Ricardo Hoelz de Oliveira; Martins, Daniel Lahan; Penachim, Thiago Jose; Caserta, Nelson Marcio Gomes, E-mail: daniel_alvafer@yahoo.com.br, E-mail: daniel_alvafer@icloud.com [Universidade Estadual de Campinas (UNICAMP), SP (Brazil). Fac. de Medicina. Dept. de Radiologia

    2014-09-15

    Partial spontaneous rupture of the upper urinary tract is rare and usually associated with nephrolithiasis. Other reported causes, apart from instrumentation and trauma, involve obstructive ureteral tumor in the pelvic cavity, retroperitoneal fibrosis, fluid overload, and pregnancy. We report a case of spontaneous rupture of renal pelvis secondary to ureteral obstruction caused by urothelial tumor, clinically suspected and evaluated by CT scans and MRIs, discussing the relevant findings for diagnosis.(author)

  11. Multispecialty retrospective review of the clinical utility of pelvic magnetic resonance imaging in the setting of pelvic pain.

    Science.gov (United States)

    Moore, John R; Pathak, Ram A; Snowden, Caroline; Bolan, Candice W; Young, Paul R; Broderick, Gregory A

    2017-12-01

    Pelvic pain is a common complaint, and management of it is often difficult. We sought to evaluate the utility of magnetic resonance imaging (MRI) in the diagnosis of male pelvic pain. Though MRIs are commonly ordered to evaluate pelvic pain, there are very few studies obtaining the efficacy of pelvic MRI in determining a definitive diagnosis. The primary aim of our study was to evaluate the clinical utility of pelvic MRI for a diagnosis code that included pain. After receiving institutional review board approval, a retrospective study was performed of all pelvic MRIs completed at our institution from January 2, 2010 to December 31, 2014. These were further delineated into ordering providers by specialty and urology-specific International Classification of Diseases, Ninth Revision (ICD-9) code diagnoses (male pelvic pain, prostatitis, groin pain, scrotal pain, testicular pain, and penile pain). Clinical utility was defined as positive if MRI findings resulted in a change in management. Subanalysis was performed on patients with an ICD-9 co-diagnosis of previous oncologic concern. A total of 2,643 pelvic MRIs were ordered at our institution over a 5-year period. Of these, 597 pelvic MRIs (23%) were ordered for a diagnosis code that included pain (hip pain, rectal pain, joint pain, penile pain, scrotal pain, male pelvic pain and orchitis). Total utility for MRIs to find anatomic abnormalities potentially responsible for the present pain was 34% (205/597). When ordered by urologic providers, utility was 23%. Oncologists represented the highest positivity rate at 57%. Chronic pelvic pain is a multispecialty complaint that is difficult to treat. We were surprised to find the large number of both specialists and generalists invested in the management of pelvic pain. The increasing availability of MRI technology makes it a likely candidate to test for a clinically significant anatomic reason for pain. Though MRI is a test with minimal adverse effect and no increased risk

  12. Noncontrast-enhanced magnetic resonance renal angiography using a repetitive artery and venous labelling technique at 3 T: comparison with contrast-enhanced magnetic resonance angiography in subjects with normal renal function

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sung Yoon [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea, Republic of); Severance Hospital, Yonsei University College of Medicine, Department of Radiology and Research Institute of Radiological Science, Seoul (Korea, Republic of); Kim, Chan Kyo; Park, Byung Kwan [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea, Republic of); Kim, EunJu [Philips Healthcare Korea, Seoul (Korea, Republic of)

    2014-09-13

    To investigate the feasibility of noncontrast-enhanced MR angiography (NC-MRA) using the repetitive artery and venous labelling (RAVEL) technique to evaluate renal arteries compared to contrast-enhanced MR angiography (CE-MRA). Twenty-five subjects with normal renal function underwent NC-MRA using a RAVEL technique and CE-MRA at 3 T. Two independent readers analysed the MRA images. Image quality, number of renal arteries, presence or absence of an early branching vessel, and diameter of the main renal arteries were evaluated. The overall image quality of NC-MRA was fair or greater in 88 % of right and 92 % of left renal arteries, while it was 96 % in both sides with CE-MRA. On NC-MRA, the number of renal arteries in all subjects was perfectly predicted by both readers. Sensitivity and specificity for predicting early branching vessels were 82 % and 100 % for reader 1 and 82 % and 95 % for reader 2. Inter-modality agreement for comparing the diameters of main renal arteries was good or excellent at all segments for both readers. Inter-reader agreement was moderate or good at all segments except at the right distal segment on NC-MRA. NC-MRA with the RAVEL technique at 3 T may have comparable diagnostic feasibility for evaluating renal arteries compared to CE-MRA. (orig.)

  13. Pelvic belt effects on sacroiliac joint ligaments: a computational approach to understand therapeutic effects of pelvic belts.

    Science.gov (United States)

    Sichting, Freddy; Rossol, Jerome; Soisson, Odette; Klima, Stefan; Milani, Thomas; Hammer, Niels

    2014-01-01

    The sacroiliac joint is a widely described source of low back pain. Therapeutic approaches to relieve pain include the application of pelvic belts. However, the effects of pelvic belts on sacroiliac joint ligaments as potential pain generators are mostly unknown. The aim of our study was to analyze the influence of pelvic belts on ligament load by means of a computer model. Experimental computer study using a finite element method. A computer model of the human pelvis was created, comprising bones, ligaments, and cartilage. Detailed geometries, material properties of ligaments, and in-vivo pressure distribution patterns of a pelvic belt were implemented. The effects of pelvic belts on ligament strain were computed in the double-leg stance. Pelvic belts increase sacroiliac joint motion around the sagittal axis but decrease motion around the transverse axis. With pelvic belt application, most of the strained sacroiliac joint ligaments were relieved, especially the sacrospinous, sacrotuberous, and the interosseous sacroiliac ligaments. Sacroiliac joint motion and ligament strains were minute. These results agree with validation data from other studies. Assigning homogenous and linear material properties and excluding muscle forces are clear simplifications of the complex reality. Pelvic belts alter sacroiliac joint motion and provide partial relief of ligament strain that is subjectively marked, although minimal in absolute terms. These findings confirm theories that besides being mechanical stabilizers, the sacroiliac joint ligaments are likely involved in neuromuscular feedback mechanisms. The results from our computer model help with unraveling the therapeutic mechanisms of pelvic belts.

  14. Infusion dynamic ureteroscintigraphy in assessment of ureteral and pelvic contractivity in renal tuberculosis and chronic pyelonephritis

    International Nuclear Information System (INIS)

    Savin, I.B.; Tovstykh, A.M.; Morozov, N.V.

    1995-01-01

    A novel radionuclide method: infusion dynamic ureterscintigraphy was used in examinations of 42 patients with the initial forms of nephrotuberculosis, 18 patients with chronic nonspecific pyelonephritis, and 51 healthy controls. The new method was shown to be highly sensitive in assessment of ureteral and pelvic contractility in specific and nonspecific involvement of the kidneys. 16 refs.; 3 figs

  15. Synchronous presentation of nasopharyngeal and renal cell carcinomas

    Directory of Open Access Journals (Sweden)

    Cem Boruban

    2006-06-01

    Full Text Available We report a rare case of synchronous presentation of nasopharyngeal and renal cell carcinomas in a-50-year old male patient with long standing smoking history. The patient was initially presented with a diagnosis of nasopharyngeal carcinoma. During staging process, the abdominal computed tomography detected a right renal solid mass, 6.5 cm in diameter, originating from posterior portion of the right renal cortex. Right radical nephrectomy was performed and pathological examination revealed renal cell carcinoma. Smoking was thought to be a risk factor for both cancers. Systemic evaluation of kidney should not be discarded in patients diagnosed with nasopharyngeal carcinoma living in western countries with a smoking history.

  16. [Obstructed hemivagina and ipsilateral renal anomaly: unusual cause of piocolpos. Report a case and review of literature ].

    Science.gov (United States)

    Cortés-Contreras, Diana Karen; Juárez-Cruz, Patricio Manuel; Vázquez-Flores, José; Vázquez-Flores, Al David

    2014-10-01

    OHVIRA (Obstructed hemivagina and ipsilateral renal anomaly) by acronym and abbreviations in English or Herlyn Werner Wunderlich syndrome is a rare congenital malformation caused by an alteration in the Mullerian ducts and Wolffian Ducts. Which is characterized by a triad: uterus didelphys, obstructed and ipsilateral renal agenesis hemivagina still uncertain etiology. Patients are usually asymptomatic until menarche where the most common clinical presentation is pelvic pain, followed by a vaginal or abdominal mass, normal menstrual periods, infertility, and vaginal discharge rarely appears. The case of a female patient of 15 years, nubile with chronic fetid vaginal discharge, initially diagnosed and treated as pelvic inflammatory disease occurs, however because it is an exceptional condition with the background of the patient, by complementary studies were conducted where pelvic ultrasound revealed pyocolpos and absence of left kidney, uterus didelphys, blind hemivagina by other imaging studies, where we could integrate Herlyn-Werner-Wunderlich syndrome. In conclusion, abnormalities in the development of the Miillerian ducts are difficult to diagnose early, so you must have the embryological knowledge, conduct thorough clinical assessment and detailed picture in whom the coridition is suspected to identify malformations coexisting urinary tract and vaginal defects with the importance of preserving reproductive success through appropriate planning of surgical approach, given that the fertility rate in these patients is comparable to the average.

  17. Chronic pelvic floor dysfunction.

    Science.gov (United States)

    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. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Radiographic cup anteversion measurement corrected from pelvic tilt.

    Science.gov (United States)

    Wang, Liao; Thoreson, Andrew R; Trousdale, Robert T; Morrey, Bernard F; Dai, Kerong; An, Kai-Nan

    2017-11-01

    The purpose of this study was to develop a novel technique to improve the accuracy of radiographic cup anteversion measurement by correcting the influence of pelvic tilt. Ninety virtual total hip arthroplasties were simulated from computed tomography data of 6 patients with 15 predetermined cup orientations. For each simulated implantation, anteroposterior (AP) virtual pelvic radiographs were generated for 11 predetermined pelvic tilts. A linear regression model was created to capture the relationship between radiographic cup anteversion angle error measured on AP pelvic radiographs and pelvic tilt. Overall, nine hundred and ninety virtual AP pelvic radiographs were measured, and 90 linear regression models were created. Pearson's correlation analyses confirmed a strong correlation between the errors of conventional radiographic cup anteversion angle measured on AP pelvic radiographs and the magnitude of pelvic tilt (P cup anteversion angle from the influence of pelvic tilt. The current method proposes to measure the pelvic tilt on a lateral radiograph, and to use it as a correction for the radiographic cup anteversion measurement on an AP pelvic radiograph. Thus, both AP and lateral pelvic radiographs are required for the measurement of pelvic posture-integrated cup anteversion. Compared with conventional radiographic cup anteversion, the errors of pelvic posture-integrated radiographic cup anteversion were reduced from 10.03 (SD = 5.13) degrees to 2.53 (SD = 1.33) degrees. Pelvic posture-integrated cup anteversion measurement improves the accuracy of radiographic cup anteversion measurement, which shows the potential of further clarifying the etiology of postoperative instability based on planar radiographs. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

  19. Recent Advances in Understanding Pelvic-Floor Tissue of Women With and Without Pelvic Organ Prolapse: Considerations for Physical Therapists.

    Science.gov (United States)

    Saunders, Kimberly

    2017-04-01

    Pelvic organ prolapse is a fairly common condition that imposes significant symptoms, diminished quality of life, social burden, financial expense, and surgical risk on women. As evidence supporting the benefit of pelvic-floor muscle training in nonsurgical management of pelvic organ prolapse grows, physical therapists are becoming a provider of choice interacting with women affected by pelvic organ prolapse. This perspective article will review recent research on tissue characteristics of 3 key components of pelvic organ support: skeletal muscle, ligament, and vaginal wall. This information will be summarized as implications for physical therapists. An improved understanding of pelvic-floor tissue in women with and without pelvic organ prolapse will provide a more comprehensive appreciation of the interaction of multiple systems in the disorder. © 2017 American Physical Therapy Association.

  20. CT staging of renal pelvis tumor

    International Nuclear Information System (INIS)

    Yoon, Soo Woong; Cho, Kyoung Sik; Lee, Jong Hwa; Ham, Su Yeon; Won, Yeong Cheol; Ji, Eun Kyung; Choi, Seong Hun; Shin, Byung Suck

    1999-01-01

    To assess the value of computed tomography (CT) in the preoperative staging of transitional cell carcinoma (TCC) of the renal pelvis. We retrospectively evaluated the CT TNM staging of 38 patients with TCC of the renal pelvis who had undergone preoperative abdominal CT examination between January 1990 and January 1998. In CT staging for differentiation between early-stage (T0-2) and advanced-stage disease (T3-T4), three criteria were used, namely the presence or obliteration of the renal sinus fat layer, the smoothness or irregularity of margin between the tumor and renal parenchyma, and the presence or absence of hydronephrosis proximal to the tumor. CT staging was performed by two genitourinary radiologists blinded to the pathologic results, and was compared with pathologic staging. Pathologic results revealed 19 cases of early stage disease (T0=8, T1=9, T2=2) and 19 of advanced stage (T3=12, T4=7). Overall CT staging accuracy was 82%(31/38) ; four cases were overstaged and three were understaged. In early-stage disease, sensitivity and specificity were 79%, and 84%, and in advanced stage disease were 83% and 80%. Three of four overstaged cases showed hydronephrosis proximal to the tumor. In the second CT staging, using proximal hydronephrosis of the tumor as a criterion for early-stage disease, the sensitivity and specificity of early-stage disease were 95% and 75%, respectively, and the specificity of advanced-stage disease was 95%. When hydronephrosis proximal to a tumor was considered to be a sign of early stage disease, the CT staging of renal pelvic TCC was highly accurate

  1. Lifestyle advice with or without pelvic floor muscle training for pelvic organ prolapse

    DEFF Research Database (Denmark)

    Due, Ulla; Brostrøm, Søren; Lose, Gunnar

    2016-01-01

    INTRODUCTION AND HYPOTHESIS: We evaluated the effect of adding pelvic floor muscle training (PFMT) to a structured lifestyle advice program. METHODS: This was a single-blinded randomized trial of women with symptomatic pelvic organ prolapse (POP) stage ≥ II. Participants were randomized...

  2. Minimally invasive anterior pelvic internal fixation: An anatomic study comparing Pelvic Bridge to INFIX.

    Science.gov (United States)

    Reichel, Lee M; MacCormick, Lauren M; Dugarte, Anthony J; Rizkala, Amir R; Graves, Sara C; Cole, Peter A

    2018-02-01

    Anterior external fixation for pelvic ring fractures has shown to effectively improve stability and reduce mortality. However, these fixators can be associated with substantial morbidity such as pin tract infection, premature loss of fixation, and decreased quality of life in patients. Recently, two new methods of subcutaneous anterior pelvic internal fixation have been developed; the INFIX and the Pelvic Bridge. These methods have the purported advantages of lower wound complications, less surgical site pain, and improved quality of life. We sought to investigate the measured distances to critical anatomic structures, as well as the qualitative and topographic differences notable during implantation of both devices in the same cadaveric specimen. The Pelvic Bridge and INFIX were implanted in eleven fresh cadavers. Distances were then measured to: the superficial inguinal ring, round ligament, spermatic cord, lateral femoral cutaneous nerve (LFCN), femoral nerve, femoral artery, and femoral vein. Observations regarding implantation and topography were also recorded. The INFIX had greater measured distances from all structures except for the LFCN, in which its proximity placed this structure at risk. Neither device appears to put other critical structures at risk in the supine position. Significant implantation and topographic differences exist between the devices. The INFIX application lacked "safety margins" concerning the LFCN in 10/11 (90.9%) specimens, while Pelvic Bridge placement lacked "safety margins" with regard to the right superficial ring (1/11, 9%) and the right spermatic cord (1/11, 9%). Both the Pelvic Bridge and INFIX lie at safe distances from most critical pelvic structures in the supine position, though INFIX application places the LFCN at risk. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Aneurisma da Artéria Renal: cirurgia renal ex-vivo - a propósito de um caso clínico Renal Artery Aneurysm: ex-vivo repair - a case report

    Directory of Open Access Journals (Sweden)

    Clara Nogueira

    2012-09-01

    Full Text Available Os aneurismas da artéria renal (AAR são raros, frequentemente assintomáticos, de etiologia variada, frequentemente secundários a aterosclerose e anomalias congénitas. Os AAR com diâmetro superior a 2 cm têm indicação cirúrgica. A escolha da técnica cirúrgica depende da localização anatómica e complexidade do AAR, bem como do tempo previsível de isquemia renal. Os autores descrevem um caso de auto-transplante renal, para tratamento de dois AAR complexos.Renal artery aneurysms (RAA are rare, frequently asymptomatic, with variable etiology, frequently due to atherosclerosis and congenital anomalies. Surgical treatment is indicated for RAA with a diameter greater to 2 cm. Surgical technique will depend on RAA anatomic localization and complexity, as well as, predicted renal isquemic time. The authors report an auto-transplant for treatment of two complex RAA.

  4. Pelvic floor and sexual male dysfunction

    Directory of Open Access Journals (Sweden)

    Antonella Pischedda

    2013-04-01

    Full Text Available The pelvic floor is a complex multifunctional structure that corresponds to the genito- urinary-anal area and consists of muscle and connective tissue. It supports the urinary, fecal, sexual and reproductive functions and pelvic statics. The symptoms caused by pelvic floor dysfunction often affect the quality of life of those who are afflicted, worsening significantly more aspects of daily life. In fact, in addition to providing support to the pelvic organs, the deep floor muscles support urinary continence and intestinal emptying whereas the superficial floor muscles are involved in the mechanism of erection and ejaculation. So, conditions of muscle hypotonia or hypertonicity may affect the efficiency of the pelvic floor, altering both the functionality of the deep and superficial floor muscles. In this evolution of knowledge it is possible imagine how the rehabilitation techniques of pelvic floor muscles, if altered and able to support a voiding or evacuative or sexual dysfunction, may have a role in improving the health and the quality of life.

  5. Retroperitoneoscopic pyelolithotomy: A minimally invasive alternative for the management of large renal pelvic stone

    Directory of Open Access Journals (Sweden)

    Saurabh Sudhir Chipde

    2014-01-01

    Full Text Available Introduction: Large stones in renal pelvis can be treated with percutaneous nephrolithotomy (PCNL or pyelolithotomy (either by open or laparoscopic techniques. PCNL is difficult in undilated system. For pyelolithotomy, laparoscopy is more preferable over the open surgery. Surgeons are more familiar with the tansperitoneoscopic anatomy than retroperitoneoscopic one, but retroperitoneoscopic approach can be attempted if we anticipate the problems in the transperitoneal route. Case: A fifty years old gentleman presented to us with the complaint of dull aching right flank pain. On ultrasonographic examination, he was found to have a large stone in renal pelvis with minimal hydronephrosis and thickened omentum on right side. Xray KUB showed a large radio-opaque shadow in renal area. We did the CECT-Urogram of the patient to know the detailed anatomy, which showed a stone of 5.3 x 3.7 cm in right extra-rena pelvis without hydronephrosis and a large focal area of marked fat stranding in omentum on the right side in mid and lower abdomen with swirling of fat stranding on the superior aspect suggestive of omental infarction and torsion. Due to undilated caliceal system, we preferred laparoscopic surgery over the PCNL in this patient. As whole of the omental tissue was stuck on right side we decided to proceed with transperitoneoscopic route instead of retroperitoneoscopic one. The DJ stent was inserted preoperatively.The surgery was performed in the flank position with three ports, one 10mm port just antero-inferior to tip of 12th rib for camera and two 5mm working ports, one at anterior axillary line and other at renal angle. We created the retroperitoneal space with the customized balloon, made with the glove-fingure. Results: The operative time was 1 hour 40 minutes, and there were no intra or post-operative complications. The stone was removed in toto. Patient was orally allowed on first postoperative day and foleys was removed on second day. patient

  6. [Orthotopic renal transplant: our experience].

    Science.gov (United States)

    De Gracia, R; Jiménez, C; Gil, F; Escuin, F; Tabernero, A; Sanz, A; Hidalgo, L

    2007-01-01

    Orthotopic renal transplant (ORT) is useful in cases of severe atherosclerosis, heterotopic bilateral transplant, unsuitable pelvic vessels and in aortic thrombosis, but it is not available in all the institutions and it is only realized of exceptional form. To review the indication, surgical technique and outcome of the ORT at our hospital. The studied included five cases between January 1990 and December 2005. We analyzed several variables: demographic characteristics, characteristics of the donor, ischemia times, evolution of renal function and morbi-mortality associated. Left ORT was performed in three men and two women. Mean patient age was 52+/-5 years, all the patients received kidneys from cadaveric donors. Mean creatinine and urea one month postoperative were 2.2+/-0.72 mg/dl and 103+/-17.2 mg/dl and at 6 months postoperative were 1.8+/-0.59 mg/dl and 78+/-14 mg/dl respectively. Immediately all patients received prophylaxis with low molecular weight heparin but it was indicated antiaggregation to two patients when they left the hospital, anticoagulation to two patients and to one of them was decided to anticoagulation nor antiagregation for history of bled digestive. A patient died for bleeding episode at level of the renal graft six months after the transplant, she was in treatment with dicumarinics, they were indicated by venous deep thrombosis in right leg. The survival a year is 80 % of the graft and the patient. Only two patients returned to hospital later, one of them for presenting an episode of diverticulitis and the other one for renal obstructive failure that needed laying of catheter pig-tail. Four patients presented stenosis of renal native vassels detected in control magnetic nuclear resonance, not symptomatic. There are two patients who take more than three years transplanted with renal stable function (creatinina 1.3 mg/dl and 1.4 mg/dl respectively). ORT is an excellent option in patients with co-morbidity increased for atherosclerosis and

  7. Mode of delivery and Pelvic floor disorder

    International Nuclear Information System (INIS)

    Noor, R.; Neelam, H.; Bashir, M.S.

    2017-01-01

    Objective: To compare pelvic floor dysfunction in non pregnant women who had delivered vaginally versus those with cesarean delivery. Methodology: The prevalence of pelvic floor disorders among non pregnant women was assesses by using a standardized tool pelvic floor distress inventory short form (PFDI-20). Data was collected from Jinnah Hospital Lahore, Pakistan. Results: Total numbers of participants were 278. 47.12% subjects had moderate, 36.69% miner and 16.19% had severe pelvic floor dysfunction. The symptoms of pelvic organ prolapse were more prevalent (mean value is 59.1876) than Urinary Distress (mean value is 40.5426), while the Colorectal-Anal Distress (mean value is 35.9150) were least prevalent. Conclusion: Pelvic floor disorders are very common among females and are strongly associated with mode of delivery. Although spontaneous vaginal birth was extensively associated with pelvic floor disorders the instrumental delivery affects most. (author)

  8. Clinical evaluation of renal function study using I-123 orthoiodohippurate (I-123 OIH) in patients with obstructive uropathy

    International Nuclear Information System (INIS)

    Okada, Junichi; Uchiyama, Guio; Katsurai, Hiroshi; Uno, Koichi; Uematsu, Sadao.

    1984-01-01

    Functional images and regional renograms using I-123 OIH were evaluated by comparing with patients' clinical courses, intravenous pyelographies and Creatinine clearances. Twenty-one patients with obstructive uropathy were studied. Functional images were processed in three parameters of Tmax, T 1/2 and ERBF (effective renal blood flow). ERBF images were composed of regional counts in early blood flow phase of renograms. Regional renograms were produced on renal parenchyma and pelvis. ERBF images represented the functioning distributions of renal tissue after the surgery and the recoveries in the renal parenchyma. Tmax and T 1/2 images and pelvic regional renograms showed the good correlations with IVP findings which presented the dilatation of pelvis and the delay of excretion. Parenchymal regional renograms showed the poor correlations with Creatinine clearances and caused sometimes errors in ROI settings. The evaluation of renal function only by the parenchymal regional renogram seemed to be inappropriated. (author)

  9. Paraparesis secondary to erratic migration of Dioctophyma renale in a dog

    OpenAIRE

    Bach, Fernando Swiech; Klaumann, Paulo Roberto; Montiani-Ferreira, Fabiano

    2016-01-01

    ABSTRACT: A 4 years old mongrel stray bitch, weighing 16kg was submitted to physical examination to demonstrated inability of locomotion with the pelvic limbs. Extradural spinal cord compression was observed in myelotomography of the thoracolumbar segment. The patient was submitted to exploratory hemilaminectomy of T13-L1 and L1-L2, in an attempt to decompress the medullar segments. During the surgery was observed one adult parasite, identified as Dioctophyma renale , located in the extradura...

  10. Biomechanics of the pelvic floor musculature

    NARCIS (Netherlands)

    Janda, S.

    2006-01-01

    The present thesis was motivated by two main goals. The first research goal of the thesis was to understand the complex biomechanical behaviour of the pelvic floor muscles. The second goal was to study the mechanism of the pelvic organ prolapse (genital prolapse). The pelvic floor in humans is a

  11. Postoperative low-pelvic irradiation for stage I-IIA cervical cancer patients with risk factors other than pelvic lymph node metastasis

    International Nuclear Information System (INIS)

    Hong, J.-H.; Tsai, C.-S.; Lai, C.-H.; Chang, T.-C.; Wang, C.-C.; Lee, Steve P.; Tseng, C.-J.; Hsueh, Swei

    2002-01-01

    Purpose: To retrospectively investigate whether postoperative low-pelvic radiotherapy (RT) is an appropriate treatment for node-negative, high-risk Stage I-IIA cervical cancer patients. Methods and Materials: A total of 228 Stage I-IIA cervical cancer patients treated by radical surgery and postoperative RT were included in this study. All patients had histopathologically negative pelvic node metastasis, but at least one of the following risk factors: parametrial involvement, positive or close resection margins, invasion depth two-thirds or greater cervical stromal thickness. Seventy-nine patients (35%) received 30-50 Gy (median 44) to whole pelvis and a boost dose to the low pelvis (whole-pelvic RT group); the other 149 patients (65%) received low-pelvic RT only (low-pelvic RT group). For both groups, the total external RT dose to the low pelvis ranged from 40 to 60 Gy (median 50). The potential factors associated with survival, small bowel (gastrointestinal) complications, and leg lymphedema were analyzed, and patients who had a relapse in the upper pelvis were identified. Results: The 5-year overall and disease-specific survival rate was 84% and 86%, respectively. After multivariate analysis, only bulky tumor (≥4 cm) and non-squamous cell carcinoma were significantly associated with survival. Parametrial involvement, lymph-vascular invasion, ≤50.4 Gy to the low pelvis, positive or close margins, and low-pelvic RT alone did not significantly affect survival. Grade I-V small bowel complications occurred in 33 patients (15%). Whole pelvic RT and >50.4 Gy to the low pelvis, but not old age and treatment technique (AP-PA vs. box), were significantly associated with gastrointestinal complications. Three patients (2%) in the low-pelvic RT group and 6 patients (8%) in the whole-pelvic RT group were found to have Grade III or higher small bowel complications (p=0.023). Thirty-one percent of patients developed lymphedema of the leg. A dose to the low pelvis >50.4 Gy

  12. The screening pelvic radiograph in pediatric trauma

    International Nuclear Information System (INIS)

    Rees, M.J.; Aickin, R.; Kolbe, A.; Teele, R.L.

    2001-01-01

    Background. Pelvic radiographs are routinely obtained in adult trauma to optimise early management. In adults, pelvic fractures are associated with high early transfusion requirement, high injury severity scores and an increased incidence of other abdominal and thoracic injuries. It is unclear whether this holds true in children. Objective. To determine whether the screening pelvic radiograph is necessary in paediatric trauma. Materials and methods. The notes of all patients who presented after trauma to the Starship Children's Hospital and were triaged to the resuscitation room during 1997 were reviewed. Results of initial radiography were obtained and correlated with later imaging. Results. Our review of 444 injured children seen over a period of 1 year revealed that of 347 children who had screening pelvic radiographs, only 1 had a pelvic fracture. The fracture in this child was clinically apparent and required no specific treatment. Conclusions. The presence of a pelvic fracture is rare in injured children. By omitting screening pelvic radiographs there are potential benefits, including reduced radiation exposure to children and cost savings. Uninterpretable or abnormal clinical examination or haematuria requires further investigation, but routine screening for pelvic fracture is unnecessary. (orig.)

  13. Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in management of lower-pole renal stones with a diameter of smaller than 15 mm.

    Science.gov (United States)

    Kirac, Mustafa; Bozkurt, Ömer Faruk; Tunc, Lutfi; Guneri, Cagri; Unsal, Ali; Biri, Hasan

    2013-06-01

    The aim of this study was to compare the outcomes of retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mini-PNL) in management of lower-pole renal stones with a diameter smaller than 15 mm. Between December 2009 and July 2012, the patients with the diagnosis of lower-pole stones were evaluated by ultrasonography, intravenous pyelography and computed tomography. The records of 73 evaluable patients who underwent mini-PNL (n = 37) or RIRS (n = 36) for lower-pole (LP) stones with diameter smaller than 15 mm were reviewed retrospectively. Of the 73 patients, 37 underwent mini-PNL and 36 underwent RIRS. The stone-free rates were 89.1 and 88.8 % for mini-PNL and RIRS groups, respectively. The mean operation time was 53.7 ± 14.5 in the mini-PNL group but 66.4 ± 15.8 in the RIRS group (P = 0.01). The mean fluoroscopy times and hospitalization times were significantly higher in the mini-PNL group. There was no major complication in any patient. RIRS and mini-PNL are safe and effective methods for treatment of LP calculi with a diameter smaller than 15 mm. RIRS is a non-invasive and feasible treatment option, and has also short hospitalization time, low morbidity and complication rate. It may be an alternative of mini-PNL in the treatment LP calculi with smaller than 15 mm.

  14. Double uterus with obstructed hemivagina and ipsilateral renal agenesis: pelvic anatomic variants in 87 cases.

    Science.gov (United States)

    Fedele, L; Motta, F; Frontino, G; Restelli, E; Bianchi, S

    2013-06-01

    What are the anatomic variants (and their frequencies) of double uterus, obstructed hemivagina and ipsilateral renal agenesis? Most cases examined (72.4%) were of the classic anatomic variant of the Herlyn-Werner-Wunderlich syndrome (with didelphys uterus, obstructed hemivagina and ipsilateral renal agenesis) but the 27.6% of cases are of a rare variant of the syndrome (with uterus septum or cervical agenesis), showing relevant clinical and surgical implications. The extreme variability of anatomic structures involved in this syndrome (both uterus, cervico-vaginal and renal anomalies) is well known, even if a complete and uniform analysis of all its heterogeneous presentations in a large series is lacking. This is a retrospective study with 87 patients referred to our third level referral center between 1981 and 2011. We analyzed the laparoscopic and chart records of 87 women, who referred to our institute with double uterus, unilateral cervico-vaginal obstruction and ipsilateral renal anomalies. Sixty-three of 87 patients had the more classic variant of didelphys uterus with obstructed hemivagina; 10/87 patients had septate bicollis uterus with obstructed hemivagina; 9/87 patients had bicornuate bicollis uterus with obstructed hemivagina; 4/87 patients had didelphys uterus with unilateral cervical atresia; 1/87 patients had bicornuate uterus with one septate cervix and unilateral obstructed hemivagina. This is a retrospective study with a long enrolling period (30 years). New insights in the anatomic variants of this rare syndrome with their relevant surgical implications.

  15. Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction

    OpenAIRE

    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 ...

  16. Transrectal Drainage of Deep Pelvic Abscesses Using a Combined Transrectal Sonographic and Fluoroscopic Guidance

    International Nuclear Information System (INIS)

    Jeong, Kyung Soon; Lee, Eun Jung; Ko, Ji Ho; Joh, Young Duk; Jung, Gyoo Sik

    2005-01-01

    To evaluate the feasibility and clinical efficacy of transrectal drainage of a deep pelvic abscess using combined transrectal sonographic and fluoroscopic guidance. From March 1995 and August 2004, 17 patients (9 men; 8 women; mean age, 39 years) suffering from pelvic pain, fever and leukocytosis were enrolled in this retrospective study. Ultrasound (US) or computed tomography (CT), which was obtained prior to the procedure, showed pelvic fluid collections that were deemed unapproachable by the percutaneous trans abdominal routes. Transrectal drainage of the pelvic abscess was performed under combined transrectal sonographic and fluoroscopic guidance. The causes of the deep pelvic abscess were postoperative complications (n=7), complications associated with radiation (n=3) and chemotherapy (n=1) as well as unknown causes (n=6). A 7.5-MHz end-firing transrectal US probe with a needle biopsy guide attachment was advanced into the rectum. Once the abscess was identified, a needle was advanced via the biopsy guide and the abscess was punctured. Under US guidance, either a 0.018'or 0.035' guide wire was passed through the needle in the abscess. Under fluoroscopic guidance, the tract was dilated to the appropriate diameter with sequential fascial dilators, and a catheter was placed over the guide wire within the abscess. Clinical success of drainage was determined by a combination closure of the cavity on the follow up images and diminished leukocytosis. The technical and clinical success rate, complications, and patient's discomfort were analyzed. Drainage was technically successful in all patients and there were no serious complications. Surgery was eventually performed in two cases due to fistular formation with the rectum and leakage of the anastomosis site. The procedure was well tolerated in all but one patient who complained of discomfort while the catheter was inserted . The catheter did not interfere with defecation and there was no incidence of catheter

  17. Renal morphology of Bradypus torquatus

    Directory of Open Access Journals (Sweden)

    Pedro Kastein Faria da Cunha Bianchi

    2012-11-01

    Full Text Available Among the Xenarthras, sloths present a hydric ingestion restricted to water from leaves, fruits, and vegetables. As a first approach to verify whether these animals have some morphophysiological difference which could justify or compensate this low hydric ingestion, the renal anatomy of these animals was investigated, particularly that of maned sloth (Bradypus torquatus. Kidneys from these animals were macroscopically analyzed, through light microscopy and scanning electron microscopy. The Bradypus torquatus kidneys are bean-shaped paired organs, located dorso-cranially to the pelvic girdle, between the peritoneum and the posterior abdominal wall. The use of histological techniques allowed us to identify, in the cortical region, the renal corpuscles and tubules, and, in the medullary region, a significant amount of interstitial tissue with a collecting duct. The results of this study showed that, although Bradypus torquatus doesn’t drink water directly, its kidneys doesn’t differ from that of most mammals, presenting the same anatomical structure, suggesting that these animals fully reach their hydric needs, basically by consuming leaves, fruits, and sprouts. Nevertheless, in order to confirm this hypothesis, studies on the effectiveness of water reabsorption, such as the renin-angiotensin-aldosterone system, must be carried out.

  18. MR imaging in female pelvic organs prolapse

    International Nuclear Information System (INIS)

    Capiel, Carlos A. h; Bouzas, Carlos A.

    2003-01-01

    Pelvic floor weakness and consequent organ prolapse may result in a variety of symptoms, including pain, urinary or fecal incontinence and constipation. Diagnosis is made primary on the basis of findings at physical pelvic examination. Imaging is useful in patients in whom findings at physical examination are equivocal. Different imaging techniques (fluoroscopy, ultrasonography), can be useful in evaluating pelvic organs prolapse. MR imaging is a new noninvasive technique that provides a multiplanar global evaluation of the pelvic contents and demonstrates pelvic organs prolapse. Reference points are the pubococcygeal line and puborectalis muscle sling. This pictorial assay illustrates different grades of cystourethrocele, recto-sigmoidocele and hysteroptosis (uterine prolapse) on MR imaging. (author)

  19. Extraperitoneal pelvic leiomyosarcoma

    International Nuclear Information System (INIS)

    Santamarina, Mario G.; Baltazar, Alberto D.; Arce, Patricia; Dettano, Veronica; Lopez, Jessica

    2003-01-01

    Extraperitoneal pelvic leiomyosarcoma is a very uncommon neoplasic process. It is a highly aggressive tumor with unfavorable prognosis. Clinical findings are nonspecific; diagnosis is generally made in an advanced stage of the disease. We present a case of a 34 years old female patient with pelvic leiomyosarcoma located at the recto vaginal septum who referred vulvar tumor and disability of the left lower limb. This case report describes the results obtained by ultrasound, Computed Tomography, Magnetic Resonance Imaging and pathology. (author)

  20. Percutaneous Fixation of Anterior Column Acetabular Fracture in a Renal Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Halil Ceylan

    2013-01-01

    Full Text Available Renal transplantation, performed per million population, ranges from 30 to 60 in developed countries. The transplanted kidney is generally placed in iliac fossa; therefore the treatment procedure of the pelvic trauma in these patients should be selected carefully. The gold standard technique for the treatment of displaced acetabulum fractures is open reduction and internal fixation. Our patient had received a living-related-donor renal transplant due to chronic renal failure. In the second year of transplantation, she had been injured in a motor-vehicle accident, and radiographs showed a right acetabular anterior column fracture and left pubic rami fractures. The patient was treated with percutaneous fixation techniques and at one year of postoperative period there was no evidence of degenerative signs and the clinical outcome was good. Beside having the advantage of avoiding dissection through the iliac fossa by the standard ilioinguinal approach, percutaneous techniques, with shorter surgical time, decreasing soft tissue disruption, and the potential for early discharge from hospital might be ideal for a renal transplant recipient carrying a higher risk of infection. Percutaneous fixation of selected acetabular fractures in a renal transplant recipient would presumably have the potential to decrease the morbidity associated with traditional open surgical procedures.

  1. Noncontrast-enhanced magnetic resonance renal angiography using a repetitive artery and venous labelling technique at 3 T: comparison with contrast-enhanced magnetic resonance angiography in subjects with normal renal function.

    Science.gov (United States)

    Park, Sung Yoon; Kim, Chan Kyo; Kim, EunJu; Park, Byung Kwan

    2015-02-01

    To investigate the feasibility of noncontrast-enhanced MR angiography (NC-MRA) using the repetitive artery and venous labelling (RAVEL) technique to evaluate renal arteries compared to contrast-enhanced MR angiography (CE-MRA). Twenty-five subjects with normal renal function underwent NC-MRA using a RAVEL technique and CE-MRA at 3 T. Two independent readers analysed the MRA images. Image quality, number of renal arteries, presence or absence of an early branching vessel, and diameter of the main renal arteries were evaluated. The overall image quality of NC-MRA was fair or greater in 88% of right and 92% of left renal arteries, while it was 96% in both sides with CE-MRA. On NC-MRA, the number of renal arteries in all subjects was perfectly predicted by both readers. Sensitivity and specificity for predicting early branching vessels were 82% and 100% for reader 1 and 82% and 95% for reader 2. Inter-modality agreement for comparing the diameters of main renal arteries was good or excellent at all segments for both readers. Inter-reader agreement was moderate or good at all segments except at the right distal segment on NC-MRA. NC-MRA with the RAVEL technique at 3 T may have comparable diagnostic feasibility for evaluating renal arteries compared to CE-MRA. • Accurate pre-treatment evaluation of renal artery anatomy helps clinical decision-making. • NC-MRA using RAVEL offers acceptable imaging quality for renal artery evaluation. • The 3 T RAVEL technique provides excellent diagnostic performance for renal artery evaluation. • The 3 T RAVEL technique may be an alternative to contrast-enhanced MRA.

  2. Morbidity and outcome of pelvic exenteration in locally advanced pelvic malignancies.

    Science.gov (United States)

    Ramamurthy, Rajaraman; Duraipandian, Amudhan

    2012-09-01

    Pelvic exenteration is a technically demanding surgical procedure performed for locally advanced cancers in the pelvis. Aim of the present study was to analyze morbidity, failure pattern and survival after pelvic exenteration during a period of 15 years in a dedicated cancer centre in South India. Retrospective analysis of case records of 50 patients who underwent pelvic exenteration from 1996 to 2011 in the Department of Surgical Oncology, Government Royapettah Hospital Chennai. Forty-six patients were females and 4 were males with a mean age of 48.3 years (range 21-72). Twenty six patients had cervical cancer,14 had rectal cancer, 3 had bladder cancer,2 had endometrial cancer, 2 had vaginal cancer, 1 had uterine sarcoma, 1 had anal cancer and 1 had ovarian cancer. The postoperative morbidity was 50%. 7 patients (14%) developed recurrence of which 5 had local and 2 had distant recurrence. The estimated 5 year overall survival for all patients in our series was 53.5% and for the patients with Ca rectum and Ca cervix was 60.6% and 40.1% respectively. Adjacent organ invasion had a significant impact over survival. Pelvic exenteration provides a curative form of treatment for carefully selected locally advanced cancer in the pelvis and it can be done safely with acceptable complications in centers experienced in multivisceral resections.

  3. Reconstruction of Complex Post-Traumatic Perineal/Pelvic Defects ...

    African Journals Online (AJOL)

    of the pelvic diaphragm). A composite pedicled. ALT flap was considered adequate for the initial reconstruction and stabilization, with the option of using a free fibular flap later, should the pelvic ring remain unstable. The fascia was used to complete the pelvic ring. It also provided anterior support to the pelvic diaphragm.

  4. Lower pole renal cut injury due to the iliac wing fracture: A rare case report

    Directory of Open Access Journals (Sweden)

    Çaglar Yildirim

    2015-07-01

    Full Text Available The most frequent causes of blunt genitourinary injuries are falls from heights, motor vehicle accidents and sports injuries. Firearm injuries and penetrating stab wounds are also frequently encountered. Skeletal system traumas in the vicinity of the urogenital system can cause urological organ injuries. Though rarely, renal traumas can be dependent on the kinetic energy of the trauma and the retroperitoneal movement capacity of the kidneys and cannot be explained with the proximity of the kidney to the skeletal system. In cases with high-energy decelerations, renal pedicle and ureteropelvic junction traumas are more frequently observed. Herein, we presented a grade 3 left kidney lower pole injury developed secondary to A2 type pelvic fracture following a high energy deceleration trauma. It should not be forgotten that especially in this type of fractures, injuries of the lower renal pole can occur.

  5. Percutaneous thermal ablation of renal neoplasms; Perkutane Thermoablation von Nierentumoren

    Energy Technology Data Exchange (ETDEWEB)

    Tacke, J. [Inst. fuer Diagnostische und Interventionelle Radiologie/Neuroradiologie, Klinikum Passau (Germany); Mahnken, A.H.; Guenther, R.W. [Klinik fuer Radiologische Diagnostik, Universitaetsklinikum Aachen (Germany)

    2005-12-15

    Due to modern examination techniques such as multidetector computed tomography and high-field magnetic resonance imaging, the detection rate of renal neoplasms is continually increasing. Even though tumors exceeding 4 cm in diameter rarely metastasize, all renal lesions that are possible neoplasms should be treated. Traditional treatment techniques include radical nephrectomy or nephron-sparing resection, which are increasingly performed laparoscopically. Modern thermal ablation techniques such as hyperthermal techniques like radiofrequency ablation RFA, laser induced thermal ablation LITT, focused ultrasound FUS and microwave therapy MW, as well as hypothermal techniques (cryotherapy) may be a useful treatment option for patients who are unfit for or refuse surgical resection. Cryotherapy is the oldest and best known thermal ablation technique and can be performed laparoscopically or percutaneously. Since subzero temperatures have no antistyptic effect, additional maneuvers must be performed to control bleeding. Percutaneous cryotherapy of renal tumors is a new and interesting method, but experience with it is still limited. Radiofrequency ablation is the most frequently used method. Modern probe design allows volumes between 2 and 5 cm in diameter to be ablated. Due to hyperthermal tract ablation, the procedure is deemed to be safe and has a low complication rate. Although there are no randomized comparative studies to open resection, the preliminary results for renal RFA are promising and show RFA to be superior to other thermal ablation techniques. Clinical success rates are over 90% for both, cryo- and radiofrequency ablation. Whereas laser induced thermal therapy is established in hepatic ablation, experience is minimal with respect to renal application. For lesions of more than 2 cm in diameter, additional cooling catheters are required. MR thermometry offers temperature control during ablation. Microwave ablation is characterized by small ablation volumes

  6. Pelvic floor dysfunction, and effects of pregnancy and mode of delivery on pelvic floor

    Directory of Open Access Journals (Sweden)

    Murat Bozkurt

    2014-12-01

    Full Text Available Pelvic floor dysfunction (PFD, although seems to be simple, is a complex process that develops secondary to multifactorial factors. The incidence of PFD is increasing with increasing life expectancy. PFD is a term that refers to a broad range of clinical scenarios, including lower urinary tract excretory and defecation disorders, such as urinary and anal incontinence, overactive bladder, and pelvic organ prolapse, as well as sexual disorders. It is a financial burden on the health care system and disrupts women's quality of life. Strategies applied to decrease PFD are focused on the course of pregnancy, mode and management of delivery, and pelvic exercise methods. Many studies in the literature define traumatic birth, usage of forceps, length of the second stage of delivery, and sphincter damage as modifiable risk factors for PFD. Maternal age, fetal position, and fetal head circumference are nonmodifiable risk factors. Although numerous studies show that vaginal delivery affects pelvic floor structures and their functions in a negative way, there is not enough scientific evidence to recommend elective cesarean delivery in order to prevent development of PFD. PFD is a heterogeneous pathological condition, and the effects of pregnancy, vaginal delivery, cesarean delivery, and possible risk factors of PFD may be different from each other. Observational studies have identified certain obstetrical exposures as risk factors for pelvic floor disorders. These factors often coexist; therefore, the isolated effects of these variables on the pelvic floor are difficult to study. The routine use of episiotomy for many years in order to prevent PFD is not recommended anymore; episiotomy should be used in selected cases, and the mediolateral procedures should be used if needed.

  7. Transcatheter ovarian vein embolization for pelvic congestion syndrome: short-term outcome

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ji Seon; Oh, Joo Hyeong; Yoon, Yup; Huh, Joo Yup [College of Medicine, Kyunghee Univ., Seoul (Korea, Republic of); Jeong, Yu Mee [College of Medicine, Dongguk Univ., Seoul (Korea, Republic of)

    2002-04-01

    To evaluate the short-term therapeutic effectiveness of ovarian vein embolization using coils for pelvic congestion syndrome (PCS), a common cause of chronic pelvic pain, and to determine patient satisfaction. Forty-four multiparous women aged 26-73 (mean, 39.9) years in whom chronic pelvic pain due to unknown causes had lasted for more than six months, and whose gynecologic findings and laboratory data suggested PCS, underwent transabdominal or transvaginal ultrasonography and selective ovarian venography. PSC was finally diagnosed in 21 of th 44, who underwent 22 ovarian vein embolizations (in one case, bilaterally). The simple pain rating system was used at admission, with a 'minimal' or 'moderate' grade representing discomfort in daily life, and 'severe; indicating the need for medication. Indications for coil embolization included dilatation of the ovarian vein to a diameter of more than 6 mm, reflux involving an incompetent valve, congestion of the pelvic venous plexus (involving the stasis of contrast media), and /or opacification of the ipsilateral internal iliac vein (or contralateral filling). Embolizations were undertaken using coils of optimal size and number, and the mean follow-up period was 217 (31-267) days. By means of a telephone questionnaire, the outcome was classified as a cure, pain reduction, or 'no change, or aggravation', and on the basis of whether or not they would opt for the same treatment, or recommend embolization to others, patient satisfaction was graded as 'substantial', 'moderate', or 'absent'. Venous occlusion was confirmed at postembolization venography in all 22 cases. Clinical treatment led to symptomatic relief in 76.2% of patients a cure in 33.3%(7/21), pain reduction in 42.9%(9/21) and no imchage, or aggravation, in 23.8%(5/21). Eighteen patients (85.5%) were very (9/21, 42.9%) or moderately (9/21, 42.9%) satisfied with coil embolization. In two, the coil

  8. Transcatheter ovarian vein embolization for pelvic congestion syndrome: short-term outcome

    International Nuclear Information System (INIS)

    Park, Ji Seon; Oh, Joo Hyeong; Yoon, Yup; Huh, Joo Yup; Jeong, Yu Mee

    2002-01-01

    To evaluate the short-term therapeutic effectiveness of ovarian vein embolization using coils for pelvic congestion syndrome (PCS), a common cause of chronic pelvic pain, and to determine patient satisfaction. Forty-four multiparous women aged 26-73 (mean, 39.9) years in whom chronic pelvic pain due to unknown causes had lasted for more than six months, and whose gynecologic findings and laboratory data suggested PCS, underwent transabdominal or transvaginal ultrasonography and selective ovarian venography. PSC was finally diagnosed in 21 of th 44, who underwent 22 ovarian vein embolizations (in one case, bilaterally). The simple pain rating system was used at admission, with a 'minimal' or 'moderate' grade representing discomfort in daily life, and 'severe; indicating the need for medication. Indications for coil embolization included dilatation of the ovarian vein to a diameter of more than 6 mm, reflux involving an incompetent valve, congestion of the pelvic venous plexus (involving the stasis of contrast media), and /or opacification of the ipsilateral internal iliac vein (or contralateral filling). Embolizations were undertaken using coils of optimal size and number, and the mean follow-up period was 217 (31-267) days. By means of a telephone questionnaire, the outcome was classified as a cure, pain reduction, or 'no change, or aggravation', and on the basis of whether or not they would opt for the same treatment, or recommend embolization to others, patient satisfaction was graded as 'substantial', 'moderate', or 'absent'. Venous occlusion was confirmed at postembolization venography in all 22 cases. Clinical treatment led to symptomatic relief in 76.2% of patients a cure in 33.3%(7/21), pain reduction in 42.9%(9/21) and no imchage, or aggravation, in 23.8%(5/21). Eighteen patients (85.5%) were very (9/21, 42.9%) or moderately (9/21, 42.9%) satisfied with coil embolization. In two, the coil migrated, and was successfully retrieved using a snare loop. In this

  9. A unique case of bifid left testicular artery having its anomalous high origin from renal artery

    Directory of Open Access Journals (Sweden)

    Ashwini P Aithal

    2016-01-01

    Full Text Available The testicular arteries are known to originate from the ventrolateral aspect of the abdominal aorta and descend obliquely to the pelvic cavity and supply the testis. An anatomical description of an uncommon variation of the left testicular artery is presented in this case report, highlighting its clinical implications. During routine dissection of a male cadaver, we found that the left testicular artery was bifid and it was arising from the left renal artery. After its origin, it then coursed behind the left renal vein, passed between the left testicular vein and left ureter and at the lower pole of the left kidney, this bifid testicular artery joined to form a single testicular artery which thereafter presented a normal course. Anatomy of the testicular artery has been studied in detail because of its importance in testicular physiology, as well as its significance in testicular and renal surgery. This vascular variation shows a major significance in renal surgery, partial or total nephrectomy, and renal transplant. In addition, this anatomical variation enhances the importance of arteriography or the Doppler ultrasound examination of the renal hilum before surgeries.

  10. Ectopia renal cruzada con fusión, reflujo vesicoureteral y riñón ectópico afuncional:: informe de un caso Crossed renal ectopia with fusion, vesicoureteral reflux and dysfunctional ectopic kidney:: A case report

    Directory of Open Access Journals (Sweden)

    Sandalio Durán Álvarez

    2010-03-01

    Full Text Available Se presenta el caso de un niño cuyo ultrasonido materno-fetal de la semana 20 de la gestación no detectó alteraciones, pero el de la semana 23,6 mostró un riñón pélvico derecho. A los 22 días de nacido el ultrasonido renal mostró un riñón derecho de tamaño y posición normal y dilatación pélvica moderada, e inmediatamente por debajo del polo inferior de éste, un bolsón hidronefrótico que parecía corresponder a una ectopia renal cruzada con hidronefrosis grave. El padre padeció reflujo vesicoureteral derecho que desapareció espontáneamente. A pesar de la profilaxis con cefalexina, hubo una infección urinaria que se trató satisfactoriamente con ceftriaxona. Investigaciones ultrasonográficas y radioisotópicas arrojaron la existencia de una anomalía congénita dada por dilatación pélvica no obstructiva del riñón derecho, ectopia renal cruzada con fusión del riñón izquierdo afuncional y reflujo vesicoureteral bilateral, de grado II del riñón derecho y de grado V del izquierdo ectópico cruzado. A los 11 meses de edad se le realizó una lumbotomía y se comprobó la fusión del bolsón hidronefrótico con el polo inferior del riñón derecho. Se resecó el bolsón y se realizó una ligadura baja del uréter.This is the case of a child whose maternal-fetus ultrasound (US at twenty weeks pregnancy not detected alterations, but at the 23, 6 weeks it showed the presence of a right pelvic kidney. At twenty two days the renal US showed a right kidney with a normal size and location as well as a moderate pelvic dilation and immediately beneath its lower pole a hydronephrosis big sac in correspondence with a crossed renal ectopia with severe hydronephrosis. His father had right vesiculorectal reflux disappeared spontaneously. Despite the prophylaxis with Cephalexin there was a urinary infection adequately treated with Cephtriaxone. Ultrasonography and radioisotope researches demonstrated the presence of a congenital anomaly

  11. CT guided percutaneous renal cysts puncture with ethanol therapy

    International Nuclear Information System (INIS)

    Zhang Xuezhe; Lu Yan; Wang Wu; Huang Zhengguo; Ren An

    2002-01-01

    Objective: To analyse our clinical experience with CT guided percutaneous renal cysts puncture and ethanol therapy. Methods: Five hundred and ten renal cysts in 445 patients were undergone CT guided percutaneous renal cysts puncture and ethanol therapy. Among the 445 cases, 385 cases had solitary renal cyst, 53 multiple renal cysts, and 7 polycystic kidneys. The renal cysts varied in size from 1.9 to 13.5 cm in diameter. The amount of aspirated fluid varied from 3 to 780 ml. A 18-21 gauge aspiration needles were used for all patients. A 25.0% cyst volume replacement with 99.7% ethanol was approved to be appropriate. Results: 427 renal cysts in 396 patients were followed up by computed tomographic (CT) or ultrasound for less than 3 months to more than one year duration. The curative effective rate and disappearance rate of the renal cystic cavity in solitary renal cysts were 97% and 82%, respectively. In multiple renal cysts, the corresponding values were 95% and 79%. In polycystic kidneys, the curative rate was 67%. The complications such as local abdominal pain (28 cases) and hematuria (four cases) were observed in this series. There were no fatal complications. Conclusions: CT guided percutaneous renal cyst puncture and ethanol therapy is an useful procedure for the treatment of solitary renal cysts and multiple renal cysts

  12. Functional anatomy of pelvic floor

    Directory of Open Access Journals (Sweden)

    Salvatore Rocca Rossetti

    2016-03-01

    Full Text Available 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.

  13. Pelvic belt effects on pelvic morphometry, muscle activity and body balance in patients with sacroiliac joint dysfunction.

    Directory of Open Access Journals (Sweden)

    Odette Soisson

    Full Text Available 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.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.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.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.

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

    Science.gov (United States)

    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

  15. Pelvic belt effects on pelvic morphometry, muscle activity and body balance in patients with sacroiliac joint dysfunction.

    Science.gov (United States)

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

    2015-01-01

    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. 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. 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. 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.

  16. [The Life Impacts and Symptom Distress in Women With Pelvic Organ Prolapse Syndrome Before Pelvic Reconstruction Surgery].

    Science.gov (United States)

    Ko, I-Chen; Lo, Tsia-Shu; Lu, Yu-Ying; Tsao, Lee-Ing

    2017-02-01

    The decision whether or not to undergo pelvic reconstructive surgery is difficult for women suffering from pelvic organ prolapse. However, little research has examined the symptom distress and life impacts that these women face prior to this surgery. Thus, it is crucial that gynecology nurses learn about these life impacts and symptom distresses in order to help these women make the best decisions with regard to surgery. To explore the life impacts and degree of symptom distress in pre-surgery women with pelvic organ prolapse; to explore the relationships between demographic data and the variables of life impact and degree of symptom distress; and to identify the factors that relate to the explainable variance in the life impacts of these women. A cross-sectional and correlational research design was used and a total of 110 women with pelvic organ prolapse who had not yet undergone pelvic reconstruction surgery were recruited in the gynecological clinics of one medical center in Taiwan. Daytime urination frequency was the most prevalent urinary tract symptom noted by the participants; vaginal protrusion was the most prevalent pelvis-related symptom noted; and depression and anxiety were the most prevalent life impacts noted. Moreover, greater lower-urinary-tract symptom distress was associated with greater pelvic-symptom distress. Furthermore, greater lower urinary tract and pelvic symptom distresses were associated with a greater negative impact on life. Education background and pelvis-related symptoms were the explained variances in pre-surgery life impacts. Women with pelvic organ prolapse should pay particular attention to symptoms that include: daytime urinary frequency, vaginal protrusion, and emotional problems including depression and anxiety. Education background and level of symptom distress should be taken into consideration when caring for the life impacts of this vulnerable group of women.

  17. Early development of the human pelvic diaphragm

    NARCIS (Netherlands)

    Koch, Wijnandus Franciscus Robertus Maria

    2006-01-01

    The last decade an increasing interest in the pelvic floor can be observed in medical sciences. The lack of data on the development of the human pelvic floor is striking. The early development of the human pelvic diaphragm was studied. Materials and methodsUse was made of 38 human embryos and

  18. [Continuous improvement of portable domestic pelvic floor neuromuscular electrical stimulation on the pelvic floor function of patients with urinary incontinence].

    Science.gov (United States)

    Sun, Zhijing; Zhu, Lan; Lang, Jinghe; Wang, Wei; Shi, Honghui; Pang, Hongxia; Shi, Xinwen

    2015-12-01

    To evaluate continuous improvement of portable domestic pelvic floor neuromuscular electrical stimulation on the pelvic floor function of patients with stress urinary incontinence after short-term pelvic floor electrophysiological treatment in hospital. Totally 60 women with stress urinary incontinence were recruited for this randomized controlled trial. The control group including a total of 30 patients, only received 4 weeks pelvic floor electrophysiological treatment in the hospital. Family consolidation treatment group (experimental group) including 30 patients, after 4-week treatment in hospital, received 12-week of pelvic floor neuromuscular electrical stimulation using portable electrical stimulator at home under the guidance of doctors. In post-treatment 6 months and 9 months, 1-hour pad test was measured for urine leakage, pelvic floor electrical physiological parameters were assessed, and subjective improvement of symptoms of urinary incontinence were evaluated. All these data were analysed to compare the effect of the two groups. In 9 months after treatment, average change of urine leakage, the control group and experiment group were (75±24)% versus (99±3)%, the difference was statistically significant (Pcontinuous improvement of pelvic floor function.

  19. Volumetric analysis of pelvic hematomas after blunt trauma using semi-automated seeded region growing segmentation: a method validation study.

    Science.gov (United States)

    Dreizin, David; Bodanapally, Uttam K; Neerchal, Nagaraj; Tirada, Nikki; Patlas, Michael; Herskovits, Edward

    2016-11-01

    Manually segmented traumatic pelvic hematoma volumes are strongly predictive of active bleeding at conventional angiography, but the method is time intensive, limiting its clinical applicability. We compared volumetric analysis using semi-automated region growing segmentation to manual segmentation and diameter-based size estimates in patients with pelvic hematomas after blunt pelvic trauma. A 14-patient cohort was selected in an anonymous randomized fashion from a dataset of patients with pelvic binders at MDCT, collected retrospectively as part of a HIPAA-compliant IRB-approved study from January 2008 to December 2013. To evaluate intermethod differences, one reader (R1) performed three volume measurements using the manual technique and three volume measurements using the semi-automated technique. To evaluate interobserver differences for semi-automated segmentation, a second reader (R2) performed three semi-automated measurements. One-way analysis of variance was used to compare differences in mean volumes. Time effort was also compared. Correlation between the two methods as well as two shorthand appraisals (greatest diameter, and the ABC/2 method for estimating ellipsoid volumes) was assessed with Spearman's rho (r). Intraobserver variability was lower for semi-automated compared to manual segmentation, with standard deviations ranging between ±5-32 mL and ±17-84 mL, respectively (p = 0.0003). There was no significant difference in mean volumes between the two readers' semi-automated measurements (p = 0.83); however, means were lower for the semi-automated compared with the manual technique (manual: mean and SD 309.6 ± 139 mL; R1 semi-auto: 229.6 ± 88.2 mL, p = 0.004; R2 semi-auto: 243.79 ± 99.7 mL, p = 0.021). Despite differences in means, the correlation between the two methods was very strong and highly significant (r = 0.91, p hematoma volumes correlate strongly with manually segmented volumes. Since semi-automated segmentation

  20. Magnetic resonance imaging of pelvic floor dysfunction.

    Science.gov (United States)

    Lalwani, Neeraj; Moshiri, Mariam; Lee, Jean H; Bhargava, Puneet; Dighe, Manjiri K

    2013-11-01

    Pelvic floor dysfunction is largely a complex problem of multiparous and postmenopausal women and is associated with pelvic floor or organ descent. Physical examination can underestimate the extent of the dysfunction and misdiagnose the disorders. Functional magnetic resonance (MR) imaging is emerging as a promising tool to evaluate the dynamics of the pelvic floor and use for surgical triage and operative planning. This article reviews the anatomy and pathology of pelvic floor dysfunction, typical imaging findings, and the current role of functional MR imaging. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Knowledge of the pelvic floor in nulliparous women

    OpenAIRE

    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 dys...

  2. Imaging findings in idiopathic pelvic fibrosis

    International Nuclear Information System (INIS)

    Wiesner, W.; Bongartz, G.; Stoffel, F.

    2001-01-01

    Two patients presented with ureteric obstruction, and voiding symptoms and constipation, respectively, and were examined by means of intravenous urography and computed tomography. One patient was additionally examined by means of MR tomography. After CT (performed in both patients) and MRT (performed in one patient) had shown a diffuse, contrast-enhancing, infiltrating process in the small pelvis with infiltration of adjacent organs and vessels, surgical biopsy proved the diagnosis of idopathic pelvic fibrosis. Extension of retroperitoneal fibrosis below the pelvic rim is very rare. Clinical symptoms of pelvic fibrosis are variable and imaging findings may lead to a broad list of differential diagnoses. We present two patients with idiopathic pelvic fibrosis and discuss radiological findings and differential diagnoses of this rare disease. (orig.)

  3. Imaging findings in idiopathic pelvic fibrosis

    Energy Technology Data Exchange (ETDEWEB)

    Wiesner, W.; Bongartz, G. [Inst. of Diagnostic Radiology University Hospital Basel (Switzerland); Stoffel, F. [Inst. of Urology, University Hospital Basel (Switzerland)

    2001-04-01

    Two patients presented with ureteric obstruction, and voiding symptoms and constipation, respectively, and were examined by means of intravenous urography and computed tomography. One patient was additionally examined by means of MR tomography. After CT (performed in both patients) and MRT (performed in one patient) had shown a diffuse, contrast-enhancing, infiltrating process in the small pelvis with infiltration of adjacent organs and vessels, surgical biopsy proved the diagnosis of idopathic pelvic fibrosis. Extension of retroperitoneal fibrosis below the pelvic rim is very rare. Clinical symptoms of pelvic fibrosis are variable and imaging findings may lead to a broad list of differential diagnoses. We present two patients with idiopathic pelvic fibrosis and discuss radiological findings and differential diagnoses of this rare disease. (orig.)

  4. Physical activity and the pelvic floor.

    Science.gov (United States)

    Nygaard, Ingrid E; Shaw, Janet M

    2016-02-01

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

  5. Intra-abdominal gout mimicking pelvic abscess

    International Nuclear Information System (INIS)

    Chen, Chia-Hui; Chen, Clement Kuen-Huang; Yeh, Lee-Ren; Pan, Huay-Ban; Yang, Chien-Fang

    2005-01-01

    Gout is the most common crystal-induced arthritis. Gouty tophi typically deposit in the extremities, especially toes and fingers. We present an unusual case of intrapelvic tophaceous gout in a patient suffering from chronic gouty arthritis. CT and MRI of the abdomen and pelvic cavity disclosed calcified gouty tophi around both hips, and a cystic lesion with peripheral enhancement in the pelvic cavity along the course of the iliopsoas muscle. The intra-abdominal tophus mimicked pelvic abscess. (orig.)

  6. Intra-abdominal gout mimicking pelvic abscess

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Chia-Hui; Chen, Clement Kuen-Huang [Kaohsiung Veterans General Hospital, Department of Radiology, Kaohsiung (Taiwan); National Yang-Ming University, School of Medicine, Taipei (Taiwan); Yeh, Lee-Ren; Pan, Huay-Ban; Yang, Chien-Fang [Kaohsiung Veterans General Hospital, Department of Radiology, Kaohsiung (Taiwan)

    2005-04-01

    Gout is the most common crystal-induced arthritis. Gouty tophi typically deposit in the extremities, especially toes and fingers. We present an unusual case of intrapelvic tophaceous gout in a patient suffering from chronic gouty arthritis. CT and MRI of the abdomen and pelvic cavity disclosed calcified gouty tophi around both hips, and a cystic lesion with peripheral enhancement in the pelvic cavity along the course of the iliopsoas muscle. The intra-abdominal tophus mimicked pelvic abscess. (orig.)

  7. Gynecological pelvic pain as emergency pathology.

    Science.gov (United States)

    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. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Triple pelvic ring fixation in patients with severe pregnancy-related low back and pelvic pain.

    NARCIS (Netherlands)

    Zwienen, C.M. van; Bosch, E.W. van den; Snijders, C.J.; Vugt, A.B. van

    2004-01-01

    STUDY DESIGN: Single-group prospective follow-up study. OBJECTIVES: To assess the functional outcome of internal fixation of the pelvic ring in patients with severe pregnancy-related low back and pelvic pain (PLBP) in whom all other treatments failed. BACKGROUND DATA: More than half of all pregnant

  9. Radiographic assessment of pelvic trauma

    International Nuclear Information System (INIS)

    Rubenstein, J.D.

    1983-01-01

    Assessment of pelvic fractures requires an understanding of the bony and soft-tissue anatomy of the pelvis. Pelvic injuries may be classified into major and minor groups. Minor fractures usually result from athletic trauma in the young or falls in the elderly and can generally be adequately evaluated with routine radiography. Major fractures are most often caused by motor vehicle accidents, falls from a height or industrial accidents and require more sophisticated examination. However, the investigation of injuries in either category should be directed by a knowledge of the history and physical findings. The classification of pelvic injuries used at Sunnbrook Medical Centre is based on mechanisms of injury

  10. A randomized clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength.

    Science.gov (United States)

    Culligan, Patrick J; Scherer, Janet; Dyer, Keisha; Priestley, Jennifer L; Guingon-White, Geri; Delvecchio, Donna; Vangeli, Margi

    2010-04-01

    The purpose of this study is to determine whether a Pilates exercise program and a pelvic floor muscle-training (PFMT) program could provide similar improvements in pelvic muscle strength. Sixty-two women with little or no pelvic floor dysfunction were randomized to Pilates or PFMT. Each group had 24 biweekly 1-h sessions with either a physical therapist or Pilates instructor. Strength was measured via perineometry (cmH(2)O). Two questionnaires--pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7)--were also collected. At baseline, the Pilates and PFMT groups measured 14.9 +/- 12.5 and 12.5 +/- 10.4 cmH(2)O, respectively (p = 0.41). Both the Pilates and PFMT groups got stronger (6.2 +/- 7.5 cmH(2)O, p = 0.0002 and 6.6 +/- 7.4 cmH(2)O, p = 0.0002, respectively), with no difference between groups p = 0.85. PFIQ and PFDI scores improved from baseline but not between groups. Further study is required to determine if Pilates can actually treat pelvic floor dysfunction.

  11. [Quality of life in women with pelvic floor dysfunction].

    Science.gov (United States)

    Segedi, Ljiljana Mladenović; Ilić, Katarina Parezanović; Curcić, Aleksandar; Visnjevac, Nemanja

    2011-11-01

    Pelvic floor dysfunction is a frequent problem affecting more than 50% of women in peri- and postmenopause. Considering that ageing and menopause befall in the significant factors causing this issue, as well as the expected longevity of women in the world and in our country, pelvic floor dysfunction prevelence is foreseen to be even higher. The aim of the study was to evaluate impact of the symptoms of pelvic dysfunction on quality of life and examine body image satisfaction in adult women with pelvic organ prolapse presenting to tertiary care clinic for surgical treatment. This prospective case-control study included 50 patients who presented to tertiary care gynecology clinic for surgical treatment and 50 controls with normal pelvic floor support and without urinary incontinence who presented tertiary care gynecology clinic for other reasons. Both, patients and controls, completed two quastionnaires recommended for the evaluation of symptoms (Pelvic floor distress inventory - short forms) and quality of life impact (Pelvic floor impact questionnaire - short form) of pelvic organ prolapse, and Body Image Scale. The patients scored significantly worse on the prolapse, urinary, colorectal scales and overall score of Pelvic floor distress inventory--20 than controls subjects (134.91 vs 78.08; p self-conscious (78% vs 42%; p body. There was a positive correlation between decreased quality of life and body image in women with pelvic dysfunction. Women with pelvic floor dysfunction have decreased quality of life and body image.

  12. Occupational lifting and pelvic pain during pregnancy:

    DEFF Research Database (Denmark)

    Larsen, Pernille Stemann; Strandberg-Larsen, Katrine; Juhl, Mette

    2013-01-01

    OBJECTIVES: Pelvic pain during pregnancy is a common ailment, and the disease is a major cause of sickness absence during pregnancy. It is plausible that occupational lifting may be a risk factor of pelvic pain during pregnancy, but no previous studies have examined this specific exposure. The aim...... of this study was to examine the association between occupational lifting and pelvic pain during pregnancy. METHODS: The study comprised 50 143 pregnant women, enrolled in the Danish National Birth Cohort in the period from 1996-2002. During pregnancy, the women provided information on occupational lifting...... (weight load and daily frequency), and six months post partum on pelvic pain. Adjusted odds ratios for pelvic pain during pregnancy according to occupational lifting were calculated by logistic regression. RESULTS: Any self-reported occupational lifting (>1 time/day and loads weighing >10 kg...

  13. Are routine pelvic radiographs in major pediatric blunt trauma necessary?

    Science.gov (United States)

    Lagisetty, Jyothi; Slovis, Thomas; Thomas, Ronald; Knazik, Stephen; Stankovic, Curt

    2012-07-01

    Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children. To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma. We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture. Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients.

  14. Pelvic pain in a young patient: Sclerosing stromal tumor

    Directory of Open Access Journals (Sweden)

    Huriye Ayşe Parlakgümüş

    2013-03-01

    Full Text Available Introduction: Sclerosing stromal tumors are rare, benign sex chord stromal tumors. They are usually unilateral and are seen in second or third decades. The complaint at admission may be menstrual irregularity, pelvic pain, palpable pelvic mass, precocious puberty and postmenopausal bleeding. Because the complaint at admission and radiological findings are not specific to SSTs preoperative diagnosis is challenging. Herein we present the sonographical, intraoperative and histopathological findings of a SST diagnosed during laparoscopy in a patient who admitted with chronic pelvic pain and received pelvic inflammatory disease and endometriosis treatment and differential diagnosis of SSTs with the other ovarian tumors. Case report: 24 years old nulliparous patient first admitted to the gynecology department with the complaint of foul smelling vaginal discharge and pelvic pain. The diagnosis was pelvic inflammatory disease and the patient received antibiotics. The pelvic examination was normal except the mass in the right ovary which had similar echogenity to the ovary. Because of the pelvic pain the mass was assumed to be an endometrioma and the patient was prescribed an oral contraceptive treatment for 3 months. Because of the persistent pelvic pain a diagnostic laparoscopy was performed which revealed a 2 cm, pinkish- white, exophytic lesion originating from the right ovary. Pathological examination reported the mass to be a sclerosing stromal tumor. After the treatment the patient no longer complained of vaginal discharge but pelvic pain still persisted. After the operation the patient no longer complained of pelvic pain. Conclusion: Although SSTs are rare, they should be kept in mind when a young patient admits with menstrual irregularity, pelvic pain and hirsutism, particularly if the pain is refractory to treatment.

  15. Urinary Extracellular Vesicles: Potential Biomarkers of Renal Function in Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Agnieszka Kamińska

    2016-01-01

    Full Text Available The aim of this study was to check the relationship between the density of urinary EVs, their size distribution, and the progress of early renal damage in type 2 diabetic patients (DMt2. Patients were enrolled to this study, and glycated hemoglobin (HbA1c below 7% was a threshold for properly controlled diabetic patients (CD and poorly controlled diabetic patients (UD. Patients were further divided into two groups: diabetic patients without renal failure (NRF and with renal failure (RF according to the Glomerular Filtration Rate. Density and diameter of EVs were determined by Tunable Resistive Pulse Sensing. Additionally, EVs were visualized by means of Transmission and Environmental Scanning Electron Microscopy. Nano-liquid chromatography coupled offline with mass spectrometry (MALDI-TOF-MS/MS was applied for proteomic analysis. RF had reduced density of EVs compared to NRF. The size distribution study showed that CD had larger EVs (mode than UD (115 versus 109 nm; p<0.05; nevertheless the mean EVs diameter was smaller in controls than in the CD group (123 versus 134 nm; p<0.05. It was demonstrated that EVs are abundant in urine. Albumin, uromodulin, and number of unique proteins related to cell stress and secretion were detected in the EVs fraction. Density and size of urinary EVs reflect deteriorated renal function and can be considered as potential renal damage biomarkers.

  16. Pelvic Mass Due to Transmigrated IUD

    Directory of Open Access Journals (Sweden)

    Nadereh Behtash

    2010-03-01

    Full Text Available Intrauterine device (IUD, a conventional method of contraception is rarely associated with uterine perforation and extra uterine dislocation. A 29 years old woman complaining of vaginal bleeding was referred for pelvic mass identified in ultrasound. The mass was confirmed with CT scan. In laparatomy we found an IUD in cul-de-sac and pelvic mass was apparently an organized hematoma. Transmigrated IUD can induce organized hematomas presenting as a pelvic mass."n© 2010 Tehran University of Medical Sciences. All rights reserved.

  17. Pelvic Pain

    Science.gov (United States)

    ... OLPP) Office of Science Policy, Reporting, and Program Analysis (OSPRA) Division of Extramural Research (DER) Extramural Scientific ... treat my pain? Can pelvic pain affect my emotional well-being? How can I cope with long- ...

  18. Pelvic Exam

    Science.gov (United States)

    ... each step so that nothing comes as a surprise to you. After the pelvic exam After the ... Clinic does not endorse any of the third party products and services advertised. Advertising and sponsorship policy ...

  19. Pelvic floor function during and after first pregnancy

    NARCIS (Netherlands)

    Brummen, H.J. van

    2006-01-01

    This study evaluated the effects the first pregnancy and childbirth on the pelvic floor. Pregnancy and vaginal delivery can negatively affect pelvic floor function. Micturition symptoms, defecation symptoms and sexual dysfunction are all signs of an impaired pelvic floor function. These symptoms are

  20. Preoperative evaluation of locally spreaded pelvic tumors

    International Nuclear Information System (INIS)

    Baramia, M.; Todua, F.; Gotsadze, D.; Khutulashvili, N.; Lashkhi, K.; Nadareishvili, A.

    1998-01-01

    Am of the study: preoperative evaluation of patients with locally advanced pelvic tumors subjected to pelvic exenteration. Determine operability to avoid explorative laparatomies, which cause serious complications in these patients. Evaluate condition of urinary system in case of this pathology. Materials and methods: 34 patients with locally advanced pelvic tumors where pelvic exenteration was attempted were studied. Along with other methods of diagnostic CT and MRI were performed. Results: In all patients secondary involvement of the urinary bladder was noted. In 30 patients CT and MR findings were confirmed (88,2%) intraoperatively and different types of pelvic organs exenteration were performed. In 1 case spread of tomoruos infiltrate to the pelvic wall and common iliac vessels was detected intraoperatively (patient had history of radiation therapy). In 2 cases carcinomatosis of the peritoneum was found. In 1 case involvement of urinary bladder was simulated by close attachment of enlarged uterus. Conclusion: Obtained results show, that CT and MR are highly informative methods of disease spread evaluation and thus determining operability. Radiotherapy performed prior to operation sets difficulties in differentiation for tumourous infiltrate and post-radiotherapy changes in pelvis. (Full text)

  1. Physical exercise and pelvic girdle pain in pregnancy

    DEFF Research Database (Denmark)

    Andersen, Linda Kahr; Backhausen, Mette; Hegaard, Hanne Kristine

    2015-01-01

    OBJECTIVE: Pelvic girdle pain is a frequent cause of sick leave among pregnant women in Denmark. Studies regarding prevention of pelvic girdle pain are sparse. The aim of this study was to examine the association between physical exercise and pelvic girdle pain in pregnancy. STUDY DESIGN: A nested...... case-control study within the Danish National Birth Cohort (n = 5304). METHODS: This study used self-reported data on pelvic girdle pain obtained from an interview six months after childbirth. Information on physical exercise was obtained from the pregnancy interview around gestational week 16....... The association was estimated using logistic regression analysis. RESULTS: Physical exercise in pregnancy was associated with decreased risk of overall pelvic girdle pain (OR = 0.87; 95% CI: 0.77-0.99, p = 0.028). Tests for trend indicated decreasing odds for pelvic girdle pain with increasing number of hours per...

  2. Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction

    Science.gov (United States)

    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

  3. Imaging pelvic floor disorders. 2. rev. ed.

    International Nuclear Information System (INIS)

    Stoker, Jaap; Taylor, Stuart A.; DeLancey, John O.L.

    2008-01-01

    This volume builds on the success of the first edition of imaging pelvic floor disorders and is aimed at those practitioners with an interest in the imaging, diagnosis and treatment of pelvic floor dysfunction. Concise textual information from acknowledged experts is complemented by high-quality diagrams and images to provide a thorough update of this rapidly evolving field. Introductory chapters fully elucidate the anatomical basis underlying disorders of the pelvic floor. State of the art imaging techniques and their application in pelvic floor dysfunction are then discussed in detail. Additions since the first edition include consideration of the effect of aging and new chapters on perineal ultrasound, functional MRI and MRI of the levator muscles. The closing sections of the book describe the modern clinical management of pelvic floor dysfunction, including prolapse, urinary and faecal incontinence and constipation, with specific emphasis on the integration of diagnostic and treatment algorithms. (orig.)

  4. Imaging pelvic floor disorders. 2. rev. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Stoker, Jaap [Amsterdam Univ. (Netherlands). Dept. of Radiology; Taylor, Stuart A. [University College Hospital, London (United Kingdom). Dept. of Specialist X-Ray; DeLancey, John O.L. (eds.) [Michigan Univ., Ann Arbor, MI (United States). L4000 Women' s Hospital

    2008-07-01

    This volume builds on the success of the first edition of imaging pelvic floor disorders and is aimed at those practitioners with an interest in the imaging, diagnosis and treatment of pelvic floor dysfunction. Concise textual information from acknowledged experts is complemented by high-quality diagrams and images to provide a thorough update of this rapidly evolving field. Introductory chapters fully elucidate the anatomical basis underlying disorders of the pelvic floor. State of the art imaging techniques and their application in pelvic floor dysfunction are then discussed in detail. Additions since the first edition include consideration of the effect of aging and new chapters on perineal ultrasound, functional MRI and MRI of the levator muscles. The closing sections of the book describe the modern clinical management of pelvic floor dysfunction, including prolapse, urinary and faecal incontinence and constipation, with specific emphasis on the integration of diagnostic and treatment algorithms. (orig.)

  5. A Suspected Pelvic Aneurysmal Bone Cyst in Pregnancy

    Directory of Open Access Journals (Sweden)

    Rayan Elkattah

    2013-01-01

    Full Text Available Albeit rare, the majority of identified bone lesions in pregnancy spare the pelvis. Once encountered with a pelvic bone lesion in pregnancy, the obstetrician may face a challenging situation as it is difficult to determine and predict the effects that labor and parturition impart on the pelvic bones. Bone changes and pelvic bone fractures have been well documented during childbirth. The data regarding clinical outcomes and management of pregnancies complicated by pelvic ABCs is scant. Highly suspected to represent an aneurysmal bone cyst, the clinical evaluation of a pelvic lesion in the ilium of a pregnant individual is presented, and modes of delivery in such a scenario are discussed.

  6. Are routine pelvic radiographs in major pediatric blunt trauma necessary?

    International Nuclear Information System (INIS)

    Lagisetty, Jyothi; Slovis, Thomas; Thomas, Ronald; Knazik, Stephen; Stankovic, Curt

    2012-01-01

    Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children. To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma. We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture. Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS <14, positive urinalysis, abdominal pain/tenderness, femur fracture) and five high-risk mechanisms of injury (unrestrained motor vehicle collision [MVC], MVC with ejection, MVC rollover, auto vs. pedestrian, auto vs. bicycle). Pelvic fractures in pediatric major blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients. (orig.)

  7. Are routine pelvic radiographs in major pediatric blunt trauma necessary?

    Energy Technology Data Exchange (ETDEWEB)

    Lagisetty, Jyothi [Memorial Hermann Medical Center, Emergency Medicine Department, Houston, TX (United States); Slovis, Thomas [Wayne State University School of Medicine, Department of Radiology, Pediatric Imaging, Children' s Hospital of Michigan, Detroit, MI (United States); Thomas, Ronald [Children' s Hospital of Michigan, Wayne State University of Medicine, Department of Pediatrics, Detroit, MI (United States); Knazik, Stephen; Stankovic, Curt [Wayne State University of Medicine, Division of Emergency Medicine, Children' s Hospital of Michigan, Detroit, MI (United States)

    2012-07-15

    Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children. To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma. We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture. Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS <14, positive urinalysis, abdominal pain/tenderness, femur fracture) and five high-risk mechanisms of injury (unrestrained motor vehicle collision [MVC], MVC with ejection, MVC rollover, auto vs. pedestrian, auto vs. bicycle). Pelvic fractures in pediatric major blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients. (orig.)

  8. Association between preterm labour and pelvic floor muscle function.

    Science.gov (United States)

    Aran, Turhan; Pekgöz, Ipek; Bozkaya, Hasan; Osmanagaoglu, Mehmet A

    2018-03-23

    We hypothesised that the pressure on the cervix increases with advancing gestation and it may lead to a cervical shortening and cause preterm labour in women with weak pelvic floor muscles. The aim of this prospective study was to measure vaginal resting pressure and pelvic floor muscle strength in the first trimester of pregnancy and to investigate their effects on labour. A study was conducted on the pregnant women with a low risk for preterm birth. The pelvic floor muscle strength and vaginal resting pressure were assessed in 320 pregnant women at their first trimester with a vaginal pressure measurement device. Fifty-two pregnant women were hospitalised for tocolytic therapy because of spontaneous preterm labour. Thirty-two of them (10.2%) had a preterm delivery despite the tocolytic therapy. Both the vaginal resting pressure (p = .009, 95%CI: 0.8; 5.9) and the pelvic floor muscle strength (p = .01, 95%CI: 3.5; 13.1) were significantly lower in the women with a preterm labour. Impact statement What is already known on this subject? The pelvic floor muscles have an essential role in continence and provide support to the pelvic organs. They also have an impact on labour. The pelvic floor muscles should distend to allow the passage of the foetus during labour. The rotation and flexion of the foetal head is due to the pelvic floor resistance. The effect of a vaginal birth on the pelvic floor's function is readily understood. On the other hand, the effect of the pelvic floor muscle function on labour is still controversial. What do the results of this study add? This prospective study showed that there is a negative association between the pelvic floor muscle strength and preterm labour. This is the first clinical study indicating that weak pelvic floor muscles may cause a preterm labour. What are the implications of these findings for clinical practice and/or further research? Pelvic floor physical therapy may be an alternative preventive strategy to reduce

  9. Pelvic X-ray misses out on detecting sacral fractures in the elderly - Importance of CT imaging in blunt pelvic trauma.

    Science.gov (United States)

    Schicho, Andreas; Schmidt, Stefan A; Seeber, Kevin; Olivier, Alain; Richter, Peter H; Gebhard, Florian

    2016-03-01

    Patients aged 75 years and older with blunt pelvic trauma are frequently seen in the ER. The standard diagnostic tool in these patients is the plain a.p.-radiograph of the pelvis. Especially lesions of the posterior pelvic ring are often missed due to e.g. bowel gas projection and enteric overlay. With a retrospective study covering these patients over a 3 year period in our level I trauma centre, we were able to evaluate the rate of missed injuries in the a.p.-radiograph whenever a corresponding CT scan was performed. Age, gender, and accompanying fractures of the pelvic ring were recorded. The intrinsic test characteristics and the performance in the population were calculated according to standard formulas. Thus, 233 consecutive patients with blunt pelvic trauma with both conventional radiographic examination and computed tomography (CT) were included. Thereof, 56 (23%) showed a sacral fracture in the CT scan. Of 233 pelvic X-ray-images taken, 227 showed no sacral fracture. 51 (21.7%) of these were false negative, yielding a sensitivity of just 10.5%. Average age of patients with sacral fractures was 85.1±6.1 years, with 88% being female. Sacral fractures were often accompanied by lesions of the anterior pelvic ring with pubic bone fractures in 75% of sacrum fracture cases. Second most concomitant fractures are found at the acetabulum (23.3%). Plain radiographic imaging is especially likely to miss out fractures of the posterior pelvic ring, which nowadays can be of therapeutic consequence. Besides the physicians experience in the ED, profound knowledge of insensitivity of plain radiographs in finding posterior pelvic ring lesions is crucial for a reliable diagnostic routine. Since the high mortality caused by prolonged immobilisation due to pelvic ring injuries, all fractures should be identified. We therefore provide a diagnostic algorithm for blunt pelvic trauma in the elderly. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Surgical reconstruction of pelvic floor descent: anatomic and functional aspects.

    Science.gov (United States)

    Wagenlehner, F M E; Bschleipfer, T; Liedl, B; Gunnemann, A; Petros, P; Weidner, W

    2010-01-01

    The human pelvic floor is a complex structure and pelvic floor dysfunction is seen frequently in females. This review focuses on the surgical reconstruction of the pelvic floor employing recent findings on functional anatomy. A selective literature research was performed by the authors. Pelvic floor activity is regulated by 3 main muscular forces that are responsible for vaginal tension and suspension of the pelvic floor organs, bladder and rectum. A variety of symptoms can derive from pelvic floor dysfunctions, such as urinary urge and stress incontinence, abnormal bladder emptying, fecal incontinence, obstructive bowel disease syndrome and pelvic pain. These symptoms mainly derive, for different reasons, from laxity in the vagina or its supporting ligaments as a result of altered connective tissue. Pelvic floor reconstruction is nowadays driven by the concept that in case of pelvic floor symptoms, restoration of the anatomy will translate into restoration of the physiology and ultimately improve patients' symptoms. The surgical reconstruction of the anatomy is almost exclusively focused on the restoration of the lax pelvic floor ligaments. Exact preoperative identification of the anatomical lesions is necessary to allow for exact anatomical reconstruction with respect to the muscular forces of the pelvic floor. Copyright 2010 S. Karger AG, Basel.

  11. [Clinical characteristics and pathophysiology of pelvic pain in women].

    Science.gov (United States)

    Wesselmann, U

    2002-12-01

    Chronic pelvic pain is a common and debilitating problem that can significantly impair the quality of life of a woman. Patients with chronic pelvic pain are usually evaluated and treated by gynecologists, gastroenterologists, urologists, and internists. Although these patients seek medical care because they are looking for help to alleviate their pelvic discomfort and pain, in many cases the only focus is on finding and possibly treating the underlying pelvic disease.However, often the examination and work-up remain unrevealing and no specific cause of the pain can be identified. At this point patients are frequently told, that no etiology for their chronic pain syndrome can be found and that nothing can be done. In these cases it is important to recognize that pain is not only a symptom of pelvic disease, but that the patient is suffering from a chronic pelvic pain syndrome. Knowledge of the clinical characteristics of visceral pain will guide the health care provider in making a diagnosis of chronic pelvic pain and in sorting it out from the lump diagnosis of idiopathic pain. Once the diagnosis of chronic pelvic pain is made, treatment should be directed towards symptomatic pain management.This conceptualization of chronic pelvic pain is very important, because chronic pelvic pain is a treatable condition! Effective treatment modalities are available to lessen the impact of pain and offer reasonable expectations of an improved functional status.

  12. The 12-month effects of structured lifestyle advice and pelvic floor muscle training for pelvic organ prolapse

    DEFF Research Database (Denmark)

    Due, Ulla; Brostrøm, Søren; Lose, Gunnar

    2016-01-01

    INTRODUCTION: We evaluated the 12-month effects of adding pelvic floor muscle training to a lifestyle advice program in women with symptomatic pelvic organ prolapse stage II-III and the number of women who had sought further treatment. MATERIAL AND METHODS: This study was a 12-month follow up...... of a randomized controlled trial comparing a structured lifestyle advice program alone (lifestyle group) or in combination with pelvic floor muscle training (training and lifestyle group). Both programs consisted of six separate group sessions within 12 weeks. RESULTS: Data were available from 83 (76%) of the 109...... surgery. More severe anterior prolapse and more bladder symptoms at the 3-month follow up were significantly associated with having sought further treatment in both groups. CONCLUSIONS: At 12-month follow up, the effects of adding pelvic floor muscle training to a structured lifestyle advice program were...

  13. Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bruno Teixeira Bernardes

    Full Text Available CONTEXT AND OBJECTIVE: Previous studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (CSA of the levator ani muscle. One way to assess the effects of training programs is to measure the CSA of the muscle, using ultrasonography. The aim here was to evaluate the efficacy of pelvic floor muscle training and hypopressive exercises for increasing the CSA of the levator ani muscle in women with pelvic organ prolapse. DESIGN AND SETTING: Prospective randomized controlled trial at the Urogynecology outpatient clinic of Universidade Federal de São Paulo. METHODS: Fifty-eight women with stage II pelvic organ prolapse were divided into three groups for physiotherapy: a pelvic floor muscle training group (GI; a hypopressive exercise group (GII; and a control group (GIII. The patients underwent transperineal ultrasonographic evaluation using a transducer of frequency 4-9 MHz. The (CSA of the levator ani muscle was measured before physiotherapy and after 12 weeks of treatment. RESULTS: The groups were homogeneous regarding age, number of pregnancies, number of vaginal deliveries, body mass index and hormonal status. Statistically significant differences in CSA were found in GI and GII from before to after the treatment (P < 0.001, but not in relation to GIII (P = 0.816. CONCLUSIONS: The CSA of the levator ani muscle increased significantly with physiotherapy among the women with pelvic organ prolapse. Pelvic floor muscle training and hypopressive exercises produced similar improvements in the CSA of the levator ani muscle.

  14. Ultrasound guided transrectal catheter drainage of pelvic collections.

    Science.gov (United States)

    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.

  15. CT in the evaluation of pelvic trauma

    International Nuclear Information System (INIS)

    Federle, M.P.

    1986-01-01

    Pelvic fractures from motor vehicle accidents are a cause of substantial morbidity and permanent disability, and are the third leading cause of death following blunt trauma. Associated extremity fractures are common, and injury to abdominal and pelvic viscera may occur. Difficulty in establishing the source of hemorrhage may be encountered, especially since pelvic fractures with extraperitoneal bleeding may result in intraperitoneal bleeding through torn fascial planes. The difficulty in properly diagnosing and managing complex fractures of the pelvis and acetabulum is well documented. Prognosis is influenced by the type and extent of pelvic fracture and associated soft tissue injuries. Computed tomography (CT) has proved to be a valuable tool in evaluation of these complex and life-threatening injuries

  16. A Case Report of Human Infection with Dioctophyma Renale from Iran.

    Science.gov (United States)

    Norouzi, Roghayeh; Manochehri, Arman; Hanifi, Mustafa

    2017-03-16

    A 75-year-old man from Kurdistan province, western part of Iran was diagnosed with a mass in the right kidney by ultrasound and computed tomography. In operation, a parasitic helminth, 30 cm long and 1.2 cm in diameter consistent with D. renale was found in the right kidney. Microscopic examination revealed that the male Dioctophyma renale. Following removal of worm, the symptoms completely resolved within a few hours. Generally, parasitism by D. renale in human is a necropsy finding, nevertheless imaging techniques as ultrasound and computed tomography have been proven to be important tool to achieve diagnosis.

  17. Biomimetic matrices for pelvic floor repair

    NARCIS (Netherlands)

    Vashaghian, M.

    2017-01-01

    Pelvic organ prolapsed (POP) is a dysfunctional disease in female pelvic floor that affects a lot of women worldwide, and reduces their quality of life. Currently, trans-vaginal knitted polypropylene meshes are used as secondary treatment, for anatomical correction of the dysfunctional tissues.

  18. [Modern aspects of surgical treatment of locally advanced pelvic cancer].

    Science.gov (United States)

    Solovyov, I A; Vasilchenko, M V; Lychev, A B; Ambartsumyan, S V; Alekseev, V V

    2015-09-01

    The aim of investigation is to improve surgical treatment of patients with locally advanced pelvic cancer. The basis of investigation is 186 patients with locally advanced pelvic cancer. The average age of patients is 65.2 ± 5.2 years (from 43.7 to 88.4 years). Among them are 112 women and 74 men. In the period from 2007 to 2015 they were carried out combined (101 patients) and expanded (85 patients) surgical intervention in the department of naval surgery of the Military medical academy after S.M.Kirov. Pelvic evisceration was performed in 63 cases. Both patients were performed isolated vascular hyperthermic chemical pelvic perfusion. Indications for plastic surgery of peritoneum pelvic were: total infralitoral pelvic evisceration (9 patients), dorsal infralitoral pelvic evisceration (11 cases) and expanded abdominoperineal rectum extirpation (34 patients). Plastic surgery with autogenouse tissues was performed to 43 patients, with reticulate explants--to 11 patients. The rate of postoperative complications was 40.2%. The rate of postoperative lethality was 8%. Expanded and combined operations of pelvic at patients with locally advanced cancer without absolute contra-indications can be performed irrespective of age. Plastic surgery of peritoneum pelvic after total and dorsal infralitoral pelvic evisceration and expanded abdominoperineal rectum extirpation indicated in all cases. The easiest method is plastic surgery with greater omentum or peritoneum pelvic. Plastic surgery with reticulate explants is performed when autoplastic is impossible.

  19. Laparoendoscopic single site in pelvic surgery

    Science.gov (United States)

    Sanchez-Salas, Rafael; Clavijo, Rafael; Barret, Eric; Sotelo, Rene

    2012-01-01

    Laparoendoscopic single site (LESS) has recently gained momentum as feasible techniques for minimal access surgery. Our aim is to describe the current status of laparoendoscopic single site (LESS) in pelvic surgery. A comprehensive revision of the literature in LESS pelvic surgery was performed. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-01 to 30-11-11. References outside the search period were obtained selected manuscript΄s bibliography. Search terms included: pelvic anatomy, less in gynecology, single port colectomy, urological less, single port, single site, NOTES, LESS and single incision. 314 manuscripts were initially identified. Out of these, 46 manuscripts were selected based in their pelvic anatomy or surgical content; including experimental experience, clinical series and literature reviews. LESS drastically limit the surgeon's ability to perform in the operative field and the latter becomes hardened by the lack of space in anatomical location like the pelvis. Potential advantages of LESS are gained with the understanding that the surgical procedure is more technically challenging. Pelvic surgical procedures related to colorectal surgery, gynecology and urology have been performed with LESS technique and information available is mostly represented by case reports and short case series. Comparative series remain few. LESS pelvic surgery remain in its very beginning and due to the very specific anatomical conditions further development of LESS surgery in the mentioned area can be clearly be facilitated by using robotic technology. Standardization ad reproducibility of techniques are mandatory to further develop LESS in the surgical arena.. PMID:22557719

  20. Laparoendoscopic single site in pelvic surgery

    Directory of Open Access Journals (Sweden)

    Rafael Sanchez-Salas

    2012-01-01

    Full Text Available Laparoendoscopic single site (LESS has recently gained momentum as feasible techniques for minimal access surgery. Our aim is to describe the current status of laparoendoscopic single site (LESS in pelvic surgery. A comprehensive revision of the literature in LESS pelvic surgery was performed. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-01 to 30-11-11. References outside the search period were obtained selected manuscript΄s bibliography. Search terms included: pelvic anatomy, less in gynecology, single port colectomy, urological less, single port, single site, NOTES, LESS and single incision. 314 manuscripts were initially identified. Out of these, 46 manuscripts were selected based in their pelvic anatomy or surgical content; including experimental experience, clinical series and literature reviews. LESS drastically limit the surgeon′s ability to perform in the operative field and the latter becomes hardened by the lack of space in anatomical location like the pelvis. Potential advantages of LESS are gained with the understanding that the surgical procedure is more technically challenging. Pelvic surgical procedures related to colorectal surgery, gynecology and urology have been performed with LESS technique and information available is mostly represented by case reports and short case series. Comparative series remain few. LESS pelvic surgery remain in its very beginning and due to the very specific anatomical conditions further development of LESS surgery in the mentioned area can be clearly be facilitated by using robotic technology. Standardization ad reproducibility of techniques are mandatory to further develop LESS in the surgical arena..

  1. Pelvic congestion syndrome masquerading as osteoarthritis of the hip

    Directory of Open Access Journals (Sweden)

    Scott J Dos Santos

    2016-12-01

    Full Text Available 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.

  2. Pelvic incidence variation among individuals: functional influence versus genetic determinism.

    Science.gov (United States)

    Chen, Hong-Fang; Zhao, Chang-Qing

    2018-03-20

    Pelvic incidence has become one of the most important sagittal parameters in spinal surgery. Despite its great importance, pelvic incidence can vary from 33° to 85° in the normal population. The reasons for this great variability in pelvic incidence remain unexplored. The objective of this article is to present some possible interpretations for the great variability in pelvic incidence under both normal and pathological conditions and to further understand the determinants of pelvic incidence from the perspective of the functional requirements for bipedalism and genetic backgrounds via a literature review. We postulate that both pelvic incidence and pelvic morphology may be genetically predetermined, and a great variability in pelvic incidence may already exist even before birth. This great variability may also serve as a further reminder that the sagittal profile, bipedal locomotion mode, and genetic background of every individual are unique and specific, and clinicians should avoid making universally applying broad generalizations of pelvic incidence. Although PI is an important parameter and there are many theories behind its variability, we still do not have clear mechanistic answers.

  3. Absence of orthotopic renal vein with aberrant suprarenal venous drainage; A case report

    International Nuclear Information System (INIS)

    Kim, Eu gene; Jeon, Yong Sun; Cho, Soon Gu; Hong, Kee Chun; Park, Keun Myung; Lee, Tack

    2015-01-01

    A CT scan of a 49-year-old female incidentally revealed a tortuous vascular structure in the right suprarenal space. According to angiographic evaluation of the right renal vessels, the right renal artery was single with normal diameter, and there was no venous drainage through the main right renal vein (orthotopic renal vein). The venous drainage of the right kidney flowed through the tortuous suprarenal vascular structure into the inferior vena cava. The color Doppler ultrasound revealed the monophasic waveform in that vascular structure without flow disturbance. The renal function and the result of urinalysis of the patient were normal, and any other congenital malformation was not found. Absence of the orthotopic renal vein and aberrant suprarenal venous drainage is a very rare congenital anomaly, and it should be discriminated from the other pathologic conditions

  4. Absence of orthotopic renal vein with aberrant suprarenal venous drainage; A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eu gene; Jeon, Yong Sun; Cho, Soon Gu; Hong, Kee Chun; Park, Keun Myung; Lee, Tack [Inha University Hospital, Incheon (Korea, Republic of)

    2015-06-15

    A CT scan of a 49-year-old female incidentally revealed a tortuous vascular structure in the right suprarenal space. According to angiographic evaluation of the right renal vessels, the right renal artery was single with normal diameter, and there was no venous drainage through the main right renal vein (orthotopic renal vein). The venous drainage of the right kidney flowed through the tortuous suprarenal vascular structure into the inferior vena cava. The color Doppler ultrasound revealed the monophasic waveform in that vascular structure without flow disturbance. The renal function and the result of urinalysis of the patient were normal, and any other congenital malformation was not found. Absence of the orthotopic renal vein and aberrant suprarenal venous drainage is a very rare congenital anomaly, and it should be discriminated from the other pathologic conditions.

  5. Retroperitoneal and pelvic fibromatosis

    International Nuclear Information System (INIS)

    Lopez de Lacalle, J. M.; Garmendia, G.; Laso, C.; Galardi, A.

    1998-01-01

    We present a case of retroperitoneal and pelvic fibromatosis in a 17-year-old boy who came to the emergency room with sudden onset acute abdominal pain. The initial radiological examination (plain X-ray and ultrasound) disclosed only minimal right hydronephrosis. Subsequent computed tomography revealed the presence of a solid retroperitoneal and pelvic mass involving right ureter and secondary right hydronephrosis. We stress its presentation in the form of acute abdominal pain with initial radiological signs suggestive of a primarily urological disorder. (Author) 8 refs

  6. Renal imaging with radionuclides, ultrasound, and computed tomography

    International Nuclear Information System (INIS)

    Kahn, P.C.

    1979-01-01

    Nuclear medicine, ultrasound, and computed tomography have all contributed greatly to the diagnosis and understanding of renal disease. The /sup 99m/Tc-glucoheptonate scan is a multipurpose test for evaluating blood flow, cortical function and excretion, and the location of renal tissue. It is especially useful in renal trauma and vascular disease, congenital anomalies, and pseudomasses. Technetium-99m diethylene triamine pentaacetic acid (DTPA) is most helpful in evaluating obstruction and reflux, and 67 Ga citrate has a major role in inflammatory disease. The gray-scale ultrasound examination helps to characterize masses as cysts, abscesses, or tumors, and is particularly helpful in localization for aspiration, biopsy, or drainage procedures. Its total innocuousness makes echography useful for sequential follow-up in hydronephrosis and masses. Computed tomography with a fast scanner allows the identification of small lesions, and gives the most anatomic information. It permits the differentiation of fat from pelvic tumors and small cysts from neoplasms, and clearly identifies perirenal structures. With contrast enhancement, additional information about the vascularity of lesions is obtained. Although these tests use different physical principles and instruments, the data they provide are often similar, and for practical purposes the use of one modality may preclude the use of others. Difficult judgments are required to make certain that the proper examination or sequence of examinations is done in each case

  7. Comparison between dynamic cystocolpoproctography and dynamic pelvic floor MRI: pros and cons: which is the "functional" examination for anorectal and pelvic floor dysfunction?

    Science.gov (United States)

    Maglinte, Dean D T; Hale, Douglass S; Sandrasegaran, Kumar

    2013-10-01

    "Functional" imaging of anorectal and pelvic floor dysfunction has assumed an important role in the diagnosis and management of these disorders. Although defecography has been widely practiced for decades to evaluate the dynamics of rectal emptying, debate concerning its clinical relevance, how it should be done and interpreted continues. Due to the recognition of the association of defecatory disorders with pelvic organ prolapse in women, the need to evaluate the pelvic floor as a unit has arisen. To meet this need, defecography has been extended to include not only evaluation of defecation disorders but also the rest of the pelvic floor by opacifying the small bowel, vagina, and the urinary bladder. The term "dynamic cystocolpoproctography" (DCP) has been appropriately applied to this examination. Rectal emptying performed with DCP provides the maximum stress to the pelvic floor resulting in complete levator ani relaxation. In addition to diagnosing defecatory disorders, this method of examination demonstrates maximum pelvic organ descent and provides organ-specific quantification of organ prolapse, information that is only inferred by means of physical examination. It has been found to be of clinical value in patients with defecation disorders and the diagnosis of associated prolapse in other compartments that are frequently unrecognized by history taking and the limitations of physical examination. Pelvic floor anatomy is complex and DCP does not show the anatomical details pelvic magnetic resonance imaging (MRI) provides. Technical advances allowing acquisition of dynamic rapid MRI sequences has been applied to pelvic floor imaging. Early reports have shown that pelvic MRI may be a useful tool in pre-operative planning of these disorders and may lead to a change in surgical therapy. Predictions of hypothetical increase cancer incidence and deaths in patients exposed to radiation, the emergence of pelvic floor MRI in addition to questions relating to the

  8. Pelvic Surgical Site Infections in Gynecologic Surgery

    Directory of Open Access Journals (Sweden)

    Mark P. Lachiewicz

    2015-01-01

    Full Text Available 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.

  9. Comparison of changes in the mobility of the pelvic floor muscle on during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction.

    Science.gov (United States)

    Jung, Halim; Jung, Sangwoo; Joo, Sunghee; Song, Changho

    2016-01-01

    [Purpose] The purpose of this study was to compare changes in the mobility of the pelvic floor muscle during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction. [Subjects] Thirty healthy adults participated in this study (15 men and 15 women). [Methods] All participants performed a bridge exercise and abdominal curl-up during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction. Pelvic floor mobility was evaluated as the distance from the bladder base using ultrasound. [Results] According to exercise method, bridge exercise and abdominal curl-ups led to significantly different pelvic floor mobility. The pelvic floor muscle was elevated during the abdominal drawing-in maneuver and descended during maximal expiration. Finally, pelvic floor muscle mobility was greater during abdominal curl-up than during the bridge exercise. [Conclusion] According to these results, the abdominal drawing-in maneuver induced pelvic floor muscle contraction, and pelvic floor muscle contraction was greater during the abdominal curl-up than during the bridge exercise.

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

    Energy Technology Data Exchange (ETDEWEB)

    Lopez, Anthony James, E-mail: consultant@radiologist.co.uk [The Imaging Clinic (United Kingdom)

    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.

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

    International Nuclear Information System (INIS)

    Lopez, Anthony James

    2015-01-01

    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

  12. Motor cortical representation of the pelvic floor muscles.

    Science.gov (United States)

    Schrum, A; Wolff, S; van der Horst, C; Kuhtz-Buschbeck, J P

    2011-07-01

    Pelvic floor muscle training involves rhythmical voluntary contractions of the external urethral sphincter and ancillary pelvic floor muscles. The representation of these muscles in the motor cortex has not been located precisely and unambiguously. We used functional magnetic resonance imaging to determine brain activity during slow and fast pelvic floor contractions. Cerebral responses were recorded in 17 healthy male volunteers, 21 to 47 years old, with normal bladder control. Functional magnetic resonance imaging was performed during metronome paced slow (0.25 Hertz) and fast (0.7 Hertz) contractions of the pelvic floor that mimicked the interruption of voiding. To study the somatotopy of the cortical representations, flexion-extension movements of the right toes were performed as a control task. Functional magnetic resonance imaging during pelvic floor contractions detected activity of the supplementary motor area in the medial wall and of the midcingulate cortex, insula, posterior parietal cortex, putamen, thalamus, cerebellar vermis and upper ventral pons. There were no significant differences in activation between slow and fast contractions. Toe movements involved significantly stronger activity of the paracentral lobule (ie the medial primary motor cortex) than did the pelvic floor contractions. Otherwise the areas active during pelvic floor and leg muscle contractions overlapped considerably. The motor cortical representation of pelvic floor muscles is located mostly in the supplementary motor area. It extends further ventrally and anteriorly than the representation of distal leg muscles. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  13. Pelvic floor spasm as a cause of voiding dysfunction.

    Science.gov (United States)

    Kuo, Tricia L C; Ng, L G; Chapple, Christopher R

    2015-07-01

    Pelvic floor disorders can present with lower urinary tract symptoms, bowel, sexual dysfunction, and/or pain. Symptoms of pelvic muscle spasm (nonrelaxing pelvic floor or hypertonicity) vary and can be difficult to recognize. This makes diagnosis and management of these disorders challenging. In this article, we review the current evidence on pelvic floor spasm and its association with voiding dysfunction. To distinguish between the different causes of voiding dysfunction, a video urodynamics study and/or electromyography is often required. Conservative measures include patient education, behavioral modifications, lifestyle changes, and pelvic floor rehabilitation/physical therapy. Disease-specific pelvic pain and pain from pelvic floor spasm needs to be differentiated and treated specifically. Trigger point massage and injections relieves pain in some patients. Botulinum toxin A, sacral neuromodulation, and acupuncture has been reported in the management of patients with refractory symptoms. Pelvic floor spasm and associated voiding problems are heterogeneous in their pathogenesis and are therefore often underrecognized and undertreated; it is therefore essential that a therapeutic strategy needs to be personalized to the individual patient's requirements. Therefore, careful evaluation and assessment of individuals using a multidisciplinary team approach including a trained physical therapist/nurse clinician is essential in the management of these patients.

  14. [Establishement for regional pelvic trauma database in Hunan Province].

    Science.gov (United States)

    Cheng, Liang; Zhu, Yong; Long, Haitao; Yang, Junxiao; Sun, Buhua; Li, Kanghua

    2017-04-28

    To establish a database for pelvic trauma in Hunan Province, and to start the work of multicenter pelvic trauma registry.
 Methods: To establish the database, literatures relevant to pelvic trauma were screened, the experiences from the established trauma database in China and abroad were learned, and the actual situations for pelvic trauma rescue in Hunan Province were considered. The database for pelvic trauma was established based on the PostgreSQL and the advanced programming language Java 1.6.
 Results: The complex procedure for pelvic trauma rescue was described structurally. The contents for the database included general patient information, injurious condition, prehospital rescue, conditions in admission, treatment in hospital, status on discharge, diagnosis, classification, complication, trauma scoring and therapeutic effect. The database can be accessed through the internet by browser/servicer. The functions for the database include patient information management, data export, history query, progress report, video-image management and personal information management.
 Conclusion: The database with whole life cycle pelvic trauma is successfully established for the first time in China. It is scientific, functional, practical, and user-friendly.

  15. 38 CFR 4.67 - Pelvic bones.

    Science.gov (United States)

    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 residuals...

  16. The relationship of mast cells and angiogenesis with prognosis in renal cell carcinoma

    International Nuclear Information System (INIS)

    Guldur, M.E.; Kocarslan, S.; Dincoglu, D.

    2014-01-01

    Objective: To evaluate the effects of mast cell count and angiogenesis on the prognosis of renal cell carcinoma. Methods: The retrospective study was conducted at the Harran University, Sanliurfa, Turkey, and included 64 cases with diagnosis of renal cell carcinoma between 2002 and 2012. Immunohistochemical analysis was performed on paraffin sections using the standard streptavidin-biotin immunoperoxidase method. CD31 antibodies were used to identify microvessels in tumoural tissues. The microvessel density was calculated using a serological method. The mean vascular density was equivalent to the vascular surface area (in mm) per unit tissue volume (in mm) (MVD=mm). Mast cells tryptase antibody was used to evaluate the mast cell count in tumoural and non-tumoural tissues. The relationship between mast cell count and microvessel density was evaluated and compared with stage, grade, tumour diameter, and age. Results: The mast cell count in the tumoral tissue of renal cell carcinoma was significantly higher compared with non-neoplastic renal tissue (p 0.05). The intratumoural mast cell count in clear cell renal carcinoma was significantly higher compared with non-clear variety (p=0.001). No significant relationship was found between microvessel density, age, stage, diameter, or grade of the tumour and tumoral mast cell count (p>0.05). Conclusion: No significant association was found between the number of mast cells in tumoral tissue and microvessel density. Further studies are needed to demonstrate the effect of mast cells on angiogenesis in renal cell carcinoma. (author)

  17. MR appearance of pelvic hemangiopericytoma

    International Nuclear Information System (INIS)

    Kehagias, D.; Gouliamos, A.; Vlahos, L.

    1999-01-01

    A case of pelvic hemangiopericytoma in a 59-year-old woman is reported. The MR imaging features are presented. The tumor was unresectable and the patient received postoperative irradiation of 4200 cGy on the pelvis. One year after diagnosis, metastasis to a lumbar vertebra was discovered and additional irradiation of 3900 cGy was applied. One year later, CT showed control of the pelvic tumor and its metastasis. (orig.) (orig.)

  18. Predictive Factors of In-Stent Restenosis in Renal Artery Stenting: A Retrospective Analysis

    International Nuclear Information System (INIS)

    Vignali, Claudio; Bargellini, Irene; Lazzereschi, Michele; Cioni, Roberto; Petruzzi, Pasquale; Caramella, Davide; Pinto, Stefania; Napoli, Vinicio; Zampa, Virna; Bartolozzi, Carlo

    2005-01-01

    Purpose. To retrospectively evaluate the role of clinical and procedural factors in predicting in-stent restenosis in patients with renovascular disease treated by renal artery stenting. Methods. From 1995 to 2002, 147 patients underwent renal artery stenting for the treatment of significant ostial atherosclerotic stenosis. Patients underwent strict clinical and color-coded duplex ultrasound follow-up. Ninety-nine patients (111 stents), with over 6 months of continuous follow-up (mean 22±12 months, range 6-60 months), were selected and classified according to the presence (group A, 30 patients, 32 lesions) or absence (group B, 69 patients, 79 lesions) of significant in-stent restenosis. A statistical analysis was performed to identify possible preprocedural and procedural predictors of restenosis considering the following data: sex, age, smoking habit, diabetes mellitus, hypertension, serum creatinine, cholesterol and triglyceride levels, renal artery stenosis grade, and stent type, length and diameter. Results. Comparing group A and B patients (χ 2 test), a statistically significant relation was demonstrated between stent diameter and length and restenosis: the risk of in-stent restenosis decreased when the stent was ≥6 mm in diameter and between 15 and 20 mm in length. This finding was confirmed by multiple logistic regression analysis. Stent diameter and length were proved to be significantly related to in-stent restenosis also when evaluating only patients treated by Palmaz stent (71 stents). Conclusion. Although it is based on a retrospective analysis, the present study confirms the importance of correct stent selection in increasing long-term patency, using stents of at least 6 mm in diameter and with a length of approximately 15-20 mm

  19. MANAGEMENT OF PELVIC FRACTURES IN DOG

    African Journals Online (AJOL)

    EDITOR-IN-CHIEF

    Dept. of Surgery and Radiology, College of Veterinary Science and Animal Husbandry,. Birsa Agricultural ... dogs, most of the pelvic fractures recover without surgery. .... management in the dog and cat,. New York: Thieme, pp. 161-199. FOSSUM, T.W. (2007) Pelvic fractures. In: Fossum, T.W., 3rd edn.Small. Animal Surgery.

  20. Percutaneous Microwave Ablation of Renal Angiomyolipomas

    Energy Technology Data Exchange (ETDEWEB)

    Cristescu, Mircea, E-mail: mcristescu@uwhealth.org [University of Wisconsin, Department of Radiology (United States); Abel, E. Jason, E-mail: abel@urology.wisc.edu [University of Wisconsin, Department of Urology (United States); Wells, Shane, E-mail: swells@uwhealth.org; Ziemlewicz, Timothy J., E-mail: tziemlewicz@uwhealth.org [University of Wisconsin, Department of Radiology (United States); Hedican, Sean P., E-mail: hedican@surgery.wisc.edu [University of Wisconsin, Department of Urology (United States); Lubner, Megan G., E-mail: mlubner@uwhealth.org; Hinshaw, J. Louis, E-mail: jhinshaw@uwhealth.org; Brace, Christopher L., E-mail: cbrace@uwhealth.org; Lee, Fred T., E-mail: flee@uwhealth.org [University of Wisconsin, Department of Radiology (United States)

    2016-03-15

    PurposeTo evaluate the safety and efficacy of US-guided percutaneous microwave (MW) ablation in the treatment of renal angiomyolipoma (AML).Materials and MethodsFrom January 2011 to April 2014, seven patients (5 females and 2 males; mean age 51.4) with 11 renal AMLs (9 sporadic type and 2 tuberous sclerosis associated) with a mean size of 3.4 ± 0.7 cm (range 2.4–4.9 cm) were treated with high-powered, gas-cooled percutaneous MW ablation under US guidance. Tumoral diameter, volume, and CT/MR enhancement were measured on pre-treatment, immediate post-ablation, and delayed post-ablation imaging. Clinical symptoms and creatinine were assessed on follow-up visits.ResultsAll ablations were technically successful and no major complications were encountered. Mean ablation parameters were ablation power of 65 W (range 60–70 W), using 456 mL of hydrodissection fluid per patient, over 4.7 min (range 3–8 min). Immediate post-ablation imaging demonstrated mean tumor diameter and volume decreases of 1.8 % (3.4–3.3 cm) and 1.7 % (27.5–26.3 cm{sup 3}), respectively. Delayed imaging follow-up obtained at a mean interval of 23.1 months (median 17.6; range 9–47) demonstrated mean tumor diameter and volume decreases of 29 % (3.4–2.4 cm) and 47 % (27.5–12.1 cm{sup 3}), respectively. Tumoral enhancement decreased on immediate post-procedure and delayed imaging by CT/MR parameters, indicating decreased tumor vascularity. No patients required additional intervention and no patients experienced spontaneous bleeding post-ablation.ConclusionOur early experience with high-powered, gas-cooled percutaneous MW ablation demonstrates it to be a safe and effective modality to devascularize and decrease the size of renal AMLs.

  1. The clinical factors associated with benign renal tumors

    International Nuclear Information System (INIS)

    Yamashita, Ryo; Nakamura, Masafumi; Matsuzaki, Masato; Matsui, Takashi; Yamaguchi, Raizo; Niwakawa, Masashi; Tobisu, Kenichi; Asakura, Koiku; Ito, Ichiro

    2009-01-01

    In this study, we sought to define the incidence of benign renal tumors in our institute and to clarify the clinical factors associated with benign renal tumors, in order to assist in forming preoperative differential diagnoses. From October 2002 to July 2007, we performed 157 nephrectomies in patients preoperatively diagnosed with renal cell carcinoma. We chose 81 tumors, all of which were less than 5 cm, for further study. We reviewed double-phase helical CT imaging retrospectively, specifically focusing on attenuation patterns and homogeneity. We also compared clinical factors, including age, sex and tumor size, between the benign and malignant renal tumors. The patient's median age was 67 years (mean age, 63 years), and the median tumor diameter was 3.0 cm (mean, 3.2 cm). Benign renal tumors were found in 10 (12%) of the 81 tumors; these included seven cases of oncocytoma and three cases of angiomyolipoma with minimal fat. Several factors were significant clinical determinants of differentiation between benign and malignant renal tumors: homogeneity in CT, female gender, and small tumor size all predominated in cases of benign tumors. Attenuation pattern in CT, however, was not a significant factor (p=0.344). When a patient, especially a female, presents with a small and homogeneous renal tumor, careful consideration should be given to the possibility of a benign process, which needs further consideration before performing excessive surgery. (author)

  2. Diagnosis and management of ureteral complications following renal transplantation

    Directory of Open Access Journals (Sweden)

    Brian D. Duty

    2015-10-01

    Full Text Available When compared with maintenance dialysis, renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life. Approximately 9% of patients will develop a major urologic complication following kidney transplantation. Ureteral complications are most common and include obstruction (intrinsic and extrinsic, urine leak and vesicoureteral reflux. Ureterovesical anastomotic strictures result from technical error or ureteral ischemia. Balloon dilation or endoureterotomy may be considered for short, low-grade strictures, but open reconstruction is associated with higher success rates. Urine leak usually occurs in the early postoperative period. Nearly 60% of patients can be successfully managed with a pelvic drain and urinary decompression (nephrostomy tube, ureteral stent, and indwelling bladder catheter. Proximal, large-volume, or leaks that persist despite urinary diversion, require open repair. Vesicoureteral reflux is common following transplantation. Patients with recurrent pyelonephritis despite antimicrobial prophylaxis require surgical treatment. Deflux injection may be considered in recipients with low-grade disease. Grade IV and V reflux are best managed with open reconstruction.

  3. Aneurisma da Artéria Renal: caso clínico Renal Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    Joana Moreira

    2011-12-01

    Full Text Available Apresenta-se o caso clínico de um doente com volumoso aneurisma da artéria renal esquerda. Do sexo masculino, de 22 anos de idade, com lombalgia à esquerda com algumas semanas de evolução. Recorreu ao médico assistente que solicitou estudo imagiológico por ecografia abdominal. Detectada imagem sugestiva de aneurisma da aorta abdominal. Este achado motivou a transferência para o nosso Hospital onde foi admitido consciente e orientado, hemodinamicamente estável, apresentando uma massa pulsátil epigástrica, com frémito e sopro sistólico à auscultação. Angio-TC revelou um aneurisma da artéria renal esquerda com 16 cm de diâmetro. Dada a estabilidade clínica e topografia lesional optou-se por tentar embolizar, sem sucesso, o tronco da artéria renal esquerda antes da abordagem cirúrgica. O doente foi então submetido a Nefrectomia total esquerda por via toraco-abdominal. Pós-operatório sem complicações, locais ou sistémicas. Alta ao 8ºdia, mantendo boa função renal e com níveis normais de hemoglobina. Diagnóstico de aneurisma da artéria renal confirmado por estudo anátomo-patológico da peça operatória.One case of a large left renal artery aneurysm in a young patient 22 years old is presented. He appealed to his assistant physician a few weeks after development of left back pain. Abdominal ultrasound imaging study has been requested. Suggestive abdominal aortic aneurysm was detected. This finding led to the transfer to our hospital where he was admitted conscious and hemodynamically stable. A pulsatile epigastric mass with a systolic murmur on auscultation and thrill were detected. Angio-CT scan revealed a left renal artery aneurysm, 16 cm in diameter. Given the clinical stability and lesional topography we decide a previous embolization of left renal artery, unsuccessfully. The patient underwent then left total nephrectomy, through thoraco-abdominal incision. No local or systemic complications in the postoperative

  4. Valutazione morfo-funzionale in pazienti ipertesi con stenosi dell'arteria renale

    International Nuclear Information System (INIS)

    Cuocolo, A.; Celentano, L.; Nappi, A.; Neumann, R.D.; Salvatore, M.

    1991-01-01

    Renovascula hypertension is the most important and common cause of secondary hypertension. We studied 10 patients with arterial hypertension and different degrees of renal artery stenosis to assess the usefulness of dynamic radionuclide renography in evaluating renal perfusion and funcion, and to compare funcional radionuclide results to the morphological findings of renal angiography. Computer-assisted dynamic renal with 00m Tc diethylenetriaminepentaacetic acid (DTPA) and 131 I orthoiodohippurate (OIH), and renal artheriography were also employed in all patients. In all patients, radionuclide results matched angiography findings in quality. In particular, 3 patients with hemodynamical insignificant renal artery stenosis exhibited normal perfusion and function at dynamic radionuclide renography. Seven patients had significant renal artery stenosis and associated functional changes at dynamic radionuclide renography. Quantitative comparison of all patients showed a significant correlation (r=0.866, p<0.001) between the degree of renal artery stenosis, quantified as the percentage of narrowing as compared to adjacent/contralateral normal vessel diameter, and the results of split renal function, as assessed during OIH studies and expressed per kidney as a percentage of the net total counts of both kidneys. In conclusion, our results demonstrated dynamic radionuclide renography to be a valuable secondary to renal artery stenosis in hypertensive patients, providing complementary results to arteriography

  5. [Biomechanical modeling of pelvic organ mobility: towards personalized medicine].

    Science.gov (United States)

    Cosson, Michel; Rubod, Chrystèle; Vallet, Alexandra; Witz, Jean-François; Brieu, Mathias

    2011-11-01

    Female pelvic mobility is crucial for urinary, bowel and sexual function and for vaginal delivery. This mobility is ensured by a complex organ suspension system composed of ligaments, fascia and muscles. Impaired pelvic mobility affects one in three women of all ages and can be incapacitating. Surgical management has a high failure rate, largely owing to poor knowledge of the organ support system, including the barely discernible ligamentous system. We propose a 3D digital model of the pelvic cavity based on MRI images and quantitative tools, designed to locate the pelvic ligaments. We thus obtain a coherent anatomical and functional model which can be used to analyze pelvic pathophysiology. This work represents a first step towards creating a tool for localizing and characterizing the source of pelvic imbalance. We examine possible future applications of this model, in terms of personalized therapy and prevention.

  6. Assessment of the effect of pelvic floor exercises on pelvic floor muscle strength using ultrasonography in patients with urinary incontinence: a prospective randomized controlled trial

    OpenAIRE

    Tosun, Ozge Celiker; Solmaz, Ulas; Ekin, Atalay; Tosun, Gokhan; Gezer, Cenk; Ergenoglu, Ahmet Mete; Yeniel, Ahmet Ozgur; Mat, Emre; Malkoc, Mehtap; Askar, Niyazi

    2016-01-01

    [Purpose] The aim of this study was to evaluate whether the effect of pelvic floor exercises on pelvic floor muscle strength could be detected via ultrasonography in patients with urinary incontinence. [Subjects and Methods] Of 282 incontinent patients, 116 participated in the study and were randomly divided into a pelvic floor muscle training (n=65) group or control group (n=51). The pelvic floor muscle training group was given pelvic floor exercise training for 12 weeks. Both groups were ev...

  7. The pelvic floor muscles: muscle thickness in healthy and urinary-incontinent women measured by perineal ultrasonography with reference to the effect of pelvic floor training. Estrogen receptor studies

    DEFF Research Database (Denmark)

    Bernstein, Inge Thomsen

    1997-01-01

    demonstrated that the striated periurethral muscles and the pelvic floor muscles are of paramount importance for the closure function. This emphasizes the importance of well-functioning pelvic floor muscles to obtain continence, and probably explains the rationale for the effect of pelvic floor training...... in treating urinary incontinence. This study presents a review of the literature on female urinary incontinence, continence mechanisms, pelvic floor muscles, and pelvic floor training. Furthermore, a review of the literature on estrogen receptors in the pelvic floor muscles is given. Perineal ultrasonography...... the effect of pelvic floor training. Additionally, a study of the Pelvic floor muscles was performed to assess the presence of estrogen receptors. Muscle thickness seems to decrease with age. In women over age 60 years, a significantly thinner pelvic floor muscle was found compared to younger women...

  8. Role of laparoscopy in evaluation of chronic pelvic pain

    Directory of Open Access Journals (Sweden)

    Hebbar Shripad

    2005-01-01

    Full Text Available Introduction: Chronic pelvic pain (CPP is a common medical problem affecting women. Too often the physical signs are not specific. This study aims at determining the accuracy of diagnostic laparoscopy over clinical pelvic examination. Settings and Design: A retrospective study of patients who underwent diagnostic laparoscopy for CPP. Materials and Methods: The medical records of 86 women who underwent laparoscopic evaluation for CPP of at least 6-month duration were reviewed for presentation of symptoms, pelvic examination findings at the admission, operative findings and follow up when available. Statistical analysis used: McNemar Chi-square test for frequencies in a 2 x 2 table. Results: The most common presentation was acyclic lower abdominal pain (79.1%, followed by congestive dysmenorrhoea (26.7%. 61.6% of women did not reveal any significant signs on pelvic examination. Pelvic tenderness was elicited in 27.9%. Diagnostic laparoscopy revealed significant pelvic pathology in 58% of those who essentially had normal pervaginal findings. The most common pelvic pathology by laparoscopy was pelvic adhesions (20.9%, followed by pelvic congestion (18.6%. Laparoscopic adhesiolyis achieved pain relief only in one-third of the women. Conclusion: The study revealed very low incidence of endometriosis (4.7%. Overall clinical examination could detect abnormality in only 38% of women, where as laparoscopy could detect significant pathology in 66% of women with CPP. This shows superiority of diagnostic laparoscopy over clinical examination in detection of aetiology in women with CPP (P < 0.001. Adhesiolysis helps only small proportion of women in achieving pain control.

  9. Comprehensive pelvic floor physical therapy program for men with idiopathic chronic pelvic pain syndrome: a prospective study.

    Science.gov (United States)

    Masterson, Thomas A; Masterson, John M; Azzinaro, Jessica; Manderson, Lattoya; Swain, Sanjaya; Ramasamy, Ranjith

    2017-10-01

    Male chronic pelvic pain syndrome (CPPS) is a heterogeneous constellation of symptoms that causes significant impairment and is often challenging to treat. In this prospective study, we evaluated men with CPPS who underwent comprehensive pelvic floor physical therapy (PFPT) program. We used the previously validated Genitourinary Pain Index (GUPI) to measure outcomes. We included 14 men who underwent physical therapy for idiopathic CPPS from October 2015 to October 2016. Men with clearly identifiable causes of pelvic pain, such as previous surgery, chronic infection, trauma, prostatitis and epididymitis were excluded. Treatment included: (I) manual therapy (internal and external) of pelvic floor and abdominal musculature to facilitate relaxation of muscles; (II) therapeutic exercises to promote range of motion, improve mobility/flexibility and strengthen weak muscles; (III) biofeedback to facilitate strengthening and relaxation of pelvic floor musculature; (IV) neuromodulation for pelvic floor muscle relaxation and pain relief. GUPI questionnaires were collected at initial evaluation and after the 10th visit. Higher scores reflect worse symptoms. Previous validation of the GUPI calculated a reduction of 7 points to robustly predict being a treatment responder (sensitivity 100%, specificity 76%) and a change in 4 points to predict modest response. Data are presented as medians (ranges). A total of 10 patients completed 10 visits, and the remaining four patients completed between 5 and 9 visits. The median National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score at initial evaluation was 30.8 [16-39] and decreased to 22.2 [7-37] at the tenth visit. Five of the 10 patients (50%) in the study had a reduction of greater than 7 points indicating a robust treatment response, and two (20%) had a change of greater than 4 indicating moderate response. Three patients (30%) did not have any meaningful change in NIH-CPSI and the remaining four are in the

  10. Microbiota and Pelvic Inflammatory Disease

    Science.gov (United States)

    Sharma, Harsha; Tal, Reshef; Clark, Natalie A.; Segars, James H.

    2014-01-01

    Female genital tract microbiota play a crucial role in maintaining health. Disequilibrium of the microbiota has been associated with increased risk of pelvic infections. In recent years, culture-independent molecular techniques have expanded understanding of the composition of genital microbiota and the dynamic nature of the microbiota. There is evidence that upper genital tract may not be sterile and may harbor microflora in the physiologic state. The isolation of bacterial vaginosis-associated organisms in women with genital infections establishes a link between pelvic infections and abnormal vaginal flora. With the understanding of the composition of the microbiota in healthy and diseased states, the next logical step is to identify the function of the newly identified microbes. This knowledge will further expand our understanding of the causation of pelvic infections, which may lead to more effective prevention and treatment strategies. PMID:24390920

  11. Computed tomography of pelvic fractures

    Energy Technology Data Exchange (ETDEWEB)

    Kimoto, Makoto; Hashimoto, Keiji; Hiraki, Yoshio

    1984-12-01

    Plain x-ray and computed tomographic (CT) findings were compared in 7 patients with pelvic fractures (2 males and 5 females) aged between 35 and 50 year. Plain x-rays had a higher sensitivity than CT in detecting fractures of the ischiatic and pubic ramuses, and deviation of bone fragments. CT was superior to plain x-rays near the acetabulum and in detecting deviation of bone fragments. Although there were no differences between the two modalities in detecting fractures of the wing of ilium, CT was more useful than plain x-rays in visualizing deviation of bone fragments. CT clearly visualized not only fractures but also injuries of the soft tissues, such as pelvic viscera and muscles, and the presence of hematoma. CT seems to be a useful method for observing the condition and process of pelvic injuries and for deciding treatment protocols.

  12. A unique case of bifid left testicular artery having its anomalous high origin from renal artery

    OpenAIRE

    Ashwini P Aithal; Naveen Kumar; Swamy S Ravindra; Jyothsna Patil

    2016-01-01

    The testicular arteries are known to originate from the ventrolateral aspect of the abdominal aorta and descend obliquely to the pelvic cavity and supply the testis. An anatomical description of an uncommon variation of the left testicular artery is presented in this case report, highlighting its clinical implications. During routine dissection of a male cadaver, we found that the left testicular artery was bifid and it was arising from the left renal artery. After its origin, it then coursed...

  13. A new tilt on pelvic radiographs: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Richards, P.J. [North Staffordshire Royal Infirmary, Department of Radiology, Stoke-on-Trent, Staffordshire (United Kingdom); Pattison, J.M. [University Hospital of North Staffordshire, Department of Radiology, Stoke on Trent (United Kingdom); Belcher, J. [Keele University, Department of Mathematics, Keele, Staffordshire (United Kingdom); DeCann, R.W. [IMECS, Department of Radiology, Market Drayton, Shropshire (United Kingdom); Anderson, Suzanne [University of Melbourne, Department of Radiology, Melbourne (Australia); Wynn-Jones, C. [University Hospital of North Staffordshire, Department of Orthopaedic Surgery, Stoke on Trent (United Kingdom)

    2009-02-15

    The aim of this study was to evaluate pelvic tilt on commonly performed measurements on radiography in primary protrusio acetabuli and developmental dysplasia of the hip. A dry assembled pelvis and spine skeleton was positioned in an isocentric skull unit and films exposed with increasing degrees of angulation of pelvic tilt. The films were then read by two independent readers for seven different measurements used to evaluate the hips and acetabular: acetabular line to ilioischial line, teardrop appearance, intercristal/intertuberous ratio, co-ordinates of femoral head, centre edge angle, acetabular depth/width ratio and acetabular angle. There was so much variation in the protrusio results that no formal recommendation of any standard radiographic test can be given. Only the inter tuberous distance is not effected by pelvic tilt. The acetabular angles for developmental dysplasia of the hip showed the most potential with pelvic tilt below 15 . As pelvic tilt increases, measurements used in protusio become unreliable, and computed tomography/magnetic resonance imaging are probably going to be more accurate as one can directly visualise pelvic intrusion. We recommend a lateral view to assess the degree of pelvic tilt in patients with protrusion to ensure these measurements are valid. (orig.)

  14. Functional imaging of the pelvic floor

    Energy Technology Data Exchange (ETDEWEB)

    Lienemann, Andreas E-mail: andreaslienemann@web.de; Fischer, Tanja

    2003-08-01

    Introduction/Objective: Pelvic floor dysfunction and associated pelvic organ prolapse represent a major problem in our present-day society, mostly afflicting parous women. Magnetic resonance imaging (MRI) is assuming an increasingly important role in the more accurate delineation of the extent of the problem. This article briefly reviews one of the main radiological methods for the dynamic evaluation of the pelvic floor: functional cine MRI. Methods and Material: Out of the literature the smallest common denominator for functional cine MRI can be defined as follows: high field system; patient either in supine or sitting position; fast gradient echo sequence; midsagittal slice orientation; either a stack of slices or repeated measurements at the same slice position with the patient at rest or straining; image analysis using the pubococcygeal reference line. Results: All except two publications stress the usefulness of functional cine MRI in the evaluation of patients with organ descent and prolapse. This well accepted method allows for the visualization of all relevant structures in the anterior, middle and posterior compartment. It is especially useful in the detection of enteroceles, and provides a reliable postoperative follow-up tool. Isolated urinary or stool incontinence are not an indication for functional cine MRI, as is the case in patients with equivocal clinical findings. To date it does not allow for real 3D imaging of the pelvic floor or sufficient determination of fascial defects. Discussion: Functional cine MRI of the pelvic floor is a promising new imaging method for the detection of organ descent and prolapse in patients with equivocal clinical findings. The combination of function and morphology allows for an innovative view of the pelvic floor, and thus adds to our understanding of the various interactions of the structures.

  15. Evaluation of the female pelvic floor in pelvic organ prolapse using 3.0-Tesla diffusion tensor imaging and fibre tractography

    Energy Technology Data Exchange (ETDEWEB)

    Zijta, F.M. [University of Amsterdam, Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Onze Lieve Vrouwe Gasthuis, Amsterdam and Department of Radiology, Amsterdam (Netherlands); Academic Medical Center, Department of Radiology, Amsterdam, AZ (Netherlands); Lakeman, M.M.E.; Roovers, J.P. [University of Amsterdam the Netherlands and Biomedical NMR, Amsterdam and Department of Gynaecology, Academic Medical Centre, Amsterdam (Netherlands); Froeling, M. [University of Amsterdam, Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Eindhoven University of Technology, Department of Biomedical Engineering, Eindhoven (Netherlands); Paardt, M.P. van der; Borstlap, C.S.V.; Bipat, S.; Nederveen, A.J.; Stoker, J. [University of Amsterdam, Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Montauban van Swijndregt, A.D. [Onze Lieve Vrouwe Gasthuis, Amsterdam and Department of Radiology, Amsterdam (Netherlands); Strijkers, G.J. [Eindhoven University of Technology, Department of Biomedical Engineering, Eindhoven (Netherlands)

    2012-12-15

    To prospectively explore the clinical application of diffusion tensor imaging (DTI) and fibre tractography in evaluating the pelvic floor. Ten patients with pelvic organ prolapse, ten with pelvic floor symptoms and ten asymptomatic women were included. A two-dimensional (2D) spin-echo (SE) echo-planar imaging (EPI) sequence of the pelvic floor was acquired. Offline fibre tractography and morphological analysis of pelvic magnetic resonance imaging (MRI) were performed. Inter-rater agreement for quality assessment of fibre tracking results was evaluated using weighted kappa ({kappa}). From agreed tracking results, eigen values ({lambda}1, {lambda}2, {lambda}3), mean diffusivity (MD) and fractional anisotropy (FA) were calculated. MD and FA values were compared using ANOVA. Inter-rater reliability of DTI parameters was interpreted using the intra-class correlation coefficient (ICC). Substantial inter-rater agreement was found ({kappa} = 0.71 [95% CI 0.63-0.78]). Four anatomical structures were reliably identified. Substantial inter-rater agreement was found for MD and FA (ICC 0.60-0.91). No significant differences between groups were observed for anal sphincter, perineal body and puboperineal muscle. A significant difference in FA was found for internal obturator muscle between the prolapse group and the asymptomatic group (0.27 {+-} 0.05 vs 0.22 {+-} 0.03; P = 0.015). DTI with fibre tractography permits identification of part of the clinically relevant pelvic structures. Overall, no significant differences in DTI parameters were found between groups. circle Diffusion tensor MRI offers new insights into female pelvic floor problems. (orig.)

  16. Transvaginal Ultrasound-Guided Aspiration of Pelvic Abscesses

    Directory of Open Access Journals (Sweden)

    P. J. Corsi

    1999-01-01

    Full Text Available Objective: To assess the utility of a less invasive approach to the care of women with a pelvic abscess, we retrospectively reviewed the outcome of women with pelvic abscesses managed by transvaginal ultrasound-guided aspiration.

  17. Straight leg elevation to rule out pelvic injury.

    Science.gov (United States)

    Bolt, Caroline; O'Keeffe, Francis; Finnegan, Pete; Dickson, Kristofer; Smit, De Villiers; Fitzgerald, Mark C; Mitra, Biswadev

    2018-02-01

    Pelvic x-ray is frequently used as a screening tool during initial assessment of injured patients. However routine use in the awake and alert blunt trauma patient may be questioned due to low yield. We propose a clinical tool that may avoid unnecessary imaging by examining whether the ability to straight leg raise, without pain, can rule out pelvic injury. We conducted a prospective cohort study with the exposure variables of ability to straight leg raise and presence of pain on doing so, and presence of pelvic fracture on x-ray as the primary outcome variable. Of the 328 participants, 35 had pelvic fractures, and of these 32 were either unable to straight leg raise, or had pain on doing so, with a sensitivity of 91.43% (95% CI: 76.94-98.2%) and a negative predictive value of 98.57% (95% CI: 95.88-99.70%). The 3 participants with a pelvic fracture who could straight leg raise with no pain, all had a GCS of less than 15, and therefore, among the sub-group of patients with GCS15, a 100% sensitivity and 100% negative predictive value for straight leg raise with no pain to rule out pelvic fracture was demonstrated. Among awake, alert patients, painless straight leg raise can exclude pelvic fractures and be incorporated into initial examination during reception and resuscitation of injured patients. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  18. The role of spiral CT in pelvic trauma management

    International Nuclear Information System (INIS)

    Cheung, E.C.F.; Fung, K.K.L.

    1999-01-01

    Rapid and accurate assessment of pelvic injury is critical for good patient management. Plain X-ray is often used as a preliminary evaluation of the injury but this may not give adequate diagnosis of the acetabulum fracture, subtle fracture of the pelvic bone and the associated soft tissue injuries. Nowadays, spiral CT has taken an increasing role in the evaluation of pelvic trauma. It gives a rapid assessment of the bone and soft tissue injuries as compared to conventional CT. Besides, 2-D (multiplanar imaging) and 3-D image reconstruction with multiple angle views, provide the maximum information which facilitates detailed pelvic trauma evaluation. Three cases were used to illustrate the role of spiral CT in pelvic trauma management. Copyright (1999) Blackwell Science Pty Ltd

  19. MR appearance of pelvic hemangiopericytoma

    Energy Technology Data Exchange (ETDEWEB)

    Kehagias, D.; Gouliamos, A.; Vlahos, L. [Dept. of Radiology, University of Athens (Greece)

    1999-02-01

    A case of pelvic hemangiopericytoma in a 59-year-old woman is reported. The MR imaging features are presented. The tumor was unresectable and the patient received postoperative irradiation of 4200 cGy on the pelvis. One year after diagnosis, metastasis to a lumbar vertebra was discovered and additional irradiation of 3900 cGy was applied. One year later, CT showed control of the pelvic tumor and its metastasis. (orig.) (orig.) With 3 figs., 10 refs.

  20. Comparative histology of mouse, rat, and human pelvic ligaments.

    Science.gov (United States)

    Iwanaga, Ritsuko; Orlicky, David J; Arnett, Jameson; Guess, Marsha K; Hurt, K Joseph; Connell, Kathleen A

    2016-11-01

    The uterosacral (USL) and cardinal ligaments (CL) provide support to the uterus and pelvic organs, and the round ligaments (RL) maintain their position in the pelvis. In women with pelvic organ prolapse (POP), the connective tissue, smooth muscle, vasculature, and innervation of the pelvic support structures are altered. Rodents are commonly used animal models for POP research. However, the pelvic ligaments have not been defined in these animals. In this study, we hypothesized that the gross anatomy and histological composition of pelvic ligaments in rodents and humans are similar. We performed an extensive literature search for anatomical and histological descriptions of the pelvic support ligaments in rodents. We also performed anatomical dissections of the pelvis to define anatomical landmarks in relation to the ligaments. In addition, we identified the histological components of the pelvic ligaments and performed quantitative analysis of the smooth muscle bundles and connective tissue of the USL and RL. The anatomy of the USL, CL, and RL and their anatomical landmarks are similar in mice, rats, and humans. All species contain the same cellular components and have similar histological architecture. However, the cervical portion of the mouse USL and RL contain more smooth muscle and less connective tissue compared with rat and human ligaments. The pelvic support structures of rats and mice are anatomically and histologically similar to those of humans. We propose that both mice and rats are appropriate, cost-effective models for directed studies in POP research.

  1. Local diagnostic reference level based on size-specific dose estimates: Assessment of pediatric abdominal/pelvic computed tomography at a Japanese national children's hospital

    Energy Technology Data Exchange (ETDEWEB)

    Imai, Rumi; Miyazaki, Osamu; Kurosawa, Hideo; Nosaka, Shunsuke [National Center for Child Health and Development, Department of Radiology, Setagaya-ku, Tokyo (Japan); Horiuchi, Tetsuya [Osaka University, Department of Medical Physics and Engineering, Division of Medical Technology and Science, Course of Health Science, Graduate School of Medicine, Suita, Osaka (Japan)

    2015-03-01

    A child's body size is not accurately reflected by volume CT dose index (CTDI{sub vol}) and dose-length product (DLP). Size-specific dose estimation (SSDE) was introduced recently as a new index of radiation dose. However, it has not yet been established as a diagnostic reference level (DRL). To calculate the SSDE of abdominal/pelvic CT and compare the SSDE with CTDI{sub vol}. To calculate the DRLs of CTDI{sub vol} and SSDE. Our hypotheses are: SSDE values will be greater than CTDI{sub vol}, and our DRL will be smaller than the known DRLs of other countries. The CTDI{sub vol} and DLP of 117 children who underwent abdominal/pelvic CT were collected retrospectively. The SSDE was calculated from the sum of the lateral and anteroposterior diameters. The relationships between body weight and effective diameter and between effective diameter and CTDI{sub vol}/SSDE were compared. Further, the local DRL was compared with the DRLs of other countries. Body weight and effective diameter and effective diameter and SSDE were positively correlated. In children ages 1, 5 and 10 years, the SSDE is closer to the exposure dose of CTDI{sub vol} for the 16-cm phantom, while in children ages 15 years, the SSDE falls between CTDI{sub vol} for the 16-cm phantom and that for the 32-cm phantom. The local DRL was lower than those of other countries. With SSDE, the radiation dose increased with increasing body weight. Since SSDE takes body size into account, it proved to be a useful indicator for estimating the exposure dose. (orig.)

  2. Modern Theories of Pelvic Floor Support : A Topical Review of Modern Studies on Structural and Functional Pelvic Floor Support from Medical Imaging, Computational Modeling, and Electromyographic Perspectives.

    Science.gov (United States)

    Peng, Yun; Miller, Brandi D; Boone, Timothy B; Zhang, Yingchun

    2018-02-12

    Weakened pelvic floor support is believed to be the main cause of various pelvic floor disorders. Modern theories of pelvic floor support stress on the structural and functional integrity of multiple structures and their interplay to maintain normal pelvic floor functions. Connective tissues provide passive pelvic floor support while pelvic floor muscles provide active support through voluntary contraction. Advanced modern medical technologies allow us to comprehensively and thoroughly evaluate the interaction of supporting structures and assess both active and passive support functions. The pathophysiology of various pelvic floor disorders associated with pelvic floor weakness is now under scrutiny from the combination of (1) morphological, (2) dynamic (through computational modeling), and (3) neurophysiological perspectives. This topical review aims to update newly emerged studies assessing pelvic floor support function among these three categories. A literature search was performed with emphasis on (1) medical imaging studies that assess pelvic floor muscle architecture, (2) subject-specific computational modeling studies that address new topics such as modeling muscle contractions, and (3) pelvic floor neurophysiology studies that report novel devices or findings such as high-density surface electromyography techniques. We found that recent computational modeling studies are featured with more realistic soft tissue constitutive models (e.g., active muscle contraction) as well as an increasing interest in simulating surgical interventions (e.g., artificial sphincter). Diffusion tensor imaging provides a useful non-invasive tool to characterize pelvic floor muscles at the microstructural level, which can be potentially used to improve the accuracy of the simulation of muscle contraction. Studies using high-density surface electromyography anal and vaginal probes on large patient cohorts have been recently reported. Influences of vaginal delivery on the

  3. Quality of life in women with pelvic floor dysfunction

    Directory of Open Access Journals (Sweden)

    Mladenović-Segedi Ljiljana

    2011-01-01

    Full Text Available Background/Aim. Pelvic floor dysfunction is a frequent problem affecting more than 50% of women in peri- and postmenopause. Considering that ageing and menopause befall in the significant factors causing this issue, as well as the expected longevity of women in the world and in our country, pelvic floor dysfunction prevelence is foreseen to be even higher. The aim of the study was to evaluate impact of the symptoms of pelvic dysfunction on quality of life and examine body image satisfaction in adult women with pelvic organ prolapse presenting to tertiary care clinic for surgical treatment. Methods. This prospective case-control study included 50 patients who presented to tertiary care gynecology clinic for surgical treatment and 50 controls with normal pelvic floor support and without urinary incontinence who presented tertiary care gynecology clinic for other reasons. Both, patients and controls, completed two quastionnaires recommended for the evaluation of symptoms (Pelvic floor distress inventory - short forms and quality of life impact (Pelvic floor impact questionnaire - short form of pelvic organ prolapse, and Body Image Scale. Results. The patients scored significantly worse on the prolapse, urinary, colorectal scales and overall score of Pelvic floor distress inventory - 20 than controls subjects (134.91 vs 78.08; p < 0.01. The patients also measured significant decrease in condition- specific quality of life (89.23 vs 3.1; p < 0.01. They were more likely to feel self-conscious (78% vs 42%; p < 0.01, less likely to feel physically attractive (78% vs 22%; p < 0.01, more likely to have difficulty looking at themselves naked (70% vs 42%; p < 0.01, less likely to feel sexually attractive (64% vs 32%; p < 0.01, and less likely to feel feminine (56% vs 16%; p < 0.05, than controls. There were no differencies in their feeling of dissatisfaction with appearance when dressed, avoiding people because of appereance and overall dissatisfaction with

  4. Pelvic floor muscle training as a persistent nursing intervention: Effect on delivery outcome and pelvic floor myodynamia

    Directory of Open Access Journals (Sweden)

    Xin Wang

    2014-03-01

    Conclusion: Persistent nursing intervention for pregnant/postpartum women helped to shorten the second stage of labour and contributed to the recovery of postpartum pelvic floor myodynamia. The influence of this intervention on the delivery mode, and rates of episiotomy and perineal laceration remains unknown. Medical staff should strengthen health education programmes that involve pelvic floor functional rehabilitation.

  5. [Studies on antimicrobial concentrations of flomoxef in serum, pelvic dead space exudate, and pelvic organs/tissues].

    Science.gov (United States)

    Obata, T; Koishi, K; Sasaki, J; Eguchi, M; Yamamoto, Y

    1987-10-01

    To women undergoing radical and total hysterectomy, flomoxef (FMOX, 6315-S) in a dose of 2 g was administered by intravenous drip infusion over 1 hour and drug concentrations in serum and pelvic dead space exudate as well as pelvic organs/tissues were determined over time. The following results were obtained: 1. Serum concentrations of FMOX after intravenous infusion showed the peak value of 92.86 +/- 17.05 micrograms/ml at the end of infusion and then gradually decreased to 29.00 +/- 10.49 micrograms/ml in 1 hour and 1.16 +/- 1.08 micrograms/ml in 6 hours. 2. Concentrations in pelvic dead space exudate, which were 6.54 +/- 3.21 micrograms/ml at the end of intravenous infusion, gradually increased to 31.28 +/- 12.69 micrograms/ml in 30 minutes, and the peak of 35.21 +/- 13.29 micrograms/ml in 1 hour. Exudate concentrations gradually decreased to 11.10 +/- 6.64 micrograms/ml at 6 hours after infusion. 3. The serum concentration at the ligature of uterine artery was 103.21 +/- 51.69 micrograms/ml. Among concentrations in pelvic organ/tissues 37.17 +/- 18.20 micrograms/ml in uterine cervix was the highest, followed by 35.77 +/- 7.68 micrograms/g in portio vaginalis, 26.35 +/- 14.15 micrograms/g in tube, 21.62 +/- 12.15 micrograms/g in ovary, 20.56 +/- 9.82 micrograms/g in myometrium, and 16.45 +/- 8.10 micrograms/g in endometrium, in this order. 4. From an analysis of the two-compartment model, the maximum serum concentration was 92.81 micrograms/ml, which was very high. The time of 50% reduction of concentration in beta phase was 1.21 hours. In the pelvic dead space exudate, the maximum concentration was 32.38 micrograms/ml and the time of 50% reduction was 2.44 hours. The AUC was 147 micrograms.hr/ml in serum and 201 micrograms.hr/ml in the pelvic dead space. The shift to the pelvic dead space was 137% when AUC's were used as the basis of the comparison. 5. Clinically, FMOX was excellently effective against adnexitis caused by Peptostreptococcus asaccharolyticus

  6. Treatment of symptomatic pelvic varices by ovarian vein embolization

    International Nuclear Information System (INIS)

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

    1997-01-01

    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

  7. Reference ranges and reliability of transabdominal ultrasonographic renal dimensions in thoroughbred horses.

    Science.gov (United States)

    Draper, Alexandra C E; Bowen, I Mark; Hallowell, Gayle D

    2012-01-01

    The aims of this study were to establish a normal reference range (mean ± 2 SD) and assess reliability of renal dimensions obtained using transabdominal ultrasonography in Thoroughbred horses (n = 7). A minimum of three ultrasonographic cineloops were obtained from each intercostal space and the left paralumbar fossa by two observers daily for three consecutive days. Renal length, width, and thickness and cortex, medulla, and pelvic dimensions were obtained. Measurements were undertaken by both observers, who were unaware of prior measurements, to assess reproducibility and measured on three separate occasions to evaluate short-term measurement repeatability. Measurements from images obtained by both operators were compared to evaluate image repeatability. The left kidney was consistently identified in the left 15th-17th intercostal space and the paralumbar fossa with maximal length in the 16th intercostal space (12.7 ± 2.0 cm) and maximal width in the paralumbar fossa (7.9 ± 1.1 cm). The right kidney was consistently identified in the right 15th-17th intercostal space with maximal length and maximal width in the 15th intercostal space (16.0 ± 0.7 cm and 7.9 ± 1.0 cm). Reproducibility, image repeatability, measurement repeatability were good to excellent, although were less good for the smaller structures. There were no differences in renal dimensions between horses. Overall renal ultrasonography was reliable and a normal reference range for Thoroughbred horses was established. Renal dimensions vary between rib spaces. As repeatability and reproducibility were excellent for renal length and width, it may be prudent to use those measurements in rib spaces where parameters were maximal. © 2011 Veterinary Radiology & Ultrasound.

  8. Chronic Pelvic Pain

    Science.gov (United States)

    ... NSAIDs) are helpful in relieving pelvic pain, especially dysmenorrhea . Physical therapy—Acupuncture, acupressure, and nerve stimulation therapies may be useful in treating pain caused by dysmenorrhea. Physical therapy that eases trigger points may give ...

  9. Pelvic Organ Prolapse

    Science.gov (United States)

    ... the Treatment Options for Pelvic Organ Prolapse? After obtaining a detailed medical history and completing a thorough ... Food and Drug Administration 10903 New Hampshire Avenue Silver Spring, MD 20993 1-888-INFO-FDA (1- ...

  10. Urea recycling from the renal pelvis in sheep: A study with [14C]urea

    International Nuclear Information System (INIS)

    Cirio, A.; Boivin, R.

    1990-01-01

    To test the hypothesis that urea can be recycled from the renal pelvis, [14C]urea diluted in native urine (1 microCi/ml) was perfused (0.5 ml/min) into one of the pelvises of sheep fed either normal (NP) or low (LP)-protein diets. Blood samples were obtained from the ipsilateral renal vein and from the carotid artery throughout the perfusions. 14C activity determinations in urine and plasma demonstrated a flux of [14C]urea from the pelvis to renal vein blood (40,000 in NP and 130,000 disintegrations/min in LP sheep, P less than 0.01). The corresponding flux of native urea was only 1.5 times higher in NP than in LP sheep (6.8 +/- 1.1 vs. 4.7 +/- 2.9 mumol/min, not significant) despite their 8 times higher urinary concentration of urea. The fraction of filtered urea that was reabsorbed in the pelvis was larger in LP sheep (7.5 +/- 3.7 vs. 1.9 +/- 0.7% in NP sheep, P less than 0.05). A fraction of urea is thus actually recycled from the renal pelvis in sheep, and this pelvic retention is enhanced in LP animals. The importance of this phenomenon in the nitrogen economy is discussed

  11. Bone Health and Pelvic Radiotherapy.

    Science.gov (United States)

    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. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  12. Pelvic reconstruction with allogeneic bone graft after tumor resection

    Science.gov (United States)

    Wang, Wei; Bi, Wen Zhi; Yang, Jing; Han, Gang; Jia, Jin Peng

    2013-01-01

    OBJECTIVES : Pelvic reconstruction after tumor resection is challenging. METHODS: A retrospective study had been preformed to compare the outcomes among patients who received pelvic reconstructive surgery with allogeneic bone graft after en bloc resection of pelvic tumors and patients who received en bloc resection only. RESULTS: Patients without reconstruction had significantly lower functional scores at 3 months (10 vs. 15, P = 0.001) and 6 months after surgery (18.5 vs. 22, P = 0.0024), a shorter duration of hospitalization (16 day vs. 40 days, P 0.05). CONCLUSIONS : Pelvic reconstruction with allogeneic bone graft after surgical management of pelvic tumors is associated with satisfactory surgical and functional outcomes. Further clinical studies are required to explore how to select the best reconstruction method. Level of Evidence IV, Case Series. PMID:24453659

  13. MRI at the completion of chemoradiotherapy can accurately evaluate the extent of disease in women with advanced urethral carcinoma undergoing anterior pelvic exenteration

    Energy Technology Data Exchange (ETDEWEB)

    Gourtsoyianni, S.; Hudolin, T. [Department of Radiology, Memorial Sloan-Kettering Cancer Centre, 1275 York Avenue, New York, NY (United States); Sala, E. [Department of Radiology, Box 218, Addenbrooke' s Hospital, Hills Road, Cambridge (United Kingdom); Goldman, D. [Department of Radiology, Memorial Sloan-Kettering Cancer Centre, 1275 York Avenue, New York, NY (United States); Bochner, B.H. [Department of Urology, Memorial Sloan-Kettering Cancer Centre, 1275 York Avenue, New York, NY (United States); Hricak, Hedvig, E-mail: muellnea@mskcc.org [Department of Radiology, Memorial Sloan-Kettering Cancer Centre, 1275 York Avenue, New York, NY (United States)

    2011-11-15

    Aim: To demonstrate the value of pelvic magnetic resonance imaging (MRI) in mapping tumour extension after chemoradiotherapy and before anterior pelvic exenteration in patients with primary carcinoma of the urethra. Materials and methods: The Institutional Review Board approved and issued a waiver of informed consent for this retrospective study, which was compliant with the Health Insurance Portability and Accountability Act. Six women (median age 51 years, range 39-63 years) with histopathology-proven urethral carcinoma who underwent neoadjuvant chemoradiotherapy before anterior pelvic exenteration were included in the study. All had MRI performed at first presentation and after completion of chemoradiotherapy. MRI images were analysed by an experienced reader, who was blinded to the clinical data. The tumour location, signal intensity, size, local extension, and presence of enlarged lymph nodes were recorded for each patient at baseline and after chemoradiotherapy. Surgical histopathology constituted the reference standard. Results: All tumours were locally advanced (stage T3) at baseline MRI. The mean maximum diameter of the tumour at baseline MRI was 3.7 cm (range 2.4-5 cm). After chemoradiotherapy, the mean reduction in maximum tumour diameter on MRI was 44% (range 13-67%), but only three cases were down-staged. MRI was accurate in the evaluation of tumour extension after completion of chemoradiotherapy in all cases. Persistence of bladder neck and anterior vaginal wall invasion was correctly identified in three cases. Conclusion: In women with advanced primary urethral cancer, MRI is an excellent tool for monitoring neo-adjuvant chemoradiotherapy changes and evaluating the extent of disease before exenterative surgery.

  14. MRI at the completion of chemoradiotherapy can accurately evaluate the extent of disease in women with advanced urethral carcinoma undergoing anterior pelvic exenteration

    International Nuclear Information System (INIS)

    Gourtsoyianni, S.; Hudolin, T.; Sala, E.; Goldman, D.; Bochner, B.H.; Hricak, Hedvig

    2011-01-01

    Aim: To demonstrate the value of pelvic magnetic resonance imaging (MRI) in mapping tumour extension after chemoradiotherapy and before anterior pelvic exenteration in patients with primary carcinoma of the urethra. Materials and methods: The Institutional Review Board approved and issued a waiver of informed consent for this retrospective study, which was compliant with the Health Insurance Portability and Accountability Act. Six women (median age 51 years, range 39-63 years) with histopathology-proven urethral carcinoma who underwent neoadjuvant chemoradiotherapy before anterior pelvic exenteration were included in the study. All had MRI performed at first presentation and after completion of chemoradiotherapy. MRI images were analysed by an experienced reader, who was blinded to the clinical data. The tumour location, signal intensity, size, local extension, and presence of enlarged lymph nodes were recorded for each patient at baseline and after chemoradiotherapy. Surgical histopathology constituted the reference standard. Results: All tumours were locally advanced (stage T3) at baseline MRI. The mean maximum diameter of the tumour at baseline MRI was 3.7 cm (range 2.4-5 cm). After chemoradiotherapy, the mean reduction in maximum tumour diameter on MRI was 44% (range 13-67%), but only three cases were down-staged. MRI was accurate in the evaluation of tumour extension after completion of chemoradiotherapy in all cases. Persistence of bladder neck and anterior vaginal wall invasion was correctly identified in three cases. Conclusion: In women with advanced primary urethral cancer, MRI is an excellent tool for monitoring neo-adjuvant chemoradiotherapy changes and evaluating the extent of disease before exenterative surgery.

  15. Interventional Management for Pelvic Pain.

    Science.gov (United States)

    Nagpal, Ameet S; Moody, Erika L

    2017-08-01

    Interventional procedures can be applied for diagnostic evaluation and treatment of the patient with pelvic pain, often once more conservative measures have failed to provide relief. This article reviews interventional management strategies for pelvic pain. We review superior and inferior hypogastric plexus blocks, ganglion impar blocks, transversus abdominis plane blocks, ilioinguinal, iliohypogastric and genitofemoral blocks, pudendal nerve blocks, and selective nerve root blocks. Additionally, we discuss trigger point injections, sacroiliac joint injections, and neuromodulation approaches. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Management of pelvic chondrosarcoma

    Directory of Open Access Journals (Sweden)

    Florin Groșeanu

    2016-11-01

    Full Text Available The partial or complete excision of the hemipelvis with sparing of the lower limb is an option of the treatment of pelvic chondrosarcoma and a therapeutic alternative of the interilio-abdominal disarticulation. The operation has in principle the same indications as the interilio-abdominal disarticulation and offers a good solution for avoiding a mutilating operation. The 149 cases include: 120 biopsies, 29 excisional biopsies, 6 interilioabdominal disarticulations and 14 resections – reconstruction’s, one of with prosthetic reconstruction. The prognostic score was established by assessing: the surgical stage, the site of the tumor, the surgical margins of the tumor, the functional mobility and the postoperative activity. The wide excision of the tumor, a stable reconstruction and an efficient recovery are essential for a successful treatment of pelvic chondrosarcoma. The limb sparing resection-reconstruction represents a highly surgical demanding procedure, followed up by complications in 60% of the cases, so that should be performed only by high skilled surgeons. Hemipelvectomy still remains a well-established life-saving surgery method for patients suffering from vast oncological extensions, where a pelvic resection is not an option.

  17. Radiology of sport injuries of pelvic apophyses

    Energy Technology Data Exchange (ETDEWEB)

    Heuck, F

    1983-09-01

    Pelvic apophyses are places of insertion of strong muscles and tendons and are therefore places of least resistance at the end of skeletal growth. Avulsions and disruptions of pelvic apophyses can be caused by overstrain during different kinds of sport activity. Typical radiological findings in 8 different cases of ruptures of apophyses, osteochondropathies, and resulting conditions of sport injuries are demonstrated. The difficulties of correct diagnosis and different diagnosis are pointed out. The significance of hormonal impairment of ossification for development and stress factor of pelvic apophyses is exposed. Questions of treatment and follow-up studies are discussed.

  18. Radiology of sport injuries of pelvic apophyses

    International Nuclear Information System (INIS)

    Heuck, F.

    1983-01-01

    Pelvic apophyses are places of insertion of strong muscles and tendons and are therefore places of least resistance at the end of skeletal growth. Avulsions and disruptions of pelvic apophyses can be caused by overstrain during different kinds of sport activity. Typical radiological findings in 8 different cases of ruptures of apophyses, osteochondropathies, and resulting conditions of sport injuries are demonstrated. The difficulties of correct diagnosis and different diagnosis are pointed out. The significance of hormonal impairment of ossification for development and stress factor of pelvic apophyses is exposed. Questions of treatment and follow-up studies are discussed. (orig.)

  19. Node-positive cervical cancer: impact of pelvic irradiation and patterns of failure

    International Nuclear Information System (INIS)

    Stock, Richard G.; Chen, Alex S. J.; Flickinger, John C.; Kalnicki, Shalom; Seski, Jan

    1995-01-01

    Purpose: The roles of postoperative pelvic and prophylactic paraaortic irradiation in pelvic node positive cervical cancer are currently controversial. A retrospective study was undertaken to examine the effect of pelvic irradiation on pelvic control and survival and to analyze the patterns of recurrence to determine whether indications exist for prophylactic paraaortic irradiation. Methods and Materials: From 1964 to 1991, 143 cases of FIGO Stage I and II cervical cancer undergoing exploratory laparotomy, pelvic lymph node dissection, and radical hysterectomy had positive pelvic lymph nodes. Postoperatively, 108 cases were treated with whole pelvic irradiation while 35 patients were observed. Prophylactic paraaortic irradiation was not given. Results: Patients who received postoperative whole pelvic irradiation compared with those treated with radical hysterectomy alone had a significantly improved pelvic control rate, disease-free survival (DFS), and overall survival. The 5-year actuarial pelvic control rate was 78% vs. 45% (p = <0.0001), respectively. The 5-year actuarial DFS was 65% vs. 41% (p = 0.0004). The 5-year actuarial overall survival was 58% vs. 46% (p 0.02). In multivariate analysis, pelvic irradiation continued to show a positive effect on DFS (p = 0.0001) and overall survival (p = 0.0035). Lymphatic invasion and the total number of positive lymph nodes were the only other independent predictors of overall survival and DFS. The actuarial 5-year pelvic, paraaortic, and distant failure rates were 30%, 10%, and 28%, respectively. An isolated first recurrence in the paraaortic nodes occurred in only three cases. Conclusion: Postoperative pelvic irradiation significantly improves pelvic control, DFS, and overall survival, and should be used in patients with early stage cervical cancer and pathologically proven pelvic nodal metastases. The low incidence of isolated paraaortic nodal failure calls into question the value of routine prophylactic paraaortic

  20. Node-positive cervical cancer: impact of pelvic irradiation and patterns of failure

    Energy Technology Data Exchange (ETDEWEB)

    Stock, Richard G; Chen, Alex S. J.; Flickinger, John C; Kalnicki, Shalom; Seski, Jan

    1995-01-01

    Purpose: The roles of postoperative pelvic and prophylactic paraaortic irradiation in pelvic node positive cervical cancer are currently controversial. A retrospective study was undertaken to examine the effect of pelvic irradiation on pelvic control and survival and to analyze the patterns of recurrence to determine whether indications exist for prophylactic paraaortic irradiation. Methods and Materials: From 1964 to 1991, 143 cases of FIGO Stage I and II cervical cancer undergoing exploratory laparotomy, pelvic lymph node dissection, and radical hysterectomy had positive pelvic lymph nodes. Postoperatively, 108 cases were treated with whole pelvic irradiation while 35 patients were observed. Prophylactic paraaortic irradiation was not given. Results: Patients who received postoperative whole pelvic irradiation compared with those treated with radical hysterectomy alone had a significantly improved pelvic control rate, disease-free survival (DFS), and overall survival. The 5-year actuarial pelvic control rate was 78% vs. 45% (p = <0.0001), respectively. The 5-year actuarial DFS was 65% vs. 41% (p = 0.0004). The 5-year actuarial overall survival was 58% vs. 46% (p 0.02). In multivariate analysis, pelvic irradiation continued to show a positive effect on DFS (p = 0.0001) and overall survival (p = 0.0035). Lymphatic invasion and the total number of positive lymph nodes were the only other independent predictors of overall survival and DFS. The actuarial 5-year pelvic, paraaortic, and distant failure rates were 30%, 10%, and 28%, respectively. An isolated first recurrence in the paraaortic nodes occurred in only three cases. Conclusion: Postoperative pelvic irradiation significantly improves pelvic control, DFS, and overall survival, and should be used in patients with early stage cervical cancer and pathologically proven pelvic nodal metastases. The low incidence of isolated paraaortic nodal failure calls into question the value of routine prophylactic paraaortic

  1. Retrospective review of pelvic malignancies undergoing total pelvic exenteration

    Directory of Open Access Journals (Sweden)

    Kuhrt Maureen P

    2012-06-01

    Full Text Available Abstract Background In patients with locally advanced or recurrent pelvic malignancies, total pelvic exenteration (TPE may be necessary for curative treatment. Despite improvements in mortality rates since TPE was first described, morbidity rates remain high due to the extensive resection and the aggressiveness of these tumors. We have studied the outcomes of TPE surgery performed at our institution. Methods Fifty-three patients with various pelvic pathologies underwent TPE between 2004 and 2010. Patients were divided into two groups based on pathology: colorectal (n = 36 versus non-colorectal (n = 17 malignancies. Demographics, operative reports, pathology reports, periprocedural events, and outcomes were analyzed. Comparison of the two groups was performed using student’s t-test and Fisher’s exact test. Survival curves were constructed using the Kaplan–Meier method and compared using the log rank test. Results The colorectal and non-colorectal groups were similar in demographics, operative times, length of stay, estimated blood loss, and rates of preoperative and intraoperative radiation use. Chemotherapy use was increased in the colorectal group compared with the non-colorectal group (55.6% vs. 23.5%, P = 0.04. Complication rates were similar: 86% in the colorectal group and 76% in the non-colorectal group. In the colorectal group, 27.8% of patients developed perineal abscesses, whereas no patients developed these complications in the non-colorectal group (P = 0.02. No survival difference was seen in primary versus recurrent colorectal tumors; however, within the colorectal group there was a survival advantage when comparing R0 resection to R1 and R2 resection combined. Median survival rates were 27.3 months for R0 resection and 10.7 months for R1 and R2 resection combined. The median survival was 21.4 months for the colorectal group and 6.9 months for the non-colorectal group (P = 0.002. Conclusions

  2. Laparoscopic pelvic sling placement facilitates optimum therapeutic radiotherapy delivery in the management of pelvic malignancy.

    LENUS (Irish Health Repository)

    Joyce, M

    2012-02-01

    BACKGROUND: Radiotherapy has a significant role in the management of pelvic malignancies. However, the small intestine represents the main dose limiting organ. Invasive and non-invasive mechanical methods have been described to displace bowel out of the radiation field. We herein report a case series of laparoscopic placement of an absorbable pelvic sling in patients requiring pelvic radiotherapy. METHODS: Six patients were referred to our minimally invasive unit. Four patients required radical radiotherapy for localised prostate cancer, one was scheduled for salvage localised radiotherapy for post-prostatectomy PSA progression and one patient required adjuvant radiotherapy post-cystoprostatectomy for bladder carcinoma. All patients had excessive small intestine within the radiation fields despite the use of non-invasive displacement methods. RESULTS: All patients underwent laparoscopic mesh placement, allowing for an elevation of small bowel from the pelvis. The presence of an ileal conduit or previous surgery did not prevent mesh placement. Post-operative planning radiotherapy CT scans confirmed displacement of the small intestine allowing all patients to receive safely the planned radiotherapy in terms of both volume and radiation schedule. CONCLUSION: Laparoscopic mesh placement represents a safe and efficient procedure in patients requiring high-dose pelvic radiation, presenting with unacceptable small intestine volume in the radiation field. This procedure is also feasible in those that have undergone previous major abdominal surgery.

  3. Sexual selection targets cetacean pelvic bones

    Science.gov (United States)

    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

  4. Assessment of female pelvic pathology by magnetic resonance

    International Nuclear Information System (INIS)

    Gil, M.; Sanchez, A.; Narvaez, J.A.; Valls, C.; Guma, A.; Andia, E.

    1997-01-01

    In recent years, magnetic resonance imaging (MRI) has become the imaging technique of choice for the detection and characterization of pelvic pathology. Its multiplanar capability, excellent soft tissue contrast, use of nonionizing radiations and noninvasive nature make MRI the ideal technique for assessing the female pelvis. The purpose of this study is to describe the normal pelvic anatomy as it appears in MRI and to asses the radiologic features of the different pelvic pathologies. (Author) 21 refs

  5. Pelvic Floor Physical Therapy for Vulvodynia: A Clinician's Guide.

    Science.gov (United States)

    Prendergast, Stephanie A

    2017-09-01

    Vulvar pain affects up to 20% of women at some point in their lives, and most women with vulvar pain have associated pelvic floor impairments. Pelvic floor dysfunction is associated with significant functional limitations in women by causing painful intercourse and urinary, bowel, and sexual dysfunction. A quick screening of the pelvic floor muscles can be performed in the gynecology office and should be used when patients report symptoms of pelvic pain. It is now known the vulvar pain syndromes are heterogeneous in origin; therefore, successful treatment plans are multimodal and include physical therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Assessment of pelvic floor dysfunctions using dynamic magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Hoda Salah Darwish

    2014-03-01

    Conclusion: Dynamic MRI is an ideal, non invasive technique which does not require patient preparation for evaluation of pelvic floor. It acts as one stop shop for diagnosing single or multiple pelvic compartment involvement in patients with pelvic floor dysfunction.

  7. Pelvic Floor Muscle Training: Underutilization in the USA.

    Science.gov (United States)

    Lamin, Eliza; Parrillo, Lisa M; Newman, Diane K; Smith, Ariana L

    2016-02-01

    Pelvic floor disorders are highly prevalent in women of all ages and can greatly impair quality of life. Pelvic floor muscle training (PFMT) is a viable treatment option for several pelvic floor conditions including urinary incontinence and pelvic organ prolapse. PFMT is a program of therapy initiated by an experienced clinician (e.g., women's health or urology nurse practitioner (NP), physical therapist (PT)) that involves exercises for women with stress urinary incontinence (UI) and exercises combined with behavioral or conservative treatments (lifestyle changes, bladder training with urge suppression) for women with urgency or mixed UI. These exercise programs are more comprehensive than simple Kegel exercises. Despite evidence-based research indicating the efficacy and cost-effectiveness for treatment of urinary incontinence, PFMT is not commonly used as a first-line treatment in clinical practice in the USA (Abrams et al., 2012). This article will review PFMT for the treatment of UI and pelvic organ prolapse (POP) and theorize how this conservative therapy can be utilized more effectively in the USA.

  8. Management of disorders of the posterior pelvic floor.

    Science.gov (United States)

    Berman, Loren; Aversa, John; Abir, Farshad; Longo, Walter E.

    2005-01-01

    INTRODUCTION: Constipation is a relatively common problem affecting 15 percent of adults in the Western world, and over half of these cases are related to pelvic floor disorders. This article reviews the clinical presentation and diagnostic approach to posterior pelvic floor disorders, including how to image and treat them. METHODS: A Pubmed search using keywords "rectal prolapse," "rectocele," "perineal hernia," and "anismus" was performed, and bibliographies of the revealed articles were cross-referenced to obtain a representative cross-section of the literature, both investigational studies and reviews, that are currently available on posterior pelvic floor disorders. DISCUSSION: Pelvic floor disorders can occur with or without concomitant physical anatomical defects, and there are a number of imaging modalities available to detect such abnormalities in order to decide on the appropriate course of treatment. Depending on the nature of the disorder, operative or non-operative therapy may be indicated. CONCLUSION: Correctly diagnosing pelvic floor disorders can be complex and challenging, and the various imaging modalities as well as clinical history and exam must be considered together in order to arrive at a diagnosis. PMID:16720016

  9. Physical, Complementary, and Alternative Medicine in the Treatment of Pelvic Floor Disorders.

    Science.gov (United States)

    Arnouk, Alex; De, Elise; Rehfuss, Alexandra; Cappadocia, Carin; Dickson, Samantha; Lian, Fei

    2017-06-01

    The purpose of the study was to catalog the most recent available literature regarding the use of conservative measures in treatment of pelvic floor disorders. Pelvic floor disorders encompass abnormalities of urination, defecation, sexual function, pelvic organ prolapse, and chronic pain, and can have significant quality of life implications for patients. Current guidelines recommend behavioral modifications and conservative treatments as first-line therapy for pelvic floor disorders. We have reviewed the literature for articles published on physical, complementary, and alternative treatments for pelvic floor disorders over the past 5 years. Review of pelvic floor muscle physiotherapy (PFMT) and biofeedback (BF) shows a benefit for patients suffering from bladder dysfunction (incontinence, overactive bladder), bowel dysfunction (constipation, fecal incontinence), pelvic organ prolapse, and sexual dysfunction (pelvic pain). Combination of PFMT and BF has shown improved results compared to PFMT alone, and some studies find that electrical stimulation can augment the benefit of BF and PFMT. Additionally, acupuncture and cognitive behavioral therapy has shown to be an effective treatment for pelvic floor disorders, particularly with respect to pelvic pain. This update highlights beneficial conservative treatments available for pelvic floor dysfunction, and supplements the current literature on treatment options for patients suffering from these disorders.

  10. Optimizing renal DMSA-scintigraphy with 7-pinhole collimator

    International Nuclear Information System (INIS)

    Botsch, H.; Pottmeyer, A.; Savaser, A.; Lochner, B.; Felix, R.

    1982-01-01

    Multiple pinhole emission tomographic imaging techniques are currently being applied to imaging of organs of a limited size. The purpose of this study was to evaluate the feasibility of this technique in kidney imaging with Tcsup(99m)-DMSA. A 7-pinhole collimator having 4.5 mm. pinhole apertures was used in conjunction with a widefield camera. Left and right kidney were imaged separately. Twelve small renal cysts with a diameter of 1 to 3.5 cm. verified by US or CAT were investigated by 7-pinhole and planar scintigraphy. Eight of 12 renal cysts were identified by 7-pinhole scintigraphy whereas only one cyst was seen by planar scintigraphy. The borderline of cysts detection was 1.5 cm. in 7-pinhole tomography. Basing on these comparative studies and experiences on many patient investigations it seems reasonable to perform renal scintigraphy with 7-pinhole tomography in a routine manner. (orig.)

  11. Skull metastasis revealing a renal tumor: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Mohamed Badri

    Full Text Available Background: Renal cell carcinomas represent 85% of malignant renal tumors. Typically, the tumor remains asymptomatic a long time before the appearance of urologic clinical signs. In some cases, metastasis can precede the manifestations of the primary tumor. Different sites are potential metastatic localizations for renal tumors, including skull metastases who represent a very rare location. Case description: We report the case of a 65-year-old man presented after the appearance of a skull mass. This tumefaction developed and had progressively grown up during 9 months. Neurological examination was normal. Brain imaging showed a soft tissue lesion in the left parietal bone with marked osteolysis. Peroperative was found a huge oval-shape hemorrhagic and firm mass associated with scalp invasion and bone destruction that was totally resected. Histopathology revealed renal cell carcinoma (RCC. Pelvic and abdominal CT scan was performed, revealing a large mass on the left kidney with irregular contours and poor definition. The patient was then transferred to urology where he underwent nephrectomy. The patient went then through adjuvant chemotherapy. Clinical and radiological follow up of 12 months did not bring to light tumor recurrence. Conclusions: Although metastases to the head and neck occur infrequently, they should be considered when evaluating any unusual subcutaneous mass in the head and neck. RCC should not be discounted when sites as unlikely as the calvaria are evaluated. Treatment of metastatic renal cell carcinoma is complex, and the optimal regimen for achieving a lasting response without severe toxicity has not yet been defined. Keywords: Renal tumor, Skull metastasis, Neurosurgery

  12. Symptomatic pelvic organ prolapse: Experience at a tertiary ...

    African Journals Online (AJOL)

    information was recorded after a detailed history, physical examination and completion of a self-administered symptom questionnaire. ... due to anatomical restoration of prolapse in ..... of terminology of female pelvic organ prolapse and pelvic.

  13. Metabolic and Hormonal Determinants of Glomerular Filtration Rate and Renal Hemodynamics in Severely Obese Individuals

    Directory of Open Access Journals (Sweden)

    Edoardo Vitolo

    2016-10-01

    Full Text Available Objective: Renal function is often compromised in severe obesity. A true measurement of glomerular filtration rate (GFR is unusual, and how estimation formulae (EstForm perform in such individuals is unclear. We characterized renal function and hemodynamics in severely obese individuals, assessing the reliability of EstForm. Methods: We measured GFR (mGFR by iohexol plasma clearance, renal plasma flow (RPF by 123I-ortho-iodo-hippurate, basal and stimulated vascular renal indices, endothelium-dependent and -independent vasodilation using flow-mediated dilation (FMD as well as metabolic and hormonal profile in morbid, otherwise healthy, obese subjects. Results: Compared with mGFR, the better performing EstForm was CKD-EPI (5.3 ml/min/1.73 m2 bias by Bland-Altman analysis. mGFR was directly related with RPF, total and incremental glucose AUC, and inversely with PTH and h8 cortisol. Patients with mGFR below the median shown significantly higher PTH and lower vitamin D3. Basal or dynamic renal resistive index, FMD, pulse wave velocity were not related with mGFR. In an adjusted regression model, renal diameter and plasma flow remained related with mGFR (R2 = 0.67, accounting for 15% and 21% of mGFR variance, respectively. Conclusions: CKD-EPI formula should be preferred in morbid obesity; glucose increments during oral glucose tolerance test correlate with hyperfiltration; RPF and diameter are independent determinants of mGFR; slightly high PTH values, frequent in obesity, might influence mGFR.

  14. Radiodiagnosis of pelvic birth injuries and their consequences

    International Nuclear Information System (INIS)

    Konycheva, E.A.; Loskutova, L.A.

    1984-01-01

    A study was made of the changes in the pelvic articulations in women with birth injuries 2-5 years following birth on the basis of the clinicoroentgenological findings. Pathological adhesion of birth injuries of the pelvic bones, that manifested itself in the formation of callus and arthrosis of the public and sacroiliac articulations, was noted. The study confirmed incomplete rehabilitation in this group of women. For prognosis of subsequent partirition roentgenopelvimetry is recommended for women with birth in uries of the pelvic girdle

  15. Radiodiagnosis of pelvic birth injuries and their consequences

    Energy Technology Data Exchange (ETDEWEB)

    Konycheva, E.A.; Loskutova, L.A. (Bashkirskij Meditsinskij Inst. (USSR))

    A study was made of the changes in the pelvic articulations in women with birth injuries 2-5 years following birth on the basis of the clinicoroentgenological findings. Pathological adhesion of birth injuries of the pelvic bones, that manifested itself in the formation of callus and arthrosis of the public and sacroiliac articulations, was noted. The study confirmed incomplete rehabilitation in this group of women. For prognosis of subsequent parturition roentgenopelvimetry is recommended for women with birth injuries of the pelvic girdle.

  16. CT-Guided Microwave Ablation of 45 Renal Tumors: Analysis of Procedure Complexity Utilizing a Percutaneous Renal Ablation Complexity Scoring System.

    Science.gov (United States)

    Mansilla, Alberto V; Bivins, Eugene E; Contreras, Francisco; Hernandez, Manuel A; Kohler, Nathan; Pepe, Julie W

    2017-02-01

    To develop a scoring system that stratifies complexity of percutaneous ablation of renal tumors. Analysis was performed of 36 consecutive patients (mean age, 64 y; range, 30-89 y) who underwent CT-guided microwave (MW) ablation of 45 renal tumors (mean tumor diameter, 2.4 cm; range, 1.2-4.0 cm). Technical success and effectiveness were determined based on intraprocedural and follow-up imaging studies. The RENAL score and the proposed percutaneous renal ablation complexity (P-RAC) score were calculated for each tumor. Technical success was 93.3% (n = 42). Biopsy of 38 of 45 renal tumors revealed 23 renal cell carcinomas. Median follow-up period was 9.7 months (range, 2.9-46.8 months). There were no tumor recurrences. One major complication, ureteropelvic junction stricture, occurred (2.6%). The P-RAC score was found to differ statistically from the RENAL score (t = 3.754, df = 44, P = .001). A positive correlation was found between the P-RAC score and number of antenna insertions (r = .378, n = 45, P = .011) and procedure duration (r = .328, n = 45, P = .028). No correlation was found between the RENAL score and number of MW antenna insertions (r = .110, n = 45, P = .472) or procedure duration (r = .263, n = 45, P = .081). Hydrodissection was significantly more common in the P-RAC high-complexity category than in low-complexity category (χ 2 = 12.073, df = 2, P = .002). The P-RAC score may be useful in stratifying percutaneous renal ablation complexity. Further studies with larger sample sizes are necessary to validate the P-RAC score and to determine if it can predict risk of complications. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  17. Pelvic Organ Prolapse in Jimma University Specialized Hospital ...

    African Journals Online (AJOL)

    Pelvic Organ Prolapse in Jimma University Specialized Hospital, Southwest Ethiopia. ... and there was a significant association between prolapse and residence area. ... Awareness creation on risk factors of pelvic organ prolapse and use of ...

  18. Diagnosis of pelvic wall tumor on multislice CT

    International Nuclear Information System (INIS)

    Zhang Keyun; Deng Lequn; Lei Hongwei

    2011-01-01

    Objective: To evaluate the value of multi-slice CT (MSCT) in diagnosing pelvic wall tumors. Methods: MSCT of 21 cases of pelvic wall tumors including metastasis (10), neurogenic tumor (5), chondrosarcoma (2), chordoma (1), aneurysmal bone cyst (1), giant cell tumor (1), and osteochondroma (1) was retrospectively analyzed. Results: CT appearances of pelvic wall tumors include bony destruction and soft tissue masses. Common features were bone destruction in metastasis, expansion of the neuroforamen in neurogenic tumor, pleomorphic calcification in chondrosarcoma, lower sacral vertebral location of chordoma, iliac crest bone destruction in giant cell tumor, cauliflower-like nodules in osteochondroma. Conclusion: MSCT with three-dimensional volume rendering demonstrates well the tumor shape, size, extent, internal structure and relationship with the surrounding organs to aid diagnosis of pelvic wall tumors. (authors)

  19. Barriers to Pelvic Floor Physical Therapy Regarding Treatment of High-Tone Pelvic Floor Dysfunction.

    Science.gov (United States)

    Zoorob, Dani; Higgins, Margaret; Swan, Kimberly; Cummings, Jennifer; Dominguez, Sarah; Carey, Erin

    Chronic pelvic pain is a prevalent and debilitating condition with a wide range of etiologies. An estimated 30% to 70% of chronic pelvic cases involve musculoskeletal component pain including high-tone pelvic floor dysfunction (HTPFD). Pelvic floor physical therapy has been shown to be a beneficial treatment for HTPFD, yet many patients do not have access to this treatment. The objective of this study was to identify the barriers preventing patients from following through with the first-line management, physical therapy. Participants with a diagnosis of HTPFD (n = 154) were identified from the list of referrals sent from the obstetrics and gynecology department to an affiliated PFPT center. Participants were contacted and asked to complete a phone survey addressing demographics and perceived barriers to care. Responses were collected in REDCap. Univariate and bivariate analyses were performed using a statistical analysis software. Seventy surveys were completed. The top barriers identified by participants were financial constraints (51.4%), perceived lack of utility (37.1%), time constraints (30.0%), and travel issues (18.6%); 84.4% of participants had 1 or more comorbid pain condition. Whereas 51.4% expressed some level of anxiety regarding the PFPT option, only 9.6% of participants did not start treatment because of fear of treatment. The majority of treatment barriers identified were concrete restraints, with insurance noncoverage and time constraints being the top issues. A fair number of participants expressed anxiety about the treatment or felt they received unclear explanations of the treatment. These are areas in which providers can potentially alleviate some barriers to care.

  20. An education program about pelvic floor muscles improved women's knowledge but not pelvic floor muscle function, urinary incontinence or sexual function: a randomised trial.

    Science.gov (United States)

    de Andrade, Roberta Leopoldino; Bø, Kari; Antonio, Flavia Ignácio; Driusso, Patricia; Mateus-Vasconcelos, Elaine Cristine Lemes; Ramos, Salvador; Julio, Monica Pitanguy; Ferreira, Cristine Homsi Jorge

    2018-04-01

    Does an educational program with instructions for performing 'the Knack' improve voluntary contraction of the pelvic floor muscles, reduce reports of urinary incontinence, improve sexual function, and promote women's knowledge of the pelvic floor muscles? Randomised, controlled trial with concealed allocation, intention-to-treat analysis and blinded assessors. Ninety-nine women from the local community. The experimental group (n=50) received one lecture per week for 4 weeks, and instructions for performing 'the Knack'. The control group (n=49) received no intervention. The primary outcome was maximum voluntary contraction of the pelvic floor muscles measured using manometry. Secondary outcomes were: ability to contract the pelvic floor muscles measured using vaginal palpation; severity of urinary incontinence measured by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scored from 0 to 21; self-reported sexual function; and knowledge related to the pelvic floor. Outcomes were measured at baseline and after 4 weeks. The intervention did not significantly improve: maximum voluntary contraction (MD 2.7 cmH 2 O higher in the experimental group, 95% CI -0.5 to 5.9); ability to contract the pelvic floor muscles (RR 2.18, 95% CI 0.49 to 9.65); or self-reported severity of urinary incontinence (MD 1 point greater reduction in the experimental group, 95% CI -3 to 1). Sexual function did not significantly differ between groups, but very few of the women engaged in sexual activity during the study period. The educational program did, however, significantly increase women's knowledge related to the location, functions and dysfunctions of the pelvic floor muscles, and treatment options. Education and teaching women to perform 'the Knack' had no significant effect on voluntary contraction of the pelvic floor muscles, urinary incontinence or sexual function, but it promoted women's knowledge about the pelvic floor. Brazilian Registry of Clinical

  1. 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

    NARCIS (Netherlands)

    Wiegersma, Marian; Panman, Chantal M. C. R.; Kollen, Boudewijn J.; Berger, Marjolein Y.; Lisman-Van Leeuwen, Yvonne; Dekker, Janny H.

    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

  2. Congenital ureteropelvic junction obstruction: physiopathology, decoupling of tout court pelvic dilatation-obstruction semantic connection, biomarkers to predict renal damage evolution.

    Science.gov (United States)

    Alberti, C

    2012-02-01

    The widespread use of fetal ultrasonography results in a frequent antenatally observation of hydronephrosis, ureteropelvic junction obstruction (UPJO) accounting for the greatest fraction of congenital obstructive nephropathy. UPJO may be considered, in most cases, as a functional obstructive condition, depending on defective fetal smooth muscle/nerve development at this level, with lack of peristaltic wave propagation--aperistaltic segment--and, therefore, poor urine ejection from the renal pelvis into the ureter. The UPJO-related physiopathologic events are, at first, the compliant dilatation of renal pelvis that, acting as hydraulic buffer, protects the renal parenchyma from the rising intrapelvic pressure-related potential damages, and, subsequently, beyond such phase of dynamic balance, the tubular cell stretch-stress induced by increased intratubular pressure and following parenchymal inflammatory lesions: inflammatory infiltrates, fibroblast proliferation, activation of myofibroblasts, tubulo-interstitial fibrosis. Reactive oxygen species (ROS), nitric oxide (NO), several chemo- and cytokines, growth factors, prostaglandins and eicosanoids, angiotensin-II are the main pathogenetic mediators of the obstructive nephropathy. Apoptosis of tubular cells is the major cause of the tubular atrophy, together with epithelial-mesenchymal transdifferentiation. Some criticisms on tout court semantic renal pelvis dilatation-obstruction connection have been raised considering that the renal pelvis expansion isn't, in any case, linked to an ostructive condition, as it may be verified by diuretic (furosemide) renogram together with scintiscan-based evaluation of differential renal function. In this regard, rather than repetitive invasive nuclear procedures that expose the children to ionizing radiations, an intriguing noninvasive strategy, based on the evaluation of urinary biomarkers and urinary proteome, can define the UPJO-related possible progress of parenchymal lesions

  3. Laparoscopic Pelvic Floor Repair Using Polypropylene Mesh

    Directory of Open Access Journals (Sweden)

    Shih-Shien Weng

    2008-09-01

    Conclusion: Laparoscopic pelvic floor repair using a single piece of polypropylene mesh combined with uterosacral ligament suspension appears to be a feasible procedure for the treatment of advanced vaginal vault prolapse and enterocele. Fewer mesh erosions and postoperative pain syndromes were seen in patients who had no previous pelvic floor reconstructive surgery.

  4. DOES URINARY DIVERSION IMPROVE THE QUALITY OF LIFE IN OBSTRUCTIVE UROPATHY SECONDARY TO ADVANCED PELVIC MALIGNANCY?

    Directory of Open Access Journals (Sweden)

    Shivashankarappa

    2016-02-01

    Full Text Available INTRODUCTION The incidence of patients presenting with advanced pelvic malignancy with obstructive uropathy is high in our country. Relentless progress of the malignancy will cause deterioration of renal function, aggravation of pain, infection, deterioration of Quality of Life (QOL, uremia and death. Decreased renal function is considered as a contraindication for palliative chemo and radiotherapy. However urinary diversion in these patients will lead to improvement in renal function and may help in administration of palliative therapy and thus, improve the quality of life of these patients. MATERIALS AND METHODS The present study includes the obstructive uropathy patients secondary to pelvic malignancy referred to our institution for urinary diversion between Jan 2010 to Dec 2014. Total 40 patients were included, of which, 25 patients underwent PCN, 9 patients retrograde DJ stenting, 4 patients refused the treatment, 2 patients were not fit for any intervention due to coagulopathy & comorbid conditions. Of 34 treated patients, 30 were female patients and 4 were male patients. All the patients were explained about the procedure and proper consent taken. Laboratory investigations like CBC, coagulation profile, LFT, routine urine analysis, urine C&S and serum electrolytes were carried out. Haemodialysis was done for 10 patients whose serum creatinine was >6mg% & potassium >6meq. USG guided PCN insertion was done in 8 patients, and in those who failed in this procedure, fluoroscopic C-ARM guided PCN insertion done in 17 patients. Post operatively RFT and serum electrolytes were assessed on 3, 7, 15, & 30th day. PCN catheter was changed once in 3 months. RESULTS 8 patients succeeded in USG guided PCN insertion and 17 patients who failed USG PCN insertion, was done under C–Arm guidance. 3 patients received blood transfusion. No deaths were seen during or post procedure in the hospital. Renal functions improved and normalised in most of the

  5. Retroperitoneal and lateral pelvic lymphadenectomy mapped by lymphoscintigraphy for rectal adenocarcinoma staging

    International Nuclear Information System (INIS)

    Quadros, C.A.; Araujo, I.; Lopes, A.

    2010-01-01

    The good prognosis of retroperitoneal and lateral pelvic lymphadenectomy has raised the question of whether total mesorectal excision is suitable for adequate staging of rectal adenocarcinoma patients. The aims of this study were to determine the accuracy of dye and probe detection of metastatic retroperitoneal and/or lateral pelvic nodes and to define the upstaging impact of retroperitoneal and lateral pelvic lymphadenectomy in rectal adenocarcinoma patients. Ninety-seven rectal adenocarcinoma patients were submitted to total mesorectal excision and retroperitoneal and lateral pelvic lymphadenectomy. Lymphoscintigraphy using technetium-99 m-phytate and patent blue was performed to detect blue and/or radioactive retroperitoneal and/or lateral pelvic nodes which were examined histopathologically and immunohistochemically with a step-sectioning technique. Mesorectal mean node count was 11.5 and retroperitoneal and/or lateral pelvic node was 11.7. Retroperitoneal and lateral pelvic lymphadenectomy identified metastases in 17.5%, upstaging 8.2%. Variables related to metastatic retroperitoneal and/or lateral pelvic nodes were the following: Stage III in total mesorectal excision specimens (P<0.04), pT3/pT4 tumors (P=0.047), high levels of carcinoembryonic antigen (P=0.014) and large tumors (P=0.03). Marker migration to retroperitoneal and/or lateral pelvic nodes occurred in 37.1%, upstaging 11.1%. The markers' accuracy in the detection of metastatic retroperitoneal and/or lateral pelvic nodes was 100%. Retroperitoneal and lateral pelvic lymphadenectomy detected an important rate of metastatic retroperitoneal and/or lateral pelvic nodes (RLPN), resulting in upstaging. When markers migrated, they were able to detect RLPN metastases. The use of markers should be improved in the identification of RLPN metastases for selective indication of retroperitoneal and lateral pelvic lymphadenectomy. (author)

  6. A case of Klippel-Feil syndrome with renal agenesis

    Directory of Open Access Journals (Sweden)

    Mehmet Karakoç

    2010-05-01

    Full Text Available Klippel-Feil syndrome (KFS is is a rare syndrome that characterized by fusion of at least two congenital vertebrae in the cervical region. The most common characteristics of KFS are short neck, low nuchal hair line and restricted joint mobility of the cervical region.Addititonal features are scoliosis, sipina bifida, cervical rib, Sprengel deformity and facial asymmetry, and renal and cardiac anomalies. In this report a 10 years old girl was admitted with complaints of short stature and abnormal neck curvature. Physical examination of the patient revealed short neck, low nuchal hair line, and Sprengel’s deformity, height hard palate, facial asymmetry and torticollis. Cervical paravertebral muscle spasm was found on the left as (+ / right (+ +. Muscle tone, muscle strength, reflexes and sensory examination were found to be normal. Radiological examination of the C4-5 and C6-7 cervical region revealed the loss of inteverebral disc spaces and block vertebra. Also there was hemivertebra anomaly and aplasia of odontoid process. Abdominal and pelvic ultrasound examination revelaed absence of right kidney. Echocardiographical examination gave no abnormality. The case was presented in order to draw attention to KFS with renal agenesia in the light of current literature.

  7. Comparison of changes in the mobility of the pelvic floor muscle on during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction

    OpenAIRE

    Jung, Halim; Jung, Sangwoo; Joo, Sunghee; Song, Changho

    2016-01-01

    [Purpose] The purpose of this study was to compare changes in the mobility of the pelvic floor muscle during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction. [Subjects] Thirty healthy adults participated in this study (15 men and 15 women). [Methods] All participants performed a bridge exercise and abdominal curl-up during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction. Pelvic floor mobility...

  8. Retrovesical cystic lesions in female patients with unilateral renal agenesis or dysplasia

    International Nuclear Information System (INIS)

    Shimada, Kenji; Matsumoto, Fumi; Matsui, Futosi; Obara, Takasi

    2010-01-01

    The objective of this study was to review our experience with female children who have unilateral renal agenesis or renal dysplasia associated with cystic lesions in the reproductive system. Between 1991 and 2007, we treated 26 patients with unilateral renal agenesis or renal dysplasia associated with pelvic, retrovesical or interlabial cystic lesions. In 16 patients, an abnormality either of the kidney or a cystic lesion was detected during the perinatal period. Another 10 patients presented clinical symptoms, including urinary incontinence in five, urinary tract infection in one, and vaginal discharge in four. Based on clinical features and imaging findings, the patients were divided into four groups: those with Gartner's duct cyst (Group 1, n=9); those with uterovaginal duplication with obstructed hemivagina (Herlyn-Werner-Wunderlich syndrome [HWW]; Group 2, n=3); those with both Gartner's duct cyst and HWW syndrome (Group 3, n=3); and those without definitive diagnosis (Group 4, n=11). In Group 1, leakage completely stopped after nephrectomy in three patients, whereas six patients continued to be incontinent despite the removal of dysgenetic kidneys. In Group 2, after the excision of a vaginal septum, no patient presented urinary incontinence. In patients in Group 3, both the mesonephric remnant and mullerian structures were confirmed on imaging or through endoscopy. Because of the high coincidence of genital and renal anomalies, it is recommended that genital systems in female patients with renal anomalies associated with cystic lesions behind the lower urinary tract be investigated. The best imaging modality to use remains under scrutiny. It is important to follow the patients until the age of puberty. The importance of a long-term follow-up in these patients needs to be emphasized. (author)

  9. [Quality of life after extensive pelvic surgery].

    Science.gov (United States)

    Levý, M; Lipská, L; Visokai, V; Šimša, J

    Multiorgan resections in the small pelvis are standard procedures in oncosurgery and some indications have no alternative. In advanced pelvic cancer, pelvic exenteration with en bloc resection of the involved organs and structures, including portions of the bony pelvis, is indicated. The 5-year survival rate is fairly good, around 50%, but little is known about the long-term quality of life. The aim was to describe the quality of life of long-term total pelvic exenteration survivors. In total, 63 pelvic exenterations were performed between 2000 to 2015 at the Department of Surgery, Thomayer Hospital, First Faculty of Medicine, Charles University in Prague, mostly for primary or relapsed rectal cancer. In this retrospective cohort study, the quality of life was assessed using the EORTC QLQ-C30 (version 3.0) and the EORTC QLQ-CR29 questionnaires. The completed questionnaires were scored according to EORTC instructions. At the time of this survey, 24 patients after TPE were surviving longer than one year after the surgery. The five-year survival of all patients was 49%, median survival 4.6 years, and median follow-up 15 months. Most of our patients reported a good level of their physical, emotional, cognitive and social functions. Some patients reported a worse body image, and of course a worsening in their sexual life. Regarding symptom-oriented questions, some patients evaluated the necessity of more frequent care of the stomia as slightly problematic; most patients reported impotence (men) or painful sexual intercourse (women). Long-term quality of life in survivors of pelvic exenteration for rectal cancer is comparable with reported results following primary rectal cancer resection with the exception of the sexual function. The quality of life gradually improves in the course of weeks to months from the surgery. pelvic exenteration quality of life.

  10. Discrepancies in the female pelvic medicine and reconstructive surgeon workforce.

    Science.gov (United States)

    Muffly, Tyler M; Weterings, Robbie; Barber, Mathew D; Steinberg, Adam C

    2015-01-01

    It is unclear whether the current distribution of surgeons practicing female pelvic medicine and reconstructive surgery in the United States is adequate to meet the needs of a growing and aging population. We assessed the geographic distribution of female pelvic surgeons as represented by members of the American Urogynecologic Society (AUGS) throughout the United States at the county, state, and American Congress of Obstetricians and Gynecologists district levels. County-level data from the AUGS, American Congress of Obstetricians and Gynecologists, and the United States Census were analyzed in this observational study. State and national patterns of female pelvic surgeon density were mapped graphically using ArcGIS software and 2010 US Census demographic data. In 2013, the 1058 AUGS practicing physicians represented 0.13% of the total physician workforce. There were 6.7 AUGS members available for every 1 million women and 20 AUGS members for every 1 million postreproductive-aged women in the United States. The density of female pelvic surgeons was highest in metropolitan areas. Overall, 88% of the counties in the United States lacked female pelvic surgeons. Nationwide, there was a mean of 1 AUGS member for every 31 practicing general obstetrician-gynecologists. These findings have implications for training, recruiting, and retaining female pelvic surgeons. The uneven distribution of female pelvic surgeons throughout the United States is likely to worsen as graduating female pelvic medicine and reconstructive surgery fellows continue to cluster in urban areas.

  11. Acupuncture for chronic pelvic inflammatory disease: A systematic review protocol.

    Science.gov (United States)

    Cheng, Ying; Yuan, Youcai; Jin, Yuhao; Xu, Na; Guo, Taipin

    2018-03-01

    Chronic pelvic inflammation disease (PID) is a difficult-to-treat gynecological disorder with complex etiologies. Acupuncture has been applied widely for treating chronic pelvic inflammation or chronic pelvic pain symptoms in China. The aim of this review is to undertake a systematic review to estimate the effectiveness and safety of acupuncture on chronic PID. A literature search will be conducted electronically with date up to October 2018 in MEDLINE, Cochrane Library, EBASE, and CNKI databases, using combination subject terms of chronic pelvic pain (or chronic pelvic inflammation, and chronic pelvic pain symptoms, etc.) and acupuncture related treatment. Also duplicates will be removed. The primary outcomes consisted of improvement rate and pain relief. Secondary outcomes include the recurrence rate and side effects, such as pneumothorax, bleeding, serious discomfort, subcutaneous nodules, and infection. Systematic reviews and databases will be searched for randomized controlled trials on acupuncture for chronic PID with acupuncture treatment will be included. Cochrane RevMan V5.3.5 risk of bias assessment tool will be implemented for risk of bias evaluation, data synthesis, meta-analyses, and subgroup analysis while condition is met. Mean difference (MD), standard mean difference (SMD), and dichotomous data will be used to present continuous outcomes. This study will generate a comprehensive review of current evidence of acupuncture for chronic pelvic inflammation diseases. The study will provide updated evidence to evaluate the effectiveness and side effects of acupuncture for chronic pelvic inflammation disease. CRD42018087950.

  12. Weight-adapted iodinated contrast media administration in abdomino-pelvic CT: Can image quality be maintained?

    Science.gov (United States)

    Perrin, E; Jackson, M; Grant, R; Lloyd, C; Chinaka, F; Goh, V

    2018-02-01

    In many centres, a fixed method of contrast-media administration is used for CT regardless of patient body habitus. The aim of this trial was to assess contrast enhancement of the aorta, portal vein, liver and spleen during abdomino-pelvic CT imaging using a weight-adapted contrast media protocol compared to the current fixed dose method. Thirty-nine oncology patients, who had previously undergone CT abdomino-pelvic imaging at the institution using a fixed contrast media dose, were prospectively imaged using a weight-adapted contrast media dose (1.4 ml/kg). The two sets of images were assessed for contrast enhancement levels (HU) at locations in the liver, aorta, portal vein and spleen during portal-venous enhancement phase. The t-test was used to compare the difference in results using a non-inferiority margin of 10 HU. When the contrast dose was tailored to patient weight, contrast enhancement levels were shown to be non-inferior to the fixed dose method (liver p contrast dose reduction of 165 ml using the weight-adapted method compared to the fixed dose method, with a mean cost per patient of £6.81 and £7.19 respectively. Using a weight-adapted method of contrast media administration was shown to be non-inferior to a fixed dose method of contrast media administration. Patients weighing 76 kg, or less, received a lower contrast dose which may have associated cost savings. A weight-adapted contrast media protocol should be implemented for portal-venous phase abdomino-pelvic CT for oncology patients with adequate renal function (>70 ml/min/1.73 m 2 ). Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  13. Endoluminal norepinephrine inhibits smooth muscle activity of the pig pyeloureter by stimulation of beta-adrenoceptors without side effects

    DEFF Research Database (Denmark)

    Mortensen, Jens; Holst, Uffe; Jacobsen, Jørn Skibsted

    2008-01-01

    of pyeloureter and to reveal possible side effects on cardiovascular and renal functions. Renal pelvis was perfused, while pelvic pressure, cardiovascular and renal functional parameters were recorded. In group A, a pelvic pressure increase was examined during pressure flow studies with norepinephrine solutions......It has been demonstrated in pigs that endoluminal administration of norepinephrine reduces the increase in renal pelvic pressure during perfusion. The purposes were to describe concentration-response relationship and receptor mechanism of the effect of norepinephrine on muscle function...... a renal pelvis pressure increase to perfusion in a dose-related way without side effects. Endoluminal norepinephrine is safe in pigs and may be useful under endoscopy of the pyeloureter....

  14. An education program about pelvic floor muscles improved women’s knowledge but not pelvic floor muscle function, urinary incontinence or sexual function: a randomised trial

    Directory of Open Access Journals (Sweden)

    Roberta Leopoldino de Andrade

    2018-04-01

    Full Text Available Question: Does an educational program with instructions for performing ‘the Knack’ improve voluntary contraction of the pelvic floor muscles, reduce reports of urinary incontinence, improve sexual function, and promote women’s knowledge of the pelvic floor muscles? Design: Randomised, controlled trial with concealed allocation, intention-to-treat analysis and blinded assessors. Participants: Ninety-nine women from the local community. Intervention: The experimental group (n = 50 received one lecture per week for 4 weeks, and instructions for performing ‘the Knack’. The control group (n = 49 received no intervention. Outcome measures: The primary outcome was maximum voluntary contraction of the pelvic floor muscles measured using manometry. Secondary outcomes were: ability to contract the pelvic floor muscles measured using vaginal palpation; severity of urinary incontinence measured by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF scored from 0 to 21; self-reported sexual function; and knowledge related to the pelvic floor. Outcomes were measured at baseline and after 4 weeks. Results: The intervention did not significantly improve: maximum voluntary contraction (MD 2.7 cmH2O higher in the experimental group, 95% CI –0.5 to 5.9; ability to contract the pelvic floor muscles (RR 2.18, 95% CI 0.49 to 9.65; or self-reported severity of urinary incontinence (MD 1 point greater reduction in the experimental group, 95% CI –3 to 1. Sexual function did not significantly differ between groups, but very few of the women engaged in sexual activity during the study period. The educational program did, however, significantly increase women’s knowledge related to the location, functions and dysfunctions of the pelvic floor muscles, and treatment options. Conclusion: Education and teaching women to perform ‘the Knack’ had no significant effect on voluntary contraction of the pelvic floor muscles

  15. Which pediatric blunt trauma patients do not require pelvic imaging?

    Science.gov (United States)

    Haasz, Maya; Simone, Laura A; Wales, Paul W; Stimec, Jennifer; Stephens, Derek; Beno, Suzanne; Schuh, Suzanne

    2015-11-01

    This study aimed to develop a tool in identifying traumatized children at low risk of pelvic fracture and to determine the sensitivity of this low-risk model for pelvic fractures. We hypothesized that the proportion of children without predictors with pelvic fracture is less than 1%. This is a retrospective trauma registry analysis of previously healthy children 1 year to 17 years old presenting to the pediatric emergency department with blunt trauma. Postulated predictors of pelvic fracture on radiograph or computed tomography included pain/abnormal examination result of the pelvis/hip, femur deformity, hematuria, abdominal pain/tenderness, Glasgow Coma Scale (GCS) score of 13 or lower, and hemodynamic instability. We used multivariable logistic regression to identify independent predictors of fracture. Of 1,121 eligible patients (mean [SD] age, 8.5 [4.6] years), 87 (7.8%) had pelvic fracture. Independent predictors included pain/abnormal examination result of the pelvis/hip (odds ratio [OR], 16.7; 95% confidence interval [CI], 9.6-29.1), hematuria (OR, 6.6; 95% CI, 3.0-14.6), femoral deformity (OR, 5.9; 95% CI, 3.1-11.3), GCS score of 13 or lower (OR, 2.4; 95% CI, 1.3-4.3), and hemodynamic instability (OR, 3.4; 95% CI, 1.7-6.9). One of 590 children (0.2%; 95% CI, 0-0.5%) without predictors had pelvic fractures versus 86 (16.2%) of 531 in those with one or more predictors (OR, 119; 95% CI, 16.6-833). One of 87 children with pelvic fractures had no predictors (1.1%; 95% CI, 0-3%). When assuming a 100% radiography rate, this tool saves 53% pelvic radiographs. Children with multiple blunt trauma without pain/abnormal examination result of the pelvis/hip, femur deformity, hematuria, abdominal pain/tenderness, GCS score of 13 or lower, or hemodynamic instability constitute a low-risk population for pelvic fracture, with less than 0.5% risk rate. This population does not require routine pelvic imaging. Therapeutic study, level IV.

  16. Fabrication of Collagen Gel Hollow Fibers by Covalent Cross-Linking for Construction of Bioengineering Renal Tubules.

    Science.gov (United States)

    Shen, Chong; Zhang, Guoliang; Wang, Qichen; Meng, Qin

    2015-09-09

    Collagen, the most used natural biomacromolecule, has been extensively utilized to make scaffolds for cell cultures in tissue engineering, but has never been fabricated into the configuration of a hollow fiber (HF) for cell culture due to its poor mechanical properties. In this study, renal tubular cell-laden collagen hollow fiber (Col HF) was fabricated by dissolving sacrificial Ca-alginate cores from collagen shells strengthened by carbodiimide cross-linking. The inner/outer diameters of the Col HF were precisely controlled by the flow rates of core alginate/shell collagen solution in the microfluidic device. As found, the renal tubular cells self-assembled into renal tubules with diameters of 50-200 μm post to the culture in Col HF for 10 days. According to the 3D reconstructed confocal images or HE staining, the renal cells appeared as a tight tubular monolayer on the Col HF inner surface, sustaining more 3D cell morphology than the cell layer on the 2D flat collagen gel surface. Moreover, compared with the cultures in either a Transwell or polymer HF membrane, the renal tubules in Col HF exhibited at least 1-fold higher activity on brush border enzymes of alkaline phosphatase and γ-glutamyltransferase, consistent with their gene expressions. The enhancement occurred similarly on multidrug resistance protein 2 and glucose uptake. Such bioengineered renal tubules in Col HF will present great potential as alternatives to synthetic HF in both clinical use and pharmaceutical investigation.

  17. Do women with pelvic floor dysfunction referred by gynaecologists and urologists at hospitals complete a pelvic floor muscle training programme?

    DEFF Research Database (Denmark)

    Tibaek, Sigrid; Dehlendorff, Christian

    2013-01-01

    For decades women with pelvic floor dysfunction (PFD) have been referred to pelvic floor muscle training (PFMT), but there is only little information on whether the women complete the programmes and why. The objectives of this study were to investigate to which extent women completed a PFMT...

  18. Magnetic resonance imaging of pelvic floor dysfunction - joint recommendations of the ESUR and ESGAR Pelvic Floor Working Group

    International Nuclear Information System (INIS)

    El Sayed, Rania Farouk; Alt, Celine D.; Maccioni, Francesca; Meissnitzer, Matthias; Masselli, Gabriele; Manganaro, Lucia; Vinci, Valeria; Weishaupt, Dominik

    2017-01-01

    To develop recommendations that can be used as guidance for standardized approach regarding indications, patient preparation, sequences acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for diagnosis and grading of pelvic floor dysfunction (PFD). The technique included critical literature between 1993 and 2013 and expert consensus about MRI protocols by the pelvic floor-imaging working group of the European Society of Urogenital Radiology (ESUR) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) from one Egyptian and seven European institutions. Data collection and analysis were achieved in 5 consecutive steps. Eighty-two items were scored to be eligible for further analysis and scaling. Agreement of at least 80 % was defined as consensus finding. Consensus was reached for 88 % of 82 items. Recommended reporting template should include two main sections for measurements and grading. The pubococcygeal line (PCL) is recommended as the reference line to measure pelvic organ prolapse. The recommended grading scheme is the ''Rule of three'' for Pelvic Organ Prolapse (POP), while a rectocele and ARJ descent each has its specific grading system. This literature review and expert consensus recommendations can be used as guidance for MR imaging and reporting of PFD. (orig.)

  19. The 3D Pelvic Inclination Correction System (PICS): A universally applicable coordinate system for isovolumetric imaging measurements, tested in women with pelvic organ prolapse (POP).

    Science.gov (United States)

    Reiner, Caecilia S; Williamson, Tom; Winklehner, Thomas; Lisse, Sean; Fink, Daniel; DeLancey, John O L; Betschart, Cornelia

    2017-07-01

    In pelvic organ prolapse (POP), the organs are pushed downward along the lines of gravity, so measurements along this longitudinal body axis are desirable. We propose a universally applicable 3D coordinate system that corrects for changes in pelvic inclination and that allows the localization of any point in the pelvis at rest or under dynamic conditions on magnetic resonance images (MRI) of pelvic floor disorders in a scanner- and software independent manner. The proposed 3D coordinate system called 3D Pelvic Inclination Correction System (PICS) is constructed utilizing four bony landmark points, with the origin set at the inferior pubic point, and three additional points at the sacrum (sacrococcygeal joint) and both ischial spines, which are clearly visible on MRI images. The feasibility and applicability of the moving frame was evaluated using MRI datasets from five women with pelvic organ prolapse, three undergoing static MRI and two undergoing dynamic MRI of the pelvic floor in a supine position. The construction of the coordinate system was performed utilizing the selected landmarks, with an initial implementation completed in MATLAB. In all cases the selected landmarks were clearly visible, with the construction of the 3D PICS and measurement of pelvic organ positions performed without difficulty. The resulting distance from the organ position to the horizontal PICS plane was compared to a traditional measure based on standard measurements in 2D slices. The two approaches demonstrated good agreement in each of the cases. The developed approach makes quantitative assessment of pelvic organ position in a physiologically relevant 3D coordinate system possible independent of pelvic movement relative to the scanner. It allows the accurate study of the physiologic range of organ location along the body axis ("up or down") as well as defects of the pelvic sidewall or birth-related pelvic floor injuries outside the midsagittal plane, not possible before in a 2D

  20. Small bowel obstruction in percutaneous fixation of traumatic pelvic fractures

    Directory of Open Access Journals (Sweden)

    Roberto Bini

    2013-01-01

    Full Text Available The use of external fixation for the initial treatment of unstable, complex pelvic injuries with hemodynamic instability remains an effective treatment for multiply injured patients. Bowel entrapment within a pelvic fracture is a rarely reported, potentially fatal complication. Here, we report a polytrauma patient with pelvic fractures who developed an intestinal obstruction after an external fixation. At an explorative laparotomy, we found an ileum segment trapped in the sacral fracture. Reported cases of bowel entrapment in pelvic fractures, especially in sacral fractures, are exceedingly rare. The diagnosis is often delayed due to difficulty distinguishing entrapment from the more common adynamic ileus. In conclusion, clinicians and radiologists should be aware of this potentially lethal complication of pelvic fractures treatment. To exclude bowel entrapment, patients with persistent ileus or sepsis should undergo early investigations.

  1. Survival trends and predictors of mortality in severe pelvic trauma

    DEFF Research Database (Denmark)

    Pohlemann, Tim; Stengel, Dirk; Tosounidis, Georgios

    2011-01-01

    STUDY OBJECTIVE: To determine longitudinal trends in mortality, and the contribution of specific injury characteristics and treatment modalities to the risk of a fatal outcome after severe and complex pelvic trauma. METHODS: We studied 5048 patients with pelvic ring fractures enrolled in the German...... Pelvic Trauma Registry Initiative between 1991 and 1993, 1998 and 2000, and 2004 and 2006. Complete datasets were available for 5014 cases, including 508 complex injuries, defined as unstable fractures with severe peri-pelvic soft tissue and organ laceration. Multivariable mixed-effects logistic...... regression analysis was employed to evaluate the impact of demographic, injury- and treatment-associated variables on all-cause in-hospital mortality. RESULTS: All-cause in-hospital mortality declined from 8% (39/466) in 1991 to 5% (33/638) in 2006. Controlling for age, Injury Severity Score, pelvic vessel...

  2. Comprehensive pelvic floor physical therapy program for men with idiopathic chronic pelvic pain syndrome: a prospective study

    OpenAIRE

    Masterson, Thomas A.; Masterson, John M.; Azzinaro, Jessica; Manderson, Lattoya; Swain, Sanjaya; Ramasamy, Ranjith

    2017-01-01

    Background Male chronic pelvic pain syndrome (CPPS) is a heterogeneous constellation of symptoms that causes significant impairment and is often challenging to treat. In this prospective study, we evaluated men with CPPS who underwent comprehensive pelvic floor physical therapy (PFPT) program. We used the previously validated Genitourinary Pain Index (GUPI) to measure outcomes. Methods We included 14 men who underwent physical therapy for idiopathic CPPS from October 2015 to October 2016. Men...

  3. Chronic pelvic pain

    African Journals Online (AJOL)

    misdiagnoses, inappropriate or inadequate treatment strategies, and poor patient compliance .... excitation tenderness implies an active pelvic inflammatory process. Pain localising to ... neoplastic process, particularly cervical cancer, must be excluded. .... The dosage should be started at 10 mg at night, and increased by 5 ...

  4. Poor Utility of Gonadal Shielding for Pediatric Pelvic Radiographs.

    Science.gov (United States)

    Lee, Mark C; Lloyd, Jessica; Solomito, Matthew J

    2017-07-01

    Plain pelvic radiographs are commonly used for a variety of pediatric orthopedic disorders. Lead shielding is typically placed over the gonads to minimize radiation exposure to these sensitive tissues. However, misplaced shielding can sabotage efforts to protect patients from excessive radiation exposure either by not covering radiosensitive tissues or by obscuring anatomic areas of interest, prompting repeat radiographic examinations. The goal of this study was to determine the incidence of misplaced shielding for pelvic radiographs obtained for pediatric orthopedic evaluation. Children 8 to 16 years old who had an anteroposterior or frog lateral pelvic radiograph between 2008 and 2014 were included. A total of 3400 patients met the inclusion criteria, and 84 boys and 84 girls were randomly selected for review. For both boys and girls, the percentage of incorrectly positioned or missing shields was calculated. Chi-square testing was used to compare the frequency of missing or incorrectly placed shields between sexes and age groups. Pelvic shields were misplaced in 49% of anteroposterior and 63% of frog lateral radiographs. Shielding was misplaced more frequently for girls than for boys on frog lateral radiographs (76% vs 51%; P<.05). Pelvic bony landmarks were often obscured by pelvic shielding, with a frequency of 7% to 43%, depending on the specific landmark. The femoral head and acetabulum were obscured by shielding in up to 2% of all images. The findings suggest that accepted pelvic shielding protocols are ineffective. Consideration should be given to alternative protocols or abandonment of this practice. [Orthopedics. 2017; 40(4):e623-e627.]. Copyright 2017, SLACK Incorporated.

  5. Primary Pelvic Involvement of Hydatid Disease

    Directory of Open Access Journals (Sweden)

    Migraci Tosun

    2011-04-01

    Full Text Available Hydatid disease is caused by larval stage of a parasite named as Echinococcus. To diagnose this condition may be challenging without surgery and postoperative pathological examination due to limited value of serological studies but imaging techniques may give a clue when hydatid disease is suspected and hydatid disease shall be considered for differential diagnosis in pelvic mass. In the present case, we present a 75-year-old postmenopausal woman with pelvic hydatosis.

  6. Imaging of the posterior pelvic floor

    International Nuclear Information System (INIS)

    Stoker, Jaap; Bartram, Clive I.; Halligan, Steve

    2002-01-01

    Disorders of the posterior pelvic floor are relatively common. The role of imaging in this field is increasing, especially in constipation, prolapse and anal incontinence, and currently imaging is an integral part of the investigation of these pelvic floor disorders. Evacuation proctography provides both structural and functional information for rectal voiding and prolapse. Dynamic MRI may be a valuable alternative as the pelvic floor muscles are visualised, and it is currently under evaluation. Endoluminal imaging is important in the management of anal incontinence. Both endosonography and endoanal MRI can be used for detection of anal sphincter defects. Endoanal MRI has the advantage of simultaneously evaluating external sphincter atrophy, which is an important predictive factor for the outcome of sphincter repair. Many aspects of constipation and prolapse remain incompletely understood and treatment is partly empirical; however, imaging has a central role in management to place patients into treatment-defined groups. (orig.)

  7. Imaging of the posterior pelvic floor

    Energy Technology Data Exchange (ETDEWEB)

    Stoker, Jaap [Department of Radiology, Academic Medical Center, University of Amsterdam (Netherlands); Bartram, Clive I.; Halligan, Steve [Intestinal Imaging Centre, St. Mark' s Hospital, London (United Kingdom)

    2002-04-01

    Disorders of the posterior pelvic floor are relatively common. The role of imaging in this field is increasing, especially in constipation, prolapse and anal incontinence, and currently imaging is an integral part of the investigation of these pelvic floor disorders. Evacuation proctography provides both structural and functional information for rectal voiding and prolapse. Dynamic MRI may be a valuable alternative as the pelvic floor muscles are visualised, and it is currently under evaluation. Endoluminal imaging is important in the management of anal incontinence. Both endosonography and endoanal MRI can be used for detection of anal sphincter defects. Endoanal MRI has the advantage of simultaneously evaluating external sphincter atrophy, which is an important predictive factor for the outcome of sphincter repair. Many aspects of constipation and prolapse remain incompletely understood and treatment is partly empirical; however, imaging has a central role in management to place patients into treatment-defined groups. (orig.)

  8. Multi-Detector CT Findings of the Normal Appendix in Children: Evaluation of the Position, Diameter, and Presence or Absence of Intraluminal Gas

    Energy Technology Data Exchange (ETDEWEB)

    Park, Woon Ju; Kim, Jong Chul [Dept. of Radiology, Chungnam National University College of Medicine, Daejeon (Korea, Republic of)

    2011-08-15

    To assess the usefulness of multi-detector CT (MDCT) with multiplanar reformations (MPR) for the evaluation of the position, diameter and presence or absence of intraluminal gas in the normal appendix in children. From 2007 to 2010, we retrospectively analyzed the MDCT images of normal appendices in 133 children, and evaluated the position, diameter, and presence or absence of intraluminal gas in the appendix. Among the 133 appendices, type I (postileal and medial paracecal position) was found in 64 children, type II (subcecal position) in 22, type III (retrocecal and retrocolic/laterocolic position) in 15, type IV (preileal and medial colic position) in 16, and type V (lower pelvic position) in 16 children. The mean diameter was 5.8 mm {+-} 1.2 (SD) (range; 3.2-8.7 mm). There was a high correlation between the appendiceal diameter and age (p = 0.000).There was no statistically significant difference in the appendiceal diameter between boys and girls (p = 0.470). Intraluminal gas was found in 115 appendices and there was no statistically significant correlation between the appendiceal diameter and intraluminal gas (p = 0.502). The MDCT with MPR was useful for the evaluation of the normal appendices in children. The procedure may be useful for the diagnosis of equivocal or unusual appendicitis in children.

  9. The value of hyoscine butylbromide in pelvic MRI

    International Nuclear Information System (INIS)

    Johnson, W.; Taylor, M.B.; Carrington, B.M.; Bonington, S.C.; Swindell, R.

    2007-01-01

    Aim: To evaluate the effect of hyoscine butylbromide (HBB) on image quality and lesion and organ visualization in pelvic magnetic resonance imaging (MRI) Materials and methods: A prospective, ethically approved study was undertaken of 47 patients attending for pelvic MRI at a cancer centre. T2-weighted transverse and sagittal sequences were performed before and after intravenous injection of 20 mg HBB. Three radiologists independently scored anonymized image series for overall image quality, visualization of pelvic lesions and visualization of individual pelvic organs. Statistical analysis was performed to assess improvements in radiologists' scores post-HBB administration. Radiologists also assessed pre-HBB administration T1-weighted images for degree of bowel peristalsis to determine whether this could predict improvement in post-HBB T2-weighted image scores. Side effects of HBB were recorded using a patient questionnaire. Results: Radiologists' scores for image quality and lesion visualization were significantly higher on the post-HBB administration T2-weighted series (p < 0.0005). Scores for the visualization of the bladder, rectum, pelvic bowel, prostate, and seminal vesicles (all p < 0.0005), cervix (p = 0.019) and vagina (p = 0.0001) were also significantly higher post-HBB administration. Scores for the degree of peristalsis on T1-weighted images were not related to improvement in image quality or lesion visualization on T2-weighted images post-HBB administration. Side effects of HBB were mild and self-limiting. Conclusion: Intravenous HBB administration improves image quality and lesion visualization in oncological pelvic MRI and is recommended for routine use

  10. Evaluation of pelvic ring injuries using SPECT/CT

    Energy Technology Data Exchange (ETDEWEB)

    Scheyerer, Max J. [University Hospital Zurich, Division of Trauma Surgery, Department of Surgery, Zurich (Switzerland); University Medical Center, Centre for Orthopaedic and Trauma Surgery, Cologne (Germany); Huellner, Martin; Pietsch, Carsten [University Hospital Zurich, Division of Nuclear Medicine, Department of Medical Radiology, Zurich (Switzerland); Werner, Clement M.L. [University Hospital Zurich, Division of Trauma Surgery, Department of Surgery, Zurich (Switzerland); Veit-Haibach, Patrick [University Hospital Zurich, Division of Nuclear Medicine, Department of Medical Radiology, Zurich (Switzerland); University Hospital Zurich, Diagnostic and Interventional Radiology, Department of Medical Radiology, Zurich (Switzerland)

    2014-08-12

    The incidence of pelvic fractures is relatively low compared with other fracture locations. The low incidence is in great contrast to the high morbidity and mortality. Particularly in the elderly, with apparently isolated fractures of the pubic rami, these observations are believed to be due to additional occult lesions of the posterior pelvic ring. In these cases diagnosis cannot be established by conventional imaging alone and SPECT/CT is considered as a diagnostic adjunct. The aim of this study was to assess concomitant bony or soft tissue lesions within the pelvic ring in a population of patients with fractures of the anterior elements. In all patients with no obvious lesions of the posterior pelvic ring on X-rays and CT or with suspicious but inconclusive findings on CT an additional SPECT/CT was carried out in a non-acute setting within 3 days of the trauma. In all cases additional lesions within the pelvic ring were found. Most lesions were vertical sacral fractures, followed by transverse fractures, one non-dislocated fracture of the acetabulum on the side of the pubic rami fracture, and one post-traumatic dilatation of the sacroiliac joint with increased tracer uptake. According to our results after SPECT/CT all patients with pubic rami fracture suffered additional lesions, none detectable previously by X-ray or CT, within the pelvic ring. In this context SPECT/CT has proved to be very helpful in the clinical routine to visualize occult fractures and instability within the sacroiliac joint. (orig.)

  11. Radiofrequency ablation for renal tumors. Our experience

    International Nuclear Information System (INIS)

    Hiraoka, Kenji; Kawauchi, Akihiro; Nakamura, Terukazu; Soh, Jintetsu; Mikami, Kazuya; Miki, Tsuneharu

    2009-01-01

    The objective of this study was to report our results of percutaneous radiofrequency ablation (RFA) for renal tumors and to assess predictors of therapeutic efficacy. Forty patients (median age 73 years) with renal tumors were treated with RFA under local or epidural anesthesia. All of them had high surgical risk or refused radical surgery. Tumors were punctured percutaneously using the Radionics Cool-tip RF System under computed tomography or ultrasonographic guidance. Median tumor diameter was 24 mm. After RFA, contrast-enhanced computed tomography or magnetic resonance imaging was performed within 1 month. Complete response (CR) was defined as no enhancement inside the tumor. Factors related to the outcome and to renal function were assessed. Median follow up was 16 months. CR was observed in 34 cases (85.0%). A significant difference in CR rate was observed between tumors ≤30 mm and those >30 mm. Outcomes tended to be better for tumors in the mid to lower kidney, and those away from the renal hilum. Recurrence was observed in one case (2.9%), but a CR was obtained again by additional RFA. Out of a total of 77 RFA procedures, complications occurred in only three cases (3.9%), and conservative treatment was possible in all cases. Serum creatinine levels 3 months after RFA did not differ from those before RFA. Percutaneous RFA is a safe and effective treatment for small renal tumors in patients with high surgical risk or who refuse radical surgery. (author)

  12. Effect of immobilization on urine calcium excretion in orthopedic patients with pelvic fracture treated by skin traction.

    Science.gov (United States)

    Derakhshan, Ali; Derakhshan, Nima; Namazi, Hamid; Ghaffarpasand, Fariborz

    2015-03-31

    To determine the effects on urine calcium excretion of immobilization by skin traction in patients with pelvic fracture. In a prospective study, a consecutive series of patients with pelvic fracture treated by skin traction were enrolled. Serum (calcium, phosphorous, alkaline phosphatase, sodium, potassium, uric acid, BUN, creatinine) and fasting urine calcium, creatinine, sodium, potassium and uric acid were checked within 48 hours of hospitalization and at 7, 14 and 21 days of immobilization and then after 3 months of mobilization. Trends in changes of variables were recorded. Fifty five patients were enrolled in this study; they were 45 (81.8%) males and 10 (18.2%) females with a mean age 19.4 ± 12.7 years. We found that serum levels of calcium (p = 0.004), phosphorous (p = 0.047) and alkaline phosphatase (p = 0.001) increased significantly during the 3 weeks of immobilization. In the same way, urine calcium/ urine creatinine ratio increased significantly in the study period (p = 0.004). No symptomatic renal stone formation was observed during the study period. Immobilization even in short term causes hypercalciuria in orthopedic patients. Although it is transient and improves with subsequent mobilization, it is needed to be considered specifically by the team caring for this group of patients.

  13. Biomechanical paradigm and interpretation of female pelvic floor conditions before a treatment

    Directory of Open Access Journals (Sweden)

    Lucente V

    2017-08-01

    Full Text Available Vincent Lucente,1 Heather van Raalte,2 Miles Murphy,1 Vladimir Egorov3 1The Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, PA, USA; 2Princeton Urogynecology, Princeton, NJ, USA; 3Artann Laboratories, Trenton, NJ, USA Background: Further progress in restoring a woman’s health may be possible if a patient with a damaged pelvic floor could undergo medical imaging and biomechanical diagnostic tests. The results of such tests could contribute to the analysis of multiple treatment options and suggest the optimal one for that patient.Aim: To develop a new approach for the biomechanical characterization of vaginal conditions, muscles, and connective tissues in the female pelvic floor.Methods: Vaginal tactile imaging (VTI allows biomechanical assessment of the soft tissue along the entire length of the anterior, posterior, and lateral vaginal walls at rest, with manually applied deflection pressures and with muscle contraction, muscle relaxation, and Valsalva maneuver. VTI allows a large body of measurements to evaluate individual variations in tissue elasticity, support defects, as well as pelvic muscle function. Presuming that 1 the female pelvic floor organs are suspended by ligaments against which muscles contract to open or close the outlets and 2 damaged ligaments weaken the support and may reduce the force of muscle contraction, we made an attempt to characterize multiple pelvic floor structures from VTI data.Results: All of the 138 women enrolled in the study were successfully examined with the VTI. The study subjects have had normal pelvic support or pelvic organ prolapse (stages I–IV. The average age of this group of subjects was 60±15 years. We transposed a set of 31 VTI parameters into a quantitative characterization of pelvic muscles and ligamentous structures. Interpretation of the acquired VTI data for normal pelvic floor support and prolapse conditions is proposed based on biomechanical assessment of the

  14. Congenital pelvic arteriovenous malformation: uncommon symptoms of lower limb venous hypertension.

    Science.gov (United States)

    Akimaro Kudo, F; Nishibe, T; Miyazaki, K; Flores, J; Yasuda, K

    2001-12-01

    Congenital pelvic arteriovenous malformations (AVMs) are rare and their clinical behavior is quite variable. A case of congenital pelvic AVM manifesting with unusual extrapelvic symptoms of ipsilateral leg pain is described. The causes of symptoms associated with congenital pelvic AVMs are discussed.

  15. Biomechanical comparison of supraacetabular external fixation and anterior pelvic bridge plating.

    Science.gov (United States)

    Çavuşoğlu, Ali Turgay; Erbay, Fatma Kübra; Özsoy, Mehmet Hakan; Demir, Teyfik

    2017-10-01

    Unstable pelvic ring injuries are complex and risky injuries due to high morbidity and mortality. Although anterior pelvic external fixator is a suitable method for rapid stabilization of an injured pelvic ring, due to some disadvantages such as high complication rate, nerve damage, and difficulties of patient's mobility and comfort, there has recently been increased searching for alternative methods for stabilization of the pelvic ring. Pubic symphysis zone freely moves in pelvic models. This study aims to evaluate the biomechanical stability of anterior pelvic bridge plating and compare it with supraacetabular external fixators in an untreated unstable pelvic fracture model. Samples were loaded statically with 2-mm/min loading rate in single leg standing position. Maximum load was 2.3 kN. When loading the samples, photographs were taken continuously. Stiffness values were calculated from the load displacement curves. Some reference parameters were described and were measured from unloaded and 2.3-kN-loaded photographs of the test. The mean stiffness values were 491.14 ± 52.22, 478.55 ± 41.44, and 470.25 ± 44.51 N/mm for anterior pelvic bridge plating group, supraacetabular external fixator group, and Control group, respectively. According to the measured parameters from photographs, the mean displacement at the pubic symphysis was 4.7 ± 0.32, 15.8 ± 2.01, and 18.2 ± 0.47 mm for anterior pelvic bridge plating, supraacetabular external fixator, and Control group, respectively. The highest displacement in the pubic symphysis was found in Control group, and minimum displacement was observed in anterior pelvic bridge plating group. When the perpendicular distance between the right and left lower end of ischium was examined, it was observed that displacement was minimum in anterior pelvic bridge plating group compared to other two groups, regarding to the high stability of pubic symphysis. In conclusion, this study revealed

  16. FUNCTIONAL DISABILITY, SAGITTAL ALIGNMENT AND PELVIC BALANCE IN LUMBAR SPONDYLOLISTHESIS

    Directory of Open Access Journals (Sweden)

    Luis Muñiz Luna

    2016-03-01

    Full Text Available ABSTRACT Objectives: To demonstrate the recovery of lumbar sagittal pelvic alignment and sagittal pelvic balance after surgical reduction of lumbar spondylolisthesis and establish the benefits of the surgery for reduction and fixation of the lumbar spondylolisthesis with 360o circumferential arthrodesis for 2 surgical approaches by clinical and functional evaluation. Method: Eight patients with lumbar spondylolisthesis treated with surgical reduction and fixation of listhesis and segmental circumferential fusion with two surgical approaches were reviewed. They were evaluated before and after treatment with Oswestry, Visual Analogue for pain and Odom scales, performing radiographic measurement of lumbar sagittal alignment and pelvic sagittal balance with the technique of pelvic radius. Results: Oswestry scales and EVA reported improvement of symptoms after treatment in 8 cases; the Odom scale had six outstanding cases reported. The lumbar sagittal alignment presented a lumbosacral lordosis angle and a lumbopelvic lordosis angle reduced in 4 cases and increased in 4 other cases; pelvic sagittal balance increased the pelvic angle in 4 cases and decreased in 3 cases and the sacral translation of the hip axis to the promontory increased in 6 cases. Conclusion: The surgical procedure evaluated proved to be useful by modifying the lumbar sagittal alignment and the pelvic balance, besides reducing the symptoms, enabling the patient to have mobility and movement and the consequent satisfaction with the surgery.

  17. Labor Dystocia as First Presentation of Pelvic Malignancy

    Directory of Open Access Journals (Sweden)

    Dennis van Hamont

    2011-01-01

    Full Text Available The underlying causes of labor dystocia can be various. Lack of expulsive forces or fetal malpresentation are amongst the most common ones. However, pelvic masses are described as well. Here we describe two cases of labor dystocia as first presentation of pelvic malignancy.

  18. Pelvic inflammatory disease: diagnosis and treatment in the emergency department [digest].

    Science.gov (United States)

    Bugg, Charles Walter; Taira, Taku; Zaurova, Milana

    2016-12-22

    Pelvic inflammatory disease is a common disease that is associated with significant complications including infertility, chronic pelvic pain, ruptured tubo-ovarian abscess, and ectopic pregnancy. The diagnosis may be delayed when the presentation has nonspecific signs and symptoms. Even when it is properly identified, pelvic inflammatory disease is often treated suboptimally. This review provides evidence-based recommendations for the diagnosis, treatment, disposition, and follow-up of patients with pelvic inflammatory disease. Arranging follow-up of patients within 48 to 72 hours and providing clear patient education are fundamental to ensuring good patient outcomes. Emerging issues, including new pathogens and evolving resistance patterns among pelvic inflammatory disease pathogens are reviewed. [Points & Pearls is a digest of Emergency Medicine Practice].

  19. Is Bariatric Surgery a Prophylaxis for Pelvic Floor Disorders?

    Science.gov (United States)

    Pomian, Andrzej; Majkusiak, Wojciech; Lisik, Wojciech; Tomasik, Paweł; Horosz, Edyta; Zwierzchowska, Aneta; Kociszewski, Jacek; Barcz, Ewa

    2018-06-01

    Obesity is one of the well-documented risk factors of pelvic floor disorders (PFDs). The PFDs include urinary and fecal incontinence (UI, FI) and pelvic organ prolapse (POP). Surgery-induced weight loss improves different kinds of incontinence as well as POP symptoms. However, there is a lack of evidence how bariatric surgery influences pelvic floor anatomy and function in women without previous PFDs and whether it may be concerned as PFD prophylaxis tool. The present analysis is a prospective, non-randomized case-control study from January 2014 to September 2017. Participants underwent pelvic floor ultrasound examination with bladder neck position estimation at rest, during levator ani tension, and at Valsalva maneuver before surgery and 12-18 months after. Pelvic organ prolapse quantification (POPQ) > 2 stage and PFD complaints were the exclusion criteria. Fifty-nine patients underwent bariatric surgery (57 sleeve gastrectomy and 2 gastric bypass). Mean BMI decreased from 43.8 ± 5.9 to 29 ± 4.6 kg/m 2 after surgery (p betterment of bladder neck position at rest, tension, and Valsalva maneuver in women without PFDs. We postulate that bariatric surgery may be a tool for PFD prevention. It does not improve levator ani function and does not limit bladder neck mobility, which implicates that it has no influence on preexisting pelvic dysfunction.

  20. Evaluation of the normal thoracic and abdominal aorta diameters by computerized tomography; Avaliacao dos diametros normais da aorta toracica e abdominal pela tomografia computadorizada

    Energy Technology Data Exchange (ETDEWEB)

    Lucarelli, Claudio Luiz

    1995-07-01

    The study was undertaken to evaluate, through computerized tomography, the diameters of the normal thoracic and abdominal aorta, as well as they are connected to gender, age and body surface area; and the ratio between measurements obtained at the ascending and descending limbs of the thoracic aorta, and between the abdominal aortic diameters. For that reason, we measured the widest anteroposterior diameters of the thoracic aortas at the levels of the arch, the root, the pulmonary artery, and the thoracic-abdominal transition, as well as the level of the emergence of the superior mesenteric artery, of the renal hila and just cephalad to the bifurcation of the abdominal aortas of 350 patients without cardiovascular diseases who had undergone computerized tomography of the thorax and/or abdomen for any other reasons. Observation and statistic analyses led us to conclude that: 1) both the thoracic and abdominal aortic diameters are reduced from their proximal to their distal portions; 2) the body surface influences the size of the aorta, although only extreme variations alter the vessel's caliber; 3) vessel diameter was observed to gradually increase with age; 4) men were found to have larger diameters than age matched women; 5) the ratio between the ascending and descending aortic diameters varies according to gender and age; 6) the relations between abdominal aortic diameters measured at the level of renal hila and cephalad to the bifurcation are independent from gender and age. But the relation between those measured at the level of the superior mesenteric artery and cephalad to the bifurcation are linked to gender, but not to age. (author)

  1. Evaluation of the normal thoracic and abdominal aorta diameters by computerized tomography; Avaliacao dos diametros normais da aorta toracica e abdominal pela tomografia computadorizada

    Energy Technology Data Exchange (ETDEWEB)

    Lucarelli, Claudio Luiz

    1995-07-01

    The study was undertaken to evaluate, through computerized tomography, the diameters of the normal thoracic and abdominal aorta, as well as they are connected to gender, age and body surface area; and the ratio between measurements obtained at the ascending and descending limbs of the thoracic aorta, and between the abdominal aortic diameters. For that reason, we measured the widest anteroposterior diameters of the thoracic aortas at the levels of the arch, the root, the pulmonary artery, and the thoracic-abdominal transition, as well as the level of the emergence of the superior mesenteric artery, of the renal hila and just cephalad to the bifurcation of the abdominal aortas of 350 patients without cardiovascular diseases who had undergone computerized tomography of the thorax and/or abdomen for any other reasons. Observation and statistic analyses led us to conclude that: 1) both the thoracic and abdominal aortic diameters are reduced from their proximal to their distal portions; 2) the body surface influences the size of the aorta, although only extreme variations alter the vessel's caliber; 3) vessel diameter was observed to gradually increase with age; 4) men were found to have larger diameters than age matched women; 5) the ratio between the ascending and descending aortic diameters varies according to gender and age; 6) the relations between abdominal aortic diameters measured at the level of renal hila and cephalad to the bifurcation are independent from gender and age. But the relation between those measured at the level of the superior mesenteric artery and cephalad to the bifurcation are linked to gender, but not to age. (author)

  2. Severe Renal Hemorrhage in a Pregnant Woman Complicated with Antiphospholipid Syndrome: A Case Report

    Directory of Open Access Journals (Sweden)

    Shohei Kawaguchi

    2011-01-01

    Full Text Available Antiphospholipid syndrome is a systemic autoimmune disease with thrombotic tendency. Consensus guidelines for pregnancy with antiphospholipid syndrome recommend low-dose aspirin combined with unfractionated or low-molecular-weight heparin because antiphospholipid syndrome causes habitual abortion. We report a 36-year-old pregnant woman diagnosed with antiphospholipid syndrome receiving anticoagulation treatment. The patient developed left abdominal pain and gross hematuria at week 20 of pregnancy. An initial diagnosis of left ureteral calculus was made. Subsequently abdominal-pelvic computed tomography was required for diagnosis because of the appearance of severe contralateral pain. Computed tomography revealed serious renal hemorrhage, and ureteral stent placement and pain control by patient-controlled analgesia were required. After treatment, continuance of pregnancy was possible and vaginal delivery was performed safely. This is the first case report of serious renal hemorrhage in a pregnant woman with antiphospholipid syndrome receiving anticoagulation treatment and is an instructive case for urological and obstetrical practitioners.

  3. Direct and indirect costs of surgically treated pelvic fractures.

    Science.gov (United States)

    Aprato, Alessandro; Joeris, Alexander; Tosto, Ferdinando; Kalampoki, Vasiliki; Stucchi, Alessandro; Massè, Alessandro

    2016-03-01

    Pelvic fractures requiring surgical fixation are rare injuries but present a great societal impact in terms of disability, as well as economic resources. In the literature, there is no description of these costs. Main aim of this study is to describe the direct and indirect costs of these fractures. Secondary aims were to test if the type of fracture (pelvic ring injury or acetabular fracture) influences these costs (hospitalization, consultation, medication, physiotherapy sessions, job absenteeism). We performed a retrospective study on patients with surgically treated acetabular fractures or pelvic ring injuries. Medical records were reviewed in terms of demographic data, follow-up, diagnosis (according to Letournel and Tile classifications for acetabular and pelvic fractures, respectively) and type of surgical treatment. Patients were interviewed about hospitalization length, consultations after discharge, medications, physiotherapy sessions and absenteeism. The study comprised 203 patients, with a mean age of 49.1 ± 15.6 years, who had undergone surgery for an acetabular fracture or pelvic ring injury. The median treatment costs were 29.425 Euros per patient. Sixty percent of the total costs were attributed to health-related work absence. Median costs (in Euros) were 2.767 for hospitalization from trauma to definitive surgery, 4.530 for surgery, 3.018 for hospitalization in the surgical unit, 1.693 for hospitalization in the rehabilitation unit, 1.920 for physiotherapy after discharge and 402 for consultations after discharge. Total costs for treating pelvic ring injuries were higher than for acetabular fractures, mainly due to the significant higher costs of pelvic injuries regarding hospitalization from trauma to definitive surgery (p fractures are associated with both high direct costs and substantial productivity loss.

  4. Effects of “Danzhi Decoction” on Chronic Pelvic Pain, Hemodynamics, and Proinflammatory Factors in the Murine Model of Sequelae of Pelvic Inflammatory Disease

    Directory of Open Access Journals (Sweden)

    Xiaoling Bu

    2015-01-01

    Full Text Available Objective. To evaluate the effect of Danzhi decoction (DZD on chronic pelvic pain (CPP, hemodynamics, and proinflammatory factors of sequelae of pelvic inflammatory diseases (SPID in murine model. Methods. SPID mice were randomly treated with high-dose DZD, mid-dose DZD, low-dose DZD, aspirin, and vehicle for 3 estrous circles. The Mouse Grimace Scale (MGS was performed to evaluate CPP; blood flows of the upper genital tract, pelvic wall, and mesentery were used to assess hemodynamics in SPID mice; expressions of vascular endothelial growth factor (VEGF, angiopoietin-2 (Ang-2, and osteopontin (OPN were measured by Western blot and immunochemistry. Results. Treatment with dose-dependent DZD significantly decreased the MGS scores, accelerated blood flows of the pelvis, and reduced expressions of VEGF, Ang-2, and OPN in the upper genital tract. Conclusions and Discussions. DZD was effective in relieving CPP and improving hemodynamics of the pelvic blood-stasis microenvironment in SPID mice. There was a relationship between CPP and the pelvic blood-stasis microenvironment. Furthermore, DZD might play a positive role in the anti-inflammatory process.

  5. Valutazione morfo-funzionale in pazienti ipertesi con stenosi dell'arteria renale; Correlazioni tra angiografia e scintigrafia dinamica. Morpho-functional evaluation in hypertensive patients with renal artery stenosis; Correlations between angiography and radionuclide renography

    Energy Technology Data Exchange (ETDEWEB)

    Cuocolo, A; Celentano, L; Nappi, A [Naples Univ. (Italy). Ist. di Scienze Radiologiche; Neumann, R D; Salvatore, M [Naples Univ. (Italy). Cattedra di Medicina Nucleare

    1991-01-01

    Renovascula hypertension is the most important and common cause of secondary hypertension. We studied 10 patients with arterial hypertension and different degrees of renal artery stenosis to assess the usefulness of dynamic radionuclide renography in evaluating renal perfusion and funcion, and to compare funcional radionuclide results to the morphological findings of renal angiography. Computer-assisted dynamic renal with {sup 00m}Tc diethylenetriaminepentaacetic acid (DTPA) and {sup 131}I orthoiodohippurate (OIH), and renal artheriography were also employed in all patients. In all patients, radionuclide results matched angiography findings in quality. In particular, 3 patients with hemodynamical insignificant renal artery stenosis exhibited normal perfusion and function at dynamic radionuclide renography. Seven patients had significant renal artery stenosis and associated functional changes at dynamic radionuclide renography. Quantitative comparison of all patients showed a significant correlation (r=0.866, p<0.001) between the degree of renal artery stenosis, quantified as the percentage of narrowing as compared to adjacent/contralateral normal vessel diameter, and the results of split renal function, as assessed during OIH studies and expressed per kidney as a percentage of the net total counts of both kidneys. In conclusion, our results demonstrated dynamic radionuclide renography to be a valuable secondary to renal artery stenosis in hypertensive patients, providing complementary results to arteriography.

  6. EFFECTIVENESS OF TRANSPU B IC URETHROPLASTY FOR RECURRENT URETHRAL STR U CTURE IN PELVIC FRACTURE URETHRAL DISTRACTION DEFECT

    Directory of Open Access Journals (Sweden)

    Mudegowdar

    2015-08-01

    Full Text Available AIM OF THE STUDY: Effectiveness of Transpubic urethroplasty in recurrent (failed urethral strictures due to pelvic fracture urethral distraction defects. INTRODUCTION: Urethral distraction injuries occur upto 10% of pelvic fracture cases. The principle indication of Transpubic urethroplasty is length >3 c ms, recur rent (failed repairs of posterior urethral stricture. Though other procedures like primary anastomotic urethroplasty, rerouting of the urethra under the corporal body, urethral substitution with tubularised flaps, two stage urethroplasty are described, Tr anspubic urethroplasty is said to produce the best results especially when repeat procedures are required. MATERIALS & METHODS: This is a prospective study from 2004 to 2014 consisting of 17 patients having recurrent stricture urethra secondary to pelvic f racture urethral distraction defects (PFUDD. All the patients were males and their age ranged from 15year to 45 years. Pre - op evaluation included X - ray KUB, Ultrasound abdomen & pelvis, retrograde urethrogram (RGU, micturating cystourethrogram (MCU, up and down Cystoscopy, urine culture and renal biochemical parameters. Urethra was approched through progressive perineal and abdominal approach with total pubectomy, followed by excising fibrosed stricture and tension free end to end anastomosis. Post opera tively pericatheteral RGU was carried out after 4 weeks and Catheter removed if there was no leak. RGU, MCU uroflowmetry and PVR were done one month after removal of catheter. Subsequently UFR, PVR and obstructive symptoms were assessed periodically. RESUL TS: All 17 Cases were followed up for a period of 3 - 11 years. Out of 17patients, 14(80% patients maintained good uroflow (UFR and insignificant PVR and procedure was considered successful. In 3 patients procedure failed, of which 2 patients had pericathe ter leak and reduced urinary flow with significant PVR and were followed up with CIC and 1 patient remained on permanent

  7. Quality of life in women with pelvic floor dysfunction

    OpenAIRE

    Mladenović-Segedi Ljiljana; Parezanović-Ilić Katarina; Ćurčić Aleksandar; Višnjevac Nemanja

    2011-01-01

    Background/Aim. Pelvic floor dysfunction is a frequent problem affecting more than 50% of women in peri- and postmenopause. Considering that ageing and menopause befall in the significant factors causing this issue, as well as the expected longevity of women in the world and in our country, pelvic floor dysfunction prevelence is foreseen to be even higher. The aim of the study was to evaluate impact of the symptoms of pelvic dysfunction on quality of life and examine body image satisfac...

  8. Pelvic morphology in ischiofemoral impingement

    Energy Technology Data Exchange (ETDEWEB)

    Bredella, Miriam A.; Azevedo, Debora C.; Oliveira, Adriana L.; Simeone, Frank J.; Chang, Connie Y.; Torriani, Martin [Massachusetts General Hospital, Department of Radiology, Musculoskeletal Imaging and Intervention, Boston, MA (United States); Stubbs, Allston J. [Wake Forest University School of Medicine, Department of Orthopedic Surgery, Division of Sports Medicine, Winston-Salem, NC (United States)

    2014-11-06

    To assess MRI measures to quantify pelvic morphology that may predispose to ischiofemoral impingement (IFI). We hypothesized that patients with IFI have a wider interischial distance and an increased femoral neck angle compared with normal controls. The study was IRB-approved and complied with HIPAA guidelines. IFI was diagnosed based on clinical findings (hip or buttock pain) and ipsilateral edema of the quadratus femoris muscle on MRI. Control subjects did not report isolated hip/buttock pain and underwent MRI for surveillance of neoplasms or to exclude pelvic fractures. Two MSK radiologists measured the ischiofemoral (IF) and quadratus femoris (QF) distance, the ischial angle as a measure of inter-ischial distance, and the femoral neck angle. The quadratus femoris muscle was evaluated for edema. Groups were compared using ANOVA. Multivariate standard least-squares regression modeling was used to control for age and gender. The study group comprised 84 patients with IFI (53 ± 16 years, 73 female, 11 male) and 51 controls (52 ± 16 years, 33 female, 18 male). Thirteen out of 84 patients (15 %) had bilateral IFI. Patients with IFI had decreased IF and QF distance (p < 0.0001), increased ischial angle (p = 0.004), and increased femoral neck angle (p = 0.02) compared with controls, independent of age and gender. Patients with IFI have increased ischial and femoral neck angles compared with controls. These anatomical variations in pelvic morphology may predispose to IFI. MRI is a useful method of not only assessing the osseous and soft-tissue abnormalities associated with IFI, but also of quantifying anatomical variations in pelvic morphology that can predispose to IFI. (orig.)

  9. Pelvic morphology in ischiofemoral impingement

    International Nuclear Information System (INIS)

    Bredella, Miriam A.; Azevedo, Debora C.; Oliveira, Adriana L.; Simeone, Frank J.; Chang, Connie Y.; Torriani, Martin; Stubbs, Allston J.

    2015-01-01

    To assess MRI measures to quantify pelvic morphology that may predispose to ischiofemoral impingement (IFI). We hypothesized that patients with IFI have a wider interischial distance and an increased femoral neck angle compared with normal controls. The study was IRB-approved and complied with HIPAA guidelines. IFI was diagnosed based on clinical findings (hip or buttock pain) and ipsilateral edema of the quadratus femoris muscle on MRI. Control subjects did not report isolated hip/buttock pain and underwent MRI for surveillance of neoplasms or to exclude pelvic fractures. Two MSK radiologists measured the ischiofemoral (IF) and quadratus femoris (QF) distance, the ischial angle as a measure of inter-ischial distance, and the femoral neck angle. The quadratus femoris muscle was evaluated for edema. Groups were compared using ANOVA. Multivariate standard least-squares regression modeling was used to control for age and gender. The study group comprised 84 patients with IFI (53 ± 16 years, 73 female, 11 male) and 51 controls (52 ± 16 years, 33 female, 18 male). Thirteen out of 84 patients (15 %) had bilateral IFI. Patients with IFI had decreased IF and QF distance (p < 0.0001), increased ischial angle (p = 0.004), and increased femoral neck angle (p = 0.02) compared with controls, independent of age and gender. Patients with IFI have increased ischial and femoral neck angles compared with controls. These anatomical variations in pelvic morphology may predispose to IFI. MRI is a useful method of not only assessing the osseous and soft-tissue abnormalities associated with IFI, but also of quantifying anatomical variations in pelvic morphology that can predispose to IFI. (orig.)

  10. Pelvic hydatid cyst with uncommon sciatalgia manifestation: a case report

    Directory of Open Access Journals (Sweden)

    Ghodratolah Maddah

    2013-11-01

    Full Text Available Background: Hydatid disease or echinococcosis is a common parasitic disease of human and bovine, caused by infection with larva of the cestode echinococcus. Liver is the most common organ that is involved in this disease. Pelvic involvement and neurological symptoms, due to mass effect of pelvic involvement, in lower extremities are very uncommon manifestations of the disease.Case presentation: A forty six year old man was referred to clinic of surgery at Ghaem Hospital, Medical University of Mashhad, Iran. The patient complained about weakness and motor impairment in right lower extremity accompanied by numbness and radicular pain over past two months. Physical examination demonstrated muscular atrophy and reduced muscular strength in right lower extremity. Computed tomography and ultrasonographic studies showed a cystic mass in right side of the pelvic cavity with extention to the sciatic notch and another cystic mass in right gluteal region. Surgical operation revealed a cystic mass deep in pelvic cavity with the extention to the right sciatic notch with compression of nerve roots. The cystic mass was contained of daughter cysts which confirmed the diagnosis of hydatid cyst disease. This diagnosis was confirmed by pathologic assessment.Conclusion: Although uncommon, but hydatid disease can involve the pelvic cavity and make a pelvic, usually cystic, mass; that can make compression on nerve roots and so making neurologic symptoms in lower extremities. So in endemic areas for hydatid disease, such as Iran, pelvic hydatid cysts should be considered as a possible differential diagnosis in patients presenting with the sciatic pain and neurological manifestations in whom a pelvic mass has been found too.

  11. Postirradiation changes in the pelvic wall

    International Nuclear Information System (INIS)

    Soevik, E.; Lien, H.H.; Tveit, K.M.

    1993-01-01

    MR images of 45 patients who had received radiation therapy for carcinoma of the anus or recurrent carcinoma of the rectum were reviewed with regard to postirradiation changes of the pelvic wall. High signal intensity in bone marrow on T1-weighted images due to fatty replacement was almost always observed. Presacral edema occurred in 7 of 36 patients who were examined 4 to 6 weeks after the end of irradiation and was more frequent at later studies. The pelvic wall muscles showed high signal intensity on T2-weighted images compatible with edema. This finding was most frequent on studies performed more than 6 weeks after the end of irradiation. The changes subsided more than a year after radiation therapy. To avoid an erroneous diagnosis of tumor infiltration into the pelvic wall, it is important to be familiar with the normal postirradiation changes of the presacral space and the muscles. (orig.)

  12. Prophylactic ibuprofed administration during pelvic irradiation

    International Nuclear Information System (INIS)

    Stryker, J.A.; Demers, L.M.; Mortel, R.

    1979-01-01

    Thirty-five patients who were to begin pelvic irradiation for malignant disease were randomized to receive ibuprofen 400 mg P.O. q.i.d. during their radiotherapy or standard therapy for radiation-induced gastrointestinal symptoms. Seventeen of 19 patients in the ibuprofen group completed the protocol. There was no significant difference in the daily stool frequency between the ibuprofen and control patients during the 5 to 6 week course of pelvic irradiation; the incidence and severity of diarrhea was the same. There was no significant difference in the incidence of nausea reported by the patients but the severity of nausea was less in the ibuprofen group; none of the 17 patients in the ibuprofen group reported vomiting at any time, whereas, 27% of the patients in the control group reported vomiting. The difference was statistically significant (p < 0.05). The data suggest that prophylactic ibuprofen administration may be beneficial in reducing the severity of nausea and preventing radiation-induced vomiting in patients who receive pelvic irradiation

  13. Pelvic floor dyssynergia: efficacy of biofeedback training.

    Science.gov (United States)

    Gadel Hak, Nabil; El-Hemaly, Mohamed; Hamdy, Emad; El-Raouf, Ahmed Abd; Atef, Ehab; Salah, Tarek; El-Hanafy, Ehab; Sultan, Ahmad; Haleem, Magdy; Hamed, Hala

    2011-03-01

    Paradoxical contraction of the pelvic floor during attempts to defaecate is described as pelvic floor dyssynergia (anismus). It is a behavioural disorder (no associated morphological or neurological abnormalities); consequently, biofeedback training has been recommended as a behavioural therapy for such a disorder. The aim of the present study was to evaluate long-term satisfaction of patients diagnosed with pelvic floor dyssynergia after biofeedback. Sixty patients (35 females and 25 males) with a mean age of 30±12years and a 4year duration of constipation were included. Forty-five patients had normal colonic transit and 15 patients had slow colonic transit. History, physical examination and barium enema were done to exclude constipation secondary to organic causes. Colonic and pelvic floor functions (colon-transit time, anorectal manometry, EMG and defaecography) were performed before and after biofeedback treatments. Patients were treated on a weekly basis with an average of (6±2) sessions. At the end of sessions, 55 out of 60 patients (91.6%) reported a subjectively overall improvement. Symptoms of dyschezia were reported less frequently after biofeedback. Age and gender were not predictive factors of outcome. No symptoms at initial assessment were predictive for patient's satisfaction but the only factor of predictive value was the diagnosis of anismus and the motivated patient who wanted to continue the sessions. Biofeedback remains a morbidity free, low-cost and effective outpatient therapy for well-motivated patients complaining of functional constipation and diagnosed as pelvic floor dyssynergia. Copyright © 2011 Arab Journal of Gastroenterology. Published by Elsevier Ltd. All rights reserved.

  14. Assessment of degree of trauma and levator ani muscle contraction function after pelvic floor reconstruction and traditional surgical treatment of pelvic organ prolapse

    Directory of Open Access Journals (Sweden)

    Chun-Hua Zhu

    2016-11-01

    Full Text Available Objective: To study the degree of trauma and levator ani muscle contraction function after pelvic floor reconstruction and traditional surgical treatment of pelvic organ prolapse. Methods: Patients with III-IV pelvic organ prolapse who received surgical treatment in our hospital between May 2011 and October 2015 were randomly divided into observation group who received vaginal hysterectomy combined with pelvic floor reconstruction and control group who received vaginal hysterectomy combined with colporrhaphy, and then the degree of trauma, urodynamics and levator ani muscle contraction function were compared between two groups of patients. Results: Operating time, intraoperative blood loss as well as serum CRP, IL-1β, TNF-α, Ins, NE and E content were not significantly different between two groups (P>0.05; 2 weeks after operation, maximum bladder volume and QMax of observation group were significantly higher than those of control group, PdetQMax, PdetMax and PVR were significantly lower than those of control group (P0.05, LAT under Valsalva maneuver was significantly more than that of control group while LHS under Valsalva maneuver was significantly less than that of control group (P<0.05. Conclusions: Pelvic floor reconstruction treatment of pelvic organ prolapse has equivalent degree of surgical trauma to traditional surgery, and has better effect on improving the urination function and levator ani muscle contraction function than traditional surgery.

  15. Laparoscopic surgery for renal stones: is it indicated in the modern endourology era?

    Directory of Open Access Journals (Sweden)

    Andrei Nadu

    2009-02-01

    Full Text Available Purpose: To report the outcomes of laparoscopic surgery combined with endourological assistance for the treatment of renal stones in patients with associated anomalies of the urinary tract. To discuss the role of laparoscopy in kidney stone disease. Materials and Methods: Thirteen patients with renal stones and concomitant urinary anomalies underwent laparoscopic stone surgery combined with ancillary endourological assistance as needed. Their data were analyzed retrospectively including stone burden, associated malformations, perioperative complications and outcomes. Results: Encountered anomalies included ureteropelvic junction obstruction, horseshoe kidney, ectopic pelvic kidney, fussed-crossed ectopic kidney, and double collecting system. Treatment included laparoscopic pyeloplasty, pyelolithotomy, and nephrolithotomy combined with flexible nephroscopy and stone retrieval. Intraoperative complications were lost stones in the abdomen diagnosed in two patients during follow up. Mean number of stones removed was 12 (range 3 to 214. Stone free status was 77% (10/13 and 100% after one ancillary treatment in the remaining patients. One patient had a postoperative urinary leak managed conservatively. Laparoscopic pyeloplasty was successful in all patients according to clinical and dynamic renal scan parameters. Conclusions: In carefully selected patients, laparoscopic and endourological techniques can be successfully combined in a one procedure solution that deals with complex stone disease and repairs underlying urinary anomalies.

  16. Magnetic resonance imaging of pelvic floor dysfunction - joint recommendations of the ESUR and ESGAR Pelvic Floor Working Group

    Energy Technology Data Exchange (ETDEWEB)

    El Sayed, Rania Farouk [Cairo University Hospitals, Genitourinary and Pelvic Floor MR Imaging Unit, Department of Radiology, Faculty of Medicine, Cairo (Egypt); Alt, Celine D. [University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Duesseldorf (Germany); Maccioni, Francesca [Sapienza University Rome, Department of Radiological Sciences, Oncology and Pathology Policlinico Umberto I Hospital, Rome (Italy); Meissnitzer, Matthias [University Hospital Salzburg, Paracelsus Medical University, Department of Radiology, Salzburg (Austria); Masselli, Gabriele [Sapienza University of Rome, Department of Radiology Dea, Umberto I Hospital, Rome (Italy); Manganaro, Lucia; Vinci, Valeria [Sapienza University of Rome, Department of Radiological Sciences, Policlinico Umberto I Hospital, Rome (Italy); Weishaupt, Dominik [Triemli Hospital Zurich, Institute of Radiology and Nuclear Medicine, Zurich (Switzerland); Collaboration: On behalf of the ESUR and ESGAR Pelvic Floor Working Group

    2017-05-15

    To develop recommendations that can be used as guidance for standardized approach regarding indications, patient preparation, sequences acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for diagnosis and grading of pelvic floor dysfunction (PFD). The technique included critical literature between 1993 and 2013 and expert consensus about MRI protocols by the pelvic floor-imaging working group of the European Society of Urogenital Radiology (ESUR) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) from one Egyptian and seven European institutions. Data collection and analysis were achieved in 5 consecutive steps. Eighty-two items were scored to be eligible for further analysis and scaling. Agreement of at least 80 % was defined as consensus finding. Consensus was reached for 88 % of 82 items. Recommended reporting template should include two main sections for measurements and grading. The pubococcygeal line (PCL) is recommended as the reference line to measure pelvic organ prolapse. The recommended grading scheme is the ''Rule of three'' for Pelvic Organ Prolapse (POP), while a rectocele and ARJ descent each has its specific grading system. This literature review and expert consensus recommendations can be used as guidance for MR imaging and reporting of PFD. (orig.)

  17. Radiation diagnosis of pelvic ring damages in acute injury

    International Nuclear Information System (INIS)

    Dytalov, M.M.

    2000-01-01

    Data on 58 victims with multifocal damages to the pelvic ring were used to examine the diagnostic potentialities of different radiation diagnostic techniques and to compare their resolving power. The later was 65.1, 83.3 and 94.7% in plain and multidimensional X-ray studies, and computed tomography, respectively. Complex of signs is described closed sacral fractures on the plain and oblique pelvic inlet (caudal) radiograms proposed, which could improve the diagnosis of fractures by 8.8 times, and an original orthopedic gauze-plate for the detection and estimation of invisible pelvic bone displacement, and an original procedure for pelvic X-ray study with target load in acute injury. This all can improve the quality of examination of casualties substantially and define indications for different treatments more precise [ru

  18. Pelvic orientation and assessment of hip dysplasia in adults

    DEFF Research Database (Denmark)

    Jacobsen, S.; Holm, S.S.; Lund, B.

    2004-01-01

    on the measurements of radiographic indices of hip dysplasia. MATERIAL AND METHODS: We investigated the effect of varying pelvic orientation on radiographic measurements of acetabular dysplasia using a cadaver model. Results from the cadaver study were used to validate the radiographic assessments of acetabular...... radiograph was recorded at each 3 degrees increment. The most widely used radiographic parameters of hip dysplasia were assessed. 2) Critical limits of acceptable rotation and inclination/reclination of pelvises were determined on 4151 standing, standardised pelvic radiographs of the CCHS cohort. RESULTS......BACKGROUND: The study was performed to qualify the source material of 4151 pelvic radiographs for the research into the relationship between unrecognised childhood hip disorders and the development of hip osteoarthrosis, and to investigate the effect of varying degrees of pelvic tilt and rotation...

  19. Concurrent rib and pelvic fractures as an indicator of solid abdominal organ injury.

    Science.gov (United States)

    Al-Hassani, Ammar; Afifi, Ibrahim; Abdelrahman, Husham; El-Menyar, Ayman; Almadani, Ammar; Recicar, Jan; Al-Thani, Hassan; Maull, Kimball; Latifi, Rifat

    2013-01-01

    To study the association of solid organ injuries (SOIs) in patients with concurrent rib and pelvic fractures. Retrospective analysis of prospectively collected data from November 2007 to May 2010. Patients' demographics, mechanism of injury, Injury severity scoring, pelvic fracture, and SOIs were analyzed. Patients with SOIs were compared in rib fractures with and without pelvic fracture. The study included 829 patients (460 with rib fractures ± pelvic fracture and 369 with pelvic fracture alone) with mean age of 35 ± 12.7 years. Motor vehicle crashes (45%) and falls from height (30%) were the most common mechanism of injury. The overall incidence of SOIs in this study was 22% (185/829). Further, 15% of patient with rib fractures had associated pelvic fracture. SOI was predominant in patients with concurrent rib fracture and pelvic fracture compared to ribs or pelvic fractures alone (42% vs. 26% vs. 15%, respectively, p = 0.02). Concurrent multiple rib fractures and pelvic fracture increases the risk of SOI compared to either group alone. Lower RFs and pelvic fracture had higher association for SOI and could be used as an early indicator of the presence of SOIs. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  20. Conventional four-field pelvic radiotherapy technique without computed tomography-treatment planning in cancer of the cervix: potential geographic miss and its impact on pelvic control

    International Nuclear Information System (INIS)

    Kim, Robert Y.; McGinnis, L. Scott; Spencer, Sharon A.; Meredith, Ruby F.; Jennelle, Richard L.S.; Salter, Merle M.

    1995-01-01

    Purpose: To evaluate the impact of inadequate margins on pelvic control using the conventional four-field pelvic portals without computed tomography (CT)-treatment planning. Methods and Materials: Between 1986 and 1991, 34 patients with invasive cancer of the cervix were eligible for outcome study of conventional four-field radiation therapy (10 Stage I, 16 Stage II, 8 Stage III). The eligibility for this study includes four-field pelvic technique, definitive radiation therapy, and diagnostic CT scan of the pelvis. For this study, an inadequate margin is arbitrarily defined as ≤ 1.0 cm of normal tissue around the CT-defined tumor volume. Results: All 34 patients had adequate margins for anterio-posterior/posterio-anterior portals. However, 19 patients had an inadequate margin at the posterior border (S2-S3 interspace) and/or custom-shaped rectal block for lateral pelvic portals. Two patients had inadequate margins at the anterior border (level of symphysis pubis) due to an enlarged uterus. With a median follow-up of 36 months, pelvic control for adequate margins and inadequate margins was 100% and 71% for Stage IB disease and 88% and 50% for Stage IIB disease, respectively. However, pelvic control for Stage IIIB disease was 50% for both groups. There was no difference in total dose to point A or point B between the two groups. Conclusion: Our preliminary data show higher local failure in patients with an inadequate margin. For four-field pelvic radiation therapy, we strongly recommend CT-treatment planning. Otherwise, anterio-posterior/posterio-anterior pelvic therapy is the most reliable treatment for cancer of the uterine cervix

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

    Energy Technology Data Exchange (ETDEWEB)

    Goldsmith, Benjamin; Baumann, Brian C.; He, Jiwei; Tucker, Kai; Bekelman, Justin; Deville, Curtiland; Vapiwala, Neha [Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (United States); Vaughn, David; Keefe, Stephen M. [Department of Medical Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (United States); Guzzo, Thomas; Malkowicz, S. Bruce [Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (United States); Christodouleas, John P., E-mail: christojo@uphs.upenn.edu [Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (United States)

    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

  2. Determinants and Management Outcomes of Pelvic Organ Prolapse ...

    African Journals Online (AJOL)

    Conclusion: The incidence of pelvic organ prolapse in this study was 6.5% and the leading determinants of pelvic organ prolapse were multiparity, menopause, chronic increase in IAP and advanced age. Most were lost to follow-up and a lesser proportion was offered conservative management. Early presentation of women ...

  3. PELVIC AREA ASSESSMENT IN BUNAJI AND RAHAJI COWS ...

    African Journals Online (AJOL)

    Keywords: Fostering calving ease, pelvic area assessment, Bunaji, Rahaji. Abstract. Pelvic area (P.A.) assessment may be used as management tool to reduce the risks associated with dystocia and foster calving ease. Relationship between cow's P.A. and age can aid pre- breeding culling decisions. This study used 100 ...

  4. The clinical significances of selective ovarian arterial angiography and embolization in the obstetrics and gynecology

    International Nuclear Information System (INIS)

    Duan Feng; Liu Fengyong; Wang Maoqiang

    2007-01-01

    Transcatheter internal iliac arterial embolization has become a first-choice treatment for control of life-threatened bleeding associated with pelvic tumors or obstetric disorders. Recently, uterine arterial embolization (UAE)has offered a successful alternative to surgery in the treatment of uterine fibroid. Clinical failure rates for this procedure was reported from 4% to 19% in literature, probably due to the existence of collateral flow to the pelvic lesions, especially the ovarian arteries (OA)being the most important source. Furthermore, the anastomosis between the ovarian and uterine arteries has been suggested as the pathway for nontarget embolization of the ovaries causing premature menopause. The OA are simple paired vessels and they usually arise from the anterolateral part of the abdominal aorta at the level of the second lumbar vertebra. Variations in origin of OA occur in 2%-10% with diameter smaller than 1.1 mm and routinely not identified on conventional aortography. However, in the presence of a uterine or other pelvic diseases, the OA become dilated as the result of pathologic blood supply demand. OA supply to the pelvic lesions are more frequently found in patients with large fundal fibroids, history of the pelvic surgery, post embolization of the uterine arteries, and dysplasia of uterine artery. In patient with one or more of these predisposing factors, the extent of OA supply to the pelvic lesions should be assessed using pigtail catheter pelvic aortography with the tip at the level of the renal arteries, followed by selective OA catheterization. In case of identified OA supply to the pelvic lesions, superselective embolization of the OA should be considered, using particles with diameters larger than 500 μm. Proximal OA embolization, in combination with bilateral UAE, may significantly increase the risk of iatrogenic ovarian dysfunction. When necessary in a premenopausal patient, OA embolization should be performed unilaterally and as near

  5. The prevalence of simple renal and hepatic cysts detected by spiral computed tomography

    International Nuclear Information System (INIS)

    Carrim, Z.I.; Murchison, J.T.

    2003-01-01

    AIM: To provide a definitive evaluation of the prevalence of simple renal and hepatic cysts using spiral computed tomography (CT). PATIENTS AND METHODS: Contrast-enhanced abdominal CT studies from 617 patients (295 women, 322 men) attending for investigations unrelated to renal or hepatic pathology were included. The number of renal cysts, their location and the diameter of the largest cyst were recorded. Hepatic cysts were recorded as being either present or absent. RESULTS: Two hundred and fifty-four patients (41%) were found to have simple renal cysts and 110 patients were found to have simple hepatic cysts (18%). Both renal and hepatic cysts became more common with age. Renal cysts were significantly more common at all ages in men (p=0.001), and increased in both size (p=0.02) and number (p<0.05) with age. CONCLUSION: A major discrepancy has, until now, existed between autopsy prevalence of renal cysts and prevalence as reported by in-vivo third-generation CT or sonography studies. Using newer spiral CT machines, we have generated prevalence data closer to post-mortem findings. We have also shown a significant, but age dependent, association between the presence of simple hepatic and simple renal cysts (p=0.001)

  6. MRI-based 3D pelvic autonomous innervation: a first step towards image-guided pelvic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Bertrand, M.M. [University Montpellier I, Laboratory of Experimental Anatomy Faculty of Medicine Montpellier-Nimes, Montpellier (France); Macri, F.; Beregi, J.P. [Nimes University Hospital, University Montpellier 1, Radiology Department, Nimes (France); Mazars, R.; Prudhomme, M. [University Montpellier I, Laboratory of Experimental Anatomy Faculty of Medicine Montpellier-Nimes, Montpellier (France); Nimes University Hospital, University Montpellier 1, Digestive Surgery Department, Nimes (France); Droupy, S. [Nimes University Hospital, University Montpellier 1, Urology-Andrology Department, Nimes (France)

    2014-08-15

    To analyse pelvic autonomous innervation with magnetic resonance imaging (MRI) in comparison with anatomical macroscopic dissection on cadavers. Pelvic MRI was performed in eight adult human cadavers (five men and three women) using a total of four sequences each: T1, T1 fat saturation, T2, diffusion weighed. Images were analysed with segmentation software in order to extract nervous tissue. Key height points of the pelvis autonomous innervation were located in every specimen. Standardised pelvis dissections were then performed. Distances between the same key points and the three anatomical references forming a coordinate system were measured on MRIs and dissections. Concordance (Lin's concordance correlation coefficient) between MRI and dissection was calculated. MRI acquisition allowed an adequate visualization of the autonomous innervation. Comparison between 3D MRI images and dissection showed concordant pictures. The statistical analysis showed a mean difference of less than 1 cm between MRI and dissection measures and a correct concordance correlation coefficient on at least two coordinates for each point. Our acquisition and post-processing method demonstrated that MRI is suitable for detection of autonomous pelvic innervations and can offer a preoperative nerve cartography. (orig.)

  7. Influence of Pelvicaliceal Anatomy on Stone Clearance After Flexible Ureteroscopy and Holmium Laser Lithotripsy for Large Renal Stones.

    Science.gov (United States)

    Inoue, Takaaki; Murota, Takashi; Okada, Shinsuke; Hamamoto, Shuzo; Muguruma, Kouei; Kinoshita, Hidefumi; Matsuda, Tadashi

    2015-09-01

    This study was performed to evaluate the impact of pelvicaliceal anatomy on stone clearance in patients with remnant fragments in the lower pole after flexible ureteroscopy and holmium laser lithotripsy (fURSL) for renal stones >15 mm. This retrospective study included 67 patients with radiopaque residual fragments (>2 mm) in the lower pole after fURSL for large renal stones (>15 mm). The preoperative infundibular length (IL), infundibular width (IW), infundibulopelvic angle (IPA), and caliceal pelvic height (CPH) were measured using intravenous urography. Multivariate analysis was performed to determine whether any of these measurements affected stone clearance. Of the 67 patients, 55 (82.1%) were stone free (SF) 3 months after fURSL. The anatomic factors significantly favorable for an SF status were a short IL, broad IW, wide IPA, and low CPH. On multivariate analysis, the IPA had a significant influence on an SF status after fURSL (p=0.010). An IPA renal stones according to our multivariate analysis. Additional studies are required to further evaluate the characteristics of the pelvicaliceal anatomy influencing stone clearance.

  8. Total pelvic exenteration: the Albert Einstein College of Medicine/Montefiore Medical Center Experience (1987 to 2003).

    Science.gov (United States)

    Goldberg, Gary L; Sukumvanich, Paniti; Einstein, Mark H; Smith, Harriet O; Anderson, Patrick S; Fields, Abbie L

    2006-05-01

    To review the trends, modifications and results of 103 consecutive total pelvic exenterations (TPE) performed at the Montefiore Medical Center and Albert Einstein College of Medicine from 1987 to 2003. All patients who underwent TPE from January 1987 to December 2003 were included. The medical record, complications, follow-up, clinical status and demographic information were entered in a database. The procedure performed, the method of urinary diversion, colonic diversion, pelvic floor support and vaginal reconstruction were documented. Surviving patients were surveyed regarding their satisfaction with the urinary diversion, the vaginal reconstruction and their sexual function since the surgery. 103 pts were identified. Indications for TPE were recurrent cancers of the cervix (95), endometrium (2), colon and rectum (5), vulva (1). Overall 5-year survival was 47%. 5-year survival for pts with recurrent cervix cancer was 48%. Six pts (6%) recurred >5 years after the TPE. 14 pts (14%) had ureteral anastomotic leaks (no difference between ileal conduit 9/65 (14%) versus 5/38 (13%) continent conduit (P = 0.92). 34 pts (89%) with continent conduits were "continent." 14 pts (17%) had wound complications. 4 pts (4%) had parastomal hernias. 5/11 (46%) pts who had a low rectal reanastomosis developed recurrence in the pelvis. 21/39 (54%) of pts with continent conduits would choose an ileal conduit if they had the option again. Long-term renal function was similar in pts with ileal and continent conduits. Mesh of any type for pelvic floor reconstruction is associated with infection and bowel/urinary fistulas. VRAM flaps for neovagina fill the pelvic dead space, reduce the risk of fistulas and 20/36 pts (55%) are sexually active. Our overall 5-year survival is encouraging, and modifications in surgical technique have improved the reconstructive phase. Low rectal anastomoses at TPE adversely affects survival. Many of our pts with continent urinary diversions would not choose

  9. Diagnostics Of Renal Hemodynamics Disturbance In Children And Teenagers With Chronic Constipation, Encopresis And Their Correction

    Directory of Open Access Journals (Sweden)

    A.L. Malykh

    2009-12-01

    Full Text Available The article gives the detailed issue of results of complex inspection of 90 children and teenagers aged 4-17 with problems of chronic constipation, incontinence and encopresis. Ultrasonic screening has shown various pathology in the functional condition of arterial renal vessels. The method of biological feedback has been considered as prospective method of treatment excluding medication of bladder and small bowel dysfunction. The efficiency of the method was marked at combination of encopresis and incontinence. The purpose of the present research was the study of renal hemodynamics disturbances and working out methods of their correction. The examination included ultrasonic investigation, electromyography and uroflowmetry. The study of functional condition of anterior abdominal wall muscles and pelvic floor muscles was performed by means of «Miomed - 938». All patients received complex therapy on the basis of which the method of biological feedback was used

  10. Pelvic Vein Embolisation in the Management of Varicose Veins

    International Nuclear Information System (INIS)

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

    2008-01-01

    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.

  11. Does fibromyalgia influence symptom bother from pelvic organ prolapse?

    Science.gov (United States)

    Adams, Kerrie; Osmundsen, Blake; Gregory, W Thomas

    2014-05-01

    Determine if women with fibromyalgia report increased bother from pelvic organ prolapse compared with women without fibromyalgia. We performed a cross-sectional study of women with symptomatic prolapse on consultation with a private urogynecology practice within a 46-month period. After matching for age, women with a diagnosis of fibromyalgia were compared with a reference group of women without fibromyalgia. Demographic, POPQ examination, medical history, and pelvic floor symptom data (PFDI, PFIQ, and PISQ-12) were collected. Our primary outcome was to compare the mean Pelvic Floor Distress Inventory (PFDI) scores of women with and without fibromyalgia. The prevalence of fibromyalgia in women evaluated for initial urogynecology consultation during the study period was 114 out of 1,113 (7%). Women with fibromyalgia reported significantly higher symptom bother scores related to pelvic organ prolapse, defecatory dysfunction, urinary symptoms, and sexual function: PFDI (p = 0.005), PFIQ (p=0.010), and PISQ (p=0.018). Women with fibromyalgia were found to have a higher BMI (p=0.008) and were more likely to report a history of sexual abuse, OR 3.1 (95 % CI 1.3, 7.9), and have levator myalgia on examination, OR 3.8 (95% CI 1.5, 9.1). In a linear regression analysis, levator myalgia was found to be the significant factor associated with pelvic floor symptom bother. In women with symptomatic prolapse, fibromyalgia is associated with an increased risk of levator myalgia and 50% more symptom bother from pelvic floor disorders.

  12. Anatomy of the collecting system of lower pole of the kidney in patients with a single renal stone: a comparative study with individuals with normal kidneys.

    Science.gov (United States)

    Zomorrodi, Afshar; Buhluli, Abulfazel; Fathi, Samad

    2010-07-01

    At least 5% of women and 12% of men during their lives will experience renal colic, at least once. Many theories have been suggested for the etiology of renal stones and variations in the anatomy of the collecting system have been suggested to have a role in stone formation. This study was conducted to examine the role of variation of lower pole collecting system in patients with lower pole kidney stone and compared the same in normal persons (kidney donors). Investigation for the anatomy of the lower pole of the kidney (angle between lower infundibulum and pelvis, length and diameter of the infundibulum and number and pattern distribution of calyces) was carried out using intravenous pyelogram (IVP) in 100 cases with urinary stone (study cases) and 400 persons with normal kidneys (control subjects). The study was a retrospective cross-sectional case control study. Results were analyzed by Mann-Whitney and independent sample chi square tests. The mean infundibulum-pelvic angle (IPA) in control subjects and in patients was 112.5 +/- 10.7 and 96.6 +/- 28.8, respectively. There was significant correlation between reduced angle and stone formation (P= kidney (IPIL) in controls and study patients was 22.5 +/- 4.1 and 27.5 +/- 7.7, respectively, which was statistically significant (Pkidney (LPCN) in controls and study patients was 2.6 +/- 0.6 and 3 +/- 0.9, respectively, which was statistically significant (P = or anatomy was more common in patients with lower pole kidney stone and should be considered a risk factor for forming lower pole kidney stone.

  13. Pelvic floor physiotherapy for women with urogenital dysfunction: indications and methods.

    Science.gov (United States)

    Rosenbaum, T Y

    2011-03-01

    Pelvic floor physiotherapy (PFPT) is considered to be a salient component of the conservative management of women with urogenital dysfunction including urinary incontinence and pelvic organ prolapse (POP). PFPT is an important adjunct to the management of female pelvic and sexual pain disorders which are often associated with bothersome bladder symptoms. Physiotherapists utilize a variety of treatment methods which include behavioral therapy, exercise instruction, manual therapy, biofeedback and electrical stimulation. This review article provides a literature-based update describing and highlighting current indications and methods for pelvic floor physiotherapy intervention.

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

    Science.gov (United States)

    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. Large cell non-Hodgkin's lymphoma masquerading as renal carcinoma with inferior vena cava thrombosis: a case report

    Directory of Open Access Journals (Sweden)

    Weissman Alan

    2011-06-01

    Full Text Available Abstract Introduction Many cancers are associated with inferior vena cava (IVC obstruction, but very few cancers have the ability to propagate within the lumen of the renal vein or the IVC. Renal cell carcinoma is the most common of these cancers. Renal cancer with IVC extension has a high rate of recurrence and a low five year survival rate. Case presentation A 62-year-old Caucasian woman previously in good health developed the sudden onset of severe reflux symptoms and right-sided abdominal pain that radiated around the right flank. A subsequent ultrasound and CT scan revealed a right upper pole renal mass with invasion of the right adrenal gland, liver, left renal vein and IVC. This appeared to be consistent with stage III renal cancer with IVC extension. Metastatic nodules were believed to be present in the right pericardial region; the superficial anterior abdominal wall; the left perirenal, abdominal and pelvic regions; and the left adrenal gland. The pattern of these metastases, as well as the invasion of the liver by the tumor, was thought to be atypical of renal cancer. A needle biopsy of a superficial abdominal wall mass revealed a surprising finding: The malignant cells were diagnostic of large-cell, B-cell non-Hodgkin's lymphoma. The lymphoma responded dramatically to systemic chemotherapy, which avoided the need for nephrectomy. Conclusion Lymphomas only rarely progress via intraluminal vascular extension. We have been able to identify only one other case report of renal lymphoma with renal vein and IVC extension. While renal cancer would have been treated with radical nephrectomy and tumor embolectomy, large-cell B-cell lymphomas are treated primarily with chemotherapy, and nephrectomy would have been detrimental. It is important to remember that, rarely, other types of cancer arise from the kidney which are not derived from the renal tubular epithelium. These may be suspected if an atypical pattern of metastases or unusual

  16. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... test used to help detect diseases of the small bowel, colon and other internal organs and is ... pelvic pain and diseases of the internal organs, small bowel and colon, such as: infections such as ...

  17. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... often used to determine the cause of unexplained pain. CT scanning is fast, painless, noninvasive and accurate. ... help diagnose the cause of abdominal or pelvic pain and diseases of the internal organs, small bowel ...

  18. Effects of Estrogen Replacement Therapy to the Renal Function in Postmenopausal Women

    Directory of Open Access Journals (Sweden)

    Setenay Arzu Yılmaz

    2011-12-01

    Full Text Available Objective: To asses the effect of estrogen replacement therapy to the renal functions in postmenopausal women following the surgery. Design: This is prospestive randomised cross-sectional descriptive study. Setting: Gazi University School Of Medicine Obstetrics and Gynecology Department between October 2000 through July 2001 Patients: Fifty-eight patients who had been undergone total abdominal hysterectomy and bilateral salpingo-oopherectomy due to benign gynecologic disorders were enrolled in this present study. Interventions: Breast and pelvic examination had been before operation. Cervical smear, blood glucose, lipid profile, liver and renal functional tests, complete blood count and urine analysis revelaed. Mammography and pelvic ultrasonography applied to all patients. Main outcome measures: Body mass index (BMI has been measured with patient’s weight (kg and heights by the formula ‘weight(kg /height (m2. Obese patients defined as boy mass index over 30. The patients who can use ERT randomised as two groups. Group I received transdermal estrogen (Climara TTS or oral conjugated estrogen (Premarin 0,625 mg, group II did not. Microalbuminuria, creatinine clearance in 24 hour urine specimen were compared preoperatively and postoperative 1st and 6 th months respectively. Results: At the end of six month of observation in the group who were in surgical menopause and given ERT, statistically significant decline in microalbuminuria was observed. However, in the group who were in surgically menopause and did not receive ERT, level of microalbuminuria did not change significantly. In the group who were oopherectomised following naturel menopause, microalbuminuria level changed clinically after ERT but was not stastistically significant. Whereas in the group who were not given ERT, decline in the level of microalbuminuria was seen and this finding is stastistically significant (p<0,05. Conclusion: We concluded that ERT is protective on

  19. INCIDENCE AND RISK FACTORS FOR CHRONIC PELVIC PAIN AFTER HYSTEROSCOPIC STERILIZATION

    Science.gov (United States)

    YUNKER, Amanda C.; RITCH, Jessica M. B.; ROBINSON, Erica F.; GOLISH, Cara T.

    2014-01-01

    Objective To investigate the incidence and pre-operative risk factors for developing pelvic pain after hysteroscopic sterilization using the Essure™ micro-inserts Design Retrospective cohort study (Canadian Task Force classification II-2). Setting University Medical Center Patients A total of 458 patients who underwent hysteroscopic sterilization with Essure™ between January 1, 2005 and June 30, 2012. Results The incidence of acute pelvic pain after hysteroscopic sterilization was 8.1%, and the incidence of persistent pain after 3 months post-procedure was 4.2%. The range of presentation with pain was 1 to 469 days, with a mean time of 56 days. Of the patients that developed chronic pelvic pain after the procedure, 75% presented within 130 days of the procedure. Patients with previous diagnoses of any chronic pain (chronic pelvic pain, chronic low back pain, chronic headache, and fibromyalgia) were more likely to report both acute pain (OR 6.81, 95% CI 2.95,15.73) and chronic pain (OR 6.15, 95% CI 2.10,18.10) after hysteroscopic sterilization. Conclusions Pelvic pain may develop after hysteroscopic sterilization. Patients with preexisting chronic pain diagnoses may be at increased risk of developing pelvic pain after the procedure. Fifty percent of new pelvic pain after Essure™ placement will resolve by 3 months. PMID:24952343

  20. Less gastrointestinal toxicity after adjuvant radiotherapy on a small pelvic field compared to a standard pelvic field in patients with endometrial carcinoma

    NARCIS (Netherlands)

    de Jong, Renske A.; Pras, Elisabeth; Boezen, H. Marike; van der Zee, Ate G. J.; Mourits, Marian J. E.; Arts, Henriette J. G.; Aalders, Jan G.; Slot, Annerie; Timmer, Paul R.; Hollema, Harry; Nijman, Hans W.

    Objective: Radiotherapy is associated with short-term and long-term morbidity. This study compared toxicity rates among patients with endometrial carcinoma (EC) treated with adjuvant external beam radiation therapy (EBRT) on a small pelvic field (SmPF) in comparison with a standard pelvic field

  1. How to differentiate acute pelvic inflammatory disease from acute appendicitis? A decision tree based on CT findings

    Energy Technology Data Exchange (ETDEWEB)

    El Hentour, Kim; Millet, Ingrid; Pages-Bouic, Emmanuelle; Curros-Doyon, Fernanda; Taourel, Patrice [Lapeyronie Hospital, Department of Medical Imaging, Montpellier (France); Molinari, Nicolas [UMR 5149 IMAG, CHU, Department of Medical Information and Statistics, Montpellier (France)

    2018-02-15

    To construct a decision tree based on CT findings to differentiate acute pelvic inflammatory disease (PID) from acute appendicitis (AA) in women with lower abdominal pain and inflammatory syndrome. This retrospective study was approved by our institutional review board and informed consent was waived. Contrast-enhanced CT studies of 109 women with acute PID and 218 age-matched women with AA were retrospectively and independently reviewed by two radiologists to identify CT findings predictive of PID or AA. Surgical and laboratory data were used for the PID and AA reference standard. Appropriate tests were performed to compare PID and AA and a CT decision tree using the classification and regression tree (CART) algorithm was generated. The median patient age was 28 years (interquartile range, 22-39 years). According to the decision tree, an appendiceal diameter ≥ 7 mm was the most discriminating criterion for differentiating acute PID and AA, followed by a left tubal diameter ≥ 10 mm, with a global accuracy of 98.2 % (95 % CI: 96-99.4). Appendiceal diameter and left tubal thickening are the most discriminating CT criteria for differentiating acute PID from AA. (orig.)

  2. How to differentiate acute pelvic inflammatory disease from acute appendicitis? A decision tree based on CT findings

    International Nuclear Information System (INIS)

    El Hentour, Kim; Millet, Ingrid; Pages-Bouic, Emmanuelle; Curros-Doyon, Fernanda; Taourel, Patrice; Molinari, Nicolas

    2018-01-01

    To construct a decision tree based on CT findings to differentiate acute pelvic inflammatory disease (PID) from acute appendicitis (AA) in women with lower abdominal pain and inflammatory syndrome. This retrospective study was approved by our institutional review board and informed consent was waived. Contrast-enhanced CT studies of 109 women with acute PID and 218 age-matched women with AA were retrospectively and independently reviewed by two radiologists to identify CT findings predictive of PID or AA. Surgical and laboratory data were used for the PID and AA reference standard. Appropriate tests were performed to compare PID and AA and a CT decision tree using the classification and regression tree (CART) algorithm was generated. The median patient age was 28 years (interquartile range, 22-39 years). According to the decision tree, an appendiceal diameter ≥ 7 mm was the most discriminating criterion for differentiating acute PID and AA, followed by a left tubal diameter ≥ 10 mm, with a global accuracy of 98.2 % (95 % CI: 96-99.4). Appendiceal diameter and left tubal thickening are the most discriminating CT criteria for differentiating acute PID from AA. (orig.)

  3. Ultrastructural Investigation of Pelvic Peritoneum in Patients With Chronic Pelvic Pain and Subtle Endometriosis in Association With Chromoendoscopy.

    Science.gov (United States)

    Mehdizadehkashi, Abolfazl; Tahermanesh, Kobra; Fazel Anvari-Yazdi, Abbas; Chaichian, Shahla; Azarpira, Negar; Nobakht, Maliheh; Abed, Seyedeh Mehr; Hashemi, Neda

    2017-01-01

    To evaluate the pelvic peritoneum under chromoendoscopy by scanning electron microscopy (SEM) as well as light microscopy with hematoxylin and eosin staining and immunohistochemistry (IHC) assays in patients with chronic pelvic pain (CPP) associated with subtle endometriosis. Case series study (Canadian Task Force classification II). A referral academic community tertiary medical center. Three women aged 29 to 37 years were referred to the obstetrics and gynecology clinic of the tertiary university hospital with CPP. They were suspicious for endometriosis, were not responding to medical treatments, and had undergone previous pelvic laparoscopy to determine the stage of endometriosis and preparation of peritoneal samples under the guidance of staining with methylene blue in 0.25% dilution. Comparison of stained and unstained pelvic peritoneal samples after the instillation of 0.25% methylene blue into the pelvic cavity. In 3 patients, laparoscopic examination showed minimal endometriosis. A total of 18 samples (9 stained and 9 unstained) from the 3 patients were prepared for SEM. Ten of the samples (55.6%) showed microstructural peritoneal destruction (7 of 9 stained [77.7%] and 3 of 9 [33.4%] unstained). Eighteen samples (9 stained and 9 unstained) from the 3 patients were also prepared for IHC. Six of these samples (33.3%) were S-100-positive, including 4 of 9 (44.4%) stained samples and 2 of 9 (22.2%) unstained samples. In general, in the context of CPP and endometriosis, there is no established relationship between the severity of pain and stage of endometriosis. In the pathophysiology of CPP associated with endometriosis, ultrastructural changes can play a significant role. Under methylene blue staining, some destroyed areas were detected, but the stained areas do not necessarily correlate with increased microstructural peritoneal destruction. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  4. Reconstruction of the pelvic floor and the vagina after total pelvic exenteration using the transverse musculocutaneous gracilis flap.

    Science.gov (United States)

    Kaartinen, Ilkka S; Vuento, Maarit H; Hyöty, Marja K; Kallio, Jukka; Kuokkanen, Hannu O

    2015-01-01

    Total pelvic exenteration (TPE) is a rare operation in which the pelvic contents are removed entirely. Several options for pelvic floor and vaginal reconstruction have been described including transverse rectus abdominis musculocutaneous (TRAM) or deep inferior epigastric perforator (DIEP) flaps. The transverse musculocutaneous gracilis (TMG) flap has been introduced for breast reconstruction as a free flap. We adopted the pedicled TMG flap for reconstructions after TPE. To the best of our knowledge, this is the first report of this method in the literature. Between November 2011 and February 2014, 12 patients underwent TPE and reconstruction with unilateral (six patients) or bilateral (six patients) pedicled TMG flaps. Five patients underwent vaginal reconstruction with bilateral TMG flaps. We describe the operative procedure and the outcome of the operation in these patients. The total mean operative times for TPE with or without vaginal reconstruction were 467 ± 12 and 386 ± 59 min, respectively. The TMG flaps had enough vascular tissue and mobility for reconstructing the TPE defects. There was distal edge necrosis in one out of 18 flaps, while the rest survived completely. During the follow-up, complete wound healing with no signs of weakening of the pelvic floor was observed in all cases. Soft-tissue reconstructions are needed to reduce complications associated with TPE, to secure the pelvic floor and to reconstruct the vagina in select patients. The TMG flap is a logical flap choice that does not lead to functional deficits, complicate the abdominal ostomies or weaken the abdominal wall. It reduces the length of operation compared to that of abdominal flaps. IV, therapeutic. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Abdominal and pelvic ultrasound study of the maned wolf (Chrysocyon brachyurus

    Directory of Open Access Journals (Sweden)

    Luciana D. Guimarães

    2013-02-01

    Full Text Available The aim of the present study was the ultrasound characterization of the abdominal and pelvic regions of five maned wolves kept in captivity at the Triage Center of Wild Animals of the Federal University of Viçosa (Centro de Triagem de Animais Silvestres, Universidade Federal de Viçosa. This characterization included descriptions of ultrasonographic aspects and measurements of various structures using B-mode ultrasound. Biometric data were collected to assess the existence of significant linear correlations between these measurements and the measurements obtained by ultrasound. Additionally, hematological and serum biochemistry evaluations of the animals were performed. The ultrasound findings were similar to those available in the literature on domestic dogs, which were used for comparison as a result of the lack of published data regarding maned wolves. The latter species showed characteristics closely resembling those of the former, differing in the spleen and left renal cortex echogenicities, in the appearance of the prostatic and testicular regions and in the hepatic portal vein morphology. In the current study, the biometric values were similar to those previously published; however, no data regarding thoracic perimeter, modified crown-rump length or thoracic depth were found in the literature for this Canidae species. Statistical analysis showed the existence of a strong negative correlation between the modified crown-rump length and left renal length, between the modified crown-rump length and the right renal volume, between the thoracic perimeter and the height at the cranial pole of the left adrenal gland and between the thoracic perimeter and the height at the caudal pole of the left adrenal gland. Laboratory findings, including segmented neutrophil, eosinophil, monocyte and lymphocyte counts and the serum levels of glucose, ALT, alkaline phosphatase, urea, total protein, globulin, creatine phosphokinase, triglyceride, sodium

  6. Transvaginal versus transabdominal sonography in the evaluation of pelvic pathology

    International Nuclear Information System (INIS)

    Qureshi, I.H.; Ullah, H.; Akram, M.H.; Ashfaq, S.; Nayyar, S.

    2004-01-01

    Objective: To find the accuracy of sonographic information provided by transvaginal sonography (TVS) in pelvic pathology as compared to transabdominal sonography (TAS). Materials and Methods: Hundred patients were included in the study from a total of 212 referred for pelvic sonography. Two radiologists independently performed transabdominal and transvaginal sonography of these patients. An independent observer compared the findings. TVS was graded as superior, equal or inferior to TAS depending on the score assigned by them. Results: TVS was considered superior in 63%, equal in 27% and inferior in 10% of the cases as compared to transabdominal sonography. It was graded inferior to TAS in cases with large pelvic masses and superior in majority of cases of ovarian follicle monitoring, polycystic ovaries, endometrial carcinoma and suspected ectopic pregnancy. Cases in which both techniques were considered equal included patients with no abnormal finding, some pelvic masses and advanced pelvic inflammatory disease. Conclusion: Transvagival sonography is superior to transabdominal sonography in most cases of pelvic pathology. However, TAS should still be the initial sonographic technique for routine evaluation of the female pelvis followed by TVS if indicated. In cases of ovarian follicle monitoring, suspected polycystic ovaries, endometrial pathology and suspected ectopic pregnancy, TVS may be used as the initial sonographic technique and can even replace TAS. (author)

  7. Identification of risk factors for neurological deficits in patients with pelvic fractures

    DEFF Research Database (Denmark)

    Schmal, Hagen; Hauschild, Oliver; Culemann, Ulf

    2010-01-01

    This multicenter register study was performed to define injury and fracture constellations that are at risk to develop pelvic associated neural lesions. Data of 3607 patients treated from 2004 to 2009 for pelvic fractures were evaluated for neurological deficits depending on Tile classification......, pelvic injury configuration, and treatment.In 223 patients (6.5%), neurological lesions were diagnosed on the day of discharge from the hospital. The degree of instability of the pelvic fracture correlated with occurrence of nerve lesions. Rate of neurological dysfunction increased from 1.5% in type...... A fractures to 14.4% in type C fractures (PPatients sustaining complex pelvic trauma (7.85%) suffered from significantly more neurological...

  8. Seminal vesicle cycts

    International Nuclear Information System (INIS)

    Alpern, M.B.; Dorfman, R.E.; Gross, B.H.; Gottlieb, C.A.; Sandler, M.A.

    1990-01-01

    PURPOSE: Adult polycystic kidney disease (APKCD), an autosomal dominant disorder, causes cyst formation in the kidney, liver, pancreas, esophagus, ovaries, uterus, and brain. This paper describes four APKCD patients with CT evidence of seminal vesicle cysts (SVCs). Four patients (aged 45-65 years) underwent abdominal/pelvic CT with oral and intravenous contrast material. Three were evaluated for possible renal transplantation and one for sepsis material. All seminal vesicles contained cystic masses with fluid that measured between 0 and 30 HU. Seminal vesicle thickness was 3-4 cm (normal, 1.5 cm). High-density walls separated the 3-12-mm diameter cysts. All patients demonstrated typical renal stigmata of APKCD. One patient had hepatic cysts, and none had cysts elsewhere. Postmortem examination in one patient confirmed the SVCs

  9. PELVIC CONGESTION SYNDROME. METHODS OF DIAGNOSIS AND TREATMENT. LITERATURE REVIEW

    Directory of Open Access Journals (Sweden)

    Svetlana Vladimirovna Verezgova

    2014-10-01

    Full Text Available Pelvic pain syndrome is not rare clinical condition without specific symptoms and usually affects multiparous women. Numerous controversies in the management such patients are still present in current publications.Different diagnostic modalities were and are now used to delineate of anatomy and physiology of pelvic venous system. The well-known and recently developed approaches to treat patients with  pelvic congestion syndrome are discussed in present overview of the scientific literature.

  10. Two-year effects and cost-effectiveness of pelvic floor muscle training in mild pelvic organ prolapse : a randomised controlled trial in primary care

    NARCIS (Netherlands)

    Panman, Chantal M.C.R.; Wiegersma, M; Kollen, B J; Berger, M Y; Lisman-Van Leeuwen, Y; Vermeulen, K M; Dekker, J H

    OBJECTIVE: To compare effects and cost-effectiveness of pelvic floor muscle training (PFMT) and watchful waiting in women with pelvic organ prolapse. DESIGN: Randomised controlled trial. SETTING: Dutch general practice. POPULATION: Women (≥55 years) with symptomatic mild prolapse, identified by

  11. Utility of diuretic renography in patients with urinary diversion procedures secondary to pelvic malignancies

    International Nuclear Information System (INIS)

    Podoloff, D.A.; Lamki, L.A.; Kim, E.E.; Haynie, T.P.

    1988-01-01

    The authors performed diuretic renography in 17 patients with pelvic malignancy and urinary tract diversion. After injection of 10 mCi of Tc-99m-labeled DTPA, perfusion and dynamic images of renal function were obtained. Patients received furosemide, 0.5 mg/kg intravenously, 20-21 minutes into the study. Background subtracted whole-kidney time activity curves were generated. Studies were interpreted as normal, intermediate, or obstructed, depending on the contour of the washout phase of the renogram. In the immediate postoperative period, 82% of patients showed an intermediate pattern. In these patients with urinary diversion procedures, the standard criterion of a half-life of 10 minutes or less could not be used. Instead, serial studies over time best separated patients into three groups: normal, dilated without obstruction, and obstruction. Diuretic renography is useful in the follow-up of patients who have undergone urinary diversion procedures

  12. Pelvic Inflammatory Disease (PID)

    Science.gov (United States)

    ... types of infections. Bacterial Vaginosis: A type of vaginal infection caused by the overgrowth of a number of ... of the uterus at the top of the vagina. Chlamydia: A sexually transmitted infection caused by bacteria that can lead to pelvic ...

  13. Can selective pharmaco-angiography of renal tumor replace the examination under surgery?

    International Nuclear Information System (INIS)

    Will, C.H.; Bach, D.; Koop, H.; Impekoven, P.

    1996-01-01

    Can primary nephrectomy be performed without preliminary sample excision of the tumor if pharmaco-angiography of the kidney has demonstrated the typical tumor vascularization? To clarify this question in 32 patients with 'displacing mass' of the kidney, verified in sonography and computer-tomography, or hematuria of unknown origin, we prospectively performed an additional pharmaco-angiography of the respective kidney. In 18 patients with tumor vascularization in the pharmaco-angiography, intraoperatively we found 15 malignant renal cell carcinomas, 1 patient with transitional cell carcinoma of the renal pelvis, 1 leiomyosarcoma, and 1 high-differentiated tumor of only 2 cm in diameter with unclear dignity, which was treated by enucleation. In cases of an intrarenal lesion of more than 3 cm in diameter and additional tumor vascularization seen in selective pharmaco-angiography, the kidney undoubtedly can be removed by primary nephrectomy without a preliminary sample excision to confirm the diagnosis. For tumors with a diameter of less than 3 cm and additional tumor-vascularization, the option should be enucleation. If there is a 'tumor' without typical malignant vascularization, the exploration by sample excision should be performed. Depending on the histological result the tumor should be removed by enucleation or nephrectomy. (orig.) [de

  14. Abdominal-Pelvic Actinomycosis Mimicking Malignant Neoplasm

    Directory of Open Access Journals (Sweden)

    Teresa Pusiol

    2011-01-01

    Full Text Available Abdominal-pelvic actinomycosis is often mistaken for other conditions, presenting a preoperative diagnostic challenge. In a 46-year-old female, computed tomography showed an abdominal-pelvic retroperitoneal mass extending from the lower pole of the right kidney to the lower pelvis. The patient had a 3-year history of intrauterine device. The mass appeared to involve the ascending colon, cecum, distal ileum, right Fallopian tube and ovary, and ureter anteriorly and the psoas muscle posteriorly. The resection of retroperitoneal mass, distal ileum appendicectomy, right hemicolectomy, and right salpingo-oophorectomy was performed. The postoperative period was uneventful. Penicillin therapy was given for six months without any complication. The retroperitoneal mass measured 4.5 × 3.5 × 3 cm, surrounded adjacent organs and histologically showed inflammatory granulomatous tissue, agglomeration of filaments, and sulfur granules of Actinomyces, with positive reaction with periodic acid Schiff. Right tubo-ovarian abscess was present. Abdominalpelvic actinomycosis should always be considered in patients with a pelvic mass especially in ones using intrauterine device.

  15. International Continence Society supported pelvic physiotherapy education guideline.

    Science.gov (United States)

    Bakker, Els; Shelly, Beth; Esch, Fetske H; Frawley, Helena; McClurg, Doreen; Meyers, Peter

    2018-02-01

    To provide a guideline of desired knowledge, clinical skills and education levels in Pelvic Physiotherapy (PT). Physiotherapy (PT) involves "using knowledge and skills unique to physiotherapists" and, "is the service only provided by, or under the direction and supervision of a physiotherapist." 1 METHODS: The PT Committee, within the body of the International Continence Society (ICS), collected information regarding existing educational levels for pelvic floor PT. Through face to face and on on-line discussion consensus was reached which was summarized in three progressive educational levels based on knowledge and skills and brought together in a guideline. The guideline was submitted to all physiotherapists and the Educational Committee of the ICS, and after approval, submitted to the Executive Board of the ICS. The guideline lists, in a progressive way, knowledge areas and skills to be achieved by education. It is broad and allows for individual interpretation based on local situations regarding education and healthcare possibilities. It is intended to be dynamic and updated on a regular basis. The proposed Pelvic PT education guideline is a dynamic document that allows course creators to plan topics for continuing course work and to recognize educational level of a therapist in the field of Pelvic PT. This education guideline can be used to set minimum worldwide standards resulting in higher skill levels for local pelvic physiotherapists and thereby better patient care outcome. © 2018 Wiley Periodicals, Inc.

  16. The Influence of Positioning of the Nellix Endovascular Aneurysm Sealing System on Suprarenal and Renal Flow: An In Vitro Study.

    Science.gov (United States)

    Boersen, Johannes T; Groot Jebbink, Erik; Van de Velde, Lennart; Versluis, Michel; Lajoinie, Guillaume; Slump, Cornelius H; de Vries, Jean-Paul P M; Reijnen, Michel M P J

    2017-10-01

    To examine the influence of device positioning and infrarenal neck diameter on flow patterns in the Nellix endovascular aneurysm sealing (EVAS) system. The transition of the aortic flow lumen into two 10-mm-diameter stents after EVAS creates a mismatched area. Flow recirculation may affect local wall shear stress (WSS) profiles and residence time associated with atherosclerosis and thrombosis. To examine these issues, 7 abdominal aortic aneurysm flow phantoms were created, including 3 unstented controls and 3 stented models with infrarenal neck diameters of 24, 28, and 32 mm. Stents were positioned within the instructions for use (IFU). Another 28-mm model was created to evaluate lower positioning of the stents outside the IFU (28-mm LP). Flow was visualized using optical particle imaging velocimetry (PIV) and quantified by time-averaged WSS (TAWSS), oscillatory shear index (OSI), and relative residence time (RRT) in the aorta at the anteroposterior (AP) midplane, lateral midplane, and renal artery AP midplane levels. Flow in the aorta AP midplane was similar in all models. Vortices were observed in the stented models in the lateral midplane near the anterior and posterior walls. In the 32-mm IFU and 28-mm LP models, a steady state of vortices appeared, with varying location during a cycle. In all models, a low TAWSS (OSI of 0.5 and peak RRT of 10 4 Pa -1 . This region was more proximally located in the stented models. The 24- and 28-mm IFU models showed flow with a higher velocity at the renal artery inflow compared to controls. TAWSS in the renal artery was lower near the orifice in all models, with the largest area in the 24-mm IFU model. OSI and RRT in the renal artery were near zero for all models. EVAS enhances vorticity proximal to the seal zone, especially with lower positioning of the device and in larger neck diameters. Endobags just below the renal artery affect the flow profile in a minor area of this artery in 24- and 28-mm necks, while lower stent

  17. [Sciatic hernia as a cause of chronic pelvic pain].

    Science.gov (United States)

    De los Ríos, José F; Calle, Gustavo; Castañeda, Juan D; Serna, Eduardo A; Vásquez, Ricardo A; Arango, Adriana M; López, Claudia C

    2013-04-01

    Sciatic hernia constitutes the scarcest group of hernias of pelvic floor; however, they should be considered in the origin of chronic pelvic pain. The proper diagnosis of sciatic hernias has allowed to surgeons treating successfully patients with acute or chronic pelvic pain, with intestinal or ureteral obstruction and with urinary or gluteus sepsis. It has to be considered as differential diagnosis before the finding of a congenital or acquired gluteus mass. Laparoscopist gynecologist should know the existence of this defect, to be familiar with its aspect in laparoscopic view and to know the laparoscopic treatment of this disease.

  18. The feasibility of measuring renal blood flow using transesophageal echocardiography in patients undergoing cardiac surgery.

    Science.gov (United States)

    Yang, Ping-Liang; Wong, David T; Dai, Shuang-Bo; Song, Hai-Bo; Ye, Ling; Liu, Jin; Liu, Bin

    2009-05-01

    There is no reliable method to monitor renal blood flow intraoperatively. In this study, we evaluated the feasibility and reproducibility of left renal blood flow measurements using transesophageal echocardiography during cardiac surgery. In this prospective noninterventional study, left renal blood flow was measured with transesophageal echocardiography during three time points (pre-, intra-, and postcardiopulmonary bypass) in 60 patients undergoing cardiac surgery. Sonograms from 6 subjects were interpreted by 2 blinded independent assessors at the time of acquisition and 6 mo later. Interobserver and intraobserver reproducibility were quantified by calculating variability and intraclass correlation coefficients. Patients with Doppler angles of >30 degrees (20 of 60 subjects) were eliminated from renal blood flow measurements. Left renal blood flow was successfully measured and analyzed in 36 of 60 (60%) subjects. Both interobserver and intraobserver variability were renal blood flow measurements were good to excellent (intraclass correlation coefficients 0.604-0.999). Left renal arterial luminal diameter for the pre, intra, and postcardiopulmonary bypass phases, ranged from 3.8 to 4.1 mm, renal arterial velocity from 25 to 35 cm/s, and left renal blood flow from 192 to 299 mL/min. In patients undergoing cardiac surgery, it was feasible in 60% of the subjects to measure left renal blood flow using intraoperative transesophageal echocardiography. The interobserver and intraobserver reproducibility of renal blood flow measurements was good to excellent.

  19. Does Attorney Advertising Influence Patient Perceptions of Pelvic Mesh?

    Science.gov (United States)

    Tippett, Elizabeth; King, Jesse; Lucent, Vincent; Ephraim, Sonya; Murphy, Miles; Taff, Eileen

    2018-01-01

    To measure the relative influence of attorney advertising on patient perceptions of pelvic mesh compared with a history of surgery and a first urology visit. A 52-item survey was administered to 170 female patients in 2 urology offices between 2014 and 2016. Multiple survey items were combined to form scales for benefit and risk perceptions of pelvic mesh, perceptions of the advertising, attitudes toward pelvic mesh, and knowledge of pelvic mesh and underlying medical conditions. Data were analyzed using hierarchical linear regression models. Exposure to attorney advertising was quite high; 88% reported seeing a mesh-related attorney advertisement in the last 6 months. Over half of patients reported seeing attorney advertisements more than once per week. A history of prior mesh implant surgery was the strongest predictor of benefit and risk perceptions of pelvic mesh. Exposure to attorney advertising was associated with higher risk perceptions but did not significantly affect perceptions of benefits. Past urologist visits increased perceptions of benefits but had no effect on risk perceptions. Attorney advertising appears to have some influence on risk perceptions, but personal experience and discussions with a urogynecologist or urologist also influence patient perceptions. Implications, limitations, and future research are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Eligibility for Renal Denervation: Anatomical Classification and Results in Essential Resistant Hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Takuya, E-mail: okabone@gmail.com; Pellerin, Olivier [Georges Pompidou European Hospital, Department of Cardiovascular and Interventional Radiology, Assistance Publique des Hôpitaux de Paris (France); Savard, Sébastien [Georges Pompidou European Hospital, Department of Hypertension, Assistance Publique des Hôpitaux de Paris (France); Curis, Emmanuel; Monge, Matthieu [INSERM, Clinical Investigation Center 9201 (France); Frank, Michael; Bobrie, Guillaume [Georges Pompidou European Hospital, Department of Hypertension, Assistance Publique des Hôpitaux de Paris (France); Yamaguchi, Masato; Sugimoto, Koji [Kobe University Hospital, Department of Radiology and Center for Endovascular Therapy (Japan); Plouin, Pierre-François; Azizi, Michel [Georges Pompidou European Hospital, Department of Hypertension, Assistance Publique des Hôpitaux de Paris (France); Sapoval, Marc [Georges Pompidou European Hospital, Department of Cardiovascular and Interventional Radiology, Assistance Publique des Hôpitaux de Paris (France)

    2015-02-15

    PurposeTo classify the renal artery (RA) anatomy based on specific requirements for endovascular renal artery denervation (RDN) in patients with drug-resistant hypertension (RH).Materials and MethodsThe RA anatomy of 122 consecutive RH patients was evaluated by computed tomography angiography and classified as two types: A (main RA ≥20 mm in length and ≥4.0 mm in diameter) or B (main RA <20 mm in length or main RA <4.0 mm in diameter). The A type included three subtypes: A1 (without accessory RAs), A2 (with accessory RAs <3.0 mm in diameter), and A3 (with accessory RAs ≥3.0 mm in diameter]. A1 and A2 types were eligible for RDN with the Simplicity Flex catheter. Type B included twi subtypes based on the main RA length and diameter. Patients were accordingly classified into three eligibility categories: complete (CE; both RAs were eligible), partial (PE; one eligible RA), and noneligibility (NE; no eligible RA).ResultsBilateral A1 type was the most prevalent and was observed in 48.4 % of the patients followed by the A1/A2 type (18 %). CE, PE, and NE were observed in 69.7, 22.9, and 7.4 % of patients, respectively. The prevalence of accessory RAs was 41 %.ConclusionsOf RH patients, 30.3 % were not eligible for bilateral RDN with the current Simplicity Flex catheter. This classification provides the basis for standardized reporting to allow for pooling of results of larger patient cohorts in the future.

  1. Eligibility for Renal Denervation: Anatomical Classification and Results in Essential Resistant Hypertension

    International Nuclear Information System (INIS)

    Okada, Takuya; Pellerin, Olivier; Savard, Sébastien; Curis, Emmanuel; Monge, Matthieu; Frank, Michael; Bobrie, Guillaume; Yamaguchi, Masato; Sugimoto, Koji; Plouin, Pierre-François; Azizi, Michel; Sapoval, Marc

    2015-01-01

    PurposeTo classify the renal artery (RA) anatomy based on specific requirements for endovascular renal artery denervation (RDN) in patients with drug-resistant hypertension (RH).Materials and MethodsThe RA anatomy of 122 consecutive RH patients was evaluated by computed tomography angiography and classified as two types: A (main RA ≥20 mm in length and ≥4.0 mm in diameter) or B (main RA <20 mm in length or main RA <4.0 mm in diameter). The A type included three subtypes: A1 (without accessory RAs), A2 (with accessory RAs <3.0 mm in diameter), and A3 (with accessory RAs ≥3.0 mm in diameter]. A1 and A2 types were eligible for RDN with the Simplicity Flex catheter. Type B included twi subtypes based on the main RA length and diameter. Patients were accordingly classified into three eligibility categories: complete (CE; both RAs were eligible), partial (PE; one eligible RA), and noneligibility (NE; no eligible RA).ResultsBilateral A1 type was the most prevalent and was observed in 48.4 % of the patients followed by the A1/A2 type (18 %). CE, PE, and NE were observed in 69.7, 22.9, and 7.4 % of patients, respectively. The prevalence of accessory RAs was 41 %.ConclusionsOf RH patients, 30.3 % were not eligible for bilateral RDN with the current Simplicity Flex catheter. This classification provides the basis for standardized reporting to allow for pooling of results of larger patient cohorts in the future

  2. Multidetector computed tomography for preoperative evaluation of vascular anatomy in living renal donors.

    Science.gov (United States)

    Türkvatan, Aysel; Akinci, Serkan; Yildiz, Sener; Olçer, Tülay; Cumhur, Turhan

    2009-04-01

    Currently, multidetector computed tomographic (MDCT) angiography has become a noninvasive alternative imaging modality to catheter renal angiography for the evaluation of renal vascular anatomy in living renal donors. In this study, we investigated the diagnostic accuracy of 16-slice MDCT in the preoperative assessment of living renal donors. Fifty-nine consecutive living renal donors (32 men, 27 women) underwent MDCT angiography followed by open donor nephrectomy. All MDCT studies were performed by using a 16-slice MDCT scanner with the same protocol consisting of arterial and nephrographic phases followed by conventional abdominal radiography. The MDCT images were assessed retrospectively for the number and branching pattern of the renal arteries and for the number and presence of major or minor variants of the renal veins. The results were compared with open surgical results. The sensitivity and specificity of MDCT for the detection of anatomic variants of renal arteries including the accessory arteries (n = 9), early arterial branching (n = 7) and major renal venous anomalies including the accessory renal veins (n = 3), late venous confluence (n = 4), circumaortic (n = 2) or retroaortic (n = 3) left renal veins were 100%. However, the sensitivity for identification of minor venous variants was 79%. All of three ureteral duplications were correctly identified at excretory phase conventional abdominal radiography. Sixteen-slice MDCT is highly accurate for the identification of anatomic variants of renal arteries and veins. Dual-phase MDCT angiography including arterial and nephrographic phases followed by conventional abdominal radiography enables complete assessment of renal donors without significant increase of radiation dose. However, the evaluation of minor venous variants may be problematic because of their small diameters and poor opacification.

  3. Encountering the Accessory Polar Renal Artery during Laparoscopic Para-Aortic Lymphadenectomy.

    Science.gov (United States)

    Lee, Won Moo; Choi, Joong Sub; Bae, Jaeman; Jung, Un Suk; Eom, Jeong Min

    2018-01-01

    A 60-year-old Korean woman underwent laparoscopic bilateral salpingo-oophorectomy and was confirmed to have high-grade serous carcinoma of both ovaries with a huge omental cake, extensive agglutinated intra-abdominal metastatic masses, extensive serosa invasion of the intestines, and mesenterial deposits. She underwent 3 cycles of neoadjuvant chemotherapy followed by laparoscopic interval debulking surgery, including hysterectomy, pelvic and para-aortic lymphadenectomy, appendectomy, partial peritonectomy, and omentectomy. We encountered the right accessory polar renal artery (APRA) during the surgery and carefully preserved the right APRA from the abdominal aorta to the right kidney (Fig. 1). Postoperative computed tomography angiography showed an intact right APRA and normal-appearing kidney (Fig. 2). The patient had adjuvant chemotherapy and is alive without disease recurrence. Because APRA is a functional end artery, it is important to preserve it during surgery to prevent ischemic damage and renal failure [1]. It is very important for the gynecologic-oncologist to have knowledge of the retroperitoneal vascular anatomy, experience in laparoscopic surgery, and an accurate surgical technique to avoid vascular injury during laparoscopic para-aortic lymphadenectomy. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.

  4. The active straight leg raising test and mobility of the pelvic joints

    OpenAIRE

    Mens, J. M. A.; Vleeming, Andry; Snijders, Chris J.; Stam, Henk J.; Ginai, Abida Z.

    1999-01-01

    Objective signs to assess impairment in patients who are disabled by peripartum pelvic girdle pain hardly exist. The purpose of this study was to develop a clinical test to quantify and qualify disability in these patients. The study examined the relationship between impaired active straight leg raising (ASLR) and mobility of pelvic joints in patients with peripartum pelvic girdle pain, focusing on (1) the reduction of impairment of ASLR when the patient was wearing a pelvic belt, and (2) mot...

  5. Quantitative metacarpal bone measurements before and after renal transplantation

    International Nuclear Information System (INIS)

    Andresen, J.; Nielsen, H.E.; Kommunehospitalet, Aarhus

    1986-01-01

    The outer (D) and inner diameter (d) of the second metacarpal bone, the combined cortical thickness (D-d), cortical area (D 2 -d 2 ) and bone mass ((D 2 d 2 /D 2 ) were measured in 74 renal transplant (RT) recipients at the time of renal transplantation and in a prospective analysis of 60 recipients after transplantation. The RT patient group was made up of recipients who after renal transplanation developed osteonecrosis or spontaneous fractures (RT-ON/SF) and an age- and sex-matched renal control group of subjects who did not develop these complications (RT-C). At the time of renal transplantation, in renal transplant recipient men and women, significantly reduced values in D, D-d and D 2 -d 2 was noticed. These findings could be explained by a higher ratio of bone resoprtion than formation at the periosteal surface. Following renal transplantation, significant increases in d were seen with significant decreases in D-d, D 2 -d 2 and (D 2 -d 2 )/D 2 , probably due to endosteal bone resorption, whereas D was unchanged compared with normal control persons. In the total group and in RT-ON/SF women, D decreased significantly and in ON/SF, increased significantly with significant decrease in bone mass compared with normal women whereas no significant changes in the parameters were seen in RT-C women. These findings indicate that bone loss after transplantation continues at the periosteal surface in women. The bone loss was most markedly demonstrated in women, who subsequently develop osteonecrosis or spontaneous fractures, probably due to combined periosteal and endosteal resorption of calcified bony tissue. (orig.)

  6. Pharmacokinetics of cephem antibiotics in exudate of pelvic retroperitoneal space after radical hysterectomy and pelvic lymphadenectomy.

    Science.gov (United States)

    Ito, K; Hayasaki, M; Tamaya, T

    1990-01-01

    Many cephalosporin antibiotics have recently been invented and attempts have been made to use them clinically. The choice of which of these drugs should be used has been difficult in gynecology. The efficacies of these drugs depend on their antibacterial spectra, potencies, and concentrations in tissues. This study was designed to investigate the pharmacokinetics of various cephem antibiotics in the exudate of the retroperitoneal space that is formed after radical hysterectomy and pelvic lymphadenectomy. These cephem antibiotics were cefoxitin, cefotiam, cefotetan, cefpiramide, cefminox, cefotaxime, ceftizoxime, cefoperazone, cefmenoxime, cefbuperazone, ceftazidime, cefpimizole, flomoxef, and cefuzonam. The maximum concentrations after administration of a 1-g dose in the exudate of the pelvic retroperitoneal space were 37.9 micrograms/ml with cefminox, 30.3 micrograms/ml with cefpimizole, 21.6 micrograms/ml with flomoxef, 21.5 micrograms/ml with ceftazidime, and 17.6 micrograms/ml with cefbuperazone, which were relatively high. When selecting antibiotics for prophylactic use against infections in the retroperitoneal space after radical hysterectomy and pelvic lymphadenectomy, on the basis of drug transfer, flomoxef, cefminox, cefbuperazone, ceftazidime, and cefpimizole were considered to be the drugs of first choice at a dose of 1 g. PMID:2393276

  7. Hormonal treatment for endometriosis associated pelvic pain

    Directory of Open Access Journals (Sweden)

    Wu Shun Felix Wong

    2011-01-01

    Full Text Available AbstractBackground: Endometriosis is a common gynecological problem associated with chronic pelvic pain. Objective: To evaluate the effectiveness of current hormonal treatments of endometriosis associated pain.Materials and Methods: Randomized Controlled studies identified from databases of Medline and Cochrane Systemic Review groups were pooled. 7 RCTs were recruited for evaluation in this review. Data from these studies were pooled and meta-analysis was performed in three comparison groups: 1 Progestogen versus GnRHa; 2 Implanon versus Progestogen (injection; 3 Combined oral contraceptive pills versus placebo and progestogen. Response to treatment was measured as a reduction in pain score. Pain improvement was defined as improvement ≥1 at the end of treatment. Results: There was no significant difference between treatment groups of progestogen and GnRHa (RR: 0.036; CI:-0.030-0.102 for relieving endometriosis associated pelvic pain. Long acting progestogen (Implanon and Mirena are not inferior to GnRHa and depot medroxy progesterone acetate (DMPA (RR: 0.006; CI:-0.142-0.162. Combined oral contraceptive pills demonstrated effective treatment of relieving endometriosis associated pelvic pain when compared with placebo groups (RR:0.321CI-0.066-0.707. Progestogen was more effective than combined oral contraceptive pills in controlling dysmenorrhea (RR:-0.160; CI:-0.386-0.066, however, progestogen is associated with more side effects like spotting and bloating than the combined contraceptive pills. Conclusion: Combined oral contraceptive pills (COCP, GnRHa and progestogens are equally effective in relieving endometriosis associated pelvic pain. COCP and progestogens are relatively cheap and more suitable for long-term use as compared to GnRHa. Long-term RCT of medicated contraceptive devices like Mirena and Implanon are required to evaluate their long-term effects on relieving the endometriosis associated pelvic pain

  8. Pelvic girdle pain affects the whole life--a qualitative interview study in Norway on women's experiences with pelvic girdle pain after delivery.

    Science.gov (United States)

    Engeset, Jorun; Stuge, Britt; Fegran, Liv

    2014-10-03

    The aim of this study was to explore how pelvic girdle pain after delivery influences women's daily life in Norway. Knowledge about living with post-partum pelvic girdle pain is lacking. A phenomenological-hermeneutical design with qualitative semi-structured interviews was used. A strategic selection procedure was chosen to recruit participants from physiotherapy clinics and a regional hospital in Norway. Five women with clinically verified pelvic girdle pain after delivery were included. Data were imported into NVivo9 and analysed in three steps: naïve reading, structural analysis and comprehensive understanding of the text. Three themes influencing the women's daily life were identified: 1) activity and pain, 2) lack of acknowledgment of pain and disability, and 3) changed roles. A daily life with pain and limited physical activity was difficult to accept and made some of the women feel discouraged, isolated and lonely. Despite this, the women had a positive attitude to their problems, which may have positively increased their ability to cope. The findings also revealed the importance of a reciprocal influence between the woman and her environment, and that social support was crucial. Pelvic girdle pain may influence women's lives for months and years after delivery. Health care professionals should appreciate and focus on the patient's knowledge and skills. Understanding the daily experiences of women with pelvic girdle pain might help improve rehabilitation strategies for these patients.

  9. Radio frequency ablation of small renal tumors:: intermediate results.

    Science.gov (United States)

    Hwang, J J; Walther, M M; Pautler, S E; Coleman, J A; Hvizda, J; Peterson, James; Linehan, W M; Wood, B J

    2004-05-01

    With evolving radio frequency technology, the clinical application of radio frequency ablation (RFA) has been actively investigated in the treatment for small renal tumors. We present our intermediate patient outcomes after RFA. Since January 2001, 17 patients with a total of 24 hereditary renal tumors ranging from 1.2 to 2.85 cm were treated with RFA using the 200 W Cool-tip RF System (Radionics, Burlington, Massachusetts) under laparoscopic (9) or percutaneous (8) guidance and had a minimum 1-year followup. A percutaneous approach was considered unsuitable if kidney tumors were contiguous to bowel, ureter or large vessels. Treatment eligibility criteria included an average tumor diameter of less than 3.0 cm, tumor growth during 1 year and solid appearance with contrast enhancement (HU change greater than 20) on computerized tomography (CT). Postoperative followup consisted of CT with and without intravenous contrast, and renal function assessment at regular intervals. Median patient age was 38 years (range 20 to 51). At a median followup of 385 days (range 342 to 691), median tumor or thermal lesion diameter decreased from 2.26 to 1.62 cm (p = 0.0013), and only 1 lesion (4%), which was located centrally near the hilum, exhibited contrast enhancement (HU change greater than 10) on CT at 12 months. Of the 15 renal tumors ablated laparoscopically, 13 were in direct contact with the bowel and 2 were abutting the ureter, necessitating mobilization before RFA. Laparoscopic ultrasound was used to guide radio frequency electrode placement and monitor the ablation process in these cases. Operative time and intraoperative blood loss (mean +/- standard mean of error) were 243 +/- 29 minutes and 67 +/- 9 cc, respectively. In 1 patient whose ureter was adherent to the tumor a ureteropelvic junction obstruction developed after laparoscopic RFA, requiring open repair. At the minimum 1-year followup 23 of 24 ablated tumors lacked contrast uptake on CT, meeting our radiographic

  10. Clinical outcome of ovarian vein embolization in pelvic congestion ...

    African Journals Online (AJOL)

    Introduction: Pelvic congestion syndrome (PCS), is a condition associated with ovarian vein (OV) incompetence among other causes. It is manifested by chronic pelvic pain with associated dyspareunia and dysmenorrhea. The diagnosis of PCS is often overlooked and the management can be difficult. Traditional therapy for ...

  11. Persistent postpartum haemorrhage after failed arterial ligation: value of pelvic embolisation

    Energy Technology Data Exchange (ETDEWEB)

    Fargeaudou, Yann; Soyer, Philippe; Sirol, Marc; Boudiaf, Mourad; Dahan, Henri; Dref, Olivier le [Hopital Lariboisiere AP-HP et Universite Diderot-Paris 7, Department of Abdominal and Interventional Imaging, Paris (France); Morel, Olivier; Barranger, Emmanuel [Hopital Lariboisiere AP-HP, Department of Obstetrics and Gynecology, Paris (France); Gayat, Etienne; Mebazaa, Alexandre [Hopital Lariboisiere AP-HP, Department of Anesthesiology and Intensive Care Medicine, Paris (France)

    2010-07-15

    To evaluate the role and efficacy of pelvic embolisation in the treatment of persistent postpartum haemorrhage after failed arterial ligation and to identify the complications of this procedure in this specific population. The clinical files and angiographic examinations of 12 consecutive women (mean age 32 years) who were treated with pelvic embolisation because of persistent, severe postpartum haemorrhage after failed arterial ligation were reviewed. Angiography revealed that persistent bleeding was due to incomplete arterial ligation (n = 4) or the presence of newly developed anastomotic routes (n = 8). In 11 women, pelvic embolisation stopped the bleeding. Hysterectomy was needed in one woman with retained placenta. Two complications due to pelvic embolisation, including leg ischaemia and transient sciatic nerve ischaemia, were identified, both after internal iliac artery ligation. In women with persistent postpartum haemorrhage after failed arterial ligation, pelvic embolisation is an effective treatment in most cases. However, embolisation of the anastomotic routes that contribute to persistent bleeding may result in ischaemic complications. These potential complications reaffirm that arterial ligation should not be the favoured option for postpartum haemorrhage and that special care must be given during pelvic embolisation after failed arterial ligation. (orig.)

  12. Pelvic floor disorders in gynecological malignancies. An overlooked problem?

    Directory of Open Access Journals (Sweden)

    Oana M. Bodean

    2018-04-01

    Full Text Available Cervical, endometrial, ovarian, vulvar, and vaginal cancers affect women of a broad age spectrum. Many of these women are still sexually active when their cancer is diagnosed. Treatment options for gynecological malignancies, such as gynecological surgery, radiation, and chemotherapy, are proven risk factors for pelvic floor dysfunction. The prevalence of urinary incontinence, fecal incontinence, and sexual dysfunction before cancer treatment is still unclear. Hypotheses have been raised in the literature that these manifestations could represent early symptoms of pelvic cancers, but most remain overlooked even in cancer surviving patients. The primary focus of therapy is always cancer eradication, but as oncological and surgical treatment options become more successful, the number of cancer survivors increases. The quality of life of patients with gynecological cancers often remains an underrated subject. Pelvic floor disorders are not consistently reported by patients and are frequently overlooked by many clinicians. In this brief review we discuss the importance of pelvic floor dysfunction in patients with gynecological malignant tumors.

  13. Plain radiography, renography, and 99mTc-DMSA renal scintigraphy before and after extracorporeal shock wave lithotripsy for urolithiasis

    International Nuclear Information System (INIS)

    Munck, O.; Gerquari, I.; Moeller, J.T.; Jensen, L.I.; Thomsen, H.S.

    1992-01-01

    Eighteen patients were evaluated before and 5 weeks after the first treatment with extracorporeal shock wave lithotripsy (ESWL) using abdominal plain radiography, 131 I-hippuran probe renography, and 99m Tc-dimercaptosuccinic acid scintigraphy. In 6 patients no urolithiasis was present on the post ESWL plain radiograph, in 7 the size had decreased, and in 5 the stone mass was unchanged. The renograms were within normal range in the 6 patients who were cured by ESWL, whereas this was the case for only 4 of the 12 who still had renal calculi. In 2 patients pelvic stones had descended into the ureter after ESWL, and the renograms indicated obstruction. Another 3 patients had ureteral stones, whereas in the remaining 7 patients only pelvic stones were found on the plain radiographs. In no patient did the scintigrams reveal scars. It is concluded that abdominal plain radiography of the urinary tract and probe renography are complementary and sufficient in the monitoring of patients with urolithiasis post ESWL. (orig.)

  14. Medical Treatments for Endometriosis-Associated Pelvic Pain

    Directory of Open Access Journals (Sweden)

    Gabriella Zito

    2014-01-01

    Full Text Available 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.

  15. Virtual reality: new method of teaching anorectal and pelvic floor anatomy.

    Science.gov (United States)

    Dobson, Howard D; Pearl, Russell K; Orsay, Charles P; Rasmussen, Mary; Evenhouse, Ray; Ai, Zhuming; Blew, Gregory; Dech, Fred; Edison, Marcia I; Silverstein, Jonathan C; Abcarian, Herand

    2003-03-01

    A clear understanding of the intricate spatial relationships among the structures of the pelvic floor, rectum, and anal canal is essential for the treatment of numerous pathologic conditions. Virtual-reality technology allows improved visualization of three-dimensional structures over conventional media because it supports stereoscopic-vision, viewer-centered perspective, large angles of view, and interactivity. We describe a novel virtual reality-based model designed to teach anorectal and pelvic floor anatomy, pathology, and surgery. A static physical model depicting the pelvic floor and anorectum was created and digitized at 1-mm intervals in a CT scanner. Multiple software programs were used along with endoscopic images to generate a realistic interactive computer model, which was designed to be viewed on a networked, interactive, virtual-reality display (CAVE or ImmersaDesk). A standard examination of ten basic anorectal and pelvic floor anatomy questions was administered to third-year (n = 6) and fourth-year (n = 7) surgical residents. A workshop using the Virtual Pelvic Floor Model was then given, and the standard examination was readministered so that it was possible to evaluate the effectiveness of the Digital Pelvic Floor Model as an educational instrument. Training on the Virtual Pelvic Floor Model produced substantial improvements in the overall average test scores for the two groups, with an overall increase of 41 percent (P = 0.001) and 21 percent (P = 0.0007) for third-year and fourth-year residents, respectively. Resident evaluations after the workshop also confirmed the effectiveness of understanding pelvic anatomy using the Virtual Pelvic Floor Model. This model provides an innovative interactive educational framework that allows educators to overcome some of the barriers to teaching surgical and endoscopic principles based on understanding highly complex three-dimensional anatomy. Using this collaborative, shared virtual-reality environment

  16.  Uterus Didelphys with Obstructed Right Hemivagina, Ipsilateral Renal Agenesis and Right Pyocolpos: A Case Report

    Directory of Open Access Journals (Sweden)

    Hansa Dhar

    2011-11-01

    Full Text Available  Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA Syndrome is a rare congenital anomaly of the female genital tract. Uterus didelphys occurs when the midline fusion of the mullerian ducts is arrested, either completely or incompletely. Women with didelphic uterus may be asymptomatic and unaware of having a double uterus. They may present with complaints of dysmenorrhoea and dyspareunia. A 25 year old woman attending the infertility clinic at Nizwa regional referral hospital presented with history of dysmenorrhoea and foul vaginal discharge with right cystic pelvic mass. She was diagnosed as a case of double uterus with obstructed right hemivagina and right pyocolpos with ipsilateral renal agenesis after routine ultrasonography in the clinic followed by MRI. Excision of the right vaginal septum with drainage of 200 ml of purulent discharge was performed. She was relieved of her symptoms and conceived promptly after the surgical excision of the partial vaginal septum.

  17. Regular exercisers have stronger pelvic floor muscles than nonregular exercisers at midpregnancy.

    Science.gov (United States)

    Bø, Kari; Ellstrøm Engh, Marie; Hilde, Gunvor

    2018-04-01

    Today all healthy pregnant women are encouraged to be physically active throughout pregnancy, with recommendations to participate in at least 30 minutes of aerobic activity on most days of the week in addition to performing strength training of the major muscle groups 2-3 days per week and also pelvic floor muscle training. There is, however, an ongoing debate whether general physical activity enhances or declines pelvic floor muscle function. The objectives of the study were to compare vaginal resting pressure, pelvic floor muscle strength, and endurance in regular exercisers (exercise ≥30 minutes 3 or more times per week) and nonexercisers at midpregnancy. Furthermore, another objective was to assess whether regular general exercise or pelvic floor muscle strength was associated with urinary incontinence. This was a cross-sectional study at mean gestational week 20.9 (±1.4) including 218 nulliparous pregnant women, with a mean age of 28.6 years (range, 19-40 years) and prepregnancy body mass index of 23.9 kg/m 2 (SD, 4.0). Vaginal resting pressure, pelvic floor muscle strength, and pelvic floor muscle endurance were measured by a high-precision pressure transducer connected to a vaginal balloon. The International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form was used to assess urinary incontinence. Differences between groups were analyzed using an independent-sample Student t test. Linear regression analysis was conducted to adjust for prepregnancy body mass index, age, smoking during pregnancy, and regular pelvic floor muscle training during pregnancy. The significance value was set to P ≤ .05. Regular exercisers had statistically significant stronger (mean 6.4 cm H 2 O [95% confidence interval, 1.7-11.2]) and more enduring (mean 39.9 cm H 2 Osec [95% confidence interval, 42.2-75.7]) pelvic floor muscles. Only pelvic floor muscle strength remained statistically significant, when adjusting for possible confounders. Pelvic floor

  18. Selective visualization of pelvic splanchnic nerve and pelvic plexus using readout-segmented echo-planar diffusion-weighted magnetic resonance neurography: A preliminary study in healthy male volunteers

    Energy Technology Data Exchange (ETDEWEB)

    Yamashita, Rikiya, E-mail: rickdom@kuhp.kyoto-u.ac.jp [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 (Japan); Isoda, Hiroyoshi, E-mail: sayuki@kuhp.kyoto-u.ac.jp [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 (Japan); Arizono, Shigeki, E-mail: arizono@kuhp.kyoto-u.ac.jp [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 (Japan); Furuta, Akihiro, E-mail: akihirof@kuhp.kyoto-u.ac.jp [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 (Japan); Ohno, Tsuyoshi, E-mail: goohno@kuhp.kyoto-u.ac.jp [Department of Diagnostic Imaging, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555 (Japan); Ono, Ayako, E-mail: onoayako@kuhp.kyoto-u.ac.jp [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 (Japan); Murata, Katsutoshi, E-mail: katsutoshi.murata@siemens.com [Siemens Healthcare Japan KK, Gate City Osaki West Tower, 11-1 Osaki 1-Chome, Shinagawa-ku, Tokyo 141-8644 (Japan); Togashi, Kaori, E-mail: ktogashi@kuhp.kyoto-u.ac.jp [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 (Japan)

    2017-01-15

    Highlights: • RS-EPI DW-MRN has a potential to selectively depict the pelvic parasympathetic nerve. • The nervous visibility showed a moderate correlation with the image artifact level. • Our method could help preserving function after pelvic nerve-preserving surgery. - Abstract: Purpose: To evaluate the potential of readout-segmented echo-planar diffusion-weighted magnetic resonance neurography (RS-EPI DW-MRN) for the selective visualization of pelvic splanchnic nerve and pelvic plexus in healthy male volunteers. Materials and methods: Institutional review board approval and written informed consent were obtained. RS-EPI DW-MRN images were acquired from thirteen healthy male volunteers aged 25–48 years between September 2013 and December 2013. For RS-EPI DW-MRN, the following parameters were used: spatial resolution, 1.1 × 1.1 × 2.5 mm; b-value, 250 s/mm{sup 2}; number of readout-segments, seven; and acquisition time, 7 min 45 s. For qualitative assessment, two abdominal radiologists independently evaluated the visibility of the pelvic splanchnic nerves and pelvic plexuses bilaterally in each subject on oblique coronal thin-slab 10-mm-thick maximum intensity projection images and scored it with a 4-point grading scale (excellent, good, fair, poor). Both readers scored twice at 6-month intervals. Inter-observer and intra-observer variability were evaluated using Cohen’s quadratically weighted κ statistics. Image artifact level was scored on a 4-point grading scale by other two abdominal radiologists in order to evaluate the correlation between the nerve visibility and the severity of imaging artifacts using the Spearman’s correlation coefficient. Results: Qualitative grading showed the following success rate (number of nerves qualitatively scored as excellent or good divided by total number of nerves): reader 1 (first set), 73% (19/26); reader 2 (first set), 77% (20/26); reader 1 (second set), 81% (21/26); and reader 2 (second set), 77% (20

  19. Extracorporeal shock wave lithotripsy in the treatment of renal pelvicalyceal stones in morbidly obese patients

    Directory of Open Access Journals (Sweden)

    V. A. Mezentsev

    2005-04-01

    Full Text Available INTRODUCTION: Management of urolithiasis in morbidly obese patients is usually associated with higher morbidity and mortality compared to non-obese patients. In morbidly obese patients, since the kidney and stone are at a considerable distance from the skin (compared to non-obese patients difficulty may be found in positioning the patient so that the stone is situated at the focal point of the lithotripter. OBJECTIVE: To evaluate the outcomes and cost-efficiency of extracorporeal shock wave lithotripsy (ESWL in the treatment of renal pelvicalyceal stones sized between 6 and 20 mm in morbidly obese patients. MATERIALS AND METHODS: Using various aids, such as mobile overtable module, extended shock pathway and abdominal compression 37 patients with body mass index more than 40 kg/m2 were treated using the Siemens Lithostar-plus third generation lithotripter. The size of renal pelvicalyceal stones was between 6 and 20 mm. Treatment costs for shock wave lithotripsy were calculated. RESULTS: The overall stone free rate at 3 months of 73% was achieved. The mean number of treatments per patient was 2.1. The post-lithotripsy secondary procedures rate was 5.4%. No complications, such as subcapsular haematoma or acute pyelonephritis were recorded. The most effective (87% success rate and cost-efficient treatment was in the patients with pelvic stones. The treatment of the patients with low caliceal stones was effective in 60% only. The cost of the treatment of the patients with low calyceal stones was in 1.8 times higher than in the patients with pelvic stones. CONCLUSION: We conclude that ESWL with the Siemens Lithostar-plus is the most effective and cost-efficient in morbidly obese patients with pelvic stones sized between 6 and 20 mm. 87% success rate was achieved. The increased distance from the skin surface to the stone in those patients does not decrease the success rate provided the stone is positioned in the focal point or within 3 cm of it on the

  20. Organ-Preserving Surgical Treatment of a Horseshoe Kidney Occupied by a Large Renal Cell Carcinoma with Extensive Venous Invasion: A Case Report.

    Science.gov (United States)

    Linxweiler, Johannes; Shayesteh-Kheslat, Roushanak; Fries, Peter; Schneider, Günther; Janssen, Martin; Ohlmann, Carsten H; Stöckle, Michael; Siemer, Stefan; Saar, Matthias

    2018-01-01

    The horseshoe kidney is one of the most common congenital disorders affecting the urogenital system. Following a fusion of the lower kidney poles, which in turn lead to the formation of an isthmus, this anatomical variation is accompanied by other characteristic properties like an incomplete ascension, ventral rotation of the pelvices as well as atypical vascular supply. Even though renal carcinoids and Wilms tumors are more common in horseshoe kidneys, the incidence of renal cell carcinomas seems to be unaffected. Here we report the case of a locally advanced renal cell carcinoma with extensive venous invasion occurring in a horseshoe kidney and its complex surgical management. The whole primary tumor as well as a majority of venous tumor thrombi could be removed by a combination of 2/3 nephrectomy and cavotomy with thrombectomy. During 1 year of follow-up, the patient neither suffered from a tumor relapse, nor did he require renal replacement therapy. Thus, we conclude that even in cases of RCC where advanced disease is associated with complex anatomical situations, organ-preserving surgical treatment should be pursued to achieve excellent functional and oncological results. © 2016 S. Karger AG, Basel.

  1. Effect of Pelvic Tilt and Rotation on Cup Orientation in Both Supine and Standing Positions.

    Science.gov (United States)

    Yun, Hohyun; Murphy, William S; Ward, Daniel M; Zheng, Guoyan; Hayden, Brett L; Murphy, Stephen B

    2018-05-01

    The purpose of this study is to analyze the effect of pelvic tilt and rotation on radiographic measurement of cup orientation. A total of 68 patients (79 hips) were included in this study. The patients had a computed tomography study and approximately 3 months of postoperative standing anteroposterior pelvic radiographs in both supine and standing positions. We used 2-dimensional (2D)/3-dimensional (3D) matching to measure pelvic tilt and rotation, and cup orientation. There was a wide range of pelvic tilt between individuals in both supine and standing positions. Supine pelvic tilt was different from standing pelvic tilt (P cup anteversion before and after 2D/3D matching in both supine and standing positions (P cup anteversion before and after 2D/3D matching. When all 79 hips were separated into right and left side, pelvic rotation inversely correlated with the pelvic tilt-adjusted difference in anteversion before and after 2D/3D matching of the right side but directly correlated with that of the left side in both supine and standing positions. This study demonstrated that the measurement of cup anteversion on anteroposterior radiographs is significantly affected by both pelvic tilt and pelvic rotation (depending on the side). Improved understanding of pelvic orientation and improved ability to measure pelvic orientation may eventually allow for desired cup positioning to potentially protect against complications associated with malposition of the cup. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. sup(99m)Tc-DMSA renal scintigraphy in renal failure due to various renal diseases

    Energy Technology Data Exchange (ETDEWEB)

    Hosokawa, S; Daijo, K; Okabe, T; Kawamura, J; Hara, A [Kyoto Univ. (Japan). Hospital

    1979-08-01

    Renal contours in renal failure were studied by means of sup(99m)Tc-dimercaptosuccinic acid (DMSA) renoscintigraphy. Renal cortical images were obtained even in renal failure cases. Causes of renal failure were chronic glomerulonephritis in 7, bilateral renal tuberculosis in 2, chronic pyelonephritis in 3, bilateral renal calculi in 3, diabetic nephropathy in 2, polycystic kidney disease in 2 and stomach cancer in 1.

  3. sup(99m)Tc-DMSA renal scintigraphy in renal failure due to various renal diseases

    International Nuclear Information System (INIS)

    Hosokawa, Shin-ichi; Daijo, Kazuyuki; Okabe, Tatsushiro; Kawamura, Juichi; Hara, Akira

    1979-01-01

    Renal contours in renal failure were studied by means of sup(99m)Tc-dimercaptosuccinic acid (DMSA) renoscintigraphy. Renal cortical images were obtained even in renal failure cases. Causes of renal failure were chronic glomerulonephritis in 7, bilateral renal tuberculosis in 2, chronic pyelonephritis in 3, bilateral renal calculi in 3, diabetic nephropathy in 2, polycystic kidney disease in 2 and stomach cancer in 1. (author)

  4. Haemodynamically Unstable Pelvic Fractures

    Science.gov (United States)

    2009-01-01

    through the pubic symphysis, and posteriorlywith the sacrum forming the sacroiliac (SI) joints (Fig. 1). The SI joints are the strongest in the body...Gardner MJ, Kendoff D, Ostermeier S, et al. Sacroiliac joint compression using an anterior pelvic compressor: a mechanical study in synthetic bone. J

  5. Pelvic floor muscle training versus watchful waiting or pessary treatment for pelvic organ prolapse (POPPS) : Design and participant baseline characteristics of two parallel pragmatic randomized controlled trials in primary care

    NARCIS (Netherlands)

    Wiegersma, Marian; Panman, Chantal M. C. R.; Kollen, Boudewijn J.; Vermeulen, Karin M.; Schram, Aaltje J.; Messelink, Embert J.; Berger, Marjolein Y.; Lisman-Van Leeuwen, Yvonne; Dekker, Janny H.

    Pelvic floor muscle training (PFMT) and pessaries are commonly used in the conservative treatment of pelvic organ prolapse (POP). Because there is a lack of evidence regarding the optimal choice between these two interventions, we designed the "Pelvic Organ prolapse in primary care: effects of

  6. Indiana pouch continent urinary reservoir in patients with previous pelvic irradiation

    International Nuclear Information System (INIS)

    Mannel, R.S.; Braly, P.S.; Buller, R.E.

    1990-01-01

    Little information exists on the use of continent urinary reservoirs in patients with previous pelvic irradiation. We report the use of the Indiana pouch urinary reservoir in ten women with a history of pelvic irradiation for cervical cancer, of whom eight underwent a total pelvic exenteration for recurrent pelvic tumor and two had diversion for radiation-induced vesicovaginal fistula. All ten women achieved daytime continence, with a median time between catheterizations of 4.5 hours and a median pouch capacity of 500 mL. There was no evidence of leakage from the reservoir or significant ureteral reflux or obstruction on postoperative radiographic evaluation. No patient has required reoperation or had significant postoperative complications with the technique described

  7. Relationship between thoracic hypokyphosis, lumbar lordosis and sagittal pelvic parameters in adolescent idiopathic scoliosis.

    Science.gov (United States)

    Clément, Jean-Luc; Geoffray, Anne; Yagoubi, Fatima; Chau, Edouard; Solla, Federico; Oborocianu, Ioana; Rampal, Virginie

    2013-11-01

    Sagittal spine and pelvic alignment of adolescent idiopathic scoliosis (AIS) is poorly described in the literature. It generally reports the sagittal alignment with regard to the type of curve and never correlated to the thoracic kyphosis. The objective of this study is to investigate the relationship between thoracic kyphosis, lumbar lordosis and sagittal pelvic parameters in thoracic AIS. Spinal and pelvic sagittal parameters were evaluated on lateral radiographs of 86 patients with thoracic AIS; patients were separated into hypokyphosis group (n = 42) and normokyphosis group (n = 44). Results were statistically analyzed. The lumbar lordosis was lower in the hypokyphosis group, due to the low proximal lordosis. The thoracic kyphosis was not correlated with any pelvic parameters but with the proximal lordosis. The pelvic incidence was correlated with sacral slope, pelvic tilt, lumbar lordosis and highly correlated with distal lumbar lordosis in the two groups. There was a significant linear regression between thoracic kyphosis and proximal lordosis and between pelvic incidence and distal lordosis. We can consider that the proximal part of the lordosis depends on the thoracic kyphosis and the distal part depends on the pelvic incidence. The hypokyphosis in AIS is independent of the pelvic parameters and could be described as a structural parameter, characteristic of the scoliotic deformity.

  8. Effect of the Individual Strengthening Exercises for Posterior Pelvic Tilt Muscles on Back Pain, Pelvic Angle, and Lumbar ROM of a LBP Patient with Excessive Lordosis: A Case Study.

    Science.gov (United States)

    Yoo, Won-Gyu

    2014-02-01

    [Purpose] The purpose of this study was to document the effect of individual strengthening exercises for posterior pelvic tilt muscles on back pain, pelvic tilt angle, and lumbar ROM of a low back pain (LBP) patient with excessive lordosis. [Subjects] The subject was a 28 year-old male with excessive lordosis who complained of severe LBP at the L3 level. [Methods] He performed individual strengthening exercises for the posterior pelvic tilt muscles (rectus abdominis, gluteus maximus, hamstring). [Results] Pelvic tilt angles on the right and left sides recovered to his normal ranges. Limited lumbar ROM increased, and low back pain decreased. [Conclusion] We suggest that an approach of individual resistance exercises is necessary for the effective and fast strengthening of the pelvic posterior tilt muscles in case of LBP with excessive lordosis.

  9. Pelvic Inflammatory Disease (PID) Statistics

    Science.gov (United States)

    ... Home Page Bacterial Vaginosis (BV) Chlamydia Genital Herpes Gonorrhea Hepatitis HIV/AIDS & STDs Human Papillomavirus (HPV) Pelvic ... last 12 months that they had chlamydia or gonorrhea or have ever been told they have herpes, ...

  10. How Is Pelvic Pain Diagnosed?

    Science.gov (United States)

    ... NICHD Research Information Find a Study More Information Pharmacology Condition Information NICHD Research Information Find a Study ... button to look inside the pelvis 4 Pelvic MRI (magnetic resonance imaging) scan, an imaging test that ...

  11. Sexual function in women with pelvic floor disorders

    OpenAIRE

    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...

  12. Transverse colon conduit urinary diversion in patients treated with very high dose pelvic irradiation

    International Nuclear Information System (INIS)

    Ravi, R.; Dewan, A.K.; Pandey, K.K.

    1994-01-01

    Urinary diversion may be required in patients receiving pelvic irradiation for gynaecological or genitourinary cancers either as part of a planned or salvage surgical procedure or for urological complications of irradiation. Records were reviewed for 30 such patients who underwent transverse colon conduit as a primary form of urinary diversion. Most of the conduits were constructed using refluxing ureterocolic anastomoses with stents. The results showed no operative mortality. Although the procedure was associated with a complication rate of 37% and a re-operation rate of 20%, there were no bowel or urinary anastomotic leaks. The operation could be safely performed on patients with renal failure, with 83% of such patients showing normal or improved serum creatinine levels post operatively. The advantages of transverse colon conduit urinary diversion are the use of non-irradiated bowel and ureters for diversion. It is recommended as a primary form of urinary diversion in these high risk cases. (Author)

  13. Renal computed angiography. Part I: Renal CT phlebography. Renal veins variants

    International Nuclear Information System (INIS)

    Al-Amin, M.; Krupev, M.; Hadjidekov, V.; Plachkov, I.

    2012-01-01

    The changing trend in renal surgery, transplantation and minimal invasive urology implies preprocedure evaluation of renal veins. Development of imaging methods offers new possibilities for venographic visualization. The goal of this study is to present authors experience in visualization of renal veins using 64 MDCT and to evaluate the utility in assessments of their variants. 128 patients (68 females and 60 males, mean age 53,3) with urological complaints underwent 64MDCT examination including CT angiography. Contrast enhancement includes 3-4ml/sec injection flow of 90 ml contrast medium followed by 20 ml saline at the same rate. In 23 out of 128 examined patients some of the common variants of the renal vein is found. 64 MDCT angiography visualize very well renal veins and becomes method of choice in preoperative assessment of renal vein anatomy. (authors)

  14. The Diagnostic Value of Pelvic Ultrasound in Girls with Central Precocious Puberty.

    Science.gov (United States)

    Lee, Sang Heon; Joo, Eun Young; Lee, Ji-Eun; Jun, Yong-Hoon; Kim, Mi-Young

    2016-01-01

    The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard for differentiating central precocious puberty (CPP) from exaggerated thelarche (ET). Because of this test's limitations, previous studies have clarified the clinical and laboratory factors that predict CPP. The present study investigated the early diagnostic significance of pelvic ultrasound in girls with CPP. The GnRH stimulation test and pelvic ultrasound were performed between March 2007 and February 2015 in 192 girls (aged values in pelvic ultrasound for differentiating between CPP and ET. Pelvic ultrasound should be combined with clinical and laboratory tests to maximize its diagnostic value for CPP.

  15. Clinical functional evaluation of female's pelvic floor: integrative review

    Directory of Open Access Journals (Sweden)

    Ana Carolina Nociti Lopes Fernandes

    2018-06-01

    Full Text Available Abstract Introduction: The effectiveness of pelvic floor muscle training (PFMT depends on the correct prescription of intensity, repetition and endurance of muscle contractions, which are provided by an adequate assessment of pelvic floor muscle. Objective: Verify the techniques, resources and strategies used for clinical functional evaluation of female pelvic floor (PF described in literature. Methods: It’s an integrative review of published studies and books from 2010 until December 2015. Relevant articles with complete description of PF evaluation were found through the use of Scielo, LILACS, PubMed and Medline databases. Results: 34 articles that fulfilled all the criteria were selected. Conclusion: The most used techniques, resources and strategies were: anamnesis, physical examination, measurement of pelvic floor muscle activity using Modified Oxford Scale or perineometry, and use of questionnaires to analyze patient's perspective of their own symptoms. Thus, we could use the parameters obtained in the evaluation to plan an ideal PFMT for each patient, so the physiotherapist would have a good database to analyze the evolution and define the end of therapy.

  16. Novel Neurostimulation of Autonomic Pelvic Nerves Overcomes Bladder-Sphincter Dyssynergia

    Science.gov (United States)

    Peh, Wendy Yen Xian; Mogan, Roshini; Thow, Xin Yuan; Chua, Soo Min; Rusly, Astrid; Thakor, Nitish V.; Yen, Shih-Cheng

    2018-01-01

    The disruption of coordination between smooth muscle contraction in the bladder and the relaxation of the external urethral sphincter (EUS) striated muscle is a common issue in dysfunctional bladders. It is a significant challenge to overcome for neuromodulation approaches to restore bladder control. Bladder-sphincter dyssynergia leads to undesirably high bladder pressures, and poor voiding outcomes, which can pose life-threatening secondary complications. Mixed pelvic nerves are potential peripheral targets for stimulation to treat dysfunctional bladders, but typical electrical stimulation of pelvic nerves activates both the parasympathetic efferent pathway to excite the bladder, as well as the sensory afferent pathway that causes unwanted sphincter contractions. Thus, a novel pelvic nerve stimulation paradigm is required. In anesthetized female rats, we combined a low frequency (10 Hz) stimulation to evoke bladder contraction, and a more proximal 20 kHz stimulation of the pelvic nerve to block afferent activation, in order to produce micturition with reduced bladder-sphincter dyssynergia. Increasing the phase width of low frequency stimulation from 150 to 300 μs alone was able to improve voiding outcome significantly. However, low frequency stimulation of pelvic nerves alone evoked short latency (19.9–20.5 ms) dyssynergic EUS responses, which were abolished with a non-reversible proximal central pelvic nerve cut. We demonstrated that a proximal 20 kHz stimulation of pelvic nerves generated brief onset effects at lower current amplitudes, and was able to either partially or fully block the short latency EUS responses depending on the ratio of the blocking to stimulation current. Our results indicate that ratios >10 increased the efficacy of blocking EUS contractions. Importantly, we also demonstrated for the first time that this combined low and high frequency stimulation approach produced graded control of the bladder, while reversibly blocking afferent

  17. Preoperative diagnosis of pelvic actinomycosis by clinical cytology

    Directory of Open Access Journals (Sweden)

    Matsuda K

    2012-09-01

    Full Text Available Katsuya Matsuda,1 Hisayoshi Nakajima,2 Khaleque N Khan,1 Terumi Tanigawa,1 Daisuke Hamaguchi,1 Michio Kitajima,1 Koichi Hiraki,1 Shingo Moriyama,3 Hideaki Masuzaki11Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, 2Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 3Shimabara Maternity Clinic, Nagasaki, JapanBackground: The purpose of this work was to investigate whether clinical cytology could be useful in the preoperative diagnosis of pelvic actinomycosis.Methods: This study involved the prospective collection of samples derived from the endometrium and the uterine cervix, and retrospective data analysis. Nine patients with clinically diagnosed pelvic actinomycosis were enrolled. The clinical and hematological characteristics of patients were recorded, and detection of actinomyces was performed by cytology, pathology, and bacteriological culture of samples and by imprint intrauterine contraceptive device (IUD cytology.Results: The detection rate of actinomyces was 77.7% by combined cervical and endometrial cytology, 50.0% by pathology, and 11.1% by bacterial culture.Conclusion: The higher detection rate of actinomyces by cytology than by pathology or bacteriology suggests that careful cytological examination may be clinically useful in the preoperative diagnosis of pelvic actinomycosis.Keywords: actinomycosis, cytology, pathology, intrauterine contraceptive device, pelvic inflammatory disease

  18. Gonad shielding in paediatric pelvic radiography : Disadvantages prevail over benefit

    NARCIS (Netherlands)

    Frantzen, M.J.; Robben, S.; Postma, A.A.; Zoetelief, J.; Wildberger, J.E.; Kemerink, G.J.

    2012-01-01

    Objective To re-evaluate gonad shielding in paediatric pelvic radiography in terms of attainable radiation risk reduction and associated loss of diagnostic information. Methods A study on patient dose and the quality of gonad shielding was performed retrospectively using 500 pelvic radiographs of

  19. Pelvic radiograph in skeletal dysplasias: An approach

    Directory of Open Access Journals (Sweden)

    Manisha Jana

    2017-01-01

    Full Text Available The bony pelvis is constituted by the ilium, ischium, pubis, and sacrum. The pelvic radiograph is an important component of the skeletal survey performed in suspected skeletal dysplasia. Most of the common skeletal dysplasias have either minor or major radiological abnormalities; hence, knowledge of the normal radiological appearance of bony pelvis is vital for recognizing the early signs of various skeletal dysplasias. This article discusses many common and some uncommon radiological findings on pelvic radiographs along with the specific dysplasia in which they are seen; common differential diagnostic considerations are also discussed.

  20. Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil.

    Science.gov (United States)

    Araujo Júnior, Edward; de Freitas, Rogério Caixeta Moraes; Di Bella, Zsuzsanna Ilona Katalin de Jármy; Alexandre, Sandra Maria; Nakamura, Mary Uchiyama; Nardozza, Luciano Marcondes Machado; Moron, Antonio Fernandes

    2013-03-01

    To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound. A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10), vaginal delivery (n=16), and forceps delivery (n=9). Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L) was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test. The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm(2), respectively, versus 12.4 cm(2) in the Control Group (elective cesarean). Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25), however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5). Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode.

  1. The Pelvic Digit: A Rare Congenital Anomaly as a Cause of Hip Pain

    OpenAIRE

    Moreta-Su?rez, Jes?s; de Ugarte-Sobr?n, Oskar S?ez; S?nchez-Sobrino, Alberto; Mart?nez-De Los Mozos, Jos? Luis

    2012-01-01

    Introduction: The pelvic digit or pelvic rib is an unusual congenital anomaly with a finger or rib like bone formation in soft tissues around normal pelvic skeleton. This is a benign lesion and mostly an Incidental finding on radiographs. Most reported cases are asymptomatic and do not require intervention. We report a case of symptomatic pelvic rib that required surgical excision. Case Report: A 57-year-old man presented with a long history of pain and functional limitation in his right hip....

  2. The prevalence and clinical predictors of incidental atherosclerotic renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Ozkan, Ugur [Baskent University Faculty of Medicine, Department of Radiology, Adana/Turkey (Turkey)], E-mail: radugur@yahoo.com; Oguzkurt, Levent; Tercan, Fahri [Baskent University Faculty of Medicine, Department of Radiology, Adana/Turkey (Turkey); Nursal, Tarik Z. [Baskent University Faculty of Medicine, Department of General Surgery, Ankara/Turkey (Turkey)

    2009-03-15

    Objective: To evaluate the prevalence of incidental renal artery stenosis due to atherosclerosis and associated risk factors in patients with peripheral arterial disease (PAD). Materials and methods: To determine renal artery stenosis, aortofemoropopliteal digital substraction angiographies (DSA) of 629 consecutive patients with PAD were prospectively reviewed. Angiographies were performed as catheter angiography with automated pump injection. Of the patients, 540 were male (86%) and 89 female (14%) (mean age {+-} S.D.: 61.5 {+-} 11.1 years). Statistical analysis was performed to determine the association of significant renal artery stenosis ({>=}60% diameter stenosis) with patient demographics (age, sex, reason for angiography and smoking status), medical history (diabetes mellitus, hypertension and coronary artery disease), laboratory values (blood creatinine, fasting glucose, triglycerides, LDL, HDL and total cholesterol) and distribution of PAD (aortoiliac, femoropopliteal and crural diseases and multisegment involvement). Results: Renal artery disease was found in 33% (207 of 629) of all patients with peripheral arterial disease, and 9.6% of patients (n = 60) had significant ({>=}60%) renal artery stenosis. Only age and hypertension (blood pressure systolic >140 mmHg or diastolic >90 mmHg) were independent risk factors for significant renal artery stenosis on multivariate analysis. Mean age of patients with RAS was 66.5 {+-} 8.9 years compared with 61 {+-} 11.2 years for patients without RAS (p < 0.001). Hypertension was found in 41% of the patients in control group and in 63% of the patients in RAS group (p = 0.01). Conclusion: Incidental renal artery stenosis which can be mild or significant is a relatively common finding among patients with peripheral arterial disease. Advance age and hypertension are closely associated with significant renal artery stenosis.

  3. Distribution of Vascular Patterns in Different Subtypes of Renal Cell Carcinoma. A Morphometric Study in Two Distinct Types of Blood Vessels.

    Science.gov (United States)

    Ruiz-Saurí, Amparo; García-Bustos, V; Granero, E; Cuesta, S; Sales, M A; Marcos, V; Llombart-Bosch, A

    2017-07-01

    To analyze the presence of mature and immature vessels as a prognostic factor in patients with renal cell carcinoma and propose a classification of renal cancer tumor blood vessels according to morphometric parameters. Tissue samples were obtained from 121 renal cell carcinoma patients who underwent radical nephrectomy. Staining with CD31 and CD34 was used to differentiate between immature (CD31+) and mature (CD34+) blood vessels. We quantified the microvascular density, microvascular area and different morphometric parameters: maximum diameter, minimum diameter, major axis, minor axis, perimeter, radius ratio and roundness. We found that the microvascular density was higher in CD31+ than CD34+ vessels, but CD34+ vessels were larger than CD31+ vessels, as well as being strongly correlated with the ISUP tumor grade. We also identified four vascular patterns: pseudoacinar, fascicular, reticular and diffuse. Pseudoacinar and fascicular patterns were more frequent in clear cell renal cell carcinoma (37.62 and 35.64% respectively), followed by reticular pattern (21.78%), while in chromophobe tumors the reticular pattern predominated (90%). The isolated pattern was present in all papillary tumors (100%). In healthy renal tissue, the pseudoacinar and isolated patterns were differentially found in the renal cortex and medulla respectively. We defined four distinct vascular patterns significantly related with the ISUP tumor grade in renal cell carcinomas. Further studies in larger series are needed in order to validate these results. Analysis of both mature and immature vessels (CD34+ and CD31+) provides additional information when evaluating microvascular density.

  4. Relationship between pelvic alignment and weight-bearing asymmetry in community-dwelling chronic stroke survivors

    Directory of Open Access Journals (Sweden)

    Suruliraj Karthikbabu

    2016-01-01

    Full Text Available 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.

  5. Pelvic Inflammatory Disease (PID)

    Science.gov (United States)

    ... a serious condition, in women. 1 in 8 women with a history of PID experience difficulties getting pregnant. You can prevent PID if you know how to protect yourself. What is PID? Pelvic inflammatory disease is an infection of a woman’s reproductive organs. It is a complication often caused ...

  6. Pelvic floor functional disorders in vaginally delivered primiparae

    OpenAIRE

    Antolic, Andrea

    2011-01-01

    In this study we examined pelvic floor functional disorders in primiparae with single pregnancies, cephalic presentation at term at the Charité delivery department before and during pregnancy as well as after vaginal delivery by means of questionnaire in relation to maternal, neonatal and obstetric risk factors. The pathophysiology of pelvic floor disorders is still not statisfyingly resolved. During pregnancy 74% of primiparae knew about the interrelation between delivery and sexual disorde...

  7. Dynamic magnetic resonance imaging for assessment of minimally invasive pelvic floor reconstruction with polypropylene implant

    International Nuclear Information System (INIS)

    Siegmann, Katja C.; Reisenauer, Christl; Speck, Sina; Barth, Sonja; Kraemer, Bernhard; Claussen, Claus D.

    2011-01-01

    Introduction: The purpose of the study was to assess the usefulness of dynamic MRI in patients with pelvic organ prolapse after pelvic floor repair with polypropylene mesh. Materials and methods: Fifteen consecutive patients (mean age 66.5 years) who were scheduled for either anterior (n = 9) or posterior (n = 6) pelvic floor repair were prospectively evaluated by clinical assessment and dynamic MRI 1 day before and 3 months after surgery. MRI diagnoses and MRI measurements of relevant anatomical points at rest and on straining were analysed before and after surgery. Results: At follow-up assessment 93.3% of all patients were clinically cured. Dynamic MRI showed newly developed (n = 6) or increased (n = 6) pelvic organ prolapse in 80% (n = 12) of all patients 3 months after pelvic floor repair. Most of them (n = 11; 91.7%) affected the untreated pelvic floor compartment. On straining anatomical points of reference in the anterior pelvic floor compartment were significantly (p < 0.05) elevated after anterior repair and rectal bulging was significantly (p = 0.036) reduced after posterior pelvic floor repair. Conclusions: In this study dynamic MRI could verify the effective support of anterior and posterior pelvic floor structures by anterior and posterior polypropylene implant respectively. But dynamic MRI demonstrates if one compartment of the pelvic floor is repaired another compartment frequently (73.3%) develops dysfunction. These results did not correspond to clinical symptoms on short-term follow-up (3 months). Studies with long-term follow-up are necessary to prove if dynamic MRI can reliably identify clinically significant pelvic organ prolapse after pelvic floor repair before the onset of symptoms.

  8. The Relationship Between Foot and Pelvic Alignment While Standing

    Directory of Open Access Journals (Sweden)

    Khamis Sam

    2015-06-01

    Full Text Available A normal motion and segmental interrelationship has been determined as a significant factor in normal function. Yet, the relationship between distal segments and pelvic alignment needs further investigation. The aim of this study was to investigate the interrelationship between distal and proximal lower extremity segments while standing and during induced feet hyperpronation. Changes in alignment of the pelvis and lower extremities were measured at a gait laboratory using the VICON 612 computerized motion analysis system. Thirty-five healthy volunteer subjects were recruited. Four randomized repeated-measure standing modes were used: standing directly on the floor and then on three wedges angled at 10°, 15° and 20° to induce bilateral hyperpronation for 20 seconds. A significant (p<0.05 bi-variate relationship was found between the anterior pelvic tilt and thigh internal rotation, in all four standing positions (.41≤r≤.46, in all p<0.014. A combined effect of rotational alignment between segments and the cumulative effect of foot hyperpronation on pelvic tilt revealed that only the shank significantly affected pelvic alignment, acting as a mediator between a foot and a thigh with the thigh having a crude significant effect on the pelvis. When internal rotation of the shank occurs, calcaneal eversion couples with thigh internal rotation and anterior pelvic tilt. It can be concluded that in response to induced hyperpronation, the shank is a pivotal segment in postural adjustment.

  9. Management of Severe Perineal Injuries in Major Pelvic Fractures

    Directory of Open Access Journals (Sweden)

    A Jangjoo

    2009-01-01

    Full Text Available Introduction: Significant perineal injuries and major pelvic fractures resulting from blunt trauma manifest a high-energy injury. Open pelvic fractures (with perineal injury are associated with higher mortality rates of 40 to 60 %. Methods: This study was a review of patients with multiple traumas comprising of major pelvic fracture and severe perineal injuries (Shahid Kamyab hospital in Mashhad from 2002- 2005. A total of 11 patients, with pelvic fracture and perineal injuries (injury to urethra and anal canal were entered in the study. The data was gathered by a checklist and analyzed with SPSS software. Results: The population under study included 11 patients (9 male, 2 female with a mean age of 35years. Cause of trauma in all patients was motor vehicle accidents. All of the patients in the first 6 hours of admission received at least 4 liters of serum ringer lactate and 3 units of packed cells. The mean of packed cell received was 8 units and one patient needed 21 units of packed cells. All of patients were taken to the operating room for diverting colostomy, distal rectal washout, cystostomy and radical debridment and irrigation of devitalized tissue. Good results were achieved in 9 patients and there was one case of mortality and one morbidity (ARF. Conclusion: Open pelvic fractures and perineal injuries are associated with higher mortality rates. Prompt diagnosis and proper treatment (reanimation, colostomy, cystostomy, debridment and irrigation is the key to success.

  10. Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): a multicentre randomised controlled trial.

    Science.gov (United States)

    Hagen, Suzanne; Glazener, Cathryn; McClurg, Doreen; Macarthur, Christine; Elders, Andrew; Herbison, Peter; Wilson, Don; Toozs-Hobson, Philip; Hemming, Christine; Hay-Smith, Jean; Collins, Marissa; Dickson, Sylvia; Logan, Janet

    2017-01-28

    Pelvic floor muscle training can reduce prolapse severity and symptoms in women seeking treatment. We aimed to assess whether this intervention could also be effective in secondary prevention of prolapse and the need for future treatment. We did this multicentre, parallel-group, randomised controlled trial at three centres in New Zealand and the UK. Women from a longitudinal study of pelvic floor function after childbirth were potentially eligible for inclusion. Women of any age who had stage 1-3 prolapse, but had not sought treatment, were randomly assigned (1:1), via remote computer allocation, to receive either one-to-one pelvic floor muscle training (five physiotherapy appointments over 16 weeks, and annual review) plus Pilates-based pelvic floor muscle training classes and a DVD for home use (intervention group), or a prolapse lifestyle advice leaflet (control group). Randomisation was minimised by centre, parity (three or less vs more than three deliveries), prolapse stage (above the hymen vs at or beyond the hymen), and delivery method (any vaginal vs all caesarean sections). Women and intervention physiotherapists could not be masked to group allocation, but allocation was masked from data entry researchers and from the trial statistician until after database lock. The primary outcome was self-reported prolapse symptoms (Pelvic Organ Prolapse Symptom Score [POP-SS]) at 2 years. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01171846. Between Dec 21, 2008, and Feb 24, 2010, in New Zealand, and Oct 27, 2010, and Sept 5, 2011, in the UK, we randomly assigned 414 women to the intervention group (n=207) or the control group (n=207). One participant in each group was excluded after randomisation, leaving 412 women for analysis. At baseline, 399 (97%) women had prolapse above or at the level of the hymen. The mean POP-SS score at 2 years was 3·2 (SD 3·4) in the intervention group versus 4·2 (SD 4·4) in the

  11. The impact of antiplatelet therapy on pelvic fracture outcomes

    Directory of Open Access Journals (Sweden)

    Christy Jonathan

    2011-01-01

    Full Text Available Introduction : Despite increasing use of antiplatelet agents (APA, little is known regarding the effect of these agents on the orthopedic trauma patient. This study reviews clinical outcomes of patients with pelvic fractures (Pfx who were using pre-injury APA. Specifically, we focused on the influence of APA on postinjury bleeding, transfusions, and outcomes after Pfx. Methods : Patients with Pfx admitted during a 37-month period beginning January 2006 were divided into APA and non-APA groups. Pelvic injuries were graded using pelvic fracture severity score (PFSS-a combination of Young-Burgess (pelvic ring, Letournel-Judet (acetabular, and Denis (sacral fracture classifications. Other clinical data included demographics, co-morbid conditions, medications, injury severity score (ISS, associated injuries, morbidity/mortality, hemoglobin trends, blood product use, imaging studies, procedures, and resource utilization. Multivariate analyses for predictors of early/late transfusions, pelvic surgery, and mortality were performed. Results : A total of 109 patients >45 years with Pfx were identified, with 37 using preinjury APA (29 on aspirin [ASA], 8 on clopidogrel, 5 on high-dose/scheduled non-steroidal anti-inflammatory agents [NSAID], and 8 using >1 APAs. Patients in the APA groups were older than patients in the non-APA group (70 vs. 63 years, P < 0.01. The two groups were similar in gender distribution, PFSS and ISS. Patients in the APA group had more comorbidities, lower hemoglobin levels at 24 h, and received more packed red blood cell (PRBC transfusions during the first 24 h of hospitalization (all, P < 0.05. There were no differences in platelet or late (>24 h PRBC transfusions, blood loss/transfusions during pelvic surgery, lengths of stay, post-ED/discharge disposition, or mortality. In multivariate analysis, predictors of early PRBC transfusion included higher ISS/PFSS, pre-injury ASA use, and lower admission hemoglobin (all, P < 0

  12. Pelvic and acetabular trauma care in Ireland: the past, present and future

    LENUS (Irish Health Repository)

    Queally, JM

    2017-08-01

    Pelvic injuries involve injury to the osseo-ligamentous ring structure of the pelvis or the acetabulum of either hip joint. They are typically caused by high-energy trauma and may be associated with significant morbidity or mortality at the time of injury due to excessive haemorrhage and associated abdominal, chest or head injuries with mortality rates of 8.6% to 19.1% reported for closed injuries and rates of up to 50% reported for open injuries1. Despite the severity of these injuries and the potential for poor long term outcomes, these injuries were managed with non-surgical treatment until the middle of the 20th century. Treatment typically involved prolonged bed rest, traction or compression devices, pelvic slings and spica casts with poor outcomes due to persistent pelvic deformity in pelvic injures and early osteoarthritis in acetabular fractures2,3. In the 1930’s, with the advent of radiography, significant progress was made in terms of understanding injury patterns, subsequent displacement and the significance of pelvic instability and deformity post injury. Along with the improved definitive management of pelvic injuries, similar progress was made with the immediate management of life-threatening haemodynamic instability and resuscitation with a significant improvement in mortality rate achieved over the past 50 years3,4. In contemporary trauma care, to ensure optimal outcomes, pelvic trauma is now considered a subspecialty practised in tertiary centres by fellowship trained specialists. Herein we describe the evolution of pelvic trauma care in Ireland over the past 30 years in an overall context of improved international paradigms of care and discuss potential future developments

  13. Evolutionary considerations in the development of chronic pelvic pain.

    Science.gov (United States)

    Jarrell, John; Arendt-Nielsen, Lars

    2016-08-01

    Chronic pelvic pain is common among women of reproductive age and is associated with significant morbidity and comorbidities. In this Viewpoint, we explore the evolutionary cause of pelvic pain and summarize evidence that supports a menstruation-related evolutionary cause of chronic visceral pelvic pain: (1) lifetime menstruation has increased; (2) severe dysmenorrhea is common in the chronic pelvic pain population, particularly among those with pain sensitization; and (3) a potential biological mechanism can be identified. Thus, chronic pelvic pain may arise from the mismatch between the slow pace of biological evolution in our bodies and the relatively rapid pace of cultural changes that have resulted in increased menstrual frequency due to earlier menarche, later mortality, and lower fecundity. One possible mechanism that explains the development of persistent pain from repeated episodes of intermittent pain is hyperalgesic priming, a physiological process defined as a long-lasting latent hyperresponsiveness of nociceptors to inflammatory mediators after an inflammatory or neuropathic insult. The repetitive severely painful menstrual episodes may play such a role. From an evolutionary perspective the relatively rapid increase in lifetime menstruation experience in contemporary society may contribute to a mismatch between lifetime menstruation and the physiological pain processes, leading to a maladaptive state of chronic visceral pelvic pain. Our current physiology does not conform to current human needs. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Production of ascorbic acid releasing biomaterials for pelvic floor repair.

    Science.gov (United States)

    Mangır, Naşide; Bullock, Anthony J; Roman, Sabiniano; Osman, Nadir; Chapple, Christopher; MacNeil, Sheila

    2016-01-01

    An underlying abnormality in collagen turnover is implied in the occurrence of complications and recurrences after mesh augmented pelvic floor repair surgeries. Ascorbic acid is a potent stimulant of collagen synthesis. The aim of this study is to produce ascorbic acid releasing poly-lactic acid (PLA) scaffolds and evaluate them for their effects on extracellular matrix production and the strength of the materials. Scaffolds which contained either l-ascorbic acid (AA) and Ascorbate-2-Phosphate (A2P) were produced with emulsion electrospinning. The release of both drugs was measured by UV spectrophotometry. Human dermal fibroblasts were seeded on scaffolds and cultured for 2weeks. Cell attachment, viability and total collagen production were evaluated as well as mechanical properties. No significant differences were observed between AA, A2P, Vehicle and PLA scaffolds in terms of fibre diameter and pore size. The encapsulation efficiency and successful release of both AA and A2P were demonstrated. Both AA and A2P containing scaffolds were significantly more hydrophilic and stronger in both dry and wet states compared to PLA scaffolds. Fibroblasts produced more collagen on scaffolds containing either AA or A2P compared to cells grown on control scaffolds. This study is the first to directly compare the two ascorbic acid derivatives in a tissue engineered scaffold and shows that both AA and A2P releasing electrospun PLA scaffolds increased collagen production of fibroblasts to similar extents but AA scaffolds seemed to be more hydrophilic and stronger compared to A2P scaffolds. Mesh augmented surgical repair of the pelvic floor currently relies on non-degradable materials which results in severe complications in some patients. There is an unmet and urgent need for better pelvic floor repair materials. Our current understanding suggests that the ideal material should be able to better integrate into sites of implantation both biologically and mechanically. The impact of

  15. Pelvic insufficiency fractures associated with radiation atrophy: clinical recognition and diagnostic evaluation

    International Nuclear Information System (INIS)

    Mumber, M.P.; Greven, K.M.; Haygood, T.M.

    1997-01-01

    Pelvic bone injuries are infrequent complications of radiotherapy. However, insufficiency fractures in irradiated pelvic bones may be underdetected, particularly in postmenopausal women. We describe the clinical presentation, radiologic evaluation, and course of disease in three patients with postradiation pelvic insufficiency fractures. Differential diagnosis included metastatic disease, tumor recurrence, and second malignancy. Recognition of radiographic features may prevent unnecessary, possibly morbid treatments. (orig.). With 6 figs

  16. [Clinical analysis of 41 children's urinary calculus and acute renal failure].

    Science.gov (United States)

    Li, Lu-Ping; Fan, Ying-Zhong; Zhang, Qian; Zhang, Sheng-Li

    2013-04-01

    To analyze the treatment of acute renal failure caused by irrational drug use. Data of 41 cases of acute renal failure seen from July 2008 to June 2012 in our hospital were reviewed. Bilateral renal parenchymas diffuse echo was found enhanced by ultrasound in all cases. Calculus image was not found by X-ray. All children had medical history of using cephalosporins or others. Alkalinization of urine and antispasmodic treatment were given to all children immediately, 17 children were treated with hemodialysis and 4 children accepted intraureteral cannula placement. In 24 children who accepted alkalinization of urine and antispasmodic treatment micturition could be restored within 24 hours, in 11 children micturition recovered after only one hemodialysis treatment and 2 children gradually restored micturition after hemodialysis twice, 4 children who accepted intraureteral cannula immediately restored micturition. In all children micturition recovered gradually after a week of treatment. Ultrasound examination showed that 39 children's calculus disappeared totally and renal parenchymas echo recovered to normal. The residual calculi with diameter less than 5 mm were found in 2 children, but they had no symptoms. The children received potassium sodium hydrogen citrate granules per os and were discharged from hospital. Ultrasound showed calculus disappeared totally one month later. Irrational drug use can cause children urolithiasis combined with acute renal failure, while renal dysfunction can reverse by drug withdrawal and early alkalinization of urine, antispasmodic treatment, intraureteral cannula or hemodialysis when necessary, most calculus can be expelled after micturition recovered to normal.

  17. Role of pelvic lymphadenectomy in stage 1A endometrial carcinoma ...

    African Journals Online (AJOL)

    Introduction: Endometrial cancer is the commonest gynecological cancer mostly affecting women in the postmenopausal age group. There is a debate regarding the need of pelvic lymphadenectomy in managing stage 1A diagnosed preoperatively, we try to evaluate this need. Objective: To evaluate the role of pelvic ...

  18. Efficacy of hypopressive abdominal gymnastics in rehabilitating the pelvic floor of women: A systematic review.

    Science.gov (United States)

    Ruiz de Viñaspre Hernández, R

    2017-12-13

    Hypopressive abdominal gymnastics has been proposed as a new paradigm in rehabilitating the pelvic floor. Its claims contraindicate the recommendation for pelvic floor muscle training during the postpartum period. To determine whether hypopressive abdominal gymnastics is more effective than pelvic floor muscle training or other alternative conservative treatments for rehabilitating the pelvic floor. We consulted the databases of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), Physiotherapy Evidence Database (PEDro), PubMed, Scopus, Trip Database and Web of Science. We selected systematic reviews, clinical trials and analytical studies that assessed the efficacy of hypopressive abdominal gymnastics in women. The measured outcomes were the strengthening of the pelvic floor muscles, the incidence of urine incontinence or prolapse and symptom remission. We included 4 clinical trials, whose quality was measured with the PEDro scale. Hypopressive gymnastics is less effective than pelvic floor muscle training for activating pelvic floor muscles, achieving closure of the levator hiatus of the anus and increasing pelvic floor muscle thickness, strength and resistance. The evidence reviewed does not support the recommendation for hypopressive abdominal gymnastics for strengthening the pelvic floor either during the postpartum period or outside that period. Pelvic floor muscle training remains the first-line treatment for pelvic floor dysfunction. There is a lack of quality clinical trials that have evaluated the efficacy of hypopressive abdominal gymnastics. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Hilar Renal Artery Aneurysm - Ex-vivo Reconstruction and Autotransplantation.

    Science.gov (United States)

    Pinto Sousa, Pedro; Veiga, Carlos; Matos, Arlindo; Sá Pinto, Pedro; Almeida, Rui

    2017-01-01

    Renal artery aneurysm (RAA) is a rare clinical entity with an estimated prevalence of 0.15% to 0.1%in the general population. The majority of patients present asymptomatically and the diagnosis is made incidentally during a hypertension study test, and more rarely, fortuitously after backache. Indications to treat have been subject of intense debate, nevertheless there seems to be some consensus that RAAs greater than 2 cm in diameter, expanding RAA, with thrombus or in pregnant women should be treated. Treatment options vary between surgical or endovascular approach. The complex (hilar) RAA constitute a subset of RAA that present a therapeutic dilemma because of their anatomic location and may require extracorporeal arterial reconstruction and auto-transplantation. We describe a 71-year-old woman with a personal history of hypertension for more than twenty years but normal renal function. Following the study for an abdominal discomfort a complex RAA was incidentally diagnosed. Computed tomographic angiography with three-dimensional reconstruction revealed a 13mm, saccular aneurysm located at the right renal hilum. We performed hand-assisted laparoscopic nephrectomy with ex vivo repair of the RAA. The aneurysm was resected and a polar renal artery was implanted over the resected area with a latero-terminal anastomosis. Complementarily, the renal vein was augmented with a spiral great saphenous vein graft and finally the kidney was implanted into the right iliac fossa. The intervention and postoperative course were uneventful and the patient submitted to ultrasound evaluation on the day after procedure. It revealed normal renal perfusion with normal flow indices. In the last follow-up realized, two months after surgery the patient was alive with a well-functioning auto-transplant. RAA may be nowadays more frequently diagnosed due to the increasing use of imaging techniques. While renal artery trunk aneurysms are most often treated using an endovascular procedure it

  20. Effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training in older women with pelvic organ prolapse : 2-year follow-up of a randomized controlled trial in primary care

    NARCIS (Netherlands)

    Panman, Chantal; Wiegersma, Marian; Kollen, Boudewijn; Berger, Marjolein Y.; Lisman-van Leeuwen, Yvonne; Vermeulen, Karin; Dekker, Janny H

    2016-01-01

    Objective: We investigated the effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training (PFMT) in women with pelvic organ prolapse over a 2-year period. Methods: Randomized controlled trial with women (>= 55 y) with symptomatic pelvic organ prolapse,

  1. Renal artery stent angioplasty for renovascular hypertension

    International Nuclear Information System (INIS)

    Li Gang; Li Haiqing; Wang Lin

    2005-01-01

    Objective: To evaluate the therapeutic results of expandable stent for treatment of atherosclerotic renovascular obstructive disease. Methods: 15 patients (10 men and 5 women, 41-75 years old; mean age, 52 years) with renal arterial hypertension underwent renal stent angioplasty including renal arterial stenosis 89%(n=13) and fully obstruction without function in 2, of which 2 patients had bilateral involvement. The stenotic range of all arterial segments showed 60% to 90% width of the normal arterial diameter. 16 stents were implanted under the guidance of fluoroscopy. The most of stents implanted were Palmaz (n=12, 75%) with regular clinical and angiographic follow up. Results: Technical success (residual stenosis <30%) was achieved in all patients without serious complication. During the follow-up (6-15 months; mean, 8 ± 4 months), hypertension was improved in 9 patients and cured in 4 patients with a total benefit of 86% and no efficacy in 2(13%). The average systolic blood pressure decreased from 27.12 ± 3.09 kPa to 18.62 ± 3.12 kPa and the average diastolic blood pressure decreased from 17.73 ± 1.92 kPa to 11.12 ± 2.43 kPa after stent treatment (P<0.05). Serum creatinine remained stable in 60% (n=9) patients with improvement in 33% (n=5) and worsened in 6% (n=1) patients. Follow-up angiography was performed in all patients with 1 case of a restenosis. 6 months after expanding through stent by using balloon, the two follow up angiographies showed a stable restenosis about 20%. Conclusions: Percutaneous transluminal stent placement is highly beneficial for patients who had renal arterial obstructive disease. The success of stent angioplasty of complete obstructive renal arteries reveals wide prospects for interventional method. (authors)

  2. Magnetic resonance imaging in deep pelvic endometriosis: iconographic essay

    International Nuclear Information System (INIS)

    Coutinho Junior, Antonio Carlos; Coutinho, Elisa Pompeu Dias; Lima, Claudio Marcio Amaral de Oliveira; Ribeiro, Erica Barreiros; Aidar, Marisa Nassar; Gasparetto, Emerson Leandro

    2008-01-01

    Endometriosis is characterized by the presence of normal endometrial tissue outside the uterine cavity. In patients with deep pelvic endometriosis, uterosacral ligaments, rectum, rectovaginal septum, vagina or bladder may be involved. Clinical manifestations may be variable, including pelvic pain, dysmenorrhea, dyspareunia, urinary symptoms and infertility. Complete surgical excision is the gold standard for treating this disease, and hence the importance of the preoperative work-up that usually is limited to an evaluation of sonographic and clinical data. Magnetic resonance imaging is of paramount importance in the diagnosis of endometriosis, considering its high accuracy in the identification of lesions intermingled with adhesions, and in the determination of peritoneal lesions extent. The present pictorial review describes the main magnetic resonance imaging findings in deep pelvic endometriosis. (author)

  3. Magnetic resonance imaging in deep pelvic endometriosis: iconographic essay

    Energy Technology Data Exchange (ETDEWEB)

    Coutinho Junior, Antonio Carlos; Coutinho, Elisa Pompeu Dias; Lima, Claudio Marcio Amaral de Oliveira; Ribeiro, Erica Barreiros; Aidar, Marisa Nassar [Clinica de Diagnostico por Imagem (CDPI), Rio de Janeiro, RJ (Brazil); Clinica Multi-Imagem, Rio de Janeiro, RJ (Brazil); E-mail: cmaol@br.inter.net; Gasparetto, Emerson Leandro [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Dept. de Radiologia

    2008-03-15

    Endometriosis is characterized by the presence of normal endometrial tissue outside the uterine cavity. In patients with deep pelvic endometriosis, uterosacral ligaments, rectum, rectovaginal septum, vagina or bladder may be involved. Clinical manifestations may be variable, including pelvic pain, dysmenorrhea, dyspareunia, urinary symptoms and infertility. Complete surgical excision is the gold standard for treating this disease, and hence the importance of the preoperative work-up that usually is limited to an evaluation of sonographic and clinical data. Magnetic resonance imaging is of paramount importance in the diagnosis of endometriosis, considering its high accuracy in the identification of lesions intermingled with adhesions, and in the determination of peritoneal lesions extent. The present pictorial review describes the main magnetic resonance imaging findings in deep pelvic endometriosis. (author)

  4. 18F-FDG PET-CT uptake is a feature of both normal diameter and aneurysmal aortic wall and is not related to aneurysm size

    Energy Technology Data Exchange (ETDEWEB)

    Barwick, Tara D. [Imperial College Healthcare NHS Trust, Charing Cross Hospital, Department of Radiology/Nuclear Medicine, London (United Kingdom); Hammersmith Hospital, Department of Surgery and Cancer, Imperial College London, London (United Kingdom); Lyons, O.T.A.; Waltham, M. [King' s College London, BHF Centre of Research Excellence and NIHR Biomedical Research Centre at King' s Health Partners, Academic Department of Surgery, London (United Kingdom); Mikhaeel, N.G. [Guy' s and St Thomas' Foundation NHS Trust, Department of Oncology, London (United Kingdom); O' Doherty, M.J. [King' s Health Partners, Clinical PET Centre, St Thomas' Hospital, London (United Kingdom)

    2014-12-15

    Aortic metabolic activity is suggested to correlate with presence and progression of aneurysmal disease, but has been inadequately studied. This study investigates the 2-[{sup 18}F] fluoro-2-deoxy-D-glucose ({sup 18}F-FDG) uptake in a population of infra-renal abdominal aortic aneurysms (AAA), compared to a matched non-aneurysmal control group. The Positron Emission Tomography - Computed Tomography (PET/CT) database was searched for infra-renal AAA. Exclusion criteria were prior repair, vasculitis, and saccular/mycotic thoracic or thoraco-abdominal aneurysms. Matching of 159 non-aneurysmal (<3 cm diameter) controls from the same population was assessed. Infra-renal aortic wall FDG uptake was assessed using visual analysis; maximum standardized uptake value (SUV{sub max}) and target to background mediastinal blood pool ratio (TBR) were documented. Predictors of FDG uptake (age, sex, aortic diameter, hypertension, statin use, and diabetes) were assessed using univariate analysis. Follow-up questionnaires were sent to referring clinicians. Aneurysms (n = 151) and controls (n = 159) were matched (p > 0.05) for age, sex, diabetes, hypertension, smoking status, statin use, and indication for PET/CT. Median aneurysm diameter was 5.0 cm (range 3.2-10.4). On visual analysis there was no significant difference in the overall numbers with increased visual uptake 24 % (36/151) in the aneurysm group vs. 19 % (30/159) in the controls, p = ns. SUV{sub max} was slightly lower in the aneurysm group vs. controls (mean (2 SD) 1.75(0.79) vs. 1.84(0.58), p = 0.02). However there was no difference in TBR between the AAA group and controls (mean (2 SD) 1.03 (0.46) vs. 1.05(0.31), p = 0.36). During a median 18 (interquartile range 8-35) months' follow-up 20 were repaired and four were confirmed ruptured. The level of metabolic activity as assessed by {sup 18}F-FDG PET/CT in infra-renal AAA does not correlate with aortic size and does not differ between aneurysms and matched controls

  5. Sagittal spino-pelvic alignment in adults: The Wakayama Spine Study.

    Directory of Open Access Journals (Sweden)

    Yoshiki Asai

    Full Text Available To establish the normal values of spino-pelvic alignment and to clarify the effect of age-related changes using large, community-based cohorts.In this study, data from 1461 participants (466 men, 995 women were analyzed. On lateral standing radiographs, the following parameters were measured: thoracic kyphosis (TK, lumbar lordosis (LL, pelvic tilt (PT, pelvic incidence (PI, and C7 sagittal vertical axis (SVA. All values are expressed as the mean±standard deviation. The Spearman rank correlation coefficient was used to examine correlations between variables of spino-pelvic parameters. Finally, we analyzed the relationship between age and spino-pelvic parameters. Therefore, we entered values for the body mass index (BMI, SVA, TK, and PI-LL into a multiple regression model to adjust for potential confounding factors.The SVA, TK, and PT increased with age, and LL decreased with age. Regarding sex differences, the TK was statistically significantly larger in men than in women, and LL, PT, and PI were statistically significantly smaller in men than in women. Correlation coefficients between the SVA and TK, between the SVA and PI-LL, and between TK and PI-LL were none, strong, and weak, respectively. Results of multiple regression analysis between age and spino-pelvic parameters showed that the standardized partial regression coefficients for the SVA, TK, and PI-LL were 0.17, 0.30, and 0.23, respectively, in men and 0.29, 0.32, and 0.23, respectively, in women.We found that all parameters were significantly associated with age in men and women. The SVA, TK, and PT increased with age, and LL decreased with age. Results of multiple regression analysis also demonstrated that the SVA, TK, and PI-LL are related to age. Indeed, the PI-LL value increased with age. In this study, a more excessive PI-LL mismatch was shown, indicating an increased risk of spinal malalignment. Differences in the absolute values of spino-pelvic parameters in each sex were small

  6. Laparoscopic Adhesiolysis and Relief of Chronic Pelvic Pain

    OpenAIRE

    Nezhat, Farr R.; Crystal, Ruth Ann; Nezhat, Ceana H.; Nezhat, Camran R.

    2000-01-01

    Objective: To evaluate the short- and long-term results of laparoscopic enterolysis in patients with chronic pelvic pain following hysterectomy. Methods: Forty-eight patients were evaluated at time intervals from 2 weeks to 5 years after laparoscopic enterolysis. Patients were asked to rate postoperative relief of their pelvic pain as complete/near complete relief (80-100% pain relief), significant relief (50-80% pain relief), or less than 50% or no pain relief. Results: We found that after 2...

  7. New paradigms in understanding chronic pelvic pain syndrome.

    Science.gov (United States)

    Konkle, Katy S; Clemens, J Quentin

    2011-08-01

    Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common male pain condition that is associated with significant discomfort and disability. Despite significant efforts, there remains no definitive etiology or treatment of the spectrum of pelvic symptoms reported by these patients. The purpose of this review is to summarize important clinical and scientific findings related to CP/CPPS from the previous 2 years, and to evaluate their impact on our understanding of, and approach to, the disease.

  8. Extraperitoneal urine leak after renal transplantation: the role of radionuclide imaging and the value of accompanying SPECT/CT - a case report

    International Nuclear Information System (INIS)

    Son, Hongju; Heiba, Sherif; Kostakoglu, Lale; Machac, Josef

    2010-01-01

    The differentiation of the nature of a fluid collection as a complication of kidney transplantation is important for management and treatment planning. Early and delayed radionuclide renography can play an important role in the evaluation of a urine leak. However, it is sometimes limited in the evaluation of the exact location and extent of a urine leak. A 71-year-old male who had sudden anuria, scrotal swelling and elevated creatinine level after cadaveric renal transplantation performed Tc-99 m MAG3 renography to evaluate the renal function, followed by an ultrasound which was unremarkable. An extensive urine leak was evident on the planar images. However, an exact location of the urine leak was unknown. Accompanying SPECT/CT images confirmed a urine leak extending from the lower aspect of the transplant kidney to the floor of the pelvic cavity, presacral region and the scrotum via right inguinal canal as well as to the right abdominal wall. Renal scintigraphy is very useful to detect a urine leak after renal transplantation. However, planar imaging is sometimes limited in evaluating the anatomical location and extent of a urine leak accurately. In that case accompanying SPECT/CT images are very helpful and valuable to evaluate the anatomical relationships exactly

  9. [Forensic Analysis of the Characteristics of Pelvic Fracture in 65 Road Traffic Accident Death Cases].

    Science.gov (United States)

    Zhang, W

    2016-12-01

    To analyze the characteristics and mechanisms of pelvic fractures in the cases of road traffic accident deaths. Total 65 cases of road traffic accident deaths with pelvic fracture were collected, and the sites, characteristics and injury mechanisms of pelvic fracture were statistically analyzed. Among the 65 cases of pelvic fracture, 38 cases of dislocation of sacroiliac joint were found, and most combined with pubis symphysis separation or fracture of pubis. In the fractures of pubis, ischium and acetabulum, linear fractures were most common, while comminuted fractures were most common in sacrum and coccyx fractures. There were 54 cases combined with pelvic soft tissue injury, and 8 cases with pelvic organ injury and 44 cases with abdominal organ injury. In the types of pelvic ring injury, 32 cases were separation, 49.32%, followed by compression, 26.15% and only one case was verticality, 1.54%. Detailed and comprehensive examination of the body and determination of the pelvic fracture type contribute to analyze the mechanisms of injury. Copyright© by the Editorial Department of Journal of Forensic Medicine

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

    Directory of Open Access Journals (Sweden)

    Christophe Boulay

    2014-01-01

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

  11. The pelvic fin and girdle of Panderichthys and the origin of tetrapod locomotion.

    Science.gov (United States)

    Boisvert, Catherine A

    2005-12-22

    One of the most marked transformations in the vertebrate transition to land was that of fins to limbs. This transformation involved not only the generation of morphological novelties (digits, sacrum) but also a shift in locomotory dominance from the pectoral to the pelvic appendage. Despite its importance, the transformation from pelvic fin to hindlimb is the least studied and least well-documented part of this transformation, which is bracketed by the osteolepiform Eusthenopteron and the early tetrapods Ichthyostega and Acanthostega, but is not directly illuminated by any intermediate form. Panderichthys is the closest tetrapod relative currently represented by complete fossils, but its pelvic fin skeleton has not been described. Here, I present the only known articulated pelvic fin endoskeleton and associated partial pelvis of Panderichthys. The pelvic girdle is even less tetrapod-like than that of the osteolepiform Eusthenopteron, but the pelvic fin endoskeleton shares derived characteristics with basal tetrapods despite being more primitive than the pectoral fin of Panderichthys. The evolution of tetrapod locomotion appears to have passed through a stage of body-flexion propulsion, in which the pelvic fins played a relatively minor anchoring part, before the emergence of hindlimb-powered propulsion in the interval between Panderichthys and Acanthostega.

  12. Accuracy of pelvic multiparametric MRI in diagnosing local recurrence following radical prostatectomy. Case report and revision of the literature

    Directory of Open Access Journals (Sweden)

    Pietro Pepe

    2016-01-01

    Full Text Available A Caucasian man (73 years old six years from radical prostatectomy for prostate cancer (PCa showed biochemical recurrence (BCR; the follow up based on PSA evaluated every 6 months was negative (0.1 ng/ml for 5 years, but in the last year PSA increased to 0.3 vs 0.5 ng/ml. The patient was asymptomatic and underwent 3.0 Tesla mpMRI equipped with surface 16 channels phased-array coil placed around the pelvic area; multiplanar turbo spin-echo T2-weighted (T2W, axial diffusion weighted imaging (DWI, axial dynamic contrast enhanced (DCE and spectroscopy were performed. Pelvic mpMRI demonstrated the presence of a nodular tissue with a diameter of 10 mm. located on the left of the prostatic fossa near the rectum that was higly sospicious for local PCa recurrence. The patient underwent salvage RT (64 Gy; one year from RT PSA was 0.1 ng/ml suggesting that the patient was free from recurrence. In conclusion, mpMRI could be combined with PSA kinetics in the evaluation of men with BRC also in the presence of PSA values < 1 ng/ml.

  13. [Comparison of pelvic floor muscle strength in competition-level athletes and untrained women].

    Science.gov (United States)

    Ludviksdottir, Ingunn; Hardardottir, Hildur; Sigurdardottir, Thorgerdur; Ulfarsson, Gudmundur F

    2018-01-01

    Exercise can stress the pelvic floor muscles. Numerous women experience urinary incontinence while exercising or competing in sports. This study investigated pelvic floor muscle strength, urinary incontinence, and knowledge in contracting pelvic floor muscles among female athletes and untrained women. This was a prospective case-control study measuring pelvic floor muscle strength using vaginal pressure meas-urement. Participants answered questions regarding general health, urinary incontinence, and knowledge on pelvic floor muscles. Partici-pants were healthy nulliparous women aged 18-30 years, athletes and untrained women. The athletes had competed in their sport for at least three years; including handball, soccer, gymnastics, badminton, BootCamp and CrossFit. The women were comparable in age and height. The athletes (n=18) had a body mass index (BMI) of 22.8 kg/m² vs. 25 kg/m² for the untrained (n=16); p<0.05. The athletes trained on average 11.4 hours/week while the untrained women participated in some activity on average for 1.3 hours/week; p< 0.05. Mean pelvic floor strength was 45±2 hPa in the athletes vs. 43±4 hPa in the untrained; p=0.36 for whether the athletes were stronger. Of the athletes, 61.1% experienced urinary incontinence (n=11) compared with 12.5% of the untrained women (n=2); p<0.05. Incontinence usually occurred during high intensity exercise. The athletes were more knowledgeable about the pelvic floor muscles; p<0.05. There was not a significant difference in the strength of pelvic floor muscles of athletes and untrained women. This suggests that pelvic floor muscles are not strengthened during general training but require specific exercises. This holds especially for football, handball and sports with high physical intensity. Coaches need to pay special attention to training and strengthening women's pelvic floor muscles to reduce the occurrence of urinary incontinence.

  14. Ovarian arteries supply to the pelvic lesions: angiographic identification and endovascular interventional management

    International Nuclear Information System (INIS)

    Wang Maoqiang; Liu Fengyong; Duan Feng; Wang Zhongpu; Wang Zhijun; Song Lei

    2006-01-01

    Objective: To investigate the frequency of the ovarian arteries (OVA) supply to the pelvic lesions and to evaluate the safety of transcatheter arterial embolization (TAE) of the OVA. Methods: Ninety-six patients referred for hypogastric-uterine arterial chemoembolization or embolization underwent selective ovarian arteriography,including pelvic malignancies in 63 cases, uterine fibroid in 17, and obstetric hemorrhage in 16 cases. Mean patient age was 46 years (range, 16-62 years). TAE supplementally was performed in patients with OVA supply to the pelvic lesions, using polyvinyl alcohol particles, gelatin sponge particles, and microcoils. The frequency of OVA supply to the pelvic lesions, the predictive factors, the technique and clinical significances of OVA embolization, were evaluated. Results: Bilateral OVA were catheterized selectively in 58 patients, and unilateral OVA in 38 patients. Thirty-three women (34.4%) had at least one ovarian artery supplying the pelvic lesions, including pelvic malignancies in 18, the fibroid in 5, and obstetric hemorrhage in 10 cases. The higher incidence of OVA supply to the pelvic lesions was observed in patients with obstetric disorders (χ 2 =6.73, P=0.009), with history of the pelvic surgery (χ 2 =3.55, P=0.04), with post embolization of the uterine arteries (χ 2 =6.80, P=0.009), and in patients with dysplasia of uterine artery bilaterally or unilaterally (χ 2 =3.40, P=0.04). Technical success of OVA embolization was achieved in the 33 cases, without severe complications related to the procedure. Persistent bleeding from the vagina was seen in 4 patients with obstetric hemorrhage after hypogastric-uterine arterial embolization, their bleeding ceased immediately after supplemental OVA embolization. Four patients developed transient symptoms of ovarian dysfunction after the hypogastric-uterine and OVA embolization. Conclusion: About 34% of the pelvic lesions can be supplied by OVA. Supplemental TAE of OVA is a safe and

  15. [Providing of a virtual simulator perineal anatomy (Pelvic Mentor®) in learning pelvic perineology: results of a preliminary study].

    Science.gov (United States)

    Legendre, G; Sahmoune Rachedi, L; Descamps, P; Fernandez, H

    2015-01-01

    Medical and surgical simulation is in high demand. It is widely used in North America as a method of education and training of medical students and surgical residents. Learning anatomy and vaginal surgery are based on palpation recognition of different structures. The absence of visual control of actions learners is a limiting factor for the reproducibility of surgical techniques prolapse and urinary incontinenence. However, this reproducibility is the only guarantee of success and safety of these minimally invasive surgeries. We evaluated the contribution of an educational module perineal anatomy using a system combining anatomic mannequin and a computerized 3D virtual simulator (Pelvic Mentor®, Simbionix) in the knowledge of pelvic-perineal anatomical structures for eight residents of obstetrics and gynecology hospitals in Paris. The self-study training module has led to substantial improvements in internal rating with a proportion of structures recognized from 31.25 to 87.5 % (P3D virtual simulator enhances and facilitates learning the anatomy of the pelvic floor. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  16. Spino-pelvic sagittal balance of spondylolisthesis: a review and classification.

    Science.gov (United States)

    Labelle, Hubert; Mac-Thiong, Jean-Marc; Roussouly, Pierre

    2011-09-01

    In L5-S1 spondylolisthesis, it has been clearly demonstrated over the past decade that sacro-pelvic morphology is abnormal and that it can be associated to an abnormal sacro-pelvic orientation as well as to a disturbed global sagittal balance of the spine. The purpose of this article is to review the work done within the Spinal Deformity Study Group (SDSG) over the past decade, which has led to a classification incorporating this recent knowledge. The evidence presented has been derived from the analysis of the SDSG database, a multi-center radiological database of patients with L5-S1 spondylolisthesis, collected from 43 spine surgeons in North America and Europe. The classification defines 6 types of spondylolisthesis based on features that can be assessed on sagittal radiographs of the spine and pelvis: (1) grade of slip, (2) pelvic incidence, and (3) spino-pelvic alignment. A reliability study has demonstrated substantial intra- and inter-observer reliability similar to other currently used classifications for spinal deformity. Furthermore, health-related quality of life measures were found to be significantly different between the 6 types, thus supporting the value of a classification based on spino-pelvic alignment. The clinical relevance is that clinicians need to keep in mind when planning treatment that subjects with L5-S1 spondylolisthesis are a heterogeneous group with various adaptations of their posture. In the current controversy on whether high-grade deformities should or should not be reduced, it is suggested that reduction techniques should preferably be used in subjects with evidence of abnormal posture, in order to restore global spino-pelvic balance and improve the biomechanical environment for fusion.

  17. Late solitary pelvic metastasis of hepatocellular carcinoma mimicking alpha-fetoprotein-producing gynaecologic tumour

    Directory of Open Access Journals (Sweden)

    Ji He Kim

    2018-01-01

    Full Text Available Extrahepatic spread of hepatocellular carcinoma (HCC is uncommon; and, pelvic metastasis, in particular, is extremely rare. A 71-year-old woman was admitted for evaluation of pelvic solitary solid mass. She had undergone a left lobectomy 28 years previously. Magnetic resonance imaging of the abdomen and pelvis demonstrated a heterogeneous mass in the right pelvic cavity, whereas no space-occupying lesions or ascites were detected in the liver. CA 125 levels were within normal limits; however, serum alpha-fetoprotein levels were markedly elevated. She underwent laparoscopic pelvic mass excision, total hysterectomy, and bilateral salpingo-oophorectomy. Histopathologic findings and immunochemical staining results indicated metastatic HCC. Herein, we report an unusual case of a patient with solitary recurrence in the pelvic cavity 28 years after initial diagnosis and treatment.

  18. Reliability of measuring pelvic floor elevation with a diagnostic ultrasonic imaging device

    OpenAIRE

    Ubukata, Hitomi; Maruyama, Hitoshi; Huo, Ming

    2015-01-01

    [Purpose] The purpose of this study was to investigate the reliability of measuring the amount of pelvic floor elevation during pelvic and abdominal muscle contraction with a diagnostic ultrasonic imaging device. [Subjects] The study group comprised 11 healthy women without urinary incontinence or previous birth experience. [Methods] We measured the displacement elevation of the bladder base during contraction of the abdominal and pelvic floor muscles was measured using a diagnostic ultrasoni...

  19. Relationship between female pelvic floor dysfunction and sexual dysfunction: an observational study.

    Science.gov (United States)

    Bortolami, Arianna; Vanti, Carla; Banchelli, Federico; Guccione, Andrew A; Pillastrini, Paolo

    2015-05-01

    The ability to express one's sexuality and engage in sexual activity requires multisystemic coordination involving many psychological functions as well as the integrity of the nervous, hormonal, vascular, immune, and neuromuscular body structures and functions. The purpose of this study was to investigate the associations among pelvic floor function, sexual function, and demographic and clinical characteristics in a population of women initiating physical therapy evaluation and treatment for pelvic floor-related dysfunctions (urinary incontinence, pelvic organ prolapse, vulvodynia, vaginismus, and constipation). We consented and collected completed demographic data and data related to symptoms and clinical condition on 85 consecutive patients in an outpatient physical therapy clinic. Clinical and anthropometric characteristics were analyzed descriptively. Analysis of variance and linear regression analyses were used to analyze Female Sexual Function Index (FSFI) scale ratings, whereas zero-inflated beta-binomial regression was applied to the pain subscale. Main outcome measure was FSFI score, whereas the secondary outcome measure was the FSFI subscale score related to pain. Women in our sample were 38 years old on average, 33% of whom had given birth and 82% of whom had high tone pelvic floor. Being in the middle-tercile age group and exhibiting low pelvic floor tone (Beta = 6.8; 95% confidence interval [CI] = [1.4; 12.0]) were significantly associated with lower levels of sexual dysfunction. Women with low tone pelvic floor also reported lower pain (odds ratio = 4.0; 95% CI = [1.6; 9.6]), whereas younger aged and physically unsatisfied subjects were more likely not to have sexual activity in the month prior to scale measurement. In female patients with pelvic floor muscle dysfunction undergoing physical therapy and rehabilitation, sexual dysfunction appears to be significantly correlated with age and high pelvic floor muscle tone. © 2015

  20. Efficient radiologic diagnosis of pelvic and acetabular trauma

    International Nuclear Information System (INIS)

    Kreitner, K.F.; Mildenberger, P.; Thelen, M.; Rommens, P.M.

    2000-01-01

    In spite of the widespread availability of CT scanners, conventional X-ray radiographs remain the basic imaging modality in patients with pelvic and/or acetabular trauma. However, the extent of their use will depend on local utilities (e.g., availability of CT scanners) and on the patient's clinical condition. Regarding the inaccuracy of conventional radiography in the diagnosis of injuries of the dorsal pelvic ring and of the acetabulum, computed tomography represents the most important imaging modality in the clinically stable patient. CT provides an exact staging of the extent of trauma and allows for differentiation of pelvic instabilities. CT clearly demonstrates the severity of acetabular trauma and is superior in the detection of local complicating factors, i.e., impressions fractures and (sub-)luxations of the femoral head as well as free intraarticular fragments. CT findings provide the basis for definite treatment regimens of the injured patient. By extension of the examination, all relevant organs and systems (craniospinal, cardiovascular, gastrointestinal, respiratory, genitourinary) can be imaged during one session. The speed of spiral CT scanners and their diagnostic accuracy will play a major role in the management of, especially, polytraumatized patients. The indication for angiography with the option of therapeutic embolization exists if a pelvic bleeding persists even after reposition and operative fixation of the injury. (orig.) [de