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Sample records for treated unstable pelvic

  1. The functional outcome of surgically treated unstable pelvic ring fractures by open reduction, internal fixation

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    Kaykhosro Mardanpour

    2011-07-01

    Full Text Available Background:Unstable Pelvic fracture,a result of high energy antero-posterior compression injury, has been managed based on internal fixation and open reduction. The mode of fixation in Unstable Pelvic fracture has, however, been a subject of controversy and some authors have proposed a need to address the issue of partial breach of the pelvic ring elements in these injuries. This study was performed to evaluate the functional and radiological results of treatment of pelvic ring fractures by open reduction, internal fixation. Methods: Thirty eight patients with unstable pelvic fractures, treated from 2002 to2008 were retrospectively reviewed. The mean age of patients’ was 37 years old (range 20 to 67. Twenty six patients were men and 12 women. The most common cause was a road traffic accident (N=37, 97%. There were 11 type-C and 27 type-B fractures according to Tile’s classification. Thirty six patients sustained additional injuries. The most prevalent additional injuries were lower extremity fractures. Open reduction, internal fixation as a definite management was applied for all patients. Quality of reduction was graded according to the grades proposed by Matta and Majeed’s score was used to assess the clinical outcome. The mean period of follow-up was 25 months (ranged from 6 to 109 months. About 81.6% of patients had either good or excellent radiological reduction. Results: The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients. There were 4 postoperative infections. No sexual function problem was reported. Nerve deficits recovered completely in 2 and partially in 3 of 11 patients with preoperative neurologic deficiency. There was no significant relation between functional outcome and the site of fracture Conclusion: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization that must be carried out as soon as the general ndition of the patient permits, and

  2. Treatment of Unstable Pelvic Ring Injuries.

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    Kim, Weon-Yoo

    2014-06-01

    Pelvic fractures are classified according to the stability of the pelvic ring. Unlike stable pelvic fractures, which heal without complications, unstable fractures may lead to pelvic ring deformities, which cause severe complications. An orthopedic surgeon must determine the stability of the pelvic ring by radiography and physical examination of the patient in order to ensure early, prompt treatment. This article includes anatomy of the pelvic ring, classification of pelvic ring injuries, its treatment algorithm, and corresponding cases involving unstable pelvic ring injury.

  3. Treatment of Unstable Pelvic Ring Injuries

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    Kim, Weon-Yoo

    2014-01-01

    Pelvic fractures are classified according to the stability of the pelvic ring. Unlike stable pelvic fractures, which heal without complications, unstable fractures may lead to pelvic ring deformities, which cause severe complications. An orthopedic surgeon must determine the stability of the pelvic ring by radiography and physical examination of the patient in order to ensure early, prompt treatment. This article includes anatomy of the pelvic ring, classification of pelvic ring injuries, its...

  4. [Surgical treatment of unstable pelvic fractures combined with acetabular fractures].

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    Wang, Tao; Wang, Jun; Li, Zong-yuan; Liu, Gang

    2015-05-01

    To discuss the treatment strategy of acetabular fractures and unstable pelvic fracture of the hip and to evaluate its outcome. Retrospective analysis of clinical data in 32 patients with unstable pelvic fracture and acetabular fractures from January 2007 to June 2013 were collected. There were 18 males and 14 females aged from 18 to 62 years old (means 38 years old). According to Tile classification of pelvic fracture, 11 cases were type B1, 8 were type B2.1, 7 were type B2.2, 3 were type C1.1, 2 were type C1.2, 1 was type C3. According to Judet-Letournel classification, anterior column fracture was in 1 case, transverse fracture in 8, transverse plus posterior wall fracture in 6, T-type fracture in 1, anterior column plus half transverse fractures in 5, double column fracture in 11. Other combined injuries were treated early, the surgical operation were performed after stable condition. The hip joint function and the fracture reduction were assessed during follow-up. The operative time was from 1.8 to 6.5 hours (averaged 3 hours). Two fat patients' incision occurred in fat liquefaction and healed after dressing, no incision infection happened. Only 1 case was lost to follow-up, 31 patients were followed up with a mean time of 23 months (6 to 42 months). The healing time of pelvic fracture was from 8 to 18 weeks (averaged in 10.6 weeks). The hip function was evaluated according to the Matta and Tornetta standard postoperatively, the result was excellent in 15 cases, good in 14 cases, fair and poor in 1 case respectively. The Majeed score of the hip function was 83.65? 7.67, the result was excellent in 15 cases, good in 12 cases and fair in 4 cases. The healing time of acetabular fractures was from 8 to 16 weeks (averaged in 10.2 weeks). The fracture reduction was assessed by Matta standard, the result was excellent in 15 cases, good in 12 cases and fair in 4 cases. The heterotopic ossification was evaluated by Brooker standard, 4 cases were grade I, 1 case was

  5. [Choices of the internal fixation and approaches on unstable pelvic ring fractures].

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    Bi, Da-Wei; Zu, Gang; Han, Lei; Chen, Yi-Min; Ma, Hai-Tao; Hu, Gang-Feng; Zhu, Yuan

    2017-03-25

    To discuss the suitable surgical approach and the internal fixation of unstable pelvic pelvic fractures. From May 2010 to May 2015, 45 patients with unstable pelvic fractures were treated with different approaches and fixations, including 38 males and 7 females with an average age of 45 years ranging from 21 to 61 years. The course was within 2 weeks. According to Young-Burg classification, 23 patients were lateral compression injuries, 6 patients were vertical shearing injuries, 16 patients were anterior-posterior compression injuries. All patients had hip pain and limitation of motion, the X-rays showed the pelvic ring fracture. All wounds healed well without complications, 45 cases were followed up for a mean period of 13 months (ranged 9 to 21 months). Patients with hip pain had a good postoperative pain relief. The post-operative X-rays showed the reduction was satisfied and the pelvic ring shaped well. According to Majeed standards, the final follow-up score was 93.5±11.6, 35 cases got excellent results, 8 were good, 2 were fare. The unstable pelvic and acetabular fractures are always with compound injury. Beside the reduction, to decrease the second surgery trauma should take into consideration as well, the intra-articular reduction and the stability of the pelvic were especially valued, so combined the different approach with minimal invasive technique can get good clinical result.

  6. Comparison of external fixation versus the trauma pelvic orthotic device on unstable pelvic injuries: a cadaveric study of stability.

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    Prasarn, Mark L; Horodyski, MaryBeth; Conrad, Bryan; Rubery, Paul T; Dubose, Dewayne; Small, John; Rechtine, Glenn R

    2012-06-01

    Most institutions treating pelvic fractures use some method of acute mechanical stabilization. This typically involves use of pelvic binders or circumferential sheeting, and/or external fixation. The comparative value of these different modalities is controversial. We hypothesized that an external fixator would provide more stability to an unstable pelvic injury than a commercially available binder device (trauma pelvic orthotic device [T-POD]). Unstable pelvic injuries (Tile C) were surgically created in five fresh whole human cadavers. Electromagnetic sensors were placed on the same position of each hemipelvis. The amount of angular motion during testing was measured using a Fastrak, three-dimensional, electromagnetic motion analysis device. Maximum displacements were recorded during application of the stabilizing devices, bed transfer, logrolling, and head-of-bed elevation. External fixation frames were constructed by placing two 5.0-mm half pins into the iliac crest and then connected them with a 10-mm curved bar. The T-POD device was placed at the level of the greater trochanters as per manufacturer's recommendations. While logrolling the patient and performing bed transfers, the T-POD conferred more stability in all planes of motion, although this did not reach statistical significance. During elevation of the head of the bed, the T-POD allowed less motion in the sagittal and coronal planes but permitted equivalent motion in axial rotation. These differences were not statistically significant. There were no significant differences in stability conferred by an external fixator or a T-POD for unstable pelvic injuries. We advocate acute, temporary stabilization of pelvic injuries with a binder device and early conversion to internal fixation when the patient's medical condition allows. Copyright © 2012 by Lippincott Williams & Wilkins.

  7. How Is Pelvic Pain Treated?

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    ... releasing hormone injections, or progestin-releasing intrauterine devices. Hormonal treatment for pelvic pain is not the same as hormone therapy that is sometimes used to treat the symptoms of menopause. Lifestyle changes. Some women's pain is helped by changes in ...

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

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

    2015-01-01

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

  9. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: A systematic review of literature

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    W.R. Spanjersberg (Willem); S.P. Knops (Simon); N.W.L. Schep (Niels); E.M.M. van Lieshout (Esther); P. Patka (Peter); I.B. Schipper (Inger)

    2009-01-01

    textabstractBackground: Pelvic fractures can cause massive haemorrhage. Early stabilisation and compression of unstable fractures is thought to limit blood loss. Reposition of fracture parts and reduction of pelvic volume may provide haemorrhage control. Several non-invasive techniques for early

  10. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature.

    NARCIS (Netherlands)

    Spanjersberg, W.R.; Knops, S.P.; Schep, N.W.; Lieshout, E.M. van; Patka, P.; Schipper, I.B.

    2009-01-01

    BACKGROUND: Pelvic fractures can cause massive haemorrhage. Early stabilisation and compression of unstable fractures is thought to limit blood loss. Reposition of fracture parts and reduction of pelvic volume may provide haemorrhage control. Several non-invasive techniques for early stabilisation

  11. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature

    NARCIS (Netherlands)

    Spanjersberg, Willem R.; Knops, Simon P.; Schep, Niels W. L.; van Lieshout, Esther M. M.; Patka, Peter; Schipper, Inger B.

    2009-01-01

    Pelvic fractures can cause massive haemorrhage. Early stabilisation and compression of unstable fractures is thought to limit blood loss. Reposition of fracture parts and reduction of pelvic volume may provide haemorrhage control. Several non-invasive techniques for early stabilisation have been

  12. The anterior subcutaneous internal fixator (ASIF) for unstable pelvic ring fractures: clinical and radiological mid-term results.

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    Müller, Franz Josef; Stosiek, Wolfgang; Zellner, Michael; Neugebauer, Rainer; Füchtmeier, Bernd

    2013-11-01

    The purpose of this study was to determine the outcome of unstable type C pelvic fractures treated with posterior stabilisation and the anterior subcutaneous internal fixator (ASIF). Altogether, 36 consecutive patients were treated for unstable type C pelvic ring fractures using posterior stabilisation and ASIF. After a minimum of 18 months, the clinical and radiological outcome was retrospectively investigated. Overall, three patients (8.3%) died, and 31 patients (86%) were available for follow-up after a mean of 4.5 years. Thirty of 31 patients (97%) showed radiographic bone consolidation of both the posterior and anterior pelvic ring. Only one non-union and two infections due to the anterior device were observed. The total German pelvic outcome score showed an excellent or good rating for 64.5% of the patients, and a fair or poor for 35.5%. The SF-12 questionnaire showed a significantly reduced total score for physical and mental health compared to a general reference population. The ASIF represents an innovative surgical procedure for the treatment of type C pelvic ring fractures. In the medium term, patient satisfaction was high and the complication rate was low, despite the small number of patients. More cases must be investigated before the procedure can be recommended in general, possibly replacing the external fixator for the treatment of pelvic ring fractures in the future.

  13. Time to pelvic embolization for hemodynamically unstable pelvic fractures may affect the survival for delays up to 60 min.

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    Tanizaki, Shinsuke; Maeda, Shigenobu; Matano, Hideyuki; Sera, Makoto; Nagai, Hideya; Ishida, Hiroshi

    2014-04-01

    We evaluated the relationship between survival and time from arrival to angiography for hemodynamically unstable patients with pelvic trauma. A retrospective review of patients admitted to Fukui Prefectural Hospital with pelvic fractures during a 7.5-year period. Charts were reviewed for age, injury characteristics, injury severity score, systolic blood pressure and heart rate on arrival, base deficit, and the lactate concentration on arrival, transfusion requirement, fracture pattern, the time from hospital arrival to angiography, and the time spent in the angiography suite. Of a total of 140 patients, 68 patients underwent pelvic angiography and embolization. Of the patients, 24 patients were hemodynamically unstable. The average injury severity score was 41.7. Of the patients, 17 had major ligamentous disruption. The average time from hospital arrival to angiography suite was 76 min. Of the hemodynamically unstable 24 patients, there were 12 deaths (50%). Patients who were embolized within 60 min of arrival had a significantly lower mortality rate (16 vs. 64%; p=0.04). There was no embolization-related complication and repeat angiography was not required in all patients. Earlier pelvic embolization within 60 min may affect the survival of hemodynamically unstable patients with pelvic fracture. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. REHABILITATION OF PATIENTS WITH UNSTABLE PELVIC RING INJURY IN POLYTRAUMA IN THE EARLY POSTOPERATIVE PERIOD

    Directory of Open Access Journals (Sweden)

    V. A. Shchetkin

    2014-01-01

    Full Text Available BACKGROUND. The relevance of such an issue as the treatment of patients with unstable pelvic ring fracture is caused by the high frequency of this pathology in the general structure of polytrauma — up to 34% and a high rate of poor functional treatment outcomes — up to 20%. Purpose of the study: the improvement of rehabilitation treatment in patients with polytrauma operated on for complex fractures of the pelvis, using mechanotherapy and electro stimulation in the complex of therapy of an early postoperative period.MATERIAL AND METHODS. There were 81 patients with severe pelvic ring injuries treated in N.V. Sklifosovsky Research Institute for Emergency Medicine in 2010 – 2013. The main group consisted of 29 patients who were recommended a comprehensive methodology of rehabilitation, including therapeutic exercises (TE, mechanotherapy using the simulator “RECK MOTOmed letto2” and electro stimulation using the “Galatea” apparatus. The test group consisted of 52 patients who underwent rehabilitation treatment only by methods of therapeutic exercises. Overall effectiveness of the treatment was evaluated using the Majeed score.CONCLUSION. Early use of therapeutic exercises in combination with mechanical therapy and electrical stimulation in patients operated on for unstable pelvic ring injuries, helps reduce pain syndrome, shortens the period of bed rest from 17.5 to 7.6 days and the duration of hospital stay from 46.1 to 35.2 days. At the same time, the 14.1% increase of excellent and good functional outcomes based on Majeed score is registered. 

  15. Comparison of circumferential pelvic sheeting versus the T-POD on unstable pelvic injuries: A cadaveric study of stability.

    Science.gov (United States)

    Prasarn, Mark L; Conrad, Bryan; Small, John; Horodyski, MaryBeth; Rechtine, Glenn R

    2013-12-01

    Commercially available binder devices are commonly used in the acute treatment of pelvic fractures, while many advocate simply placing a circumferential sheet for initial stabilization of such injuries. We sought to determine whether or not the T-POD would provide more stability to an unstable pelvic injury as compared to circumferential pelvic sheeting. Unstable pelvic injuries (OTA type 61-C-1) were surgically created in five fresh, lightly embalmed whole human cadavers. Electromagnetic sensors were placed on each hemi-pelvis. The amount of angular motion during testing was measured using a Fastrak, three-dimensional, electromagnetic motion analysis device (Polhemus Inc., Colchester, VT). Either a T-POD or circumferential sheet was applied in random order for testing. The measurements recorded in this investigation included maximum displacements for sagittal, coronal, and axial rotation during application of the device, bed transfer, log-rolling, and head of bed elevation. There were no differences in motion of the injured hemi-pelvis during application of either the T-POD or circumferential sheet. During the bed transfer, log-rolling, and head of bed elevation, there were no significant differences in displacements observed when the pelvis was immobilized with either a sheet or pelvic binder (T-POD). A circumferential pelvic sheet is more readily available, costs less, is more versatile, and is equally as efficacious at immobilizing the unstable pelvis as compared to the T-POD. We advocate the use of circumferential sheeting for temporary stabilization of unstable pelvic injuries. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Effect of a new pelvic stabilizer (T-POD®) on reduction of pelvic volume and haemodynamic stability in unstable pelvic fractures.

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    Tan, Edward C T H; van Stigt, Sander F L; van Vugt, Arie B

    2010-12-01

    Pelvic fractures, often the result of high energy blunt trauma, are associated with severe morbidity and mortality. A new pelvic stabilizer (T-POD®) provides secure and effective simultaneous circumferential compression of the pelvis. In this study we describe 15 patients with a prehospital untreated unstable pelvic fracture with signs of hypovolaemic shock with the T-POD®. Before and 2 min after applying the T-POD®, heart rate and blood pressure were measured. An X-ray before and directly after applying the T-POD® was made to measure the effect on reduction in symphyseal diastasis. Application of the T-POD® reduced the symphyseal diastasis with 60% (p = 0.01). The mean arterial pressure (MAP) increased significant from 65.3 to 81.2 mm Hg (p = 0.03) and the heart rate declined from 107 beats per minute to 94 (p = 0.02). Out of ten patients in whom the circulatory response before and after the T-POD® was recorded, seven were good responders, one had a transient response and two responded poor. In the acute setting, the T-POD® device has a clear compressive effect on the pelvic volume in unstable pelvic fractures. The T-POD® is therefore an effective and easy to use device in (temporarily) stabilizing the pelvic ring in haemodynamically unstable patients.

  17. Immediate percutaneous sacroiliac screw insertion for unstable pelvic fractures: is it safe enough?

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    Acker, A; Perry, Z H; Blum, S; Shaked, G; Korngreen, A

    2018-04-01

    The purpose of this study was to compare the results of immediate and delayed percutaneous sacroiliac screws surgery for unstable pelvic fractures, regarding technical results and complication rate. Retrospective study. The study was conducted at the Soroka University Medical center, Beer Sheva, Israel, which is a level 1 trauma Center. 108 patients with unstable pelvic injuries were operated by the orthopedic department at the Soroka University Medical Center between the years 1999-2010. A retrospective analysis found 50 patients with immediate surgery and 58 patients with delayed surgery. Preoperative and postoperative imaging were analyzed and data was collected regarding complications. All patients were operated on by using the same technique-percutaneous fixation of sacroiliac joint with cannulated screws. The study's primary outcome measure was the safety and quality of the early operation in comparison with the late operation. A total of 156 sacroiliac screws were inserted. No differences were found between the immediate and delayed treatment groups regarding technical outcome measures (P value = 0.44) and complication rate (P value = 0.42). The current study demonstrated that immediate percutaneous sacroiliac screw insertion for unstable pelvic fractures produced equally good technical results, in comparison with the conventional delayed operation, without additional complications.

  18. 3D printing-based minimally invasive cannulated screw treatment of unstable pelvic fracture.

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    Cai, Leyi; Zhang, Yingying; Chen, Chunhui; Lou, Yiting; Guo, Xiaoshan; Wang, Jianshun

    2018-04-04

    Open reduction and internal fixation of pelvic fractures could restore the stability of the pelvic ring, but there were several problems. Minimally invasive closed reduction cannulated screw treatment of pelvic fractures has lots advantages. However, how to insert the cannulated screw safely and effectively to achieve a reliable fixation were still hard for orthopedist. Our aim was to explore the significance of 3D printing technology as a new method for minimally invasive cannulated screw treatment of unstable pelvic fracture. One hundred thirty-seven patients with unstable pelvic fractures from 2014 to 2016 were retrospectively analyzed. Based on the usage of 3D printing technology for preoperative simulation surgery, they were assigned to 3D printing group (n = 65) and control group (n = 72), respectively. These two groups were assessed in terms of operative time, intraoperative fluoroscopy, postoperative reduction effect, fracture healing time, and follow-up function. The effect of 3D printing technology was evaluated through minimally invasive cannulated screw treatment. There was no significant difference in these two groups with respect to general conditions, such as age, gender, fracture type, time from injury to operation, injury cause, and combined injury. Length of surgery and average number of fluoroscopies were statistically different for 3D printing group and the control group (p 3D printing group, versus 22/72 cases (30.6%) scored as excellent and 36/72 cases (50%) as good for the control group. On the other hand, using the Majeed functional scoring criteria, there were 27/65 (41.5%) excellent and 26/65 (40%) good cases for the 3D printing group in comparison to 30/72 (41.7%) and 28/72 (38.9%) cases for the control group, respectively. This suggests no significant difference between these two groups about the function outcomes. Full reduction and proper fixation of the pelvic ring and reconstruction of anatomical morphology are of great

  19. When do anterior external or internal fixators provide additional stability in an unstable (Tile C) pelvic fracture? A biomechanical study.

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    Mcdonald, E; Theologis, A A; Horst, P; Kandemir, U; Pekmezci, M

    2015-12-01

    This study aimed at evaluating the additional stability that is provided by anterior external and internal fixators in an unstable pelvic fracture model (OTA 61-C). An unstable pelvic fracture (OTA 61-C) was created in 27 synthetic pelves by making a 5-mm gap through the sacral foramina (posterior injury) and an ipsilateral pubic rami fracture (anterior injury). The posterior injury was fixed with either a single iliosacral (IS) screw, a single trans-iliac, trans-sacral (TS) screw, or two iliosacral screws (S1S2). Two anterior fixation techniques were utilized: external fixation (Ex-Fix) and supra-acetabular external fixation and internal fixation (In-Fix); supra-acetabular pedicle screws connected with a single subcutaneous spinal rod. The specimens were tested using a nondestructive single-leg stance model. Peak-to-peak (P2P) displacement and rotation and conditioning displacement (CD) were calculated. The Ex-Fix group failed in 83.3 % of specimens with concomitant single-level posterior fixation (Total: 15/18-7 of 9 IS fixation, 8 of 9 TS fixation), and 0 % (0/9) of specimens with concomitant two-level (S1S2) posterior fixation. All specimens with the In-Fix survived testing except for two specimens treated with In-Fix combined with IS fixation. Trans-sacral fixation had higher pubic rotation and greater sacral and pubic displacement than S1S2 (p pelvic fracture (OTA 61-C), anterior fixation with an In-Fix was biomechanically superior to an anterior Ex-Fix in the setting of single-level posterior fixation. There was no biomechanical difference between the In-Fix and Ex-Fix when each was combined with two levels of posterior sacral fixation.

  20. Technical and clinical outcome of percutaneous CT fluoroscopy-guided screw placement in unstable injuries of the posterior pelvic ring

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    Strobl, Frederik F.; Haeussler, Sophia M.; Paprottka, Philipp M.; Hoffmann, Ralf-Thorsten; Reiser, Maximilian F.; Trumm, Christoph G. [Institute for Clinical Radiology, Munich (Germany); Pieske, Oliver [Ludwig-Maximilians-University Hospital Munich, Department of Trauma Surgery, Munich (Germany)

    2014-08-15

    To evaluate technical success, complications, and effective dose in patients undergoing CT fluoroscopy-guided iliosacral screw placement for the fixation of unstable posterior pelvic ring injuries. Our retrospective analysis includes all consecutive patients with vertical sacral fractures and/or injury of the iliosacral joint treated with CT fluoroscopy-guided screw placement in our department from 11/2005 to 03/2013. Interventions were carried out under general anesthesia and CT fluoroscopy (10-20 mAs; 120 kV; 16- or 128-row scanner, Siemens Healthcare, Erlangen, Germany). Technical outcome, major and minor complications, and effective patient dose were analyzed. We treated 99 consecutive patients (mean age 53.1 ± 21.7 years, 50 male, 49 female) with posterior pelvic ring instability with CT fluoroscopy-guided screw placement. Intervention was technically successful in all patients (n = 99). No major and one minor local complication occurred (1 %, secondary screw dislocation). General complications included three cases of death (3 %) due to pulmonary embolism (n = 1), hemorrhagic shock (n = 1), or cardiac event (n = 1) during a follow-up period of 30 days. General complications were not related to the intervention. Mean effective patient radiation dose per intervention was 12.28 mSv ± 7.25 mSv. Mean procedural time was 72.1 ± 37.4 min. CT fluoroscopy-guided screw placement for the treatment of posterior pelvic ring instabilities can be performed with high technical success and a low complication rate. This method provides excellent intrainterventional visualization of iliac and sacral bones, as well as the sacral neuroforamina for precise screw placement by applying an acceptable effective patient dose. (orig.)

  1. Technical and clinical outcome of percutaneous CT fluoroscopy-guided screw placement in unstable injuries of the posterior pelvic ring

    International Nuclear Information System (INIS)

    Strobl, Frederik F.; Haeussler, Sophia M.; Paprottka, Philipp M.; Hoffmann, Ralf-Thorsten; Reiser, Maximilian F.; Trumm, Christoph G.; Pieske, Oliver

    2014-01-01

    To evaluate technical success, complications, and effective dose in patients undergoing CT fluoroscopy-guided iliosacral screw placement for the fixation of unstable posterior pelvic ring injuries. Our retrospective analysis includes all consecutive patients with vertical sacral fractures and/or injury of the iliosacral joint treated with CT fluoroscopy-guided screw placement in our department from 11/2005 to 03/2013. Interventions were carried out under general anesthesia and CT fluoroscopy (10-20 mAs; 120 kV; 16- or 128-row scanner, Siemens Healthcare, Erlangen, Germany). Technical outcome, major and minor complications, and effective patient dose were analyzed. We treated 99 consecutive patients (mean age 53.1 ± 21.7 years, 50 male, 49 female) with posterior pelvic ring instability with CT fluoroscopy-guided screw placement. Intervention was technically successful in all patients (n = 99). No major and one minor local complication occurred (1 %, secondary screw dislocation). General complications included three cases of death (3 %) due to pulmonary embolism (n = 1), hemorrhagic shock (n = 1), or cardiac event (n = 1) during a follow-up period of 30 days. General complications were not related to the intervention. Mean effective patient radiation dose per intervention was 12.28 mSv ± 7.25 mSv. Mean procedural time was 72.1 ± 37.4 min. CT fluoroscopy-guided screw placement for the treatment of posterior pelvic ring instabilities can be performed with high technical success and a low complication rate. This method provides excellent intrainterventional visualization of iliac and sacral bones, as well as the sacral neuroforamina for precise screw placement by applying an acceptable effective patient dose. (orig.)

  2. How bilateral iliolumbar fusion increases the stability of horizontal osteosynthesis in unstable pelvic ring injuries?

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    Bodzay, T; Sztrinkai, G; Gál, T; Simonovics, J; Váradi, K

    2013-07-01

    In type C pelvic ring injuries, the operative stabilization of the posterior ring is absolutely indicated. There exist four different types of operative methods: iliosacral screw fixation, transsacral plate synthesis, ventral plate fixation (primarily for sacroiliac luxations), and local plate synthesis performed on the dorsal cortex of the sacrum. In our current article, we analyzed the stability of fixation methods used together with bilateral iliolumbar techniques. We analyzed a finite element pelvic model attached to lumbar 4-5 vertebrae. By imitating a standing position on two feet, we measured the differences in tension and displacement in T1 and T2 thoracic vertebrae fractures with and without iliolumbar fusion in cases of iliosacral screw fixation, transsacral plate synthesis and KFI-H (small fragment-H) plate synthesis. The osteosynthesises reinforced via Galveston technique were rather stable; the amount of displacement measured in the fracture gap was significantly less than in the cases without iliolumbar fusion. The tension in the implants were below the allowed values, therefore they were capable of withstanding the imposed loads without permanent deformation. In unilateral pelvis injuries, if a non-weight bearing status cannot be achieved on the injured side, unilateral iliolumbar fusion reinforcement is justified, since the contralateral lower limb must also be non-weight bearing due to the pelvis injury itself. In the case of the most unstable sacrum fracture--"jumper's fracture", bilateral iliolumbar fusion is necessary, in which case the patient will be able to bear weight during the early postoperative period.

  3. Kendrick's extrication device and unstable pelvic fractures: Should a trochanteric belt be added? A cadaveric study.

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    Reynard, Floran A; Flaris, Alexandros N; Simms, Eric R; Rouvière, Olivier; Roy, Pascal; Prat, Nicolas J; Damizet, Jean-Gabriel; Caillot, Jean-Louis; Voiglio, Eric J

    2016-03-01

    Pre-hospital pelvic stabilisation is advised to prevent exsanguination in patients with unstable pelvic fractures (UPFs). Kendrick's extrication device (KED) is commonly used to extricate patients from cars or crevasses. However the KED has not been tested for potential adverse effects in patients with pelvic fractures. The aim of this study was to examine the effect of the KED on pubic symphysis diastasis (SyD) with and without the use of a trochanteric belt (TB) during the extraction process following a MVC. Left-sided "open-book" UPFs were created in 18 human cadavers that were placed in seven different positions simulating pre-extraction and extraction positions using the KED with and without a TB in two different positions (through and over the thigh straps). The SyD was measured using anteroposterior radiographs. The effects of the KED with and without TB, on the SyD, were evaluated. The KED alone resulted in a non-significant increase of the SyD compared to baseline, whereas the addition of a TB to the KED resulted in a significant reduction of the SyD (p<0.001). The TB through the straps provided a significantly better reduction than the TB over the straps in the extracted position (p<0.05). Our study demonstrated that a TB in combination with the KED on UPFs is an effective way to achieve early reduction. The addition of the TB in combination with the KED could be considered for Pre-Hospital Trauma Life Support (PHTLS) training protocols. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality.

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    Yoshihara, Hiroyuki; Yoneoka, Daisuke

    2014-02-01

    Unstable pelvic fracture is predominantly caused by high-energy blunt trauma and is associated with a high risk of mortality. The epidemiology in the United States is largely unknown. The purpose of this study was to examine the epidemiology of unstable pelvic fracture based on patient and hospital demographics in the United States during the last decade. The Nationwide Inpatient Sample was used to identify patients who were hospitalized with unstable pelvic fracture from 2000 to 2009, using the International Classification of Diseases--9th Rev.--Clinical Modification (ICD-9-CM) codes. The primary outcome parameter consisted of analyzing the temporal trends of in-hospital admissions for unstable pelvic fracture and the associated in-hospital mortality. The data were stratified by demographic variables, including age, sex, race, and hospital region in the United States. From 2000 to 2009, there were 24,059 patients in total; among these, 1,823 (7.6%) had open fractures, and 22,236 (92.4%) had closed fractures. The population growth-adjusted incidence was stable over time (p = 0.431). The incidence was the lowest in the northeastern region. The in-hospital mortality rate in patients with unstable pelvic fracture was 8.3% (21.3% for open fracture, 7.2% for closed fracture) and remained stable over time (p = 0.089). The in-hospital mortality rate was higher in several subgroups of patients, such as older patients, male patients, African-American patients, and patients in the northeastern region. During the last decade, the incidence of unstable pelvic fracture has remained stable over time in the United States. The in-hospital mortality rate in patients with unstable pelvic fracture was 8.3% and remained stable over time. The rate in patients with an open fracture was approximately three times higher than that in patients with a closed fracture. The incidence was the lowest, but the in-hospital mortality rate was the highest in the northeastern region compared with the

  5. Ligamentous contributions to pelvic stability in a rotationally unstable open-book injury: a cadaver study.

    Science.gov (United States)

    Abdelfattah, Adham; Moed, Berton R

    2014-10-01

    Due to the orientation of the sacroiliac joint (SIJ), as the symphysis widens in an open-book pelvic ring disruption, it should displace inferiorly. The purposes of this study were to reconfirm this inferior displacement and to evaluate the relative contributions of the pubic symphysis (PS), the sacrotuberous/sacrospinous ligament complex (STL/SSL) and the anterior sacroiliac ligament (ASIL) to pelvic ring stability in a rotationally unstable open-book injury. For each of 6 cadaver pelves, the right hemipelvis was fixed to a table and the PS was sectioned. Under fluoroscopy, a manual external rotational force was then applied through the unfixed, left ilium. At the point of maximal displacement, a permanent AP image was obtained. With magnification corrected, horizontal (H) and vertical (V) displacements were measured. The pelves were then divided into two groups of three each. In Group 1, the PS release was followed by sectioning of the STL/SSL, and then the ASIL. In Group 2, the PS release was followed by sectioning of the ASIL and then the STL/SSL. The above described technique of manual manipulation and radiographic measurement was repeated after each stage of ligament release. The displacement after initial PS sectioning was not significantly different when comparing Group 1 to Group 2. In both groups, a significant and progressive increase in displacement was noted when the PS (H and V; ppelvic ring external rotational stability. However, the SSL/STL has little, if any, effect in this regard. Due to the orientation of the SIJ, external rotation of the hemipelvis, as in open-book injury, will show inferior vertical, as well as horizontal, displacement on the AP radiograph, despite the PSIL being intact. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. How Are Pelvic Floor Disorders Commonly Treated?

    Science.gov (United States)

    ... incontinence at the time of surgery for pelvic organ prolapse in women who don't have symptoms of stress incontinence can help to prevent stress incontinence from occurring after surgery and without increasing ... organ prolapse. American Family Physician, 81 , 1111-1117. Shamliyan, ...

  7. Three-in-one protocol reduces mortality of patients with haemodynamically unstable pelvic fractures-a five year multi-centred review in Hong Kong.

    Science.gov (United States)

    Cheng, Mina; Lee, Kin-Yan; Chang, Annice-M L; Ho, Hiu-Fai; Chan, Lily-P S; Lee, Kin-Bong; Kwok, Philip-C H; Lee, Alexander-C W; Wong, Kevin-Y K; Kam, Chak-Wah; Leung, Gilberto-K K; Wong, John-K S; Cheung, Nai-Kwong; Yeung, Janice-H H; Tang, Ning; Choi, Shing-Hing; Lau, Tak-Wing; Wong, Heidi-H T; Leung, Ming

    2018-02-27

    The mortality rate in patients with haemodynamically unstable pelvic fractures is as high as 40-60%. Despite the new advances in trauma care which are in phase in trauma centres in Hong Kong, the management of haemodynamically unstable pelvic fracture is still heterogeneous. The aim of this study is to review the results of management of haemodynamically unstable pelvic fracture patients in Hong Kong over a five year period. This is a retrospective multi-centred cohort study of patients with haemodynamic and mechanically unstable pelvic fractures from 1 January 2010 to 31 December 2014. The primary outcome investigated is mortality of patients (including overall, 30-day, 7-day and 24-hour mortalities). Implementation of three-in-one pelvic damage control protocol was identified to be a significant independent predictive factor for overall, 30-day, seven-day and 24-hour mortalities. The overall in-hospital and 30-day mortality rates for patients managed with three-in-one protocol was 12.5%, while it was 11% for seven day mortality and 6% for 24 hour mortality. There were no significant differences in demographic characteristics, physiological measurements, types of pelvic fracture, severity and mechanism of injury between patients managed with or without three-in-one protocol. Implementation of the multidisciplinary three-in-one pelvic damage control protocol reduces mortality and therefore should be highly recommended. The results are convincing as it has eliminated the limitations of our previous single-centred trial.

  8. Effect of a new pelvic stabilizer (T-POD) on reduction of pelvic volume and haemodynamic stability in unstable pelvic fractures.

    NARCIS (Netherlands)

    Tan, E.C.T.H.; Stigt, S.F. van; Vugt, A.B. van

    2010-01-01

    BACKGROUND: Pelvic fractures, often the result of high energy blunt trauma, are associated with severe morbidity and mortality. A new pelvic stabilizer (T-POD) provides secure and effective simultaneous circumferential compression of the pelvis. METHODS: In this study we describe 15 patients with a

  9. UNSTABLE FEMORAL FRACTURES TREATED WITH TITANIUM ELASTIC INTRAMEDULLARY NAILS, IN CHILDREN

    OpenAIRE

    Soni, Jamil Faissal; Schelle, Gisele; Valenza, Weverley; Pavelec, Anna Carolina; Souza, Camila Deneka Arantes

    2012-01-01

    Objective: To evaluate the indications, epidemiology, associated lesions, complications and prognosis among children with unstable femoral diaphysis fractures who were treated with titanium elastic intramedullary nails. Method: This was a retrospective analysis on 24 patients aged 5-12 years with unstable femoral diaphysis fractures who underwent surgical treatment with elastic titanium intramedullary nails at the Cajuru University Hospital, Curitiba-PR, between April 2002 and March 2008, wit...

  10. Intraoperative Computed Tomography Navigation for Transpedicular Screw Fixation to Treat Unstable Thoracic and Lumbar Spine Fractures

    Science.gov (United States)

    Lee, Ching-Yu; Wu, Meng-Huang; Li, Yen-Yao; Cheng, Chin-Chang; Hsu, Chu-Hsiang; Huang, Tsung-Jen; Hsu, Robert Wen-Wei

    2015-01-01

    Abstract Transpedicular screw (TPS) fixation in unstable thoracic and lumbar (TL) spine fractures remains technically difficult because of destroyed anatomical landmarks, unstable gross segments, and discrepancies in anatomic orientation using conventional anatomic landmarks, fluoroscopic guidance, or computed tomography (CT)-based navigation. In this study, we evaluated the safety and accuracy of TPS placement under intraoperative computed tomography (iCT) navigation in managing unstable TL spine fractures. From 2010 to 2013, we retrospectively reviewed the Spine Operation Registry records of patients who underwent posterior instrumented fusion to treat unstable TL spine fractures via the iCT navigation system. An unstable spine fracture was identified as AO/Magerl classification type B or type C. In all, 316 screws in 37 patients with unstable TL spine fractures were evaluated and involved 7 thoracic, 23 thoracolumbar junctional, and 7 lumbar fractures. The accuracy of TPS positioning in the pedicle without breach was 98% (310/316). The average number of iCT scans per patient was 2.1 (range 2–3). The average total radiation dose to patients was 15.8 mSv; the dose per single level exposure was 2.7 mSv. The TPS intraoperative revision rate was 0.6% (2/316) and no neurovascular sequela was observed. TPS fixation using the iCT navigation system obtained a 98% accuracy in stabilizing unstable TL spine fractures. A malplaced TPS could be revised during real-time confirmation of the TPS position, and no secondary operation was required to revise malplaced screws. The iCT navigation system provides accurate and safe management of unstable TL spine fractures. In addition, operating room personnel, including surgeons and nurses, did not need to wear heavy lead aprons as they were not exposed to radiation. PMID:25997042

  11. Does Lumbopelvic Fixation Add Stability? A Cadaveric Biomechanical Analysis of an Unstable Pelvic Fracture Model.

    Science.gov (United States)

    Jazini, Ehsan; Klocke, Noelle; Tannous, Oliver; Johal, Herman S; Hao, John; Salloum, Kanaan; Gelb, Daniel E; Nascone, Jason W; Belin, Eric; Hoshino, C Max; Hussain, Mir; OʼToole, Robert V; Bucklen, Brandon; Ludwig, Steven C

    2017-01-01

    We sought to determine the role of lumbopelvic fixation (LPF) in the treatment of zone II sacral fractures with varying levels of sacral comminution combined with anterior pelvic ring (PR) instability. We also sought to determine the proximal extent of LPF necessary for adequate stabilization and the role of LPF in complex sacral fractures when only 1 transiliac-transsacral (TI-TS) screw is feasible. Fifteen L4 to pelvis fresh-frozen cadaveric specimens were tested intact in flexion-extension (FE) and axial rotation (AR) in a bilateral stance gliding hip model. Two comminution severities were simulated through the sacral foramen using an oscillating saw, with either a single vertical fracture (small gap, 1 mm) or 2 vertical fractures 10 mm apart with the intermediary bone removed (large gap). We assessed sacral fracture zone (SZ), PR, and total lumbopelvic (TL) stability during FE and AR. The following variables were tested: (1) presence of transverse cross-connector, (2) presence of anterior plate, (3) extent of LPF (L4 vs. L5), (4) fracture gap size (small vs. large), (5) number of TI-TS screws (1 vs. 2). The transverse cross-connector and anterior plate significantly increased PR stability during AR (P = 0.02 and P = 0.01, respectively). Increased sacral comminution significantly affected SZ stability during FE (P = 0.01). Two versus 1 TI-TS screw in a large-gap model significantly affected TL stability (P = 0.04) and trended toward increased SZ stabilization during FE (P = 0.08). Addition of LPF (L4 and L5) significantly improved SZ and TL stability during AR and FE (P < 0.05). LPF in combination with TI-TS screws resulted in the least amount of motion across all 3 zones (SZ, PR, and TL) compared with all other constructs in both small-gap and large-gap models. The role of LPF in the treatment of complex sacral fractures is supported, especially in the setting of sacral comminution. LPF with proximal fixation at L4 in a hybrid approach might be needed in highly

  12. Tissue engineering as a potential alternative or adjunct to surgical reconstruction in treating pelvic organ prolapse

    DEFF Research Database (Denmark)

    Boennelycke, M; Gräs, Søren; Lose, G

    2013-01-01

    Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP).......Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP)....

  13. UNSTABLE FEMORAL FRACTURES TREATED WITH TITANIUM ELASTIC INTRAMEDULLARY NAILS, IN CHILDREN.

    Science.gov (United States)

    Soni, Jamil Faissal; Schelle, Gisele; Valenza, Weverley; Pavelec, Anna Carolina; Souza, Camila Deneka Arantes

    2012-01-01

    To evaluate the indications, epidemiology, associated lesions, complications and prognosis among children with unstable femoral diaphysis fractures who were treated with titanium elastic intramedullary nails. This was a retrospective analysis on 24 patients aged 5-12 years with unstable femoral diaphysis fractures who underwent surgical treatment with elastic titanium intramedullary nails at the Cajuru University Hospital, Curitiba-PR, between April 2002 and March 2008, with a minimum follow-up of 36 months. The epidemiological data, angular deviations, leg shortening and bone consolidation were evaluated. The medical files of 113 cases operated between April 2002 and March 2008 were reassessed. From these, 24 cases of unstable femoral diaphysis fractures treated with elastic titanium intramedullary nails with retrograde insertion were included in the study. There were two bilateral fractures and two exposed fractures. Seven patients were female and 17 were male, and the mean age was 8.3 years. The following were presented at the end of the study: shortening, varus or valgus displacement, final retrocurvatum or antecurvatum of zero, and absence of delayed consolidation or pseudarthrosis. The elastic titanium intramedullary nails were easily placed and removed. We believe that using elastic titanium intramedullary nails is a good option for fixation of unstable femoral fractures in children.

  14. Haemodynamically Unstable Pelvic Fractures

    Science.gov (United States)

    2009-01-01

    DPL ) and/or CT scanning. When performed by properly accredited staff as part of the Focused Assessment with Sonography for Trauma (FAST), abdominal...peritoneal lavage ( DPL ) may be used in cases of equivocal ultrasound findings, which may be caused by anatomic distortions of the retroperitoneum from...injury.121Used alone in this patient population however, DPL is associated with a high number of false positive results, non-therapeutic laparotomy and

  15. How to Treat the Complex Unstable Intertrochanteric Fractures in Elderly Patients? DHS or Arthroplasty

    Directory of Open Access Journals (Sweden)

    Ebrahim Hasankhani

    2014-09-01

    Full Text Available Background:  Due to difficulty in obtaining anatomical reduction, management of the unstable intertrochanteric fractures in elderly osteoporotic patients is challenging. The purpose of this study is to compare the results of hip arthroplasty (total, hemi, or bipolar with DHS in the elderly patients with unstable intertrochanteric fractures.   Methods:  We prospectively studied and followed-up 80 old patients with complex unstable intertrochanteric fracture from January 2007 to December 2010. Depending on the time of the patients’ admission, we alternatively treated them by DHS and arthroplasty, and placed them in Groups A and B, respectively. We followed them up radiologically and also clinically by Harris Hip Score for more than 24 months. Statistical analysis was performed using SPSS version 11.5 for Windows.  Results: The mean length of follow-up and age were 34.3±4.1 months (ranged; 24-59 and the 75.2±5.2 years (ranged; 58-96, respectively. Comparing Group A with B, demographic data, mean blood loss, duration of operation, time to walking and duration of hospital stay had no significant difference but overall device related complications were significantly higher in Group A. Functional scores were also higher in Group B, but this difference was not significant statistically. In both groups, the patients with Type A3 compared with Type A2, had more duration of surgery and blood loss.  Conclusions:  Arthroplasty is an alternative treatment in elderly patients with unstable intertrochanteric fractures and can provide good and satisfactory clinical outcomes associated with low complication and mortality rates.

  16. Safflower yellow injection combined with conventional therapy in treating unstable angina pectoris: a meta-analysis.

    Science.gov (United States)

    Kong, Dezhao; Xia, Wei; Zhang, Zhe; Xiao, Lei; Yuan, Dongchao; Liu, Yue; Yang, Guanlin

    2013-10-01

    To evaluate the clinical efficacy of safflower yellow injection combined with conventional therapy in treating unstable angina pectoris. We searched online databases: Chinese journal full-text database, China National Knowledge Infrastructure, Wanfang database, Chinese journal full-text database, Pubmed, ScienceDirect, Embase, and the Cochrane Library with manual-screening of relevant literature. Eligible randomized controlled trials (RCT) on angina pectoris were included. We conducted meta-analysis using the RevMan 5.1 software from The Cochrane Collaboration. We treated the relief rate of angina symptoms and electrocardiograph (ECG) as evaluation. Seven articles, including in 1134 patients, were enrolled after the evaluation. There was no significant heterogeneity among the studies (chi2 = 1.08, df = 6, P = 0.98, I2 = 0%). The safflower yellow injection with conventional therapy has a higher effective rate than the control group in relieving the symptoms of angina pectoris [odds ratio (OR)= 2.95, 95% (CI) (1.81, 4.81)] and improving ischemic ECG [OR = 2.85, 95% CI (1.67, 4.86)]. The difference was statistically significant in the "80 mg dosage" and "100 mg dosage" subgroups (P unstable angina and improving ECG over basic therapy alone. However, the conclusions should be interpreted with care until more high-quality RCTs are reported.

  17. [Clinical effect and mechanismn of xuefu zhuyu capsule in treating unstable angina pectoris].

    Science.gov (United States)

    Zheng, Guo-ling; Wang, Sheng-hua

    2009-01-01

    To observe the clinical effect of Xuefu Zhuyu Capsule (XFZYC) in treating unstable angina pectoris (UAP) and to investigate its mechanism of protection on vascular endothelia. Sixty UAP patients were randomly assigned to two groups, the 30 in the treated group were treated by conventional therapy plus XFZYC, and the 30 in the control group treated by conventional therapy alone. The frequency and persistent time of angina pectois, dosage of nitroglycerin used, changes of electrocardiogram (ECG) were observed, and the plasma levels of endothelin (ET), nitric oxide (NO), von Willebrand factor (vWF), soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1) were tested before and after the two-month therapeutic course. (1) The clinical symptoms as frequency and persistent time of angina pectoris in the treated group were bettered significantly after treatment and the dosage of nitroglycerin used decreased (all P angina pectoris partially by decreasing the plasma levels of ET, vWF, sVCAM-1 and sICAM-1 and elevating the level of NO.

  18. Pelvic nodal CTV from L4-L5 or aortic bifurcation? An audit of the patterns of regional failures in cervical cancer patients treated with pelvic radiotherapy.

    Science.gov (United States)

    Rai, Bhavana; Bansal, Anshuma; Patel, Firuza; Gulia, Abhishek; Kapoor, Rakesh; Sharma, Suresh C

    2014-10-01

    To assess the patterns of recurrence in cervical cancer patients treated with pelvic nodal clinical target volume at L4-L5 junction instead of aortic bifurcation. Records of patients with locally advanced cervical cancer treated with chemo-radiation were reviewed. Patients treated with standard pelvic fields (superior border of the field at L4/L5 junction), without any radiological evidence of regional lymphadenopathy (advanced cervical cancer. Radiotherapy fields need to be defined cautiously in patients with subcentimeter pelvic lymph nodes. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Unstable intertrochanteric femur fractures in geriatric patients treated with the DLT trochanteric nail.

    Science.gov (United States)

    Temiz, Aytun; Durak, Aslihan; Atici, Teoman

    2015-07-01

    To evaluate clinical-functional and radiological results of geriatric patients with unstable intertrochanteric femur fracture treated with intramedullary nail. Thirty-two patients treated with intramedullary nail (DLT trochanteric nail) due to unstable intertrochanteric femur fractures were reviewed retrospectively. Fractures 31-A2 and 31-A3 (AO classification) were evaluated. Operation time, blood loss, and blood transfusion requirements, hospitalization period, time to fracture union were evaluated and perioperative and postoperative complications were recorded. According to the modified Baumgaertner criteria fracture reduction was analyzed radiologically, and nail tip-apex distance was measured. Femoral neck-shaft angle was also evaluated. Harris Hip Score for clinical evaluation and Kyo criteria for walking capacity were used. The mean age was 72 years (65-81), mean follow up time was 18.3 months (12-26). Nineteen patients had type 31-A2 and 13 had type 31-A3 fractures. Mean operation time was 36.3min (25-45), blood loss 185.9ml (100-250). Blood transfusion was required in 7 patients. The average hospitalization duration was 6 days (4-14) while the time to surgery from admission was 2.9 days (2-6). Radiologically, in 21 of the cases fracture reduction was well (65.6%), acceptable in 9 (28.1%), and poor in 2 (6.3%). In early postoperative period, the mean collo-diaphyseal angle was 129.1° (120-140°), mean tip-apex distance was 15.5mm (10-27). The mean Harris Hip Score was 63.4 (38-90). Two patients (6.3%) had excellent, 21 patients (65.6%) had good, 7 patients (21.8%) had moderate, and 2 patients (6.3%) had poor results. Walking capacity in the last follow-up in 20 of the cases (62.5%) was pre-fracture level. While complications were observed in seventeen patients (53.1%) (5 superficial wound infections, 5 fractures of the greater trochanter, 3 cases of secondary varus angulation and 4 cases of heterotopic ossification) none of them required additional surgery

  20. Treating Pelvic Floor Disorders of Defecation: Management or Cure?

    Science.gov (United States)

    Rao, Satish S.C.; Go, Jorge T.

    2013-01-01

    Pelvic floor disorders that affect defecation consist of structural disorders such as rectocele and functional disorders such as dyssynergic defecation. Evaluation includes a good history and physical examination, a careful digital rectal exam, as well as physiological tests such as anorectal manometry, colonic transit study and balloon expulsion test. Defecography and dynamic magnetic resonance imaging may facilitate detection of structural defects. Their management consists of education and counseling regarding bowel function, diet, laxatives and behavioral therapies. Recently, several randomized clinical trials have shown that biofeedback therapy is effective in dyssynergic defecation. Dyssynergia may also co-exist in structural disorders such as solitary rectal ulcer syndrome or rectocele. Hence, before proceeding with surgery, neuromuscular training or biofeedback should be considered. Several surgical approaches including stapled transanal rectal resection (STARR) have been advocated, but there is lack of well controlled randomized studies and their efficacy is unproven. PMID:19615303

  1. Frequency of unstable chromosome aberrations in peripheral lymphocytes of women with breast cancer treated with radiotherapy

    International Nuclear Information System (INIS)

    Espinoza Jeria, Marcela; Castro Acuna, Daniel

    2003-01-01

    This study proposes to obtain information about the behavior of the frequency and distribution of radiation induced lymphocyte dicentric chromosome aberrations with therapeutic doses in women with breast cancer treated only with radiotherapy, about which there are no existing works in Chile. Blood samples were taken from 6 women volunteers included in the study, with their informed consent, treated in the Fundacion Arturo Lopez Perez, aged 24 to 65 years old, without prior or parallel chemotherapy, nor prior radiotherapy. Three peripheral blood samples were taken from each patient in 0, 16.2 and 43.2 Gy doses. The lymphocytes obtained from each sample were cultivated using the micro-culture technique following the protocol in IAEA Technical Report No. 405, 2001. The samples were evaluated under a microscope and the unstable chromosome aberrations for lymphocytes were counted. A total of 500 cells per sample was evaluated in most cases, which were distributed depending on the number of aberrations that they had. The results were analyzed by treatment dose for each of the study patients, using the Papworth u test, Dolphin's 'Contaminated Poisson' method and Sasaki's 'QDR'. Great variations were observed in the frequency distribution of aberrations among the patients studied, which could be due to the influence of factors related to the patients' partial irradiations (C.Wood)

  2. MODELING OF BONE FRAGMENTS FIXATION WITH AN EXTERNAL FIXATION DEVICE FOR BILATERAL ROTATION UNSTABLE PELVIC INJURIES B TYPE ACCORDING TO AO/ASIF CLASSIFICATION

    Directory of Open Access Journals (Sweden)

    V. G. Vinogradov

    2014-01-01

    Full Text Available Objective: to determine the stability of bone fragments fixation with an external fixation device in the simulation of bilateral partly unstable pelvic injuries of B type according to AO/ASIF classification and to identify the role of different fixation elements in the stability of fixation. Material and methods: the study was performed on the finite element model of a system “an external fixation device - pelvis” developed for a software package MSCNastran. Formation of a fracture of pubic and ischial pelvic bones was accomplished by means of rupture in the finite element network and decrease of elasticity modulus in the ilio-sacral joint on both sides up to 35 mm at the site of a fracture. Loads were carried on top of the body of the first sacral vertebra with a force of 500H.The second area of application of the load was from the bottom-up on the acetabular roof with a force of 250H. In this study the effect of different elements of an external fixation device on the stiffness of bone fragments fixation was evaluated. Symmetrical elements were removed both separately and together. As a result, the stiffness of a system decreased and the displacement at the fracture site increased. Conclusion: in a model of partly stable pelvic injuries accompanied by general rotation instability in the horizontal and sagittal planes to 35 mm, an external fixation device provided high stability of bone fragments (to 3 mm due to introduction of bone rods in the iliac wings with the obligatory introduction of the rod in the vertical branches of pubic bones and strengthening the anterior lower bar between the subsystems. What is more, installing the anterior upper bar or introduction of bone rods in the bodies of iliac bone are not necessary.

  3. UNSTABLE INTERTROCHANTERIC FRACTURE IN ELDERLY TREATED WITH CEMENTED BIPOLAR HEMIARTHROPLASTY AND TROCHANTERIC RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Jagadeesh Kumar

    2015-06-01

    Full Text Available INTRODUCTION : Unstable inter - trochanteric fracture in the geriatric population is a common injury and is associated with poor bone quality, excessive collapse, loss of fixation, and cut - out of the lag screw, are the common problems of attempts to fix these fractures. Pr esent study is an attempt to evaluate the functional outcome of primary cemented bipolar hemiarthroplasty and trochanter reconstruction in these patients. MATERIALS AND METHOD S : This prospective study included 30 cases of elderly osteoporotic patients with mean age of 65.4 years who sustained comminuted inter - trochanteric femur fracture treated with cemented bipolar hemiarthroplasty& tension band wiring for greater trochanter rec onstruction. It is an essential technical step to avoid complication like abductor lurch gait. W e here describe a technique of reconstruction and fixation of greater trochanter using tension band wiring in figure of eight pattern. The patients were followe d up at six week, three month, six month and one year postoperatively and assessed using Harris Hip Score (HHS. RESULTS : The mean HHS score was was 85.6+SD 9.5 (range from 74 to 96. B y the end of one year. The main clinical measures were early post - opera tive full weight bearing, post - operative complication & functional outcome. The time to full weight bearing, the rate of post - operative complications & functional outcome was significantly better in cemented bipolar arthroplasty group . DISCUSSION : The chan ges in HHS up to six months periods are much greater which starts showing a stable trend thereafter. Fair to good scores were observed in all the patients. The purpose of its use was that while Harris Hip Score (HHS provides information on a multitude of factors. Superficial infection in 2 patients, anterior thigh pain in a patient, shortening less than 2cms in 2 patients, abductor lurch in a patient are the complications noted in post - operative period, but no patient required

  4. How to Treat the Complex Unstable Intertrochanteric Fractures in Elderly Patients? DHS or Arthroplasty

    Directory of Open Access Journals (Sweden)

    Ebrahim Hasankhani

    2014-09-01

     Arthroplasty is an alternative treatment in elderly patients with unstable intertrochanteric fractures and can provide good and satisfactory clinical outcomes associated with low complication and mortality rates. 

  5. Interventions for preventing and treating pelvic and back pain in pregnancy.

    Science.gov (United States)

    Pennick, V E; Young, G

    2007-04-18

    More than two-thirds of pregnant women experience back pain and almost one-fifth experience pelvic pain. The pain increases with advancing pregnancy and interferes with work, daily activities and sleep. To assess the effects of interventions for preventing and treating back and pelvic pain in pregnancy. We searched the Cochrane Pregnancy and Childbirth Review Group's Trials Register (February 2006). Randomised controlled trials of any treatment to prevent or reduce the incidence or severity of back or pelvic pain in pregnancy. Two authors independently assessed trial quality and extracted data. We found no studies dealing specifically with prevention of back or pelvic pain. We included eight studies (1305 participants) that examined the effects of adding various pregnancy-specific exercises, physiotherapy, acupuncture and pillows to usual prenatal care. For women with low-back pain, participating in strengthening exercises, sitting pelvic tilt exercises (standardised mean difference (SMD) -5.34; 95% confidence interval (CI) -6.40 to -4.27), and water gymnastics reduced pain intensity and back pain-related sick leave (relative risk (RR) 0.40; 95% CI 0.17 to 0.92) better than usual prenatal care alone. The specially-designed Ozzlo pillow was more effective than a regular one in relieving back pain (RR 1.84; 95% CI 1.32 to 2.55), but is no longer commercially available. Both acupuncture and stabilising exercises relieved pelvic pain more than usual prenatal care. Acupuncture gave more relief from evening pain than exercises. For women with both pelvic and back pain, in one study, acupuncture was more effective than physiotherapy in reducing the intensity of their pain; stretching exercises resulted in more total pain relief (60%) than usual care (11%); and 60% of those who received acupuncture reported less intense pain, compared to 14% of those receiving usual prenatal care. Women who received usual prenatal care reported more use of analgesics, physical modalities

  6. [Effects of Surgically Treated Pelvic Ring and Acetabular Fractures on Postural Control].

    Science.gov (United States)

    Lang, P; Schnegelberger, A; Riesner, H-J; Stuby, F; Friemert, B; Palm, H-G

    2016-04-01

    The aim of surgical treatment of pelvic ring and acetabular fractures is to allow rapid mobilisation of patients in order to restore stance and gait stability (postural control), as this significantly correlates with a positive outcome. The regulation of postural stability is mainly controlled by transmission of proprioceptive stimuli. In addition, the pelvis serves as a connection between the legs and the spine and thus is also of great importance for mechanical stabilisation. It remains unclear whether surgical treatment of pelvic ring and acetabular fractures affects the regulation of postural control. Therefore, the aim of this study was to examine the impact of surgically treated pelvic ring and acetabular fractures on postural stability by means of computerised dynamic posturography (CDP) after a mean of 35 months and to compare the results with a healthy control group. A retrospective case control study of 38 patients with surgically treated pelvic ring and acetabular fractures and 38 healthy volunteers was carried out using CDP. The average time of follow-up was 35 (12-78) months. The most important outcome parameter in this investigation was the overall stability index (OSI). Hip joint mobility, the health-related quality of life (SF-12) and pain were supplementary outcome parameters. It was found that surgically treated pelvic ring and acetabular fractures had no influence on postural stability. The OSI was 2.1 ° in the patient group and 1.9 ° in the control group. There was no significant difference between the groups in hip joint mobility. A total of 52 % of patients showed no or only mild pain. Mean health-related quality of life was the same as in the total population. Surgically treated pelvic ring and acetabular fractures do not lead to deterioration in postural control in the mid term. This is of high prognostic importance for rapid mobilisation of the patients. Therefore no increase in the risk of falling is expected after successfully

  7. Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Míriam Raquel Diniz Zanetti

    Full Text Available CONTEXT AND OBJECTIVE: Urinary incontinence is a public health problem that affects more than 200 million people worldwide. Stress incontinence is the most prevalent type. Pelvic floor muscle exercises have been used for treating it, although there is no consensus regarding their application. The aim of this study was to compare the results from treating female stress urinary incontinence with pelvic floor muscle exercises with or without physiotherapist supervision. DESIGN AND SETTING: This was a randomized, prospective, controlled trial in the Urogynecology and Vaginal Surgery Sector, Universidade Federal de São Paulo. METHODS: Forty-four women were randomized to be treated for stress urinary incontinence with pelvic floor exercises for three consecutive months, into two groups: one with and the other without physiotherapist supervision. They were evaluated before and after treatment using a quality-of-life questionnaire, pad test, micturition diary and subjective evaluation. Descriptive analysis was used to evaluate the population. The homogeneity of the two groups was evaluated using the Kruskal-Wallis and Chi-squared tests. The success of the two groups after treatment was evaluated using the Wilcoxon test. RESULTS: The supervised group showed statistically greater improvement in the pad test, micturition diary and quality of life than did the control group. In the subjective evaluation, only 23.8% of the control group patients were satised with their treatment. In the supervised group, 66.8% of patients did not want any other treatment. CONCLUSION: Supervised pelvic floor muscle exercises presented better results in objective and subjective evaluations than did unsupervised exercises.

  8. EFFICACY OF PELVIC FLOOR THERAPY IN TREATING URINARY INCONTINENCE AMONG FEMALE COPD PATIENTS

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    Mohankumar Thekkinkattil

    2016-08-01

    Full Text Available Background: Chronic obstructive pulmonary disease (COPD is a leading cause of morbidity and mortality worldwide. The major manifestation of COPD includes dyspnea, decreased oxygenation and reduced exercise tolerance. The other manifestations such as urinary incontinence are less noted and treated inadequately. The prevalence of urinary incontinence in Indian COPD population has not been well documented. The treatment of urinary incontinence includes pelvic floor exercises (Kegel’s exercises, biofeedback, and acupuncture etc. Methods: Forty female moderate COPD patients diagnosed according to American Thoracic Criteria with a complaint of urinary incontinence were selected for the study. Pelvic floor therapy exercises were given daily 5 sets per day (1 set =1-3 counts for seven days. Baseline evaluation was done using International Consultation on Incontinence Short Form (ICIQ-SF on the day of referral for physiotherapy and the post study measurements were taken on 7th day of hospital stay. Wilcoxon Signed Rank calculator was used to assess the data collected. Results: The z value of ICIQ-SF questionnaire was 5.5109 ( p≤ 0.05 based on Wilcoxon Sign rank test and it was significant when we compared the pre and post test mean difference. The pre test mean score of ICIQ-SF was 14.175 and post test mean score was 4.4.Based on the findings, the results showed significant improvement in patient symptoms and reduced stress incontinence post pelvic floor therapy exercises. Conclusion: The study emphasizes the importance of pelvic floor therapy in treating stress urinary incontinence among COPD patients and it should also be included in a comprehensive pulmonary rehabilitation program.

  9. Low Toxicity in Inflammatory Bowel Disease Patients Treated With Abdominal and Pelvic Radiation Therapy.

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    White, Evan C; Murphy, James D; Chang, Daniel T; Koong, Albert C

    2015-12-01

    To determine the short-term and long-term toxicity of abdominal and pelvic radiation therapy in a cohort of patients with inflammatory bowel disease (IBD). We hypothesize that with newer techniques, such as intensity-modulated radiation therapy (IMRT) and 3-dimensional conformal radiotherapy (3D-CRT), patients with IBD can safely undergo abdominal and pelvic radiation, with low risk for major acute or late toxicity. Nineteen consecutive patients with IBD (14 with ulcerative colitis, 5 with Crohn disease) who were treated with abdominal or pelvic external beam radiation therapy at Stanford University from 1997 to 2011 were identified. Fourteen patients were treated with IMRT and 5 were treated with 3D-CRT. Treated sites included prostate (n=8), gastric/esophageal (n=5), rectal/anal (n=3), and liver (n=3) tumors. Charts were reviewed and toxicity was graded according to the Common Terminology Criteria for Acute Events version 4.0. Median follow-up was 32.5 months. Fisher exact test was used to determine if any clinical and/or treatment factors were associated with toxicity outcomes. Acute grade ≥3 toxicity occurred in 2 patients (11%). Late grade ≥3 toxicity occurred in 1 patient (6%). Acute grade ≥2 toxicity occurred in 28% of patients treated with IMRT versus 100% of patients treated with 3D-CRT (P=0.01). Acute grade ≥2 gastrointestinal toxicity was lower in patients treated with IMRT versus 3D-CRT (14% vs. 100%, respectively, P=0.002). Late grade ≥2 toxicity occurred in 21% of patients. Higher total dose (Gy) and biologically effective dose (Gy) were associated with increased rates of late grade ≥2 toxicity (P=0.02 and 0.03, respectively). These data suggest that select patients with IBD can safely undergo abdominal and pelvic radiation therapy. The use of IMRT was associated with decreased acute toxicity. Acute and late severe toxicity rates were low in this patient population with the use of modern radiation techniques.

  10. Interventions for preventing and treating pelvic and back pain in pregnancy.

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    Pennick, Victoria; Liddle, Sarah D

    2013-08-01

    More than two-thirds of pregnant women experience low-back pain (LBP) and almost one-fifth experience pelvic pain. Pain increases with advancing pregnancy and interferes with work, daily activities and sleep. To assess the effects of interventions for preventing and treating pelvic and back pain in pregnancy. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (18 July 2012), identified related studies and reviews from the Cochrane Back Review Group search strategy to July 2012, and checked reference lists from identified reviews and studies. Randomised controlled trials (RCTs) of any treatment to prevent or reduce the incidence or severity of pelvic or back pain in pregnancy. Two review authors independently assessed risk of bias and extracted data. Quality of the evidence for outcomes was assessed using the five criteria outlined by the GRADE Working Group. We included 26 randomised trials examining 4093 pregnant women in this updated review. Eleven trials examined LBP (N = 1312), four examined pelvic pain (N = 661), and 11 trials examined lumbo-pelvic (LBP and pelvic) pain (N = 2120). Diagnoses ranged from self-reported symptoms to the results of specific tests. All interventions were added to usual prenatal care and unless noted, were compared to usual prenatal care. For LBP, there was low-quality evidence that in general, the addition of exercise significantly reduced pain (standardised mean difference (SMD) -0.80; 95% confidence interval (CI) -1.07 to -0.53; six RCTs, N = 543), and disability (SMD -0.56; 95% CI -0.89 to -0.23; two RCTs, N = 146); and water-based exercise significantly reduced LBP-related sick leave (risk ratio (RR) 0.40; 95% CI 0.17 to 0.92; one RCT, N = 241). Low-quality evidence from single trials suggested no significant difference in pain or function between two types of pelvic support belt, between osteopathic manipulation (OMT) and usual care or sham ultrasound (sham US). Very low-quality evidence suggested that a

  11. Tratamento cirúrgico da fratura instável do anel pélvico em pacientes esqueleticamente imaturos Surgical treatment of unstable pelvic ring fracture in skeletally immature patients

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    João Antonio Matheus Guimarães

    2010-01-01

    Full Text Available OBJETIVO: Apresentar o resultado do tratamento cirúrgico definitivo da fratura instável do anel pélvico na criança submetida a redução e estabilização cirúrgica. MÉTODOS: Avaliamos 10 pacientes com esqueleto imaturo que sofreram fraturas instáveis do anel pélvico tratados cirurgicamente no período entre março de 2004 a janeiro de 2008. O estudo foi retrospectivo, baseado na avaliação clínica e radiográfica. RESULTADOS: A média etária na época do trauma foi de 8,8 anos (dois a 13 anos, sendo sete do sexo feminino e três do sexo masculino. As causas dos traumas foram atropelamento em oito casos, e acidente com motocicleta e queda de altura em um caso cada. Cinco pacientes apresentavam lesões associadas, como fraturas da clavícula, diáfise do fêmur, úmero proximal, ossos da perna, olecrânio e lesão de bexiga. Todos os pacientes avaliados apresentaram excelente evolução clínica. A assimetria pélvica antes do procedimento cirúrgico variava de 0,7 a 2,9cm (média 1,45cm, e caiu para valores entre 0,2 a 0,9cm (média 0,39cm após a redução. Em nenhum dos casos houve alteração da assimetria pélvica medida no pós-operatório imediato e no fim do seguimento. CONCLUSÃO: A fratura do anel pélvico em pacientes esqueleticamente imaturos é rara e a indicação de tratamento cirúrgico não é usual. Diversos autores questionam o tratamento conservador devido às complicações encontradas. A remodelação óssea não parece suficiente para que ocorra uma melhora da assimetria pélvica, fator que justifica a opção pelo tratamento cirúrgico para a redução e correção das deformidades do anel pélvico.OBJECTIVES: To present the outcome of the definitive surgical treatment of unstable fracture of the pelvic ring in children submitted to surgical reduction and stabilization. METHODS: We studied 10 patients with immature skeletons that suffered unstable fractures of the pelvic ring treated during the period between

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

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

    2015-01-01

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

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

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    Jianyin Lei

    2015-01-01

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

  14. Effectiveness of pelvic floor muscle training in treating urinary incontinence in women: A current review.

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    García-Sánchez, E; Rubio-Arias, J A; Ávila-Gandía, V; Ramos-Campo, D J; López-Román, J

    2016-06-01

    To analyse the content of various published studies related to physical exercise and its effects on urinary incontinence and to determine the effectiveness of pelvic floor training programmes. We conducted a search in the databases of PubMed, CINAHL, the Cochrane Plus Library, The Cochrane Library, WOS and SPORTDiscus and a manual search in the Google Scholar metasearcher using the search descriptors for documents published in the last 10 years in Spanish or English. The documents needed to have an abstract or complete text on the treatment of urinary incontinence in female athletes and in women in general. We selected 3 full-text articles on treating urinary incontinence in female athletes and 6 full-text articles and 1 abstract on treating urinary incontinence in women in general. The 9 studies included in the review achieved positive results, i.e., there was improvement in the disease in all of the studies. Physical exercise, specifically pelvic floor muscle training programmes, has positive effects on urinary incontinence. This type of training has been shown to be an effective programme for treating urinary incontinence, especially stress urinary incontinence. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. A STUDY OF UNSTABLE INTERTROCHANTERIC FEMORAL FRACTURES TREATED BY TROCHANTERIC FEMORAL NAIL

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    Sreenivasa Neikar

    2017-11-01

    Full Text Available BACKGROUND Intertrochanteric fracture is one of the most common fracture of the hip especially in the elderly. The incidence of intertrochanteric fracture is rising because of the increase in number of elderly population along with superadded osteoporosis. MATERIALS AND METHODS Study included cases of unstable intertrochanteric fractures (AO and OTA Classification 31-A2 and 31-A3 fracture patterns that were operated with the short trochanteric femoral nail, which fitted into the inclusion criteria done in medical college hospital, Vijayanagara Institute of Medical Sciences, Bellary, from February 2015 to September 2016. RESULTS The age distribution was from 40 to 80 years. The largest group of patients were from 61 to 70 years. The average age was 60.5 years. The number of male patients in our series was 20 (66.7% and female was 10 (33.3%. Right side was affected in 11 cases (36.7% and left side in 19 cases (63.3%. Good reduction was achieved in 23 patients (76.7%. Acceptable reduction was achieved in 7 (23.3% patients due to severe comminution. In our study, 25 patients (83.33% had no complications. We encountered one intraoperative complication in the form of greater trochanter splintering, while inserting the nail. In our study, we encountered following postoperative complications. We noticed one case of delayed union, one case of Z effect and 2 cases of varus malunion. CONCLUSION We conclude that short trochanteric femoral nail provides good fixation for unstable intertrochanteric fractures if proper preoperative planning, good reduction and surgical technique are followed leading to high rate of bone union and minimal soft tissue damage especially for Asian patients with relatively small femora.

  16. 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.

  17. Factors of Pelvic Infection and Death in Patients with Open Pelvic Fractures and Rectal Injuries.

    Science.gov (United States)

    Song, Wenhao; Zhou, Dongsheng; Xu, Weicheng; Zhang, Guoming; Wang, Chunhui; Qiu, Daodi; Dong, Jinlei

    Open pelvic fractures associated with rectal injuries are uncommon. They often cause serious pelvic infection, even death. This combination of injuries has been reviewed infrequently. Herein, we report factors associated with pelvic infection and death in a group of patients with open pelvic fractures and concurrent rectal injuries. We retrospectively reviewed the records of patients with open pelvic fractures and rectal injuries who were treated at our institution from January 2010-April 2014. From the medical records, age, gender, Injury Severity Score (ISS), cause of fracture, associated injuries, classification of the fracture, degree of soft-tissue injury, Glasgow Coma Score (GCS), Revised Trauma Score (RTS), packed red blood cells (PRBCs) needed, presence/absence of shock, early colostomy (yes or no), drainage (yes or no), and rectal washout (yes or no) were extracted. Univariable and multivariable analysis were performed to determine the association between risk factors and pelvic infection or death. Twenty patients were identified. Pelvic infection occurred in 50% (n = 10) of the patients. Four patients suffered septicemia, and three patients died of multiple organ dysfunction. The mortality rate thus was 15%. According to the univariable analysis, the patients in whom pelvic infection developed had shock, RTS ≤8, GCS ≤8, blood transfusion ≥10 units in the first 24 h, no colostomy, or Gustilo grade III soft-tissue injury. According to the multivariable analysis, shock and absence of colostomy were independently associated with pelvic infection. By univariable analysis, the only factor associated with death was RTS ≤8. The incidence of pelvic infection was lower in patients having early colostomy (p < 0.05). Patients with shock had a higher risk of pelvic infection, and we recommend aggressive measures to treat these patients. According to our results, RTS ≤8 could be a predictor of poor outcomes in patients with open pelvic fracture and

  18. Intraoperative computed tomography navigation for transpedicular screw fixation to treat unstable thoracic and lumbar spine fractures: clinical analysis of a case series (CARE-compliant).

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    Lee, Ching-Yu; Wu, Meng-Huang; Li, Yen-Yao; Cheng, Chin-Chang; Hsu, Chu-Hsiang; Huang, Tsung-Jen; Hsu, Robert Wen-Wei

    2015-05-01

    Transpedicular screw (TPS) fixation in unstable thoracic and lumbar (TL) spine fractures remains technically difficult because of destroyed anatomical landmarks, unstable gross segments, and discrepancies in anatomic orientation using conventional anatomic landmarks, fluoroscopic guidance, or computed tomography (CT)-based navigation. In this study, we evaluated the safety and accuracy of TPS placement under intraoperative computed tomography (iCT) navigation in managing unstable TL spine fractures.From 2010 to 2013, we retrospectively reviewed the Spine Operation Registry records of patients who underwent posterior instrumented fusion to treat unstable TL spine fractures via the iCT navigation system. An unstable spine fracture was identified as AO/Magerl classification type B or type C.In all, 316 screws in 37 patients with unstable TL spine fractures were evaluated and involved 7 thoracic, 23 thoracolumbar junctional, and 7 lumbar fractures. The accuracy of TPS positioning in the pedicle without breach was 98% (310/316). The average number of iCT scans per patient was 2.1 (range 2-3). The average total radiation dose to patients was 15.8 mSv; the dose per single level exposure was 2.7 mSv. The TPS intraoperative revision rate was 0.6% (2/316) and no neurovascular sequela was observed. TPS fixation using the iCT navigation system obtained a 98% accuracy in stabilizing unstable TL spine fractures. A malplaced TPS could be revised during real-time confirmation of the TPS position, and no secondary operation was required to revise malplaced screws.The iCT navigation system provides accurate and safe management of unstable TL spine fractures. In addition, operating room personnel, including surgeons and nurses, did not need to wear heavy lead aprons as they were not exposed to radiation.

  19. Biomechanical stability of a supra-acetabular pedicle screw Internal Fixation device (INFIX vs External Fixation and plates for vertically unstable pelvic fractures

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    Vigdorchik Jonathan M

    2012-09-01

    Full Text Available Abstract Background We have recently developed a subcutaneous anterior pelvic fixation technique (INFIX. This internal fixator permits patients to sit, roll over in bed and lie on their sides without the cumbersome external appliances or their complications. The purpose of this study was to evaluate the biomechanical stability of this novel supraacetabular pedicle screw internal fixation construct (INFIX and compare it to standard internal fixation and external fixation techniques in a single stance pelvic fracture model. Methods Nine synthetic pelves with a simulated anterior posterior compression type III injury were placed into three groups (External Fixator, INFIX and Internal Fixation. Displacement, total axial stiffness, and the stiffness at the pubic symphysis and SI joint were calculated. Displacement and stiffness were compared by ANOVA with a Bonferroni adjustment for multiple comparisons Results The mean displacement at the pubic symphysis was 20, 9 and 0.8 mm for external fixation, INFIX and internal fixation, respectively. Plate fixation was significantly stiffer than the INFIX and external Fixator (P = 0.01 at the symphysis pubis. The INFIX device was significantly stiffer than external fixation (P = 0.017 at the symphysis pubis. There was no significant difference in SI joint displacement between any of the groups. Conclusions Anterior plate fixation is stiffer than both the INFIX and external fixation in single stance pelvic fracture model. The INFIX was stiffer than external fixation for both overall axial stiffness, and stiffness at the pubic symphysis. Combined with the presumed benefit of minimizing the complications associated with external fixation, the INFIX may be a more preferable option for temporary anterior pelvic fixation in situations where external fixation may have otherwise been used.

  20. Biomechanical stability of a supra-acetabular pedicle screw internal fixation device (INFIX) vs external fixation and plates for vertically unstable pelvic fractures.

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    Vigdorchik, Jonathan M; Esquivel, Amanda O; Jin, Xin; Yang, King H; Onwudiwe, Ndidi A; Vaidya, Rahul

    2012-09-27

    We have recently developed a subcutaneous anterior pelvic fixation technique (INFIX). This internal fixator permits patients to sit, roll over in bed and lie on their sides without the cumbersome external appliances or their complications. The purpose of this study was to evaluate the biomechanical stability of this novel supraacetabular pedicle screw internal fixation construct (INFIX) and compare it to standard internal fixation and external fixation techniques in a single stance pelvic fracture model. Nine synthetic pelves with a simulated anterior posterior compression type III injury were placed into three groups (External Fixator, INFIX and Internal Fixation). Displacement, total axial stiffness, and the stiffness at the pubic symphysis and SI joint were calculated. Displacement and stiffness were compared by ANOVA with a Bonferroni adjustment for multiple comparisons The mean displacement at the pubic symphysis was 20, 9 and 0.8 mm for external fixation, INFIX and internal fixation, respectively. Plate fixation was significantly stiffer than the INFIX and external Fixator (P = 0.01) at the symphysis pubis. The INFIX device was significantly stiffer than external fixation (P = 0.017) at the symphysis pubis. There was no significant difference in SI joint displacement between any of the groups. Anterior plate fixation is stiffer than both the INFIX and external fixation in single stance pelvic fracture model. The INFIX was stiffer than external fixation for both overall axial stiffness, and stiffness at the pubic symphysis. Combined with the presumed benefit of minimizing the complications associated with external fixation, the INFIX may be a more preferable option for temporary anterior pelvic fixation in situations where external fixation may have otherwise been used.

  1. Extra-peritoneal pressure packing without external pelvic fixation: A life-saving stand-alone surgical treatment

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    Guy Ron

    2015-01-01

    Full Text Available Purpose: Traditional maneuvers aim to decrease retroperitoneal bleeding in hemodynamically unstable multi-trauma patients with unstable pelvic fractures, are reportedly successful in approximately only 50%. The life-saving effect of extra-peritoneal pressure packing (EPPP is based on direct compression and control of both venous and arterial retroperitoneal bleeders. This study describes the safety and efficacy of emergent EPPP employment, as a stand-alone surgical treatment, that is, carried out without external pelvic fixation or emergent angiography. Materials and Methods: A retrospective chart review of all hemodynamic unstable, multi-trauma patients with mechanically unstable pelvic fractures treated by the EPPP technique at our medical center between the years 2005 and 2011. Survival rates, clinical, and physiological outcomes were followed prospectively. Results: Twenty-five of the 181 pelvic fracture patients had biomechanically unstable fractures that required surgical fixation. Fourteen of those 25 patients had deteriorating hemodynamic instability from massive pelvic bleeding which was resistant to resuscitation, and they underwent EPPP, as a stand-alone treatment. The procedure successfully achieved hemodynamic stability in all 14 patients and obviated the early mortality associated with massive pelvic bleeding. Three of these patients eventually succumbed to their multiple injuries. Conclusion: Implementation of EPPP improved all measured physiological outcome parameters and survival rates of hemodynamically unstable multi-trauma patients with unstable pelvic fractures in our trauma center. It provided the unique advantage of directly compressing the life-threatening retroperitoneal bleeders by applying direct pressure and causing a tamponade effect to stanch venous and arterial pelvic blood flow and obviate the early mortality associated with massive pelvic bleeding.

  2. An evaluation of setup uncertainties for patients treated to pelvic sites

    International Nuclear Information System (INIS)

    Hunt, Margie A.; Schultheiss, Timothy E.; Desobry, Gregory E.; Hakki, Morgan; Hanks, Gerald E.

    1995-01-01

    Purpose: Successful delivery of conformal fields requires stringent immobilization and treatment verification, as well as knowledge of the setup reproducibility. The purpose of this study was to compare the three-dimensional distribution of setup variations for patients treated to pelvic sites with electronic portal imaging devices (EPID) and portal film. Methods and Materials: Nine patients with genitourinary and gynecological cancers immobilized with custom casts and treated with a four-field whole-pelvis technique were imaged daily using an EPID and filmed once every five to seven treatments. The three-dimensional translational and rotational setup errors were determined using a technique that relies on anatomical landmarks identified on simulation and treatment images. The distributions of the translational and rotational variations in each dimension as well as the total displacement of the treatment isocenter from the simulation isocenter were determined. Results: Grouped analysis of all patients revealed average unidirectional translational deviations of less than 2 mm and a standard deviation of 5.3 mm. The average total undirected distance between the treatment and simulated isocenters was 8.3 mm with a standard deviation of 5 mm. Individual patient analysis revealed eight of nine patients had statistically significant nonzero mean translational variations (p < 0.05). Translational variations measured with film were an average of 1.4 mm less than those measured with EPID, but this difference was not statistically significant. Conclusion: Translational variations measured in this study are in general agreement with previous studies. The use of the EPID in this study was less intrusive and may have resulted in less additional attention being given each imaging setup. This may explain the slightly larger average translational variations observed with EPID vs. film, and suggests that the use of EPIDs is a superior method for assessing the true extent of setup

  3. Dose-Volume Relationships for Acute Bowel Toxicity in Patients Treated With Pelvic Nodal Irradiation for Prostate Cancer

    International Nuclear Information System (INIS)

    Fiorino, Claudio; Alongi, Filippo; Perna, Lucia; Broggi, Sara; Cattaneo, Giovanni Mauro; Cozzarini, Cesare; Di Muzio, Nadia; Fazio, Ferruccio; Calandrino, Riccardo

    2009-01-01

    Purpose: To find correlation between dose-volume histograms (DVHs) of the intestinal cavity (IC) and moderate-severe acute bowel toxicity in men with prostate cancer treated with pelvic nodal irradiation. Methods and Materials: The study group consisted of 191 patients with localized prostate cancer who underwent whole-pelvis radiotherapy with radical or adjuvant/salvage intent during January 2004 to November 2007. Complete planning/clinical data were available in 175 of these men, 91 of whom were treated with a conventional four-field technique (50.4 Gy, 1.8 Gy/fraction) and 84 of whom were treated with IMRT using conventional Linac (n = 26, 50.4 Gy, 1.8 Gy/fraction) or Helical TomoTherapy (n = 58, 50-54 Gy, 1.8-2 Gy/fraction). The IC outside the planning target volume (PTV) was contoured and the DVH for the first 6 weeks of treatment was recovered in all patients. The correlation between a number of clinical and DVH (V10-V55) variables and toxicity was investigated in univariate and multivariate analyses. The correlation between DVHs for the IC outside the PTV and DVHs for the whole IC was also assessed. Results: Twenty-two patients experienced toxicity (3/22 in the IMRT/tomotherapy group). Univariate analyses showed a significant correlation between V20-V50 and toxicity (p = 0.0002-0.001), with a higher predictive value observed for V40-V50. Previous prostatectomy (p = 0.066) and abdominal/pelvic surgery (p = 0.12) also correlated with toxicity. Multivariate analysis that included V45, abdominal/pelvic surgery, and prostatectomy showed that the most predictive parameters were V45 (p = 0.002) and abdominal/pelvic surgery (p = 0.05, HR = 2.4) Conclusions: Our avoidance IMRT approach drastically reduces the incidence of acute bowel toxicity. V40-V50 of IC and, secondarily, previous abdominal/pelvic surgery were the main predictors of acute bowel toxicity.

  4. Management of recent unstable fractures of the pelvic ring. An update conference supported by the Club Bassin Cotyle. (Pelvis-Acetabulum Club).

    Science.gov (United States)

    Tonetti, J

    2013-02-01

    Traumatic injury to the pelvic ring is a result of high energy trauma in young patients. These osteo-ligamentous injuries are associated with numerous lesions including retroperitoneal hematoma, urogenital, cutaneous and neurological (lumbosacral plexus). The goal of initial management is to restore vital indicators, urinary excretion function and protect the patient from infectious complications. An emergency decisional algorithm helps manage haemodynamic instability. Initial bone and ligament procedures should reduce displacement and make it possible for the patient the wait until his condition is stable enough for definitive surgical fixation. The goal of surgical treatment is to avoid nonunion and malunion. Stable fixation of the posterior arch after reduction favors union. Different techniques can be used by the posterior, anterior ilio-inguinal or lateral percutaneous approaches. Anterior fixation is discussed to improve reduction and increase the stability obtained with a posterior procedure. Anterior external fixation is useful to temporarily reinforce posterior stabilization. Copyright © 2013. Published by Elsevier Masson SAS.

  5. Comparing electromagnetic stimulation with electrostimulation plus biofeedback in treating male refractory chronic pelvic pain syndrome

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    Min-Hsin Yang

    2017-09-01

    Conclusion: Both EMS and ESB physical therapy of the pelvic floor muscle effectively reduce pain, increase the QoL, and improve urinary tract symptoms in male CPPS patients who are refractory to medical treatments. The combination therapy of ES plus biofeedback demonstrates additional benefits in pain and QoL when compared with EMS alone.

  6. Sacral gigantocellular tumor treated with total sacrectomy and spinal-pelvic fixation

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    Savić Milenko

    2011-01-01

    Full Text Available Background. Total sacrectomy with spinal-pelvic fixation is considered to be a successful approach to the radical surgical treatment of extensive sacral tumors, however, technically very demanding, thus only rarely reported in the literature. We presented a patient with sacral gigantocellular tumor managed successfully using this method but with certain standard operative techniques improvements. Case report. A 30-year old patient with a pronounced painful syndrome and sphincter disorders was confirmed to have sacral gigantocellular tumor affecting a greater part of the sacrum. Tumor resection was performed in the first act out off retroperitoneal organs (colon and blood vesels, sacroiliac joints were open by the ventral side, the L5 discus removed, the S2-S5 roots cut off. In the second act, performed three weeks later, sacrectomy was completed by the reconstruction of pelvic ring and spinal-pelvic fixation. Then, the standard technique was modified to provide additional spinal fixation. The results of the operation (duration, blood loss, postoperative deficit were quite comparable with, and in some aspects even better than the results published in the literature. Conclusion. Total sacrectomy with spinal-pelvic fixation can be a therapy of choice in patients with extensive sacral tumors requaring, however, the multidisciplinary approach and a considerable experience with instrumental spinal stabilization.

  7. Locally recurrent rectal cancer successfully treated by total pelvic exenteration with combined ischiopubic rami resection: report of a case.

    Science.gov (United States)

    Uehara, Keisuke; Yoshioka, Yuichiro; Taguchi, Yoshiro; Igami, Tsuyoshi; Ebata, Tomoki; Yokoyama, Yukihiro; Sugawara, Gen; Tsukushi, Satoshi; Nishida, Yoshihiro; Yoshino, Yasushi; Nagino, Masato

    2012-01-01

    A combined ischiopubic rami resection is extremely rare in the field of gastroenterologic surgery. We report a case of a locally recurrent rectal cancer that was successfully treated by total pelvic exenteration with combined ischiopubic rami resection. A 58-year-old male with locally recurrent rectal cancer and liver metastases was referred to our hospital. Computed tomography and magnetic resonance imaging showed a perineal tumor, which had invaded the prostate, urethra, and obturator internus muscle, and two liver metastases. Because the perineal tumor was very close to the dorsal vein complex and the pubic symphysis, it was considered difficult to approach and divide the dorsal vein complex, and still retain oncologic safety. To achieve R0 resection, total pelvic exenteration with ischiopubic rami resection, total emasculation and partial liver resection were performed. Pathological examination revealed that surgical margins were negative for cancer cells. Although reconstruction of the pelvic ring was not performed, his ambulatory function had recovered to an almost normal status at 6 months after the operation.

  8. A case of laparoscopic surgery for endometrial cancer in a patient previously treated with a transvaginal mesh procedure for pelvic organ prolapse

    Directory of Open Access Journals (Sweden)

    Kiyoshi Yoshino

    2017-11-01

    Full Text Available Transvaginal mesh (TVM surgery is an effective treatment option for women with pelvic organ prolapse (POP. Because the TVM procedure preserves the uterus, it is possible for endometrial cancer to occur at a later date. We herein present the first report of such an endometrial cancer, diagnosed well after TVM surgery for POP, and the use of laparoscopic surgery to conduct a simple total hysterectomy to treat it. Keywords: endometrial cancer, laparoscopic surgery, pelvic organ prolapse, transvaginal mesh

  9. Portal Hypertensive Colopathy with Pelvic Varices presenting as Severe Lower GI Bleed treated with TIPSS

    LENUS (Irish Health Repository)

    Murphy, SF

    2018-02-01

    We present the case of a 71-year-old lady with a background of significant alcohol intake who presented with frank lower gastrointestinal (GI) bleeding, lower abdominal pain and haemoglobin 6.3g\\/dL. CT abdominal angiogram showed right-sided colonic thickening, atrophic liver and enlarged superior mesenteric vein (SMV) and right-sided pelvic varix. This lead to a diagnosis of portal hypertensive colopathy secondary to alcoholic liver cirrhosis. The patient failed conservative management and underwent a Transjugular Intrahepatic Portosystemic Shunt (TIPSS) procedure. This lead to an immediate resolution of her lower-GI bleeding. Repeat CT at three weeks showed a decompressed SMV and resolution of the right-sided pelvic varix. The patient was discharged after three months following optimization of medical condition and social circumstances.

  10. Cerebellar infarction after posterior direct reduction and fixation to treat an unstable Jefferson fracture: a case report.

    Science.gov (United States)

    Baek, Seung Hwan; Yoo, Seung Ho; Cho, Kyoung Rai; Shin, Jun Jae

    2018-03-01

    A 42-year-old man had an unstable Jefferson type IV atlas fracture with unilateral vertebral artery occlusion after a diving accident. We performed C1-ring reconstruction with a crosslink rod and C2 fixation to directly reduce the fracture fissure. Within 6 h, cerebellar hemisphere infarction developed. After decompressive craniectomy, duroplasty, and release of the vertebral artery occlusion caused by the transfixing rod, a postoperative computed tomography angiogram showed that blood flow in the right vertebral artery improved. We suggest cautiously inserting screws into the fractured C1 lateral mass and gently tightening the crosslink rod to prevent distal migration of a thrombus.

  11. Favorable outcomes in locally advanced and node positive prostate cancer patients treated with combined pelvic IMRT and androgen deprivation therapy

    International Nuclear Information System (INIS)

    Lilleby, Wolfgang; Narrang, Amol; Tafjord, Gunnar; Vlatkovic, Ljiljana; Russnes, Kjell Magne; Stensvold, Andreas; Hole, Knut Håkon; Tran, Phuoc; Eilertsen, Karsten

    2015-01-01

    The most appropriate treatment for men with prostate cancer and positive pelvic nodes, N+, is an area of active controversy. We report our 5-years outcomes in men with locally advanced prostate cancer (T1-T4N0-N1M0) treated with definitive radiotherapy encompassing the prostate and pelvic lymph nodes (intensity modulated radiotherapy, IMRT) and long-term androgen deprivation therapy (ADT). Of the 138 consecutive eligible men all living patients have been followed up to almost 5 years. Survival endpoints for 5-year biochemical failure-free survival (BFFS), relapse-free survival (RFS), prostate cancer-specific survival (PCSS), and overall survival (OS) were assessed by Kaplan-Meier analysis. Univariate and multivariate Cox regression proportional hazards models were constructed for all survival endpoints. The RTOG morbidity grading system for physician rated toxicity was applied. Patients with locally advanced T3-T4 tumors (35 %) and N1 (51 %) have favorable outcome when long-term ADT is combined with definitive radiotherapy encompassing pelvic lymph nodes. The 5-year BFFS, RFS, PCSS and OS were 71.4, 76.2, 94.5 and 89.0 %, respectively. High Gleason sum (9–10) had a strong independent prognostic impact on BFFS, RFS and OS (p = 0.001, <0.001, and 0.005 respectively). The duration of ADT (= > 28 months) showed a significant independent association with improved PCSS (p = 0.02) and OS (p = 0.001). Lymph node involvement was not associated with survival endpoints in the multivariate analysis. The radiotherapy induced toxicity seen in our study population was moderate with rare Grade 3 GI side effects and up to 11 % for Grade 3 GU consisting mainly of urgency and frequency. Pelvic IMRT in combination with long-term ADT can achieve long-lasting disease control in men with N+ disease and unfavorable prognostic factors. The online version of this article (doi:10.1186/s13014-015-0540-3) contains supplementary material, which is available to authorized users

  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. Clinical nursing of pelvic neoplasm treated with infusion chemotherapy by using an anti-reflux arterial port-catheter system

    International Nuclear Information System (INIS)

    Xing Li; Yuan Chanjuan

    2011-01-01

    Objective: To discuss the clinical nursing care for patients with pelvic neoplasm who were treated with infusion chemotherapy by using an anti-reflux arterial port-catheter system. Methods: After the implantation of an anti-reflux arterial port-catheter system was successfully completed, intra-arterial infusion chemotherapy was carried out in 17 patients with pelvic neoplasm and the infusion chemotherapy was repeated for several times. The pre-procedural clinical nursing care was well done and the technique of proper placement was well grasped. The side effects of chemotherapy drugs and complications were dealt with in time. Medical orientation at discharge time included the protection methods for port-catheter system. Results: Seventeen patients received infusion chemotherapy successfully several times (ranged from 3 to 8 times) with a scheduled regular interval time. No severe complications occurred. No catheter leakage nor obvious irritation and compression symptoms of local skin developed during infusion period. Of the 17 patients, 6 had a complete response, 9 achieved a partial response, while the remaining 2 failed to respond. Conclusion: In accordance with characteristics of infusion chemotherapy by using an anti-reflux arterial port-catheter system, the reasonable and effective nursing care is important to guarantee the achievement of a successful performance and a satisfactory therapeutic result. (authors)

  14. Survival of nonsurgically staged patients with negative lymphangiograms who had Stage IIB carcinoma of the cervix treated by pelvic radiation plus hydroxyurea

    International Nuclear Information System (INIS)

    Piver, M.S.; Krishnamsetty, R.M.; Emrich, L.J.

    1985-01-01

    Twenty patients with Stage IIB carcinoma of the cervix who did not undergo pretherapy para-aortic lymphadenectomy, but who had negative preradiation therapy lymphangiograms, were treated with pelvic radiation plus hydroxyurea. Patients received a median of 5020 rads of pelvic radiation plus 4000 rads of radium to point A. During radiation therapy and for a total of 12 weeks, patients received hydroxyurea administered at a dose of 80 mg/kg of body weight every 3 days if the white blood cell count was greater than or equal to 2,500/mm3 and platelets were greater than or equal to 75,000/mm3. The median follow-up time was 28 months (6 to 83 months). The estimated 5-year survival rate was 92%. Seventeen patients are alive with no evidence of disease (median, 28 months); one died of intercurrent disease with no evidence of disease (17 months); one is alive with no evidence of disease after recurrence (18 months); and one died of cervical cancer (22 months). The survival rate of patients with nonsurgically staged negative pretherapy lymphangiograms who had Stage IIB cervical cancer treated by pelvic radiation therapy plus hydroxyurea approximated the improved survival rate reported for patients with negative pretherapy para-aortic lymphadenectomy who were treated with pelvic radiation therapy plus hydroxyurea. Both studies would suggest that pelvic radiation plus hydroxyurea improves the rate of survival in patients with Stage IIB cervical cancer

  15. 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)

  16. Plasma citrulline levels predict intestinal toxicity in patients treated with pelvic radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Onal, Cem; Kotek, Ayse; Arslan, Gungor; Topkan, Erkan (Dept. of Radiation Oncology, Baskent Univ. Faculty of Medicine, Adana (Turkey)), E-mail: hcemonal@hotmail.com; Unal, Birsel (Dept. of Biochemistry, Baskent Univ. Faculty of Medicine, Ankara (Turkey)); Yavuz, Aydin; Yavuz, Melek (Dept. of Radiation Oncology, Akdeniz Univ. Faculty of Medicine, Antalya (Turkey))

    2011-11-15

    Background. Radiotherapy (RT) for abdominal and pelvic malignancies often causes severe small bowel toxicity. Citrulline concentrations are known to decrease with intestinal failure. We thus evaluated the feasibility of plasma citrulline levels in predicting radiation-induced intestinal toxicity. Material and methods. Fifty-three patients (36 prostate cancer, 17 endometrial cancer) who received 45 Gy pelvic RT using conventional fractionation were prospectively evaluated. Patients with prostate cancer received an additional 25-30.6 Gy conformal boost. Plasma citrulline levels were assessed on day 0, mid- (week 3) and post-RT (week 8), and four months post-RT. Dose-volume histogram, citrulline concentration changes, and weekly intestinal toxicity scores were analyzed. Results. Mean age was 63 years (range: 43-81 years) and mean baseline citrulline concentration was 38.0 +- 10.1 mumol/l. Citrulline concentrations were significantly reduced at week 3 (27.4 +- 5.9 mumol/l; p < 0.0001), treatment end (29.9 +- 8.8 mumol/l; p < 0.0001), and four months post-treatment (34.3 +- 12.1; p 0.01). The following factor pairs were significantly positively correlated: Citrulline concentration/mean bowel dose during, end of treatment, and four months post-RT; dose-volume parameters/citrulline change groups; cumulative mean radiation dose/intestinal toxicity at end and four months post-RT; citrulline changes/intestinal toxicity during and end of RT. Citrulline concentration changes significantly differed during treatment according to RTOG intestinal toxicity grades (p < 0.0001). Although the citrulline changes differed significantly within RTOG intestinal toxicity grades (p = 0.003), the difference between Grade 0 and Grade 1 did not differ significantly at the end of the treatment. At four months after RT, no significant differences were apparent. Conclusion. Citrulline-based assessment scores are objective and should be considered in measuring radiation-induced intestinal toxicity

  17. Unstable volatility

    DEFF Research Database (Denmark)

    Casas, Isabel; Gijbels, Irène

    2012-01-01

    The objective of this paper is to introduce the break-preserving local linear (BPLL) estimator for the estimation of unstable volatility functions for independent and asymptotically independent processes. Breaks in the structure of the conditional mean and/or the volatility functions are common i...

  18. Nursing intervention to enhance efficacy of home practice of pelvic floor muscle exercises in treating mixed urinary incontinence.

    Science.gov (United States)

    Ng, Soo-Cheen; Lin, Tzu-Li; Chang, Su-Jung; Tai, Hui-Lung; Hu, Shu-Woan; Chen, Gin-Den

    2008-05-01

    This study was conducted to evaluate nursing intervention to enhance the efficacy of a home-based pelvic floor muscle exercise (PFME) in treating mixed urinary incontinence among a community-based population. Eighty-eight women with mixed incontinence were recruited for this study and were asked to practice PFME at home as instructed. A registered nurse monitored the study group via telephone checkups twice a week. The Symptoms (LUTS) Questionnaire and a disease-specific questionnaire of impact index were used for repeat measurements before intervention, at 3 and 6 months after PFME. Symptoms such as frequency, nocturia, urge incontinence, and urinary stress incontinence improved significantly in the study group at 6 months. Quality of life with regard to worry about pads/towels leakage and getting wet also improved in the study group at 6 months. Nursing intervention can significantly improve the efficacy of a home-based PFME program in community women with mixed storage symptoms.

  19. Internal fixation of S1-S3 iliosacral screws and pubic screw as the best configuration for unstable pelvic fracture with unilateral vertical sacral fracture (AO type C1.3).

    Science.gov (United States)

    Dilogo, Ismail Hadisoebroto; Satria, Oryza; Fiolin, Jessica

    2017-01-01

    Although internal fixation is the definitive treatment in unstable pelvic fractures with disruption of the anterior arch and a vertical fracture of the sacrum (AO type C1.3), there have been no agreement of the best technique of internal fixation yet. We aimed to derive comparable objective data on stiffness and load to failure in this type of fracture fixations. Synbone was modified into AO type C1.3 fracture model, while treatments were divided into six internal fixation treatment groups using tension band plate (TBP), symphysis pubis plate (SP) with iliosacral screw at S1 and S2 (IS S1-S2), pubic screw (PS) with iliosacral TBP, PS and IS S1-S2, SP and IS S1-S3, PS and S1-S3 and finally PS and IS S1-S3. Sensor was applied to detect the shifting and rotation of fracture fragments. Mechanical strength test conducted with the application of axial force on the sacrum vertebra (S1). The highest translational stiffness was observed in the group IS S1-S3 + PS (830.36 N/mm, p = 0.031) and there was no difference on the rigidity of the rotation between the groups posterior fixation using IS S1-S2 and IS S1-S3 ( p = 0.51). Meanwhile the highest load to failure was found in group IS S1-S3 + PS (1522.20 N). PS provided advantages compared to the use of plate. Group of PS and S1-S3 IS is the configuration of internal fixation with best translational and rotational stiffness and the largest load to failure compared to other techniques in AO type C1.3 fracture.

  20. Do Cerclage Cables Delay the Time to Bone Union in Patients with an Unstable Humeral Shaft Fracture Treated with Intramedullary Nails?

    Science.gov (United States)

    Han, Kyeong Jin; Lee, Doo Hyung; Bang, Joon Young

    2017-07-01

    To evaluate the time to bone union after open reduction and internal fixation with cerclage cables followed by intramedullary nailing (IMN) for unstable humeral shaft fractures. Patients with a humeral shaft fracture treated by IMN were enrolled. One group of patients was treated via open reduction and internal fixation with cables followed by IMN (cable group; n=32), while the other group was treated with a conventional closed IMN (non-cable group; n=64). The length of time to bone union and functional scores [Disabilities of the Arm, Shoulder and Hand (DASH) and University of California, Los Angeles (UCLA) scores] were measured for all patients. No significant differences were found in terms of age, gender, injury type, or smoking history between the two groups, except for the type of fracture. The cable group had significantly more complex types of fracture than the non-cable group (punion was 3.9 months in the cable group, while in the non-cable group, it was 4.4 months (p=0.041). The incidence of postoperative complications, such as non-union, delayed union, and radial nerve palsy, was similar between the two groups (p>0.05). No differences were identified in terms of DASH and UCLA scores (28.8 and 32.1 in the cable group and 26.4 and 32.6 in the non-cable group, respectively; p=0.335 and 0.264). In unstable humeral shaft fractures treated by IMN, open reduction and internal fixation with additional cerclage cables do not delay the length of time to bone union or increase the rate of other complications. © Copyright: Yonsei University College of Medicine 2017

  1. 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.

  2. 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.

  3. Postpartum Hemorrhage Resulting from Pelvic Pseudoaneurysm: A Retrospective Analysis of 588 Consecutive Cases Treated by Arterial Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Dohan, Anthony, E-mail: anthony.dohan@lrb.aphp.fr; Soyer, Philippe, E-mail: philippe.soyer@lrb.aphp.fr; Subhani, Aqeel, E-mail: drsubhani07@gmail.com [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France); Hequet, Delphine, E-mail: delphine.hequet@gmail.com [Universite Paris-Diderot (France); Fargeaudou, Yann, E-mail: yannfargeaudou4@hotmail.com [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France); Morel, Olivier, E-mail: olivier.morel17@gmail.com [Maternite Universitaire de Nancy, Universite Henri Poincare Nancy 1 (France); Boudiaf, Mourad, E-mail: mourad.boudiaf@lrb.aphp.fr [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France); Gayat, Etienne, E-mail: etienne.gayat@9online.fr [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Anesthesiology and Intensive Care Medicine (France); Barranger, Emmanuel, E-mail: emmanuel.barranger@lrb.aphp.fr [Universite Paris-Diderot (France); Dref, Olivier Le, E-mail: olivier.ledref@lrb.aphp.fr; Sirol, Marc, E-mail: marc.sirol@lrb.aphp.fr [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France)

    2013-10-15

    Objective: This study was designed to determine the incidence of arterial pseudoaneurysm in patients presenting with postpartum hemorrhage (PPH), to analyze the angiographic characteristics of pseudoaneurysms that cause PPH, and to evaluate the effectiveness of pelvic arterial embolization for the treatment of this condition.Study designEighteen women with pelvic arterial pseudoaneurysm were retrieved from a series of 588 consecutive patients with PPH treated by arterial embolization. Clinical files, angiographic examinations, and procedure details were reviewed. Results: The incidence of pseudoaneurysm was 3.06 % (18/588; 95 % confidence interval (CI): 1.82-4.8 %). A total of 20 pseudoaneurysms were found; 15/20 (75 %) were located on the uterine arteries. Angiography revealed extravasation of contrast material from pseudoaneurysm indicating rupture in 9 of 18 (50 %) patients. Arterial embolization was performed using gelatin sponge alone in 12 of 18 (67 %) patients or in association with metallic coils in 5 of 18 (28 %) patients or n-butyl-2-cyanoacrylate in 1 of 18 (6 %) patients. Arterial embolization allowed controlling the bleeding in all patients after one or two embolization sessions in 17 of 18 (94 %) and 1 of 18 patients (6 %) respectively, without complications, obviating the need for further surgery. Conclusions: Pseudoaneurysm is rarely associated with PPH. Arterial embolization is an effective and safe procedure for the treatment of PPH due to uterine or vaginal artery pseudoaneurysm. Our results suggest that gelatin sponge is effective for the treatment of ruptured pseudoaneurysms, although we agree that our series does not contain sufficient material to allow drawing definitive conclusions with respect to the most effective embolic material.

  4. [Clinical research of chronic pelvic cavity pain syndrome treated with acupoint catgut embedding therapy].

    Science.gov (United States)

    Ma, Yong; Li, Xinyuan; Li, Fuqiang; Yu, Wenjun; Wang, Zulong

    2015-06-01

    To explore the clinical efficacy of acupoint catgut embedding therapy on chronic pelvic cavity pain syndrome differentiated as kidney deficiency and stagnation of damp heat, and explore the impacts on plasma P substance (SP), plasma beta-endorphin (β-EP). One hundred and eighty cases were randomly divided into a catgut embedding group (90 cases) and a western medication group (90 cases). In the western medication group, tamsulosin capsules 0. 2 mg were prescribed for oral administration, once a day; indometacin sustained release tablets, 25 mg, three times a day. Totally, the oral administration for 8 weeks was required. In the catgut embedding group, the acupoint catgut embedding therapy was applied to Qugu (CV 2), Shenshu (BL 23), Zhibian (BL 54), Huiyin (CV 1) and Sanyinjiao (SP 6), once every two weeks; the treatment of 4 weeks made one session, and two sessions were required. Before and after treatment, TCM symptom score, NIH-CPSI (the National Institute of Health Chronic Prostatitis Symptom Index) score, lecithin body numbers in prostatic fluid, score in SAS (self-rating anxiety scale), score in SDS (self-rating depression scale), the levels of SP and β-EP, etc. were observed in the two groups, and the clinical efficacy was assessed in the two groups. (1) Ten cases were dropped in either group. The total effective rate was 91. 25% (73/80) in the catgut embedding group, higher than 78. 75% (63/80) in the western medication group (Ppain score and the scores in SAS and SDS were all reduced as compared with those before treatment in the two groups (all Ppain score in NIH-CPSI, and the scores in SAS and SDS in the catgut embedding group were both lower than those in the western medication group (all Ppain syndrome differentiated as kidney deficiency and stagnation of damp heat as well as the condition of anxiety and depression, increases lecithin body numbers in prostatic fluid and β-EP level and reduces SP level.

  5. Infliximab to Treat Refractory Inflammation After Pelvic Pouch Surgery for Ulcerative Colitis.

    Science.gov (United States)

    Kelly, Orlaith B; Rosenberg, Morgan; Tyler, Andrea D; Stempak, Joanne M; Steinhart, A Hillary; Cohen, Zane; Greenberg, Gordon R; Silverberg, Mark S

    2016-04-01

    Inflammatory pouch complications refractory to first-line therapies remain problematic following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). We evaluated infliximab efficacy and associations with therapeutic response. Data from individuals who underwent colectomy and IPAA for UC (2000-2014) were reviewed. Patients with chronic refractory pouchitis (CP) and Crohn's disease (CD)-like outcomes treated with infliximab were included. Pre-treatment parameters and response at median 8 (initial) and 48 weeks (sustained) were measured. Complete response was defined as symptomatic and endoscopic resolution with modified Pouchitis Disease Activity Index (mPDAI) 2. Serum was analysed for Anti-Saccharomyces cerevisiae antibodies (ASCA), anti-OmpC, anti-CBir1 and perinuclear Anti-Neutrophil Cytoplasmic Antibodies (pANCA). One hundred and fifty-two patients with CP or a CD-like phenotype were identified. Forty-two were treated with infliximab (33% male; age 32.6±2.6 years, 28.5% CD-like). Post-induction response was achieved in 74% (48% complete) and sustained response in 62.6% (29.6% complete). Mean mPDAI and C-reactive protein declined from 8.5±0.3 to 2±3.4 (p infliximab use (p Infliximab can effectively treat inflammatory pouch complications. Pre-treatment mPDAI <10 and early endoscopy may identify responders. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  6. Risk factors for cut-out failure of Gamma3 nails in treating unstable intertrochanteric fractures: An analysis of 176 patients.

    Science.gov (United States)

    Tsai, Shang-Wen; Lin, Chien-Fu Jeff; Tzeng, Yun-Hsuan; Lin, Chun-Cheng; Huang, Ching-Kuei; Chang, Ming-Chau; Chiang, Chao-Ching

    2017-09-01

    Cut-out failure is one of the most common complications in the Gamma3 nail fixation system. The purpose of this retrospective study was to determine pre-operative or intra-operative risk factors for cut-out failure of lag screws in unstable, intertrochanteric fractures fixed with short Gamma3 nails. One hundred and seventy-six patients over 60 years of age, with unstable intertrochanteric fractures (AO/OTA 31-A2, 31-A3) treated with short Gamma3 nails were included in this study. All patients completed a minimum of 1-year follow-up. Analysis of post-operative radiographs included assessment for cut-out failure of lag screw, appropriateness of the entry point, posterior lag screw axis, fracture gaps, posterior displacement of the proximal fragment, and tip-apex distance. Of the 176 patients in this study, 22 patients were identified with cut-out failure. Multivariate logistic regression analysis revealed that improper entry point in an antero-posterior projection (odds ratio 10.39, 95% confidence interval 1.74-78.4), posterior displacement distance of the proximal fragment in a lateral projection (odds ratio 1.35, 95% confidence interval 1.17-1.59), and female sex (odds ratio 17.14, 95% confidence interval 1.88-876.11) were correlated with cut-out failure. This study emphasizes the importance of an optimal position of reduction in the lateral projection in reducing the risk of cut-out failure. In addition, sex difference in bone mineral density, proximal femur geometry, and the bone strength in elderly females may explain why female sex is a risk factor. Copyright © 2017 the Chinese Medical Association. Published by Elsevier Taiwan LLC. All rights reserved.

  7. A double-barrelled fibula graft restoring pelvic stability after late posterior ring instability related to a surgical treated osteitis pubis: a case report.

    Science.gov (United States)

    Pieroh, Philipp; Spindler, Nick; Langer, Stefan; Josten, Christoph; Böhme, Jörg

    2016-01-01

    Osteitis pubis or symphysitis pubis is a rare occurring non-infectious inflammation of the symphysis, the adjacent pubic bones and surrounding tissue. The therapy might be conservative or surgical by a resection of the symphysis and involved parts of the pubic bone. Nevertheless, this resection might lead to an anterior instability impairing the posterior arch and the sacroiliac joints in the aftermath. Here, we report about a 50-year-old women suffering from osteitis pubis treated by wedge resection of the symphysis and parts of the pubic bone. To maintain stability and for local antibiotic treatment a cement spacer was implemented. By clinical inconspicuous findings and the patient's desire, no further surgery was performed. However, 2 years after surgery the spacer dislocated and the patient complained about pain in the posterior arch due to an impaired mobility. Reconstruction surgery was planned including the bridging of the accrued space with a vascularized double-barrelled fibula graft, plate osteosynthesis and rectus abdominis flap coverage. The performed surgery led to pain relief and increased mobility. The present case highlights the possible complication of surgical treated osteitis pubis leading to anterior arch instability affecting the posterior arch and thus impairing pelvic ring stability and patient mobility. Furthermore, we describe an opportunity to treat this complication or other etiologies contributing to anterior pelvic ring stability with large bone defects using a vascularized double-barrelled fibula graft to restore pelvic stability.

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

    Science.gov (United States)

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

    2016-11-01

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

  9. Unstable angina pectoris prior to ST elevation myocardial infarction in patients treated with primary percutaneous coronary intervention has no influence on prognosis.

    Science.gov (United States)

    Kluz, Krystyna; Parenica, Jiri; Kubkova, Lenka; Littnerova, Simona; Tomandl, Josef; Poloczek, Martin; Toman, Ondrej; Tesak, Martin; Cermakova, Zdenka; Gottwaldova, Jana; Manousek, Jan; Pavkova Goldbergova, Monika; Spinar, Jindrich; Jarkovsky, Jiri

    2015-06-01

    Pre-infarction unstable angina pectoris (UAP) can be considered ischemic preconditioning. The aim of this study was to compare short and long term outcomes in patients with or without pre-infarction UAP and ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). 593 patients with STEMI (388 without and 205 with UAP) were evaluated. Levels of biomarkers (troponin I, BNP, NT-ProBNP, neopterin, endoglin and pentraxin-3) at hospital admission and 24 h after STEMI onset were assessed. Echocardiography was undertaken on the fourth day after MI and after 12 months. The median follow-up was 37 months. We found no significant differences in sex, age or risk factors for atherosclerosis between the UAP and non-UAP group. As the median time from the onset of chest pain to admission was significantly longer in the UAP group (228 min vs 258 min; P=0.009), we used a propensity score to obtain comparable matched groups for use in further analyses. The levels of NT-proBNP were significantly higher on admission and after 24 hours in the UAP group. Left ventricular functions according to invasive and echocardiographic parameters were entirely comparable at hospitalization and after 12 months. No differences were found in severity index of acute heart failure during hospitalization. The incidence of major acute coronary events during follow-up was comparable for the groups. In patients with STEMI treated with primary PCI, pre-infarction UAP has no beneficial clinical effect during hospitalization or during long-term follow-up.

  10. [Efficacy of Sacroiliac Joint Anterior Approach with Double Reconstruction Plate and Computer Assisted Navigation Percutaneous Sacroiliac Screw for Treating Tile C1 Pelvic Fractures].

    Science.gov (United States)

    Tan, Zhen; Fang, Yue; Zhang, Hui; Liu, Lei; Xiang, Zhou; Zhong, Gang; Huang, Fu-Guo; Wang, Guang-Lin

    2017-09-01

    To compare the efficacy of sacroiliac joint anterior approach with double reconstruction plate and computer assisted navigation percutaneous sacroiliac screw for treating Tile C1 pelvic fractures. Fifty patients with pelvic Tile C1 fractures were randomly divided into two groups ( n =25 for each) in the orthopedic department of West China Hospital of Sichuan University from December 2012 to November 2014. Patients in group A were treated by sacroiliac joint dislocation with anterior plate fixation. Patients in group B were treated with computerized navigation for percutaneous sacroiliac screw. The operation duration,intraoperative blood loss,incision length,and postoperative complications (nausea,vomiting,pulmonary infection,wound complications,etc.) were compared between the two groups. The postoperative fracture healing time,postoperative patient satisfaction,and postoperative fractures MATTA scores (to evaluate fracture reduction),postoperative MAJEED function scores,and SF36 scores of the patients were also recorded and compared. No significant differences in baseline characteristics were found between the two groups of patients. All of the patients in both groups had their operations successfully completed. Patients in group B had significantly shorter operations and lower intraoperative blood loss,incision length and postoperative complications than those in group A ( P 0.05). Sacroiliac joint anterior approach with double reconstruction plate and computer assisted navigation percutaneous sacroiliac screws are both effective for treating Tile C1type pelvic fractures,with similar longterm efficacies. However,computer assisted navigation percutaneous sacroiliac screw has the advantages of less trauma,less bleeding,and quicker.

  11. Closed reduction with CT-guided screw fixation for unstable sacroiliac joint fracture-dislocation.

    Science.gov (United States)

    Baskin, Kevin M; Cahill, Ann Marie; Kaye, Robin D; Born, Christopher T; Grudziak, Jan S; Towbin, Richard B

    2004-12-01

    Unstable posterior pelvic ring fractures and dislocations are uncommon but potentially life-threatening injuries in children. Early definitive management reduces risk of immediate complications as well as chronic pain and gait dysfunction. Conventional operative therapy carries substantial risk of extensive blood loss and iatrogenic neurological and vascular injury. Minimally invasive image-guided intervention may further reduce immediate risk and improve long-term outcome. To describe CT-guided closed reduction and internal fixation (CRIF) and review outcomes of unstable fracture-dislocation of the sacroiliac (SI) joint in children. Between 2000 and 2003, three children (two girls, one boy) age 8-14 years were referred to interventional radiology for treatment of unstable SI joint fracture-dislocation not adequately treated with anterior external fixation alone. The three affected SI joints (two left, one right) were treated in a combined approach by pediatric interventional radiologists and orthopedic surgeons, using a percutaneous approach under CT guidance. Over a threaded guiding pin, 7.3 mm cannulated screws were used to achieve stable reduction of the affected SI joints. One screw was removed after slight (2 mm) migration. No neurovascular or other complications occurred. All patients had satisfactory healing with near-anatomic reduction, although recovery of the youngest was delayed by associated spinal injury. Compared to open surgical alternatives, CRIF under CT guidance reduces operating time, decreases blood loss, and allows early definitive fixation and immediate non-weight-bearing mobilization with a low rate of complication for unstable posterior pelvic ring fractures. In addition, CT-guided placement of the guide pin may allow safer screw positioning and may minimize the total number of screws needed to achieve pelvic stability.

  12. Closed reduction with CT-guided screw fixation for unstable sacroiliac joint fracture-dislocation

    International Nuclear Information System (INIS)

    Baskin, Kevin M.; Cahill, Ann Marie; Kaye, Robin D.; Born, Christopher T.; Grudziak, Jan S.; Towbin, Richard B.

    2004-01-01

    Unstable posterior pelvic ring fractures and dislocations are uncommon but potentially life-threatening injuries in children. Early definitive management reduces risk of immediate complications as well as chronic pain and gait dysfunction. Conventional operative therapy carries substantial risk of extensive blood loss and iatrogenic neurological and vascular injury. Minimally invasive image-guided intervention may further reduce immediate risk and improve long-term outcome. To describe CT-guided closed reduction and internal fixation (CRIF) and review outcomes of unstable fracture-dislocation of the sacroiliac (SI) joint in children. Between 2000 and 2003, three children (two girls, one boy) age 8-14 years were referred to interventional radiology for treatment of unstable SI joint fracture-dislocation not adequately treated with anterior external fixation alone. The three affected SI joints (two left, one right) were treated in a combined approach by pediatric interventional radiologists and orthopedic surgeons, using a percutaneous approach under CT guidance. Over a threaded guiding pin, 7.3 mm cannulated screws were used to achieve stable reduction of the affected SI joints. One screw was removed after slight (2 mm) migration. No neurovascular or other complications occurred. All patients had satisfactory healing with near-anatomic reduction, although recovery of the youngest was delayed by associated spinal injury. Compared to open surgical alternatives, CRIF under CT guidance reduces operating time, decreases blood loss, and allows early definitive fixation and immediate non-weight-bearing mobilization with a low rate of complication for unstable posterior pelvic ring fractures. In addition, CT-guided placement of the guide pin may allow safer screw positioning and may minimize the total number of screws needed to achieve pelvic stability. (orig.)

  13. Can dosimetric parameters predict acute hematologic toxicity in rectal cancer patients treated with intensity-modulated pelvic radiotherapy?

    International Nuclear Information System (INIS)

    Wan, Juefeng; Liu, Kaitai; Li, Kaixuan; Li, Guichao; Zhang, Zhen

    2015-01-01

    To identify dosimetric parameters associated with acute hematologic toxicity (HT) in rectal cancer patients undergoing concurrent chemotherapy and intensity-modulated pelvic radiotherapy. Ninety-three rectal cancer patients receiving concurrent capecitabine and pelvic intensity-modulated radiation therapy (IMRT) were analyzed. Pelvic bone marrow (PBM) was contoured for each patient and divided into three subsites: lumbosacral spine (LSS), ilium, and lower pelvis (LP). The volume of each site receiving 5–40 Gy (V 5, V10, V15, V20, V30, and V40, respectively) as well as patient baseline clinical characteristics was calculated. The endpoint for hematologic toxicity was grade ≥ 2 (HT2+) leukopenia, neutropenia, anemia or thrombocytopenia. Logistic regression was used to analyze correlation between dosimetric parameters and grade ≥ 2 hematologic toxicity. Twenty-four in ninety-three patients experienced grade ≥ 2 hematologic toxicity. Only the dosimetric parameter V40 of lumbosacral spine was correlated with grade ≥ 2 hematologic toxicity. Increased pelvic lumbosacral spine V40 (LSS-V40) was associated with an increased grade ≥ 2 hematologic toxicity (p = 0.041). Patients with LSS-V40 ≥ 60 % had higher rates of grade ≥ 2 hematologic toxicity than did patients with lumbosacral spine V40 < 60 % (38.3 %, 18/47 vs.13 %, 6/46, p =0.005). On univariate and multivariate logistic regression analysis, lumbosacral spine V40 and gender was also the variable associated with grade ≥ 2 hematologic toxicity. Female patients were observed more likely to have grade ≥ 2 hematologic toxicity than male ones (46.9 %, 15/32 vs 14.8 %, 9/61, p =0.001). Lumbosacral spine -V40 was associated with clinically significant grade ≥ 2 hematologic toxicity. Keeping the lumbosacral spine -V40 < 60 % was associated with a 13 % risk of grade ≥ 2 hematologic toxicity in rectal cancer patients undergoing concurrent chemoradiotherapy

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

    International Nuclear Information System (INIS)

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

    2012-01-01

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

  15. Clinical results of an EPID-based in-vivo dosimetry method for pelvic cancers treated by intensity-modulated radiation therapy.

    Science.gov (United States)

    Camilleri, J; Mazurier, J; Franck, D; Dudouet, P; Latorzeff, I; Franceries, X

    2014-09-01

    The purpose of our work was to investigate the feasibility of using an EPID-based in-vivo dosimetry method initially designed for conformal fields on pelvic dynamic IMRT fields. The method enables a point dose delivered to the patient to be calculated from the transit signal acquired with an electronic portal imaging device (EPID). After defining a set of correction factors allowing EPID pixel values to be converted into absolute doses, several tests on homogeneous water-equivalent phantoms were performed to estimate the validity of the method in reference conditions. The effects of different treatment parameters, such as delivered dose, field size dependence and patient thickness were also studied. The model was first evaluated on a group of 53 patients treated by 3D conformal radiotherapy (3DCRT) and then on 92 patients treated by IMRT, both for pelvic cancers. For each measurement, the dose was reconstructed at the isocenter (DREC) and compared with the dose calculated by our treatment planning system (DTPS). Excellent agreement was found between DREC and DTPS for both techniques. For 3DCRT treatments, the mean deviation between DREC and DTPS for the 211 in-vivo dose verifications was equal to -1.0  ±  2.2% (1SD). Concerning IMRT treatments, the averaged deviation for the 418 fields verified was equal to -0.3 ± 2.6% (1SD) proving that the method is able to reconstruct a dose for dynamic IMRT pelvic fields. Based on these results, tolerance criteria and action levels were established before its implementation in clinical routine. Copyright © 2014 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  16. Comparison of long-term mortality after percutaneous coronary intervention in patients treated for acute ST-elevation myocardial infarction versus those with unstable and stable angina pectoris.

    Science.gov (United States)

    Hirsch, Alexander; Verouden, Niels J W; Koch, Karel T; Baan, Jan; Henriques, José P S; Piek, Jan J; Rohling, Wim J; van der Schaaf, Rene J; Tijssen, Jan G P; Vis, Marije M; de Winter, Robbert J

    2009-08-01

    Data remain limited regarding the comparative long-term mortality across the spectrum of patients with different indications for percutaneous coronary intervention (PCI). We evaluated early and late mortality in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI compared with early and late mortality in patients undergoing PCI for unstable angina (UA) or non-STEMI (NSTEMI) and stable angina. A total of 10,549 consecutive patients undergoing PCI from 1997 to 2005 at a single institution were followed up prospectively (median 3.2 years, interquartile range 1.5 to 5.6) to assess all-cause mortality. The indication for PCI was STEMI in 28%, UA/NSTEMI in 32%, and stable angina in 40%. The mortality rate at 6 years was 18.9% in patients with STEMI, 16.2% in patients with UA/NSTEMI, and 11.7% in those with stable angina. During the initial 6 months, patients with STEMI had an increased risk of death compared with patients with UA/NSTEMI (relative risk [RR] 3.09, 95% confidence interval [CI] 2.46 to 3.89) and stable angina (RR 5.82, 95% CI 4.45 to 7.62). However, between 6 months and 6 years, mortality accrued at an almost similar rate among patients with STEMI and those with stable angina (RR 1.06, 95% CI 0.86 to 1.32) and mortality was greatest in patients with UA/NSTEMI (UA/NSTEMI vs stable angina: RR 1.33, 95% CI 1.11 to 1.58; STEMI vs UA/NSTEMI: RR 0.80, 95% CI 0.65 to 0.99). In conclusion, we have demonstrated that the inferior survival rates in patients with STEMI after primary PCI are mainly attributed to greater mortality in the first months after the event. These observations highlight that new adjunctive therapeutic strategies should aim at mortality reduction in the first months after primary PCI.

  17. Management of hemodynamically unstable pelvic trauma: results of the first Italian consensus conference (cooperative guidelines of the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology -Section of Vascular and Interventional Radiology- and the World Society of Emergency Surgery).

    Science.gov (United States)

    Magnone, Stefano; Coccolini, Federico; Manfredi, Roberto; Piazzalunga, Dario; Agazzi, Roberto; Arici, Claudio; Barozzi, Marco; Bellanova, Giovanni; Belluati, Alberto; Berlot, Giorgio; Biffl, Walter; Camagni, Stefania; Campanati, Luca; Castelli, Claudio Carlo; Catena, Fausto; Chiara, Osvaldo; Colaianni, Nicola; De Masi, Salvatore; Di Saverio, Salomone; Dodi, Giuseppe; Fabbri, Andrea; Faustinelli, Giovanni; Gambale, Giorgio; Capponi, Michela Giulii; Lotti, Marco; Marchesi, Gianmariano; Massè, Alessandro; Mastropietro, Tiziana; Nardi, Giuseppe; Niola, Raffaella; Nita, Gabriela Elisa; Pisano, Michele; Poiasina, Elia; Poletti, Eugenio; Rampoldi, Antonio; Ribaldi, Sergio; Rispoli, Gennaro; Rizzi, Luigi; Sonzogni, Valter; Tugnoli, Gregorio; Ansaloni, Luca

    2014-03-07

    Hemodynamically Unstable Pelvic Trauma is a major problem in blunt traumatic injury. No cosensus has been reached in literature on the optimal treatment of this condition. We present the results of the First Italian Consensus Conference on Pelvic Trauma which took place in Bergamo on April 13 2013. An extensive review of the literature has been undertaken by the Organizing Committee (OC) and forwarded to the Scientific Committee (SC) and the Panel (JP). Members of them were appointed by surgery, critical care, radiology, emergency medicine and orthopedics Italian and International societies: the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology, Section of Vascular and Interventional Radiology and the World Society of Emergency Surgery. From November 2012 to January 2013 the SC undertook the critical revision and prepared the presentation to the audience and the Panel on the day of the Conference. Then 3 recommendations were presented according to the 3 submitted questions. The Panel voted the recommendations after discussion and amendments with the audience. Later on a email debate took place until December 2013 to reach a unanimous consent. We present results on the 3 following questions: which hemodynamically unstable patient needs an extraperitoneal pelvic packing? Which hemodynamically unstable patient needs an external fixation? Which hemodynamically unstable patient needs emergent angiography? No longer angiography is considered the first therapeutic maneuver in such a patient. Preperitoneal pelvic packing and external fixation, preceded by pelvic binder have a pivotal role in the management of these patients

  18. [DIAGNOSIS AND TREATMENT OF OVERACTIVE BLADDER SYNDROME IN PELVIC INJURIES].

    Science.gov (United States)

    Neymark, A I; Voytenko, A N; Bondarenko, A V; Muzalevskaya, N I; Kruglykhin, I V

    2015-01-01

    Case records of 1994 patients with injuries of the pelvic ring were analyzed. The article presents the results of examination and treatment of patients with urinary tract dysfunction. A frequent complications of pelvic fractures include overactive bladder syndrome (OAB) (18.9%). Many factors play a role in the development of this syndrome, in particular damage to the pelvic diaphragm and the development of pelvic hematoma. OAB is more common in unstable pelvic fractures (24.8%). Surgical stabilization of the pelvic ring injuries and the use of M-cholinoblockers and a1-blockers lead to a reduction of OAB.

  19. Comparison of Biomechanical Characteristics and Pelvic Ring Stability Using Different Fixation Methods to Treat Pubic Symphysis Diastasis

    Science.gov (United States)

    Yao, Feng; He, Yu; Qian, Hebu; Zhou, Dongsheng; Li, Qinghu

    2015-01-01

    Abstract The intention of this study was to compare the biomechanical characteristics using 5 internal fixation methods used clinically to stabilize a pubic symphysis diastasis (PSD, Tile type B1). A 3-dimensional finite element model of PSD was simulated using 5 implants, including single superior plate (Single-Plate), superior and anterior plate (Dual-Plate), single cannulated screw (Single-Screw), crossed dual cannulated screws (Cross-Screw), and parallel dual cannulated screws (Para-Screw). Three loads were distributed in all models, including dual-leg standing, single-leg stance, and rotation. To evaluate the biomechanical properties, the construct stiffness, the stress distribution, and the von Misses stress were recorded and analyzed. To evaluate pelvic ring stability, the micromotion of the pubic symphysis and iliosacral joint was analyzed. Disruption of pubic symphysis dramatically decreased the pelvic ring stability. Cross-screw and Para-Screw showed higher stiffness than other methods. All implants endured the maximum von Misses stress under single-leg stance. For Plate-Screw system, the maximum stress occurred at a place where it strides over pubic symphysis and adjacent Plate-Screw interface. The single implant and Para-Screw had a tendency to fail. Para-Screw showed the best fixation effect under dual-leg conditions. Cross-screw showed superior antishearing force capacity under single-leg stance. Dual-Plate provided maximum antihorizontal rotation. Para-Screw provided the maximum stabilization for the posterior pelvic ring. This study showed the biomechanical advantages of dual-implant for PSD only from the finite element view. The Para-Screw provided high construct stiffness under 3 load conditions. The single implant and Para-Screw had a tendency to fail. The better anterior and posterior pelvic stabilization were obtained by the dual-implant fixation than other methods. Therefore, the Cross-Screw and Dual-Plate fixation methods should be preferred

  20. Manual Thrombus Aspiration and the Improved Survival of Patients With Unstable Angina Pectoris Treated With Percutaneous Coronary Intervention (30 Months Follow-Up).

    Science.gov (United States)

    Yildiz, Bekir S; Bilgin, Murat; Zungur, Mustafa; Alihanoglu, Yusuf I; Kilic, Ismail D; Buber, Ipek; Ergin, Ahmet; Kaftan, Havane A; Evrengul, Harun

    2016-02-01

    The clinical effect of intracoronary thrombus aspiration during percutaneous coronary intervention in patients with unstable angina pectoris is unknown. In this study, we aimed to assess how thrombus aspiration during percutaneous coronary intervention affects in-hospital and 30-month mortality and complications in patients with unstable angina pectoris.We undertook an observational cohort study of 645 consecutive unstable angina pectoris patients who had performed percutaneous coronary intervention from February 2011 to March 2013. Before intervention, 159 patients who had culprit lesion with thrombus were randomly assigned to group 1 (thrombus aspiration group) and group 2 (stand-alone percutaneous coronary intervention group). All patients were followed-up 30 months until August 2015.Thrombus aspiration was performed in 64 patients (46%) whose cardiac markers (ie, creatinine kinase [CK-MB] mass and troponin T) were significantly lower after percutaneous coronary intervention than in those of group 2 (CK-MB mass: 3.80 ± 1.11 vs 4.23 ± 0.89, P = 0.012; troponin T: 0.012 ± 0.014 vs 0.018 ± 0.008, P = 0.002). Left ventricular ejection fraction at 6, 12, and 24 months postintervention was significantly higher in the group 1. During a mean follow-up period of 28.87 ± 6.28 months, mortality rates were 6.3% in the group 1 versus 12.9% in the group 2. Thrombus aspiration was also associated with significantly less long-term mortality in unstable angina pectoris patients (adjusted HR: 4.61, 95% CI: 1.16-18.21, P = 0.029).Thrombus aspiration in the context of unstable angina pectoris is associated with a limited elevation in cardiac enzymes during intervention that minimises microembolization and significantly improves both of epicardial flow and myocardial perfusion, as shown by angiographic TIMI flow grade and frame count. Thrombus aspiration during percutaneous coronary intervention in unstable angina pectoris patients has better

  1. Pelvic fractures: part 1. Evaluation, classification, and resuscitation.

    Science.gov (United States)

    Langford, Joshua R; Burgess, Andrew R; Liporace, Frank A; Haidukewych, George J

    2013-08-01

    Pelvic fractures range in severity from low-energy, generally benign lateral compression injuries to life-threatening, unstable fracture patterns. Initial management of severe pelvic fractures should follow Advanced Trauma Life Support protocols. Initial reduction of pelvic blood loss can be provided by binders, sheets, or some form of external fixation, which serve to reduce pelvic volume, stabilize clot formation, and reduce ongoing tissue damage. Persistently unstable patients may benefit from angiography with selective embolization, pelvic packing, or a combination of these interventions. Open pelvic fractures involving the perineum or bowel injury benefit from fecal diversion by colostomy. Trauma team coordination facilitates efficient resuscitative efforts and may affect definitive management by optimizing incision, ostomy, or catheter placement. Established protocols for both open and closed pelvic fractures help to standardize care.

  2. Effect of Whole Pelvic Radiotherapy for Patients With Locally Advanced Prostate Cancer Treated With Radiotherapy and Long-Term Androgen Deprivation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Mantini, Giovanna [Department of Radiotherapy, Policlinico Universitario A. Gemelli, Catholic University, Rome (Italy); Tagliaferri, Luca, E-mail: luca.tagliaferri@rm.unicatt.it [Department of Radiotherapy, Policlinico Universitario A. Gemelli, Catholic University, Rome (Italy); Mattiucci, Gian Carlo; Balducci, Mario; Frascino, Vincenzo; Dinapoli, Nicola [Department of Radiotherapy, Policlinico Universitario A. Gemelli, Catholic University, Rome (Italy); Di Gesu, Cinzia; Ippolito, Edy; Morganti, Alessio G. [Department of Radiotherapy, John Paul II Center for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso (Italy); Cellini, Numa [Department of Radiotherapy, Policlinico Universitario A. Gemelli, Catholic University, Rome (Italy)

    2011-12-01

    Purpose: To evaluate the effect of whole pelvic radiotherapy (WPRT) in prostate cancer patients treated with RT and long-term (>1 year) androgen deprivation therapy (ADT). Methods and materials: Prostate cancer patients with high-risk features (Stage T3-T4 and/or Gleason score {>=}7 and/or prostate-specific antigen level {>=}20 ng/mL) who had undergone RT and long-term ADT were included in the present analysis. Patients with bowel inflammatory disease, colon diverticula, and colon diverticulitis were excluded from WPRT and treated with prostate-only radiotherapy (PORT). Patients were grouped according to nodal risk involvement as assessed by the Roach formula using different cutoff levels (15%, 20%, 25%, and 30%). Biochemical disease-free survival (bDFS) was analyzed in each group according to the RT type (WPRT or PORT). Results: A total of 358 patients treated between 1994 and 2007 were included in the analysis (46.9% with WPRT and 53.1% with PORT). The median duration of ADT was 24 months (range, 12-38). With a median follow-up of 52 months (range, 20-150), the overall 4-year bDFS rate was 90.5%. The 4-year bDFS rate was similar between the patients who had undergone WPRT or PORT (90.4% vs. 90.5%; p = NS). However, in the group of patients with the greatest nodal risk (>30%), a significant bDFS improvement was recorded for the patients who had undergone WPRT (p = .03). No differences were seen in acute toxicity among the patients treated with WPRT or PORT. The late gastrointestinal toxicity was similar in patients treated with PORT or WPRT (p = NS). Conclusions: Our analysis has supported the use of WPRT in association with long-term ADT for patients with high-risk nodal involvement (>30%), although a definitive recommendation should be confirmed by a randomized trial.

  3. Quality of life and sexual function of women affected by endometriosis-associated pelvic pain when treated with dienogest.

    Science.gov (United States)

    Caruso, S; Iraci, M; Cianci, S; Casella, E; Fava, V; Cianci, A

    2015-11-01

    The aim of the study was to evaluate the effects of dienogest (DNG) on quality of life (QoL) and sexual function of women affected by endometriosis pain. Fifty-four women constituted the study group and were given 2 mg/daily DNG; 48 women were given non-steroidal anti-inflammatory drugs and constitut ed the control group. To define the endometriosis-associated pelvic pain, the Visual Analogic Scale (VAS) was used. The Short Form-36 (SF-36), the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) were used to assess the QoL, the sexual function and the sexual distress, respectively. The study included two follow-ups at 3 and 6 months. Pain improvement was observed in the study group at 3 (p < 0.05) and 6 months (p < 0.001) of treatment. At the 1st follow-up, women reported QoL improvements in some functions (p < 0.05); at the 2nd follow-up, they reported improvement in all categories (p < 0.001). The FSFI score did not change at the 1st follow-up (p = NS). On the contrary, at the 2nd follow-up, it improved with respect to the baseline (p < 0.05). At the 2nd follow-up, the FSFI score had risen to 27.8 (p < 0.001) and the FSDS score had dropped to 11.3 (p < 0.001). No change was observed in the control group (p = NS). The progressive reduction of the pain syndrome reported by women over the treatment period could contribute to improve the QoL and sexual life of women on DNG.

  4. Pelvic Inflammatory Disease (PID)

    Science.gov (United States)

    ... FAQs Pelvic Inflammatory Disease (PID) Page Navigation ▼ ACOG Pregnancy Book Pelvic Inflammatory Disease (PID) Patient Education FAQs Pelvic Inflammatory Disease (PID) Patient Education Pamphlets - ...

  5. 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 ...

  6. Magnetic resonance imaging in the treatment planning of radiation therapy in carcinoma of the cervix treated with the four-field pelvic technique

    International Nuclear Information System (INIS)

    Thomas, Laurence; Chacon, Bosco; Kind, Michele; Lasbareilles, Olivier; Muyldermans, Piet; Chemin, Antony; Le Treut, Alain; Pigneux, Jaques; Kantor, Guy

    1997-01-01

    Purpose: To evaluate magnetic resonance imaging (MRI) in the planning of radiation therapy for patients with carcinoma of the cervix treated with a four-field technique. Methods and Materials: Between May 1994 and February 1995, 18 patients with carcinoma of the cervix were entered in the study (1 T1 N-; 2 T2a N-; 1 T2b NO; 10 T2b N-; 2 T2b N+; 2 T3b N+). Node status was assessed by a laparoscopic pelvic lymphadenectomy. During the first step, all the patients were simulated with an isocentric four-field pelvic technique. In one group (11 patients) simulation was done based on clinical examination, computed tomography (CT), and standard guidelines. In the second group (seven patients) simulation was based on clinical examination, CT, and with the help of diagnostic MRI, which was available at that time. During the second step, MRI in treatment position with skin markings of the isocenter of the radiation fields was then performed in every patient. During the third step, in each patient, the simulated radiation fields were correlated with the MRI defined target volume by superimposing them on midsagittal and midcoronal MR images. The adequacy of the margins was arbitrarly defined as 1 cm around the MRI defined target volume (tumor of the cervix and its extension, and uterus). Results: In the first group (11 patients), MRI in treatment position led to a change in 7 patients: six inadequate margins in the lateral fields and one in the anterior and lateral field. In almost all the cases, the adjustments were of an increase of 10 mm, equally matched between the anterior and posterior borders of the lateral fields. In the second group (seven patients), MRI in treatment position has led to a change in lateral fields in five patients. The mean adjustment was 10 mm: four increases (two anterior border, one posterior border, one anterior and posterior border), and one decrease of the posterior border. In the two groups, modifications of the anterior border of the lateral

  7. Pediatric pelvic fractures.

    Science.gov (United States)

    Holden, Candice P; Holman, Joel; Herman, Martin J

    2007-03-01

    Pediatric pelvic fractures account for only 1% to 2% of fractures seen by orthopaedic surgeons who treat children. They are typically associated with high-energy trauma, requiring a comprehensive workup for concomitant life-threatening injuries. Anteroposterior radiographs and rapid-sequence computed tomography are the standards of diagnostic testing to identify the fracture and recognize associated injuries. Treatment is individualized based on patient age, fracture classification, stability of the pelvic ring, extent of concomitant injuries, and hemodynamic stability of the patient. Most pelvic injuries in children are treated nonsurgically, with protected weight bearing and gradual return to activity. Open reduction and internal fixation is required for acetabular fractures with >2 mm of fracture displacement and for any intra-articular or triradiate cartilage fracture displacement >2 mm. To prevent limb-length discrepancies, external fixation is necessary for pelvic ring displacement >2 cm. Fractures involving immature triradiate cartilage may lead to growth disturbance of the acetabulum, resulting in acetabular dysplasia, hip subluxation, or hip joint incongruity. Osteonecrosis of the femoral head may develop after acetabular fractures associated with hip dislocation. Other complications include myositis ossificans and neurologic deficits secondary to sciatic, femoral, and/or lumbosacral plexus nerve injuries.

  8. Pelvic lymph node dissection in the context of radical cystectomy: a thorough insight into the connection between patient, surgeon, pathologist and treating institution

    Directory of Open Access Journals (Sweden)

    Seiler R

    2013-08-01

    Full Text Available Roland Seiler, George N Thalmann, Pascal ZehnderDepartment of Urology, University of Bern, Bern, SwitzerlandAbstract: Pelvic lymph node dissection (PLND in patients with bladder cancer varies widely in extent, technique employed, and pathological workup of specimens. The present paper provides an overview of the existing evidence regarding the effectiveness of PLND and elucidates the interactions between patient, surgeon, pathologist, and treating institution as well as their cumulative impact on the final postoperative lymph node (LN staging. Bladder cancer patients undergoing radical cystectomy with extended PLND appear to have better oncologic outcomes compared to patients undergoing radical cystectomy and limited PLND. Attempts have been made to define and assess the quality of PLND according to the number of lymph nodes identified. However, lymph node counts depend on multiple factors such as patient characteristics, surgical template, pathological workup, and institutional policies; hence, meticulous PLND within a defined and uniformly applied extended template appears to be a better assurance of quality than absolute lymph node counts. Nevertheless, the prognosis of the patients can be partially predicted with findings from the histopathological evaluation of the PLND specimen, such as the number of positive lymph nodes, extracapsular extension, and size of the largest LN metastases. Therefore, particular prognostic parameters should be addressed within the pathological report to guide the urologist in terms of patient counseling.Keywords: bladder cancer, outcome, pathological workup, postoperative staging

  9. 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.

  10. Unstable slope management program.

    Science.gov (United States)

    2009-08-01

    This Rapid Response Project gathered information on existing unstable slope management programs, with a : focus on asset management practices in the United States and overseas. On the basis of this study, the research : team summarized and recommende...

  11. The brachytherapy vaginal cuff boost in patients with cervix cancer IB1-IB2 that have been treated with surgery plus pelvic radiotherapy in ION SOLCA, Guayaquil Ecuador from November 1 to October 2002

    International Nuclear Information System (INIS)

    Gamboa, Eugenia; Falquez, Roberto

    2003-01-01

    To determine if the additional vaginal cuff irradiation is necessary or not in patients with cervix cancer, stages IB 1- IB 2, that has been treated previously with radical hysterectomies and pelvic radiotherapy, to get better local control and global survival versus presence of complications. We studied 54 patients from Radiation Oncology Department of ION SOLCA Guayaquil Ecuador, with cervix cancer stages IB1 - IB2, that have been treated with surgery plus pelvic radiotherapy plus or not brachytherapy. They have been divides into two arms, group one included surgery plus Rx T (radiotherapy) plus BxT (Brachytherapy), and group two included those patients with surgery plus external RxT alone. We studied, aged, histologic type, surgery type, doses and techniques of teletherapy and brachytherapy and we analyzed the presence of complications. Conclusions: The brachytherapy vaginal cuff boost in patients with cervix cancer IB1-IB2 that have been treated with surgery plus pelvic radiotherapy is not useful to get better local control and global survival in some patients carefully chosen without desfavorable factors, because this therapy represent and increase in the complication. (The author)

  12. Height restoration and maintenance after treating unstable osteoporotic vertebral compression fractures by cement augmentation is dependent on the cement volume used.

    Science.gov (United States)

    Krüger, Antonio; Baroud, Gamal; Noriega, David; Figiel, Jens; Dorschel, Christine; Ruchholtz, Steffen; Oberkircher, Ludwig

    2013-08-01

    Two different procedures, used for percutaneous augmentation of vertebral compression fractures were compared, with respect to height restoration and maintenance after cyclic loading. Additionally the impact of the cement volume used was investigated. Wedge compression fractures were created in 36 human cadavaric vertebrae (T10-L3). Twenty-seven vertebrae were treated with the SpineJack® with different cement volumes (maximum, intermediate, and no cement), and 9 vertebrae were treated with Balloon Kyphoplasty. Vertebral heights were measured pre- and postfracture as well as after treatment and loading. Cyclic loading was performed with 10,000cycles (1Hz, 100-600N). The average anterior height after restoration was 85.56% for Kyphoplasty; 96.20% for SpineJack® no cement; 93.44% for SpineJack® maximum and 96% for the SpineJack® intermediate group. The average central height after restoration was 93.89% for Kyphoplasty; 100.20% for SpineJack® no cement; 99.56% for SpineJack® maximum and 101.13% for the SpineJack® intermediate group. The average anterior height after cyclic loading was 85.33 % for Kyphoplasty; 87.30% in the SpineJack® no cement, 92% in the SpineJack® maximum and 87% in the SpineJack® intermediate group. The average central height after cyclic loading was 92% for Kyphoplasty; 93.80% in the SpineJack® no cement; 98.56% in the SpineJack® maximum and 94.25% in the SpineJack® intermediate group. Height restoration was significantly better for the SpineJack® group compared to Kyphoplasty. Height maintenance was dependent on the cement volume used. The group with the SpineJack® without cement nevertheless showed better results in height maintenance, yet the statistical significance could not be demonstrated. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Unstable resonator with multiple outputs

    Science.gov (United States)

    Konopnicki, M. J.; Smithers, M. E.

    1983-03-01

    Two or more unstable optical resonators can be coupled together by sharing optical elements. The result is then a single compound resonator with multiple outputs. For identical coupled cavities, the transverse structure of the outputs would be identical. In general, there will be misalignments and other aberrations that will vary from cavity to cavity. The cumulative effects of such aberrations are treated using both analytical and numerical approaches. It is shown that the average output of a multioutput resonator is the same as the output of a single uncoupled resonator with aberrations equal to the average of those contained in the multioutput resonator.

  14. Concomitant pelvic irradiation and chemotherapy in locally advanced cervical carcinoma. A retrospective study of 92 patients treated at the Curie Institute

    International Nuclear Information System (INIS)

    Nguyen, D.; Rochefordiere, A. de la; Chauveinc, L.; Cosset, J.M.; Clough, K.B.; Mouret-Fourme, E.; Guyonnet, M.

    2002-01-01

    The prognosis of locally advanced cervix cancers is poor with metastatic and local recurrence risks. Recent publications reported that concurrent chemotherapy and pelvic radiation increased local control compared to radiotherapy alone. Chemotherapy could also decrease metastatic recurrences. We report 92 cases of patients with locally advanced cervix cancer treated between 1986 and 1998 at the Institut Curie. Patients and methods. - Concurrent chemo-radiation was exclusive in 51 cases and added to surgery in 41 cases. Chemotherapy with 5FU -Cisplatin-Mitomycin C-Vindesin (protocol A) was performed for 43% of patients and 57% of them received 5FU-Cisplatin alone (protocol B). Results. -Median follow-up was 64 months (6-149 months). Five-year disease-free survival rate was 47% and local control rate was 70%. Disease-free survival was correlated with therapeutic response. After exclusive chemo-radiation, the good responsive patients had a better DFS (54% vs 26%, p=0.018). In the surgery group, those patients with sterilized lymph nodes and tumours had also a higher DFS (76% vs 47%, p=0.036). Toxicity was higher with protocol A. Conclusion. - From our study, it appears that local control of advanced cervix cancers is better with combined chemoradiotherapy but disease-free survival stays low according to the metastatic evolution. Metastasis without local recurrence remained frequent in our study. 5FU-CDDP chemotherapy has a lower toxicity and is as effective as 5FU-CDDP-Mitomycin C-Vindesin protocol, in association with radiotherapy. (author)

  15. Fraturas instáveis do fêmur em crianças tratadas com hastes intramedulares elásticas de titânio Unstable femoral fractures treated with titanium elastic intramedullary nails, in children

    Directory of Open Access Journals (Sweden)

    Jamil Faissal Soni

    2012-10-01

    Full Text Available OBJETIVO: Avaliar as indicações, epidemiologia, lesões associadas, complicações e prognóstico das fraturas diafisárias instáveis do fêmur na criança tratadas com hastes intramedulares elásticas de titânio. MÉTODO: Estudo retrospectivo composto por 24 pacientes com fraturas diafisárias instáveis do fêmur com idade entre cinco e 12 anos, submetidos a tratamento cirúrgico com hastes intramedulares elásticas de titânio no Hospital Universitário Cajuru - Curitiba, PR. Pacientes atendidos no período de abril de 2002 a março de 2008, com seguimento mínimo de 36 meses, submetidos à avaliação de dados epidemiológicos, desvios angulares, encurtamento e consolidação óssea. RESULTADOS: Foram reavaliados os prontuários de 113 casos operados de abril de 2002 a março de 2008, destes, incluídos no estudo 24 casos com fraturas de fêmur diafisárias instáveis tratadas com hastes intramedulares elásticas de titânio com inserção retrógrada. Apresentando duas fraturas bilaterais, duas fraturas expostas, sete pacientes do sexo feminino e 17 masculinos, com idade média de 8,3 anos. Apresentaram, ao final do estudo: encurtamento, desvios em varo ou valgo, retrocurvato ou antecurvato final igual a zero, não havendo ainda presença de retardo de consolidação ou pseudartrose. CONCLUSÕES: As hastes intramedulares elásticas de titânio são de fácil colocação e remoção. Consideramos a utilização das hastes intramedulares elásticas de titânio uma boa opção para a fixação de fraturas instáveis do fêmur em crianças.OBJECTIVE: To evaluate the indications, epidemiology, associated lesions, complications and prognosis among children with unstable femoral diaphysis fractures who were treated with titanium elastic intramedullary nails. METHOD: This was a retrospective analysis on 24 patients aged 5-12 years with unstable femoral diaphysis fractures who underwent surgical treatment with elastic titanium intramedullary

  16. Painful/unstable shoulder

    International Nuclear Information System (INIS)

    Saez, F.; Negueruela, J.; Martin, J.C.; Elizagaray, E.; Pena, J.M.; Merino, A.

    1991-01-01

    This paper reports on the diagnostic performance of CT-arthrography of the painful/unstable shoulder that was evaluated in more than 300 patients. We have encountered a great variety of painful shoulder pathology, including impingement syndrome, cuff tear arthropathy, lesions of the long head of the biceps tendon, calcifying tendinitis, adhesive capsulitis, dead arm syndrome, and degenerative joint disease. Lesions related to instability include cases of capsular avulsions, disruption of the glenohumeral ligaments, labral pathology, glenoid fractures, Hill-Sachs lesions, and changes in glenoid angulation. CT-arthrography is an accurate exploration for both unstable and painful shoulders

  17. [Pelvic fracture. Diagnostics and current treatment options].

    Science.gov (United States)

    Culemann, U; Tosounidis, G; Reilmann, H; Pohlemann, T

    2003-07-01

    Pelvic fracture, especially in combination with multiple trauma, can still lead to life-threatening situations. Only clear inclusion criteria and decisions can ensure the survival of the patient, the key task being mechanical stabilization using external fixators or pelvic clamps with or without surgical intervention for hemostasis. The basis for problem-oriented management is a precise classification, which is based on conventional X-rays in emergency situations and detailed analysis of computed tomography for the planning of definitive surgical interventions. The classification groups postulated are stable pelvic fractures (type A), rotational unstable pelvic fractures (type B--partial stability of the posterior pelvic ring present), and translational instabilities (type C--with a complete disruption of the anterior and posterior pelvic ring). This classification leads to clear indications for pelvic ring stabilization as surgical interventions are only exceptionally indicated in type A fractures, stabilization of the anterior ring is sufficient for type B fractures, and combined posterior and anterior stabilization is necessary for treatment of type C fractures. Following these concepts and by using standardized procedures and implants, the high rate of enclosed anatomical healing can be achieved even after type C injuries. Nevertheless, the role of concomitant soft tissue injuries and scar formation is not clear as the origin of the frequently observed long-term clinical impairments even after anatomical reconstruction of the osteoligamentous structures.

  18. The value of 'binder-off' imaging to identify occult and unexpected pelvic ring injuries.

    Science.gov (United States)

    Fagg, James A C; Acharya, Mehool R; Chesser, Tim J S; Ward, Anthony J

    2018-02-01

    To determine the effectiveness of 'binder-off' plain pelvic radiographs in the assessment of pelvic ring injuries. All patients requiring operative intervention at our tertiary referral pelvic unit/major trauma centre for high-energy pelvic injuries between April 2012 and December 2014 were retrospectively identified. Pre-operative pelvic imaging with and without pelvic binder was reviewed with respect to fracture pattern and pelvic stability. The frequency with which the imaging without pelvic binder changed the opinion of the pelvic stability and need for operative intervention, when compared with the computed tomography (CT) scans and anteroposterior (AP) radiographs with the binder on, was assessed. Seventy-three percent (71 of 97) of patients had initial imaging with a pelvic binder in situ. Of these, 76% (54 of 71) went on to have 'binder-off' imaging. Seven percent (4 of 54) of patients had unexpected unstable pelvic ring injuries identified on 'binder-off' imaging that were not identified on CT imaging in binder. Trauma CT imaging of the pelvis with a pelvic binder in place is inadequate at excluding unstable pelvic ring injuries, and, based on the original findings in this paper, we recommend additional plain film 'binder-off' radiographs, when there is any clinical concern. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Sexual function and quality of life in women with urinary incontinence treated by a complete pelvic floor rehabilitation program (biofeedback, functional electrical stimulation, pelvic floor muscles exercises, and vaginal cones).

    Science.gov (United States)

    Rivalta, Massimo; Sighinolfi, Maria Chiara; Micali, Salvatore; De Stefani, Stefano; Bianchi, Giampaolo

    2010-03-01

    Urinary incontinence (UI) is a debilitating condition that can cause discomfort, embarrassment, loss of confidence; it can lead to withdrawal from social life, and adversely affects physical and mental health, sexual function and quality of life (QoL) in women. The aim is to determine the impact of combined pelvic floor rehabilitation (PFR) on UI, female sexual dysfunction, and QoL. Female Sexual Function Index questionnaire (FSFI) and King's Health Questionnaire (KHQ). Sixteen patients with UI were selected and underwent a complete PFR program (biofeedback, functional electrical stimulation, pelvic floor muscles exercises, and vaginal cones). Patient filled out the FSFI questionnaire and the KHQ at the baseline and at follow-up. After PFR none of the patients reported urine leakage during sexual activity. Resolution of incontinence was achieved in 13 (81.25%) women. Only three (18.75%) patients had positive 1-hour pad test after the treatment. There was significant difference between pad test leakage before and after the PFR (P incontinence score was 1.37 +/- 0.5 at the baseline vs. 0.25 +/- 0.57 at the follow up (P incontinence scores. The treatment caused an improvement in patient's QoL index and sexual function.

  20. Feasibility of retroperitoneal pelvic lymph node exploration in cervix-carcinoma treated by radio-surgery association or a definitive radiotherapy

    International Nuclear Information System (INIS)

    Bolla, M.; Sarrazin, R.; Berland, E.; Schmidt, M.H.; Rolachon, I.; Salvat, J.

    1995-01-01

    From June 1980 to May 1993, 52 patients with a mean age of 49, underwent a retroperitoneal pelvic lymph node laparoscopy procedure for cervix carcinoma classified as stage IA (14), IB (12), IIA (6), IIB (14), IIIB(3), IVA (3). Two techniques were used: a retroperitoneoscopy in 16 cases and a panoramic retroperitoneal pelviscopy (PRPP) in 36 cases. The aim was to define, with a better accuracy, the pelvic lymph node status, to adapt the target volume, and to estimate the morbidity.More nodes were biopsied with PRPP than with retroperitoneoscopy (p<0.05). There was a disagreement between the conventional radiologic assessment and the histological results in 28.6%. Specificity is 100%. Intra-operative and post-surgical morbidity was equivalent in the two procedures. One grade 3 urinary late morbidity (3%) was observed among the 33 patients who underwent a pelvic external irradiation. There was no morbidity of the gastro-intestinal tract. Discussion deals with the support offered by the two laparoscopic procedures to define the pelvic lymph node status, to choose the planning target volume, and to precise the lymph node boost. (authors) 24 refs., 3 tabs

  1. Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence

    NARCIS (Netherlands)

    Chapple, C.R.; Cruz, F.; Deffieux, X.; Milani, A.L.; Arlandis, S.; Artibani, W.; Bauer, R.M.M.J.; Burkhard, F.; Cardozo, L.; Castro-Diaz, D.; Cornu, J.N.; Deprest, J.; Gunnemann, A.; Gyhagen, M.; Heesakkers, J.P.; Koelbl, H.; MacNeil, S.; Naumann, G.; Roovers, J.W.R.; Salvatore, S.; Sievert, K.D.; Tarcan, T.; Aa, F. Van der; Montorsi, F.; Wirth, M.; Abdel-Fattah, M.

    2017-01-01

    CONTEXT: Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP). OBJECTIVE: A consensus review of existing

  2. Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence

    NARCIS (Netherlands)

    Chapple, Christopher R.; Cruz, Francisco; Deffieux, Xavier; Milani, Alfredo L.; Arlandis, Salvador; Artibani, Walter; Bauer, Ricarda M.; Burkhard, Fiona; Cardozo, Linda; Castro-Diaz, David; Cornu, Jean Nicolas; Deprest, Jan; Gunnemann, Alfons; Gyhagen, Maria; Heesakkers, John; Koelbl, Heinz; MacNeil, Sheila; Naumann, Gert; Roovers, Jan-Paul W. R.; Salvatore, Stefano; Sievert, Karl-Dietrich; Tarcan, Tufan; van der Aa, Frank; Montorsi, Francesco; Wirth, Manfred; Abdel-Fattah, Mohamed

    2017-01-01

    Context: Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP). Objective: A consensus review of existing

  3. Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence.

    Science.gov (United States)

    Chapple, Christopher R; Cruz, Francisco; Deffieux, Xavier; Milani, Alfredo L; Arlandis, Salvador; Artibani, Walter; Bauer, Ricarda M; Burkhard, Fiona; Cardozo, Linda; Castro-Diaz, David; Cornu, Jean Nicolas; Deprest, Jan; Gunnemann, Alfons; Gyhagen, Maria; Heesakkers, John; Koelbl, Heinz; MacNeil, Sheila; Naumann, Gert; Roovers, Jan-Paul W R; Salvatore, Stefano; Sievert, Karl-Dietrich; Tarcan, Tufan; Van der Aa, Frank; Montorsi, Francesco; Wirth, Manfred; Abdel-Fattah, Mohamed

    2017-09-01

    Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP). A consensus review of existing data based on published meta-analyses and reviews. This document summarises the deliberations of a consensus group meeting convened by the European Association of Urology (EAU) and the European Urogynecological Association, to explore the current evidence relating to the use of polypropylene (PP) materials used for the treatment of SUI and POP, with reference to the 2016 EAU guidelines (European Association of Urology 2016), the European Commission's SCENIHR report on the use of surgical meshes (SCENIHR 2015), other available high-quality evidence, guidelines, and national recommendations. Current data suggest that the use of nonautologous durable materials in surgery has well-established benefits but significant risks, which are specific to the condition and location they are used for. Various graft-related complications have been described-such as infection, chronic pain including dyspareunia, exposure in the vagina, shrinkage, erosion into other organs of xenografts, synthetic PP tapes (used in SUI), and meshes (used in POP)-which differ from the complications seen with abdominal herniae. When considering surgery for SUI, it is essential to evaluate the available options, which may include synthetic midurethral slings (MUSs) using PP tapes, bulking agents, colposuspension, and autologous sling surgery. The use of synthetic MUSs for surgical treatment of SUI in both male and female patients has good efficacy and acceptable morbidity. Synthetic mesh for POP should be used only in complex cases with recurrent prolapse in the same compartment and restricted to those surgeons with appropriate training who are working in multidisciplinary referral centres. Synthetic slings can be safely used

  4. Assessment of pelvic fractures resulting from the 2010 Haiti earthquake: opportunities for improved care.

    Science.gov (United States)

    Dailey, Steven K; Casstevens, E Christopher; Archdeacon, Michael T; Mamczak, Christiaan N; Burgess, Andrew R

    2014-03-01

    On January 12, 2010, a catastrophic 7.0 magnitude earthquake shook the Haitian capital of Port-au-Prince. Because of their sudden and destructive nature, earthquakes can result in unfamiliar mass casualty situations accompanied by devastating orthopedic injuries. Evaluation of the pelvic fractures resulting from this earthquake revealed several factors that we hope will facilitate optimal preparation and planning for future disaster situations. A cohort of patients with earthquake-related pelvic ring fractures who were treated aboard the USNS Comfort was retrospectively analyzed. Anteroposterior radiographs of the pelvis were evaluated and categorized according to the Young-Burgess classification system. Sixty-eight patients were included in the cohort. The mean (SD) age was 29.6 (14.4) years. Nineteen patients (29.7%) were male, and 49 (70.3%) were female. Pelvic fractures were categorized as anteroposterior compression in 7 patients, lateral compression (LC) in 47 patients, vertical shear (VS) in 8 patients, and combination of pelvic ring/acetabulum in 6 patients. Among the 23 patients treated operatively, the mean (SD) delay from injury to surgery was 19.2 (7.4) days. Patients showed predominance toward LC injuries (69.1%), consistent with crush under rubble. Thirty-one percent of the fractures were considered unstable (anteroposterior compression Type III, LC Type III, VS, and combination of pelvic ring/acetabulum). The VS injuries observed (11.8%) may be the result of a previously unidentified injury mechanism, an upright individual being struck by falling rubble, violently applying a downward force to the body over an extended lower extremity. A substantial delay in the treatment observed in this series may lead to an underestimation of both quantity and severity of pelvic fractures as critically ill patients may have perished before evaluation and treatment. In addition, the application of pelvic sheeting techniques may be a lifesaving intervention for

  5. Imaging unstable plaque

    International Nuclear Information System (INIS)

    SRIRANJAN, Rouchelle S.; TARKIN, Jason M.; RUDD, James H.; EVANS, Nicholas R.; CHOWDHURY, Mohammed M.

    2016-01-01

    Recent advances in imaging technology have enabled us to utilise a range of diagnostic approaches to better characterise high-risk atherosclerotic plaque. The aim of this article is to review current and emerging techniques used to detect and quantify unstable plaque in the context of large and small arterial systems and will focus on both invasive and non-invasive imaging techniques. While the diagnosis of clinically relevant atherosclerosis still relies heavily on anatomical assessment of arterial luminal stenosis, evolving multimodal cross-sectional imaging techniques that encompass novel molecular probes can provide added information with regard to plaque composition and overall disease burden. Novel molecular probes currently being developed to track precursors of plaque rupture such as inflammation, micro-calcification, hypoxia and neoangiogenesis are likely to have translational applications beyond diagnostics and have the potential to play a part in quantifying early responses to therapeutic interventions and more accurate cardiovascular risk stratification.

  6. Comparison of Biomechanical Characteristics and Pelvic Ring Stability Using Different Fixation Methods to Treat Pubic Symphysis Diastasis: A Finite Element Study.

    Science.gov (United States)

    Yao, Feng; He, Yu; Qian, Hebu; Zhou, Dongsheng; Li, Qinghu

    2015-12-01

    The intention of this study was to compare the biomechanical characteristics using 5 internal fixation methods used clinically to stabilize a pubic symphysis diastasis (PSD, Tile type B1).A 3-dimensional finite element model of PSD was simulated using 5 implants, including single superior plate (Single-Plate), superior and anterior plate (Dual-Plate), single cannulated screw (Single-Screw), crossed dual cannulated screws (Cross-Screw), and parallel dual cannulated screws (Para-Screw). Three loads were distributed in all models, including dual-leg standing, single-leg stance, and rotation. To evaluate the biomechanical properties, the construct stiffness, the stress distribution, and the von Misses stress were recorded and analyzed. To evaluate pelvic ring stability, the micromotion of the pubic symphysis and iliosacral joint was analyzed.Disruption of pubic symphysis dramatically decreased the pelvic ring stability. Cross-screw and Para-Screw showed higher stiffness than other methods. All implants endured the maximum von Misses stress under single-leg stance. For Plate-Screw system, the maximum stress occurred at a place where it strides over pubic symphysis and adjacent Plate-Screw interface. The single implant and Para-Screw had a tendency to fail. Para-Screw showed the best fixation effect under dual-leg conditions. Cross-screw showed superior antishearing force capacity under single-leg stance. Dual-Plate provided maximum antihorizontal rotation. Para-Screw provided the maximum stabilization for the posterior pelvic ring.This study showed the biomechanical advantages of dual-implant for PSD only from the finite element view. The Para-Screw provided high construct stiffness under 3 load conditions. The single implant and Para-Screw had a tendency to fail. The better anterior and posterior pelvic stabilization were obtained by the dual-implant fixation than other methods. Therefore, the Cross-Screw and Dual-Plate fixation methods should be preferred in the

  7. Mortality in patients with pelvic fractures

    DEFF Research Database (Denmark)

    Hauschild, Oliver; Strohm, Peter C; Culemann, Ulf

    2008-01-01

    BACKGROUND: Pelvic and acetabular fractures are rare injuries and account for approximately 3% to 8% of all fractures. Often the result of high energy blunt trauma, most of the patients sustaining pelvic injuries are at high risk of associated injuries strongly influencing outcome and survival...... rates. Because of anatomic differences it has been suggested that pediatric pelvic fractures are different injuries as compared with that of adults. However, this has been controversially discussed. Aim of this multicenter register study was to identify similarities and differences between pediatric...... and adult pelvic trauma and evaluate the influence of changes in medical treatment by comparison of two treatment periods. METHODS: In this multicenter register study, data of 4,291 patients treated from 1991 to 1993 (n = 1,723) or 1998 to 2000 (n = 2,568) for pelvic fractures in one of the 23 participating...

  8. Pelvic Inflammatory Disease: Diagnosis And Treatment In The Emergency Department.

    Science.gov (United States)

    Bugg, Charles Walter; Taira, Taku

    2016-12-01

    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.

  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. Management of pelvic fractures in dog | Sharma | Nigerian ...

    African Journals Online (AJOL)

    Pelvic fractures are common sequelae of major traumatic injury of dogs and cat which, comprise of at least 25% of all fractures in veterinary practice (Piermattei et al., 2006). Fracture of ilium, the most ... We hereby report the successful surgical management of unstable fracture of ilium and ischium of pelvis in a Spitz dog.

  11. Percutaneous cannulated screw fixation of sacral fractures and sacroiliac joint disruptions with CT-controlled guidewires performed by interventionalists: Single center experience in treating posterior pelvic instability

    International Nuclear Information System (INIS)

    Fischer, Sebastian; Vogl, Thomas J.; Marzi, Ingo; Zangos, Stephan; Wichmann, Julian L.; Scholtz, Jan-Erik; Mack, Martin G.; Schmidt, Sven; Eichler, Katrin

    2015-01-01

    Highlights: • Minimally invasive sacroiliac screw fixation can be performed under CT-imaging. • Guidewires help in precise placement of cannulated sacroiliac screw. • Only a diminishing rate of misplacements can be seen. • The method appears to be a safe and very accurate procedure. - Abstract: Objective: The purpose of our study was to evaluate minimally invasive sacroiliac screw fixation for treatment of posterior pelvic instability with the help of CT controlled guidewires, assess its accuracy, safety and effectiveness, and discuss potential pitfalls. Methods: 100 guidewires and hollow titan screws were inserted in 38 patients (49.6 ± 19.5 years) suffering from 35 sacral fractures and/or 16 sacroiliac joint disruptions due to 33 (poly-)traumatic, 2 osteoporotic and 1 post-infectious conditions. The guidewire and screw positions were analyzed in multiplanar reconstructions. Results: The mean minimal distance between guidewire and adjacent neural foramina was 4.5 ± 2.01 mm, with a distinctly higher precision in S1 than S2. Eight guidewires showed cortical contacts, resulting in a total of 2% mismatched screws with subsequent wall violation. The fracture gaps were reduced from 3.6 ± 0.53 mm to 1.2 ± 0.54 mm. During follow-up 3 cases of minor iatrogenic sacral impaction (<5 mm) due to the bolting and 2 cases of screw loosening were observed. Interventional time was 84.0 min with a mean of 2.63 screws per patient whilst acquiring a mean of 93.7 interventional CT-images (DLP 336.7 mGy cm). Conclusions: The treatment of posterior pelvic instability with a guidewire-based screw insertion technique under CT-imaging results in a very high accuracy and efficacy with a low complication rate. Careful attention should be drawn to radiation levels

  12. Percutaneous cannulated screw fixation of sacral fractures and sacroiliac joint disruptions with CT-controlled guidewires performed by interventionalists: Single center experience in treating posterior pelvic instability

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Sebastian, E-mail: sebastian.fischer@kgu.de [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Vogl, Thomas J. [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Marzi, Ingo [Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Zangos, Stephan; Wichmann, Julian L.; Scholtz, Jan-Erik; Mack, Martin G. [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Schmidt, Sven [Orthopaedic University Hospital Friedrichsheim, Marienburgstraße, 260528 Frankfurt (Germany); Eichler, Katrin [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany)

    2015-02-15

    Highlights: • Minimally invasive sacroiliac screw fixation can be performed under CT-imaging. • Guidewires help in precise placement of cannulated sacroiliac screw. • Only a diminishing rate of misplacements can be seen. • The method appears to be a safe and very accurate procedure. - Abstract: Objective: The purpose of our study was to evaluate minimally invasive sacroiliac screw fixation for treatment of posterior pelvic instability with the help of CT controlled guidewires, assess its accuracy, safety and effectiveness, and discuss potential pitfalls. Methods: 100 guidewires and hollow titan screws were inserted in 38 patients (49.6 ± 19.5 years) suffering from 35 sacral fractures and/or 16 sacroiliac joint disruptions due to 33 (poly-)traumatic, 2 osteoporotic and 1 post-infectious conditions. The guidewire and screw positions were analyzed in multiplanar reconstructions. Results: The mean minimal distance between guidewire and adjacent neural foramina was 4.5 ± 2.01 mm, with a distinctly higher precision in S1 than S2. Eight guidewires showed cortical contacts, resulting in a total of 2% mismatched screws with subsequent wall violation. The fracture gaps were reduced from 3.6 ± 0.53 mm to 1.2 ± 0.54 mm. During follow-up 3 cases of minor iatrogenic sacral impaction (<5 mm) due to the bolting and 2 cases of screw loosening were observed. Interventional time was 84.0 min with a mean of 2.63 screws per patient whilst acquiring a mean of 93.7 interventional CT-images (DLP 336.7 mGy cm). Conclusions: The treatment of posterior pelvic instability with a guidewire-based screw insertion technique under CT-imaging results in a very high accuracy and efficacy with a low complication rate. Careful attention should be drawn to radiation levels.

  13. Chronic pelvic pain

    African Journals Online (AJOL)

    It affects all spheres of life, from physical and psychological ... Peripheral sensitisation: This refers to overactive afferent nerve pathways. • Pelvic floor hypertonicity: This refers to upregulation of the pelvic muscle tone. ... Chronic pelvic pain is defined as pain in the pelvis lasting for more than six months (some say three).

  14. Unstable Jefferson fractures: Results of transoral osteosynthesis.

    Science.gov (United States)

    Hu, Yong; Albert, Todd J; Kepler, Christopher K; Ma, Wei-Hu; Yuan, Zhen-Shan; Dong, Wei-Xin

    2014-03-01

    Majority of C1 fractures can be effectively treated conservatively by immobilization or traction unless there is an injury to the transverse ligament. Conservative treatment usually involves a long period of immobilization in a halo-vest. Surgical intervention generally involves fusion, eliminating the motion of the upper cervical spine. We describe the treatment of unstable Jefferson fractures designed to avoid these problems of both conservative and invasive methods. A retrospective review of 12 patients with unstable Jefferson fractures treated with transoral osteosynthesis of C1 between July 2008 and December 2011 was performed. A steel plate and C1 lateral mass screw fixation were used to repair the unstable Jefferson fractures. Our study group included eight males and four females with an average age of 33 years (range 23-62 years). Patients were followed up for an average of 16 months after surgery. Range of motion of the cervical spine was by and large physiologic: Average flexion 35° (range 28-40°), average extension 42° (range 30-48°). Lateral bending to the right and left averaged 30° and 28° respectively (range 12-36° and 14-32° respectively). The average postoperative rotation of the atlantoaxial joint, evaluated by functional computed tomography scan was 60° (range 35-72°). Total average lateral displacement of the lateral masses was 7.0 mm before surgery (range 5-12 mm), which improved to 3.5 mm after surgery (range 1-6.5 mm). The total average difference of the atlanto-dens interval in flexion and extension after surgery was 1.0 mm (range 1-3 mm). Transoral osteosynthesis of the anterior ring using C1 lateral mass screws is a viable option for treating unstable Jefferson fractures, which allows maintenance of rotation at the C1-C2 joint and restoration of congruency of the atlanto-occipital and atlantoaxial joints.

  15. Baseline demographic profile and general health influencing the post-radiotherapy health related quality-of-life in women with gynaecological malignancy treated with pelvic irradiation

    Directory of Open Access Journals (Sweden)

    Sourav Sau

    2013-01-01

    Full Text Available Background: Cancer specific survival and quality-of-life (QOL assessment are important in evaluating cancer treatment outcomes. Baseline demographic profiles have significant effects on follow-up health related QOL (HRQOL and affect the outcome of treatments. Materials and Methods: Post-operative gynaecological cancer patients required adjuvant pelvic radiation enrolled longitudinal assessment study. Patients had completed the short form-36 (SF-36 questionnaire before the adjuvant radiotherapy and functional assessments of cancer therapy-general module at 6 th month′s follow-up period to assess the HRQOL. Baseline variables were race, age, body mass index (BMI, education, marital status, type of surgery, physical composite scores (PCS and mental composite scores (MCS summary scores of the SF-36. Univariate and multivariate regression analysis used to determine the influence of these variables on post-radiotherapy HRQOL domains. Results: Baseline PCS, MCS, age, education and marital status had positively correlation with post-radiotherapy HRQOL while higher BMI had a negative impact in univariate analysis. In multivariate regression analysis, education and MCS had a positive correlation while higher BMI had a negative correlation with HRQOL domains. Conclusion: Enhance our ability to detect demographic variables and modify those factors and develops new treatment aimed at improving all aspect of gynaecological cancer including good QOL.

  16. Treatment of Unstable Ankle Fractures

    OpenAIRE

    Yaniel Truffín Rodríguez; Gerardo Águila Tejeda

    2015-01-01

    Patients with unstable ankle fractures frequently attend the emergency rooms. It is estimated that there are 122 ankle fractures per 100 000 people a year. Surgical treatment of those that are unstable is inevitable since they can not be corrected in a conservative way. Several surgical procedures for repair of such lesions have been described and all of them constitute important tools for the orthopedic surgeon. Therefore, we conducted a literature review to discuss the current management of...

  17. Quantitative MDCT assessment of binder effects after pelvic ring disruptions using segmented pelvic haematoma volumes and multiplanar caliper measurements.

    Science.gov (United States)

    Dreizin, David; Bodanapally, Uttam; Mascarenhas, Daniel; O'Toole, Robert V; Tirada, Nikki; Issa, Ghada; Nascone, Jason

    2018-03-13

    To assess effects of pelvic binders for different instability grades using quantitative multidetector computed tomography (MDCT) parameters including segmented pelvic haematoma volumes and multiplanar caliper measurements. CT examinations of 49 patients with binders and 49 controls performed from January 2008-June 2016, and matched 1:1 for Tile instability grade and Pennal/Young-Burgess force vector, were compared for differences in pubic symphysis and sacroiliac displacement using caliper measurements in three orthogonal planes. Pelvic haematoma volumes (ml) were derived using semi-automated seeded region-growing segmentation. Median caliper measurements and volumes were compared using the Mann-Whitney U test, and correlations assessed with Pearson's correlation coefficient. Relevant caliper measurement cutoffs were established using ROC analysis. Rotationally unstable (Tile B) patients with binders showed significant decreases in sacroiliac diastasis (2.7 mm vs. 4.5 mm; p=0.003) and haematoma volumes (135 ml vs. 295 ml; p=0.008). Globally unstable (Tile C) binder patients showed decreased sacroiliac diastasis (4.7 mm vs. 6.4 mm, p=0.04), without significant difference in haematoma volumes (284 ml vs. 234 ml, p=0.34). Four Tile C patients with binders demonstrated over-reduction resulting in pubic body over-ride. Rotationally unstable patients with binders have significantly less sacroiliac diastasis versus controls, corresponding with significantly lower haematoma volumes. • Haematoma segmentation and multiplanar caliper measurements provide new insights into binder effects. • Binder reduction corresponds with decreased pelvic haematoma volume in rotationally unstable injuries. • Discrimination between rotational and global instability is important for management. • Several caliper measurement cut-offs discriminate between rotationally and globally unstable injuries. • Pubic symphysis over-ride is suggestive of binder over-reduction in globally unstable

  18. Effect of Teriparatide on Unstable Pertrochanteric Fractures

    Directory of Open Access Journals (Sweden)

    Tsan-Wen Huang

    2015-01-01

    Full Text Available We retrospectively analyzed the radiographic and clinical outcomes of unstable pertrochanteric fractures (AO/OTA 31-A2 in 44 patients who underwent dynamic hip screw (DHS fixation and compared the results with 29 patients who received teriparatide in addition to DHS fixation. A significantly shorter time for fracture healing was recorded in the teriparatide-treated group than in the control group. Rates of lag screw sliding, femoral shortening, and varus collapse were all significantly reduced in the teriparatide-treated group. There were no significant differences with regard to superficial wound infection, pneumonia, urinary tract infection, mortality, malunion, and cutting of the lag screw. The mean overall mobility scores were significantly better in the teriparatide-treated group at 3 and 6 months (P<0.001 and P<0.001, resp. but not at 12 months or the last follow-up. The pain scores were also significantly better in the teriparatide-treated group at 3 and 6 months (P=0.040 and P=0.041, resp. but not at 12 months or the last follow-up. Teriparatide improves radiographic outcomes and yields better clinical outcomes at 3 and 6 months postoperatively. The improvement in union time may be important for elderly populations with unstable pertrochanteric fractures to enable them to return to daily activities and reduce morbidity and mortality.

  19. Effect of teriparatide on unstable pertrochanteric fractures.

    Science.gov (United States)

    Huang, Tsan-Wen; Yang, Tien-Yu; Huang, Kuo-Chin; Peng, Kuo-Ti; Lee, Mel S; Hsu, Robert Wen-Wei

    2015-01-01

    We retrospectively analyzed the radiographic and clinical outcomes of unstable pertrochanteric fractures (AO/OTA 31-A2) in 44 patients who underwent dynamic hip screw (DHS) fixation and compared the results with 29 patients who received teriparatide in addition to DHS fixation. A significantly shorter time for fracture healing was recorded in the teriparatide-treated group than in the control group. Rates of lag screw sliding, femoral shortening, and varus collapse were all significantly reduced in the teriparatide-treated group. There were no significant differences with regard to superficial wound infection, pneumonia, urinary tract infection, mortality, malunion, and cutting of the lag screw. The mean overall mobility scores were significantly better in the teriparatide-treated group at 3 and 6 months (P teriparatide-treated group at 3 and 6 months (P = 0.040 and P = 0.041, resp.) but not at 12 months or the last follow-up. Teriparatide improves radiographic outcomes and yields better clinical outcomes at 3 and 6 months postoperatively. The improvement in union time may be important for elderly populations with unstable pertrochanteric fractures to enable them to return to daily activities and reduce morbidity and mortality.

  20. Physics of Unstable Nuclei

    Science.gov (United States)

    Khoa, Dao Tien; Egelhof, Peter; Gales, Sydney; Giai, Nguyen Van; Motobayashi, Tohru

    2008-04-01

    Studies at the RIKEN RI beam factory / T. Motobayashi -- Dilute nuclear states / M. Freer -- Studies of exotic systems using transfer reactions at GANIL / D. Beaumel et al. -- First results from the Magnex large-acceptance spectrometer / A. Cunsolo et al. -- The ICHOR project and spin-isospin physics with unstable beams / H. Sakai -- Structure and low-lying states of the [symbol]He exotic nucleus via direct reactions on proton / V. Lapoux et al. -- Shell gap below [symbol]Sn based on the excited states in [symbol]Cd and [symbol]In / M. Górska -- Heavy neutron-rich nuclei produced in the fragmentation of a [symbol]Pb beam / Zs. Podolyák et al. -- Breakup and incomplete fusion in reactions of weakly-bound nuclei / D.J. Hinde et al. -- Excited states of [symbol]B and [symbol]He and their cluster aspect / Y. Kanada-En'yo et al. -- Nuclear reactions with weakly-bound systems: the treatment of the continuum / C. H. Dasso, A. Vitturi -- Dynamic evolution of three-body decaying resonances / A. S. Jensen et al. -- Prerainbow oscillations in [symbol]He scattering from the Hoyle state of [symbol]C and alpha particle condensation / S. Ohkubo, Y. Hirabayashi -- Angular dispersion behavior in heavy ion elastic scattering / Q. Wang et al. -- Microscopic optical potential in relativistic approach / Z.Yu. Ma et al. -- Exotic nuclei studied in direct reactions at low momentum transfer - recent results and future perspectives at fair / P. Egelhof -- Isotopic temperatures and symmetry energy in spectator fragmentation / M. De Napoli et al. -- Multi-channel algebraic scattering theory and the structure of exotic compound nuclei / K. Amos et al. -- Results for the first feasibility study for the EXL project at the experimental storage ring at GSI / N. Kalantar-Nayestanaki et al. -- Coulomb excitation of ISOLDE neutron-rich beams along the Z = 28 chain / P. Van Duppen -- The gamma decay of the pygmy resonance far from stability and the GDR at finite temperature / G. Benzoni et al

  1. The Diminishing Role of Pelvic Stability Evaluation in the Era of Computed Tomographic Scanning.

    Science.gov (United States)

    Fu, Chih-Yuan; Teng, Lan-Hsuan; Liao, Chien-Hung; Hsu, Yu-Pao; Wang, Shang-Yu; Kuo, Ling-Wei; Yuan, Kuo-Ching

    2016-04-01

    Pelvic fractures can result in life-threatening hemorrhages or other associated injuries. Therefore, computed tomography (CT) scanning plays a key role in the management of pelvic fracture patients. However, CT scanning is utilized as an adjunct in secondary survey according to traditional Advanced Trauma Life Support (ATLS) guidelines, whereas pelvic x-ray is used as a primary tool to evaluate pelvic stability and the necessity of further CT scanning. In the current study, we attempted to evaluate the role of CT scanning in the era of advanced technology. The significance of pelvic stability was also analyzed. From January 2012 to December 2014, the trauma registry and medical records of pelvic fracture patients were retrospectively reviewed. A 64-slice multidetector CT scanner was used in our emergency department as a standard diagnostic tool for evaluating trauma patients. Pelvic x-ray was used as a primary tool for screening pelvic fractures, and pelvic stability was evaluated accordingly. CT scans were performed in patients with unstable pelvic fractures, suspected associated intra-abdominal injuries (IAIs), or other conditions based on the physicians' clinical judgment. The clinical features of patients with stable and unstable pelvic fractures were compared. The patients with stable pelvic fractures were analyzed to determine the characteristics associated with retroperitoneal hemorrhage (RH) or IAIs. Patients with stable pelvic fractures were also compared based on whether they underwent a CT scan. A total of 716 patients were enrolled in this study. There were 533 (74.4%) patients with stable pelvic fractures. Of these patients, there were 66 (12.4%) and 50 (9.4%) patients with associated RH and IAI, respectively. There were no significant differences between the patients with associated RH based on their primary evaluation (vital signs, volume of blood transfusion, and hemoglobin level). Similarly, the demographics and the primary evaluation results

  2. Application of Circumferential Compression Device (Binder in Pelvic Injuries: Room for Improvement

    Directory of Open Access Journals (Sweden)

    Matthew Roth

    2016-11-01

    Full Text Available Introduction The use of a noninvasive pelvic circumferential compression device (PCCD to achieve pelvic stabilization by both decreasing pelvic volume and limiting inter-fragmentary motion has become commonplace, and is a well-established component of Advanced Trauma Life Support (ATLS protocol in the treatment of pelvic ring injuries. The purpose of this study was to evaluate the following: 1 how consistently a PCCD was placed on patients who arrived at our hospital with unstable pelvic ring injuries; 2 if they were placed in a timely manner; and 3 if hemodynamic instability influenced their use. Methods We performed an institutional review board-approved retrospective study on 112 consecutive unstable pelvic ring injuries, managed over a two-year period at our Level I trauma center. Our hospital electronic medical records were used to review EMT, physician, nurses’, operative notes and radiographic images, to obtain information on the injury and PCCD application. The injuries were classified by an orthopaedic trauma surgeon and a senior orthopaedic resident. Proper application of a pelvic binder using a sheet is demonstrated. Results Only 47% of unstable pelvic fractures received PCCD placement, despite being the standard of care according to ATLS. Lateral compression mechanism pelvic injuries received PCCDs in 33% of cases, while anterior posterior compression (APC and vertical shear (VS injuries had applications in 63% of cases. Most of these PCCD devices were applied after imaging (72%. Hemodynamic instability did not influence PCCD application. Conclusion PCCD placement was missed in many (37% of APC and VS mechanism injuries, where their application could have been critical to providing stability. Furthermore, to provide rapid stability, pelvic circumferential compression devices should be applied after secondary examination, rather than after receiving imaging results. Better education on timing and technique of PCCD placement at our

  3. Assessing the most accurate formula to predict the risk of lymph node metastases from prostate cancer in contemporary patients treated with radical prostatectomy and extended pelvic lymph node dissection

    International Nuclear Information System (INIS)

    Abdollah, Firas; Cozzarini, Cesare; Sun, Maxine; Suardi, Nazareno; Gallina, Andrea; Passoni, Niccolò Maria; Bianchi, Marco; Tutolo, Manuela; Fossati, Nicola; Nini, Alessandro; Dell’Oglio, Paolo; Salonia, Andrea; Karakiewicz, Pierre; Montorsi, Francesco; Briganti, Alberto

    2013-01-01

    Background and purpose: The aim of this study was to perform a head-to-head comparison of the Roach formula vs. two other newly developed prediction tools for lymph node invasion (LNI) in prostate cancer, namely the Nguyen and the Yu formulas. Material and methods: We included 3115 patients treated with radical prostatectomy and extended pelvic lymph node dissection (ePLND), between 2000 and 2010 at a single center. The predictive accuracy of the three formulas was assessed and compared using the area-under-curve (AUC) and calibration methods. Moreover, decision curve analysis compared the net-benefit of the three formulas in a head-to-head fashion. Results: Overall, 10.8% of patients had LNI. The LNI-predicted risk was >15% in 25.5%, 3.4%, and 10.2% of patients according to the Roach, Nguyen and Yu formula, respectively. The AUC was 80.5%, 80.5% and 79%, respectively (all p > 0.05). However, the Roach formula demonstrated more favorable calibration and generated the highest net-benefit relative to the other examined formulas in decision curve analysis. Conclusions: All formulas demonstrated high and comparable discrimination accuracy in predicting LNI, when externally validated on ePLND treated patients. However, the Roach formula showed the most favorable characteristics. Therefore, its use should be preferred over the two other tools

  4. Pelvic floor rehabilitation is effective in patients with multiple sclerosis.

    Science.gov (United States)

    Vahtera, T; Haaranen, M; Viramo-Koskela, A L; Ruutiainen, J

    1997-08-01

    To determine the effect of pelvic floor muscle exercises combined with electrical stimulation of pelvic floor on lower urinary tract dysfunction in multiple sclerosis (MS) patients with near normal (current symptoms of lower urinary tract dysfunction. The muscle activity of the pelvic floor muscles was tested using surface EMG. Subjective urinary symptoms were assessed using a questionnaire. Pelvic floor muscles were stimulated using electrical stimulation at six sessions. During and after the final session the patients were taught to exercise their pelvic floor muscles and advised to continue these exercises regularly for at least six months. The control group was not treated. The maximal contraction power and endurance of the pelvic floor muscles increased after six sessions of electrical stimulation with interferential currents. Symptoms of urinary urgency, frequency and incontinence were significantly less frequent in the treated group than in the untreated subjects. Male patients appeared to respond better to the treatment than female patients. Compliance with the pelvic floor exercises was over 60% at the end of a follow-up for six months. Most drop-outs were due to the disappearance of urinary tract symptoms or to severe relapses in MS. The present study indicates that pelvic floor muscle exercises combined with electrical stimulation of the pelvic floor constitute an effective treatment for lower urinary tract dysfunction at least in male patients with MS.

  5. Concomitant trocar-guided transvaginal mesh surgery with a midurethral sling in treating advanced pelvic organ prolapse associated with stress or occult stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Chia-Jen Wu

    2013-12-01

    Conclusion: Concomitant trocar-guided TVM surgery and MUS with the use of total Prolift and Tension-free Vaginal Tape-Obturator offer good efficacy in treating women with advanced POP and SUI or OSUI. The vaginal hysterectomy group had more perioperative complications.

  6. Manual control of unstable systems

    Science.gov (United States)

    Allen, R. W.; Hogue, J. R.; Parseghian, Z.

    1986-01-01

    Under certain operational regimes and failure modes, air and ground vehicles can present the human operator with a dynamically unstable or divergent control task. Research conducted over the last two decades has explored the ability of the human operator to control unstable systems under a variety of circumstances. Past research is reviewed and human operator control capabilities are summarized. A current example of automobile directional control under rear brake lockup conditions is also reviewed. A control system model analysis of the driver's steering control task is summarized, based on a generic driver/vehicle model presented at last year's Annual Manual. Results from closed course braking tests are presented that confirm the difficulty the average driver has in controlling the unstable directional dynamics arising from rear wheel lockup.

  7. Unstable oscillators based hyperchaotic circuit

    DEFF Research Database (Denmark)

    Murali, K.; Tamasevicius, A.; G. Mykolaitis, A.

    1999-01-01

    A simple 4th order hyperchaotic circuit with unstable oscillators is described. The circuit contains two negative impedance converters, two inductors, two capacitors, a linear resistor and a diode. The Lyapunov exponents are presented to confirm hyperchaotic nature of the oscillations in the circ......A simple 4th order hyperchaotic circuit with unstable oscillators is described. The circuit contains two negative impedance converters, two inductors, two capacitors, a linear resistor and a diode. The Lyapunov exponents are presented to confirm hyperchaotic nature of the oscillations...

  8. Pelvic Floor Dysfunction

    Science.gov (United States)

    ... intake. Biofeedback, which is a special form of pelvic floor physical therapy aimed at improving a patient’s rectal sensation and ... therapy. As patients perform this specialized form of pelvic floor physical therapy, they are often able to view EMG or ...

  9. Pelvic floor imaging

    NARCIS (Netherlands)

    Stoker, J.; Halligan, S.; Bartram, C. I.

    2001-01-01

    A greater awareness of the therapies now available for pelvic floor dysfunction has increased demand for specialized imaging of this region. Some of the techniques required are available at relatively few centers, and the purpose of this review is to introduce the emerging subspecialty of pelvic

  10. External Fixation of Unstable Distal Radius Fracture. A Case Report

    OpenAIRE

    Yaniel Truffin Rodríguez; Rafael Esmandy Gámez Arregoitía; Indira L. Gómez Gil; José Julio Requeiro Morejón

    2014-01-01

    Unstable fracture of the distal radius is a common injury. If not properly treated, it can cause major disturbance in the radiocarpal joint and impaired hand function. A case of a 42-year-old patient of rural origin without a history of previous conditions treated at the Gustavo Aldereguía Lima Hospital in Cienfuegos is presented. He suffered a fall on the outstretched hand, which led to an unstable fracture of the left distal radius. Emergency surgery consisting of manual fracture reduction ...

  11. [A simple supraacetabular external fixation for pelvic ring fractures].

    Science.gov (United States)

    Gänsslen, Axel; Pohlemann, Tim; Krettek, Christian

    2005-09-01

    Closed reduction and maintenance of pelvic ring injuries by external stabilization. Emergency management of unstable type B and type C pelvic ring fractures. Definitive treatment of type B injuries. Definitive treatment of the anterior pelvic ring in type C injuries with transpubic instability after posterior internal stabilization. Adjunct stabilization of internal fixation. Stabilization of pelvic ring fractures in children. Poor general condition. Local soft-tissue damage. Local infection. Bilateral percutaneous insertion of Schanz screws into the supraacetabular area of iliac bone. Closed reduction and stabilization of the pelvic ring by compression and application of a connecting rod under image intensification. Depending on the patient's condition and the degree of pelvic instability, a change to an open procedure may become necessary. Mobilization of the patient with partial weight bearing (one fifth of body weight) on the side of the injured posterior pelvic ring using forearm crutches, irrespective of the degree of stability of the pelvis. Retrospective analysis of 64 supraacetabular external fixator applications to stabilize the anterior pelvic ring in 20 type B and 44 type C injuries. Iatrogenic lesions of the lateral femoral cutaneous nerve: 4.5%; all sensory disturbances completely reversed within 1 year. No pin site infection. In two patients (3%) primary perforation of the Schanz screw into the small pelvis not necessitating any treatment. No secondary displacements of the anterior or posterior pelvic ring in type B injuries nor for type C injuries, sacral fractures associated with fractures of the pubic ramus. One pseudarthrosis of the pubic and ischial rami requiring surgical treatment.

  12. Unstable Semiclassical Trajectories in Tunneling

    CERN Document Server

    Levkov, D G; Sibiryakov, S M

    2007-01-01

    Some tunneling phenomena are described, in the semiclassical approximation, by unstable complex trajectories. We develop a systematic procedure to stabilize the trajectories and to calculate the tunneling probability, including both the suppression exponent and prefactor. We find that the instability of tunneling solutions modifies the power-law dependence of the prefactor on h as compared to the case of stable solutions.

  13. Proton scattering from unstable nuclei

    Indian Academy of Sciences (India)

    Abstract. Recent improvements in the intensities and optical qualities of radioactive beams have made possible the study of elastic and inelastic proton scattering on unstable nuclei. The design and performances of an innovative silicon strip detector array devoted to such experiments are described. The quality of the data ...

  14. 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

  15. TREATMENT OF UNSTABLE FRACTURES OF THE TIBIA

    Directory of Open Access Journals (Sweden)

    Dragan Petković

    2004-07-01

    Full Text Available Unstable fractures of cruris are all those fractures which cannot hold satisfactory position even after orthopedic reposition and imobilization.Bone fragments or fractures which redislocate and whithin 7 days after primary well done reposition and adeqate imobilization are also unstable fractures. These fractures can be treated by orthopedic repozition, by transosal traction through calcaneus or through supramalleolar area.These fractures can also be treated surgically by internal or by external fixation. The safest operative method today is external fixation. Using of Mitkovic external flxator this method minimally traumatizes bone and soft tisue of cruris,the operation is not time consuming and complications as infection and nonunion aresignificantly more rare in comparison to internal fixation. External fixation is minimaly invasive method, preserving both periostal and intramedular blood circulation. Mitkovic system also provides biological conditions, which are very similar to biomechanical features of natural tibia and probably it is one of important factor for qicker fracture healing with big periostal callus fortnation.This external flxation system has additional advantages in comparison to other existing devices, especialy in regard of simplicity of application and possibility of accurate closed intraoperative and postoperative fracture reduction.

  16. [Advances in Diagnosis and Treatment of Posterior Distal Injury of Pelvic Fracture].

    Science.gov (United States)

    Tan, Zhen; Wang, Guang-Lin

    2017-09-01

    Pelvic fracture is one of the common diseases of traumatic orthopedics. With the increase of accidents such as traffic accidents,high craters and crush injuries in China,the incidence of pelvic fractures is also increasing year by year. Since pelvic bones and the ligament structure are close to neurovascular,cavity organs and the urogenital structure,early diagnosis and treatment of pelvic fractures is essential for preventing early complications and late sequelae. The treatment of pelvic ring injury has been the focus of pelvic fracture treatment,which determines the outcome of treatment. The application of external fixation and internal fixation to pelvic fracture is still subject to ongoing debate. For unstable pelvic ring injury,emergency external fixation plays a very important role. Pelvic ring injury is often accompanied with nerve injury (lumbosacral plexus injury),which often leads to pain,dysfunction and other complications. Because of its refractory,extensive studies have been undertaken to identify clinical innovations that may be able to repair nerve damage and reduce complications. These research advances can help improve the diagnosis and treatment of pelvic fractures and patient survival and prognosis. Copyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).

  17. Genetic polymorphisms of PAI-1 and PAR-1 are associated with acute normal tissue toxicity in Chinese rectal cancer patients treated with pelvic radiotherapy

    Directory of Open Access Journals (Sweden)

    Zhang H

    2015-08-01

    developed grade ≥2 toxicities for diarrhea and fecal incontinence, respectively. The variant genotype GG of rs1050955 in PAI-1 was found to be negatively associated with the risk of diarrhea and incontinence (P<0.05, whereas the AG and GG genotypes of rs2227631 in PAI-1 were associated with an increased risk of incontinence. The CT genotype of PAR-1 rs32934 was associated with an increased risk of total toxicity compared with the CC allele. Our results demonstrated that SNPs in the PAI-1 and PAR-1 genes were associated with acute injury in rectal cancer patients treated with pelvic irradiation. These SNPs may be useful biomarkers for predicting acute radiotoxicity in patients with rectal cancer if validated in future studies. Keywords: rectal cancer, pelvic radiotherapy, polymorphism, acute toxicity, biomarker

  18. Pelvic ring fractures: what the orthopedic surgeon wants to know.

    Science.gov (United States)

    Khurana, Bharti; Sheehan, Scott E; Sodickson, Aaron D; Weaver, Michael J

    2014-01-01

    Treating trauma patients with displaced pelvic fractures requires a multidisciplinary approach at a designated trauma center to reduce morbidity and mortality. Immediate recognition of pelvic ring disruption and determination of pelvic stability are critical components in the evaluation of such patients. Stability is achieved by the ability of the osseoligamentous structures of the pelvis to withstand physiologic stresses without abnormal deformation. The supporting pelvic ligaments, including the posterior and anterior sacroiliac, iliolumbar, sacrospinous, and sacrotuberous ligaments, play a crucial role in pelvic stabilization. Radiologists should be familiar with the ligamentous anatomy and biomechanics relevant to understanding pelvic ring disruptions, as well as the Young and Burgess classification system, a systematic approach for interpreting pelvic ring disruptions and assessing stability on the basis of fundamental force vectors that create predictable patterns. This system provides an algorithmic approach to interpreting images and categorizes injuries as anterioposterior (AP) compression, lateral compression, vertical shear, or combined. Opening and closing of the pelvis from rotational forces result in AP compression and lateral compression injuries, respectively, whereas vertical shear injuries result from cephalad displacement of the hemipelvis. AP and lateral compression fractures are divided into types 1, 2, and 3, with increasing degrees of severity. Knowledge of these injury patterns leads to prompt identification and diagnosis of other subtle injuries and associated complications at pelvic radiography and cross-sectional imaging, allowing the orthopedic surgeon to apply corrective forces for prompt pelvic stabilization. ©RSNA, 2014.

  19. Early embolization without external fixation in pelvic trauma.

    Science.gov (United States)

    Tanizaki, Shinsuke; Maeda, Shigenobu; Hayashi, Hiroyuki; Matano, Hideyuki; Ishida, Hiroshi; Yoshikawa, Jun; Yamamoto, Toru

    2012-02-01

    In this retrospective study, we reviewed our protocol consisting of early embolization without acute external fixation in patients with pelvic fracture. Eighty-eight patients with pelvic fracture were identified by reviewing the records of the Fukui Prefectural Hospital from April 2005 through September 2009. We managed the patients with a treatment protocol consisting of hemodynamic resuscitation and early pelvic embolization. Patients with hemodynamic instability without nonpelvic hemorrhage or extravasation of contrast in the pelvis by computed tomography (CT) were indicated to angiography and embolization. External fixation of the pelvic ring was not used in our protocol. Of the 88 patients with pelvic fractures, 43 underwent angiography. Twenty-eight patients (65%) were hemodynamically unstable. Twenty-five patients (58%) had major ligamentous disruption. Computed tomography detected extravasation in 21 patients (48%). Of the 43 patients who underwent angiography, 29 (67%) were positive. The average time from hospital arrival to angiography was 76.3 ± 34.5 minutes. The packed red blood cell requirement in the initial 24 hours was 8.4 ± 8.2 U, required in the embolization group. There was no complication-related embolization. Repeat angiography was not required in all patients. The mortality rate of patients requiring angiography was 11%. Early pelvic embolization without external fixation may be useful for the initial treatment for patients with hemodynamic instability without nonpelvic hemorrhage or with extravasation of contrast in the pelvis by CT. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

  20. [Re-treatments of recurrence after pelvic floor repair surgery].

    Science.gov (United States)

    Fan, S X; Wang, F M; Lin, L S; Song, Y F

    2017-06-25

    Objective: To analyze re-treatments of recurrence after the pelvic floor repair surgery. Methods: The protocol and the effect of re-treatments were investigated by reviewing and analyzing the clinical data of 81 recurrent patients (grade Ⅱ and above), who had received the pelvic floor repair surgery from January 2011 to January 2016. Pelvic organ prolapse quantitation system (POP-Q) and two questionnaires about quality of life [pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7)] were used to evaluate objective and subjective efficacy, respectively. Results: Among 81 recurrent patients who were followed up for a median of 35 months (10- 69 months), 78 cases (with prolapse up to grade Ⅲ or Ⅳ) were treated by surgical operation with both objective cure rate and subjective satisfaction being 100% (78/78); 3 cases (with grade Ⅱ prolapse) were treated by pelvic floor electrical stimulation biofeedback, and 1 case among the three cases had the vaginal foreign body sensation, the subjective satisfaction was 2/3. The methods of surgical operation for the 78 recurrent patients included: total pelvic floor reconstructive surgery (55 cases; 3 of which involve trachelectomy), anterior pelvic reconstructive surgery (2 cases), posterior pelvic reconstructive surgery (3 cases), Y-mesh sacral colpopexy (2 cases), colpocleisis (11 cases), vaginal hysterectomy combined posterior fornix forming (3 cases), and vaginal hysterectomy combined posterior pelvic reconstructive surgery(2 cases). Conclusion: The extent of recurrence, the recurrent site and complications must be carefully considered and evaluated for re-treatments of recurrence after pelvic floor repair surgery, and then an appropriately individualized re-treatment protocol could be designed for each of the patients.

  1. Ultrasonography of pelvic masses

    International Nuclear Information System (INIS)

    Kim, Chu Wan; Lee, Kyung Hi; Yeon, Kyung Mo; Choo, Dong Woon; Rha, Keun Yung; Kim, Syng Wook

    1980-01-01

    56 cases of ultrasonography in patient with proven pelvic mass were reviewed. Ultrasonography is a very useful noninvasive diagnostic modality in the patient with clinically suspected pelvic masses giving accurate assessment of the size, location, internal structure and origin as well as its existence. A specific diagnosis was possible in selected patients with ovarian cystadenoma, dermoids, uterine myoma, and H-mode. Nonspecific pattern was common in pelvic abscess and ectopic pregnancy. Diagnostic errors were primarily due to small lesions (2 cm or less in diameter) or misinterpretation of the lesion.

  2. 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.

  3. Delayed diagnosis of an unsuspected pelvic fracture in a patient with tetraplegia.

    Science.gov (United States)

    Kriz, Jiri; Andel, Ross; Hakova, Renata

    2014-07-01

    Case report. In patients with a complete spinal cord injury (SCI) above T6 level, autonomic dysreflexia (AD) can be the only alerting sign of complications below the level of injury. A case report is presented of a patient with tetraplegia who progressively developed an AD syndrome after falling from a wheelchair. Initially, he was treated for symptomatic urinary tract infection and only later an unstable pelvic fracture was detected. A patient with chronic tetraplegia fell from his wheelchair while intoxicated. After the fall, he showed no signs of injury. Two days later, AD symptoms appeared while lying on his side or sitting. He presented to his community-based physician and received antibiotics for concomitant urinary tract infection. Because of persisting complaints, the patient was referred to the Spinal Cord Unit. Once the history of falling from the wheelchair was made known, symptoms of AD were suggestive of an internal injury. Radiography showed pelvic fracture and conservative treatment was administered. The fractures healed in 3 months, the therapeutic bed rest regimen was relaxed without trigerring AD symptoms. AD symptoms can suggest complications below the SCI level. Awareness and recognition of these symptoms are of utmost importance. However, etiology may be misleading. The role of a community-based general physician is to recognize the right moment when the need of a specialized assessment in a Spinal Cord Unit arises. In addition, patients should also be well informed about the most common possible complications from specialized SCI centers.

  4. 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.

  5. 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- ...

  6. Pelvic Inflammatory Disease

    Science.gov (United States)

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

  7. 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 ...

  8. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... organs and is often used to determine the cause of unexplained pain. CT scanning is fast, painless, ... procedure is typically used to help diagnose the cause of abdominal or pelvic pain and diseases of ...

  9. Dynamics and statistics of unstable quantum states

    International Nuclear Information System (INIS)

    Sokolov, V.V.; Zelevinsky, V.G.

    1989-01-01

    The statistical theory of spectra formulated in terms of random matrices is extended to unstable states. The energies and widths of these states are treated as real and imaginary parts of complex eigenvalues for an effective non-hermitian hamiltonian. Eigenvalue statistics are investigated under simple assumptions. If the coupling through common decay channels is weak we obtain a Wigner distribution for the level spacings and a Porter-Thomas one for the widths, with the only exception for spacings less than widths where level repulsion fades out. Meanwhile in the complex energy plane the repulsion of eigenvalues is quadratic in accordance with the T-noninvariant character of decaying systems. In the opposite case of strong coupling with the continuum, k short-lived states are formed (k is the number of open decay channels). These states accumulate almost the whole total width, the rest of the states becoming long-lived. Such a perestroika corresponds to separation of direct processes (a nuclear analogue of Dicke coherent superradiance). At small channel number, Ericson fluctuations of the cross sections are found to be suppressed. The one-channel case is considered in detail. The joint distribution of energies and widths is obtained. The average cross sections and density of unstable states are calculated. (orig.)

  10. 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)

  11. [Postpartum pelvic floor muscle training and abdominal rehabilitation: Guidelines].

    Science.gov (United States)

    Deffieux, X; Vieillefosse, S; Billecocq, S; Battut, A; Nizard, J; Coulm, B; Thubert, T

    2015-12-01

    Provide guidelines for clinical practice concerning postpartum rehabilitation. Systematically review of the literature concerning postpartum pelvic floor muscle training and abdominal rehabilitation. Pelvic-floor rehabilitation using pelvic floor muscle contraction exercises is recommended to treat persistent urinary incontinence at 3 months postpartum (grade A), regardless of the type of incontinence. At least 3 guided sessions with a therapist is recommended, associated with pelvic floor muscle exercises at home. This postpartum rehabilitation improves short-term urinary incontinence (1 year) but not long-term (6-12 years). Early pelvic-floor rehabilitation (within 2 months following childbirth) is not recommended (grade C). Postpartum pelvic-floor rehabilitation in women presenting with anal incontinence, is associated with a lower prevalence of anal incontinence symptoms in short-term (1 year) (EL3) but not long-term (6 and 12) (EL3). Postpartum pelvic-floor rehabilitation is recommended to treat anal incontinence (grade C) but results are not maintained in medium or long term. No randomized trials have evaluated the pelvic-floor rehabilitation in asymptomatic women in order to prevent urinary or anal incontinence in medium or long term. It is therefore not recommended (expert consensus). Rehabilitation supervised by a therapist (physiotherapist or midwife) is not associated with better results than simple advice for voluntary contraction of the pelvic floor muscles to prevent/correct, in short term (6 months), a persistent prolapse 6 weeks postpartum (EL2), whether or not with a levator ani avulsion (EL3). Postpartum pelvic-floor rehabilitation is not associated with a decrease in the prevalence of dyspareunia at 1-year follow-up (EL3). Postpartum pelvic-floor rehabilitation guided by a therapist is therefore not recommended to treat or prevent prolapse (grade C) or dyspareunia (grade C). No randomized trials have evaluated the effect of pelvic

  12. Anorectal and Pelvic Pain

    Science.gov (United States)

    Bharucha, Adil E.; Lee, Tae Hee

    2016-01-01

    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 three 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 two 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 pharmacologic, behavioral, and physical therapy. Opioids should not be avoided, and surgery has a limited role, primarily in refractory interstitial cystitis. PMID:27712641

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

    OpenAIRE

    H?ch, Andreas; Pieroh, Philipp; Dehghani, Faramarz; Josten, Christoph; B?hme, J?rg

    2016-01-01

    Glucocorticoids are well known for altering bone structure and elevating fracture risk. Nevertheless, there are very few reports on pelvic ring fractures, compared to other bones, especially with a predominantly ligamentous insufficiency, resulting in a rotationally unstable pelvic girdle. We report a 39-year-old premenopausal woman suffering from an atraumatic symphysiolysis and disruption of the left sacroiliac joint. She presented with external rotational pelvic instability and immobilizat...

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

    Science.gov (United States)

    Maldonado, Pedro A; Wai, Clifford Y

    2016-03-01

    As the field of reconstructive pelvic surgery continues to evolve, with descriptions of new procedures to repair pelvic organ prolapse, it remains imperative to maintain a functional understanding of pelvic floor anatomy and support. The goal of this review was to provide a focused, conceptual approach to differentiating anatomic defects contributing to prolapse in the various compartments of the vagina. Rather than provide exhaustive descriptions of pelvic floor anatomy, basic pelvic floor anatomy is reviewed, new and historical concepts of pelvic floor support are discussed, and relevance to the surgical management of specific anatomic defects is addressed. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Concurrent femoral neck fractures following pelvic irradiation: a case report

    Directory of Open Access Journals (Sweden)

    Okolo Clement

    2009-12-01

    Full Text Available Abstract Introduction Fracture of the neck of the femur is common in older people. It often occurs in a single hip, with osteoporosis being the most common cause. Sometimes this fracture may also occur following pelvic irradiation, though this is not common. To the best of our knowledge, we present the first reported case in Nigeria of concurrent bilateral fractures of the femoral neck following pelvic irradiation. Case presentation A 74-year-old Nigerian woman presented at our surgical outpatients department with a 5-month history of pain in both hips and a 4-month history of inability to walk. She had had pelvic irradiation for carcinoma of the cervix 2 years earlier. Pelvic radiographs confirmed bilateral subcapital neck fractures. Conclusion Patients with hip pain who have been treated with pelvic irradiation should be thoroughly investigated for hip fractures.

  16. 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.

  17. Pelvic Exenteration in Gynecologic Cancer: La Paz University Hospital Experience.

    Science.gov (United States)

    Moreno-Palacios, Elisa; Diestro, Maria D; De Santiago, Javier; Hernández, Alicia; Zapardiel, Ignacio

    2015-07-01

    Pelvic exenteration is an ultraradical surgery involving the en bloc resection of the pelvic organs, including the internal reproductive organs, the distal urinary tract (ureters, bladder, urethra), and/or anorectum. It is mainly applied as a salvage surgery for recurrent gynecologic tumors of any origin (vulva, vagina, cervix, uterine, and also ovary). Our aim was to establish the most favorable cases for this type of surgery by means of a review of our institution experience. Retrospective analyses of all patients treated with pelvic exenteration for recurrent gynecologic cancer from 2008 to 2014 at La Paz University Hospital. Ten patients underwent pelvic exenteration for recurrent gynecologic cancers including uterine, cervical, vaginal, vulvar, and ovarian cancer. All patients had received prior treatment: surgery, radiotherapy, and/or chemotherapy. Eight patients underwent total pelvic exenteration, one anterior and one posterior pelvic exenteration. Urinary diversions technique consisted of ileal conduits in all cases. Permanent colostomy was performed in all cases. Postoperative complications were related to the urinary diversion in 50% of the cases, to the reconstructive technique in 30%, and to systemic or pelvic infections in 20%. Despite the high morbidity and mortality rates, pelvic exenteration is feasible, and in selected cases of cancer recurrence is the last possible treatment.

  18. Pelvic support, pelvic symptoms, and patient satisfaction after colpocleisis

    OpenAIRE

    FitzGerald, M. P.; Richter, H. E.; Bradley, C. S.; Ye, W.; Visco, A. C.; Cundiff, G. W.; Zyczynski, H. M.; Fine, P.; Weber, A. M.

    2008-01-01

    The objective was to study the effect of colpocleisis on pelvic support, symptoms, and quality of life and report-associated morbidity and postoperative satisfaction. Women undergoing colpocleisis for treatment of pelvic organ prolapse (POP) were recruited at six centers. Baseline measures included physical examination, responses to the Pelvic Floor Distress Inventory, and Pelvic Floor Impact Questionnaire. Three and 12 months after surgery we repeated baseline measures. Of 152 patients with ...

  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. 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...

  1. 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

  2. Pelvic Inflammatory Disease (For Parents)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Pelvic Inflammatory Disease KidsHealth / For Parents / Pelvic Inflammatory Disease What's in this article? Symptoms Complications Prevention Treatment ...

  3. Pelvic inflammatory disease (PID) -- aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000710.htm Pelvic inflammatory disease (PID) - aftercare To use the sharing features on ... have just seen your health care provider for pelvic inflammatory disease (PID). PID refers to an infection of the ...

  4. Pelvic floor muscle training exercises

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003975.htm Pelvic floor muscle training exercises To use the sharing features on this page, please enable JavaScript. Pelvic floor muscle training exercises are a series of exercises ...

  5. Pelvic Inflammatory Disease (PID) Statistics

    Science.gov (United States)

    ... Search Form Controls Cancel Submit Search the CDC Pelvic Inflammatory Disease (PID) Note: Javascript is disabled or is not supported ... Twitter STD on Facebook Sexually Transmitted Diseases (STDs) Pelvic Inflammatory Disease (PID) Statistics Recommend on Facebook Tweet Share Compartir ...

  6. [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.

  7. Triple Pelvic Osteotomy and Double Pelvic Osteotomy.

    Science.gov (United States)

    Guevara, Francisco; Franklin, Samuel P

    2017-07-01

    Triple and double pelvic osteotomy (TPO, DPO) are performed with the goal of increasing acetabular ventro-version, increasing femoral head coverage, and decreasing femoral head subluxation. Since the first descriptions of TPO, there have been modifications in technique, most notably omission of the ischial osteotomy for DPO, and improvements in the implants, including availability of locking TPO/DPO bone plates. Associated complication rates seem to have declined accordingly. The most salient questions regarding these procedures remain what selection criteria should be used to identify candidates and whether halting or preventing osteoarthritis is necessary to consider these surgeries clinically beneficial. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Anorectal and pelvic floor anatomy

    NARCIS (Netherlands)

    Stoker, Jaap

    2009-01-01

    The anorectum and pelvic floor are crucial in maintaining continence, facilitating evacuation, providing pelvic organ support while in females the pelvic floor is part of the birth canal. The anal sphincter is a multilayered cylindrical structure, including the smooth muscle internal sphincter and

  9. Unstable decay and state selection

    International Nuclear Information System (INIS)

    McKane, Alan; Tarlie, Martin

    2001-01-01

    The decay of unstable states when several metastable states are available for occupation is investigated using path-integral techniques. Specifically, a method is described that enables the probabilities with which the metastable states are occupied to be calculated by finding optimal paths, and fluctuations about them, in the weak-noise limit. The method is illustrated on a system described by two coupled Langevin equations, which are found in the study of instabilities in fluid dynamics and superconductivity. The problem involves a subtle interplay between nonlinearities and noise, and a naive approximation scheme that does not take this into account is shown to be unsatisfactory. The use of optimal paths is briefly reviewed and then applied to finding the conditional probability of ending up in one of the metastable states, having begun in the unstable state. There are several aspects of the calculation that distinguish it from most others involving optimal paths: (i) the paths do not begin and end on an attractor, and moreover, the final point is to a large extent arbitrary, (ii) the interplay between the fluctuations and the leading-order contribution are at the heart of the method, and (iii) the final result involves quantities that are not exponentially small in the noise strength. This final result, which gives the probability of a particular state being selected in terms of the parameters of the dynamics, is remarkably simple and agrees well with the results of numerical simulations. The method should be applicable to similar problems in a number of other areas, such as state selection in lasers, activationless chemical reactions, and population dynamics in fluctuating environments

  10. Clinical characteristics, prognosis and treatment for pelvic cryptorchid seminoma

    OpenAIRE

    Li; COUCKE, Philippe; Qian; Huang, Yi-Rong; Gu, Da-Zhong; Mirimanoff, René-Olivier; Yu, Zi-Hao

    1997-01-01

    Purpose: To analyze the clinical characteristics, prognosis, and treatment outcome of pelvic cryptorchid seminoma (PCS), and to determine whether whole abdominal-pelvic irradiation for Stage I disease is necessary. Methods and Materials: From 1958 to 1991,60 patients with PCS were treated at the Cancer Hospital of Chinese Academy of Medical Sciences, Beijing. They presented with a lower abdominal mass and showed a predominance for the right side. A high proportion of patients with...

  11. 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...

  12. Does application position of the T-POD affect stability of pelvic fractures?

    Science.gov (United States)

    Prasarn, Mark L; Small, John; Conrad, Bryan; Horodyski, Nicole; Horodyski, Marybeth; Rechtine, Glenn R

    2013-05-01

    Most trauma centers place pelvic binders on unstable pelvic fractures for acute management and control of hemorrhage. It has been proposed that the binders be placed at the level of the greater trochanters of the femur. Our hypothesis was that application of the T-POD at this site would provide better immobilization of an unstable pelvic injury than a more cephalad location. Unstable pelvic injuries (OTA type 61-C1) were surgically created in 9 fresh whole human cadavers. Electromagnetic sensors were affixed to the intact and injured sides of the pelvis. A Fastrak, three-dimensional electromagnetic motion analysis device was used to determine the angular motion occurring at the fractured sites. Maximum displacements for sagittal, coronal, and axial rotation were recorded during application of the binder, while performing bed transfers, while logrolling, and elevating the head of the bed. The T-POD device was placed either over the greater trochanters or at the level of the anterior superior iliac spine as per manufacturer's recommendations. There were no significant differences in the amount of motion produced during application of the T-POD at either location. There was less motion observed in all planes of motion during all maneuvers when the T-POD was placed at the level of the greater trochanters versus anterior superior iliac spine. During bed transfers, this was statistically significant in all planes. This was statistically significant while logrolling in the axial plane and the coronal plane during head of bed elevation. We advocate the placement of pelvic binder devices at the level of the greater trochanters for improved control of the fracture in an unstable pelvic injury. This may result in improved control of hemorrhage, better access to the abdomen, and greater patient comfort.

  13. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... to help diagnose the cause of abdominal or pelvic pain and diseases of the internal organs, small bowel and colon, such as: infections such as appendicitis , pyelonephritis or infected fluid collections, also known as abscesses. inflammatory bowel disease such as ulcerative colitis or Crohn's ...

  14. Chronic Pelvic Pain

    Science.gov (United States)

    ... pain. Such types include relaxation exercises and biofeedback . Nutrition therapy—Vitamin B 1 and magnesium may be used to relieve dysmenorrhea. Surgery—Pelvic pain that does not respond to other treatments can be relieved by surgery. Cutting or destroying nerves blocks pain signals from reaching ...

  15. 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.

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

    Science.gov (United States)

    Thubert, T; Bakker, E; Fritel, X

    2015-05-01

    Our goal is to provide an update on the results of pelvic floor rehabilitation in the treatment of urinary incontinence and genital prolapse symptoms. Pelvic floor muscle training allows a reduction of urinary incontinence symptoms. Pelvic floor muscle contractions supervised by a healthcare professional allow cure in half cases of stress urinary incontinence. Viewing this contraction through biofeedback improves outcomes, but this effect could also be due by a more intensive and prolonged program with the physiotherapist. The place of electrostimulation remains unclear. The results obtained with vaginal cones are similar to pelvic floor muscle training with or without biofeedback or electrostimulation. It is not known whether pelvic floor muscle training has an effect after one year. In case of stress urinary incontinence, supervised pelvic floor muscle training avoids surgery in half of the cases at 1-year follow-up. Pelvic floor muscle training is the first-line treatment of post-partum urinary incontinence. Its preventive effect is uncertain. Pelvic floor muscle training may reduce the symptoms associated with genital prolapse. In conclusion, pelvic floor rehabilitation supervised by a physiotherapist is an effective short-term treatment to reduce the symptoms of urinary incontinence or pelvic organ prolapse. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  17. Gluteal Compartment Syndrome Secondary to Pelvic Trauma

    Directory of Open Access Journals (Sweden)

    Fernando Diaz Dilernia

    2016-01-01

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

  18. Osteoporosis in unstable adult scoliosis

    Energy Technology Data Exchange (ETDEWEB)

    Velis, K.P.; Healey, J.H.; Schneider, R.

    1988-12-01

    New noninvasive techniques as well as conventional methods were used to evaluate skeletal mass in the following three populations of adult white women as follows: (1) 79 subjects with preexisting idiopathic scoliosis designated as unstable (US) because of the associated presence in the lumbar spine of lateral spondylolisthesis with segmental instability; (2) 67 subjects with preexisting idiopathic scoliosis without lateral spondylolisthesis designated as stable (SS); and (3) 248 age-matched nonscoliotic controls. Ages in all three groups were categorized into premenopausal (25-44 years), perimenopausal (45-54 years), and postmenopausal (55-84 years). The results showed higher scoliosis morbidity in the US compared to the SS populations. The prevalence and severity of osteoporosis were markedly increased in US versus SS populations. Femoral neck density determined by dual-photon absorptiometry techniques averaged 26% to 48% lower in all age categories of US patients compared to controls. These changes were found in the youngest age groups, indicating reductions in bone mineral content earlier in the adult life of white women with a specific type of high-morbidity US characterized by the marker of lateral spondylolisthesis.

  19. Transperineal Sonography Evaluation of Muscles and Vascularity in the Male Pelvic Floor

    OpenAIRE

    Roll, Shawn C.; Kutch, Jason J.

    2013-01-01

    Idiopathic chronic male pelvic pain is difficult to diagnose and treat. Currently, diagnosis relies on subjective symptoms; objective measures of neuromuscular mechanisms have not been investigated. Sonographic imaging has been used to investigate these neuromuscular mechanisms in the female pelvic floor, but neither research nor books describe sonography evaluation of the male pelvic floor. The purpose of this study was to develop and evaluate a perineal sonographic technique for the examina...

  20. Electromagnetic Radiation Originating from Unstable Electron Oscillations

    DEFF Research Database (Denmark)

    Juul Rasmussen, Jens; Pécseli, Hans

    1975-01-01

    Electromagnetic oscillations in the range 300 – 700 MHz were observed from an unmagnetized argon discharge with an unstable electron velocity distribution function.......Electromagnetic oscillations in the range 300 – 700 MHz were observed from an unmagnetized argon discharge with an unstable electron velocity distribution function....

  1. 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.

  2. [Physiotherapy of pelvic floor for incontinence].

    Science.gov (United States)

    Galeri, S; Sottini, C

    2001-09-01

    The rate of urinary incontinence after prostatectomy, as reported in several studies, varies between 0 and 88%. In the last years, pelvic floor rehabilitation in the women stress incontinence has been strengthened, with a great amount of clinical studies and results. Recently, the rehabilitation treatment has been studied in men who underwent a radical prostatectomy. The Cochrane Database of Systematic Reviews recently published the "Conservative management for post prostatectomy incontinence". The aim of this study was to determine the effects of conservative management in post prostatectomy urinary incontinence. Randomized or almost-randomized trials were analyzed up to January 1999; five studies were included, with the following results: 1. Pelvic floor muscle training versus no active treatment. Two trials compared pelvic floor muscle training with patients in a control group. In both groups there was a clinical improvement, especially in the first months after prostatectomy. The results of the two studies suggest a benefit in the treated group, even if not statistically significant, mainly in the first months after surgery. 2. Pelvic floor muscle training + biofeedback versus no active treatment. The treated group regained continence in shorter time, with decrease of incontinence episodes, of urinary frequency, of the quantity of urine loss; these data were not statistically significant. 3. Pelvic floor muscle training + rectal electrical stimulation versus no active treatment No detectable differences among the two groups, either in number of men still incontinent, and in Pad-test results. 4. Pelvic floor muscle training + rectal electrical stimulation + biofeedback versus no active treatment. Pad-test evaluation was similar in the treated and in the control group; no other outcomes were described. 5. Pelvic floor muscle training + rectal electrical stimulation versus pelvic floor muscle training. There was a progressive improvement in three months of

  3. Rheology of unstable mineral emulsions

    Directory of Open Access Journals (Sweden)

    Sokolović Dunja S.

    2013-01-01

    Full Text Available In this paper, the rheology of mineral oils and their unstable water emulsion were investigated. The oil samples were domestic crude oil UA, its fractions UA1, UA4 and blend semi-product UP1, while the concentration of oil in water emulsions was in the range from 1 up to 30%. The results were analyzed based on shear stress. The oil samples UA, UA1 and UP1 are Newtonian fluids, while UA4 is pseudoplastic fluid. The samples UA and UA4 show higher value of shear stress (83.75 Pa, 297 Pa, then other two samples UA1 and UP1 (18.41 Pa, 17.52 Pa. Rheology of investigated oils due to its complex chemical composition should be analyzed as a simultaneous effect of all their components. Therefore, structural composition of the oils was determined, namely content of paraffins, naphthenes, aromatics and asphaltenes. All samples contain paraffins, naphthenes and aromatics but only oils UA and UA4 contain asphaltenes as well. All investigated emulsions except 30% EUA4 are Newtonian fluids. The EUA4 30% emulsion shows pseudoplastic behaviour, and it is the only 30% emulsion among investigated ones that achieves lower shear stress then its oil. The characteristics of oil samples that could have an influence on their properties and their emulsion rheology, were determined. These characteristics are: neutralization number, interfacial tension, dielectric constant, and emulsivity. Oil samples UA and UA4 have significantly higher values of neutralization number, dielectric constants, and emulsivity. The sample UA has the lowest value of interface tension and the greatest emulsivity, indicating that this oil, among all investigated, has the highest preference for building emulsion. This could be the reason why 20% and 30% emulsions of the oil UA achieve the highest shear stress among all investigated emulsions.

  4. [Minimally invasive percutaneous plate osteosynthesis for the treatment of acetabulum anterior column fracture with intact true pelvic brim].

    Science.gov (United States)

    Mo, Ting-Ting; Su, Yong-Bin; Zhang, Wei-Kang

    2017-06-25

    To discuss feasibility and clinical effects of minimally invasive percutaneous plate osteosynthesis in treating acetabulum anterior column fracture with intact true pelvic brim. From May 2013 to December 2015, 8 patients with acetabulum anterior column fracture with intact true pelvic brim were reviewed retrospectively. According to Judet-Letournel classification, all were simple unstable acetabulum anterior column fracture. Among them, there were 5 males and 3 females with an average age of 42.8 years old ranging from 22 to 63. The injury was caused by crush in 4 cases, smash of heavy object in 3 cases, and falling down in 1 case. The time from injury to operation was ranged from 5 to 19 days with an average of 9.5 days. Preoperative CT showed high anterior column fracture of acetabulum with intact true pelvic brim, the fracture separation was less than 1 cm. All the patients were treated with closed reduction and minimally invasive percutaneous plate osteosynthesis. The quality of fracture reduction, operation time, blood loss, fracture healing time, hip function and postoperative complications were observed and recorded. All patients were followed up from 10 to 19 months with an average of 14.5 months. The quality of reduction was classified as anatomical in 4 patients, imperfect in 3, poor in 1 by Matta's score system. The operation time was 30 to 80 min, averaged 51.3 min;the blood loss was 50 to 120 ml, averaged 86.2 ml; fracture healing time was 10 to 19 weeks, averaged 13.3 weeks. At the latest follow-up, the hip function was evaluated by Merle D'Aubigne scoring system, 5 cases got excellent results, 2 cases in good, and 1 case in fair. No vascular nerve injury, wound infection, bleeding, deep vein thrombosis and other complications occurred in 8 patients. Minimally invasive percutaneous plate osteosynthesis in treating acetabulum anterior column fracture with intact true pelvic brim has advantages of less trauma, less bleeding, quick recovery and good

  5. 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.

  6. Pelvic reconstruction improves pelvic floor strength in pelvic organ prolapse patients.

    Science.gov (United States)

    Guan, Zhong; Li, Huai-Fang; Yang, Xiang; Guo, Li-Li

    2015-10-01

    To evaluate pelvic floor muscle strength after the modified pelvic reconstruction procedure for pelvic organ prolapse (POP). Patients were assigned to two groups consisting of 37 patients diagnosed with POP and undergoing modified pelvic reconstruction (reconstruction group), and 30 patients admitted to our hospital during the same period for other surgical indications (control group). Vaginal palpation of pelvic floor muscle strength was performed according to the modified Oxford grading system before operating on the two groups and again in the 3(rd) month following surgery for the reconstruction group. A comparative study was performed to evaluate the differences between the two groups and the improvement of pelvic floor muscle strength in the reconstruction group. The pelvic floor muscle strength was significantly improved postoperatively when compared with preoperative results in the reconstruction group (t = -17.478, p pelvic reconstruction procedure could improve pelvic floor muscle strength in POP patients, which remains lower when compared with the normal population. Pelvic floor muscle strength should be included in the assessment of surgical outcomes in POP. Copyright © 2015. Published by Elsevier B.V.

  7. Cefotaxime Treatment of Pelvic Inflammatory Disease

    OpenAIRE

    Monson, Thomas P.; Miller, Timothy T.; Nolan, Charles M.

    1981-01-01

    We studied cefotaxime in the treatment of gonococcal and nongonococcal pelvic inflammatory disease. Cefotaxime was uniformly effective against gonococcal pelvic inflammatory disease. However, 4 of 11 patients with nongonococcal pelvic inflammatory disease had a suboptimal response.

  8. 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, ...

  9. [Correlation of subjective and objective assessment of vaginal prolapse surgery - secondary analysis of randomized controlled study in patients with pelvic floor injury treated with vaginal mesh or with sacrospinous ligament fixation].

    Science.gov (United States)

    Švabík, K; El Haddad, R; Mašata, J; Hubka, P; Martan, A

    2015-10-01

    We had provided secondary analysis of our randomized controlled study comparing vaginal mesh with sacrospinous fixation for vaginal prolapse. We correlated data from subjective and objective assessment. Secondly we had provided correlations results of subjective and objective assessment between patient with anatomical failure and those without. The aim of this analysis was to provide correlation between objective and subjective outcome measures. Subanalysis of randomized controlled study. Obstetric Gynecology Department, First Faculty of Medicine of Charles University and General University Hospital in Prague. This is secondary analysis of single center randomized controlled study comparing two standard procedures for vaginal prolapse after hysterectomy in patients with levator avulsion injury. We had analyzed pre- and postoperative subjective POPDI score (Pelvic Organ Prolapse Distress Inventory) and correlated this score with most prolapsed portion of vaginal wall. We had compared all vaginal compartments using POPQ (Pelvic Organ Prolapse Quantification): anterior wall with point Ba, apical with point C, and posterior with point Bp. Subsequently we compared subjective POPDI score in group of patients with anatomical failure and those without. We had included in randomized study 70 women. Mean preoperative POPDI score was 65.25 (3.57-200). We didnt found any correlation between subjective score and objective assessment in preoperative data: POPDI vs. Ba (p = 0.75) POPDI vs. C (p = 0.57) a POPDI vs. Bp (p = 0.22) and no correlation in postoperative assessment. Postoperative POPDI score decreased to 26.1, but there was no difference in POPDI score in woman with anatomical failure and no failure - 17.4 vs. 23.3 (p = 0.64)CONCLUSION: Secondary analysis of randomized controlled study had shown that objective and subjective assessment have poor correlation. We didnt found any correlation between degree of prolapse and intensity of complains. The large inter

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

    Science.gov (United States)

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

    2014-11-01

    A pelvic discontinuity occurs when the superior and inferior parts of the hemi-pelvis are no longer connected, which is difficult to manage when associated with a failed total hip replacement. Chronic pelvic discontinuity is found in 0.9% to 2.1% of hip revision cases with risk factors including severe pelvic bone loss, female gender, prior pelvic radiation and rheumatoid arthritis. Common treatment options include: pelvic plating with allograft, cage reconstruction, custom triflange implants, and porous tantalum implants with modular augments. The optimal technique is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable healing between the two segments. A method of treating pelvic discontinuity using porous tantalum components with a distraction technique that achieves both initial stability and subsequent long-term biological fixation is described. ©2014 The British Editorial Society of Bone & Joint Surgery.

  11. Stabilization of switched nonlinear systems with unstable modes

    CERN Document Server

    Yang, Hao; Cocquempot, Vincent

    2014-01-01

    This book provides its reader with a good understanding of the stabilization of switched nonlinear systems (SNS), systems that are of practical use in diverse situations: design of fault-tolerant systems in space- and aircraft; traffic control; and heat propagation control of semiconductor power chips. The practical background is emphasized throughout the book; interesting practical examples frequently illustrate the theoretical results with aircraft and spacecraft given particular prominence. Stabilization of Switched Nonlinear Systems with Unstable Modes treats several different subclasses of SNS according to the characteristics of the individual system (time-varying and distributed parameters, for example), the state composition of individual modes and the degree and distribution of instability in its various modes. Achievement and maintenance of stability across the system as a whole is bolstered by trading off between individual modes which may be either stable or unstable, or by exploiting areas of part...

  12. Emergency coronary angioplasty in refractory unstable angina

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); M.J.B.M. van den Brand (Marcel); K. Balakumaran (Kulasekaram); A.L. Soward; P.G. Hugenholtz (Paul); A.E.R. Arnold (Alfred); B. Mochtar (Bas)

    1985-01-01

    textabstractWe performed percutaneous transluminal coronary angioplasty as an emergency procedure in 60 patients with unstable angina pectoris that was refractory to treatment with maximally tolerated doses of beta-blockers, calcium antagonists, and intravenous nitroglycerin. The initial success

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

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Shinn-Yn [Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (China); Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taiwan (China); Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan (China); Tsai, Chien-Sheng [Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taiwan (China); Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan (China); Chang, Yu-Chen [Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taiwan (China); Molecular Imaging Center and Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (China); Ng, Koon-Kwan [Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung, Taiwan (China); Chang, Ting-Chang [Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (China); Kao, Wei-Heng [Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (China); Lai, Chyong-Huey [Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (China); Hong, Ji-Hong, E-mail: jihong@adm.cgmh.org.tw [Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (China); Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taiwan (China); Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital, Taiwan (China)

    2015-07-01

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

  14. How Unstable Are Fundamental Quantum Supermembranes?

    OpenAIRE

    Kaku, Michio

    1996-01-01

    String duality requires the presence of solitonic $p$-branes. By contrast, the existence of fundamental supermembranes is problematic, since they are probably unstable. In this paper, we re-examine the quantum stability of fundamental supermembranes in 11 dimensions. Previously, supermembranes were shown to be unstable by approximating them with SU(n) super Yang-Mills fields as $n \\rightarrow \\infty$. We show that this instability persists even if we quantize the continuum theory from the ver...

  15. The Unstable Lives of Bicycles

    DEFF Research Database (Denmark)

    Larsen, Jonas; Christensen, Mathilde Dissing

    2015-01-01

    A predictable byproduct of any ‘successful’ mobility system is the breakdown and destruction of once desired, fashionable, shiny, and useful objects, yet mobilities scholars have largely ignored such issues. In this paper we document and analyze ethnographically neglected and ‘half-dead’ bikes in......, (un)becoming, and marked by that life. Where cycling is normally conceived of as a sustainable and environmentally friendly practice, this study shows that many bikes are ill treated and quickly become waste, and ‘matter out place...

  16. 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

  17. 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

    depends on the structural components in the urethral wall, the position of the bladder neck and proximal urethra, the periurethral striated muscles, and the pelvic floor muscles. By means of pudendal blockade and simultaneous recordings of pressure and cross-sectional area in the urethra, it has been...... 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...

  18. Noncontiguous double-level unstable spinal injuries.

    Science.gov (United States)

    Takami, Masanari; Okada, Motohiro; Enyo, Yoshio; Iwasaki, Hiroshi; Yamada, Hiroshi; Yoshida, Munehito

    2017-01-01

    Noncontiguous double-level unstable spinal injuries (NDUSI) are uncommon and have not been well described. In this study, we aimed to better understand the patterns of NDUSI, in order to recommend proper diagnostic and treatment methods, as well as to raise awareness among traumatologists about the possibility of these uncommon injuries. A total of 710 consecutive patients with spine fractures were treated for >9 years since 2007 at a single regional trauma center. Of them, 18 patients with NDUSI were reviewed retrospectively. The incidence of NDUSI was 2.5 % of all spine fractures. In 17 of 18 patients (94.7 %), NDUSI was caused by a high-energy trauma. Nine patients (50.0 %) exhibited complete neurological deficit. Spinal cord injury occurred in the cranial injured region in all American Spinal Injury Association grade A cases. In one case, a second fracture was overlooked at the initial examination. NDUSI are common in cases of high-energy trauma and should be taken into consideration at the initial examination. A second fracture may be easily overlooked because of the high frequency of concomitant severe spinal cord injury in the cranial injured region and/or loss of consciousness due to associated injuries. To avoid overlooking injuries, full spine computed tomography is useful at the initial examination. Operative reduction and internal fixation with instrumentation through a posterior approach is recommendable for cases of NDUSI. In elderly patients, a very rapid stabilizing surgery should be planned before aspiration pneumonia occurs or the pulmonary condition worsens.

  19. 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.

  20. Estudo das fraturas peritrocanterianas instáveis do fêmur tratadas com haste céfalo-diafisária bloqueada: técnica minimamente invasiva Study of femur unstable peritrochanteric fractures treated with blocked cephalodiaphyseal shaft: a minimally invasive technique

    Directory of Open Access Journals (Sweden)

    Maurício de Moraes

    2005-01-01

    Full Text Available Sessenta e cinco pacientes com fraturas peritrocanterianas instáveis foram tratados cirurgicamente com fixação intramedular céfalo-diafisária bloqueada (sistema minimamente invasivo. Realizou-se redução fechada em mesa de tração com utilização da radioscopia. Carga parcial assistida foi encorajada a partir do segundo dia pós-operatório. Em todos os pacientes estudados, foi obtida consolidação entre 12 e 18 semanas (média de 14.5 semanas, sendo observados seis casos (9,2% de consolidação viciosa, quatro (6,1% de encurtamento do membro (Sixty five patients with unstable peritrochanteric fractures were surgically treated with blocked intramedullary cephalodiaphyseal fixation (minimally invasive system. Closed reduction in traction table was performed with radioscopy. Assisted partial load was encouraged after the second postoperative day. In all examined patients, healing was achieved within 12 to 18 weeks (average 14.5 weeks. Complications were seen in six cases (9.2% with vicious union, four cases (6.1% with shortening of the limb (<1cm, three cases (4.6% with compression screw migration to acetabulum, and one case (1.5% with intraoperative fracture of the lateral femur cortical. Five patients (7.6% presented with distal deep venous thrombosis (DVT with no clinical repercussion. No superficial or deep infection was seen up to the last review. In the three cases of proximal migration of the compression screw, system was removed without intercurrences. We concluded that the methodology employed here is efficient, safe, with low morbidity potential. It is a fast technique, presenting little complications, promoting an early rehabilitation for the patient.

  1. [Unstable pertrochanteric fractures, biomechanic, classification and therapy.].

    Science.gov (United States)

    Cech, O; Kostál, R; Váchal, J

    2000-01-01

    The authors deal with unstable pertrochanteric, intertrochanteric and subtrochanteric fractures extending as far as calcar femorale. The treatment of pertrochanteric issues is a serious issue as their total number in the Czech Republic exceeds 5.000 annually and with the exception of those which are contraindicated due to their health condition, all patients are indicated to surgery. In the treatment of unstable pertrochanteric fractures there occurs failure of internal fixation also with the use of implants such as dynamic hip screw or Gamma nail. The cause of unsuccessful treatment of unstable fractures is the defect in calcar femorale - impairment of the weightbearing area of proximal femur and failure of the implant as a result of its cyclic overloading - breakage of the nail, cutting out of the screw from the head in the osteoporotic bone or breaking out of screws fixing the plate to the femoral shaft. For a causal procedure the authors consider the reconstruction of the calcar femorale by a wedge valgus osteotomy of the comminuted zone after the original design of Debrunner and Cech (1969). Simultaneously with reconstruction of the medial cortical support in the calcar femorale the 160 degrees valgization is performed. In the AO classification the authors consider for unstable the fractures of types 31.A2.1, A2.2, A3.3. Significant from the therapeutic viewpoint is the classification of stable fractures (with open reduction the anatomic reconstruction of weight-bearing calcar femorale is possible) and unstable fractures - where with open reduction the defect of calcar femorale persists. For stabilization of unstable the authors recommend fixation by DHS at 150 degrees angle. If need be, this fixation may be combined with lag screws and in case of a simultaneous fracture of greater trochanter and in reverse fractures a trochanteric buttress plate has to be added. Key words: unstable pertrochanteric fractures, nonanatomic valgus reduction, DHS fixation.

  2. Post-traumatic pelvic deformity with old injuries of rectum and urogenital tract: 18-year follow-up

    Directory of Open Access Journals (Sweden)

    A. V. Runkov

    2015-01-01

    Full Text Available The authors described a case of management the severe combined pelvis trauma in female patient with 18 years follow-up. At the age of seven, the patient was injured: the open vertical unstable pelvis injury with severe damage of urogenital tract and rectum. Numerous operations on the pelvic organs without surgical treatment of pelvic ring fractures were accompanied by complications. At the age of 21 (14 years later the patient was subjected to the surgery according to the techniques designed in the Chaklin Ural Scientific Research Institute of Traumatology and Orthopaedics: percutaneous osteotomy of posterior and anterior pelvis, external pelvis fixation using circular device with a further gradual (within 1.5 months correction of the deformity with apparatus and subsequent internal fixation with screws. There were achieved partially elimination of shortening of the right lower limb, correction of the pelvic ring form, increasing the pelvic cavity volume, elimination of vaginal impingement, that allowed to correct urological problems with the possibility of further recovery of the vagina and hip replacement surgery. This case showed that the management of patients with complicated pelvis injuries required a multidisciplinary approach: emergency fixation of the unstable injuries and application of techniques to correct long-standing pelvis deformities to restore stability and shape of the pelvic ring, which created the more favorable conditions for reconstructive surgery of the pelvic organs.

  3. Vertical pelvic ring displacement in pelvic ring injury: Measurements in pelvic outlet radiograph and in cadavers.

    Science.gov (United States)

    Boontanapibul, Krit; Harnroongroj, Thos; Sudjai, Narumol; Harnroongroj, Thossart

    2015-01-01

    Vertical pelvic ring displacement (VPRD) is a serious injury and needs assessment. Pelvic outlet radiographs are routinely taken. However, relationship of radiographic and actual VPRD is still in question. Thus, measurement of VPRD from pelvic radiographs was studied. 2 dry pelvic bones and 1 sacrum from same cadaver was reconstructed to be the pelvic ring. Five specimens were enrolled. 10, 20 and 30 mm vertical displacement of right pelvic bone was performed at levels of sacroiliac joint and pubic symphysis for representing right VPRD. Then, the pelvis was set sacral inclination at 60° from X-ray table for outlet and anteroposterior pelvic radiographs. Right VPRD was measured by referring to superior most pelvic articular surface of both sacroiliac joints and sacral long axis. Radiographic VPRD and actual displacement were analyzed by Pearson correlation coefficient at more than 0.90 for the strong correlation and strongly significant simple regression analysis was set at P outlet and anteroposterior pelvic views at 10 mm actual displacement were 20.12 ± 1.98 and 4.08 ± 3.76 mm, at 20 mm were 40.31 ± 1.97 and 9.94 ± 7.27 mm and at 30 mm were 58.56 ± 2.53 and 11.29 ± 2.89 mm. Statistical analyses showed that radiographic VPRD from pelvic outlet view is 1.95 times of actual displacement with strong correlation at 0.992 coefficient and strongly significant regression analysis (P outlet radiograph provides efficient measurement of VPRD with 2 times of actual displacement.

  4. Pelvic irradiation for stage II ovarian carcinoma

    International Nuclear Information System (INIS)

    Terada, K.Y.; Morley, G.W.; Roberts, J.A.

    1988-01-01

    Over a 20-year period, 34 patients with FIGO stage II ovarian carcinoma were treated with postoperative pelvic irradiation at the University of Michigan. Complications of radiation treatment were minimal. The overall actuarial disease-free 5-year survival was 53%. This was not significantly different for substages IIA, IIB, or IIC. Patients with well-differentiated tumors had a significantly better survival than patients with moderate or poorly differentiated tumors (P less than 0.05). The implications for managing stage II ovarian carcinoma are discussed

  5. Determinants and Management Outcomes of Pelvic Organ Prolapse ...

    African Journals Online (AJOL)

    after initial consultation, as these may shift the focus from symptomatic relief and obtaining information to treatment.[9]. Management is guided by the severity of symptoms and the degree of prolapse. Women with mild degree of organ prolapse are appropriately treated with pelvic floor exercises and/or physical therapy with ...

  6. Acute Pelvic Inflammatory Disease in Cameroon: A Cross Sectional ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    found that they can be responsible for urethritis in men, cervicitis and PID in women10,11. In our settings, many women with pelvic infection have their complaints resolved when genital tract mycoplasmas are identified and treated. This shows that screening for genital tract mycoplasmas should be as frequent as screening ...

  7. 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.

  8. The role of endovascular treatment of pelvic fracture bleeding in emergency settings.

    Science.gov (United States)

    Ierardi, Anna Maria; Piacentino, Filippo; Fontana, Federico; Petrillo, Mario; Floridi, Chiara; Bacuzzi, Alessandro; Cuffari, Salvatore; Elabbassi, Wael; Novario, Raffaele; Carrafiello, Gianpaolo

    2015-07-01

    To evaluate the role of endovascular treatment for controlling haemorrhage in haemodynamically unstable patients with pelvic bone fractures and to relate clinical efficacy to pre-procedural variables. From March 2009 through April 2013, 168 patients with major pelvic trauma associated with high-flow haemorrhage were referred to our emergency department and were retrospectively reviewed. Pelvic arteries involved were one or more per patient. Embolisation was performed using various materials (micro-coils, Spongostan, plug, glue, covered stent), and technical success, complications, treatment success, clinical efficacy, rebleeding, and mortality rates were assessed. Factors influencing clinical efficacy were also evaluated. The technical success rate was 100%; no complications occurred during the procedures. Treatment was successful in 94.6% cases, and clinical efficacy was 85.7%. Three patients had to undergo a second arteriography due to recurrent haemorrhage. Fifteen patients died. Pre-embolisation transfusion demand was significantly associated with clinical efficacy. Percutaneous embolisation of pelvic bleeding may be considered a safe, effective, and minimally invasive therapeutic option. As haemodynamic stability is the first objective with traumatic haemorrhagic patient, arterial embolisation can assume a primary role. On the basis of our results, pre-procedural transfusion status may be considered a prognostic factor. • The series presented is one of the largest in a single centre. • Arterial embolisation is a life-saving procedure in patients with pelvic haemorrhage. • In pelvic traumas associated with haemorrhage, prognosis is dependent upon prompt treatment. • Transfusion status is significantly related to clinical efficacy.

  9. [Injury to the pelvic ring. Diagnosis and current possibilities for treatment].

    Science.gov (United States)

    Culemann, U; Tosounidis, G; Reilmann, H; Pohlemann, T

    2004-12-01

    Pelvic fracture, especially in combination with multiple trauma, can still lead to ife-threatening situations. Only clear inclusion criteria and decisions can ensure survival of the patient, the key task being mechanical stabilization using external fixators or pelvic clamps with or without surgical intervention for hemostasis. The basis for problem-orientated management is a precise classification, which is based on conventional X-rays in emergency situations and detailed analysis of computed tomography for the planning of definitive surgical interventions. The classification groups postulated are stable pelvic fractures (type A), rotational unstable pelvic fractures (type B -- partial stability of the posterior ring present), and translational instabilities (type C -- with a complete disruption of the anterior and posterior pelvic ring). This classification leads to clear indications for pelvic ring stabilization as surgical interventions are only exceptionally indicated in type A fractures, stabilization of the anterior ring is sufficient for type B fractures, and combined posterior and anterior stabilization is necessary for treatment of type C fractures. Following these concepts and by using standardized procedures and implants, the high rate of enclosed anatomical healing can be achieved even after type C injuries. Nevertheless, the role of concomitant soft tissue injuries and scar formation is not clear as the origin of the frequently observed long-term clinical impairments even after anatomical reconstruction of the osteoligamentous structures.

  10. Clinical Outcome of Intra-Arterial Embolization for Treatment of Patients with Pelvic Trauma

    Directory of Open Access Journals (Sweden)

    M. W. Barentsz

    2011-01-01

    Full Text Available Purpose. To analyse the technical success of pelvic embolization in our institution and to assess periprocedural hemodynamic status and morbidity/mortality of all pelvic trauma patients who underwent pelvic embolization. Methods. A retrospective analysis of patients with a pelvic fracture due to trauma who underwent arterial embolization was performed. Clinical data, pelvic radiographs, contrast-enhanced CT-scans, and angiographic findings were reviewed. Subsequently, the technical success and peri-procedural hemodynamic status were evaluated and described. Results. 19 trauma patients with fractures of the pelvis underwent arterial embolization. Initially, 10/19 patients (53% were hemodynamically unstable prior to embolization. Technical success of embolization was 100%. 14/19 patients (74% were stable after embolization, and treatment success was high as 74%. Conclusion. Angiography with subsequent embolization should be performed in patients with a pelvic fracture due to trauma and hemodynamic instability, after surgical intervention or with a persistent arterial blush indicative of an active bleeding on CT.

  11. On the definition of entropy for quantum unstable states

    International Nuclear Information System (INIS)

    Civitarese, Osvaldo; Gadella, Manuel

    2015-01-01

    The concept of entropy is central to the formulation of the quantum statistical mechanics, and it is linked to the definition of the density operator and the associated probabilities of occupation of quantum states. The extension of this scheme to accommodate for quantum decaying states is conceptually difficult, because of the nature of these states. Here we present a way to treat quantum unstable states in the context of statistical mechanics. We focuss on the definition of the entropy and avoid the use of complex temperatures

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Andreas Höch

    2016-01-01

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

  14. Analysis of pelvic movement in the elderly during walking using a posture monitoring system equipped with a triaxial accelerometer and a gyroscope.

    Science.gov (United States)

    Ishigaki, Norio; Kimura, Teiji; Usui, Yuki; Aoki, Kaoru; Narita, Nobuyo; Shimizu, Masayuki; Hara, Kazuo; Ogihara, Nobuhide; Nakamura, Koichi; Kato, Hiroyuki; Ohira, Masayoshi; Yokokawa, Yoshiharu; Miyoshi, Kei; Murakami, Narumichi; Okada, Shinpei; Nakamura, Tomokazu; Saito, Naoto

    2011-06-03

    The incidence of falls in the elderly is increasing with the aging of society and is becoming a major public health issue. From the viewpoint of prevention of falls, it is important to evaluate the stability of the gait in the elderly people. The pelvic movement, which is a critical factor for walking stability, was analyzed using a posture monitoring system equipped with a triaxial accelerometer and a gyroscope. The subjects were 95 elderly people over 60 years of age. The criteria for instability were open-eye standing on one leg for 15s or less, and 11s or more on 3m timed up and go test. Forty subjects who did not meet both of these criteria comprised the stable group, and the remaining 55 subjects comprised the unstable group. Pelvic movement during walking was compared between the two groups. The angle, angular velocity, and acceleration were analyzed based on the wave shape derived from the device worn around the second sacral. The results indicated that pelvic movement was lower in all three directions in the unstable group compared to the stable group, and the changes in the pelvic movement during walking in unstable elderly people were also reduced. This report is the first to evaluate pelvic movement by both a triaxial accelerometer and a triaxial gyroscope simultaneously. The characteristics of pelvic movement during walking can be applied in screening to identify elderly people with instability, which is the main risk factor associated with falls. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Pelvic Inflammatory Disease (For Teens)

    Science.gov (United States)

    ... might cause ongoing pelvic pain, infertility, or an ectopic pregnancy. What Are the Symptoms of PID? PID can ... has more of a chance of being infertile. Ectopic pregnancy. If a girl who has had PID does ...

  16. 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)

  17. 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)

  18. Treatment of pelvic endometriosis with etonogestrel subdermal implant (Implanon).

    Science.gov (United States)

    Yisa, Solomon B; Okenwa, Angela A; Husemeyer, Roy P

    2005-01-01

    Endometriosis is one of the commonest benign gynaecological disorders and has a peak incidence between 30 and 45 years of age. Treatment options are medical or surgical, depending on the location and extent of the disease and the woman's childbearing aspirations or need for contraception. Over the past five decades several formulations of progestogen have been used to treat endometriosis. Our study was not planned research but a series of case studies of women with severe symptoms of endometriosis treated in an innovative way with a new long-acting progestogen contraceptive system (etonogestrel subdermal implant) which could reasonably have been expected to have a favourable effect on their disease and its symptoms. Five women with severe pelvic endometriosis were treated. Two of them were nulliparous and wished to become pregnant in due course; the other three had completed their childbearing and were contemplating hysterectomy. One of the five women had relief of pelvic pain but requested removal of the implant after 3 months because of side effects; the other four remained very satisfied with their treatment for the symptoms of pelvic endometriosis. Two of the four very satisfied women have had their implant replaced and the other two are expected to have their implant replaced when necessary. Etonogestrel subdermal implants are an additional treatment option in women with symptoms related to pelvic endometriosis.

  19. Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial.

    Science.gov (United States)

    Oakeshott, Pippa; Kerry, Sally; Aghaizu, Adamma; Atherton, Helen; Hay, Sima; Taylor-Robinson, David; Simms, Ian; Hay, Phillip

    2010-04-08

    To determine whether screening and treating women for chlamydial infection reduces the incidence of pelvic inflammatory disease over the subsequent 12 months. Randomised controlled trial. Common rooms, lecture theatres, and student bars at universities and further education colleges in London. 2529 sexually active female students, mean age 21 years (range 16-27). Participants completed a questionnaire and provided self taken vaginal swabs, with follow-up after one year. Samples were randomly allocated to immediate testing and treatment for chlamydial infection, or storage and analysis after a year (deferred screening controls). Incidence of clinical pelvic inflammatory disease over 12 months. Baseline prevalence of chlamydia was 5.4% (68/1254) in screened women and 5.9% (75/1265) in controls. 94% (2377/2529) of women were followed up after 12 months. The incidence of pelvic inflammatory disease was 1.3% (15/1191) in screened women compared with 1.9% (23/1186) in controls (relative risk 0.65, 95% confidence interval 0.34 to 1.22). Seven of 74 control women (9.5%, 95% confidence interval 4.7% to 18.3%) who tested positive for chlamydial infection at baseline developed pelvic inflammatory disease over 12 months compared with one of 63 (1.6%) screened women (relative risk 0.17, 0.03 to 1.01). However, most episodes of pelvic inflammatory disease occurred in women who tested negative for chlamydia at baseline (79%, 30/38). 22% (527/2377) of women reported being tested independently for chlamydia during the trial. Although some evidence suggests that screening for chlamydia reduces rates of pelvic inflammatory disease, especially in women with chlamydial infection at baseline, the effectiveness of a single chlamydia test in preventing pelvic inflammatory disease over 12 months may have been overestimated. Trial registration ClinicalTrials.gov NCT00115388.

  20. PELVIC INJURY IN CHILDHOOD: WHAT IS ITS CURRENT IMPORTANCE?

    Science.gov (United States)

    Guerra, María Roxana Viamont; Braga, Susana Reis; Akkari, Miguel; Santili, Claudio

    2016-01-01

    The purpose of this study was to assess the importance of pelvic fractures in childhood by analyzing epidemiological characteristics and associated injuries. This is a retrospective study performed between 2002 and 2012 at two trauma referral centers in São Paulo. We identified 25 patients aged 16 years old or younger with pelvic fracture. The main mechanism of trauma was traffic accident (80%), followed by fall from height (16%). At hospital admission, 92% had traumatic brain injury and 40% had hemodynamic instability. Besides pelvic fractures, 56% of the children had other associated injuries (genitourinary, abdominal, vascular, chest and neurological), and 79% of them required operative treatment. According to the Torode and Zieg classification, the majority of cases were types III and IV. Seventy-two percent of all pelvic fractures were treated by surgery; 52% involved external fixation and 20% involved open reduction and internal fixation. The pelvic fractures in childhood can be considered a marker for injury severity, because the associated injuries usually are severe, needing operative treatment and leading to a high mortality rate (12%). Level of Evidence IV, Case Series.

  1. Optical isotope shifts for unstable samarium isotopes

    International Nuclear Information System (INIS)

    Eastham, D.A.; Walker, P.M.; Griffith, J.A.R.; Evans, D.E.; Grant, I.S.; England, J.G.; Fawcett, M.J.

    1984-01-01

    Using a tunable dye laser beam intersecting a thermal atomic beam, optical isotope shifts and hyperfine splittings have been measured for the four unstable samarium isotopes between 144 Sm and 154 Sm, covering the well known transition region from spherical to deformed shapes. (orig.)

  2. Pelvic inflammatory diseases in perimenopause and menopause

    Directory of Open Access Journals (Sweden)

    Cabunac Petar

    2012-03-01

    Full Text Available Introduction: In the gynecological profession Pelvic Inflammatory Disease (PID has a significant role due to its frequency, many complications and high costs of treatment Aim: The aim of this study was to investigate frequency and complications caused by these diseases, and used methods of treatment. Methods: The research was conducted in Clinic of Obstetrics and Gynecology 'Narodni Front', Belgrade, and included all consecutive patients diagnosed with PID during the period from year 2007 to 2010. The diagnosis of PID was set on the basis of: gynecological examination, test analysis (leucocytes, sedimentation, platelets, CRP, CA125, and ultrasound examination. A clinical criterion is divided into minimal and additional. The study included 112 patients. There were 33.93% of women in perimenopause/menopause (experimental group, while the control group consisted of 66.07% female subjects. Results: The frequency of surgically treated patients in experimental and control group was: 44.74% : 39.19% (χ2 test; p > 0.05. Women in experimental group used Intrauterine Device (IUD more than other patients 57.89% : 13.15% (χ2 test; p = 0.0001. A link was established between the use of intrauterine devicela in (χ2 test; p = 0.0516, patients’ irregular control of IUD (χ2 test; p = 0.0114 and surgical treatments of women in experimental group. The conservative treatment usually applies dual antibiotic therapy. Costs of surgically treated patients are around 1300 and conservatively treated around 210 €. Conclusion: Women in perimenopause and menopause are not exposed to higher risks of contracting PID. Women in perimenopause and menopause which use intrauterine device and don’t have regular controls, have higher risk of surgical treatments in case of pelvic inflammatory disease. Costs of treatment are 6-7 times in lower with conservatively treated patients compared to operatively treated ones.

  3. Early definitive stabilization of unstable pelvis and acetabulum fractures reduces morbidity.

    Science.gov (United States)

    Vallier, Heather A; Cureton, Beth Ann; Ekstein, Charles; Oldenburg, F Parke; Wilber, John H

    2010-09-01

    Although the benefits of acute stabilization of long bone fractures are recognized, the role of early fixation of unstable pelvis and acetabular fractures is not well-defined. The purpose of this study was to review complications and hospital course of patients treated surgically for pelvis and acetabulum fractures. We hypothesized that early definitive fixation would reduce morbidity and decrease length of stay. Six hundred forty-five patients were treated surgically at a level I trauma center for unstable fractures of the pelvic ring (n = 251), acetabulum (n = 359), or both (n = 40). Mean age was 40.5 years, and mean Injury Severity Score (ISS) was 25.6 (range 9-66). They were retrospectively reviewed to determine complications including acute respiratory distress syndrome (ARDS), pneumonia, deep vein thrombosis, pulmonary embolism, multiple organ failure (MOF), infections, and reperations. Definitive fixation was within 24 hours of injury in 233 patients (early, mean 13.4 hours) and >24 hours in 412 (late, mean 99.2 hours). Twenty-nine patients (12.4%) had complications after early fixation versus 81 (19.7%) after late, p = 0.006. Length of stay and intensive care unit days were 10.7 days versus 11.6 days (p = 0.26) and 8.1 days versus 9.9 days (p = 0.03) for early and late groups, respectively. With ISS >18 (n = 165 early [ISS 32.7]; n = 253 late [ISS 33.1]), early fixation resulted in fewer pulmonary complications (12.7% versus 25%, p = 0.0002), less ARDS (4.8% versus 12.6%, p = 0.019), and less MOF (1.8% versus 4.3%, p = 0.40). Rates of complications, pulmonary complications, deep vein thrombosis, and MOF were no different for patients with pelvis versus acetabulum fractures. In patients receiving ≥ 10U packed red blood cells (n = 41 early, n = 56 late) early fixation led to fewer pulmonary complications (24% versus 55%, p = 0.002), less ARDS (12% versus 25%, p = 0.09), and MOF (7.3% versus 14%, p = 0.23). Two hundred ten patients had some chest injury (32

  4. Incorporating pelvic/vaginal reconstruction into radical pelvic surgery.

    Science.gov (United States)

    Fowler, Jeffrey M

    2009-10-01

    The objective of this review is to discuss the more common surgical scenarios that often require pelvic/vaginal reconstruction with an emphasis on incorporating reconstructive options into the pelvic exenteration. A review of the literature regarding pelvic/vaginal reconstruction in patients undergoing radical pelvic surgery was performed and supplemented with the authors' own experience. Reconstructive surgical procedures are often necessary with outcome goals that include any combination of enhanced wound healing, decrease in acute and chronic morbidity, and restoration of anatomic form and function. Many reconstruction techniques are available including, but not limited to, skin grafting, simple tissue transposition flaps, fasciocutaneous flaps, and myocutaneous flaps. It is extremely important that the gynecologic oncologist be proficient with more than one of the reconstructive options available to address the various pelvic/vaginal defects one may encounter. There is a wide range in the complexity of surgical situations requiring reconstruction. The pelvic exenteration in the previously radiated patient offers the highest level of challenge in terms of pre-operative planning, intra-operative decision-making and surgical skills. Vaginal reconstruction for sexual intercourse may be a priority for some patients, however pelvic/vaginal reconstruction plays a major role in facilitating wound healing, minimizing significant morbidity, and improving patient quality of life and functional outcomes. The gynecologic oncologist is best suited to orchestrate this multifaceted surgical process. It is extremely important that the gynecologic oncologist be well versed in the reconstructive options available in order that it is optimally planned and effected at the primary surgical procedure.

  5. [Pelvic floor exercise and biofeedback in women with urinary stress incontinence].

    Science.gov (United States)

    Gordon, D; Luxman, D; Sarig, Y; Groutz, A

    1999-04-15

    Stress urinary incontinence is a medical and social problem. In the past decade there has been increased awareness of this condition and the number of those affected who seek help is increasing. Treatment is usually surgical-elevation of the bladder neck. Pelvic floor exercise is an accepted conservative treatment modality used for mild to moderate cases who have not yet completed their families. We present our results in 30 women, aged 28-71 years, av. 49% with genuine stress incontinence treated with pelvic floor exercise and biofeedback. 14 patients (46.7%) were completely cured and 15 (50%) were improved. In only 1 was there no improvement. Our results show significant improvement in the duration and intensity of pelvic floor contractions after treatment. Pelvic floor exercise with biofeedback is a very important treatment modality, requiring a highly motivated patient and a physiotherapist specialized in pelvic floor exercise.

  6. 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].

  7. Pelvic Floor Dysfunction in Aging Women

    Directory of Open Access Journals (Sweden)

    Gin-Den Chen

    2007-12-01

    Full Text Available The occurrence of pelvic floor dysfunction may increase steadily during the aging process in women. Pelvic floor dysfunction may be associated with dysfunctions of micturition, defecation, prolapse, and sex. The natural history and mechanism of pelvic floor dysfunction in aged women are not well understood or explored. In this article, we review the effect of age on the prevalence of pelvic floor dysfunction and on the structural and functional changes of the lower urinary tract, anorectum and pelvic floor. Altogether, the aging process has a negative impact on either the function or structure of the lower urinary tract, anorectum and pelvic floor in women.

  8. Pharmacologic attenuation of pelvic pain in a murine model of interstitial cystitis

    Directory of Open Access Journals (Sweden)

    Schaeffer Anthony J

    2009-11-01

    Full Text Available Abstract Background Interstitial cystitis/painful bladder syndrome (IC/PBS is a bladder disease that causes debilitating pelvic pain of unknown origin, and IC/PBS symptoms correlate with elevated bladder lamina propria mast cell counts. Similar to IC/PBS patients, pseudorabies virus (PRV infection in mice induces a neurogenic cystitis associated with bladder lamina propria mast cell accumulation and pelvic pain. We evaluated several drugs to determine the effectiveness of reducing PRV-induced pelvic pain. Methods Neurogenic cystitis was induced by the injection of Bartha's strain of PRV into the abductor caudalis dorsalis tail base muscle of female C57BL/6 mice. Therapeutic modulation of pelvic pain was assessed daily for five days using von Frey filament stimulation to the pelvic region to quantify tactile allodynia. Results Significant reduction of PRV-induced pelvic pain was observed for animals treated with antagonists of neurokinin receptor 1 (NK1R and histamine receptors. In contrast, the H1R antagonist hydroxyzine, proton pump inhibitors, a histamine receptor 3 agonist, and gabapentin had little or no effect on PRV-induced pelvic pain. Conclusion These data demonstrate that bladder-associated pelvic pain is attenuated by antagonists of NK1R and H2R. Therefore, NK1R and H2Rrepresent direct therapeutic targets for pain in IC/PBS and potentially other chronic pain conditions.

  9. Transperineal Sonography Evaluation of Muscles and Vascularity in the Male Pelvic Floor.

    Science.gov (United States)

    Roll, Shawn C; Kutch, Jason J

    2013-01-01

    Idiopathic chronic male pelvic pain is difficult to diagnose and treat. Currently, diagnosis relies on subjective symptoms; objective measures of neuromuscular mechanisms have not been investigated. Sonographic imaging has been used to investigate these neuromuscular mechanisms in the female pelvic floor, but neither research nor books describe sonography evaluation of the male pelvic floor. The purpose of this study was to develop and evaluate a perineal sonographic technique for the examination of the male pelvic floor muscles. Anatomic landmarks were identified with images collected from two subjects, one with intermittent reports of pelvic pain and one with no history of pain in the pelvic region. A description of the equipment settings, the examination protocol, and the resulting comparative image analysis is included. A validated protocol such as this may be useful in documenting differences in the soft tissue structures between asymptomatic individuals and patients with chronic pelvic pain to aid in diagnosis and treatment. This is the first known study to report sonographic findings of the individual muscles in the male pelvic floor, and additional research is needed to validate the techniques that have been deemed feasible.

  10. Synergism between abdominal and pelvic floor muscles in healthy women: a systematic review of observational studies

    Directory of Open Access Journals (Sweden)

    Lia Ferla

    Full Text Available Abstract Introduction: The training of the pelvic floor muscles is widely used for treating pelvic floor dysfunctions, like urinary incontinence. During the training, abdominal contractions are avoided; however several studies support the use of the synergy between these muscle groups. Objective: Carrying out a systematic review of studies that seek to identify the presence of synergy between the muscles of the abdomen and the pelvic floor and its functionality in women without pelvic floor dysfunction. Methodology: To conduct the review, we have followed the recommendations proposed by the Cochrane Collaboration for systematic reviews. The literature search included the databases SCIELO, PEDro, MEDLINE, Cochrane CENTRAL and EMBASE, and manual research, the starting date of the databases until August 2013. We included cross observational studies with healthy women who were assessed to find the presence of synergy between the abdominal muscles and the pelvic floor. Results: We included 10 articles and they all showed the existence of synergy between the abdominal and pelvic floor muscles in healthy women in the supine, sitting and standing positions. Conclusion: Thus, we can conclude that there is synergy between the muscles of the abdomen and the pelvic floor in healthy women. Better understanding the behavior of these muscles and synergy may favor the development of strategies for the prevention and treatment of disorders of the female pelvic floor muscles.

  11. Functional anatomy of pelvic floor.

    Science.gov (United States)

    Rocca Rossetti, Salvatore

    2016-03-31

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

  12. 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. Decay Law of Moving Unstable Particle

    CERN Document Server

    Shirokov, M I

    2004-01-01

    Quantum relativistic decay law of moving unstable particle is analytically calculated in the model case of the Breit-Wigner mass distribution. It turns out that Einstein time dilation of the moving particle decay holds approximately at times when the decay is exponential. The related correction is calculated analytically. Being very small at these times it is practically unobservable. It is shown that Einstein dilation fails for large times t when decay is not exponential. An unstable system of the kind of K_0 meson (which is the superposition of K_s and K_l) is also considered. In this case, the violation of Einstein dilation is shown to be appreciable at all times under some condition.

  14. The Fate of Unstable Circumbinary Planets

    Science.gov (United States)

    Kohler, Susanna

    2016-03-01

    What happens to Tattooine-like planets that are instead in unstable orbits around their binary star system? A new study examines whether such planets will crash into a host star, get ejected from the system, or become captured into orbit around one of their hosts.Orbit Around a DuoAt this point we have unambiguously detected multiple circumbinary planets, raising questions about these planets formation and evolution. Current models suggest that it is unlikely that circumbinary planets would be able to form in the perturbed environment close their host stars. Instead, its thought that the planets formed at a distance and then migrated inwards.One danger such planets face when migrating is encountering ranges of radii where their orbits become unstable. Two scientists at the University of Chicago, Adam Sutherland and Daniel Fabrycky, have studied what happens when circumbinary planets migrate into such a region and develop unstable orbits.Producing Rogue PlanetsTime for planets to either be ejected or collide with one of the two stars, as a function of the planets starting distance (in AU) from the binary barycenter. Colors represent different planetary eccentricities. [Sutherland Fabrycky 2016]Sutherland and Fabrycky used N-body simulations to determine the fates of planets orbiting around a star system consisting of two stars a primary like our Sun and a secondary roughly a tenth of its size that are separated by 1 AU.The authors find that the most common fate for a circumbinary planet with an unstable orbit is ejection from the system; over 80% of unstable planets were ejected. This has interesting implications: if the formation of circumbinary planets is common, this mechanism could be filling the Milky Way with a population of free-floating, rogue planets that no longer are associated with their host star.The next most common outcome for unstable planets is collision with one of their host stars (most often the secondary), resulting inaccretion of the planet

  15. Nonlinear adaptive neural controller for unstable aircraft

    OpenAIRE

    Suresh, S; Omkar, SN; Mani, V; Sundararajan, N

    2005-01-01

    A model reference indirect adaptive neural control scheme that uses both off-line and online learning strategies is proposed for an,unstable nonlinear aircraft controller design. The bounded-input-bounded-output stability requirement for the controller design is circumvented using an off-line, finite interval of time training scheme. The aircraft model is first identified using a neural network with linear filter (also known as time-delayed neural network) with the available input-output data...

  16. Development and testing of a pelvic goniometer designed to measure pelvic tilt and hip flexion.

    Science.gov (United States)

    Sprigle, Stephen; Flinn, Nannette; Wootten, Mary; McCorry, Stephanie

    2003-06-01

    To determine the reliability and validity of a pelvic goniometer designed to measure the pelvic tilt and hip flexion during seated posture. Assessment of the seated posture requires measurement of the pelvis and hip. Determining accurate pelvic tilt and hip flexion angles during sitting is often difficult using standard techniques. A pelvic goniometer has been designed to measure pelvic tilt and hip flexion angle of persons in a seated posture. VALIDATION of the pelvic goniometer was done radiographically. Ten male volunteers sat in three postures--erect, forward or anterior tilt, and posterior tilt. Pelvic tilt and hip angle were recorded using radiographs and the pelvic goniometer. Reliability of pelvic and conventional goniometers was done using seated nondisabled subjects with physical therapists performing measurements. the average differences and correlation between the pelvic goniometer and radiographic measures were as follows--pelvic tilt: -4.9 degrees, 0.93; hip angle 1.2 degrees, 0.81. Reliability: average range of hip angle across three measures was about 3 degrees for both goniometers. The data indicate that the pelvic goniometer has utility in measuring pelvic tilt and hip angle, especially within the seated posture. Because it measures both pelvic tilt and hip angle, the pelvic goniometer has an advantage over conventional goniometers that only measure the latter. A valid and reliable tool that measures pelvic tilt and hip angle of persons in a seated posture is needed for clinical research and practice. Its applications include wheelchair seating evaluations and ergonomic assessments of seated workers.

  17. 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

  18. Unstable angina and exposure to carbon monoxide.

    Science.gov (United States)

    Balzan, M V; Cacciottolo, J M; Mifsud, S

    1994-10-01

    Inhalation of small amounts of carbon monoxide diminishes the pain threshold in patients with stable angina pectoris. The aim of this study was to identify and describe patients who had been exposed unknowingly to toxic inhalations of this gas and subsequently presented to hospital with a clinical picture of unstable angina. Blood carboxyhaemoglobin levels of 104 patients referred with unstable angina to a coronary care unit were determined on admission. The likely source of carbon monoxide was identified in all patients. Three patients had definite carbon monoxide intoxication. Another five patients had evidence of minor exposure. When the three cases with carbon monoxide poisoning were excluded, the mean carboxyhaemoglobin level was 2.5% (+/- 1.3) for smokers (n = 30) and 0.6% (+/- 0.5) for non-smokers (n = 71). Use of fossil fuel combustion in an enclosed environment was responsible for the three most serious intoxications and one of the minor cases. We suggest that a number of patients admitted for coronary care with unstable angina may have significant carbon monoxide poisoning. This intoxication is often overlooked by attending physicians with the result that high concentration oxygen therapy is not administered, when it is in fact a necessary part of treatment.

  19. How Are Pelvic Floor Disorders Diagnosed?

    Science.gov (United States)

    ... Share Facebook Twitter Pinterest Email Print How are pelvic floor disorders diagnosed? A physical exam may be all ... fee ). This test is used to evaluate the pelvic floor and rectum while the patient is having a ...

  20. Pelvic Inflammatory Disease (PID) Treatment and Care

    Science.gov (United States)

    ... Search Form Controls Cancel Submit Search the CDC Pelvic Inflammatory Disease (PID) Note: Javascript is disabled or is not supported ... Twitter STD on Facebook Sexually Transmitted Diseases (STDs) Pelvic Inflammatory Disease (PID) Treatment and Care Recommend on Facebook Tweet ...

  1. Is group pelvic floor retraining as effective as individual treatment?

    Science.gov (United States)

    Jones, H J S; Gosselink, M P; Fourie, S; Lindsey, I

    2015-06-01

    Traditionally, pelvic floor retraining for faecal incontinence or obstructed defaecation has been delivered to patients through individual sessions with a specialist pelvic floor nurse, a resource-intensive practice. This study aimed to assess whether a similar outcome can be achieved by delivering retraining to patients in small groups, allowing considerable savings in the use of resources. Data were collected prospectively in a pelvic floor database. Patients received pelvic floor retraining either individually or in a small group setting and completed baseline and follow-up questionnaires. Two hundred and fifteen patients were treated, 119 individually and 96 in a small group setting. Scores before and after treatment for the two settings were compared for the Gastrointestinal Quality of Life Index, the Fecal Incontinence Severity Index and the Patient Assessment of Constipation Symptoms. Additionally patients receiving group treatment completed a short questionnaire on their experience. The median change in Gastrointestinal Quality of Life Index score was 5 (range -62 to 73) for individual treatment and 4 (range -41 to 47) for group treatment, both showing statistically significant improvement. However, there was no significant difference between the settings. Similar results were obtained with the Fecal Incontinence Severity Index and Patient Assessment of Constipation Symptoms scores for the faecal incontinence and obstructed defaecation subgroups respectively. The majority of patients experienced symptomatic improvement following pelvic floor retraining and there was no significant difference in the resulting improvement according to treatment setting. As treatment costs are considerably less in a group setting, group pelvic floor retraining is more cost-effective than individual treatment. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

  2. Unstable Angina Pectoris in a 22-year-old Female Patient.

    Science.gov (United States)

    Yoshimura, Hanae; Oba, Toyoharu; Nagata, Takanobu; Kumagai, Eita; Itaya, Naoki; Yoshikawa, Naohiro; Akagaki, Daiki; Ohshima, Hideki; Nishihara, Michihide; Ueno, Takafumi; Fukumoto, Yoshihiro

    2017-04-13

    Because of the protective effect of estrogen for atherosclerosis, the prevalence of acute coronary syndrome in women before menopause is low. We report a rare case of unstable angina in a young Japanese female who had a history of cigarette smoking and contraceptive use. Her coronary stenosis was successfully treated by percutaneous coronary intervention.

  3. External fixation of the pelvic ring: an experimental study on the role of pin diameter, pin position, and parasymphyseal fixator pins

    NARCIS (Netherlands)

    Ponsen, Kees-Jan; Joosse, Pieter; Hoek van Dijke, Gilbert A.; Snijders, Chris J.

    2007-01-01

    BACKGROUND: The mechanical properties of current external fixator systems for unstable (type C) pelvic ring fractures are inferior to internal fixation, and are not optimal for definitive treatment. We explored methods to increase stability of external fixator constructs. METHODS: An experimental

  4. Biomechanics of the pelvic floor musculature

    OpenAIRE

    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 very complex muscular structure. It is largely responsible for supporting both pelvic and abdominal organs and acts synergistically with the striated muscle of the anterior abdominal wall to generate ...

  5. Percutaneous drainage of pelvic fluid collection

    International Nuclear Information System (INIS)

    Lee, Eun Young; Sohn, Cheol Ho

    1995-01-01

    To evaluate safe access route and success rate of percutaneous drainage of pelvic fluid collection. The 35 percutaneous drainages of pelvic fluid collection under the CT and fluorosocpic guidance were done in 32 patients. The anterior transabdominal approach was done in 20 patients, while the nine patients used the transgluteal approach through greater sciatic foramen. Three patients, who had septated or noncommunicating abscesses, underwent drainage using both approaches. The catheter was removed when the patient's symptom and laboratory data were improved or the amount of drainage and the size of fluid collection were markedly reduced. Success, partial success and failure were classified. The causes of fluid collection were complication of intraabdominal operation in 27 patient. The diagnosis after drainage included abscess (21), loculated ascites (6), and hematoma (4). The 27 cases (30 procedure) were treated successfully and the mean duration of catheter insertion was 10 days. The partial successes were two cases (2 procedures), which had palliative purpose. Three cases (3 procedures) were failed, which were multiple loculated ascites of pancreatic origin (2) and recurrent abscess (1). The significant complication during the procedure or drainage was not noted

  6. Effects of radiation therapy on the structure and function of the pelvic floor muscles of patients with cancer in the pelvic area: a systematic review.

    Science.gov (United States)

    Bernard, Stéphanie; Ouellet, Marie-Pier; Moffet, Hélène; Roy, Jean-Sébastien; Dumoulin, Chantale

    2016-04-01

    Radiation therapy (RT) is often recommended in the treatment of pelvic cancers. Following RT, a high prevalence of pelvic floor dysfunctions (urinary incontinence, dyspareunia, and fecal incontinence) is reported. However, changes in pelvic floor muscles (PFMs) after RT remain unclear. The purpose of this review was to systematically document the effects of RT on the PFM structure and function in patients with cancer in the pelvic area. An electronic literature search using Pubmed Central, CINAHL, Embase, and SCOPUS was performed from date of inception up to June 2014. The following keywords were used: radiotherapy, muscle tissue, and pelvic floor. Two reviewers selected the studies in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). Out of the 369 articles screened, 13 met all eligibility criteria. The methodological quality was assessed using the QualSyst scoring system, and standardized mean differences were calculated. Thirteen studies fulfilled all inclusion criteria, from which four were of good methodological quality. One presented strong evidence that RT affects PFM structure in men treated for prostate cancer. Four presented high-level evidence that RT affects PFM function in patients treated for rectal cancer. Meta-analysis was not possible due to heterogeneity and lack of descriptive statistics. There is some evidence that RT has detrimental impacts on both PFMs' structure and function. A better understanding of muscle damage and dysfunction following RT treatment will improve pelvic floor rehabilitation and, potentially, prevention of its detrimental impacts.

  7. 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

  8. 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

  9. Office Evaluation of Pelvic Pain.

    Science.gov (United States)

    Bennis, Stacey; Hwang, Sarah

    2017-08-01

    The history and physical examination are important keys to diagnosis and treatment of patients with chronic pelvic pain. The comprehensive history should include questioning regarding patient's pain complaint and a thorough history and review of any body system that may be involved, including neuromusculoskeletal, obstetric, gynecologic, gastrointestinal, urologic, dermatologic, infectious, oncologic, and psychiatric. The physical examination should also follow a focused systems-based approach and includes examination of gastrointestinal, dermatologic, neurologic, and musculoskeletal (including lumbosacral spine, sacroiliac joints, pelvis, and hips) systems, and the pelvic floor (internal and external examination, including neuromuscular anatomy). Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Crisis-induced unstable dimension variability in a dynamical system

    International Nuclear Information System (INIS)

    Kubo, Geraldo T.; Viana, Ricardo L.; Lopes, Sergio R.; Grebogi, Celso

    2008-01-01

    Unstable dimension variability is an extreme form of non-hyperbolic behavior in chaotic systems whose attractors have periodic orbits with a different number of unstable directions. We propose a new mechanism for the onset of unstable dimension variability based on an interior crisis, or a collision between a chaotic attractor and an unstable periodic orbit. We give a physical example by considering a high-dimensional dissipative physical system driven by impulsive periodic forcing

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

    Directory of Open Access Journals (Sweden)

    Asama Vanichtantikul

    2017-01-01

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

  12. Ultrasound-guided drainage of deep pelvic abscesses

    DEFF Research Database (Denmark)

    Lorentzen, Torben; Nolsøe, Christian; Skjoldbye, Bjørn

    2011-01-01

    The aim of this study was to demonstrate and evaluate the ultrasound-guided drainage of deep pelvic abscesses in which transabdominal percutaneous access could not be performed because of overlying structures. A retrospective analysis of 32 consecutive patients with 33 deep pelvic abscesses...... (median diameter 7 cm), 19 were treated with catheter drainage and 18 of these cases resulted in favorable clinical outcomes. Of the smaller abscesses (median diameter 4 cm), 14 were treated with needle drainage. In two of these cases, follow-up US showed that a repeat puncture and drainage was necessary....... All needle drainages resulted in favorable clinical outcomes. Sixteen of the 29 transrectal or transvaginal drainage procedures were performed without any anesthesia (10 were performed with a needle and six were performed with a catheter). Apart from minor discomfort during the drainage procedure...

  13. Anatomy and Physiology of the Pelvic Floor.

    Science.gov (United States)

    Eickmeyer, Sarah M

    2017-08-01

    Understanding the anatomic relationship of the pelvic floor muscles with the pelvic girdle, spine, and hips aids the rehabilitation provider in diagnosis, management, and appropriate referrals. The bony anatomy of the pelvic girdle consists of 3 bones and 3 joints. The pelvic floor muscles are comprised mainly of the levator ani muscles with somatic innervation from the lumbosacral plexus. The bony and muscular pelvis is highly interconnected to the hip and gluteal musculature, which together provide support to the internal organs and core muscles. Pelvic floor physiology is centered on bladder and bowel control, sexual functioning, and pregnancy. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Ultrasound Imaging of the Pelvic Floor.

    Science.gov (United States)

    Stone, Daniel E; Quiroz, Lieschen H

    2016-03-01

    This article discusses the background and appraisal of endoluminal ultrasound of the pelvic floor. It provides a detailed anatomic assessment of the muscles and surrounding organs of the pelvic floor. Different anatomic variability and pathology, such as prolapse, fecal incontinence, urinary incontinence, vaginal wall cysts, synthetic implanted material, and pelvic pain, are easily assessed with endoluminal vaginal ultrasound. With pelvic organ prolapse in particular, not only is the prolapse itself seen but the underlying cause related to the anatomic and functional abnormalities of the pelvic floor muscle structures are also visualized. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. 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)

  16. The fate of unstable gauge flux compactifications

    Energy Technology Data Exchange (ETDEWEB)

    Burgess, C.P. [McMaster Univ., Hamilton, ON (Canada). Dept. of Physics and Astronomy]|[Perimeter Institute for Theoretical Physics, Waterloo, ON (Canada); Parameswaran, S.L. [Hamburg Univ. (Germany). 2. Inst. fuer Theoretische Physik; Zavala, I. [Bonn Univ. (Germany). Bethe Center for Theoretical Physics and Physikalisches Inst.

    2008-12-15

    Fluxes are widely used to stabilise extra dimensions, but the supporting monopolelike configurations are often unstable, particularly if they arise as gauge flux within a non-abelian gauge sector. We here seek the endpoint geometries to which this instability leads, focussing on the simplest concrete examples: sphere-monopole compactifications in six dimensions. Without gravity most monopoles in non-abelian gauge groups are unstable, decaying into the unique stable monopole in the same topological class. We show that the same is true in Einstein-YM systems, with the new twist that the decay leads to a shrinkage in the size of the extra dimensions and curves the non-compact directions: in D dimensions a Mink{sub D-2} x S{sub 2} geometry supported by an unstable monopole relaxes to AdS{sub D-2} x S{sub 2}, with the endpoint sphere smaller than the initial one. For supergravity the situation is more complicated because the dilaton obstructs such a simple evolution. The endpoint instead acquires a dilaton gradient, thereby breaking some of the spacetime symmetries. For 6D supergravity we argue that it is the 4D symmetries that break, and examine several candidates for the endpoint geometry. By using the trick of dimensional oxidation it is possible to recast the supergravity system as a higher-dimensional Einstein-YM monopole, allowing understanding of this system to guide us to the corresponding endpoint. The result is a Kasner-like geometry conformal to Mink{sub 4} times S{sub 2}, with nontrivial conformal factor and dilaton breaking the maximal 4D symmetry and generating a singularity. Yet the resulting configuration has a lower potential energy than did the initial one, and is perturbatively stable, making it a sensible candidate endpoint for the evolution. (orig.)

  17. 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

  18. 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.

  19. Obesity and pelvic organ prolapse

    NARCIS (Netherlands)

    Lee, U.J.; Kerkhof, M.H.; Leijsen, S.A. van; Heesakkers, J.P.F.A.

    2017-01-01

    PURPOSE OF REVIEW: The purpose of this review is to review the data on the relationship of obesity and pelvic organ prolapse (POP). This review is timely and relevant as the prevalence of obesity is increasing worldwide, and it is an important risk factor to consider in counseling women on

  20. Pelvic Inflammatory Disease (PID)

    Science.gov (United States)

    ... negative STD test results; • Using latex condoms the right way every time you have sex. How do I know if I have PID? ... any damage that has already happened to your reproductive system. The ... sure to tell your recent sex partner(s), so they can get tested and treated ...

  1. Exploring the physics of unstable nuclei

    International Nuclear Information System (INIS)

    Volya, Alexander

    2015-01-01

    In this presentation the Continuum Shell Model (CSM) approach is advertised as a powerful theoretical tool for studying physics of unstable nuclei. The approach is illustrated using 17 O as an example, which is followed by a brief presentation of the general CSM formalism. The successes of the CSM are highlighted and references are provided throughout the text. As an example, the CSM is applied perturbatively to 20 O allowing one to explore the effects of continuum on positions of weakly bound states and low-lying resonances, as well as to discern some effects of threshold discontinuity. (author)

  2. Nuclear Data on Unstable Nuclei for Astrophysics

    International Nuclear Information System (INIS)

    Smith, Michael Scott; Meyer, Richard A; Lingerfelt, Eric; Scott, J.P.; Hix, William Raphael; Ma, Zhanwen; Bardayan, Daniel W.; Blackmon, Jeff C.; Guidry, Mike W.; KOZUB, RAYMOND L.; Chae, Kyung YuK.

    2004-01-01

    Recent measurements with radioactive beams at ORNL's Holifield Radioactive Ion Beam Facility (HRIBF) have prompted the evaluation of a number of reactions involving unstable nuclei needed for stellar explosion studies. We discuss these evaluations, as well as the development of a new computational infrastructure to enable the rapid incorporation of the latest nuclear physics results in astrophysics models. This infrastructure includes programs that simplify the generation of reaction rates, manage rate databases, and visualize reaction rates, all hosted at a new website http://www.nucastrodata.org

  3. Signatures of unstable particles in finite volume

    International Nuclear Information System (INIS)

    Luescher, M.

    1991-05-01

    Unstable particles (resonances) occur in QCD, the Higgs model and many other quantum field theories of interest. Since they are a dynamical phenomenon, showing up in scattering processes of stable particles, it is not obvious how to extract their masses from numerical simulations of the theory in euclidean space. For resonances in the elastic region, a solution to this problem in proposed here on the basis of a recently established relation between the scattering matrix in infinite volume and the two-particle energy spectrum in a periodic box. (orig.)

  4. Endometritis does not predict reproductive morbidity after pelvic inflammatory disease.

    Science.gov (United States)

    Haggerty, Catherine L; Ness, Roberta B; Amortegui, Antonio; Hendrix, Susan L; Hillier, Sharon L; Holley, Robert L; Peipert, Jeffrey; Randall, Hugh; Sondheimer, Steven J; Soper, David E; Sweet, Richard L; Trucco, Guiliana

    2003-01-01

    We investigated the association between endometritis and reproductive morbidity. Participants were 614 women in the PID Evaluation and Clinical Health (PEACH) Study with pelvic pain, pelvic organ tenderness, and leukorrhea, mucopurulent cervicitis, or untreated cervicitis. We compared women with endometritis (>or=5 neutrophils or >or=2 plasma cells), Neisseria gonorrhoeae or Chlamydia trachomatis upper genital tract infection (UGTI) or both to women without endometritis/UGTI for outcomes of pregnancy, infertility, recurrent pelvic inflammatory disease (PID), and chronic pelvic pain (CPP), adjusting for age, race, education, PID history, and baseline infertility. Endometritis/UGTI was not associated with reduced pregnancy (odds ratio [OR] 0.8, 95% CI 0.6-1.2) or elevated infertility (OR 1.0, 95% CI 0.6-1.6), recurrent PID (OR 0.6, 95% CI 0.4-0.9), or CPP (OR 0.6, 95% CI 0.4-0.9). PEACH participants with and without endometritis/UGTI had higher age- and race-specific pregnancy rates than 1997 national rates. Among women with clinically suspected mild-to-moderate PID treated with standard antibiotics, endometritis/UGTI was not associated with reproductive morbidity.

  5. Obliterative LeFort colpocleisis for pelvic organ prolapse in elderly women aged 70 years and over

    Directory of Open Access Journals (Sweden)

    Soo-Cheen Ng

    2016-02-01

    Conclusion: Colpocleisis should be considered as one of the surgical options for treating advanced pelvic organ prolapse in elderly patients who do not wish to preserve vaginal function for sexual intercourse.

  6. Triple pelvic osteotomy: effect on limb function and progression of degenerative joint disease

    International Nuclear Information System (INIS)

    Johnson, A.L.; Smith, C.W.; Pijanowski, G.J.; Hungerford, L.L.

    1998-01-01

    The objective of this study was to evaluate prospectively the outcome of 21 clinical patients treated with triple pelvic osteotomies during the year following surgery. Specific aims included documenting the time of and extent of improved limb function as measured by force plate analysis, evaluating the progression of degenerative joint disease (DJD) in the treated and untreated coxofemoral joints, and determining whether or not triple pelvic osteotomy resulted in degenerative joint changes in the ipsilateral stifle and hock. Twelve dogs were treated unilaterally and nine dogs were treated bilaterally with triple pelvic osteotomies. There were no differences in mean anteversion angles, angles of inclination, or preoperative DJD between treated hips and untreated hips. Degenerative joint disease progressed significantly in all hips regardless of treatment. Two cases developed hyperextension of their hocks after the triple pelvic osteotomies. However, no radiographic evidence of DJD was observed for any of the stifles or hocks at any observation time. A significant increase in vertical peak force (VPF) scores was noted for treated legs by two-to-three months after surgery, which continued over time. Untreated legs did not show a significant change in VPF scores over time. No differences were found in progression to higher scores when unilaterally treated legs, first-side treated legs, and second-side treated legs were compared

  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. Botox combined with myofascial release physical therapy as a treatment for myofascial pelvic pain

    Science.gov (United States)

    Scott, Lauren; Wyman, Allison; Mora, Nelsi; Miladinovic, Branko; Bassaly, Renee; Hoyte, Lennox

    2017-01-01

    Purpose To report the effects of combined onabotulinumtoxinA (Botox) injections and myofascial release physical therapy on myofascial pelvic pain (MFPP) by comparing pre- and posttreatment average pelvic pain scores, trigger points, and patient self-reported pelvic pain. Secondary outcomes were to examine posttreatment complications and determine demographic differences between patients with/without an improvement in pain. Materials and Methods This was an Institutional Review Board approved retrospective case series on women over 18 years with MFPP who received Botox and physical therapy between July 2006 and November 2014. Presence of trigger points and pelvic pain scores were determined by digital palpation of the iliococcygeus, puborectalis, obturator internus, and rectus muscles. Average pelvic pain scores (0–10) reflected an average of the scores obtained from palpation of each muscle. Self-reported improvement in pain was recorded as yes/no. Results Fifty women met the inclusion/exclusion criteria. Posttreatment, patients had lower average pelvic pain scores (3.7±4.0 vs. 6.4±1.8, p=0.005), and fewer trigger points (44% vs. 100%, pphysical therapy under anesthesia can be effective in treating women with chronic pelvic pain secondary to MFPP. PMID:28261683

  9. Relativistic mean field theory for unstable nuclei

    International Nuclear Information System (INIS)

    Toki, Hiroshi

    2000-01-01

    We discuss the properties of unstable nuclei in the framework of the relativistic mean field (RMF) theory. We take the RMF theory as a phenomenological theory with several parameters, whose form is constrained by the successful microscopic theory (RBHF), and whose values are extracted from the experimental values of unstable nuclei. We find the outcome with the newly obtained parameter sets (TM1 and TMA) is promising in comparison with various experimental data. We calculate systematically the ground state properties of even-even nuclei up to the drip lines; about 2000 nuclei. We find that the neutron magic shells (N=82, 128) at the standard magic numbers stay at the same numbers even far from the stability line and hence provide the feature of the r-process nuclei. However, many proton magic numbers disappear at the neutron numbers far away from the magic numbers due to the deformations. We discuss how to describe giant resonances for the case of the non-linear coupling terms for the sigma and omega mesons in the relativistic RPA. We mention also the importance of the relativistic effect on the spin observables as the Gamow-Teller strength and the longitudinal and transverse spin responses. (author)

  10. Tracer filamentation at an unstable ocean front

    Science.gov (United States)

    Feng, Yen Chia; Mahadevan, Amala; Thiffeault, Jean-Luc; Yecko, Philip

    2017-11-01

    A front, where two bodies of ocean water with different physical properties meet, can become unstable and lead to a flow with high strain rate and vorticity. Phytoplankton and other oceanic tracers are stirred into filaments by such flow fields, as can often be seen in satellite imagery. The stretching and folding of a tracer by a two-dimensional flow field has been well studied. In the ocean, however, the vertical shear of horizontal velocity is typically two orders of magnitude larger than the horizontal velocity gradient. Theoretical calculations show that vertical shear alters the way in which horizontal strain affects the tracer, resulting in thin, sloping structures in the tracer field. Using a non-hydrostatic ocean model of an unstable ocean front, we simulate tracer filamentation to identify the effect of vertical shear on the deformation of the tracer. In a complementary laboratory experiment, we generate a simple, vertically sheared strain flow and use dye and particle image velocimetry to quantify the filamentary structures in terms of the strain and shear. We identify how vertical shear alters the tracer filaments and infer how the evolution of tracers in the ocean will differ from the idealized two-dimensional paradigm. Support of NSF DMS-1418956 is acknowledged.

  11. Accelerator complex for unstable beams at INS

    International Nuclear Information System (INIS)

    Tomizawa, M.; Arai, S.; Doi, M.; Katayama, T.; Niki, K.; Tokuda, N.; Yoshizawa, M.

    1992-11-01

    The construction of the prototype facility of the Exotic arena in the Japan Hadron Project (JHP) is started in 1992 at the Institute for Nuclear Study (INS), University of Tokyo. The purpose of this facility is to study the various technical problems of the Exotic arena, and to perform the experiment on nuclear and astrophysics with unstable nuclear beam. The unstable nuclei produced by bombarding a thick target with 40 MeV proton beam from the existing SF cyclotron are ionized in the ion sources, mass-analyzed by an ISOL, and transported to the accelerator complex. The accelerator complex consists of a split coaxial RFQ and an interdigital H type linac. The construction of accelerator will be completed in fiscal year 1994. The development of the SCRFQ and the IH linac which is suitable to the post-accelerator of the SCRFQ are reported. Charge stripper and the beam matching between the SCRFQ and the IH linac are explained. A buncher is necessary for the matching of longitudinal phase space between the SCRFQ and the IH linac. (K.I.)

  12. 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....

  13. Negative Stress Examination Under Anesthesia Reliably Predicts Pelvic Ring Union Without Displacement.

    Science.gov (United States)

    Whiting, Paul S; Auston, Darryl; Avilucea, Frank R; Ross, Daniel; Archdeacon, Michael; Sciadini, Marcus; Collinge, Cory A; Sagi, Henry C; Mir, Hassan R

    2017-04-01

    To identify the negative predictive value of examination under anesthesia (EUA) for determining pelvic ring stability and union without further displacement. Retrospective cohort study. Two academic Level 1 trauma centers. Thirty-four adult patients with closed pelvic ring injuries treated over a 5-year period. Pelvic stress EUA. Pelvic ring union and pelvic ring displacement at final follow-up. Thirty-four patients with closed pelvic ring injuries who underwent pelvic EUA during the study period and had a negative examination (indicating a stable pelvis) were identified. Mean age was 38 years (range 16-76), and 19 patients (55.9%) were male. Twenty-two patients (64.7%) had Young-Burgess lateral compression (LC)-1 injuries with complete sacral fractures, 4 patients (11.8%) had LC-2 injuries, and 8 patients (23.5%) had anteroposterior compression (APC)-1 injuries. Eight patients (23.5%) had associated injuries requiring restricted weight-bearing on one or both lower extremities and were excluded from the analysis. Immediate weight-bearing as tolerated was permitted bilaterally in the remaining 26 patients. Mean pelvic ring displacement at the time of injury was 3.8 mm (range 1-15 mm) for LC injuries and 9.1 mm (range 2-20 mm) for APC injuries. Patients were followed for a mean of 8 months (range 3-34 months). At final follow-up, mean displacement was 3.7 mm (range 0-17 mm) for LC injuries and 7.1 mm (range 2-19 mm) for APC injuries. Mean change in displacement from injury to union was -0.1 mm for LC injuries and -2.0 mm for APC injuries, indicating decreased pelvic ring displacement at union. All patients were able to tolerate full weight-bearing bilaterally with no pain, and there were no instances of delayed operative fixation after negative EUA. Negative pelvic EUA after closed pelvic ring injury accurately predicts pelvic stability and union without displacement after nonoperative treatment with full weight-bearing bilaterally. Unless otherwise dictated by

  14. Integrated total pelvic floor ultrasound in pelvic floor defaecatory dysfunction.

    Science.gov (United States)

    Hainsworth, A J; Solanki, D; Hamad, A; Morris, S J; Schizas, A M P; Williams, A B

    2017-01-01

    Imaging for pelvic floor defaecatory dysfunction includes defaecation proctography. Integrated total pelvic floor ultrasound (transvaginal, transperineal, endoanal) may be an alternative. This study assesses ultrasound accuracy for the detection of rectocele, intussusception, enterocele and dyssynergy compared with defaecation proctography, and determines if ultrasound can predict symptoms and findings on proctography. Treatment is examined. Images of 323 women who underwent integrated total pelvic floor ultrasound and defaecation proctography between 2011 and 2014 were blindly reviewed. The size and grade of rectocele, enterocele, intussusception and dyssynergy were noted on both, using proctography as the gold standard. Barium trapping in a rectocele or a functionally significant enterocele was noted on proctography. Demographics and Obstructive Defaecation Symptom scores were collated. The positive predictive value of ultrasound was 73% for rectocele, 79% for intussusception and 91% for enterocele. The negative predictive value for dyssynergy was 99%. Agreement was moderate for rectocele and intussusception, good for enterocele and fair for dyssynergy. The majority of rectoceles that required surgery (59/61) and caused barium trapping (85/89) were detected on ultrasound. A rectocele seen on both transvaginal and transperineal scanning was more likely to require surgery than if seen with only one mode (P = 0.0001). If there was intussusception on ultrasound the patient was more likely to have surgery (P = 0.03). An enterocele visualized on ultrasound was likely to be functionally significant on proctography (P = 0.02). There was, however, no association between findings on imaging and symptoms. Integrated total pelvic floor ultrasound provides a useful screening tool for women with defaecatory dysfunction such that defaecatory imaging can avoided in some. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  15. Occult posterior pelvic ring fractures in elderly patients with osteoporotic pubic rami fractures.

    Science.gov (United States)

    Lau, Tak-wing; Leung, Frankie

    2010-08-01

    To evaluate postoperative walking status of elderly patients with osteoporotic pubic rami fractures with or without posterior pelvic ring fractures. 33 women and 4 men aged 66 to 95 (mean, 85) years presented with osteoporotic pubic rami fractures after a fall. 22 (59%) of the patients had additional posterior pelvic ring fractures (9 had lateral compression type-II fractures involving the ilium and 13 had lateral compression type-I fractures involving the sacroalar region). Seven of the 9 patients with lateral compression type-II fractures underwent open reduction and internal fixation using plates and/ or screws. The remaining 30 patients were treated conservatively. Postoperative walking status was similar in elderly patients with osteoporotic pubic rami fractures with or without posterior pelvic ring fractures. Posterior pelvic ring fractures are easily missed in elderly patients with pubic rami fractures. Routine computed tomography of the pelvis is useful in making the diagnosis.

  16. Can a modified anterior external fixator provide posterior compression of AP compression type III pelvic injuries?

    Science.gov (United States)

    Sellei, Richard Martin; Schandelmaier, Peter; Kobbe, Philipp; Knobe, Matthias; Pape, Hans-Christoph

    2013-09-01

    Current anterior fixators can close a disrupted anterior pelvic ring. However, these anterior constructs cannot create posterior compressive forces across the sacroiliac joint. We explored whether a modified fixator could create such forces. We determined whether (1) an anterior external fixator with a second anterior articulation (X-frame) would provide posterior pelvic compression and (2) full pin insertion would deliver higher posterior compressive forces than half pin insertion. We simulated AP compression Type III instability with plastic pelvis models and tested the following conditions: (1) single-pin supraacetabular external fixator (SAEF) using half pin insertion (60 mm); (2) SAEF using full pin insertion (120 mm); (3) modified fixator with X-frame using half pin insertion; (4) modified fixator using full pin insertion; and (5) C-clamp. Standardized fracture compression in the anterior and posterior compartment was performed as in previous studies by Gardner. A force-sensitive sensor was placed in the symphysis and posterior pelvic ring before fracture reduction and the fractures were reduced. The symphyseal and sacroiliac compression loads of each application were measured. The SAEF exerted mean compressions of 13 N and 14 N to the posterior pelvic ring using half and full pin insertions, respectively. The modified fixator had mean posterior compressions of 174 N and 222 N with half and full pin insertions, respectively. C-clamp application exerted a mean posterior load of 407 N. Posterior compression on the pelvis was improved using an X-frame as an anterior fixation device in a synthetic pelvic fracture model. This additive device may improve the initial anterior and posterior stability in the acute management of unstable and life-threatening pelvic ring injuries.

  17. Efficacy of biofeedback-assisted pelvic floor muscle training in ...

    African Journals Online (AJOL)

    Background: Stress urinary incontinence (SUI), fecal incontinence (FI) and/or pelvic floor dyssynergia, with pelvic organ prolapse (POP) are described as pelvic floor dysfunction (PFD). Pelvic floor muscle training (PFMT) is the first-line therapy in the treatment of PFD either alone or combined with biofeedback assisted pelvic ...

  18. 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

  19. A case of pelvic lipomatosis

    OpenAIRE

    岡, 裕也; 畑山, 忠; 滝, 洋二; 飛田, 収一; 上山, 秀麿; 小松, 洋輔

    1991-01-01

    This is a report of the fifth case of pelvic lipomatosis in Japan. A 52-year-old man presented himself in our hospital with a complaint of left lower abdominal pain on August 28, 1988. At that time, physical examination was unremarkable with the exception of mild obesity. The excretory urogram and retrograde pyelogram revealed left hydroureteronephrosis with tapering of the left lower ureter. Urethrocystogram showed an elongated posterior urethra with anterior displacement and elevation of th...

  20. 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.)

  1. 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.)

  2. Pelvic trauma: WSES classification and guidelines.

    Science.gov (United States)

    Coccolini, Federico; Stahel, Philip F; Montori, Giulia; Biffl, Walter; Horer, Tal M; Catena, Fausto; Kluger, Yoram; Moore, Ernest E; Peitzman, Andrew B; Ivatury, Rao; Coimbra, Raul; Fraga, Gustavo Pereira; Pereira, Bruno; Rizoli, Sandro; Kirkpatrick, Andrew; Leppaniemi, Ari; Manfredi, Roberto; Magnone, Stefano; Chiara, Osvaldo; Solaini, Leonardo; Ceresoli, Marco; Allievi, Niccolò; Arvieux, Catherine; Velmahos, George; Balogh, Zsolt; Naidoo, Noel; Weber, Dieter; Abu-Zidan, Fikri; Sartelli, Massimo; Ansaloni, Luca

    2017-01-01

    Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.

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

    OpenAIRE

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

    2015-01-01

    This study aims to evaluate the biomechanical mechanism of pelvic ring injury for the stability of pelvis using the finite element (FE) method. Complex pelvic fracture (i.e., anterior column with posterior hemitransverse lesion) combined with pelvic ramus fracture was used to evaluate the biomechanics stability of the pelvis. Three FE fracture models (i.e., Dynamic Anterior Plate-Screw System for Quadrilateral Area (DAPSQ) for complex pelvic fracture with intact pubic ramus, DAPSQ for complex...

  4. Progressively unstable c2 spondylolysis requiring spinal fusion: case report.

    Science.gov (United States)

    Nishimura, Yusuke; Ellis, Michael John; Anderson, Jennifer; Hara, Masahito; Natsume, Atsushi; Ginsberg, Howard Joeseph

    2014-01-01

    Cervical spondylolysis is a rare condition defined as a corticated cleft at the pars interarticularis in the cervical spine. This is the case of C2 spondylolysis demonstrating progressive significant instability, which was successfully treated by anterior cervical discectomy and fusion (ACDF) with cervical anterior plate. We describe a 20-year-old female with C2 spondylolysis presenting with progressive worsening of neck pain associated with progressive instability at the C2/3 segment. The progression of instability was well-documented on flexion-extension cervical spine x-rays. She was successfully treated by C2/3 ACDF with anterior cervical plate. Her preoperative significant neck pain resolved immediately after the surgical intervention. She was completely free from neurological symptoms at 1-year postoperative follow-up. We also review the literature and discuss 24 reported cases with C2 spondylolysis. When planning treatment, we should make sure to differentiate this pathology from acute traumatic fracture, which is a hangman's fracture. Assessment of C2/3 instability associated with neurological deficits is extremely important to consider management properly. C2/3 ACDF with cervical plate is biomechanically viable, less invasive, and provides adequate surgical stabilization for unstable C2 spondylolysis.

  5. Can Transabdominal Sonography Predict Pelvic Relaxation?

    OpenAIRE

    Atoosa Adibi; Mahtab Zargham

    2009-01-01

    Introduction: Pelvic relaxation and cystocele is a common problem in middle to old age women. Transabdominal ultrasound (TAS) is a noninvasive, available routine procedure in many situations. We evaluated whether TAS can predict pelvic relaxation or not. "nMaterials and Methods: In a cross sectional case- control study one hundred women 30 years or older were enrolled into the study. An expert female urologist examined the cases for the presence of signs and the grading of pelvic relaxat...

  6. 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.

  7. Verification of the Patient Positioning in the Bellyboard Pelvic Radiotherapy

    International Nuclear Information System (INIS)

    Kasabasic, M.; Faj, D.; Smilovic Radojcic, D.; Svabic, M.; Ivkovic, A.; Jurkovic, S.

    2008-01-01

    The size and shape of the treatment fields applied in radiotherapy account for uncertainties in the daily set-up of the patients during the treatment. We investigated the accuracy of daily patient positioning in the bellyboard pelvic radiotherapy in order to find out the magnitude of the patients movement during the treatment. Translational as well as rotational movements of the patients are explored. Film portal imaging is used in order to find patient positioning error during the treatment of the pelvic region. Patients are treated in the prone position using the bellyboard positioning device. Thirty six patients are included in the study; 15 patients were followed during the whole treatment and 21 during the first 5 consecutive treatment days. The image acquisition was completed in 85 percent and systematic and random positioning errors in 453 images are analyzed. (author)

  8. A CASE OF PELVIC ACTINOMYCOSIS ASSOCIATED WITH AN INTRAUTERINE DEVICE

    Directory of Open Access Journals (Sweden)

    Mateja Pirš

    2004-02-01

    Full Text Available Background. Actinomycosis is a rare slowly progressive infection caused by Gram-positive anaerobic bacteria from the genus Actinomyces. The disease is characterized by the formation of the abscesses surrounded by dense fibrosis that extend slowly across natural anatomic boundaries.Patients and methods. The case of a 49-year-old patient with pelvic actinomycosis associated with an intrauterine device is presented. The patient was successfully treated with the combination of antibiotic and surgical therapy.Conclusions. Pelvic actinomycosis is a rare disorder. The infection may occur as a consequence of an abdominal disease or an ascending infection from the genito-urinary tract. Diagnosis of the actinomycosis can be difficult, malignant disease if often suspected. The diagnosis is frequently not established until after surgery.

  9. 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

  10. Pole mass, width, and propagators of unstable fermions

    International Nuclear Information System (INIS)

    Kniehl, B.A.; Sirlin, A.

    2008-01-01

    The concepts of pole mass and width are extended to unstable fermions in the general framework of parity-nonconserving gauge theories, such as the Standard Model. In contrast with the conventional on-shell definitions, these concepts are gauge independent and avoid severe unphysical singularities, properties of great importance since most fundamental fermions in nature are unstable particles. General expressions for the unrenormalized and renormalized dressed propagators of unstable fermions and their field-renormalization constants are presented. (orig.)

  11. Conservative treatment of excessive anterior pelvic tilt

    DEFF Research Database (Denmark)

    Brekke, Anders Falk

    , DK-5000 Odense C, Denmark ABSTRACT (1795 anslag) Background: Excessive anterior pelvic tilt has been linked to pain and dysfunction of the hip and pelvic region. Conservative treatment (e.g. manual therapy and physical training) is suggested in correcting the tilt and eventually related symptoms....... However, the effectiveness in reducing excessive anterior pelvic tilt in adults is unknown. Purpose: To systematically review studies investigating the effectiveness of conservative treatment in reducing anterior pelvic tilt in adults and evaluate the quality of evidence. Materials and methods: MEDLINE...

  12. Testing of the Anorectal and Pelvic Floor Area

    Science.gov (United States)

    ... Large Intestine Disorders of the Pelvic Floor Motility Testing Personal Stories Contact About GI Motility Twitter Facebook ... Large Intestine Disorders of the Pelvic Floor Motility Testing Personal Stories Contact Anorectal and Pelvic Floor Area ...

  13. 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.

  14. On the Velocity of Moving Relativistic Unstable Quantum Systems

    Directory of Open Access Journals (Sweden)

    K. Urbanowski

    2015-01-01

    Full Text Available We study properties of moving relativistic quantum unstable systems. We show that in contrast to the properties of classical particles and quantum stable objects the velocity of freely moving relativistic quantum unstable systems cannot be constant in time. We show that this new quantum effect results from the fundamental principles of the quantum theory and physics: it is a consequence of the principle of conservation of energy and of the fact that the mass of the quantum unstable system is not defined. This effect can affect the form of the decay law of moving relativistic quantum unstable systems.

  15. Slinky Mechanics: Static Shapes and Unstable States

    Science.gov (United States)

    Holmes, Douglas; Borum, Andy; Moore, Billy; Plaut, Raymond; Dillard, David

    2014-03-01

    The floppy nature of a tumbling Slinky has captivated children and adults alike for over half a century. Highly flexible, the spring will walk down stairs, turn over in your hands, and-much to the chagrin of children everywhere-become easily entangled. The Slinky is an educational tool for demonstrating standing waves, and a structural inspiration due to its ability to extend to many times beyond its initial length without imparting plastic strain on the material. In this work, we provide a mechanical model that captures the static equilibrium configurations of the Slinky in terms of its geometric and material properties. We present both continuous and discrete models to capture a Slinky's static equilibria and unstable transitions. We compare these with experimental results obtained for the Slinky's static equilibrium shapes. We emphasize the importance of modeling coil contact, and determine the critical criteria for the Slinky to topple over in terms of a tilt angle, and the vertical displacement of one bale of coils. Finally, we provide a general description of highly flexible helical springs by considering the nondimensional potential energy of the spring, which characterizes the ``Slinkiness'' of a spring.

  16. 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.)

  17. Communication barriers among Spanish-speaking women with pelvic floor disorders: lost in translation?

    Science.gov (United States)

    Khan, Aqsa A; Sevilla, Claudia; Wieslander, Cecilia K; Moran, Meghan B; Rashid, Rezoana; Mittal, Brita; Maliski, Sally L; Rogers, Rebecca G; Anger, Jennifer T

    2013-01-01

    The purpose of our study was to evaluate barriers in communication and disease understanding among office staff and interpreters when communicating with Spanish-speaking women with pelvic floor disorders. We conducted a qualitative study to evaluate barriers to communication with Spanish-speaking women with pelvic floor disorders among office staff and interpreters. Sixteen office staff and interpreters were interviewed; interview questions focused on experiences with Spanish-speaking patients with pelvic floor disorders in the clinic setting. Interview transcripts were analyzed qualitatively using grounded theory methodology. Analysis of the interview transcripts revealed several barriers in communication as identified by office staff and interpreters. Three major classes were predominant: patient, interpreter, and system-related barriers. Patient-related barriers included a lack of understanding of anatomy and medical terminology and inhibited discussions due to embarrassment. Provider-related barriers included poor interpreter knowledge of pelvic floor vocabulary and the use of office staff without interpreting credentials. System-related barriers included poor access to information. From these preliminary themes, an emergent concept was revealed: it is highly likely that Spanish-speaking women with pelvic floor disorders have poor understanding of their condition owing to multiple obstacles in communication. There are many levels of barriers to communications with Latin women treated for pelvic floor disorders, arising from the patient, interpreter, and the system itself. These barriers contribute to a low level of understanding of their diagnosis, treatment options, and administered therapies.

  18. Pelvic Arterial Embolisation in a Trauma Patient with a Pre-Existing Aortobifemoral Graft

    International Nuclear Information System (INIS)

    Abulaban, Osama; Hopkins, Jonathan; Willis, Andrew P.; Jones, Robert G.

    2011-01-01

    Pelvic fractures secondary to blunt trauma are associated with a significant mortality rate due to uncontrolled bleeding. Interventional radiology (IR) can play an important and central role in the management of such patients, offering definitive minimally invasive therapy and avoiding the need for high-risk surgery. Rapid access to whole-body computed tomography has been shown to improve survival in polytrauma patients and allows rapid diagnosis of vascular injury and assessment of suitability for endovascular therapy. IR can then target and treat the specific area of bleeding. Embolisation of bleeding pelvic arteries has been shown to be highly effective and should be the treatment of choice in this situation. The branches of the internal iliac artery (IIA) are usually involved, and these arteries are accessed by way of IIA catheterisation after abdominal aortography. Occasionally these arteries cannot be accessed by way of this conventional route because of recent IIA ligation carried out surgically in an attempt to stop the bleeding or because (in the rare situation we describe here) these vessels are excluded secondary to previous aortoiliac repair. In this situation, knowledge of pelvic arterial collateral artery pathways is important because these will continue to supply pelvic structures whilst making access to deep pelvic branches challenging. We describe a rare case, which has not been previously reported in the literature, in which successful embolisation of a bleeding pelvic artery was carried out by way of the collateral artery pathways.

  19. Latent profile analysis of pelvic floor muscle pain in patients with chronic pelvic pain.

    Science.gov (United States)

    Fenton, B W; Grey, S F; Armstrong, A; McCarroll, M; Von Gruenigen, V

    2013-02-01

    Chronic pelvic pain (CPP) is a syndrome of related diagnoses including pain originating from the muscles of the pelvic floor. The objective of this study was to evaluate which muscles are important to examine, in what manner pelvic floor muscle pain contributes to patients' pain experience, or what thresholds should be applied to identify significant pelvic floor muscle pain by comparing exam findings with outcome measures A total of 428 patients meeting the definition for CPP were evaluated using a standardized physical examination of the abdominal wall, pelvic floor, and vestibule along with the 12 domain Patient Reported Outcome Measures Information System (PROMIS). These scores were evaluated for unidimensionality followed by latent profile analysis. The areas under the receiver operator characteristic curves were used to identify the best pain threshold for each muscle. The eight pelvic floor muscle sites all loaded onto a single factor, separate from other areas examined. Two latent classes were found within all the variables. Patients in the severe pelvic floor pain class had significantly worse pain related PROMIS scores. Optimal thresholds for identifying significant pelvic floor pain ranged between 3 and 5. Pain in the pelvic floor muscles is distinguishable from pain in the abdominal wall and vulva. Any of the lateral muscle sites evaluated can be used to identify patients with significant pelvic floor pain. Two latent classes of CPP patients were identified: those with limited and those with severe pain, as identified by moderate to severe pelvic floor tenderness.

  20. Reconstructive options in pelvic tumours

    Directory of Open Access Journals (Sweden)

    Mayilvahanan N

    2005-01-01

    Full Text Available Background: Pelvic tumours present a complex problem. It is difficult to choose between limb salvage and hemipelvectomy. Method: Forty three patients of tumours of pelvis underwent limb salvage resection with reconstruction in 32 patients. The majority were chondrosarcomas (20 cases followed by Ewing sarcoma. Stage II B was the most common stage in malignant lesions and all the seven benign lesions were aggressive (B3. Surgical margins achieved were wide in 31 and marginal in 12 cases. Ilium was involved in 51% of cases and periacetabular involvement was seen in 12 patients. The resections done were mostly of types I &II of Enneking′s classification of pelvic resection. Arthrodesis was attempted in 24 patients. Customized Saddle prosthesis was used in seven patients and no reconstruction in 12 patients. Adjuvant chemotherapy was given to all high-grade malignant tumours, combined with radiotherapy in 7 patients. Results: With a mean follow up of 48.5 months and one patient lost to follow up, the recurrence rate among the evaluated cases was 16.6%. Oncologically, 30 patients were continuously disease free with 7 local recurrences and 4 deaths due to disseminated disease and 2 patients died of other causes. During the initial years, satisfactory functional results were achieved with prosthetic replacement. Long-term functional result of 36 patients who were alive at the time of latest follow up was satisfactory in 75% who underwent arthrodesis and in those where no reconstruction was used. We also describe a method of new classification of pelvic resections that clarifies certain shortcomings of the previous systems of classification. Conclusion: Selection of a procedure depends largely on the patient factors, the tumour grade, the resultant defect and the tissue factors. Resection with proper margins gives better functional and oncological results

  1. 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.

  2. The clinical value of trans-vaginal ultrasound-guided puncture in the treatment of pelvic abscess

    International Nuclear Information System (INIS)

    Wang Ping; Gong Wei

    2008-01-01

    Objective: To investigate the clinical value of trans-vaginal ultrasound-guided (TVS) puncture in the treatment of pelvic abscess. Methods 30 cases with pelvic abscess were treated by transvaginal ultrasound-guided puncture. The long-dated effects were followed-up. Results: 29 cases were cured by TVS puncture. Operation was performed in 1 patient because of invalid effect. The cure rate was 97%. Conclusion: Ultrasound-guided puncture is a safe and convenient method in the treatment of pelvic abscess. (authors)

  3. Urinary incontinence and sport: first and preliminary experience with a combined pelvic floor rehabilitation program in three female athletes.

    Science.gov (United States)

    Rivalta, Massimo; Sighinolfi, Maria Chiara; Micali, Salvatore; De Stefani, Stefano; Torcasio, Francesca; Bianchi, Giampaolo

    2010-05-01

    A relationship between sport or fitness activities and urinary incontinence (UI) previously has been described in women. We report our preliminary experience with the use of a complete pelvic floor rehabilitation program in three female athletes affected by UI. The athletes were submitted to a combined pelvic floor rehabilitation program, including biofeedback, functional electrical stimulation, pelvic floor muscle exercises, and vaginal cones. After the scheduled rehabilitation scheme, none of the patients reported incontinence, nor referred to urine leakage during sport or during daily life. We therefore conclude that UI that affects female agonistic athletes may be effectively treated with this combined approach.

  4. 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.

  5. Krukenberg Tumour Simulating Uterine Fibroids and Pelvic ...

    African Journals Online (AJOL)

    To report a case of cancer of the colonwhich presented as secondaries to the ovaries. Case report. The case presented is that of a 39 year old female who presented with lower abdominal pain and a multinodular pelvic mass which led to an initial diagnosis of multiple uterine fibroids and pelvic inflammatory disease.

  6. 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 ai...

  7. 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...

  8. Pelvic Inflammatory Disease (PID) Fact Sheet

    Science.gov (United States)

    ... Search Form Controls Cancel Submit Search the CDC Pelvic Inflammatory Disease (PID) Note: Javascript is disabled or is not supported ... Twitter STD on Facebook Sexually Transmitted Diseases (STDs) Pelvic Inflammatory Disease (PID) - CDC Fact Sheet Language: English (US) Español ( ...

  9. 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.

  10. Crisis and unstable dimension variability in the bailout embedding ...

    Indian Academy of Sciences (India)

    indicating unstable dimension variability (UDV) in the system. The presence of unstable dimension ... flow dynamics is embedded in a larger set of equations which includes the differ- ences between the particle and ... map is taken as the base map, which is a prototypical area preserving system. In this paper we confine our ...

  11. Crisis and unstable dimension variability in the bailout embedding ...

    Indian Academy of Sciences (India)

    length distribution of times before bursts give rise to a power law with the exponent β = −1/3. The maximum Lyapunov exponent near the crisis fluctuates around zero indicating unstable dimension variability (UDV) in the system. The presence of unstable dimension variability is confirmed by the behaviour of the probability ...

  12. 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.)

  13. PROBLEMS AND PITFALLS IN PELVIC RECONSTRUCTIVE SURGERY

    Directory of Open Access Journals (Sweden)

    Paul A. Riss

    2003-12-01

    Full Text Available Background. Pelvic reconstructive surgery requires a solid understanding of the anatomy of the small pelvis and the pelvic floor, in particular to avoid complications during and after pelvic reconstructive surgery.Methods. Possible complications of the pelvic floor reconstructive surgery are analised. There are 2 typical surgical problems encountered in pelvic reconstructive surgery: lesion of adjacent structures (rectum, bladder, ureter, small bowel and hemorrhage.Results. Postoperatively there is always a risk of pain, stenosis and dyspareunia, erosion of allograft, voiding problems, incontinence and prolapse.Conclusions. These complications can be reduced by insisting on an exact preoperative diagnosis and by choosing the correct procedure, by having a good knowledge of anatomy and by using meticulous surgical technique.

  14. 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.)

  15. 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.

  16. Effects of “Danzhi Decoction” on Chronic Pelvic Pain, Hemodynamics, and Proinflammatory Factors in the Murine Model of Sequelae of Pelvic Inflammatory Disease

    Science.gov (United States)

    Bu, Xiaoling; Liu, Yanxia; Lu, Qiudan; Jin, Zhe

    2015-01-01

    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. PMID:27087818

  17. Effects of "Danzhi Decoction" on Chronic Pelvic Pain, Hemodynamics, and Proinflammatory Factors in the Murine Model of Sequelae of Pelvic Inflammatory Disease.

    Science.gov (United States)

    Bu, Xiaoling; Liu, Yanxia; Lu, Qiudan; Jin, Zhe

    2015-01-01

    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.

  18. Unstable ground in western North Dakota

    Science.gov (United States)

    Trimble, Donald E.

    1979-01-01

    Unstable ground in western North Dakota is mainly the result of mass-wasting processes. The units most affected are mudstones, siltstones, and sandstones of the Fort Union Formation. Ground instability generally is indicated by landslides, soil slides, or subsidence. Landslides are mostly of the slump-earthflow type and are localized along the flanks of the high buttes in southwestern North Dakota, including HT (Black) Butte, Chalky Buttes, Sentinel Butte, and East and West Rainy Buttes, and along parts of the valleys of the Des Lacs, Missouri, Little Missouri, and Heart Rivers. Landslides are sparse elsewhere. Soil slides are common in the areas south and southwest of the maximum position of the Pleistocene glacial ice margin on slopes of 15 degrees or more, and have taken place on some slopes as gentle as five degrees. The weathered, exposed surface of the Fort Union Formation seems to be especially susceptible to soil slides. Soil slides constitute the major type of ground instability in southwestern North Dakota. Subsidence is of two types: (1) subsidence over old underground mine workings, and (2) subsidence over naturally ignited and burned underground coal beds. Major subsidence has taken place over old, underground workings near Beulah, Wilton, Lehigh, Haynes, and Belfield, and lesser subsidence near Scranton, and west and north of Bowman. Thickness of overburden above the coal in all these areas is believed to be less than 30 m (100 ft). Subsidence has not taken place over old underground workings along the Des Lacs and-Souris valleys northwest of Minot, where the thickness of overburden is more than 60 m (200 ft). Spectacular subsidence has occurred over a burning underground coal bed at Burning Coal Vein Park near the Little Missouri River, northwest of Amidon.

  19. Managing risk in an unstable world.

    Science.gov (United States)

    Bremmer, Ian

    2005-06-01

    With emerging markets like China and politically unstable countries like Saudi Arabia figuring more than ever into companies' investment calculations, business leaders are turning to political risk analysis to measure the impact of politics on potential markets, minimize risks, and make the most of global opportunities. But political risk is more subjective than its economic counterpart. It is influenced by the passage of laws, the foibles of government leaders, and the rise of popular movements. So corporate leaders must grapple not just with broad, easily observable trends but also with nuances of society and even quirks of personality. And those hard-to-quantify factors must constantly be pieced together into an ongoing narrative within historical and regional contexts. As goods, services, information, ideas, and people cross borders today with unprecedented velocity, corporations debating operational or infrastructural investments abroad increasingly need objective, rigorous assessments. One tool for measuring and presenting stability data, for example, incorporates 20 composite indicators of risk in emerging markets and scores risk variables according to both their structural and their temporal components. The indicators are then organized into four equally weighted subcategories whose ratings are aggregated into a single stability score. Countries are ranked on a scale of zero (a failed state) to100 (a fully institutionalized, stable democracy). Companies can buy political risk analyses from consultants or, as some large energy and financial services organizations have done, develop them in-house. Either way, a complete and accurate picture of any country's risk requires analysts with strong reportorial skills; timely, accurate data on a variety of social and political trends; and a framework for evaluating the impact of individual risks on stability.

  20. A case of pelvic psteosarcoma effectively treated with pamidronate

    International Nuclear Information System (INIS)

    Yano, M.; Mori, T.; Hoshino, Y.; Iwatani, N.; Murakami, M.; Sakai, H.; Tanigawa, T.; Maruo, K.

    2010-01-01

    A 7-year-old, 34 kg, castrated male Golden retriever was presented with a month history of lameness in the hind limbs, especially the left hind limb. The dog was referred to our hospital. Computed Tomography (CT) findings showed bone absorption in over 50% of the pubis and part of the ischial bone, in the left hip joint region. A CT-guided biopsy was performed. A histopathologic diagnosis of osteosarcoma was made. Treatment with the bisphosphonate drug pamidronate was performed every month. At one or two weeks after the first dose of pamidronate, the lameness disappeared. CT showed high bone remodeling of the affected region on the 146th day. Over the course of 11 administrations of pamidronate, serve side effects were not observed until the dog died on the 469th day. Therefore, pamidronate lead to an improvement in the quality of life

  1. Tissue Selective Androgen Receptor Modulators (SARMs) Increase Pelvic Floor Muscle Mass in Ovariectomized Mice.

    Science.gov (United States)

    Ponnusamy, Suriyan; Sullivan, Ryan D; Thiyagarajan, Thirumagal; Tillmann, Heather; Getzenberg, Robert H; Narayanan, Ramesh

    2017-03-01

    Stress urinary incontinence (SUI), a prevalent condition, is represented by an involuntary leakage of urine that results, at least in part, from weakened or damaged pelvic floor muscles and is triggered by physical stress. Current treatment options are limited with no oral therapies available. The pelvic floor is rich in androgen receptor and molecules with anabolic activity including selective androgen receptor modulators (SARMs) may serve as therapeutic options for individuals with SUI. In this study, two SARMs (GTx-024 and GTx-027) were evaluated in a post-menopausal animal model in order to determine their effect on pelvic floor muscles. Female C57BL/6 mice were ovariectomized and their pelvic muscles allowed to regress. The animals were then treated with vehicle or doses of GTx-024 or GTx-027. Animal total body weight, lean body mass, and pelvic floor muscle weights were measured along with the expression of genes associated with muscle catabolism. Treatment with the SARMs resulted in a restoration of the pelvic muscles to the sham-operated weight. Coordinately, the induction of genes associated with muscle catabolism was inhibited. Although a trend was observed towards an increase in total lean body mass in the SARM-treated groups, no significant differences were detected. Treatment of an ovariectomized mouse model with SARMs resulted in an increase in pelvic floor muscles, which may translate to an improvement of symptoms associated with SUI and serves as the basis for evaluating their clinical use. J. Cell. Biochem. 118: 640-646, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  2. Unstable femoral neck fractures in children - A new treatment option

    Directory of Open Access Journals (Sweden)

    Pruthi K

    2006-01-01

    Full Text Available Background : Femoral neck fractures in children are an uncommon but difficult situation. The aim of our study was to evaluate clinical results of closed reduction internal fixation and primary valgus osteotomy fixed with a tension band wire loop in high angled pediatric femoral neck fractures. Methods : In a prospective nonrandomized study conducted at 2 centres, sixteen children and adolescents with a Pauwel type 2/3 fracture neck femur were taken as participants. The femoral neck fractures were stabilized using closed reduction and internal fixation (6.5 mm noncannulated screw and a primary valgus osteotomy fixed with a tension band wire loop preferably within 24-36 hours of injury. Patients were evaluated to determine complications, clinical and radiological outcome. Results : At a mean post operative follow up of 5 years, union was achieved in all cases. Three patients had AVN and one developed coxavara. Results were evaluated using IOWA hip scores. Thirteen patients had an excellent result while 3 patients had a good result. Conclusion : Use of this technique holds promise in treating these difficult unstable fractures. Although results from a larger series are still awaited yet the use of this technique can safely be extended to stable fractures also, to minimize the incidence of complications as nonunion and AVN.

  3. Urinary incontinence, pelvic floor dysfunction, exercise and sport.

    Science.gov (United States)

    Bø, Kari

    2004-01-01

    Urinary incontinence is defined as "the complaint of any involuntary leakage of urine" and is a common problem in the female population with prevalence rates varying between 10% and 55% in 15- to 64-year-old women. The most frequent form of urinary incontinence in women is stress urinary incontinence, defined as "involuntary leakage on effort or exertion, or on sneezing or coughing". The aim of this article is to systematically review the literature on urinary incontinence and participation in sport and fitness activities with a special emphasis on prevalence and treatment in female elite athletes. Stress urinary incontinence is a barrier to women's participation in sport and fitness activities and, therefore, it may be a threat to women's health, self-esteem and well-being. The prevalence during sports among young, nulliparous elite athletes varies between 0% (golf) and 80% (trampolinists). The highest prevalence is found in sports involving high impact activities such as gymnastics, track and field, and some ball games. A 'stiff' and strong pelvic floor positioned at an optimal level inside the pelvis may be a crucial factor in counteracting the increases in abdominal pressure occurring during high-impact activities. There are no randomised controlled trials or reports on the effect of any treatment for stress urinary incontinence in female elite athletes. However, strength training of the pelvic floor muscles has been shown to be effective in treating stress urinary incontinence in parous females in the general population. In randomised controlled trials, reported cure rates, defined as athletes than in other women. There is a need for more basic research on pelvic floor muscle function during physical activity and the effect of pelvic floor muscle training in female elite athletes.

  4. Transvaginal Pelvic Floor Muscle Injection Technique: A Cadaver Study.

    Science.gov (United States)

    Gupta, Priyanka; Ehlert, Michael; Sirls, Larry T; Peters, Kenneth

    Women with pelvic floor dysfunction can have tender areas on vaginal examination, which can be treated with trigger-point injections. There are no publications to evaluate the accuracy of pelvic floor muscle injections. Trigger-point injections were performed on 2 fresh cadaveric pelvises using a curved nasal cannula guide and 7-in spinal needle. This was performed using our standard template of 2 sets of injections at the 1-, 3-, and 5-o'clock positions distally and proximally. The first pelvis was dissected to examine dye penetration. Based on these results, we modified our technique and repeated the injections on the second cadaver. We dissected the second pelvis and compared our findings. The 1-o'clock proximal and distal injections stained the obturator internus and externus near the insertion at the ischiopubic ramus. The 3-o'clock injections stained the midbody of the pubococcygeus and puborectalis. The distal 5-o'clock position was too deep and stained the fat of the ischiorectal space. The proximal 5-o'clock injection stained the area of the pudendal nerve. Our goal at the distal 5-o'clock position was to infuse the iliococcygeus muscle, so we shortened the needle depth from 2 to 1 cm beyond the cannula tip. In our second dissection, the distal 5-o'clock injection again stained only the fat of the ischiorectal space. This is the first study to characterize the distribution of pelvic floor muscle injections in a cadaver model and confirms the ability to deliver medications effectively to the pelvic floor muscles.

  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. Total pelvic floor ultrasound for pelvic floor defaecatory dysfunction: a pictorial review

    Science.gov (United States)

    Solanki, Deepa; Schizas, Alexis M P; Williams, Andrew B

    2015-01-01

    Total pelvic floor ultrasound is used for the dynamic assessment of pelvic floor dysfunction and allows multicompartmental anatomical and functional assessment. Pelvic floor dysfunction includes defaecatory, urinary and sexual dysfunction, pelvic organ prolapse and pain. It is common, increasingly recognized and associated with increasing age and multiparity. Other options for assessment include defaecation proctography and defaecation MRI. Total pelvic floor ultrasound is a cheap, safe, imaging tool, which may be performed as a first-line investigation in outpatients. It allows dynamic assessment of the entire pelvic floor, essential for treatment planning for females who often have multiple diagnoses where treatment should address all aspects of dysfunction to yield optimal results. Transvaginal scanning using a rotating single crystal probe provides sagittal views of bladder neck support anteriorly. Posterior transvaginal ultrasound may reveal rectocoele, enterocoele or intussusception whilst bearing down. The vaginal probe is also used to acquire a 360° cross-sectional image to allow anatomical visualization of the pelvic floor and provides information regarding levator plate integrity and pelvic organ alignment. Dynamic transperineal ultrasound using a conventional curved array probe provides a global view of the anterior, middle and posterior compartments and may show cystocoele, enterocoele, sigmoidocoele or rectocoele. This pictorial review provides an atlas of normal and pathological images required for global pelvic floor assessment in females presenting with defaecatory dysfunction. Total pelvic floor ultrasound may be used with complementary endoanal ultrasound to assess the sphincter complex, but this is beyond the scope of this review. PMID:26388109

  7. Efficacy of biofeedback-assisted pelvic floor muscle training in ...

    African Journals Online (AJOL)

    Ibrahim Khalil Ibrahim

    2014-07-18

    Jul 18, 2014 ... Pelvic floor dysfunction;. Pelvic floor electrophysiology. Abstract Background: Stress urinary incontinence (SUI), fecal incontinence (FI) and/or pelvic ... Pelvic floor muscle training (PFMT) is the first-line therapy in the treatment of PFD either .... PFD attending the outpatient clinic at the Physical Medicine,.

  8. Advocating "spine damage control" as a safe and effective treatment modality for unstable thoracolumbar fractures in polytrauma patients: a hypothesis.

    Science.gov (United States)

    Stahel, Philip F; Flierl, Michael A; Moore, Ernest E; Smith, Wade R; Beauchamp, Kathryn M; Dwyer, Anthony

    2009-05-11

    The "ideal" timing and modality of fracture fixation for unstable thoracolumbar spine fractures in multiply injured patients remains controversial. The concept of "damage control orthopedics" (DCO), which has evolved globally in the past decade, provides a safe guidance for temporary external fixation of long bone or pelvic fractures in multisystem trauma. In contrast, "damage control" concepts for unstable spine injuries have not been widely implemented, and the scarce literature in the field remains largely anecdotal. The current practice standards are reflected by two distinct positions, either (1) immediate "early total care" or (2) delayed spine fixation after recovery from associated injuries. Both concepts have inherent risks which may contribute to adverse outcome. We hypothesize that the concept of "spine damage control" - consisting of immediate posterior fracture reduction and instrumentation, followed by scheduled 360 degrees completion fusion during a physiological "time-window of opportunity" - will be associated with less complications and improved outcomes of polytrauma patients with unstable thoracolumbar fractures, compared to conventional treatment strategies. We propose a prospective multicenter trial on a large cohort of multiply injured patients with an associated unstable thoracolumbar fracture. Patients will be assigned to one of three distinct study arms: (1) Immediate definitive (anterior and/or posterior) fracture fixation within 24 hours of admission; (2) Delayed definitive (anterior and/or posterior) fracture fixation at > 3 days after admission; (3) "Spine damage control" procedure by posterior reduction and instrumentation within 24 hours of admission, followed by anterior 360 degrees completion fusion at > 3 days after admission, if indicated. The primary and secondary endpoints include length of ventilator-free days, length of ICU and hospital stay, mortality, incidence of complications, neurological status and functional recovery

  9. Transrectal bladder prolapse secondary to pelvic fracture in two dogs.

    Science.gov (United States)

    Crivellenti, L Z; Silveira, M P; Silva, A N; Borin-Crivellenti, S; Raposo, T M M; Honsho, D K

    2014-08-01

    This report describes the exteriorisation of the urinary bladder in two dogs as a result of a laceration of the rectum from a traumatic pelvic fracture. Clinical examination and contrast radiography of the bladder were used as diagnostic tools. Both patients were treated with exploratory laparotomy, where traction of the bladder was utilised to pull the bladder through the traumatic rectal laceration allowing the organ to return to its normal anatomical position. This procedure was followed by surgical reconstruction of the rectum, resulting in effective resolution of each case. © 2014 British Small Animal Veterinary Association.

  10. Uterine carcinosarcoma associated with pelvic radiotherapy for sacral chordoma: A case report

    Directory of Open Access Journals (Sweden)

    Korhan Kahraman

    2012-03-01

    Conclusion: In uterine masses seen in patients with history of irradiation to the pelvic field, the probability of uterine sarcomas should always be kept in mind. These tumors may occur simultaneously with recurrence of primary tumor previously treated by adjuvant radiation therapy.

  11. Do Patients Prefer a Pessary or Surgery as Primary Treatment for Pelvic Organ Prolapse

    NARCIS (Netherlands)

    Thys, S. D.; Roovers, J. P.; Geomini, P. M.; Bongers, M. Y.

    2012-01-01

    Background/Aims: To assess whether patients prefer surgery or a pessary as treatment for pelvic organ prolapse (POP). Methods: A structured interview was performed among treated and untreated women with POP. We conducted fictive scenarios of potential disadvantages of surgery and pessary use. Our

  12. Risk Factors for Pelvic Insufficiency Fractures in Locally Advanced Cervical Cancer Following Intensity Modulated Radiation Therapy

    DEFF Research Database (Denmark)

    Ramlov, Anne; Pedersen, Erik Morre; Røhl, Lisbeth

    2017-01-01

    PURPOSE: To investigate the incidence of and risk factors for pelvic insufficiency fracture (PIF) after definitive chemoradiation therapy for locally advanced cervical cancer (LACC). METHODS AND MATERIALS: We analyzed 101 patients with LACC treated from 2008-2014. Patients received weekly cisplatin...

  13. Treatment options for unstable trochanteric fractures: Screw or helical proxima femoral nail.

    Science.gov (United States)

    Bajpai, Jeetendra; Maheshwari, Rajesh; Bajpai, Akansha; Saini, Sumit

    2015-01-01

    To compare treatment outcome of screw proximal femoral nail (PFN) system with that of a helical PFN. The study included 77 patients with closed unstable intertrochanteric fracture classified as AO 31A2&31A3, between June 2008 to August 2011. Inclusion criteria were: all mature skeletons above 50 years of age; closed unstable trochanteric fracture classified as AO 31A2&A3. Exclusion criteria were: immature skeleton, pathological fracture of any cause other than osteoporosis, inability to walk inde- pendently prior to injury. Patients were randomized to 2 treatment groups based on admission sequence. Forty patients were treated with screw PFN and thirty seven were treated with helical PFN. Both groups were similar in respect of time of surgery, blood loss and functional assessment and duration of hospitalization. In screw PFN group 2 patients had superficial wound infection, 1 patient had persistent hip pain and 1 patient had shortening>1 cm buttrochanteric fractures even in Indian patients where the bones are narrow and neck diameter is small. It is an implant of choice for osteoporotic and unstable trochanteric fractures.

  14. Outcome analysis of pelvic ring fractures

    Directory of Open Access Journals (Sweden)

    Sen Ramesh

    2010-01-01

    Full Text Available Background: The behavior of pelvic ring fractures in the long run has been very sparsely studied. The purpose of this study is to assess the long-term outcome of pelvic ring fractures. Materials and Methods: A total of 24 patients with pelvic ring fractures, not involving the acetabulum, were followed up for an average duration of 33 months (range 24-49 months. The clinicoradiological assessment was done using the pelvic scoring system adapted from Cole et al. Parameters assessed included sacroiliac (SI joint involvement and, among SI joint injuries, the presence of a fracture disruption and the degree of displacement. Results: Pain and limp were present in 13 patients (54.2% each and residual working disability in 9 patients (37.5%. The overall Cole′s pelvic score was 31.3 ± 7.02 of a total score of 40. The average pelvic score in patients with SI disruption was 29.2 ± 6.75; much lower than patients without SI disruption with an average score of 34.9 ± 6.25 reaching statistical significance. The pelvic score among patients with a displacement ≤10 mm was 33.0 ± 3.92 and with a displacement> 10 mm 25.88 ± 7.14. The difference was statistically significant. Conclusions: Pelvic ring injuries can lead to long term problems significantly. The involvement of the SI joint affects the long-term outcome adversely, more so if the residual displacement is> 10 mm. The pelvic scoring system is comprehensive and depicts subtle differences in the outcome, which the individual parameters of the assessment fail to show.

  15. Restrictions in the realisation of multipass unstable resonators

    International Nuclear Information System (INIS)

    Strakhov, S Yu

    2009-01-01

    Main restrictions in the realisation of multipass unstable resonators caused by intracavity losses and large-scale aberrations are considered. The influence of intracavity losses on the laser radiation power and divergence is analysed based on the numerical simulation of an unstable resonator. The efficiency criterion for the unstable multipass resonator is proposed, which is proportional to the radiation brightness and takes into account the influence of the misalignment, thermal deformation and the main parameters of the active medium and resonator on the parameters of laser radiation. (resonators)

  16. Feasibility of retroperitoneal pelvic lymph node exploration in cervix-carcinoma treated by radio-surgery association or a definitive radiotherapy; Faisabilite de l`exploration ganglionnaire pelvienne retroperitoneale dans les cancers du col uterin traites par association radiochirurgicale ou radiotherapie exclusive. A propos d`une serie de 52 cas

    Energy Technology Data Exchange (ETDEWEB)

    Bolla, M.; Sarrazin, R.; Berland, E.; Schmidt, M.H.; Rolachon, I. [Hopital Regional des Sablons, 38 - Grenoble (France); Salvat, J. [Centre Hospitalier, 74 - Thonon-les-Bains (France)

    1995-12-31

    From June 1980 to May 1993, 52 patients with a mean age of 49, underwent a retroperitoneal pelvic lymph node laparoscopy procedure for cervix carcinoma classified as stage IA (14), IB (12), IIA (6), IIB (14), IIIB(3), IVA (3). Two techniques were used: a retroperitoneoscopy in 16 cases and a panoramic retroperitoneal pelviscopy (PRPP) in 36 cases. The aim was to define, with a better accuracy, the pelvic lymph node status, to adapt the target volume, and to estimate the morbidity.More nodes were biopsied with PRPP than with retroperitoneoscopy (p<0.05). There was a disagreement between the conventional radiologic assessment and the histological results in 28.6%. Specificity is 100%. Intra-operative and post-surgical morbidity was equivalent in the two procedures. One grade 3 urinary late morbidity (3%) was observed among the 33 patients who underwent a pelvic external irradiation. There was no morbidity of the gastro-intestinal tract. Discussion deals with the support offered by the two laparoscopic procedures to define the pelvic lymph node status, to choose the planning target volume, and to precise the lymph node boost. (authors) 24 refs., 3 tabs.

  17. Establishing Criteria for Bilateral Pelvic Lymph Node Dissection in the Management of Penile Cancer: Lessons Learned from an International Multicenter Collaboration.

    Science.gov (United States)

    Zargar-Shoshtari, Kamran; Djajadiningrat, Rosa; Sharma, Pranav; Catanzaro, Mario; Zhu, Yao; Nicolai, Nicola; Horenblas, Simon; Spiess, Philippe E

    2015-09-01

    Penile carcinoma with bilateral pelvic lymph node metastasis is a relatively rare condition with poor outcomes. There are little data available on optimal strategies for staging and treating this group of patients. We assessed factors predicting bilateral pelvic lymph node metastasis in patients with penile cancer and confirmed inguinal lymph node metastasis. Multi-institutional data from a total of 4 centers in Europe, the People's Republic of China and the United States were retrospectively analyzed. Patients with penile carcinoma and inguinal lymph node metastasis who underwent bilateral pelvic lymphadenectomy were included in analysis. The Kaplan-Meier and log rank tests were used to express overall survival. Logistic regression was used for multivariate analysis of factors predicting bilateral pelvic lymph node metastasis. Cox regression was done in the multivariable analysis of overall survival. We identified 140 patients with penile carcinoma who had confirmed pelvic lymph node metastasis. Of the patients 83 had bilateral inguinal lymph node metastasis and 64 underwent bilateral pelvic lymphadenectomy. Bilateral pelvic lymph node metastasis was observed in 16 patients (25%). The ROC of the total number of inguinal lymph node metastases and the detection of bilateral pelvic lymph node metastasis had an AUC of 0.76 (p = 0.002) with 95% sensitivity for the cutoff point of 4 inguinal nodes. On logistic regression analysis the detection of 4 or more positive inguinal nodes was the only independent predictor of bilateral pelvic lymph node metastasis (OR 14.0, CI 1.71-115). On Cox regression analysis 4 or more inguinal lymph node metastases, adjuvant chemotherapy, inguinal extraprostatic extension and bilateral procedures were associated with overall survival. Patients with bilateral inguinal lymph node metastasis who are treated with unilateral pelvic lymphadenectomy should be considered for bilateral pelvic lymphadenectomy in the presence of 4 or more metastatic

  18. Management of pelvic inflammatory disease by primary care physicians. A comparison with Centers for Disease Control and Prevention guidelines.

    Science.gov (United States)

    Hessol, N A; Priddy, F H; Bolan, G; Baumrind, N; Vittinghoff, E; Reingold, A L; Padian, N S

    1996-01-01

    The Centers for Disease Control and Prevention published recommendations for clinicians on the management of pelvic inflammatory disease, but it is unknown if providers are aware of the guidelines or follow them. To compare pelvic inflammatory disease screening, diagnosis, treatment, and reporting practices among primary care physicians with the Centers for Disease Control and Prevention guidelines for pelvic inflammatory disease. A weighted random sample of California primary care physicians surveyed in November 1992 and January 1993. Of the 1,165 physicians surveyed, 553 (48%) returned completed questionnaires. Among respondents, 302 (55%) reported having treated a case of pelvic inflammatory disease during the last 12 months, and of these, 52% answered that they were unsure of or do not follow the Centers for Disease Control and Prevention guidelines for pelvic inflammatory disease. Pediatricians and those with more years since residency were less likely to deviate from the Centers for Disease Control and Prevention guidelines for pelvic inflammatory disease, and family practitioners were more likely to deviate from the guidelines. Pelvic inflammatory disease is commonly encountered by primary care physicians in California. Training and experience were important predictors of compliance with the Centers for Disease Control and Prevention recommendations; however, substantial divergence from the guidelines occurs.

  19. 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.

  20. 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.)

  1. 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 ...

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

    Directory of Open Access Journals (Sweden)

    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.

  3. The effect of nonlinearity on unstable zones of Mathieu equation

    Science.gov (United States)

    Saryazdi, M. Gh

    2017-03-01

    Mathieu equation is a well-known ordinary differential equation in which the excitation term appears as the non-constant coefficient. The mathematical modelling of many dynamic systems leads to Mathieu equation. The determination of the locus of unstable zone is important for the control of dynamic systems. In this paper, the stable and unstable regions of Mathieu equation are determined for three cases of linear and nonlinear equations using the homotopy perturbation method. The effect of nonlinearity is examined in the unstable zone. The results show that the transition curves of linear Mathieu equation depend on the frequency of the excitation term. However, for nonlinear equations, the curves depend also on initial conditions. In addition, increasing the amplitude of response leads to an increase in the unstable zone.

  4. Stabilizing unstable steady states using extended time-delay autosynchronization.

    Science.gov (United States)

    Chang, Austin; Bienfang, Joshua C.; Hall, G. Martin; Gardner, Jeff R.; Gauthier, Daniel J.

    1998-12-01

    We describe a method for stabilizing unstable steady states in nonlinear dynamical systems using a form of extended time-delay autosynchronization. Specifically, stabilization is achieved by applying a feedback signal generated by high-pass-filtering in real time the dynamical state of the system to an accessible system parameter or variables. Our technique is easy to implement, does not require knowledge of the unstable steady state coordinates in phase space, automatically tracks changes in the system parameters, and is more robust to broadband noise than previous schemes. We demonstrate the controller's efficacy by stabilizing unstable steady states in an electronic circuit exhibiting low-dimensional temporal chaos. The simplicity and robustness of the scheme suggests that it is ideally suited for stabilizing unstable steady states in ultra-high-speed systems. (c) 1998 American Institute of Physics.

  5. DIFFERENTIAL DIAGNOSIS OF DEEP GLUTEAL PAIN IN A FEMALE RUNNER WITH PELVIC INVOLVEMENT: A CASE REPORT

    Science.gov (United States)

    Podschun, Laura; Kolber, Morey J.; Garcia, Ashley; Rothschild, Carey E.

    2013-01-01

    Background: Gluteal injuries, proximal hamstring injuries, and pelvic floor disorders have been reported in the literature among runners. Some suggest that hip, pelvis, and/or groin injuries occur in 3.3% to 11.5% of long distance runners. The purpose of this case report is to describe the differential diagnosis and treatment approach for a patient presenting with combined hip and pelvic pain. Case description: A 45-year-old female distance runner was referred to physical therapy for proximal hamstring pain that had been present for several months. This pain limited her ability to tolerate sitting and caused her to cease running. Examination of the patient's lumbar spine, pelvis, and lower extremity led to the initial differential diagnosis of hamstring syndrome and ischiogluteal bursitis. The patient's primary symptoms improved during the initial four visits, which focused on education, pain management, trunk stabilization and gluteus maximus strengthening, however pelvic pain persisted. Further examination led to a secondary diagnosis of pelvic floor hypertonic disorder. Interventions to address the pelvic floor led to resolution of symptoms and return to running. Outcomes: Pain level on the Visual Analog Scale decreased from 7/10 to 1/10 over the course of treatment. The patient was able to return to full sport activity and improved sitting tolerance to greater then two hours without significant discomfort. Discussion: This case suggests the interdependence of lumbopelvic and lower extremity kinematics in complaints of hamstring, posterior thigh and pelvic floor disorders. This case highlights the importance of a thorough examination as well as the need to consider a regional interdependence of the pelvic floor and lower quarter when treating individuals with proximal hamstring pain. Level of Evidence: Level 4 PMID:24175132

  6. Botox combined with myofascial release physical therapy as a treatment for myofascial pelvic pain

    Directory of Open Access Journals (Sweden)

    Gabriela E. Halder

    2017-03-01

    Full Text Available Purpose: To report the effects of combined onabotulinumtoxinA (Botox injections and myofascial release physical therapy on myofascial pelvic pain (MFPP by comparing pre- and posttreatment average pelvic pain scores, trigger points, and patient selfreported pelvic pain. Secondary outcomes were to examine posttreatment complications and determine demographic differences between patients with/without an improvement in pain. Materials and Methods: This was an Institutional Review Board approved retrospective case series on women over 18 years with MFPP who received Botox and physical therapy between July 2006 and November 2014. Presence of trigger points and pelvic pain scores were determined by digital palpation of the iliococcygeus, puborectalis, obturator internus, and rectus muscles. Average pelvic pain scores (0–10 reflected an average of the scores obtained from palpation of each muscle. Self-reported improvement in pain was recorded as yes/no. Results: Fifty women met the inclusion/exclusion criteria. Posttreatment, patients had lower average pelvic pain scores (3.7±4.0 vs. 6.4±1.8, p=0.005, and fewer trigger points (44% vs. 100%, p<0.001. Fifty-eight percent of patients (95% confidence interval, 44–72 noted an improvement in self-reported pain. Patients most likely to report no improvement in pain had chronic bowel disorders, while those most likely to report an improvement in pain had a history of past incontinence sling (p=0.03. Posttreatment complications included: constipation (8%, worsening urinary retention (2%, and urinary tract infection (4%. Conclusions: Botox combined with soft tissue myofascial release physical therapy under anesthesia can be effective in treating women with chronic pelvic pain secondary to MFPP.

  7. Pelvic floor muscle problems mediate sexual problems in young adult rape victims.

    Science.gov (United States)

    Postma, Riemke; Bicanic, Iva; van der Vaart, Huub; Laan, Ellen

    2013-08-01

    Prior studies have addressed sexual abuse and sexual function in adult women. No studies have focused on the effect of adolescence rape on sexual functioning. To investigate the effect of rape on sexual problems and on pelvic floor problems, as well as the mediating role of pelvic floor problems on sexual problems, in a homogenous group of victims of adolescence rape without a history of childhood sexual, physical, and/or emotional abuse. Sexual functioning and pelvic floor functioning were assessed using self-report questionnaires. In this cross-sectional study, a group of 89 young women aged 18-25 years who were victimized by rape in adolescence was compared with a group of 114 nonvictimized controls. The rape victims were treated for posttraumatic stress disorder (PTSD) 3 years prior to participation in the study. Three years posttreatment, rape victims were 2.4 times more likely to have a sexual dysfunction (lubrication problems and pain) and 2.7 times more likely to have pelvic floor dysfunction (symptoms of provoked vulvodynia, general stress, lower urinary tract, and irritable bowel syndrome) than nonvictimized controls. The relationship between rape and sexual problems was partially mediated by the presence of pelvic floor problems. Rape victims and controls did not differ with regard to sexual activities. Rape victims suffer significantly more from sexual dysfunction and pelvic floor dysfunction when compared with nontraumatized controls, despite the provision of treatment for PTSD. Possibly, physical manifestations of PTSD have been left unaddressed in treatment. Future treatment protocols should consider incorporating (physical or psychological) treatment strategies for sexual dysfunction and/or pelvic floor dysfunction into trauma exposure treatments. © 2013 International Society for Sexual Medicine.

  8. Imaging comparison of pelvic ring disruption and injury reduction with use of the junctional emergency treatment tool for preinjury and postinjury pelvic dimensions: a cadaveric study with computed tomography.

    Science.gov (United States)

    Gary, Joshua L; Kumaravel, Manickam; Gates, Keith; Burgess, Andrew R; Routt, Milton L; Welch, Timothy; Podbielski, Jeanette M; Beeler, Angela M; Holcomb, John B

    2014-01-01

    Complex dismounted blast injuries from (improvised) explosive devices have caused amputations of the lower extremities associated with open injuries to the pelvic ring, resulting in life-threatening hemorrhage from disruption of blood vessels near the pelvic ring. Provisional stabilization of the skeletal pelvis by circumferential pelvic compression provides stability for intrapelvic clots and reduces the volume of the pelvis, thereby limiting the amount of hemorrhage. The Junctional Emergency Treatment Tool (JETTtm; North American Rescue Products, http://www.narescue.com) is a junctional hemorrhage control device developed to treat pelvic and lower extremity injuries sustained in high-energy trauma on the battlefield and in the civilian environment. Our purpose was to evaluate the compressive function of the JETT in the reduction of pelvic ring injuries in a cadaveric model. Radiographic comparison of pre (intact) and post pelvic ring disruption and injury was compared with radiographic measurements post reduction with the JETT device in two cadavers. The device's ability to reduce pelvic disruption and injury in a human cadaver model was assessed through measurements of the anteroposterior (AP) and transverse diameters obtained at the inlet and outlet of the pelvis. Computed tomography (CT) scans demonstrated that JETT application effectively induced circumferential soft tissue compression that was evoked near anatomic reduction of the sacroiliac joint and symphysis pubis. The JETT is capable of effectively reducing an AP compression type III injury (APC III) pelvic ring disruption and injury by approximating the inlet and outlet dimensions toward predisruption measurements. Such a degree of reduction suggests that the JETT device may be suitable in the acute setting for provisional pelvic stabilization. 2014.

  9. Optimal Sensor and Actuator Location for Unstable Systems

    DEFF Research Database (Denmark)

    Shaker, Hamid Reza; Tahavori, Maryamsadat

    2013-01-01

    proposed so far, only support stable systems. However, in industrial practices it is often the case that the system, which is needed to be controlled, is not stable. The method which is proposed in this paper is a general method in the sense that it supports both stable and unstable systems. The technique...... is successfully used for determining the optimal sensor locations of the linearized Continuous Stirred-Tank Reactor unstable model....

  10. Aspirin inhibits human telomerase activation in unstable carotid plaques

    OpenAIRE

    LI, FANGMING; GUO, YI; JIANG, XIN; ZHONG, JIANXIN; LI, GUANDONG; SUN, SHENGGANG

    2013-01-01

    The activation of telomerase in unstable plaques is an important factor in atherosclerosis, and may be predictive of the risk of cerebrovascular diseases. Human telomerase reverse transcriptase (hTERT) is a subunit of telomerase that is essential for telomerase activation. The aim of the present study was to investigate whether aspirin inhibits the activation of telomerase and hTERT in unstable carotid plaques. Polymorphonuclear neutrophils (PMNs) derived from carotid plaques were isolated fr...

  11. Effects of pelvic adjustment on pelvic posture and angles of the lower limb joints during walking in female university students

    OpenAIRE

    Cho, Misuk

    2016-01-01

    [Purpose] This study investigated the effects of pelvic adjustment on pelvic posture and lower limb joint angles during walking in female university students. [Subjects] Thirty healthy female university students were randomly assigned to an experimental group (pelvic adjustment group, n = 15) and a control group (stretching group, n = 15). [Methods] Pelvic adjustment was performed three times on the experimental group. The control group performed three sets of pelvic muscle stretching for 15 ...

  12. 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.

  13. 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.)

  14. Study on unstable fracture characteristics of light water reactor piping

    International Nuclear Information System (INIS)

    Kurihara, Ryoichi

    1998-08-01

    Many testing studies have been conducted to validate the applicability of the leak before break (LBB) concept for the light water reactor piping in the world. It is especially important among them to clarify the condition that an inside surface crack of the piping wall does not cause an unstable fracture but ends in a stable fracture propagating only in the pipe thickness direction, even if the excessive loading works to the pipe. Pipe unstable fracture tests performed in Japan Atomic Energy Research Institute had been planned under such background, and clarified the condition for the cracked pipe to cause the unstable fracture under monotonous increase loading or cyclic loading by using test pipes with the inside circumferential surface crack. This paper examines the pipe unstable fracture by dividing it into two parts. One is the static unstable fracture that breaks the pipe with the inside circumferential surface crack by increasing load monotonously. Another is the dynamic unstable fracture that breaks the pipe by the cyclic loading. (author). 79 refs

  15. A fascia lata free flap in pelvic exenteration for Fournier gangrene due to advanced rectal cancer: a case report.

    Science.gov (United States)

    Sawayama, Hiroshi; Miyanari, Nobutomo; Sugihara, Hidetaka; Iwagami, Shiro; Mizumoto, Takao; Kubota, Tatsuo; Haga, Yoshio; Baba, Hideo

    2017-12-01

    Fournier gangrene due to advanced rectal cancer is a rapidly progressive gangrene of the perineum and buttocks. Emergency surgical debridement of necrotic tissue is crucial, and secondary surgery to resect tumors is necessary for wound healing. However, pelvic exenteration damages the pelvic floor, increasing the likelihood of herniation of internal organs into the infectious wound. The management of pelvic exenteration for rectal cancer with Fournier gangrene has not yet been established. We herein describe the use of a fascia lata free flap in pelvic exenteration for rectal cancer with Fournier gangrene. A 66-year-old male who had undergone colostomy for large bowel obstruction due to advanced rectal cancer and continued chemotherapy was referred to our hospital for Fournier gangrene resulting from chemotherapy. Emergency surgical debridement was performed, and the infectious wound around the rectal cancer was treated with intravenous antibiotic agents postoperatively. However, the tumor was exposed by the wound, and exudate persisted. Pelvic exenteration was performed due to tumor infiltration into the bladder and prostate. Tumor resection resulted in a defect in the pelvic floor. A fascia lata free flap (15 × 9 cm) obtained from the left thigh was fixed to the edge of the peritoneum and ileal conduit to close the defect in the pelvic floor and prevent small bowel herniation into the resected space. There was no intraabdominal inflammation or bowel obstruction postoperatively, and outpatient chemotherapy was continued. Surgical repair with a fascia lata free flap to close the defect in the pelvic floor led to a good clinical outcome for pelvic exenteration in a patient with Fournier gangrene due to advanced rectal cancer.

  16. Biomimetic matrices for pelvic floor repair

    OpenAIRE

    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. However, the meshes can create sever adverse complications in some patients, such as chronic pain and dypareunia, in longer-term. In the hope of finding an alternative surgical treatment, we developed ...

  17. Salvianolate injection in the treatment of unstable angina pectoris

    Science.gov (United States)

    Zhang, Dan; Wu, Jiarui; Liu, Shi; Zhang, Xiaomeng; Zhang, Bing

    2016-01-01

    Abstract Background: To systematically evaluate the clinical efficacy and safety of Salvianolate injection in the treatment of unstable angina pectoris (UAP). Methods: Using literature databases, we conducted a thorough and systematic retrieval of randomized controlled trials (RCTs) that using Salvianolate injection for treating UAP. The Cochrane Risk of Bias Assessment Tool was used to evaluate the methodological quality of the RCTs, and then the data were extracted and meta-analyzed by RevMan5.2 software. Results: A total of 22 RCTs with 2050 participants were included. The meta-analysis indicated that the combined use of Salvianolate injection and western medicine (WM) in the treatment of UAP can achieve a superior effect in angina pectoris total effective rate (risk ratio [RR] = 1.22, 95% confidence interval [CI] (1.17, 1.27), Z = 10.15, P < 0.00001], and the total effectiveness rate of electrocardiogram [RR = 1.26, 95% CI (1.19,1.34), Z = 7.77, P < 0.00001]. In addition, Salvianolate injection can improve the nitroglycerin withdrawal rate and the serum level of NO, decrease high-sensitivity C-reactive protein. Adverse drug reactions (ADRs) or adverse drug events (ADEs) were reported in 6 RCTs involving 15 cases; however, there were no serious ADRs/ADEs. Conclusion: Based on the systematic review, the combined use of Salvianolate injection and WM in the treatment of UAP can achieve a better effect; however, there was no definitive conclusion about its safety. More the large-sample and multicenter RCTs are needed to support its clinical usage. PMID:28002341

  18. Neutron Capture Experiments on Unstable Nuclei

    Energy Technology Data Exchange (ETDEWEB)

    Jon M. Schwantes; Ralf Sudowe; Heino Nitsche; Darleane C. Hoffman

    2003-12-16

    A primary objective of this project is to study neutron capture cross sections for various stable and unstable isotopes that will contribute to the Science Based Stockpile Stewardship (SBSS) program by providing improved data for modeling and interpretation of nuclear device performance. The information obtained will also be important in astrophysical modeling of nucleosynthesis. During this reporting period, the emphasis has been on preparing a radioactive target of {sup 155}Eu (half-life = 4.7 years), and several stable targets, including isotopically separated {sup 154}Sm, {sup 151}Eu, and {sup 153}Eu. Measurements of their neutron capture cross sections will be conducted in collaboration with researchers at the Los Alamos Neutron Science Center (LANSCE) facility using the Detector for Advanced Neutron Capture Experiments (DANCE). A suitable backing material (beryllium) for the targets has been selected after careful calculations of its contribution to the background of the measurements. In addition, a high voltage plating procedure has been developed and optimized. Stable targets of {sup 151}Eu and {sup 153}Eu and a target of natural Eu ({approx}50% {sup 151}Eu and {approx}50% {sup 153}Eu) have each been plated to a mass thickness of >1 mg/cm{sup 2} and delivered to the DANCE collaboration at Los Alamos National Laboratory (LANL). Natural Eu targets will be tested first to confirm that the target dimensions and backing are appropriate prior to performing measurements on the extremely valuable targets of separated isotopes. In order to prepare a target of the radioactive {sup 155}Eu, it must first be separated from the {sup 154}Sm target material that was irradiated in a very high neutron flux of 1.5x1015 neutrons/cm{sup 2}/s for 50 days. The reaction is {sup 154}Sm (n,f){sup 155}Sm (half-life = 22 minutes) {sup 155}Eu. Considerable progress has been made in developing a suitable high-yield and high-purity separation method for separating Eu from targets

  19. 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.

  20. Seasonal trend of acute pelvic inflammatory disease.

    Science.gov (United States)

    Xholli, Anjeza; Cannoletta, Marianna; Cagnacci, Angelo

    2014-05-01

    Many infections follow a seasonal trend. Aim of our study was to check whether acute pelvic inflammatory disease (PID) follows a seasonal progress. In a retrospective study on 12,152 hospital records, 158 cases of acute pelvic inflammatory disease were identified. Periodogram analysis was applied to the date of pelvic inflammatory disease admission and to related environmental factors, such as temperature and photoperiod. Pelvic inflammatory disease follows a seasonal rhythm with mean to peak variation of 23 % and maximal values in September (±37.2 days). The rhythm, more evident in married women, is related to the rhythm of temperature advanced by 2 months and of photoperiod advanced by 3 months. Cases of pelvic inflammatory disease are more frequent than expected in unmarried (36 vs. 17.3/34,626, p = 0.015), particularly divorced women 30-40 years of age. Our study evidences a seasonal trend and confirms unmarried, particularly divorced status, as important risk factor for acute pelvic inflammatory disease.

  1. Vaginal parity and pelvic organ prolapse.

    Science.gov (United States)

    Quiroz, Lieschen H; Muñoz, Alvaro; Shippey, Stuart H; Gutman, Robert E; Handa, Victoria L

    2010-01-01

    To investigate whether the odds of pelvic organ prolapse vary significantly with the number of vaginal births and whether cesarean birth is associated with prolapse. In this cross-sectional study of women over the age of 40, pelvic organ prolapse was defined as descent to or beyond the hymen. Logistic regression was used to estimate the relative odds of pelvic organ prolapse for each vaginal birth or cesarean birth, controlling for confounders. Two hundred ninety women underwent a pelvic organ prolapse quantification POPQ examination, and 72 were found to have pelvic organ prolapse. A single vaginal birth significantly increased the odds of prolapse (OR 9.73, 95% CI 2.68-35.35). Additional vaginal births were not associated with a significant increase in the odds of prolapse. Cesarean births were not associated with prolapse (OR 1.31, 95% CI 0.49-3.54). The odds of pelvic organ prolapse were almost 10 times higher after a single vaginal birth. The marginal impact of additional births on this association was small.

  2. 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)

  3. Surgical versus percutaneous isolated pelvic perfusion (IPP) for advanced melanoma: comparison in terms of melphalan pharmacokinetic pelvic bio-availability.

    Science.gov (United States)

    Guadagni, Stefano; Palumbo, Giancarlo; Fiorentini, Giammaria; Clementi, Marco; Marsili, Luca; Giordano, Aldo Victor; Masedu, Francesco; Valenti, Marco

    2017-08-15

    Isolated pelvic perfusion (IPP) can be used to treat unresectable melanoma metastases of the pelvis. IPP can be performed either by surgical or percutaneous approaches, using different balloon catheters. The aim of this study was to examine whether the surgical and percutaneous approaches were comparable with respect to tumor drug exposure in the pelvis. A pharmacokinetic study was performed in 5 melanoma patients treated with surgical IPP and five with percutaneous IPP. Both groups received melphalan at the dose of 30 mg/m 2 . Melphalan pharmacokinetic analyses were performed and the main parameter used to evaluate pelvic tumor drug-exposure was the ratio of areas under the melphalan plasma concentration curves in the pelvis and the systemic compartment, during the perfusion time (AUC 0 to 20 ). Non-parametric Mann-Whitney tests were employed for statistical comparisons. The median and interquartile range (IQR) values of the ratios between melphalan AUC 0 to 20 in pelvic and systemic compartments were 7.9 (IQR 7.2 to 9.9) and 5 (IQR 4 to 7.9) for surgical and percutaneous IPPs, respectively (p = 0.209). Tumor exposure to drug using these two methods did not statistically differ and both methods, therefore, can be adopted interchangeably, utilizing a perfusion blood flow rate of approximately 120 ml/min. The small sample size is a limitation of this study but our preliminary results can be used to calculate the effect size of a larger trial. Trial Registration Clinical Trials.gov Identifier NCT01920516; date of trial registration: August 6, 2013.

  4. Pelvic floor tenderness in the etiology of superficial dyspareunia.

    Science.gov (United States)

    Yong, Paul J; Mui, Justin; Allaire, Catherine; Williams, Christina

    2014-11-01

    To calculate the prevalence of pelvic floor tenderness in the population of women with pelvic pain and to determine its implications for symptoms of pelvic pain. We conducted a retrospective review of patients with pelvic pain at a tertiary referral centre. Pelvic floor tenderness was defined as levator ani tenderness on at least one side during single digit pelvic examination. The prevalence of pelvic floor tenderness in this cohort of women with pelvic pain was compared with the prevalence in a cohort of women without pain attending a gynaecology clinic. In the women with pelvic pain, multiple regression was performed to determine which variables were independently associated with pelvic floor tenderness. The prevalence of pelvic floor tenderness was 40% (75/189) in the cohort with pelvic pain, significantly greater than the prevalence of 13% (4/32) in the cohort without pain (OR 4.61; 95% CI 1.55 to 13.7, P = 0.005). On multiple logistic regression, superficial dyspareunia (OR 4.45; 95% CI 1.86 to 10.7, P = 0.001), abdominal wall pain (OR 4.04; 95% CI 1.44 to 11.3, P = 0.005), and bladder base tenderness (OR 4.65; 95% CI 1.87 to 11.6, P = 0.001) were independently associated with pelvic floor tenderness. Pelvic floor tenderness was similarly present in women with or without underlying endometriosis. Pelvic floor tenderness is common in women with pelvic pain, with or without endometriosis, and is a contributor to superficial dyspareunia. Pelvic floor tenderness was also associated with abdominal wall pain and bladder base tenderness, suggesting that nervous system sensitization is involved in the etiology of pelvic floor tenderness.

  5. 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.

  6. Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction

    NARCIS (Netherlands)

    Pool-Goudzwaard, A.L.; Slieker ten Hove, M.C.; Vierhout, M.E.; de Mulder, PH; Pool, J.J.M.; Snijders, C.J.; Stoeckart, R.

    2005-01-01

    To assess the occurrence of pelvic floor dysfunction (PFD) in pregnancy- related low back and pelvic pain (PLBP) patients, a cross-sectional study was performed, comprising 77 subjects. Each subject underwent physical assessment, and filled in the Urogenital Distress Inventory completed with

  7. Pelvic floor muscle function in a general population of women with and without pelvic organ prolapse

    NARCIS (Netherlands)

    M.C.P. Slieker-ten Hove (Marijke); A.L. Pool-Goudzwaard (Annelies); M.J.C. Eijkemans (René); R.P.M. Steegers-Theunissen (Régine); C.W. Burger (Curt); M.E. Vierhout (Mark)

    2010-01-01

    textabstractIntroduction and hypothesis: This study aims to examine the relationship between pelvic floor muscle function (PFMF) and pelvic organ prolapse (POP) in a general female population. Methods: Cross-sectional study on women aged 45-85 years. Validated questionnaires were used to assess

  8. Clinical outcome of extended-field irradiation vs. pelvic irradiation using intensity-modulated radiotherapy for cervical cancer.

    Science.gov (United States)

    Ouyang, Yi; Wang, Yanhong; Chen, Kai; Cao, Xinping; Zeng, Yiming

    2017-12-01

    The aim of the present study was to evaluate the distinctions in survival and toxicity between patients with cervical cancer with common iliac node or para-aortic node involvement, who were treated with extended-field intensity-modulated radiotherapy (EF-IMRT) and patients with or without lower involved pelvic nodes, who were treated with pelvic IMRT. A total of 55 patients treated with EF-IMRT and 52 patients treated with pelvic IMRT at the Sun Yat-Sen University Cancer Center (Guangzhou, China) were retrospectively analyzed. Patients treated with EF-IMRT had the highest level of lymph node involvement to the para-aortic or common iliac nodes, while patients treated with pelvic IMRT had no para-aortic or common iliac nodes involved (Pirradiation was a protective prognostic factor for OS and DFS. A total of 16 patients in the EF-IMRT group and 13 patients in the pelvic IMRT group experienced treatment failure (P=0.67), with the patterns of failure being the same for the two groups (P=0.88). The cumulative incidence of grade 3 and 4 acute toxicities in the EF-IMRT group was 34.5%, in comparison with 19.2% in the pelvic group (P=0.048). The results of the present study suggest that patients with cervical cancer with grossly involved common iliac or para-aortic nodes should be electively subjected to EF irradiation to improve the survival and alter patterns of recurrence. Notably, EF irradiation delivered via IMRT exhibits an increased toxicity incidence, however, this remains within an acceptable range.

  9. Comparing the predictive value of the pelvic ring injury classification systems by Tile and by Young and Burgess.

    Science.gov (United States)

    Osterhoff, Georg; Scheyerer, Max J; Fritz, Yannick; Bouaicha, Samy; Wanner, Guido A; Simmen, Hans-Peter; Werner, Clément M L

    2014-04-01

    Radiology-based classifications of pelvic ring injuries and their relevance for the prognosis of morbidity and mortality are disputed in the literature. The purpose of this study was to evaluate potential differences between the pelvic ring injury classification systems by Tile and by Young and Burgess with regard to their predictive value on mortality, transfusion/infusion requirement and concomitant injuries. Two-hundred-and-eighty-five consecutive patients with pelvic ring fractures were analyzed for mortality within 30 days after admission, number of blood units and total volume of fluid infused during the first 24h after trauma, the Abbreviated Injury Severity (AIS) scores for head, chest, spine, abdomen and extremities as a function of the Tile and the Young-Burgess classifications. There was no significant relationship between occurrence of death and fracture pattern but a significant relationship between fracture pattern and need for blood units/total fluid volume for Tile (p<.001/p<.001) and Young-Burgess (p<.001/p<.001). In both classifications, open book fractures were associated with more fluid requirement and more severe injuries of the abdomen, spine and extremities (p<.05). When divided into the larger subgroups "partially stable" and "unstable", unstable fractures were associated with a higher mortality rate in the Young-Burgess system (p=.036). In both classifications, patients with unstable fractures required significantly more blood transfusions (p<.001) and total fluid infusion (p<.001) and higher AIS scores. In this first direct comparison of both classifications, we found no clinical relevant differences with regard to their predictive value on mortality, transfusion/infusion requirement and concomitant injuries. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. [Preclinical and clinical treatment of instable pelvic injuries : Results of an online survey].

    Science.gov (United States)

    Wohlrath, B; Trentzsch, H; Hoffmann, R; Kremer, M; Schmidt-Horlohè, K; Schweigkofler, U

    2016-09-01

    external emergency stabilization despite the very low sensitivity, in cases of false negative testing there is a risk of insufficient treatment resulting in life-threatening hemorrhage. From our viewpoint, it therefore makes sense to treat patients with a suspicion of instable pelvic fractures based on the trauma mechanism and clinical examination (without mechanical stability testing) with non-invasive external pelvic stabilization as early as possible.

  11. Unstable genes unstable mind: beyond the central dogma of molecular biology.

    Science.gov (United States)

    Hegde, Mahabaleshwar V; Saraph, Arundhati A

    2011-08-01

    Schizophrenia has a polygenic mode of inheritance and an estimated heritability of over 80%, but success in understanding its genetic underpinnings to date has been modest. Unlike in trinucleotide neurodegenerative disorders, the phenomenon of genetic anticipation observed in schizophrenia or bipolar disorder has not been explained. For the first time, we provide a plausible molecular explanation of genetic anticipation and pathophysiology of schizophrenia, at least in part, with supporting evidence. We postulate that abnormally increased numbers of CAG repeats in many genes being expressed in the brain, coding for glutamine, cumulatively press for higher demand of glutamine in the respective brain cells, resulting in a metabolic crisis and dysregulation of the glutamate-glutamine cycle. This can adversely affect the functioning of both glutamate and GABA receptors, which are known to be involved in psychosis, and may also affect glutathione levels, increasing oxidative stress. The resulting psychosis (gain in function), originating from unstable genes, is described as an effect "beyond the central dogma of molecular biology". The hypothesis explains genetic anticipation, as further expansions in subsequent generations may result in increased severity and earlier occurrence. Many other well described findings provide proof of concept. This is a testable hypothesis, does not deny any known facts and opens up new avenues of research. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. CALCAR PRESERVING OSTEOTOMY IN CEMENTED BIPOLAR HEMIARTHROPLASTY FOR UNSTABLE TROCHANTERIC FRACTURES

    Directory of Open Access Journals (Sweden)

    Mohammed Ashraf

    2016-03-01

    Full Text Available INTRODUCTION Intertrochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat. Conservative treatment with traction and prolonged immobilisation lands up with many complications and often fatality. Rate of failure with internal fixation has been found to be high, especially in osteoporotic bones. Revision osteosynthesis is technically demanding and it leads to complications, a second surgical procedure for revision synthesis, arthroplasty or removal of a symptomatic implant is again a risky procedure in elderly patients with lot of comorbidities. The aim of this study was to assess the efficacy of a cemented bipolar hemiarthroplasty with calcar preserving intracapsular osteotomy in the management of unstable trochanteric fractures in elderly patients with osteoporosis. Hemiarthroplasty in unstable trochanteric fractures have been described in the past with varying outcome. The reasons for poor outcome were shortening, varus positioning and abductor insufficiency. This was mainly due to the deficient medial support due to the removal of lesser trochanter and calcar. Recently, free calcar grafting excised from the removed neck for medial support was reported, but in our technique we are preserving the calcar and lesser trochanter with all its soft tissue and muscle attachments. MATERIALS AND METHODS 52 patients with mean age 71.4 (range from 65 to 89 who underwent cemented bipolar hemiarthroplasty with calcar preserving osteotomy for unstable intertrochanteric fractures were prospectively evaluated. Posterior approach was used in all patients. Harris hip score was used for the clinical evaluation. The mean followup period was 5 years. RESULT In our study, which was done on 52 cases which had a mean age 71.4 years. The average Harris hip score was 81. Excellent to fair results were obtained at followup in 50 (96% cases, and in 2(4% cases the results were poor. Average hospital stay was 14

  13. Vibrating vaginal balls to improve pelvic floor muscle performance in women after childbirth: a protocol for a randomised controlled feasibility trial.

    Science.gov (United States)

    Oblasser, Claudia; McCourt, Christine; Hanzal, Engelbert; Christie, Janice

    2016-04-01

    This paper presents a feasibility trial protocol the purpose of which is to prepare for a future randomised controlled trial to determine the effectiveness of vibrating vaginal pelvic floor training balls for postpartum pelvic floor muscle rehabilitation. Vibrating vaginal pelvic floor training balls are available in Austria to enhance women's pelvic floor muscles and thus prevent or treat urinary incontinence and other pelvic floor problems following childbirth. Nonetheless, there is currently little empirical knowledge to substantiate their use or assess their relative effectiveness in comparison to current standard care, which involves pelvic floor muscle exercises. Single blind, randomised controlled feasibility trial with two parallel groups. It is planned to recruit 56 postpartum women in Vienna, who will be randomised into one of two intervention groups to use either vibrating vaginal balls or a comparator pelvic floor muscle exercises for 12 weeks. As this is a feasibility study, study design features (recruitment, selection, randomisation, intervention concordance, data collection methods and tools) will be assessed and participants' views and experiences will be surveyed. Tested outcome measures, collected before and after the intervention, will be pelvic floor muscle performance as reported by participants and measured by perineometry. Descriptive and inferential statistics and content analysis will serve the preparation of the future trial. The results of this feasibility trial will inform the design and conduct of a full randomised controlled trial and provide insight into the experiences of women regarding the interventions and study participation. © 2015 John Wiley & Sons Ltd.

  14. Effects of Unstable Links on AODV Performance in Real Testbeds

    Directory of Open Access Journals (Sweden)

    Borgia Eleonora

    2007-01-01

    Full Text Available A link between a pair of nodes is defined unstable if it is characterized by a packet loss which is not negligible in one or both directions. The presence of unstable links in multihop ad hoc networks is very likely and it depends on several factors (e.g., different transmission capabilities of the devices, interferences caused by additional wireless devices. Their management by the routing protocols is of paramount importance since they negatively affect applications performance. In our previous experimental studies, we found that AODV is characterized by very low performance in some specific situations and, in this work, we demonstrate that it mainly depends on the wrong management of unstable links as valid routes. We present some policies that have been proposed in literature to avoid this problem, and we validate two of them through experimental results, exploiting also a direct comparison with the proactive routing protocol OLSR. Our results show that AODV is not able to avoid the use of unstable links, even when an alternative stable route exists. In the same conditions, OLSR outperforms AODV by correctly managing unstable links. In fact, it is able to guarantee a higher packet delivery ratio to the application by using the most stable path to reach the destination.

  15. Carcinoma of vagina 10 or more years following pelvic irradiation therapy

    International Nuclear Information System (INIS)

    Pride, G.L.; Buchler, D.A.

    1977-01-01

    Gynecologic cancer records of 4,238 patients treated between 1956 and 1974 were reviewed. Sixteen patients developed neoplasia in the cervix or vagina 10 or more years following pelvic irradiation. Three patients had squamous carcinoma in situ; the other 13 patients had invasive squamous cancer involving the upper vagina. Only 1.26 percent of invasive carcinoma of the cervix treated by radiation therapy from 1956 to 1966 presented with a late or recurrent or new primary tumor involving the vagina or cervix 10 or more years after primary treatment. The authors conclude that the risk of developing radiation-induced carcinoma in the upper vagina or cervix following pelvic irradiation is low. Follow-up Pap smears are indicated for all patients treated for cervical or vaginal malignancies by radiation therapy in order to detect vaginal neoplasia as well as recurrent carcinoma of the cervix

  16. Acute and late side-effects of conventional and conformal pelvic radiotherapy for cervical and endometrial cancer

    International Nuclear Information System (INIS)

    Izmajlowicz, B.; Komafel, J.

    2010-01-01

    Aim of the study. The purpose of this prospective study was to analyze and compare acute and late side-effects observed in patients with cervical and endometrial cancer treated with conventional 2-dimensional (2D) and conformal 3-dimensional (3D) pelvic radiotherapy. Patients and method. 50 patients treated with conventional pelvic radiotherapy and 50 patients treated with conformal pelvic radiotherapy at the Clinical Department of Gynecological Radiotherapy of the Lower Silesian Oncology Center between November 2004 and October 2005 were entered into a prospective study. We assessed Radiotherapy side-effects according to EORTCIRTOG, performance status according to the WHO, Body Mass Index and hematologic parameters during radiotherapy and one year after treatment. Results. Performance status acc. to the WHO was significantly better in the conformal arm. Anemia and nausea were more frequent in the conventional arm. In both the study groups acute gastrointestinal and genitourinary morbidity was more frequent than late morbidity and performance status was better after than before radiotherapy. Mean BMI was lower after radiotherapy than before treatment. Conclusions. Conformal pelvic radiotherapy in patients with cervical and endometrial cancer is less toxic than conventional pelvic radiotherapy which is also confirmed by the performance status. (authors)

  17. [Clinical application of percutaneous iliosacral screws combined with pubic ramus screws in Tile B pelvic fracture].

    Science.gov (United States)

    Xu, Qi-Fei; Lin, Kui-Ran; Zhao, Dai-Jie; Zhang, Song-Qin; Feng, Sheng-Kai; Li, Chen

    2017-03-25

    To investigate the application and effect of minimally invasive percutaneous anterior pelvic pubic ramus screw fixation in Tile B fractures. A retrospective review was conducted on 56 patients with posterior pelvic ring injury combined with fractures of anterior pubic and ischiadic ramus treated between May 2010 and August 2015, including 31 males and 25 females with an average age of 36.8 years old ranging from 35 to 65 years old. Based on the Tile classification, there were 13 cases of Tile B1 type, 28 cases of Tile B2 type and 15 cases of Tile B3 type. Among them, 26 patients were treated with sacroiliac screws combined with external fixation (external fixator group) and the other 30 patients underwent sacroiliac screw fixation combined with anterior screw fixation (pubic ramus screw group). Postoperative complications, postoperative ambulation time, fracture healing, blood loss, Majeed pelvic function score and visual analogue scale(VAS) were compared between two groups. Fifty-four patients were followed up from 3 to 24 months with a mean of 12 months. There were no significant difference in the peri-operative bleeding and operation time between two groups( P >0.05). The postoperative activity time and fracture healing time of pubic ramus screw group were shorter than those of the external fixator group, the differences were statistically significant( P safty treatment method to the Tile B pelvic fracture. It has advantages of early ambulation, relief of the pain and few complications.

  18. Physical therapist management of chronic prostatitis/chronic pelvic pain syndrome.

    Science.gov (United States)

    Van Alstyne, Linda S; Harrington, Kendra L; Haskvitz, Esther M

    2010-12-01

    Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) negatively affects quality of life and sexual function in men of all ages. Typical treatment with antibiotic and antimicrobial drugs often is not successful. The purpose of this case report is to describe a multimodal physical therapy intervention that included manual therapy techniques applied to the pelvic floor in 2 patients who were unsuccessfully treated with the biomedical model of prescription drug therapies. Two men, aged 45 years and 53 years and diagnosed with chronic prostatitis, were referred for physical therapy following unsuccessful pharmacological treatment. The patients were treated with manual therapy techniques applied to the pelvic floor and instructed in progressive muscle relaxation, flexibility exercises, and aerobic exercises. Changes in the patients' National Institutes of Health Chronic Prostatitis Symptom Index revealed differences between preintervention and postintervention scores reflecting decreased pain and improved quality of life. One patient improved from a score of 25 (total possible score = 43) before treatment to a score of 0 after treatment, and the other patient improved from a score of 29 to a score of 21. Manual therapy techniques applied to the pelvic floor and performed by a physical therapist specially trained in these techniques, along with progressive muscle relaxation, flexibility exercises, and aerobic exercises, appeared to be beneficial to both patients in reducing pain and improving sexual function.

  19. Anterior vaginal wall tenderness (AVWT) as a physical symptom in chronic pelvic pain.

    Science.gov (United States)

    Paulson, John D; Paulson, Joseph N

    2011-01-01

    Chronic pelvic pain is often difficult to diagnose and treat properly. Physicians called on to treat this problem may not be able to give a specific diagnosis. The aim of this study was to see whether the physical presence of anterior vaginal wall tenderness could help narrow down and elucidate diagnoses in a practice focusing on diagnosis and treatment of chronic pelvic pain. The study cohort comprised 284 patients with chronic pelvic pain limited to gynecologic and lower urinary problems. Histories, physical examinations, and endoscopic procedures were performed on each patient. An analysis of this information was conducted. Of the chronic pelvic pain patients, 78% had endometriosis, 81% had interstitial cystitis, and 61% had both concurrently. The sensitivity of anterior vaginal wall tenderness (AVWT) in patients with interstitial cystitis was 95%, and in those with only endometriosis and no interstitial cystitis, the sensitivity was 17%. The positive predictive value for interstitial cystitis was 85%, and for endometriosis it was 67%. Examination of the anterior vaginal wall with an empty bladder at the initial examination can lead one to suspect interstitial cystitis and possibly either concomitant or singular endometriosis and allow the physician to approach the workup accordingly.

  20. Stricture of the sigmoid colon after pelvic irradiation. Report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Koga, Yutaka; Nakamura, Katsuya; Tasaki, Akira; Tsutsumi, Nobuo; Terasaka, Reiji [Shin Kokura Hospital, Kitakyushu, Fukuoka (Japan); Taguchi, Kenichi [Kyushu Univ., Fukuoka (Japan). Graduate School of Medical Sciences

    2002-07-01

    Disorders of the large and small intestines after pelvic irradiation are classified into early and late complications. Common late complications are stricture and perforation. Some cases with such complications are indicated for surgical therapy. Moreover, it is suggested that radiation induced cancer can occur in patients surviving more than 5 years after radiotherapy. Patient 1, a 78-year-old woman, had been treated by surgery and pelvic irradiation for uterine cancer 20 years earlier. She had been suffered from constipation for a long time after the treatment. This time, examinations revealed a whole- circumference stricture and cancer of the sigmoid colon. Sigmoidectomy was performed. Pathological diagnosis was carcinoma in radiation colitis. Patient 2, a 73-year-old woman, had been treated by surgery and pelvic irradiation for uterine cancer 15 years earlier. This time, she admitted to the hospital because of intestinal bleeding. Angiography showed hemorrhage in the ileum. Arterial injection of vasopressin succeeded in hemostasis. However, the procedure caused marked stricture of the sigmoid colon unexpectedly. A sigmoidectomy and a partial resection of the ileum were performed. Pathological diagnosis was radiation colitis and ileitis without malignant findings. Patients with long interval after pelvic irradiation must be carefully followed from the standpoint of late complications and cancer. (author)

  1. 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

  2. Unstable three dimensional nuclear matter in stochastic mean field approach

    International Nuclear Information System (INIS)

    Colonna, M.; Chomaz, Ph.

    1993-01-01

    A semi-classical stochastic mean-field approach is discussed. In the case of unstable infinite nuclear matter, the characteristic time of the exponential growing of fluctuations and the diffusion coefficients associated to the unstable modes are calculated in the framework of the Boltzmann-Langevin theory. In order to make realistic 3D calculations feasible, the complicated Boltzmann-Langevin theory is suggested to be replaced by a simpler stochastic meanfield approach corresponding to a standard Boltzmann evolution, complemented by a simple noise chosen to reproduce the dynamics of the most unstable modes. Finally, it is explained how to approximately implement this method by simply tuning the noise associated to the use of a finite number of test particles in Boltzmann-like calculations. (authors) 17 refs., 5 figs

  3. Pelvic floor health: a concept analysis.

    Science.gov (United States)

    Pierce, Heather; Perry, Lin; Gallagher, Robyn; Chiarelli, Pauline

    2015-05-01

    To report an analysis of the concept 'pelvic floor health'. 'Pelvic floor health' is a term used by multiple healthcare disciplines, yet as a concept is not well defined. Rodger's evolutionary view was used to guide this analysis. Academic literature databases and public domain websites viewed via the Internet search engine Google. Literature in English, published 1946-July 2014 was reviewed. Websites were accessed in May 2014, then analysed of presentation for relevance and content until data saturation. Thematic analysis identified attributes, antecedents and consequences of the concept. Based on the defining attributes identified in the analysis, a contemporary definition is offered. 'Pelvic floor health' is the physical and functional integrity of the pelvic floor unit through the life stages of an individual (male or female), permitting an optimal quality of life through its multifunctional role, where the individual possesses or has access to knowledge, which empowers the ability to prevent or manage dysfunction. This analysis provides a definition of 'pelvic floor health' that is based on a current shared meaning and distinguishes the term from medical and lay terms in a complex, multifaceted and often under-reported area of healthcare knowledge. This definition provides a basis for theory development in future research, by focusing on health rather than disorders or dysfunction. Further development of the meaning is required in an individual's social context, to ensure a contemporaneous understanding in a dynamic system of healthcare provision. © 2015 John Wiley & Sons Ltd.

  4. Pedicle screw-only constructs with lumbar or pelvic fixation for spinal stabilization in patients with Duchenne muscular dystrophy.

    Science.gov (United States)

    Mehta, Satyen S; Modi, Hitesh N; Srinivasalu, Santhana; Suh, Seung-Woo; Yi, Ju-Won; Cho, Jae-Woo; Song, Hae-Ryong

    2009-08-01

    Retrospective case study. We present a retrospective clinical study of 36 patients of Duchenne muscular dystrophy (DMD) treated for correction of scoliosis with pedicle screw-only constructs with the objective to analyze our technique, correction and maintenance of spinal and pelvic deformity, spinal fusion, the complications we encountered, and the adequacy of lumbar fixation. Pedicle screw constructs have shown better deformity correction and maintenance as compared with other methods of instrumentation in adolescent idiopathic scoliosis. There are very few reports of pedicle screw-only constructs for DMD patients. Thirty-six patients were followed up for an average period of 37.75 months (min 24 mo). All patients were instrumented from T2, T3, or T4 to L5 and all levels were instrumented. Pelvic fixation was performed only if the pelvic tilt was more than 15 degrees (10 patients). Cobb angle improved 65% (Ppelvic fixation was performed, pelvic tilt improved 62% (Ppelvic fixation was not performed, the pelvic obliquity also improved from 10.5 degrees preoperatively to 5.8 degrees postoperatively (41.5% correction) and 8.5 degrees at final follow-up (4.2% correction). Pedicle screw-only constructs provide good stability allowing better correction and maintenance of coronal and lumbar deformities, obtaining good sitting balance, and mobilizing patients early after surgery. Longer follow-up is required to adequately comment on the need for pelvic stabilization.

  5. Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA Injection

    Directory of Open Access Journals (Sweden)

    Jia-Fong Jhang

    2015-06-01

    Full Text Available Chronic pelvic pain (CPP is defined as pain in the pelvic organs and related structures of at least 6 months’ duration. The pathophysiology of CPP is uncertain, and its treatment presents challenges. Botulinum toxin A (BoNT-A, known for its antinociceptive, anti-inflammatory, and muscle relaxant activity, has been used recently to treat refractory CPP with promising results. In patients with interstitial cystitis/bladder pain syndrome, most studies suggest intravesical BoNT-A injection reduces bladder pain and increases bladder capacity. Repeated BoNT-A injection is also effective and reduces inflammation in the bladder. Intraprostatic BoNT-A injection could significantly improve prostate pain and urinary frequency in the patients with chronic prostatitis/chronic pelvic pain syndrome. Animal studies also suggest BoNT-A injection in the prostate decreases inflammation in the prostate. Patients with CPP due to pelvic muscle pain and spasm also benefit from localized BoNT-A injections. BoNT-A injection in the pelvic floor muscle improves dyspareunia and decreases pelvic floor pressure. Preliminary studies show intravesical BoNT-A injection is useful in inflammatory bladder diseases such as chemical cystitis, radiation cystitis, and ketamine related cystitis. Dysuria is the most common adverse effect after BoNT-A injection. Very few patients develop acute urinary retention after treatment.

  6. Pelvic ultrasonography in pubertal girls.

    Science.gov (United States)

    Seth, Anju; Aggarwal, Anu; Sandesh, K; Solanki, R S; Aneja, S; Kumar, Guresh

    2002-10-01

    To derive norms for the size of uterus, uterine shape (fundal-cervical ratio) and ovarian volume in girls in various Tanners stages of puberty. Pelvic ultrasound was performed in ninety-two healthy girls in the age group of 8-15 years. These included twenty girls each in Tanner stages 1-4 and twelve in stage 5. All the subjects enrolled in the study had a weight and height within 5th-95th percentile of NCHS standards and their bone ages corresponded to the chronological age. Uterine height, fundal-cervical ratio (FCR) and ovarian volume were measured in all the subjects. The data was stratified according to various pubertal stages as well as for different ages. Statistical analysis was carried out to derive the percentiles for the three parameters in different pubertal stages and to study the correlation between these parameters and age, weight and height of the subjects. A statistically significant increase in uterine height, FCR and ovarian volume was observed with progressive pubertal stages. Maximum increase in uterine height was observed during the transition from stage 2 to stage 3. All girls beyond the age of 10 years or beyond Tanner stage 2 had a FCR>1. The ovarian volume, after showing an initial increase, tended to plateau and there was no significant increase from stage 4-stage 5. A significant correlation was found between the three parameters and the subject's age, weight and height, the maximum correlation was with age (correlation coefficients being 0.748, 0.648, 0.568 for uterine height, FCR and ovarian volume respectively). Centiles for these parameters were obtained for different pubertal stages. This work has provided some guidelines for normative data for various pubertal stages as well as for ages between 8-15 years. These may be used as a reference in evaluation of patients with suspected disorders of puberty.

  7. Laparoscopy and ultrasound examination in women with acute pelvic pain

    DEFF Research Database (Denmark)

    Mikkelsen, A L; Felding, C

    1990-01-01

    The results of preoperative pelvic examination and eventual ultrasound examination were correlated with the laparoscopic findings in 316 women with acute pelvic pain. The predictive values of normal and abnormal findings at pelvic examination were 46.9 and 82.1%, respectively. 42.1% of the women...... had ultrasound examination performed. This investigation showed to be helpful especially in patients with normal findings at pelvic examination. If ultrasonic findings were abnormal the results at laparoscopy were also abnormal in 90%. On the contrary, normal findings at ultrasound examination did...... not exclude abnormal pelvic findings. The predictive value of normal results at ultrasound examination was 50.0%. This discrepancy between ultrasonic and pelvic findings can be explained by the size of the pelvic masses. Ultrasound examination is a valuable tool in the evaluation of patients with acute pelvic...

  8. 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.

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

    Science.gov (United States)

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

    2016-11-01

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

  10. Extent of pelvic lymph node dissection in penile cancer may impact survival.

    Science.gov (United States)

    Zargar-Shoshtari, Kamran; Sharma, Pranav; Djajadiningrat, Rosa; Catanzaro, Mario; Ye, Ding-Wei; Zhu, Yao; Nicolai, Nicola; Horenblas, Simon; Spiess, Philippe E

    2016-03-01

    Current guidelines on management of penile carcinoma (PC) recommend ipsilateral pelvic lymph node dissection (PLND) in patients with inguinal lymph node metastasis (LNM) who meet specific criteria. The aim of this article was to assess outcomes in patients treated with bilateral PLND in the presence of unilateral metastatic pelvic nodes. After IRB approval, four international centers contributed to this study. Men with PC and unilateral inguinal LNM and pelvic node metastases were retrospectively analyzed. Estimates of overall survival (OS) and cancer-specific survival were provided by the Kaplan-Meier method. Comparisons between subgroups were made using the log-rank test, and Cox regression analysis was used to adjust comparisons for covariates of interest. From 1978 to 2012, fifty-one men with unilateral inguinal LNM and positive pelvic nodes on PLND were identified. Thirty-eight (75 %) had ipsilateral and 13 (25 %) had bilateral PLND. Except the extent of the PLND, patients were comparable with respect to disease and therapeutic interventions. The Kaplan-Meier estimated median OS was significantly longer in the bilateral PLND patients (21.7 vs. 13.1, p = 0.051). On Cox regression analysis, bilateral PLND [HR 0.25, (95 % CI 0.10-0.64)], multiple pelvic node involvement [HR 2.12 (95 % CI 1.02-4.43)], neoadjuvant chemotherapy [HR 0.01, (95 % CI 0.02-0.44)] and adjuvant therapies [HR 0.16, (95 % CI 0.06-0.45)] (compared to no additional therapy) were independent predictors of OS. Men with PC and pelvic node metastases may benefit from a bilateral PLND. This hypothesis requires further confirmation.

  11. The Treatment of Chronic Coccydynia and Postcoccygectomy Pain With Pelvic Floor Physical Therapy.

    Science.gov (United States)

    Scott, Kelly M; Fisher, Lauren W; Bernstein, Ira H; Bradley, Michelle H

    2017-04-01

    Coccydynia is a challenging disorder that often is refractory to treatments such as medications and injections. Physical therapy for coccydynia rarely has been studied. To evaluate the efficacy of pelvic floor physical therapy for reducing pain levels in patients with coccydynia. Retrospective chart review. The pelvic floor rehabilitation clinic of a major university hospital. A total of 124 consecutive patients over age 18 with a chief complaint of coccydynia between 2009 and 2012. A subgroup of 17 of the 124 patients had previously undergone coccygectomy with continued pain postoperatively. The primary treatment intervention was pelvic floor physical therapy aimed at pelvic floor muscle relaxation. Secondary treatment interventions included the prescription of baclofen for muscle relaxation (19% of patients), ganglion impar blocks (8%), or coccygeus trigger point injections (17%). Primary outcome measures included final minimum, average, and maximum pain numeric rating scales. A secondary outcome measure was the patient's subjective percent global improvement assessment. Baseline demographics were used to determine which pretreatment characteristics were correlated with treatment outcomes. Of the 124 patients, 93 participated in pelvic floor physical therapy and were included in statistical analysis. For the 79 patients who completed treatment (with a mean of 9 physical therapy sessions), the mean average pain ratings decreased from 5.08 to 1.91 (P physical therapy. Pain duration and history of trauma did not affect treatment outcomes. Pelvic floor physical therapy is a safe and effective method of treating coccydynia. III. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  12. Treating Infertility

    Science.gov (United States)

    ... Patients Search FAQs Treating Infertility Page Navigation ▼ ACOG Pregnancy Book Treating Infertility Patient Education FAQs Treating Infertility Patient Education Pamphlets - Spanish Treating ...

  13. Using the Vibrance Kegel Device With Pelvic Floor Muscle Exercise for Stress Urinary Incontinence: A Randomized Controlled Pilot Study.

    Science.gov (United States)

    Ong, Teng Aik; Khong, Su Yen; Ng, Keng Lim; Ting, Jesse Ron Swire; Kamal, Norlia; Yeoh, Wei Sien; Yap, Ning Yi; Razack, Azad Hassan

    2015-09-01

    To evaluate the effectiveness of pelvic floor muscle exercises (PFMEs) performed with the new biofeedback Vibrance Kegel Device (VKD), compared to PFMEs alone, in treating stress urinary incontinence (SUI). This was a pilot prospective, randomized trial of women aged ≥18 years with SUI symptoms who underwent PFMEs at University Malaya Medical Centre from October 2011 to October 2013. The patients were randomly divided into two groups: control (PFMEs alone) and VKD (PFMEs with VKD biofeedback). The patients underwent 16 weeks of pelvic floor training, during which they were assessed using Australian pelvic floor questionnaires and modified Oxford scales for pelvic floor muscle strength at week 0, 4, and 16. Forty patients were recruited (control 19, VKD 21). Three patients in the control group dropped out during week 16 training, whereas the VKD group had no dropouts. The VKD group reported significantly earlier improvement in SUI scores, as assessed by the Australian pelvic floor questionnaires (P = .035) at week 4. However, there was no significant difference between the groups' SUI scores at week 16. Pelvic floor muscle strength was significantly better in the VKD group at week 4 (P = .025) and week 16 (P = 0.001). The subjective cure rate was similar in both groups at week 16 (62.5% for control and 61.9% for VKD) (P = 0.742). Using the VKD resulted in significant early improvement in SUI scores, and pelvic muscle strength had improved significantly by the end of the study. The VKD proved useful as an adjunct for pelvic floor training. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  14. Dynamics of pelvic floor muscle functional parameters and their correlations with urinary incontinence in men after radical prostatectomy.

    Science.gov (United States)

    Zachovajevienė, Brigita; Šiupšinskas, Laimonas; Zachovajevas, Pavelas; Milonas, Daimantas

    2017-01-01

    To evaluate the dynamics of pelvic floor muscle strength, endurance, and urinary incontinence in a 6-month period in men after radical prostatectomy and to determine correlations between pelvic floor muscle strength, endurance, and urinary incontinence. Forty-two men with prostate cancer treated with radical prostatectomy participated in the study. Pelvic floor muscles parameters were evaluated using the anal perineometer. An 8-hour pad test was used with the catheter removed. The greatest change in strength occurred during the last 3 months, i.e., from the third to the sixth month following surgery (P ≤ 0.05). The average amount of urinary incontinence on the day of catheter removal was approximately 311 g per 8 hr. Urinary incontinence decreased by 93.6% from the day of catheter removal 6 months later. A strong correlation (P ≤ 0.001) of reverse dependence was determined between pelvic floor muscle strength before surgery and the amount of urinary incontinence 6 months following surgery. The greatest change of pelvic floor muscles strength and endurance occurred during the third to the sixth month following surgery. The greatest change in urinary incontinence occurred during the first month following surgery. Pelvic floor muscle strength causes a greater decrease in urinary incontinence than endurance. The greater the pelvic floor muscle strength before surgery, the lower the amount of urinary incontinence. Age also affects pelvic floor muscle strength and endurance; this relation gradually weakens and with age disappears. Neurourol. Urodynam. 36:126-131, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  15. Pelvic radiotherapy and sexual dysfunction in women

    DEFF Research Database (Denmark)

    Jensen, Pernille Tine; Froeding, Ligita Paskeviciute

    2015-01-01

    BACKGROUND: During the past decade there has been considerable progress in developing new radiation methods for cancer treatment. Pelvic radiotherapy constitutes the primary or (neo) adjuvant treatment of many pelvic cancers e.g., locally advanced cervical and rectal cancer. There is an increasing...... of life (QOL) issues; sexual functioning has proved to be one of the most important aspects of concern in long-term survivors. METHODS: An updated literature search in PubMed was performed on pelvic radiotherapy and female sexual functioning/dysfunction. Studies on gynaecological, urological...... and gastrointestinal cancers were included. The focus was on the period from 2010 to 2014, on studies using PROs, on potential randomized controlled trials (RCTs) where female sexual dysfunction (FSD) at least constituted a secondary outcome, and on studies reporting from modern radiotherapy modalities. RESULTS...

  16. 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.)

  17. 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.)

  18. 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...

  19. 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.)

  20. Immobilization for the radiation therapy treatment of the pelvic region

    Energy Technology Data Exchange (ETDEWEB)

    Van den Heuvel, F.; De Beukeleer, M.; Nys, F.; Bijdekerke, P.; Robberechts, M.; Van Cauwenbergh, R. [Brussels Univ. (Belgium). Dept. of Radiotherapy

    1995-12-01

    Previous experience with the treatment of the pelvic region has shown that geometric setup errors are considerable in extent and incidence. A proposal to alleviate this problem is the introduction of immobilization devices in analogy with head and neck treatment. The practicality and efficacy of such a technique is investigated and compared with an earlier proposed technique using interactive adjustment and Electronic Portal Imaging (EPI). A group of 13 patients treated in the pelvic region using external radiation therapy was immobilized using an Orfit-like cast. Every fraction for every patients was imaged using an EPID. Immediately after obtaining an image it was compared to a digitized simulation image using the in-house developed OPIDUM system. Patient position was adjusted when an error in one of the main directions (transversal or longitudinal) exceeded 5 mm. Time measurements were carried out in order to asses the impact of the immobilization procedure on the patient throughput. In 68% of the cases a corrective action was necessary. The fraction of total treatment time was 50% for 26% of the fields. The range of errors measured in the longitudinal direction was between 29 and -22 mm. In the transversal direction the range was from -7 to 60 mm. A full analysis 13 patients yielding statistics for more than 200 fields is presented. Special attention has been paid to the determination of the nature of the errors (random or systematic) and the impact on patient throughput.

  1. Immobilization for the radiation therapy treatment of the pelvic region

    International Nuclear Information System (INIS)

    Van den Heuvel, F.; De Beukeleer, M.; Nys, F.; Bijdekerke, P.; Robberechts, M.; Van Cauwenbergh, R.

    1995-01-01

    Previous experience with the treatment of the pelvic region has shown that geometric setup errors are considerable in extent and incidence. A proposal to alleviate this problem is the introduction of immobilization devices in analogy with head and neck treatment. The practicality and efficacy of such a technique is investigated and compared with an earlier proposed technique using interactive adjustment and Electronic Portal Imaging (EPI). A group of 13 patients treated in the pelvic region using external radiation therapy was immobilized using an Orfit-like cast. Every fraction for every patients was imaged using an EPID. Immediately after obtaining an image it was compared to a digitized simulation image using the in-house developed OPIDUM system. Patient position was adjusted when an error in one of the main directions (transversal or longitudinal) exceeded 5 mm. Time measurements were carried out in order to asses the impact of the immobilization procedure on the patient throughput. In 68% of the cases a corrective action was necessary. The fraction of total treatment time was 50% for 26% of the fields. The range of errors measured in the longitudinal direction was between 29 and -22 mm. In the transversal direction the range was from -7 to 60 mm. A full analysis 13 patients yielding statistics for more than 200 fields is presented. Special attention has been paid to the determination of the nature of the errors (random or systematic) and the impact on patient throughput

  2. Comparison of occipitocervical and atlantoaxial fusion in treatment of unstable Jefferson fractures.

    Science.gov (United States)

    Hu, Yong; Yuan, Zhen-Shan; Kepler, Christopher K; Dong, Wei-Xin; Sun, Xiao-Yang; Zhang, Jiao

    2017-01-01

    Controversy exists regarding the management of unstable Jefferson fractures, with some surgeons performing reduction and immobilization of the patient in a halo vest and others performing open reduction and internal fixation. This study compares the clinical and radiological outcome parameters between posterior atlantoaxial fusion (AAF) and occipitocervical fusion (OCF) constructs in the treatment of the unstable atlas fracture. 68 consecutive patients with unstable Jefferson fractures treated by AAF or OCF between October 2004 and March 2011 were included in this retrospective evaluation from institutional databases. The authors reviewed medical records and original images. The patients were divided into two surgical groups treated with either AAF ( n = 48, F/M 30:18) and OCF ( n = 20, F/M 13:7) fusion. Blood loss, operative time, Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, atlanto-dens interval, lateral mass displacement, complications, and the bone fusion rates were recorded. Five patients with incomplete paralysis (7.4%) demonstrated postoperative improvement by more than 1 grade on the American Spinal Injury Association impairment scale. The JOA score of the AAF group improved from 12.5 ± 3.6 preoperatively to 15.7 ± 2.3 postoperatively, while the JOA score of the OCF group improved from 11.2 ± 3.3 preoperatively to 14.8 ± 4.2 postoperatively. The VAS score of AAF group decreased from 4.8 ± 1.5 preoperatively to 1.0 ± 0.4 postoperatively, the VAS score of the OCF group decreased from 5.4 ± 2.2 preoperatively to 1.3 ± 0.9 postoperatively. The OCF or AAF combined with short-term external immobilization can establish the upper cervical stability and prevent further spinal cord injury and nerve function damage.

  3. Comparison of occipitocervical and atlantoaxial fusion in treatment of unstable Jefferson fractures

    Directory of Open Access Journals (Sweden)

    Yong Hu

    2017-01-01

    Full Text Available Background: Controversy exists regarding the management of unstable Jefferson fractures, with some surgeons performing reduction and immobilization of the patient in a halo vest and others performing open reduction and internal fixation. This study compares the clinical and radiological outcome parameters between posterior atlantoaxial fusion (AAF and occipitocervical fusion (OCF constructs in the treatment of the unstable atlas fracture. Materials and Methods: 68 consecutive patients with unstable Jefferson fractures treated by AAF or OCF between October 2004 and March 2011 were included in this retrospective evaluation from institutional databases. The authors reviewed medical records and original images. The patients were divided into two surgical groups treated with either AAF ( n = 48, F/M 30:18 and OCF ( n = 20, F/M 13:7 fusion. Blood loss, operative time, Japanese Orthopaedic Association (JOA score, visual analog scale (VAS score, atlanto-dens interval, lateral mass displacement, complications, and the bone fusion rates were recorded. Results: Five patients with incomplete paralysis (7.4% demonstrated postoperative improvement by more than 1 grade on the American Spinal Injury Association impairment scale. The JOA score of the AAF group improved from 12.5 ± 3.6 preoperatively to 15.7 ± 2.3 postoperatively, while the JOA score of the OCF group improved from 11.2 ± 3.3 preoperatively to 14.8 ± 4.2 postoperatively. The VAS score of AAF group decreased from 4.8 ± 1.5 preoperatively to 1.0 ± 0.4 postoperatively, the VAS score of the OCF group decreased from 5.4 ± 2.2 preoperatively to 1.3 ± 0.9 postoperatively. Conclusions: The OCF or AAF combined with short-term external immobilization can establish the upper cervical stability and prevent further spinal cord injury and nerve function damage.

  4. Maternal pelvic dimensions and neonatal size

    Science.gov (United States)

    Figueiroa, José N; Alves, Joao G

    2017-01-01

    Abstract Patterns of fetal growth predict non-communicable disease risk in adult life, but fetal growth variability appears to have a relatively weak association with maternal nutritional dynamics during pregnancy. This challenges the interpretation of fetal growth variability as ‘adaptation’. We hypothesized that associations of maternal size and nutritional status with neonatal size are mediated by the dimensions of the maternal pelvis. We analysed data on maternal height, body mass index (BMI) and pelvic dimensions (conjugate, inter-spinous and inter-cristal diameters) and neonatal gestational age, weight, length, thorax girth and head girth (n = 224). Multiple regression analysis was used to identify independent maternal predictors of neonatal size, and the mediating role of neonatal head girth in these associations. Pelvic dimensions displaced maternal BMI as a predictor of birth weight, explaining 11.6% of the variance. Maternal conjugate and inter-spinous diameters predicted neonatal length, thorax girth and head girth, whereas inter-cristal diameter only predicted neonatal length. Associations of pelvic dimensions with birth length, but not birth weight, were mediated by neonatal head girth. Pelvic dimensions predicted neonatal size better than maternal BMI, and these associations were mostly independent of maternal height. Sensitivity of fetal growth to pelvic dimensions reduces the risk of cephalo-pelvic disproportion, potentially a strong selective pressure during secular trends in height. Selection on fetal adaptation to relatively inflexible components of maternal phenotype, rather than directly to external ecological conditions, may help explain high levels of growth plasticity during late fetal life and early infancy. PMID:29423225

  5. 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.

  6. Clinical Presentation of Pelvic Tuberculosis Imitating Ovarian Malignancy

    Directory of Open Access Journals (Sweden)

    Yun-Ju Huang

    2004-03-01

    Conclusion: Pelvic tuberculosis should be taken into account, especially in premenopausal women who manifest with massive ascites and adnexal tumors. Tumor markers such as CA-125 give limited information for the differential diagnosis of pelvic tuberculosis and ovarian carcinoma. We suggest exploratory laparotomy and intraoperative frozen pathology for the diagnosis of pelvic tuberculosis. New insight needs to be applied to tuberculosis.

  7. An approach to constipation associated with pelvic floor dysfunction ...

    African Journals Online (AJOL)

    An approach to constipation associated with pelvic floor dysfunction. ... A detailed history and physical examination is necessary. Tests of colonic and pelvic floor function help distinguish constipation ... A small group of patients, refractory to medical therapy should be considered for surgery. Should test results show pelvic ...

  8. Prophylactic Antibiotics Use at IUCD Insertion and Pelvic Infection in ...

    African Journals Online (AJOL)

    Only one had positive preinsertion swab for Chlamydia, and only one client had clinical pelvic inflammatory disease (PID) with negative swab. Conclusion: Pelvic infection with Chlamydia isolation was not common amongst new IUCD insertions to warrant routine antibiotic prophylaxis in Brook Jersey. All cases of pelvic ...

  9. 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

  10. 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.

  11. 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.

  12. PHYSICAL ACTIVITY AND THE PELVIC FLOOR

    Science.gov (United States)

    Nygaard, Ingrid E.; Shaw, Janet M.

    2015-01-01

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

  13. 2D versus 3D fluoroscopy-based navigation in posterior pelvic fixation: review of the literature on current technology.

    Science.gov (United States)

    Thakkar, Savyasachi C; Thakkar, Rashmi S; Sirisreetreerux, Norachart; Carrino, John A; Shafiq, Babar; Hasenboehler, Erik A

    2017-01-01

    Percutaneous sacroiliac (SI) fixation of unstable posterior pelvic ring injuries is a widely accepted procedure. The complex sacral anatomy with narrow osseous corridors for SI screw placement makes this procedure technically challenging. Techniques are constantly evolving as a result of better understanding of the posterior pelvic anatomy. Recently developed tools include fluoroscopy-based computer-assisted navigation, which can be two-dimensional (2D) or three-dimensional (3D). Our goal is to determine the relevant technical considerations and clinical outcomes associated with these modalities by reviewing the published research. We hypothesize that 3D fluoroscopy-based navigation is safer and superior to its 2D predecessor with respect to lower radiation dose and more accurate SI screw placement. We searched four medical databases to identify English-language studies of 2D and 3D fluoroscopy-based navigation from January 1990 through August 2015. We included articles reporting imaging techniques and outcomes of closed posterior pelvic ring fixation with percutaneous SI screw fixation. Injuries included in the study were sacral fractures (52 patients), sacroiliac fractures (88 patients), lateral compression fractures (20 patients), and anteroposterior compression type pelvic fractures (8 patients). We excluded articles on open reduction of posterior pelvic ring injuries and solely anatomic studies. We then reviewed these studies for technical considerations and outcomes associated with these technologies. Six studies were included in our analysis. Results of these studies indicate that 3D fluoroscopy-based navigation is associated with a lower radiation dose and lower rate of screw malpositioning compared with 2D fluoroscopy-based systems. It may be advantageous to combine modern imaging modalities such as 3D fluoroscopy with computer-assisted navigation for percutaneous screw fixation in the posterior pelvis.

  14. Wear Behavior of an Unstable Knee: Stabilization via Implant Design?

    Directory of Open Access Journals (Sweden)

    Jörn Reinders

    2014-01-01

    Full Text Available Background. Wear-related failures and instabilities are frequent failure mechanisms of total knee replacements. High-conforming designs may provide additional stability for the joint. This study analyzes the effects of a ligamentous insufficiency on the stability and the wear behavior of a high-conforming knee design. Methods. Two simulator wear tests were performed on a high-conforming total knee replacement design. In the first, a ligamentous-stable knee replacement with a sacrificed anterior cruciate ligament was simulated. In the second, a ligamentous-unstable knee with additionally insufficient posterior cruciate ligament and medial collateral ligament was simulated. Wear was determined gravimetrically and wear particles were analyzed. Implant kinematics was recorded during simulation. Results. Significantly higher wear rates (P≤0.001 were observed for the unstable knee (14.58±0.56 mg/106 cycles compared to the stable knee (7.97 ± 0.87 mg/106 cycles. A higher number of wear particles with only small differences in wear particle characteristics were observed. Under unstable knee conditions, kinematics increased significantly for translations and rotations (P≤0.01. This increase was mainly attributed to higher tibial posterior translation and internal rotations. Conclusion. Higher kinematics under unstable test conditions is a result of insufficient stabilization via implant design. Due to the higher kinematics, increased wear was observed in this study.

  15. Unstable oscillatory Pierce modes of neutralized electron beams

    International Nuclear Information System (INIS)

    Cary, J.R.; Lemons, D.S.

    1982-01-01

    Oscillatory modes of the Pierce system have been calculated. These modes are found to have growth rates comparable to the previously investigated purely growing modes. When these modes are included, it is found that the Pierce system is unstable for most values of ω/sub p/ L/V 0 >π

  16. Control of an under activated unstable nonlinear object

    DEFF Research Database (Denmark)

    Andersen, Nils Axel; Skovgaard, L.; Ravn, Ole

    2001-01-01

    This paper presents a comprehensive comparative study of several nonlinear controllers for stabilisation of the under actuated unstable nonlinear object known as the Acrobot in the literature. The object is a two DOF robot arm only actuated at the elbow. The study compares several control...

  17. Characterization of Unstable Rock Slopes Through Passive Seismic Measurements

    Science.gov (United States)

    Kleinbrod, U.; Burjanek, J.; Fäh, D.

    2014-12-01

    Catastrophic rock slope failures have high social impact, causing significant damage to infrastructure and many casualties throughout the world each year. Both detection and characterization of rock instabilities are therefore of key importance. An analysis of ambient vibrations of unstable rock slopes might be a new alternative to the already existing methods, e.g. geotechnical displacement measurements. Systematic measurements have been performed recently in Switzerland to study the seismic response of potential rockslides concerning a broad class of slope failure mechanisms and material conditions. Small aperture seismic arrays were deployed at sites of interest for a short period of time (several hours) in order to record ambient vibrations. Each measurement setup included a reference station, which was installed on a stable part close to the instability. Recorded ground motion is highly directional in the unstable parts of the rock slope, and significantly amplified with respect to stable areas. These effects are strongest at certain frequencies, which were identified as eigenfrequencies of the unstable rock mass. In most cases the directions of maximum amplification are perpendicular to open cracks and in good agreement with the deformation directions obtained by geodetic measurements. Such unique signatures might improve our understanding of slope structure and stability. Thus we link observed vibration characteristics with available results of detailed geological characterization. This is supported by numerical modeling of seismic wave propagation in fractured media with complex topography.For example, a potential relation between eigenfrequencies and unstable rock mass volume is investigated.

  18. Coronary angioplasty early after diagnosis of unstable angina

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); H. Suryapranata (Harry); K.J. Beatt (Kevin); M.J.B.M. van den Brand (Marcel)

    1987-01-01

    textabstractCoronary angioplasty (PTCA) was performed early after diagnosis of unstable angina in 71 patients who responded favorably with initial pharmacologic treatment and who also had persistent exertional angina. The patients selected for PTCA had predominantly single-vessel disease and a

  19. The effect of nonlinearity on unstable zones of Mathieu equation

    Indian Academy of Sciences (India)

    Mathieu equation is a well-known ordinary differential equation in which the excitation term appears as the non-constant coefficient. The mathematical modelling of many dynamic systems leads to Mathieu equation. The determination of the locus of unstable zone is important for the control of dynamic systems. In this paper ...

  20. Function-preserving reduction and fixation of unstable Jefferson fractures using a C1 posterior limited construct.

    Science.gov (United States)

    Hu, Yong; Xu, Rong-Ming; Albert, Todd J; Vaccoro, Alexander R; Zhao, Hong-Yong; Ma, Wei-Hu; Gu, Yong-Jie; Yuan, Zhen-Shan

    2014-08-01

    This is a retrospective, clinical, and radiologic study of posterior reduction and fusion of the C1 arch in the treatment of unstable Jefferson fractures. The aim of the study was to describe a new motion-preserving surgical technique in the treatment of unstable Jefferson fracture. The management of unstable Jefferson fractures remains controversial. The majority of C1 fractures can be effectively treated nonoperatively with external immobilization unless there is an injury to the transverse atlantal ligament (TAL). Conservative treatment usually involves immobilization for a long time in Halo vest, whereas surgical intervention generally involves C1-C2 fusion, eliminating the range of motion of the upper cervical spine. We propose a novel method for the treatment of unstable Jefferson fractures without restricting the range of motion. A retrospective review of 12 patients with unstable C1 fractures between April 2008 and October 2011 was performed. They were treated by inserting bilateral posterior C1 pedicle screws or lateral mass screws interconnected by a transversal rod to achieve internal fixation. There were 8 men and 4 women, with an average age of 35.6 years (range, 20-60 y). Presenting symptoms included neck pain, stiffness, and decreased range of motion but none had neurological injury. Seven patients had bilateral posterior arch fractures associated with unilateral anterior arch fractures (posterior 3/4 Jefferson fracture, Landells type II), and 5 had unilateral anterior and posterior arch fractures (half-ring Jefferson fracture, Landells type II). Seven patients had intact TAL, and 5 patients had fractures and avulsion of the attachment of TAL (Dickman type II). A total of 24 screws were inserted. Five cases had screws placed in the lateral mass: 3 because of posterior arch breakage, and 2 because the height of the posterior arch at the entry point was Jefferson fractures, which allows preservation of the function of the craniocervical junction

  1. Chronic pelvic pain syndrome: reduction of medication use after pelvic floor physical therapy with an internal myofascial trigger point wand.

    Science.gov (United States)

    Anderson, Rodney U; Harvey, Richard H; Wise, David; Nevin Smith, J; Nathanson, Brian H; Sawyer, Tim

    2015-03-01

    This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1-10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes in medication use were at the patient's discretion. Changes in medication use were assessed by McNemar's test in both complete case and modified intention to treat (mITT) analyses. 374 out of 396 patients met inclusion criteria; 79.7 % were male, median age of 43 years and median symptom duration of 5 years. In the complete case analysis, the percent of patients using medications at baseline was 63.6 %. After 6 months of treatment the percentage was 40.1 %, a 36.9 % reduction (p < 0.001). In the mITT analysis, there was a 22.7 % overall reduction from baseline (p < 0.001). Medication cessation at 6 months was significantly associated with a reduction in total symptoms (p = 0.03).

  2. 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

  3. Is the timing of surgery associated with avascular necrosis after unstable slipped capital femoral epiphysis? A multicenter study.

    Science.gov (United States)

    Kohno, Yusuke; Nakashima, Yasuharu; Kitano, Toshio; Irie, Taichi; Kita, Atsushi; Nakamura, Tomoyuki; Endo, Hirosuke; Fujii, Yosuke; Kuroda, Takayuki; Mitani, Shigeru; Kitoh, Hiroshi; Matsushita, Masaki; Hattori, Tadashi; Iwata, Koji; Iwamoto, Yukihide

    2017-01-01

    An unstable slipped capital femoral epiphysis (SCFE) is associated with a high rate of avascular necrosis (AVN). The etiology of AVN seems to be multifactorial, although it is not thoroughly known. The aims of our study were to determine the rate of AVN after an unstable SCFE and to investigate the risk factors for AVN, specifically evaluating the notion of an "unsafe window", during which medical interventions would increase the risk for AVN. This retrospective multicenter study included 60 patients with an unstable SCFE diagnosed between 1985 and 2014. Timing of surgery was evaluated for three time periods, from acute onset of symptoms to surgery: period I, 7 days. Multivariate logistic regression analysis was used to identify risk factors for AVN. Closed reduction and pinning was performed in 43 patients and in situ pinning in 17. Among these cases, 16 patients (27%) developed AVN. The rate of AVN was significantly higher in patients treated by closed reduction and pinning (15/43, 35%) than in those treated by in situ pinning (1/17, 5.9%) (p = 0.022). In patients treated by closed reduction and pinning, the incidence of AVN was 2/11 (18%) in period I, 10/13 (77%) in period II and 3/15 (20%) in period III, showing the significantly higher rate in period II (p = 0.002). The surgery provided in period II was identified as an independent risk factor for the development of AVN. Our rate of AVN was 27% using two classical treatment methods. Time-to-surgery, between 24 h and 7 days, was independently associated with AVN, supporting the possible existence of an "unsafe window" in patients with unstable SCFE treated by closed reduction and pinning. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  4. A novel approach to modeling unstable EOR displacements. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Peters, E.J.

    1994-04-01

    Most enhanced oil recovery schemes involve the displacement of a more dense and more viscous oil by a less dense and less viscous fluid in a heterogeneous porous medium. The interaction of heterogeneity with the several competing forces, namely, viscous, capillary, gravitational, and dispersive forces, can conspire to make the displacements unstable and difficult to model and to predict. The objective of this research was to develop a systematic methodology for modeling unstable fluid displacements in heterogeneous media. Flow visualization experiments were conducted using X-ray computed tomography imaging and a video imaging workstation to gain insights into the dynamics of unstable displacements, acquire detailed quantitative experimental image data for calibrating numerical models of unstable displacements, and image and characterize heterogeneities in laboratory cores geostatistically. High-resolution numerical models modified for use on vector-architecture supercomputers were used to replicate the image data. Geostatistical models of reservoir heterogeneity were incorporated in order to study the interaction of hydrodynamic instability and heterogeneity in reservoir displacements. Finally, a systematic methodology for matching the experimental data with the numerical models and scaling the laboratory results to other systems were developed. The result is a new method for predicting the performance of unstable EOR displacements in the field based on small-scale displacements in the laboratory. The methodology is general and can be applied to forecast the performance of most processes that involve fluid flow and transport in porous media. Therefore, this research should be of interest to those involved in forecasting the performance of enhanced oil recovery processes and the spreading of contaminants in heterogeneous aquifers.

  5. Dose-Effect Relationships for Individual Pelvic Floor Muscles and Anorectal Complaints After Prostate Radiotherapy

    International Nuclear Information System (INIS)

    Smeenk, Robert Jan; Hoffmann, Aswin L.; Hopman, Wim P.M.; Lin, Emile N.J. Th. van; Kaanders, Johannes H.A.M.

    2012-01-01

    Purpose: To delineate the individual pelvic floor muscles considered to be involved in anorectal toxicity and to investigate dose-effect relationships for fecal incontinence-related complaints after prostate radiotherapy (RT). Methods and Materials: In 48 patients treated for localized prostate cancer, the internal anal sphincter (IAS) muscle, the external anal sphincter (EAS) muscle, the puborectalis muscle (PRM), and the levator ani muscles (LAM) in addition to the anal wall (Awall) and rectal wall (Rwall) were retrospectively delineated on planning computed tomography scans. Dose parameters were obtained and compared between patients with and without fecal urgency, incontinence, and frequency. Dose-effect curves were constructed. Finally, the effect of an endorectal balloon, which was applied in 28 patients, was investigated. Results: The total volume of the pelvic floor muscles together was about three times that of the Awall. The PRM was exposed to the highest RT dose, whereas the EAS received the lowest dose. Several anal and rectal dose parameters, as well as doses to all separate pelvic floor muscles, were associated with urgency, while incontinence was associated mainly with doses to the EAS and PRM. Based on the dose-effect curves, the following constraints regarding mean doses could be deduced to reduce the risk of urgency: ≤30 Gy to the IAS; ≤10 Gy to the EAS; ≤50 Gy to the PRM; and ≤40 Gy to the LAM. No dose-effect relationships for frequency were observed. Patients treated with an endorectal balloon reported significantly less urgency and incontinence, while their treatment plans showed significantly lower doses to the Awall, Rwall, and all pelvic floor muscles. Conclusions: Incontinence-related complaints show specific dose-effect relationships to individual pelvic floor muscles. Dose constraints for each muscle can be identified for RT planning. When only the Awall is delineated, substantial components of the continence apparatus are

  6. Dose-Effect Relationships for Individual Pelvic Floor Muscles and Anorectal Complaints After Prostate Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Smeenk, Robert Jan, E-mail: r.smeenk@rther.umcn.nl [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Hoffmann, Aswin L. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Hopman, Wim P.M. [Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Lin, Emile N.J. Th. van; Kaanders, Johannes H.A.M. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)

    2012-06-01

    Purpose: To delineate the individual pelvic floor muscles considered to be involved in anorectal toxicity and to investigate dose-effect relationships for fecal incontinence-related complaints after prostate radiotherapy (RT). Methods and Materials: In 48 patients treated for localized prostate cancer, the internal anal sphincter (IAS) muscle, the external anal sphincter (EAS) muscle, the puborectalis muscle (PRM), and the levator ani muscles (LAM) in addition to the anal wall (Awall) and rectal wall (Rwall) were retrospectively delineated on planning computed tomography scans. Dose parameters were obtained and compared between patients with and without fecal urgency, incontinence, and frequency. Dose-effect curves were constructed. Finally, the effect of an endorectal balloon, which was applied in 28 patients, was investigated. Results: The total volume of the pelvic floor muscles together was about three times that of the Awall. The PRM was exposed to the highest RT dose, whereas the EAS received the lowest dose. Several anal and rectal dose parameters, as well as doses to all separate pelvic floor muscles, were associated with urgency, while incontinence was associated mainly with doses to the EAS and PRM. Based on the dose-effect curves, the following constraints regarding mean doses could be deduced to reduce the risk of urgency: {<=}30 Gy to the IAS; {<=}10 Gy to the EAS; {<=}50 Gy to the PRM; and {<=}40 Gy to the LAM. No dose-effect relationships for frequency were observed. Patients treated with an endorectal balloon reported significantly less urgency and incontinence, while their treatment plans showed significantly lower doses to the Awall, Rwall, and all pelvic floor muscles. Conclusions: Incontinence-related complaints show specific dose-effect relationships to individual pelvic floor muscles. Dose constraints for each muscle can be identified for RT planning. When only the Awall is delineated, substantial components of the continence apparatus are

  7. A quality control study of the accuracy of patient positioning in irradiation of pelvic fields

    International Nuclear Information System (INIS)

    Creutzberg, Carien L.; Althof, Vincent G.M.; Hoog, Marjan de; Visser, Andries G.; Huizenga, Henk; Wijnmaalen, Arendjan; Levendag, Peter C.

    1996-01-01

    Purpose: Determining and improving the accuracy of patient positioning in pelvic fields. Methods and Materials: Small pelvic fields were studied in 16 patients treated for urological cancers using a three-field isocentric technique. Large pelvic fields were studied in 17 gynecological cancer patients treated with anterior and posterior (AP-PA) parallel opposed fields. Quantitative analysis of 645 megavolt images and comparison to 82 simulation images were carried out. Results: Small pelvic fields: for the position of the patient in the field, standard deviations of the difference between simulation (SIM) and treatment (MV) images were 3.4 mm in the lateral direction, 5.3 mm in the cranio-caudal direction, and 4.8 mm in the ventro-dorsal direction. Alterations in the positioning technique were made and tested. Large pelvic fields: differences between simulation and treatment images for the position of the patient in the field were 4 mm [1 standard deviation (SD)] in the lateral direction and 6.5 mm in the cranio-caudal direction. A systematic shift of the treatment field in the cranial direction had occurred in the majority of patients. A positioning technique using laser lines and marking of the caudal field border was shown to be more accurate. Conclusion: Studies of positioning accuracy in routine irradiation techniques are needed to obtain data for definition of the margins for each treatment site at each institution. Random variations should be kept at a minimum by monitoring and improving positioning techniques. Treatment verification by megavolt imaging or film should be used to detect and correct systematic variations early in the treatment series

  8. The early detection and management of unstable concentric closed reduction of DDH with percutaneous K-wire fixation in infants 6 to 12 months of age.

    Science.gov (United States)

    Alsiddiky, Abdul Monem Mohamed; Bakarman, Khalid Abdulla; Alzain, Kholoud Omar; Aljassir, Fawzi Fahad; Al-Ahaideb, Abdulaziz Suliman; Kremli, Mamoun Khalid; Zamzam, Mohammed Medhat; Mervyn Letts, Robert

    2012-01-01

    In some infants with developmental dysplasia of the hip, concentric closed reduction, although initially achievable, cannot be maintained even by casting because of a deficient posterior acetabular wall. Usually, these hips will redislocate in the cast and a rereduction will be necessary, often requiring an open reduction subsequently. A 3-year retrospective review of 88 infants, (M/F; 14/74) 6 to 12 months of age with 124 dislocated hips, was conducted to assess the efficacy of percutaneous Kirschner wire fixation in achieving permanent hip stability. A "hip-at-risk" instability test was developed to detect potentially unstable hips at the time of closed reduction that might redislocate in the hip spica cast, and these hips were stabilized with a percutaneous K-wire through the greater trochanter into the pelvic bone. The hip instability test was positive in 27 hips and negative in 97. Percutaneous K-wire fixation was used to stabilize 21 hips with a positive hip instability test. All 21 unstable hips that were stabilized with the K-wire technique maintained their concentric reduction and went on to stable development. No K-wire breakage was encountered and only 1 superficial pin tract infection occurred. K-wire stabilization of unstable closed reductions is a safe, reliable technique for maintaining concentric hip reduction in infants 6 to 12 months of age with developmental dislocation of the hips. Level II retrospective study.

  9. Pelvic floor reconstruction by modified rectus abdominis myoperitoneal (MRAM) flap after pelvic exenterations.

    Science.gov (United States)

    Cibula, D; Zikan, M; Fischerova, D; Kocian, R; Germanova, A; Burgetova, A; Dusek, L; Fartáková, Z; Schneiderová, M; Nemejcová, K; Slama, J

    2017-03-01

    To describe the technique and report experiences with pelvic floor reconstruction by modified rectus abdominis myoperitoneal (MRAM) flap after extensive pelvic procedures. Surgical technique of MRAM harvest and transposition is carefully described. The patients in whom pelvic floor reconstruction with MRAM after either infralevator pelvic exenteration and/or extended lateral pelvic sidewall excision was carried out were enrolled into the study (MRAM group, n=16). Surgical data, post-operative morbidity, and disease status were retrospectively assessed. The results were compared with a historical cohort of patients, in whom an exenterative procedure without pelvic floor reconstruction was performed at the same institution (control group, n=24). Both groups were balanced in age, BMI, tumor types, and previous treatment. Substantially less patients from the MRAM group required reoperation within 60days of the surgery (25% vs. 50%) which was due to much lower rate of complications potentially related to empty pelvis syndrome (1 vs. 7 reoperations) (p=0.114). Late post-operative complication rate was substantially lower in the MRAM group (any grade: 79% vs. 44%; grade≥3: 37% vs. 6%) (p=0.041). The performance status 6months after the surgery was ≤1 in the majority of patients in MRAM (81%) while in only 38% of patients from the control group (p=0.027). There was one incisional hernia in MRAM group while three cases were reported in the controls. Pelvic floor reconstruction by MRAM in patients after pelvic exenterative procedures is associated with a substantial decrease in postoperative complications that are potentially related to empty pelvis syndrome. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Triathlete Risk of Pelvic Floor Disorders, Pelvic Girdle Pain, and Female Athlete Triad.

    Science.gov (United States)

    Yi, Johnny; Tenfelde, Sandi; Tell, Dina; Brincat, Cynthia; Fitzgerald, Colleen

    2016-01-01

    Our primary objective was to describe the prevalence of pelvic floor disorders (PFDs), pelvic girdle pain (PGP), and the female athlete triad (disordered eating, menstrual irregularities, and osteoporosis) in a female triathlete population. We also evaluated for an association between these conditions. We administered an online survey to women who self-identified as female triathletes. Using validated questionnaires, Epidemiology of Prolapse and Incontinence Questionnaire and Pelvic Girdle Questionnaire, along with the female athlete triad questionnaire, we identified the prevalence of PFDs, PGP, and female athlete triad in this specific population. Demographic and exercise intensity were also queried to characterize these female triathletes. Three hundred eleven female triathletes responded to the Internet survey. There was a significant prevalence of PFDs with stress urinary incontinence and anal incontinence symptoms being most common (37.4% and 28%, respectively). Urgency urinary incontinence and pelvic organ prolapse were less common (16% and 5%, respectively). Stress urinary incontinence and pelvic organ prolapse were more common in parous triathletes (P = 0.001, P = 0.05). Pelvic girdle pain was noted in 18% of these triathletes but was not disabling. Twenty-four percent of participants screened positive for at least 1 arm of the female athlete triad. No association was found between the female athlete triad and PFDs. Pelvic floor disorders are common and bothersome in female triathletes. Pelvic girdle pain, while present, does not limit these athletes from their training. These female triathletes may be at risk for the female athlete triad. Female triathletes may be at risk for both metabolic and PFDs and should be screened when identified.

  11. Effectiveness of Dual-Maneuver Using K-Wire and Dingman Elevator for the Reduction of Unstable Zygomatic Arch Fracture.

    Science.gov (United States)

    Yoon, Hyungwoo; Kim, Jiye; Chung, Seum; Chung, Yoon-Kyu

    2014-08-01

    The zygoma is the most prominent portion of the face. Almost all simple zygomatic arch fractures are treated in a closed fashion with a Dingman elevator. However, the open approach should be considered for unstable zygomatic arch fractures. The coronal approach for a zygomatic arch fracture has complications. In this study, we introduce our method to reduce a special type of unstable zygomatic fracture. We retrospectively reviewed zygomatic arch view and facial bone computed tomography scans of 424 patients who visited the Wonju Severance Christian Hospital from 2007 to 2010 with zygomaticomaxillary fractures, among whom 15 patients met the inclusion criteria. We used a Dingman elevator and K-wire simultaneously to manage this type of zygomatic arch fracture. Simple medial rotation force usually collapses the posterior fractured segment, and the fracture becomes unstable. Thus, the posterior fracture segment must be concurrently elevated with a Dingman elevator through Keen's approach with rotation force applied through the K-wire. All fractures were reduced without any instability using this method. We were able to reduce unstable and difficult zygomatic arch fractures without an open incision or any external fixation device.

  12. Pelvic floor electrophysiology patterns associated with faecal ...

    African Journals Online (AJOL)

    Hussein Al-Moghazy Sultan

    2012-12-28

    Dec 28, 2012 ... a Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, University of Alexandria, Egypt ... Aim: The present study was conducted to determine the patterns of pelvic floor electrophysiology that are associated ..... decision of the appropriate therapy whether conservative or.

  13. Sexual selection targets cetacean pelvic bones.

    Science.gov (United States)

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

    2014-11-01

    Male genitalia evolve rapidly, probably as a result of sexual selection. Whether this pattern extends to the internal infrastructure that influences genital movements remains unknown. Cetaceans (whales and dolphins) offer a unique opportunity to test this hypothesis: since evolving from land-dwelling ancestors, they lost external hind limbs and evolved a highly reduced pelvis that seems to serve no other function except to anchor muscles that maneuver the penis. Here, we create a novel morphometric pipeline to analyze the size and shape evolution of pelvic bones from 130 individuals (29 species) in the context of inferred mating system. We present two main findings: (1) males from species with relatively intense sexual selection (inferred by relative testes size) tend to evolve larger penises and pelvic bones compared to their body length, and (2) pelvic bone shape has diverged more in species pairs that have diverged in inferred mating system. Neither pattern was observed in the anterior-most pair of vertebral ribs, which served as a negative control. This study provides evidence that sexual selection can affect internal anatomy that controls male genitalia. These important functions may explain why cetacean pelvic bones have not been lost through evolutionary time. © 2014 The Author(s). Evolution © 2014 The Society for the Study of Evolution.

  14. CASE REPORT CAS Transcolonic pelvic abscess drainage

    African Journals Online (AJOL)

    Although there are a number of reports of successful drainage of deep pelvic collections using transrectal, transvaginal, transgluteal and other routes,1,2 some collections remain difficult to access. An elderly female patient with renal failure presented with features of sepsis following a partial sigmoid colectomy for ...

  15. EAU Guidelines on Chronic Pelvic Pain

    NARCIS (Netherlands)

    Fall, Magnus; Baranowski, Andrew P.; Elneil, Sohier; Engeler, Daniel; Hughes, John; Messelink, Embert J.; Oberpenning, Frank; Williams, Amanda C. de C.

    Context: These guidelines were prepared on behalf of the European Association of Urology (EAU) to help urologists assess the evidence-based management of chronic pelvic pain (CPP) and to incorporate the recommendations into their clinical practice. Objective: To revise guidelines for the diagnosis,

  16. Epidemiology and outcome of complex pelvic injury

    DEFF Research Database (Denmark)

    Schmal, Hagen; Markmiller, Max; Mehlhorn, Alexander T

    2005-01-01

    center were analysed for associated intrapelvic injuries, classification, severity of trauma, type of intervention and outcome. Of 552 patients with a pelvic fracture who entered the study, 15.5% presented with associated intrapelvic injuries secondary to the fracture (group I). A subgroup of patients...

  17. 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

  18. [Treatment of pelvic Ewing's sarcoma in children and the effect on the skeletal growth and development].

    Science.gov (United States)

    Fu, Jun; Guo, Zheng; Wang, Zhen; Li, Xiang-dong; Li, Jing; Chen, Guo-jing; Wu, Zhi-gang

    2012-12-01

    To explore the effect of neo-adjuvant chemotherapy and computer-assisted surgery on children and adolescents with primary pelvic Ewing's sarcoma, and assess the therapeutic effect on the pelvic skeletal growth and development. This is a retrospective analysis of 10 children with primary pelvic Ewing's sarcoma treated between Jan 2001 and Oct 2010 at the Department of Oncologic Orthopaedics at Xijing Hospital. There were 3 girls and 7 boys in the age of 7 to 16 years (average 12.7 years). All patients were pathologically diagnosed as Ewing's sarcoma. There were two cases in the sacroiliac joint, one in the ilium, one in the pubic bone, and 6 cases in peri-acetabular area including 5 below the triradiate cartilage and one above the triradiate cartilage, without cartilage invasion. All patients underwent neo-adjuvant chemotherapy, resection and reconstruction surgery and postoperative chemotherapy. CDP, ADM and IFO regimen chemotherapy were given as the main treatment. Five cases were treated by traditional resection and reconstruction, and after 2008, five cases were treated by computer-assisted surgery. During the reconstruction, the hip rotation center was put at a depressed location. All of the 10 cases underwent postoperative radiotherapy in a dose of 45-55 Gy. All patients were followed-up for 12-72 months (mean: 37.8 months). One child had tumor recurrence and lung metastasis and 9 patients had no evidence of disease (NED). After neo-adjuvant chemotherapy, the oncologic statuses (RECIST) were: 1 CR, 8 PR and 1 SD. The functional recoveries after surgery (Enneking's) were: 4 cases excellent, 4 good, 1 fair and 1 poor. Five cases who underwent computer-assisted surgery achieved a good reconstruction without local recurrence. There were no effects on skeletal growth in 8 cases. An unbalanced hip rotational center occurred in one case, and a compemsatory scoliosis was found in another case. There were no serious complications in all patients. The comprehensive

  19. Chronic female pelvic pain--part 1: clinical pathoanatomy and examination of the pelvic region.

    Science.gov (United States)

    Apte, Gail; Nelson, Patricia; Brismée, Jean-Michel; Dedrick, Gregory; Justiz, Rafael; Sizer, Phillip S

    2012-02-01

    Chronic pelvic pain is defined as the presence of pain in the pelvic girdle region for over a 6-month period and can arise from the gynecologic, urologic, gastrointestinal, and musculoskeletal systems. As 15% of women experience pelvic pain at some time in their lives with yearly direct medical costs estimated at $2.8 billion, effective evaluation and management strategies of this condition are necessary. This merits a thorough discussion of a systematic approach to the evaluation of chronic pelvic pain conditions, including a careful history-taking and clinical examination. The challenge of accurately diagnosing chronic pelvic pain resides in the degree of peripheral and central sensitization of the nervous system associated with the chronicity of the symptoms, as well as the potential influence of the affective and biopsychosocial factors on symptom development as persistence. Once the musculoskeletal origin of the symptoms is identified, a clinical examination schema that is based on the location of primary onset of symptoms (lumbosacral, coccygeal, sacroiliac, pelvic floor, groin or abdominal region) can be followed to establish a basis for managing the specific pain generator(s) and manage tissue dysfunction. © 2011 The Authors. Pain Practice © 2011 World Institute of Pain.

  20. Management of severe periacetabular bone loss combined with pelvic discontinuity in revision hip arthroplasty.

    Science.gov (United States)

    Friedrich, Max J; Schmolders, Jan; Michel, Robert D; Randau, Thomas M; Wimmer, Matthias D; Kohlhof, Hendrik; Wirtz, Dieter C; Gravius, Sascha

    2014-12-01

    Revision of failed total hip arthroplasty with massive acetabular bone loss resulting in pelvic discontinuity represents a rare but challenging problem. The objective of this study was to present short to mid-term results of revision total hip arthroplasty with a custom-made acetabular implant in a consecutive series of patients with pelvic discontinuity. We retrospectively reviewed 18 consecutive patients with massive acetabular bone loss (Paprosky Type 3B) resulting in pelvic discontinuity reconstructed with revision total hip arthroplasty using a custom-made acetabular component. The prosthesis was created on the basis of a thin-cut 1-mm computed tomography (CT) scan of the pelvis. Initial stability of the implant was obtained by screw fixation. Harris hip score and sequential radiographs were used to evaluate the clinical and radiographic results. At an average follow up of 30 months (range 17-62 months) 16 of 18 (88.9%) custom-made implants were considered radiographically stable without signs of acetabular migration of more than 2 mm in the horizontal or vertical direction, implant rotation or screw breakage. Complications included two periprosthetic joint infections treated with explantation of the implant. Three patients had recurrent dislocations postoperatively. The mean Harris hip score improved from 28 ± 12 points preoperatively to 69 ± 13 points at the time of last follow up. Treatment of acetabular bone loss and pelvic discontinuity with a custom-made acetabular component can provide a durable solution with good clinical and radiographic results.

  1. Factors influencing long-term adherence to pelvic floor exercises in women with urinary incontinence.

    Science.gov (United States)

    Venegas, Mónica; Carrasco, Bernardita; Casas-Cordero, Romina

    2018-03-01

    To ensure the effectiveness of Physical Therapy for urinary incontinence (UI), it is crucial that patients adhere to treatment in both the long and the short term. Treatment adherence may prevent symptom progression and the need for surgery, which is associated with higher costs and potential complications. Adherence is defined as carrying out a recommended behavioral modification or change. The World Health Organization (WHO) has established that adherence is a multifactorial phenomenon determined by the interaction of five dimensions, which include diverse factors that affect long-term adherence on many levels. To identify the factors that influence long-term adherence to pelvic floor exercises in women with UI. Observational, descriptive, cross-sectional study. The sample was recruited from the "Centro Integral de Reeducación de Piso Pélvico" (CIREP), and included 61 women treated for UI at the center in 2014 and 2015. Participants completed a self-administered, 28-item questionnaire developed for this study based on the WHO five dimensions. Data analysis was performed using STATA 13.0 software. Having performed pelvic floor home exercises after discharge from Physical Therapy was significantly associated with self-rated treatment adherence (P pelvic floor exercise program (P pelvic floor exercises in women with UI; forgetting to do the exercises and boredom with the exercises were the factors most strongly related to low treatment adherence, while motivation and commitment were associated with high adherence in this population. © 2017 Wiley Periodicals, Inc.

  2. Role of laparohysteroscopy in women with normal pelvic imaging and failed ovulation stimulation with intrauterine insemination

    Directory of Open Access Journals (Sweden)

    K Jayakrishnan

    2010-01-01

    Full Text Available Context: Women with primary infertility and no obvious pelvic pathology on clinical evaluation and imaging are either treated empirically or further investigated by laparoscopy. Aims: The role of diagnostic laparoscopy in women who fail to conceive after empirical treatment with ovulation induction and intrauterine insemination was evaluated. Settings and Design: Retrospective study at a private infertility center. Materials and Methods: A study of patients who underwent diagnostic laparoscopy between 1 st January 2001 and 31 st December 2008 was performed. Those patients who had no detectable pathology based on history, physical examination, and ultrasound and had treatment for three or more cycles in the form of ovulation induction and IUI were included in the study. Moderate and severe male factor infertility and history of any previous surgery were exclusion criteria. Statistical Analysis Used: Data were statistically analyzed using Statistics Package for Social Sciences (ver. 16.0; SPSS Inc., Chicago. Results: Of the 127 women who underwent diagnostic laparoscopy and hysteroscopy, 87.4% ( n= 111 of patients had positive findings. Significant pelvic pathology (moderate endometriosis, pelvic inflammatory disease, and tubal pathology was seen in 26.8% of cases. Conclusion: One in four women had significant pelvic pathology where treatment could possibly improve future fertility. Diagnostic laparoscopy has a role in infertile women with no obvious abnormality before they proceed to more aggressive treatments.

  3. A case of multiple cancers in the pelvic organs after radiation for uterine cancer

    International Nuclear Information System (INIS)

    Miyake, Yasuhiro; Kurokawa, Eiji; Iijima, Shohei; Handa, Rio; Kato, Takeshi; Kikkawa, Nobuteru

    2005-01-01

    Patients who have undergone pelvic irradiation are reported to be at an increased risk of subsequently developing malignancies of the pelvic organs. We report a case of multiple cancers in the pelvic organs after radiation therapy for uterine cancer. The patient was a 76-year-old woman who had undergone a hysterectomy with radiation therapy for uterine cancer in 1960. Thereafter, she had undergone a total cystectomy for bladder cancer in 1989; an abdominoperineal resection for rectal cancer with radiation proctitis in February 1991; and a right hemicolectomy for cecum cancer in 1995. Then, in 2005, she was found to have early cancer of the sigmoid colon at the stoma, so that the colon was dissected from the periphery of the stoma, the sigmoid colon was removed, and an artificial anus was reconstructed again. The histopathological diagnosis was early well-differentiated adenocarcinoma. She had undergone three operations for multiple cancers of the large intestine in the pelvis at different times during 16 years since 1989 when the bladder cancer was detected and surgically treated. And she has been alive and well. Long-term follow-up would be mandatory for such patients undergone pelvic irradiation who might be able to survive for a long time with appropriate therapies like this patient. (author)

  4. Detection of posterior pelvic injuries in fractures of the pubic rami.

    Science.gov (United States)

    Scheyerer, Max J; Osterhoff, Georg; Wehrle, Silvio; Wanner, Guido A; Simmen, Hans-Peter; Werner, Clement M L

    2012-08-01

    Fractures of the pubic rami are associated with prolonged pain, bed rest and increased morbidity and mortality. Often no further diagnostic work-up is undertaken and the pubic rami fractures are classified as stable injuries. However, fractured pubic rami seem to be only part of the picture and are often associated with posterior pelvic ring injury. This retrospective study was designed to evaluate the posterior ring for undetected injury in patients diagnosed with pubic rami fractures. All patients (n=233) with diagnosed fractures of the pubic rami were retrospectively retrieved. All patients with a CT scan available at time of admission (n=177) were included in the study. In 28.8% of the cases a fracture of the acetabulum was found additionally to the pubic rami. In cases without obvious other injury of the ap radiograph, an injury of the posterior pelvic ring was found on CT scans in 96.8% of the patients. Most lesions represented transforaminal sacral fractures, avulsion fractures of ligaments or compression fractures of the lateral mass. All patients with dorsal injuries could initially be treated conservatively, nevertheless 30% of them needed operative treatment in the course. Nearly all cases with fractures of the pubic rami do have a lesion elsewhere within the pelvic ring. In patients with prolonged pain and immobility following 'pubic rami fractures' one should be aware that they probably represent an undiagnosed pelvic ring injury and further diagnostic work-up - sometimes even surgery - is warranted. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. Ligamentous influence in pelvic load distribution.

    Science.gov (United States)

    Hammer, Niels; Steinke, Hanno; Lingslebe, Uwe; Bechmann, Ingo; Josten, Christoph; Slowik, Volker; Böhme, Jörg

    2013-10-01

    The influence of the posterior pelvic ring ligaments on pelvic stability is poorly understood. Low back pain and sacroiliac joint (SIJ) pain are described being related to these ligaments. Computational approaches involving finite element (FE) modeling may aid to determine their influence. Previous FE models lacked in precise ligament geometries and material properties, which might have influence on the results. The aim of this study is to investigate ligamentous influence in pelvic stability by means of FE using precise ligament material properties and morphometries. An FE model of the pelvis bones was created from computer tomography, including the pubic symphysis joint (PSJ) and the SIJ. Ligament data were used from 55 body donors: anterior (ASL), interosseous (ISL), and posterior (PSL) sacroiliac ligaments; iliolumbar (IL), inguinal (IN), pubic (PL), sacrospinous (SS), and sacrotuberous (ST) ligaments; and obturator membrane (OM). Stress-strain data were gained from iliotibial tract specimens. A vertical load of 600 N was applied. Pelvic motion related to altered ligament and cartilage stiffness was determined in a range of 50% to 200%. Ligament strain was investigated in the standing and sitting positions. Tensile and compressive stresses were found at the SIJ and the PSJ. The center of sacral motion was at the level of the second sacral vertebra. At the acetabula and the PSJ, higher ligament and cartilage stiffnesses decrease pelvic motion in the following order: SIJ cartilage>ISL>ST+SS>IL+ASL+PSL. Similar effects were found for the sacrum (SIJ cartilage>ISL>IL+ASL+PSL) but increased ST+SS stiffnesses increased sacral motion. The influence of the IN, OM, and PL was less than 0.1%. Compared with standing, total ligament strain was reduced to 90%. Increased strains were found for the IL, ISL, and PSL. Posterior pelvic ring cartilage and ligaments significantly contribute to pelvic stability. Their effects are region- and stiffness dependent. While sitting

  6. Pelvic floor dysfunction in inflammatory bowel disease.

    Science.gov (United States)

    Bondurri, A; Maffioli, A; Danelli, P

    2015-12-01

    Advances in tailored medical therapy and introduction of biologic agents for inflammatory bowel disease (IBD) treatment have ensured long-term disease remission. Some patients, however, still report defecatory symptoms. Patients present with a wide spectrum of conditions - anal incontinence, obstructed defecation and pelvic pain among the most frequent - that have a great impact on their quality of life. Due to IBD diagnosis, little relevance is attributed to this type of symptoms and their epidemiologic distribution is unknown. Pathogenetic hypotheses are currently under investigation. Routine diagnostic workflow and therapeutic options in pelvic floor service are often underused. The evaluation of these disorders starts with an endoscopy to rule out ongoing disease; the following diagnostic workflow is the same as in patients without IBD. For fecal incontinence and obstructed defecation, simple conservative therapy with dietary modifications and appropriate fluid intake is effective in most cases. In non-responding patients, anorectal physiology tests and imaging are required to select patients for pelvic floor muscle training and biofeedback. These treatments have been proven effective in IBD patients. Some new minimally invasive alternative strategies are available for IBD patients, as sacral nerve and posterior tibial nerve stimulation; for other ones (e.g., bulking agent implantation) IBD still remains an exclusion criterion. In order to preserve anatomical areas that could be useful for future reconstructive techniques, surgical options to cure pelvic floor dysfunction are indicated only in a small group of IBD patients, due to the high risk of failure in wound healing and to the possible side effects of surgery, which can lead to anal incontinence or to a possible proctectomy. A particular issue among defecatory symptoms in patients with IBD is paradoxical puborectalis contraction after restorative proctocolectomy: if this disorder is properly diagnosed, a

  7. Pelvic migration of the helical blade after treatment of transtrochanteric fracture using a proximal femoral nail

    Directory of Open Access Journals (Sweden)

    Pedro Luciano Teixeira Gomes

    2016-08-01

    Full Text Available ABSTRACT Proximal femoral nails with a helical blade are a new generation of implants used for treating transtrochanteric fractures. The blade design provides rotational and angular stability for the fracture. Despite greater biomechanical resistance, they sometimes present complications. In the literature, there are some reports of cases of perforation of the femoral head caused by helical blades. Here, a clinical case of medial migration of the helical blade through the femoral head and acetabulum into the pelvic cavity is presented.

  8. Use of Pulsing Electromagnetic Fields for the Treatment of Pelvic Stress Fractures Among Female Soldiers.

    Science.gov (United States)

    1995-08-11

    activities. Pulsing electromagnetic fields ( PEMFs )have been shown to speed the healing of non-union fractures and we have used them successfully to...and then randomized into actual PEMF and placebo PEMF groups and treated for one hour per day until they return to duty. Changes in the bone scan are...musculoskeletal groups. Results to date indicate that pelvic stress fractures are being misdiagnosed. If these results are confirmed, treatments for

  9. Internal hemipelvectomy with intraoperative and external beam radiotherapy in the limb-sparing treatment of a pelvic girdle chondrosarcoma

    NARCIS (Netherlands)

    Hoekstra, HJ; Szabo, BG

    The case of a patient with an extensive pelvic girdle chondrosarcoma treated with internal hemipelvectomy and intraoperative radiotherapy, followed by adjuvant high-dose external beam radiotherapy, with a successful attempt in achieving long-term local tumor control and limb-sparing treatment is

  10. Ultrasonography findings of the pelvic masses

    International Nuclear Information System (INIS)

    Yim, Neung Jae; Lee, Hak Seo; Youn, Eun Kyung

    1984-01-01

    Ultrasonography is most common utilized diagnostic tool in obstetric and gynecology for the evaluation of patient with a pelvic mass or pregnancy. For it is characterized by no radiation hazard, noninvasive examination and high diagnostic accuracy. Also it affords an accurate assessment of the presence, size, location and internal consistency of a pelvic mass. The recent availability and improved resolution of realtime scanning have afforded a more flexible and complete approach to evaluation of normal and abnormal structures in the pelvis. We analyzed ultrasonographic findings in 154 pathologically proven cases of pelvic mass examined at Korea General Hospital from January 1983 to April 1984. The results were as follows: 1. The age distribution was from 12 years to 66 years and the majority of patients were between the ages of 21 and 51 years (91.4%). 2. The incidence of pelvic mass was 27.9% in uterine leiomyoma, 22.7% in ovarian cyst, 13.0% in adenomyosis and 8.4% in serous cystadenoma. 3. Mild to moderately echogenic nodular uterine enlargement with some cystic change (81.4%) of leiomyoma and multiple small vesicular pattern of intrauterine contents with uterine enlargement of H-mole were the most common ultrasonographic findings. The location and type of leiomyoma were most common in the fundus and body (95.3%), and intramural myoma (53.5%). The most frequent findings of ovarian teratoma was cystic mass with echogenic focus (41.7%) but the echogenic appearance of the lesions was extremely variable.The ultrasonographic findings of ectopic pregnancy were cystic or complex adnexal mass (80.0%), with or without fluid in cul-de-sac and deviation of uterus by adnexal mass. 4. Accuracy of ultrasonography i determining the overall correct diagnosis of the pelvic masses compared with proven diagnosis was approximately 61.7%. The diagnostic accuracy was 90.7% in uterine leiomyoma, 100% in H-mole and 80.0% in ectopic pregnancy.

  11. Comparison of conformal and intensity modulated radiation therapy techniques for treatment of pelvic tumors. Analysis of acute toxicity

    International Nuclear Information System (INIS)

    Ferrigno, Robson; Santos, Adriana; Martins, Lidiane C; Weltman, Eduardo; Chen, Michael J; Sakuraba, Roberto; Lopes, Cleverson P; Cruz, José C

    2010-01-01

    This retrospective analysis reports on the comparative outcome of acute gastrointestinal (GI) and genitourinary (GU) toxicities between conformal radiation therapy (CRT) and intensity modulated radiation therapy (IMRT) techniques in the treatment of patients with pelvic tumors. From January 2002 to December 2008, 69 patients with pelvic tumors underwent whole pelvic CRT and 65 underwent whole pelvic IMRT to treat pelvic lymph nodes and primary tumor regions. Total dose to the whole pelvis ranged from 50 to 50.4 Gy in 25 to 28 daily fractions. Chemotherapy (CT) regimen, when employed, was based upon primary tumor. Acute GI and GU toxicities were graded by RTOG/EORTC acute radiation morbidity criteria. Absence of GI symptoms during radiotherapy (grade 0) was more frequently observed in the IMRT group (43.1% versus 8.7; p < 0.001) and medication for diarrhea (Grade 2) was more frequently used in the CRT group (65.2% versus 38.5%; p = 0.002). Acute GI grade 1 and 3 side effects incidence was similar in both groups (18.5% versus 18.8%; p = 0.95 and 0% versus 7.2%; p = 0.058, respectively). Incidence of GU toxicity was similar in both groups (grade 0: 61.5% versus 66.6%, p = 0.54; grade 1: 20% versus 8.7%, p = 0.06; grade 2: 18.5% versus 23.5%, p = 0.50 and grade 3: 0% versus 1.5%, p > 0.99). This comparative case series shows less grade 2 acute GI toxicity in patients treated with whole pelvic IMRT in comparison with those treated with CRT. Incidence of acute GU toxicity was similar in both groups

  12. Pharmacological treatment and regional anesthesia techniques for pain management after completion of both conservative and surgical treatment of endometriosis and pelvic adhesions in women with chronic pelvic pain as a mandated treatment strategy

    Directory of Open Access Journals (Sweden)

    Małgorzata Malec-Milewska

    2015-05-01

    Full Text Available Introduction. Chronic pelvic pain syndrome occurs in 4–14% of women. Pain pathomechanism in this syndrome is complex, as it is common to observe the features of nociceptive, inflammatory, neuropathic and psychogenic pain. The common findings in women with pelvic pain are endometriosis and pelvic adhesions. Objective. Aim of the study was to test the effectiveness of pharmacological treatment and regional anesthesia techniques for pain control as the next step of treatment after the lack of clinical results of surgical and pharmacological methods normally used in the management of endometriosis and pelvic adhesions. Materials and method. 18 women were treated between January 2010 – October 2013 in the Pain Clinic of the Department of Anaesthesiology and Intensive Care at the Centre for Postgraduate Education in Warsaw due to chronic pelvic pain syndrome related to either endometriosis or pelvic adhesions. During the previous step of management, both conservative and surgical treatments were completed without achieving satisfactory results. Initial constant pain severity was 3–9 points on the Numeric Rating Scale, while the reported paroxysmal pain level was 7–10. The pharmacological treatment implemented was based on oral gabapentinoids and antidepressants, aided by neurolytic block of ganglion of Walther, pudendal nerve blocks and topical treatment (5% lidocaine, 10% amitriptyline, 10% gabapentin. Results. In 17 women, a significant reduction of both constant and paroxysmal pain was achieved, of which complete and permanent cessation of pain occurred in 6 cases. One patient experienced no improvement in the severity of her symptoms. Conclusions. The combination of pain management with pharmacological treatment, pudendal nerve blocks, neurolysis of ganglion impar (Walther and topical preparations in cases of chronic pelvic pain syndrome seems to be adequate medical conduct after failed or otherwise ineffective causative therapy.

  13. EARLY RESULTS OF UNSTABLE DISTAL RADIUS FRACTURES- ORIF WITH LOCKING COMPRESSION PLATE VERSUS LIGAMENTOTAXIS WITH EXTERNAL FIXATORS

    Directory of Open Access Journals (Sweden)

    Mondeep Gayan

    2017-04-01

    Full Text Available BACKGROUND External Fixation (EF and Open Reduction and Internal Fixation (ORIF have been the traditional surgical modalities for unstable distal radius fractures. The Locking Compression Plates (LCP acting as “internal external fixators” are particularly valuable in difficult situations of fractures. We undertook a study to evaluate the outcome of unstable distal radius fractures treated with ORIF with LCP versus those treated by ligamentotaxis with external fixators. MATERIALS AND METHODS A comparative study was carried out in a tertiary care centre with 30 cases of unstable distal radius fractures (15 cases in each group. In one group, open reduction and internal fixation with distal radius volar locking compression plate was carried out and in the other group ligamentotaxis with external fixator was done. The patients were treated and followed up over a period of one and a half year between June 2011 to November 2012. The fractures were classified according to AO classification (Arbeitsgemeinschaft für Osteosynthesefragen: German for “Association for the Study of Internal Fixation” or AO. The functional results were evaluated at the end of 6 months according to Demerit point system of Gartland and Werley modified by Sarmiento (1975 and the anatomical results as per Lindstrom criteria (1959 modified by Sarmiento (1980. RESULTS Overall 86.66% (13 cases had good-to-excellent anatomical results in external fixator group as compared to 93.33% (14 cases in LCP group. The functional outcome was excellent in 80% (12 and good in 13.33% (2 cases in external fixator group as compared to 66.66% (10 excellent and 26.66% (4 good in LCP group. CONCLUSION Both open reduction and internal fixation with locking compression plate and ligamentotaxis with external fixators are good treatment modalities for unstable distal radius fractures. However, the choice should be guided by the fracture configuration, surgeons’ experience and patient’s profile.

  14. Lipoprotein(a Is the Best Single Marker in Assessing Unstable Angina Pectoris

    Directory of Open Access Journals (Sweden)

    Vidosava B. Djordjević

    2011-01-01

    Full Text Available This study evaluated whether statin therapy changed a diagnostic validity of lipid and inflammatory markers in ischemic heart disease (IHD patients. Levels of lipids, lipoproteins, apolipoproteins, inflammatory markers, and atherogenic indexes were determined in 49 apparently healthy men and women, 82 patients having stable angina pectoris (SAP, 80 patients with unstable angina (USAP, and 106 patients with acute ST-elevation myocardial infarction (STEMI treated or not treated with statins. Diagnostic accuracy of markers was determined by ROC curve analysis. Significantly lower apoA-I in all statin-treated groups and significantly higher apoB in statin-treated STEMI group compared to non-statin-treated groups were observed. CRP showed the best ROC characteristics in the assessment of STEMI patients. Lp(a is better in the evaluation of SAP and USAP patients, considering that Lp(a showed the highest area under the curve (AUC. Regarding atherogenic indexes, the highest AUC in SAP group was obtained for TG/apoB and in USAP and STEMI patients for TG/HDL-c. Statins lowered total cholesterol, LDL-c, and TG but fail to normalize apoA-I in patients with IHD.

  15. 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.

  16. The unstable modes of a two-component electron plasma

    Science.gov (United States)

    McQuillan, P.; McClements, K. G.

    1988-12-01

    The linear generation of electrostatic waves in a homogeneous, collisionless, unmagnetized plasma with two Maxwellian electron components, one drifting with respect to the other, is investigated. It is shown that such a system may be unstable to a beam mode rather than the well-known Langmuir mode if the drifting electron component is sufficiently dense and has a sufficiently low temperature. The dispersion characteristics of this 'electron-beam instability' and the Langmuir instability at the critical drift velocity for wave growth are determined for a wide range of parameters. The results are applied to electron beams producing hard X-ray emission in solar flares, and it is argued that such beams may be unstable to the generation of electrostatic waves at frequencies below the electron plasma frequency.

  17. A numerical study of unstable Hele-Shaw flow

    DEFF Research Database (Denmark)

    Hansen, Erik Bent; Rasmussen, Henning

    1999-01-01

    A numerical procedure which is based on an integral equation for the normal velocity at the interface is developed for the unstable flow with surface tension in a Hele-Shaw cell. The procedure has been validated by comparing solutions obtained by it with published results. It has also been applie...... to a study of the effect of small changes in the initial data on the later profiles and it was found that even very small differences can lead to large differences in the profiles at later times. (C) 1999 Elsevier Science Ltd. All rights reserved.......A numerical procedure which is based on an integral equation for the normal velocity at the interface is developed for the unstable flow with surface tension in a Hele-Shaw cell. The procedure has been validated by comparing solutions obtained by it with published results. It has also been applied...

  18. Dose-volume effects for pelvic bone marrow in predicting hematological toxicity in prostate cancer radiotherapy with pelvic node irradiation.

    Science.gov (United States)

    Sini, Carla; Fiorino, Claudio; Perna, Lucia; Noris Chiorda, Barbara; Deantoni, Chiara Lucrezia; Bianchi, Marco; Sacco, Vincenzo; Briganti, Alberto; Montorsi, Francesco; Calandrino, Riccardo; Di Muzio, Nadia; Cozzarini, Cesare

    2016-01-01

    To prospectively identify clinical/dosimetric predictors of acute/late hematologic toxicity (HT) in chemo-naÏve patients treated with whole-pelvis radiotherapy (WPRT) for prostate cancer. Data of 121 patients treated with adjuvant/salvage WPRT were analyzed (static-field IMRT n=19; VMAT/Rapidarc n=57; Tomotherapy n=45). Pelvic bone marrow (BM) was delineated as ilium (IL), lumbosacral, lower and whole pelvis (WP), and the relative DVHs were calculated. HT was graded both according to CTCAE v4.03 and as variation in percentage relative to baseline. Logistic regression was used to analyze association between HT and clinical/DVHs factors. Significant differences (p<0.005) in the DVH of BM volumes between different techniques were found: Tomotherapy was associated with larger volumes receiving low doses (3-20 Gy) and smaller receiving 40-50 Gy. Lower baseline absolute values of WBC, neutrophils and lymphocytes (ALC) predicted acute/late HT (p ⩽ 0.001). Higher BM V40 was associated with higher risk of acute Grade3 (OR=1.018) or late Grade2 lymphopenia (OR=1.005). Two models predicting lymphopenia were developed, both including baseline ALC, and BM WP-V40 (AUC=0.73) and IL-V40+smoking (AUC=0.904) for acute/late respectively. Specific regions of pelvic BM predicting acute/late lymphopenia, a risk factor for viral infections, were identified. The 2-variable models including specific constraints to BM may help reduce HT. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. Risk factors for pelvic insufficiency fractures and outcome after conservative therapy.

    Science.gov (United States)

    Maier, Gerrit Steffen; Kolbow, Kristina; Lazovic, Djordje; Horas, Konstantin; Roth, Klaus Edgar; Seeger, Jörn Bengt; Maus, Uwe

    2016-01-01

    classification for fragility fractures of the pelvis (FFP), 51 were FFP Type Ia, 26 were FFP Type IIb lesions and 26 were FFP Type IIc. Osteoporosis was found to be significantly associated with pelvic insufficiency fractures (p=0.003), as was hypertension (p=0.036), diabetes (p=0.021), vitamin D deficiency (p=0.004), hypocalcaemia (p=0.002) and nicotine abuse (p=0.0012) after adjustment for possible confounders in the multivariate linear regression analysis. Comparing the autonomous state before and after pelvic fracture, a high loss of autonomy was observed. Patients needing daily assistance nearly doubled their number. Overall mortality was high (20%). In conclusion, this study showed multiple risk factors for pelvic insufficiency fractures. Some, like vitamin D deficiency, can benefit easy preventive measures. Outcome of conservative therapy is poor, with loss of social and physical independence and autonomy. The mortality rate is high. Efforts should be made in preventing pelvic insufficiency fractures. All patients should be treated for the severe osteoporosis being associated with these fracture type. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Unstable Titan-generated Rayleigh-Taylor Lakes Impact Ice

    Science.gov (United States)

    Umurhan, O. M.; Korycansky, D. G.; Zahnle, K. J.

    2014-12-01

    The evolution of surface morphology on Titan, Triton, and other worlds is strongly influenced by the interplay of various fluid dynamical processes. Specifically, overturning instabilities can easily arise due to the special circumstances of landform evolution that probably occurred on these worlds. On Titan, large impacts that formed basins like Menrva crater (and possibly Hotei Regio) would have generated impact-melt ice lakes unstably arranged over less dense ice. Cantaloupe terrains, for example as seen on Triton, may be the result of condensation of volatiles (methane, nitrogen) leading to unstably stratified layers of different compositions and densities. In each of these cases, Rayleigh-Taylor instabilities leading to large scale diapirism may be at play. In addition to the dynamics of these instabilities, other physical effects (e.g. heat diffusion, freezing/melting, porosity, temperature dependent viscosity) likely play an important role in the evolution of these features. In this ongoing study, we examine the properties of unstably stratified fluids in which the lower less-dense ice has a temperature dependent viscosity. Surprisingly, we find that there exists an optimal disturbance length scale corresponding to the fastest growth of the Rayleigh-Taylor instability. For unstably stratified layers of water (low viscosity heavy liquid lying above an ice whose viscosity increases with depth) the fastest growing mode corresponds to 40-60 km scales with overturn times of approximately 100 days. We present a detailed numerical stability analysis in a corresponding Boussinessq model (in the creeping flow limit) incorporating thermal conduction and latent heat release and we examine the stability properties surveying a variety of parameters. We have also developed a two-dimensional numerical code (a hybrid spectral/compact-differencing scheme) to model the evolution of such systems for which we shall present preliminary numerical results depicting the outcome of

  1. Order parameter model for unstable multilane traffic flow

    OpenAIRE

    Lubashevsky, Ihor A.; Mahnke, Reinhard

    1999-01-01

    We discuss a phenomenological approach to the description of unstable vehicle motion on multilane highways that explains in a simple way the observed sequence of the phase transitions "free flow -> synchronized motion -> jam" as well as the hysteresis in the transition "free flow synchronized motion". We introduce a new variable called order parameter that accounts for possible correlations in the vehicle motion at different lanes. So, it is principally due to the "many-body" effects in the ...

  2. Unstable states produced in collisions among complex nuclei

    International Nuclear Information System (INIS)

    Sepulveda J, D.

    1978-01-01

    A theory about resonant elastic dispersion is formulated and the wave function of unstable states associated with the resonances observed in the differential and total sections is studied. The object of this theory is to extend to the elastic collisions among complex nuclei interesting case, the methods and formalism of the dispersion of particles without structure by an external potential, following an idea originally formulated by H. Feshbach. (author)

  3. ${ \\mathcal P }{ \\mathcal T }$-symmetric interpretation of unstable effective potentials

    CERN Document Server

    Bender, Carl M.; Mavromatos, Nick E.; Sarkar, Sarben

    2016-01-01

    The conventional interpretation of the one-loop effective potentials of the Higgs field in the Standard Model and the gravitino condensate in dynamically broken supergravity is that these theories are unstable at large field values. A ${ \\mathcal P }{ \\mathcal T }$-symmetric reinterpretation of these models at a quantum-mechanical level eliminates these instabilities and suggests that these instabilities may also be tamed at the quantum-field-theory level.

  4. Human muscular and postural responses in unstable load lifting.

    Science.gov (United States)

    Lee, Yung-Hui; Lee, Tzu-Hsien

    2002-09-01

    Most studies of manual material handling have focused on stable (fixed) loads. The muscular response during unstable load handling deserves more investigative attention. To investigate muscular and postural responses during unstable load lifting, and to quantify the threat posed by such loads in the workplace. Accurate assessment of load weight is important for lifters. Unfortunately, this information is not always available to individuals handling containers of liquids or shifting loads, or those encountering impact loading or a sudden unexpected load. In this study, 12 subjects were subjected to time-variant loads, in which a box weighing 18 kg was used to generate a sudden 12 (kg. m)/second load impact internally during the lifting process. Responses were investigated as a function of different load-shift conditions (anterior-to-posterior and posterior-to-anterior rolling loads and stable load), two foot placements (wide and narrow stance), and two lifting techniques (stoop and squat). Normalized electromyography signals, joint angles, and total linear length for center of pressure (COP-length) were investigated. Lifting an unstable load significantly increases total lifting time, COP-length, and muscular contraction levels. When responding to impact momentum, subjects attempted to lift with greater elbow extension and shoulder and trunk flexion. A more flexed knee joint (approximately an additional 5 degrees ) was observed during preparation for load impact in the anterior-to-posterior rolling task, allowing the formation of a more stable platform to compensate for the load variation. The largest erector spinae contraction for unstable lifting was approximately 12% to 25% greater maximal voluntary contraction than for the stable analog. The normalized electromyography data demonstrate that the central nervous system detects and responds to the need to stabilize the joints closest to the location of load-shift perturbation.

  5. Regularity and chaos in Vlasov evolution of unstable nuclear matter

    International Nuclear Information System (INIS)

    Jacquot, B.; Chomaz, Ph.; Guarnera, A.; Colonna, M.

    1996-01-01

    An analysis of the onset of chaos in mean-field dynamics in presence of volume instabilities is performed. As a main finding, it is shown that the mean-field evolution presents two different regimes: a first one dominated by the almost decoupled amplification of several collective unstable modes, leading to the early condensation of the system into clusters, which is followed by a second stage dominated by a coalescence mechanism among the large-density domains. (K.A.)

  6. The monitoring of unstable rock masses applied to risk management

    OpenAIRE

    POTHERAT, Pierre; DURANTHON, Jean Paul

    2010-01-01

    Rock mass fall case studies presented in this paper show that rupture occur after a more or less long preparation stage which is link to different parameters such as the rate of displacement or the volume and the morphology of the unstable mass. In all sites efficient safety decision could have been taken early enough, with an appropriate monitoring system, even in the case of cliff collapses that are generally considered as sudden movements impossible to anticipate. Kinematics criteria that ...

  7. CP Violation in Correlated Production and Decay of Unstable Particles

    CERN Document Server

    Kittel, Olaf

    2012-01-01

    We study resonant CP-violating Einstein--Podolsky--Rosen correlations that may take place in the production and decay of unstable scalar particles at high-energy colliders. We show that as a consequence of unitarity and CPT invariance of the S-matrix, in 2 --> 2 scatterings mediated by mixed scalar particles, at least three linearly independent decay matrices associated with the unstable scalar states are needed to obtain non-zero CP-odd observables that are also odd under C-conjugation. Instead, for the correlated production and decay of two unstable particle systems in 2 --> 4 processes, we find that only two independent decay matrices are sufficient to induce a net non-vanishing CP-violating phenomenon. As an application of this theorem, we present numerical estimates of CP asymmetries for the correlated production and decay of supersymmetric scalar top--anti-top pairs at the LHC, and demonstrate that these could reach values of order one. As a byproduct of our analysis, we develop a novel spinorial trace ...

  8. Oxygen Consumption While Standing with Unstable Shoe Design

    Directory of Open Access Journals (Sweden)

    Gasser Benedikt A.

    2014-09-01

    Full Text Available Purpose. This study explored the effects of unstable shoe design on oxygen consumption. Methods. Oxygen consumption (VO2 and heart rate (HR were measured in 16 individuals while barefoot, wearing unstable shoes (Masai Barefoot Technology and wearing conventional sport shoes while standing and walking on a treadmill and for 5 individuals while walking around a 400 m track. Results. When wearing the MBT shoes, a significant (p < 0.01 increase of 9.3 ± 5.2% in VO2 was measured while standing quietly for 6 min. No differences in VO2 and HR were observed between the MBT shoes or weight-adjusted conventional shoes (to match the weight of the MBT shoes while walking on a treadmill. However, significant increases (p < 0.01 in VO2 (4.4 ± 8.2% and HR (3.6 ± 7.3% were observed for the MBT shoes compared with being barefoot. No significant differences in VO2 and HR were recorded while walking around a 400 m track either with MBT shoes, weight-adjusted conventional shoes or barefoot. Nonetheless, a comparison of the MBT shoes with barefoot revealed a tendency for VO2 to be higher when wearing the MBT shoes (7.1 ± 6.5%, p < 0.1 although HR was not significantly affected. Conclusions. The unstable shoe design predominantly effects oxygen consumption while standing, most likely due to increased muscle activity of the lower extremities.

  9. Metastability in plyometric training on unstable surfaces: a pilot study

    Science.gov (United States)

    2014-01-01

    Background In the past, plyometric training (PT) has been predominantly performed on stable surfaces. The purpose of this pilot study was to examine effects of a 7-week lower body PT on stable vs. unstable surfaces. This type of exercise condition may be denoted as metastable equilibrium. Methods Thirty-three physically active male sport science students (age: 24.1 ± 3.8 years) were randomly assigned to a PT group (n = 13) exercising on stable (STAB) and a PT group (n = 20) on unstable surfaces (INST). Both groups trained countermovement jumps, drop jumps, and practiced a hurdle jump course. In addition, high bar squats were performed. Physical fitness tests on stable surfaces (hexagonal obstacle test, countermovement jump, hurdle drop jump, left-right hop, dynamic and static balance tests, and leg extension strength) were used to examine the training effects. Results Significant main effects of time (ANOVA) were found for the countermovement jump, hurdle drop jump, hexagonal test, dynamic balance, and leg extension strength. A significant interaction of time and training mode was detected for the countermovement jump in favor of the INST group. No significant improvements were evident for either group in the left-right hop and in the static balance test. Conclusions These results show that lower body PT on unstable surfaces is a safe and efficient way to improve physical performance on stable surfaces. PMID:25089202

  10. Trunk muscle electromyographic activity with unstable and unilateral exercises.

    Science.gov (United States)

    Behm, David G; Leonard, Allison M; Young, Warren B; Bonsey, W Andrew C; MacKinnon, Scott N

    2005-02-01

    The purpose of this cross-sectional study was to evaluate the effect of unstable and unilateral resistance exercises on trunk muscle activation. Eleven subjects (6 men and 5 women) between 20 and 45 years of age participated. Six trunk exercises, as well as unilateral and bilateral shoulder and chest presses against resistance, were performed on stable (bench) and unstable (Swiss ball) bases. Electromyographic activity of the upper lumbar, lumbosacral erector spinae, and lower-abdominal muscles were monitored. Instability generated greater activation of the lower-abdominal stabilizer musculature (27.9%) with the trunk exercises and all trunk stabilizers (37.7-54.3%) with the chest press. There was no effect of instability on the shoulder press. Unilateral shoulder press produced greater activation of the back stabilizers, and unilateral chest press resulted in higher activation of all trunk stabilizers, when compared with bilateral presses. Regardless of stability, the superman exercise was the most effective trunk-stabilizer exercise for back-stabilizer activation, whereas the side bridge was the optimal exercise for lower-abdominal muscle activation. Thus, the most effective means for trunk strengthening should involve back or abdominal exercises with unstable bases. Furthermore, trunk strengthening can also occur when performing resistance exercises for the limbs, if the exercises are performed unilaterally.

  11. From stable to unstable anomaly-induced inflation

    Energy Technology Data Exchange (ETDEWEB)

    Paula Netto, Tiberio de [Universidade Federal de Juiz de Fora, Departamento de Fisica, ICE, Juiz de Fora, MG (Brazil); Pelinson, Ana M. [Universidade Federal de Santa Catarina, Departamento de Fisica, CFM, Bairro da Trindade, Florianopolis, SC (Brazil); Shapiro, Ilya L. [Universidade Federal de Juiz de Fora, Departamento de Fisica, ICE, Juiz de Fora, MG (Brazil); Tomsk State Pedagogical University and Tomsk State University, Tomsk (Russian Federation); Starobinsky, Alexei A. [L.D. Landau Institute for Theoretical Physics RAS, Moscow (Russian Federation); Utrecht University, Department of Physics and Astronomy, Institute for Theoretical Physics, Utrecht (Netherlands)

    2016-10-15

    Quantum effects derived through conformal anomaly lead to an inflationary model that can be either stable or unstable. The unstable version requires a large dimensionless coefficient of about 5 x 10{sup 8} in front of the R{sup 2} term that results in the inflationary regime in the R+R{sup 2} (''Starobinsky'') model being a generic intermediate attractor. In this case the non-local terms in the effective action are practically irrelevant, and there is a 'graceful exit' to a low curvature matter-like dominated stage driven by high-frequency oscillations of R - scalarons, which later decay to pairs of all particles and antiparticles, with the amount of primordial scalar (density) perturbations required by observations. The stable version is a genuine generic attractor, so there is no exit from it. We discuss a possible transition from stable to unstable phases of inflation. It is shown that this transition is automatic if the sharp cut-off approximation is assumed for quantum corrections in the period of transition. Furthermore, we describe two different quantum mechanisms that may provide a required large R{sup 2}-term in the transition period. (orig.)

  12. Pelvic actinomycosis presenting as a malignant pelvic mass: a case report

    Directory of Open Access Journals (Sweden)

    Perek Asiye

    2011-01-01

    Full Text Available Abstract Introduction Pelvic actinomycosis constitutes 3% of all human actinomycosis infections. It is usually insidious, and is often mistaken for other conditions such as diverticulitis, abscesses, inflammatory bowel disease and malignant tumors, presenting a diagnostic challenge pre-operatively; it is identified post-operatively in most cases. Here we present a case that presented as pelvic malignancy and was diagnosed as pelvic actinomycosis post-operatively. Case presentation A 48-year-old Caucasian Turkish woman presented to our clinic with a three-month history of abdominal pain, weight loss and difficulty in defecation. She had used an intra-uterine device for 16 years, however it had recently been removed. The rectosigmoidoscopy revealed narrowing of the lumen at 12 cm due to a mass lesion either in the wall or due to an extrinsic lesion that prevented the passage of the endoscope. On examination, there was no gynecological pathology. Magnetic resonance imaging showed a mass, measuring 5.5 × 4 cm attached to the rectum posterior to the uterus. The ureter on that side was dilated. Surgically there was a pelvic mass adhered to the rectum and uterine adnexes, measuring 10 × 12 cm. It originated from uterine adnexes, particularly ones from the left side and formed a conglomerated mass with the uterus and nearby organs; the left ureter was also dilated due to the pelvic mass. Because of concomitant tubal abscess formation and difficulty in dissection planes, total abdominal hysterectomy and bilateral salphingo-oophorectomy was performed (our patient was 48 years old and had completed her childbearing period. The cytology revealed inflammatory cells with aggregates of Actinomyces. Penicillin therapy was given for six months without any complication. Conclusions Pelvic actinomycosis should always be considered in patients with a pelvic mass especially in ones using intra-uterine devices, and who have a history of appendectomy, tonsillectomy

  13. 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