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At least 217 records · Page 12Linked to original sources
PubMed1984

A multiple-site perineal applicator (MUPIT) for treatment of prostatic, anorectal, and gynecologic malignancies.

Recently, transperineal interstitial-intracavitary applicators have been used to treat locally limited and advanced perineal and gynecologic malignancies. We have developed a single afterloading applicator, referred to as the "MUPIT" (Martinez Universal Perineal Interstitial Template), which with its prototypes has been utilized to treat 78 patients with malignancies of the cervix, vagina, female urethra, perineum, prostate, and anorectal region. The device basically consists of two acrylic cylinders, an acrylic template with a predrilled array of holes that serve as guides for trocars, and a cover plate. Some of the guide holes on the template are angled outward to permit a wide lateral coverage without danger of striking the ischium. The cylinders have an axial hole large enough to pass a central tandem or a suction tube for the drainage of secretions. Thus, the device allows for the interstitial placement of 192Ir ribbons as well as the intracavitary placement of either 137Cs tubes or 192Ir ribbons. In use, the cylinders are placed in the vagina and rectum and then fastened to the template, so that a fixed geometric relationship among the tumor volume, normal structures, and source placement is preserved throughout the course of the implantation. Hollow, closed-end, stainless steel trocars are then inserted through the guide holes that produce optimal coverage of the treatment volume. Appropriate computer programs also have been developed on a minicomputer for the corresponding dose-rate computations. These programs run with sufficient speed that they may be used for both the planning of the source placement beforehand and the computation of the actual dose-rate distribution obtained. The advantages of the system are (1) greater control of the placement of sources relative to the tumor volume and critical structures owing to the fixed geometry provided by the template and cylinders, and (2) improved dose-rate distributions obtained by means of computer-assisted optimization of the source placement and strength during the planning phase.

Anus Neoplasms↗
PubMed2005

Elevated activated partial thromboplastin time during administration of first-generation adenoviral vectors for gene therapy for prostate cancer: identification of lupus anticoagulants.

OBJECTIVES: To evaluate the cause and significance of elevated activated partial thromboplastin time (aPTT) in a group of patients who received a first-generation adenoviral vector (Ad-OC-TK) delivering a toxic gene to prostate cancer cells as part of a Phase I clinical trial at the University of Virginia. METHODS: Eleven subjects were injected intratumorally to metastatic lesions of prostate cancer in the prostatic fossa, retroperitoneal lymph nodes, or bone (iliac, ischium, or vertebrae). After the initial laboratory evaluation, patients with elevated aPTT underwent a series of additional tests, including mixing studies, coagulation factor, prekallikrein, and high-molecular-weight kininogen, and lupus anticoagulant studies (modified Russell viper venom time) with phospholipid correction, and a Staclot LA assay. RESULTS: Of the 11 subjects who were enrolled in the trial, 6 had elevated aPTT values. Of the 6 patients, 3 had aPTT elevation of more than 10 seconds above normal. Two of the subjects with higher values demonstrated an inhibitory pattern with the factor VIII and XI assays, and the lupus anticoagulant studies were positive. No clinical sequelae to the elevated aPTT values were observed. CONCLUSIONS: This is, to our knowledge, the first formal report of a first-generation adenoviral vector causing a slight transient elevation of the aPTT through the induction of an antiphospholipid antibody. No clinical sequelae related to elevated aPTT values were observed. The adenoviral protocol was safe; similar protocols should be aware of this phenomenon.

Adenoviridae↗
PubMed2005

Long-term prevention of skeletal complications by pamidronate in a patient with bone metastasis from endometrial carcinoma: a case report.

INTRODUCTION: Bisphosphonates are an effective treatment for bone metastases from breast cancer. However, it is unclear whether they are effective for bone metastases from endometrial carcinoma. CASE: A 70-year-old woman previously treated for endometrial carcinoma was referred to our hospital due to osteolytic destruction of the left ischial tuberosity. Technetium-99m-HMDP bone scintigraphy revealed abnormal uptake in the ischium. Biopsy revealed a metastatic bone tumor, but computed tomography scans did not show general metastatic spread. The patient received intravenous administration of pamidronate and three cycles of chemotherapy (epirubicin + paclitaxel + carboplatin). Three years later, the bone lesion showed prominent sclerotic changes with no evidence of disease recurrence radiologically. CONCLUSION: Pamidronate may prevent skeletal complications in selected patients with bone metastasis due to endometrial carcinoma.

Aged↗
PubMed1983

The radiologic anatomy of the puborectalis muscle.

Dissections of the puborectalis muscle were made postmortem in seven newborns dying of non-surgical causes. The muscle was outlined with contrast material; lateral x-rays showed the normal radiologic position of this muscle to lie along a line drawn from pubis to the lowest point of the ischium.

Female↗
PubMed1988

Achondrogenesis type I: delineation of further heterogeneity and identification of two distinct subgroups.

Achondrogenesis has traditionally been divided into type I (Parenti-Fraccaro) and type II (Langer-Saldino). We studied the clinical, radiologic, and morphologic features of 17 cases previously diagnosed as achondrogenesis type I to define whether there is even further heterogeneity. On radiographic analysis, two distinct groups of patients were defined based on the presence or absence of rib fractures and ossification of the vertebral pedicles, ischium, and fibula. Two distinct chondroosseous morphologic patterns were observed that directly correlated with the radiographic grouping. One group had round vacuolated chondrocytes with inclusion bodies; the other had collagenous rings around the chondrocytes. We conclude that achondrogenesis type I (Parenti-Fraccaro) consists of two distinct disorders: type IA, which corresponds to the cases originally published by Houston et al. and Harris et al., and type IB, which corresponds to the case originally published by Fraccaro. Analysis of Parenti's case suggests the diagnosis of achondrogenesis type II. All three types of achondrogenesis appear to be inherited as autosomal recessive traits.

Enchondromatosis↗
PubMed1999

Anatomic study of the pelvis in carcinoma of the uterine cervix as related to the box technique.

PURPOSE: To review the radiation therapy "box" technique for cancer of the cervix by means of magnetic resonance imaging (MRI), lymphangiography, and anatomic studies on cadavers. METHODS AND MATERIALS: From 1993 to 1996, the anatomic borders of the "box" technique used at our Radiation Oncology Department-the superior border of the AP-PA fields at the inferior edge of L4; the inferior border at the inferior edge of the ischium; the lateral borders placed 2.5 cm outside of the bony pelvis rim; the anterior border of the lateral fields over the anterior edge of the pubic symphysis; and the posterior at the S2-S3 interspace-were reviewed in 35 sagittal MRI and 10 lymphangiographies of patients with FIGO IB (6), IIA (6), IIB (19), IIIB (3), and IVA (1). An anatomic revision was conducted on 30 cadavers to identify aortic bifurcation, lymphatic nodes, and uterus flexion. RESULTS: In 50% of the patients with FIGO IB, the posterior border of the lateral field was inadequate to encompass the planning target volume (PTV), and in 67% with Stage IIA. In IIB, the anterior border was inadequate in 1 patient, and the posterior in 8 (42%). In IIB and IVA patients, the PTV was not encompassed. When correlating the anterior and posterior borders of the lateral field and the treatment volume in the 35 sagittal MRIs, the posterior border of the lateral field was inadequate in 49%, and the anterior border in 9% of the cases. According to the lymphangiography, the portals encompassed the external iliac nodes. Dissected female pelvises revealed that the aortic bifurcation occurred at the level of the inferior L4 edge in 80% of the cadavers. There was no correlation between uterus flexion in MRIs and in cadavers. CONCLUSION: The design of the lateral fields of the four-field technique for the irradiation of the uterine cervix based on anatomic bone references failed to encompass the planning-target volume in a significant number of patients.

Cadaver↗
PubMed1997

Profile of geriatric pelvic fractures presenting to the emergency department.

Few studies have examined differences in mechanism, presentation, and outcome of trauma in geriatric patients. This study compared pelvic fractures and associated injuries in geriatric and nongeriatric patients. The medical charts of all patients presenting to a large urban emergency medicine teaching program with a pelvic fracture between January 1, 1987 and December 31, 1993 were retrospectively reviewed by study-blinded physicians. Data collected included mechanism and site of injury, associated injuries, disposition (admission or discharge), need for operative repair, length of hospital stay, as well as subsequent deaths and causes. The data were stratified into patients less than 65 years of age (group A) and 65 years or older (group B). Two-hundred five pelvic fractures were reviewed with 85 (41%) in group B. A significantly greater number of pelvic fractures in group B occurred by fall (86% v 25%, P < .05) and significantly less by motor vehicle accident (14% v 75%, P < .05). Site of pelvic fracture differed significantly only in the decreased number of geriatric iliac fractures (6% v 16%, P < .05). The sites of pelvic fractures for geriatric patients in descending order were multiple sites (58%), pubic rami (56%), acetabulum (19%), ischium (11%), iliac (6%), and sacroiliac (2%), and did not differ from nongeriatric patients. Geriatric patients had significantly fewer total associated injuries (40% v 61%, P < .05) although associated chest injuries were significantly more common (21% v 8%, P < .05). Death occurred in three (3%) nongeriatric and nine (11%) geriatric patients. Six geriatric deaths were caused by exacerbation of underlying cardiovascular disease. Geriatric patients underwent significantly fewer operative procedures (6% v 43%, P < .05) but there were no significant differences in the percent admitted (85%) or mean length of hospital stay (9.59 days). Despite the decreased severity of pelvic fractures, care must be taken to prevent morbidity caused by exacerbation of premorbid illnesses in geriatric patients with pelvic fractures.

Accidental Falls↗
PubMed1986

The impact of modern cement techniques on acetabular fixation in cemented total hip replacement.

A radiographic study was performed to assess acetabular fixation in 78 total hip replacements performed between 1971 and 1980. In 1979, the technique of acetabular component insertion was modified to include water-pik lavage, preservation of subchondral bone of the acetabulum during reaming, multiple fixation holes in the pubis ischium and ilium, and devices that improve pressurization of the cement into the cancellous bone surfaces. The impact of these techniques was studied. A cumulative radiolucency score was calculated for each acetabulum from 5-year follow-up radiographs, and the mean cup radiolucency scores for two chronologic groups were compared using the t-test for independent samples. No significant differences in patient age, weight, or sex, type of prosthesis, or approach used was found between groups. The acetabular components inserted between 1979 and 1980 had significantly lower cup radiolucency scores than those inserted between 1971 and 1978, at 5-year follow-up evaluation. Modern cement technique may be responsible for significantly enhanced durability of acetabular fixation in cemented total hip replacement.

Acetabulum↗
PubMed2000

The smallest known non-avian theropod dinosaur.

Non-avian dinosaurs are mostly medium to large-sized animals, and to date all known mature specimens are larger than the most primitive bird, Archaeopteryx. Here we report on a new dromaeosaurid dinosaur, Microraptor zhaoianus gen. et sp. nov., from the Early Cretaceous Jiufotang Formation of Liaoning, China. This is the first mature non-avian dinosaur to be found that is smaller than Archaeopteryx, and it eliminates the size disparity between the earliest birds and their closest non-avian theropod relatives. The more bird-like teeth, the Rahonavis-like ischium and the small number of caudal vertebrae of Microraptor are unique among dromaeosaurids and improve our understanding of the morphological transition to birds. The nearly completely articulated foot shows features, such as distally positioned digit I, slender and recurved pedal claws, and elongated penultimate phalanges, that are comparable to those of arboreal birds. The discovery of these in non-avian theropods provides new insights for studying the palaeoecology of some bird-like theropod dinosaurs.

Animals↗
PubMed2000

Internal hemipelvectomy for bone sarcomas in children and young adults: surgical considerations.

AIMS: Pelvic bone sarcomas in children and young adults are rare, and associated with a poor prognosis and a high rate of local recurrence. Primary goals of treatment include prevention of local recurrence and distant metastases. A secondary goal is maintenance of quality of life by avoiding major amputative surgery. This is why internal hemipelvectomy (a limb-sparing surgery) is advocated whenever possible. The focus of our presentation is surgical issues in the context of resection and reconstruction of the pelvis in the first two decades of life. MATERIALS AND METHODS: Between January 1988 and June 1998, 27 patients were treated and operated on (follow-up time 1.5-12 years). There were 17 males and 10 females. Their age ranged between 2 and 22 years. There were 24 patients with Ewing's sarcoma (ES) and three with other bone sarcomas. In 19 patients the tumour involved the entire or part of the iliac bone (in some cases with extension to the sacrum). In five patients the tumour involved the pubis and/or ischium. In three patients the tumour involved the sacrum with some extension to the posterior iliac bone. All patients received neoadjuvant and adjuvant chemotherapy and radiotherapy with different protocols (related to the origin of referral). RESULTS: Twenty-seven patients underwent internal hemipelvectomy. According to Enneking's classification there were: type I-10; type II-one; type III-six; type IV-five (including one localized sacrectomy); type I+IV-five patients. In 15 patients some kind of reconstruction was needed and in 12 no reconstruction was done. Four wound infections occurred that were managed successfully by surgical debridement, antibiotics and local wound care. In one case removal of the 'implant' was needed. No primary or secondary amputations were performed in the series. The rate of local recurrence was 22%. Functional status at the last follow-up visit or before death, according to the AMSTS functional rating system: excellent-six; good-17; fair-three and poor-one. All patients except the one poor result maintained their walking ability during the follow-up time. CONCLUSIONS: Internal hemipelvectomy is achievable in most cases and justified for better quality of life in children, adolescents and young adults with sarcomas. Further efforts are needed to improve the reconstructive options in the pelvis.

Adolescent↗
PubMed2003

Newborn with an open posterior hip dislocation and sciatic nerve injury after intrauterine radiofrequency ablation of a sacrococcygeal teratoma.

Advanced prenatal ultrasonography techniques have allowed for better understanding of the natural history, treatment, and prognosis of sacrococcygeal teratomas. Several intrauterine surgical techniques to debulk the tumor when fetal and maternal life are in jeopardy have been described. Orthopaedic impairment, such as lower extremity weakness and swelling, also has been described in association with sacrococcygeal teratomas. The authors report on a newborn in whom a large soft tissue defect overlying the posterior hip region with direct exposure of the disarticulated hip joint existed at the time of birth, which resulted from intrauterine radiofrequency ablation of a sacrococcygeal teratoma. This unexpected complication has resulted in a loss of sciatic nerve function, malformation of the acetabulum and femoral head, and loss of the left ischium, coccyx, inferior sacrum, gluteal, adductor and piriformis muscles, and posterior hip capsule. At 16 months of age, the patient has a flaccid left lower extremity with a hypoplastic hip joint.

Catheter Ablation↗
PubMed2002

Don't throw away the ring: indications and use.

Protective rings are a valuable adjunct in revision acetabular surgery. Two types of rings are used. The roof ring, which is the smaller of the 2 rings, provides support from the ilium to the inferomedial part of the acetabulum. The reconstructive ring or cage provides support from the ilium to the ischium. Both devices can be used to protect morcellized or structural bone-graft. The roof ring can be used with morcellized graft if the ring can make contact with host-bone at the superior and inferomedial aspect of the acetabulum. If the defect is more global but still contained so that the entire acetabulum is filled with morcellized bone, the larger reconstructive ring should be used. Small structural grafts that support <50% of the cup may be protected by a roof ring. Larger structural grafts that support >50% of the cup should be protected by a reconstructive ring.

Arthroplasty, Replacement, Hip↗
PubMed1978

[Cleido-cranial dysplasia--two observations].

The radiological changes of cleido-cranial dysplasia are described on the basis of two cases. Special attention is paid to the dental and facio-maxillary aspects. The main features are: (1) Supernumerary teeth, persistence of the first dentition, retention of the second dentition. (2) Open fontanelles and sutures and intercalary bones. (3) Hypo- or aplasia of the clavicles. (4) Defects in the vertebral neural arches and (5) dehiscence of the symphysis due to absent or delayed ossification of the pubis and ischium.

Adult↗
PubMed1995

[Tumorous space-occupying lesions of the pelvic skeleton. A radiological analysis of 234 cases].

PURPOSE: From the material of a bone tumour record file, an attempt was made to determine criteria enabling radiographic prediction of malignancy and tumour entity of lesions of the pelvis. METHODS: Patients' age, location and radiographic morphology of 234 space-occupying lesions of the pelvis were analysed retrospectively. RESULTS: 62.8% of all lesions were malignant, and the portion of malignant tumours increased with increasing age. While 68.0% of the lesions were found in the ilium, 18.8% in the pubis and 13.2% in ischium, the proportion of benign and malignant lesions did not vary in the different bones. Lesions showing a growth rate according to Lodwick grade IA and to IB were benign in 100% and in 82.0%, respectively. In contrast, tumours of grade II or III were malignant in 89.1% and 88.0% of cases, respectively. CONCLUSIONS: By the construction of subgroups by combining the patients' age and growth rate, the prediction of the malignant potential of a lesion increased significantly. The younger the patient, the more aggressively a benign lesion may grow, while the older the patient the slower a malignant tumour may grow. Prediction of the tumour entity is rarely possible.

Adolescent↗
PubMedDate not supplied

[Creation of a weight-bearing leg stump and the fitting for a prosthesis].

Whether for functional or cosmetic reasons in oncologic patients, following amputation or severe crush injuries of the lower limbs with complete severance of vessels and nerves, microsurgery enables a weight-bearing lower limb or femoral stump to be created if such a result cannot be achieved by transplanting plantar skin with an intact vessel-nerve bundle. When first fitting a prosthesis in a patient with a weight-bearing lower leg stump created by autologous grafting of plantar skin employing the microsurgical method, it is advisable initially to partially relieve the grafted covering tissue in the prosthesis shaft. However, as soon as the transplanted skin flap has recovered full sensitivity it is advisable ti fit a limb supported on the end of the stump. It is then longer necessary to support the prosthesis on the ischium or the trochanter major. Fitting of a prosthesis of this type permits optimal rehabilitation.

Adolescent↗
PubMedDate not supplied

[Surgical therapy of metastases of the pelvis and sacrum].

We are reporting on 42 surgical and 5 conservative treatment approaches in metastases of the pelvis and sacrum. With an average disease-free survival of 14.4 months the majority of the lesions were resected intralesionally. In the area of the ischium and the pubis resection alone was done without further stabilizing measures. If the resection was in the area of the iliac wings, stabilization was achieved by means of osteosynthesis in 50% of the cases. Periacetabular resections required reconstruction with endoprotheses in all cases. In patients with good prognosis and solitary metastases also extralesional resections were performed. Reoperated embolization was used in advanced stages of the disease or if the metastases were not easily accessible surgically. Because of the complexity of pelvic resections and the often considerable loss of function, patients with metastases are often treated with intralesional resection and osteosynthesis. In exceptional cases, if radiotherapy had failed or multiple intralesional resections were followed by recurrences, we feel however that extralesional resection should be attempted with good prognosis for the patient.

Adenocarcinoma↗
PubMedDate not supplied

[Triple osteotomy of the pelvis in dysplastic hip joints in children and adults].

We report on a post operative radiological and clinical follow-up (3-6.4 years) of 80 triple-osteotomies (29 operations according to the technique of Carlioz and 51 according to Tönnis). This study includes 32 osteotomies in children and 48 in adults. In 82% of the cases of low dysplastic hip joints and in 88% of the cases in severe dysplastic hip joints, the results came up to the expectations of the patients. The acetabular inclination angle and the acetabular angle improved about 10 degrees and the center edge angle about 25 degrees. In cases of neurological diseases, the radiological results of the hips were less satisfactory. The results is negatively influenced by pseudarthrosis and stress fractures in the ischium. These complications occur to a lower degree after Tönnis-osteotomy. From the age of 7, the triple-osteotomy represents an useful alternative to the operative correction of the hip joint dysplasia. The operation can be carried out in cases of congruity of head and acetabulum. Under certain circumstances, a transposition operation is additionally necessary, it is only indicated with a coxa valga. The triple-osteotomy can positively influence the biomechanical situation of the hip joint by means of an improved head roofing, by an ameliorated adjoining of the area of force reception to the pressure resultant and by medialisation of the acetabulum.

Adolescent↗
PubMedDate not supplied

[Tuberculosis of the pelvic girdle].

Between 1955 and 1980 a total of 67 patients (42 female, 25 male) with advanced tuberculosis of the pelvic girdle underwent surgery at the authors' clinic. In 43 patients the sacroiliac joint was affected (in 2 cases bilaterally), in 11 the ischium, in 9 the pubic bone, and in 2 each the ilium and the sacrum. The average of the patients (who included 4 migrant workers) was 44. The youngest patient was 8, the oldest 67 years old. The average interval between the onset of complaints and diagnosis was 4.6 years (minimum 1 month, maximum 20 years). Thirty-eight of the patients had already had treatment for an organic or osteoarticular tuberculosis. Although 24 (35.8%) of the patients were simultaneously suffering from a florid, specific infection localized elsewhere, and abscesses, fistulas, or a combination of these were identified in 40 patients (59.7%), only 17 (25.4%) were in slightly impaired general condition, and in over one-half of the patients, the hourly blood sedimentation rate was normal or only slightly elevated (up to 20 mm n.W.). In 9 cases (13.4%) the only pointers to tuberculosis were the patient's history, clinical and radiological findings, and the subsequent evolution of the disease. In these cases the diagnosis could not be confirmed either by histologic or by bacteriologic study of focal tissue. In 67 patients, 66 osseous foci were removed and in 2 cases merely an abscess (after an average of 2-3 weeks' tuberculostatic therapy), the bone cavities were filled with a mixture of heterogeneous or autogenous spongiosa and tuberculostatics or merely with chemotherapeutic drugs, and primary closure of the wound was performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗