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[Apophyseal fractures of the pelvis and trochanter minor in 20 adolescents and 2 young children].

From 1978 to 1999, 22 patients (17 male, 5 female) who suffered apophyseal fractures of the pelvis and femoral lesser trochanter (18 patients by avulsion, 4 patients by direct trauma) were treated. The median age of the patients was 12.5 years (range, 1-16 years). Eighteen patients were injured during sports activities. Predominantly the anterior inferior iliac spine (n = 9) was affected, followed by fractures of the femoral lesser trochanter (n = 3), periacetabular rim (n = 3), anterior superior iliac spine (n = 2), and iliac crest (n = 2), retrospectively. The diagnosis was established using plain x-ray films. The treatment was conservative in 21 patients (95%) and operative in one (5%). Of the patients, 20 (91%) were followed-up for a median interval of 12 months (3 weeks to 84 months). At follow-up, 15 patients (75%) reported that they were free of pain during sport activities, while five patients (25%), at an average time of 33 months after accident, complained of pain at the former fracture site when exercising vigorously during sport. At clinical examination no patient was found suffering from limitation of ROM (range of motion), adjacent joints, or muscular insufficiency. Plain [not readable: see text]

Acetabulum↗

[Congenital cysts and teratomas in the sacrococcygeal region. Report of 2 cases].

Developmental abnormalities in the embryo may lead to tumours in the sacro-coccygeal area, so-called sacral cysts and the teratomas (5, 7). At birth they are caudal tumours of variable size covered with thin, stretched skin. Blood vessels can be seen through the skin, particularly in the mid-line. One gains the impression that the stretched skin could burst at any moment. It is assumed that these teratomas derive from the pluripotent cells of Hensen's node and then grow in front of the coccyx (2). They grow and spread in various directions, particularly in a dorsal and caudal direction extra-rectally and, to a lesser extent, into the pelvis in a pre-sacral position. The classification of these tumours depends on their spread. The spread and localisation of these tumours may cause stenosis of elongation of the rectum and displacement of small and large bowel and of the bladder.

Cysts↗

Uptake of Tc-99m MAA by the liver during a thromboscintigram/lung scan.

A young man with a swollen left leg was referred to us for a thromboscintigram/lung scan. The unexpected visualization of the liver during the flow study after intravenous injection of Tc-99m MAA into the dorsal veins of both feet provided the clue to his underlying problem. He was shown to have extensive venous collateralization in the left pelvis, and to a lesser degree on the right, due to a large pelvic mass. This was shown to consist of metastases from a previously treated testicular carcinoma. Venous drainage from the legs was shunted into the mesenteric circulation, which them emptied into the portal vein, thereby carrying the radiopharmaceutical to the liver. No uptake was seen in the spleen.

Adult↗

Peritonitis: pathophysiology and local defense mechanisms.

The peritoneal cavity can be divided in the supracolic infracolic and paracolic spaces, the lesser sack and the pelvis. The peritoneum is a semipermeable membrane which allows a flux of solutes into and from the peritoneal cavity. In addition, particles can be absorbed through the stomata of the diaphragmatic peritoneum. Secondary peritonitis is always a polymicrobial infection. The flora consists of aerobic enterobacteriaeceae and anaerobs mainly B. fragilis. These two groups of bacteria act synergistically. Besides unspecific defence mechanisms, i.e. the direct absorption of bacteria and the entrapment of bacteria in fibrin, the immunological defence mechanisms of the peritoneal cavity are triggered by endotoxin contained in the cell wall of the invading bacteria leading to the production of cytokines by macrophages, activation of complement and as a result the migration of granulocytes from the intervascular space into the peritoneal cavity.

Animals↗

Computer-assisted kinematic evaluation of induced compensatory movements resembling lameness in horses trotting on a treadmill.

OBJECTIVE: To characterize compensatory movements of the head and pelvis that resemble lameness in horses. ANIMALS: 17 adult horses. PROCEDURE: Kinematic evaluations were performed while horses trotted on a treadmill before and after shoe-induced lameness. Lameness was quantified and the affected limb determined by algorithms that measured asymmetry in vertical movement of the head and pelvis. Induced primary lameness and compensatory movements resembling lameness were assessed by the Friedman test. Association between induced lameness and compensatory movements was examined by regression analysis. RESULTS: Compensatory movements resembling lameness in the ipsilateral forelimb were seen with induced lameness of a hind limb. There was less downward and less upward head movement during and after the stance phase of the ipsilateral forelimb. Doubling the severity of lameness in the hind limb increased severity of the compensatory movements in the ipsilateral forelimb by 50%. Compensatory movements resembling lameness of the hind limb were seen after induced lameness in a forelimb. There was less upward movement of the pelvis after the stance phase of the contralateral hind limb and, to a lesser extent, less downward movement of the pelvis during the stance phase of the ipsilateral hind limb. Doubling the severity of lameness in the forelimb increased compensatory movements of the contralateral hind limb by 5%. CONCLUSIONS AND CLINICAL RELEVANCE: Induced lameness in a hind limb causes prominent compensatory movements resembling lameness in the ipsilateral forelimb. Induced lameness in a forelimb causes slight compensatory movements resembling lameness in the ipsilateral and contralateral hind limbs.

Animals↗

[Intrarenal localisation of renorenal collaterals in the dog. Observations on renal arteries as end-arteries (author's transl)].

One of the two main branches of the left renal artery was slowly occluded in four dogs. Repeated angiography was carried out from 45 to 61 days postoperatively; this made it possible to observe the development of collaterals between the normal and constricted branches of the renal artery, i.e. intrarenal renorenal collaterals. These collaterals developed predominantly from preexisting vessels of the extraglomerular system in the vicinity of the renal pelvis and calyces and, to a lesser extent, from medullary vessels and from forating capsular arteries.

Animals↗

Perforated amebic liver abscesses: successful percutaneous treatment.

Perforation of hepatic amebic abscess is associated with high morbidity and may result in death. Traditional treatment has been emergency surgery. The authors report successful percutaneous drainage of perforated hepatic amebic abscesses in five severely ill patients. These perforations resulted in abscesses in the subhepatic space, pelvis, chest, right and left paracolic gutters, lesser sac, retroperitoneum, and flank. A total of ten intrahepatic abscesses also were drained in these patients. Catheter drainage lasted from 7 to 34 days and was combined with metronidazole therapy; the latter had been used for 1 week in two patients and in one patient for 2 days without success before drainage. Associated fistulas were demonstrated to the bile ducts, duodenum, and colon; all healed spontaneously. This experience suggests an expanded use of catheter drainage for perforation, a serious complication of amebic abscess.

Adult↗

[Tumors as a cause of acute abdomen in children].

The authors share their experience in treating children aged 1 day to 14 years with acute processes in the abdomen induced by various tumors. During 10 years 51 patients have been observed. "Acute abdomen" was induced by tumors and cysts of ovaries (16 patients), lymphangiomas, cysts and tumors of the mesentery, greater and lesser omentum, retroperitoneal cavity (14 patients), intestinal tumors (7), small pelvis tumors (6), tumors of kidneys (4), liver (3), cyst of the pancreatic gland (1). The clinical picture of the disease, possible timely diagnosing and tactics are presented. All the patients were operated urgently. After operation 44 patients recovered and were discharged from the hospital, 7 patients died.

Abdomen, Acute↗

Anatomic, physiologic, bacteriologic and immunologic aspects of peritonitis.

The anatomic aspect of peritonitis describes the division of the abdominal cavity into the supracolic, infracolic and paracolic spaces, moreover the lesser sac and the cul-de-sac of the pelvis. Physiologically the peritoneum plays an important role in the passive exchange of fluid and absorption of particles. Endotoxin, which is elaborated by bacteria activates the classical as well as the alternative complement pathway. It activates also the arachidonic acid metabolism, leading to the release of prostaglandins (PG) and leukotriens (LTC). The local host defense against a bacterial invasion includes the activation of cellular and humeral immunologic defense mechanism, in which the final product of the complement pathway (C5b-9), as well as chemoattractants C3a, C5a and C567 play a key role.

Abdomen↗

Roentgenographic measurements after Müller total hip replacement. Correlations among roentgenographic measurements and hip strength and mobility.

In fifty-two patients with Müller total hip replacement, roentgenographic measurements of prosthetic component positioning were correlated with hip-muscle strength and mobility measurements. Compared with the normal side, the average position of the center of the prosthetic head was more medial and superior in the pelvis, and the greater trochanter was more distal and lateral. Increasing neck length (distance from the center of the prosthetic head to the lesser trochanter) and a more distal position of the greater trochanter were among the measurements that related favorably to measurements of patient function. More superior placement of the center of the prosthetic head in the pelvis was associated with a more superior position of the lesser trochanter, which related adversely to function.

Aged↗

Prognostic and treatment factors affecting pelvic control of Stage IB and IIA-B carcinoma of the intact uterine cervix treated with radiation therapy alone.

This is a retrospective analysis of 264 patients with Stage IB and IIA-B carcinoma of the cervix treated with curative intent at the University of Florida from October 1964 through April 1980. There is a minimum 2-year follow-up. Patients dead of distant metastases (13), dead from intercurrent disease (14), or lost to follow-up (1) less than 24 months from treatment with pelvic disease controlled were excluded from analysis of pelvic control. All patients were included in analysis of complications and survival. Tumor size and hematocrit were noted to be significant prognostic factors with regard to control of disease in the pelvis in Stage IB and IIA cancers. Tumor size and hematocrit also influenced pelvic control in Stage IIB, but to a lesser extent than in Stages IB and IIA. Patient age was a weak prognostic factor for control of disease in the pelvis for Stages IB, IIA, and IIB, but more strongly influenced pelvic control when considered in conjunction with tumor size and hematocrit. Overall treatment time influenced pelvic control in all cases when the size of the lesion was greater than or equal to 6 cm. In lesions greater than or equal to 6 cm in diameter, the amount of tumor regression noted at the time of the radium application after 3500 to 4000 rad external beam irradiation was a predictor of pelvic control. Data on treatment complications and survival are included, and future treatment strategies discussed.

Actuarial Analysis↗

Intraperitoneal therapy for ovarian cancer: analysis of fluid distribution by computerized tomography.

Nineteen patients with ovarian cancer and minimal residual or persistent disease who were treated with cisplatin or carboplatin-based intraperitoneal (IP) regimens had distribution studies of IP contrast and computerized tomography prior to and during treatment. The distribution pattern was assessed retrospectively and scored for the presence of contrast in each of eight regions: the under surface of right and left diaphragms, the right and left paracolic gutters, the lesser omental sac, the intramesenteric region and the true and false pelvis. Assigning a point to each region with adequate distribution, we classified 10 patients to an excellent pattern (greater than or equal to 7 of 8 regions), 6 to a good pattern (5 to less than 7 regions), and 3 to an inadequate distribution pattern (less than 5 regions). Serial studies were performed in 8 patients after more than 4 cycles of IP therapy. In these patients, all of whom were tolerating treatment without progression, the distribution remained virtually unchanged for those with excellent distribution. One of three with good distribution manifested inadequate distribution on repeat study, and one of two with inadequate distribution improved to show a good pattern. In this small study there was no correlation of distribution patterns with plasma CA-125 at onset of IP treatment and prior surgical procedures or placement of the catheter tip. However, three patients with unsatisfactory patterns had procedures consisting of catheter placement only rather than formal reassessment laparotomies for ovarian cancer. Since satisfactory IP distribution may be required for obtaining a therapeutic advantage from IP therapy, methods for its assessment must be developed.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗

Bone mineral density in flatwater sprint kayakers.

To elucidate the possible skeletal benefits of the muscular contractions and the nonweight-bearing loading pattern associated with kayaking, we investigated the bone mineral density (BMD, g/cm2) of 10 elite kayakers, six males and four females, with a median age of 19 years. Each subject was compared with the mean value of two matched controls. BMD of the total body, head, ribs, humerus, legs, proximal femur (neck, wards, trochanter), spine, lumbar spine, and bone mineral content (BMC, g), of the arms was obtained using a dual energy X-ray absorptiometer (DXA). Body composition was also assessed. The kayakers had a significantly (P < 0.05-0.01) greater BMD in most upper body sites: left and right humerus (10.4% and 11. 7%), respectively, ribs (6.4%), spine (10.9%), and a greater BMC of the left and right arm (15.7% and 10.6%, respectively). No significant differences in the BMD of the total body, head, or any of the lower body sites were found, except for the pelvis, which was significantly greater in kayakers (5.1%). The controls had a significantly lesser lean body mass (10.4%) and greater percentage of body fat (19.5%) than the kayakers. Bivariate correlation analysis in the controls demonstrated significant and strong relationships between BMD in upper body sites and lean body mass, weight, and fat; the effects of training seem to outweigh most such relationships in kayakers. In conclusion, it seems that the loading pattern and muscular contractions associated with kayaking may result in site-specific adaptations of the skeleton.

Absorptiometry, Photon↗

Computerized tomography with and without intraperitoneal contrast for determination of intraabdominal fluid distribution and diagnosis of complications in peritoneal dialysis patients.

Seven computed tomography scans and 19 computed tomograph peritoneography (CTP) studies performed in 20 peritoneal dialysis patients were analyzed retrospectively as to their diagnostic usefulness in peritoneal dialysis related complications. Computed tomographic peritoneography was found to be superior to computed tomography scans in localizing small leak sites. In seven of nine patients with clinically diagnosed dialysate leakage, computed tomographic peritoneography supported the clinical diagnosis and localized the leak site in six patients. All patients with a conspicuous leak site and/or with leaks through hernias had to have surgical treatment. Computed tomographic peritoneography failed to reveal a leak or identify a fluid tract in patients with intermittent, small leaks. Those leaks responded easily to a dialysis regimen with diminished intraabdominal pressure. Normal intraperitoneal fluid distribution was based on 17 studies after intraperitoneal infusion of 2,000 ml of peritoneal dialysis solution in patients without intraabdominal organomegaly and/or any clinical suspicion of fluid maldistribution, with average peritoneal transport characteristics. As appraised in the supine position, approximate fluid contents in the intraperitoneal spaces were pelvis, 30-55%; paracolic gutter, 15-30%; perisplenic and perihepatic, 10-20% each, and lesser sac, 1-3%. Severe fluid maldistribution on computed tomography peritoneography, particularly a small fluid volume in the pelvic space, is a poor prognostic sign as to the feasibility of peritoneal dialysis; neither of our two patients with no fluid in the pelvic space could be maintained on peritoneal dialysis, while patients with no fluid in the lesser sac, perihepatic and perisplenic spaces could be maintained on peritoneal dialysis. No fluid was seen in the peritoneal cavity after drainage in the vertical position.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Scintigraphy of the sacroiliac joint region in asymptomatic riding horses: scintigraphic appearance and evaluation of method.

The sacroiliac region in 33 clinically normal riding horses was examined with scintigraphy to determine the normal scintigraphic appearance, to evaluate a semiquantitative method used to calculate a sacroiliac joint (SI joint) ratio, and to identify factors that affect the scintigraphic appearance of the pelvis. The scintigraphic examination included dorsal views of each SI joint region and one lateral view of the urinary bladder. Two predefined areas (the SI joint and the area between the tuber sacrale and the SI joint) were evaluated subjectively by comparing the intensity in each area to the intensity in the tuber sacrale, and a semiquantitative method was applied on the images to calculate an SI joint ratio. The thickness of the muscle mass overlying each SI joint was measured by using ultrasound. A corrected ratio was calculated based on a corrected pixel count for each SI joint. Of 29 evaluated horses, 28 had normal radiotracer uptake in the SI joints and 10 horses had symmetric normal radiotracer uptake in the area between the tuber sacrale and the SI joint. The mean SI joint ratio was 0.53 on both the left and right sides, and the mean corrected SI joint ratio was 2.15 on the left side and 2.13 on the right side. Factors that affect the scintigraphic appearance of the pelvis were identified and included attenuation, radioactive urine, and muscle symmetry. The muscle thickness ranged from 8-11 cm, causing 71-82% attenuation. Radioactive urine in the urinary bladder was located ventral to the SI joint region in 16 horses, and four of these were excluded from further evaluation because of risk of misinterpretation. A visual assessment of symmetry of the horses' gluteal muscle mass was compared with the ultrasound measurements. Fourteen horses (14/33) were regarded symmetric by both techniques. Soft tissue attenuation was found to severely compromise the result and indicated that only lesions in the SI joint with severely increased radiotracer uptake can be detected with scintigraphy. Knowledge about presence of radioactive urine ventral to the SI joint region and assessment of muscle symmetry is essential for a correct subjective evaluation. Any situation with difference in muscle mass between the left and right side of the pelvis will give a false impression of increased radiotracer uptake on the side with lesser muscle mass.

Animals↗

Abdominal and pelvic CT for detection and volume assessment of peritoneal sarcomatosis.

OBJECTIVE: Peritoneal sarcomatosis is a common finding in patients with recurrent abdominal or pelvic sarcoma. CT of the abdomen and pelvis is the standard radiological examination for evaluation of tumor volume and location in the peritoneal cavity; however data regarding the reliability of recurrent sarcoma detection has not been available. The purpose of this study was to evaluate the sensitivity of CT in detecting recurrent peritoneal sarcomatosis. METHODS: Abdominal and pelvic CT scans of 33 patients with abdominal or pelvic sarcoma recurrence were retrospectively reviewed. Subsequently all patients underwent surgery at which time complete exploration of the abdomen and pelvis was performed. Twenty-five CT parameters were evaluated and statistically analyzed using the findings at surgery as a standard. RESULTS: Among the anatomic sites, the lesser omentum and the Douglas pouch showed a sensitivity of 100%. In the nine abdominopelvic regions sensitivity was greater than 85% in the central region, the left lower quadrant and the pelvis. In all regions and sites, the pelvis and Douglas pouch showed the highest accuracy (91%). The volume of tumor present within an abdominopelvic region influenced the sensitivity. A sensitivity of 72.5% was recorded when tumor nodules were less than 0.5 cm in diameter. This increased to 90% when tumor diameter was greater than 5 cm. CONCLUSIONS: Abdominal and pelvic CT is a reliable test to evaluate recurrent sarcoma. The nodules in the pelvis were most accurately detected. Even small nodules of 0.5 cm were detected; the sensitivity increased as the nodules became greater than 5 cm.

Adult↗

The "lesser pelvic loop" of the external iliac artery.

The dorsal part of the external iliac a. may extend down into the pelvis minor either lateral or medial to the external iliac v. as well as to the obturator nerve. In such cases, the relationship to the direct projection of the acetabulum on the inner surface of the pelvis minor may be of interest to orthopedic surgeons in hip-joint replacement operations and to vascular surgeons.

Acetabulum↗

[Postoperative urinary retention].

Postoperative retention of urine (PU) is a common complication which may occur after any surgical intervention. It may affect both sexes in all age groups and result in considerable morbidity. The frequency depends upon the type of operation and its duration but statements in the literature vary greatly on account of inaccurate and varying definitions and uncertain diagnostic criteria. Intervention in the true pelvis results in the highest frequencies of postoperative urinary retention. The method of anesthesia is of lesser significance. Spinal anesthesia and epidural morphine constitute, however, a particular risk for the development of postoperative retention of urine. The pathological physiology is complex and includes: 1) disturbance of the balance between the sympathetic/parasympathetic influence on bladder and urethral function, 2) drugs which inhibit the miction reflex, 3) anaesthesia and sedation which cloud the awareness of bladder filling, 4) rapid filling of the bladder with subsequent overdistension, 5) lesion of the nerve fibres to the lower urinary tract, 6) mechanical obstruction and 7) difficult positions and/or situations for miction. Preoperative information about difficulty in emptying the bladder constitutes a predisposing factor and may require preoperative elucidation and treatment. Postoperative retention of urine may be countered by informative and practical measures and restriction of fluid intake. In selected cases, prophylactic treatment with alpha-blockers and prostaglandin may reduce the frequency. Therapeutically, oral parasympathomimetica do not appear to be effective while alpha-blockers may be employed. In cases where catheter treatment is employed and which is anticipated to be required for more than 48 hours, suprapubic drainage is recommended as this results in fewer cases of urinary infection than transurethral indwelling catheters.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗