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PubMed1999

Femoral neck length and hip fracture risk.

To determine whether there are differences in femoral skeletal geometry in fracture-prone subjects when size, positioning diagnosis, and age are controlled, we compared femoral measurements made from the uninvolved hip on 119 plane anteroposterior pelvis radiographs of women without fracture to those of the contralateral hip in a group of 43 female patients with hip fractures (neck, 23; intertrochanteric, 20). The hip was imaged in a standardized position of rotation and adduction. Race, age, and musculoskeletal diagnosis were known. Subjects were grouped by diagnosis of the opposite hip condition (rheumatoid arthritis, osteoarthritis, and normal) and compared. Measurements were also analyzed as ratios to head diameter (HD), neck diameter (ND), and pelvic width. Femoral neck length (NL) was measured from skeletal preparations and imaged in controlled positions of abduction and external rotation. No differences were found between the neck and intertrochanteric fracture groups. The differences between the fracture group and the controls were a thinner femoral cortex (measured at a point one head radius below the lesser trochanter) a larger femoral head, and a larger femoral ND in the fracture group (p < 0.025). The difference in cortical thickness was still significant when scaled by size, but the ratio of HD to ND was equivalent in fractures and controls. No difference in femoral NL could be demonstrated. The experimental measurements showed that apparent NL is significantly position sensitive and this may explain previously reported differences in fracture-prone groups.

Aged↗
PubMed1983

Hepatocarcinogenesis in rats fed methyl-deficient, amino acid-defined diets.

The ability of methyl-deficient, amino acid-defined diets to produce liver tumors was studied in rats treated both with and without initiating doses of diethylnitrosamine (DENA). Male, weanling F344 rats were fed a complete, amino acid-defined diet for one week. They were then injected once i.p. with one of 3 doses of DENA (20, 70 or 200 mg/kg body weight) and fed the complete diet for an additional week. Thirty animals from each dose group were then maintained for 76 weeks on the complete diet (Diet 1) or one of 4 methyl-deficient diets: Diet 2, devoid of methionine and choline; Diet 3, devoid of methionine only; Diet 4, devoid of choline only and Diet 5, devoid of methionine, choline, folic acid and vitamin B12. In Diets 2, 3 and 5 methionine was replaced by equimolar amounts of its metabolic precursor DL-homocystine. Control rats were injected i.p. with the saline vehicle and maintained for the 76-week period on Diets 1 and 2. Forty percent of the rats fed Diet 2, but receiving no DENA, developed hepatocellular carcinomas or cholangiomas. A 90-100% incidence of hepatocellular carcinomas was seen in all groups initiated with DENA and fed Diet 2. No malignant liver tumors developed in Diet 1 rats that had received 0 or 20 mg/kg DENA; however, hepatocellular carcinomas were noted in one-half of such animals receiving the 70 and 200 mg/kg doses. Liver metastases grew in the lungs of 60% of the tumor-bearing rats fed Diet 2; none were seen in the Diet 1-fed rats. The singly deficient Diets 3 and 4 enhanced liver tumor formation to DENA-initiated rats to a significantly lesser extent than did Diet 2. All DENA-initiated rats fed the severely deficient Diet 5, died within 23 experimental weeks with livers containing hepatocytes of atypical appearance and, particularly at the 2 higher dosages, a cirrhotic pseudonodular architecture. No hepatocellular carcinomas or cholangiomas were observed in Diet 5-fed rats. None of the diets tested appeared to enhance tumor formation in extrahepatic tissues. In fact, significant decreases were noted in the formation of spontaneous testicular interstitial cell tumors in Diet 2-fed rats and of pancreatic acinar tumors in rats fed Diets 2 and 3. Diet 2, devoid of both methionine and choline, also induced metaplasia of pancreatic acinar cells to hepatocyte-like cells and was associated with moderate to severe hyperplasia of the transitional epithelium lining the renal pelvis.(ABSTRACT TRUNCATED AT 400 WORDS)

Adenoma, Bile Duct↗
PubMed1995

Ten years of experience with porous acetabular components for revision surgery.

A prospective study was completed for 139 porous-coated revision acetabular components that were implanted with rim fit fixation and had a mean of 4.3 years' followup (range, 2-9.8 years). The Anatomic Porous Replacement component was studied. Harris Hip Scores were used for clinical evaluation, and the pain and limp components of the Harris Hip Score were assessed. Radiographic measurements were recorded as radiolucent lines by Delee and Charnley zones. Clinical results were of lesser value in this study because of the emphasis on the acetabular component. Of these components, 4.3% had revision; only 2 (1.4%) were revised for loosening. Migration occurred in 2.1% of these acetabular components. In the first 2 years postoperatively, 17.4% of components had increased radiolucent lines and 9.4% had fewer radiolucent lines. After 2 years, fixation was stable: 4% had progressively more radiolucent lines and 2% fewer radiolucent lines. The authors could not show any statistical difference in radiographic fixation of these components when adjunctive screw fixation was used or not used. Fixation of the acetabular components was better when slurry bone graft was not used to layer the acetabular surface. Fixation was similar whether the rim fit was obtained with or without protrusion of the medial dome of the cup into the pelvis. The authors did not observe osteolysis in the acetabular bone surrounding these components.

Acetabulum↗
PubMed1989

Autonomic innervation of reproductive organs: analysis of the neurons whose axons project in the main penile nerve in the pelvic plexus of the rat.

An understanding of the composition of the various nerves of the pelvic plexus is essential in the design of studies to explore the autonomic control of pelvic visceral tissues. As a correlate of this interest, the present study was designed to determine the composition of the main penile nerve in the pelvic plexus of the laboratory rat, an animal commonly used for studies of reproductive physiology. Retrograde tracing studies indicate that the main penile nerve contains neurons which project to the penile crura, the corpus spongiosum, and the bulbourethral glands. The main penile nerve is the major source of neurons which innervate the corpus spongiosum and bulbourethral gland and contains about one-third of all parasympathetic neurons which project to the penile crura. Dye placed on the proximal cut end of the main penile nerve indicates that neurons in the parasympathetic region of the spinal cord (L6-S1) and to a lesser extent a sympathetic region of the cord, L1-L2, provide preganglionic innervation to ganglion cells in the main pelvic nerve. Processes of neurons in dorsal root ganglia L6-S1 and of neurons in the abdominopelvic sympathetic chain course in the main penile nerve to unknown destinations. In many respects this presumed postganglionic fiber tract is essentially a region of the pelvic plexus which subserves extrapelvic visceral tissues.

Animals↗
PubMed1996

The use of radiotherapy for patients with isolated elevation of serum prostate specific antigen following radical prostatectomy.

PURPOSE: An analysis was performed to assess the outcome of patients who received radiotherapy for isolated elevation of serum prostate specific antigen (PSA) levels following radical retropubic prostatectomy. MATERIALS AND METHODS: Forty-six patients were initially treated for localized prostate cancer with radical retropubic prostatectomy following negative pelvic lymphadenectomy. These patients had detectable serum PSA 6 or more months postoperatively. No patient had other clinical evidence of recurrent disease as determined by history, physical examination, bone scan, computerized tomography of the abdomen and pelvis, chest radiographs, complete blood cell counts and serum chemistry profiles. The patients received prostate bed irradiation using 10 MV. x-rays and a 4-field approach. Doses ranged from 60.0 to 67.0 Gy. in 1.8 to 2.0 Gy. fractions. Freedom from failure after radiotherapy was defined as maintaining a PSA of 0.3 ng./ml. or less without hormonal intervention. RESULTS: In 27 of the 46 patients (59%) PSA had decreased to 0.3 ng./ml. or less at last measurement without hormonal intervention. The freedom from failure rate was 50% at 3 and 5 years. More favorable responses to salvage radiotherapy occurred in patients with low grade tumors and serum PSA 1.1 ng./ml. or less at initiation of radiotherapy. Patients, receiving radiation doses of 64 Gy. or more had more favorable response rates than those receiving lesser doses. CONCLUSIONS: Isolated elevations of serum PSA following prostatectomy reflect residual disease. Radiotherapy administered to the prostate bed effectively decreased serum PSA in approximately half of the cases. This effect appears to be accomplished by eradicating tumor cells in the prostate bed.

Combined Modality Therapy↗
PubMed2000

[Pelvic lipomatosis: clinical review and report of 4 new cases].

First described by the end of the fifties, pelvic lipomatosis is an uncommon disease that develops as a result of an excessive proliferation of benign fat tissue within the perivesical and perirectal spaces. The compressive effect on the urinary, and to a lesser degree, the digestive and vascular structures result in the well-known symptoms. Diagnosis is reached through X-ray studies, primarily computerised tomography. Contribution of four new cases in young males diagnosed through imaging studies as well as biopsies in three of them. Evolution has been varying, with medical control of symptoms in two cases and renal function impairment due to upper obstructive uropathy in the other two.

Adult↗
PubMed2004

Purinergic component of mechanosensory transduction is increased in a rat model of colitis.

ATP contributes to mechanosensory transduction in the rat colorectum. P2X3 receptors are present on dorsal root ganglia (DRG) neurons that supply this area of the gut. Previous studies have shown an increased role for ATP in inflamed tissues. We aimed to investigate whether an increased purinergic component exists during mechanosensory transduction in a rat model of colitis. An in vitro rat colorectal preparation was used to investigate whether distension increased ATP release and to evaluate the role of purinergic antagonists in distension-evoked sensory discharges in the pelvic nerve in normal and colitis preparations. DRG neuron purinoceptors were also studied. Distension-evoked responses in the colitis model were attenuated to a significantly greater extent by 2',3'-O-trinitrophenyl-ATP and pyridoxyl 5-phosphate 6-azophenyl-2',4'-disulfonic acid. Inflammation caused augmented distension-evoked sensory nerve excitation after application of ATP and alpha,beta-methylene ATP. Single-fiber analysis confirmed that mean firing per unit was increased. Distension-evoked increases in ATP release from epithelial cells were substantially higher. The number of DRG neurons responding to ATP and the number of those staining for the P2X3 receptor, particularly those containing calcitonin gene-related peptide, were increased. Adenosine, after ectoenzymatic breakdown of ATP, is involved to a lesser degree in the longer-lasting distension-evoked sensory discharge, suggesting reduced ATPase activity. It was therefore concluded that ATP has an enhanced role in mechanosensory transduction in the inflamed rat colorectum. The underlying mechanisms appear to involve increased distension-evoked release of ATP as well as an increase in the number of DRG neurons supplying the colorectum expressing P2X3 receptors, especially those containing calcitonin gene-related peptide.

Adenosine Triphosphate↗
PubMed2000

A pilot study of preoperative continuous infusion 5-fluorouracil, external microwave hyperthermia, and external beam radiotherapy for treatment of locally advanced, unresectable, or recurrent rectal cancer.

PURPOSE: To determine the feasibility of combining external beam radiotherapy, continuous infusion 5-fluorouracil (5-FU), and external microwave hyperthermia in patients with locally advanced, unresectable, or recurrent adenocarcinoma of the rectum. METHODS AND MATERIALS: From 7/95 through 2/99, 15 patients were enrolled in the study. The treatment regimen consisted of continuous infusion 5-FU 250 mg/m(2)/d 7 days/week beginning on day 1, external beam radiotherapy to the pelvis, 4500 cGy, 180 cGy/d 5 days/week using a 3 or 4-field technique, and external microwave hyperthermia on days 3, 8, 15, 22, and 29. Chemotherapy was stopped on the last day of radiotherapy. Surgical resection, if feasible, was scheduled 3-6 weeks after completing thermochemoradiotherapy. For this regimen to be considered feasible, no more than 2 of the 15 patients should fail to complete therapy due to life-threatening toxicity. Toxicity was scored using National Cancer Institute Criteria. RESULTS: All patients completed the chemoradiotherapy portion of the protocol. Eleven of the 15 patients completed all 5 hyperthermia treatments. Of the 4 patients who did not receive the full course of hyperthermia, only 1 patient had treatment stopped due to life-threatening toxicity. The other 3 patients did not complete hyperthermia due to scheduling errors (n = 2) or patient request (n = 1). Five of 15 patients required a treatment interruption due to toxicity > or = Grade 3. Seven patients experienced lesser degrees of toxicity which did not require treatment interruption. Three patients experienced no side effects. The most common toxicities were dermatitis and diarrhea. Of the 14 patients in whom surgery was planned, 11 (79%) were resectable. There was one pathologic complete response. CONCLUSIONS: It is feasible to deliver thermochemoradiotherapy, as prescribed in this study, to patients with locally advanced, unresectable, or recurrent rectal cancer. The therapy is moderately toxic, with one-third of patients requiring temporary treatment interruptions. The regimen appears active against rectal cancer, and appears to warrant further consideration as a treatment option for this patient population.

Adult↗
PubMed2005

Trunk muscular activation patterns and responses to transient force perturbation in persons with self-reported low back pain.

Trunk stability requires muscle stiffness associated with appropriate timing and magnitude of activation of muscles. Abnormality of muscle function has been implicated as possible cause or consequence of back pain. This experimental study compared trunk muscle activation and responses to transient force perturbations in persons with and without self-reported history of low back pain. The objective was to determine whether or not history of back pain was associated with (1) altered anticipatory preactivation of trunk muscles or altered likelihood of muscular response to a transient force perturbation and (2) altered muscle activation patterns during a ramped effort. Twenty-one subjects who reported having back pain (LBP group) and twenty-three reporting no recent back pain (NLBP group) were tested while each subject stood in an apparatus with the pelvis immobilized. They performed 'ramped-effort' tests (to a voluntary maximum effort), and force perturbation tests. Resistance was provided by a horizontal cable from the thorax to one of five anchorage points on a wall track to the subject's right at angles of 0 degrees, 45 degrees, 90 degrees, 135 degrees and 180 degrees to the forward direction. In the perturbation tests, subjects first pulled against the cable to generate an effort nominally 15% or 30% of their maximum extension effort. The effort and the EMG activity of five right/left pairs of trunk muscles were recorded, and muscle responses were detected. In the ramped-effort tests the gradient of the EMG-effort relationship provided a measure of each muscle's activation. On average, the LBP group subjects activated their dorsal muscles more than the NLBP group subjects in a maximum effort task when the EMG values were normalized for the maximum EMG, but this finding may have resulted from lesser maximum effort generated by LBP subjects. Greater muscle preactivation was recorded in the LBP group than the NLBP group just prior to the perturbation. The likelihood of muscle responses to perturbations was not significantly different between the two groups. The findings were consistent with the hypothesis that LBP subjects employed muscle activation in a quasi-static task and preactivation prior to a perturbation in an attempt to stiffen and stabilize the trunk. However, interpretation of the findings was complicated by the fact that LBP subjects generated lesser efforts, and it was not known whether this resulted from anatomical differences (e.g., muscle atrophy) or reduced motivation (e.g., pain avoidance).

Adult↗
PubMed1994

Radiotherapy for isolated increases in serum prostate-specific antigen levels after radical prostatectomy.

OBJECTIVE: To assess the outcome of radiotherapy in patients with increased serum prostate-specific antigen (PSA) levels 6 months or more after radical prostatectomy. DESIGN: In 27 Mayo Clinic patients, we examined the results of radiotherapy relative to various potentially prognostic factors during a median follow-up of 25 months. MATERIAL AND METHODS: All 27 patients had no nodal involvement at the time of prostatectomy and no clinical evidence of disease, as determined by history, physical examination, a radionuclide bone scan, computed tomography of the abdomen and pelvis, chest roentgenography, complete blood cell counts, and serum chemistry profiles. With use of 10-MV photons and a four-field approach, these patients received irradiation to the prostatic bed (60 to 67 Gy in 1.8- to 2.0-Gy fractions). RESULTS: Levels of PSA initially decreased in 24 of the 27 patients (89%). In 16 of the 27 patients (59%), the PSA level decreased to 0.3 ng/mL or less without hormonal intervention. "Freedom from failure" (defined as the actuarial chance of maintaining a PSA level of 0.3 ng/mL or less) was 58% at 2 years and 48% at 3 years. The response to salvage radiotherapy was more favorable in patients with no tumor spread into the seminal vesicles and those with serum PSA levels of less than 1.1 ng/mL at the beginning of radiotherapy than in those with seminal vesicle involvement or higher PSA levels. In addition, patients who received radiation doses of 64 Gy or more had more favorable responses than did those who received lesser doses. Radiotherapy resulted in no severe toxicity. No patient had clinical evidence of disease at the time of this report. CONCLUSION: Isolated increases in serum PSA after prostatectomy indicate the presence of residual or recurrent disease, and radiotherapy effectively decreases the PSA in approximately half the cases. This result is achieved by eradicating residual or recurrent cancer in the postoperative tumor bed.

Aged↗
PubMed1986

Arterial reconstructions of the lower limbs in diabetics and nondiabetics. Comparative late results.

1,261 arterial reconstructions concerning the pelvis level and the lower limbs were performed in our department between 1970 and 1981. 510 of all patients (35.4%) were diabetics, a vascular reconstruction could be performed in 337 diabetic patients, in 173 an amputation was unavoidable. 62% of all diabetics underwent a bypass operation, 38% an aorto-iliac reconstruction. There were one and a half more females than in nondiabetics. The diabetics were operated five years later than nondiabetics. The numbers of risk factors was more frequent. The onset of vascular disorders was not dependent on duration or treatment of the diabetes. The clinical stage IV preponderated. Immediate limb salvage rate was 87.7% in our diabetics. The hospital mortality was 7.4%, in nondiabetics 3.8%. Comparative results between diabetics and nondiabetics concerning the five-, eight- and ten year patency and limb salvage rate for different graft materials were demonstrated. In diabetics the possibility of a deterioration after surgery is three times more frequent and the amputation rate is three times higher than in nondiabetics. The five year patency rate is 12% and the five year limb salvage rate 7% lesser in diabetics after femorotibial bypass.

Aged↗
PubMed1983

Spondylolysis and spondylolisthesis in children.

Spondylolysis is a common problem found in 5% of the general population. The etiology is a combination of two factors: (1) hereditary predisposition resulting from a congenital deficiency of the sacrum and posterior structures and (2) developmental factors, such as trauma, posture, or certain repetitive activities, that may precipitate a stress fracture of the pars interarticularis in susceptible individuals. Although the lesion occurs during the growth years, few individuals develop symptoms during childhood and adolescence. For the occasional child who develops symptoms, the onset usually coincides with the adolescent growth spurt, and similarly progression of spondylolisthesis occurs between the ages of 10 and 15. When symptoms develop, the child may complain of low back pain and to a lesser extent pain in the posterior buttock and thighs, usually without a neurologic deficit. A few seek medical attention because of the postural deformity or abnormal gait, secondary to hamstring tightness. Symptoms are usually initiated by strenuous activity and relieved by limitation of activity or rest. Children with spondylolisthesis appear to have more flexibility or looseness at the L5-S1 junction than their adult counterparts (Fig. 7-11). This increased mobility is reflected in the radiologic appearance of the vertebrae. There is gradual erosion of the anterior as well as the posterior aspect of the sacrum, which becomes domed or peaked in the middle. This inhibition of growth is mirrored in the trapezoid shape of the body of L5 and directly related to the degree of slip. The wear pattern suggests a teeter-totter type of instability of the fifth lumbar vertebra on the sacrum (Fig. 7-15). The sclerotic buttress appearance or reactive changes common in adults are uncommon in children (Fig. 7-17). As the slip advances to the higher grades, the sacrum and posterior aspect of the pelvis become more vertical (anterior inclination), again reflecting instability in combination with tight hamstrings and backward pulling of the pelvis (angle of tilt), giving rise to the marked physical changes and localized kyphosis of the lumbosacral spine. There is considerable evidence to suggest that when the spondylolisthesis exceeds 50%, there are many dynamic and anatomic factors at work to potentiate continued deformity and symptoms in the growing adolescent. This is reflected clinically by the frequent failure of conservative measures in controlling symptoms and the need for surgical intervention in a significant percentage of patients once the slip exceeds grade II.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2001

Dynamic magnetic resonance imaging defecography: a diagnostic alternative in the assessment of pelvic floor disorders in proctology.

PURPOSE: Standard diagnostic proctologic procedures in the assessment of pelvic floor disorders include clinical evaluation and endoscopy. Particular aspects of combined pelvic floor disorders, especially those involving more than one pelvic compartment, may remain undetected without additional technical diagnostic procedures such as videoproctoscopy, cinedefecography, or colpocystodefecography. The aim of the study was to review the potentials of dynamic magnetic resonance imaging defecography to elucidate the underlying anatomic and pathophysiologic background of pelvic floor disorders in proctologic patients. PATIENTS AND METHODS: Dynamic magnetic resonance imaging defecography was performed in 20 Patients (13 females) with main diagnoses such as rectal prolapse or intussusception, rectocele, descending perineum, fecal incontinence, outlet obstruction, and dyskinetic puborectalis muscle after clinical evaluation. The investigation was performed on a 1.5 T-magnetic resonance imaging machine in supine position. The rectum was filled with Gd-DTPA enriched ultrasound gel. First a T1/T2 weighted investigation of the pelvis was performed, followed by defecography with evacuation of the rectum. Images were obtained in a sagittal plane in a frequency of 1 image/second (true FISP) at rest and during straining. The obtained magnetic resonance imaging video tapes were analyzed off-line with cinematographic evaluation of bladder base, uterus, and anal canal position in relation to the pubococcygeal line by a blinded radiologist. Investigation time was 20 minutes. RESULTS: In dynamic magnetic resonance imaging defecography of the pelvic floor, 12 patients with descending perineum, 10 rectoceles (10 females), 6 cystoceles (6 females), 4 enteroceles (4 females), 8 intussusceptions (5 females), and a dyskinetic puborectalis muscle in 3 males were detected. In 11 females and 3 males multifocal disorders were found, involving more than one compartment in females, whereas in males complex defects were restricted to the posterior compartment. Magnetic resonance imaging defecography revealed diagnoses consistent with clinical results in 77.3 percent and defects in addition to clinical diagnoses in combined pelvic floor disorders in 34 percent. CONCLUSIONS: In complex pelvic floor disorders, involving more than a single defect, dynamic magnetic resonance imaging represents a convenient diagnostic procedure in females and to a lesser extent in males, in particular in terms of dynamic imaging of pelvic floor organs during defecation. In addition to the clinical assessment, dynamic magnetic resonance imaging had clinical impact in proctologic and interdisciplinary treatment.

Adult↗
PubMed1988

[Indications of radio-pelvimetry at a university hospital and a district general hospital].

Studies carried out on the phantom have shown how reliable transverse diameter measurements of the pelvis are when carried out by X-Ray scanning pelvimetry compared with conventional X-Ray pelvimetry. The practice of scanning radiopelvimetry (digital radiography) depends on the availability of the machine and of an induced, secondary circuit. The arrival of this new technique makes it necessary for the sake of economy to limit the indications for the investigation. We have studied the indications for the examination in a population of pregnant women in a University Hospital Service as well as pregnant women in a District General Hospital. Since the conditions under which obstetrics are carried out in general hospitals are more precarious, more radiological examinations are carried out in them. Frequently investigations were carried out on primiparous women who have normal pelves. It appeared difficult to lower the number of indications. Digital X-Rays will therefore cost a lot. In university hospitals the indications for carrying out the investigations were studied critically. It seems to be possible to reduce the numbers to 6% of all patients who are delivered. Rationalizing the indications will make it possible to avoid the extra cost which results from carrying out scanning X-Ray pelvimetries more reliably and delivering a lesser dose of X-Rays than ordinary conventional X-Ray pelvimetries deliver.

Female↗
PubMed2000

A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography.

BACKGROUND: A reliable model for predicting the outcome of primary cytoreductive surgery may be a useful tool in the clinical management of patients with advanced epithelial ovarian carcinoma. METHODS: Forty-one women with a preoperative computed tomographic (CT) scan of the abdomen and pelvis and a histologic diagnosis of Stage III or IV epithelial ovarian carcinoma following primary surgery performed by one of nine gynecologic oncologists were identified from tumor registry databases. All CT scans were analyzed retrospectively using a panel of 25 radiographic features without knowledge of the operative findings. Patient demographics, surgical findings and outcome, Gynecologic Oncology Group performance status, and pre-operative serum CA125 values were collected from patient medical records. Residual disease measuring < or = 1 cm in maximal diameter was considered an optimal surgical result. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each radiographic feature and clinical characteristic. Based on statistical probability of each factor predicting cytoreductive outcome, 13 radiographic features, in addition to performance status, were selected for inclusion in the final model. Each parameter was assigned a numeric value based on the strength of statistical association, and a total Predictive Index score was tabulated for each patient. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of the model to predict surgical outcome. Statistical significance was evaluated using the Fisher exact test. RESULTS: Twenty of 41 patients (48.8%) underwent optimal cytoreduction to </= 1 cm residual disease. CT features of peritoneal thickening, peritoneal implants (>/= 2 cm), bowel mesentery involvement (>/= 2 cm), suprarenal paraaortic lymph nodes (>/= 1 cm), omental extension (spleen, stomach, or lesser sac), and pelvic sidewall involvement and/or hydroureter were most strongly associated with surgical outcome. Using the Predictive Index scores, a receiver operating characteristic curve was generated with an area under the curve = 0. 969 +/- 0.023. In the final model, a Predictive Index score >/= 4 had the highest overall accuracy at 92.7% and identified patients undergoing suboptimal surgery with a sensitivity of 100% (21/21). The specificity, or ability to identify patients undergoing optimal surgery, was 85.0% (17/20). The PPV of a Predictive Index score >/= 4 was 87.5% (21/24), and the NPV was 100%. The ability of this model to correctly predict surgical outcome was statistically significant (P < 0.001). CONCLUSIONS: In this model, a Predictive Index score >/= 4 demonstrated high sensitivity, specificity, PPV, and NPV, and was highly accurate in identifying patients with advanced epithelial ovarian carcinoma unlikely to undergo optimal primary cytoreductive surgery. The Predictive Index model may have clinical utility in guiding the management of patients with ovarian carcinoma.

Adult↗
PubMed2005

Anterior sciatic nerve block--new landmarks and clinical experience.

BACKGROUND: Anterior sciatic nerve blocks can be complicated by several problems. Pain can be caused by bony contacts and, in obese patients, identification of the landmarks is frequently difficult. METHODS: In a first step, 100 normal anterior-posterior pelvic X-rays were analyzed. The landmarks of the classical anterior approach were drawn on these X-rays and assessed for their sufficiency. Then, in a prospective case study, 200 consecutive patients undergoing total knee replacement were investigated. These patients received femoral and sciatic nerve catheters for postoperative pain management. Using modified anatomical landmarks, sciatic nerve catheters were inserted 5 cm distal from the insertion site of the femoral nerve block perpendicularly in the midline of the lower extremity. This midline connected the insertion site of the femoral nerve catheter to the midpoint between the medial and lateral epicondyle. Correct catheter positioning was verified by magnetic resonance imaging (MRI) in six patients. RESULTS: Evaluation of pelvic X-rays showed that puncture following the classical landmarks pointed in 51% at the lesser trochanter, in 5% medial to the lesser trochanter and in 42% directly at the femur. In the latter patients, location of the sciatic nerve would have been difficult or even impossible. Using our modified anterior approach, the sciatic nerve could be blocked in 196 patients (98%). In nine patients (4.5%) blockade of the posterior femoral cutaneous nerve failed. Vascular puncture happened in 10 (5%) and bony contact in 35 patients (17.5%). Median puncturing depth was 9.5 (7.5-14) cm. Correct sciatic nerve catheter positioning was verified in all patients who underwent MRI. CONCLUSION: Our landmarks for locating the sciatic nerve help to avoid bony contacts and thereby reduce pain during puncture. Our method reliably enabled catheter placement.

Aged↗
PubMed2001

Systemic and topical drug administration in the pig ureter: effect of phosphodiesterase inhibitors alpha1, beta and beta2-adrenergic receptor agonists and antagonists on the frequency and amplitude of ureteral contractions.

PURPOSE: We searched for compounds that are pharmacologically active on ureteral motility for treating ureteral colic to ease retrograde access into the ureter and improve the clearance of stones or stone particles from the ureter. The effects of the alpha1-adrenergic receptor agonist phenylephrine, the nonselective beta and beta2-adrenergic receptor agonists isoproterenol and fenoterol, and the phosphodiesterase inhibitors papaverine (nonspecific) and rolipram (type IV) on the frequency and amplitude of ureteral contractions when administered intravenously or topically were investigated in pigs. MATERIALS AND METHODS: A total of 52 pigs were anesthetized. A double lumen 6Fr catheter was inserted through each renal pelvis and into the ureter, allowing perfusion of saline or drug solution into the renal pelvis and the recording of contractions from the mid portion of the ureter. RESULTS: The alpha1 and beta-adrenergic receptors of the ureter are not tonically activated by endogenous epinephrine or norepinephrine. Phenylephrine administered intravenously at a dose of 0.01 to 3 mg./kg. and topically at 0.1 to 3 mg./ml. per minute increased contraction frequency 10 and 4-fold, respectively, and contraction amplitude 2-fold each in a dose dependent manner. Arterial blood pressure increased markedly during intravenous administration of phenylephrine but was minimally affected during topical application. The phenylephrine effects were reversed by the antagonist prazosin. Isoproterenol administered intravenously at a dose of 0.01 to 10 mg./kg. and topically at 0.1 to 200 microg./ml. per minute decreased contraction frequency to 13% and 31% of controls, respectively. Contraction amplitude was not affected by intravenous administration but decreased to 59% of controls when applied topically. These effects were also observed with a slight delay in the saline perfused contralateral ureter. The heart rate also increased, suggesting absorption of the drug by the urothelium. The isoproterenol effects were blocked by the antagonist propranolol. Fenoterol administered intravenously at a dose of 0.1 to 30 microg./kg. and topically at 0.003 to 1 mg./ml. per minute decreased contraction frequency to 14% and 10% of controls, and contraction amplitude to 84% and 65%, respectively. These effects on the drug perfused ureter were also observed on the contralateral saline perfused ureter but to a lesser extent. The fenoterol effects were blocked by the antagonist propranolol. Papaverine administered intravenously at a dose of 0.001 to 3 mg./kg. decreased contraction frequency to 33% of controls. Topically administered papaverine as well as intravenous and topically administered rolipram had no relevant effect on ureteral motility. CONCLUSIONS: Intravenous phenylephrine increases, and isoproterenol and fenoterol decrease the frequency and amplitude of ureteral contractions in the pig. The same effects are observed with the topical administration of phenylephrine, which causes a significant local but not systemic side effect. Topical administration of isoproterenol and fenoterol produced local as well as systemic effects, suggesting absorption by the urothelium. However, to our knowledge a drug that relaxes ureteral peristalsis in pigs without causing systemic side effects has not yet been identified.

Administration, Topical↗
PubMed1980

Management of ureteropelvic obstruction in the first year of life.

From July 1971 until December 1978 we treated 19 male and 5 female children less than 1 year old for ureteropelvic junction obstruction. Diagnosis was based on high dose excretory urography with delayed films. Ultrasound was performed in some cases to confirm hydronephrosis. Cystoscopy and retrograde pyelography were not required. Of 32 obstructed kidneys 27 were repaired by dismembered reduction pyeloureteroplasty. Of 8 patients with bilateral involvement 3 underwent unilateral repair only because of lesser contralateral obstruction and 1 underwent unilateral nephrectomy. Of the 27 repairs 20 were protected by nephrostomy or pyelostomy drainage plus a small caliber silicone rubber or polyvinyl stent. Of the 6 non-stented repairs 2 had delayed opening of the repair. A frozen section renal biopsy aided in a decision to repair the kidney in 4 of 6 instances and in 10 other instances a renal biopsy was obtained for prognostic purposes. There were no secondary nephrectomies, although 2 boys required reoperations for a successful result. Instillation pyelography with fluoroscopic monitoring was used to determine when the tubes could be removed. Generally, we removed the stent 4 or 5 days postoperatively and the nephrostomy at a variable time after demonstration of patency of repair. In this group of small children pyelostomy or nephrostomy and intubation of the repair are useful additions to the surgical technique to prevent obstruction of the tiny and delicate infant ureter by anastomotic edema or kinking of the repair.

Drainage↗