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At least 415 records · Page 23Linked to original sources
PubMed2003

Multimodal therapy for the treatment of nonmetastatic Ewing sarcoma of pelvis.

The purpose of this study was to evaluate the outcome of patients with Ewing sarcoma (ES) of the pelvis, attempting to identify prognostic factors to select patients for more aggressive treatment. Seventy-seven patients with nonmetastatic ES of the pelvis were treated at Rizzoli Institute between 1979 and 1996. Four different protocols of chemotherapy were used successively. Two protocols consisted of VACAc, and two of VACAc plus ifosfamide and etoposide. Local treatment consisted of surgery in 5 patients, radiotherapy in 60, and surgery followed by radiotherapy in 12. Mean follow-up was 11 years (range 5-25 years). Thirty-three patients remained continuously free of disease; 43 relapsed (24 due to metastases and 19 to local recurrence and metastases); 1 died of treatment-related complications. The 5- and 10-year event-free survival rates were 45% and 44%, respectively, and the 5- and 10-year overall survival rates were 48 and 44. These results are significantly worse than the ones achieved in 329 contemporary patients with extrapelvic lesions treated with the same protocols of chemotherapy (5- and 10-year event-free survival = 46% vs. 64% and 44% vs. 69%). Thus, despite associated chemotherapy, the outcome of ES localized in the pelvis remains poor, and new innovative methods for the treatment of this tumor are needed.

Adolescent↗
PubMed2003

Reconstruction of the pelvis after resection of tumors about the acetabulum.

Periacetabular resections for primary malignancies and metastatic disease require reconstruction to restore weightbearing along anatomic axes. Without reconstruction, patients are unable to ambulate independently, and are left with a disfigured pelvis and shortened limb. The current authors describe a reconstruction technique using Steinmann pins augmented with methylmethacrylate reconstruction, and autoclaved autografting, in combination with total hip arthroplasty, after resection of primary sarcomas of the pelvis. For this study, the results of 15 patients at two institutions who had surgery by the same surgeons were retrospectively reviewed. The patients had primary malignant tumors of the pelvis, and had limb-sparing resections between 1985 and 2000. Three measures of outcome were evaluated: survival, function, and pain. The surgical method uses Steinmann pins with bone cement to fill in areas of bone loss that cannot be reconstructed with autoclaved autograft. A constrained polyethylene acetabular component is cemented into this bed. Twelve patients had chondrosarcoma and one patient had osteosarcoma. The remaining two patients had alveolar sarcoma of soft parts. Six patients died of disease. Seven patients were alive with no evidence of disease, and two were alive with disease at the most recent followup. Early return to ambulation without assistive devices occurred in nine of 15 patients. The functional outcome of this technique compares favorably with others reported. Sixty percent of patients ambulated independently without assistive devices, compared with 0% to 10% in other studies reviewed. The time required for independent gait is similar to recovery from a total hip arthroplasty. Moreover, this method minimized leg length discrepancy, while also producing a favorable cosmetic result.

Acetabulum↗
PubMed2004

Sagittal alignment of the spine and pelvis during growth.

STUDY DESIGN: Prospective study of the sagittal plane alignment of the spine and pelvis in the normal pediatric population. OBJECTIVES: To document the sagittal alignment of the spine and pelvis and its change during growth in the normal pediatric population. SUMMARY OF BACKGROUND DATA: Pelvic morphology as well as sagittal alignment of the spine and pelvis in the pediatric population are poorly defined in the literature. METHODS: Five parameters were evaluated on lateral standing radiographs of 180 normal study participants 4 to 18 years of age: thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence. Statistical analysis was performed using two-tailed Student t tests and Pearson's coefficients (level of significance = 0.01). RESULTS: The mean thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence values were 43.0 degrees, 48.5 degrees, 41.2 degrees, 7.2 degrees and 48.4 degrees, respectively. There was no significant difference between males and females. Thoracic kyphosis, lumbar lordosis, pelvic tilt, and pelvic incidence were found to be weakly correlated with age, while sacral slope remained stable with growth. CONCLUSIONS: Pelvic morphology, as measured by the pelvic incidence angle, tends to increase during childhood and adolescence before stabilizing into adulthood, most likely to maintain an adequate sagittal balance in view of the physiologic and morphologic changes occurring during growth. Pelvic tilt and lumbar lordosis, two position-dependent parameters, also react by increasing with age, most likely to avoid inadequate anterior displacement of the body center of gravity. Sacral slope is achieved with the standing posture and is not further significantly influenced by age. These results are important to establish baseline values for these measurements in the pediatric population, in view of the reported association between pelvic morphology and the development of various spinal disorders such as spondylolisthesis and scoliosis.

Adolescent↗
PubMed1996

Vesico-ureteric reflux and surgically treated pelvi-ureteric junction obstruction in infants under the age of 12 months.

BACKGROUND: Pelvi-ureteric junction obstruction has been increasingly diagnosed in infants, mostly as a consequence of antenatal ultrasound examinations. METHODS: Of 55 infants below the age of 12 months who underwent dismembered pyeloplasty over a 7-year period, we aimed to determine the patterns and outcome of associated vesico-ureteric reflux that was present in 15 (28%) of the 53 infants in whom follow-up was available. RESULTS: A total of eight infants had resolution of their reflux with conservative management and the median time to resolution was 15 months. Five infants proceeded to ureteroneocystotomy. CONCLUSIONS: Given the association of vesico-ureteric reflux and pelvi-ureteric junction obstruction, routine cystography is recommended when the diagnosis of pelvi-ureteric junction obstruction is made.

Cystostomy↗
PubMed2004

Role of multiphasic helical computed tomography in planning surgical treatment for pelvi-ureteric junction obstruction.

OBJECTIVE: To evaluate the role of multiphasic helical computed tomography (CT) in planning surgical treatment for pelvi-ureteric junction obstruction (PUJO). PATIENTS AND METHODS: Multiphasic helical CT was used in 60 consecutive patients (mean age 32 years, sd 13.72) with primary PUJO. The different images were interpreted before surgery by a urologist and radiologist. The number, type and relation of the crossing vessels to the PUJ were detected. Pyeloplasty (open or laparoscopic) was used in patients where there was a significant crossing vessel (i.e. > 2 mm in diameter and passing at the PUJ) or with ballooning of the renal pelvis. Endopyelotomy (antegrade or retrograde) was used in the other patients. Subjective and objective success rates were determined 3-6 months after treatment and then every 6 months. RESULTS: Hyperdense renal stones were detected in precontrast images in 15 patients, significant crossing vessels in 33 (55%), and anterior malrotation of the renal pelvis in 23 (38%; 19 associated with significant crossing vessels, i.e. ureterovascular hydronephrosis). A large para-pelvic cyst compressing the PUJ and upper ureter was detected in one patient. Pyeloplasty was used in 45 patients, among whom the sensitivity of multiphasic helical CT in detecting crossing vessels was 97%, the specificity 92% and accuracy 96%. Uncomplicated endopyelotomy was used in 14 patients and percutaneous aspiration of the para-pelvic cyst in one. CONCLUSION: Multiphasic helical CT can accurately delineate the spatial anatomy of the renal and peri-renal area; it may be important in planning surgical treatment for PUJO, especially when endopyelotomy is considered.

Adolescent↗
PubMed1983

Fractures of the pelvis.

Pelvic fractures in this series constituted 3.3% of all traumatic admissions and 5.7% of all fractures. A classification of pelvic fractures was adopted in which five types were identified. Type I (24.2%) comprised fractures without a break in the pelvic ring. Type II (17.7%) comprised those with a single break in the pelvic ring. Fractures with a double break of the pelvic ring constituted Type III (23.6%). Multiple fractures of the pelvis were identified as Type IV (10.8%). Fractures of the acetabulum were grouped separately as Type V (23.7%). On the basis of blood loss, mortality and potential disability, Types I and II constituted the 'minor' fractures of the pelvis. Types III, IV and V were the 'major' fractures of the pelvis, of which Type IV were the worst. The commonest fracture encountered was that of a single pubic ramus. The pubic area was involved in 43.0% of the cases. Associated injuries were common (2.19 per patient). Some of these lesions were the result of the causative trauma. Some others, however, were related to certain types of pelvic fractures.

Adolescent↗
PubMed1993

An improved method for the scintigraphic detection of acute bone damage to the equine pelvis by probe point counting.

A fracture of the pelvis in a horse can be detected scintigraphically by probe point counting. However, the pelvis is covered by a large and variable muscle mass, and is close to the urinary bladder, both of which can introduce errors. This paper describes an improved technique which uses a larger set of sampling points and analyses the data with a small computer to construct a three dimensional graph of the gamma-ray output across the pelvis, thus helping to improve the interpretation of the data. The scintigraphic plot from a normal horse, three cases of fracture (confirmed by radiography, ultrasound imaging or post mortem examination) and examples of the artefacts produced by isotope in the bladder and by marked muscle wasting are presented.

Animals↗
PubMed1992

Pediatric pelvis: radiographic appearance in various congenital disorders.

This article presents the spectrum of pelvic abnormalities in developmental diseases of bone. The pelvis comprises the ilium, ischium and pubis, and the sacrum. Knowledge of pelvic embryology and normal development is essential in recognizing pelvic abnormalities and disorders, which involve the number of bone elements, rate of ossification, density, and size or shape. Anarchic development of bone and dysplasias identifiable at birth must also be considered. The pelvis is important in the evaluation of such disorders because of the frequent, varied, and often specific radiologic abnormalities. The pelvis may also be the first evidence for a congenital malformation syndrome because it is often included in routine radiographic examinations.

Bone Diseases, Developmental↗
PubMed1990

The ventilatory movements of the avian pelvis and tail: function of the muscles of the tail region of the pigeon (Columba livia).

We have observed that birds of several different taxa move their tails in conjunction with sound production. These observations suggested to use that tail movements might also be associated with ventilation. Since we hypothesized that rhythmic movements of the tail and pelvis will ventilate the lungs, the activities of tail, epaxial and cloacal muscles of the pigeon were examined. Electromyograms (EMGs) were recorded from these muscles while ventilation was monitored. A muscle was considered to have ventilatory activity when the EMG activity had an obvious correlation to either inspiration or expiration. To obtain further information about the correlation between muscular activity and ventilation, we induced hyperpnea by administering 5% CO2. We report that the tail muscles that function as expiratory muscles are the M. caudofemoralis, the M. pubocaudalis internus and the M. pubocaudalis externus. We refer to these as the suprapubic abdominal muscles to distinguish them from the infrapubic (ventral) abdominal muscles. These muscles depress the pelvis and the uropygium and compress the thoracoabdominal cavity. M. transversus cloacae functions as an expiratory muscle by protracting the cloaca or by reducing its compliance. Of the suprapubic muscles we studied, the only inspiratory muscle is the axial muscle, M. longissimus dorsi. M. longissimus dorsi acts at the notarial-synsacral junction to elevate the pelvis. The rocking movements of the notarial-synsacral joint appear to be important for ventilation during conditions in which the sternum is 'fixed', such as when the bird is resting on its breast. We suggest that a division of labor may exist between the infra- and suprapubic abdominal muscles during ventilation such as panting or vocalization.

Abdominal Muscles↗
PubMed1995

The anatomy of the pelvis in the exstrophy complex.

We compared computerized tomography scans of the pelvis of twenty-four patients who had exstrophy of the bladder with scans of age-matched controls in order to analyze the pelvic deformity that accompanies the variably severe manifestations of this condition. The patients who had classic exstrophy of the bladder were found to have a mean of 12 degrees of external rotation of the posterior aspect of the pelvis on each side, retroversion of the acetabula, a mean additional 18 degrees of external rotation and 30 per cent shortening of the pubic rami, and progressive diastasis of the symphysis pubis. The foot-progression angle demonstrated 20 to 30 degrees of external rotation beyond the normal limits seen in early childhood, but this improved with age. The patients who had exstrophy of the cloaca and the bladder not only had all of these pelvic deformities to a greater degree but also had asymmetry of measured parameters between the right and left sides of the pelvis, malformation of the sacro-iliac joints, and occasional dislocation of the hip. An understanding of the pelvic anatomy that accompanies exstrophy is essential when corrective approaches are planned. Such an understanding will improve the rate of success of both closure of the bladder and control of urinary continence postoperatively.

Adolescent↗
PubMed1975

Renal osteodystrophy in patients on hemodialysis as reflected in the bony pelvis.

Roentgen studies in a group of 131 patients on maintenance hemodialysis reveal renal osteodystrophy in 25 patients (19 per cent). In 24 patients of the latter group (98 per cent), the various manifestations of renal osteodystrophy appear in the bony pelvis. These include: osteomalacia; osteitis fibrosa; osteosclerosis; dialysis osteopenia; and extraosseous calcifications. Some of the changes, i.e., bending of bone, Looser's lines, metaphyseal fractures and dialysis osteopenia, are due, at least in part, to the weight bearing nature of the bony pelvis. These findings are ararely, if ever, seen in the digits or in other non-weight bearing bones. It is therefore proposed to evaluate the bony pelvis, together with the magnification digital roentgenogram, when a less costly and less time consuming skeletal survey is needed in hemodialized patients.

Adolescent↗
PubMed1996

Primary bone tumors of the pelvis presenting as spinal disease.

Low back pain and sciatica are usually attributed to localized structural pathology; however, tumors of the pelvis may also cause these symptoms. Pelvic bone neoplasms are seldom immediately diagnosed and, therefore, may result in significant morbidity and mortality. Fourteen cases of malignant primary bone tumors of the pelvis that caused spinal symptoms were referred to our Musculoskeletal Tumor Service. Several recurring characteristics of these cases that may alert the clinician to the possibility of underlying pelvic bone malignancy in a patient with low back pain were identified: 1) age > or = 45 years; 2) insidious onset of symptoms without antecedent trauma; 3) prolonged symptoms for more than 1 month; 4) progressive pain that fails conservative therapy; and 5) presence of anorexia, malaise, or night pain. We suggest that in diagnosis of a patient presenting with these characteristics, the clinician instruct that the pelvis be included in initial radiographs. If plain radiograph is non-diagnostic and symptoms remain unresponsive, we recommend obtaining a bone scan, and then, if necessary, computerized tomography or magnetic resonance imaging.

Adult↗
PubMedDate not supplied

[A fibroepithelial myxoid polyp of the renal pelvis in a patient with horseshoe kidneys. Apropos a case].

Tumours of the renal pelvis are usually urothelial carcinomas. The benign tumors are extremely rare. Fibroepithelial polyps are the most common mesodermal tumors of the upper urinary tract. They are found most commonly in the ureter but several have been reported in the renal pelvis. Patients usually present with pain and less commonly hematuria. Grossly, these polypoid structures are smooth nodules or filiform projections varying is size from a few millimeters to several centimetres. Histologically, they consist of a thick fibrous stalk with numerous vascular channels covered by a layer of normal or hyperplastic transitional epithelium. The etiology of these tumors is unknown but congenital, obstruction, allergy and trauma have been implicated. Conservative treatment is recommended when the diagnosis is certain. To our knowledge, this is the first report of fibroepithelial polyp of the renal pelvis in a patient with horseshoe kidney.

Humans↗
PubMedDate not supplied

Lumbar corsets: their effect on three-dimensional kinematics of the pelvis.

Lumbar corsets have been recommended for low back pain patients as a way of stabilizing the lumbar region, facilitating flexion movements, and reducing pain. However, little is known about how these devices affect lumbar motion. To determine the degree of changes in the lumbar region, our approach was to quantify three-dimensional kinematic data of the pelvis in harness-supported treadmill walking. Twelve healthy subjects (age=32+/-11.8 years) walked on a motorized treadmill at 4.5 km/h with and without wearing a lumbar corset. Three external markers overlying the sacrum were tracked by three ultrasound microphones, determining a local coordinate system, to obtain pelvic motions in the frontal, sagittal, and transverse planes. Raw kinematic data were low-pass filtered and normalized relative to the right heel strike. Mean values for net angular displacements of the pelvis were calculated for each plane within the 5th and 95th percentile. The Student's t-test demonstrated significant differences (P<0.001) between the corset/no-corset conditions in the frontal plane. An average 40% decrease in the relative pelvis up- and downward movement occurred in the frontal plane (4.1 degrees+/-2.9 degrees vs. 7.1 degrees+/-3.3 degrees). The analysis revealed no significant differences of net angular displacements in the sagittal (2.9 degrees+/-1.4 vs. 3.4 degrees+/-1.7 degrees) and the transverse planes (4.4 degrees+/-2.6 degrees vs. 4.3 degrees+/-2.1 degrees).

Adult↗
PubMed1975

Displaced fractures of the major pelvis: a method of management.

Fractures of the bony pelvis occur with such violence that associated non-musculo-skeletal injury is common. The patients require an aggressive team approach if they are to leave the hospital alive. After the visceral injuries are treated, the bony pelvis should be aligned to minimize secondary sacroiliac arthritis. Following initial pelvic sling management, the reduction of these fractures is accomplished by using the Keim-Surcingle table coupled with a pantaloon spica cast to maintain the reduction. The patient is then managed by bedrest at home until 12 weeks post-injury at which time the plaster is removed and ambulation is progressed as tolerated. The pubic diastasis may increase if plaster immobilization is discontinued too early. We hope that an aggressive initial evaluation and team approach coupled with this method of reduction and immobilization will decrease significantly the mortality and morbidity associated with displaces fractures of the major pelvis.

Adult↗
PubMed2002

[Elevated level of CA 125 antigen in women in reproductive age without neoplastic diseases in pelvis minor].

Behaviour of CA 125 antigen in women in reproductive age without neoplastic diseases in pelvis minor was presented. The study material was divided into 4 groups: 29 women with endometriosis, 16 women with inflammation of pelvis minor, 7 women with cirrhosis, developmental malformation of reproductive organs and pregnancy, 8 women of middle gynaecological age 6.75 had endometriosis. It has been revealed that the inflammatory state of the uterine adnexa and the appendix as well as cirrhosis, developmental malformation of reproductive organs may evolve with elevated level of CA 125 marker. It has also been shown that endometriosis in pelvis minor may be expressed by a raised level of CA 125 marker.

Adolescent↗
PubMed2003

[Malignant melanoma of the pelvis as a possible cause of pelvic limb lameness in two gray mares].

Two grey mares, a 12-year-old Arabian and a 13-year-old Lippizaner cross, were referred for chronic pelvic limb lameness and abduction of the limb during the non supporting phase of the stride. The clinical examination revealed melanomas under the tail and on the perineum, and oedema of the proximal lame limb. A mass in the pelvic area was detected on rectal palpation. Laparoscopy was performed and the provisional diagnosis of malignant melanoma was made. Histological examination of the biopsy taken under laparoscopic control from the mass in the pelvis confirmed the diagnosis of malignant melanoma. In the postmortem examination a large black mass in the pelvis and metastases in several organs were diagnosed. The process under the tail showed microscopically the characteristics of dermal melanomatosis. The metastases showed the appearance of a malignant melanoma. The lameness and abduction during the non supporting phase of the stride were possibly caused by a combination of pain, a mechanical limitation, and paresis/paralysis. When an older grey horse with melanomas on the predilection sites is submitted with pelvic limb lameness and abduction of the limb during the non supporting phase of the stride, a malignant melanoma in the pelvis is one of the differential diagnoses and a rectal examination should be performed. Diagnostic laparoscopy in the standing horse can be useful to confirm the provisional diagnosis.

Animals↗
PubMed2003

[Clinical examination of the pelvis in patients with multiple traumas is unreliable].

BACKGROUND: The primary examination of a seriously injured patient is often done according to the Advanced Trauma Life Support concept. This concept calls for routine x-rays of the chest, pelvis and cervical spine. We have seen a tendency in Norway towards selective use of the pelvic film according to trauma mechanism and physical findings, even in patients with multiple traumas. MATERIAL AND METHODS: Four cases illustrate the risk of missing serious injuries in patients with multiple injuries if routine pelvic x-ray is omitted. A review of the literature confirms that routine pelvic x-ray may be omitted only if the patient is alert, has a negative physical pelvic examination, and no other distracting painful injuries. INTERPRETATION: Early x-ray of the pelvis should still be a routine in patients with multiple injuries, but may be omitted in patients with normal consciousness, no distracting painful injuries and no pain on examination of the pelvis.

Accidental Falls↗