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PubMed1992

Topological localization of the frequency and amplitude characteristics of the whole and segmented renal pelvis.

The contractile characteristics of pacemaker regions in the unicalyceal renal pelvis of the rabbit were examined in vitro. The amplitude and frequency spectra of spontaneous contractions of whole and separated circular and longitudinal renal pelvic strips were identified. The effect of stretch on these parameters were examined in order to establish whether the pacemaker region that generates contractions in the renal pelvis was sensitive to distention. The results show that the frequency of spontaneous contractions in the whole pelvis (65 +/- 18 mHz) was significantly higher than any part of the circularly (41 x 8 mHz) or longitudinally cut (43 +/- 8 mHz) pelvis. The amplitude of longitudinal strips, 52 +/- 11 mg, was significantly smaller than that of the circular strips, 267 +/- 52 mg. In the circularly separated pelvis the frequency of spontaneous contractions was highest in the proximal part (41 +/- 8 mHz) and lowest in the pelviureteral junction (8 +/- 1 mHz). No significant increase in frequency was seen upon stretch in the whole or separated pelvis although there was a decrease in the amplitude of both the whole and separated pelvis. These results show that the frequency of contraction of the whole or the segmented renal pelvis is not sensitive to stretch.

Animals↗
PubMed1998

[Customized 3D radiographic reconstruction of the human pelvis].

The pelvis is an essential element in the study of scoliosis since it constitutes the base of the spine and its orientation may affects postural balance. In order to study the role of the pelvis in the evolution and treatment of this disease, a new technique for the 3D personalised reconstruction of the pelvis was developed. It consists in identifying and digitizing 19 pelvic anatomical landmarks on postero-anterior and lateral x-rays and to reconstruct them in 3D with two techniques: the DLT algorithm developed by Marzan (1976) and, for 6 of the 19 landmarks, an adaptation of it called DLT with confidence coefficients. The latter takes into account the confidence given to the identification of the landmarks on each x-rays. Two methods were used to validate the reconstruction of the pelvis. The first one, used for 11 scoliotic patients and 2 dry pelvis specimens, consists in applying the reconstruction algorithm in an inverse way on the 3D coordinates of the reconstructed landmarks to obtain their 2D retroprojection on the x-ray planes, and thus comparing the retroprojected coordinates with the 2D digitized coordinates. The second method consists in measuring a dry pelvis specimen and comparing the 3D measured landmarks with the ones reconstructed with the x-rays of this specimen. For the first validation, results have shown that the lowest retroprojection errors (less than 2.5 +/- 2.6 mm) for the scoliotic patient group are located on the superior base of the sacrum, on the sacral curve and on the acetabula, while the highest (6.4 +/- 7.2 mm) were on the iliac crests. For the dry specimens, the retroprojection errors were below the millimeter. The second validation method showed 3D differences of 2.4 +/- 1.2 mm between measured and reconstructed landmarks of a dry specimen, which is of the same order of magnitude as what is reported in the literature for vertebrae. The reconstruction of the pelvis is thus considered adequate and its graphical wireframe representation allows to visualise and measure clinical indices concerning its orientation in space. Moreover, the reconstructed landmarks will be used to develop a personalised geometrical and mechanical model of the pelvis which, when integrated with the one for the spine and rib cage, will allow to simulate in a more realistic manner the biomechanical behaviour of the scoliotic trunk, particularly for the study of orthopaedic treatments with braces leaning on it.

Acetabulum↗
PubMed1982

A morphometric study of the pelvi-ureteric junction and review of the pathogenesis of upper ureteric obstruction.

A morphometric analysis has been made of the normal human pelvi-ureteric junction and upper ureter. There was found to be no anatomically definable pelvi-ureteric junction. Muscle bundles of renal pelvis and upper ureter run a spiral course and do not form clear-cut layers. There is a great normal variation of thickness of the renal pelvic and ureteric muscularis, as well as of the total thickness of these structures. Smaller, but sometimes still large differences, are seen between right and left pelvi-ureteric specimens of individual patients. Suggested normal ranges of thickness are: (1) Renal pelvis: total thickness 340-1300 micrometers, muscularis 270-1100 micrometer. (2) Upper ureter: total thickness 450-1000 micrometer, muscularis 240-790 micrometer. No neurones are present in the renal pelvis or upper ureter. The possible etiologies of pelvi-ureteric obstruction are discussed.

Cadaver↗
PubMed1997

Pelviureteral inhibitory reflex and ureteropelvic excitatory reflex: role of the two reflexes in regulation of urine flow from the renal pelvis to the ureter.

The mechanism by which the ureteropelvic junction (UPJ) regulates the passage of urine from the renal pelvis to the ureter, and prevents urinary backflow from the the ureter to the renal pelvis, is not completely understood. The current communication studies this mechanism in 18 dogs. With the dogs under anesthesia, nephrostomy was done through which two catheters (one pressure and one balloon-tipped) were introduced into the UPJ and the renal pelvis, respectively. Renal pelvis distension with a balloon filled with 1 ml of saline effected a rise of renal pelvic pressure from a mean basal pressure of 4.8 +/- 1.2 cm H2O to 6.9 +/- 2.3 cm H2O (P < 0.05). The basal UPJ pressure of 12.6 +/- 2.7 cm H2O showed no significant change with 1 ml distention of the renal pelvic balloon (P > 0.05). Renal pelvic distension with 2, 3, and 4 ml caused a significant rise of renal pelvic pressure to 8.4 +/- 2.7 (P < 0.05), 10.6 +/- 2.2 (P < 0.01), and 11.8 +/- 1.9 (P < 0.01) cm H2O, respectively, and a significant drop of UPJ pressure to 4.8 +/- 1.2, 4.7 +/- 1.1, and 4.6 +/- 1.2 cm H2O (P < 0.01), respectively. Ureteric distension with a balloon filled with 0.5 ml of saline significantly raised the ureteric pressure from a mean basal value of 4.3 +/- 1.4 cm H2O to 14.7 +/- 3.3 cm H2O (P < 0.01) and the UPJ pressure to a mean of 20.8 +/- 3.8 (P < 0.05). Ureteric distension with 1 and 1.5 ml of saline led to an elevation of ureteric and UPJ pressure which was not significantly different from that observed with distension with 0.5 ml (P > 0.05). In contrast, the UPJ showed no significant pressure change upon distension of the locally anesthetized renal pelvis or ureter, respectively. Likewise, the locally anesthetized UPJ exhibited no significant pressure response to renal pelvic or ureteric distension. The study demonstrates that urine might have to accumulate in the renal pelvis up to a certain volume and pressure so as to effect UPJ opening, which occurs at its maximum irrespective of the distending volume. UPJ opening upon renal pelvic distension postulates a reflex relationship which we call "pelviureteral inhibitory reflex." This reflex is believed to regulate the passage of urine from the renal pelvis to the ureter. Ureteric distension closes the UPJ; we call this reflex action the "ureteropelvic excitatory reflex" as it seems to prevent reflux of urine through the UPJ and thus protects the kidney. The concept that the UPJ acts as a physiologic sphincter is put forward.

Anesthesia↗
PubMed2000

Chronic expansion of the renal pelvis: a new method for reconstruction of upper ureteral defects.

OBJECTIVES: To evaluate whether the dilated renal pelvis can be used as an autologous source for the surgical reconstruction of upper ureteral defects or strictures. METHODS: In 7 female pigs, the renal pelvis was expanded by a percutaneously placed Council balloon catheter. Every other day for 4 weeks, the renal pelvis was progressively dilated with a bolus injection of saline and contrast medium, which allowed expansion of the renal pelvis to 70 to 75 mL. Four to six weeks after the initial intervention, 5 to 7 cm of the proximal ureter was resected in an open operation and replaced with a tubularized spiral flap made from the expanded renal pelvis. Three weeks later, the animals were killed, and the area of manipulation was resected for pathologic evaluation. RESULTS: All animals reached the desired expansion of the renal pelvis, and in all cases, the spiral flap was fashioned and anastomosed to the distal ureteral segment, bridging the initial defect (mean length 7 cm). Two animals died from sepsis, 4 and 6 days after the spiral flap reconstruction. A viable ureteral lumen with a patent anastomosis and a functioning pelvocaliceal unit was observed on intravenous urography in all animals. The main histologic findings were a chronic inflammatory process with concomitant mucinous metaplasia and reactive atypia of the tubules. CONCLUSIONS: The use of a balloon expander in the renal pelvis is a safe and effective technique for producing native tissue for the reconstruction of defects or strictures of the upper ureteral segment.

Anastomosis, Surgical↗
PubMed2006

High-grade urothelial carcinoma of the renal pelvis: clinicopathologic study of 108 cases with emphasis on unusual morphologic variants.

A clinicopathologic study of 108 cases of high-grade urothelial carcinomas of the renal pelvis is presented. Of the 108 tumors, 44 (40%) showed unusual morphologic features, including micropapillary areas (four cases), lymphoepithelioma-like carcinoma (two cases), sarcomatoid carcinoma (eight cases, including pseudoangiosarcomatous type), squamous differentiation and squamous cell carcinoma (15 cases), clear cells (two cases), glandular differentiation (two cases), rhabdoid, signet-ring or plasmacytoid cells (four cases), pseudosarcomatous stromal changes (four cases) and intratubular extension into the renal pelvis (three cases). Pathological staging was available in 62 patients; of these, 46 cases (74%) were in high stage (pT2-pT4) and 16 (26%) were in low stage (pTis, pTa, pT1). Clinical follow-up ranging from 1 to 256 months (median: 50 months) was available in 42 patients; of these, 26 (61%) died of tumor with a median survival of 31 months. The patients who did not die of their tumors showed only minimal or focal infiltration of the renal parenchyma by urothelial carcinoma, whereas those who died of their tumors showed massive infiltration of the kidney by the tumor. High-grade urothelial carcinomas of the renal pelvis can show a broad spectrum of histologic features similar to those seen in the urinary bladder. Our results support the finding that, unlike urothelial carcinomas of the bladder, the majority of primary urothelial carcinomas of the renal pelvis are of high histologic grade and present in advanced stages. Our study further highlights the fact that, in the renal pelvis, urothelial carcinomas show a tendency to frequently display unusual morphologic features and metaplastic phenomena. The importance of recognizing these morphologic variants of urothelial carcinoma in the renal pelvis is to avoid confusion with other conditions. The possibility of a high-grade urothelial carcinoma should always be considered in the evaluation of a tumor displaying unusual morphologic features in the renal pelvis, and attention to proper sampling as well as the use of immunohistochemical stains will be of importance to arrive at the correct diagnosis.

Adult↗
PubMed2002

Pelvis-thorax coordination in the transverse plane during walking in persons with nonspecific low back pain.

STUDY DESIGN: Transverse pelvis and thorax rotations were studied during walking in 39 patients with nonspecific low back pain and 19 healthy participants. OBJECTIVES: To gain insight into the consequences of low back pain for gait and to identify clinically useful measures for characterizing the quality of walking in patients with low back pain. SUMMARY OF BACKGROUND DATA: Gait studies in patients with low back pain have reported a decrease in walking velocity. In normal gait, in-phase pelvis-thorax coordination (synchronicity) evolves toward antiphase coordination (counterrotation) as walking velocity increases. This study examined the effect of walking velocity on pelvis and thorax rotations in patients with low back pain. METHODS: Amplitudes of pelvis and thorax rotations were calculated, and spectral analyses were performed. Pelvis-thorax coordination was characterized in terms of relative Fourier phase, and coupling strength was assessed by means of cross-spectral analysis. RESULTS: In comparison with healthy participants, relative Fourier phase was significantly smaller in low back pain patients for walking velocities of 3.8 km/h and higher, whereas coupling strength was significantly higher for velocities from 1.4 to 3.0 km/h. No significant group differences were found in amplitude or spectral content of individual pelvis and thorax rotations. CONCLUSION: In comparison with healthy participants, the gait of patients with low back pain was characterized by a more rigid, less flexible pelvis-thorax coordination in the absence of significant differences in the kinematics of the component rotations. This result suggests that coordination measures are more adequate in assessing quality of walking in patients with low back pain than are kinematic measures pertaining to the individual segment rotations, and that conservative therapy should use methods aimed at improving intersegmental coordination.

Adult↗
PubMed2005

Renal pelvis cuff pyeloplasty for ureteropelvic junction obstruction for the high inserting ureter: an initial experience.

PURPOSE: Ureteropelvic junction (UPJ) obstruction can result from a high inserting ureter without intrinsic ureteral obstruction. We describe our initial experience using a renal pelvis cuff pyeloplasty technique to treat this cause of UPJ obstruction. MATERIALS AND METHODS: We reviewed our experience regarding all children who underwent renal pelvis cuff pyeloplasty. All patients had Society for Fetal Urology grade 3 to 4 hydronephrosis on ultrasonography and radiographic confirmation of UPJ obstruction by diuretic mercaptoacetyltriglycine renography. Pyeloplasty was performed through a flank incision. A circumferential incision was made of the renal pelvis proximal to the insertion site of the ureter into the renal pelvis. Next, a catheter was passed through the UPJ to ensure uniform patency. The cuff of pelvis with the attached ureter was then sutured to the dependent portion of the pelvis. Postoperative resolution of the obstruction was evaluated by ultrasonography and mercaptoacetyltriglycine renography. RESULTS: A total of 11 children (6 boys and 5 girls) underwent renal cuff pyeloplasty for UPJ obstruction due to a high inserting ureter. Median patient age was 6 months (range 2.5 months to 2.4 years) and median followup was 11 months (8 months to 3.4 years). All patients were discharged home within 2 days postoperatively. No intraoperative or postoperative complications were noted. All patients exhibited resolution of UPJ obstruction on followup radiographs. CONCLUSIONS: Renal pelvis cuff pyeloplasty is a surgical technique for UPJ obstruction resulting from a high inserting ureter without intrinsic ureteral obstruction. The procedure was straightforward with good results and without complications in this initial experience.

Anastomosis, Surgical↗
PubMed1992

Effects of dobutamine and terbutaline on adenylate cyclase activity and cyclic AMP content in the renal pelvis of rabbits.

We measured the adenylate cyclase activity and the cyclic AMP content of the upper and lower renal pelvis in rabbits in order to clarify whether cyclic AMP acted as the intracellular messenger of the response elicited by beta-agonists in renal pelvic smooth muscle. Adenylate cyclase activity was determined by the method of Salomon et al. and tissue cyclic AMP content by radioimmunoassay. Dobutamine elevated the adenylate cyclase activities and tissue cyclic AMP contents of the upper part of the renal pelvis more than those of the lower part of the renal pelvis. Terbutaline also elevated the adenylate cyclase activities and tissue cyclic AMP contents of both the upper and lower part of the renal pelvis. The terbutaline-induced increase was the same in the upper and lower pelvis. These data suggest that cyclic AMP acts as the intracellular second messenger in renal pelvic smooth muscle of rabbits. Furthermore it is thought that both beta 1- and beta 2-adrenergic receptors exist in rabbit renal pelvis and the distribution of these beta-receptor subtypes is different between the upper and lower part of the renal pelvis.

Adenylyl Cyclases↗
PubMed1995

Why perirenal disease does not extend into the pelvis: the importance of closure of the cone of the renal fasciae.

OBJECTIVE: The prevailing concept is that lack of fusion of the anterior and posterior renal fasciae caudally (an open cone) allows free communication between the perirenal space and the extraperitoneal portion of the pelvis. However, perirenal disease rarely extends into the pelvis and an open cone has not been observed on CT scans. Accordingly, we determined the anatomy of the caudal extent of the cone of the renal fasciae in cadavers and on CT scans. MATERIALS AND METHODS: Anatomic dissections of the lower portion of the retroperitoneum and the extraperitoneal portion of the pelvis were made in eight cadavers. Two cadavers were intact, two had colored latex injected into the perirenal space before dissections, and the abdomens and pelves of four were sectioned transversely in 3- to 5-cm-thick slices. The renal fasciae were traced on transparent films placed on the cross sections, and computer-generated three-dimensional representations of the tracings were made. These anatomic findings were correlated with observations made on CT scans of 59 consecutive patients with diseases involving the lower part of the retroperitoneum and the extraperitoneal portion of the pelvis (32 patients with hemorrhage, 16 with inflammatory processes, and 11 with neoplastic conditions). RESULTS: The anatomic study showed that the anterior and posterior renal fasciae merge to form a single multilaminar fascia in the iliac fossa. Anteriorly, this common fascia is loosely connected to the parietal peritoneum. Posteriorly lies the caudal continuation of the posterior pararenal compartment. This joins with the laterocaudal continuation of the central part of the retroperitoneum, which contains the iliac vessels. The distal part of the ureter lies within the caudal continuation of the single multilayered renal fascia. The CT studies done in patients showed that extension of the perirenal processes to the pelvis and vice versa was both restrained and uncommon: no direct extension of any abnormalities was observed in either direction, and laminar thickening of the fasciae was seen in one fifth of the patients. Similarly, no inferior communication of the perirenal space with the anterior or posterior pararenal spaces was seen. CONCLUSION: There is an anatomic barrier between the inferior perirenal space and the extraperitoneal pelvis formed by the fusion of the leaves of the renal fasciae into a single multilaminar fascia that acts as a barrier of disease extension. The multilaminar nature of this fascia, however, may also act as a filter, allowing some permeability between its layers. This potential interlaminar pathway is rare and is manifested as fascial thickening on CT scans. This laminar filter-barrier observation explains the lack of extension of perirenal diseases into the pelvis.

Adult↗
PubMed2000

Inflammatory pseudotumor of the renal pelvis. A report of 2 cases with clinicopathologic and immunohistochemical study.

We describe 2 cases of inflammatory pseudotumor of the renal pelvis. Case 1, the male patient, was 37 years old, and case 2, the female patient, was 54 years old. Both patients presented with macroscopic hematuria and flank pain. Computed tomographic (CT) scan and ureterocystoscopy revealed in case 1 a mass in the left renal pelvis and the calyces. In case 2, urography showed a lacuna of the renal pelvis, and CT scan showed an irregular thickening of the renal pelvis. In both cases, the preoperative clinical diagnosis was urothelial carcinoma, and both patients underwent nephrectomy. Microscopic examination revealed in case 1 a tumor of the renal pelvis composed of spindle cells with eosinophilic cytoplasm in a myxoid and vascular stroma with abundant inflammatory infiltrate. In case 2, the tumor was composed of densely basophilic spindle cells in a fascicular pattern intermingled with lymphocytes and plasma cells and involving the lamina propria of the renal pelvis. The spindle cells reacted strongly with antibody to vimentin and focally with antibodies to smooth muscle actin and muscle-specific actin. In the urogenital tract inflammatory pseudotumor involves preferentially the urinary bladder. Rare cases have been reported in the kidney. The 2 cases presented here are unusual due to the location in the renal pelvis, mimicking urothelial carcinoma.

Adult↗
PubMed2004

[Combined trauma of the abdomen and pelvis].

Experience in treatment of 164 patients with combined trauma of abdomen and pelvis is analyzed. Mean age of the patients was 40.1+/-17 years, 94 patients were male, 70 -- female. ISS was 28.6+/-11 points. Lethality was 44.5%, during first day -- 61.6%. High lethality may be associated with mistakes in surgical and traumatological policy. Abdominal surgery was performed in 64 (39%) patients, only in 24 (14.6%) of them laparotomy was curative, the rest 40 (85.4%) patients underwent diagnostic laparotomy. It is demonstrated that diagnostic laparotomy has negative influence on prognosis of combined trauma of the abdomen and pelvis. Adequate traumatological policy has also great influence on lethality, particularly during the first day. Overall lethality of patients with rotary-vertical instability of the pelvis was lower in the group with fixation of the pelvis than in conservatively treated patients (41.7 and 56.6%). Lethality during day 1 in patients with fixed pelvis was 0, without fixation of the pelvis -- 82%. It is concluded that verified indications for laparotomy and active traumatological policy improve treatment results in patients with combined trauma of abdomen and pelvis.

Abdominal Injuries↗
PubMed1996

Long-term outcome after percutaneous treatment of transitional cell carcinoma of the renal pelvis.

PURPOSE: The application of conservative surgery has been established in the treatment of transitional cell tumors of the renal pelvis. We reviewed retrospectively the long-term outcome after percutaneous treatment of select patients referred to a tertiary center with transitional cell tumors of the renal pelvis. MATERIALS AND METHODS: We studied 28 patients referred with a presumptive diagnosis of transitional cell carcinoma of the renal pelvis based on filling defects noted on excretory urograms. At percutaneous endoscopy tumor was resected in 26 patients, while no tumor was found in 2. All 19 men and 7 women smoked, and mean age at presentation was 65 years. Of the patients 18 presented with hematuria and 6 had bilateral upper tract tumors. After percutaneous resection, the access tract was irradiated either with iridium wire in 12 patients or a commercial high dose rate radiation delivery system in 12. Thiotepa was instilled into the nephrostomy tube without brachytherapy in 1 patient and 1 received no adjuvant treatment in all. All patients were followed by excretory urography and urine cytology. Cystoscopy and retrograde pyelography were performed when technically possible. RESULTS: After percutaneous tumor resection 6 patients (23%) had local recurrence in the treated renal pelvis, including 3 at 44, 55 and 60 months, respectively. Further conservative treatment was initially possible in 4 of these patients but ultimately only 2 (both of whom had late recurrences) retained the treated kidney. Of the 11 patients with recurrence elsewhere in the urinary tract the bladder was invariably involved (11), while synchronous or metachronous ureteral recurrence was less common (3). Nine patients remained free of any urothelial recurrence in the upper or lower tract. No patient had recurrent tumor in the nephrostomy tract. Of the patients 7 suffered from procedure-related complications, including 1 who had a persistent urinary fistula that failed to heal after brachytherapy and required nephroureterectomy. There have been 6 deaths during followup, of which 2 were disease related. The 3-year estimated local recurrence-free survival rate was 86% (95% confidence interval 63 to 95%), cause-specific survival rate 91% (95% confidence interval 67 to 98%) and overall survival rate 78% (95% confidence interval 55 to 90%). Differences in recurrence-free survival, comparing those with recurrence in the treated renal pelvis or elsewhere in the urothelium and those remaining disease-free, did not translate to a significant overall survival difference (p < 0.5) between these groups. CONCLUSIONS: Our results suggest that the combination of percutaneous local resection and tract irradiation offers an effective long-term alternative to radical extirpation in the management of select patients with superficial transitional cell carcinoma confined to the renal pelvis. When the postoperative nephrostogram demonstrates a leaking renal pelvis, tract irradiation should not be given.

Aged↗
PubMedDate not supplied

Analysis of the structural behavior of the pelvis during lateral impact using the finite element method.

In this study, three-dimensional finite element models were created from computer tomography data to study lateral impact fractures of the pelvis. The models reflect the complex geometry and material properties of the pelvis. The models were compared to published experimental results for validation. Dynamic analyses of the pelvic structure were performed for different peak forces in the range of 5520 to 15550 N to correspond to the velocities and impulses of real world accidents. The locations of structurally significant regions of the pelvis were identified based upon the stress distribution and upon the energy stored by the pelvis to failure. The impact force which induced fracture of the pelvic bone was 8610 N. The region which failed first in left lateral impact was the right pubic ramus. The fracture pattern was a variant of the lateral compression pelvic injury. The results suggest that the anterior structures of the pelvis are the most sensitive regions. The energy absorbed by the pelvis prior to failure was 8.98 J. The finite element method may be used to determine the strength and energy-absorbing capability of the pelvis for lateral impact loading.

Biomechanical Phenomena↗
PubMed1981

Transplantation of a free peritoneal patch in surgery of the renal pelvis and ureter.

Operations on the urinary collecting system successfully utilized the free peritoneal patch in a variety of situations, as animal experiments have shown. When used to cover defects the peritoneum works as a multipotent matrix for invasion of urothelium; when used as an envelope it prevents stricture due to perihilar/periureteral scarring. We used a free peritoneal patch in 31 operations on the renal pelvis and ureter between 1975 and 1980. The indications for the patch were; defects of the renal pelvis of ureteropelvic junction due to surgery for recurring stones or carcinoma of the pelvis; and pyelocalicotomy of an intrarenal pelvis if it was impossible to suture the pelvis. We also used the patch to envelop renal pelvis and ureter in extended perihilar inflammation or stenosis of the pyeloureteral junction and proximal ureter due to scarring. The results, as shown by urography, were excellent or good in 25 or the 31 cases. The transplantation of a free peritoneal patch is a simple, reliable technique that can be recommended for covering defects or preventing stricture in surgery of the renal pelvis and ureter.

Adult↗
PubMed2000

[Sagittal equilibrium of the pelvis: analysis of the inclination of the ischio-pubic ramus from the horizontal].

PURPOSE OF THE STUDY: The sagittal equilibrium of the spine and pelvis has been examined in numerous studies looking for the origin of certain posture disorders of the spine and the cause of lower back pain. Sagittal x-rays of the pelvis provide an analysis of the degree of inclination of the pelvis from the horizontal and the bi-coxo-femoral axis and information on the form of the sacrum. There is no radiographic parameter however which analyzes the transition between the pelvis-sacrum component and the femoral component, i.e. the periacetabular region. In the sagittal plane, a line tangent to the ischio-pubic ramus would appear to best reflect the orientation of the periacetabular region and the muscular forces applied to this region. The purpose of this work was to analyze the inclination of the ischio-pubic ramus from the horizontal and its relations with other sagittal radiographic parameters in a population of growing children with spinal disorders. MATERIALS AND METHOD: The study population included 100 children with spinal disorders who underwent a teleradiographic series with lateral view in the upright position. Most of the children had scoliosis (80 cases), 7 had kyphoscoliosis, 4 isthmic spondylolysis with spondylolisthesis, 1 spondylodiscitis and 4 lower back pain. Mean age was 13 years (range 2.5-22 years). We measured 7 radiographic parameters: lumbo-sacral angle, slope of the sacrum, pelvic version, incidence, thickness, overhang, and inclination of the ischio-pubic ramus from the horizontal. Data were analyzed to search for correlations between radiographic parameters and between radiographic parameters and clinical features. RESULTS: Mean inclination of the ischio-pubic ramus from the horizontal was 33.9 degrees (SD =5.9 degrees ). The only positive statistical correlation between the inclination of the ischio-pubic ramus and the clinical data was a relationship with the position of the arms compared with the horizontal (p =0.04). There was no correlation with age, sex, ethnic background, etiology. There was no correlation between the inclination of the ischio-pubic ramus and the other radiographic parameters (coefficient r ranging from 0.06 to 0.43). DISCUSSION: The interdependence of sagittal radiographic parameters of the pelvis and the spine have been largely demonstrated. Certain pathological situations (isthmic spondylolysis with spondylolisthesis, lower back pain, etc.) can be explained by the value of these parameters, particularly incidence. The inclination of the ischio-pubic ramus from the horizontal reflects the periacetabular region. When analyzed in the sagittal plane, it was found to be a more stable parameter, independent of most clinical criteria (particularly age, and etiology) and of the other radiographic parameters studied. The only determining factor appears to be acquisition of the upright position. The consistency of this parameter constrasts with the variability of the other radiographic parameters of the pelvis and the spine, particularly incidence, although the inclination of the ischio-pubis ramus is an expression of a region different than the pelvis. This study suggests that the periacetabular region plays a key role in acquisition of the upright position in humans. The periacetabular region would be a fixed point around which the lower limbs and spine describe varying orientations.

Adaptation, Biological↗
PubMed1996

The shapes of the female pelvis. Contributing factors.

OBJECTIVE: To determine the etiologic factors that play a role in shaping the female pelvis. STUDY DESIGN: The backgrounds of 611 pregnant women at term who underwent x-ray pelvimetry between 1962 and 1980 at term were extensively investigated. RESULTS: Several facts were statistically significant. First, 24.1% of the patients had an android pelvis, although only 5.7% presented any sign of hyperandrogenism. Signs of hyperandrogenism were similarly encountered in patients with a gynecoid and any other type of pelvis. Second, the android pelvis was encountered mostly in patients exposed to strenuous physical activity during adolescence. Third, the anthropoid pelvis was encountered more often when the acquisition of erect posture was delayed beyond the usual age of 14 months, while a platypelloid pelvis was more frequent when erect posture was acquired before 14 months. CONCLUSION: The final shape of the female pelvis seems to be determined by culture and environment as well as by genetics.

Aging↗
PubMed1992

Calcitonin gene-related peptide (CGRP)-immunoreactive nerve plexuses in the renal pelvis and ureter of rats.

The distribution of calcitonin gene-related peptide-immunoreactive nerve fibers in the renal pelvis and ureter was examined by immunohistochemistry using whole-mount preparations and cryostat sections. The patterns of innervation were contrasted between the pelvis and ureter; the immunoreactive nerve fibers in the pelvis ran parallel to the long axis of each of the circular and longitudinal muscle layers, causing a lattice-like appearance of the nerve fibers. In the ureter, the immunoreactive fibers were accumulated in the subepithelial region and the longitudinal muscle. In both the pelvis and ureter, a portion of the nerve fibers of smaller caliber showed a swollen or beaded structure; they were located in the musculature and beneath the epithelium extending for considerable distances. Ligation of the ureter caused a marked decrease in the immunoreactive nerves in the pelvis and the proximal portion of the ureter, suggesting that the axonal flow in the calcitonin gene-related peptide-containing neurons of the ureter runs towards the pelvis.

Animals↗