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At least 775 records · Page 43Linked to original sources
PubMed1999

Which patients with newly diagnosed prostate cancer need a computed tomography scan of the abdomen and pelvis? An analysis based on 588 patients.

OBJECTIVES: Although a computed tomography (CT) scan of the abdomen and pelvis is often recommended as part of the staging evaluation for newly diagnosed prostate cancer, most scans are negative for metastases. We hypothesized that biopsy Gleason score, serum prostate-specific antigen (PSA) levels, and clinical stage could predict for a positive CT scan and that a low-risk group of patients could be identified in whom CT might be omitted. METHODS: All patients who had both pathologic review of their prostate cancer biopsies and abdominopelvic CT scans at our institution between January 1990 and May 1996 were studied. Gleason score, PSA, and stage were evaluated by univariate (chi-square) and multivariate (logistic regression) analyses for their ability to predict for a positive CT. RESULTS: Of 588 patients, 41 (7%) had a positive CT scan. Multivariate analysis showed Gleason score, PSA, and clinical stage to be significant independent predictors of a positive CT scan, all P <0.001. The odds ratios for a positive CT scan were 6.17 (95% confidence interval [CI] = 1.58 to 24) for Gleason score 8 to 10 versus 2 to 6; 2.25 (CI = 1.24 to 4) for PSA greater than 50 versus 0 to 15 ng/mL; 2.08 (CI = 1.70 to 3.21 ) for Stage T2c-T4 versus T2b or lower. All 244 patients with Gleason score 2 to 7, PSA 1 5 ng/mL or less, and clinical Stage T2b or less had negative CT scans. Of the other 174 patients with a Gleason score of 2 to 7, 8 (5%) had a positive CT scan. Of the 1 26 patients with a Gleason score of 8 to 10, 28 (22%) had a positive CT scan. CONCLUSIONS: Gleason score, PSA, and clinical stage were independent predictors for a positive CT scan of the abdomen and pelvis in patients with newly diagnosed prostate cancer. In this cost-conscious era, we can decrease expenditure by obviating the need for a CT scan in low-risk patients (clinical Stage T2b or less, Gleason score 2 to 7, and PSA 15 ng/mL or less). A CT scan should be considered in all other patients.

Adenocarcinoma↗
PubMed1999

Epidermoid cyst of the scrotum extending into the true pelvis.

A 9-year-old boy presented with an asymptomatic scrotal mass that was separate from the testes. The workup included a scrotal ultrasound scan and voiding cystourethrogram. On surgical exploration, the mass was solid, separate from the testes, and extended into the pelvis. The mass was removed, and pathologic examination revealed an epidermoid cyst. This is an uncommon scrotal lesion in boys and may represent a monodermal teratoma or abnormal closure of the median raphe. To our knowledge, this is only the second case report of an epidermoid cyst of the scrotum extending into the true pelvis.

Child↗
PubMed2003

Unusual presentation of a malignant granular cell tumor of the pelvis: case report and literature review.

BACKGROUND: Malignant granular cell tumors are among the rarest of soft tissue cancers, currently understood to be of Schwann cell origin. As with their benign counterparts, malignant granular cell tumors (MGCTs) have a wide anatomic distribution and carry a poor prognosis, with recurrence and metastasis typically within 1 year of diagnosis. Only a handful of MGCTs have been described in the pelvis. CASE: We describe a case of malignant granular cell tumor that presented as a pararectal mass associated with severe rectal pain. The patient underwent pelvic exenteration and postoperative radiation therapy. She recurred with evidence of liver metastases on imaging studies 8 months following her exenteration. CONCLUSION: We discuss the diagnosis and prognosis of malignant granular cell tumors arising in the pelvis.

Combined Modality Therapy↗
PubMed1998

125Iodine brachytherapy for colorectal adenocarcinoma recurrent in the pelvis and paraortics.

PURPOSE: To evaluate the results of 125I brachytherapy in colorectal cancers recurrent in the pelvis and paraortics. METHODS AND MATERIALS: From September 1989 to January 1997, 29 patients with colorectal adenocarcinoma recurrent in the pelvis or the paraortic nodes were treated intraoperatively with permanent 125iodine seed implantation at the James Cancer Center of The Ohio State University (OSU). All patients had undergone prior surgery; 72% had prior EBRT. The implanted residual tumor volume was microscopic in 38% and gross in 62%. The implanted area (median 25 cc) received a median minimal peripheral dose of 140 Gy to total decay. An omental pedicle was used to minimize irradiation of the bowel. Five patients received additional postimplant EBRT (20-50 Gy; median 30 Gy). RESULTS: The 1-, 2-, and 4-year actuarial local-regional control rates were 38%, 17%, and 17%, respectively, with a median time to local failure of 11 months (95% CI 10-12 months). The first manifestation of disease progression in 52 % of the patients was local-regional. In addition, 22 patients (75%) developed distant metastases. The 1-, 2-, and 4-year actuarial overall survival rates were 70%, 35%, and 21%, (median = 18 months; 95% CI: 14-22 months). Overall survival was better for patients smaller volume implants (p = 0.007), with a lower total activity implanted (p = 0.0003), with a smaller number of implanted sites (p = 0.004), and with microscopic residual disease (p = 0.01). Patients receiving additional EBRT also had a better prognosis (p = 0.005). Local tumor progression was the cause of death in 34% of the patients who have died at the time of this report and 56% died of distant metastases. Of the patients, 13 (45%) experienced 15 toxic events, including 3 patients (10%) with enteric fistula. Neuropathy was not observed. CONCLUSIONS: 125I brachytherapy can be successfully used for salvage in patients with recurrent colorectal cancer. Patients with isolated, microscopic, or minimal gross residual disease requiring small-volume implants and those receiving additional EBRT have a better prognosis. Postimplant EBRT is now routinely added, even for previously irradiated patients, in an attempt to improve local control. Compared to IOERT and IOHDR, 125I brachytherapy is not associated with clinical neuropathy, probably due to the continuous low dose rate irradiation delivered by the 125I seeds.

Adult↗
PubMed2004

Dermoid cyst in bony pelvis that coexists with pheochromocytoma: report of a case and review of the literature.

A 42-year-old man presented with right lower quadrant abdominal pain and dysuria. The bladder was displaced to the right side of the pelvis in excretory urography. Abdominal CT revealed a mass in right adrenal gland, measuring 8 cm in diameter. There was also a cystic mass; filling left half of the bony pelvis and displacing bladder to the right, measuring 14.5 x 10, 5 x 7 cm. The patient underwent right adrenalectomy and pelvic mass excision. Pathologic examination showed that the adrenal mass was pheochromocytoma and pelvic mass was dermoid cyst. This case is the first one in literature that an intrapelvic dermoid cyst is not derived from an organ coexists with pheochromocytoma.

Adrenal Gland Neoplasms↗
PubMed1996

Urethral injury in girls with fractured pelvis following blunt abdominal trauma.

OBJECTIVE: To review the management of major urethral injury in three girls with fractured pelvis following blunt abdominal trauma. PATIENTS AND METHODS: Three girls aged 5 years, 1 year and 3 years sustained major urethral injury in association with fractured pelvis following blunt abdominal trauma. Initial management was undertaken elsewhere. Two girls, with complete loss of the urethra and a closed bladder base, were managed by construction of a neourethra using a flipped anterior bladder-wall tube. The third patient with extensive perineal soft-tissue loss and rupture of the bladder neck and urethra had a modified Young-Dees-Leadbetter bladder neck reconstruction. All three had an associated vaginal injury which did not require a specific surgical procedure. RESULTS: The two girls who underwent construction of a neourethra using a flipped anterior bladder-wall tube are continent. The first voids normally and the second is managed by clean intermittent catheterization. The patient who underwent bladder neck reconstruction is incontinent and further surgery, possibly a continent diversion, may be necessary. CONCLUSION: Pelvic fracture following blunt abdominal trauma in girls may be associated with major urethral injury, usually with an associated vaginal injury. Surgical ingenuity is required to repair such injuries successfully. In those with complete loss of the urethra, a flipped anterior bladder-wall tube neourethra is suitable.

Abdominal Injuries↗
PubMed1996

Retrograde balloon dilatation for primary pelvi-ureteric junction stenosis in children.

OBJECTIVE: To evaluate the efficacy of retrograde balloon dilatation for primary pelvi-ureteric junction (PUJ) stenosis (RBDP) in children. PATIENTS AND METHODS: Sixteen children (12 boys, four girls; mean age 29 months) with primary PUJ stenosis initially underwent RBDP. A double-pigtail catheter was left in the ureter for 6 weeks to provide drainage. The initial diagnosis of PUJ stenosis and the subsequent post-operative assessment were both made by diuretic renography in almost all patients. All children were followed up for between 9 and 38 months (mean 25) after the procedure. RESULTS: RBDP was unsuccessful in nine of 17 renal units. In three of these, failure was caused by inability to pass the catheter through the PUJ or vesico-ureteric junction (VUJ). In six cases, failure was caused by recurrent or persistent stenosis. In eight of 17 renal units, RBDP was successful in relieving the stenosis. The morbidity from the procedure was minimal. CONCLUSIONS: Long-term follow-up revealed a significant failure rate for RBDP, caused by the inability to pass the catheter through the VUJ or PUJ, or persistent and/or recurrent stenosis. Recurrent stenosis may result from excessive dilatation which traumatizes the PUJ and causes subsequent scarring. Failure to overcome the stenosis is thought to be caused by a large redundant renal pelvis, producing 'kinking' of the upper ureter. In these cases, only reduction pyeloplasty may be successful in relieving the obstruction.

Catheterization↗
PubMed2002

Does delaying pyeloplasty affect renal function in children with a prenatal diagnosis of pelvi-ureteric junction obstruction?

OBJECTIVE: To evaluate retrospectively children with an antenatal diagnosis of pelvi-ureteric junction (PUJ) obstruction who required pyeloplasty for deteriorating renal function during the follow-up, specifically assessing the recovery of function after surgery. PATIENTS AND METHODS: Between 1988 and 2000, 44 consecutive patients with a prenatal diagnosis of PUJ obstruction who were initially treated by observation underwent pyeloplasty because their renal function deteriorated during the follow-up. Patients with bilateral disease, a single kidney or vesico-ureteric reflux were excluded from the study. The mean (sd) age of the patients was 13.3 (4.5) months and their mean (range) initial renal function 39.7 (30.4-45)%. In all patients the diagnostic criteria and indications for surgery were identical. The main indication for surgery was deteriorating renal function of >5%, confirmed by renal scintigraphy. Of 44 patients, 35 (77%) had severe dilatation of the renal pelvis by >3 cm. The mean (sd) deterioration in renal function during the follow-up, just before surgery, was 8.2 (2.4)%, and the mean time between the last acceptable renogram and the study showing deterioration was 8.3 (1.3) months; the mean follow-up was 5.1 (1.6) years. The results were assessed statistically using the unpaired nonparametric Mann-Whitney U-test. RESULTS: An improvement in hydronephrosis was confirmed in all patients, with renal function returning to the initial levels in 36 of 44 (81%) patients 6-12 months after surgery, although in two patients renal function did not improve after surgery. There was no significant difference between the preoperative characteristics and the degree of hydronephrosis, renal function or patient age with the level of renal functional improvement after surgery. CONCLUSION: In patients with an antenatal diagnosis of PUJ obstruction, expectant management is recommended and spares the children unnecessary surgery. Even if renal function deteriorates, delayed pyeloplasty recovers the initial functional level.

Decision Making↗
PubMed2002

Urothelial carcinoma of the renal pelvis with choriocarcinomatous features: genetic evidence of clonal evolution.

Urothelial carcinoma with choriocarcinomatous features is a rare malignancy arising in the urinary bladder or renal pelvis. We report the case of a 60-year-old man with a biphasic neoplasm of the right kidney composed of papillary urothelial carcinoma and choriocarcinoma. Widespread hepatic and pulmonary metastases with choriocarcinomatous features were found on autopsy 6 weeks after initial diagnosis. Chromosomal analysis revealed a close genetic relationship between the papillary urothelial and choriocarcinomatous tumor components, documenting for the first time that choriocarcinoma of the renal pelvis results from clonal evolution of urothelial carcinoma with acquisition of trophoblastic differentiation.

Carcinoma, Transitional Cell↗
PubMed2002

Is there a role for balloon dilatation of pelvi-ureteric obstruction in children?

PURPOSE: The aim of this study was to examine the effectiveness of balloon dilatation with double J stenting in the management of children with pelvi-ureteric junction (PUJ) obstruction. METHODS: A retrospective study of a 4-year experience of PUJ balloon dilatation in children was conducted in a single unit. Information was collected on patient demographics, clinical presentation, the procedure of balloon dilatation, renal function, and antero-posterior renal pelvis diameter both pre- and postoperatively. RESULTS: There were 10 patients with a median age of 12.5 years (range, 21 months to 15 years). Four cases presented with ipsilateral flank pain, 3 with urinary tract infection, and 3 were discovered incidentally. Retrograde dilation was performed in all cases. Dilation was considered an initial success in 8 of 10 cases, and 1 patient deteriorated after 17 months. Double J stents were placed in all cases and remained in situ for a median of 7.5 weeks (range, 7 to 8.5). Median in-hospital stay was 2 days. Median follow-up was 34 months (range, 7 to 48). Ipsilateral renal excretion times (on MAG III isotope scanning) improved markedly from a median of 84 minutes (range 13 to 200) preoperatively to 7 minutes (range, 1 to 200) at 3 months and 7 minutes (range 1 to 113) at 12 months postoperatively. Median pelvic AP diameter reduced from 30 mm (range 22 to 74) to 16 mm (range, 8 to 36) at 2 months and 10 mm (range, 4 to 41) at 7 months. There were 2 immediate failed procedures, both occurred in patients who went on to open pyeloplasty and were found to have aberrant renal vessels causing extrinsic PUJ compression. One child deteriorated between 10 and 17 months and went on to open pyeloplasty. Twenty-two patients underwent open pyeloplasty in the unit during the same time period with a 95% success rate. Median stay was longer at 5 days and median age younger at 22 months (range, 6 weeks to 13 years). CONCLUSION: Balloon dilatation is a viable option in the management of PUJ obstruction, carrying minimal morbidity in experienced hands.

Adolescent↗
PubMed2005

Coronal ultra-thick multiplanar CT reconstructions (MPR) of the pelvis in the multiple trauma patient: an alternative for the initial conventional radiograph.

PURPOSE: Multiple trauma patients with clinically suspected pelvic fractures often directly undergo a CT scan. However, the initial portable pelvis film (PPF) for further follow-up is then not available. This study examines whether coronal ultra-thick multiplanar reconstructions from CT data are similar when compared with the initial PPF, thus having the potential to serve as an alternative baseline image. MATERIALS AND METHODS: Initial PPF and coronal ultra-thick multiplanar CT reconstructions of 33 multiple trauma patients with pelvic fractures were retrospectively analyzed by two independent radiologists with regard to image quality, visualization of anatomical landmarks, and diagnostic accuracy. The primary diagnosis of pelvic fractures was made by using thin axial CT images and thin slice coronal and sagittal reconstructions and served as the standard of reference. RESULTS: Coronal ultra-thick multiplanar CT reconstructions were superior to PPF regarding image adjustment (p < 0.02), absence of overlaying structures (p < 0.05), and overall image quality (p < 0.01). Visualization of most anatomical landmarks was similar with both modalities, except of the iliosacral joint and acetabular lines which were more accurately depicted on ultra-thick multiplanar CT reconstructions (p < 0.05). Diagnostic accuracy of coronal ultra-thick CT reconstructions was similar to PPF regarding most fracture types, except of a higher accuracy of coronal ultra-thick CT reconstructions for iliosacral joint and acetabular column fractures (p < 0.05). CONCLUSION: Coronal ultra-thick multiplanar CT reconstructions of the pelvis provide similar image quality and diagnostic accuracy compared to PPF and are therefore suited as alternative baseline image in multiple trauma patients who directly undergo CT.

Adult↗
PubMedDate not supplied

[Partial replacement of the pelvis with the hip joint and proximal femur. A possibility in tumor treatment].

In cases of extensive destructive osteolytic processes in the pelvis and hip region, alloplastic replacement of a part of the pelvis with a total hip replacement and, if necessary, partial replacement of the femur, can represent a therapeutic alternative to hemipelvectomy for preserving the limb in the presence of malignancies; it offers the same degree of radicality in removing the affected bone and soft tissue while preserving the bone. This applies with regard both to primary malignant growths as well as extensive isolated metastases and aseptic osteolysis following multiple total replacement procedures. The partial pelvic prostheses, produced individually on the basis of roentgenograms, are adapted to a great degree intraoperatively and fixed with screws, locknuts, and Palacos, and if possible lined with autogenous bone. Where the defects are extensive the pubic bone of the unaffected side is incorporated in the stabilization. Experience gathered so far and follow-up examinations show that all patients regain full mobility and weight-bearing ability, with almost complete lack of complaints and adequate to good motility. This is demonstrated by examples.

Adult↗
PubMedDate not supplied

[Growth of the pelvis following pelvic osteotomy by the Chiari technic].

A Chiari pelvic osteotomy results in a medical displacement of the hip joint and a bony abutment cranio-lateral of the femoral head. Observations on patients show that in most cases the medial displacement of the hip joint will be completely compensated by the postoperative growth of the pelvis. Similar to revalgisation of the femoral neck following varisation osteotomy thus the pelvis shows a tendency to restore the preoperative geometrical configuration by means of adaptive bone remodeling.

Adolescent↗
PubMedDate not supplied

[Changes in the juvenile pelvis in congenital systemic diseases of the skeleton (author's transl)].

Constitutional disorders of the skeleton show a characteristic appearance in the radiogram of the juvenile pelvis. These radiologic changes are presented in tables and are discussed demonstrating individual cases. Because of the limited reactive possibility of the skeleton not every disorder shows a typical feature of differential diagnosis and radiologic pattern. To differentiate from the congenital dysplasia of the hip and Legg-Calvé-Perthes disease the distribution of the skeletal disorders and their course therefore have to be known. Accordingly the therapeutic consequences have to be drawn. In this purpose the radiologic diagnostics of the juvenile pelvis are of significant value.

Bone Diseases, Developmental↗
PubMed1982

[Computer-tomographic evaluation of tumors of the pelvis (author's transl)].

Some cases selected from a group of 35 patients with bone tumors of the pelvis (16 primary, 15 secondary malignant neoplasia, 3 semimalignant tumors, and 1 benign tumor) serve to demonstrate the significant information gained by computed tomography. In bone tumors of the pelvis neither conventional radiography nor angiography render reliable information about the extent of the tumor. Computed tomography is helpful in showing the intra- and extraosseous extent of the lesion, in demonstrating the relationship of the tumor to the organs in the neighbourhood, in measuring of volume and density and discovering the recurrence of tumor.

Adolescent↗
PubMed1998

New drainage technique in the ureteropelvic junction obstructions. Side-to-side ureterocalicostomy (or ureterocaliceal by-pass) preserving renal pelvis and ureteropelvic junction.

We present a new ureterocalicostomy technique in a patient with intrarenal pelvis together with renal artery compression on the pelvis and ureteropelvic junction (UPJ). The patient had grade 4 hydronephrosis in the left kidney and angulation at the ureteropelvic junction. We performed side-to-side ureterocalicostomy between the ureter and lower calyx of the kidney.

Adult↗
PubMed1999

Early fixation of the vertically unstable pelvis: the role of iliosacral screw fixation of the posterior lesion.

OBJECTIVES: To evaluate the effectiveness of the use of iliosacral screw fixation in the management of the vertically unstable pelvis. STUDY DESIGN: Retrospective analysis with clinical follow-up of patients to assess functional outcome. METHODS: Thirty-eight vertically unstable pelvic fractures were treated using iliosacral screw fixation. Anterior fixation was by means of plating in sixteen pelves and by external fixation in fifteen pelves. Four pelves had no anterior fixation. Complications were recorded and radiographs were analyzed to classify fractures and identify screw misplacement and malunion. Twenty-six patients had a functional evaluation. RESULTS: Five patients (13 percent) suffered a pulmonary embolus in the early postoperative period, one of which was fatal, a hospital mortality of 2.6 percent. Screw misplacement occurred in five patients but there were no adverse sequelae. In thirty-four cases with radiographic follow-up, malunion was noted in fifteen cases (44 percent). A lower rate of malunion (36 percent) was noted with internal fixation of the anterior lesion. Of twenty-six patients with long-term follow-up, only four (15 percent) had no pain. Sacroiliac fusion for pain was performed in three patients (11 percent). Twelve patients (46 percent) returned to their preinjury occupation, six patients (23 percent) changed occupation, and nine patients (30 percent) had not yet returned to work by last follow-up. CONCLUSIONS: Iliosacral screw fixation is a useful method of fixation in the vertically unstable pelvis but needs to be augmented by rigid anterior fixation to minimize malunion.

Adolescent↗