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At least 109 records · Page 6Linked to original sources
PubMed1986

Technical aspects of resection of pelvic tumors.

Tumors in the greater or lesser pelvis with lateral fixation present difficulties in their resection due to inadequate exposure distally. Two illustrative examples of such tumors, of a total of 26 pelvic tumors, suggest that resection of tumors in the pelvis with lateral fixation is facilitated with the use of the abdominoinguinal incision, ligation of one or both internal iliac arteries, and dissection at clean planes away from the tumor surface.

Aged↗
PubMed2003

[Rupture of internal iliac artery aneurysm -- a rare cause of life-threatening rectal bleeding].

Isolated aneurysms of the iliac arteries are rare. Located deep in the lesser pelvis, they are diagnosed late or in a symptomatic stage. Because of their manifold anatomic relationships to pelvic structures, iliac aneurysms may cause different symptoms such as obstipation, hydronephrosis, venous thrombosis, and entrapment neuropathy. Aneurysm rupture is associated with high mortality. The rupture of an iliac aneurysm into the rectum with massive lower intestinal bleeding is extremely rare. We report a patient with 6-year follow-up after aneurysm resection, extra-anatomic bypass, and suture repair of the rectum with temporary colostomy.

Aged↗
PubMed2006

[The male genital in legal medicine].

Pathomorphological findings for the male genital are an exception among forensic cases. In earlier publications they were usually published as individual cases. A significant percentage are the so-called fertility- and potency medical certificates, which are usually commissioned for doubtful paternity cases. Old forensic writings about genital injuries distinguish--apart from the necessity of a complete dissection--between "deadly as such" and "accidentally deadly" injuries. Another group consists of reports about self-inflicted genital mutilation, e.g. among prison inmates or soldiers of the last world wars to become an invalid. When it was necessary to identify a corpse, e.g. in cases of progressive decomposition, Merkel recommended in 1945 the representation of the so-called "Schnepfenkopf" (snipe head; colliculus seminalis) in the lesser pelvis. In this article a medical and forensic review of forensically relevant findings of the male genital is presented and illustrated with historical cases.

Forensic Medicine↗
PubMed2007

Polymyositis in a patient with recurring ovarian cancer and history of unrelated breast cancer.

BACKGROUND: Polymyositis (PM) is an idiopathic inflammatory myopathy. Occasionally, it may present as a paraneoplastic syndrome and it is strongly associated with ovarian and weakly with breast cancer. We present here a case of a 60-year-old patient with sequential breast and ovarian (second primary) carcinomas followed by PM as a paraneoplastic disorder. CASE REPORT: The patient had been diagnosed with stage I breast carcinoma 3 years ago and had been treated with conservative surgery followed by radiotherapy and six cycles of chemotherapy (CMF). One and a half year later an ovarian carcinoma was diagnosed for which the patient underwent abdominal hysterectomy oophorectomy and omentectomy. The pathological report characterized it as second primary. Adjuvant chemotherapy with carboplatin and taxol was administered. Fourteen months after the initial laparotomy, the patient was re-operated due to ovarian carcinoma recurrence which was involving all lesser pelvis organs. After a successful radical removal of the recurrence the patient developed a fully expressed PM. This case serves to remind that this disease can occur as a paraneoplastic disorder.

Adenocarcinoma↗
PubMed1992

Abdominoinguinal incision in resection of pelvic tumors with lateral fixation.

Large tumors in the area of the iliac fossa, external iliac vessels, wall of the lesser pelvis, and pubic bone are often considered unresectable through conventional abdominal incisions due to the lack of exposure, or they are managed with hindquarter amputation. The abdominoinguinal incision provides the necessary exposure for en-bloc resection of many of these tumors. It involves a lower midline incision that is extended transversely to the mid-inguinal point on the side of involvement and then vertically, over the course of the femoral vessels, which are exposed. The rectus abdominis is divided off the pubic crest and the inguinal ligament off the pubic tubercle, and the inferior epigastric vessels are ligated and divided at their origin. This allows in-continuity exposure of the lower abdomen, pelvis, and the groin in one field and dramatically improves the exposure.

Abdominal Muscles↗
PubMed2001

[Is it necessary to use an isotopic diuretic renogram in grade II pyelocaliceal dilatations diagnosed with ultrasonography?].

PURPOSE: The increasing number of ultrasonographically detected asymptomatic, renal dilations have caused a lot of explorations to be performed in these patients. The Society of Fetal Urology proposed a four grades classification of echographic renal dilations and renographic studies are recommended in grades II to IV. However we have observed that grade II dilations don't evolve to obstruction. The aim of this work is to evaluate the obstruction rate in this group of patients, and the necessity or not of practising diuretic renography. MATERIAL AND METHODS: We studied 42 children diagnosed of grade II renal dilation during a 1.5 year period. Left side was more frequently affected, 23 cases, 7 cases were bilateral what means 49 affected renal units. There was a male predominance (69%). Mean age at diagnosis was 2 months (0 to 36 months). Seventy nine per cent were prenatally diagnosed. RESULTS: The MAG-3 renal scan showed 48 unobstructed renal units and 1 obstructed. The F-15 variant was made in 15 cases by a doubtful curve or retarded elimination. The patient with obstructive curve presented an 15 mm renal pelvic diameter echographically measured and the intravenous urography showed a higher dilation being operating on. The mean time follow up was 23.5 months (13 to 53 months) without any change. CONCLUSION: Grade II pielocalicial dilations with renal pelvis lesser than 15 mm can be echographically controlled without renal scan. It should be performed only if renal dilation increases.

Child, Preschool↗
PubMed2000

Abdominoinguinal incision and other incisions in the resection of pelvic tumors.

In the past, sarcomas located in the iliac fossa, in the area over the external iliac vessels, or those in the lesser pelvis with fixation to the lateral wall, were inaccessible through the conventional abdominal incisions, mainly due to a lack of distal exposure. They were often called unresectable or were dealt with by an external hemipelvectomy. The abdominoinguinal incision provides exposure in one continuous field of the lower abdomen and the groin area on the side involved by the tumor, or bilaterally, if needed. It provides control of the vessels proximally and distally and easy identification of the femoral nerve lateral to the femoral artery. A simplified version in the form of an L or a reverse T through transection of the ipsilateral/bilateral rectus abdominis off the pubic crest provides a significantly improved exposure for low pelvic tumors in the midline. This affords the opportunity to perform under direct vision dissection in the area of the obturator nodes and obturator foramen, as well as exposure of the distal portion of the external iliac artery and vein. The technique of internal hemipelvectomy and sacral resection for tumors involving any part of the innominate bone or the sacrum, respectively, also amplify the surgical armamentarium in the resection of pelvic tumors with pelvic wall fixation. These incisions, although developed in the management of soft tissue sarcomas of the pelvis, are applicable for other histologic types of cancer when the biology and stage of the tumor are supportive of surgery for the pelvic disease.

Abdomen↗
PubMed2002

A spontaneous uterine sarcoma in a rhesus monkey (Macaca mulatta).

In primates, little has been reported about malignant mesenchymal uterine tumours. A case of a spontaneous metastasising uterine sarcoma in a 17-year-old rhesus monkey is presented. Clinically, transient abdominal pain, spasms, nausea, anaemia, a firm uterus and bloody vaginal discharge were noted. In a diagnostic laparoscopy, both massive adhesions in the lesser pelvis and 10 ml of ascites fluid were detected. In necropsy, in addition to peritonitis with massive adhesions, a cauliflower-shaped, irregular, tough, greyish-white uterine tumour was seen. Two cherry-sized tumour metastases were noticed in the greater omentum. In histology, both in the uterus and the metastases, a sarcoma with a low amount of connective tissue and well-differentiated cell nuclei was identified.

Animals↗
PubMed1997

[Ultrasound assessment of ovarian tumors--comparison between transvaginal 3D technique and conventional 2-dimensional vaginal ultrasonography].

DEFINITION: Three-dimensional (3D) ultrasound is capable of visualising all three orthogonal planes simultaneously. With the stored volumetric data, imaging planes can be reconstructed that are not visible when using standard vaginosonographic procedures. AIMS OF THE STUDY: In patients with ovarian tumours, diagnosis and the appropriate therapeutic approach depend to a crucial degree upon the results of sonographic investigations, which therefore need very exact diagnostic data. Two-dimensional (2D) vaginosonography can only yield sagittal and frontal sections of the lesser pelvis; 3D volume scanning, however, visualises all three perpendicular planes simultaneously on a monitor screen. In cystic tumours of the ovary, conspicuous parietal structures can be specifically localised and rendered three-dimensionally in the surface mode. Such imaging capabilities create new perspectives in assessing ovarian tumours. METHOD: Within the framework of a prospective study at the Gynecological Clinic of the University of Mainz, we compared the sonographic findings obtained for 45 patients with ovarian tumours using 2D and 3D vaginosonography. After the transvaginal application of conventional 2D vaginosonography, the tumours were examined by means of 3D sonography. RESULTS: The use of 3D volume scanning was advantageous because we could image specifically targeted planes and reconstruct image planes that cannot be shown using standard vaginosonography. In addition, the volumetric technique allows 3D surface reconstruction of conspicuous parietal structures from a wide variety of different perspectives. These advantages allow one to better assess the grading of tumours especially of those that are cystic. Problems associated with the application of this transvaginal 3D technique module orientation within a given volume, the overlapping of sonographic planes, increase the time required for surface calculations and increased data storage capacity. CONCLUSION: Transvaginal 3D sonography represents a new technique of imaging. Owing to its ability to register all three imaging planes simultaneously as well as to visualise surfaces three-dimensionally, this technique opens up new sonomorphologic possibilities in the evaluation of ovarian tumours.

Adolescent↗
PubMed1987

Metal chelates as urographic contrast agents for magnetic resonance imaging. A comparative study.

Paramagnetic metal chelates including Fe-EDTA, Fe-CDTA, Fe-DTPA, and Gd-DTPA were compared as intravenous urographic contrast agents for magnetic resonance (MR) imaging in rats. Each compound, administered intravenously at three different doses (0.05, 0.1, and 0.2 mmol./kg.), was rapidly excreted through the kidneys yielding renal signal enhancement between 5 min. and 50 min. after injection. Gd-DTPA was most effective vor the enhancement of the renal parenchyma and pelvis. Lesser enhancement was achieved by administration of Fe-CDTA followed by Fe-EDTA and Fe-DTPA. Enhancement of skeletal muscle and liver parenchyma could not be achieved with any of the compounds included in this study. We conclude that the iron chelates mentioned above are less effective as urographic agents for MR imaging than Gd-DTPA.

Animals↗
PubMed1982

A CT evaluation of the intraperitoneal fluid distribution.

The intraperitoneal distribution of fluid and its detectability with a CT scanning were investigated in 13 patients during infusion of dialysate for peritoneal dialysis. An ascending pattern of spread i.e. from the lesser pelvis through the inframesocolic compartment to the supramesocolic compartment prevailed. Accumulation of fluid in the perihepatic space and in Morison's pouch as a function of fluid volume is at best approximated by a parabolic curve. Fifty to two hundred fifty ml. of fluid were detectable with a CT scanning in supine position in the majority of cases within the perihepatic space and Morison's pouch. The lowest amount of fluid detectable in the peritoneal cavity--25 ml. was found between the anterior abdominal wall and bowel loops in right decubitus.

Ascites↗
PubMed2002

An organ-sparing treatment using combined intra-arterial chemotherapy and radiotherapy for muscle-invading bladder carcinoma.

OBJECTIVE: We describe the results of an organ-sparing approach for the treatment of non-metastatic, invasive bladder carcinoma. MATERIAL AND METHODS: Twenty-three patients (mean age 71 years; age range 47-87 years) with bladder carcinoma of clinical stage T2-T3N0M0 and histologically proven muscle invasion were examined between 1992 and 1998. The median duration of follow-up was 30 months. The treatment protocol for intra-arterial chemotherapy consisted of methotrexate 30 mg/m(2) and cisplatin 50 mg/m(2) in 7 patients and cisplatin 50 mg/m(2) in 16 patients, administered in three cycles via catheters inserted in the internal iliac arteries. Concomitantly, 41.4 Gy of radiotherapy was given to the lesser pelvis. Transurethral biopsy and urine cytology were performed after the completion of treatment; patients were followed observationally if residual tumor was absent, and underwent radical cystectomy if it was present. RESULTS: At the end of treatment, 18 patients (78%) showed a complete response (CR) and the bladder was spared in all cases. Radical cystectomy was performed for 4 non-CR cases, with the result that 2 cases had residual superficial cancer and the other 2 had muscle-invading cancer histologically. Among the patients with a CR, 2 experienced intravesical recurrence. Overall, 2 patients died of cancer, 5 died of other causes and 2 died during treatment. The 5-year disease-specific survival rate was 70.3% and the overall survival rate 46.4%. CONCLUSIONS: A bladder-sparing approach for the treatment of muscle-invading bladder carcinoma which utilizes combined intra-arterial chemotherapy and radiotherapy may arrest the decline in quality of life induced by urinary diversion and yield equivalent therapeutic benefit to that of radical cystectomy.

Aged↗
PubMed1994

Buschke-Loewenstein tumour infiltrating pelvic organs.

We report a 42-year-old HIV-negative patient with a 12-year history of exceptionally extensive genital warts and coexisting verrucous carcinoma of the anogenital region (Buschke-Loewenstein tumour). Masses of both tumour and viral papillomas infiltrated the external genitalia, perineum and buttocks, pelvic diaphragm and parts of the lesser pelvis, as well as the urethra, prostate and parts of the urinary bladder, necessitating repeated surgical intervention and plastic reconstruction. Adjuvant interferon-alpha therapy was given without any lasting effects. Human papillomavirus type 6 was detected by DNA in situ hybridization and Southern blot analysis.

Adult↗
PubMed2006

Outcome of post-prostatectomy radiotherapy in one institution.

We present a retrospective study to evaluate the outcome of postoperative radiotherapy for biochemical or clinical recurrent prostate cancer. Twenty-six patients (median age 60 years) underwent radiotherapy after radical prostatectomy between January 1997 and January 2004. Seven patients received adjuvant radiotherapy and 19 received salvage radiotherapy. The median prostate-specific antigen at diagnosis was 8.6 (0.9-89) and most (23 patients) presented with T(3)N(0) disease. The median follow up was 19.5 months (5-84 months). All patients received a dose of 61.2 Gy at 1.8 Gy per fraction, 20 initially receiving 45 Gy to the lesser pelvis. The median dose to the bladder, rectum and left femoral head were 55.6, 57.5 and 33.8 Gy, respectively. All patients were managed radiotherapeutically by the first author. Twenty-four patients are alive. Two patients have died, one from oesophageal cancer and the second from metastatic prostate cancer. Two other patients also developed metastatic disease. Four asymptomatic patients with a rising prostate-specific antigen are under observation. None of the 26 patients has developed a local recurrence. Seven patients have developed grade 1 late bowel effects and three a grade 2 late effect. Eight patients suffer from grade 1 late genitourinary effects and two from grade 2 effects. One patient developed impotence, whereas 23 patients were rendered impotent postoperatively. There were no grade 3/4 late effects. Postoperative radiotherapy is well tolerated and provides effective local control.

Aged↗
PubMed1980

Computed tomography in staging of bladder carcinoma.

A comparison was made between the use of clinical methods and computed tomography for staging of carcinoma of the urinary bladder in 52 patients. CT was found to be the most reliable method for determining the perivesical extension of the tumour. It is of value for determining the extent of the tumour before irradiation and for establishing the tumour response. It was less reliable for diagnosing metastases in the lesser pelvis.

Carcinoma↗
PubMedDate not supplied

Thoracic neuroblastoma of the neonate.

Five cases of neonatal thoracic neuroblastoma were either clinically asymptomatic or presented as uncharacteristic respiratory distress. Chest radiography demonstrated a spectrum of abnormalities varying from a lobulated, apical thoracic mass with or without evidence of expansion, to a spindle-shaped paraspinal soft tissue widening, or a homogeneously dense hemithorax. In the newborn a neoplasm in the posterior mediastinum most likely represents a neuroblastoma, either primary or metastatic. In a high percentage of cases the primary tumour as well as possible skeletal metastases have an increased uptake of radiopharmaceuticals. Therefore a bone scan should be the next step for evaluation of the neoplasm. Supplementary sonographic screening of the retroperitoneum and lesser pelvis is easily performed and may contribute significant information. Urography is hardly mandatory any longer. Metrizamide CT myelography, highly recommended in infants and children, may be omitted in the neonate with no neurologic deficit. Urinary excretion of catecholamine metabolites is usually elevated and must always be determined.

Catecholamines↗
PubMedDate not supplied

From small pelvic outlet syndrome to sirenomelia.

We report 5 newborns with a contracted lesser pelvis, imperforate anus (severely stenotic and ectopic anus in 1 case), absent or rudimentary urinary tract, and defective or absent external genitalia, vagina, and uterus but normal gonads. The first 2 patients had small pelvic outlet syndrome (SPOS). The findings in the third patient, a possible transition to sirenomelia, were more severe and included malposition of the penis to the posterior sacral area. The fourth and fifth patients had sirenomelia. The remarkable similarity of many abnormalities observed in these cases and related material in the literature suggests that SPOS and sirenomelia may be part of the same malformation complex (SPOS/sirenomelia complex).

Abnormalities, Multiple↗
PubMed1999

[Ureteroureteral end-to-side anastomosis in kidney transplantation--personal experience].

The most widely used way of reconstruction of the urinary pathways in transplantations of the kidney is at present a ureteroneocysto anastomosis. In some patients this type of reconstruction is difficult, if not impossible (adhesions in the lesser pelvis of the recipient, atrophic urinary bladder, short ureter of the graft, transplantation of child kidneys). In these instances the authors indicated a uretero-uretero end-to-side anastomosis. The authors performed in 13 patients a total of 17 uretero-uretero end-to-side anastomoses. In six transplantation of child kidneys en bloc was involved. During the postoperative period one female patient developed a urinary fistula from the renal pelvis of the graft which healed after conservative treatment. End-to-side uretero-uretero anastomosis is a simple and safe way of reconstruction of the urinary pathways in renal transplantations.

Adult↗