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At least 145 records · Page 8Linked to original sources
PubMed1989

Neuroanatomy of the pelvis in an infant with cloacal exstrophy: a detailed microdissection with histology.

The internal anatomy of the pelvis in the patient with cloacal exstrophy has not been described in detail previously. We present in detail the pelvic anatomical relationships of a patient with cloacal exstrophy who died 72 days after birth and whose body subsequently was perfused with a formalin-based anatomical fluid. Microdissection of the pelvis with histological confirmation of the identity of structures dissected was performed. The vascular supply to the urinary hemibladders arises from the internal iliac arteries, which pass along the lateral portion of the pelvis and enter each hemibladder. The autonomic innervation to the bladder and corporeal bodies arises from a pelvic plexus that lies on the anterior surface of the sacrum. The innervation to the hemibladders then travels in the midline along the posteroinferior surface of the pelvis before extending laterally to communicate with each hemibladder. Autonomic innervation to the duplicated corporeal bodies arises from the sacral pelvic plexus and travels in the midline to pierce the inferior portion of the pelvic floor posterior and medial to the hemibladders. These nerves then enter the crural region of the corpora. Sensory innervation to the corporeal bodies arises from the sacral trunk and passes posterior to the pelvic floor muscles, traveling just medial to the widely separated ischial spines and then laterally along the corporeal bodies. Illustrations of the anatomy and implications for management of the exstrophy patient are presented.

Abnormalities, Multiple↗
PubMed2000

The extended latissimus dorsi muscle island flap for flexion or extension of the fingers.

We describe the technique of transferring the latissmus dorsi muscle as an island flap for the restoration of digital flexion or extension in 28 patients. The latissmus dorsi muscle is raised down to the posterior iliac crest and prolonged with the gluteal superficial facia. We believe that this method is particularly suitable for extensive and prolonged paralysis of the lower elements of brachial plexus. It can be used also for severe Volkmann's contracture or the loss of flexor or extensor muscles of the fingers due to extensive debridement. The technique does not require microsurgery and there is no delay in reinnervation of the muscle.

Adolescent↗
PubMed1976

[Cavo-spinal phlebography in myelopathies of venous origin. Application of the method in 115 cases].

The intraspinal venous stasis, described by ABOULKER as the cause of numerous myelopathies, is due to the addition of multiple venous abnormalities, demonstrated by cavospinal phlebography. The venae cavae and their major affluents and the prespinal system (lumbar and ascending lumbar veins, azygos, hemi-azygos, right superior intercostal and vertebral veins) are explored by catheterization. Cavo-spinal phlebography reveals multiple obstacles and the resulting stasis in the intraspinal plexus.

Azygos Vein↗
PubMed1996

Vascular anatomy of experimentally induced left varicocele in the rat.

A variety of techniques have been used by various investigators to study the effects of experimentally induced left varicocele in the rat model. It has become apparent that information about the vascular anatomy of this condition in the rat is deficient, though such information could be important to understanding the model. We have examined the left and right venous architecture serving the testes in rats with and without experimentally induced left varicocele. The left spermatic vein has four consistent collaterals that are tributary to the left iliac vein. The right spermatic vein does not have these consistent collaterals, but many times a collateral develops from the right spermatic vein to either the right iliac vein or the distal part of the caudal vena cava. When this occurs, the remaining length of the right spermatic vein becomes a minor effluent vessel. Eleven irregularly observed vessels were identified, none of which existed on the left and only two of which were observed on the right. Experimentally induced left varicocele is associated with dilatation of the left spermatic vein and all collaterals to the left iliac vein. The condition does not cause dilatation of the right venous system, but one collateral was identified that communicated between the left and right sides via the vesicular plexus. It is speculated that the differences between left and right sides in the number of consistent collaterals might be due to the patterns of embryologic development, which differ somewhat between the left and right spermatic veins.

Animals↗
PubMed1995

Intramedullary nailing of humeral shaft fractures.

Twenty-one patients with 22 acute traumatic fractures of the humeral diaphysis were treated either with the True/Flex intramedullary rod or the Russell-Taylor rod. Follow-up is provided on 20 fractures. Indications for fixation on all but 3 patients was either multiple fractures, associated chest or abdominal trauma, vascular interruption, or open fracture. The series included 4 open fractures. Time to union averaged 7.6 weeks, with two nonunions, both in open fractures. Two isolated preoperative radial nerve palsies resolved fully; four brachial plexus injuries had a more complex recovery. No iatrogenic nerve damage was encountered. Excluding those patients with brachial plexus deficits, shoulder range of motion returned reliably. Impingement with a rod prominence was noted in 1 fracture. Functionally, all of the fractures, aside from those associated with a brachial plexus injury, had a normal or only mildly limiting result as reported by the patient. Additionally, eight humeral nonunions were treated with a reamed Russell-Taylor humeral nail with supplemental iliac crest bone graft at the time of nailing in 3 patients. Five of these 8 patients went on to union.

Elbow Joint↗
PubMed1995

Superior hypogastric plexus block for chronic pelvic pain in the presence of endometriosis: CT techniques and results.

PURPOSE: To evaluate the use of superior hypogastric plexus block with computed tomographic (CT) guidance in patients with endometriosis and chronic pelvic pain. MATERIALS AND METHODS: Seven blocks were performed on an outpatient basis in five women with endometriosis and pelvic pain. In the first four patients, one or two 20-gauge, 15-cm needles were placed anterior to the spine at the common iliac bifurcation from a posterior approach. In the fifth patient, the block was performed from an anterior approach with a single needle. RESULTS: One procedure resulted in mild pain relief, three in considerable pain relief, one in complete midline pain relief with no change in the lateral pain, and one in complete pain relief. One procedure was terminated because anesthetic was injected into the peritoneal cavity. There were no other complications. CONCLUSION: CT-guided superior hypogastric plexus block is easily performed and can be used to assess whether chronic pelvic pain can be attenuated by blocking the superior hypogastric plexus.

Adult↗
PubMed2006

Adductor T and H reflexes in humans.

In the belief that changes in the adductor reflex (AR) may be helpful in evaluating lumbar root and plexus lesions, expression of the AR was studied in 43 healthy human subjects. ARs elicited with an electronic reflex hammer were recorded from the inner side of the proximal thigh using needle and surface electrodes, and patellar reflexes (PRs) were recorded simultaneously. These reflexes were obtained by tapping the ipsilateral medial aspect of the knee, the contralateral patellar tendon, the ipsilateral and contralateral anterior superior iliac spines, and the Achilles tendon. The H reflex of the obturator nerve was also evaluated in 17 cases. ARs were evoked consistently by tapping the ipsilateral medial aspect of the knee and by contralateral patellar tap, and by tapping ipsilateral and contralateral anterior superior iliac spines when a needle recording electrode was used. Sometimes an Achilles tendon tap also elicited the AR ipsilaterally. By contrast, the PR could only be elicited by a tap to the ipsilateral patellar tendon. ARs have somewhat different features than other well-known tendon reflexes such as the PR and are recorded consistently when a needle electrode is used, being elicited from both distal and proximal areas of the legs by tapping the Achilles tendon or anterior superior iliac spines unilaterally or bilaterally. Their role in evaluating lumbar root disease and monitoring adductor spasticity merits investigation.

Achilles Tendon↗
PubMedDate not supplied

Short rib-polydactyly syndrome: a case report.

Short rib-polydactyly syndrome (SRPS) is a group of rare, lethal skeletal dysplasias characterized by short ribs and limbs, polydactyly, hypoplastic thorax and visceral anomalies. Our case had coarsening of facial features, low-set ears, lobulated tongue, cleft palate, and hypoplastic epiglottis. Short proximal parts of upper limbs, bilateral postaxial polydactyly of hands, and bifid big toe with zygodactyly were additional findings. Chest was narrow. Ambiguous genitalia was noted but testicles were in scrotum. Choroid plexus cyst and coarctation of aorta were found in autopsy. Radiographies of the skull revealed occipital horn accompanied by prominent external occipital protuberance. The thoracic cage was narrow and elongated with short and iliac wings, pubic and ischial rami were were hypoplastic, and both acetabula were shallow and trident shaped. All tubular bones had wide and rounded metaphyses. Because clinical and radiological features of the four established subtypes are very similar, there are difficulties in the classification. We report an infant whose radiological, clinical and postmortem features were consistent with type IV SRPS (Beemer-Langer).

Fatal Outcome↗
PubMed2000

Lateral ligament: its anatomy and clinical importance.

Since Miles proposed abdominoperineal excision as a radical surgery for rectal cancer in 1908, surgeons have recognized the lateral ligament in the pararectal space of their patients and attached clinical importance to it, although anatomists did not describe any such configuration in cadavers. By analyzing an experience of 421 lower rectal cancer cases at the Cancer Institute Hospital in Tokyo, discussion of the lateral ligament was focused on its relationship to the fascial arrangements in the pelvis, the pelvic autonomic nervous system, and the lymphatic drainage of the rectum. The lateral ligament is not an anatomical term, but a clinical or surgical one. It exists in a living pelvis as a condensation of connective tissue around the middle rectal artery and is divided into two segments by the inferior hypogastric nerve plexus inside it and the visceral endopelvic fascia around it. The lateral ligament is a pathway of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes. Therefore, the lateral ligament plays a critical role in surgery for lower rectal cancer in two respects: the anatomic extent of resection for curing rectal cancer, and the preservation of sexual function.

Collateral Ligaments↗
PubMed2004

[The mechanisms of the natural history of small pelvis varicosis].

An analysis was made of the results of an all-round clinical, ultrasound, phlebotonometric and phlebographic examination of 89 patients with the clinical evidence of chronic venous insufficiency (CVI) of the pelvis. It is established that small pelvis varicosis develops because of hemodynamic disorders in the system of the inferior vena cava, iliac and left renal veins. In men, blood reflux from the iliac vein to the parietal tributaries leads to the development of the atypical forms of varicosis. In women, the left- sided regional renal venous hypertension induces valvular insufficiency of the left ovarian vein with the extent of the renoovarian blood reflux to the pampiniform, uterovaginal, presacral, vesical and rectal venous plexus. The concomitant action of the caval and renoovarian blood refluxes causes the origination of the syndrome of the blood overfilling of the pelvic organs and varicosis of the pubis, perineum, vulva, and buttocks. The clinical, ultrasound and phlebographic appearance of small pelvis varicosis is described in detail.

Adolescent↗
PubMed2006

Complications associated with surgical stabilization of high-grade sacral fracture dislocations with spino-pelvic instability.

STUDY DESIGN: Retrospective evaluation of 19 consecutive patients with sacral fracture dislocations and cauda equina syndrome. OBJECTIVE: To review the safety and patient impact of early surgical decompression, and rigid segmental stabilization in patients with high-grade sacral fracture dislocations. SUMMARY OF BACKGROUND DATA: The ideal treatment for patients presenting with fracture dislocations of the sacrum resulting from high-energy mechanisms remains unknown. Previous studies consisted of multicenter case reviews that showed satisfactory outcomes with either nonoperative or a variety of surgical methods. However, over the last 20 years, no consistent treatment algorithm for these severe injuries has emerged. The advent of rigid, low-profile segmental fixation of the lumbar spine to the pelvic ring has offered a solution to many of the surgical challenges. This study evaluates the rate of complications of this method. It is intended to serve as a foundation for further evaluation and development of this treatment strategy, and as a basis for future comparison studies. METHODS: Patients were treated with a formally established algorithm, including resuscitation, and clinical assessment with detailed neurologic assessment and radiographic workup with pelvic computerized tomography and reformatted views. Electrophysiologic testing was conducted to confirm the presence of sacral plexus injuries in patients who were unable to be examined. Patients received neural element decompression and open reduction with segmental internal fixation through a midline posterior approach by connecting lower lumbar pedicle screws to long iliac screws when the patient's general medical condition allowed for surgical intervention. A formal sacroiliac arthrodesis was not performed. For the purposes of this study, patients were assessed specifically for the following adverse events: (1) infection, (2) wound healing, (3) neurologic deterioration following surgical treatment, (4) postoperative loss of sacral fracture reduction, (5) instrumentation failure, (6) axial lumbopelvic pain requiring further treatment, and (7) unplanned secondary surgery. RESULTS: There were 19 patients with an average age of 32 years treated according to this algorithm. Fracture reduction was successfully maintained in all patients. During the index surgical intervention, 14/19 patients (74%) had had either a traumatic dural tear or nerve root avulsion. Major complications involved fracture of the connecting rods in 6/19 patients (31%) and wound healing disturbances in 5/19 (26%). There were no lasting complications such as chronic osteomyelitis noted. In patients followed over a 1-year period, the visual analog score, referable to the sacral injury, averaged 5.5 on a scale of 0-10. CONCLUSIONS: Rigid segmental lumbopelvic stabilization allowed for reliable fracture reduction of the lumbosacral spine and posterior pelvic ring, permitting early mobilization without external immobilizaton and neurologic improvement in a large number of patients. Complications were primarily related to infection, wound healing, and asymptomatic rod breakage, and were without long-term sequelae.

Adolescent↗
PubMed1977

Methods of transfemoral lumbar epidural venography in the diagnosis of lumbar disc herniation.

This article outlines several ways of achieving adequate visualization of the epidural venous plexus in the diagnosis of lumbar disc herniation. Preference is expressed for simultaneous injection of contrast medium via two catheters selecttively introduced into the lateral sacral segmental veins or into the left and right internal iliac veins. For visualization of the epidural veins, the investigator has a choice of over 20 different procedures. The position of choice of the catheter tip(s) can vary during the examination, dependent on diagnostic problems or technical catheterization problems. Epidural venography should be regarded as a very accurate, relatively simple method of demonstrating disc herniations in the lumbar region. This method is especially recommendable in cases that are clinically suspect but have a negative or dubious caudogram. The risk of complications is very small. It is also a good method for azygography. It is possible to perform the examination on outpatients.

Catheterization↗
PubMed1992

245 transaxillary arteriograms in arteriopathic patients: success rate and complications.

Two hundred and forty-five transaxillary arteriograms were attempted at Charing Cross Hospital between 1982 and 1991 on 195 arteriopathic patients (mean age 64 years) in whom the femoral route was contra-indicated due to absent pulses (94), previous surgery (108), femoral artery aneurysm (5), severe aorto-iliac disease (8) or previous failure by the femoral route (30). Most arteriograms (211) were carried out to investigate peripheral vascular disease, the others were carried out to perform transluminal angioplasty (16) to assess cerebrovascular disease (10) and to investigate arterial insufficiency of the kidneys, alimentary tract and upper limb (8). There were two (0.8%) technical failures where the axillary artery could not be punctured. Selective catheterization of the carotid, vertebral, axillary, lumbar, renal, superior mesenteric, inferior mesenteric, iliac, femoral or popliteal arteries was performed in the course of 38 procedures. There were three (1.2%) serious complications related to the puncture site, a large haematoma followed by a prolonged neurological deficit of the brachial plexus in a hypertensive patient receiving haemodialysis, and thrombosis of the axillary artery in two other patients both of whom responded to surgical thrombectomy. There were three (1.2%) serious systemic complications, two patients had a cardiac arrest and although both were successfully resuscitated one became anuric and died from renal failure and septicaemia 4 weeks later. One patient with a history of transient ischaemic attacks developed a similar transient episode at the end of the procedure. Compared with six series of 290 attempted brachial artery catheterizations in patients where the femoral route was contra-indicated which have been reported since 1986, our series of 245 attempted axillary artery catheterizations had a significantly higher incidence of technical success at the first attempt (P = 0.021) and a lower incidence of vascular complications requiring surgery or angioplasty which was not statistically significant. Our conclusion is that transaxillary arterial catheterization has a high rate of technical success (99%) and should be considered in patients where the femoral route is contra-indicated due to arterial disease.

Aged↗
PubMed1990

[Morphology and development of bovine testicular vein (V. testicularis) during the prenatal and neonatal periods].

Investigation into the morphology and development of the testicular vein in bovine was carried out with 85 male foetuses from the 8-40th week of pregnancy and with 10 newborns aged 1 to 10 days of life, the total being 95 preparations. The age of the foetuses was determined by Kantorova method complemented with those by other authors. The observations were made with using rubber latex introduced into the lumen of the tested veins by means of an automatic device of our own construction. It was found out that the developmental transformations of the testicular veins, initiated in the embryo, progress very dynamically in foetuses up to about the 20th week of pregnancy and them gradually slow down in older foetuses. Finally, in a fully formed testicular vein of the oldest foetuses and newborns there can be distinguished the proximal and distal part of this vessel. The proximal part carries the blood away from labile components of the testicular vein, the only exceptions being the aortic branch and the ureteral vein. Now, the solid components escape into the distal part of testicular vein. In the course of the distal part of the vessel there are its three basic plexuses, i.e. the testicular plexus, the marginal plexus of testicular vein and the largest of them--the pampiniform plexus of testicular vein. The blood from the last plexus is carried away into the main trunk of testicular vein by two anastomotic branches--lateral and medial. Of the veins examined the right one usually escapes to the caudal vena cava or to the deep circumflex iliac vein, while the left one to deep circumflex iliac vein or to the common iliac vein.

Animals↗
PubMedDate not supplied

[Intra- and extra-pelvic venous connections. Anatomical study].

Regarding to clinical diseases, the authors emphasize the important part of pelvic veins as collateral flows when iliac channels are occluded. They point out the three mains streams of this collateral network: the obturator veins, the gluteal veins, and the pudendal veins. Longitudinal anastomoses are connected each other by transversal veins such as Santorini plexus, and sacral veins; they allow venous supply from one side to the other when two levels or more are involved.

Female↗
PubMed2001

Prevention and management of sigmoid and pelvic ischemia associated with aortic surgery.

Ischemia of the colon, rectum, and pelvis continues to be a significant source of morbidity and mortality after aortic reconstruction. Complications associated with colonic and pelvic ischemia are severe and include impotency, buttock claudication, colonic and rectal infarction, buttock and perineal necrosis, and spinal cord or lumbar plexus injury. To prevent these complications the vascular surgeon must make every attempt to guarantee the adequacy of colonic and pelvic blood supply after aortic reconstructive procedures. During open surgical repair of aneurysms or aortoiliac arterial occlusive disease, patent inferior mesenteric arteries must either be routinely reimplanted or selectively ligated on the basis of object intraoperative assessment of colonic perfusion. In addition, when possible, antegrade perfusion should be maintained in patent internal iliac arteries, and femoral reconstructions should include reconstruction of the deep femoral artery to assure adequate perfusion of potential pelvic collaterals. The rate of colonic and pelvic ischemia after endovascular aneurysm repair appears lower than after open repair, but all of the complications of colonic and pelvic ischemic seen after open repairs have been reported after endoluminal aneurysm repair. Thus, during stent-graft repair of abdominal aortic aneurysms, all attempts also should be made to preserve pelvic perfusion by maintaining antegrade flow to a least one patent internal iliac artery. The principle to remember in the management of complications of pelvic ischemia associated with aortic reconstruction is prevention because when complications of pelvic ischemia occur, the damage often is irreversible.

Aorta↗