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At least 145 records · Page 8Linked to original sources
PubMed1983

Analysis of the severe complications of irradiation of carcinoma of the cervix: whole pelvis irradiation and intracavitary radium.

From January, 1967 to December, 1974, 325 patients with carcinoma of the uterine cervix were treated with a minimum of 4,000 rad whole pelvis irradiation plus intracavitary radium. These patients had large, sometimes massive, tumors. Generally, the larger the primary tumor the greater the amount of external irradiation delivered, with an appropriate reduction in the amount of intracavitary radium. Patients who had a positive lymphangiogram or a pre- or postirradiation hysterectomy or lymphadenectomy are not included in this analysis. All patients were followed for a minimum of 5 years. Local and regional failure rate in 193 patients receiving 4,000 rad whole pelvis irradiation plus radium was 1% and 4%, respectively, with a 3.1% incidence of severe complications. In 111 patients who received 5,000 rad whole pelvis irradiation plus radium, the local and regional failure rate was 3.5% and 4.5%, respectively, with a 10% incidence of severe complications. In patients who received 5,000 rad whole pelvis irradiation, complications were associated with unilateral parametrial boosts and with protruding vaginal sources. Of 21 patients who received 6,000 rad whole pelvis irradiation, three patients developed fistulae associated with high doses to the vagina delivered with protruding vaginal sources.

Brachytherapy↗
PubMed1980

Radiology of the pelvis and hips in adults with Down's syndrome.

In a radiological study of the pelvis in 66 adult subjects with Down's syndrome, 25 (38%) were found to have the classical pelvic sharpe associated with Down's syndrome in infancy and childhood. The appearance of the pelvis and hip joints was very variable and matched the variety of appearances seen in normal subjects, except that generally the pelvis was smaller than normal. The discriminating value of the iliac index (which is abnormal in up to 80% of affected infants) was lost in this group of affected adults. Subluxation and osteoarthrosis of the hips were very uncommon features. In addition to the primary morphological abnormalities in the pelvis in Down's syndrome that are described in the literature, posture probably plays a part in producing the variable radiological appearances of the pelvis.

Adult↗
PubMed1983

Cholesteatoma of the renal pelvis treated by extracorporeal surgery and autotransplantation with pyelocystostomy.

We report on a patient who had had recurrent renal stones on the right side for 37 years. At the sixth lithotomy the diagnosis of cholesteatoma of the renal pelvis was discussed. After another recurrence of stones and a pelvic lesion nephrectomy was considered. However, the kidney still had 60 per cent of total renal function and the other kidney also harbored stones. Therefore, extracorporeal exploration was performed. The stones and keratin masses were removed from the pelvis and frozen section showed no malignant changes. The kidney was reimplanted in the ipsilateral iliac fossa with end-to-side anastomosis to the external iliac vessels and a wide direct anastomosis between the pelvis and the bladder. At followup 2 months postoperatively the patient was well. Autotransplantation with pyelocystostomy facilitates free passage of recurrent stones and keratin fragments, and allows for future transurethral control of the renal pelvis. Thus, the procedure is well suited for the treatment of cholesteatoma of the renal pelvis.

Cholesteatoma↗
PubMed1994

'Moderate-risk' ovarian cancer (stage I, grade 2; stage II, grade 1 or 2) treated with cisplatin chemotherapy (single agent or combination) and pelvi-abdominal irradiation.

We placed patients with invasive epithelial ovarian cancer into four distinct prognostic groups: 'low', 'moderate', 'high' and 'extreme' risk. The 'moderate-risk' group contained all residual negative, stage I and II patients with two exceptions: stage Ia or b, grade 1 cancers and grade 3 cancers. They were treated with primary surgery, usually including bilateral salpingo-oophorectomy, hysterectomy and omentectomy. Chemotherapy was then given (cisplatin at 100 mg m-2 every 2 weeks for three cycles) followed by pelvi-abdominal irradiation (2250 cGy in 10 fractions to the pelvis and 2250 cGy in 22 fractions to the whole abdomen including pelvis). An early cohort with ascites or positive washings instead received six cycles of cisplatin and cyclophosphamide at 75 mg m-2 and 600 mg m-2 every 4 weeks with the same pelvi-abdominal irradiation sandwiched between cycles 3 and 4. One-hundred and nine patients were treated between November 1983 and December 1989. Median follow-up was 4.7 years (range 0.7-9 years). The 5-year actuarial overall and failure-free survivals were 81% and 76%, respectively. Chronic toxicity, although usually minor, included 15% with peripheral neuropathy or ototoxicity and 23% with chronic abdominal complaints. Our combined-modality results are similar to those obtained by other centers utilizing either pelvi-abdominal irradiation alone or cisplatin-based chemotherapy alone.

Journal Article↗
PubMed1983

[Axial and semi-axial views of the pelvis in bone scintigraphy. Technic, anatomy, limitations, possibilities].

A new method of skeletal scintigraphy offering axial views of the pelvis is described. The anatomy, method of examination, limits and advantages of the axial pelvis views are given by reporting on the scintigraphic examinations (167 axial pelvis views) of 50 patients with 52 increased uptakes of the isotope in the pelvis region. The standard ventral and dorsal pelvis views represented all increased uptakes. However, when employing the axial views the localisation and extent of the tracer accumulation could be more precisely determined in 73%. In 27% no additional information was given. This new method is characterized by the opportunity of distinguishing more clearly between the increased bone uptakes and the activity in the urinary bladder. This distinction was given in 24% of increased bone uptakes in the regions of the pubic bones, the symphysis, the sacrum and the coccyx.

Adolescent↗
PubMed2005

Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters.

OBJECTIVE: The purpose of this study is to introduce a method to analyze and characterize the global sagittal balance of the human trunk using indexes derived from the shape and orientation of the pelvis and cervical, thoracic, and lumbar spine. METHODS: Standing lateral x-rays of a cohort of 160 asymptomatic young adult volunteers were obtained. On each radiograph, a simplified model of the spine and pelvis was created using a dedicated computer software, and the following shape and orientation variables were calculated at each anatomic level: pelvic incidence, pelvic tilt, sacral slope, cervical curvature and tilt, thoracic curvature and tilt, and lumbar curvature and tilt. RESULTS: Significant linear correlations were found between each single adjacent shape parameter as well as between each single adjacent orientation parameter at all anatomic levels. Significant correlations were also found between some shape and orientation parameters at the same anatomic level as well as between adjacent anatomic areas. In general, the linear correlations were stronger between shape and orientation variables at the pelvic, lumbar, and cervical areas and weaker at the thoracic level and between the thoracic and lumbar areas. CONCLUSIONS: These results confirm that the pelvis and spine in the sagittal plane can be considered as a linear chain linking the head to the pelvis where the shape and orientation of each anatomic segment are closely related and influence the adjacent segment to maintain a stable posture with a minimum of energy expenditure. Changes in shape or orientation at one level will have a direct influence on the adjacent segment. Knowledge of these normal relationships is of prime importance for the comprehension of sagittal balance in normal and pathologic conditions of the spine and pelvis.

Adult↗
PubMed1991

Total body bone mineral and pelvis bone mineral content as parameters of bone mass in men. A dual-energy X-ray absorptiometry study.

Total body bone mineral content (TBBM) is a highly discriminating determinant of bone mass. We correlated TBBM with pelvis bone mineral content (PBMC) and pelvis bone mineral density (PBMD) in 179 normal men, in order to observe whether the pelvis is an adequate region of bone mass evaluation. There was a good correlation between PBMC and TBBM (r = 927, p less than 0.001), and significant correlations between PBMD and TBBM (r = 818, p less than 0.001) and between PBMC and PBMD (r = 0.902, p less than 0.001). As the pelvis does not undergo the densitometric changes so often observed in the spine, we believe that the pelvis is appropriate as anatomic region for bone mass evaluation studies.

Absorptiometry, Photon↗
PubMed2005

Benign mixed epithelial stromal tumor of the renal pelvis with exophytic growth: case report.

BACKGROUND: Mixed epithelial and stromal tumor (MEST) is a distinctive benign composite neoplasm of the kidney predominantly seen in females mostly in the perimenopausal period. Although these tumors are known to arise from renal pelvis, our case was distinct in that it had no intrapelvic component growing in exophytic fashion. CASE REPORT: A 35 year old female patient presented to us with vague abdominal pain. She had undergone excision of bilateral ovarian cystic masses for cystic teratoma twelve years earlier. A computed tomography scan of abdomen and pelvis showed a 9 x 7 cm uniformly solid mass with poor contrast enhancement situated in the inferomedial aspect of the left kidney. On exploration, the mass was arising from the inferior and anterior aspect of left renal pelvis, and was attached to it with a narrow pedicle. There was no adherence or attachment to the renal parenchyma. The mass was excised preserving the kidney. Microscopically, the tumor was composed of large collagenized areas containing bundles of spindle cells and several 'microcysts' lined by cuboidal epithelium suggestive of a benign mixed epithelial stromal tumor. DISCUSSION: Mixed epithelial tumors usually present in perimenopausal women as a partially cystic mass. Tumors are composed of irregular mixtures of cystic and solid areas, glands with variable complexity and distribution and the stromal component is characterized by a spindle cell proliferation. Commonly, it arises from the renal parenchyma and pelvis and nephrectomy is advocated to manage these tumors. CONCLUSION: MEST is a distinctive benign tumor of the kidney that should be distinguished from other renal neoplasms. MEST arising from the renal pelvis and growing exophytically is a rare entity. The overall prognosis is favorable.

Journal Article↗
PubMed1995

CT diagnosis and localization of rupture of the bladder in children with blunt abdominal trauma: significance of contrast material extravasation in the pelvis.

OBJECTIVE: The purpose of this study was to determine the utility of CT performed with maximal bladder distension in showing extravasation of IV contrast material as a means of detecting and localizing bladder rupture in children after blunt trauma. MATERIALS AND METHODS: Seven of 1500 consecutive children who had IV contrast-enhanced CT of the abdomen after blunt trauma had a rupture of the bladder proved at surgery (five patients) or by clinical and imaging findings (two patients). The scanning protocol in all patients included occlusion of the Foley catheter if present and a 5-min delay after IV injection of contrast material prior to scanning the pelvis. The CT scans of all 1500 children were prospectively evaluated for the presence and location of extravasated contrast material in the pelvis. RESULTS: Extravasated IV contrast material in the pelvis was noted in all seven children with bladder rupture (intraperitoneal in four, extraperitoneal in three) and two of 1493 children without bladder rupture (extraperitoneal in both). Both children with contrast material extravasation who did not have bladder rupture had a renal injury. The location of the rupture (intraperitoneal or extraperitoneal) could be determined from the distribution of extravasated contrast material in the pelvis seen on CT scans. CONCLUSION: The use of a scanning delay at CT prior to imaging the pelvis showed extravasation of IV contrast material in all seven children with bladder rupture. Intraperitoneal and extraperitoneal bladder rupture could be differentiated on the basis of the distribution of extravasated contrast material seen on CT scans.

Abdominal Injuries↗
PubMed2000

[Morpho-metrical features of the pelvis in standing posture].

The morpho-metrical features of the human pelvis differ according to gender, particularly with regard to size and shape, and bipedal standing posture appears to have been a major determinant of pelvic structure. In standing posture, the three points of the right and left superior anterior iliac spines and pubic tubercle are in contact with the vertical frontal plane. In this situation, the superior anterior iliac spine is lower than the superior posterior iliac spine. From a lateral view, the vertical line from the body's center of gravity passes through the center of the hip joint or acetabulum. The anatomical or biomechanical problem has been whether the line of gravity passes through the promontory or the center of auricular surface. To clarify this point, the three points of the acetabular center, promontory and auricular center were examined as to how they are positioned in relation to each other and the distance of each on the vertical frontal plane. Those measurements are as followed: A) distance between vertical frontal plane and promontory, B) distance between vertical frontal plane and anterior margin of auricular surface, C) distance between vertical frontal plane and mid-point of auricular surface computed from (B + D)/2, D) distance between vertical frontal plane and posterior margin of auricular surface, E) distance between vertical frontal plane and mid-point of acetabulum, F) inclination angle of the pelvis. From the results, the acetabular center and promontory are in alignment with the vertical line. The auricular center is positioned further back than the acetabular center or promontory. In this situation, the mean angle of inclination of the pelvis was found to be 63 degrees in 16 Japanese male specimens. The means of the other Japanese populations are into range of 63 degrees to 66 degrees in the males. If the auricular center coincides with the acetabular center, it is possible the angle of inclination of the pelvis would exceed 63 degrees. The frontal plane in contact with the right and left superior anterior iliac spines and pubic tubercle is not vertical. The morphological features clarified in the present study are that the promontory and acetabular center are in vertical alignment when viewed laterally and that the angle of inclination of the pelvis is 63 degrees.

Asian People↗
PubMed1997

[Experimental study of distribution of stress and strain on pelvis in normal Chinese adult].

To approach the biomechanical properties of pelvis in normal Chinese adult, an intact pelvis taken from fresh healthy male cadaver after sudden death was used in this study. The pelvis joined up with lumber4, 5 and proximal segment of femurs. After appropriate management of the specimen, the loads in the simulated test (stand position of normal adult) are 300 N, 600 N and 900 N. With strain electric measuring apparatus, the distribution of stress and strain, and the actual linear strain of every measuring point are obtained. Data processing was performed on computer. The main stress sigma 1, sigma 2 and their direction angles were acquired. The results of the simulated test demonstrated that the stress of iliac bone adjacent to sacro-iliac articulation was maximum in all measuring points. The linear strain values of 0 degree direction parallel with coronal section were negative in majority, but those of 45 degrees and 90 degrees direction vertical with coronal section were positive in majority. So the distribution of the linear strain of pelvis should be very complicated. When 900 N weight acted on the pelvis, the maximum main stress sigma max = 0.269-20.01 MPa and the minimum main stress sigma min = -0.095(-)-16.56 MPa. The angle of the maximum main stress with coronal section did not exceed 4 degrees.

Adult↗
PubMed1996

False-positive radioiodine uptake in the abdomen and the pelvis: radioiodine retention in the kidneys and review of the literature.

Because the kidneys are usually not visualized on radioiodine whole-body scans, the renal uptake can be mistaken for a thyroid cancer metastasis. The authors report the prevalence and characteristics of radioiodine retention in the kidneys and review the reported causes of false-positive radioiodine uptake in the abdomen and pelvic areas. Radioiodine uptake in the renal bed was noted on 9 of 400 (2.2%) I-123 diagnostic whole-body scans performed over a 7-month period in our center. The uptake was noted more clearly on posterior views, cleared on delayed images after further hydration, and was not consistently present on follow-up scans. It was unilateral and mimicked a renal or adrenal metastasis in 44% of the scans. In three cases, the uptake was associated with a dilated calyx, an extrarenal pelvis, or a voluminous pelvis. False-positive radioiodine uptake in the abdomen and pelvis has been previously reported in association with 14 different conditions. However, renal retention may represent the most common cause of false-positive radioiodine uptake in the abdomen pelvis. Delayed imaging after additional hydration is usually sufficient to clarify its origin.

Abdomen↗
PubMed1999

Ureteropelvic junction obstruction associated with extrarenal pelvis: A potential cause of cystic abdominal mass anterior to a normal-appearing kidney in the newborn.

An extrarenal pelvis is associated with the absence of central sinus echoes on sonography. However, central sinus echoes are normally inapparent in some newborns. Furthermore, true absence of a central sinus may cause calices to simulate normal renal pyramids so that the kidney appears normal in a fetus or newborn. This case illustrates the potential for an obstructed extrarenal pelvis in a fetus or newborn to distend so that it is mistaken on sonography for a cystic anterior abdominal mass unrelated to the kidney. However, the absence of central sinus echoes should suggest the diagnosis of an obstructed extrarenal pelvis if the adjacent cystic abdominal mass is positioned to obstruct an intrarenal pelvis.

Congenital Abnormalities↗
PubMed1988

The Copenhagen case-control study of renal pelvis and ureter cancer: role of smoking and occupational exposures.

Smoking habits and occupational exposures were investigated for 96 patients with cancer of the renal pelvis and ureter (including papilloma) and 294 hospital controls. In comparison with persons who never smoked, significantly increased relative risks were seen for smokers of cigarettes alone (RR = 2.6; 95% CI: 1.0-6.7) and in combination with other types of tobacco (RR = 3.8; 95% CI: 1.3-11.5). Non-significantly increased relative risks were observed for pipe smokers (RR = 2.2; 95% CI: 0.1-97) and for mixed pipe, cigar, and cigarillo smokers (RR = 6.5; 95% CI: 0.4-21.2). A strong dose-effect (p less than 0.001) relationship was seen between the lifetime total amount of tobacco smoked and the risk of pelvis-ureter tumors, with the heaviest smokers having an 8-fold risk. Comparison with the dose-effect relationship for a parallel study of bladder cancer indicated that the relationship with tobacco was stronger for pelvis-ureter tumors. Deep inhalation of cigarette smoke increased the risk (RR = 3.4; 95% CI: 1.9-6.1), while stopping smoking (RR = 0.6; 95% CI: 0.3-1.1) and use of filter cigarettes (RR = 0.5; 95% CI: 0.3-0.9) decreased the risk. Significantly increased risks emerged for employment in the chemical, petrochemical and plastics industries (RR = 4.0; 95% CI: 1.6-9.8), and for exposure to coal and coke (RR = 4.0; 95% CI: 1.2-13.6), asphalt and tar (RR = 5.5; 95% CI: 1.6-19.6). Cigarette smoking accounted for 56% of male and 40% of female pelvis and ureter tumors in eastern Denmark.

Adult↗
PubMed2004

Diagnostic accuracy of fetal renal pelvis anteroposterior diameter as a predictor of uropathy: a prospective study.

OBJECTIVE: The purpose of this study was to assess the accuracy of prenatal ultrasound measurement of anteroposterior renal pelvis diameter (APD) to discriminate between significant uropathy and idiopathic renal pelvis dilatation. METHODS: One-hundred-and-three neonates who were found to have fetal renal pelvis dilatation, defined as presence of an APD > or = 5 mm, underwent systematic investigation for uropathies and were prospectively followed. An ultrasound scan was performed after the first week of postnatal life and all infants underwent a voiding cystourethrogram. Neonates with an APD larger than 10 mm underwent renal scintigraphy. Ultrasound scans, clinical examination and laboratory reviews were scheduled at 6-month intervals. Receiver-operating characteristics (ROC) curves were constructed to determine the best cut-offs for APD to identify renal units with significant uropathy as well as those requiring surgical intervention. Significant uropathy was defined as the presence of well-established urinary tract abnormalities or when there was abnormal renal scintigraphy. RESULTS: The estimated area under the curve for APD was 0.900 (95% CI, 0.841-0.942) indicating excellent power to discriminate between idiopathic pelvis dilatation and significant uropathy. The sensitivity and specificity for the 7.5 mm cut-off point were 97.9% and 40.6%, respectively. To identify infants who required surgical intervention, the calculated area under the curve was 0.953 (95% CI, 0.908-0.980). CONCLUSION: Our results suggest that measurement of APD is an excellent test to identify fetuses with significant uropathy, as well as those requiring postnatal intervention.

Area Under Curve↗
PubMed1988

Imaging the direct bidirectional spread of disease between the abdomen and the female pelvis via the subperitoneal space.

This report expands the concept of the subperitoneal space (SS) as the potential conduit for direct spread of disease in the abdomen to include the female pelvis. The normal anatomy of the SS in the lower abdomen, the female pelvis, and its uninterrupted continuation between the abdomen and pelvis are demonstrated by several imaging modalities. Surgically proven cases of bidirectional spread of disease between the abdomen and female pelvis are reported. The unifying concept of the interrelationship formed by the SS provides an understanding of the basic concepts of the pathways of direct spread of disease and the pathogenesis of the clinical presentation of disease distant from its site of origin.

Abdomen↗
PubMed2000

Neuroanatomy of the pelvis: implications for colonic and rectal resection.

PURPOSE: Urinary dysfunction remains a common complication of radical pelvic surgery, particularly after abdominoperineal resection. In treating rectal carcinoma, the extent of primary resection and lymphadenectomy are major determinants in the degree of postoperative urologic morbidity. METHODS: Twelve male and eight female hemipelves from fresh cadavers were dissected with reference to the neuroanatomy of the lower genitourinary tract. These cadavers were dissected within twelve hours of thaw from frozen state. The cadavers were hemisected at the level of the sacral promontory for better exposure of neural trunks and vascular structures leading into the pelvis. These structures were followed down sequentially into the true pelvis, using magnified dissection under operating microscope or loupe dissection or both. RESULTS: Coordinated lower urinary tract function relies on both autonomic and somatic nerve activity. Emanating from the inferior hypogastric plexus, the pelvic nerve supplies sympathetic and parasympathetic innervation to the pelvic viscera. The course of the pelvic nerve is as follows: 1) from the inferior hypogastric plexus, it has multiple branches forming a web-like complex within the endopelvic fascial sleeve, some of which innervate the bladder detrusor; 2) a main branch traveling inferolateral to the rectum remains deep to the fascia of the levator ani muscle and courses to the external urinary sphincter; 3) at the level of the prostatic apex (or bladder neck in females), this pelvic nerve branch sends direct branches to the urinary sphincter. The pudendal nerve traverses the pelvis in the pudendal canal, and before leaving the pelvis to enter the perineum, it gives an intrapelvic branch that courses alongside the ischium to enter the external urinary sphincter. In the ischiorectal fossa, terminal branches of the pudendal nerve (i. e., perineal nerve) can be seen inserting into the urinary sphincter. CONCLUSIONS: Urinary retention and urinary incontinence represent two distinct urologic complications after abdominoperineal resection. Injury to detrusor branches of the pelvic nerve can cause detrusor denervation and urinary retention. In addition, injury to intrapelvic branches of the pelvic and pudendal nerves to the urinary sphincter can result in intrinsic sphincter deficiency and urinary incontinence. A better understanding of the neuroanatomy of the lower genitourinary tract can give a physiologic basis for clinical findings of postoperative voiding dysfunction and may help the surgeon refine surgical technique by more precisely determining resection limits to minimize urologic complications.

Aged↗
PubMed1998

[Complex injuries of the pelvis and acetabulum].

Injuries of the joints of the pelvis and of the acetabulum are still a problem even today. When the joints of the pelvis are damaged the risk of complicated pelvic injuries, that is to say pelvic injuries with damage to the soft tissues in and around the pelvis, is increased threefold. The lethality, the overall gravity of the injuries, the probability of haemorrhagic complications and the proportion of associated pelvic injuries are also increased. Even when anatomical reconstruction of the lower limb girdle is achieved, long-term secondary conditions such as pain and genitourinary and neurological sequelae frequently persist. Complicated pelvic injuries, i.e. pelvic injury with concomitant damage to organs and soft tissues in the pelvis and pelvic injuries with ipsilateral femoral fracture (floating hip) are special cases. Haemodynamic stabilization of the patient and the treatment of organic lesions must be the first priorities in the interdisciplinary therapy. Even when these priorities are correctly observed, the lethality is almost three times as high as in the case of pelvic injuries not involving soft-tissue damage. Acetabular fractures are a particular challenge even compared with other joint fractures. Operative treatment with anatomical joint reconstruction and stable internal fixation has been shown to have the best results. In addition to the type of fracture and the personal experience of the surgeon concerned, such fracture-specific factors as the presence of further fractures of the posterior wall, comminuted fractures, joint depression fractures and intra-articular fragments increasingly play a part. The long-term result worsens with increasing number of these additional pathologies. The primary cartilaginous damage caused by the accident seems to have a considerable influence on the long-term result following acetabular fractures.

Acetabulum↗