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The Orthopedic Clinics of North America Oct 2014Pediatric pelvic and acetabular fractures are rare injuries. They are almost always the result of a high-energy injury mechanism. A full trauma protocol should be... (Review)
Review
Pediatric pelvic and acetabular fractures are rare injuries. They are almost always the result of a high-energy injury mechanism. A full trauma protocol should be instituted, having a high index of suspicion for associated life-threatening injuries. In the past, it was recommended that almost all of these injuries be treated nonoperatively. However, pelvic and acetabular fractures do not all remodel well. Prospective studies are needed to establish optimal treatment guidelines. Until then, in the presence of instability or significant displacement, operative fixation by a pelvic and acetabular fracture specialist should be considered to allow the best possible outcome.
Topics: Acetabulum; Animals; Child; Diagnostic Errors; Diagnostic Imaging; Disease Models, Animal; Fracture Fixation, Internal; Fractures, Bone; Humans; Magnetic Resonance Imaging; Pelvis; Radiography; Wounds, Nonpenetrating
PubMed: 25199420
DOI: 10.1016/j.ocl.2014.06.009 -
Radiographics : a Review Publication of... 2022The pelvic venous system is complex, with the potential for numerous pathways of collateralization. Owing to stenosis or occlusion, both thrombotic and nonthrombotic... (Review)
Review
The pelvic venous system is complex, with the potential for numerous pathways of collateralization. Owing to stenosis or occlusion, both thrombotic and nonthrombotic entities in the pelvis may necessitate alternate routes of venous return. Although the pelvic venous anatomy and collateral pathways may demonstrate structural variability, a number of predictable paths often can be demonstrated on the basis of the given disease and the level of obstruction. Several general categories of collateral pathways have been described. These pathway categories include the deep pathway, which is composed of the lumbar and sacral veins and vertebral venous plexuses; the superficial pathway, which is composed of the circumflex and epigastric vessels; various iliofemoral collateral pathways; the intermediate pathway, which is composed of the gonadal veins and the ovarian and uterine plexuses; and portosystemic pathways. The pelvic venous anatomy has been described in detail in cadaveric and anatomic studies, with the aforementioned collateral pathways depicted on CT and MR images in several imaging studies. A comprehensive review of the native pelvic venous anatomy and collateralized pelvic venous anatomy based on angiographic features has yet to be provided. Knowledge of the diseases involving a number of specific pelvic veins is of clinical importance to interventional and diagnostic radiologists and surgeons. The ability to accurately identify common collateral patterns by using multiple imaging modalities, with accurate anatomic descriptions, may assist in delineating underlying obstructive hemodynamics and diagnosing specific occlusive disease entities. RSNA, 2022.
Topics: Abdomen; Collateral Circulation; Humans; Pelvis; Phlebography; Vascular Diseases; Veins
PubMed: 35867595
DOI: 10.1148/rg.220012 -
Best Practice & Research. Clinical... Jan 2019Understanding anatomy is one of the pillars for performing a safe, effective, and efficient surgery, but recently, it is reported that there has been a decline in... (Review)
Review
Understanding anatomy is one of the pillars for performing a safe, effective, and efficient surgery, but recently, it is reported that there has been a decline in teaching anatomy during the preclinical years of medical school. There is also evidence that by the time a medical student becomes a clinician, a considerable proportion of the basic anatomy knowledge is lost. Hence, it is crucial for surgeons performing or assisting in pelvic floor surgery to revisit this integral clinical aspect of pelvic anatomy for performing a safe surgery. Pelvic organ prolapse repair, especially abdominal laparoscopic sacrocolpopexy, which is the gold standard of pelvic organ prolapse repair, presents a significant challenge to surgeons because the technique requires thorough and meticulous negotiation through abdomino-pelvic vascular structures and nerves supplying the pelvis, rectum, and ureters. The abdominal laparoscopic sacrocolpopexy surgery requires surgeons to have a deep understanding of anatomy to prevent potential life-threatening complications, which is as critical as it is for a pilot to understand the navigation route for a safe landing. This review is an extensive look and a great reminder to laparoscopic surgeons working in the pelvic cavity, especially those performing a pelvic floor surgery, about the anatomical safe routes for performing laparoscopic pelvic floor repairs. For easy reading and clear understanding, we have described step by step the safe anatomical journey a surgeon needs to take during laparoscopic sacrocolpopexy. We divided the technique into five critical anatomic locations (landmarks), which serves as our "flight map" for performing safe and efficient laparoscopic sacrocolpopexy.
Topics: Abdominal Wall; Anatomic Landmarks; Blood Vessels; Female; Gynecologic Surgical Procedures; Humans; Laparoscopy; Pelvic Floor; Pelvic Organ Prolapse; Pelvis; Peripheral Nerves; Rectum; Sacrum; Ureter; Vagina
PubMed: 30554856
DOI: 10.1016/j.bpobgyn.2018.11.005 -
Seminars in Ultrasound, CT, and MR Jun 2017Chronic pelvic pain syndrome is commonly caused by nerve injury, inflammation, or entrapment. Owing to the complex anatomy and branching patterns of pelvic nerves,... (Review)
Review
Chronic pelvic pain syndrome is commonly caused by nerve injury, inflammation, or entrapment. Owing to the complex anatomy and branching patterns of pelvic nerves, pelvic neuropathies are often difficult to illustrate and diagnose. High-resolution 3-T magnetic resonance neurography is a promising technique for the evaluation of peripheral neuropathy. In this article, the authors discuss the normal anatomy of major pelvic nerves, technical considerations of high-resolution imaging, and normal and abnormal imaging appearances with relevant case examples.
Topics: Chronic Pain; Humans; Magnetic Resonance Imaging; Pelvic Pain; Pelvis; Peripheral Nervous System Diseases
PubMed: 28705371
DOI: 10.1053/j.sult.2016.11.006 -
Abdominal Radiology (New York) Aug 2022Percutaneous ultrasound-guided biopsies have become the standard of practice for tissue diagnosis in the abdomen and pelvis for many sites including liver, kidney,... (Review)
Review
Percutaneous ultrasound-guided biopsies have become the standard of practice for tissue diagnosis in the abdomen and pelvis for many sites including liver, kidney, abdominal wall, and peripheral nodal stations. Additional targets may appear difficult or impossible to safely biopsy by ultrasound due to interposed bowel loops/vasculature, deep positioning, association with the bowel, or concern for poor visibility; however, by optimizing technique, it is often possible to safely and efficiently use real-time ultrasound guidance for sampling targets that normally would be considered only appropriate for CT guided or surgical/endoscopic biopsy.
Topics: Abdomen; Biopsy; Humans; Image-Guided Biopsy; Pelvis; Ultrasonography; Ultrasonography, Interventional
PubMed: 34322727
DOI: 10.1007/s00261-021-03223-4 -
Radiologic Clinics of North America Nov 2018Musculoskeletal (MSK) conditions are growing in prevalence. Ultrasound (US) is increasingly used for managing MSK conditions due to its low cost and ability to provide... (Review)
Review
Musculoskeletal (MSK) conditions are growing in prevalence. Ultrasound (US) is increasingly used for managing MSK conditions due to its low cost and ability to provide real-time image guidance during therapeutic interventions. As MSK US becomes more widespread, familiarity and comfort with US-guided interventions will become increasingly important. This article focuses on general concepts regarding therapeutic US-guided injections of corticosteroids and platelet-rich plasma and highlights several of the US-guided procedures commonly performed, involving the pelvis and lower extremity.
Topics: Adrenal Cortex Hormones; Humans; Leg; Leg Injuries; Pelvis; Platelet-Rich Plasma; Ultrasonography, Interventional
PubMed: 30322485
DOI: 10.1016/j.rcl.2018.06.011 -
Surgical and Radiologic Anatomy : SRA Mar 2015Although several studies have reported that the peritoneum does not contribute to the formation of a fascia between the urogenital organs and rectum, Denonvilliers'...
Although several studies have reported that the peritoneum does not contribute to the formation of a fascia between the urogenital organs and rectum, Denonvilliers' fascia (DF), a fascia between the mesorectum and prostate (or vagina) in adults, is believed to be a remnant of the peritoneum. Remnants of the peritoneum, however, were reportedly difficult to detect in other fusion fasciae of the abdominopelvic region in mid-term fetuses. To examine morphological changes of the pelvic cul-de-sac of the peritoneum, we examined 18 male and 6 female embryos and fetuses. A typical cul-de-sac was observed only at 7 weeks, whereas, at later stages, the peritoneal cavity did not extend inferiorly to the level of the prostatic colliculus or the corresponding structure in females. The cul-de-sac had completely disappeared in front of the rectum at 8 weeks and homogeneous and loose mesenchymal tissue was present in front of the rectum at the level of the colliculus at 12-16 weeks. We found no evidence that linearly arranged mesenchymal cells developed into a definite fascia. Therefore, the development of the DF in later stages of fetal development may result from the mechanical stress on the increased volumes of the mesorectum, seminal vesicle, prostate and vagina and/or enlarged rectum. Therefore, we considered the DF as a tension-induced structure rather than a fusion fascia. Fasciae around the viscera seemed to be classified into (1) a fusion fascia, (2) a migration fascia and (3) a tension-induced fascia although the second and third types are likely to be overlapped.
Topics: Cadaver; Fascia; Female; Fetus; Humans; Male; Pelvis; Peritoneum; Rectum; Stress, Mechanical
PubMed: 25008480
DOI: 10.1007/s00276-014-1336-0 -
Magnetic Resonance Imaging Clinics of... Feb 2023The ovary resides in the pelvic cavity and is a dynamic organ with physiologic changes from birth to menopause. The imaging features of the normal ovary depend on the... (Review)
Review
The ovary resides in the pelvic cavity and is a dynamic organ with physiologic changes from birth to menopause. The imaging features of the normal ovary depend on the physiologic changes through puberty, reproductive age, and menopause. It is important for radiologists to understand the imaging features of normal physiologic changes in the ovaries and differentiate them from disease states.
Topics: Female; Humans; Ovary; Magnetic Resonance Imaging; Menopause; Puberty; Pelvis
PubMed: 36368854
DOI: 10.1016/j.mric.2022.07.001 -
Journal of Medicine and Life 2015Pelvic exenteration remains one of the most destructive surgical procedures in gynecologic oncology, performed in patients with locally advanced malignancies who were... (Review)
Review
Pelvic exenteration remains one of the most destructive surgical procedures in gynecologic oncology, performed in patients with locally advanced malignancies who were considered for a long time as unresectable. However, for these patients, an aggressive surgical approach seems to be the only potential curative solution. This is a literature review of the most important studies, which analyzes the benefits and the secondary risks of this demanding procedure.
Topics: Female; Genital Neoplasms, Female; Humans; Pelvic Exenteration; Pelvis
PubMed: 25866569
DOI: No ID Found -
Journal of Clinical Neurophysiology :... Aug 2014Currently, the means to assess the autonomic nervous system primarily depend on end organ functional measurement: intravesical pressure, skin resistance, and penile... (Review)
Review
Currently, the means to assess the autonomic nervous system primarily depend on end organ functional measurement: intravesical pressure, skin resistance, and penile strain gauge tension, for example. None of these measures has been generally accepted in the operating room. Nevertheless, the segmental and peripheral pelvic autonomic nerve supply is placed at risk during both pelvic and lower spine surgery. In this difficult era of suboptimal post-prostatectomy outcomes, the urological literature does reveal the salutary development of safer dissection techniques about the peri-prostatic and cavernous plexus. Means of reliably specific nerve identification remain elusive. The need for actual nerve monitoring (not just identification) has only recently been proposed. Data from the animal lab reinforce an appreciation of the intimate and elegant interconnectedness of autonomic and somatic structures, particularly at the segmental level. Also, the biochemistry of erectile tissue engorgement (in both sexes) is very well understood (the electrophysiology increasingly so). Understanding these principles should permit parallel investigation and implementation of neurophysiological techniques which both identify and monitor pelvic autonomic function. The predicates for these proposed new approaches in the operating room are discussed in this review.
Topics: Autonomic Nervous System; Humans; Monitoring, Intraoperative; Pelvis; Spinal Cord
PubMed: 25083841
DOI: 10.1097/WNP.0000000000000055