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Sports Medicine and Health Science Sep 2021We recently observed a high prevalence of low pelvic bone mineral density (BMD) in female professional ballet performers. Because this population is susceptible to...
We recently observed a high prevalence of low pelvic bone mineral density (BMD) in female professional ballet performers. Because this population is susceptible to musculoskeletal overuse injuries, we aimed to determine which regions of the pelvis may be at greatest risk compared to general population females (GENPOP) as well as professional female soccer players (SOCCER, a comparison to other elite athletes regularly subjected to high degrees of loading). Three groups of age-matched females [(GENPOP; = 38, 27±1yrs), (BALLET; single company, = 36, 26±3yrs), (SOCCER; single NWSL® club, = 34, 25±1yrs)] consented to have their BMD and body composition assessed (DEXA, GE®). In addition to soft tissue and total and regional BMD analyses, a segmental analysis of the pelvis was performed to determine site-specific BMD for the iliac fossa, iliac fossa/iliac crest/ilium combined, pubic bone, ischium, and sacrum. A mixed-model ANOVA followed by a Tukey's post-hoc test was used to compare the groups (Type-I error; = 0.05). The BALLET group had lower pelvic BMD for all measures (. = 15%-27%, <0.001) compared to the SOCCER group and for the ischium (.= 8%; =0.007) and sacrum (Avg. = 7%; = 0.028) compared to the GENPOP group. The BALLET group had lower lean mass for all measures compared to the other groups ( = 12%-18%; < 0.01). Professional ballet performers exhibit reduced pelvic region soft tissue and site-specific BMD not previously detected using standard DEXA analyses. These findings highlight which pelvic regions may benefit from preventative strength training and/or nutritional interventions.
PubMed: 35784521
DOI: 10.1016/j.smhs.2021.08.002 -
Ultrasound in Obstetrics & Gynecology :... Jun 2021To evaluate the utility of pelvic floor ultrasound (US) in the detection and evaluation of suburethral masses, using magnetic resonance imaging (MRI) as the reference... (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate the utility of pelvic floor ultrasound (US) in the detection and evaluation of suburethral masses, using magnetic resonance imaging (MRI) as the reference standard.
METHODS
This was a retrospective analysis of US and MRI scans of all women with a suburethral mass on clinical examination at a single urogynecology clinic over a 13-year period (February 2007 to March 2020). All women were examined using two-dimensional transperineal US (2D-TPUS) with or without three-dimensional endovaginal US (3D-EVUS). All patients underwent unenhanced T1-weighted and T2-weighted MRI, which was considered the reference standard in this study. Presence of a suburethral mass and its size, location, connection with the urethral lumen and characteristics were evaluated on both pelvic floor US and MRI. Agreement between pelvic floor US and MRI was assessed using intraclass correlation coefficients (ICC; 3,1).
RESULTS
Forty women suspected of having a suburethral mass on clinical examination underwent both MRI and US (2D-TPUS with or without 3D-EVUS). MRI detected a suburethral mass in 34 women, which was also detected by US. However, US also identified a suburethral mass in the remaining six women. Thus, the agreement between US and MRI for detecting a suburethral mass was 85% (95% CI, 70.2-94.3%). The ICC analysis showed good agreement between MRI and 2D-TPUS for the measured distance between the suburethral mass and the bladder neck (ICC, 0.89; standard error of measurement (SEM), 3.64 mm) and excellent agreement for measurement of the largest diameter of the mass (ICC, 0.93; SEM, 4.31 mm). Good agreement was observed between MRI and 3D-EVUS for the measured distance from the suburethral mass to the bladder neck (ICC, 0.88; SEM, 3.48 mm) and excellent agreement for the largest diameter of the suburethral mass (ICC, 0.94; SEM, 4.68 mm).
CONCLUSIONS
2D-TPUS and 3D-EVUS are useful in the imaging of suburethral masses. US shows good-to-excellent agreement with MRI in identifying and measuring suburethral masses; therefore, the two modalities can be used interchangeably depending on availability of equipment and expertise. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. - Legal Statement: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Topics: Adult; Aged; Female; Genital Neoplasms, Female; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Middle Aged; Pelvic Floor; Predictive Value of Tests; Retrospective Studies; Ultrasonography; Urethra; Young Adult
PubMed: 32936990
DOI: 10.1002/uog.23123 -
PloS One 2020Testicular germ cell tumor (TGCT) incidence has increased in recent decades along with the use and dose of diagnostic radiation. Here we examine the association between...
BACKGROUND
Testicular germ cell tumor (TGCT) incidence has increased in recent decades along with the use and dose of diagnostic radiation. Here we examine the association between reported exposure to diagnostic radiation and TGCT risk.
METHODS
We conducted a case-control study of men with and without TGCT recruited from hospital- and population-based settings. Participants reported on exposures to 1) x-ray or CT below the waist and 2) lower GI series or barium enema, which consists of a series of x-rays of the colon. We also derived a combined measure of exposure. We used logistic regression to determine the risk of developing TGCT according to categories of exposures (0, 1-2, or ≥3 exposures) and age at first exposure, adjusting for age, year of birth, race, county, body mass index at diagnosis, family history of TGCT, and personal history of cryptorchidism.
RESULTS
There were 315 men with TGCT and 931 men without TGCT in our study. Compared to no exposures, risk of TGCT was significantly elevated among those reporting at least three exposures to x-ray or CT (OR≥3 exposures, 1.78; 95% CI, 1.15-2.76; p = 0.010), lower GI series or barium enema (OR≥3 exposures, 4.58; 95% CI, 2.39-8.76; p<0.001), and the combined exposure variable (OR≥3 exposures, 1.59; 95% CI, 1.05-2.42; p = 0.029). The risk of TGCT was elevated for those exposed to diagnostic radiation at age 0-10 years, compared to those first exposed at age 18 years or later, although this association did not reach statistical significance (OR, 2.00; 95% CI, 0.91-4.42; p = 0.086).
CONCLUSIONS
Exposure to diagnostic radiation below the waist may increase TGCT risk. If these results are validated, efforts to reduce diagnostic radiation doses to the testes should be prioritized.
Topics: Abdominal Cavity; Adolescent; Adult; Age Factors; Case-Control Studies; Child; Child, Preschool; Cryptorchidism; Diagnostic Imaging; Humans; Infant; Infant, Newborn; Logistic Models; Male; Middle Aged; Neoplasms, Germ Cell and Embryonal; Pelvis; Radiation; Radiation Injuries; Risk Factors; Testicular Neoplasms; Testis; Young Adult
PubMed: 33175879
DOI: 10.1371/journal.pone.0239321 -
European Journal of Case Reports in... 2024Subepithelial haemorrhage of the renal pelvis is a rare cause of haematuria and can be diagnosed based on radiographic findings. This haemorrhage often appears as a...
UNLABELLED
Subepithelial haemorrhage of the renal pelvis is a rare cause of haematuria and can be diagnosed based on radiographic findings. This haemorrhage often appears as a non-enhancing hyperdense mass in the renal pelvis on computed tomography, which sometimes results in unnecessary nephrectomy because it can mimic renal neoplasms. It can be managed conservatively, and its prognosis is generally benign. We report a case of renal pelvic haemorrhage complicating emphysematous pyelonephritis that needed emergent nephrectomy. Our case highlights the importance of careful observation for complications of urinary tract infection, although complications are rare.
LEARNING POINTS
Renal pelvic haemorrhage is an uncommon cause of haematuria. It can mimic renal neoplasms, which sometimes results in unnecessary nephrectomy.Although the prognosis of renal pelvic haemorrhage is generally benign, careful observation for complications of urinary tract infection is important.
PubMed: 38223272
DOI: 10.12890/2023_004241 -
International Journal of Environmental... Jan 2023This comparative pre-post intervention study investigated the feasibility and benefits of Kegel exercises amongst incontinent women, prior to commencing resistance...
This comparative pre-post intervention study investigated the feasibility and benefits of Kegel exercises amongst incontinent women, prior to commencing resistance training (RT), to reduce the risk of stress urinary incontinence (SUI) compared to a group of women without prior Kegel exercises (KE). Incontinence severity index (ISI) score, pelvic floor muscle strength (PFMS), and body composition (such as body mass index (BMI), fat, and muscle mass), were obtained pre and post intervention. Results demonstrated that RT reduced SUI to a significantly greater extent only if preceded by KE as was observed in the Kegel exercise plus RT group (KE + RT) over time. The improvements in total ISI in both the KE + RT and RT groups were large (d = 1.50 and d = 1.17 respectively). A two-way ANOVA indicated a statistically significant improvement in average PFMS within the KE + RT group over time and between the two groups. A positive correlation was found between the average strength of pelvic floor muscles and SUI. Participants in KE + RT group demonstrated a significant increase in muscle mass ( ≤ 0.001) and concomitant reduction in fat mass ( = 0.018). This study determined a dedicated program of KE preceding a RT program improved average pelvic floor muscle strength and was effective in reducing SUI among incontinent women.
Topics: Female; Humans; Urinary Incontinence, Stress; Resistance Training; Pelvic Floor; Exercise Therapy; Urinary Incontinence; Treatment Outcome
PubMed: 36674234
DOI: 10.3390/ijerph20021481 -
American Journal of Human Biology : the... Aug 2022Imaging methods to measure the human pelvis in vivo provide opportunities to better understand pelvic variation and adaptation. Magnetic resonance imaging (MRI) provides...
OBJECTIVES
Imaging methods to measure the human pelvis in vivo provide opportunities to better understand pelvic variation and adaptation. Magnetic resonance imaging (MRI) provides high-resolution images, but is more expensive than dual-energy X-ray absorptiometry (DXA). We sought to compare pelvic breadth measurements collected from the same individuals using both methods, to investigate if there are systematic differences in pelvic measurement between these imaging methods.
METHODS
Three pelvic breadth dimensions (bi-iliac breadth, bi-acetabular breadth, medio-lateral inlet breadth) were collected from MRI and DXA scans of a cross-sectional sample of healthy, nulliparous adult women of South Asian ancestry (n = 63). Measurements of MRI and DXA pelvic dimensions were collected four times in total, with one baseline data collection session and three replications. Data collected from these sessions were averaged, used to calculate technical error of measurement and entered into a Bland-Altman analysis. Linear regression models were fitted with a given MRI pelvic measurement regressed on the same measurement collected from DXA scans, as well as MRI mean bias regressed on DXA mean bias.
RESULTS
Technical error of measurement was higher in DXA measurements of bi-iliac breadth and medio-lateral pelvic inlet breadth and higher for MRI measurements of bi-acetabular breadth. Bland Altman analyses showed no statistically significant relationship between the mean bias of MRI and DXA, and the differences between MRI and DXA pelvic measurements.
CONCLUSIONS
DXA measurements of pelvic breadth are comparable to MRI measurements of pelvic breadth. DXA is a less costly imaging technique than MRI and can be used to collect measurements of skeletal elements in living people.
Topics: Absorptiometry, Photon; Adult; Body Mass Index; Cross-Sectional Studies; Female; Humans; Magnetic Resonance Imaging; Pelvis
PubMed: 35460113
DOI: 10.1002/ajhb.23753 -
The Journal of Maternal-fetal &... Dec 2023While a basic understanding of pelvic size and typology is still important for obstetricians, pelvic measurement data for Japanese women are very scarce. To our best... (Observational Study)
Observational Study
OBJECTIVE
While a basic understanding of pelvic size and typology is still important for obstetricians, pelvic measurement data for Japanese women are very scarce. To our best knowledge, no large-scale pelvimetry studies of Japanese women have been made for the past 50 years. This study aimed to investigate the accurate size, particularly the obstetric conjugate (OC) and transverse diameter of the pelvic inlet (TD), of modern Japanese women, using three-dimensional (3D) computed tomography (CT), and to obtain their reference values.
METHODS
This retrospective, single-center observational study enrolled Japanese non-pregnant women aged between 20 and 40 years, who underwent pelvic CT examination from 2016 to 2021. CT was performed for various reasons, including acute abdomen, search for cancer metastases, and follow-up of existing disease. However, no cases were taken for pelvic measurements. Pelvimetry was performed retrospectively using a 3D workstation. The OC was measured on a strict lateral view and the TD was measured on an axial-oblique view. Other clinical data, such as age, height, and weight, were also extracted from the medical charts and analyzed.
RESULTS
A total of 1,263 patients were enrolled, with the mean age of 32.7 years (standard deviation [SD] 6.2). The mean height, weight, and body mass index were 158.8 cm (SD 5.8), 54.8 kg (SD 11.7), and 21.7 kg/m (SD 4.4), respectively. The mean OC length was 127.0 mm (SD 9.5, 95% confidence interval [CI] 126.5-127.5), while the mean TD length was 126.8 mm (SD 7.5, 95% CI 126.4-127.2). Both values were normally distributed. Height was significantly associated with OC (regression coefficient = 0.75 [95% CI 0.66-0.84], < .001) and TD (regression coefficient = 0.63 [95% CI 0.56-0.70], < .001). Age showed a weak but statistically significant positive association with TD (regression coefficient = 0.14 [95% CI 0.07-0.20], < .001) and OC (regression coefficient = -0.10 [95% CI -0.18 to -0.01], = .026).
CONCLUSION
The 3D CT pelvimetry in 1,263 non-pregnant Japanese women of childbearing age revealed the mean OC and TD of 127.0 mm, and 126.8 mm, which were 11.8 mm and 4.3 mm larger, respectively, than those in the survey in 1972. Our data will be referred to in clinical practice as the standard pelvic measurement values for the Japanese population.
Topics: Pregnancy; Humans; Female; Young Adult; Adult; Pelvimetry; Retrospective Studies; East Asian People; Pelvis; Tomography, X-Ray Computed
PubMed: 36927362
DOI: 10.1080/14767058.2023.2190444 -
Women's Health (London, England) 2022Pelvic floor dysfunction has a high prevalence among women worldwide. However, in the Kingdom of Saudi Arabia, it is underreported. Thus, we aimed to estimate the...
OBJECTIVE
Pelvic floor dysfunction has a high prevalence among women worldwide. However, in the Kingdom of Saudi Arabia, it is underreported. Thus, we aimed to estimate the prevalence and risk factors of pelvic floor dysfunction in women in the Kingdom of Saudi Arabia.
METHODS
We conducted a cross-sectional study on literate non-pregnant women aged ⩾18 years who agreed to participate in our survey. We used the validated and translated Australian pelvic floor questionnaire and conducted a multivariate logistic regression analysis to assess the risk factors of pelvic floor dysfunction.
RESULTS
A total of 824 participants completed the questionnaire. While 60.2% of the participants had pelvic floor dysfunction, 67.7% reported signs of bowel dysfunction. Urinary dysfunction, prolapse, and sexual dysfunction were present in 44.1%, 67.7%, and 55.4% of the participants, respectively. Age, high body mass index, chronic medical illness, heavy weight lifting, and multiparity were found as the risk factors of bladder function problems. Meanwhile, chronic medical illness, heavy weight lifting, and multiparity were found as the risk factors of bowel dysfunction and prolapse. Age group and marital status were the independent factors associated with sexual dysfunction.
CONCLUSION
We noted a high rate of pelvic floor dysfunction in the Kingdom of Saudi Arabia, which calls for the need to provide holistic approaches for the prevention and management of pelvic floor dysfunction among women.
Topics: Adolescent; Australia; Cross-Sectional Studies; Fecal Incontinence; Female; Humans; Pelvic Floor; Pelvic Floor Disorders; Prevalence; Saudi Arabia; Surveys and Questionnaires; Urinary Incontinence
PubMed: 35100887
DOI: 10.1177/17455065211072252 -
International Journal of Surgery Case... 2019Malignant peripheral nerve sheath tumors (MPNST) are rare, aggressive sarcomatous tumors that arise from peripheral nerve sheaths and show schwann cell differentiation...
INTRODUCTION
Malignant peripheral nerve sheath tumors (MPNST) are rare, aggressive sarcomatous tumors that arise from peripheral nerve sheaths and show schwann cell differentiation (Thangadurai, 2017) [1]. They commonly arise among patients with neurofibromatosis I and following radiation therapy (Farid et al., 2014). High resolution PET scans confirm the diagnosis and the definitive treatment is surgical excision. Post operative radiotherapy plays an important role in disease free survival rates. Chemotherapy is offered to people who have a systemic disease.
PRESENTATION OF CASE
This case report is on a 47 year old lady, a known case of Von Recklinghausen, who complained of a vague mass in the pelvis with recent history of pain to her right thigh. Pelvic examination revealed a vague mass on the right side of her pelvis. She was planned for excision of the mass. Intraoperative findings were consistent with the clinical and radiological findings. She is currently on regular follow-up and disease free.
DISCUSSION
MPNSTs are rare tumours that arise in patients with neurofibromatosis I. Mutations at the genetic level is responsible for the development of MPNST. Early presentation, radiological confirmation, aggressive margin free surgery followed by chemoradiation helps in near complete cure of the disease.
CONCLUSION
MPNST are difficult to manage because of their aggressive nature and the limitations in early diagnosis and management. In patients with Von Recklinghausens disease, malignancy must be suspected when a patient presents with the complaints as mentioned in this case report.
PubMed: 31670144
DOI: 10.1016/j.ijscr.2019.10.004 -
Arthroplasty Today Dec 2023Intraoperative pelvic motion during total hip arthroplasty (THA) in the supine position affects acetabular cup placement and occurs at each step of THA; however, there...
BACKGROUND
Intraoperative pelvic motion during total hip arthroplasty (THA) in the supine position affects acetabular cup placement and occurs at each step of THA; however, there are no reports of pelvic motion changes during each stage of THA via the direct anterior approach (DAA). This study aimed to evaluate pelvic motion at each step of THA through the DAA.
METHODS
From March to October 2022, 71 hips were prospectively measured for intraoperative pelvic tilt and axial rotation during THA through the DAA at a single center. These parameters were measured during each surgical step using the augmented reality-hip navigation system.
RESULTS
Both pelvic tilt and axial rotation were maximal during acetabular cup placement. The mean intraoperative pelvic tilt and axial rotation during cup placement were 4.8 ± 2.6° (95% confidence interval, 4.19-5.41°) and 4.2 ± 3.3° (95% confidence interval, 3.42-4.98°), respectively. The effects of the acetabular retractor and cup impactor on pelvic tilt and axial rotation were comparable. Spearman's correlation tests showed significant correlation between axial rotation and body mass index (r = -0.444, = .00011).
CONCLUSIONS
The pelvis tilts forward and rotates toward the surgical side during THA through the DAA. The effects of the acetabular retractor and cup impactor on pelvic motion are comparable. Cup implantation must take into account pelvic movement, and it must be recognized that the pelvis is moving at that time, even with only the acetabular retractor inserted, compared to before the skin incision.
PubMed: 38023653
DOI: 10.1016/j.artd.2023.101251