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International Journal of Surgery Case... Jan 2023Primary peritoneal ectopic pregnancy is a rare condition that can be life-threatening. Herein, we report such a case which was managed by laparoscopy.
INTRODUCTION
Primary peritoneal ectopic pregnancy is a rare condition that can be life-threatening. Herein, we report such a case which was managed by laparoscopy.
PRESENTATION OF THE CASE
A 31-year-old G1P0 woman, who had a history of pelvic infection and primary infertility, presented with lower abdominal pain and mild vaginal spotting. Abdominal and bimanual pelvic examination revealed mild left pelvic tenderness. Her serum β-human chorionic gonadotropin (β-HCG) was 7247 IU. Transvaginal ultrasound demonstrated a mass measuring around 1.5 cm in diameter with a well-defined yolk sac adherent to the left ovary. A left fallopian tube ectopic pregnancy was suspected. Laparoscopy revealed that both fallopian tubes were normal and freely moving. Peritoneal ectopic pregnancy was seen behind the uterus which was removed laparoscopically. Histopathology confirmed the diagnosis. The patient had a smooth postoperative recovery.
DISCUSSION
Primary peritoneal pregnancy can be life-threatening. A thorough laparoscopic examination of the entire pelvis and abdomen should be done by an experienced surgeon when the location of the suspected ectopic pregnancy could not be identified.
CONCLUSION
Diagnostic laparoscopy for ectopic pregnancy should include the whole pelvis and the accessible part of the abdomen when the tubes and ovaries are normal.
PubMed: 36599251
DOI: 10.1016/j.ijscr.2022.107847 -
Medical Archives (Sarajevo, Bosnia and... Jun 2020The e physical anatomical characteristics of Vietnamese people are similar to those of other East Asian populations, with a deep and narrow pelvis but an average body...
INTRODUCTION
The e physical anatomical characteristics of Vietnamese people are similar to those of other East Asian populations, with a deep and narrow pelvis but an average body mass index (BMI) among patients at the advanced stage of rectal cancer.
AIM
This study aimed to prospectively evaluate the short-term outcomes of transanal total mesorectal excision (TaTME) for rectal cancer treatment in a Vietnamese population.
METHODS
A total of 64 patients who underwent TaTME were included in this study. The pelvic anatomical parameters, BMI, operative morbidities, macroscopic qualities of the mesorectal specimens, circumferential resection margins, and anal sphincter functional data were collected. The method popularized by Quirke and Kirwan's classification were used to assess to quality of the mesorectal specimens and the sphincter function, respectively. Statistical analysis was performed using SPSS 20.0.
RESULTS
The mean age and BMI of the patients were 66.4 years and 20.5 kg/m2, respectively. Most patients had narrow pelvises, with mean transverse pelvic outlet diameters of 10.12 ±1.85 cm, for males, and 10.43 ± 1.32 cm, for females, and pelvic depths of 12.36 ±2.03 cm, for males, and 11.73 ±1.12 cm, for females. The mean tumor size was 5.17 ±1.62 cm. Among the mesorectal specimens, 82.8% were complete and 14.1% were nearly complete. Disease-free survival and overall survival rates were 98.2% and 100%, respectively. Sphincter functions at 12 months post-operation were rated as 30.8% Kirwan I, 42.3% Kirwan II, and 26.9% Kirwan III.
CONCLUSION
TaTME surgery represents a safe and suitable option among Vietnamese patients with narrow and deep pelvises and advanced rectal tumors in the middle third and lower third of the rectum.
Topics: Aged; Aged, 80 and over; Anal Canal; Asian People; Disease-Free Survival; Female; Humans; Laparoscopy; Male; Middle Aged; Pelvis; Postoperative Period; Prospective Studies; Rectal Neoplasms; Survival Rate; Transanal Endoscopic Surgery; Tumor Burden; Vietnam
PubMed: 32801439
DOI: 10.5455/medarh.2020.74.216-223 -
Obstetrics and Gynecology Aug 2022To examine the role of physical function impairments on the change in urinary incontinence (UI) symptoms after pelvic floor muscle training in older women.
OBJECTIVE
To examine the role of physical function impairments on the change in urinary incontinence (UI) symptoms after pelvic floor muscle training in older women.
METHODS
This is a prospective cohort study of 70 community-dwelling participants, older than age 70 years, with at least moderate incontinence symptoms. A comprehensive pelvic floor and physical function assessment was done at baseline. Individualized pelvic floor muscle training prescriptions with behavioral management strategies to reduce incontinence episodes were provided for 12 weeks. Baseline physical function was determined using the SPPB (Short Physical Performance Battery). A total score of 9 or lower out of 12 indicated impaired physical function, and scores higher than 9 indicated normal physical function. A 3-day bladder diary established daily incontinence episodes. The between-group difference in the change in number of UI episodes, from baseline to 6 weeks, was our primary outcome. Descriptive analyses compared important demographic and clinical characteristics. Longitudinal mixed model linear regression analyses determined the change in incontinence episodes and estimates of improvement based on the presence of impaired physical function and adjusted for age, race, and body mass index (BMI).
RESULTS
Participants' mean±SD age was 76.9±5.4 years, and 15.7% identified as African American, with no significant differences in age or race between groups. Participants with impaired physical function had higher mean±SD BMI (33.6±14.5 vs 27.4±5.8; P=.03) and more baseline incontinence episodes (4.5±2.9 vs 2.7±2.1 episodes per day; P=.005) than in women without functional impairment. After 6 weeks of pelvic floor exercises, the change in number of incontinence episodes per day was not different between participants with physical functional impairment compared with women with normal physical function (mean [95% CI] -1.2 [-2.0 to -0.5] vs -0.4 [-1.1 to 0.3], P=.31). Overall, after 12 weeks of pelvic floor muscle training, complete satisfaction with incontinence symptom improvement was low for both groups (41.8% with physical function impairments vs 44.8% with normal physical function; P=.90).
CONCLUSION
Behavioral therapy including pelvic floor muscle training may not significantly decrease UI symptoms to a degree that is satisfactory in women who are older than 70 years and are seeking treatment for UI, regardless of the presence of physical function impairments.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, NCT03057834.
Topics: Aged; Aged, 80 and over; Behavior Therapy; Exercise Therapy; Female; Humans; Pelvic Floor; Prospective Studies; Treatment Outcome; Urinary Incontinence; Urinary Incontinence, Stress
PubMed: 35852275
DOI: 10.1097/AOG.0000000000004852 -
Medicine Nov 2022Aggressive angiomyxoma (AAM) is a rare mesenchymal tumor primarily involving the lower genital tract of reproductive females. It often shares pathologic morphology with... (Review)
Review
RATIONALE
Aggressive angiomyxoma (AAM) is a rare mesenchymal tumor primarily involving the lower genital tract of reproductive females. It often shares pathologic morphology with other mesenchymal lesions, which result in diagnostic difficulties for pathologists.
PATIENT CONCERNS AND DIAGNOSES
We described the case of a 32-year-old female presenting with a pelvic mass. Imaging examination showed a "swirling sign" within the mass. The mass was 10.2 × 10 × 7.7 cm, located in the right front of the uterus, with unclear demarcation from the surrounding organs and tissues. The gross appearance was grayish brown with a solid section and a myxedematous cut surface. Microscopically, it was a mesenchymal tumor with a presence of perivascular smooth muscle fibers radiating from the blood vessel and an infiltrative growth pattern. The pelvic AAM was diagnosed based on clinicopathologic and imaging features.
INTERVENTIONS AND OUTCOMES
A surgery with local excision of the mass was performed. The patient experienced 1 relapse during 2-year follow-up and underwent the radiation therapy.
LESSONS
When the pathological morphology of AAM overlaps with other mesenchymal lesions, the comprehensive understanding of tumor clinicopathological characteristics combined with imaging features is important for the accurate diagnosis of AAM.
Topics: Humans; Female; Adult; Neoplasm Recurrence, Local; Myxoma; Pelvis
PubMed: 36401457
DOI: 10.1097/MD.0000000000031617 -
Journal of Clinical and Diagnostic... Jul 2017Magnetic Resonance Imaging (MRI) of adult female pelvis is a well-established tool in the evaluation of utero-ovarian lesions and is often used to supplement...
INTRODUCTION
Magnetic Resonance Imaging (MRI) of adult female pelvis is a well-established tool in the evaluation of utero-ovarian lesions and is often used to supplement ultrasonography. The need for diagnostic surgical intervention has largely been eclipsed with the advent of MRI, which has become the imaging modality of choice for characterization of pelvic masses.
AIM
To assess the role of MRI in female pelvic mass lesions and to exploit the tissue characterization capability of MRI.
MATERIALS AND METHODS
A prospective observational study was done on all patients referred to Department of Radiodiagnosis, Krishna Hospital, Karad, for MRI pelvis with clinically suspected uterine and adnexal masses or with indeterminate diagnosis on ultrasonography. Study was conducted between September 2014 to August 2016 with a sample size of 100 patients. All patients were scanned using 1.5 Tesla Seimens Avanto (Tim+Dot) scanner with Body matrix coil Tim. Histopathology was taken as gold standard. Results on continuous measurements were presented on Mean±SD (Min-Max) and results on categorical measurements were presented in Number (%).
RESULTS
Among 100 cases, on MRI, the maximum number of patients was having uterine lesions (48) followed by ovarian lesions (40), inconclusive adnexal/ovarian lesions (6), adnexal lesions (4). Two patients had normal findings. This correlated well with histopathology results, which showed the maximum number of patients were having uterine lesions (48) followed by ovarian lesions (41), adnexal lesions (5). Normal findings were observed in two patients.
CONCLUSION
Due to excellent depiction of pelvic anatomy, non-invasiveness and absence of ionizing radiation, MRI is an excellent tool for assessment of utero-ovarian disorders, for detecting and characterization of various diseases, and staging patients with carcinomas where accurate diagnosis will make an impact on their surgical and medical management planning.
PubMed: 28892996
DOI: 10.7860/JCDR/2017/26030.10182 -
Radiology Case Reports Jun 2023Pelvic neurofibromas are benign and uncommon retroperitoneal masses. They arise from Schwann cells. One of the most common types of these benign tumors is intraneural...
Pelvic neurofibromas are benign and uncommon retroperitoneal masses. They arise from Schwann cells. One of the most common types of these benign tumors is intraneural neurofibromas, which are solitary, sporadic, and not associated with neurofibromatosis type 1. Here we discuss a case of pelvic neurofibroma in a 20-year-old male who presented with chronic pelvic pain. He had no positive family history of genetic disorders. On physical exam, just a partly firm mass without mobility in the hypogastric region was detected. Ultrasound and Computed tomography scan showed pelvic retroperitoneal mass superior to the urinary bladder with extension to the rectovesical pouch and invasion of the posterior wall and dome of the bladder. The patient underwent laparotomy revealing an infiltrative retroperitoneal mass with the invasion of the posterior wall, dome, and trigone of the bladder. Histopathological findings showed neurofibroma.
PubMed: 37153482
DOI: 10.1016/j.radcr.2023.03.024 -
Turkiye Parazitolojii Dergisi Jun 2015Cystic echinococcosis caused by Echinococcus granulosus is still an important health problem in endemic areas. Cystic echinococcosis may involve different organs or...
Cystic echinococcosis caused by Echinococcus granulosus is still an important health problem in endemic areas. Cystic echinococcosis may involve different organs or areas with the most common sites being the liver and the lungs. Pelvic involvement has previously been reported and was mainly accepted as secondary to cystic echinococcosis in other organs, isolated pelvic involvement is very rare. In this case report, we aimed to present the case with pelvic cystic mass that was finally diagnosed with isolated pelvic cystic echinococcosis in and after the operation, and we would like to draw attention to include "cystic echinococcosis" in the differential diagnosis of pelvic masses.
Topics: Animals; Diagnosis, Differential; Echinococcosis; Echinococcus granulosus; Female; Humans; Middle Aged; Pelvic Infection; Pelvis
PubMed: 26081894
DOI: 10.5152/tpd.2015.3623 -
BioMed Research International 2020To correlate body weight, body mass index (BMI), and water-equivalent diameter ( ) and to assess size-specific dose estimates (SSDEs) based on body weight and BMI for...
BACKGROUND
To correlate body weight, body mass index (BMI), and water-equivalent diameter ( ) and to assess size-specific dose estimates (SSDEs) based on body weight and BMI for chest and abdomen-pelvic CT examinations.
METHODS
An in-house program was used to calculate , size-dependent conversion factor (), and SSDE for 1178 consecutive patients undergoing chest and abdomen-pelvic CT examinations. Associations among body weight, BMI, and were determined, and linear equations were generated using linear regression analysis of the first 50% of the patient population. SSDEs (SSDE and SSDE) were calculated based on body weight and BMI as surrogates on the second 50% of the patient population. Mean root-mean-square errors of SSDE and SSDE were computed with SSDE from the axial images as reference values.
RESULTS
Both body weight and BMI correlated strongly with for the chest ( = 0.85, 0.87, all < 0.001) and abdomen-pelvis ( = 0.85, 0.86, all < 0.001). Mean values of SSDE and SSDE based on the linear equations for body weight, BMI, and were in close agreement with SSDE from the axial images, with overall mean root-mean-square errors of 0.62 mGy (6.10%) and 0.57 mGy (5.65%), for chest, and 0.76 mGy (5.61%) and 0.71 mGy (5.22%), for abdomen-pelvis, respectively.
CONCLUSIONS
Both body weight and BMI, serving as surrogates, can be used to calculate SSDEs in the chest and abdomen-pelvis CT examinations, providing values comparable to SSDEs from the axial images, with an overall mean root-mean-square error of less than 0.76 mGy or 6.10%.
Topics: Abdomen; Body Mass Index; Body Size; Body Weight; Dose-Response Relationship, Radiation; Female; Humans; Male; Middle Aged; Pelvis; Radiation; Thorax; Tomography, X-Ray Computed
PubMed: 32733946
DOI: 10.1155/2020/6046501 -
Computational and Mathematical Methods... 2022To observe the effects of pelvic floor muscle mass on the priority outcome of frozen embryo transfer in patients with thin endometrium. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To observe the effects of pelvic floor muscle mass on the priority outcome of frozen embryo transfer in patients with thin endometrium.
METHODS
The patients who were prepared for freeze-thaw embryo transfer were randomly divided into the study group and control group. Both groups of patients began to take estradiol valerate tablets 3 mg on the third day of menstrual cycle and added progesterone for luteal support after 14 days. Both groups selected high-quality embryos for embryo transfer on the day of embryo transfer. The basic information, embryo transfer, intimal thickness, intimal type, clinical pregnancy rate, and early abortion rate of the two groups were compared.
RESULTS
The intimal thickness of patients in the control group and the study group on the second day of menstruation was (0.49 ± 0.03) and (0.45 ± 0.02) and that before progesterone was (1.17 ± 0.03) and (1.20 ± 0.04), respectively ( < 0.05). At the same time, the number of excellent embryos in the study group was significantly higher than that in the control group ( < 0.05), but there was no significant difference in the number of transplants between the two groups ( > 0.05). The proportion of intimal blood flow of type III + II in the study group was significantly higher than that in the control group ( < 0.05). The main adverse pregnancy outcomes of the whole group included biochemical pregnancy, early abortion, and ectopic pregnancy. The incidence of biochemical pregnancy in the control group and the study group was 63.3% (38/60) and 40.0% (24/60), respectively. The incidence of biochemical pregnancy in the control group was significantly higher than that in the study group, but there was no significant difference in the incidence of early abortion and ectopic pregnancy between the two groups ( > 0.05).
CONCLUSION
Pelvic floor muscle massage can improve endometrial thickness and subendometrial blood flow, so as to improve the pregnancy rate of frozen thawed embryo transfer patients.
Topics: Cryopreservation; Embryo Transfer; Endometrium; Female; Humans; Massage; Pelvic Floor; Pregnancy; Pregnancy Outcome; Pregnancy, Ectopic; Progesterone
PubMed: 35813410
DOI: 10.1155/2022/2803363 -
Journal of Cancer Research and... 2019Carcinoma of cervix is a common gynaecological malignancy and remains the third most common cancer in developing countries. While nodal metastases are common in cervical...
INTRODUCTION
Carcinoma of cervix is a common gynaecological malignancy and remains the third most common cancer in developing countries. While nodal metastases are common in cervical cancer, major sites of the less common haematogenous metastases include lung, liver and bones. Bone involvement in cases of carcinoma of cervix is low and the estimates range from 0.8-16 % according to various series.Several patterns of bone involvement are observed in cases of carcinoma of cervix including, (1) direct extension into bone, either from the parametrial extensions of the primary or recurrent pelvic tumor, (2) direct extension into adjacent bone from the pelvic or distant lymph node metastasis (3) regional or systemic haematogenous metastasis to bones.
AIMS
To evaluate the pattern of metastases in patients of carcinoma of uterine cervix, with particular emphasis on the pattern of bone involvement on contrast enhanced CT.
SETTINGS AND DESIGN
Retrospective study.
MATERIALS AND METHODS
This was a retrospective study, where we reviewed the hospital records and data of patients of cervical cancer who underwent contrast enhanced CT (CECT) of the chest and abdomen over a period of one year between January and December 2016. A total of 100 patients of carcinoma cervix were included. CT images were reviewed by two experienced radiologists. The bony erosion due to pelvic mass or lymphadenopathy was classified as subtle or gross.
RESULTS
Bone involvement was seen in 11 out of 100 cases (11% cases). Among 13 cases direct bone involvement by the pelvic mass/recurrence and metastatic lymph nodes (8/11; 72.7%) was slightly more common than thehematogenous bone metastasis (5/11; 45.4% cases). Among the direct bone involvement direct erosion of the underlying bone by the nodal metastasis (6/8; 75%) was twice more common than the direct bone involvement by the pelvic mass/recurrence(2/8; 25%).
CONCLUSIONS
Direct bone involvement by erosion of adjacent bone by nodal metastasis is the most common mechanism of bone involvement in cases of carcinoma of cervix signifying the high propensity of lymph nodal deposits to erode the underlying bone. This finding of direct bone erosion is not seen in any other gynaecological malignancy and should be promptly looked for in all cases of carcinoma of cervix.
Topics: Biopsy; Bone Neoplasms; Combined Modality Therapy; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Neoplasm Invasiveness; Pelvis; Recurrence; Tomography, X-Ray Computed; Treatment Outcome; Uterine Cervical Neoplasms
PubMed: 31898657
DOI: 10.4103/jcrt.JCRT_374_18