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The British Journal of Surgery Mar 2024Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of...
BACKGROUND
Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored.
METHOD
Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition.
RESULTS
One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed.
CONCLUSIONS
EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
Topics: Humans; Treatment Outcome; Quality of Life; Pelvis; Pelvic Exenteration; Health Personnel; Delphi Technique; Research Design
PubMed: 38456677
DOI: 10.1093/bjs/znae042 -
Annals of Biomedical Engineering Feb 2024Remodeling of the sacrum and coccyx to accommodate pregnancy and delivery has been hypothesized but not directly quantified. This study aimed to quantify the remodeling...
Remodeling of the sacrum and coccyx to accommodate pregnancy and delivery has been hypothesized but not directly quantified. This study aimed to quantify the remodeling of the sacrum and coccyx by comparing midsagittal lengths, angles, curvature, and shape between nulliparous, pregnant, and parous women using both 2 and 3 dimensional measures. Ninety pelvic magnetic resonance images of the pelvis were retrospectively collected and segmented. Twelve length, angle, and curvature measurements were made using definitions from previous literature on the midsagittal plane to define the sacrum, coccyx, and combined sacrum-coccyx shape. These measures were followed by a statistical shape analysis, which returned modes of variation and principal component scores. A separate MANCOVA analysis was conducted for both the 2D and 3D measures. The 2D and 3D analyses agreed that pregnant women had a significantly straighter coccyx and combined sacrum/coccyx than nulliparous (9.1% and 5.6%, respectively) and parous (7.5% and 2.7%, respectively) subjects. All comparisons showed that, on average, a pregnant woman's sacrum and coccyx were significantly straighter than their nulliparous counterparts. Then after delivery, the sacrum/coccyx returned, but not completely back to a more curved configuration.
Topics: Humans; Female; Pregnancy; Sacrum; Coccyx; Retrospective Studies; Pelvis; Magnetic Resonance Imaging
PubMed: 37828266
DOI: 10.1007/s10439-023-03375-y -
Abdominal Radiology (New York) May 2024Vascular compression syndromes are a diverse group of pathologies that can manifest asymptomatically and incidentally in otherwise healthy individuals or symptomatically... (Review)
Review
Vascular compression syndromes are a diverse group of pathologies that can manifest asymptomatically and incidentally in otherwise healthy individuals or symptomatically with a spectrum of presentations. Due to their relative rarity, these syndromes are often poorly understood and overlooked. Early identification of these syndromes can have a significant impact on subsequent clinical management. This pictorial review provides a concise summary of seven vascular compression syndromes within the abdomen and pelvis including median arcuate ligament (MAL) syndrome, superior mesenteric artery (SMA) syndrome, nutcracker syndrome (NCS), May-Thurner syndrome (MTS), ureteropelvic junction obstruction (UPJO), vascular compression of the ureter, and portal biliopathy. The demographics, pathophysiology, predisposing factors, and expected treatment for each compression syndrome are reviewed. Salient imaging features of each entity are illustrated through imaging examples using multiple modalities including ultrasound, fluoroscopy, CT, and MRI.
Topics: Humans; Renal Nutcracker Syndrome; Median Arcuate Ligament Syndrome; Diagnostic Imaging; Abdomen; Diagnosis, Differential; Vascular Diseases; Pelvis; May-Thurner Syndrome; Superior Mesenteric Artery Syndrome
PubMed: 38683215
DOI: 10.1007/s00261-024-04315-7 -
The Journal of Arthroplasty Oct 2023Automatic methods for labeling and segmenting pelvis structures can improve the efficiency of clinical and research workflows and reduce the variability introduced with...
BACKGROUND
Automatic methods for labeling and segmenting pelvis structures can improve the efficiency of clinical and research workflows and reduce the variability introduced with manual labeling. The purpose of this study was to develop a single deep learning model to annotate certain anatomical structures and landmarks on antero-posterior (AP) pelvis radiographs.
METHODS
A total of 1,100 AP pelvis radiographs were manually annotated by 3 reviewers. These images included a mix of preoperative and postoperative images as well as a mix of AP pelvis and hip images. A convolutional neural network was trained to segment 22 different structures (7 points, 6 lines, and 9 shapes). Dice score, which measures overlap between model output and ground truth, was calculated for the shapes and lines structures. Euclidean distance error was calculated for point structures.
RESULTS
Dice score averaged across all images in the test set was 0.88 and 0.80 for the shape and line structures, respectively. For the 7-point structures, average distance between real and automated annotations ranged from 1.9 mm to 5.6 mm, with all averages falling below 3.1 mm except for the structure labeling the center of the sacrococcygeal junction, where performance was low for both human and machine-produced labels. Blinded qualitative evaluation of human and machine produced segmentations did not reveal any drastic decrease in performance of the automatic method.
CONCLUSION
We present a deep learning model for automated annotation of pelvis radiographs that flexibly handles a variety of views, contrasts, and operative statuses for 22 structures and landmarks.
Topics: Humans; Deep Learning; Radiography; Neural Networks, Computer; Pelvis; Postoperative Period
PubMed: 37236288
DOI: 10.1016/j.arth.2023.05.036 -
Minerva Pediatrics Aug 2023
Topics: Male; Humans; Nevus, Sebaceous of Jadassohn; Skin Neoplasms; Nevus; Pelvis; Penis
PubMed: 36852958
DOI: 10.23736/S2724-5276.23.07188-4 -
Radiotherapy and Oncology : Journal of... Feb 2024MRI-only planning relies on dosimetrically accurate synthetic-CT (sCT) generation to allow dose calculation. Here we validated the dosimetric accuracy of sCTs generated...
BACKGROUND AND PURPOSE
MRI-only planning relies on dosimetrically accurate synthetic-CT (sCT) generation to allow dose calculation. Here we validated the dosimetric accuracy of sCTs generated using a deep learning algorithm for pelvic, brain and head and neck (H&N) cancer sites using variable MRI data from multiple scanners.
METHODS
sCT generation models were trained using a cycle-GAN algorithm, using paired MRI-CT patient data. Input MRI sequences were: T2 for pelvis, T1 with gadolinium (T1Gd) and T2 FLAIR for brain and T1 for H&N. Patient validation sCTs were generated for each site (49 - pelvis, 25 - brain and 30 - H&N). VMAT plans, following local clinical protocols, were calculated on planning CTs and recalculated on sCTs. HU and dosimetric differences were assessed, including DVH differences and gamma index (2 %/2mm).
RESULTS
Mean absolute error (MAE) HU differences were; 48.8 HU (pelvis), 118 HU (T2 FLAIR brain), 126 HU (T1Gd brain) and 124 HU (H&N). Mean primary PTV D95% dose differences for all sites were < 0.2 % (range: -0.9 to 1.0 %). Mean 2 %/2mm and 1 %/1mm gamma pass rates for all sites were > 99.6 % (min: 95.3 %) and > 97.3 % (min: 80.1 %) respectively. For all OARs for all sites, mean dose differences were < 0.4 %.
CONCLUSION
Generated sCTs had excellent dosimetric accuracy for all sites and sequences. The cycle-GAN model, available on the research version of a commercial treatment planning system, is a feasible method for sCT generation with high clinical utility due to its ability to use variable input data from multiple scanners and sequences.
Topics: Humans; Deep Learning; Tomography, X-Ray Computed; Radiotherapy Planning, Computer-Assisted; Head and Neck Neoplasms; Brain; Magnetic Resonance Imaging; Pelvis; Radiotherapy Dosage; Blood Coagulation Disorders
PubMed: 38096921
DOI: 10.1016/j.radonc.2023.110052 -
Sexual Medicine Reviews Sep 2023The artificial urinary sphincter and 3-piece inflatable penile prosthesis each require a fluid storage component and thus have components in the inguinal and pelvic... (Review)
Review
INTRODUCTION
The artificial urinary sphincter and 3-piece inflatable penile prosthesis each require a fluid storage component and thus have components in the inguinal and pelvic regions. Because of this, patients with urologic prosthetics sometimes present challenges during future nonprosthetic operations. Presently, there is no established guideline for device management with ensuing inguinal or pelvic surgery.
AIMS
This article outlines concerns during pelvic and inguinal surgery for patients with an artificial urinary sphincter and/or inflatable penile prosthesis and proposes an algorithm for preoperative surgical planning and decision making.
METHODS
We conducted a narrative review of the literature on operative management of these prosthetic devices. Publications were identified by searching electronic databases. Only peer-reviewed publications available in English were considered for this review.
RESULTS
We review the important considerations as well as available options for operative management of these prosthetic devices during subsequent nonprosthetic surgery and highlight the advantages and disadvantages of each. Finally, we suggest a framework for helping surgeons determine which management strategy is most appropriate for their individual patients.
CONCLUSION
The best management strategy will differ depending on patient values, the planned surgery, and patient-specific factors. Surgeons should understand and counsel patients on all available options and encourage informed, shared decision making to determine the best individualized approach.
Topics: Male; Humans; Penile Implantation; Erectile Dysfunction; Penile Prosthesis; Prosthesis Implantation; Pelvis
PubMed: 37200135
DOI: 10.1093/sxmrev/qead018 -
International Urogynecology Journal Mar 2024Despite exercise being the standard approach to diastasis recti abdominis (DRA) rehabilitation, there is no consensus on the most effective exercise routine and adjunct... (Review)
Review
INTRODUCTION AND HYPOTHESIS
Despite exercise being the standard approach to diastasis recti abdominis (DRA) rehabilitation, there is no consensus on the most effective exercise routine and adjunct modalities for reducing DRA and improving functional parameters. The present study is aimed at investigating evidence for DRA rehabilitation in postpartum women, as well as knowledge gaps and areas for future research.
METHODS
For this scoping review a systematic search was conducted in MEDLINE, AMED, CINAHL, Embase, ScienceDirect, Scopus, and PEDro up to November 2022. Selection criteria included studies investigating exercise therapy interventions both with and without adjunct modalities for postpartum DRA. Sample characteristics, diagnostic criteria, program design, and outcome measures were recorded. Critical appraisal of clinical trials was performed using PEDro classification.
RESULTS
Twenty-eight studies were included: 14 clinical trials, 3 case series, and 11 observational studies. DRA exercises that focused on deep and superficial muscles, pelvic floor muscles, respiratory maneuvers, functional exercises, or alternative interventions (yoga, suspension training, hypopressive exercise) and adjunct modalities showed promising results in reducing the inter-recti distance and related dysfunction. However, there was great variability in diagnostic criteria and methods, DRA severity, time post-birth, and exercise program design.
CONCLUSIONS
Reviewed studies provide valuable insights into exercise therapy, but it is important to recognize their limitations, as variability in diagnostic criteria, sample characteristics, and exercise program design hinder the generalizability of the findings. Further high-quality research is needed to strengthen the evidence in this area and provide reliable recommendations for clinical practice.
Topics: Female; Humans; Rectus Abdominis; Postpartum Period; Exercise Therapy; Diastasis, Muscle; Pelvis
PubMed: 38340172
DOI: 10.1007/s00192-024-05727-1 -
Journal of Biomechanical Engineering Oct 2023Biomechanical testbench emulating the physiological loading of the pelvis is crucial in developing reconstructive implants for fragility fractures of the pelvis....
Biomechanical testbench emulating the physiological loading of the pelvis is crucial in developing reconstructive implants for fragility fractures of the pelvis. Additionally, it will help understand the influence of the common daily loading on the pelvic ring. However, most reported experimental studies were mainly comparative with simplified loading and boundary conditions. In Part I of our study, we described the concept of the computational experiment design to design and construct a biomechanical testbench emulating the gait movement of the pelvis. The 57 muscles and joints' contact forces were reduced to four force actuators and one support, producing a similar stress distribution. The experimental setup is explained in this paper and some experimental results are presented. In addition, a series of repeatability and reproducibility tests were conducted to assess the test stand capabilities of replicating the gait physiological loading. The calculated stresses and the experimentally recorded strains showed that the pelvic ring response to the loading always follows the loaded leg side during the gait cycle. Furthermore, the experimental results of the pelvis displacement and strain at selected locations match the numerical ones. The developed test stand and the concept of computational experiment design behind it provide guidelines on how to design biomechanical testing equipment with physiological relevance.
Topics: Reproducibility of Results; Biomechanical Phenomena; Pelvis; Gait; Mechanical Phenomena
PubMed: 37219841
DOI: 10.1115/1.4062578 -
Journal of Orthopaedic Trauma Nov 2023Multidimensional fluoroscopy has been increasingly used in orthopaedic trauma to improve the intraoperative assessment of articular reductions and implant placement....
Multidimensional fluoroscopy has been increasingly used in orthopaedic trauma to improve the intraoperative assessment of articular reductions and implant placement. Owing to the complex osteology of the pelvis, cross-sectional imaging is imperative for accurate evaluation of pelvic ring and acetabular injuries both preoperatively and intraoperatively. The continued development of fluoroscopic technology over the past decade has resulted in improved ease of intraoperative multidimensional fluoroscopy use in pelvic and acetabular surgery. This has provided orthopaedic trauma surgeons with a valuable tool to better evaluate reduction and fixation at different stages during operative treatment of these injuries. Specifically, intraoperative 3D fluoroscopy during treatment of acetabulum and pelvis injuries assists with guiding intraoperative decisions, assessing reductions, ensuring implant safety, and confirming appropriate fixation. We outline the useful aspects of this technology during pelvic and acetabular surgery and report its utility with a consecutive case series at a single institution. The added benefits of this technology have improved the ability to effectively manage patients with pelvis and acetabulum injuries.
Topics: Humans; Fractures, Bone; Fracture Fixation, Internal; Bone Screws; Hip Fractures; Spinal Fractures; Pelvis; Acetabulum; Fluoroscopy; Pelvic Bones
PubMed: 37828694
DOI: 10.1097/BOT.0000000000002686