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Acta Clinica Croatica Jun 2021Benign multicystic peritoneal mesothelioma is a rare pathology that arises from the abdominal peritoneum. It has an affinity to develop on the surfaces of pelvic...
Benign multicystic peritoneal mesothelioma is a rare pathology that arises from the abdominal peritoneum. It has an affinity to develop on the surfaces of pelvic viscera. It predominantly occurs in women of reproductive age. The most used form of treatment is complete surgical removal. We report a case of a a 21-year-old female patient who presented with unclear diffuse abdominal pain. Transvaginal ultrasound and magnetic resonance imaging of the abdomen and pelvis revealed multiple functional cysts in the projection of the right and left ovary and free fluid in the pouch of Douglas. Laparoscopy was performed and multicystic tumor with thin, smooth walls, filled with clear serous content was found in lesser pelvis spreading to the left paracolic region and under the spleen. The multicystic mass was removed. Histologic examination revealed cystic formations filled with mucous content and formed from connective tissue outside and single row epithelium-mesothelium inside. Definitive diagnosis was benign multicystic mesothelioma of the abdominal peritoneum. The patient was well at one year follow-up.
Topics: Abdomen; Abdominal Pain; Adult; Female; Humans; Laparoscopy; Mesothelioma, Cystic; Peritoneal Neoplasms; Young Adult
PubMed: 34744286
DOI: 10.20471/acc.2021.60.02.22 -
Scientific Reports May 20213D free-hand ultrasound (3DFUS) is becoming increasingly popular to assist clinical gait analysis because it is cost- and time-efficient and does not expose participants...
3D free-hand ultrasound (3DFUS) is becoming increasingly popular to assist clinical gait analysis because it is cost- and time-efficient and does not expose participants to radiation. The aim of this study was to evaluate its reliability in localizing the anterior superior iliac spine (ASIS) at the pelvis and the hip joint centers (HJC). Additionally, we evaluated its accuracy to get a rough estimation of the potential to use of 3DFUS to segment bony surface. This could offer potential to register medical images to motion capture data in future. To evaluate reliability, a test-retest study was conducted in 16 lean and 19 obese individuals. The locations of the ASIS were determined by manual marker placement (MMP), an instrumented pointer technique (IPT), and with 3DFUS. The HJC location was also determined with 3DFUS. To quantify reliability, intraclass correlation coefficients (ICCs), the standard error of measurement (SEm), among other statistical parameters, were calculated for the identified locations between the test and retest. To assess accuracy, the surface of a human plastic pelvic phantom was segmented with 3DFUS in a distilled water bath in 27 trials and compared to a 3D laser scan of the pelvis. Regarding reliability, the MMP, but especially the IPT showed high reliability in lean (SEm: 2-3 mm) and reduced reliability in obese individuals (SEm: 6-15 mm). Compared to MMP and IPT, 3DFUS presented lower reliability in the lean group (SEm: 2-4 mm vs. 2-8 mm, respectively) but slightly better values in the obese group (SEm: 7-11 mm vs. 6-16 mm, respectively). Correlations between test-retest reliability and torso body fat mass (% of body mass) indicated a moderate to strong relationship for MMP and IPT but only a weak correlation for the 3DFUS approach. The water-bath experiments indicated an acceptable level of 3.5 (1.7) mm of accuracy for 3DFUS in segmenting bone surface. Despite some difficulties with single trials, our data give further rise to the idea that 3DFUS could serve as a promising tool in future to inform marker placement and hip joint center location, especially in groups with higher amount of body fat.
Topics: Adolescent; Anatomic Landmarks; Child; Female; Hip Joint; Humans; Imaging, Three-Dimensional; Male; Obesity; Pelvis; Reproducibility of Results; Thinness; Ultrasonography
PubMed: 34017023
DOI: 10.1038/s41598-021-89763-7 -
Gynecologic and Obstetric Investigation 2021Our study aimed to evaluate the quality of life (QoL) and pelvic floor function of cervical cancer (CC) patients after treatment. (Observational Study)
Observational Study
OBJECTIVES
Our study aimed to evaluate the quality of life (QoL) and pelvic floor function of cervical cancer (CC) patients after treatment.
DESIGN
This was a cross-sectional observational cohort study.
PARTICIPANTS
The participants included in this study were CC patients who underwent radical hysterectomy (RH) from 2012 to 2018 at 18 medical centers across China.
METHODS
The validated versions of the Pelvic floor Distress Inventory-Short Form 20, Overactive Bladder Symptom Score, and Euro Qol Five-Dimension questionnaires were used to evaluate postoperative pelvic floor dysfunction (PFD) and QoL.
RESULTS
A total of 689 CC patients were enrolled. The incidence of stress urinary incontinence (SUI), incomplete urinary emptying, and constipation were 32.7, 27.7, and 28.6%, respectively. Multivariate analysis confirmed that laparoscopic RH (LRH) and vaginal wall resection greater than 3 cm were risk factors for lower urinary tract symptoms (LUTS). LRH and chemotherapy were risk factors for SUI. Chemoradiotherapy and LRH were risk factors for overactive bladder (OAB). A high body mass index and LRH were risk factors for more severe defecation symptoms. ARH and large amount of operative blood loss were risk factors for poor QoL.
CONCLUSION
PFD is common in CC patients after treatment. LRH seems to increase the postoperative distress, including LUTS and defecation symptoms. Postoperative urinary incontinence and OAB are more bothersome for patients undergoing chemotherapy and radiotherapy. We recommend evaluating pelvic floor function as a standard assessment during follow-up.
Topics: Cross-Sectional Studies; Female; Humans; Pelvic Floor; Quality of Life; Retrospective Studies; Surveys and Questionnaires; Uterine Cervical Neoplasms
PubMed: 34375972
DOI: 10.1159/000517995 -
Radiology Case Reports Jun 2024A 40-year-old woman without history of endometriosis was found to have 10 cm pelvic mass on the routine first trimester ultrasound. Magnetic resonance imaging (MRI) of...
A 40-year-old woman without history of endometriosis was found to have 10 cm pelvic mass on the routine first trimester ultrasound. Magnetic resonance imaging (MRI) of the pelvis demonstrated a large solid mass abutting the rectum which raised the concern for malignancy. Transrectal biopsy of the mass was performed with histopathology result of decidualized endometriosis. Patient continued her pregnancy and had cesarean section at 39 weeks. Interestingly, no mass was found when obstetrician performed pelvic examination after delivery in the operative room. This case is a unique presentation of endometriosis during pregnancy in a patient with no prior history of endometriosis. Large size and abutment of the rectum by the decidualized endometriosis on MRI led to misinterpretation as malignancy. Our case highlights complexity of the deep infiltrative endometriosis (DIE) during pregnancy which can misguide the providers, lead to unnecessary procedures and unwanted complications.
PubMed: 38585388
DOI: 10.1016/j.radcr.2024.03.018 -
Frontiers in Cardiovascular Medicine 2022Ovarian vein thrombosis (OVT) is an uncommon condition, occurring in ~1 in every 600-2,000 pregnancies. It is associated with various conditions, including...
BACKGROUND
Ovarian vein thrombosis (OVT) is an uncommon condition, occurring in ~1 in every 600-2,000 pregnancies. It is associated with various conditions, including thrombophilia, malignancy, sepsis, intra-abdominal and pelvic inflammatory conditions, pregnancy, and the postpartum period, and specific surgical interventions, particularly gynecological surgeries. Thus, this study aims to identify the associated factors for OVT and elaborate on the standard treatment strategies for its management.
METHODS
Retrospective data collection was used. Our study consists of 18 patients diagnosed with OVT between 2005 and 2016; the data was collected from the Health Information Management system at King Fahad Medical City, Riyadh, Saudi Arabia using a standard format.
RESULTS
Our study found that OVT involves the right ovarian vein more often than the left and mainly occurs in women during their postpartum period. These patients other associated factor included hypertension, diabetes, and a higher body mass index (BMI) of above 25 kg/m. The most frequently presenting complaints were abdominal pain and fever. The most common treatment was the administration of enoxaparin (a low molecular weight heparin) for an average duration of one to three months, which resulted in a low recurrence rate of OVT.
CONCLUSIONS
Physicians should be vigilant for suspicion of OVT in female patients presenting with lower abdominal pain and fever in their postpartum period. Additionally, it is suggested to use low molecular weight heparin as initial therapy for OVT for one to three months, resulting in a high remission rate.
PubMed: 35783843
DOI: 10.3389/fcvm.2022.916920 -
International Journal of Surgery Case... Apr 2022Epidermal inclusion cysts are a common benign finding, and they are predominantly asymptomatic. They can rarely form in the pelvis or abdomen, however, and may cause...
INTRODUCTION AND IMPORTANCE
Epidermal inclusion cysts are a common benign finding, and they are predominantly asymptomatic. They can rarely form in the pelvis or abdomen, however, and may cause symptoms secondary to mass effect. This case highlights management of an anterectal epidermal inclusion cyst connected to the perineal cyst, mimicking a dumbbell-shaped lesion, found in a male.
CASE PRESENTATION
This is a unique case of a 21-year-old Caucasian male with a palpable perineal mass, lower extremity hypoesthesia, and constipation who was found to have a complex-shaped cyst on computed tomography and magnetic resonance imaging. This was ultimately managed with a two-stage perineal and transabdominal resection.
CLINICAL DISCUSSION
This case highlights that perineal epidermal inclusion cysts may have pelvic extension, especially in patients with additional new-onset neurologic, gastrointestinal, or urologic symptoms. These symptoms should completely resolve after resection. Additionally, resection is recommended to prevent complications including malignant degeneration and fistulization.
CONCLUSION
This is the first reported case of an anterectal, epidermal inclusion cyst connected to a perineal cyst found in a male. Perineal and pelvic cysts may be synchronous and may be connected through the pudendal canal. These masses can be safely removed via a combined perineal and transabdominal resection. The connecting portion of lesions that have both pelvic and perineal components should be meticulously identified and dissected because even a thin, patent segment - if left unresected - may result in lesion recurrence.
PubMed: 35286977
DOI: 10.1016/j.ijscr.2022.106932 -
Journal of Craniovertebral Junction &... 2020This was a systematic review of the literature and meta-analysis. (Review)
Review
STUDY DESIGN
This was a systematic review of the literature and meta-analysis.
OBJECTIVE
The objective of this study was to evaluate the current literature regarding the risk factors contributing to reoperation due to adjacent segment disease (ASD).
SUMMARY OF BACKGROUND DATA
ASD is a broad term referring to a variety of complications which might require reoperation. Revision spine surgery is known to be associated with poor clinical outcomes and high rate of complications. Unplanned reoperation has been suggested as a quality marker for the hospitals.
MATERIALS AND METHODS
An electronic search was conducted using PubMed. A total of 2467 articles were reviewed. Of these, 55 studies met our inclusion criteria and included an aggregate of 1940 patients. Data were collected pertaining to risk factors including age, sex, fusion length, lumbar lordosis, body mass index, pelvic incidence, sacral slope, pelvis tilt, initial pathology, type of fusion procedure, floating versus sacral or pelvic fusion, presence of preoperative facet or disc degeneration at the junctional segment, and sagittal orientation of the facets at the junctional segment. Analysis of the data was performed using Comprehensive Meta-Analysis software (Biostat, Inc.).
RESULTS
The overall pooled incidence rate of reoperation due to ASD from all included studies was 0.08 (confidence interval: 0.065-0.098). Meta-regression analysis demonstrated no significant interaction between age and reoperation rate ( = 0.48). A comparison of the event rates between males and females demonstrated no significant difference between male and female reoperation rates ( = 0.58). There was a significantly higher rate of ASD in patients with longer fusion constructs ( = 0.0001).
CONCLUSIONS
We found that 8% of patients in our included studies required reoperation due to ASD. Our analysis also revealed that longer fusion constructs correlated with a higher rate of subsequent revision surgery. Therefore, the surgeon should limit the number of fusion levels if possible to reduce the risk of future reoperation due to ASD.
LEVEL OF EVIDENCE
IV.
PubMed: 32549706
DOI: 10.4103/jcvjs.JCVJS_10_20 -
Minerva Urologica E Nefrologica = the... Aug 2019To evaluate the factors including pelvic dimensions, which might influence operative difficulty and complications after open radical cystoprostatectomy and orthotopic...
BACKROUND
To evaluate the factors including pelvic dimensions, which might influence operative difficulty and complications after open radical cystoprostatectomy and orthotopic neobladder reconstruction in men.
METHODS
A total of 198 RC patients operated in our institution with preoperative magnetic resonance (MRI) were analyzed were included in the study. Pelvic dimensions, including interspinous distance (ISD), bony femoral - (BFW) and soft tissue width (SW), apical prostate depth (AD), upper conjugate (UC), lower conjugate (LC) were measured by preoperative MRI. BFW, ISD, and SW indexes were defined as BFW/AD, ISD/AD, and SW/AD, respectively. Complicatons were classified according to the Clavien-Dindo classification system. As indicators of surgical difficulty; transfusion rate (TR), estimated blood loss (EBL), operative time (OT) and hospital stay (HS) were assessed. SPSS version 17.0 was used for statistical analyses.
RESULTS
A total of 239 complications developed in 143 of the 198 patients (72.2%). Correlation analysis revealed a significant indirect relationship between TR and SW/AD (P=0.023). For EBL, there were significant indirect correlations between the SW/AD, BFW/AD and ISD/AD indexes (P=0.026, P=0.05, P=0.009; respectively). Additionally, OT was directly correlated body mass index (BMI) (P=0.001); and indirectly correlated with UC, SW/AD, and BFW/AD (P=0.047, P=0.038, P=0.016, respectively). On multivariate logistic regression analyses higher American Society of Anesthesiologist (ASA) score was associated with major complications. Multivariate analyses revealed that pathological stage was a significant predictor of EBL.
CONCLUSIONS
Patients with smaller pelvises might undergo more difficult surgeries. However, it seems that small sized pelvis does not impact on operative difficulty and complication rate in radical cystoprostatectomy and orthotopic neobladder.
Topics: Adult; Aged; Aged, 80 and over; Blood Loss, Surgical; Blood Transfusion; Humans; Length of Stay; Magnetic Resonance Imaging; Male; Middle Aged; Operative Time; Pelvis; Postoperative Complications; Prostate; Prostatectomy; Plastic Surgery Procedures; Urinary Bladder
PubMed: 31086130
DOI: 10.23736/S0393-2249.19.03195-3 -
Medicine Aug 2022Extrauterine leiomyoma occasionally occurs in rare locations with unusual growth patterns, especially pelvic retroperitoneal leiomyoma, which brings great challenges for...
RATIONALE
Extrauterine leiomyoma occasionally occurs in rare locations with unusual growth patterns, especially pelvic retroperitoneal leiomyoma, which brings great challenges for surgeons to make a diagnosis. It is essential to distinguish benign from malignant retroperitoneal neoplasms according to the imaging manifestations. Laparotomy and laparoscopy are the common options for pelvic retroperitoneal neoplasms, while they may cause side effects during operation such as secondary damage. Appropriate surgical techniques should be adopted to ensure the complete excision of neoplasms meanwhile preserve the urination, defecation, and sexual function.
PATIENT CONCERNS
A 30-year-old woman was referred to our hospital because of dull pain in the perianal region for 1 month. Laboratory results including tumor markers were all within normal limits. The digital rectal examination revealed a huge and tough mass with smooth mucosa protruding into the rectal cavity from the rear area of rectum.
DIAGNOSIS
Imaging examinations were performed. Contrasted computed tomography (CT) of pelvis showed an enhanced retroperitoneal solid mass in the space between sacrum and rectum, and very close to the levator ani muscle. The mass was about 11.0*8.0 cm in size. Computerized tomography angiography (CTA) showed the distal branches of bilateral internal iliac artery went into the mass. Endoscopic ultrasonography (US) showed the mass compressed the rectum, as well as a clear boundary to the rectal wall. A histopathologic examination confirmed the mass was a pelvic retroperitoneal leiomyoma.
INTERVENTIONS
The patient underwent an operative resection with da Vinci Si surgical system after routine preoperative preparation. Anorectal motility was weekly monitored postoperation. No additional adjuvant therapy was performed.
OUTCOMES
The patient could walk after 1 day and defecate normally on the third day after operation. She was discharged on the seventh postoperative day. No adverse events including pelvic floor hernia or defecation dysfunction occurred in the follow-up period. At 4 weeks follow-up, the patient was pain-free and recovered well.
LESSONS
Although imaging examinations were crucial for retroperitoneal neoplasms, histopathological examination remains the "gold standard" for making a definite diagnosis. This case highlights the possibility of retroperitoneal leiomyoma occurring in a woman of reproductive age and the advantages of robotic surgical system in pelvic retroperitoneal surgeries.
Topics: Adult; Female; Humans; Leiomyoma; Pelvic Neoplasms; Pelvis; Retroperitoneal Neoplasms; Retroperitoneal Space; Robotics
PubMed: 35945744
DOI: 10.1097/MD.0000000000029650