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Anatomical Record (Hoboken, N.J. : 2007) Apr 2022Medical education's treatment of obstetric-related anatomy exemplifies historical sex bias in medical curricula. Foundational obstetric and midwifery textbooks teach...
Medical education's treatment of obstetric-related anatomy exemplifies historical sex bias in medical curricula. Foundational obstetric and midwifery textbooks teach that clinical pelvimetry and the Caldwell-Moloy classification system are used to assess the pelvic capacity of a pregnant patient. We describe the history of these techniques-ostensibly developed to manage arrested labors-and offer the following criticisms. The sample on which these techniques were developed betrays the bias of the authors and does not represent the sample needed to address their interest in obstetric outcomes. Caldwell and Moloy wrote as though the size and shape of the bony pelvis are the primary causes of "difficult birth"; today we know differently, yet books still present their work as relevant. The human obstetric pelvis varies in complex ways that are healthy and normal such that neither individual clinical pelvimetric dimensions nor the artificial typologies developed from these measurements can be clearly correlated with obstetric outcomes. We critique the continued inclusion of clinical pelvimetry and the Caldwell-Moloy classification system in biomedical curricula for the racism that was inherent in the development of these techniques and that has clinical consequences today. We call for textbooks, curricula, and clinical practices to abandon these outdated, racist techniques. In their place, we call for a truly evidence-based practice of obstetrics and midwifery, one based on an understanding of the complexity and variability of the physiology of pregnancy and birth. Instead of using false typologies that lack evidence, this change would empower both pregnant people and practitioners.
Topics: Female; Humans; Parturition; Pelvimetry; Pelvis; Pregnancy
PubMed: 35202515
DOI: 10.1002/ar.24880 -
International Journal of Colorectal... May 2021Male sex, high BMI, narrow pelvis, and bulky mesorectum were acknowledged as clinical variables correlated with a difficult pelvic dissection in colorectal surgery. This...
PURPOSE
Male sex, high BMI, narrow pelvis, and bulky mesorectum were acknowledged as clinical variables correlated with a difficult pelvic dissection in colorectal surgery. This paper aimed at comparing pelvic biometric measurements in female and male patients and at providing a perspective on how pelvimetry segmentation may help in visualizing mesorectal distribution.
METHODS
A 3D software was used for segmentation of DICOM data of consecutive patients aged 60 years, who underwent elective abdominal CT scan. The following measurements were estimated: pelvic inlet, outlet, and depth; pubic tubercle height; distances from the promontory to the coccyx and to S3/S4; distance from S3/S4 to coccyx's tip; ischial spines distance; pelvic tilt; offset angle; pelvic inlet angle; angle between the inlet/sacral promontory/coccyx; angle between the promontory/coccyx/pelvic outlet; S3 angle; and pelvic inlet to pelvic depth ratio. The measurements were compared in males and females using statistical analyses.
RESULTS
Two-hundred patients (M/F 1:1) were analyzed. Out of 21 pelvimetry measurements, 19 of them documented a significant mean difference between groups. Specifically, female patients had a significantly wider pelvic inlet and outlet but a shorter pelvic depth, and promontory/sacral/coccyx distances, resulting in an augmented inlet/depth ratio when comparing with males (p < 0.0001). The sole exceptions were the straight conjugate (p = 0.06) and S3 angle (p = 0.17). 3D segmentation provided a perspective of the mesorectum distribution according to the pelvic shape.
CONCLUSION
Significant differences in the structure of pelvis exist in males and females. Surgeons must be aware of the pelvic shape when approaching the rectum.
Topics: Colorectal Neoplasms; Digestive System Surgical Procedures; Female; Humans; Male; Pelvimetry; Pelvis; Rectum
PubMed: 33230658
DOI: 10.1007/s00384-020-03802-9 -
The Journal of International Medical... Jun 2021The number of patients with metastatic bone tumors of the pelvis (MBTP) has increased, and the risk of metastasis and recurrence in the pelvic bones is difficult to...
OBJECTIVE
The number of patients with metastatic bone tumors of the pelvis (MBTP) has increased, and the risk of metastasis and recurrence in the pelvic bones is difficult to assess. Therefore, we investigated the clinical features and oncological outcomes of patients with MBTP.
METHODS
We analyzed the clinical features and oncological outcomes of MBTP in 72 patients (42 men, 30 women; mean age, 50.5 years) from 2008 to 2017. Recurrence in the pelvic bones and survival rates were analyzed with regard to patients' potential contributing factors.
RESULTS
Enneking region I was the area most commonly containing MBTP (47.3%). Low- and high-grade tumors were identified in 40 and 32 patients, respectively. The most common pathological type was adenomatous carcinoma (34.7%), and the most common primary lesion was lung cancer (20.8%). The 3-year overall recurrence rate within the pelvic bones was 34.7%, and the 5-year overall survival rate was 29.2%.
CONCLUSION
Patients with MBTP have a high risk of recurrence in the pelvic bones and poor survival after multimodal treatment. Pelvic recurrence might be affected by the metastatic involvement, tumor grade, surgical margins, and type of surgery, whereas the survival rate tends to be associated with the tumor grade.
Topics: Bone Neoplasms; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Pelvic Bones; Pelvic Neoplasms; Pelvis; Retrospective Studies
PubMed: 34154434
DOI: 10.1177/03000605211013152 -
Polski Przeglad Chirurgiczny Sep 2022Pelvic fractures are life-threatening injuries with mortality as high as 40%. The major cause of death is pelvic exsanguination. Extraperitoneal pelvic packing has been...
Pelvic fractures are life-threatening injuries with mortality as high as 40%. The major cause of death is pelvic exsanguination. Extraperitoneal pelvic packing has been suggested in recent years to be an effective method for hemorrhage control. This article briefly reviews the various aspects related to this procedure with emphasis on history, outcomes, technique and complications.
Topics: Humans; Bandages; Pelvis; Hemorrhage
PubMed: 36805990
DOI: 10.5604/01.3001.0015.9819 -
Investigative Radiology Dec 2019Balanced steady-state free precession-based quiescent-interval slice-selective (bSSFP QISS) magnetic resonance angiography (MRA) is accurate for the noncontrast...
Free-Breathing Fast Low-Angle Shot Quiescent-Interval Slice-Selective Magnetic Resonance Angiography for Improved Detection of Vascular Stenoses in the Pelvis and Abdomen: Technical Development.
OBJECTIVES
Balanced steady-state free precession-based quiescent-interval slice-selective (bSSFP QISS) magnetic resonance angiography (MRA) is accurate for the noncontrast evaluation of peripheral arterial disease (PAD); however, drawbacks include the need for breath-holding when imaging the abdomen and pelvis, and sensitivity to off-resonance artifacts. The purpose of this study was to evaluate the image quality and diagnostic accuracy in the pelvis and abdomen of free-breathing fast low-angle shot-based QISS (FLASH QISS) techniques in comparison to bSSFP QISS in patients with PAD, using computed tomographic angiography as the reference.
MATERIALS AND METHODS
Twenty-seven patients (69 ± 10 years, 17 men) with PAD were enrolled in this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant prospective study between April and December 2018. Patients underwent noncontrast MRA using standard bSSFP QISS and prototype free-breathing radial-FLASH and Cartesian-FLASH QISS at 3 T. A subset of patients (n = 22) also underwent computed tomographic angiography as the reference standard. Nine arterial segments per patient were evaluated spanning the abdomen, pelvis, and upper thigh regions. Objective (signal intensity ratio and relative standard deviation) and subjective image quality (4-point scale) and stenosis (>50%) were evaluated by 2 readers and compared using one-way analysis of variance, Wilcoxon, and McNemar tests, respectively.
RESULTS
A total of 179 vascular segments were available for analysis by all QISS techniques. No significant difference was observed among bSSFP, radial-FLASH, and Cartesian-FLASH QISS techniques in signal intensity ratio (P = 0.428) and relative standard deviation (P = 0.220). Radial-FLASH QISS demonstrated the best image quality (P < 0.0001) and the highest interreader agreement (κ = 0.721). The sensitivity values of bSSFP, radial-FLASH, and Cartesian-FLASH QISS for the detection of greater than 50% stenosis were 76.0%, 84.0%, and 80.0%, respectively, whereas specificity values were 97.6%, 94.0%, and 92.8%, respectively. Moreover, FLASH QISS consistently reduced off-resonance artifacts compared with bSSFP QISS.
CONCLUSIONS
Free-breathing FLASH QISS MRA techniques provide improved image quality and sensitivity, high specificity, and reduced off-resonance artifacts for vascular stenosis detection in the abdomen and pelvis.
Topics: Abdomen; Aged; Arterial Occlusive Diseases; Artifacts; Constriction, Pathologic; Female; Humans; Magnetic Resonance Angiography; Male; Pelvis; Prospective Studies; Reproducibility of Results; Respiration; Sensitivity and Specificity
PubMed: 31299678
DOI: 10.1097/RLI.0000000000000592 -
Spine Apr 2023A retrospective radiographic and biomechanical analysis of 108 thoracolumbar fusion patients from two clinical centers.
STUDY DESIGN
A retrospective radiographic and biomechanical analysis of 108 thoracolumbar fusion patients from two clinical centers.
OBJECTIVE
This study aimed to determine the validity of a computational framework for predicting postoperative patient posture based on preoperative imaging and surgical data in a large clinical sample.
SUMMARY OF BACKGROUND DATA
Short-term and long-term studies on thoracolumbar fusion patients have discussed that a preoperative predictive model would benefit surgical planning and improve patient outcomes. Clinical studies have shown that postoperative alignment changes at the pelvis and intact spine levels may negatively affect postural balance and quality of life. However, it remains challenging to predict such changes preoperatively because of confounding surgical and patient factors.
MATERIALS AND METHODS
Patient-specific musculoskeletal models incorporated weight, height, body mass index, age, pathology-associated muscle strength, preoperative sagittal alignment, and surgical treatment details. The sagittal alignment parameters predicted by the simulations were compared with those observed radiographically at a minimum of three months after surgery.
RESULTS
Pearson correlation coefficients ranged from r=0.86 to 0.95, and mean errors ranged from 4.1° to 5.6°. The predictive accuracies for postoperative spinopelvic malalignment (pelvic incidence minus lumbar lordosis>10°) and sagittal imbalance parameters (TPA>14°, T9PA>7.4°, or LPA>7.2°) were between 81% and 94%. Patients treated with long fusion (greater than five segments) had relatively lower prediction errors for lumbar lordosis and spinopelvic mismatch than those in the local and short groups.
CONCLUSIONS
The overall model performance with long constructs was superior to those of the local (one to two segments) and short (three to four segments) fusion cases. The clinical framework is a promising tool in development to enhance clinical judgment and to help design treatment strategies for predictable surgical outcomes.
LEVEL OF EVIDENCE
3.
Topics: Humans; Lordosis; Lumbar Vertebrae; Retrospective Studies; Quality of Life; Pelvis; Spinal Fusion
PubMed: 36988224
DOI: 10.1097/BRS.0000000000004555 -
The British Journal of Radiology Sep 2022To investigate the value of conventional MRI and diffusion-weighted imaging (DWI) in diagnosing normal-sized pelvic lymph nodes metastases in patients with cervical...
OBJECTIVES
To investigate the value of conventional MRI and diffusion-weighted imaging (DWI) in diagnosing normal-sized pelvic lymph nodes metastases in patients with cervical cancer.
METHODS
102 patients with cervical cancer who underwent MRI and DWI scan were included. 137 lymph nodes were analyzed, including 44 metastatic lymph nodes (MLNs) and 93 non-metastatic lymph nodes (non-MLNs). The morphology and apparent diffusion coefficient (ADC) value of lymph nodes were measured including short-axis diameter (D), long-axis diameter (D), ratio of short-to-long-axis diameter (D), fatty hilum, asymmetry, ADC, ADC and ADC. The Mann-Whitney U-test, independent sample t-test and Chi-square test were employed to compare the differences of all criteria between MLNs and non-MLNs. Logistic regression and decision tree were used to develop the combined diagnostic model. ROC analyses were used to evaluate the diagnostic performance.
RESULTS
The D and D of MLNs were significantly higher than those of non-MLNs ( < 0.05), the ADC, ADC and ADC of MLNs were significantly lower than those of non-MLNs ( < 0.05). Presence of fatty hilum and asymmetric lymph nodes between MLNs and non-MLNs were significantly different (<0.05). Combined measurement of ADC, D and D had the highest AUC 0.937 with 90.9% sensitivity and 87.1% specificity. The accuracy of decision tree was 88.3%.
CONCLUSION
MRI with DWI had potential in diagnosing normal-sized pelvic lymph nodes metastases in patients with cervical cancer. The combined evaluation of D, D and ADC of lymph nodes and decision tree of the combined measure showed better diagnostic performances than sole criteria.
ADVANCES IN KNOWLEDGE
The short-axis diameter, ratio of short-to-long-axis diameter and ADC of lymph nodes have moderate value in the diagnosis of the metastases of the normal-sized lymph nodes for the patient with cervical cancer as the sole indices. The combined evaluation of D, D and ADC is much more valuable in the detection of metastatic lymph nodes.
Topics: Diffusion Magnetic Resonance Imaging; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Pelvis; Sensitivity and Specificity; Uterine Cervical Neoplasms
PubMed: 33095657
DOI: 10.1259/bjr.20200203 -
Journal of Computer Assisted TomographyThe COVID-19 pandemic presents an ongoing global health threat. The SARS-CoV-2 is known to cause substantial pulmonary disease, and most of the current radiological... (Review)
Review
The COVID-19 pandemic presents an ongoing global health threat. The SARS-CoV-2 is known to cause substantial pulmonary disease, and most of the current radiological publications are dedicated to describing and characterizing these findings. However, studies regarding imaging findings in the abdomen and pelvis of infected patients are still very limited. The aim of this review is to discuss the most frequent abdominal manifestations based on the current literature and representative images from our local experience.
Topics: Abdomen; COVID-19; Female; Humans; Male; Multidetector Computed Tomography; Pelvis; Radiographic Image Interpretation, Computer-Assisted
PubMed: 33797437
DOI: 10.1097/RCT.0000000000001152 -
Journal of Investigative Medicine High... 2022Primary diffuse large B-cell lymphoma presenting as an extranodal site in the pelvis is rare and can mimic a gynecological malignancy. Although management for diffuse...
Primary diffuse large B-cell lymphoma presenting as an extranodal site in the pelvis is rare and can mimic a gynecological malignancy. Although management for diffuse large B-cell lymphoma is standardized and curative, prognosis depends on timely diagnosis and therapy. Diagnosis can be challenging as patients lack classical symptoms of fever, night sweats, weight loss, and lymphadenopathy associated with lymphoma. A multidisciplinary approach is recommended to diagnose and treat judiciously. In this article, we present cases of 2 females who presented with pelvic masses with initial suspicion of a gynecological malignancy but were ultimately diagnosed as diffuse large B-cell lymphoma of the pelvis and managed accordingly.
Topics: Female; Genital Neoplasms, Female; Humans; Lymphadenopathy; Lymphoma, Large B-Cell, Diffuse; Male; Pelvis; Prognosis
PubMed: 35470733
DOI: 10.1177/23247096221089505 -
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