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Chirurgia (Bucharest, Romania : 1990) 2017The incidence of fragility fractures of the pelvis is increasing quickly. The characteristics of these fractures are different from pelvic ring disruptions in adults.... (Review)
Review
The incidence of fragility fractures of the pelvis is increasing quickly. The characteristics of these fractures are different from pelvic ring disruptions in adults. Fragility fractures of the pelvis are the consequence of a low-energy trauma which occurs in a patient with an important decrease of bone mineral density. Due to a consistent pattern of alteration of bone mass distribution in the sacrum, other fracture morphologies occur than in younger adults. The leading symptom is immobilizing pain in the lower back, in the buttocks, in the inguinal region and/or at the pubic symphysis. Conventional radiographs and CT will show the presence and localization of the fractures in the anterior and posterior pelvic ring. A new, comprehensive classification system distinguishes four categories of instability. This first criterion is most important, because it also gives hints for the preferred type of treatment. The second criterion, leading to the subtypes in the four categories, is the localization of the instability in the posterior pelvic ring. This criterion points the way towards the type of the surgical procedure to be used. When a surgical treatment is chosen, the procedure should be as minimal invasive as possible. Different techniques for percutaneous or less invasive fixation of the posterior pelvic ring have been developed. Their advantages and limitations are presented: sacroplasty, iliosacral screw osteosynthesis, cement augmentation, transiliac internal fixation, trans-sacral osteosynthesis, lumbopelvic fixation. Fractures of the anterior pelvic ring also need special attention. Retrograde transpubic screw fixation is recommended for pubic rami fractures. Fractures of the pubic body and instabilities of the pubic symphysis need bridging plate osteosynthesis. We do not recommend anterior pelvic external fixation in elderly because of the risk of pin track infection and pin loosening.
Topics: Aging; Bone Plates; Bone Screws; Fracture Fixation, Internal; Fracture Healing; Humans; Minimally Invasive Surgical Procedures; Osteoporotic Fractures; Pelvis; Treatment Outcome
PubMed: 29088552
DOI: 10.21614/chirurgia.112.5.524 -
American Journal of Obstetrics and... Nov 2019An increase in size of the aperture of the pelvis that must be spanned by pelvic floor support structures translates to an increase in the force on these structures....
BACKGROUND
An increase in size of the aperture of the pelvis that must be spanned by pelvic floor support structures translates to an increase in the force on these structures. Prior studies have measured the bony dimensions of the pelvis, but the effect of changes in muscle bulk that may affect the size of this area are unknown.
OBJECTIVES
To develop a technique to evaluate the aperture size in the anterior pelvis at the level of the levator ani muscle attachments, and to identify age-related changes in women with and without prolapse.
MATERIALS AND METHODS
This was a technique development and pilot case-control study evaluating pelvic magnetic resonance imaging from 30 primiparous women from the Michigan Pelvic Floor Research Group MRI Data Base: 10 younger women with normal support, 10 older women with prolapse, and 10 older menopausal women without prolapse. Anterior pelvic area measurements were made in a plane that included the bilateral ischial spines and the inferior pubic point, approximating the level of the arcus tendineus fascia pelvis. Measurements of the anterior pelvic area, obturator internus muscles, and interspinous diameter were made by 5 independent raters from the Society of Gynecologic Surgeons Pelvic Anatomy Group who focused on developing pelvic imaging techniques, and evaluating interrater reliability. Demographic characteristics were compared across groups of interest using the Wilcoxon rank sum test, χ, or Fisher exact test where appropriate. Multiple linear regression models were created to identify independent predictors of anterior pelvic area.
RESULTS
Per the study design, groups differed in age and prolapse stage. There were no differences in race, height, body mass index, gravidity, or parity. Patients with prolapse had a significantly longer interspinous diameter, and more major (>50% of the muscle) levator ani defects when compared to both older and younger women without prolapse. Interrater reliability was high for all measurements (intraclass correlation coefficient = 0.96). The anterior pelvic area (cm) was significantly larger in older women with prolapse compared to older (60 ± 5.1 vs 53 ± 4.9, P = .004) and younger (60 ± 5.1 vs 52 ± 4.6, P = .001) women with normal support. The younger and older women with normal support did not differ in anterior pelvic area (52 ± 4.6 vs 53 ± 4.9, P = .99). After adjusting for race and body mass index, increased anterior pelvic area was significantly associated with the following: being an older woman with prolapse (β = 6.61 cm, P = .004), and interspinous diameter (β = 4.52 cm, P = .004).
CONCLUSION
Older women with prolapse had the largest anterior area, suggesting that the anterior pelvic area is a novel measure to consider when evaluating women with prolapse. Interspinous diameter, and being an older woman with prolapse, were associated with a larger anterior pelvic area. This suggests that reduced obturator internus muscle size with age may not be the primary factor in determining anterior pelvic area, but that pelvic dimensions such as interspinous diameter could play a role. The measurements were highly repeatable. The high intraclass correlation coefficient indicates that all raters were able to successfully learn the imaging software and to perform measurements with high reproducibility.
Topics: Adolescent; Adult; Aging; Case-Control Studies; Female; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Middle Aged; Pelvic Floor; Pelvic Organ Prolapse; Pilot Projects; Young Adult
PubMed: 31401263
DOI: 10.1016/j.ajog.2019.08.001 -
Abdominal Radiology (New York) Apr 2019There are numerous common and rare macroscopic fat-containing masses found in the abdomen and pelvis. These include benign masses, such as lipoleiomyoma, ovarian... (Review)
Review
There are numerous common and rare macroscopic fat-containing masses found in the abdomen and pelvis. These include benign masses, such as lipoleiomyoma, ovarian teratoma, mesenteric teratoma, and lipoma, as well as malignant masses, including liposarcoma and malignant transformation of benign entities. Any mass may become symptomatic due to the development of a complication which may range from ovarian torsion to intussusception to hemorrhage. Imaging plays a vital role in diagnosis and treatment planning when confronted with a symptomatic fat-containing mass.
Topics: Abdomen; Diagnosis, Differential; Humans; Neoplasms, Adipose Tissue; Pelvis
PubMed: 30276422
DOI: 10.1007/s00261-018-1784-9 -
Journal of Gynecology Obstetrics and... Jun 2022Schwannomas are benign nerve tumors arising mainly in the intracranial, cervical, or lumbar regions. We describe the case of a presacral schwannoma in a 42-year-old...
Schwannomas are benign nerve tumors arising mainly in the intracranial, cervical, or lumbar regions. We describe the case of a presacral schwannoma in a 42-year-old woman. This atypical localization is most often discovered by symptoms related to compression of nervous structures. Our patient presented only with deep dyspareunia. The schwannoma was diagnosed on MRI which revealed a presacral hyperintense mass with an antero-posterior diameter of 47 mm opposite the S3 sacral orifice. After 6 years of follow-up, the mass was resected because of worsening dyspareunia and sudden lesion growth. The resection was performed through an open abdominal anterior approach and resulted in alleviation of the symptoms without postoperative complications. To our knowledge, this is the first case of pelvic schwannoma expressing a gynecological symptom such as dyspareunia.
Topics: Adult; Dyspareunia; Female; Humans; Neurilemmoma; Pelvis; Sacrococcygeal Region; Sacrum
PubMed: 35490988
DOI: 10.1016/j.jogoh.2022.102402 -
Obstetrics and Gynecology Aug 2008Wandering spleen is a rare entity characterized by the incomplete fixation of the gastrosplenic ligaments. Several imaging modalities have been used to diagnose this...
BACKGROUND
Wandering spleen is a rare entity characterized by the incomplete fixation of the gastrosplenic ligaments. Several imaging modalities have been used to diagnose this condition, including Doppler ultrasonography, computed tomography, nuclear scintigraphy, and magnetic resonance imaging.
CASE
We report a case of an asymptomatic woman presenting to a family planning center. An adnexal mass palpated on pelvic examination was diagnosed subsequently as a wandering spleen.
CONCLUSION
This case illustrates that ultrasonography and nuclear medicine are useful to make a definitive diagnosis of wandering spleen.
Topics: Adult; Female; Humans; Pelvis; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Ultrasonography; Wandering Spleen
PubMed: 18669771
DOI: 10.1097/AOG.0b013e3181809671 -
The Journal of Arthroplasty Dec 1997External venous compression can be a cause of deep vein thrombosis (DVT). This is an unusual case of acetabular component failure and resultant polyethylene and titanium...
External venous compression can be a cause of deep vein thrombosis (DVT). This is an unusual case of acetabular component failure and resultant polyethylene and titanium alloy wear debris that presented as a pelvic mass and resulted in iliac vein compression and subsequent DVT.
Topics: Alloys; Arthroplasty, Replacement, Hip; Female; Femoral Vein; Follow-Up Studies; Granuloma, Foreign-Body; Humans; Middle Aged; Pelvis; Polyethylenes; Postoperative Complications; Prosthesis Failure; Radiography; Recurrence; Reoperation; Thrombophlebitis; Titanium
PubMed: 9458261
DOI: 10.1016/s0883-5403(97)90165-0 -
Radiology Jul 2015A 53-year-old woman presented with a 3-month history of left inguinocrural and lumbar pain and anorexia with weight loss. No fever was reported. The patient had no prior...
A 53-year-old woman presented with a 3-month history of left inguinocrural and lumbar pain and anorexia with weight loss. No fever was reported. The patient had no prior pelvic surgery. Physical examination revealed a palpable nontender mass in the left groin area. There was no bloody or purulent discharge. Laboratory findings revealed inflammation with an increased C-reactive protein level (127 mg/L [1209 nmol/L]), leukocytosis (13 800/mm(3)), and microcytic anemia (hemoglobin level, 7.2 g/dL). Computed tomography (CT), fluorine 18 ((18)F) fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT, and magnetic resonance (MR) imaging were performed.
Topics: Actinomycosis; Diagnosis, Differential; Female; Humans; Middle Aged; Pelvic Neoplasms; Pelvis
PubMed: 26101924
DOI: 10.1148/radiol.2015131224 -
Southern Medical Journal Mar 1956
Topics: Disease; Humans; Pelvis
PubMed: 13311611
DOI: 10.1097/00007611-195603000-00012 -
Archives of Physical Medicine and... Feb 2001To evaluate the effect of pelvic rotation, originally described as the first determinant of gait, on reducing the vertical displacement of the center of mass (COM)...
OBJECTIVE
To evaluate the effect of pelvic rotation, originally described as the first determinant of gait, on reducing the vertical displacement of the center of mass (COM) during comfortable speed walking.
DESIGN
Pelvic and lower extremity kinematic data during walking were collected. A modified compass gait model incorporating measured inputs was used to estimate the effect of pelvic rotation on reducing the vertical displacement of the COM. The actual reduction in vertical displacement was also calculated.
SETTING
A gait laboratory.
PARTICIPANTS
Thirty able-bodied subjects.
MAIN OUTCOME MEASURE
The estimated reduction in COM vertical displacement caused by pelvic rotation was compared with the actual reduction in COM displacement.
RESULTS
The estimated effect of pelvic rotation in reducing COM displacement was 2.5 +/- 1.1mm, accounting for only 12% of the actual reduction.
CONCLUSION
During normal comfortable speed walking by able-bodied subjects, pelvic rotation contributes only a small portion of the actual reduction in the vertical displacement of the COM compared with a compass gait model. Other primary gait factors or determinants are needed to explain the actual reduction in vertical displacement of the COM.
Topics: Adult; Biomechanical Phenomena; Female; Gait; Humans; Male; Pelvis; Rotation; Walking
PubMed: 11239313
DOI: 10.1053/apmr.2001.18063 -
Annales de Pathologie Nov 2023Peritoneal inclusion cyst is a rare benign tumor. It usually affects women of reproductive age. Its etiology is poorly understood; a history of endometriosis, pelvic... (Review)
Review
Peritoneal inclusion cyst is a rare benign tumor. It usually affects women of reproductive age. Its etiology is poorly understood; a history of endometriosis, pelvic inflammatory disease and pelvic surgery are sometimes implicated in its occurrence. Its diagnosis is difficult with complex management. We report the case of a 29-year-old woman presenting a rectal mass for which the analysis of echo-endoscopic samples was not contributory. The PET-scan revealed a rectal submucosal mass and deep adenopathy. An exploratory laparoscopy was performed, and allowed to remove cystic inflammatory areas and lymph nodes. The histopathological study confirmed the diagnosis of peritoneal inclusion cyst with endometriosis and reactive adenitis. Peritoneal inclusion cyst is a rare condition that develops at the expense of the serosa. The risk of recurrence is high with a possibility of malignant transformation. Excision and monitoring are essential for good management.
Topics: Adult; Female; Humans; Cysts; Endometriosis; Pelvis
PubMed: 37202297
DOI: 10.1016/j.annpat.2023.04.001