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Abdominal Radiology (New York) Jun 2024As the use of cross-sectional abdominal and pelvic imaging has increased exponentially in the past several decades, incidental musculoskeletal findings have become... (Review)
Review
As the use of cross-sectional abdominal and pelvic imaging has increased exponentially in the past several decades, incidental musculoskeletal findings have become commonplace. These are often unrelated to the indication for the examination and are frequently referred to as the "radiologist's blind spot" on these studies. The differential diagnosis for abnormalities of the paraspinal and pelvic musculature is, in many cases, quite different from the anterior abdominal wall muscles. Furthermore, due to their relatively deep location, pathology involving the former muscle groups is more likely to be clinically occult, often presenting only incidentally when the patient undergoes cross-sectional imaging. Effective treatment of diseases of these muscles is dependent on adherence to a diverse set of diagnostic and treatment algorithms. The purpose of this review article is to familiarize the radiologist with the unique pathology of these often-overlooked muscles of the abdomen and pelvis.
PubMed: 38831073
DOI: 10.1007/s00261-024-04365-x -
International Journal of Women's Health 2024In recent years, female infertility has become a research hotspot in the field of health management, and its cause may be related to insulin resistance (IR). We used a...
PURPOSE
In recent years, female infertility has become a research hotspot in the field of health management, and its cause may be related to insulin resistance (IR). We used a novel and practical IR indicator, the TyG index to explore its association with infertility.
PATIENTS AND METHODS
We calculated the TyG index using data from adult women who participated in the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. Then, we used multivariate logistic regression, smooth curve fitting, and subgroup analysis to examine the association between the TyG index and infertility in women.
RESULTS
Logistic regression models showed a positive correlation between the TyG index and infertility, which remained significant even after adjusting for all confounders (OR=1.51,95% CI:1.14-2.00, =0.005). This association was consistent in all subgroups (age, education level, marital status, BMI, smoking, alcohol consumption, hypertension, diabetes, pelvic inflammatory disease/PID treatment, and menstrual regularity in the past 12 months) (p>0.05 for all interactions). However, the diagnostic power of the TyG index for infertility was limited (AUC=0.56, 95% CI: 0.52-0.61).
CONCLUSION
The TyG index is positively correlated with infertility, but its diagnostic value is limited. Further research is needed on the TyG index as an early predictor of infertility.
PubMed: 38827929
DOI: 10.2147/IJWH.S461950 -
International Journal of Women's Health 2024An ectopic kidney is a rare congenital defect that is often asymptomatic, but can be incidentally discovered during imaging examinations. Moreover, the morphological...
An ectopic kidney is a rare congenital defect that is often asymptomatic, but can be incidentally discovered during imaging examinations. Moreover, the morphological characteristics and laboratory features of ectopic kidneys are nonspecific, which may lead to misleading diagnostic approaches, particularly when there are additional factors, such as infection, obstruction, or other anomalies. A 43-year-old female presented with a mass in the left adnexal area. She had septate uterus and a history of congenital urinary incontinence. Ultrasound and MRI findings indicated that the mass was a cyst originating from the ovary. However, it is possible that the lump was derived from the urinary system. To confirm the diagnosis, laparoscopy was performed, followed by pathological examination, which confirmed the presence of an ectopic kidney with a single-system ectopic ureter. The patient underwent nephroureterectomy, and her symptoms successfully resolved, leading to a favorable prognosis. This case report highlights a rare case involving an ectopic kidney with a vaginal ectopic ureter that initially presented as an adnexal cyst and caused urinary dribbling. This case emphasizes the importance of early recognition and accurate diagnosis in women with similar symptoms.
PubMed: 38827928
DOI: 10.2147/IJWH.S457828 -
Cureus May 2024To document our initial experience using whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) and bi-parametric magnetic resonance imaging (bpMRI) as...
OBJECTIVES
To document our initial experience using whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) and bi-parametric magnetic resonance imaging (bpMRI) as a single exam in the staging of biopsy-proven prostate cancers.
METHODS
This retrospective study involved 120 African men with biopsy-confirmed prostate cancer (PCa). All the participants had a single exam that included both a bpMRI and a WB-DWI/MRI. The results were analyzed based on the American Urological Association's risk stratification system and evaluated using descriptive statistics.
RESULTS
The combined imaging approach confirmed PCa in all cases, identifying pelvic lymph node metastases in 21 (17.5%) patients. Among 72 high-risk patients, bpMRI+WB-DWI/MRI detected pelvic lymph node metastases in 18 (25.0%), bone metastases in 15 (20.8%), retroperitoneal lymph node metastases in six (8.3%), and extraprostatic extension in 18 (25%), with no solid organ metastases observed.
CONCLUSION
The combination of WB-DWI/MRI and bpMRI in a single-step approach demonstrates diagnostic potential in primary prostate cancer staging for high-risk groups, with the added advantage of shorter examination times, lower patients' costs, and elimination of the risks of adverse events associated with the use of contrast agents and exposure to radiation.
PubMed: 38826908
DOI: 10.7759/cureus.59470 -
Orvosi Hetilap Jun 2024
Topics: Humans; Female; Pregnancy; Adult; Low Back Pain; Cross-Sectional Studies; Surveys and Questionnaires; Pregnancy Complications; Pelvic Pain; Pain Measurement; Postpartum Period; Disability Evaluation; Body Mass Index; Risk Factors; Exercise
PubMed: 38824615
DOI: 10.1556/650.2024.33047 -
Journal of the American College of... Jun 2024Cervical cancer is a common gynecological malignancy worldwide. Cervical cancer is staged based on the International Federation of Gynecology and Obstetrics (FIGO)...
Cervical cancer is a common gynecological malignancy worldwide. Cervical cancer is staged based on the International Federation of Gynecology and Obstetrics (FIGO) classification system, which was revised in 2018 to incorporate radiologic and pathologic data. Imaging plays an important role in pretreatment assessment including initial staging and treatment response assessment of cervical cancer. Accurate determination of tumor size, local extension, and nodal and distant metastases is important for treatment selection and for prognostication. Although local recurrence can be diagnosed by physical examination, imaging plays a critical role in detection and follow-up of local and distant recurrence and subsequent treatment selection. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Topics: Humans; Female; Uterine Cervical Neoplasms; Societies, Medical; United States; Neoplasm Invasiveness; Neoplasm Staging; Evidence-Based Medicine
PubMed: 38823948
DOI: 10.1016/j.jacr.2024.02.026 -
Neuro-Chirurgie May 2024Anterior sacral meningocele is a rare congenital disorder, occurring isolated or in syndromic disease.
INTRODUCTION
Anterior sacral meningocele is a rare congenital disorder, occurring isolated or in syndromic disease.
CASE REPORT
A 15-year-old patient who complained of abdominal pain and urinary dysfunction was managed surgically. Imaging diagnosed a giant presacral meningocele and agenesis of the coccyx.
DISCUSSION
The presentation of sacral meningocele can be poorly symptomatic, which is why some patients are diagnosed late. Sometimes, diagnosis is suggested by non-specific abdominal symptoms or complications. Abdominal-pelvic radiological examination and lumbar spine MRI are essential, and treatment must be surgical. There are several surgical approaches, but currently no consensus.
CONCLUSION
An unusual huge presacral cystic mass in a young patient may be isolated or part of a syndrome, and can be asymptomatic for a long time, leading to late diagnosis. The surgical approach should be based on multidisciplinary discussion. We operated on a giant anterior sacral meningocele in a child using a posterior approach, with a satisfactory result.
PubMed: 38820830
DOI: 10.1016/j.neuchi.2024.101571 -
Frontiers in Medicine 2024Pelvic fracture (PF) is common, especially among older patients, and its prevalence increases over time. In contrast to hip fracture (HF), the literature on...
PURPOSE
Pelvic fracture (PF) is common, especially among older patients, and its prevalence increases over time. In contrast to hip fracture (HF), the literature on rehabilitation after PF is scant, mandating a study of the outcomes of rehabilitation in patients with PF. The present study compared patients who underwent intensive rehabilitation following HF or PF.
METHODS
A retrospective study of patients 65 years of age and older who underwent intensive rehabilitation in the Geriatrics Department. Data were collected on patients with PF, while data on patients with HF were taken from an earlier study. All patients in both groups suffered from low-energy trauma. Rehabilitation outcomes were measured using the Montebello Rehabilitation Factor Score-revised (MRSF-R).
RESULTS
144 PF patients were compared with 138 HF patients. The mean age of the patients in the HF group was 82.5 ± 7.1 compared to 81.5 ± 6.9 in the PF group ( = 0.230). Females comprised 77.5% of the patients in the HF group and 90.3% in the PF group ( = 0.04). All patients in the HF group underwent surgical repair of their fracture, while all patients in the PF group had non-surgical treatment. More patients in the HF sample had a nursing caregiver prior to the fracture (92.0% vs. 60.4%, < 0.001), had a higher Charlson Co-morbidity Index total score (2.1 ± 1.9 vs. 1.6 ± 1.7, = 0.13), developed more delirium (21.7% vs. 8.3%, = 0.16), more infections (29.0% vs. 11.1%, < 0.002), and more cardiovascular complications (23.9% vs. 5.6%, < 0.001) during hospitalization. They had longer hospital stays (20.9 ± 7.5 vs. 18.2 ± 7.7 days, = 0.0007), and had a higher mortality rate (13.8% vs. 6.3%, = 0.037) over the first year following the fracture than the PF group. A similar rate of patients in both groups (64.5% vs. 60.4%, = 0.483) had successful intensive rehabilitation. In the PF group only cognitive state was an independent predictor of successful rehabilitation, with each additional point in the Mini Mental State Examination (MMSE) increasing the patient's chance of reaching an MRFS-R score ≥ 50 by 20.5%.
CONCLUSION
Despite slightly different characteristics in the two groups, the results of intensive rehabilitation were similar. Cognitive state was the only independent factor that affected achievement of a better rehabilitation outcome. With the increasing rate of PF, more studies should focus on rehabilitation in this patient population.
PubMed: 38818387
DOI: 10.3389/fmed.2024.1346354 -
Journal of Surgical Case Reports May 2024Cervical polyps are common gynecological findings, typically small and benign. However, larger polyps can mimic malignant neoplasms and pose diagnostic challenges. We...
Cervical polyps are common gynecological findings, typically small and benign. However, larger polyps can mimic malignant neoplasms and pose diagnostic challenges. We present a case of a 40-year-old woman with a large cervical polyp, highlighting the critical role of radiological imaging in diagnosis and management. The lesion was successfully resected, with histological examination confirming a benign nature. This case underscores the necessity for careful evaluation of large cervical polyps to ensure accurate diagnosis and treatment.
PubMed: 38817781
DOI: 10.1093/jscr/rjae338 -
Cureus Apr 2024Background Pelvic fractures caused by high-energy trauma, such as motor vehicle accidents or falls from a considerable height, commonly lead to sacral fractures....
Background Pelvic fractures caused by high-energy trauma, such as motor vehicle accidents or falls from a considerable height, commonly lead to sacral fractures. Approximately a quarter of sacral fractures are linked to neurological injury, and overlooking these fractures may result in neurological issues such as sexual dysfunction, hindered lower limb functionality, and urinary and rectal difficulties. The main goal of this study is to introduce our patient group who underwent either operative or nonoperative treatment for sacral fractures, with a follow-up period of one year, and assess their functional outcomes. Methodology This is a retrospective review of prospectively collected data from a consecutive series of patients at the Apex Trauma Centre, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. A consecutive series of 24 patients (17-55 years old) with sacral fractures treated either operatively or nonoperatively from 2018 to 2023 was studied. A total of 20 patients were available for follow-up questionnaires, and 20 patients participated in a physical examination. Time to final follow-up averaged 27.19 months (range = 12-57 months). The personal data of each patient was collected, including gender, age, comorbidities, concomitant injuries, mechanism of injury, fracture pattern/classification, surgical or nonsurgical treatment, other surgeries, length of surgery, length of hospital stays, adverse events, complications, neurologic and/or motor deficits, bowel and bladder function, and mortality. At a minimum one-year follow-up, the Majeed score, Oswestry Disability Index (ODI) questionnaire, and Gibbon's classification were assessed. Results All fractures were healed. Five patients showed neurological weakness, with three patients having only paresthesia and two patients having lower limb weakness. The mean Majeed score was 75.4, representing a moderate clinical outcome. Final ODI scores averaged 10.6, representing mild disability among patients with sacrum fractures. Overall, 40% of sacrum fractures were associated with sexual dysfunction, with 30% of females and 50% of males reporting this issue. There was no significant difference (p > 0.05) between operated and conservatively managed sacrum fractures concerning ODI scores, neurological deficit, and sexual dysfunction. Conclusions Both male and female patients with traumatic sacrum fractures experienced a significant decrease in their quality of life and sexual function at least 12 months after their surgery. Sacrum fractures are associated with an increased prevalence of sexual dysfunction and bowel/bladder incontinence. Our study findings indicate that patients with sacrum fractures experience similar functional outcomes and incidences of sexual dysfunction irrespective of whether they are managed operatively or conservatively.
PubMed: 38817452
DOI: 10.7759/cureus.59375