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Annals of Medicine and Surgery (2012) Oct 2019Sliding hernia occurs when the hernia sac is partially formed by the wall of a viscus. The most common components of a sliding hernia includes the sigmoid colon, cecum,...
Sliding hernia occurs when the hernia sac is partially formed by the wall of a viscus. The most common components of a sliding hernia includes the sigmoid colon, cecum, appendix, urinary bladder, and the ascending colon. However, the presence of bilateral vesical sliding hernia is rare and few cases have been reported in the literature. Patients with vesical sliding hernia may present with groin swelling with an associated lower urinary tract symptom. Computed tomography (CT) scan is the modality of choice for suspected cases which may reveal the classic pelvic micky mouse sign. The method of repair should be individualized taking in account the diagnostic findings. Although laparoscopic repair is becoming the mainstay management for inguinal hernia, the majority of sliding hernias are repaired using an open approach, which could be attributed to the presence of large hernias, associated complications, or recurrence with associated adhesions. We present a case of a 60-year-old male patient presented with bilateral inguinal swelling associated with urinary hesitancy and intermittency. He had undergone transabdominal preperitoneal (TAPP) repair for a left inguinal hernia 8 years ago. CT scan confirmed the presence of a bilateral hernia with the bladder herniating bilaterally. He underwent an elective bilateral open Lichtenstein tension-free mesh repair.
PubMed: 31485328
DOI: 10.1016/j.amsu.2019.08.005 -
Acta Ortopedica Mexicana 2019Bone cystic angiomatosis is a disease with only 200 cases described, based on angiomatous nonmalignant proliferation, in bone tissue and viscera. It focuses on pelvis,...
INTRODUCTION
Bone cystic angiomatosis is a disease with only 200 cases described, based on angiomatous nonmalignant proliferation, in bone tissue and viscera. It focuses on pelvis, long bones and scapular waist. Clinical evolution ranges from self-limiting forms to massive aggressive osteolysis (Gorham-Stout).Its diagnosis is of exclusion, with nonspecific clinical, radiological (lytic images) and histopathological findings.
CLINICAL CASE
Our study is based on the clinical case of a 14-year-old man diagnosed with bone cystic angiomatosis, with disseminated bone involvement, who came to our center for pain and functional impotence in the right hip, diagnosing a pertrochanteric fracture. It was operated by open reduction and osteosynthesis with four-hole VERSA sliding plate screw. An allogeneic graft of cancellous bone was used from femoral head. The evolution was satisfactory, with ambulation at full load per month without requiring analgesic medication and control X-ray at eight months that showed signs of complete integration of the graft. The analgesic pain scale (visual analogue scale) showed a score of 2/10 per month.
DISCUSSION
There is controversy regarding the treatment of these fractures by osteosynthesis with bone graft. We are facing a case without serious clinical criteria, but with multiple foci of osteolysis. It was decided not to intervene prophylactically the contraleteral hip, since it is asymptomatic and there are different patterns of evolution described in the literature and risks in surgery.
Topics: Adolescent; Angiomatosis; Bone Plates; Bone Screws; Fracture Fixation, Internal; Hip Fractures; Humans; Male
PubMed: 31480127
DOI: No ID Found -
Cureus May 2019According to current scientific standards, the fascia is a connective tissue derived from two separate germ layers, the mesoderm (trunk and limbs, part of the neck) and... (Review)
Review
According to current scientific standards, the fascia is a connective tissue derived from two separate germ layers, the mesoderm (trunk and limbs, part of the neck) and the ectoderm (cervical tract and skull). The fascia has the property of maintaining the shape and function of its anatomical district, but it also can adapt to mechanical-metabolic stimuli. Smooth muscle and non-voluntary striated musculature originated from the mesoderm have never been properly considered as a type of fascia. They are some of the viscera present in the mediastinum, in the abdomen and in the pelvic floor. This text represents the first article in the international scientific field that discusses the inclusion of some viscera in the context of what is considered fascia, thanks to the efforts of our committee for the definition and nomenclature of the fascial tissue of the Foundation of Osteopathic Research and Clinical Endorsement (FORCE).
PubMed: 31312576
DOI: 10.7759/cureus.4651 -
Animals : An Open Access Journal From... Jul 2019Leonardo da Vinci was one of the most influencing personalities of his time, the perfect representation of the ideal Renaissance man, an expert painter, engineer and... (Review)
Review
Leonardo da Vinci was one of the most influencing personalities of his time, the perfect representation of the ideal Renaissance man, an expert painter, engineer and anatomist. Regarding Leonardo's anatomical drawings, apart from human anatomy, he also depicted some animal species. This comparative study focused only on two species: Bears and horses. He produced some anatomical drawings to illustrate the dissection of "a bear's foot" (Royal Collection Trust), previously described as "the left leg and foot of a bear", but considering some anatomical details, we concluded that they depict the bear's right pelvic limb. This misconception was due to the assumption that the bear's (1st toe) was the largest one, as in humans. We also analyzed a rough sketch (not previously reported), on the same page, and we concluded that it depicts the left (forearm) and (hand) of a dog/wolf. Regarding Leonardo's drawing representing the horse anatomy "The viscera of a horse", the blood vessel arrangement and other anatomical structures are not consistent with the structure of the horse, but are more in accordance with the anatomy of a dog. In addition, other drawings comparing the anatomy of human leg muscles to that of horse pelvic limbs were also discussed in motion.
PubMed: 31295863
DOI: 10.3390/ani9070435 -
Journal of Medical Case Reports Jul 2019Simultaneous occurrence of colorectal malignancy with pelvic kidney has been considered a rare phenomenon. A review of the related literature revealed three previous...
BACKGROUND
Simultaneous occurrence of colorectal malignancy with pelvic kidney has been considered a rare phenomenon. A review of the related literature revealed three previous reports of rectal cancer and pelvice kidney.
CASE PRESENTATION
This case report describe the case of 40-year-old Asian man with complaints of bleeding and a feeling of discomfort in his anus. A colonoscopy revealed a raised large multilobulated mass in his rectum. Multiple biopsies of the lesion were done after detecting a tumor in his rectum 4 cm above the dentate line; a diagnosis of rectal adenocarcinoma was made by pathological examinations. Subsequent investigations, carried out by computed tomography (CT) scans, incidentally showed an ectopic pelvic kidney. Because of the progress of the rectal cancer, our patient was a candidate for neoadjuvant radiotherapy. Six weeks after radiotherapy, he underwent total mesorectal excision (TME) surgery maintaining the ectopic kidney after using a coloanal anastomosis for additional curative surgery. A very low anterior resection surgery was performed to maintain the ectopic kidney. Thereafter, adjuvant chemotherapy was performed.
CONCLUSIONS
Due to the proximity of the tumor to the pelvic viscera, especially the ectopic kidney, the probability of inadequate abscission of the lesion in surgery and radiotherapy, as well as complications and localized relapse were increased so that the kidney could be maintained. Carrying out careful pre-treatment examinations can result in maintaining an ectopic kidney and its daily conditioned function dependent on the status of the patient, including the proximity of the ectopic kidney to the tumor, anatomical position, and prior damage. The lesson learned from the present case is that radiotherapy and surgery are possible treatments in the presence of pelvic kidney and rectal cancer without incurring renal damage.
Topics: Adenocarcinoma; Adult; Humans; Kidney; Laparoscopy; Magnetic Resonance Imaging; Male; Organ Sparing Treatments; Rectal Neoplasms; Tomography, X-Ray Computed
PubMed: 31288853
DOI: 10.1186/s13256-019-2151-3 -
Arab Journal of Urology Mar 2019: To identify various predisposing factors, the clinical presentation, and the management of vaginal mesh-related complications, with special emphasis on mesh exposure... (Review)
Review
: To identify various predisposing factors, the clinical presentation, and the management of vaginal mesh-related complications, with special emphasis on mesh exposure and the indications for and results of vaginal mesh removal. : A systematic literature review was performed using a search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. PubMed was queried for studies regarding aetiology, risk factors, and management of vaginal mesh exposure from 1 January 2008 to June 2018. Full-text articles were obtained for eligible abstracts. Relevant articles were included, and the cited references were used to identify relevant articles not previously included. : A total of 102 abstracts were identified from the PubMed search criteria. An additional 45 studies were identified based on review of the cited references. After applying eligibility criteria and excluding impertinent articles, 58 studies were included in the final analysis. : Numerous studies have found at least some degree of symptomatic improvement regardless of the amount of mesh removed. Focal areas of exposure or pain can be successfully managed with partial mesh removal with low rates of complications. With partial mesh removal, many patients will ultimately require subsequent mesh removal procedures. For this reason, complete mesh excision is an alternative for patients with diffuse vaginal pain, large mesh exposure, and extrusion of mesh into adjacent viscera. However, when considering complete mesh removal, it is important to counsel patients regarding possible complications of removal and the increased risk of recurrent stress urinary incontinence and pelvic organ prolapse postoperatively. : MUS: midurethral sling; OR: odds ratio; POP: pelvic organ prolapse; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-analyses; SUI: stress urinary incontinence; TOT: transobturator; TVT: tension-free vaginal tape.
PubMed: 31258942
DOI: 10.1080/2090598X.2019.1589787 -
American Journal of Obstetrics and... Jan 2020Without cesarean delivery, obstructed labor can result in maternal and fetal injuries or even death given a disproportion in size between the fetus and the maternal... (Review)
Review
Without cesarean delivery, obstructed labor can result in maternal and fetal injuries or even death given a disproportion in size between the fetus and the maternal birth canal. The precise frequency of obstructed labor is difficult to estimate because of the widespread use of cesarean delivery for indications other than proven cephalopelvic disproportion, but it has been estimated that at least 1 million mothers per year are affected by this disorder worldwide. Why is the fit between the fetus and the maternal pelvis so tight? Why did evolution not lead to a greater safety margin, as in other primates? Here we review current research and suggest new hypotheses on the evolution of human childbirth and pelvic morphology. In 1960, Washburn suggested that this obstetrical dilemma arose because the human pelvis is an evolutionary compromise between two functions, bipedal gait and childbirth. However, recent biomechanical and kinematic studies indicate that pelvic width does not considerably affect the efficiency of bipedal gait and thus is unlikely to have constrained the evolution of a wider birth canal. Instead, bipedalism may have primarily constrained the flexibility of the pubic symphysis during pregnancy, which opens much wider in most mammals with large fetuses than in humans. We argue that the birth canal is mainly constrained by the trade-off between 2 pregnancy-related functions: while a narrow pelvis is disadvantageous for childbirth, it offers better support for the weight exerted by the viscera and the large human fetus during the long gestation period. We discuss the implications of this hypothesis for understanding pelvic floor dysfunction. Furthermore, we propose that selection for a narrow pelvis has also acted in males because of the role of pelvic floor musculature in erectile function. Finally, we review the cliff-edge model of obstetric selection to explain why evolution cannot completely eliminate cephalopelvic disproportion. This model also predicts that the regular application of life-saving cesarean delivery has evolutionarily increased rates of cephalopelvic disproportion already. We address how evolutionary models contribute to understanding and decision making in obstetrics and gynecology as well as in devising health care policies.
Topics: Animals; Biological Evolution; Cephalopelvic Disproportion; Cesarean Section; Female; Gait; Hominidae; Humans; Parturition; Pelvic Bones; Pelvimetry; Pelvis; Pregnancy; Pubic Symphysis; Selection, Genetic
PubMed: 31251927
DOI: 10.1016/j.ajog.2019.06.043 -
Gut Sep 2019Imaging of the living human brain is a powerful tool to probe the interactions between brain, gut and microbiome in health and in disorders of brain-gut interactions, in... (Review)
Review
Imaging of the living human brain is a powerful tool to probe the interactions between brain, gut and microbiome in health and in disorders of brain-gut interactions, in particular IBS. While altered signals from the viscera contribute to clinical symptoms, the brain integrates these interoceptive signals with emotional, cognitive and memory related inputs in a non-linear fashion to produce symptoms. Tremendous progress has occurred in the development of new imaging techniques that look at structural, functional and metabolic properties of brain regions and networks. Standardisation in image acquisition and advances in computational approaches has made it possible to study large data sets of imaging studies, identify network properties and integrate them with non-imaging data. These approaches are beginning to generate brain signatures in IBS that share some features with those obtained in other often overlapping chronic pain disorders such as urological pelvic pain syndromes and vulvodynia, suggesting shared mechanisms. Despite this progress, the identification of preclinical vulnerability factors and outcome predictors has been slow. To overcome current obstacles, the creation of consortia and the generation of standardised multisite repositories for brain imaging and metadata from multisite studies are required.
Topics: Big Data; Brain; Humans; Irritable Bowel Syndrome; Nerve Net; Neuroimaging; Sex Characteristics
PubMed: 31175206
DOI: 10.1136/gutjnl-2019-318308 -
Journal of Digital Imaging Feb 2020The volume of pelvic hematoma at CT has been shown to be the strongest independent predictor of major arterial injury requiring angioembolization in trauma victims with...
The volume of pelvic hematoma at CT has been shown to be the strongest independent predictor of major arterial injury requiring angioembolization in trauma victims with pelvic fractures, and also correlates with transfusion requirement and mortality. Measurement of pelvic hematomas (unopacified extraperitoneal blood accumulated from time of injury) using semi-automated seeded region growing is time-consuming and requires trained experts, precluding routine measurement at the point of care. Pelvic hematomas are markedly variable in shape and location, have irregular ill-defined margins, have low contrast with respect to viscera and muscle, and reside within anatomically distorted pelvises. Furthermore, pelvic hematomas occupy a small proportion of the entire volume of a chest, abdomen, and pelvis (C/A/P) trauma CT. The challenges are many, and no automated methods for segmentation and volumetric analysis have been described to date. Traditional approaches using fully convolutional networks result in coarse segmentations and class imbalance with suboptimal convergence. In this study, we implement a modified coarse-to-fine deep learning approach-the Recurrent Saliency Transformation Network (RSTN) for pelvic hematoma volume segmentation. RSTN previously yielded excellent results in pancreas segmentation, where low contrast with adjacent structures, small target volume, variable location, and fine contours are also problematic. We have curated a unique single-institution corpus of 253 C/A/P admission trauma CT studies in patients with bleeding pelvic fractures with manually labeled pelvic hematomas. We hypothesized that RSTN would result in sufficiently high Dice similarity coefficients to facilitate accurate and objective volumetric measurements for outcome prediction (arterial injury requiring angioembolization). Cases were separated into five combinations of training and test sets in an 80/20 split and fivefold cross-validation was performed. Dice scores in the test set were 0.71 (SD ± 0.10) using RSTN, compared to 0.49 (SD ± 0.16) using a baseline Deep Learning Tool Kit (DLTK) reference 3D U-Net architecture. Mean inference segmentation time for RSTN was 0.90 min (± 0.26). Pearson correlation between predicted and manual labels was 0.95 with p < 0.0001. Measurement bias was within 10 mL. AUC of hematoma volumes for predicting need for angioembolization was 0.81 (predicted) versus 0.80 (manual). Qualitatively, predicted labels closely followed hematoma contours and avoided muscle and displaced viscera. Further work will involve validation using a federated dataset and incorporation into a predictive model using multiple segmented features.
Topics: Deep Learning; Hematoma; Humans; Pelvis; Tomography, X-Ray Computed
PubMed: 31172331
DOI: 10.1007/s10278-019-00207-1 -
American Journal of Veterinary Research Mar 2019OBJECTIVE To describe a technique for endoscopic evaluation of the coelomic viscera of koi (Cyprinus carpio) and to evaluate the ability to visually examine coelomic...
OBJECTIVE To describe a technique for endoscopic evaluation of the coelomic viscera of koi (Cyprinus carpio) and to evaluate the ability to visually examine coelomic structures by use of an approach cranial or caudal to the pelvic girdle. ANIMALS 16 subadult koi. PROCEDURES Koi were anesthetized with buffered tricaine methanesulfonate. Coelioscopic examination was performed via a ventral midline incisional approach cranial or caudal to the pelvic girdle. A 2.7-mm × 18-cm 30° oblique endoscope within a 4.8-mm operating sheath and infusion of saline (0.9% NaCl) solution was used. Ease of entry into the coelomic cavity and visual examination of structures were scored for each fish. Fish were euthanized 2 or 8 weeks after the procedure, and necropsy was performed. RESULTS The coelioscopic procedure was tolerated well, and all koi recovered uneventfully. For all fish, ease of entry and visual examination scores of the liver, intestines, gonads, heart, and anterior kidney were satisfactory to excellent. Visual examination of the posterior kidney and swim bladder was satisfactory to difficult, whereas the spleen and gallbladder were not visually identified. No significant differences were noted in entry or visual examination scores between the cranial and caudal approaches or between sexes. Minor complications included mild hemorrhage, rupture of the gonadal capsule, formation of adhesions between the viscera and incision site, and delayed healing of the incision. CONCLUSIONS AND CLINICAL RELEVANCE Diagnostic coelioscopy of koi appeared to be safe and effective. This procedure could have potential for use in examination of coelomic structures and disease diagnosis.
Topics: Animals; Carps; Endoscopy; Female; Fish Diseases; Male
PubMed: 30801217
DOI: 10.2460/ajvr.80.3.221