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Female Pelvic Medicine & Reconstructive... 2018Intra-abdominal pressure (IAP) may contribute to pelvic floor health, although the direction and magnitude of such an effect, if any, are not yet known. Identifying... (Observational Study)
Observational Study
OBJECTIVES
Intra-abdominal pressure (IAP) may contribute to pelvic floor health, although the direction and magnitude of such an effect, if any, are not yet known. Identifying individual characteristics, and in particular modifiable factors, associated with higher IAP during recovery from vaginal childbirth might serve to mitigate early pelvic floor dysfunction. The aim of this study was to identify characteristics associated with maximal IAP during lifting in postpartum primiparous women who delivered vaginally.
METHODS
At 6 to 10 weeks postpartum, we measured maximal IAP, assessed via an upper vaginal sensor, as participants (enrolled in an ongoing cohort study) lifted a weighted car seat (12.5 kg). We evaluated whether the following independent variables were associated with maximal IAP: age, ethnicity, body mass index, height, abdominal circumference, weight gain during pregnancy, lifting time, breath holding during lifting, lifting technique, measures of muscular fitness, and days since delivery.
RESULTS
In the 206 participants, weight, waist circumference, body mass index, and days since delivery were positively associated with mean maximal IAP during lifting, whereas IAP decreased as height increased. As the duration of the lifting task increased, mean maximal IAP during lifting also increased, but there were no associations between lifting technique or breath holding during lifting and IAP. Neither pelvic floor muscle strength nor abdominal muscle endurance was associated with IAP during lifting.
CONCLUSIONS
Other than measures of body habitus and lifting duration, we did not identify modifiable factors that could mitigate maximal pressures experienced by the pelvic floor during the early postpartum period.
Topics: Adult; Female; Humans; Lifting; Muscle Strength; Pelvic Floor; Pelvic Floor Disorders; Postpartum Period; Pressure; Prospective Studies; Risk Factors; Time Factors; Young Adult
PubMed: 28727649
DOI: 10.1097/SPV.0000000000000462 -
Medical Physics Mar 2017Dual-energy CT (DECT) enhances tissue characterization because of its basis material decomposition capability. In addition to conventional two-material decomposition...
PURPOSE
Dual-energy CT (DECT) enhances tissue characterization because of its basis material decomposition capability. In addition to conventional two-material decomposition from DECT measurements, multimaterial decomposition (MMD) is required in many clinical applications. To solve the ill-posed problem of reconstructing multi-material images from dual-energy measurements, additional constraints are incorporated into the formulation, including volume and mass conservation and the assumptions that there are at most three materials in each pixel and various material types among pixels. The recently proposed flexible image-domain MMD method decomposes pixels sequentially into multiple basis materials using a direct inversion scheme which leads to magnified noise in the material images. In this paper, we propose a statistical image-domain MMD method for DECT to suppress the noise.
METHODS
The proposed method applies penalized weighted least-square (PWLS) reconstruction with a negative log-likelihood term and edge-preserving regularization for each material. The statistical weight is determined by a data-based method accounting for the noise variance of high- and low-energy CT images. We apply the optimization transfer principles to design a serial of pixel-wise separable quadratic surrogates (PWSQS) functions which monotonically decrease the cost function. The separability in each pixel enables the simultaneous update of all pixels.
RESULTS
The proposed method is evaluated on a digital phantom, Catphan©600 phantom and three patients (pelvis, head, and thigh). We also implement the direct inversion and low-pass filtration methods for a comparison purpose. Compared with the direct inversion method, the proposed method reduces noise standard deviation (STD) in soft tissue by 95.35% in the digital phantom study, by 88.01% in the Catphan©600 phantom study, by 92.45% in the pelvis patient study, by 60.21% in the head patient study, and by 81.22% in the thigh patient study, respectively. The overall volume fraction accuracy is improved by around 6.85%. Compared with the low-pass filtration method, the root-mean-square percentage error (RMSE(%)) of electron densities in the Catphan©600 phantom is decreased by 20.89%. As modulation transfer function (MTF) magnitude decreased to 50%, the proposed method increases the spatial resolution by an overall factor of 1.64 on the digital phantom, and 2.16 on the Catphan©600 phantom. The overall volume fraction accuracy is increased by 6.15%.
CONCLUSIONS
We proposed a statistical image-domain MMD method using DECT measurements. The method successfully suppresses the magnified noise while faithfully retaining the quantification accuracy and anatomical structure in the decomposed material images. The proposed method is practical and promising for advanced clinical applications using DECT imaging.
Topics: Algorithms; Head; Humans; Least-Squares Analysis; Leg; Models, Statistical; Pelvis; Phantoms, Imaging; Tomography, X-Ray Computed
PubMed: 28060999
DOI: 10.1002/mp.12096 -
European Urology Feb 2012With the increasing use of laparoscopic and robotic radical cystectomy (RC), there are perceived concerns about the adequacy of lymph node dissection (LND).
BACKGROUND
With the increasing use of laparoscopic and robotic radical cystectomy (RC), there are perceived concerns about the adequacy of lymph node dissection (LND).
OBJECTIVE
Describe the robotic and laparoscopic technique and the short-term outcomes of high extended pelvic LND (PLND) up to the inferior mesenteric artery (IMA) during RC.
DESIGN, SETTING, AND PARTICIPANTS
From January 2007 through September 2009, we performed high extended PLND with proximal extent up to the IMA (n=10) or aortic bifurcation (n=5) in 15 patients undergoing robotic RC (n=4) or laparoscopic RC (n=11) at two institutions.
SURGICAL PROCEDURE
We performed robotic extended PLND with the proximal extent up to the IMA or aortic bifurcation. The LND was performed starting from the right external iliac, obturator, internal iliac, common iliac, preaortic and para-aortic, precaval, and presacral and then proceeding to the left side. The accompanying video highlights our detailed technique.
MEASUREMENTS
Median age was 69 yr, body mass index was 26, and American Society of Anesthesiologists class ≥ 3 was present in 40% of patients. All urinary diversions, including orthotopic neobladder (n=5) and ileal conduit (n=10), were performed extracorporeally.
RESULTS AND LIMITATIONS
All 15 procedures were technically successful without need for conversion to open surgery. Median operative time was 6.7h, estimated blood loss was 500 ml, and three patients (21%) required blood transfusion. Median nodal yield in the entire cohort was 31 (range: 15-78). The IMA group had more nodes retrieved (median: 42.5) compared with the aortic bifurcation group (median: 20.5). Histopathology confirmed nodal metastases in four patients (27%), including three patients in the IMA group and one patient in the aortic bifurcation group. Perioperative complications were recorded in six cases (40%). During a median follow-up of 13 mo, no patient developed local or systemic recurrence. Limitations of the study include its retrospective design and small cohort of patients.
CONCLUSIONS
High extended PLND during laparoscopic or robotic RC is technically feasible. Longer survival data in a larger cohort of patients are necessary to determine the proper place for robotic and laparoscopic surgery in patients undergoing RC for high-risk bladder cancer.
Topics: Aged; Aged, 80 and over; Carcinoma; Cystectomy; Female; Humans; Laparoscopy; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Pelvis; Prostatic Neoplasms; Retrospective Studies; Robotics; Surgery, Computer-Assisted; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 22036642
DOI: 10.1016/j.eururo.2011.09.011 -
International Journal of Radiation... Dec 2021Radiation therapy to the prostate and pelvic lymph nodes (PLNRT) is part of the curative treatment of high-risk prostate cancer. Yet, the broader influence of radiation... (Observational Study)
Observational Study
Impact of Pelvic Radiation Therapy for Prostate Cancer on Global Metabolic Profiles and Microbiota-Driven Gastrointestinal Late Side Effects: A Longitudinal Observational Study.
PURPOSE
Radiation therapy to the prostate and pelvic lymph nodes (PLNRT) is part of the curative treatment of high-risk prostate cancer. Yet, the broader influence of radiation therapy on patient physiology is poorly understood. We conducted comprehensive global metabolomic profiling of urine, plasma, and stools sampled from patients undergoing PLNRT for high-risk prostate cancer.
METHODS AND MATERIALS
Samples were taken from 32 patients at 6 timepoints: baseline, 2 to 3 and 4 to 5 weeks of PLNRT; and 3, 6, and 12 months after PLNRT. We characterized the global metabolome of urine and plasma using H nuclear magnetic resonance spectroscopy and ultraperformance liquid chromatography-mass spectrometry, and of stools with nuclear magnetic resonance. Linear mixed-effects modeling was used to investigate metabolic changes between timepoints for each biofluid and assay and determine metabolites of interest.
RESULTS
Metabolites in urine, plasma and stools changed significantly after PLNRT initiation. Metabolic profiles did not return to baseline up to 1 year post-PLNRT in any biofluid. Molecules associated with cardiovascular risk were increased in plasma. Pre-PLNRT fecal butyrate levels directly associated with increasing gastrointestinal side effects, as did a sharper fall in those levels during and up to 1 year postradiation therapy, mirroring our previous results with metataxonomics.
CONCLUSIONS
We showed for the first time that an overall metabolic effect is observed in patients undergoing PLNRT up to 1 year posttreatment. These metabolic changes may effect on long-term morbidity after treatment, which warrants further investigation.
Topics: Humans; Male; Metabolome; Metabolomics; Microbiota; Pelvis; Prostatic Neoplasms
PubMed: 34352290
DOI: 10.1016/j.ijrobp.2021.07.1713 -
Sports Health 2017Weighted-ball throwing programs are commonly used in training baseball pitchers to increase ball velocity. The purpose of this study was to compare kinematics and...
BACKGROUND
Weighted-ball throwing programs are commonly used in training baseball pitchers to increase ball velocity. The purpose of this study was to compare kinematics and kinetics among weighted-ball exercises with values from standard pitching (ie, pitching standard 5-oz baseballs from a mound).
HYPOTHESIS
Ball and arm velocities would be greater with lighter balls and joint kinetics would be greater with heavier balls.
STUDY DESIGN
Controlled laboratory study.
METHODS
Twenty-five high school and collegiate baseball pitchers experienced with weighted-ball throwing were tested with an automated motion capture system. Each participant performed 3 trials of 10 different exercises: pitching 4-, 5-, 6-, and 7-oz baseballs from a mound; flat-ground crow hop throws with 4-, 5-, 6-, and 7-oz baseballs; and flat-ground hold exercises with 14- and 32-oz balls. Twenty-six biomechanical parameters were computed for each trial. Data among the 10 exercises were compared with repeated measures analysis of variance and post hoc paired t tests against the standard pitching data.
RESULTS
Ball velocity increased as ball mass decreased. There were no differences in arm and trunk velocities between throwing a standard baseball and an underweight baseball (4 oz), while arm and trunk velocities steadily decreased as ball weight increased from 5 to 32 oz. Compared with values pitching from a mound, velocities of the pelvis, shoulder, and ball were increased for flat-ground throws. In general, as ball mass increased arm torques and forces decreased; the exception was elbow flexion torque, which was significantly greater for the flat-ground holds. There were significant differences in body positions when pitching on the mound, flat-ground throws, and holds.
CONCLUSIONS
While ball velocity was greatest throwing underweight baseballs, results from the study did not support the rest of the hypothesis. Kinematics and kinetics were similar between underweight and standard baseballs, while overweight balls correlated with decreased arm forces, torques, and velocities. Increased ball velocity and joint velocities were produced with crow hop throws, likely because of running forward while throwing.
CLINICAL RELEVANCE
As pitching slightly underweight and overweight baseballs produces variations in kinematics without increased arm kinetics, these exercises seem reasonable for training pitchers. As flat-ground throwing produces increased shoulder internal rotation velocity and elbow varus torque, these exercises may be beneficial but may also be stressful and risky. Flat-ground holds with heavy balls should not be viewed as enhancing pitching biomechanics, but rather as hybrid exercises between throwing and resistance training.
Topics: Arm; Baseball; Biomechanical Phenomena; Elbow; Electromyography; Foot; Humans; Knee; Lower Extremity; Pelvis; Risk Factors; Shoulder; Time and Motion Studies; Torso; Upper Extremity
PubMed: 27872403
DOI: 10.1177/1941738116679816 -
Ginekologia Polska 2020Retroperitoneal lymph nodes metastases occur frequently in patients with ovarian cancer. Lymphadenectomy increases risk of perioperative complications. In clinical...
OBJECTIVES
Retroperitoneal lymph nodes metastases occur frequently in patients with ovarian cancer. Lymphadenectomy increases risk of perioperative complications. In clinical practice to reduce rate of complications aortocaval lymphadenectomy is omitted and solely resection of pelvic lymph nodes is performed. To establish factors affecting metastases to pelvic lymph nodes in advanced ovarian cancer.
MATERIAL AND METHODS
A retrospective study among patients with serous advanced ovarian cancer (FIGO IIIB-IVB) was conducted at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw and Department of Gynecologic Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw. All patients underwent surgical treatment including pelvic lymphadenectomy between 2014 and 2017. Data including age, body mass index (BMI), pretreatment CA125 serum level, tumor volume, grading, one-/both-sided tumor, menopausal status, ascites were analysed as possible factors influencing the pelvic lymph nodes involvement. The statistical analysis was performed with Python software.
RESULTS
87 consecutive patients were eligible for the study. Metastases to pelvic lymph nodes were found in 29 (33.33%) patients. Pretreatment serum CA-125 concentration (652 U/mL vs 360.9 U/mL, p < 0.05) and high grade histology corresponded with pelvic nodal involvement.
CONCLUSIONS
The knowledge of factors influencing metastases to pelvic lymph nodes may help clinicians in proper counselling and tailoring of therapy.
Topics: Adult; Aged; Aged, 80 and over; CA-125 Antigen; Cystadenocarcinoma, Serous; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Membrane Proteins; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Ovarian Neoplasms; Pelvis; Retrospective Studies
PubMed: 32141051
DOI: 10.5603/GP.2020.0019 -
The Malaysian Journal of Pathology Apr 2022Solitary fibrous tumour (SFT) of the sacrum is a very rare disease. So far, there have been few reports on this disease. Here, we reported 2 such cases and reviewed the... (Review)
Review
INTRODUCTION
Solitary fibrous tumour (SFT) of the sacrum is a very rare disease. So far, there have been few reports on this disease. Here, we reported 2 such cases and reviewed the other 7 reports in the literature.
CASE SERIES
Case 1, a 48-year-old man presented with lumbosacral pain for 2 months and numbness in the left plantar region for more than 1 month. The report of CT scan indicated that the sacrum was destroyed and the soft tissue mass projected into the pelvis. Histopathology showed that the cells were fusiform or short fusiform, arranged in strips, sheets, and wavy patterns. Case 2, a 40-year-old woman presented with hip joint pain and lower extremity dyskinesia for more than 2 months. The result of the MRI examination demonstrated a mass on the right sacral foramen and anterior sacrum. The characteristics of histopathology are ovoid or spindle-shaped cells with focal nuclear pleomorphism and prominently branched, hemangiopericytoma-like vascular patterns. In addition, immunohistochemical showed that CD34, Bcl-2, CD99, STAT6 and vimentin were positive, while Desmin, MSA, EMA, S100 were negative in both cases.
CONCLUSION
Previous literatures have revealed that SFTs of the sacrum are rare neoplasms. Case 1 and a part of these lesions previously reported seem to be malignant and should be treated with surgery. Radiation or chemotherapy was adopted if necessary. Since SFT of the sacrum is prone to recur and metastasis, long-term follow-up should be considered. To a certain extent, new risk stratification models can predict prognosis more accurately.
Topics: Adult; Female; Hemangiopericytoma; Humans; Male; Middle Aged; Pelvis; Prognosis; Sacrum; Solitary Fibrous Tumors
PubMed: 35484892
DOI: No ID Found -
BMC Musculoskeletal Disorders Dec 2019LBP is a common and serious problem affecting vast populations of the world. However, only few studies on LBP in sub-Saharan Africa have been conducted. Studies report...
BACKGROUND
LBP is a common and serious problem affecting vast populations of the world. However, only few studies on LBP in sub-Saharan Africa have been conducted. Studies report that LBP and pelvic angle are interrelated, and African residents have a high pelvic tilt. The strategy to prevent LBP should focus on activities that promote holistic health. For that purpose, it is important to grasp the state of LBP and how it affects people's lifestyle in Tanzania to clarify the direction of implementation of physiotherapy treatment and reduce the incidences of LBP among adults. This study aimed to investigate the prevalence and presentation of low back pain (LBP) and the relationship between anthropometric measurements and LBP among people in Moshi city, Kilimanjaro region Tanzania.
METHODS
Following signing consent forms, participants were given questionnaires regarding LBP and then grouped accordingly into either asymptomatic or symptomatic cohorts. Anthropometric measurements of participants' height, weight, curvature of the spine, and pelvic angle were obtained.
RESULTS
A Mann-Whitney U test analysis showed a significant difference in pelvic angle, body mass index (BMI), and thoracic kyphosis angle between the asymptomatic group and the symptomatic group. No significant differences in lumbar lordosis angle or abdominal muscle strength were found between the two groups.
CONCLUSIONS
A person with symptomatic LBP in Tanzania has a large anteversion of the pelvic tilt and a thoracic kyphotic posture. This study shows a relationship between sagittal spinal alignment and LBP in Tanzania, which could allow for prospective identification of subjects prone to developing LBP in the future.
Topics: Adult; Body Mass Index; Female; Humans; Kyphosis; Low Back Pain; Male; Middle Aged; Pelvis; Prevalence; Prospective Studies; Risk Factors; Tanzania; Thoracic Vertebrae; Young Adult
PubMed: 31801500
DOI: 10.1186/s12891-019-2953-x -
3D statistical model of the pelvic ring - a CT-based statistical evaluation of anatomical variation.Journal of Anatomy Mar 2019The pelvic ring is a highly complex construct with a central role for human stability and mobility. The observable interindividual differences in skeletal anatomy are...
The pelvic ring is a highly complex construct with a central role for human stability and mobility. The observable interindividual differences in skeletal anatomy are caused by anatomical variation in the innominate bones as well as the sacrum, further to differences in the spatial arrangement of these bones to each other. The aim of this study was to generate a 3D statistical model of the entire pelvic ring in order to analyse the observed interindividual differences and anatomical variation. A series of 50 anonymized pelvic CT scans of uninjured Japanese adults [30 males, 20 females, average age of 74.9 years, standard deviation (SD) 16.9 years] were processed and analysed, resulting in a 3D statistical overall mean model and separate male and female mean models. Principal component analysis (PCA) of the overall statistical model predominantly showed size variation (20.39%) followed by shape variation (14.13%), and a variation of the spatial arrangement of the sacrum to the innominate bones in different anatomical peculiarities (11.39 and 8.85%). In addition, selected internal and external pelvic parameters were manually measured with the objective of further evaluating and quantifying the observed interindividual as well as the known sex-specific differences. A separate statistical model of the grey value distribution based on the given Hounsfield unit (HU) values was calculated for assessing bone mass distribution, thus an indication of bone quality utilizing grey values as a quantitative description of radiodensity was obtained. A consistent pattern of grey value distribution was shown, with the highest grey values observed between the sacro-iliac joint and the acetabulum along the pelvic brim. Low values were present in the sacral ala, in the area of the iliac fossa as well as in the pubic rami next to the symphysis. The present model allows a differentiated analysis of the observed interindividual variation of the pelvic ring and an evaluation of the grey value distribution therein. Besides providing a better understanding of anatomical variation, this model could be also used as a helpful tool for educational purposes, preoperative planning and implant design.
Topics: Adult; Aged; Anatomic Variation; Biometry; Female; Gender Identity; Humans; Ilium; Imaging, Three-Dimensional; Male; Models, Statistical; Pelvic Bones; Pelvis; Principal Component Analysis; Sacroiliac Joint; Sacrum; Tomography, X-Ray Computed
PubMed: 30575034
DOI: 10.1111/joa.12928 -
Tumori Nov 2017Paraganglioma, a kind of pheochromocytoma originating from embryonic neural crest, is a rare neuroendocrine neoplasm commonly located at extra-adrenal areas such as... (Review)
Review
PURPOSE
Paraganglioma, a kind of pheochromocytoma originating from embryonic neural crest, is a rare neuroendocrine neoplasm commonly located at extra-adrenal areas such as head, neck, and abdomen. There are a few reports on renal paragangliomas; fewer than 5 reported cases are renal pelvic paragangliomas, including our case.
METHODS
Our patient, who had not experienced headache, hypertension, or palpitation, was founded to have a fixed mass in the left renal pelvis incidentally. Ultrasonography and computed tomography (CT) demonstrated a heterogeneous mass before surgery, and histopathologic test subsequently revealed that the infrequent mass was paraganglioma.
RESULTS
During 6 months follow-up, ultrasonography and CT examinations showed no signs of recurrence or metastasis.
CONCLUSIONS
The present case report confirms surgery as the standard to treat patients with paraganglioma. We present this case to serve as a reminder of suspected paraganglioma when it has occurred in renal pelvis.
Topics: Adult; Humans; Kidney Neoplasms; Kidney Pelvis; Male; Paraganglioma; Pelvic Neoplasms; Prognosis; Young Adult
PubMed: 28799639
DOI: 10.5301/tj.5000677