-
Journal of Vascular Surgery Feb 2018Previous studies of men suggested that patients with varicocele may be leaner than the normal population. No such work exists in women with pelvic congestion syndrome...
OBJECTIVE
Previous studies of men suggested that patients with varicocele may be leaner than the normal population. No such work exists in women with pelvic congestion syndrome (PCS). This study evaluated the correlation between body mass index (BMI) and PCS.
METHODS
A case-control study at a single institution was performed of women who had the objective diagnosis of PCS. Data were prospectively collected for 100 consecutive patients with PCS. BMI was calculated for every patient and categorized into normal weight (BMI <25), overweight (BMI 25-29.9), and obese (BMI >30). Diagnosis of PCS was made by ultrasound and venography. Mean BMI was compared with that of the general female population of the United States from 1999 to 2002. Furthermore, analyses included comparison of patients with and without ovarian vein dilation and pelvic varices.
RESULTS
There were 100 women with a median age of 44 years (range, 24-73 years). The mean BMI of the study group was 25 ± 5.6 kg/m. The cohort was categorized into 59 women with normal BMI, 23 overweight women, and 18 obese women. The study cohort's BMI was less than that of the general U.S. female population (P = .02). The majority of the study group were white with lower BMI (P < .0001). Leg varicosities were more prevalent in obese patients (100% obese vs 81% normal BMI; P = .01). Patients with ovarian vein dilation had significantly lower BMI (24.1 ± 5.6 kg/m and 26.7 ± 5.4 kg/m; P = .036). No differences were identified for pelvic varices or reflux.
CONCLUSIONS
Women with PCS are more likely to have a normal BMI with ovarian vein dilation compared with obese women, who are more frequently affected by leg varicosities.
Topics: Adult; Aged; Body Mass Index; Databases, Factual; Dilatation, Pathologic; Female; Humans; Middle Aged; Obesity; Ovary; Pelvis; Phlebography; Prevalence; Regional Blood Flow; Retrospective Studies; Risk Factors; Syndrome; Ultrasonography; United States; Varicose Veins; Veins; Venous Insufficiency; Young Adult
PubMed: 28943005
DOI: 10.1016/j.jvs.2017.06.115 -
Tomography (Ann Arbor, Mich.) Jan 2022The complex anatomy and similarity of imaging features of various pathologies in the pelvis can make accurate radiology interpretation difficult. While prompt... (Review)
Review
The complex anatomy and similarity of imaging features of various pathologies in the pelvis can make accurate radiology interpretation difficult. While prompt recognition of ovarian cancer remains essential, awareness of processes that mimic ovarian tumors can avoid potential misdiagnosis and unnecessary surgery. This article details the female pelvic anatomy and highlights relevant imaging features that mimic extra-ovarian tumors, to help the radiologists accurately build a differential diagnosis of a lesion occupying the adnexa.
Topics: Adnexa Uteri; Diagnosis, Differential; Diagnostic Imaging; Female; Humans; Ovarian Neoplasms; Pelvis
PubMed: 35076619
DOI: 10.3390/tomography8010009 -
Ultrasound in Obstetrics & Gynecology :... Nov 2022To define associations between partial levator trauma and symptoms and signs of pelvic organ prolapse (POP).
OBJECTIVE
To define associations between partial levator trauma and symptoms and signs of pelvic organ prolapse (POP).
METHODS
This was a retrospective study of 3484 women attending a tertiary urogynecology unit for symptoms of pelvic floor dysfunction between January 2012 and February 2020. All women underwent a standardized interview, clinical pelvic organ prolapse quantification (POP-Q) examination and tomographic ultrasound imaging of the pelvic floor. Women with full levator avulsion were excluded from analysis. Partial levator avulsion was quantified using the tomographic trauma score (TTS), in which slices 3-8 are scored bilaterally for abnormal insertions. Binomial multiple logistic regression was analyzed independently for the outcome variables prolapse symptoms, symptom bother and objective prolapse on clinical examination and imaging, with age and body mass index as covariates. Two continuous outcome variables, prolapse bother score and hiatal area on Valsalva, were analyzed using multiple linear regression.
RESULTS
Of the 3484 women, ultrasound data were missing or incomplete in 164 due to lack of equipment, clerical error and/or inadequate image quality. Full levator avulsion was diagnosed in 807 women, leaving 2513 for analysis. TTS ranged from 0-10, with a median of 0. Partial trauma (TTS > 0) was observed in 667/2513 (26.5%) women. All subjective and objective measures of POP were associated significantly with TTS, most strongly for cystocele. Associations were broadly linear and similar for all slice locations but disappeared after accounting for hiatal area on Valsalva.
CONCLUSION
Partial avulsion is associated with POP and prolapse symptoms. This association was strongest for cystocele, both on POP-Q and ultrasound imaging. The effect of partial avulsion on POP and prolapse symptoms is explained fully by its effect on hiatal area. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Pregnancy; Humans; Female; Male; Retrospective Studies; Cystocele; Pelvic Floor; Pelvic Organ Prolapse; Ultrasonography
PubMed: 35872659
DOI: 10.1002/uog.26034 -
Anatomical Record (Hoboken, N.J. : 2007) Apr 2017The human pelvis has evolved over time into a remarkable structure, optimised into an intricate architecture that transfers the entire load of the upper body into the... (Review)
Review
The human pelvis has evolved over time into a remarkable structure, optimised into an intricate architecture that transfers the entire load of the upper body into the lower limbs, while also facilitating bipedal movement. The pelvic girdle is composed of two hip bones, os coxae, themselves each formed from the gradual fusion of the ischium, ilium and pubis bones. Unlike the development of the classical long bones, a complex timeline of events must occur in order for the pelvis to arise from the embryonic limb buds. An initial blastemal structure forms from the mesenchyme, with chondrification of this mass leading to the first recognisable elements of the pelvis. Primary ossification centres initiate in utero, followed post-natally by secondary ossification at a range of locations, with these processes not complete until adulthood. This cascade of events can vary between individuals, with recent evidence suggesting that fetal activity can affect the normal development of the pelvis. This review surveys the current literature on the ontogeny of the human pelvis. Anat Rec, 300:643-652, 2017. © 2017 Wiley Periodicals, Inc.
Topics: Humans; Osteogenesis; Pelvic Bones; Pelvis
PubMed: 28297183
DOI: 10.1002/ar.23541 -
Brazilian Journal of Physical Therapy 2022One of the sequalae of breast cancer treatments may be pelvic floor (PF) dysfunction such as urinary incontinence (UI), faecal incontinence (FI), and pelvic organ...
BACKGROUND
One of the sequalae of breast cancer treatments may be pelvic floor (PF) dysfunction such as urinary incontinence (UI), faecal incontinence (FI), and pelvic organ prolapse (POP).
OBJECTIVE
The aim of this study was to compare the occurrence and related distress and impact of PF dysfunction between women with and without breast cancer.
METHODS
Women with and without breast cancer participated in this cross-sectional study. The Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire were used to quantify the prevalence and related distress, and impact of PF dysfunction. Factors associated with PF outcomes were examined using logistic and linear regressions while controlling for known risk factors for PF dysfunction (age, body mass index, and parity).
RESULTS
120 women with breast cancer, and 170 women without breast cancer responded. The occurrence of any type of UI was higher in women with breast cancer than women without breast cancer (percentage difference=17%; 95% CI: 7, 29). Women with breast cancer experienced higher impact of urinary symptoms (mean difference=18.2; 95% CI: 8.9, 27.7) compared to those without. Multivariable analysis indicated that having breast cancer (β 0.33; 95%CI: 0.08, 0.51) was the strongest predictor of greater impact of urinary symptoms.
CONCLUSION
Women with breast cancer reported a higher occurrence and impact of urinary symptoms than women without breast cancer. While further studies are required to confirm our findings, routine screening and offering treatment for urinary symptoms may be indicated for women with breast cancer.
Topics: Pregnancy; Female; Humans; Cross-Sectional Studies; Breast Neoplasms; Pelvic Floor; Urinary Incontinence; Parity; Surveys and Questionnaires; Pelvic Floor Disorders
PubMed: 36283252
DOI: 10.1016/j.bjpt.2022.100455 -
Acta Oncologica (Stockholm, Sweden) Feb 2014Locally advanced and recurrent rectal cancers frequently cause pelvic morbidity including pain, bleeding and mass effect. Palliative pelvic radiotherapy is used to... (Review)
Review
BACKGROUND
Locally advanced and recurrent rectal cancers frequently cause pelvic morbidity including pain, bleeding and mass effect. Palliative pelvic radiotherapy is used to relieve these symptoms and delay local progression. There is no established optimal radiotherapy regimen and clinical practices vary. Our aim was to review the efficacy and toxicity of palliative pelvic radiotherapy of symptomatic rectal cancer and to evaluate different fractionation schedules, based on published literature.
MATERIAL AND METHODS
Systematic literature searches of Medline, Embase and Cochrane databases were performed through 2011. Studies reporting symptomatic response or quality of life (QOL) after palliative radiotherapy for rectal or rectosigmoid cancer were eligible. Results. Twenty-seven studies were included, of which 23 were retrospective reviews. There were no patient-reported outcomes or QOL assessments. There were large variations in applied radiotherapy regimens. Pooled overall symptom response rate was 75% and positive responses were reported for pain (78%), bleeding and discharge (81%), mass effect (71%) and other pelvic symptoms (72%). Toxicity results were not evaluable.
CONCLUSION
Palliative pelvic radiotherapy for symptomatic rectal cancer appears to provide relief of a variety of pelvic symptoms, although there is no documented optimal radiotherapy regimen in this context. There is inadequate evidence regarding onset, duration and degree of symptom palliation, QOL and associated toxicity with this treatment and prospective studies are therefore needed.
Topics: Dose Fractionation, Radiation; Humans; Palliative Care; Pelvis; Radiotherapy; Radiotherapy Dosage; Rectal Neoplasms
PubMed: 24195692
DOI: 10.3109/0284186X.2013.837582 -
Revue Medicale de Liege Jul 2023An accessory and cavitated uterine mass (ACUM) is a rare anomaly with an embryological origin of dysfunctionning female gubernaculum. It is an accessory mass internally...
An accessory and cavitated uterine mass (ACUM) is a rare anomaly with an embryological origin of dysfunctionning female gubernaculum. It is an accessory mass internally lined with normal endometrium, separated from the uterine cavity and located near the insertion of the round ligament. ACUM's clinical manifestations are severe dysmenorrhea and/or chronic pelvic pain. It is a relatively unknown condition, which makes its diagnosis complicated and suggests a large differential diagnosis. We report the case of a 31-year-old female presenting with pelvic chronic pain and crippling dysmenorrhea. The initial work-up consists of a magnetic resonance imaging showing an interstitial lesion possibly corresponding to an ACUM. This supposition was then confirmed by histopathology.
Topics: Female; Humans; Adult; Dysmenorrhea; Pelvic Pain; Uterus; Diagnosis, Differential; Pelvis
PubMed: 37560956
DOI: No ID Found -
Ultrasound in Obstetrics & Gynecology :... Nov 2018To describe morphometry of the pelvic floor in a large population of nulliparous women, comparing those with and those without pelvic pain. We also aimed to assess its...
OBJECTIVES
To describe morphometry of the pelvic floor in a large population of nulliparous women, comparing those with and those without pelvic pain. We also aimed to assess its association with characteristics such as age and body mass index (BMI).
METHODS
This was a prospective study performed between January 2013 and November 2015 in non-pregnant nulliparous women attending a general gynecology clinic. Following collection of demographic data, women were examined using translabial four-dimensional (4D) ultrasound. Dynamic volumes of pelvic floor muscle were obtained at rest, on maximal contraction and on Valsalva maneuver, and analyzed at a later date by an assessor blinded to demographic details. Standard measurements for each volume included levator hiatal area and anteroposterior and transverse diameters, and pubovisceral muscle length and width. Subanalysis was performed comparing women with and those without pelvic pain. Linear regression analysis was performed to assess the association between characteristics, including age and BMI, and levator hiatal area at rest.
RESULTS
Three hundred and sixty eight nulliparous women were examined using translabial 4D ultrasound. Median levator hiatal area was 10.62 cm at rest, 11.95 cm on Valsalva maneuver and 8.18 cm on maximal contraction. There was no difference between women with and those without pelvic pain when comparing biometric measurements of the pelvic floor musculature, except for in pubovisceral muscle width during the contraction phase. Regression analysis demonstrated that higher age and BMI were associated with increased levator hiatal area measurement.
CONCLUSIONS
Pelvic floor morphometry in nulliparous women is unchanged by pelvic pain, but levator hiatal area is increased in women with higher BMI and age. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Adult; Age Factors; Body Mass Index; Female; Humans; Muscle Contraction; Pelvic Floor; Pelvic Pain; Ultrasonography; Valsalva Maneuver; Young Adult
PubMed: 29700879
DOI: 10.1002/uog.19075 -
Radiotherapy and Oncology : Journal of... Mar 2021There is growing evidence on the role of carbon-ion radiotherapy (C-ion RT) for gynaecological tumours. Pelvic insufficiency fracture (PIF) decreases the quality of life...
BACKGROUND AND PURPOSE
There is growing evidence on the role of carbon-ion radiotherapy (C-ion RT) for gynaecological tumours. Pelvic insufficiency fracture (PIF) decreases the quality of life after photon beam radiotherapy (RT). However, there is little information on PIF after C-ion RT. This study retrospectively assessed incidence of PIF after C-ion RT for uterine carcinomas (UCs) and the associations of clinical and dosimetric parameters with PIF incidence.
MATERIAL AND METHODS
We performed a pooled analysis of 102 patients with UCs who underwent definitive C-ion RT alone and were followed up for >6 months without any additional RT in the pelvic region. PIF occurrence was surveyed using magnetic resonance imaging and/or computed tomography. Associations of clinical and dosimetric parameters with PIF incidence were analysed.
RESULTS
The 2- and 5-year actuarial incidences of ≥grade 1 PIF in all pelvic regions were 22.3% and 42.4%, respectively. The most frequent site of involvement was the sacrum. Log-rank tests showed that higher volumes receiving >10 Gy (relative biological effectiveness) (V10), V20, V30, and V40, body mass index (BMI) under 18.5, and current smoking were associated with increased incidence of ≥grade 1 PIF in the sacrum.
CONCLUSIONS
We clarified the actuarial incidence of PIF after C-ion RT for UCs. Higher V10, V20, V30, V40, D, D, current smoking, BMI <18.5, and using the anterior-posterior direction in whole pelvic irradiation were associated with higher incidences of PIF in the sacrum. The present results may lead to further improvement of C-ion RT for UCs.
Topics: Carbon; Carcinoma; Female; Fractures, Stress; Humans; Pelvis; Quality of Life; Radiotherapy Dosage; Retrospective Studies; Risk Factors
PubMed: 33278405
DOI: 10.1016/j.radonc.2020.11.030 -
BioMed Research International 2020To correlate body weight, body mass index (BMI), and water-equivalent diameter ( ) and to assess size-specific dose estimates (SSDEs) based on body weight and BMI for...
BACKGROUND
To correlate body weight, body mass index (BMI), and water-equivalent diameter ( ) and to assess size-specific dose estimates (SSDEs) based on body weight and BMI for chest and abdomen-pelvic CT examinations.
METHODS
An in-house program was used to calculate , size-dependent conversion factor (), and SSDE for 1178 consecutive patients undergoing chest and abdomen-pelvic CT examinations. Associations among body weight, BMI, and were determined, and linear equations were generated using linear regression analysis of the first 50% of the patient population. SSDEs (SSDE and SSDE) were calculated based on body weight and BMI as surrogates on the second 50% of the patient population. Mean root-mean-square errors of SSDE and SSDE were computed with SSDE from the axial images as reference values.
RESULTS
Both body weight and BMI correlated strongly with for the chest ( = 0.85, 0.87, all < 0.001) and abdomen-pelvis ( = 0.85, 0.86, all < 0.001). Mean values of SSDE and SSDE based on the linear equations for body weight, BMI, and were in close agreement with SSDE from the axial images, with overall mean root-mean-square errors of 0.62 mGy (6.10%) and 0.57 mGy (5.65%), for chest, and 0.76 mGy (5.61%) and 0.71 mGy (5.22%), for abdomen-pelvis, respectively.
CONCLUSIONS
Both body weight and BMI, serving as surrogates, can be used to calculate SSDEs in the chest and abdomen-pelvis CT examinations, providing values comparable to SSDEs from the axial images, with an overall mean root-mean-square error of less than 0.76 mGy or 6.10%.
Topics: Abdomen; Body Mass Index; Body Size; Body Weight; Dose-Response Relationship, Radiation; Female; Humans; Male; Middle Aged; Pelvis; Radiation; Thorax; Tomography, X-Ray Computed
PubMed: 32733946
DOI: 10.1155/2020/6046501