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1.
Ann Anat ; 239: 151837, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34601060

RESUMO

The main aim of this study is to present, describe and compare the most significant anatomical classifications of the internal iliac artery (IIA) and its branches, their pros and cons, to relate them to clinical practice and note their clinical importance, and to offer a new classification based on number of main vessels origins. Many classifications covering the detailed morphology of the IIA have been developed, focusing on the destination of vessels making it possible to determine the name and type of branching precisely. However, because the allocation criteria are overdetailed and of doubtful accuracy, these classifications have become impractical for clinical practice and advanced statistical calculations. The argument of this research paper is that highly variable vascularized regions should be classified from either an anatomical point of view to determine detailed morphology aspects or a clinical perspective. Presented classification proposes unification of many branching types presented among various classifications, which look identical when determining the origin pattern from the main vessel and differ only in the destination point of the vessel, what brings clarity and increases the statistical usefulness of the collected data. This should translate into better cooperation between scientists and clinicians and thus benefit patients. The paper proposes a new, clinically useful classification based on the model of vessel origins from the main stem. The IIA is the main vascular supply to the pelvic region, so precise knowledge of origin and its branching pattern is essential for all clinicians, especially for general and orthopaedic surgeons, gynecologists, obstetricians and urologists.


Assuntos
Artéria Ilíaca , Pelve , Aorta Abdominal , Humanos , Região Sacrococcígea
3.
Acta Chir Orthop Traumatol Cech ; 88(5): 333-338, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34738891

RESUMO

PURPOSE OF THE STUDY Vertically unstable transforaminal sacral fractures can be stabilized with several types of transiliac internal fixators (TIFI): the classical one (TIFI-C), the supraacetabular one (TIFI-A) and by dual application of TIFI (DTIFI). MATERIAL AND METHODS Pelvic models made of solid foam (Sawbones 1301) were used in the study. Mechanical loading tests were performed in order to assess the stiffness of the studied pelvic structures. The stiffness of the intact model was approximated as the slope of load/displacement curve. Then vertically unstable right-sided linear transforaminal fracture was created and subsequently fixed by TIFI-C, TIFI-A and DTIFI (each fixator for a separate model). The fixation techniques were compared based on the ratio between the stiffness of the treated and of the intact pelvis. Motion of the posterior pelvic structures and their deformations were measured using a photogrammetric system with four synchronous cameras. Loads applied at the base of sacrum and sacral base displacements were recorded by the testing device and used to assess the stiffness of the model structure. A dedicated load cell and a monoaxial extensometer were utilised. Every measurement was repeated at least 10 times. Obtained data were analysed by one way ANOVA test with post hoc comparison by Tukey HSD test. RESULTS Mean stiffness ratio (±1SD) of pelvic structure was 0.638 ± 0.005 for TIFI-C, 0.722 ± 0.014 for TIFI-A and 0.720 ± 0.008 for DTIFI. Dual transiliac internal fixation and supraacetabular fixation were superior to the classical one (p < 0.0001), but DTIFI and TIFI-A stiffness ratios were statistically equivalent (p = 0.9112). CONCLUSIONS Results of the mechanical analysis using pelvic models indicate that for linear vertical transforaminal sacral fracture without comminuted zone, an application of either TIFI-A or DTIFI provides significantly higher stiffness of the lateral pelvic segment than application of TIFI-C. Key words: transforaminal sacral fracture, transiliac internal fixator, dual TIFI, stability, biomechanics, digital image correlation.


Assuntos
Fraturas Ósseas , Ossos Pélvicos , Fenômenos Biomecânicos , Parafusos Ósseos , Fixação Interna de Fraturas , Humanos , Fixadores Internos , Testes Mecânicos , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/cirurgia , Pelve , Sacro/cirurgia
4.
Adv Skin Wound Care ; 34(12): 675-679, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34807899

RESUMO

ABSTRACT: A 59-year-old man with recurrent rectal cancer and type 2 diabetes mellitus underwent palliative total pelvic exenteration and intraoperative radiotherapy. After surgery, he experienced a pelvic abscess and abdominal-perineal fistula. Profuse exudate contaminated the midline abdominal incision through the abdominal-perineal fistula and delayed healing. Because of a residual tumor and the high cost, negative-pressure wound therapy was not performed. After 76 days of local treatment that involved removing necrotic tissue, controlling inflammation with an antimicrobial silver dressing, absorbing and draining exudate with a hypertonic saline dressing, promoting granulation and preventing infection with a silver alginate dressing, and promoting re-epithelialization with recombinant human epidermal growth factor gel, the abdominal wound and abdominal-perineal fistula healed successfully.


Assuntos
Abscesso/complicações , Fístula/etiologia , Exenteração Pélvica/normas , Abscesso/cirurgia , Fístula/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Exenteração Pélvica/métodos , Pelve/anormalidades , Pelve/cirurgia , Radioterapia/métodos , Neoplasias Retais/complicações , Neoplasias Retais/cirurgia , Recidiva , Cicatrização
5.
Zhongguo Gu Shang ; 34(11): 1082-6, 2021 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-34812029

RESUMO

OBJECTIVE: To explore the consistency of the parameters of the lumbar spine pelvic sagittal plane between the whole spine EOS images (EOS) and traditional X-ray imaging. METHODS: A total of 50 patients (26 males and 24 females) hospitalized in the Spine Surgery Department of Beijing Jishuitan Hospital from May to July 2019 were selected for standard standing EOS full-length spine anterolateral and traditional X-ray lumbar pelvic anterior and lateral X-rays. Two attending physicians used Surgimap software to measure the pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL) of the two types of images and repeated these process after two weeks. The consistency test (reliability analysis) was performed on the results measured by two physicians, and the results measured at the two time points were tested for intra-observer consistency (repeatability analysis).The data were combined to perform consistency and difference tests for the parameters between two types of images finally. RESULTS: The mean values of PI measured by EOS imaging and traditional X-ray imaging were(50.5±12.6)° and (51.4±12.2)°, mean difference 0.9, 95% credible interval (0.2-1.6), P=0.020; the mean values of PT were (16.2±8.9)° and (16.9±8.6)°, mean difference 0.7, 95% credible interval (-0.6-2.0), P=0.283; the mean values of SS were (34.3±9.9)° and (34.5±10.4)°, mean difference 0.2, 95% credible interval (-1.2-1.5), P=0.800;the mean values of LL were (42.7±14.9)° and (43.3±15.3)°, mean difference 0.6, 95% confidence interval (-0.8-2.0), P=0.149. The difference in PI between the two imaging methods was statistically significant (P =0.020, P <0.05), but the average difference was small (0.9°), there was no clinical difference. There were no significant differences in PT, SS and LL between the two imaging methods (P>0.05). Inter-group reliability analysis showed excellent agreement between the two physicians in measuring lateral PI, PT, SS and LL using Surgimap software (correlation coefficients within EOS imaging were 0.984, 0.993, 0.980, 0.989;correlation coefficients within X-ray imaging were 0.975, 0.985, 0.976, 0.988). Repeatability analysis showed that PI, PT, SS and LL measured by the two attending physicians at two time points had excellent consistency(ICC within the group was 0.963-0.996). CONCLUSION: In the local lumbar pelvis segment, the PI, PT SS and LL measured by EOS imaging and traditional X-ray imaging had good agreement, and there was no difference in guiding clinical application.


Assuntos
Lordose , Região Lombossacral , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pelve/diagnóstico por imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos , Raios X
6.
BMJ Case Rep ; 14(10)2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598960

RESUMO

An 85-year-old man was referred for an MRI scan of the pelvis for further evaluation of a suspected left neck of femur fracture, which was regarded as equivocal on plain radiograph and CT. The initial MRI demonstrated unusual appearances of the visualised bone marrow and subcutaneous adipose tissue and was initially misinterpreted as a technical malfunction of the scanner. However, a repeat study on a different scanner the following day once again demonstrated the same appearances. The appearances were consistent with serous atrophy of bone marrow, a non-neoplastic disorder of the bone marrow, which is most commonly seen in severe anorexia nervosa or cachexia. These unusual, but distinct, bone marrow and subcutaneous adipose tissue appearances, which are specific to MRI, have been colloquially termed as the 'flip-flop' effect.


Assuntos
Medula Óssea , Imageamento por Ressonância Magnética , Idoso de 80 Anos ou mais , Atrofia , Medula Óssea/diagnóstico por imagem , Caquexia , Humanos , Masculino , Pelve
7.
Z Gastroenterol ; 59(10): 1053-1058, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34638153

RESUMO

BACKGROUND: Drainage is essential for source control of the infection in a pelvic abscess. The purpose of this study was to report 2 cases of endoscopic ultrasound (EUS)-guided drainage of the pelvic abscess and review the literature of different modalities of EUS-guided drainage of pelvic abscess. CASE PRESENTATION: A 60-year-old male developed a pelvic abscess 1 month after laparoscopic complete tumor resection. An abdominal CT showed a mass shadow (about 7.1 cm × 5.1 cm) in the right pelvic region. Another case was an 85-year-old male who developed a pelvic abscess 3 days after recurrent tumor resection of multiple organs. The CT showed pelvic effusion and gas accumulation (approximately 6.5 cm × 4.2 cm), and the intestinal tube above the small intestinal anastomosis was dilated with effusion. A 19G-A puncture needle was used to puncture the abscess. An 8-mm cylindrical balloon was inserted, followed by a 10 Fr-3 cm double pigtail stent and an 8.5 Fr drainage tube. After EUS-guided drainage of pelvic abscess, the symptoms disappeared without recurrence. CONCLUSIONS: EUS-guided drainage is an effective and safe method for treating pelvic abscesses as long as the drainage modality is appropriately selected based on the etiology, size, and mucus viscosity of the abscess.


Assuntos
Abscesso , Endossonografia , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Idoso de 80 Anos ou mais , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Pelve/cirurgia , Ultrassonografia de Intervenção
8.
Artigo em Inglês | MEDLINE | ID: mdl-34639248

RESUMO

Structured reporting systems for endometriotic disease are gaining a central role in diagnostic imaging: our aim is to evaluate applicability and the feasibility of the recent ENZIAN score (2020) assessed by MRI. A total of 60 patients with suspected tubo-ovarian/deep endometriosis were retrospectively included in our study according to the following criteria: availability of MR examination; histopathological results from laparoscopic or surgical treatment; patients were not assuming estro-progestin or progestin therapy. Three different readers (radiologists with 2-, 5-, and 20-years of experience in pelvic imaging) have separately assigned a score according to the ENZIAN score (revised 2020) for all lesions detected by magnetic resonance imaging (MRI). Our study showed a high interobserver agreement and feasibility of the recent ENZIAN score applied to MRI; on the other hand, our experience highlighted some limitations mainly due to MRI's inability to assess tubal patency and mobility, as required by the recent score (2020). In view of the limitations which arose from our study, we propose a modified MRI-ENZIAN score that provides a complete structured reporting system, more suitable for MRI. The high interobserver agreement of the recent ENZIAN score applied to MRI confirms its validity as a complete staging system for endometriosis, offering a shared language between radiologists and surgeons.


Assuntos
Endometriose , Laparoscopia , Endometriose/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Pelve , Estudos Retrospectivos
9.
J Orthop Traumatol ; 22(1): 40, 2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34647237

RESUMO

INTRODUCTION: Sciatic nerve injury is an uncommon but potentially devastating complication in hip and pelvis surgery. Intraoperative nerve monitoring (IONM) was applied since the seventies in neurosurgery and spine surgery. Nowadays, IONM has gained popularity in other surgical specialities including orthopaedic and trauma surgery. Aim of this systematic review is to resume the literature evidences about the effectiveness of intraoperative monitoring of sciatic nerve during pelvic and hip surgery. METHODS: Two reviewers (GC and MD) independently identified studies by a systematic search of PubMed and Google Scholar from inception of database to 10 January 2021. Inclusion criteria were: (a) English written papers, (b) use of any type of intraoperative nerve monitoring during traumatic or elective pelvic and hip surgery, (c) comparison of the outcomes between patients who underwent nerve monitoring and patient who underwent standard procedures, (d) all study types including case reports. The present review was conducted in accordance with the 2009 PRISMA statement. RESULTS: The literature search produced 224 papers from PubMed and 594 from Google Scholar, with a total amount of 818 papers. The two reviewer excluded 683 papers by title or duplicates. Of the 135 remaining, 72 were excluded after reading the abstract, and 31 by reading the full text. Thus, 32 papers were finally included in the review. CONCLUSIONS: The use of IONM during hip and pelvis surgery is debated. The review results are insufficient to support the routine use of IONM in hip and pelvis surgery. The different IONM techniques have peculiar advantages and disadvantages and differences in sensitivity and specificity without clear evidence of superiority for any. Results from different studies and different interventions are often in contrast. However, there is general agreement in recognizing a role for IONM to define the critical maneuvers, positions or pathologies that could lead to sciatic nerve intraoperative damage. LEVEL OF EVIDENCE: Level 2.


Assuntos
Ortopedia , Humanos , Monitorização Intraoperatória , Procedimentos Neurocirúrgicos , Pelve/cirurgia , Estudos Retrospectivos
10.
BMC Cancer ; 21(1): 1091, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34627169

RESUMO

BACKGROUND: Current opinions on whether surgical patients with cervical cancer should undergo para-aortic lymphadenectomy at the same time are inconsistent. The present study examined differences in survival outcomes with or without para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer. METHODS: We retrospectively compared the survival outcomes of 8802 stage IB1-IIA2 cervical cancer patients (FIGO 2009) who underwent abdominal radical hysterectomy + pelvic lymphadenectomy (n = 8445) or abdominal radical hysterectomy + pelvic lymphadenectomy + para-aortic lymphadenectomy (n = 357) from 37 hospitals in mainland China. RESULTS: Among the 8802 patients with stage IB1-IIA2 cervical cancer, 1618 (18.38%) patients had postoperative pelvic lymph node metastases, and 37 (10.36%) patients had para-aortic lymph node metastasis. When pelvic lymph nodes had metastases, the para-aortic lymph node simultaneous metastasis rate was 30.00% (36/120). The risk of isolated para-aortic lymph node metastasis was 0.42% (1/237). There were no significant differences in the survival outcomes between the para-aortic lymph node unresected and resected groups. No differences in the survival outcomes were found before or after matching between the two groups regardless of pelvic lymph node negativity/positivity. CONCLUSION: Para-aortic lymphadenectomy did not improve 5-year survival outcomes in surgical patients with stage IB1-IIA2 cervical cancer. Therefore, when pelvic lymph node metastasis is negative, the risk of isolated para-aortic lymph node metastasis is very low, and para-aortic lymphadenectomy is not recommended. When pelvic lymph node metastasis is positive, para-aortic lymphadenectomy should be carefully selected because of the high risk of this procedure.


Assuntos
Excisão de Linfonodo/mortalidade , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/cirurgia , Estudos de Casos e Controles , China , Feminino , Seguimentos , Humanos , Histerectomia/métodos , Histerectomia/mortalidade , Histerectomia/estatística & dados numéricos , Excisão de Linfonodo/estatística & dados numéricos , Metástase Linfática , Pessoa de Meia-Idade , Pelve , Estudos Retrospectivos , Análise de Sobrevida , Neoplasias do Colo do Útero/patologia
11.
Sensors (Basel) ; 21(19)2021 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-34640930

RESUMO

Inappropriate posture and the presence of spinal disorders require specific monitoring systems. In clinical settings, posture evaluation is commonly performed with visual observation, electrogoniometers or motion capture systems (MoCaps). Developing a measurement system that can be easily used also in non-structured environments would be highly beneficial for accurate posture monitoring. This work proposes a system based on three magneto-inertial measurement units (MIMU), placed on the backs of seventeen volunteers on the T3, T12 and S1 vertebrae. The reference system used for validation is a stereophotogrammetric motion capture system. The volunteers performed forward bending and sit-to-stand tests. The measured variables for identifying the posture were the kyphosis and the lordosis angles, as well as the range of movement (ROM) of the body segments. The comparison between MIMU and MoCap provided a maximum RMSE of 5.6° for the kyphosis and the lordosis angles. The average lumbo-pelvic contribution during forward bending (41.8 ± 8.6%) and the average lumbar ROM during sit-to-stand (31.8 ± 9.8° for sitting down, 29.6 ± 7.6° for standing up) obtained with the MIMU system agree with the literature. In conclusion, the MIMU system, which is wearable, inexpensive and easy to set up in non-structured environments, has been demonstrated to be effective in posture evaluation.


Assuntos
Movimento , Postura , Fenômenos Biomecânicos , Humanos , Pelve , Postura Sentada
12.
Isr Med Assoc J ; 23(10): 639-645, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34672446

RESUMO

BACKGROUND: Extra peritoneal packing (EPP) is a quick and highly effective method to control pelvic hemorrhage. OBJECTIVES: To determine whether EPP can be as safely and efficiently performed in the emergency department (ED) as in the operating room (OR). METHODS: Retrospective study of 29 patients who underwent EPP in the ED or OR in two trauma centers in Israel 2008-2018. RESULTS: Our study included 29 patients, 13 in the ED-EPP group and 16 in the OR-EPP group. The mean injury severity score (ISS) was 34.9 ± 11.8. Following EPP, hemodynamic stability was successfully achieved in 25 of 29 patients (86.2%). A raise in the mean arterial pressure (MAP) with a median of 25 mmHg (mean 30.0 ± 27.5, P < 0.001) was documented. All patients who did not achieve hemodynamic stability after EPP had multiple sources of bleeding or fatal head injury and eventually succumbed. Patients who underwent EPP in the ED showed higher change in MAP (P = 0.0458). The overall mortality rate was 27.5% (8/29) with no difference between the OR and ED-EPP. No differences were found between ED and OR-EPP in the amount of transfused blood products, surgical site infections, and length of stay in the hospital. However, patients who underwent ED-EPP were more prone to develop deep vein thrombosis (DVT): 50% (5/10) vs. 9% (1/11) in ED and OR-EPP groups respectively (P = 0.038). CONCLUSIONS: EPP is equally effective when performed in the ED or OR with similar surgical site infection rates but higher incidence of DVT.


Assuntos
Exsanguinação , Fraturas Ósseas , Hemostasia Cirúrgica , Pelve , Complicações Pós-Operatórias , Infecção da Ferida Cirúrgica , Trombose Venosa , Determinação da Pressão Arterial/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Exsanguinação/diagnóstico , Exsanguinação/etiologia , Exsanguinação/mortalidade , Exsanguinação/cirurgia , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/cirurgia , Hemostasia Cirúrgica/efeitos adversos , Hemostasia Cirúrgica/instrumentação , Hemostasia Cirúrgica/métodos , Humanos , Escala de Gravidade do Ferimento , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pelve/diagnóstico por imagem , Pelve/lesões , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Centros de Traumatologia/estatística & dados numéricos , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia
13.
Medicina (Kaunas) ; 57(10)2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34684078

RESUMO

The objective of this review is to describe the effectiveness of laparoscopy in the diagnosis and treatment of pelvic congestion syndrome (PCS). PCS is a cause of chronic pelvic pain (CPP) and is associated with dysfunction of the pelvic venous system. PCS is more common in women of reproductive age, and hormonal changes are associated with its development along with other reasons (e.g., working and living habits). There is an urgent need to establish an effective algorithm for the diagnosis and treatment of CPP, which could have a dramatic effect in patients' everyday life. This algorithm should be able to overcome known issues that lead to the underdiagnosis of PCS, such as the overlap of its symptoms with other diseases. Here, we present our findings from literature articles about the methods used in practice today for the diagnosis of this syndrome. We also compare the methods to propose the most promising technique for providing a diagnosis with high accuracy. In our understanding, laparoscopy is superior when compared to other methods. It can provide a diagnosis of PCS while excluding or identifying other comorbidities and can also lead toward the next steps for the treatment of PCS.


Assuntos
Dor Crônica , Laparoscopia , Varizes , Feminino , Humanos , Dor Pélvica/etiologia , Pelve , Varizes/diagnóstico , Varizes/cirurgia
14.
J Med Case Rep ; 15(1): 540, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34702352

RESUMO

BACKGROUND: Desmoid-type fibromatosis is a rare disease that can result in hydronephrosis. Hydronephrosis associated with desmoid-type fibromatosis often requires surgery or ureteral stent insertion. Although radiation therapy is recommended for inoperable cases of desmoid-type fibromatosis, there has been no report of treatment for hydronephrosis associated with desmoid-type fibromatosis by radiation therapy alone. We herein report a case of successful treatment for inoperable recurrence of desmoid-type fibromatosis with unilateral hydronephrosis by radiation therapy alone. CASE PRESENTATION: A 43-year-old Japanese female underwent resection of desmoid-type fibromatosis in the right inguinal region and combined resection of the right external iliac vein 5 years before. Other treatment was not performed because of her pregnancy. Four years after surgery, desmoid-type fibromatosis recurred in the right pelvic wall. Cyclooxygenase-2 selective inhibitor treatment was given for 1 year, but her desmoid-type fibromatosis enlarged to more than 10 cm, and she had swelling of her right leg and hydronephrosis of her right kidney. The patient received 50.4 Gy in 28 fractions of prophylactic irradiation using 10 MV X-ray and 9 Gy in five fractions of a sequential boost for the recurrent desmoid-type fibromatosis. Although there was temporary tumor progression at 1 month after radiation therapy, slow regression of the tumor was seen. At 5 years after radiation therapy, there was no disease progression or severe complications. CONCLUSION: We experienced successful treatment for an inoperable case of desmoid-type fibromatosis with hydronephrosis. Moderate-dose radiation therapy alone is an effective and feasible approach for the management of hydronephrosis associated with desmoid-type fibromatosis.


Assuntos
Fibromatose Agressiva , Hidronefrose , Adulto , Feminino , Fibromatose Agressiva/complicações , Fibromatose Agressiva/diagnóstico por imagem , Fibromatose Agressiva/radioterapia , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/etiologia , Recidiva Local de Neoplasia , Pelve , Radiografia
15.
Medicine (Baltimore) ; 100(42): e27381, 2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34678865

RESUMO

ABSTRACT: One of the most important achievements of infancy is mobility, through which the child gradually becomes independent and can discover new places and objects. One form of mobility that occurs in a child's development is rolling over from supine-to-prone.The assumption of the work was to check whether all particular motor elements from the 3rd month had a comparable effect on development in the 6th month of life.The study population included 119 children, 69 born at term, and 50 born preterm. Children were born at week 38 ±â€Š3 (born at term 40  ±â€Š1/preterm 34 ±â€Š3), with a mean body weight of 3100 ±â€Š814 g (born at term 3462 ±â€Š505/ preterm 2282 ±â€Š788). Pre-term children were assessed at the corrected age. The physiotherapeutic qualitative assessment at the age of 3 months was performed in the prone and supine positions, and the qualitative assessment included 15 elements in the prone position and 15 in the supine position. A detailed mathematical analysis was then performed. Values of Cramer's V coefficient with confidence range, Goodman-Kruskal's coefficient, and the values of the probability coefficient p were given.The position of the scapulae and pelvis (3rd month) had the strongest impact on achieving proper support on the upper extremities in the 6th month of life, while the supine position was most significantly affected by the position of the head, spine, and pelvis.


Assuntos
Desenvolvimento Infantil/fisiologia , Destreza Motora/fisiologia , Peso ao Nascer , Idade Gestacional , Humanos , Lactente , Recém-Nascido Prematuro , Pelve/fisiologia , Decúbito Ventral/fisiologia , Escápula/fisiologia , Decúbito Dorsal/fisiologia
16.
Comput Biol Med ; 138: 104917, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34688037

RESUMO

PURPOSE: To create synthetic CTs and digital reconstructed radiographs (DRRs) from MR images that allow for fiducial visualization and accurate dose calculation for MR-only radiosurgery. METHODS: We developed a machine learning model to create synthetic CTs from pelvic MRs for prostate treatments. This model has been previously proven to generate synthetic CTs with accuracy on par or better than alternate methods, such as atlas-based registration. Our dataset consisted of 11 paired CT and conventional MR (T2) images used for previous CyberKnife (Accuray, Inc) radiotherapy treatments. The MR images were pre-processed to mimic the appearance of fiducial-enhancing images. Two models were trained for each parameter case, using a sub-set of the available image pairs, with the remaining images set aside for testing and validation of the model to identify the optimal patch size and number of image pairs used for training. Four models were then trained using the identified parameters and used to generate synthetic CTs, which in turn were used to generate DRRs at angles 45° and 315°, as would be used for a CyberKnife treatment. The synthetic CTs and DRRs were compared visually and using the mean squared error and peak signal-to-noise ratio against the ground-truth images to evaluate their similarity. RESULTS: The synthetic CTs, as well as the DRRs generated from them, gave similar visualization of the fiducial markers in the prostate as the true counterparts. There was no significant difference found for the fiducial localization for the CTs and DRRs. Across the 8 DRRs analyzed, the mean MSE between the normalized true and synthetic DRRs was 0.66 ± 0.42% and the mean PSNR for this region was 22.9 ± 3.7 dB. For the full CTs, the mean MAE was 72.9 ± 88.1 HU and the mean PSNR was 31.2 ± 2.2 dB. CONCLUSIONS: Our machine learning-based method provides a proof of concept of a way to generate synthetic CTs and DRRs for accurate dose calculation and fiducial localization for use in radiation treatment of the prostate.


Assuntos
Radiocirurgia , Procedimentos Cirúrgicos Robóticos , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Pelve/diagnóstico por imagem , Planejamento da Radioterapia Assistida por Computador , Tomografia Computadorizada por Raios X
17.
BMC Emerg Med ; 21(1): 113, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620106

RESUMO

BACKGROUND: Crohn's disease (CD) is a chronic disorder with frequent complications. The objective of this study was to assess the predictive factors of finding a complication of CD using abdominopelvic CT-scan in patients with a visit to the emergency department. METHODS: Patients with at least one visit to the gastroenterology department of our University hospital during the year with a CD were retrospectively included. All visits to the emergency department of the hospital during the follow-up of these patients were identified. RESULTS: A total of 638 patients were included and 318 (49.8%) had at least one visit to the emergency department since the beginning of their follow-up. Abdominopelvic CT-scan was performed in 141 (23.7%) of the 595 visits for digestive symptoms. Only 4.3% of these CT-scans were considered as normal; there was luminal inflammation without complication in 24.8%, abscess, fistula or perforation in 22.7%, mechanical bowel obstruction in 36.9% and diagnosis unrelated to CD in 11.3%. In univariate analysis, stricturing phenotype (OR, 2.48; 95% CI, 1.16-5.29; p = 0.02) and previous surgery (OR, 2.90; 95% CI, 1.37-6.14; p = 0.005) were predictive factors of finding a complication of CD using abdominopelvic CT-scan, whereas no independent predictive factor was statistically significant in multivariate analysis. CONCLUSION: In CD patients consulting in emergency department, CT-scan examination was performed in 24% of visits for digestive symptoms and complications of CD were found in 60%. Complications were more frequent in patients with stricturing phenotype and previous surgery.


Assuntos
Doença de Crohn , Abdome/diagnóstico por imagem , Adolescente , Adulto , Doença de Crohn/complicações , Doença de Crohn/diagnóstico por imagem , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pelve/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
19.
Radiat Prot Dosimetry ; 196(3-4): 190-198, 2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34635920

RESUMO

The purpose of this study is to examine radiation doses and image quality of a low-dose (LD) protocol for chest and abdomen/pelvis (CAP) CT compared with a standard (STD) protocol. A total of 361 patients were included between October 2019 and April 2020; 104 patients with LD-protocol (100 kV, ref mAs 80 (chest)/145 (abdomen/pelvis)) and 257 patients with STD-protocol (100 kV, ref mAs 100 (chest)/180 (abdomen/pelvis)) at second-generation dual-source CT. Radiation doses for CTDIvol and DLP, and objective and subjective image qualities of 50 examinations from each group were evaluated. The LD-protocol applied significantly lower radiation doses compared with the STD-protocol (p < 0.001), achieving a dose reduction by 37% for the median DLP in chest, 19% in abdomen/pelvis and 22% in total. Median total DLP was 342 mGy·cm (LD) vs. 436 mGy·cm (STD). The LD-CAP CT protocol achieved a significant dose reduction far below national diagnostic reference levels, ensuring acceptable and good image quality.


Assuntos
Pelve , Tomografia Computadorizada por Raios X , Abdome/diagnóstico por imagem , Humanos , Pelve/diagnóstico por imagem , Doses de Radiação , Tórax/diagnóstico por imagem
20.
PLoS One ; 16(10): e0258341, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34634091

RESUMO

The human pelvic canal (true pelvis) functions to support the abdominopelvic organs and serves as a passageway for reproduction (females). Previous research suggests that these two functions work against each other with the expectation that the supportive role results in a narrower pelvic midplane, while fetal passage necessitates a larger opening. In this research, we examine how gut size relates to the size and shape of the true pelvis, which may have implications on how gut size can influence pelvic floor integrity. Pelves and in vivo gut volumes were measured from CT scans of 92 adults (48 female, 44 male). The true pelvis was measured at three obstetrical planes (inlet, midplane, outlet) using 11 3D landmarks. CT volumetry was used to obtain an individual's gut size. Gut volume was compared to the pelvic planes using multiple regression to evaluate the relationship between gut size and the true pelvis. We find that, in males, larger gut sizes are associated with increased mediolateral canal dimensions at the inlet and midplane. In females, we find that larger gut sizes are associated with more medially-projecting ischial spines and an anteroposteriorly longer outlet. We hypothesize that the association of larger guts with increased canal width in males and increased outlet length in females are adaptations to create adequate space for the gut, while more medially projecting ischial spines reduce the risk of pelvic floor disorders in females, despite its possible spatial consequences for fetal passage.


Assuntos
Trato Gastrointestinal/fisiologia , Pelve/fisiologia , Adolescente , Adulto , Pontos de Referência Anatômicos , Feminino , Humanos , Masculino , Tamanho do Órgão , Pelve/anatomia & histologia , Análise de Regressão , Adulto Jovem
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