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1.
Prostate ; 82(11): 1098-1106, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35652585

RESUMO

BACKGROUND: Whole pelvic radiation therapy (WPRT) may improve outcomes compared with prostate only radiation therapy (PORT) in some subsets of men with prostate cancer, as in the POP-RT trial. However, there is concern about increased risk of adverse effects with WPRT, including the development of radiation-induced second malignancies (SM). Given the rarity of SM, little is known about relative rates of SM between WPRT and PORT. METHODS: A retrospective cohort analysis was performed of men with nonmetastatic, node-negative prostate cancer with at least 60 months of follow-up using a national database. SM probabilities were compared in men receiving either WPRT or PORT using multivariable logistic models adjusting for clinical and sociodemographic factors. Temporal sensitivity analyses stratified by year of diagnosis and length of follow-up were also conducted. RESULTS: Of 50,237 patients in the study, 39,338 (78.4%) received PORT, and 10,899 (21.7%) received WPRT. Median follow-up was 106.2 months (interquartile range 82.32-132.25). Crude probabilities of SM were 9.16% for WPRT and 8.88% for PORT. The adjusted odds ratio (AOR) for development of SM with PORT versus WPRT was 1.046 (95% confidence interval 0.968-1.130). Temporal sensitivity analyses by stratifying by year of diagnosis and follow-up length also did not demonstrate any significant difference in rates of SM between WPRT and PORT using AORs with WPRT as the referent. CONCLUSIONS: Retrospective analysis of over 50,000 patients did not demonstrate an association between WPRT and an increased probability of SM compared to PORT. Given the findings of POP-RT, the use of WPRT may become widespread for certain subsets of men. Thus, our findings could help guide how we counsel patients deciding between WPRT and PORT and suggest the need for prospective assessment of SM risk with WPRT and PORT.


Assuntos
Segunda Neoplasia Primária , Neoplasias da Próstata , Antagonistas de Androgênios/uso terapêutico , Humanos , Masculino , Segunda Neoplasia Primária/tratamento farmacológico , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/etiologia , Pelve/patologia , Probabilidade , Estudos Prospectivos , Próstata/patologia , Antígeno Prostático Específico , Neoplasias da Próstata/patologia , Estudos Retrospectivos
2.
Radiology ; 304(1): 238-240, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35727713

RESUMO

HISTORY: A 45-year-old woman presented to the emergency department with acute worsening of prolonged unexplained nausea, nonbilious vomiting, and mild upper abdominal pain of 4 years duration. Her bowel habits were regular, and there was no history of diarrhea or fresh or altered blood in her stool. On further inquiry, there was no history of facial flushing, excessive diaphoresis, or asthmalike symptoms. Her history was unrevealing; in particular, there was no history of known malignancy. On clinical examination, her vital signs were stable. The abdomen was soft, with no focal tenderness or palpable mass. Routine blood investigations, including complete blood counts, and liver, kidney, and thyroid function tests yielded results that were within normal limits. Her 5-hydroxyindoleacetic acid and chromogranin A levels were not elevated. Initial evaluation with contrast-enhanced CT of the abdomen and pelvis was performed. Subsequently, an indium 111 octreotide scan was performed at the recommendation of the radiologist 1 month after CT (Figs 1, 2).


Assuntos
Abdome , Dor Abdominal , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Pessoa de Meia-Idade , Pelve
3.
BMJ Case Rep ; 15(6)2022 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-35675964

RESUMO

A man in his 80s presented to the emergency department with a 5-week history of lower abdominal and groin pain which had substantially affected his mobility. He practised intermittent self-catheterisation following radiotherapy for prostate cancer. Multiple suggestive features led to initial treatment for a urinary tract infection (UTI). However, CT imaging revealed pubic symphysis osteomyelitis with associated abdominal wall abscesses and fistulation to the prostate. This case illustrates the need to consider osteomyelitis as a differential for pain in previously irradiated body areas and to beware of diagnosing UTI where pain affects mobility.


Assuntos
Osteomielite , Sínfise Pubiana , Virilha , Humanos , Masculino , Osteomielite/diagnóstico , Osteomielite/etiologia , Dor Pélvica/etiologia , Pelve , Sínfise Pubiana/diagnóstico por imagem
4.
World J Surg Oncol ; 20(1): 185, 2022 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-35676716

RESUMO

BACKGROUND: Paraganglioma of the urinary bladder (Pub) is rare and presents with clinical symptoms caused by catecholamine production and release. The typical symptoms of Pub are hypertension, macroscopic hematuria, and a hypertensive crisis during micturition. The average size of detected Pubs is approximately 3 cm. Herein, we report a case of a large Pub in which the symptoms were masked by oral medication, precise preoperative diagnosis was difficult, and intraoperative confirmation of tumoral adhesion to the rectum resulted in hypertensive attacks during surgery. CASE PRESENTATION: A 64-year-old Japanese male with a history of hypertension and arrhythmia controlled with oral medication presented with a large tumor in the pelvic region, detected on examination for weight loss, with no clinical symptoms. Computed tomography and magnetic resonance imaging revealed a tumor measuring 77 mm in diameter in the posterior wall of the urinary bladder. The border with the rectum was unclear, and the tumor showed heterogeneous enhancement in the solid part with an enhancing hypodense lesion. Cystoscopy revealed compression of the bladder trigone by external masses; however, no tumor was visible in the lumen. Endoscopic ultrasonography-guided fine-needle aspiration revealed CD34-positive spindle-shaped cells in the fibrous tissue, suggestive of a mesenchymal neoplasm. The tumor was suspected to be a gastrointestinal stromal tumor, and surgery was performed. After laparotomy, we suspected that the tumor had invaded the rectum, and total cystectomy and anterior resection of the rectum were performed. Histologically, the tumor cells had granular or clear amphophilic cytoplasm with an oval nucleus and nests of cells delimited by connective tissue and vascular septations. Immunohistochemically, the tumor was positive for chromogranin A, CD56, and synaptophysin, and a diagnosis of paraganglioma of the urinary bladder was confirmed. There was no tumor recurrence at the 7-month follow-up. CONCLUSION: This case highlights the importance of careful examination of pelvic tumors, including endocrine testing, for detecting paraganglioma of the urinary bladder in patients with a history of hypertension or arrhythmia.


Assuntos
Neoplasias das Glândulas Suprarrenais , Tumores do Estroma Gastrointestinal , Hipertensão , Paraganglioma , Feocromocitoma , Neoplasias da Bexiga Urinária , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Paraganglioma/diagnóstico , Paraganglioma/patologia , Paraganglioma/cirurgia , Pelve/patologia , Reto/patologia , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia
5.
Clin J Sport Med ; 32(4): 368-374, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35762861

RESUMO

OBJECTIVE: To evaluate whether delay in the diagnosis of pelvic avulsion fractures in young athletes leads to prolonged treatment and prolonged return toward sport activities, whether fractures at certain locations are associated with a greater risk of diagnostic delay, and what reasons may exist for delay in diagnosis. DESIGN: Retrospective chart review of young patients who presented with pelvic region avulsion fracture to a community-based sports medicine clinic over a 19-year period. SETTING: Private practice, primary care sports medicine clinic. PATIENTS: Patients younger than 20 years diagnosed with pelvic region avulsion fracture. INTERVENTIONS: None, this was a retrospective study. MAIN OUTCOME MEASURES: Clearance for return toward sport activities. RESULTS: Two hundred twenty-five cases were reviewed for reasons for delay in diagnosis; 208 cases met criteria for the duration of treatment and return to play activities portions of the study. The mean time from date of injury diagnosis was 19.59 days, and the mean duration from date of injury to clearance for return to play advancement was 67.20 days. Duration of treatment varied slightly depending on timing of diagnosis, whereas duration from date of injury to clearance for return to play advancement varied greatly depending on diagnostic delay. Those who did not sense a "pop" at the time of injury were more likely to experience diagnostic delay, as were athletes with ischial tuberosity fractures. The most common cause of diagnostic delay was patient/family decision on when to seek care; misdiagnosis as a muscle strain was also common. CONCLUSIONS: Diagnostic delay of adolescent pelvic avulsion fractures may unnecessarily prevent athletes from returning to play within an optimal time frame. Our observations highlight a need for educating athletes and their families on when to seek initial or follow-up medical care as well as educating medical providers regarding the diagnosis of pelvic avulsion fractures.


Assuntos
Traumatismos em Atletas , Fratura Avulsão , Fraturas Ósseas , Adolescente , Atletas , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Diagnóstico Tardio/efeitos adversos , Fratura Avulsão/complicações , Fratura Avulsão/diagnóstico , Fratura Avulsão/terapia , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/terapia , Humanos , Ísquio/lesões , Pelve , Estudos Retrospectivos
6.
Artigo em Inglês | MEDLINE | ID: mdl-35682407

RESUMO

BACKGROUND: The aim of this study was to describe the clinicopathological features of endometrial cancer (EC) patients with bone metastases treated with surgery and to systematically review the literature. METHODS: We performed a retrospective study to include patients with bone metastases of EC at Peking University People's Hospital from 2000 to 2019. Clinicopathological features and survival outcomes were collected. RESULTS: Among the 1662 patients with EC, 14 (0.84%) were identified with bone metastases, and all were treated surgically. Thirteen cases were analyzed. Four had bone metastases when diagnosed, and the remaining nine cases had bone metastases when first relapsed, with a median time to recurrence of 13 months (range, 5-144). The median age of the 13 patients was 58 years old (range, 45-76). Twelve were endometrioid carcinoma. The majority of sites of bone metastases were the pelvis, followed by the spine. The median overall survival (OS) was 57 months. We further combined the 13 patients with another 24 cases identified from literature research. There was no significant difference in clinicopathological characteristics between the patients with bone metastases when diagnosed and when they first relapsed. The median OS was numerically longer for patients with bone metastases when diagnosed than when they first relapsed (57 vs. 36 months, p = 0.084). CONCLUSIONS: Patients with bone metastases of EC might benefit from comprehensive treatment based on surgery, as symptoms can be palliated and survival can probably be extended.


Assuntos
Neoplasias Ósseas , Carcinoma Endometrioide , Neoplasias do Endométrio , Idoso , Neoplasias Ósseas/patologia , Neoplasias Ósseas/secundário , Neoplasias Ósseas/cirurgia , Carcinoma Endometrioide/patologia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pelve , Estudos Retrospectivos
7.
In Vivo ; 36(4): 1887-1895, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35738601

RESUMO

BACKGROUND/AIM: To evaluate the quality of error detectability with a three-dimensional verification system using isodose volumes as regions of interest (ROIs) in quality assurance (QA) of intensity-modulated radiation therapy. PATIENTS AND METHODS: Treatment plans with four types of intentional errors were created from the data of 20 patients with localized prostate cancer. These plans underwent QA using the three-dimensional verification system. The datasets of another 30 cases without inserted errors were assessed as controls. The ROIs used in the evaluations were those used in our conventional method (planning target volume, rectum, and bladder). The isodose volume method (5%, 50% and 95% isodose volume) and the error detection rates (measurement above the tolerance values, as set from the other 30 cases) were assessed and compared. RESULTS: There was significantly higher multileaf collimator systematic closed error detectability with the isodose volume method compared to the conventional method (A-side 0.2 mm: p=0.005, A-side 0.35 mm: p=0.002, B-side 0.2 mm: p=0.001 and B-side 0.35 mm: p=0.010). There were no error types for which the error detection rate of the isodose volume method was lower than that of the conventional method. CONCLUSION: The isodose volume method was able to evaluate the irradiated ROIs that could be delineated, and improved error detectability. This method has the potential to provide a wider margin of safety in intensity-modulated radiation therapy.


Assuntos
Neoplasias da Próstata , Radioterapia de Intensidade Modulada , Humanos , Masculino , Pelve , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/métodos
8.
Semin Ultrasound CT MR ; 43(4): 293-310, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35738815

RESUMO

Virtual non-contrast (VNC) imaging is a post-processing technique generated from contrast-enhanced scans using dual-energy computed tomography (DECT). It is generated by removing iodine from imaging acquired at multiple energies. Myriad clinical studies have shown its ability to diagnose the various abdominal and pelvic pathologies discussed in the article. VNC is also a problem-solving tool for characterizing incidentally detected lesions ("incidentalomas"), often decreasing the need for additional follow-up imaging. It also obviates the multiphase image acquisitions to evaluate hematuria, hepatic steatosis, aortic endoleaks, and gastrointestinal bleeding by generating image datasets from different tissue attenuation values. The scope of this article is to provide an overview of various applications of VNC imaging obtained by DECT in the abdomen and pelvis.


Assuntos
Imagem Radiográfica a Partir de Emissão de Duplo Fóton , Tomografia Computadorizada por Raios X , Abdome/diagnóstico por imagem , Meios de Contraste , Humanos , Pelve/diagnóstico por imagem , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
9.
J Orthop Trauma ; 36(7): 294-297, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35727006

RESUMO

CLINICAL VIGNETTE: A 35 year-old female is injured in a high-speed motor vehicle collision in which her car is struck on the driver's side by a distracted driver. The patient is unable to self-extricate from the vehicle and she is confused at the scene. She comes directly to the trauma bay via EMS and a binder is placed in transit for suspicion of a pelvic ring injury. Upon presentation she has a GCS of 14 due to confusion, and an initial pressure of 87/50. Workup does not disclose an associated head, chest or abdominal injury and the anteroposterior pelvis radiograph demonstrates a windswept pelvis injury pattern. Despite being transfused 4 units of whole blood, her hypotension does not improve. Please describe your institution's advanced resuscitation protocol and management of this scenario, and provide the rational and support for it.


Assuntos
Traumatismos Abdominais , Ressuscitação , Acidentes de Trânsito , Adulto , Feminino , Humanos , Pelve/diagnóstico por imagem , Ressuscitação/métodos
10.
Medicina (Kaunas) ; 58(6)2022 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-35744073

RESUMO

Background and Objectives: The number of geriatric patients presenting with fragility fractures of the pelvis is increasing due to ageing Western societies. There are nonoperative and several operative treatment approaches. Many of which cause prolonged hospitalisation, so patients become bedridden and lose mobility and independence. This retrospective study evaluates the postoperative outcome of a computed tomography-guided (CT-guided) minimally invasive approach of sacroiliac screw osteosynthesis. The particular focus is to demonstrate its ease of use, feasibility with the equipment of virtually every hospital and beneficial outcomes to the patients. Materials and Methods: 28 patients (3 men, 25 women, age 80.5 ± 6.54 years) with fragility fractures of the pelvis types II-IV presenting between August 2015 and September 2021 were retrospectively reviewed. The operation was performed using the CT of the radiology department for intraoperative visualization of screw placement. Patients only received screw osteosynthesis of the posterior pelvic ring and cannulated screws underwent cement augmentation. Outcomes measured included demographic data, fracture type, postoperative parameters and complications encountered. The quality of life (QoL) was assessed using the German version of the EQ-5D-3L. Results: The average operation time was 32.4 ± 9.6 min for the unilateral and 50.7 ± 17.4 for the bilateral procedure. There was no significant difference between surgeons operating (p = 0.12). The postoperative CT scans were used to evaluate the outcome and showed only one case of penetration (by 1 mm) of the ventral cortex, which did not require operative revision. No case of major complication was reported. Following surgery, patients were discharged after a median of 4 days (Interquartile range 3-7.5). 53.4% of the patients were discharged home or to rehabilitation. The average score on the visual analogue scale of the EQ-5D-3L evaluating the overall wellbeing was 55.6 (Interquartile range (IQR) 0-60). Conclusions: This study shows that the operative method is safe to use in daily practice, is readily available and causes few complications. It permits immediate postoperative mobilization and adequate pain control. Independence and good quality of life are preserved.


Assuntos
Fraturas Ósseas , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Parafusos Ósseos , Feminino , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pelve , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
11.
BMC Surg ; 22(1): 208, 2022 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-35643545

RESUMO

OBJECTIVE: To evaluate the effect of continuous traction with a combined adjustable Halo-pelvic fixation brace on the cervical spine alignment in patients with severe rigid spinal deformity and analyze its related factors. METHODS: We conducted a retrospective cohort study of 21 patients with severe rigid spinal deformity treated in our department between 2015 and 2019. All subjects received combined adjustable Halo-pelvic fixation brace traction before secondary orthopedic surgery. The influence of the Halo-pelvic fixation brace on the cervical spine alignment was evaluated by measuring the parameters of lateral cervical X-ray at three time points: before traction, at the end of traction, and 6 months after orthopedic surgery. The correlation between parameter changes and total traction duration was analyzed to explore factors influencing cervical alignment. RESULTS: The C2L-C7L angle was 22.40 ± 15.91° before traction, which decreased to 5.91 ± 6.78° at the end of traction but increased to 14.51 ± 10.07° after orthopedic surgery (BT vs ET p < 0.005, ET vs AOS p < 0.005, BT vs AOS p < 0.005). Accordingly, C2L-C7U angle, C2L-C6L angle, C2L-C6U angle, C2L-C5L angle, C7 or T1 slope, C2-C7 SVA, SCA, C2-T1 Ha, C0 slope, and C0-C2 angle also changed similarly to C2L-C7L angle. Furthermore, moderate correlation was observed between C2L-C7L angle and total traction volume (r = 0.563, p = 0.008) and SCA and traction duration (r = 0.525, p = 0.015). However, no significant correlation was found between other cervical alignment parameters and total traction volume and traction duration. CONCLUSIONS: The continuous traction of a combined adjustable Halo-pelvic fixation brace can affect the cervical spine alignment of patients with severe rigid spinal deformity and straighten the physiological curvature of the cervical spine. However, the sagittal alignment gradually recovers after the traction, without any adverse effects on the orthopedic surgery and global balance after the operation; therefore, this apparatus is worthy of wide application.


Assuntos
Vértebras Cervicais , Pelve , Vértebras Cervicais/cirurgia , Humanos , Pescoço , Radiografia , Estudos Retrospectivos
13.
BMJ Case Rep ; 15(6)2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35667692

RESUMO

There are isolated case reports of Walthard cells in paratesticular structures although these benign epithelial cells are commonly found in relation to fallopian tubes. This is a second case report of cystic Walthard rest presented in an elderly man in right inguinal hernia.


Assuntos
Cistos , Hérnia Inguinal , Cordão Espermático , Idoso , Cistos/complicações , Cistos/diagnóstico por imagem , Tubas Uterinas , Feminino , Hérnia Inguinal/complicações , Hérnia Inguinal/diagnóstico por imagem , Hérnia Inguinal/cirurgia , Humanos , Masculino , Pelve
14.
BMC Cancer ; 22(1): 657, 2022 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-35701738

RESUMO

BACKGROUND AND PURPOSE: We aimed to explore the necessity of the external iliac lymph nodes (EIN) along with inguinal nodes (IN) region in clinical target volume (CTV) for rectal carcinomas covering the anal canal region. MATERIALS AND METHODS: This research premise enrolled 399 patients who had primary low rectal cancer detected below the peritoneal reflection via magnetic resonance imaging (MRI) and were treated with neoadjuvant radiotherapy (NRT), without elective EIN along with IN irradiation. We stratified the patients into two groups based on whether the lower edge of the rectal tumor extended to the anal canal (P group, n = 109) or not (Rb group, n = 290). Comparison of overall survival (OS), locoregional recurrence-free survival (LRFS), disease-free survival (DFS), as well as distant metastasis-free survival (DMFS) were performed via inverse probability of treatment weighting (IPTW) along with multivariable analyses. We compared the EIN and IN failure rates between the two groups via the Fisher and Gray's test. RESULTS: P group showed a similar adjusted proportion along with five-year cumulative rate of EIN failure compared with the Rb group. The adjusted proportion and five-year cumulative rate of IN failure in the P group was higher in comparison to the Rb group. There were no remarkable differences in the adjusted five-year OS, DFS, DMFS or LRFS between the two groups. Anal canal involvement (ACI) exhibited no effect on OS, LRFS, DFS, or DMFS. CONCLUSIONS: During NRT for rectal cancer with ACI, it may be possible to exclude the EIN and IN from the CTV.


Assuntos
Linfadenopatia , Neoplasias Retais , Canal Anal/patologia , Humanos , Linfonodos/patologia , Linfadenopatia/patologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Pelve/patologia , Prognóstico , Neoplasias Retais/patologia , Estudos Retrospectivos
15.
J Med Case Rep ; 16(1): 238, 2022 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-35701835

RESUMO

BACKGROUND: Trophoblastic differentiation in primary urothelial carcinoma of the prostate is extremely rare. An increased level of ß-subunit human chorionic gonadotropin in serum in urothelial carcinoma is detected in approximately 30% of cases. To our knowledge, increased concentration of ß-subunit human chorionic gonadotropin in serum in prostatic urothelial carcinoma has never been reported and its clinical significance is not evaluated yet. CASE REPORT: Here we present the case of a 67-year-old European patient who was admitted to the hospital with hematuria, dysuria, and enlarged painful testis. Ultrasonographic examination of the testis did not reveal any focal lesion. Magnetic resonance imaging of the pelvis showed a tumor of 62 mm diameter mainly located in the posterior part of the prostatic gland. A pathological examination from cystoscopy biopsy allowed us to set the diagnosis of high-grade invasive urothelial carcinoma with trophoblastic differentiation. The patient received neoadjuvant treatment. Nonetheless, after a short period of disease stabilization, he developed progression and brain metastasis. He died 9 months after diagnosis. During the disease course, his ß-human chorionic gonadotropin level was measured repeatedly and analyzed in relation to disease progression. The level of serum ß-human chorionic gonadotropin corresponded with the therapy response; it was at its lowest during stabilization and the highest in the metastatic stage. CONCLUSION: Our case study provides the first report of urothelial cancer of the prostate, with a concomitant increase of ß-subunit human chorionic gonadotropin level with testis enlargement. Besides its rarity, it constitutes an interesting observation of increasing ß-subunit human chorionic gonadotropin concentration with concomitant disease progression.


Assuntos
Carcinoma de Células de Transição , Neoplasias da Bexiga Urinária , Idoso , Carcinoma de Células de Transição/diagnóstico por imagem , Carcinoma de Células de Transição/patologia , Gonadotropina Coriônica , Gonadotropina Coriônica Humana Subunidade beta , Progressão da Doença , Humanos , Masculino , Pelve , Próstata , Neoplasias da Bexiga Urinária/patologia
16.
World J Surg Oncol ; 20(1): 199, 2022 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-35698131

RESUMO

BACKGROUND: Undifferentiated pleomorphic sarcoma (UPS) is a malignant soft tissue tumor that has been reclassified from malignant fibrous histiocytoma with the development of the pathological diagnosis. It principally occurs in the extremities but rarely occurs in the rectum. We herein report a rare case of UPS arising in the rectum. CASE PRESENTATION: A 85-year-old woman was referred to our hospital with a complaint of anal pain, which had persisted for several months. Computed tomography (CT) showed a 53 × 58 × 75 mm mass on the left side of the rectum. Colonoscopy revealed a submucosal elevation in the rectum without any exposure of the tumor to the surface. Contrast-enhanced CT and magnetic resonance imaging revealed an 80-mm mass that originated in the rectal muscular propria, and we suspected a gastrointestinal stromal tumor. No lymph node metastasis or distant metastasis was observed. We performed a laparoscopic Hartmann's operation. Intraoperatively, severe adhesion around the tumor caused tumor injury and right ureteral dissection. Thus, laparoscopic right ureteral anastomosis and ureteral stenting were additionally performed. The operation time was 6 h and 3 min, and the estimated blood loss was small. The patient was discharged without complications 25 days after surgery. A pathological examination showed that the tumor was composed of highly heterogeneous cells with no specific differentiation traits, leading to a diagnosis of UPS. Contrast-enhanced CT performed 2 months after surgery showed bilateral pelvic lymph node enlargement, which indicated recurrence. Considering the patient's age, we performed radiotherapy (50 Gy/25 Fr targeting the pelvic region). At present, 16 months have passed since the completion of radiotherapy. Contrast-enhanced CT shows that the recurrent lymph nodes have disappeared, and no new distant metastasis has been observed. CONCLUSIONS: We reported a case of UPS arising in the rectum. The surgical procedure and indication of preoperative therapy should be carefully selected because complete removal of the tumor is desirable in UPS.


Assuntos
Histiocitoma Fibroso Maligno , Sarcoma , Neoplasias de Tecidos Moles , Idoso de 80 Anos ou mais , Feminino , Histiocitoma Fibroso Maligno/diagnóstico , Humanos , Pelve/patologia , Reto/patologia , Reto/cirurgia , Sarcoma/patologia , Neoplasias de Tecidos Moles/cirurgia
17.
J Sports Sci Med ; 21(2): 182-190, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35719223

RESUMO

This cohort-based cross-sectional study compares the original (OV) and a newly developed standardized version (SV) of the Bunkie Test, a physical test used to assess the dorsal chain muscles. Twenty-three participants (13 females, 10 males; median age of 26 ± 3 years) performed the test, a reverse plank, with one foot on a stool and the contralateral leg lifted. In the SV, the position of the pelvis and the foot were predefined. The test performance time (s) and surface electromyography (sEMG) signals of the dorsal chain muscles were recorded. We performed a median power frequency (MPF) analysis, using short-time Fourier transformation, and calculated the MPF/time linear regression slope. We compared the slopes of the linear regression analysis (between legs) and the performance times (between the OV and SV) with the Wilcoxon test. Performance times did not differ between SV and OV for either the dominant (p = 0.28) or non-dominant leg (p = 0.08). Linear regression analysis revealed a negative slope for the muscles of the tested leg and contralateral erector spinae, with a significant difference between the biceps femoris of the tested (-0.91 ± 1.08) and contralateral leg (0.01 ± 1.62) in the SV (p = 0.004). The sEMG showed a clearer pattern in the SV than in the OV. Hence, we recommend using the SV to assess the structures of the dorsal chain of the tested leg and contralateral back.


Assuntos
Perna (Membro) , Músculo Esquelético , Adulto , Estudos Transversais , Eletromiografia , Feminino , Humanos , Masculino , Músculo Esquelético/fisiologia , Pelve , Adulto Jovem
18.
J Orthop Surg Res ; 17(1): 312, 2022 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-35690864

RESUMO

BACKGROUND: Minimally invasive surgery for pelvic fracture using anterior ring internal fixator system is increasing gradually, and the way to insert the fixation screws in the fixation system is the key technical points of the method. However, there have been few studies on insertion of fixation screws for the anterior pelvic ring internal fixator system. OBJECTIVE: To identify safe channels for fixation screws in the anterior pelvic fixator system and provide the anatomical basis for insertion of fixation screws in clinical operation. METHODS: Screw insertion was simulated into a total of 40 pelvic finite element models as well as 16 fresh pelvic specimens, and the channel parameters were measured. RESULTS: Finite elements (male, female) include: screws in ilium: length 114.4 ± 4.1 and 107.6 ± 8.3 mm, respectively; diameter 11.7 ± 0.5 and 10.0 ± 0.6 mm, distance between screw and anterior inferior iliac spine: 5.5 ± 1.0 and 5.6 ± 1.0 mm, angle of coronal plane 55.8° ± 2.4° and 50.6° ± 3.1°, angle of sagittal plane 26.6° ± 1.0° and 24.5° ± 1.9° and angle of horizontal plane 64.9 ± 3.7 and 58.1 ± 3.1; screws in pubis: length 47.0 ± 2.0 and 39.8 ± 3.9 mm, diameter 7.1 ± 0.4 and 6.1 ± 0.4 mm. Specimens (male, female) include: distance between screw and anterior inferior iliac spine: 5.5 ± 0.5 and 5.6 ± 0.7 mm, angle of coronal plane 55.9° ± 1.3° and 50.7° ± 1.5°, angle of sagittal plane 26.7° ± 0.5° and 24.1° ± 0.9° and angle of horizontal plane 64.8° ± 0.6° and 58.8° ± 0.8°. In the comparison between female and male in each group, differences in distances between screws and anterior inferior iliac spine and median line of symphysis pubis (P > 0.05) were not statistically significant; differences in the remaining parameters were statistically significant (P < 0.05). CONCLUSIONS: If surgeons paid attention to sex differences, select screws of appropriate diameter and length and hold the insertion position and direction, screws in the anterior pelvic ring fixation system could be safely inserted.


Assuntos
Fraturas Ósseas , Ossos Pélvicos , Parafusos Ósseos/efeitos adversos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Humanos , Ílio/cirurgia , Masculino , Ossos Pélvicos/cirurgia , Pelve
19.
Clin Orthop Surg ; 14(2): 196-204, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35685970

RESUMO

Background: Patients with developmental dysplasia of the hip (DDH) are known to have abnormal pelvic morphologies; however, rotation of innominate bone features remains unclear. Thus, we investigated innominate bone rotation in patients with DDH by measuring the associated angles and distances using three-dimensional (3D) computed tomography. Methods: We defined four straight lines in pelvic 3D models: from the anterior superior iliac spine to the posterior superior iliac spine, from the anterior inferior iliac spine to the posterior inferior iliac spine, from the pubic tubercle to the ischial spine, and from the pubic tubercle to the ischial tuberosity. Similarly, we measured the angles formed by these lines using the vertical axis of the anterior pelvic plane on the horizontal plane and the horizontal axis on the sagittal plane. Additionally, we measured the distances between the femoral head centers and the acetabular centers in the coronal plane. Results: The difference in internal rotation angle between the superior and inferior parts of the iliac bone was significantly lower, by approximately 1.7°, in the DDH group than in the control group (p = 0.007); the difference between the inferior and superior parts of the ischiopubic bone was significantly higher, by approximately 1.5°, in the DDH group (p < 0.001). In the sagittal plane, the sum of the superior aspect of the iliac bone and the inferior aspect of the ischium was significantly lower in the DDH group (p = 0.001) than in the control group. The distances between the femoral heads and the acetabula were significantly greater in the DDH group than in the control group (p = 0.03, p < 0.01, respectively). Conclusions: Patients with DDH had a more internally rotated ilium and ischiopubic bone than normal individuals; however, it should be emphasized that internal rotation was reduced near the acetabulum, and the acetabulum was shifted laterally. Similarly, it was shown that patients with DDH had different rotations of the ilium and ischiopubic bone in the sagittal plane.


Assuntos
Displasia do Desenvolvimento do Quadril , Luxação Congênita de Quadril , Acetábulo , Feminino , Cabeça do Fêmur , Luxação Congênita de Quadril/diagnóstico por imagem , Humanos , Ísquio/diagnóstico por imagem , Pelve
20.
Rev Col Bras Cir ; 49: e20223130, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35703677

RESUMO

OBJECTIVE: to describe and measure the Bicrista Iliaca Pubo Angle (APBCI) as a new anthropometric parameter. Correlate the measurement with patients with giant incisional hernia (HIG), in the midline of the anterior abdominal wall (AAW). METHODS: measurement of APBCI, through 3D reconstruction from computed tomography (CT). Measurements performed by two observers, R and C, in 246 women and 60 men, normal adults, in order to obtain the APBCI measurement and its correlation in patients with HIG of the AAW. RESULTS: after sample calculations, the measurement of APBCI in men: 92.5+6.3º to 93.8+6.7º; in women: 90+6.7° to 94.3+6.8° [p-value 0.337(R)/0.628(C)]. The mean age was 57.9+15.9 years (22 to 91 years). Female gender 57+15.7 years (22 to 91 years) and male 61.7+16.5 years (23 to 89 years) p=0.067. As for the distribution of the ranges from 5 to 5 degrees, there is no difference in the distribution of the angle [p-value 0.455(R)/0.672(C)]. The correlation between age and angle showed that the higher the age, the higher the APBCI. There was no variability between angle measurements: 0.97 (95% CI 0.97; 0.98). In men with HIG, the average is between 108.3+5.37º (102.92º to 113.67º), and in women, 107.8+6.64 (101.16º to 114.44º). CONCLUSION: the study allowed us to conclude that HIG is not just an isolated AAW defect. Determines skeletal changes, as the APBCI is influenced by the distance of the iliac crests.


Assuntos
Hérnia Incisional , Adulto , Idoso , Feminino , Humanos , Ílio , Imageamento Tridimensional , Hérnia Incisional/cirurgia , Masculino , Pessoa de Meia-Idade , Pelve , Estudos Prospectivos
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