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1.
Zhongguo Yi Liao Qi Xie Za Zhi ; 48(3): 257-263, 2024 May 30.
Artigo em Chinês | MEDLINE | ID: mdl-38863090

RESUMO

The treatment of bone defects caused by fractures or bone tissue lesions has always been a difficult problem in the field of orthopedics. Implantation of high-performance titanium alloy prosthesis is an effective method to treat bone defects. 3D printing technology can produce low-modulus titanium alloy implants with porous structures, providing a better solution to the above problems. This technology is convenient to design and has a huge advantage in making orthopedic implants. The article used electron beam melting in 3D printing technology to create two samples of Ti-6Al-4V prosthesis, including solid structural pelvic prosthesis and porous structural pelvic prosthesis. The mechanical properties of the prosthesis showed that the yield and tensile strengths of the rod tensile specimen were 894 MPa and 956 MPa, respectively, and the compressive modulus and compressive strength of the porous pelvic prosthesis were 55 GPa and 65.2 MPa, respectively. The results of the L929 cytotoxicity assay and the MC3T3-E1 cell adhesion assay demonstrated good biocompatibility of the prosthetic samples. New Zealand white rabbits were used to prepare the femoral joint cavity defect models and two pelvic prostheses were implanted. A microscopic CT scan 4 weeks after implantation showed that the bone defect caused by the drill had healed and that the porous structure of the pelvic prosthesis formed a new trabecular structure within the hole. In conclusion, the 3D printed Ti-6Al-4V pelvic prosthesis has excellent mechanical properties, biocompatibility, and the ability to promote new bone growth.


Assuntos
Ligas , Materiais Biocompatíveis , Teste de Materiais , Impressão Tridimensional , Titânio , Animais , Coelhos , Próteses e Implantes , Camundongos , Desenho de Prótese , Porosidade , Ossos Pélvicos , Pelve
2.
World J Surg Oncol ; 22(1): 153, 2024 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-38863003

RESUMO

In rectal cancer treatment, the diagnosis and management of lateral pelvic lymph nodes (LLN) are critical for preventing local recurrence. Over time, scholars have reached a consensus: when imaging suggests LLN metastasis, combining neoadjuvant chemoradiotherapy (nCRT) with selective LLN dissection (LLND) can mitigate the risk of recurrence. Selective LLND typically encompasses lymph nodes in the internal iliac and obturator regions. Recent studies emphasize distinctions between internal iliac and obturator lymph nodes regarding prognosis and treatment outcomes, prompting the need for differentiated diagnostic and treatment approaches.


Assuntos
Excisão de Linfonodo , Linfonodos , Metástase Linfática , Neoplasias Retais , Humanos , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Linfonodos/patologia , Linfonodos/cirurgia , Excisão de Linfonodo/métodos , Prognóstico , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Pelve/patologia
3.
PLoS One ; 19(6): e0300938, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38829863

RESUMO

PURPOSE: To clarify the morphological factors of the pelvis in patients with developmental dysplasia of the hip (DDH), three-dimensional (3D) pelvic morphology was analyzed using a template-fitting technique. METHODS: Three-dimensional pelvic data of 50 patients with DDH (DDH group) and 3D pelvic data of 50 patients without obvious pelvic deformity (Normal group) were used. All patients were female. A template model was created by averaging the normal pelvises into a symmetrical and isotropic mesh. Next, 100 homologous models were generated by fitting the pelvic data of each group of patients to the template model. Principal component analysis was performed on the coordinates of each vertex (15,235 vertices) of the pelvic homologous model. In addition, a receiver-operating characteristic (ROC) curve was calculated from the sensitivity of DDH positivity for each principal component, and principal components for which the area under the curve was significantly large were extracted (p<0.05). Finally, which components of the pelvic morphology frequently seen in DDH patients are related to these extracted principal components was evaluated. RESULTS: The first, third, and sixth principal components showed significantly larger areas under the ROC curves. The morphology indicated by the first principal component was associated with a decrease in coxal inclination in both the coronal and horizontal planes. The third principal component was related to the sacral inclination in the sagittal plane. The sixth principal component was associated with narrowing of the superior part of the pelvis. CONCLUSION: The most important factor in the difference between normal and DDH pelvises was the change in the coxal angle in both the coronal and horizontal planes. That is, in the anterior and superior views, the normal pelvis is a triangle, whereas in DDH, it was more like a quadrilateral.


Assuntos
Displasia do Desenvolvimento do Quadril , Imageamento Tridimensional , Curva ROC , Humanos , Feminino , Displasia do Desenvolvimento do Quadril/patologia , Displasia do Desenvolvimento do Quadril/diagnóstico por imagem , Imageamento Tridimensional/métodos , Análise de Componente Principal , Ossos Pélvicos/diagnóstico por imagem , Pelve/patologia , Pelve/diagnóstico por imagem , Modelos Anatômicos , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/patologia
4.
Eur J Radiol ; 176: 111450, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38879203

RESUMO

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), the European Society of Human Reproduction and Embryology (ESHRE), the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counseling and planning of surgical treatment strategies. This Consensus Statement should be cited as: 'G. Condous, B. Gerges, I. Thomassin-Naggara, C. Becker, C. Tomassetti, H. Krentel, B.J. van Herendael, M. Malzoni, M. S. Abrao, E. Saridogan, J. Keckstein, G. Hudelist and Collaborators. Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: An International Consensus Statement. Eur. J. Radiol. 2024. https://doi.org/10.1016/j.ejrad.2024.111450.'


Assuntos
Endometriose , Endometriose/diagnóstico por imagem , Endometriose/classificação , Humanos , Feminino , Consenso , Pelve/diagnóstico por imagem , Ultrassonografia/métodos , Imageamento por Ressonância Magnética/métodos
5.
Clin Biomech (Bristol, Avon) ; 116: 106269, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38861874

RESUMO

BACKGROUND: Slipped capital femoral epiphysis is a prevalent pediatric hip disorder. Recent studies suggest the spine's sagittal profile may influence the proximal femoral growth plate's slippage, an aspect not extensively explored. This study utilizes finite element analysis to investigate how various spinopelvic alignments affect shear stress and growth plate slip. METHODS: A finite element model was developed from CT scans of a healthy adult male lumbar spine, pelvis, and femurs. The model was subjected to various sagittal alignments through reorientation. Simulations of two-leg stance, one-leg stance, walking heel strike, ascending stairs heel strike, and descending stairs heel strike were conducted. Parameters measured included hip joint contact area, stress, and maximum growth plate Tresca (shear) stress. FINDINGS: Posterior pelvic tilt cases indicated larger shear stresses compared to the anterior pelvic tilt variants except in two leg stance. Two leg stance resulted in decreases in the posterior tilted pelvi variants hip contact and growth plate Tresca stress compared to anterior tilted pelvi, however a combination of posterior pelvic tilt and high pelvic incidence indicated larger shear stresses on the growth plate. One leg stance and heal strike resulted in higher shear stress on the growth plate in posterior pelvic tilt variants compared to anterior pelvic tilt, with a combination of posterior pelvic tilt and high pelvic incidence resulting in the largest shear. INTERPRETATION: Our findings suggest that posterior pelvic tilt and high pelvic incidence may lead to increased shear stress at the growth plate. Activities performed in patients with these alignments may predispose to biomechanical loading that shears the growth plate, potentially leading to slip.


Assuntos
Análise de Elementos Finitos , Pelve , Humanos , Masculino , Pelve/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/fisiopatologia , Estresse Mecânico , Escorregamento das Epífises Proximais do Fêmur/fisiopatologia , Escorregamento das Epífises Proximais do Fêmur/diagnóstico por imagem , Adulto , Simulação por Computador , Articulação do Quadril/fisiopatologia , Articulação do Quadril/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Fêmur/fisiopatologia , Lâmina de Crescimento/diagnóstico por imagem , Lâmina de Crescimento/fisiopatologia , Lâmina de Crescimento/fisiologia , Cartilagem/diagnóstico por imagem , Modelos Biológicos , Fenômenos Biomecânicos , Postura/fisiologia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/fisiopatologia , Coluna Vertebral/fisiologia
6.
Clin Genitourin Cancer ; 22(4): 102108, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38843766

RESUMO

PURPOSE: The role of elective pelvic nodal irradiation in salvage radiotherapy (sRT) remains controversial. Utilizing 18F-DCFPyL PET/CT, this study aimed to investigate differences in disease distribution after whole pelvic (WPRT) or prostate bed (PBRT) radiotherapy and to identify risk factors for pelvic lymph node (LN) relapse. METHODS: This retrospective study included patients with PSA > 0.1 ng/mL post-radical prostatectomy (RP) or post-RP and sRT who underwent 18F-DCFPyL PET/CT. Disease distribution on 18F-DCFPyL PET/CT after sRT was compared using Chi-square tests. Risk factors were tested for association with pelvic LN relapse after RP and salvage PBRT using logistic regression. RESULTS: 979 18F-DCFPyL PET/CTs performed at our institution between 1/1/2022 - 3/24/2023 were analyzed. There were 246 patients meeting criteria, of which 84 received salvage RT after RP (post-salvage RT group) and 162 received only RP (post-RP group). Salvage PBRT patients (n = 58) had frequent pelvic nodal (53.6%) and nodal-only (42.6%) relapse. Salvage WPRT patients (n = 26) had comparatively lower rates of pelvic nodal (16.7%, p = 0.002) and nodal-only (19.2%, p = 0.04) relapse. The proportion of distant metastases did not differ between the two groups. Multiple patient characteristics, including ISUP grade and seminal vesicle invasion, were associated with pelvic LN disease in the post-RP group. CONCLUSION: At PSA persistence or progression, salvage WPRT resulted in lower rates of nodal involvement than salvage PBRT, but did not reduce distant metastases. Certain risk factors increase the likelihood of pelvic LN relapse after RP and can help inform salvage RT field selection.


Assuntos
Recidiva Local de Neoplasia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Prostatectomia , Neoplasias da Próstata , Terapia de Salvação , Humanos , Masculino , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/diagnóstico por imagem , Recidiva Local de Neoplasia/radioterapia , Estudos Retrospectivos , Idoso , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Pessoa de Meia-Idade , Fatores de Risco , Metástase Linfática , Pelve/diagnóstico por imagem , Pelve/efeitos da radiação , Linfonodos/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/efeitos da radiação , Lisina/análogos & derivados , Ureia/análogos & derivados
7.
J Orthop Surg Res ; 19(1): 337, 2024 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-38849873

RESUMO

BACKGROUND: Limited research has examined the impact of lower limb length discrepancy (LLLD) alteration on spinopelvic compensation in individuals with developmental dysplasia of the hip (DDH). This study aimed to investigate the effects of LLLD on spinopelvic compensation following total hip arthroplasty (THA) and elucidate the complex biomechanical adaptations in the spinopelvic structures. METHODS: A retrospective review of DDH patients undergoing THA from January 2014 to December 2021 categorized individuals with Crowe type I and II into the low dislocation group (LDG, n = 94) and those with Crowe type III and IV into the high dislocation group (HDG, n = 43). Demographic data, as well as preoperative, postoperative, and last follow-up imaging data, including lower limb length (LLL), sacral obliquity (SO), iliac obliquity (IO), hip obliquity (HO), Cobb angle, apical vertebral translation (AVT), and coronal decompensation (CD), were collected for analysis. RESULTS: Patients in the LDG had a significantly higher surgical age and shorter disease duration (P<0.05). In LDG, patients exhibited substantial postoperative reductions in LLLD, SO, IO, and HO (P<0.05), while Cobb Angle, AVT, and CD showed no statistically significant changes (P>0.05). The variation in LLLD correlated significantly with the variations in SO, IO, and HO (P<0.05). Postoperative outcomes in the HDG demonstrated marked decreases in LLLD, SO, IO, HO, and CD (P<0.05), with no significant change in Cobb angle and AVT (P>0.05). The variation in LLLD correlated significantly with the variations in SO, IO, HO, and CD (P<0.05). CONCLUSIONS: THA effectively reduces LLLD in patients with DDH, and the variation in LLLD correlates meaningfully with the recovery of spinopelvic compensatory mechanisms.


Assuntos
Artroplastia de Quadril , Displasia do Desenvolvimento do Quadril , Desigualdade de Membros Inferiores , Humanos , Artroplastia de Quadril/métodos , Feminino , Masculino , Estudos Retrospectivos , Desigualdade de Membros Inferiores/etiologia , Desigualdade de Membros Inferiores/diagnóstico por imagem , Pessoa de Meia-Idade , Displasia do Desenvolvimento do Quadril/cirurgia , Displasia do Desenvolvimento do Quadril/diagnóstico por imagem , Idoso , Adulto , Pelve/diagnóstico por imagem , Fenômenos Biomecânicos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia
8.
Prosthet Orthot Int ; 48(3): 337-343, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38857166

RESUMO

BACKGROUND: Hip- and pelvic-level amputations are devastating injuries that drastically alter patient function and quality of life. This study examined the experience of military beneficiaries with a hip- or pelvic-level amputation to better characterize their challenges and specific needs and to optimize treatment in the future. METHODS: We conducted a retrospective review of the Military Health System and identified 118 patients with a history of one or more amputation(s) at the hip or pelvic level between October 2001 and September 2017. Surviving participants (n = 97) were mailed a letter which explained the details of the study and requested participation in a telephonic interview. A total of six individuals (one female, five males) participated in structured interviews. RESULTS: The study group included four participants with hip disarticulations and two participants with hemipelvectomies (one internal, one external). All six participants reported significant challenges with activities related to prosthetic use, mobility, residual limb health, pain, gastrointestinal and genitourinary function, psychiatric health, and sexual function. CONCLUSIONS: These interviews highlight the unique needs of individuals with hip- and pelvic-level amputations and may improve access to higher echelons of care that would enhance the function and quality of life for these participants.


Assuntos
Membros Artificiais , Militares , Qualidade de Vida , Humanos , Masculino , Feminino , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Militares/psicologia , Amputação Cirúrgica/reabilitação , Amputação Cirúrgica/psicologia , Hemipelvectomia , Amputados/psicologia , Amputados/reabilitação , Estados Unidos , Pelve
9.
Cardiovasc Intervent Radiol ; 47(6): 822-828, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38691123

RESUMO

PURPOSE: The aim of this article is to present our experience with minimally-invasive treatment for nulliparous patients with pelvic venous congestion syndrome (PVCS) with special attention to anatomical considerations, procedural and clinical outcome. MATERIALS AND METHODS: In this retrospective, monocentric study, 21 patients with PVCS treated from January 2014 to June 2023 were included. The preprocedural imaging evaluation of PVCS was based on color Doppler ultrasound, contrast-enhanced CT and/or MRI. In all cases insufficient ovarian veins and/or internal iliac branches were occluded with coils and sclerosant. Procedural and clinical outcomes were measured 30 and 90 days after the procedure. RESULTS: Average duration of pelvic pain was 44.8 ± 54.2 months (from 6 to 200) with the mean VAS-recorded pain intensity of 8.5 ± 1.1 (range from 7 to 10 where 0 was "no pain" and 10 "worst pain possible"). Most common symptoms included dysmenorrhea, dyspareunia and dysuria. Complete embolization was observed in in all cases. Targeted vessels included left ovarian vein (13/21, 62%), both ovarian veins (7/21, 33%) and left pudendal with left ovarian (1/21, 5%). Residual PVCS was noted in 1 patient. Mean VAS at 90-days after the procedure was 2.4 ± 1.4 (range from 0 to 6, p < 0.001). Nineteen patients (90%) were satisfied with the clinical outcome (13 "very satisfied", 6 "satisfied") and reported improvement in quality of life. Two patients (9.5%) reported to be "neutral" as the VAS reduction was less than 50%. CONCLUSION: Our study confirms that endovascular coil embolization is safe and effective in treatment of nulliparous patients with PVCS that provides very high rate of clinical success and overall satisfaction.


Assuntos
Embolização Terapêutica , Dor Pélvica , Humanos , Feminino , Estudos Retrospectivos , Adulto , Dor Pélvica/terapia , Embolização Terapêutica/métodos , Resultado do Tratamento , Pelve/irrigação sanguínea , Procedimentos Endovasculares/métodos , Paridade , Adulto Jovem , Ultrassonografia Doppler em Cores , Síndrome
10.
Phys Med Biol ; 69(12)2024 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-38821109

RESUMO

Objective.The validation of deformable image registration (DIR) for contour propagation is often done using contour-based metrics. Meanwhile, dose accumulation requires evaluation of voxel mapping accuracy, which might not be accurately represented by contour-based metrics. By fabricating a deformable anthropomorphic pelvis phantom, we aim to (1) quantify the voxel mapping accuracy for various deformation scenarios, in high- and low-contrast regions, and (2) identify any correlation between dice similarity coefficient (DSC), a commonly used contour-based metric, and the voxel mapping accuracy for each organ.Approach. Four organs, i.e. pelvic bone, prostate, bladder and rectum (PBR), were 3D printed using PLA and a Polyjet digital material, and assembled. The latter three were implanted with glass bead and CT markers within or on their surfaces. Four deformation scenarios were simulated by varying the bladder and rectum volumes. For each scenario, nine DIRs with different parameters were performed on RayStation v10B. The voxel mapping accuracy was quantified by finding the discrepancy between true and mapped marker positions, termed the target registration error (TRE). Pearson correlation test was done between the DSC and mean TRE for each organ.Main results. For the first time, we fabricated a deformable phantom purely from 3D printing, which successfully reproduced realistic anatomical deformations. Overall, the voxel mapping accuracy dropped with increasing deformation magnitude, but improved when more organs were used to guide the DIR or limit the registration region. DSC was found to be a good indicator of voxel mapping accuracy for prostate and rectum, but a comparatively poorer one for bladder. DSC > 0.85/0.90 was established as the threshold of mean TRE ⩽ 0.3 cm for rectum/prostate. For bladder, extra metrics in addition to DSC should be considered.Significance. This work presented a 3D printed phantom, which enabled quantification of voxel mapping accuracy and evaluation of correlation between DSC and voxel mapping accuracy.


Assuntos
Pelve , Imagens de Fantasmas , Humanos , Pelve/diagnóstico por imagem , Doses de Radiação , Processamento de Imagem Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Masculino , Impressão Tridimensional
11.
J Bodyw Mov Ther ; 38: 339-345, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38763578

RESUMO

OBJECTIVES: To determine the effects of Pilates exercises on lumbo-pelvic alignment in non-specific low back pain (NSLBP) patients. METHODS: Twenty-two patients (Male:7; Female:15) with NSLBP aged 20-65 years were recruited and classified based on a modified O'Sullivan's classification system into flexion pattern (FP) or active extension pattern (EP) groups. Oswestry Disability index (ODI), Roland-Morris Disability Questionnaire (RMDQ) as well as radiographic lumbar global range of motion (ROM) and lumbo-pelvic alignment were measured Pre- and immediately post-intervention and at 6- and 12-month. The intervention included supervised six-weeks Pilates program with 60 min per session and up to two sessions per week. RESULTS: Lumbar lordosis, sacral slope and sacral inclination were found to be significantly different between the FP and EP groups based on the O'Sullivan's classification system. However, despite the significant changes in RMDQ (p = 0.001), no significant changes were found for any of the alignment parameters (p > 0.05) post intervention for both groups. For lumbar global ROM, a statistically significant change was observed for the EP group (p = 0.028) but not for the FP group (p = 0.249). No significant correlations were identified between any of the self-reported outcomes, radiographic alignment and ROM parameters. CONCLUSIONS: Patients self-perceived long-term functional improvements based on responding to questionnaires after Pilates exercises were not reflected in significant changes in lumbo-pelvic alignment or lumbar ROM. This may be due to the current cohort demonstrating within normal ranges due to the lesser severity of their condition, but further research is needed for clarification.


Assuntos
Técnicas de Exercício e de Movimento , Dor Lombar , Vértebras Lombares , Amplitude de Movimento Articular , Humanos , Dor Lombar/reabilitação , Dor Lombar/terapia , Dor Lombar/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Técnicas de Exercício e de Movimento/métodos , Amplitude de Movimento Articular/fisiologia , Vértebras Lombares/fisiopatologia , Idoso , Adulto Jovem , Região Lombossacral , Pelve , Avaliação da Deficiência , Radiografia
12.
J Bodyw Mov Ther ; 38: 615-620, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38763616

RESUMO

INTRODUCTION: Low-back pain (LBP) is one of the most common causes of disability in adults. There are many non-invasive interventions to improve this condition, of which the use of exercise therapy is one of the most widely used. But there is contradictory evidence regarding the effectiveness of different types of exercise methods. Therefore, the current research aimed to investigate the effect of pelvic clock exercises on pain reduction and lumbopelvic proprioception in women with chronic nonspecific low back pain (CNSLBP). MATERIALS AND METHODS: This was a quasi-experimental study with a controlled pre-test-post-test design. The study population included middle-aged women with CNSLBP with an age range of 35-50 years. A total of 30 eligible middle-aged women with CNSLBP were selected using purposive and convenience sampling. The pelvic clock exercise was carried out by the researcher in a gym for eight 45- min sessions each week (three sessions each week). A visual analog scale (VAS) and goniometer were used to measure pain and lumbopelvic proprioception, respectively. However, the control group only participated in the pre-test and post-test stages. For intra-group and inter-group comparisons, paired t-test and independent t-test were used at P < 0.05, respectively. RESULTS: The results showed that eight-week pelvic clock exercises had an effect on decreased pain and increase lumbopelvic proprioception in middle-aged women with CNSLBP, but no effect was observed in the control group (P > 0.05). CONCLUSION: According to the results of the present study, pelvic clock exercises should be used as a new and practical method to reduce pain and improve lumbopelvic proprioception in middle-aged women with CNSLBP.


Assuntos
Terapia por Exercício , Dor Lombar , Propriocepção , Humanos , Dor Lombar/terapia , Feminino , Propriocepção/fisiologia , Adulto , Pessoa de Meia-Idade , Terapia por Exercício/métodos , Medição da Dor , Dor Crônica/terapia , Pelve , Região Lombossacral
13.
Int J Colorectal Dis ; 39(1): 79, 2024 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-38797803

RESUMO

BACKGROUND: Empty Pelvis Syndrome, subsequent to the removal of pelvic organs, results in the descent of the small bowel into an inflamed pelvic cavity, leading to the formation of adhesions and subsequent small bowel obstruction. However, no effective measures have been previously described. OBJECTIVE: Describe a simple and autologous solution to prevent "Empty Pelvis Syndrome," small bowel obstruction, and adhesions by utilizing the cecum to occlude the pelvis. DESIGN: Mobilization of the right colon to lower the cecum into the pelvic cavity to occlude the superior pelvic ring to some degree and changing the direction of the terminal ileum. SETTINGS: Hospital Universitario Fundación Jiménez Díaz, Department of General Surgery, Colorectal Service. PATIENTS: Eight anonymized patients were included in this study, each with varying colorectal pathologies. Patients were above 18 years old. MAIN OUTCOME MEASURES: Percent of blockage of the superior pelvic ring produced by the descended cecum recorded in percentage; the amount of small intestine descended past the superior pelvic ring recorded in cm. RESULTS: The mobilization of the cecum achieved partial occlusion of the superior pelvic ring. The descent of the small bowel beyond this landmark ranged from 0 to 4.9 cm. LIMITATIONS: Given the small number of patients included in this study, these results cannot be generalized to the whole of the population. A bladder emptying protocol prior to CT scans was not implemented, resulting in variations in measurements among patients. CONCLUSION: The cecum-to-pelvis technique is a simple method that can serve as an autologous solution to EPS (enteropelvic fistula) and help reduce postoperative complications such as SBO (small bowel obstruction) and adhesions. It is not essential to completely occlude the superior pelvic ring to achieve successful outcomes.


Assuntos
Ceco , Pelve , Complicações Pós-Operatórias , Humanos , Ceco/cirurgia , Pelve/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Feminino , Masculino , Pessoa de Meia-Idade , Aderências Teciduais/prevenção & controle , Aderências Teciduais/etiologia , Adulto , Obstrução Intestinal/prevenção & controle , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Idoso
14.
J Appl Clin Med Phys ; 25(6): e14353, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38693646

RESUMO

BACKGROUND: A physical scatter grid is not often used in pelvic bedside examinations. However, multiple studies regarding scatter correction software (SC SW) are available for mobile chest radiography but the results are unclear for pelvic radiography. PURPOSE: We evaluated SC SW of Fujifilm (Virtual Grid) on gridless pelvic radiographs obtained from a human Thiel-embalmed body to investigate the potential of Virtual Grid in pelvic bedside examinations. METHODS: Gridless, Virtual Grid, and physical grid pelvic radiographs of a female Thiel-embalmed body were collected with a broad range of tube loads. Different software (SW) grid ratios-6:1, 10:1, 13:1, 17:1, and 20:1-were applied on the gridless radiographs to investigate the image quality (IQ) improvement of 13 IQ criteria in a visual grading analysis (VGA) setup. RESULTS: Gridless radiograph scores are significantly lower (p < 0.001) than Virtual Grid and physical grid scores obtained with the same tube load. Virtual Grid radiographs score better than gridless radiographs obtained with a higher tube load which makes a dose reduction possible. The averaged ratings of the IQ criteria processed with different SW ratios increase with increasing SW grid ratios. However, no statistically significant differences were found between the SW grid ratios. The scores of the physical grid radiographs are higher than those of the Virtual Grid radiographs when they are obtained with the same tube load. CONCLUSION: We conclude that Virtual Grid with an SW ratio of 6:1 improves the IQ of gridless pelvic radiographs in such a manner that a dose reduction is possible. However, physical grid radiograph ratings are higher compared to those of Virtual Grid radiographs.


Assuntos
Pelve , Humanos , Feminino , Pelve/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Software , Espalhamento de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Doses de Radiação , Imagens de Fantasmas
15.
Anticancer Res ; 44(6): 2621-2626, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38821614

RESUMO

BACKGROUND/AIM: This study investigated the clinical impact of resection of pelvic sentinel lymph nodes (PSLNs) in squamous cell vulvar cancer (SCVC). PATIENTS AND METHODS: Sixty-two groins of 33 patients with SCVC who underwent sentinel lymph node (SLN) resection between 2010 and 2021 at the University Hospital of Cologne, Germany, were analyzed in this retrospective cohort study. The frequency of additionally resectable PSLNs, histological findings, and count rates were analyzed and compared to the findings for inguinal sentinel lymph nodes (ISLNs). RESULTS: In all patients and in 61 (98%) of the 62 radiolabeled groins, at least one SLN could be resected. Five (8%) of the 62 groins had histologically confirmed lymph node metastases (4/33 patients, 12%). Twenty (33%) of the 62 groins underwent additional PSLN resection. Resection of these PSLNs was feasible without causing an additional burden for the patients. None of the PSLNs showed signs of tumor infiltration. Information on the extent of radioactivity for ISLNs and simultaneously for PSLNs, expressed as count rate of intraoperative measurement with the gamma probe, was available for 20 (32%) groins. In three (15%) of these cases, the highest count rate in a SLN was found in a PSLN and not in an ISLN. CONCLUSION: Resection of PSLNs is feasible and can be performed without short-term complications. In patients with early SCVC, resection of PSLNs is not necessary, even in those with early infiltration of inguinal lymph nodes. The intraoperative count rate of SLN is not relevant for the decision to perform resection.


Assuntos
Carcinoma de Células Escamosas , Metástase Linfática , Biópsia de Linfonodo Sentinela , Linfonodo Sentinela , Neoplasias Vulvares , Humanos , Feminino , Neoplasias Vulvares/patologia , Neoplasias Vulvares/cirurgia , Biópsia de Linfonodo Sentinela/métodos , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/patologia , Idoso , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Adulto , Pelve/patologia , Excisão de Linfonodo/métodos
16.
Sci Rep ; 14(1): 12258, 2024 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-38806582

RESUMO

With the recent increase in traffic accidents, pelvic fractures are increasing, second only to skull fractures, in terms of mortality and risk of complications. Research is actively being conducted on the treatment of intra-abdominal bleeding, the primary cause of death related to pelvic fractures. Considerable preliminary research has also been performed on segmenting tumors and organs. However, studies on clinically useful algorithms for bone and pelvic segmentation, based on developed models, are limited. In this study, we explored the potential of deep-learning models presented in previous studies to accurately segment pelvic regions in X-ray images. Data were collected from X-ray images of 940 patients aged 18 or older at Gachon University Gil Hospital from January 2015 to December 2022. To segment the pelvis, Attention U-Net, Swin U-Net, and U-Net were trained, thereby comparing and analyzing the results using five-fold cross-validation. The Swin U-Net model displayed relatively high performance compared to Attention U-Net and U-Net models, achieving an average sensitivity, specificity, accuracy, and dice similarity coefficient of 96.77%, of 98.50%, 98.03%, and 96.32%, respectively.


Assuntos
Aprendizado Profundo , Fraturas Ósseas , Ossos Pélvicos , Humanos , Fraturas Ósseas/diagnóstico por imagem , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/lesões , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Algoritmos , Idoso , Pelve/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Adolescente , Adulto Jovem
17.
Int J Colorectal Dis ; 39(1): 80, 2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38806953

RESUMO

PURPOSE: Although lateral lymph node dissection has been performed to prevent lateral pelvic recurrence in locally advanced lower rectal cancer, the incidence of lateral pelvic recurrence after this procedure has not been investigated. Therefore, this study aimed to investigate the long-term outcomes of patients who underwent lateral pelvic lymph node dissection, with a particular focus on recurrence patterns. METHODS: This was a retrospective study conducted at a single high-volume cancer center in Japan. A total of 493 consecutive patients with stage II-III rectal cancer who underwent lateral lymph node dissection between January 2005 and August 2022 were included. The primary outcome measures included patterns of recurrence, overall survival, and relapse-free survival. Patterns of recurrence were categorized as lateral or central pelvic. RESULTS: Among patients who underwent lateral lymph node dissection, 18.1% had pathologically positive lateral lymph node metastasis. Lateral pelvic recurrence occurred in 5.5% of patients after surgery. Multivariate analysis identified age > 75 years, lateral lymph node metastasis, and adjuvant chemotherapy as independent risk factors for lateral pelvic recurrence. Evaluation of the recurrence rate by dissection area revealed approximately 1% of recurrences in each area after dissection. CONCLUSION: We demonstrated the prognostic outcome and limitations of lateral lymph node dissection for patients with advanced lower rectal cancer, focusing on the incidence of recurrence in the lateral area after the dissection. Our study emphasizes the clinical importance of lateral lymph node dissection, which is an essential technique that surgeons should acquire.


Assuntos
Excisão de Linfonodo , Recidiva Local de Neoplasia , Pelve , Neoplasias Retais , Humanos , Neoplasias Retais/cirurgia , Neoplasias Retais/patologia , Feminino , Masculino , Idoso , Recidiva Local de Neoplasia/patologia , Pessoa de Meia-Idade , Pelve/cirurgia , Pelve/patologia , Metástase Linfática , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Adulto , Estudos Retrospectivos , Fatores de Risco , Análise Multivariada
18.
Am J Sports Med ; 52(7): 1735-1743, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38767153

RESUMO

BACKGROUND: Spinopelvic parameters, including pelvic tilt (PT), sacral slope (SS), and pelvic incidence, have been developed to characterize the relationship between lumbar spine and hip motion, but a paucity of literature is available characterizing differences in spinopelvic parameters among patients with femoroacetabular impingement syndrome (FAIS) versus patients without FAIS, as well as the effect of these parameters on outcomes of arthroscopic treatment of FAIS. PURPOSE: To (1) identify differences in spinopelvic parameters between patients with FAIS versus controls without FAIS; (2) identify associations between spinopelvic parameters and preoperative patient-reported outcomes (PROs); and (3) identify differences in PROs between patients with stiff spines (standing-sitting ΔSS ≤10°) versus those without. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: The study enrolled patients ≥18 years of age who underwent primary hip arthroscopy for treatment of FAIS with cam, pincer, or mixed (cam and pincer) morphology. Participants underwent preoperative standing-sitting imaging with a low-dose 3-dimensional radiography system and were matched on age and body mass index (BMI) to controls without FAIS who also underwent EOS imaging. Spinopelvic parameters measured on EOS films were compared between the FAIS and control groups. Patients with FAIS completed the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) before surgery and at 1-year follow-up. Outcome scores were compared between patients with stiff spines versus those without. Associations between spinopelvic parameters and baseline outcome scores were assessed with Pearson correlations. Continuous variables were compared with Student t test and/or Mann-Whitney U test, and categorical variables were compared with Fisher exact test. RESULTS: A total of 50 patients with FAIS (26 men; 24 women; mean age, 36.1 ± 10.7 years; mean BMI, 25.6 ± 4.2) were matched to 30 controls without FAIS (13 men; 17 women; mean age, 36.6 ± 9.5 years; mean BMI, 26.7 ± 3.6). Age, sex, and BMI were not significantly different between the FAIS and control groups (P > .05). Standing PT was not significantly different between stiff and non-stiff cohorts (P = .73), but sitting PT in the FAIS group was more than double that of the control group (36.5° vs 15.0°; P < .001). Incidence of stiff spine was significantly higher in the FAIS group (62.0% vs 3.3%; P < .001). Among FAIS patients, those with stiff spines had a significantly higher prevalence of cam impingement, whereas those with non-stiff spines had a higher prevalence of mixed impingement (P = .04). No significant differences were seen in preoperative mHHS or NAHS scores or pre- to postoperative improvement in scores between FAIS patients with stiff spines versus those without (P > .05), but a greater sitting SS was found to be positively correlated with a higher baseline mHHS (r = 0.36; P = .02). CONCLUSION: Patients with FAIS were more likely to have a stiff spine (standing-sitting ΔSS ≤10°) compared with control participants without FAIS. FAIS patients with stiff spines were more likely to have isolated cam morphology than patient without stiff spines. Although sitting SS was positively correlated with baseline mHHS, no significant differences were seen in 1-year postoperative outcomes between FAIS patients with versus without stiff spine.


Assuntos
Artroscopia , Impacto Femoroacetabular , Medidas de Resultados Relatados pelo Paciente , Humanos , Impacto Femoroacetabular/cirurgia , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/fisiopatologia , Feminino , Masculino , Adulto , Adulto Jovem , Pessoa de Meia-Idade , Vértebras Lombares/cirurgia , Vértebras Lombares/diagnóstico por imagem , Articulação do Quadril/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Pelve/cirurgia , Pelve/diagnóstico por imagem , Resultado do Tratamento , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/cirurgia
19.
Radiat Prot Dosimetry ; 200(8): 770-778, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38726990

RESUMO

This study aimed to evaluate the dose reduction using gonad shielding (GS) during pelvic imaging. Three types of pelvic images (radiography, magnetic resonance and computed tomography) were fused to elucidate the three-dimensional relationship between the position of ovaries and GS. To estimate the dose received by the ovaries, the off-axis dose at any given depth was measured under two different imaging conditions using thermoluminescence dosemeters and a polymethyl methacrylate phantom. The mean ovarian depth was 8.4 cm. The mean estimated ovarian dose without an additional filter was 0.36 mGy without GS and 0.14 mGy with GS. The mean estimated ovarian dose with an additional filter was 0.24 mGy without GS and 0.10 mGy with GS. The efficacy of ovarian dose reduction should be evaluated based on the achieved ovarian dose, considering the ovarian depth and use of additional filtration, rather than the ovarian protection rate of GS.


Assuntos
Ovário , Pelve , Imagens de Fantasmas , Doses de Radiação , Proteção Radiológica , Feminino , Humanos , Proteção Radiológica/métodos , Ovário/efeitos da radiação , Ovário/diagnóstico por imagem , Pelve/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Dosimetria Termoluminescente/instrumentação , Gônadas/efeitos da radiação
20.
Appl Ergon ; 119: 104310, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38776566

RESUMO

Dynamic sitting may mitigate low back pain during prolonged seated work. The current study compared pelvis and lumbar spine kinematics, pain, and work productivity, in traditional and dynamic sitting. Sixteen participants completed three 20-min blocks of computer work and activity guided tasks in a traditional office chair or backless and multiaxial rotating seat pan while kinematics were measured from accelerometers on the low back. Pain ratings were recorded on a visual analogue scale every 10 min. Similar pelvis and lumbar kinematics emerged when performing computer work in traditional and dynamic sitting. Pelvis and lumbar sagittal and frontal plane shifts and fidgets were largest for dynamic sitting in the activity guided tasks. Buttocks pain was higher in dynamic sitting, but low back pain and work productivity were unaffected. Dynamic sitting increased spine movement during activity guided tasks, without negatively impacting lumbar kinematics, low back pain, or productivity during seated computer work.


Assuntos
Dor Lombar , Vértebras Lombares , Postura Sentada , Humanos , Fenômenos Biomecânicos , Masculino , Vértebras Lombares/fisiologia , Vértebras Lombares/fisiopatologia , Feminino , Dor Lombar/etiologia , Dor Lombar/fisiopatologia , Adulto , Adulto Jovem , Movimento/fisiologia , Computadores , Pelve/fisiologia , Acelerometria , Medição da Dor , Análise e Desempenho de Tarefas , Ergonomia , Eficiência/fisiologia , Postura/fisiologia , Nádegas/fisiologia , Doenças Profissionais/etiologia , Trabalho/fisiologia
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