Age-related trends of lesser pelvic architecture in females and males: a computed tomography pelvimetry study / 대한해부학회지

The pelvis and the spine form a system balancing human skeleton. Within this system, the pelvis adapts to age-related changes in the spine. Previous studies were predominantly focused on changes of pelvic parameters in the sagittal plane. The aim of this study was to reveal age-related changes of lesser pelvic dimensions at different levels of the pelvic cavity in the sagittal and coronal planes and to explore sexual dimorphism in age-related tendencies. The computed tomography pelvimetry was performed on the three-dimensional workstation. The research sample included 211 females aged 18 to 84 years and 181 males aged 18 to 82 years, who underwent an examination at the Riga East University Hospital, Clinical Center “Gailezers,” Latvia. Three pelvic angles and transverse and sagittal diameters of the lesser pelvis were measured at four levels: the inlet, two axial planes in the mid-cavity, and the outlet. The results demonstrated that more pronounced age-related changes occurred in the inlet and the outlet of the lesser pelvis. The mid-cavity was less changing. The transverse diameter between acetabular centers and the sagittal diameter at the level of ischial spines were independent of age. In general, the common age-related trends were observed for pelvic parameters in females and males. A single exception was the proportion of diameters at the level of ischial spines, which decreased in males only. For parameters associated with pelvic floor diseases, age-related changes occurred in the direction of pathology.

Right sided descending and sigmoid colon: its embryological basis and clinical implications / 대한해부학회지

Anatomical variations of the colon are described by various authors, but the occurrence of right sided descending and sigmoid colon is rare and has not been reported. We found that the anomalous right-sided descending and sigmoid colon had four parts. The proximal segment of the first part consisted of the descending colon extending across the midline from the splenic flexure to the portion supplied by the left colic artery. The distal segment was supplied by the superior sigmoid artery. The second and third parts formed a loop in the right lumbar region anterior to the lumbar cecum. The fourth part was in the lesser pelvis, extending from right sacroiliac joint to the third sacral body. Parts two, three, and four were supplied by the inferior sigmoid artery, which arose from the right side of the inferior mesenteric artery. The ascending and transverse colon was normally placed. This is a rare anomaly that has not been reported so far in adults and is of immense importance to interventional radiologists and colorectal surgeons. The embryological basis of such an anomaly is defective fixation occurring as early as the 12th-17th week of intrauterine life.

A Case of Recurrent Endometrial Carcinoma at the Vagina / 대한산부인과학회잡지

FIGO stage III endometrial carcinoma, which is extending outside the uterus, but limited to the true pelvis represent a small subgroup of patients with endometrial carcinoma. This stage of disease is uncommon and only limited experience is available regarding the management of this advanced stage of disease. And isolated vaginal recurrence of endometrial carcinoma occurs infrequently following hysterectomy and appropriate use of external beam irradiation and brachytherapy. We experienced one case of recurrent endometrial carcinoma at the vagina after total abdominal hysterectomy with bilateral salpingo-oophorectomy and adjuvant radiotherapy for stage III endometrial cancer in 41-year old woman who was treated with complete local excision of vaginal recurrent cancer mass and locovaginal radiotherapy. The clinicopathologic finding and a review of literature on endometrial carcinoma were described briefly.

A Case of Splenic Embolization Followed by Splenectomy with Preservation of Accessory Spleen in Gaucher's Disease

Gaucher's disease is an autosomal recessive genetic disorder of lipid metabolism. A deficiency of beta-glucocerebrosidase causes an accumulation of glucocerebroside in the reticulo-endothelial system and bone marrow. Total or partial splenectomy has been used in case of massive splenomegaly with hypersplenism and/or mechanical pressure symtoms. Partial splenectomy is preferred to prevent susceptibility to overwhelming postsplenectomy sepsis and to delay the massive deposition of glucocerebroside in the liver and bones. We report the case of a 20-year-old woman with Gaucher's disease and who had a splenic embolization 4 years ago. The spleen cross the midline of the abdomen reached to the true pelvis and elevated the left diaphragm. Angiotensin-converting enzyme, acid phophatase and ESR were increased but beta-glucocerebrosidase was normal. Osteosclerotic changes of the distal femur was observed. Hepatomegaly and splenomegaly with mutiple accessory spleens were seen on abdominal CT. On isotope scan for liver and spleen, multiple accessory spleens had isotope uptake, but spleen did not. We noted severe adhesion of spleen to neighboring structure and no viable splenic tissue for preservation. Total splenectomy with preservation of four accessory spleens was performed. We needed multiple transfusion during dissection and bleeding was continuous for 3 days postoperatively. The patient was discharged without problems on the postoperative 15 th day.

Intrinsic Endometriosis of Ureter: A Case Report

Endometriosis is a rare cause of an ureteral obstruction. We report a case of intrinsic ureteral endometriosis resulting in severe hydroureteronephrosis. The diagnosis of ureteral endometriosis may be considered in women with flank pain and ureteric obstruction within true pelvis.

Periprostatic Pelvic Arteriovenous Malformation with Postejaculatory Hematuria / 대한비뇨기과학회지

Congenital arteriovenous malformations in the true pelvis are extremely rare : only 8 cases have been described in male patient. In most cases, the diagnosis may be obscure and the management is difficult due to frequent recurrence, so appropriate angiographic study is decisive in establishing the diagnosis and directing the mode of treatment. We report on 53 year old male patient who was treated with embolization due to congenital pelvic arteriovenous malformation with painless gross hematuria after erection or sexual intercourse. Diagnosis was established as periprostatic pelvic arteriovenous malformation by means of transrectal color Doppler ultrasonography and confirmed by angiography. Our attempt at management by embolization is described. A literature review and discussion of congenital arteriovenous malformation and worth of color Doppler ultrasonography are presented.

Results of Radiation Therapy in Stage III Uterine Cevical Cancer / 대한치료방사선과학회지

PURPOSE: The aim of this study is to analyze the survival rate, treatment failure and complication of radiation therapy alone in stage III uterine cervical cancer. MATERIALS AND METHODS: From January 1980 through December 1985, 227 patients with stage II uterine cervical cancer treated with radiation therapy at Kosin Medical Center were retrospectively studied. Among 227 patients, 72 patients(31.7%) were stage IIIa, and 155 patients(68.3%) were stage IIIb according to FIGO classification. Age distribution was 32-71 years(median: 62 years). Sixty nine patients(95.8%) in stage IIIa and 150 patients(96.8%) in stage IIIb were squamous cell carcinoma. Pelvic lymphnode metastasis at initial diagnosis was 8 patients (11.1%) in stage IIIa and 29 patients(18.7%) in stage IIIb. Among 72 patients with stage IIIa, 36 patients(50%) were treated with external radiation therapy alone by conventional technique (180-200 cGy/fr). And 36 patients(50%) were treated with external radiation therapy with intracavitary radiotherapy(ICR) with Cs137 sources, and among 155 patients with stage IIIb, 80 patients(51.6%) were treated with external radiation therapy alone and 75 patients(48.4%) were treated with external radiation therapy with ICR. Total radiation doses of stage IIIa and IIIb were 65-105 Gy(median : 78.5 Gy) and 65-125.5 Gy (median :83.5 Gy). Survival rate was calculated by life-table method. RESULTS: Complete response rates were 58.3% (42 patients) in state IIIa and 56.1%(87 patients) in stage Iiib. Overall 5 year survival rates were 57% in stage IIIa and 40% in stage IIIb. Five year survival rates by radiation technique in stage IIIa and IIIb were 64%, 40% in group treated in combination of external radiation and ICR, and 50%, 40% in the group of external radiation therapy alone(P=NS). Five year survival rates by response of radiation therapy in stage IIIa and IIIb were 90%, 66% in responder group, and 10%, 7% in non-responder group (p<0.01). There were statistically no significances of 5 year survival rate by total radiation doses and external radiation doses (40 Gy vs 50 Gy) of whole or true pelvis in stage IIIa and IIIb(P=NS). Treatement failures rates were 40.3%(29 patients) in stage IIIa and 57.4%(89 patients) in stage IIIb, 17 patients (23.6%) in stage IIIa and 46 patients (29.7%) in stage IIIb experienced complications. Total radiation doses more than 85 Gy produced serious complication in both stage IIIa(50%) and Iib(50%), Serious complicaton rates were higher in group received externl radiaton doses of 50 Gy than 40 Gy to whole or true pelvis in stage IIIa and IIIb. Seious rectal complication developed in rectal doses more than 65 Gy, and serious bladder complication developed in bladder doses more than 75 Gy. Major cause of deah was cachexia due to locoregional failure in both stage IIIa(34.7%) and IIIb(43.9%). CONCLUSION: From this study, we found that external radiation therapy with ICR was found to have a tendency to be superior to external radiation therapy alone in survival rate, local control rate and complication rate but not different in statistics, and external radiation doses of 50 Gy than 40 Gy tho whole or true pelvis produced serious rectal and bladder complications in stage III uterine cervical cancer.