Evaluation of the Association between Pelvic Diameters and Pelvic Types on Computed Tomography Images in Healthy Turkish Females / Evaluación de la Asociación entre Diámetros Pélvicos y Tipos de Pelvis en Imágenes de Tomografías Computarizadas en Mujeres Turcas Sanas

SUMMARY: Pelvis contributes to both human locomotion and obstetrics, and normal vaginal delivery is associated with a spacious inlet, a large interspinosus diameter. This paper aimed to measure crucial diameters of pelvic ring, and to determine both the prevalence of pelvic types, and labor types including normal vaginal delivery or caesarean section in Turkish healthy females. Additionally, it was aimed to evaluate presence of relationship between pelvic types and pelvic diameters. Labor shape of subjects was obtained from hospital records. This retrospective study was carried out on 165 healthy subjects aged between 18 and 45 years. Anteroposterior diameter of the pelvic inlet (APDI), anteroposterior diameter of the pelvic outlet, sacrum length (SL), sacrum depth, conjugata vera, obstetrical conjugate, the diagonal conjugate, diameter transversa, diameter bispinous, intertuberous diameter were measured. From these measurements, brim index was calculated and decided to gynecoid, anthropoid and platypelloid type. Also, the andoid type was calculated to the ratio of posterior sagittal diameter of the inlet to conjugata obstetrica. 50.91 % of participants has gynecoid type pelvis, followed by 24.85 % anthropoid type, 14.55 % platypelloid, and 9.70 % android type pelvis. There was a significant difference in APDI, SL, SD, Conjugata vera, Conjugata obstetrica, Conjugata diagonalis, Conjugata transversa, diameter bispinous, diameter intertubercularis and Brim index measurements according to pelvic types. the first degree of narrowing (conjugata vera from 11 to 9) was found in 18 pelvises and 12 pelvises with the pathological degree of narrowing bellonged to the platypelloid type followed by android type pelvis with 6 pelvices. The android type pelvis is not appropriate for natural labor and a good assessment of birth canal can reduce the labor risks. Also, only 7 females who delivered with cesarean have gynecoid type pelvic type. The APDI and SL were significantly lower in subjects having pathological narrowing according to conjugata obstetrica values.

La pelvis contribuye tanto a la locomoción humana como a la obstetricia. El parto vaginal normal se asocia con una entrada espaciosa y un diámetro interespinoso grande. Este artículo tuvo como objetivo medir diámetros cruciales del anillo pélvico y determinar tanto la prevalencia de los tipos pélvicos como los tipos de parto, incluido el parto vaginal normal o la cesárea en mujeres turcas sanas. Además, se buscó evaluar la presencia de relación entre los tipos de pelvis y los diámetros de la pelvis. La forma laboral de los sujetos se obtuvo de los registros hospitalarios. Este estudio retrospectivo se llevó a cabo en 165 mujeres sanas con edades comprendidas entre 18 y 45 años. Se midieron el diámetro anteroposterior de la entrada pélvica (APDPI), el diámetro anteroposterior de la salida pélvica, la longitud del sacro (SL), la profundidad del sacro, la conjugada vera, el conjugado obstétrico, el conjugado diagonal, el diámetro transverso, el diámetro biespinoso y el diámetro intertuberoso. A partir de estas mediciones se calculó el índice del ala y se decidió tipo ginecoide, antropoide y platipoide. Además, el tipo androide se calculó en función de la relación entre el diámetro sagital posterior de la entrada y la conjugada obstétrica. El 50,91 % de los participantes tenía pelvis de tipo ginecoide, seguida del 24,85 % de pelvis de tipo antropoide, el 14,55 % de tipo platipeloide y el 9,70 % de tipo androide. Hubo una diferencia significativa en las mediciones de APDPI, SL, SD, Conjugada vera, Conjugada obstétrica, Conjugada diagonal, Conjugata transversa, diámetro biespinoso, diámetro intertubercular e índice de ala según los tipos de pelvis. El primer grado de estrechamiento (conjugada vera del 11 al 9) se encontró en 18 pelvis y 12 pelvis, siendo el grado patológico de estrechamiento del tipo platipeloide seguido de pelvis tipo androide con 6 pelvis. La pelvis tipo androide no es apropiada para el parto natural y una buena evaluación del canal del parto puede reducir los riesgos. Además, solo 7 mujeres que dieron a luz por cesárea tenían un tipo pélvico de tipo ginecoides. El APDPI y SL fueron significativamente más bajos en mujeres que tenían estrechamiento patológico según los valores obstétricos conjugados.

Is There Any Difference Between a Spherical Marker and a Simple Coin for Hip Replacement Digital Planning? / Existe alguma diferença entre um marcador esférico e uma moeda simples para planejamento digital de substituição de quadril?

Abstract Objective To evaluate the accuracy and differences between 2 types of metallic markers, sphere, and coin, for radiographic calibration in the preoperative planning of hip arthroplasty. Methods Four spherical metallic markers and four coins, both 25 mm in diameter, were placed on the greater trochanter, pubic symphysis, between the thighs, and on the table of the exam, for radiographic examination of the hip in 33 patients with hip prosthesis. The prosthesis head was used for calibration and two examiners measured the markers' image diameters, and the results were analyzed statistically. Results In the greater trochanter, the sphere and the coin were not visualized in 19 radiographs (57.6%). Between the thighs, the coin marker was not visualized in 13 radiographs (39.4%). In the greater trochanter, the 25-mm accuracy of the coin and the sphere was, respectively, between 57.1 and 63.3% and between 64.3 and 92.9%. The coin between the thighs reached 25-mm accuracy in between 50 and 60% of cases. Over the exam table, the coin and sphere markers reached, respectively, the mean diameters of 22.91 mm and 23 mm, the lowest coefficient of variation, the lowest confidence interval, and the easiest positioning. There was statistical difference between the evaluations of the markers (coin vs. sphere) in all positions (p< 0.032), except for the exam table position (p= 0.083). Conclusions The coin between the thighs is the best marker for radiographic calibration in the preoperative planning of hip arthroplasty, and we suggest the use of another coin on the exam table for comparison, considering the 8% reduction in relation to its real size.

Resumo Objetivo Avaliar a precisão e as diferenças entre 2 tipos de marcadores metálicos, esfera e moeda, para calibração radiográfica no planejamento pré-operatório da artroplastia de quadril. Métodos Quatro marcadores metálicos esféricos e quatro moedas, ambas de 25 mm de diâmetro, foram colocadas em trocânter maior, sínfise púbica, entre as coxas e a mesa do exame, para exame radiográfico do quadril em 33 pacientes com prótese de quadril. A cabeça da prótese foi utilizada para calibração e dois examinadores mediram os diâmetros da imagem dos marcadores, e os resultados foram analisados estatisticamente. Resultados No trocânter maior, a esfera e a moeda não foram visualizadas em 19 radiografias (57,6%). Entre as coxas, o marcador de moeda não foi visualizado em 13 radiografias (39,4%). No trocânter maior, a precisão de 25 mm da moeda e da esfera foi, respectivamente, entre 57,1 e 63,3% e entre 64,3 e 92,9%. A moeda entre as coxas atingiu 25 mm de precisão entre 50 e 60%. Sobre a mesa de exame, os marcadores de moeda e esfera atingiram, respectivamente, diâmetros médios de 22,91 mm e 23 mm, o menor coeficiente de variação, o menor intervalo de confiança e o posicionamento mais fácil. Houve diferença estatística entre as avaliações dos marcadores (moeda vs. esfera) em todas as posições (p< 0,032), com exceção da posição na mesa de exame (p= 0,083). Conclusões A moeda entre as coxas é o melhor marcador para calibração radiográfica no planejamento pré-operatório da artroplastia de quadril, e sugerimos o uso de outra moeda na mesa de exame para comparação, considerando os 8% de redução em relação ao seu tamanho real.

Resonancia magnética en el estudio de dos pacientes con dolor pélvico crónico asociado a endometriosis de infiltración profunda / Magnetic resonance imaging in the study of two patients with chronic pelvic pain associated to infiltrating endometriosis deep

INTRODUCCIÓN: La endometriosis de infiltración profunda (EIP) es una enfermedad crónica de difícil diagnóstico, que frecuentemente es confundida con otras patologías pelvianas. OBJETIVO: Presentar dos casos de endometriosis de infiltración profunda, donde la resonancia magnética (RM) de pelvis, fue importante para el diagnóstico y planificación del tratamiento quirúrgico. CASO CLÍNICO: Se describe el caso de dos pacientes. La primera de 24 años afectada por un nódulo de EIP retrocervical con extensión intestinal sintomática y la segunda, una paciente de 37 años con una recidiva sintomática de EIP en la cúpula vaginal después de una histerectomía total. RESULTADOS: La RM de pelvis describe en ambos casos la extensión de las lesiones endometriósicas y presenta una excelente correlación con los hallazgos intra operatorios en la laparoscopía quirúrgica. CONCLUSIONES: La RM de pelvis es un excelente recurso en el estudio diagnóstico de las pacientes con dolor pélvico crónico, tanto en el caso de EIP retrocervical con extensión intestinal y también en la recidiva de EIP en la cúpula vaginal después de una histerectomía total

INTRODUCTION: Deep infiltration endometriosis (DIE) is a chronic disease of difficult diagnosis, which is frequently confused with other pelvic pathologies. OBJETIVE: To present two cases of deep infiltrating endometriosis, where the pelvic magnetic resonance imaging (MRI) was important in the diagnosis and surgical treatment planning. CLINICAL CASES: Two cases, one 24 years-old patient suffering from retrocervical DIE nodule with symptomatic bowel involvement, and a 37 years-old patient, with a symptomatic DIE at the vaginal cuff after total hysterectomy. RESULTS: Pelvic MRI describes in both cases the extension of the endometriotic lesions and presents an excellent correlation with the intra operatory findings during surgical laparoscopy. CONCLUSIONS: Pelvic MRI is an excellent diagnostic tool for patients with pelvic pain, in case of retrocervical DIE with bowel involvement, and also in recurrence of DIE at the vaginal cuff after total hysterectomy

El fin de la protección gonadal en radiografía de pelvis: una revisión / The end of gonadal protection in pelvic radiography: a review

Resumen: La protección gonadal ha sido durante largo tiempo un importante factor para abordar el requisito "tan bajo como sea razonablemente posible" ALARA. El presente artículo realiza una revisión sistemática sobre la utilidad de la protección gonadal en la radiografía de pelvis en la cual se han destacado los factores que tienen que ver con su realización diaria, es decir, la dosis de radiación involucrada, la radiosensibilidad de las gónadas, la posición del protector gonadal y el factor psicológico de la población en relación con su uso. La incorporación de equipamientos modernos, con dosis y protocolo optimizados, transforma el beneficio de la protección en un tema al menos debatible. Mientras algunos siguen respaldando la medida, otros organismos y autores ya no la respaldan. Es necesario reconsiderar prácticas actuales fundadas en consensos científicos que pueden estar obsoletos y considerar el factor de cambio cultural basados en estos nuevos consensos para su implementación, sin generar mayor preocupación en la población.

Abstract: Gonadal protection has long been an important factor in addressing the ALARA "as low as reasonably possible" requirement. This article performs a systematic review on the usefulness of gonadal protection in pelvic radiography, in which the factors that have to do with its daily performance have been highlighted, that is, radiation dose involved, the radiosensitivity of the gonads, the position of the gonadal shielding and the psychological factor of the population in relation to its use. The incorporation of modern equipment, with optimized dose and protocols, transforms the benefit of gonad shielding into an issue that is at least debatable. While some continue to support the measure, other agencies and authors no longer support it. It is necessary to reconsider current practices based on scientific consensus that may be obsolete and consider the factor of cultural change based on these new consensus for its implementation, without generating major concern in the population.

Is it Important to Know Where to Place the Spherical Marker for Hip Replacement Digital Planning? / É importante saber onde posicionar o marcador esférico para o planejamento digital de artroplastia de quadril?

Abstract Objective The present paper aims to evaluate the influences of individual characteristics in radiographic magnification and to identify the most accurate method for radiographic calibration. Methods During radiographical exam of 50 patients with hip prosthesis, anthropometric data was collected and 4 spherical metal markers with 25 mm diameters were positioned: at the greater trochanter level and lateral to it, over the pubic symphysis, between the thighs at the greater trochanter level, and over the exam table. Since the prosthesis head is the best internal radiographic marker for hip arthroplasty, it was our calibration parameter. Two examiners measured the markers' image for further analysis. Results The sample consisted of 50 participants, 19 of whom were male. A difference in pubic symphysis magnification was found. Other individual characteristics (weight, height and body mass index) had weak correlation. The higher accuracy of the markers was at the greater trochanter, between 68.4 and 78.9%, visualized in only19 radiographs. The marker positioned between the thighs was visualized in all radiographs, with an accuracy ranging from 30 to 46%. Conclusions Of all individual characteristics, only gender influences magnification at the pubic symphysis. We suggest the use of two spherical markers: at the greater trochanter, due the best accuracy, and between the thighs, considered the best positioning for better visibility.

Resumo Objetivo Os objetivos desse artigo são avaliar as influências das características pessoais na magnificação radiográfica e identificar o método de maior acurácia e o mais adequado. Métodos Durante o exame radiográfico em 50 pacientes com prótese de quadril, foram coletados dados antropométricos e posicionados quatro marcadores metálicos esféricos: ao nível e lateral ao trocânter maior, na sínfise púbica, ao nível do trocânter maior entre as coxas, sobre a mesa do exame. A cabeça da prótese é o melhor marcador radiográfico interno e foi o nosso parâmetro de calibragem. Dois avaliadores mediram as imagens desses marcadores para análise de resultados. Resultados Foram selecionados 50 participantes, sendo 19 do sexo masculino. Houve diferença de magnificação entre os sexos na posição sínfise púbica. As outras características pessoais avaliadas (peso, altura e índice de massa corpórea) tiveram correlação fraca. A maior acurácia do marcador foi no trocânter maior, entre 68,4 e 78,9%, visualizado em apenas 19 radiografias. O marcador entre as coxas obteve acurácia entre 30 e 46% e foi visualizado em todas as radiografias. Conclusão Das características pessoais, apenas o sexo influencia a magnificação e somente na posição da sínfise púbica. Sugerimos padronizar o uso de duas esferas: no trocanter maior, pela maior acurácia, e entre as coxas, por ser o mais adequado e com melhor visibilidade em todas radiografias.

Pubic arch angle measurement by transperineal ultrasonography: a prospective cross-sectional study / Medida do ângulo do arco púbico por ultrassonografia transperineal: um estudo prospectivo transversal

Abstract Objective To evaluate the ability of the pubic arch angle (PAA) as measured by transperineal ultrasonography during labor to predict the delivery type and cephalic pole disengagement mode. Methods The present prospective cross-sectional study included 221 women in singleton-gestational labor ≥ 37 weeks with cephalic fetuses who underwent PAA measurement using transperineal ultrasonography. These measurements were correlated with the delivery type, cephalic pole disengagement mode, and fetal and maternal characteristics. Results Out of the subjects, 153 (69.2%) had spontaneous vaginal delivery, 7 (3.2%) gave birth by forceps, and 61 (27.6%) delivered by cesarean section. For the analysis, deliveries were divided into two groups: vaginal and surgical (forceps and cesarean). The mean PAA was 102 ± 7.5º (range, 79.3-117.7º). No statistically significant difference was observed in delivery type (102.6 ± 7.2º versus 100.8 ± 7.9º, p = 0.105). The occipitoanterior position was seen in 94.1% of the fetuses and the occipitoposterior position in 5.8%. A narrower PAA was found in the group of surgical deliveries (97.9 ± 9.6º versus 102.6 ± 7.3º, p = 0.049). Multivariate regression analysis showed that PAA was a predictive variable for the occurrence of head disengagement in occipital varieties after birth (odds ratio, 0.9; 95% confidence interval, 0.82-0.99; p = 0.026). Conclusion Ultrasonographic measurement of the PAA was not a predictor of delivery type, but was associated with the persistence of occipital varieties after birth.

Resumo Objetivo Avaliar a medida do ângulo do arco púbico (AAP) por ultrassonografia transperineal durante trabalho de parto em predizer tipo de parto e modo de desprendimento do polo cefálico. Métodos Um estudo prospectivo transversal foi conduzido com 221 mulheres em trabalho de parto com gestação única ≥ 37 semanas, com fetos em apresentação cefálica, foram submetidas à avaliação ultrassonográfica por via transperineal para aferição do AAP. Correlações com tipo de parto, modo de desprendimento do polo cefálico e características fetais e maternas foram realizadas. Resultados Um total de 153 (69,2%) mulheres apresentaram parto vaginal espontâneo, 7 (3,2%) parto a fórceps e 61 (27,6%) parto cesárea. Para fins de análise, dividiu-se os partos em dois grupos: partos vaginais e cirúrgicos (fórceps e cesáreas). A média do AAP foi 102 ± 7,5º (variação: 79,3-117,7º). Não foi observada significância estatística do AAP em relação ao tipo de parto (102,6 ± 7,2º versus 100,8 ± 7,9º; p = 0,105). Um total de 94,1% dos fetos desprenderam em variedade de posição occipito anterior e 5,8% em occipito posterior. Encontrou-se AAP mais estreitado no grupo de partos cirúrgicos (97,9 ± 9,6º versus 102,6 ± 7,3º; p = 0,049). A análise de regressão multivariada demonstrou que AAP foi uma variável de proteção para a ocorrência de desprendimento da cabeça em variedades occipito posteriores ao nascimento (odds ratio [OR]= 0,9; índice de confiança (IC) 95%: 0,82-0,99; p = 0,026). Conclusão A medida ultrassonográfica do AAP não foi preditora do tipo de parto, porém demonstrou associação com persistência de variedades occipito posteriores ao nascimento.

Diseño y aplicación piloto de un atlas imagenológico de pelvis femenina utilizando dispositivos móviles como apoyo al aprendizaje de la anatomía humana / Design and pilot application of an image atlas of female pelvis using mobile devices to support the learning of human anatomy

Resumen: Introducción: Las imágenes médicas constituyen un recurso de enseñanza-aprendizaje que complementa las metodologías tradicionales en el estudio de la Anatomía Humana para las profesiones de la salud. La pelvis femenina es una entidad anatómica compleja que contiene estructuras de varios sistemas, cuyas relaciones anatómicas son susceptibles de estudiar con detalle utilizando imágenes de resonancia magnética. Propósito: Diseñar una aplicación móvil como complemento al aprendizaje de la anatomía radiológica de la pelvis femenina y realizar una aplicación piloto a baja escala. Metodología: Se diseñó una aplicación móvil de anatomía normal de la pelvis femenina utilizando recursos gratuitos disponibles en línea, a partir de imágenes anonimizadas de resonancia magnética del archivo digital local. A partir de literatura anatómica relevante se seleccionaron las estructuras a rotular. Para evaluar la percepción de los usuarios, se diseñó y aplicó una encuesta por vía digital. Resultados: La aplicación móvil interactiva fue diseñada para dispositivos Android, con 7 secciones y 107 imágenes. Existió una adecuada recepción de la herramienta por parte de los seis estudiantes que participaron en la implementación piloto, destacando la accesibilidad como el principal aspecto a mejorar. Conclusión: Este atlas imagenológico a través de dispositivos móviles es un complemento del aprendizaje de la anatomía humana utilizando imágenes médicas.

Abstract: Introduction: Medical imaging is a teaching-learning resource that complements traditional methodologies in the study of Human Anatomy to health professions. The female pelvis is a complex anatomical entity that contains structures of several systems, whose anatomical relationships can be studied in detail using magnetic resonance imaging. Purpose: To design a mobile application as a complement to the learning of the radiological anatomy of the female pelvis and to carry out a pilot application in a small scale. Methodology: A mobile application of normal anatomy of the female pelvis was designed using free resources available online from anonymized magnetic resonance images from the local digital archive. The structures to be labelled were selected from relevant anatomical literature. In order to evaluate user's perception, a digital survey was designed and applied. Results: The interactive mobile application was designed for Android devices, with 7 sections and 107 images. There was an adequate reception of the tool by the six students who participated in the pilot implementation, highlighting accessibility as the main aspect to improve. Conclusion: This atlas imaging through mobile devices is a complement to the learning of human anatomy using medical images.

Radiographic pelvimetry in 0 to 24 month-old pacas (Agouti paca, Linnaeus, 1766) / Pelvimetria radiográfica em pacas de 0 a 24 meses de idade (Agouti paca, Linnaeus, 1766)

The pelvimetry consists of the metric determination of the pelvis dimensions and its use is directly related to the reproduction. The cartilage closure time of the ossification centers varies according to the bone, some closing already in the uterine life and others remaining present for many years. The objective was to evaluate, radiographically, the pelvic diameters by pelvimetry during the first 24 months of life in pacas, the second lagest Brazilian rodent and an animal that has shown big recent scientific interest, aiming the estimated age determination. Twelve pacas were used, which were monthly radiographed up from birth until 24 months old, with the animals anesthetized. The pacas are dolicopelvic animals and with pelvis presenting strong tendency to constant growth along the 12 first months of age, fact that can be useful in the approximated animals' age determination that do not have precise birth date, for example.(AU)

A pelvimetria consiste na determinação métrica das dimensões pélvicas, e sua utilização está diretamente relacionada à reprodução. O momento de fechamento da cartilagem dos centros de ossificação varia de acordo com o osso, algumas fechando já na vida uterina e outras permanecendo presentes por vários anos. Objetivou-se avaliar, radiograficamente, os diâmetros pélvicos, mediante pelvimetria, durante os 24 primeiros meses de vida de pacas, o segundo maior roedor brasileiro e sobre o qual tem havido grande interesse científico, para a determinação aproximada da idade. Foram utilizadas 12 pacas, as quais foram radiografadas mensalmente a partir do nascimento até 24 meses de idade, com os animais anestesiados. As pacas são animais dolicopélvicos e com pelve apresentando forte tendência ao crescimento constante durante os 12 primeiros meses de vida, o que pode ser útil na determinação aproximada da idade em animais que não possuem data precisa de nascimento, por exemplo.(AU)

Prevalencia de divertículos colónicos asintomáticos en población chilena como hallazgo imagenológico en tomografía de abdomen y pelvis / Prevalence of asymptomatic colonic diverticula in Chilean population as an imaging finding in abdominal and pelvic tomography

INTRODUCCIÓN: La prevalencia de diverticulosis colónica en población general varía entre 20-60% según referencias internacionales, sin embargo, hay escasos datos nacionales. Un buen método para la detección de esta entidad es la tomografía computarizada de abdomen y pelvis (TACP). OBJETIVOS: Determinar la prevalencia de diverticulosis colónica en población general como hallazgo en tomografías computarizadas de abdomen y pelvis. MATERIALES Y MÉTODO: Estudio de corte transversal con estadística observacional, seleccionando pacientes sin antecedentes de diverticulosis que se realizaron TCAP en un hospital clínico en un periodo de 3 meses. Se revisan 1.449 TCAP y se incluyen 1.177 casos. RESULTADOS: La prevalencia general de divertículos colónicos fue de 28,3%, esta cifra aumenta con la edad alcanzando un 60% en mayores de 80 años. Casi un 90% se localizan en colon izquierdo, y los casos en lado derecho se acumulan en menores de 60 años. CONCLUSIONES: La prevalencia global de diverticulosis, detectadas por TCAP en esta población, corresponde a cerca del 30% de los pacientes.

INTRODUCTION: Asymptomatic colonic diverticular prevalence varies in the general population between 20 and 60% in international references, however, we couldn't find statistics about it in national reports. A method for detection of this nosological entity is the abdomen and pelvis computed tomography. AIM: Determine the prevalence of asymptomatic colonic diverticulosis in the general population as a find in abdomen and pelvis computed tomography (TCAP). MATERIALS AND METHOD: Cross-sectional study with descriptive statistics, selecting patients with no history of diverticulosis, who underwent TCAP in our Hospital. 1,449 cases are reviewed and 1,177 are included. RESULTS: The general prevalence of colonic diverticula was 28.3%. Their presence increases with age, being close to 60% in > 80 years. Almost 90% are located in the left colon, being more frequent the right side diverticulosis in population under 60 years. CONCLUSIONS B The overall prevalence of asymptomatic colonic diverticulosis, detected as a finding in TCAP, corresponds to about one third of patients.

Dolor pélvico crónico secundario a síndrome de congestión pélvica: resultados del tratamiento endovascular de la insuficiencia venosa pelviana y várices genitales / Embolization of insufficient pelvic veins for pelvic congestion syndrome: analysis of 17 cases

Background: Pelvic venous insufficiency may cause pelvic congestion syndrome that is characterized by chronic pelvic pain exacerbated by prolonged standing, sexual activity or menstrual cycle. It may be treated by embolizing the dysfunctional pelvic venous drainage and sometimes resecting vulvar, perineal and thigh varices. Aim: To assess the results of embolization of insufficient pelvic or ovarian veins on pelvic congestion syndrome. Material and Methods: Analysis of 17 female patients aged 32 to 53 years, who underwent subjected to a selective coil embolization of insufficient pelvic and/or ovarian veins through the jugular, basilic or cephalic veins. In the preoperative period, all patients had a lower extremity venous duplex pelvic ultrasound examination and some had an abdominal and pelvic CT angiogram. Results: The technical success of the procedure was 100% and no complications were registered. During a 32 month follow up, no patient had symptoms of pelvic venous insufficiency or relapse of vulvar or thigh varices. Conclusions: Embolization of insufficient pelvic and ovarian veins is a safe and successful procedure for the treatment of pelvic venous insufficiency or vulvar varices.

Pseudoquiste hemorrágico crónico posterior a hernioplastia crural / Chronic hemorrhagic pseudocyst following crural hernioplasty

Entre las complicaciones alejadas de las hernioplastias inguino-crurales, el pseudoquiste hemorrágico crónico, no ha sido referido en nuestro país. Se describen los métodos complementarios de imagenología para el diagnóstico y se destaca la resección quirúrgica como el tratamiento definitivo. Se concluye que esta complicación al igual que la inguinodinia y la recidiva herniaria influyen en el grado de satisfacción posoperatoria.

Among the long term complications of hernioplasty, chronic hemorrhagic pseudocyst has not been reported so far in our country. Complementary imaging methods for diagnosis are described and surgical resection is highlighted as the definitive treatment. It is concluded that this complication as well as inguinodynia and hernia recurrence influence the degree of postoperative satisfaction.

Influência do posicionamento radiográfico no cálculo interobservador do ângulo do platô tibial em cães / Influence of radiographic positioning in the interobserver measuring of the tibial plateau angle in dogs

O objetivo deste trabalho foi demonstrar que o posicionamento radiográfico inadequado do membro pélvico de cães (imagens obliquadas) afeta a mensuração do ângulo do platô tibial (APT), levando à maior variação entre observadores. Foram realizadas duas projeções radiográficas nos membros pélvicos direito e esquerdo, uma em perfil verdadeiro e a outra com o membro obliquado em 21 cães provenientes do atendimento clínico cirúrgico do Hospital Veterinário da Universidade de Cuiabá, em Cuiabá-MT. Os critérios de inclusão foram cães livres de histórico ou afecção ortopédica nos membros pélvicos, pesando entre 15 e 40 quilos, sem predileção por raça ou sexo, entre dois e sete anos de idade. Foram obtidas 42 imagens radiográficas em perfil verdadeiro e 42 imagens radiográficas obliquadas. Três observadores com experiência em cálculo do APT fizeram as mensurações. Nos cálculos das imagens em perfil verdadeiro, o observador 1 obteve uma média de 23,35º ± 2,82; o observador 2, média de 23,88º ± 4,83; e o observador 3, média de 24,54º ± 4,01, não sendo encontrada diferença significativa entre o cálculo dos três avaliadores, P=0,944 (P > 0,05), nas imagens em perfil verdadeiro. Nos cálculos das imagens obliquadas, o observador 1 obteve uma média de 21,69º ± 4,22; o observador 2, média de 19,42º ± 5,92; e o observador 3, média de 22,64º ± 5,23, e foi encontrada diferença significativa entre o cálculo dos três observadores, P=0,016 (P < 0,05). Com esses dados, pôde-se demonstrar que a imagem radiográfica obliquada compromete o valor final do cálculo do ângulo do platô tibial em cães, levando à variação numérica estatisticamente significativa entre observadores. Conclui-se, assim, que um posicionamento correto do membro pélvico, em perfil verdadeiro, deve ser sempre utilizado para a obtenção de imagens, com o objetivo de mensurar o valor do APT.(AU)

This work aimed at demonstrating that an inadequate radiographic position of pelvic limbs of dogs, from a strict lateral radiographic view, resulted in oblique images, affecting the measurement of the tibial plateau angle (TPA). There were two radiographic projections of the right and the left pelvic limb, one in strict lateral radiographic view and another with inclined hind limb in 21 dogs from the clinical surgical assistance at Hospital Veterinário of Universidade de Cuiabá in Cuiabá-MT. Inclusion criteria were dogs free from pelvic hind limbs orthopedic affection records, weighing between 15 and 40 kilos, without a preference for breed or gender and ageing between two and seven years old. A total of 42 radiographic images in strict lateral radiographic view and 42 inclined limb radiographic views were obtained. Three observers with TPA calculation experience made measurements. In the calculus for the strict lateral radiographic view the first observer has reached an average of 23,35º ± 2,82, the second observer 23,88º ± 4,83 and the third observer 24,54º ± 4,01. No significant statistic differences among the calculus of the three evaluators p=0,944 (P>0,05) was found. In the calculus of the inclined limbs radiographic views the first observer reached an average of 21,69º ± 4,22, the second observer 19,42º ± 5,92 and the third observer 22,64º ±. 5,23. Significant statistic difference in the calculus of the three observers, p=0,016, that is to say, P<0,05 was found. The data indicated that the inclined limb radiographic image compromises the final value of the calculation of tibial plateau angle in dogs. Thus, correct positioning of the pelvic limb, in a strict lateral radiographic view, must be always used for obtaining images aiming at measuring the value of TPA.(AU)

Fístulas perianales: caracterización con resonancia magnética / Perianal fistulas: magnetic resonance classification

Las fístulas perianales constituyen una problemática frecuente en la consulta médica actual, con un gran impacto en la morbilidad. Su tratamiento no está exento de complicaciones, como la recurrencia local y la incontinencia fecal. La resonancia magnética (RM) cumple un rol fundamental en la planificación preoperatoria de estos casos, ya que la notable resolución espacial de los equipos de última generación permite generar un mapa de la anatomía de la pelvis menor, señalando el número y la relación de los trayectos con el esfínter anal. El objetivo del presente trabajo es identificar los distintos tipos de fístulas en base a sus características por RM, haciendo énfasis en la anatomía de la región y la técnica de estudio de esta entidad.

Perianal fistulas are a prevalent problem in current medical practice, with a high impact on morbidity. The treatment is not exempt from complications, such as local recurrence and faecal incontinence. Magnetic resonance imaging (MRI) performs an essential role insurgical planning of these patients, since the high spatial resolution of the latest equipment provides more precise information of the pelvis anatomy, indicating the number and relationship of the fistulous tracks with the anal sphincter. The aim of this work is to identify the different types of fistulas based on MRI classification, with particular emphasis on the local anatomy and study techniques.

Does MRI help in the pre - operative evaluation of pelvic fracture urethral distraction defect? - a pilot study

ABSTRACT Objectives To study the usefulness of MRI in preoperative evaluation of PFUDD. Can MRI provide additional information on urethral distraction defect (UDD) and cause of erectile dysfunction (ED)? Materials and Methods In this prospective study, consecutive male patients presenting with PFUDD were included from Feb 2011 till Dec 2012. Those with traumatic spinal cord injury and pre-existing ED were excluded. Patients were assessed using IIEF questionnaire, retrograde urethrogram and micturating cystourethrogram (RGU+MCU) and MRI pelvis. Primary end point was erectile function and secondary end point was surgical outcome. Results Twenty patients were included in this study. Fourteen patients (70%) were ≤40years; fifteen patients (75%) had ED, seven patients (35%) had severe ED. MRI findings associated with ED were longer median UDD (23mm vs. 15mm, p=0.07), cavernosal injury (100%, p=0.53), rectal injury (100%, p=0.53), retropubic scarring (60%, p=0.62) and prostatic displacement (60%, p=0.99). Twelve patients (60%) had a good surgical outcome, five (25%) had an acceptable outcome, three (15%) had a poor outcome. Poor surgical outcome was associated with rectal injury (66.7%, p=0.08), cavernosal injury (25%, p=0.19), retropubic scarring (18.1%, p=0.99) and prostatic displacement (16.7%, p=0.99). Five patients with normal erections had good surgical outcome. Three patients with ED had poor outcome (20%, p=0.20). Conclusions MRI did not offer significant advantage over MCU in the subgroup of men with normal erections. Cavernosal injury noted on MRI strongly correlated with ED. Role of MRI may be limited to the subgroup with ED or an inconclusive MCU.

Aneurysmal bone cyst of ischiopubic ramus: a rare location with literature review

Aneurysmal bone cyst [ABC] is a locally destructive lesion of the bone rather than a true neoplasm. The pelvis is not an unusual site for an ABC; approximately 12% of cases occur in this location. We present a case of aneurysmal bone cyst [ABC] in ischiopubic ramus in a 22 years old male who presented with right inguinal swelling and pain. He was evaluated with X-ray and Magnetic Resonance Imaging MRI of pelvis. A review of literature regarding this rare site of ABC with radiological features is also described in this case report. ABC of ischiopubic ramus is an uncommon entity hence diagnosis of such a case requires proper clinical, radiological and histopathological evaluation to rule out other differential diagnoses of an expansile, osteolytic lesion. This will help in selecting a proper treatment plan

Long-term results of post-operative pelvic image guided intensity modulated radiotherapy in gynecological malignancies

Objective: To assess late clinical outcomes with image guided intensity modulated radiotherapy [IG- IMRT] in gynecological malignancies

Patients and methods: We have been practicing IG IMRT for gynecological malignancies since January 2009. Here we are presenting our experience with this modern technique at median follow up of 38 months. During whole treatment bladder filling protocol was followed, Both target volumes and critical structures were contoured according to RTOG guidelines. Dose prescribed to clinical target volume [postop bed and nodal volume] was 50.4 Gy in 28 fractions. Cone beam CT [CBCT] scans were taken to quantify the status of target volume and normal structures

Results: 80 patients were evaluated and analyzed who were treated from January 2009 to December 2014. Median age of our patients was 56.5 years. Out of eighty forty four patients [55%] were of carcinoma endometrium and the rest 36 [45%] were of carcinoma cervix. None of our patients experienced late grade 3 or 4 bladder toxicity Although late grade 3 and 4 bowel and rectal toxicity was experienced by single patient. 2.5% patients developed local recurrence, 5% patient developed nodal with distant metastases and 6.25% only distant metastases. Three ol our patients developed lung cancer as second primary during follow up. 76.2% patients are alive with regulaf follow up

Conclusions: Our study concluded that IG IMRI increases patient compliance and reduces long-term side effects in post-operative gynecological malignancies without compromising local-regional control, disease free survival and overall survival