Pararectal Epidermal Inclusion Cyst in a Pediatric Patient.

Epidermal inclusion cysts, commonly found cutaneously, rarely manifest in the pelvis. They are typically asymptomatic and often occur following trauma or surgical interventions. Imaging modalities, notably computed tomography (CT) scans and magnetic resonance imaging (MRI), play a crucial diagnostic role. Herein, we report a rare case of a four-year-old female with a complicated medical and surgical history, presented with pain in the right gluteal region in the setting of past history of abscess drainage in the same area. Imaging revealed a cystic lesion in the right pararectal space and a fistula extending between the pelvic cavity and gluteal region. A laparotomy was performed, and a histopathologic examination confirmed the diagnosis of an epidermal inclusion cyst with no evidence of malignancy.

Finite Element Analysis of Pelvic Floor Biomechanical Models to Elucidate the Mechanism for Improving Urination and Defecation Dysfunction in Older Adults: Protocol for a Model Development and Validation Study.

BACKGROUND: The population is constantly aging, and most older adults will experience many potential physiological changes as they age, leading to functional decline. Urinary and bowel dysfunction is the most common obstacle in older people. At present, the analysis of pelvic floor histological changes related to aging has not been fully elucidated, and the mechanism of improving intestinal control ability in older people is still unclear. OBJECTIVE: The purpose of this study is to describe how the finite element method will be used to understand the mechanical characteristics of and physiological changes in the pelvic cavity during the rehabilitation process, providing theoretical support for the mechanism for improving urination and defecation dysfunction in older individuals. METHODS: We will collect magnetic resonance imaging (MRI) and computed tomography (CT) data of the pelvic cavity of one male and one female volunteer older than 60 years and use the finite element method to construct a 3D computer simulation model of the pelvic cavity. By simulating different physiological states, such as the Valsalva maneuver and bowel movement, we will verify the accuracy of the constructed model, investigate the effects of different neuromuscular functional changes, and quantify the impact proportions of the pelvic floor muscle group, core muscle group, and sacral nerve. RESULTS: At present, we have registered the study in the Chinese Clinical Trial Registry and collected MRI and CT data for an older male and an older female patient. Next, the construction and analysis of the finite element model will be accomplished according to the study plan. We expect to complete the construction and analysis of the finite element model by July 2024 and publish the research results by October 2025. CONCLUSIONS: Our study will build finite element models of the pelvic floor of older men and older women, and we shall elucidate the relationship between the muscles of the pelvic floor, back, abdomen, and hips and the ability of older adults to control bowel movements. The results of this study will provide theoretical support for elucidating the mechanism for improving urination and defecation dysfunction through rehabilitation. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2400080749; https://www.chictr.org.cn/showproj.html?proj=193428. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56333.

Usefulness of serum amyloid A for the diagnosis of pyelonephritis in cats: A prospective evaluation.

BACKGROUND: The diagnosis of pyelonephritis in cats is challenging and development of a noninvasive and accurate biomarker is needed. HYPOTHESES: Serum amyloid A (SAA) is increased in cats with pyelonephritis, but not in cats with other urinary tract diseases. ANIMALS: A cohort of 125 cats (149 observations). METHODS: This was a prospective study. Group 1 included cats with a diagnosis of pyelonephritis either confirmed by bacterial culture of pelvic urine (Group 1a) or presumed (1b). Group 2 included cats for which pyelonephritis was ruled out (with certainty: Group 2a or judged unlikely: Group 2b). SAA concentration was compared between groups, and accuracy of SAA for the diagnosis of pyelonephritis was calculated using a Receiver Operating Characteristic (ROC) curve analysis. RESULTS: Median SAA concentration was significantly higher in Group 1a (86.8 mg/L [73.3; 161.5]; n = 8) than in Group 2a (4 mg/L [1.8; 5.6], n = 19; P < .001) and in Group 2b (5.4 mg/L [3.1; 9.7], n = 113; P < .001). It was also significantly higher in Group 1b (98.8 mg/L [83.1; 147.3]; n = 9) than in Group 2b (P < .001) and Group 2a (P < .001). Optimal diagnostic cut-off for SAA concentration was 51.3 mg/L. yielding a sensitivity of 88% (95% confidence interval: [64%; 99%]) and a specificity of 94% (95% confidence interval: [88%; 97%]). CONCLUSIONS AND CLINICAL IMPORTANCE: Measurement of SAA could be used to rule out pyelonephritis in the case of low suspicion of the disease. Increased SAA concentration is suggestive of pyelonephritis despite a lack of specificity.

Chinese expert consensus on standardized treatment for presacral cysts.

Presacral cysts are cystic or cyst-solid lesions between the sacrum and rectum, almost involving adjacent pelvic floorstructures including sacrococcygeal fascia, rectum, and anal sphincter. Presacral cysts are usually benign, currently believed to arise from aberrant embryogenesis. Presacral cysts are clinically rare and the true incidence is unknown. Surgical resection remains the major treatment for presacral cysts. Unless the cysts are completely resected, recurrence is unavoidable. Recurrent cysts or hard-to-heal sinuses in the sacrococcyx cause patients extreme pain. However, the current knowledge of presacral cysts is insufficient. They are occasionally confused with other diseases such as ovarian cysts and perianal abscesses. Moreover, lack of the correct surgical concept and skills leads to palliative treatment for complex presacral cysts and serious complications such as impairing the function of the anal sphincter or important blood vessels and nerves. The consensus summarizes the opinions and experiences of multidisciplinary experts in presacral cysts and aims to provide clinicians with a more defined concept of the treatment, standardize the surgical approach, and improve the efficacy of presacral cysts.

Configuration of sacral plexuses in Hasmer and Hasak sheep breeds: a comparative macro-anatomical approach.

The aim of this study was to examine and compare the macro-anatomical structures and configurations of plexus sacralis in Hasmer and Hasak sheep breeds. For this purpose, 18 sheep (eight female Hasmer sheep, three male Hasak sheep and seven female Hasak sheep) were assessed. After induction of anesthesia, the body cavities were opened. The sheep were fixed with formaldehyde after draining of the blood. The nerves of the plexus sacralis were dissected separately and photographed. Both in Hasmer and Hasak sheep breeds, the plexus sacralis was a large anastomotic complex of nerves which gave rise to nerves distributed to pelvic cavity and pelvic limb. It was derived from the ventral branches of the six spinal segments. It was observed that this plexus was formed by the ventral rami of four (first to fourth) sacral spinal nerves as well as ventral ramus of the sixth and fifth lumbar nerves. The results of this study are believed to be improved further with the future morphometric studies and to make a contribution to future anatomical and surgical studies in this area.

The predictive value of common symptoms in early pregnancy for complications later in pregnancy and at birth.

INTRODUCTION: The aim was to investigate whether common pregnancy-related symptoms-nausea, vomiting, back pain, pelvic girdle pain, pelvic cavity pain, vaginal bleeding, itching of vulva, pregnancy itching, leg cramps, uterine contractions and varicose veins-in the first trimester of pregnancy add to the identification of women at high risk of future pregnancy and birth complications. MATERIAL AND METHODS: Survey data linked to national register data. All women booking an appointment for a first prenatal visit in one of 192 randomly selected General Practices in East Denmark in the period April 2015-August 2016. The General Practices included 1491 women to this prospective study. Two outcomes, pregnancy complications and birth complications, were collected from the Danish Medical Birth Register. RESULTS: Among the 1413 included women, 199 (14%) experienced complications in later pregnancy. The most serious complication, miscarriage, was experienced by 65 women (4.6%). Other common pregnancy complications were gestational diabetes mellitus (n = 11, 0.8%), gestational hypertension without proteinuria (n = 34, 2.4%), mild to moderate preeclampsia (n = 34, 2.4%) and gestational itching with effect on liver (n = 17, 1.2%). Women who experienced pelvic girdle pain, pelvic cavity pain or vaginal bleeding in the first trimester of pregnancy had a higher risk of pregnancy complications later on in later pregnancy. None of the other examined symptoms showed associations to pregnancy complications. No associations were found between pregnancy-related physical symptoms in first trimester and birth complications. CONCLUSIONS: Symptoms in early pregnancy do not add much information about the risk of pregnancy or birth complications, although pain and bleeding may give reason for some concern. This is an important message to women experiencing these common symptoms and to their caregivers.

Pelvic cavity and its spaces - anatomical overview.

Anatomical nomenclature commonly does not follow changes in the clinical language and demands. Therefore we tried to explain the pelvic relationships based on the changes that occur in the pelvis as well as to compare different nomenclatural strategies used in every day language. Courses of fasciae in the male and female pelvis are also considered.

[Androgen Insensitivity Syndrome with Bilateral Cryptorchidism and Seminoma in Tibet:Report of One Case].

Androgen insensitivity syndrome(AIS)with bilateral testicular malignant transformation is very rare,and its diagnosis should be based on clinical manifestations,physical examination,serological findings,karyotype analysis,and pathological findings.This study reported a case of complete androgen insensitivity syndrome among Tibetan in Tibet.It took 17 years from the discovery of congenital absence of uterus to bilateral pelvic mass resection.Pathological examination confirmed that bilateral pelvic space occupying lesions were dysplastic testicular tissue with seminoma and sertoli cell adenoma-like nodules.This study summarized the clinicopathological features to deepen the understanding of the disease.

The Performance and Optimum Cutoff Value for Pelvic Cavity Index as a Predictor of Early Continence After Extraperitoneal Single-Port Robotic Radical Prostatectomy: Role of Pelvic Anatomical Characteristics.

Purpose: The aim of this study was to assess the value of the pelvic cavity index (PCI), as an objective pelvimetry feature, to predict operative time, margin status, and early urine continence after extraperitoneal single-port robotic radical prostatectomy (RP). We sought to define an optimal cutoff point for PCI in predicting postoperative outcomes. Methods: A total of 94 patients who underwent extraperitoneal single-port robotic RP and preoperative cross-sectional imaging were enrolled. PCI was calculated as follows: Pelvicinletdiameter×PelvicoutletdiameterPelvicdepth. The predictive value of PCI for operative time, surgical margin status, and 3-month urinary continence recovery was assessed using regression models. To report the optimum cutoff value, on receiver operating characteristic (ROC) analysis, we calculated the performance of PCI cutoff points ranging from 5.56 to 10.80 cm by every 0.01 increment. Results: No significant associations were noted between clinical characteristics (including PCI) and operative time. Similarly, other than pathological stage, no clinical variables (including PCI) were predictive of the positive surgical margin. However, a higher PCI was associated with a significantly higher rate of continence 3 months after surgery [odds ratio 2.44 (1.75-5.33); p = 0.01]. On ROC analysis, a PCI cutoff value = 8.21 cm yielded the best accuracy (area under the curve = 0.733, 95% confidence interval 0.615-0.851; p = 0.001). No association was noted between variables and 6-month continence rates. Conclusions: With a single-port robotic system, the operative time, positive surgical margin rate, and long-term continence after prostatectomy would be independent of the bony pelvic cavity. However, a higher PCI is associated with a higher rate of early continence after surgery. PCI at a cutoff of 8.21 cm has the optimum performance to predict postoperative urine continence recovery. If validated, this information may be helpful regarding patient counseling before single-port robotic RP.

Simulation of vaginal uterosacral ligament suspension damage, mimicking a mesh-augmented apical prolapse repair.

Synthetic implants were used for repair of anterior compartment prolapses, which can be caused by direct trauma resulting in damaged pelvic structures. The mechanical properties of these implants may cause complications, namely erosion of the mesh through the vagina. In this study, we evaluated, by modeling, the behavior of implants, during Valsalva maneuver, used to replace damaged uterosacral ligaments (USLs), mimicking a sacrocolpopexy repair. For this purpose, two synthetic implants (A®, for prolapse repair and B®, for Hernia repair) were uniaxially tested, and the mechanical properties obtained were incorporated in the computational models of the implants. The computational model for the implant was incorporated into the model of the female pelvic cavity, in order to mimic the USLs after its total rupture and with 90% and 50% impairment. The total rupture and impairments of the USLs, caused a variation of the supero-inferior displacement and displacement magnitude of the vagina, with higher values for the total rupture. With total rupture of the USLs, when compared to healthy USLs, supero-inferior displacement and displacement magnitude of the vagina increased by 4.98 mm (7.69 mm vs 12.67 mm) and 6.62 mm (9.38 mm vs 16.00 mm), respectively. After implantation (A® and B®) a reduction of the supero-inferior displacements of the anterior vaginal wall occurred, to values found in the case of the model without any impairment or rupture of the ligaments. The simulation was able to mimic the biomechanical response of the USLs, in response to different implants stiffnesses, which can be used in the development of novel meshes.

Efficacy and safety of iopromideas a contrast agent in gynecological pelvic CT examination / 中国辐射卫生

Objective To investigate the efficacy and safety of iopromide as a contrast agent in gynecological pelvic CT examination. Methods In a retrospective study, 78 patients hospitalized from February 2018 to January 2021 who underwent contrast-enhanced gynecological pelvic CT were involved to investigate the image quality, systemic and local tolerance, and adverse reactions. Results Among the 78 cases, 97.44% had excellent image quality and 97.44% showed tolerance. Mild adverse reactions such as nausea and vomiting, dizziness, headache, local pain, and facial flushing occurred in 8.98% cases. Moderate adverse reactions included severe vomiting with generalized rash (one case) and chest tightness and shortness of breath with generalized rash (one case), and both patients returned to normal after treatment. Conclusion The non-ionic contrast agent iopromide can be used to obtain good image quality in gynecological pelvic CT examination. The incidence of adverse reactions of iopromide is lower than ionic iodine contrast agents, but higher other non-ionic contrast agents.

Androgen Insensitivity Syndrome with Bilateral Cryptorchidism and Seminoma in Tibet:Report of One Case / 中国医学科学院学报

Androgen insensitivity syndrome(AIS)with bilateral testicular malignant transformation is very rare,and its diagnosis should be based on clinical manifestations,physical examination,serological findings,karyotype analysis,and pathological findings.This study reported a case of complete androgen insensitivity syndrome among Tibetan in Tibet.It took 17 years from the discovery of congenital absence of uterus to bilateral pelvic mass resection.Pathological examination confirmed that bilateral pelvic space occupying lesions were dysplastic testicular tissue with seminoma and sertoli cell adenoma-like nodules.This study summarized the clinicopathological features to deepen the understanding of the disease.

[Surgical anatomy of extraorganic anastomoses of inferior vesical artery]. / Khirurgicheskaya anatomiya vneorgannykh anastomozov nizhnei mochepuzyrnoi arterii.

OBJECTIVE: To determine the variants of topography and quantity of extraorganic anastomoses of inferior vesical artery (IVA). MATERIAL AND METHODS: The study included 186 corpses of males (age 22-82 years) and 109 females (age 32-93 years). All people died from accidental causes not associated with pelvic organ diseases. Dissection, vascular injection and statistical analysis were performed. RESULTS: IVA forms anastomoses with other branches of internal iliac artery in 11.3% of cases on the right and in 12.4% of cases on the left in males. These collaterals in females are noted in 9.2% of cases on the right and in 7.3% of cases on the left. Mean length of extraorganic anastomoses of a. vesicalis inferior in males is 1.4 cm, mean diameter - 1.7 mm. Mean length of such collaterals in females is 1.7 cm, mean diameter - 1.7 mm. Extraorganic anastomoses are more common in proximal and middle thirds of IVA, rarely - in distal third. Linear correlation between diameters of a. vesicalis inferior and its extraorganic anastomoses was not detected in females but found in males. CONCLUSION: Extraorganic anastomoses of IVA are characterized by certain pattern of origination in males and in females.

[Chinese expert consensus on standardized treatment of presacral cysts].

Presacral cysts are cystic or cyst-solid lesions between the sacrum and rectum. They are closely connected with adjacent pelvic floor structures such as sacrococcygeal fascia, rectum and anal sphincter. They are usually benign and are believed to be caused by aberrant embryogenesis. Clinically they are rare and its true incidence rate is unknown. Surgical resection remains the major treatment of presacral cysts. Unless the cysts are completely resected, the recurrence are unavoidable. The recurrent cysts even generate hard-to-heal sinus in the sacrococcyx, and cause the patients extreme pain. However, the current knowledge of presacral cysts is vague, even confused with other diseases such as ovarian cysts and perianal abscesses. Moreover, lack of the correct surgical concept or skills leads to palliative treatment of complex presacral cysts and serious complications such as fecal incontinence and massive haemorrhage which were attributed to impairing the function of anal sphincter or important blood vessels and nerves. The consensus summarizes the opinions and experiences of multidisciplinary experts in presacral cysts, and aims to provide clinicians with more detailed concept of the treatment, standardize the surgical approach and improve the resected efficacy of presacral cysts.

Effect of mesh anchoring technique in uterine prolapse repair surgery: A finite element analysis.

The female pelvic cavity involves muscles, ligaments, endopelvic fasciae and multiple organs where different pathologies may occur, namely the pelvic organ prolapse (POP). The synthetic implants are used for the reconstructive surgery of POP, but severe complications associated with their use have been reported, mainly related to their mechanical properties (e.g., implant stiffness) and microstructure. In this study, we mimicked a transvaginal reconstructive surgery to repair the apical ligaments (uterosacral ligaments (USLs) and cardinal ligaments (CLs)), by modeling, their impairment (90% and 50%) and/or total rupture. The implants to reinforce/replace these ligaments were built based on literature specifications and their mechanical properties were obtained through uniaxial tensile tests. The main aim of this study was to simulate the effect of mesh anchoring technique (simple stich and continuous stitch), and compare the displacement magnitude of the pelvic tissues, during Valsalva maneuver. The absence/presence of the synthetic implant was simulated when total rupture of the CLs and USLs occurs, causing a variation of the vaginal displacement (9% for the CLs and 27% for the USLs). Additionally, the simulations showed that there was a variation of the supero-inferior displacement of the vaginal wall between different anchoring techniques (simple stich and continuous stitch) being approximately of 10% for the simulation USLs and CLs implant. The computational simulation was able to mimic the biomechanical behavior of the USLs and CLs, in response to different anchoring techniques, which can be help improving the outcomes of the prolapse surgery.

Postoperative Extra-Cranial Metastasis of Glioblastoma: A Case Report.

Glioblastoma (WHO grade IV) is the most common malignant tumor of neural tissues in adults as a primary tumor. Because of blood brain barrier and short median survival of patients with glioblastoma, metastasis of this tumor is very rare. A 46-year-old man was admitted to Sina hospital with chief complaint of headache and visual impairment. After neuro-radiologic evaluation the patient underwent surgery. Pathologic examination of the tumor confirmed the diagnosis of glioblastoma multiforme. Cytogenetic study of the tumor cells confirmed GBM IDH1 wild type with TERT mutation and EGFR amplification. Two months after surgical resection, the tumor recurred with involvement of the dura matter. After the second operation, metastasis to the pelvic cavity and cervical lymph node was found. Almost all cases of glioblastoma metastasis had undergone surgery or any manipulation; this fact suggests that iatrogenic intra-vascular seeding of tumor cells at the time of resection and disruption of blood brain barrier could cause extra-neural metastasis.

Treatment of a giant low-grade appendiceal mucinous neoplasm: A case report.

BACKGROUND: Low-grade appendiceal mucinous neoplasm (LAMN) is extremely rare and easily misdiagnosed before surgery. CASE SUMMARY: We report the treatment of an asymptomatic case of LAMN diagnosed by magnetic resonance imaging (MRI) and surgical findings. A 70-year-old woman presented with an adnexal mass found by physical examination in July 2020. Gynecologic ultrasonography revealed a cystic mass in the right adnexa, and computed tomography showed a cystic mass in the pelvic cavity. All tumor markers were normal. A further MRI examination suggested mucinous neoplasm in the right pelvic cavity, excluding the possibility of adnexal cyst. Laparoscopic exploration found a huge cystic mass of about 10 cm × 7 cm that originated from the apex of the appendix, with spontaneous rupture. LAMN was confirmed by pathological examination. As of May 2021, no disease recurrence occurred after an open appendectomy. CONCLUSION: This case indicates that we should pay more attention to female patients who are clinically diagnosed with an adnexal mass at admission,. The physical examination should be done carefully, and the laboratory and imaging examination results should be comprehensively analyzed to avoid misdiagnosis and to ensure prompt diagnosis and treatment, and to improve prognosis. MRI may be a better option for the diagnosis of appendiceal mucinous neoplasm.

A Rare Simultaneous Occurrence of Splenic and Pelvic Cavity Hydatid Cyst.

Hydatid cyst is a significant health-threatening problem that can affect almost all organs, especially the lungs and the liver, but the possibility of its occurrence in organs such as the spleen or pelvic cavity is rare. Thus, simultaneous hydatid cysts in the spleen and pelvic cavity are probably very rare. Nevertheless, since hydatid cysts in different areas can cause various symptoms, it should be considered a significant diagnosis. This article presents a case report of a 21-year-old woman presenting with right lower quadrant abdominal pain mimicking appendicitis but found to have simultaneous hydatid cysts in the spleen and the pelvic cavity.