臀肌挛缩症所致骨盆倾斜

Twenty－ninecasesofpelvictiltofgluteuscontracture（PGTC）wereoperatedduring１９９０～１９９８．Twenty－twowereretrospec－tivelyreviewedin２～８years，andagoodresultwasobtained．１Subjectandmethod１．１SubjectFourhundredfifty－onechildrenwithgluteuscon－tractureweretreatedbetween１９９０and１９９８attheRuijinhospi－tal．Allcaseswereinvolvedbilaterally．Twenty－nineofthemwerePTGC：１９inboysand１０ingirls，withanaverageof１２yearsold（rang，８to１６years）．Thereasonofcomingtoourhospitalist…     

盆腔炎性包块的B型超声诊断价值

目的探讨盆腔炎性包块的B型超声声像图表现及诊断价值。方法对B超诊断为盆腔炎性包块的病例进行追踪观察，经抗感染治疗后行B超复查。结果117例病例中115例抗感染治疗后复查B超包块明显缩小或消失，诊断准确率为98．3％。结论盆腔炎性包块在B超影像上有一定特征，较其他影像学检查有较大的优越性。     

Structure and functional significance of the transverse vesical fold

The plica vesicalis transversa or transverse vesical fold (TVF) is a peritoneal fold extending from the lateral side of the bladder to the side of the lesser pelvis near the deep inguinal ring. It is an important landmark in laparoscopic surgery of the pelvis but is variably observed in the embalmed cadaver. We investigated the gross anatomy of this structure in the cadaver and confirmed that its medial portion corresponds to the location of the superior vesical artery(ies), thus supporting the idea that the TVF is "mesovesical." However, no large vessels were observed grossly in the lateral portion of the TVF. The hypothesis that the lateral TVF has a suspensory function was tested histologically by comparison with the suspensory ligament of the duodenum and the phrenicocolic ligament, both of which have smooth muscle contributing to their inferred suspensory function. Microscopic examination of prepared samples from 20 cadavers shows that the TVF evinces no smooth muscle in either its lateral or medial segments. The TVF is demonstrated to be a mesentery-like reflection of peritoneum raised by branches of the superior vesical artery which provides no demonstrable structural support for the bladder. Implications of these findings include avoidance of sectioning of medial TVF during laparoscopic surgery because of its vascular nature, and inadvisability of utilizing any portion of theTVF for an anchor in reconstruction of the anterior pelvic floor within the paravesical fossae.     

Pelvic rotations: a pelvic phantom study

Background: Radiographic measurements made on standard pelvic radiographs are commonly used in studying conditions related to the hip joints. Effects caused by variations in pelvic orientation may be a source of error in comparing measurements between sequential radiographs.

Purpose: To define and characterize parameters able to measure rotational differences separately around two axes and altered radiographic focusing along two axes when sequential standard anteroposterior (AP) pelvic radiographs are compared.

Material and Methods: A pelvic phantom was constructed based on direct three-dimensional measurements of five defined landmarks in a pelvic model. Two ratios, the vertical and transversal rotation ratios, were defined using radiographs of the phantom. The phantom was radiographed in 33 different orientations and with 16 different radiographic focuses using a specially constructed tilt table. On each radiograph, measurements were made and the two rotation ratios were calculated using a measurement program.

Results: Linear correlations between pelvic rotations around one axis and the corresponding rotation ratio were found with almost no influence of simultaneous rotation around the other axis. Also, linear correlations were found between altered radiographic focusing along one axis and the non-corresponding rotation ratio.

Conclusion: Rotational differences around two axes or altered radiographic focusing along two axes can be measured independently. Effects caused by rotations cannot be distinguished from effects caused by altered radiographic focusing.     

Functional MR imaging of the female pelvis

Recent developments in MR techniques have magnified the roles and potential of MRI in the female pelvis. This article reviews the techniques and clinical applications of functional MRI (fMRI) of the female pelvis, including cine MRI, diffusion-weighted MRI (DWI), and dynamic contrast-enhanced (DCE)-MRI. Cine MRI is a useful tool for evaluating uterine contractility, including sustained contraction and peristalsis, in a variety of conditions and gynecologic disorders, and for evaluating pelvic-floor weakness. DWI can demonstrate abnormal signals in pathologic foci based on differences in molecular diffusion. It also enables the quantitative evaluation of the apparent diffusion coefficient (ADC), which may be useful for distinguishing malignant from benign tissues and monitoring therapeutic outcome. DCE-MRI has the potential to improve tumor detection and local staging, and can also provide quantitative information about perfusion of the tumor, which may be useful for both monitoring therapeutic effects and predicting therapeutic outcome. Understanding the roles played by functional MR techniques in the female pelvic region is beneficial not only for determining clinical applications, but also for developing further investigations with MRI.     

Large retroperitoneal schwannoma mimicking a cystic ovarian mass in a patient with Hansen's disease

We present a rare case of retroperitoneal cystic schwannoma of the pelvis in a patient with Hansen's disease that mimicked an ovarian cyst. Due to economic constraints and because the lesion was assumed to be of ovarian origin, the patient did not undergo any cross-sectional imaging other than sonography. Sonographically guided fine needle aspiration of the cystic lesion was inconclusive. A cystic schwannoma was diagnosed at laparotomy.     

Reoperative laparoscopic pyeloplasty in children: comparison with open surgery

PURPOSE: We assessed the feasibility of pediatric redo laparoscopic pyeloplasty in comparison to redo open pyeloplasty for safety, efficacy, operative time, blood loss, postoperative analgesic requirements, length of hospitalization, complications, need for readmission and subsequent procedures. MATERIALS AND METHODS: We performed a retrospective chart review of consecutive patients undergoing reoperative pyeloplasty between June 2003 and July 2006. RESULTS: A total of 10 patients (11 redo pyeloplasties) were divided into 2 groups, ie those undergoing redo open (4) and laparoscopic (6) pyeloplasty. Groups were similar in age, sex, weight, laterality, and number and type of prior interventions to repair ureteropelvic junction obstruction. Surgical time for redo laparoscopic pyeloplasty was longer than for redo open pyeloplasty (290 vs 203 minutes, p<0.05). Success rate was the same in both groups (80%). The redo laparoscopic pyeloplasty group had a shorter hospital stay (mean 2.5 vs 4.6 days, p<0.05), decreased use of parenteral narcotics (0.2 vs 5 mg/kg, p<0.01), and a trend toward decreased oral narcotics (0.2 vs 2.1 mg/kg, p=0.09) and fewer complications (0 vs 4, p<0.05). CONCLUSIONS: We confirm the feasibility of redo laparoscopic pyeloplasty in the pediatric population. In experienced hands pediatric redo laparoscopic pyeloplasty can be performed safely with a success rate similar to that of open surgery, and it may provide a faster recovery with decreased narcotic requirements and morbidity. Further studies are needed to better define the role of laparoscopic pyeloplasty for secondary ureteropelvic junction obstruction in the pediatric population.     

Percutaneous renal intervention: comparison of 2-D and time-resolved 3-D (4-D) ultrasound for minimal calyceal dilation using an ultrasound phantom and fluoroscopic control

The rapid advances made by ultrasound in recent years have increasingly taken 3-D ultrasound (3DUS) and 4-D ultrasound (4DUS) from the research setting to the patient's bedside. There are still unexplored areas like renal percutaneous intervention, where 4DUS has yet to be proven an effective tool. Ultrasound-only guidance in renal percutaneous access is used in selected well-dilated pelvi-calyceal systems (PCS), and fluoroscopy is often utilized as an adjunct. Our aim was to compare 2-D and 4-D guidance for punctures, with fluoroscopy as control, using an in vitro ultrasound phantom. Agar and latex were the tissue-mimicking materials used for the construction of the phantom. The latex targets were designed to simulate multidirection-facing minimally dilated renal calyces. Two interventional fellows punctured the "calyces" using first 2DUS and then 4DUS guidance, making use of a different set of targets each time. The time to puncture, time to introduction of wire, quality of puncture (judged on fluoroscopy) and global rating of both modalities were documented. There was no significant difference between the times to puncture using 2DUS (1.8 min) and 4DUS (2 min). Nor was there a significant difference in the quality of puncture. 4DUS had a higher median difficulty rating. The multiplanar reformatted (MPR) longitudinal and transverse images were found to be the most useful for needle guidance. Cross hairs in all MPR images were not just useful in aligning the images on target but also as surrogate targets. The phantom was found to be robust, with only one instance of air introduction after 30 punctures. We have found that 4DUS is at least as good as 2DUS in terms of quality of punctures in vitro. The technology still has some way to go as frame rates, transducer size and resolution improve.     

Reconstruction with pasteurized autograft-total hip prosthesis composite for periacetabular tumors

BACKGROUND: With the development of preoperative adjuvant treatment, imaging techniques, and improvement of surgical technique, limb salvage is now possible even in patients with pelvic tumors. However, reconstruction after periacetabular resection is complicated and challenging. METHODS: We retrospectively evaluated the usefulness of pasteurized autograft-total hip composite in pelvic reconstruction with regard to graft survival, union, graft-related complications, and functional outcome in 14 patients with periacetabular tumor. RESULTS: The 5-year and 10-year survival rates of the pasteurized bones were 64.3% and 32.1%, respectively. Major complications that necessitated graft removal included infection in three, fracture in two, and loosening in three patients. The average functional score of seven long-term successful patients was 25.6 (85.2%). CONCLUSIONS: In spite of the high complication rate, pasteurized autograft can be considered as an option for periacetabular reconstruction in the selected patients who meet the following criteria. First, iliopectineal and ilioischial lines are radiologically intact; second, the tumor volume is small (preferably less than 100 ml).