Normal Pelvis Research Articles

3D Finite Elemental Analysis on Treatment of Sacral Fractures with Different Internal Fixation Implants

To provide the doctors a basis for treating sacral fractures and offer optimal surgical program, three-dimensional (3D) finite element method was used to simulate normal pelvis and the unstable pelvis sufferedIsection, IIsection and III section sacral fracture respectively.The unstable pelvises were respectively fixed with five different internal fixation implants types, which are respectively rectangular plate with cannulated screw, rectangular plate with solid screw, expansile bolt, convex plate with cannulated screw, convex plate with solid screw. The stress distribution and the X, Y, Z direction displacement of the sacrum were calculated for each sacral fracture treatment of five internal fixation implants after giving 500N axial load on lumbar vertebra and were compared with the normal pelvis, then the optimal surgery program were determined. After the analysis, by comparing the five combinations for each sacral fracture treatment of five internal fixation implants, the preferred combinations for the reset treatment of theIsection sacral fractures were rectangular plate with cannulated screw and convex plate with cannulated screw; The preferred combination for the reset treatment of the II section sacral fractures was expansile bolt; The preferred combination for the reset treatment of the III section sacral fractures was convex plate with cannulated screw.

Biomechanical analysis of the acetabular buttress-plate: are complex acetabular fractures in the quadrilateral area stable after treatment with anterior construct plate-1/3 tube buttress plate fixation?

OBJECTIVE:The acetabular buttress-plate has been widely used in treating difficult cases with satisfying clinical results. However, the biomechanical properties of a postoperative acetabular fracture fixed by the buttress-plate are not clear. The purpose of this study was to evaluate the biomechanical properties of stability after the anterior tube buttress-plate fixation of complex acetabular fractures in the quadrilateral area.METHODS:A construct was proposed based on anterior construct plate - 1/3 tube buttress plate fixation for acetabular both-column fractures. Two groups of six formalin-preserved cadaveric pelvises were analyzed: (1) group A, the normal pelvis and (2) group B, anterior construct plate-1/3 tube buttress plate with quadrilateral area fixation. The displacements were measured, and cyclical loads were applied in both standing and sitting simulations.RESULTS:As the load was added, the displacements were A<B, increasing in line. In the 600 N physiological loading, the differences were significant (standing position: p = 0.013; sitting position: p = 0.009) between groups A and B.CONCLUSION:The anterior construct plate - 1/3 tube buttress plate fixation provided a better stable construct for early sitting. The standing mode yielded more significant differences between the groups. Placing a 1/3 tube buttress-plate via an anterior approach is a novel method of providing quadrilateral area support in this setting.

Analysis of normal pelvis morphometry of modern Chinese southern Han female and its correlation with age

To analyze the normal pelvis morphometry of Chinese southern Han female and its correlation with age. From August 2009 to September 2011, 289 Han nationality females who received pelvis CT scan at Nanfang Hospital of Southern Medical University were eligible for the study. Their mean age was 43.5 years, with normal body development and no pelvic abnormality. The patients were divided into 3 age groups: 25 to 40 (n = 109), 41 to 50 (n = 115), and >50 years (n = 65). After constructing a three-dimensional digital model of the pelvis, the following parameters were measured, including transverse inlet diameter, posterior sagittal diameter of pelvic inlet, sagittal inlet, diagonal conjugate, biischial diameter, posterior sagittal diameter of midpelvis, sagittal midpelvic diameter, intertuberous distance, posterior sagittal diameter of outlet, angle of pubic arch, sagittal outlet, penal height, sacrum length and sacrum curvature. The relationship between all parameters and age was analyzed. (1) The posterior sagittal diameters of pelvic inlet of the 25 to 40 age group, 41 to 50 age group, >50 years age group were (53 ± 8), (51 ± 7), (48 ± 6) mm. The sagittal inlet of the three groups were (122 ± 8), (120 ± 9), (114 ± 8) mm. And the diagonal conjugate of the three groups were (135 ± 10), (132 ± 9), (127 ± 9) mm. All had significant differences among the three groups (P < 0.01) . (2) The posterior sagittal diameter of midpelvis of the three groups were (43 ± 6), (44 ± 6), (43 ± 7) mm, and the sagittal midpelvic diameter of the three groups were (119 ± 8), (120 ± 8), (119 ± 7) mm, with no significant difference among the three groups (P > 0.05). (3) The intertuberous distance of the three groups were (122 ± 11), (121 ± 10), (117 ± 11) mm, and the posterior sagittal diameter of outlet of the three groups were (56 ± 9), (58 ± 8), (57 ± 9) mm. There was no significant difference among the three groups (P > 0.05) .(4) Penal height of three groups were (31 ± 3), (33 ± 3), (34 ± 3) mm, there was with significant differences (P < 0.01) .(5) Pearson correlation analysis showed that penal height was positively correlated with age (r = 0.331, P < 0.05), while sagittal inlet, posterior sagittal diameter of inlet, diagonal conjugate, intertuberous distance, angle of pubic arch, sacrum length and sacrum curvature were negatively correlated with age (r = -0.120 to -0.343, P < 0.05). The shape of the pelvic inlet of Chinese southern Han female changed from sagittal elliptic into transverse elliptic form, and the posterior part of pelvic inlet became larger.Sacral concavity was increased and the pelvis became deeper. Mid pelvis and the pelvic outlet was almost unchanged, and showed no correlation with age.

Gynecologic laparoscopy and reproductive failure: Review of 4103 infertile Egyptian women

Abstract Objective To assess the prevalence and varieties of pelvic pathology found during laparoscopic investigation of infertility in a large cohort of women. Study design Retrospective, descriptive study. Setting University Hospital. Materials and methods The medical records of women who underwent laparoscopy for the investigation of infertility between January 2001 and December 2010 were reviewed. Results 4103 cases were reviewed. 2980 (72.6%) were diagnosed with pelvic pathology while 1123 (27.4%) had a normal pelvis. Overall, the most common pathology was PCOS (25.5%), followed by pelvic adhesions (23.5%), tubal pathology (16.0%), endometriosis (7.9%), ovarian cyst(s) (7.0%), congenital anomalies (6.9%), and myoma (5.0%). Among 2944 (71.8%) women with primary infertility, 70.6% had pelvic pathology, the most common abnormality being PCOS (30.6%), followed by pelvic adhesions (16.5%), tubal pathology (14.4%), endometriosis (9.2%), ovarian cyst(s) (6.9%), congenital anomalies (7.9%), and myoma (5.6%). Among 1159 (28.2%) women with secondary infertility, 77.8% had pelvic pathology, the most common abnormality being pelvic adhesions (39.6%), followed by tubal pathology (19.8%), PCOS (13.7%), ovarian cyst(s) (7.2%), endometriosis (4.9%), congenital anomalies (4.8%), and myoma (3.9%). Conclusion The high prevalence of pelvic pathology found during laparoscopy confirms its role in the investigation and management of infertile women. While not all infertile women will need IVF, they will still benefit from laparoscopy either to assist natural conception, to direct them to IVF-ET, or to enhance IVF results.

Finite element analysis of the pelvis after modular hemipelvic endoprosthesis reconstruction

Dear Editor We read the article by Zhou et al. with great interest [1]. The authors conducted a study to investigate the biomechanics of the pelvis reconstructed with a modular hemipelvic prosthesis using finite element (FE) analysis. At the end of the study, they found that stress distribution of the postoperative pelvis was similar to that in the normal pelvis at three different static positions and that reconstruction with a modular hemipelvic prosthesis yielded good biomechanical characteristics. We appreciate their study, but we believe that the study has some limitations that would essentially effect the conclusion. The main criticism of this article is that the authors neglected to present data that establishes model validity. The second criticism is the lack of details concerning the quality of the FE analysis. Without these details, the results cannot be judged as being or not being valid. We believe that the study should include details on the FE mesh: element type, element edge length relative to smallest geometric features and mesh sensitivity analyses [2, 3]. The paper should also include a figure of the mesh showing the element distribution for a qualitative evaluation of mesh quality. Third, there is no detail on how the acetabular cup, CS fixator, pubic plate and screw–bone interface was modeled. Fourth, it is not clear how the authors modeled the contact surfaces between the femoral head and the acetabulum. Fifth, we could not determine whether or not articular cartilage, trabecular and subchondral bone were included in this model. Sixth, we believe that it would be more appropriate to clarify the boundary conditions precisely for the three different loadings that were modeled. Also, lack of experimental validation, justification of simplifying assumptions of mechanical properties and interface conditions are other drawbacks of the study. It is not clear why the authors chose that particular patient to model for their study. If the others were chosen, would they find similar results? Though the authors mentioned as one of the limitations that the strength of the periacetabular muscle was not considered because it was greatly affected by the widespread resection and could not be calculated accurately, we did not understand whether all 21 muscles [2] inserting onto the pelvic bone or only some that were resected were or were not incorporated in the model. Physiological loads occur under anatomical circumstances; thus, simulations of them should also contain the appropriate model of anatomic structures. Because the muscle forces have a stabilizing effect on pelvic-load transfer, analysis without muscle forces could result in higher stresses at certain locations than in the situation where muscle forces are included [2]. Muscle forces have considerable influence on stress patterns in the pelvic bone also. Analysis without muscle forces show that load transfer is entirely directed along the axis from the sacroiliac joint to the pubic symphysis. The ischial bone and the superior part of the iliac bone remain virtually unloaded, whereas the pubic bone is more highly stressed than in if muscle forces were included. The values and directions of the hip-joint reaction force and muscle forces in the three positions considered—sitting, standing on two feet and standing on the foot of the affected side—would also be expected to be different [2]. We believe that lack of all these details we mention limits the validity of the study and that it would be appropriate to clarify the issues pointed out herein in order to make more clinically relevant conclusions.

Screw fixation of pelvic fractures: the applied anatomy and clinical significance

Objective To understand the thickness of each section of the pelvic loop and the positions of the peripheral large vessels and nerves,so as to provide evidence for the screw fixation of pelvic fractures. Methods A total of 74 normal osseous specimens of the pelvis(male 40 cases,female 34 cases) were selected for the present study.Pelvic center was taken as the dot,and the thickness of the pelvic bone along the pelvis line were measured in the clockwise direction.Thirty 30 CT images of normal pelvis were used to measure the bone thickness of the pelvic loop in the same manner.Moreover,cadaver specimens were also dissected and the position line of the peripheral large vessels and nerves of the pelvic loop were observed in the clockwise direction. Results(1) The thicknesses(mm) of the pelvic bone along the pelvis line(from 0:00 to 6:00) were 25.36±3.03(female 24.48±2.16),32.59±7.21(female 22.88±2.13),24.06±2.89(female 20.40±2.07),44.12±3.97(female 37.55±3.60),27.88±2.36(female 22.68±2.26),13.80±2.14(female 10.22±2.05),and 15.04±2.31(female 13.53±2.22),respectively;and the results of CT measurement were 25.44±2.95,30.45±7.14,24.49±2.74,44.35±4.21,27.66±2.12,14.06±1.86 and 15.85±2.15,respectively.(2)Based on the clockwise scale,the positions of the main vessels and nerves around the pelvic loop were as follows: the positions of the femoral nerves and the femoral arteries and veins were between 4:00 and 4:30 on the left and between 7:00 and 7:30 on the right;the positions of obturator nerve vessels were between 4:30 and 5:00 on the left and between 7:00 and 7:30 on the right.Conclusion When pelvic center is taken as the dot,it is simple and practical to determine the position of each point of the pelvis and the large vessels and nerves in the clockwise direction.The thickness of each part of the pelvic loop is important to guide screw internal fixation of the pelvic fracture.

Biomechanical comparison of pedicle screw-rod system and pelvic external fixator in models of rotatory unstable pelvic injury

Objective To compare the biomechanical performances of pedicle screw-rod system versus pelvic ala ilium external fixator in cadaveric models of rotatory unstable pelvic injury.Methods Seven cadaveric specimens of normal adult pelvis were used for the test,retaining intact spines from the fifth lumbar vertebra to the proximal 20 centimeters of both femurs,intact pubic symphysis,bilateral hip joints,bilateral sacroiliac joints,bilateral sacrotuberous ligaments,bilateral sacrospinous ligaments,bilateral anterior sacroiliac ligaments and bilateral posterior sacroiliac ligaments.The pelvic specimens were put in an AGX biomechanical testing machine at a standing neutral posture and subjected to a vertical load of up to 500 N downward from the L5 body.The displacements of the symphysis pubis were recorded sequentially in the following 4 conditions:1.intact pelvis; 2.pelvic Tile B1 injury in simulation of rotatory unstable injury of the pelvis in which the symphysis pubis was cut off and accompanied with ruptures of ipsilateral sacrospinous and sacrotuberous ligaments; 3.pelvic Tile B1 injury fixated with the pedicle screw-rod system; 4.pelvic Tile B1 injury fixated with the pelvic ala ilium external fixator.Results Under the vertical load of 500 N,displacements of the symphysis pubis increased significantly from condition 1 (0.121 ± 0.025 mm),to condition 3 (0.656 ±0.103 mm),to condition 4 (1.512 ±0.101 mm) and last to condition 2 (4.512 ±0.391 mm).The difference between any two conditions was significant (P ＜ 0.05).Conclusion Fixation by the pedicle screw-rod system is significantly better than that by the pelvic ala ilium external fixator for rotatory unstable pelvic injury,because the former can more effectively restore the biomechanical stability of the pelvic ring. Key words: Pelvis; Bone nails; External fixators; Biomechanics

Laparoscopic approach to ureteropelvic junction obstruction in a bifid pelvis

About 10% of renal pelvis are bifids and not so there is a larger index of kidney disease over the normal pelves. The laparoscopy and minimally invasive techniques treat the ureteropelvic junction disease in a low agressive manner. We showed a video of an atypical pyeloplasty of ureteropelvic junction obstruction of a lower unit. The patient is a 33 year-old woman with an intermitent lumbar pain for 3 years. Your image exams showed a bifid left pelvis with a stenosis of the lower unit. We chose to do the fix of this pathology laparoscopically. We positioned the patient in a right lateral decubitus and 3 trocars was placed, we identify the obstructed junction and a terminolateral anastomosis was performed. The procedure lasted 95 minutes, with little blood loss and the patient was discharged in 2 days. We withdraw the double J catheter after 1 month, a pyelography and a ureteroscopy was performed which showed a pervious anastomosis. After 2 months of follow-up the patient is doing well. As far as we know, this is the first case of literature with correction by laparoscopy. The stenosis of ureteropelvic junction in the lower unit of a bifid pelvis can be corrected effectively by laparoscopic surgery.

SU‐E‐J‐103: Preliminary Evaluation of the Dosimetric Accuracy of the Cone‐Beam CT for the Cases with the Respiratory Motion

Purpose: Cone‐beam computed tomography (CBCT) images are currently used for patient positioning and adaptive dose calculation. However, it is still interesting to know how large the uncertainty of CBCT for the cases of respiratory motion. This study evaluated the uncertainty of the dose calculation based on CBCT for the cases of the respiratory motion. Methods: The geometrical and Hounsfield Unit (HU) differences estimated for CT and CBCT by using the caphan phantom (The Phantom Laboratory, Salem, NY). The ECLIPSE (Varian Medical Systems, Palo Alto, CA) radiation treatment planning system was used the dose calculations both of CT and CBCT image to compare the dose distributions. HU and dose calculation Result are compared between CT and CBCT to evaluate the effect by respiratory motion. Results: A geometrical uncertainties of CT and CBCT image of the catphan phantom were measured less than 0.15 cm. The CBCT gives a relatively large uncertainty, but absolute value of the uncertainty was not significant. The HU difference between CT and CBCT with standard‐dose‐head mode, high‐quality‐head mode, normal pelvis mode and low‐dose‐thorax mode measured as 31, 36, 23 and 33 HU. The dose calculation difference estimated as gamma (3%, 0.3 cm) as less than 1 in 99% of area. The HU difference with motion phantom was ranged from 5 to 450 HU. The dose calculation difference was estimated as gamma as less than 1 in 98% of area. Conclusion: We evaluated the uncertainty of CBCT based dose calculation for cases of the respiratory motion. The dosimetric uncertainty by motion is not significant in the case of the planning CT with 4DCT MIPS for whole phase, because of CBCT gives similar scanning Result of their scan time (about 1minute). On the other hand, it is expected that the CBCT base adaptive planning with respiratory gate treatment will give the relatively large uncertainty.

Transvaginal sonographic sliding sign: accurate prediction of pouch of Douglas obliteration

Transvaginal sonographic sliding sign: accurate prediction of pouch of Douglas obliteration

Bisphenol A and phthalates and endometriosis: the Endometriosis: Natural History, Diagnosis and Outcomes Study

To explore the relation between bisphenol A and 14 phthalate metabolites and endometriosis. Matched cohort design. Fourteen clinical centers. The operative cohort comprised 495 women undergoing laparoscopy/laparotomy, whereas the population cohort comprised 131 women matched on age and residence. None. Surgically visualized or pelvic magnetic resonance imaging diagnosed endometriosis in the two cohorts, respectively. Odds ratios (OR) and 95% confidence intervals (CIs) were estimated using logistic regression adjusting for age, body mass index, and creatinine. In the population cohort, six phthalate metabolites-mono-n-butyl phthalate, mono-[(2-carboxymethyl) hexyl] phthalate, mono (2-ethyl-5-carboxyphentyl) phthalate, mono (2-ethylhexyl) phthalate, mono (2-ethyl-5-hydroxyhexyl) phthalate, and mono (2-ethyl-5-oxohexyl) phthalate-were significantly associated with an approximately twofold increase in the odds of an endometriosis diagnosis. Two phthalates were associated with endometriosis in the operative cohort when restricting to visualized and histologic endometriosis (monooctyl phthalate; OR 1.38; 95% CI 1.10-1.72) or when restricting comparison women to those with a postoperative diagnosis of a normal pelvis [mono (2-ethylhexyl) phthalate; OR 1.35; 95% CI 1.03-1.78]. Select phthalates were associated with higher odds of an endometriosis diagnosis for women with magnetic resonance imaging-diagnosed endometriosis. The lack of consistency of findings across cohorts underscores the impact of methodology on findings.

Finite element analysis of the pelvis after modular hemipelvic endoprosthesis reconstruction

The aim of this study was to investigate the biomechanics of the pelvis reconstructed with a modular hemipelvic prosthesis using finite element (FE) analysis. A three-dimensional FE model of the postoperative pelvis was developed and input into the Abaqus FEA software version 6.7.1. Mesh refinement tests were then performed and a force of 500 N was applied at the lamina terminalis of the fifth lumbar vertebra along the longitudinal axis of the normal pelvis and the postoperative pelvis for three positions: sitting, standing on two feet, and standing on the foot of the affected side. Stress distribution analysis was performed between the normal pelvis and postoperative pelvis at these three static positions. In the normal pelvis, stress distribution was concentrated on the superior area of the acetabulum, arcuate line, sacroiliac joint, sacral midline and, in particular, the superior area of the greater sciatic notch. In the affected postoperative hemipelvis, stress distribution was concentrated on the proximal area of the pubic plate, the top of the acetabular cup, the connection between the CS-fixator and acetabular cup and the fixation between the prosthesis and sacroiliac joint. Stress distribution of the postoperative pelvis was similar to the normal pelvis at three different static positions. Reconstruction with a modular hemipelvic prosthesis yielded good biomechanical characteristics.

Risk factors associated with endometriosis among infertile Iranian women

IntroductionEndometriosis is defined as overgrowth of endometrial tissue outside the uterine cavity. Endometriosis may be asymptomatic or associated with dysmenorrheal symptoms, dyspareunia, pelvic pain, abnormal uterine bleeding and infertility. The aim of this study was to explore the risk factors related to endometriosis among infertile Iranian women.Material and methodsIn this case control study, infertile women referred for laparoscopy and infertility workup to two referral infertility clinics in Tehran, Iran were studied. According to the laparoscopy findings, women were divided into case (women who had pelvic endometriosis) and control (women with normal pelvis) groups. The case group was divided into two subgroups: stage I and II of endometriosis were considered as mild while stage III and IV were categorized as severe endometriosis. A questionnaire was completed for each patient.ResultsLogistic regression showed that age, duration of infertility, body mass index (BMI), duration of menstrual cycle, abortion history, dyspareunia, pelvic pain and family history of endometriosis are independent predictive factors for any type of endometriosis. In addition, it was shown that education, duration of infertility, BMI, amount and duration of menstrual bleeding, menstrual pattern, dyspareunia, pelvic pain and family history of endometriosis are independent predictive factors of severe endometriosis. The AUCs for these models were 0.781 (0.735-0.827) and 0.855 (0.810-0.901) for any type of endometriosis and severe endometriosis, respectively.ConclusionsIt seems that any type of endometriosis and severe ones could be predicted according to demographic, menstrual and reproductive characteristics of infertile women.

Pathogenesis of Endometriosis and Uterine Fibroids

Endometriosis and uterine fibroids are important, common pathological conditions that impose a major healthcare burden. Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity and represents one of the most frequent gynaecological disorders, affecting 10–15% of all women of reproductive age and >30% of the infertile women. Uterine fibroids (leiomyomas or myomas) are benign tumors of the myometrium. Uterine leiomyomas affect as many as 77% of women in reproductive age, of whom 20–50% are symptomatic. Although they are nonneoplastic conditions, they heavily impact women's health and fertility and are a common indication for surgery, and the socioeconomic cost is huge. The mechanisms of formation remain unclear. The knowledge and the understanding of the pathogenesis of these conditions are essential to develop successful medical therapies and to understand the mechanisms of action of the currently available therapies and are of interest to clinicians and basic and clinical researchers. The focus of this special issue is to highlight novel aspects pertaining to endometriosis and uterine fibroids focusing on the pathogenetic mechanisms and new avenues of enquiry (novel hypotheses). The special issue presents reviews, research articles, and a clinical study and is the effort of a truly international group of researchers giving varied experiences from across the world. The paper entitled “The natural history of uterine leiomyomas: light and electron microscopic studies of fibroid phases, interstitial ischemia, inanosis, and reclamation” and the companion paper entitled “The natural history of uterine leiomyomas: morphometric concordance with concepts of interstitial ischemia, inanosis” by G. Flake et al. describe a fascinating natural history of uterine leiomyoma hypothesizing progressive developmental changes occurring in many uterine fibroids. The paper entitled “Uterine fibroids: pathogenesis and interactions with endometrium and endomyometrial junction” by A. Ciavattini et al., summarizes the available literature concerning current knowledge on pathogenesis of uterine fibroids considering risk factors, genetic, epigenetic, hormonal, and growth and differentiation contributors. This review also describes how endomyometrial junction disruption may play a crucial role in fibroid-related infertility, uterine bleeding, and growth of submucosal and intramural myomas. In the paper entitled “Angiogenesis and endometriosis” A. L. L. Rocha et al. review the evidence for the important role of angiogenesis in the pathogenesis of endometriosis and discuss the rationale for the search of antiangiogenic agents as a new therapeutic option in the treatment of endometriosis. In the paper entitled “Interplay between misplaced Mullerian-derived stem cells and peritoneal immune dysregulation in the pathogenesis of endometriosis” A. Simone Lagana et al. hypothesize that during postpubertal age, under the influence of different stimuli, misplaced and quiescent endometriotic cells derived from Mullerian structures of the embryonic female reproductive tract may acquire new phenotype, biological functions, and immunogenicity. These cells may differentiate, specializing in epithelium, glands, and stroma to form a functional ectopic endometrial tissue. The paper entitled “Gene expression of leptin and long leptin receptor isoform in endometriosis: a case-control study” is an original clinical study suggesting a putative role of leptin in the development of endometrial implants. In this study, A. P. Nacul et al. report a significantly higher serum leptin/BMI ratio in women with endometriosis as well as a significantly higher expression of leptin and long form leptin receptor transcripts in the ectopic endometrium compared to the eutopic endometrium of patients with endometriosis and those with normal pelvis (controls). Overall, this special issue is an excellent resource for researchers and physicians and provides “state of the art” information on these very common benign uterine/pelvic conditions, which have a major impact on women's quality of life. Although this special issue does not focus directly on therapies, this should be a valuable compendium for researchers, students, and physicians to stimulate continuing efforts to further the understanding of the pathogenesis of endometriosis and uterine fibroids and to help to develop new therapies. Pasquapina Ciarmela Hilary Critchley Gregory M. Christman Fernando M. Reis

OC13.02: Office sonovaginography: redefining the concept of a normal pelvis on transvaginal ultrasound in women with suspected endometriosis

OC13.02: Office sonovaginography: redefining the concept of a normal pelvis on transvaginal ultrasound in women with suspected endometriosis

Evaluation of normal female Sudanese pelvic anatomy using Magnetic Resonance Imaging (MRI)

Purpose: This study aims to investigate the dimensions of the bony pelvis and soft tissue structures and to characterize the normal gynaecological appearance of single Sudanese females using magnetic resonance imaging (MRI). Design/methodology/approach: Seventy-two single females aged between 15 and 80 years were selected using Sagittal T 2 -weighted pelvic MRIs of 1.5 tesla. The determined variables were uterine cervix cranio-caudal, uterus length, pelvis outlet, pelvic cavity and true conjugate, linearly correlated with age. Signal intensity was used to characterize the normal pelvis structures. For the bladder, uterus endometrium, myometrium, cervix, vagina, adenexa, ovaries, Sagittal T 1 ,T 2 and Coronal T 2 -weighted images were used. Findings: There were significant differences in Sudanese results when compared with Afro-American groups. Originality/value: This study may contribute to obstetrics and gynaecology in the future.

Combined mRNA microarray and proteomic analysis of eutopic endometrium of women with and without endometriosis

An early semi-invasive diagnosis of endometriosis has the potential to allow early treatment and minimize disease progression but no such test is available at present. Our aim was to perform a combined mRNA microarray and proteomic analysis on the same eutopic endometrium sample obtained from patients with and without endometriosis. mRNA and protein fractions were extracted from 49 endometrial biopsies obtained from women with laparoscopically proven presence (n= 31) or absence (n= 18) of endometriosis during the early luteal (n= 27) or menstrual phase (n= 22) and analyzed using microarray and proteomic surface enhanced laser desorption ionization-time of flight mass spectrometry, respectively. Proteomic data were analyzed using a least squares-support vector machines (LS-SVM) model built on 70% (training set) and 30% of the samples (test set). mRNA analysis of eutopic endometrium did not show any differentially expressed genes in women with endometriosis when compared with controls, regardless of endometriosis stage or cycle phase. mRNA was differentially expressed (P< 0.05) in women with (925 genes) and without endometriosis (1087 genes) during the menstrual phase when compared with the early luteal phase. Proteomic analysis based on five peptide peaks [2072 mass/charge (m/z); 2973 m/z; 3623 m/z; 3680 m/z and 21133 m/z] using an LS-SVM model applied on the luteal phase endometrium training set allowed the diagnosis of endometriosis (sensitivity, 91; 95% confidence interval (CI): 74-98; specificity, 80; 95% CI: 66-97 and positive predictive value, 87.9%; negative predictive value, 84.8%) in the test set. mRNA expression of eutopic endometrium was comparable in women with and without endometriosis but different in menstrual endometrium when compared with luteal endometrium in women with endometriosis. Proteomic analysis of luteal phase endometrium allowed the diagnosis of endometriosis with high sensitivity and specificity in training and test sets. A potential limitation of our study is the fact that our control group included women with a normal pelvis as well as women with concurrent pelvic disease (e.g. fibroids, benign ovarian cysts, hydrosalpinges), which may have contributed to the comparable mRNA expression profile in the eutopic endometrium of women with endometriosis and controls.

Abstract 4564: Dysregulated p15 in urothelial carcinoma of the upper urinary tract

Abstract OBJECTIVE: To investigate tumorigenic characteristics of upper urinary tract urothelial carcinoma (UTUC) by evaluating genomic alterations and protein expression of p15, located in 9p21, in primary tumors and in the morphologically normal pelvis of UTUC patients. METHODS: 10 pairs of tumor and pelvis tissues were submitted for comparative genomic hybridization (CGH) to examine chromosome abberations. Western blotting assays were performed to compare the fold change of p15 expression between another 16 pairs of tumor and normal tissues. Immunohistochemistry was conducted to determine the presence of p15-positive tumor cells and staining intensity in 53 tumor tissues, including 26 superficial and 27 invasive tumors. The Student's t-test and Chi-square test were applied to explore the correlation between the p15 expression and clinicopathologic parameters of UTUC patients. RESULTS AND CONCLUSIONS: CGH revealed incomplete 9p21 in 70% of UTUC tumors, including 3 low-grade and 7 high-grade cases. Results of Western blotting assays showed high frequencies (75%) of p15 downregulation (fold change &amp;gt; 1.5) in UTUC tissues compared to their normal pelvis control. Immunohistochemistry results indicated that superficial tumors had lower p15 expression than invasive tumors (p=0.002). In patients with tumor metastases, local recurrence or distal recurrence, the p15 expression level was significantly increased in UTUC tissues (p=0.038, 0.01 and 0.017, respectively). Taken together, our data suggest that the decreased expression of p15 may be an important step in early neoplastic transformation of the urothelium of upper urinary tract and, during tumor progression, p15 may be up-regulated by other molecules, such as SP-1. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4564. doi:1538-7445.AM2012-4564

21st World Congress on Ultrasound in Obstetrics and Gynecology, 18-22 September 2011, Los Angeles, USA: presentations and awards

21st World Congress on Ultrasound in Obstetrics and Gynecology, 18-22 September 2011, Los Angeles, USA: presentations and awards

OC11.04: Office sonovaginography: redefining the concept of a normal pelvis on transvaginal ultrasound in women with suspected endometriosis

POSTERIOR VAGINAL FORNIX Sensitivity Specificity LR+ Total accuracy 57.9% 88.6% 5.1 77.8% 57.9% 91.4% 6.7 79.63% 94.7% 97.1% 33.2 96.3% 73.1% 94.3% 12.9 87.1% UTERO-SACRAL LIGAMENTS Sensitivity Specificity LR+ Total accuracy 55.6% 80% 2.8 75.9% 55.6% 95.6% 12.5 88.8% 88.9% 95.6% 20 94.5% 66.7% 95.6% 15 94.7% RECTO-VAGINAL SEPTUM Sensitivity Specificity LR+ Total accuracy 58.3% 83.3% 1.7 66.7% 63.9% 88.9% 5.7 72.2% 80.6% 100% Infinity 87% 83.3% 77.8 6 81.5%