Pelvic Soft Tissue Research Articles

Nursing care of pelvic fracture combined with soft tissue defect by vacuum sealing drainage and external fixator

Objective To explore the perioperative nursing pattern in patients with pelvic fracture and soft tissue defect in treatment with vacuum sealing drainage(VSD) and external fixator. Methods A total of 60 cases of patients with pelvic fracture combined with soft tissue defect admitted to the hospital from January 2014 to January 2016 were selected. According to the random number table method, they were divided into the observation group and the control group, 30 cases of each group, and were treated with VSD combined with external fixator.The observation group was given routine nursing and the control group was given comprehensive nursing.The body temperature of the two groups was higher than normal time, hospitalization time, fracture healing time, survival rate of first-stage skin grafting, incidence of complications, blood routine and indexes of liver and kidney function at 1 week after surgery, quality of life score at 1 week after surgery and patient satisfaction were compared. Results The body temperature of the observation group was higher than normal time and the length of hospitalization was shorter than that of the control group, and the difference was statistically significant (P<0.05). There was no significant difference in fracture healing time between the two groups (P<0.05). The survival rate of the observation group was higher than that of the control group, and the incidence of postoperative complications was lower than that of the control group, and differences were statistical significance (P<0.05). At 1 week after surgery, WBC, NEU, AST, ALT and Ccr of the observation group were all lower than those of the control group, while the scores of sleep, spirit, diet, psychology and total condition were all higher than those of the control group, and the differences were statistically significant (P<0.05). The satisfaction of the observation group was higher than that of the control group, and the difference was statistically significant (P<0.05). Conclusions For the patients with pelvic fracture combined with soft tissue defect, the implementation of comprehensive nursing in the perioperative period of VSD combined with external fixation is conducive to the recovery of the body, reducing the risk of postoperative complications, and the patients are highly satisfied, which is worthy of promotion. Key words: Pelvic fracture; Soft tissue defect; Vacuum sealing drainage; External fixator; Nursing

A Prospective Correlation of Tissue Histopathology With Nucleic Acid Yield in Metastatic Castration-Resistant Prostate Cancer Biopsy Specimens.

ObjectiveTo determine histopathologic, exome, and transcriptome nucleic acid material yield from prospectively collected metastatic tissue biopsy specimens in patients with metastatic castration-resistant prostate cancer (mCRPC).Patients and MethodsPatients with mCRPC initiating abiraterone acetate therapy underwent 2 serial metastatic site core needle biopsies after study activation on May 17, 2013. Multiple cores were obtained, and from each core, 1- to 2-mm segments were separated and formalin fixed for histopathologic examination. Tumor purity was determined for DNA and RNA from the rest of the biopsy specimen. RNA quality was assessed by calculation of an RNA integrity number and a DV200 score.ResultsA total of 89 patients underwent 172 uniformly processed core needle biopsies (89 on visit 1 and 83 on visit 2) between May 30, 2013, and September 10, 2015. Metastatic sites biopsied included bone (131), lymph nodes (31), liver (5), lung (3), and pelvic soft tissues (2). Of the 172 biopsy specimens, 85 (49%) had at least one of the multiple cores positive for tumor on histopathologic examination (53 of 88 [60%] from visit 1 and 32 of 83 [39%] from visit 2; P=.006). Metastatic carcinoma was observed in 50 of 130 bone lesion specimens (38%), compared to 35 of 41 nonbone specimens (85%) (P<.001). More than 10% tumoral DNA purity was observed in 89% and 80% of visit 1 and visit 2 biopsy specimens, respectively. Similarly, more than 10% tumor RNA purity was observed in 79% of visit 1 vs 59% for visit 2 (P=.008). In all, 134 of 172 procedures (78%) yielded tumor material either by histopathologic or nucleic acid purity analysis.ConclusionThis study found that biopsy specimens from mCRPC sites yield adequate histopathologic, exome, and transcriptome material in most, but not all, cases. This finding has relevance for future genome sequencing studies on the introduction of targeted therapeutic agents.Trial Registrationclinicaltrials.gov Identifier: 01953640.

The effect of consecutive pregnancies on the ovine pelvic soft tissues: Link between biomechanical and histological components

BackgroundPelvic organ prolapse, various types of incontinence (urinary incontinence, defecatory dysfunction), chronic cystourethritis, and sexual dysfunctions remain between the most common disorders in urogynecology. Currently, it is believed that the nature and number of births plays a major role in their development. Moreover, after these events, pelvic floor tissues may not recover to their original statuses. The close anatomical relationship among the vaginal wall, bladder and rectum often contribute to the emergence of anatomical-functional failure of adjacent organs and systems. Basic proceduresThe aim of this study was to investigate the effect of consecutive pregnancies on pelvic floor soft tissues, conducting biomechanical and histological analysis. Fifteen Swifter ewes: virgins, parous and pregnant were used. Samples, for uniaxial tension tests and histological analysis, were cut out from fresh tissue. A description of the mechanical properties of native tissue was obtained from the stress-strain curve. Histological samples were stained with Miller’s Elastica staining and analyzed using ImageJ software. Collagen, elastin, and smooth muscle contents (%) were analyzed along the full wall thickness of the selected organs. The links between mechanical properties of the soft tissues and histological parameters were analyzed. Main findingsMechanically, vaginal wall tissue and cervix of pregnant sheep were more compliant. In contrast, bladder and rectum became stiffer and had the highest total collagen content. Parous sheep rectum and bladder were stiffer, compared to virgin sheep. Principal conclusionsTensile strength appears to be linked to total collagen content. Elastin and smooth muscle show a direct influence on tissue compliance.

Remodeling of Rectal Innervation After Pullthrough Surgery for Hirschsprung Disease: Relevance to Criteria for the Determination of Retained Transition Zone.

After pullthrough surgery for Hirschsprung disease (HSCR), Glut1-positive submucosal nerve hypertrophy is used to diagnose retained transition zone in the neorectum. We hypothesized that pelvic nerves, severed during pullthrough surgery, sprout into the neorectum to mimic transition zone. The density (nerves/100x field) and maximum diameter of Glut1-positive submucosal nerves were measured in biopsies and redo resections from 20 patients with post-pullthrough obstructive symptoms. Their original and/or redo resections excluded unequivocal features of transition zone (myenteric hypoganglionosis or partial circumferential aganglionosis) in 17. Postoperative values were compared with control data from 28 cadaveric and 6 surgical non-HSCR specimens, and 14 primary HSCR resections. When possible, nerves were tracked from attached native pelvic soft tissue or aganglionic rectal cuff into the pulled-through colon. Glut1-positive submucosal nerves were not present in the 11 colons of non-HSCR infants less than 1 year of age, except sparsely in the rectum. In 17 older non-HSCR controls, occasional Glut1-positive nerves were observed in prerectal colon and were larger and more numerous in the rectum. In redo resections, Glut1-positive submucosal innervation in post-pullthrough specimens did not differ significantly from age-appropriate non-HSCR rectal controls and pelvic Glut1-positive nerves were never observed to penetrate the pulled-through colon. However, the density and caliber of Glut1-positive nerves in the neorectums were significantly greater than expected based on the prerectal location from which the pulled-through bowel originated. Submucosal innervation in post-pullthrough specimens does not support the hypothesis that native pelvic nerves innervate the neorectum, but suggests remodeling occurs to establish the age-appropriate density and caliber of rectal Glut1-positive innervation. The latter should not be interpreted as transition zone pullthrough in a rectal biopsy from a previously done pullthrough.

A Computer Modeling Study to Assess the Durability of Prophylactic Dressings Subjected to Moisture in Biomechanical Pressure Injury Prevention

The sacral area is the most common site for pressure injuries (PIs) associated with prolonged supine bedrest. In previous studies, an anisotropic multilayer prophylactic dressing was found to reduce the incidence of PIs and redistribute pressure. The purpose of the current study was to further investigate relationships between design features and biomechanical efficacy of sacral prophylactic dressings. Using computer modeling, the anisotropic multilayer dressing and a hypothetical dressing with different mechanical properties were tested under dry and 3 levels of moist/wet conditions. Sixteen (16) finite element model variants representing the buttocks were developed. The model variants utilized slices of the weight-bearing buttocks of a 28-year-old healthy woman for segmentation of the pelvic bones and soft tissues. Effective stresses and maximal shear stresses in a volume of interest of soft tissues surrounding the sacrum were calculated from the simulations, and a protective endurance (PE) index was further calculated. Resistance to deformations along the direction of the spine when wet was determined by rating simulation outcomes (volumetric exposures to effective stress) for the different dressing conditions. Based on this analysis, the anisotropic multilayer prophylactic dressing exhibited superior PE (80%), which was approximately 4 times that of the hypothetical dressing (22%). This study provides additional important insights regarding the optimal design of prophylactic dressings, especially when exposed to moisture. A next step in research would be to optimize the extent of the anisotropy, particularly the property ratio of stiffnesses (elastic moduli).

T(6;11) renal cell carcinoma: a study of seven cases including two with aggressive behavior, and utility of CD68 (PG-M1) in the differential diagnosis with pure epithelioid PEComa/epithelioid angiomyolipoma

Renal cell carcinomas with t(6;11) chromosome translocation involving the TFEB gene are indolent neoplasms which often occur in young patients. In this study, we report seven cases of renal cell carcinoma with TFEB rearrangement, two of whom had histologically proven metastasis. Patients (4F, 3M) ranged in age from 19 to 55 years (mean 37). One patient developed paratracheal and pleural metastases 24 months after surgery and died of disease after 46 months; another one recurred with neoplastic nodules in the perinephric fat and pelvic soft tissue. Histologically, either cytological or architectural appearance was peculiar in each case whereas one tumor displayed the typical biphasic morphology. By immunohistochemistry, all tumors labelled for cathepsin K, Melan-A and CD68 (KP1 clone). HMB45 and PAX8 staining were detected in six of seven tumors. All tumors were negative for CD68 (PG-M1 clone), CKAE1-AE3, CK7, CAIX, and AMACR. Seven pure epithelioid PEComa/epithelioid angiomyolipomas, used as control, were positive for cathepsin K, melanocytic markers, and CD68 (PG-M1 and KP1) and negative for PAX8. Fluorescence in situ hybridization results showed the presence of TFEB gene translocation in all t(6;11) renal cell carcinomas with a high frequency of split TFEB fluorescent signals (mean 74%). In the primary and metastatic samples of the two aggressive tumors, increased gene copy number was observed (3–5 fluorescent signals per neoplastic nuclei) with a concomitant increased number of CEP6. Review of the literature revealed older age and larger tumor size as correlating with aggressive behavior in these neoplasms. In conclusion, we present the clinical, morphological and molecular features of seven t(6;11) renal cell carcinomas, two with histologically demonstrated metastasis. We report the high frequency of split signals by FISH in tumors with t(6;11) chromosomal rearrangement and the occurrence of TFEB gene copy number gains in the aggressive cases, analyzing either the primary or metastatic tumor. Finally, we demonstrate the usefulness of CD68 (PG-M1) immunohistochemical staining in distinguishing t(6;11) renal cell carcinoma from pure epithelioid PEComa/epithelioid angiomyolipoma.

Solitary Fibrous Tumour of Pelvic Soft Tissue Mimicking A Prostatic Mass: Diagnosis and Management

Solitary fibrous tumor (SFT) is a rare soft tissue tumor occurring rarely in extrapleural sites like the pelvis. We here present a case of SFT of the pelvis which was initially diagnosed radiologically as a mass arising from prostate and on biopsy found to be a solitary fibrous tumor. On exploration, there was a well encapsulated tumor in retro-vesical space separate from prostate. Histopathology with Immuno-histochemistry confirmed the diagnosis of SFT. We retrospectively reviewed the literature to avoid such confusion in future. Pubmed search was made with the following keywords: solitary fibrous tumor, treatment, soft tissue, pelvis, radiology, and histopathology.

Aggressive angiomyxoma of the uterine corpus: A rare presentation

Aggressive angiomyxoma (AA) is a rare benign soft tissue tumor usually affecting the female pelvis and perineum. A 16‑year‑old girl presented on June 23, 2016, with vaginal protrusion of 1‑year duration. Examination revealed protrusion through the introitus; it was hyperemic with necrosis. Investigation revealed urinalysis that revealed blood (+), leucocytes (+), and others normal; Swab (taken from purulent discharge on the protruded mass) microscopy revealed numerous pus cells; and culture yielded no growth. Abdominopelvic ultrasound (USS) showed left‑sided pelvic soft tissue mass with no features of metastasis. Other investigations were normal. She had polypectomy with subtotal abdominal hysterectomy. Histology revealed benign AA. A rare tumor of the genital tract had been presented with a diagnostic dilemma. However, confirmation of diagnosis was easy with histology. Keywords: Angiomyxoma; uterine corpus; vaginal protrusion

Soft tissue tumors of the pelvis: Technical and histological considerations.

In this review, we first address the anatomic and technical considerations in the resection of pelvic soft tissue tumors, including the challenges unique to these tumors, such as the narrow anatomic confines of the bony pelvis, the often locally aggressive nature of these tumors, as well as the major functional deficits that may result from their resection. We then review the optimal, multidisciplinary, histology-driven treatment approach to pelvic tumors.

A Pilot Study: The Role of Radio-Opaque Hydrogel Tissue Marker in the Treatment of Postprostatectomy Intensity Modulated Radiation Therapy

It is well documented that the prostate bed is highly susceptible to inter-fraction motion leading to larger treatment planning margins to account for daily treatment set up uncertainties when matching to bony anatomy. The use of fiducial markers in the prostate bed has significantly improved accuracy of treatment delivery. This pilot study aims to investigate the role and benefits of radio-opaque hydrogel tissue marker in the treatment of post prostatectomy intensity modulated radiation therapy (IMRT). Twenty patients treated with IMRT to a dose of 70.2Gy in 39 fractions between Jan 2016 to Jan 2017 were included in this study. All patients underwent transperineal injection of hydrogel tissue marker at the level of vesico-urethral anastomosis and cystoscopically into the posterior bladder wall. Instructions for bladder and bowel preparation to be followed during CT simulation and daily treatments were provided to the patients. Daily on-line cone beam CT matching to the hydrogel tissue marker was performed prior to each treatment and off-sets relative to skin tattoos were recorded in 3 directions: left-right (LR); superior-inferior (SI) and anterio-posterior (AP). Daily image registration using bony matching was then assessed off-line and off-sets relative to skin tattoos were again recorded. The mean and standard deviation of the differences between the hydrogel tissue markers and bony off-sets were calculated for all fractions for each patient; then the overall mean and systematic (Σ) and random errors (σ) for the entire cohort were calculated. The planning target volume (PTV) margin required for bony matching was estimated using van Herk's formula of 2.5Σ + 0.7σ, which is designed to ensure a minimum dose of 95% of prescribed dose to the clinical target volume (CTV) in 90% of patients. These margins are relative to the hydrogel tissue markers which are assumed to be in the target tissue. A total of 1520 images were analysed. The overall mean shift differences between the hydrogel tissue markers and bones for the entire cohort were LR: 0.13mm (Σ 0.38mm, σ 1.35mm); SI: 0.92mm (Σ 1.40mm, σ 2.50mm) and AP: 0.40mm (Σ 1.98mm, σ 3.18mm). The calculated PTV margins for bony matching relative to hydrogel tissue markers were 1.90mm in LR, 5.25mm in SI and 7.17mm AP directions. Prostate bed motion is independent of pelvic bone anatomy and soft tissue matching has shown to be superior compared with pelvic bone matching. With a required PTV margin of 7.17mm in the AP direction, the use of hydrogel tissue marker can significantly improve treatment set up accuracy even in patients with optimal bowel and bladder preparations who undergo image guidance with pelvic bone matching. This will provide the best CTV coverage whilst minimising the current PTV margin and mitigating bladder and rectal toxicities.

Predicting local failure after radical cystectomy in patients with bladder cancer: Implications for the selection of candidates at adjuvant radiation therapy

ObjectiveTo evaluate incidence and predictors of local failure (LF) after radical cystectomy (RC) due to bladder cancer. MethodsWe focused on 1,112 patients treated with RC, between 1990 and 2012, at a single center. LF was defined as imaging evidence of recurrence in the pelvic soft tissues or nodes below the aortic bifurcation at least 3 months before the detection of distant metastases. Competing risk analyses tested the relationship between clinical and pathological factors and the risk to develop LF. Regression tree analysis stratified patients into risk-groups based on their characteristics and the corresponding LF rate. ResultsOverall, 50 (4.5%) patients developed LF during a median follow-up period of 62 (35–92) months. On univariable competing risk regression analyses, pathological T stage (pT4 vs. pT3; hazard ratio [HR] = 2.55, P = 0.003), soft tissue surgical margin (STSM; HR = 2.95, P = 0.005), and variant histology (HR = 1.79, P = 0.03) were associated with an increased risk of developing LF. The cohort was stratified into 4 risk groups: very low (≤pT3a disease and pure urothelial histology), low (≤pT3a disease and variant histology), intermediate (pT4 disease), and high (positive STSM). ConclusionsLF is an important event in RC patients. We developed a new risk model based on bladder cancer characteristics. Our findings could help with the identification of the best candidate for consideration of adjuvant radiotherapy.

Biomechanical and morphological properties of the multiparous ovine vagina and effect of subsequent pregnancy

Pelvic floor soft tissues undergo changes during the pregnancy. However, the degree and nature of this process is not completely characterized. This study investigates the effect of subsequent pregnancy on biomechanical and structural properties of ovine vagina. Vaginal wall from virgin, pregnant (in their third pregnancy) and parous (one year after third vaginal delivery) Swifter sheep (n=5 each) was harvested. Samples for biomechanics and histology, were cut in longitudinal axis (proximal and distal regions). Outcome measurements describing Young’s modulus, ultimate stress and elongation were obtained from stress-strain curves. For histology samples were stained with Miller's Elastica staining. Collagen, elastin and muscle cells and myofibroblasts contents were estimated, using image processing techniques. Statistical analyses were performed in order to determine significant differences among experimental groups. Significant regional differences were identified. The proximal vagina was stiffer than distal, irrespective the reproductive status. During the pregnancy proximal vagina become more compliant than in parous (+47.45%) or virgin sheep (+64.35%). This coincided with lower collagen (−15 to −21%), higher elastin (+30 to +60%), and more smooth muscle cells (+17 to +37%). Vaginal tissue from parous ewes was weaker than of virgins, coinciding with lower collagen (−10%), higher elastin (+50%), more smooth muscle cells (+20%). It could be proposed that after pregnancy biomechanical properties of vagina do not recover to those of virgins. Since elastin has a significant influence on the compliance of soft tissues and collagen is the main “actor” regarding strength, histological analysis performed in this study justifies the mechanical behavior observed.

MP58-09 PREDICTING LOCAL FAILURE AFTER RADICAL CYSTECTOMY IN BLADDER CANCER PATIENTS: IMPLICATIONS FOR THE SELECTION OF CANDIDATES AT ADJUVANT RADIATION THERAPY

You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2017MP58-09 PREDICTING LOCAL FAILURE AFTER RADICAL CYSTECTOMY IN BLADDER CANCER PATIENTS: IMPLICATIONS FOR THE SELECTION OF CANDIDATES AT ADJUVANT RADIATION THERAPY Marco Moschini, Andrea Gallina, Nicola Fossati, Stefano Luzzago, Rocco Damiano, Agostino Mattei, Shahrokh Shariat, Vincenzo Mirone, Giusy Burgio, Andrea Salonia, Alberto Briganti, Francesco Montorsi, and Renzo Colombo Marco MoschiniMarco Moschini More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Stefano LuzzagoStefano Luzzago More articles by this author , Rocco DamianoRocco Damiano More articles by this author , Agostino MatteiAgostino Mattei More articles by this author , Shahrokh ShariatShahrokh Shariat More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Giusy BurgioGiusy Burgio More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Renzo ColomboRenzo Colombo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1804AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Local failure (LF) after radical cystectomy (RC) due to bladder cancer (BCa) is a common and deadly event. Clinical trials are currently evaluating the impact of adjuvant radiotherapy on the reduction of LF, however scarce data exists about selection of candidates who might benefit from multimodal approach. METHODS We focused on 1112 patients treated with RC and pelvic lymph node dissection, between 1990 and 2012, at a single tertiary referral center. LF was defined as imaging evidence of recurrence in the pelvic soft tissues or nodes below the aortic bifurcation before or within 3 months of detection of distant metastases. Kaplan-Meier log-rank, univariable and multivariable competing risk analyses tested the relationship between clinical and pathological factors and the risk to develop LF during follow up period. Regression tree analysis stratified patients into risk-groups based on their tumor characteristics and the corresponding LF rate. RESULTS Of the 1,122 individuals included in the study, 50 (4.5%) developed LF during follow up period. Median (IQR) follow-up was 62 (35-92) months. At univariable competing risk regression, pathological T stage pT4 vs. pT3 (Hazard Ratio [HR]: 2.55, p=0.003), positive soft tissue surgical margin (STSM) vs. negative (HR: 2.95, p=0.005) and non-pure transitional vs. pure transitional histology (HR: 1.79, p=0.03) were associated with an increased risk of developing LF. On the basis of these variables, the cohort was stratified into four risk groups: very low risk (=pT3a disease, pure transitional histology and negative STSM), low risk (=pT3a disease, non-pure transitional histology and negative STSM), intermediate risk (pT4 disease, negative STSM and any histology), and high risk (all patients with positive STSM). CONCLUSIONS LF is a common event in RC patients. We developed a new risk model based on BCa characteristics. Our findings should be considered by threating physicians when deciding the necessity of adjuvant radiotherapy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e775-e776 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Marco Moschini More articles by this author Andrea Gallina More articles by this author Nicola Fossati More articles by this author Stefano Luzzago More articles by this author Rocco Damiano More articles by this author Agostino Mattei More articles by this author Shahrokh Shariat More articles by this author Vincenzo Mirone More articles by this author Giusy Burgio More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Renzo Colombo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinical Outcomes for Stereotactic Ablative Radiotherapy in Oligometastatic and Oligoprogressive Gynecological Malignancies.

We report single-institution clinical outcomes of women treated with stereotactic ablative radiotherapy (SABR) for oligometastatic or progressive gynecological malignancies. From 2009 to 2015, 47 lesions from 28 patients were treated with SABR and retrospectively analyzed. All patients had oligometastatic (93%) or oligoprogressive (7%) disease. Primary cancer diagnoses were 15 ovarian, 8 endometrial, 2 cervical, 2 vaginal, and 1 uterine carcinosarcoma. Treatment was delivered using a median of 5 fractions to a median total dose of 40 Gy. Targets were grouped by treatment site and assessed for response using Response Evaluation Criteria in Solid Tumors v1.1. Mean biologically effective dose and pre-SABR tumor size were compared with response. Progression-free survival (PFS) was determined using Kaplan-Meier analysis, and toxicity outcomes were graded using Common Terminology Criteria for Adverse Events version 4.03. Median follow-up was 12.8 months. Target locations were 17% liver, 21% lung, 17% paraaortic node, 26% other node, and 19% pelvic soft tissue. After treatment, 34% of targets were stable (SD), 32% had a partial response (PR), 17% had a complete response (CR), and 17% had progressive disease (PD). No failures occurred in lung or nodal targets. Mean ± standard deviation pre-SABR tumor diameter was 24 ± 22 mm. There was a significant difference in mean size between lesions that had a favorable (SD, PR, and CR) versus unfavorable response (PD) (17.2 vs 57.6 mm, P = 0.0044). Lesions that responded favorably were also more likely to have received a higher biologically effective dose (79.0 vs 59.6 Gy, P = 0.027). Median PFS was 10.8 months, and 1 patient experienced grade 3 toxicity. The SABR is a safe and effective local treatment modality in patients with oligometastatic gynecological disease. Distant progression remains the primary mode of failure in this patient population. In carefully selected patients, a combination of systemic treatment and SABR may offer long-term PFS.

Forensic Analysis of the Characteristics of Pelvic Fracture in 65 Road Traffic Accident Death Cases

To analyze the characteristics and mechanisms of pelvic fractures in the cases of road traffic accident deaths. Total 65 cases of road traffic accident deaths with pelvic fracture were collected, and the sites, characteristics and injury mechanisms of pelvic fracture were statistically analyzed. Among the 65 cases of pelvic fracture, 38 cases of dislocation of sacroiliac joint were found, and most combined with pubis symphysis separation or fracture of pubis. In the fractures of pubis, ischium and acetabulum, linear fractures were most common, while comminuted fractures were most common in sacrum and coccyx fractures. There were 54 cases combined with pelvic soft tissue injury, and 8 cases with pelvic organ injury and 44 cases with abdominal organ injury. In the types of pelvic ring injury, 32 cases were separation, 49.32%, followed by compression, 26.15% and only one case was verticality, 1.54%. Detailed and comprehensive examination of the body and determination of the pelvic fracture type contribute to analyze the mechanisms of injury.

MRI in pelvic inflammatory disease: a pictorial review.

Pelvic inflammatory disease (PID) is an ascending infection of the female genital tract caused by the spread of bacteria from the vagina to the pelvic reproductive organs and occasionally the peritoneum. The most common causative organisms are sexually transmitted. PID is a significant source of morbidity among reproductive age women both as a cause of abdominal pain and as a common cause of infertility. Its clinical presentation is often nonspecific, and the correct diagnosis may first come to light based on the results of imaging studies. MRI is well suited for the evaluation of PID and its complications due to its superior soft tissue contrast and high sensitivity for inflammation. MRI findings in acute PID include cervicitis, endometritis, salpingitis/oophoritis, and inflammation in the pelvic soft tissues. Acute complications include pyosalpinx, tuboovarian abscess, peritonitis, and perihepatitis. Hydrosalpinx, pelvic inclusion cysts and ureteral obstruction may develop as chronic sequela of PID. The pathophysiology, classification, treatment, and prognosis of PID are reviewed, followed by case examples of the appearance of acute and subclinical PID on MR images.

Identification of Site-specific Recurrence Following Primary Radiation Therapy for Prostate Cancer Using C-11 Choline Positron Emission Tomography/Computed Tomography: A Nomogram for Predicting Extrapelvic Disease

BackgroundManagement of recurrent prostate cancer (CaP) after radiotherapy (RT) is dependent on accurate localization of the site of recurrent disease. ObjectiveTo describe the anatomic patterns and clinical features associated with CaP recurrence following RT identified on advanced imaging. Design, setting, and participantsRetrospective review of 184 patients with a rising prostate-specific antigen (PSA) after RT for CaP. InterventionC-11 choline positron emission tomography/computed tomography (CholPET). Outcome measurements and statistical analysisRecurrence patterns were classified as pelvic soft tissue only (as a surrogate for potentially salvageable disease) versus any extrapelvic disease, and clinical features were compared between patterns. Multivariable logistic regression was used to generate a predictive nomogram for extrapelvic recurrence. Discrimination was assessed with a c-index. Results and limitationsRecurrence site was identified in 161 (87%) patients, with 95 (59%) sites histologically confirmed. Factors associated with the detection of recurrence included the difference between PSA nadir and PSA at CholPET (odds ratio: 1.30, p<0.01) and National Comprehensive Cancer Network high-risk classification (odds ratio: 10.83, p=0.03). One hundred (54.3%) patients recurred in the pelvic soft tissue only, while 61 (33%) had extrapelvic recurrence. Of 21 patients who underwent CholPET prior to meeting the Phoenix criteria of biochemical failure, 15 (71%) had recurrence identified on CholPET with 11 localized to the pelvis. On multivariable analysis, the difference between PSA nadir and PSA at CholPET, time from RT, and National Comprehensive Cancer Network risk group were predictive of recurrence outside of the pelvis, and a nomogram was generated with a c-index of 0.79. ConclusionsCholPET identified the site of recurrence in 87% of patients with a rising PSA after RT; most commonly within the pelvis in potentially salvageable locations. A predictive nomogram was generated, and pending external validation, this may aid in assessing the risk of disease beyond the pelvis. These findings underscore the importance of advanced imaging when considering management strategies for patients with a rising PSA following primary RT. Patient summaryWe identified anatomic patterns of recurrence in patients with a rising prostate-specific antigen after radiotherapy using C-11 choline positron emission tomography/computed tomography. Most recurrences were localized to the pelvis and we were able to generate a tool to aid in disease localization prior to evaluation with advanced imaging.

Complications after transcatheter arterial embolization for pelvic trauma: relationship to level and laterality of embolization.

Transcatheter arterial embolization (TAE) is commonly used to control hemorrhage after pelvic trauma. Despite the procedures reported safety, there can be severe complications, mostly related to ischemia of embolized tissues. Our purpose was to examine the complications of trauma patients resulting from the embolization techniques utilized at our level 1 trauma center. A retrospective chart review was conducted. One hundred and seven patients who underwent pelvic embolization between January 2003 and December 2013 were included. Patient demographics, ISS, angiography techniques, and major complications including gluteal and skin necrosis, wound breakdown, and deep infection were compared. Nine patients (8.4%) developed major complications after undergoing TAE. This rate dropped to 5.1% after exclusion of patients with Morel-Lavallee lesions. Nonselective embolization trended toward a higher complication rate compared to superselective embolization. Patients who developed complications were more likely to have undergone pelvic surgery. The majority of patients who developed complications had nonselective TAE. Morel-Lavallee lesions are a confounding factor, but TAE may impose an additional risk. Pelvic surgery after TAE may further predispose patients to complications. We recommend superselective embolization as first-line treatment and caution the use of prophylactic embolization, especially in patients with substantial pelvic soft tissue injuries.

Penetrating pelvic trauma: Initial assessment and surgical management in emergency

Penetrating pelvic trauma (PPT) is defined as a wound extending within the bony confines of the pelvis to involve the vascular, intestinal or urinary pelvic organs. The gravity of PPT is related to initial hemorrhage and the high risk of late infection. If the patient is hemodynamically unstable and in hemorrhagic shock, the urgent treatment goal is rapid achievement of hemostasis. Initial strategy relies on insertion of an intra-aortic occlusion balloon and/or extraperitoneal pelvic packing, performed while damage control resuscitation is ongoing before proceeding to arteriography. If hemodynamic instability persists, a laparotomy for hemostasis is performed without delay. In a hemodynamically stable patient, contrast-enhanced CT is systematically performed to obtain a comprehensive assessment of the lesions prior to surgery. At surgery, damage control principles should be applied to all involved systems (digestive, vascular, urinary and bone), with exteriorization of digestive and urinary channels, arterial revascularization, and wide drainage of peri-rectal and pelvic soft tissues. When immediate definitive surgery is performed, management must address the frequent associated lesions in order to reduce the risk of postoperative sepsis and fistula.

MP23-12 INTRAOPERATIVE RADIATION THERAPY DURING GENITOURINARY SURGERY: THE IMPORTANCE OF SPECIMEN MARGIN STATUS IN IMPROVING SURVIVAL

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I1 Apr 2016MP23-12 INTRAOPERATIVE RADIATION THERAPY DURING GENITOURINARY SURGERY: THE IMPORTANCE OF SPECIMEN MARGIN STATUS IN IMPROVING SURVIVAL Meera Chappidi, Max Kates, Zeyad Schwen, Nikolai Sopko, Phuoc Tran, Nita Ahuja, Stephanie Terezakis, Phillip Pierorazio, and Trinity Bivalacqua Meera ChappidiMeera Chappidi More articles by this author , Max KatesMax Kates More articles by this author , Zeyad SchwenZeyad Schwen More articles by this author , Nikolai SopkoNikolai Sopko More articles by this author , Phuoc TranPhuoc Tran More articles by this author , Nita AhujaNita Ahuja More articles by this author , Stephanie TerezakisStephanie Terezakis More articles by this author , Phillip PierorazioPhillip Pierorazio More articles by this author , and Trinity BivalacquaTrinity Bivalacqua More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.734AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intraoperative radiation therapy (IORT) is used to provide effective local control (LC) for patients with locally advanced or recurrent tumors. Since 2006, our institution has performed IORT for pelvic and retroperitoneal soft tissue malignancies. We sought to assess outcomes of IORT cases in which there was genitourinary (GU) involvement. METHODS We retrospectively reviewed patients from 2006-2015 who underwent IORT with GU involvement. Case selection for IORT included those in which pre-op EBRT could not obtain LC without excessive toxicity or pre-op imaging suggested difficulty obtaining negative surgical margins due to proximity to vital structures, bladder, or bowel. To provide IORT, the area at risk for local recurrence is measured following tumor resection and an appropriately sized Freiburg flap is created with linear, connected silicone rubbers balls to provide a uniform radiation dose (10-16 Gy) to the targeted area while using lead shields to protect surrounding structures. The primary endpoint was overall survival (OS) with secondary endpoints of recurrence free survival (RFS, defined as local recurrence in the surgical bed), 90-day readmission rate and Clavien grade IV or V complication rates. RESULTS Of the 158 patients who underwent IORT, 87 cases (55.1%) involved GU surgery. The most common procedures were 33 (37.9%) radical cystectomies and 21 (24.1%) radical nephrectomies. With a median follow-up time of 21.6 months, the 2-year OS was 71% [95% confidence interval (CI) 57-81%]. OS for patients with positive and negative margins was 54% [CI 29-73%] vs. 81% [CI 62-91%] (p=0.04) respectively. The 2-year RFS for patients with negative margins was 73% [CI 55-85%]. In a multivariate model controlling for age and receipt of neoadjuvant chemotherapy, margin status was the only predictor of OS [HR=2.10 (1.32-9.95)]. The 90-day readmission rate was 44.2% and 90-day rate of Clavien IV complications was 16.3% with no deaths in the cohort. CONCLUSIONS IORT is a safe and feasible treatment for high-risk patients undergoing complex surgery for sarcomas and other soft tissue malignancies with GU involvement. While IORT can improve LC, it does not serve as a substitute for adequate surgical control as surgical margin is still an important predictor of survival. Effort should be taken to achieve a negative margin in order to maximize the LC achieved with IORT. As this mode of cancer therapy expands into other sectors of urologic oncology, future studies will need to address the benefits of this cancer therapy versus additional local toxicity. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e266 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Meera Chappidi More articles by this author Max Kates More articles by this author Zeyad Schwen More articles by this author Nikolai Sopko More articles by this author Phuoc Tran More articles by this author Nita Ahuja More articles by this author Stephanie Terezakis More articles by this author Phillip Pierorazio More articles by this author Trinity Bivalacqua More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...