Pelvic Size Research Articles

Genetic mapping of principal components of canine pelvic morphology

BackgroundConcentrated breeding effort to produce various body structures and behaviors of dogs to suit human demand has inadvertently produced unwanted traits and diseases that accompany the morphological and behavioral phenotypes. We explored the relationship between pelvic conformation and canine hip dysplasia (HD) because purebred dogs which are predisposed, or not, to HD share common morphologic features, respectively. Thirteen unique bilateral anatomical features of the pelvis were measured on 392 dogs of 51 breeds and 95 mixed breed dogs. Principal components (PCs) were derived to describe pelvic morphology. Dogs were genotyped at ~183,000 single nucleotide polymorphisms and their hip conformation was measured by the Norberg angle and angle of inclination between the femoral neck and diaphysis.ResultsNo associations reached genome wide significance for the Norberg angle when averaged over both hips. PC1 was negatively correlated with the Norberg angle (r = -0.31; P < 0.05) but not the angle of inclination (r = -0.08; P > 0.05). PC1, 2, 4, and 5 differed significantly between male and female dogs confirming pelvic sexual dimorphism. With sex as a covariate, the eigenvector contribution to PC1 reflected the overall size of the pelvis and was significantly associated with the IGF-1 locus, a known contributor to canine body size. PC3, which represented a tradeoff between ilial length and ischial length in which a longer ischium is associated with a shorter ilium, was significantly associated with a marker on canine chromosome 16:5181388 bp. The closest candidate gene is TPK1, a thiamine-dependent enzyme and part of the PKA complex. Associations with the remaining PCs did not reach genome wide significance.ConclusionIGF-1 was associated with the overall size of the pelvis and sex is related to pelvic size. Ilial/ischial proportion is genetically controlled and the closest candidate gene is thiamine-dependent and affects birth weight and development of the nervous system. Dogs with larger pelves tend to have smaller NAs consistent with increased tendency toward HD in large breed dogs. Based on the current study, pelvic shape alone was not strongly associated with canine hip dysplasia.

Allometry and Sexual Dimorphism in the Human Pelvis.

Sexual dimorphism in the human pelvis has evolved in response to several jointly acting selection regimes that result from the pelvis' multiple roles in locomotion and childbirth, among others. Because human males are, on average, taller than females, some aspects of sexual dimorphism in pelvis shape might result from allometry, the association between stature and pelvis shape across individuals. In this study, they aimed to disentangle and quantify the two components contributing to pelvic sex differences: the allometric component, which emerges as a consequence of dimorphism in stature, and the remaining non-allometric sexual dimorphism component. A geometric morphometric analysis of a dense set of 3D landmarks, measured on 99 female and male adult individuals was conducted. While pelvis size was similar in both sexes, the average differences in pelvis shape reflected the well-documented pattern of sexual dimorphism. There was almost no overlap between females and males in shape space. Their analysis showed that pelvis size and shape were similarly associated with stature in both sexes. It was found that dimorphism in the height-to-width ratio of the pelvis and in the orientation of the iliac blades was largely allometric, whereas dimorphism in the subpubic angle and the relative size and distance of the acetabula was largely non-allometric. It was concluded that, in contrast to the overall pelvic proportions, sexual dimorphism in the birth-relevant pelvic dimensions was mainly of non-allometric origin and was presumably mediated via steroid hormone secretion during puberty. Anat Rec, 300:698-705, 2017. © 2017 Wiley Periodicals, Inc.

A New Ophthalmosaurid (Ichthyosauria) from Svalbard, Norway, and Evolution of the Ichthyopterygian Pelvic Girdle.

In spite of a fossil record spanning over 150 million years, pelvic girdle evolution in Ichthyopterygia is poorly known. Here, we examine pelvic girdle size relationships using quantitative methods and new ophthalmosaurid material from the Slottsmøya Member Lagerstätte of Svalbard, Norway. One of these new specimens, which preserves the most complete ichthyosaur pelvic girdle from the Cretaceous, is described herein as a new taxon, Keilhauia nui gen. et sp. nov. It represents the most complete Berriasian ichthyosaur known and the youngest yet described from the Slottsmøya Member. It is diagnosed on the basis of two autapomorphies from the pelvic girdle, including an ilium that is anteroposteriorly expanded at its dorsal end and an ischiopubis that is shorter or subequal in length to the femur, as well as a unique character combination. The Slottsmøya Member Lagerstätte ichthyosaurs are significant in that they represent a diverse assemblage of ophthalmosaurids that existed immediately preceding and across the Jurassic–Cretaceous boundary. They also exhibit considerable variation in pelvic girdle morphology, and expand the known range in size variation of pelvic girdle elements in the clade.

Metabolic and reproductive characteristics of replacement beef heifers subjected to an early-weaning regimen involving high-concentrate feeding

In an effort to better understand the consequences of early weaning (EW) for replacement beef heifers, a two-phase experiment was conducted investigating the impact on metabolic function and documenting reproductive characteristics. In phase 1, Angus×Simmental heifers (n=35) were stratified by BW and sire, and randomly assigned to either a normal weaning (NW, n=18) or EW (n=17) treatment. EW heifers were weaned at 107±3 days of age and provided access to a concentrate-based ration ad libitum with limit-fed mixed grass hay. NW heifers remained with their dams until 232±3 days of age, at which point heifers from both treatments were comingled and grazed on mixed summer pasture. Following NW, weekly blood samples were collected from all heifers for progesterone analyses used to determine the onset of puberty. Pelvic and ovarian size was measured before breeding. All heifers were subjected to an estrous synchronization protocol with timed artificial insemination (AI) at 437±4 days of age. During phase 2 of the experiment, a subset of pregnant heifers (n=16) were divided into two replicates and subjected to a glucose tolerance test, epinephrine challenge and progesterone clearance analysis. Neither age nor BW at puberty differed between EW and NW heifers. Likewise, no differences in pelvic area or ovarian size were observed. Thus, it appears that the reproductive maturity of EW and NW heifers was similar. Heifers studied during phase 2 of the experiment were restricted to those that had become pregnant to their first AI. Within this cohort, EW heifers tended to have lower overall circulating progesterone concentrations than those that were NW (P=0.14). Aspects of glucose and insulin dynamics were also altered, as EW heifers tended to have lower baseline glucose concentrations (P=0.10) despite similar baseline insulin concentrations. Compared with NW heifers, EW heifers had lower insulin area under the curve (P<0.05), which was partly the result of a tendency for lower peak insulin concentrations (P=0.11). Results of the glucose tolerance test indicate that a lesser insulin response was necessary to properly clear the glucose in the EW heifers, suggesting enhanced insulin sensitivity. Collectively, these results indicate that EW is not detrimental for the growth or reproductive development of replacement beef heifers, although some differences in glucose and insulin dynamics persist into adulthood.

Management of Pelvic Metastases in Patients With Testicular Cancer

To evaluate the clinicopathologic features and predictors of pelvic metastasis in patients with germ cell tumors. Between 1990 and 2009, 2722 patients undergoing retroperitoneal lymph node dissection (RPLND) were prospectively included in our institution's testis cancer database. Patients with pelvic disease were identified and clinicopathologic features were analyzed. Of the 134 patients, 14.5% had a history of prior groin surgery. At the time of referral, 98% had received prior chemotherapy, 19.4% had undergone prior RPLND, and 24% presented as late relapse. Surgery consisted of pelvic excision alone in 37 (27.6%) and pelvic excision with primary RPLND in 2 (1.5%) or with postchemotherapy RPLND in 95 (70.9%). Median pelvic mass size was 6.5 cm. Pathology of pelvic disease revealed teratoma in 74 (55%), nonseminomatous germ cell tumor in 28 (21%), sarcoma in 8 (6%), and necrosis in 22 (16.5%). Patients with pelvic metastases had a statistically higher initial stage of presentation (P <.001) and had a higher incidence of prior groin surgeries (P <.001). Pelvic metastasis in testicular cancer is uncommon and can be a site of late relapse. These patients tend to present with high-volume retroperitoneal disease or a history of prior groin surgeries. Surgery is curative in most patients, and pelvic pathology was teratoma in more than half.

Obstetric Forceps: A Species on the Brink of Extinction.

Both resident training in the use of obstetric forceps and forceps deliveries are experiencing precipitous declines in the United States. Current minimum training requirements are insufficient to ensure competency in this skill. These trends bear striking similarities to observations regarding the decline and ultimate extinction of biologic species and portend the inevitable disappearance of this valuable skill from the obstetric armamentarium. Attempts by experienced teaching faculty to provide residents with experience in a few forceps deliveries are of little value and may do more harm than good. There would seem to be only two viable solutions to this dilemma: 1) abandon attempts to teach forceps and prepare residents for a real-world practice setting in which management of second-stage labor does not include the availability forceps delivery; or 2) prioritize the development of high-fidelity simulation models in which fetal head size and attitude and pelvic size and architecture can be continuously varied to allow residents to obtain sufficient experience to know both how and when to proceed with forceps delivery. We believe this latter approach is the sole alternative to inevitable extinction of this species.

Laparoscopic Pyeloplasty: Always Dismembered?

To compare three laparoscopic surgical techniques for the treatment of ureteropelvic junction obstruction (UPJO), assessing their difficulty, operating time, effectiveness, and complications. The clinical histories of 54 patients with UPJO who underwent a laparoscopic procedure between June 2003 and September 2013 were reviewed. Anderson-Hynes (A-H) pyeloplasty was performed on 34 patients, nondismembered pyeloplasty on 11 cases (8 Y-V Foley plasty and 3 Fenger plasty), and cephalad vascular displacement or Hellström technique (HT) on 9 patients. The patients were selected for the different techniques depending on the findings during the procedures, according to renal pelvic size and the presence of crossing vessels. We compared the techniques according to intraoperative and postoperative outcomes. Complications were interpreted following the Clavien-Dindo classification. The success rate was defined as the absence of clinical symptoms and normal diuretic renography. Analysis of variance and chi-square tests were used for the statistical analysis. Mean follow-up was 55.58 months. The success rate achieved was 88.5% for A-H pyeloplasty, 90.9% for nondismembered pyeloplasty, and 100% for HT (p > 0.05). HT was the least time-consuming: 124 ± 30 vs 202 ± 44 minutes of A-H pyeloplasty and 147 ± 27 minutes of nondismembered plasty (p < 0.005). Mean hospital stay was 6.7 ± 1.4 days for A-H pyeloplasty, 6.6 ± 2 days for nondismembered pyeloplasty, and 3.42 ± 1.5 days for HT (p < 0.05). The postoperative complication rate was 21.1% for A-H pyeloplasty, 18.8% for nondismembered pyeloplasty, and 12.5% for HT (p > 0.05). None of the cases required open surgery, and urinary fistula was the most frequent complication. Intraoperative observation of ureteropelvic junction allows selecting cases to undergo nondismembered pyeloplasty techniques, achieving similar results to A-H pyeloplasty, reducing operating time, complication rate, and hospital stay.

Size and thickness effect on creep behavior in conventional and vitamin E-diffused highly crosslinked polyethylene for total hip arthroplasty

Since the early 2000s, the use of large femoral heads is becoming increasingly popular in total hip arthroplasty (THA), which provides an improved range of motion and joint stability. Large femoral heads commonly necessitate to be coupled with thinner acetabular liners than the conventionally used because of the limited sizes of outer shells (especially for patients with small pelvic size). However, the influence of the liner thinning on the mechanical performance is still not clearly understood. The objective of this study was to experimentally clarify the size and thickness effect on the rates of compressive creep strain in conventional (virgin low-crosslinked) and vitamin E-diffused highly crosslinked, ultra-high molecular weight polyethylene (UHMWPE) acetabular liners. We applied uniaxial compression to these liners of various internal diameters (28, 32 and 36mm) and thicknesses (4.8, 6.8 and 8.9mm) up to 4320min under the constant load of 3000N. Vitamin E-diffused highly crosslinked UHMWPE components showed significantly greater creep resistance than the conventional ones. In the both types of UHMWPE, the rates of creep strain significantly decreased by increasing the internal diameter and thickness. Varying the component thickness contributed more largely to the creep behavior rather than the internal diameter. Our results suggest the positive mechanical advantage of using large femoral heads, but at the same time, a considerable liner thinning is not recommended for minimizing creep strain. Therefore, the further in-vitro as well as in-vivo research are necessary to conclude the optimal balance of head diameter and liner thickness within the limited sizes of outer shells.

Age related changes in pelvis size among adolescent and adult females with reference to parturition from Naraingarh, Haryana (India)

This research examines the ontogenic patterns of changes in growth during adolescence, pelvis variations and growth during twenties and thirties of age, structural remodeling of pelvis related to childbirth and relationship of pelvis area with physique based on the cross-sectional data on 391 females from the state of Haryana. Peak growth velocity for body height and breadths of skeletal traits occurred between 11 and 12 years, much before mean age of menarche at 13.5 years; while for body weight and body mass index (BMI) occurred between 14 and 15 years, after the mean age of menarche. Untill the age 11 years, 11.87% of growth in stature was remaining, 19.37% for bi-cristal breadth, 25.96% for bi-ischial breadth and 35.82% for pelvic area. The hypothesis of critical value of pelvic width of 240mm at iliocristale for menarche to occur has been only a statistical association. Higher prevalence of malnutrition during pubertal phase than pre- and post-pubertal phases was due to greater nutritional needs during puberty.Among adult females, BMI was very poorly correlated with stature but very strongly correlated with body breadths, body breadth-stature indices and body weight. The body mass and pelvis size continued to change during 20s and first half of 30s. The continued increase of BMI was due to increase in body fat and muscle mass in females 18 years and older. To tease apart age and parturition effects on pelvis variations, the analysis showed that pelvic bones remodeling took place after the first child was born and not after the subsequent births, and it was a sign of childbirth phenotypic plasticity rather than age. Pelvis area was strongly associated with stature, BMI and age. Mean pelvic area of tall females was greater than those of medium and short stature. Females with broad shoulders had significantly greater mean pelvis area than those with narrow shoulders and medium shoulders. Females having thin/lean physique had the smallest mean pelvis area compared to those having medium and obese types of physiques. The stepwise multiple regression analysis revealed that BMI was the major determinant factor (multiple r=0.37) of pelvis area; addition of stature component increased the value of multiple r to 0.50, while addition of age marginally increased multiple r to 0.53.

Immunohistochemical study of ovarian psammocarcinoma: Report of a rare case

Psammocarcinoma is a rare variant of serous carcinoma of the ovaries and has a favourable prognosis resembling that of serous borderline tumors [1]. A 60-year-old woman had a pelvic mass 20weeks size. Magnetic resonance imaging (MRI) showed bilateral ovarian cysts with suspicious peritoneal deposits (Figure. 1A). Carbohydrate antigen 125 level was 1300 U/mL. Peritoneal fluid cytology showed large cell groups with high nucleocytoplasmic ratio, irregular nuclear borders, and indistinct nucleoli. A single psammoma body (PB) was detected (Figure 1B). A diagnosis of ovarian carcinoma was offered. Intraoperatively, bilateral large cystic ovarian masses were seen with thickened omentum and multiple subdiaphragmatic deposits. A biopsy of the omental deposits showed tumor composed of small cuboidal to round cells arranged in a papillary, cribriform pattern. The cells showed minimal pleomorphism and scant mitotic figures. Abundant PBs were scattered throughout the fibrous stroma and in the tips of the papillae (Figure 1C). A diagnosis of metastatic deposits of ovarian psammocarcinoma, International Federation of Gynecology and Obstetrics (FIGO) Stage IIIc was given. Cytokeratin 7 and epithelial membrane antigen showed strong immunoreactivity in tumor cells (Figure 1D and 1E) and none for cytokeratin 20, calretinin, and desmin. Immunoreactivity for estrogen receptors was seen in 75% of tumor cells (Figure 1F). The patient was given tamoxifen and chemotherapy. Patients with psammocarcinoma range in age from 36 years to 76 years (mean age 57 years) [1]. Psammocarcinoma shows: (1)

Randomized comparison of long and short vascular sheaths in reduction of the operator radiation exposure during uterine artery embolization.

To introduce a method in which a long sheath is used instead of the traditional short sheath, to reduce the radiation exposure of operators in uterine artery embolization (UAE). 52 patients undergoing UAE were randomly divided into two groups before the procedure: an 11-cm short sheath was used in Group A (n = 25), and a 45-cm-long sheath was used in Group B (n = 27); the 45-cm-long sheath was only partly inserted such that the hub of the sheath was approximately 34 cm caudal to the groin puncture site. All the procedures were standard bilateral UAE operations through unilateral approach. The other parameters of the two groups were kept the same, including the fluoroscopy conditions and the pelvic radiation field size. The thermoluminescent personal dosemeters were attached to the left wrist and left outer side of the thyroid collar of the operator during each operation. The radiation exposure of the operator, procedure duration and fluoroscopy time of each procedure were recorded. Statistical analysis was performed using independent samples t-test. The radiation exposure of both the left hand and thyroid of the operator was significantly reduced with the long sheath compared with the short sheath (89.5 ± 7.2 μGy vs 186.7 ± 12.6 μGy, p < 0.001, and 54.1 ± 5.5 μGy vs 63.9 ± 7.4 μGy, p < 0.001, respectively). No significant differences were found in the procedure duration and fluoroscopy time between the two groups (p > 0.1). Using a long sheath in UAE could significantly reduce the radiation exposure to the interventionists without extending the procedure duration or fluoroscopy time. For the first time, we introduce a simple and convenient method to reduce the radiation exposure of the operator in the UAE procedure.

Assessment of Pelvic Shape by a Newly Developed Posture Analyzer in Young Women in Japan

Background: Body composition has been changing along with change in the life style environment but there have been no studies on pelvic size by objective anthropometric assessment in young Japanese women. The objective was to examine pelvic shape by measuring the angle of inclination (AOI) and the distance between right and left anterior superior (AS) iliac spines. We also investigated associations of these measurements with physical symptoms related to distortion of the pelvis in young Japanese women. Methods: The AOI and the distance between right and left AS iliac spines in 92 female undergraduate students were measured by using a newly developed posture analyzer with a self-administered questionnaire. Results: The mean values of AOI and distance between right and left AS iliac spines were 0.31 radian and 270.1 mm, respectively. The distance between right and left AS iliac spines showed significant positive associations with body weight and height. According to tertiles of AOI, a large percentage of the subjects with a large AOI responded positively to the item “Heights of the fingers of the right and left hands being different when the upper limbs are raised”. According to tertiles of distance between right and left AS iliac spines, a large percentage of the subjects with a large distance responded positively to the item “Unhealed past injury in lower legs” and the item “Sitting with one’s legs folded sideways”. Conclusion: Increase in body weight and height were shown to be associated with pelvic shape. It has also shown that change in pelvic size can be estimated by the item “Heights of the fingers of the right and left hands being different when the upper limbs are raised”.

Predictors of systemic inflammatory response syndrome following percutaneous nephrolithotomy.

Introduction and Objectives:Sepsis remains one of the dreaded complications of percutaneous nephrolithotomy (PCNL). To analyze prospectively the preoperative and intraoperative factors that predict the occurrence of systemic inflammatory response syndrome (SIRS) in patients undergoing PCNL so that we can aggressively manage those patients from the preoperative period itself and avert the dangerous complications.Materials and Methods:A prospective study was carried out between August 2012 and March 2013 including all patients who underwent PCNL. Patients with infected collecting system, synchronous ureteric stones, stents, or percutaneous nephrostomy drainage were excluded from the study. Patients were evaluated with physical examination, urine analysis, urine culture and sensitivity, complete blood count, renal function test, X-ray kidney, ureter, and bladder (KUB), and plain and contrast-enhanced computerized tomography KUB. Patients who developed any two or above of the following in the postoperative period were considered to have developed SIRS. (1) Temperature >100.4°F (38°C) or <96.8°F (36°C). (2) Pulse rate >90/min. (3) Respiratory rate >20/min. (4) White blood cell count >12,000/ml or <4000/ml.Results:Of the 120 patients who underwent PCNL 29 (24.1%) developed features of SIRS. On univariate analysis, gender, diabetes mellitus, bladder urine culture, and serum creatinine were found to be statistically insignificant. Blood transfusion (P = 0.009), no of access tracts (P = 0.001), pelvic urine culture (P = 0.04), stone culture (P = 0.003), stone size (P = 0.001), age (P = 0.019), and operative time (P = 0.004) were found to be statistically significant. On multivariate regression analysis stone size, no of access tracts, operative time, and stone culture were found to be statistically significant with regard to the occurrence of SIRS.Conclusion:Patients with above-identified risk factors must be aggressively treated to prevent the occurrence of sepsis postoperatively.

The value of computed tomography-urography in predicting the postoperative outcome of antenatally diagnosed pelviureteric junction obstruction

Background The natural course of pelviureteric junction (PUJ) obstruction is variable. Of those who require surgical intervention, there is no definite reliable preoperative predictor of the likely postoperative outcome. We evaluated the value of preoperative computed tomography (CT)-urography in predicting the postoperative outcome. Patients and methods Ten newborns with antenatally diagnosed PUJ obstruction were evaluated after delivery with an abdominal ultrasound, and those with a renal pelvis measuring more than 3 cm in diameter were subjected to preoperative CT-urography. The kidney size, renal pelvis size, and renal parenchyma thickness were measured and documented. All underwent open surgical Anderson-Hynes dismembered pyeloplasty. The outcome was correlated to the preoperative renal parenchymal thickness as measured by means of preoperative CT-urography. Results Ten newborns (seven male and three female) with PUJ obstruction were operated on. Their ages at surgery ranged from 8 days to 4 months (mean= 1.75 months). Eight had PUJ obstruction on the right side and two had PUJ obstruction on the left side. The mean renal pelvis size on the affected side was 4.9 cm (3.6–6.3 cm). The mean renal parenchymal thickness was 0.57cm (0.25–1.3 cm). Four patients had a renal parenchymal thickness less than 0.5 cm, and these patients showed poor results on followup isotope scan compared with those who had a renal parenchymal thickness of more than 0.5 cm [mean= 14.9% (12–19.6%)] compared with a mean of 44.2% (33–54%). Conclusion This is a preliminary report and the number of patients in our study is small to make definite conclusions, and further studies in this regard are important. We believe that renal parenchymal thickness as measured by means of preoperative CT-urography is an important predictor of the final outcome in patients with antenatally diagnosed hydronephrosis. Those who had a renal parenchymal thickness of 0.5 cm or less showed poor results on followup isotope scan compared with those who had a renal parenchymal thickness of more than 0.5 cm. Keywords: outcome, pelviureteric junction obstruction, pyeloplasty

Pelvic sexual dimorphism among species monomorphic in body size: relationship to relative newborn body mass.

Females have larger pelves than males among eutherians to mitigate obstetrical difficulty. This study addresses 3 issues concerning pelvic sexual dimorphism using 8 species that are sexually monomorphic in nonpelvic size: Aotus azarae , Castor canadensis , Dasypus novemcinctus , Hylobates lar , Saguinus geoffroyi , Sciurus carolinensis , Sylvilagus floridanus , and Urocyon cinereoargenteus . Using published data to compute the index of relative newborn body mass (RNBM = [newborn body mass/adult female body mass]100%) for 266 eutherian species, A. azarae , H. lar , and S. geoffroyi are characterized as giving birth to relatively large newborns and the other 5 species as giving birth to relatively small newborns. The 3 issues are, compared to species giving birth to relatively small newborns, whether species that give birth to relatively large newborns have 1) higher magnitude of pelvic sexual size dimorphism (SSD), 2) lower prevalence of pelvic joint fusion, and 3) dissociation between pelvic and nonpelvic sizes. Nine measures of the pelvis were taken, and fusion of interpubic and sacroiliac joints was observed. Species grouped by high and low RNBM do not differ significantly in magnitude of SSD of pelvic inlet circumference. Species with high RNBM have significantly lower prevalence of interpubic joint fusion than those with low RNBM. Sexes do not differ in their multiple correlation coefficients between inlet circumference and nonpelvic body size in 7 of 8 species. Results suggest that 1) there are multiple anatomical pathways for pelvic obstetrical sufficiency, 2) an unfused interpubic joint is obstetrically advantageous, and 3) relative newborn size does not change the association between pelvic and nonpelvic size in females and males.

What is the pelvic lymph node normal size? Determination from normal MRI examinations.

There are few previous reports on maximal pelvic lymph node sizes and no data on normal mesorectal nodes. Therefore, the aim of the study was to estimate the normal size of pelvic lymph nodes and to determine the upper limits of the normal range. Pelvic magnetic resonance imaging (MRI) examinations were prospectively carried out using a Intera 1.5T magnet (Philips, the Netherlands), on 36 healthy volunteers (22 females, 14 males, mean age 25years). A balanced fast field echo (b-FFE) sequence was used with the following parameters: 3-mm-thick contiguous slice, matrix 512×512. Short axis diameters of pelvic and inguinal lymph nodes were measured in each anatomic territory (internal iliac, external iliac, common iliac, mesorectum and inguinal). After normalization of the measurements, the influences of age, gender, laterality and territory were evaluated. Upper limits (95th percentile) were then calculated. A total of 1147 lymph nodes were measured. Age, gender and side (right/left) had no significant influence on size. The upper limits of the normal range were, respectively, 5.3, 4.4, 6.3 and 3.9mm for the external and common iliac, internal iliac, inguinal and mesorectum nodes. This work presents maximal normal values for each pelvic area, and the values for mesorectum nodes are reported for the first time. The mesorectum nodes should be considered as abnormal when they are over 4mm in short diameter. For the other node areas, the upper limits of the normal range were, respectively, 6, 6, 5, 7mm for the external and common iliac, internal, iliac and inguinal nodes for the short axis.

Maternal pelvic size, fetal growth and risk of stroke in adult offspring in a large Swedish cohort.

Earlier research suggests that maternal pelvic size is associated with offspring's stroke risk in later life. We followed 6362 men and women from Uppsala, Sweden, born between 1915 and 1929 from 1964 to 2008 to assess whether maternal pelvic size was associated with incidence of thrombotic stroke (TS), haemorrhagic stroke (HS) and other stroke (OS). Offspring whose mothers had a flat pelvis had lower birth weight and birth-weight-for-gestational-age compared with those who did not. Inverse linear associations of birth-weight-for-gestational-age were observed with TS and OS. Female offspring whose mothers had a flat pelvis had increased risk of TS, but flat pelvis was not associated with other types of stroke. A smaller difference between intercristal and interspinous diameters and a smaller external conjugate diameter were independently associated with HS, whereas no pelvic measurements were associated with OS. We conclude that a smaller pelvis in women may impact the health of their offspring in adulthood.

Diagnosis of isolated fetal renal pyelectasis during midtrimester and follow-up the outcome in utero by prenatal ultrasonography

Objective To assess the clinical significance of fetal pyelectasis and its changing in utero. Methods One hundred and ninty-seven isolated pyelectasis cases were retrospective reviewed from Jan 2012 to Jul 2014. Isolated pyelectasis was defined as a renal pelvis anteroposterior diameter (RPAPD) of ≥5 mm without other fetal anomaly in second trimester. Persistent or progressive pyelectasis was defined as a RPAPD of ≥10 mm before delivery. They were divided into two groups according to the size of renal pelvis in second trimester: group A (RPAPD 5-10 mm) and group B (RPAPD ≥10 mm). As the same, there were two groups after 32 weeks of gestation: group C (RPAPD <10 mm) and group D (RPAPD ≥10 mm). Results Totally 154 cases were followed up. There were 188 cases (95.4%) in group A, with 41 cases lost, 141 cases (95.9%) RPAPD <10 mm, 6 cases (4.1%) RPAPD ≥10 mm before delivery. There were 9 cases (4.6%) in group B, with 2 cases lost, remained 7 cases RPAPD ≥10 mm before delivery. Conclusions Although most of the fetuses with RPAPD 5-10 mm in second trimester will remain the same or resolved before delivery, those with RPAPD ≥10 mm may persistent or progress.Prenatal assessment of fetal renal pelvis may provide properly consultation. Key words: Ultrasonography, prenatal; Fetus; Pyelectasis; Pregnancy trimester, second

Ovarian mature teratoma: a ten year experience in our institution

To describe the surgical management and diagnoses of mature ovarian teratomas and ovarian strumas in the present centre.Descriptive retrospective analysis of cases of mature ovarian teratoma at the present university-associated hospital over ten years.The mean age was 29 years and in 17 patients the diagnosis was made during other surgery. When surgery was planned, the approach was 80.2% laparoscopic and 16.1% laparotomic. In the laparoscopy group more cases had been diagnosed previously as dermoid cyst by ultrasound and fewer days of hospital admission. In the laparotomy group the authors found higher ultrasound size and the size in the gross pathology description. With regards to treatment, 45.3% of cases underwent ovariectomy and 49.3% a cystectomy. Comparing these two groups, the authors found larger pelvic mass size in the group of ovariectomies. Healthy ovarian tissue in the removed specimen was found more frequently in the ovariectomies group (29.1%) but also in some cystectomies (7.5%).The surgical treatment of the ovarian mature teratoma in the present center was directed on the basis of ultrasound diagnosis, ultrasound tumor size, and the existence of associated gynecologic pathology. The authors strongly recommend a laparoscopic approach and a cystectomy in order to preserve fertility especially in young women.

PWE-386 Development of perineal hernias following abdominoperineal excision for low rectal cancer

Introduction Previously, perineal herniation following abdominoperineal excision (APE) has been considered a rare complication affecting Method Retrospective data on patients who underwent APE between May 2006 and October 2014 in a single UK institution were collected. Analysis of Magnetic Resonance Imaging (MRI) and Computerised Tomography (CT) scans determined pelvic cavity dimensions and the presence of perineal herniation. Perineal hernias were defined as a defect containing bowel, uterus, bladder, vagina or omentum dropping below the pubococcygeal line. Consequently asymptomatic perineal hernias were included in this data. Perineal defects resolving naturally over time were not considered to be a hernia. Pelvic floor descent was measured from the pubococcygeal line to the lowest point of the descended material or matter. Data for gender and treatment with chemoradiotherapy (CRT) were extracted from patient notes. Data were tested for normality and appropriate t-tests used. Results Post-operative data were available for 63/73 patients, mean age 67 years (range 26–85), of which 67% were male. First postoperative scans presented 17/63 (27%) patients with a perineal hernia. Most recent scans showed 23/63 (37%) patients with a perineal hernia. No significant difference was found between post-operative pelvic outlet size and presence of a perineal hernia (9.8 v 10.3, P Conclusion Our data suggest that the size of the pelvic outlet and gender could be less important than previously thought in development of a perineal hernia. It could be suggested that patients at risk of perineal herniation present early after surgery and that increased survival time does not necessarily increase the risk of developing a perineal hernia. This may be due to improved surgical technique and closure with porcine mesh. Disclosure of interest None Declared.