Caecal volvulus has been reported to be associated with various abdominal and pelvic pathologies. Its signs and symptoms are usually non-specific and maybe overlooked in favour of benign causes, such as constipation. A high degree of suspicion is required for prompt diagnosis. Herein, we report on an unusual case of caecal volvulus after a dental procedure that was managed initially as constipation.
Transperineal ultrasound (TPUS) is an image-guided radiotherapy system used for tracking intrafraction prostate displacements in real time. The objectives of this study are to evaluate intrafraction prostate displacements and derive planning target volume (PTV) margins for prostate radiotherapy at our institution. The ultrasound (US) data of nine prostate cancer patients referred for VMAT radiotherapy was retrieved. Prior to beam on, patient position was set up with the US probe positioned transperineally with the aid of reference images (fused US and computed tomography images). In each fraction, prostate displacements in three directions [superior/inferior (SI), left/right (LR) and anterior/posterior (AP)] were recorded. PTV margins were determined using Van Herk's formula. To assess the prostate displacement time trend, continuous displacement data were plotted in 30-s intervals for eight minutes. The intrafraction prostate monitoring found a population mean setup error (Mp) of 0.8, 0.1, - 1.7 mm, a systematic error of (∑p) 0.7, 0.4, 0.9 mm and random error (σp) of 0.2, 0.1, 0.3 mm in SI, LR and AP directions, respectively. The PTV margin was found to be the largest in the AP direction at 2.5 mm compared with 1.9 mm and 1.1 mm for SI and LR directions, respectively. The PTV margin allowed for prostate radiotherapy at our institution was 2.5 mm in all directions. The prostate displacement time trend showed an increase in intrafraction displacements, with most patients were observed to have strong positive correlation between time and intrafraction prostate displacements in SI direction. TPUS is feasible for monitoring intrafraction displacement of the prostate and may facilitate PTV margin generation to account for such displacements during radiotherapy.
Ureteral triplication is a rare congenital anomaly of the urinary tract. We report a case of ureteral triplication with contralateral partial kidney duplication in a patient with right loin pain. The development and types of ureteral triplication and the features of type 2 ureteral triplication on intravenous urography and magnetic resonance urography are described.
Variations of the sciatic nerve have been extensively studied in the past including its relationship with the piriformis muscle and associated clinical conditions like piriformis syndrome and sciatica. In the present study we noticed some interesting variations of the sciatic nerve, which were slightly different from the cases described earlier. In the previous studies most of the authors described the higher division of sciatic nerve and none of them discussed its formation. In this study we tried to look its formation from the sacral plexus and its divisions in the thigh. We noticed that in one cadaver the two components of the sciatic nerve originated directly from the sacral plexus and coursed down without merging in the thigh. Should this be called a higher division or non formation of the sciatic nerve? On the other hand in two other cadavers, the two divisions after emerging separately from the sacral plexus, united in the gluteal region and in the thigh respectively. Should we call this as higher division or low formation of the sciatic nerve? In two other cadavers the sciatic nerve emerged from the greater sciatic foramen below the piriformis and divided in the gluteal region itself. Ideally this should be called as higher division of sciatic nerve.
Fraktur avulsi tulang belakang iliac anterior (ASIS) jarang terjadi, dan lebih lumrah berlaku di kalangan remaja muda semasa bersukan. Ini disebabkan oleh rawan apophyseal yang lemah semasa remaja, apabila kontraksi otot yang kuat mengatasi ASIS semasa aktiviti olahraga. Seorang lelaki berusia 15 tahun dibawa ke Jabatan Kecemasan (ED) mengadu sakit pinggul kanan selepas perlumbaan semasa Hari Sukan sekolahnya. Ketika dia melintasi garisan penamat dan menang, dia tiba-tiba rasa sensasi “pop” di pinggul kanannya dan jatuh ke tanah dengan kesakitan. Di ED, dia baring meniarap dengan skor sakit 6/10. Intravena Ketorolac diberikan untuk melegakan kesakitannya. Pemeriksaan fizikal menunjukkan kesakitan setempat di kawasan hadapan pelvis kanan, tanpa bengkak atau kecacatan pada sendi pinggul kanan. Tiada perbezaan antara kepanjangan kaki kanan berbanding kaki kiri. Pergerakan pinggul kanan terhad akibat kesakitan. Pemeriksaan neurovaskular adalah normal. Radiografi pelvis menunjukkan fraktur avulsi ASIS kanan. Beliau telah dirujuk kepada pasukan Ortopedik dan telah dirancang untuk rawatan konservatif rehat di katil, analgesik, dan ambulansi tanpa berat. Dia dibenarkan pulang dan dirancang untuk temujanji di Klinik Ortopedik. Pemeriksaan semula selepas 2 bulan kecederaan menunjukkan pesakit sihat dan bebas kesakitan. ASIS mudah terdedah kepada kecederaan avulsi semasa menjalankan aktiviti sukan kerana otot sartorius menarik anteroinferior ASIS semasa lekukan maksimum pinggul dan lanjutan lutut. Walaupun fraktur avulsi apophyses pelvis jarang berlaku, ia harus dipertimbangkan di kalangan atlet remaja jika mekanisma kecederaan adalah sangat sugestif.
Uncontrolled bleeding due to pelvic fractures contributes to trauma-related morbidity and mortality. Three main strategies that have been outlined to combat this condition which include reduction of pelvic volume that lead to tamponade-like effect, arresting haemorrhage through angioembolization of the major vessels, and stabilization of the pelvic bone with external fixation need to be initiated early. A prehospital device that allow these strategies will aid significantly in the management of the patient. At present most devices used to treat pelvic fractures in the pre-hospital setting do have its’ own advantages but also have some limitations. A characteristic ‘wish-list’ of a good pelvic and lower limb immobilization device was created and the research team from UKM takes the challenge to design and produce a device that concurs to it. A two phase development project that incorporate anthropometric, biomechanical, cadaveric and radiological study was carried out over a period of seven years. Finally, BRIMTM immobilizer, a new pelvic and lower limb immobilization device that is user friendly, tough, cost effective, radiolucent, light and reusable that answers most of the requirement of a good device was invented.
Pelvimetry is the measurement of the dimensions of the pelvis, measured internally or externally, and is typically conducted with the aid of a pelvimeter. Intrapelvic dimensions, namely the intrapelvic height and width, are used to calculate pelvic area which has a moderate to high degree of heritability. Pelvic area measurements are associated with calving difficulty and have been used by producers to select for heifers to be included in their breeding herd.
Our aim is to study the inflammatory response towards the collagen-coated and non-coated polypropylene meshes in rats and the urodynamic investigation post-operatively. Forty-two female Sprague Dawley were divided into 7 groups of 6 rats; Control, Day 7 and 30 for Sham, Avaulta Plus (MPC), Perigee (MP). UDS were taken at days 7 and 30. Mesh with the vagina and bladder wall was removed and sent for immunohistochemical examination. Results showed intense inflammatory reaction on day 7 in the study groups which decreased on day 30. IL-1, TNF-α, MMP-2 and CD31 were observed to decrease from day 7 to day 30. NGF was almost normal on day 30 in all groups. UDS showed no difference in voiding pressure. Both Study and Sham groups had shorter voiding interval (VI) on day 7 but significantly lower in MPC. VI had significantly increased on day 30 in all groups. Voided volume was significantly lower in the mesh groups even when an increase was seen on day 30. In conclusion, the higher levels of IL-1, TNF-α and MMP-2 in collagen-coated polypropylene mesh imply greater inflammation than the non-coated polypropylene mesh. Mesh implantation can lead to shorter voiding interval and smaller bladder capacity.
Ureteric and bladder injuries are uncommon, difficult to diagnose and rarely occur in isolation. Diagnosis is often delayed or missed at presentation. Therefore, high clinical suspicion and appropriate timing of computed tomography (CT) are of paramount importance. We report two cases (ureteropelvic junction avulsion and ruptured dome of bladder) whereby the presentations were subtle and would have been missed if not for high clinical suspicion. This article discusses the problems associated with these urologic injuries, as well as how to develop a high index of suspicion based on the pattern of anatomical disruption, mechanism of injury, physiological abnormality and comorbidity.
This paper describes an extremely rare case of a huge aneurysmal bone cyst (ABC) in the pelvis, occurring in the patient's 5(th) decade of life. The patient presented with a history of painless huge pelvic mass for 10 years. Plain radiograph and computed tomography showed huge expansile lytic lesion arising from the right iliac bone. A biopsy was performed and histology confirmed diagnosis of aneurysmal bone cyst. Unfortunately, the patient succumbed to profuse bleeding from the tumour.
Sex assessment is an essential step in person identification, both in forensic and anthropological contexts. Many parts of skeletal remains such as skull, pelvis and long bones have been proven to be useful in determining sex. However, literature has shown that short bones such as carpal bones are also sexually dimorphic. In the last few years, there was an unpublished study using lunate, scaphoid and hamate from bone collection in Northern Thailand to create 6 discriminant equations to assess sex. The objective of this study was to investigate the application of those equations in the sample from other parts of Thailand.
Gastrointestinal stromal tumour (GIST) is extremely rare with reported incidence of 20 per million per year. It is the most common mesenchymal tumour of the gastrointestinal tract. When it occurs at the pelvis in a female patient, it can be misleading to a gynaecological diagnosis. Non gynaecological diagnosis such as GIST must be considered in patients with pelvic mass presenting with atypical symptoms.
Locked pubic symphysis is a rare form of pelvic injury that usually occurs after a lateral compression injury to
the pelvis, where the intact pubis is trapped behind the contralateral pubis. To the best of our knowledge, there
were 25 similar cases reported in the English literature since it was first described in 1952. We present a case
of locked pubic symphysis with a left iliac wing fracture and a left femur shaft fracture requiring open reduction
and internal fixation. We also reviewed previous reported cases of locked pubic symphysis and analysed the
pattern of presentation and guide to management of such injuries. We propose a classification system for
grading overlapping pubic symphysis that will provide a better guide to the management of such injuries.
Malignant melanoma, primarily a cutaneous malignancy, can also involve mucosal surfaces and constitutes 2% to 7% of all gynecological malignancies. Primary melanoma of the uterine cervix is an uncommon tumor and has poor prognosis. In the female genital tract, the synchronous occurrence of primary malignant melanoma in the cervix and vagina is rare. We report a case of a 48-year-old female patient who presented with a blackish vaginal mass and associated growth in the cervix. Biopsy from the vaginal mass was reported as malignant melanoma. Following this, she underwent radical surgery and adjuvant radiotherapy. After 12 months, the patient is doing well.
Malignant pelvic tumours often present late, hence a high index of suspicion should be maintain in order to arrive at the diagnosis. This is particularly true for those who have unusual symptoms. A proper planning and staging strategies is required to save the limb, and the limb salvage surgery is at present the surgery of choice to achieve local control and restoring optimum functions of the lower limbs as being illustrated by our three cases.