• Title, Summary, Keyword: Pelvic insufficiency

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A Clinical Study on 1 Case of Postpartum Patient with Pelvic Girdle Pain (추나 수기 치료를 병행하여 호전된 산후 골반통 환자 치험 1례)

  • Choi, Kyung-Hee;Jung, Eun-Hye;Kwon, Ji-Myung;Yoo, Dong-Youl
    • The Journal of Korean Obstetrics and Gynecology
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    • v.26 no.4
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    • pp.204-212
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    • 2013
  • Objectives: The purpose of this study is to report the effects of traditional Korean treatment (acupuncture, herb medicine and Chuna manipulation treatment) on a postpartum patient with pelvic girdle pain. Methods: The postpartum patient with pelvic girdle pain was treated by traditional Korean treatment such as herbal medication (Boheotanggagam-bang), acupuncture. The patient was diagnosed pelvic insufficiency in pelvis AP x-ray. So we treated the patient a total of 10 times of acupuncture and Chuna manipulation treatment. Results: After the treatment, the patient's pain was disappeared and the pelvic insufficiency in pelvis AP x-ray was improved. Conclusions: This case shows that traditional Korean treatment might be effective in improving postpartum patients' pain and pelvic insufficiency.

Post Pelvic Radiotherapy Bony Changes (골반 방사선 치료후의 골 변화와 손상)

  • Huh, Seung-Jae
    • Radiation Oncology Journal
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    • v.27 no.1
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    • pp.1-9
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    • 2009
  • There has been recent interest in radiation-induced bone injury in clinical conditions, especially for pelvic insufficiency fracture (PIF). A PIF is caused by the effect of normal or physiological stress on bone with demineralization and decreased elastic resistance. Pelvic radiotherapy (RT) can also contribute to the development of a PIF. A PIF has been regarded as a rare complication with the use of megavoltage equipment. However, recent studies have reported the incidence of PIFs as $8.2{\sim}20%$ after pelvic RT in gynecological patients, an incidence that was higher than previously believed. The importance of understanding a PIF lies in the potential for misdiagnosis as a bony metastasis. If patients complain of pelvic pain after whole-pelvis radiation therapy, the presence of a PIF must be considered in the differential diagnosis. The use of multibeam arrangements and conformal RT to reduce the volume and dose of irradiated pelvic bone can be helpful to minimize the risk of fracture. In addition to a PIF, osteonecrosis and avascular necrosis of the femoral head can develop after radiation therapy. Osteoradionecrosis of the pelvic bone is a clinical diagnostic challenge that must be differentiated from an osseous metastasis. A post-radiation bone sarcoma can result as a long-term sequela of pelvic irradiation for uterine cervical cancer.

Clinical Features and Outcomes of Pelvic Insufficiency Fractures (골반 부전 골절의 임상 양상과 치료 결과)

  • Seo, Yong Min;Kim, Young Chang;Kim, Ji Wan
    • Journal of the Korean Fracture Society
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    • v.30 no.4
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    • pp.186-191
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    • 2017
  • Purpose: The purpose of this study was to investigate the radiological and epidemiological characteristics, as well as the clinical course of pelvic insufficiency fractures in the elderly population. Materials and Methods: At a Haeundae Paik Hospital, we retrospectively reviewed patients with pelvic insufficiency fractures between March 2010 and May 2017. The demographic data of patients were analyzed, and bone mineral density and bone turnover markers were evaluated to estimate the metabolic status of the bone. The radiological characteristics were evaluated by comparing the simple x-ray images with the computed tomography images, and the types of fractures were classified via computed tomography images. For clinical course evaluation, we investigated comorbid complications, and compared the walking ability scale before and 6 months after the fracture. Results: A total of 42 patients were included, with an average age of 76.5 years. All were female except one case. In 5 cases where the initial medical examination was from another institution, the fracture was not found in 3 cases. All cases received conservative treatment. After the diagnosis of pelvic bone fracture using a simple x-ray imaging, additional fractures were found in 81.0% of the study population using a computed tomography. Initiation of gait occurred at an average of 2.8 weeks, and every case except 1 (97.6%) fully recovered their gait ability. Conclusion: We concluded that there was a limitation with diagnosing pelvic insufficiency fracture using only a simple x-ray imaging technique. In general, cases in this study showed conservative treatment yielded favorable clinical outcome with relatively less critical complications.

Pelvic insufficiency fracture after radiotherapy in patients with cervical cancer in the era of PET/CT

  • Park, Shin-Hyung;Kim, Jae-Chul;Lee, Jeong-Eun;Park, In-Kyu
    • Radiation Oncology Journal
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    • v.29 no.4
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    • pp.269-276
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    • 2011
  • Purpose: To determine the incidence, risk factors, and clinical characteristics of pelvic insufficiency fracture (PIF) in patients with cervical cancer. Materials and Methods: Between July 2004 and August 2009, 235 patients with non-metastatic cervical cancer were treated with definitive chemoradiation or postoperative radiotherapy. Among 235 patients, 117 (49.8%) underwent the first positron emission tomography/computed tomography (PET/CT) within 1 year after radiotherapy. The median radiation dose was 55 Gy (range, 45 to 60 Gy). Medical charts and imaging studies, including PET/CT, magnetic resonance imaging (MRI), CT. bone scintigraphy were reviewed to evaluate the patients with PIF. Results: Among 235 patients, 16 developed PIF. The 5-year detection rate of PIF was 9.5%. The 5-year detection rate of PIF in patients who underwent the first PET/CT within a year was 15.6%. The median time to development of PIF was 12.5 months (range, 5 to 30 months). The sites of fracture included 12 sacroiliac joints, 3 pubic rami, 3 iliac bones, and 1 femoral neck. Eleven of 16 patients having PIF complained of hip pain requiring medications. One patient required hospitalization for pain control. The significant risk factors of PIF were old age, body mass index less than 23, bone mineral density less than -3.5 SD, and the first PET/CT within a year after radiotherapy. Radiation dose and concurrent chemotherapy had no impact on PIF rate. Conclusion: PIFs were not rare after pelvic radiotherapy in cervical cancer patients in the era of PET/CT. Timely diagnosis and management of PIF can improve quality of life in patients with cervical cancer, in addition to reducing unnecessary medical expenses.

The Comparative Study between Leg Length Analysis and X-ray on Diagnosis of Pelvic Malpositions - according to Positions and Valuation Bases - (기능성 족지장단분석과 X-ray의 골반변위 진단의 비교 연구 - X-ray 촬영 자세 및 평가 기준에 따라 -)

  • Lee, Jung-Min;Koog, Gil-Ho;Choi, Bo-Mi;Jeong, Hyun-A;Hong, Seo-Young
    • The Journal of Korea CHUNA Manual Medicine for Spine and Nerves
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    • v.5 no.2
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    • pp.169-180
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    • 2010
  • Objectives: This study was carried out to investigate the relationship of leg length analysis and X-ray finding according to positions and valuation bases on diagnosis of pelvic malpositions. Methods: Twenty-two people who get $33.09{\pm}10.73$ as average were evaluated by leg length analysis and X-ray findings. After measuring innominate measurement(IM), femur head line. distance between S2 and posterior superior iliac spine(PSIS). ilium shadow measurement(ISM), major axis of obturator foramen(MaF), minor axis of obturator foramen(MiF) and distance between off centering measurement and symphysis pubis, those were analyzed. Results: 1. In assessment of posterior rotation malposition ilium(PI), it was showed the best coincidence between leg length analysis and X-ray analyzed by 1M in supine position(11 cases, 50.5%). 2. In assessment of inflare, coincidence index between leg length analysis and X-ray were not good($4.00{\pm}3.03$ cases, $18.15{\pm}13.82%$). And leg length analysis were not sensitive. 3. On the whole, coincidence index between leg length analysis and X-ray were not good(best: 1 case, 45.5%; worst: 11 cases, 50.0%). Conclusions: Results form this investigation showed the relationship of leg length analysis and X-ray according 10 positions and valuation bases on diagnosis of pelvic malpositions. This results are expected to contribute to establish method of assessment in diagnosis of pelvic malpositions.

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Sacral Insufficiency Fractures : How to Classify?

  • Bakker, Gesa;Hattingen, Joerg;Stuetzer, Hartmut;Isenberg, Joerg
    • Journal of Korean Neurosurgical Society
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    • v.61 no.2
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    • pp.258-266
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    • 2018
  • Objective : The diagnosis of insufficiency fractures of the sacrum in an elder population increases annually. Fractures show very different morphology. We aimed to classify sacral insufficiency fractures according to the position of cortical break and possible need for intervention. Methods : Between January 1, 2008 and December 31, 2014, all patients with a proven fracture of the sacrum following a low-energy or an even unnoticed trauma were prospectively registered : 117 females and 13 males. All patients had a computer tomography of the pelvic ring, two patients had a magnetic resonance imaging additionally : localization and involvement of the fracture lines into the sacroiliac joint, neural foramina or the spinal canal were identified. Results : Patients were aged between 46 and 98 years (mean, 79.8 years). Seventy-seven patients had an unilateral fracture of the sacral ala, 41 bilateral ala fractures and 12 patients showed a fracture of the sacral corpus : a total of 171 fractures were analyzed. The first group A included fractures of the sacral ala which were assessed to have no or less mechanical importance (n=53) : fractures with no cortical disruption ("bone bruise") (A1; n=2), cortical deformation of the anterior cortical bone (A2; n=4), and fracture of the anterolateral rim of ala (A3; n=47). Complete fractures of the sacral ala (B; n=106) : parallel to the sacroiliac joint (B1; n=63), into the sacroiliac joint (B2; n=19), and involvement of the sacral foramina respectively the spinal canal (B3; n=24). Central fractures involving the sacral corpus (C; n=12) : fracture limited to the corpus or finishing into one ala (C1; n=3), unidirectional including the neural foramina or the spinal canal or both (C2; n=2), and horizontal fractures of the corpus with bilateral sagittal completion (C3; n=8). Sixty-eight fractures proceeded into the sacroiliac joint, 34 fractures showed an injury of foramina or canal. Conclusion : The new classification allowes the differentiation of fractures of less mechanical importance and a risk assessment for possible polymethyl methacrylate leaks during sacroplasty in the direction of the neurological structures. In addition, identification of instable fractures in need for laminectomy and surgical stabilization is possible.

Surgical Repair of Aortocaval Fistula Presenting with Cardiogenic Shock

  • Kim, In Ha;Min, Ho-Ki;Kim, Ji Yong;Kim, Dong-Kie;Kang, Do Kyun;Jun, Hee Jae;Hwang, Youn-Ho
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.51 no.6
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    • pp.406-409
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    • 2018
  • Aortocaval fistula (ACF) occurs in <1% of all abdominal aortic aneurysms (AAAs), and in 3% to 7% of all ruptured AAAs. The triad of clinical findings of AAA with ACF are abdominal pain, abdominal machinery bruit, and a pulsating abdominal mass. Other findings include pelvic venous hypertension (hematuria, oliguria, scrotal edema), lower-limb edema with or without arterial insufficiency or venous thrombus, shock, congestive heart failure, and cardiac arrest. Surgery is the main treatment modality. We report successful surgical treatment in a patient with a ruptured AAA with ACF who presented with cardiogenic shock.

A Clinical Case Report on the Malalignment Treated by Chuna Manual Therapy - Based on the Full Spine AP X-ray and VAS - (추나치료를 이용한 골반, 척추 및 견갑대 부정렬의 치험 3례 - Full spine AP X-ray, VAS 분석에 따른 -)

  • Park, Ji-Hyun;Jeong, Hyun-A;Hong, Seo-Young
    • The Journal of Korea CHUNA Manual Medicine for Spine and Nerves
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    • v.5 no.2
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    • pp.135-149
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    • 2010
  • Objectives : This study was designed to observe the effect of Chuna manual therapy on the asymmetrical alignment. Methods : To analyze static structural alignment, posterior inferior ilium deviation(PI), inflare change of pelvis were checked from full spine AP X-ray. And Cobb's angle of spine and height of shoulder girdle were analyzed. To evaluate the pain visual analogue score(VAS) was scored. Chuna therapy treated 8-10 times for 1 month. Results and Conclusions : In 3 cases, VAS was improved significantly. Full spine AP X-ray shows improvement of structural imbalace. Shoulder height difference, cobb's angle, pelvic insufficiency improved considerably. These results suggest that Chuna therapy might be effective for malalignment patients.

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Study on the Treatment of Benign Prostatic Hyperplasia(BPH) in Oriental Medicine (전립선비대증 치료의 한의학적 접근방법에 관한 연구)

  • Kim, Joong-Kil;Song, Bong-Keun;Lee, Eun-Jeong;Kim, Hyeong-Kyun
    • The Journal of Korean Medicine
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    • v.19 no.2
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    • pp.211-227
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    • 1998
  • Benign Prostatic Hyperplasia(BPH) is the most common benign tumor seen in the western male, and it is found in 50% of men over 50 years of age. It is characterized by the formation of large discrete lesions in the periurethral region. As they enlarge, these nodules tend to compress the urethra and cause partial or almost complete obstruction of .urine flow. The etiology of BPH is uncertain, but the increasing incidence with advancing age suggests the possibility of an imbalance between male and female sex hormones. In the past, most patients have had multiple indications to support the decision to initiate therapy. But both the urologic surgeon and the patient must be clearly aware of the results that can be expected and the risks involved in achieving them. The aims of this study are to investigate and summarize the current trends of treatment for BPH so as to suggest the effective and available way to treat the disease. In Oriental medicine, the BPH is recognized as uroschesis and ischuria, and the etiology is mainly in stagnated blood and insufficiency of the kidneys. The point of treatment of BPH is recovery of urination, and the treatment can be approached in two ways through herb drugs and acupuncture. Some of the herb drugs have substances which reduce BPB. Acupuncture therapy stimulates the pelvic plexus and is reported to be effective for voiding. Suppository, massotherapy, rectal injection, locus injection and attachment of herb drugs to the navel or the acupoint are announced as the effective treatments. So, this study of the approach and application of these treatments on BPH would be necessary.

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Traumatic Asphyxia with Compressive Thoracic Injuries -4 Cases Report- (흉부손상에 의한 외상성 가사 4예)

  • 김현순
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.13 no.3
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    • pp.212-218
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    • 1980
  • A severe crushing injury of the chest produce a very striking syndrome referred to as traumatic asphyxia. This syndrome is characterized by bluish-red discoloration of the skin which is limited to the distribution of the valveless veins of the head and neck. And also if it is characterized by bilateral subconjunctival hemorrhages and neurological manifestations. But these clinical entities faded away progressively in a few weeks. Apporximately 90% of the patients who live for more than a few hours will recover from traumatic asphyxia when it occurs as a single entity. And so, death results from either severe associated injuries of from subsequent infection, rather than from pulmonary or cardiac insufficiency in traumatic asphyxia. We have experienced 4 cases of traumatic asphyxia with severe crushing thoracic injuries at department of the chest surgery, Captial Armed forces General Hospital during about 3 years from April 1977 to Aug. 1980. The 1st 22 year-old male was struct 2$\frac{1}{2}$ ton truck on the road and was transferred to this hospital immediately. He had taken tracheostomy due to severe dyspnea with contusion pneumonia and for removal of a large amount of bronchial secretion. The 2nd case was 23 year-old male who was got buried in a chasm. In this case, the heavy metal post tumbled over him back while at work. The 3rd case was 39 year-old male who leapt out of a window in 5th story while fire broke out in living room by oil stove heating. He had multiple rib fracture with right hemothor x and right colle's fracture and pelvic bone fracture. The last 22 year-old male was run over by a gun carriage. The wheel of this gun carriage passed over his thorax and right chin. He was brought to this hospital by helicopter. when he was first examined at emergency room, he was in semicomatose state and has pneurmomediastinum with multiple rib fracture and severe subcutaneous emphysema. As soon as he arrived, bilateral closed thoracostomy was performed and cardiopulmonary resuscitation was done. In hospital 8th weeks, chest series showed fibrothorax in right side even if chest wall stabilized. All 4 cases had multiple petechiae over their facees and chest and bilateral subconjunctival hemorrhages referred to as traumatic asphyxia. 3 cases except one case who received splenectomy, had been suffered from contusion pneumonia and had been treated with respiratory care. In these 3 cases, they had warning of impending injury before accident, and took a deep breath hold it and braces himself. And also, even if he had not impending fear in remaining one case, he had taken a deep breath and had got valsalva maneuver for pulling off the heavy metal post. Intrathoracic pressure rose suddenly and resulted to traumatic asphyxia in this situation. All these cases were recovered completely without sequelae except one fibrothorax, right.

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