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385 abnormal computer tomograms of the organs in the lesser pelvis were analysed; the normal anatomy, indications for CT and its value are discussed. Particular attention is paid to the relevance of the computer tomographic information for treatment.
This study reports two cases of fatal necrosis of the lesser pelvis in patients with advanced cervical carcinoma, who had received combined radiotherapy and hyperthermia. The necrosis reached far from the high dose area, in one of the cases even outside the radiation portals. Both patients initially had treatment-related morbidity which responded well to surgical treatment. After a disease-free interval, a rapidly progressive necrosis developed. Necrosis to this extent after combined modality treatment has, to the authors' knowledge, not been described.
Five-year results of treatment in 661 patients with cervical cancer depending on the technic of dose fractionation in external irradiation of the lesser pelvis under static gamma therapy are reported. Two methods of fractionation were employed: small (daily irradiation, the single focal dose of 125--150 rad) and average dose fractionation (irradiation 3 times a week, focal dosage--280--330 rad). In similar initial data (age, stage of the disease, a form of tumor growth and its histological structure) both with the combined and associated radiotherapy the best five-year results were gained with average dose fractionation.
One hundred and twenty-three female patients were subjected to ultrasound and CT examinations on account of suspected tumours in the area of the lesser pelvis, or to evaluate the postoperative situation. Twenty-five patients were subjected in addition to the mentioned examinations also to angiography of the pelvic arteries. From comparison of the results of the radiodiagnostic examination and the surgical (histological) diagnosis ensues that in patients with a malignant tumour of the ovaries and uterus and with a benign tumour of the uterus the CT examination gives-more satisfactory results than the ultrasound examination. In patients with a benign tumour of the ovaries ultrasonic and CT examinations were approximately equally satisfactory.
Technological innovations which change diagnostic routines are continually being introduced in medical care, as exemplified by magnetic resonance imaging (MRI) with its advanced diagnostic capacity, now considered indispensible for the investigation of many disorders of the central nervous system. The article consists in an outline of applications of MRI in the investigation of the lower abdomen, a field characterised by substantial technical improvements in recent years, and a brief review of subject literature. Based on their experience of pelvic MRI, the authors advocate its more frequent use in investigating disorders of the lesser pelvis.
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Occasional reports describe various aspects of the fine morphology of the pelvic peritoneum, but its complete organ characteristics remain undefined. The peritoneal covering of the urinary bladder, rectum, uterus, uterine tube, ovary, broad ligament (BL) and testis in Wistar rats was examined by means of transmission and scanning electron microscopy (TEM, SEM). Unusually complicated relief and stomata between the cubic mesothelial cells characterized the surface of the BL. Deep, parallel furrows separated the wide longitudinal folds over the entire length of the uterine tube. The uterus and the ovary formed less numerous, shallow or extremely deep crypt-like invaginations, as well as serous villus-like or papilla-like evaginations. The flat cells were the predominant cell type over the BL, while the cubic mesothelium was the basic covering of the organs. Most of the cubic cells were located in the invagination of the submesothelial layer (SML). Such cells formed an almost smooth surface over the urinary bladder or formed larger areas of the rectum and the testis surfaces. Numerous microvilli, ciliae, round evaginations and complex lamellar bodies characterized their apical plasmalemma. In conclusion, the mesothelial heterogeneity is a stable feature of the lesser pelvis peritoneum, confirmed by TEM and SEM. The cubic mesothelium characterizes the organ peritoneum, while the BL plays the role of the parietal sheet, involving lymphatic units in the SML. The different types of contacts between the mesothelio-endothelial cells, large lymphatic vessels and occasional stomata are the usual components of the lymphatic units in norm, visible by TEM. Images of stomata, seen by SEM, demonstrate oval-shaped deep channel-like gaps surrounded by cubic mesothelium. The last data extend the evidence on stomata regions, which resemble the diaphragmatic ones. Clusters of cells (macrophages, mastocytes and Lymphocytes), small vessels (blood or lymphatic) and nerve fibers (unmyelinated and rare myelinated) form highly specialized complexes in the SML of the ovary, the uterus and the testis.
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