Osteogenesis imperfecta (OI) is a rare genetic connective tissue disorder characterized by increased fracture risk and bone deformity. Protrusio acetabuli (PA) is a well-recognized radiographic finding in patients with OI, yet data on its incidence, severity, and associated factors across different OI phenotypes remain limited. This retrospective study evaluated pelvic radiographs and clinical data of patients with OI treated in two centers. PA was assessed using established radiographic criteria and graded according to the Sotelo-Garza/Charnley classification. Demographic and clinical variables were analyzed to identify factors associated with PA. Of 69 patients included, PA was found in 32 (46.4%), of whom nine presented with severe, 15 with moderate, and eight with mild PA. Patients with PA were significantly older than those without PA. Univariable logistic regression identified female sex, body mass index > 25 kg/m[2], and scoliosis as factors significantly associated with PA. PA is a frequent radiographic finding in OI, affecting patients across all phenotypic severities, including mild disease, and may represent an underrecognized manifestation across the disease spectrum. While several factors were associated with its presence, these findings should be interpreted descriptively. Given the potential for selection bias, the reported prevalence may not be generalizable to the broader OI population. Further prospective studies are required to clarify the clinical relevance and natural history of PA in OI.Level of Evidence IV.

Iatrogenic ureteric injury is an uncommon but serious complication of gynaecological surgery, with significant potential for renal impairment, fistula formation, prolonged hospitalisation, and medico-legal consequences. The ureter is at risk not only in complex pelvic procedures but also during apparently straightforward operations, and injuries may go unrecognised at the time of surgery, contributing to delayed diagnosis and worse clinical outcomes. We present a case series of five female patients aged 33, 59, 45, 46, and 47 years, respectively, who underwent complex gynaecological surgery for large fibroids at the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Rajkot, Gujarat, India. Each case illustrates a distinct clinical challenge and a tailored ureteric safeguarding strategy. Preoperative magnetic resonance imaging (MRI) fibroid mapping was employed. In one case with a large cervical fibroid and documented bilateral ureteric dilatation, contrast-enhanced computed tomography (CT) with three-dimensional ureteric reconstruction provided an informed surgical roadmap and guided the decision for bilateral prophylactic double-J (DJ) ureteric stenting. In another case, attempted left-sided preoperative stenting failed due to fibroid-related ureteric obstruction - a finding that was reinterpreted as a diagnostically valuable signal of significant ureteric compromise rather than a procedural failure, directly heightening intraoperative vigilance. Across all five cases, systematic retroperitoneal dissection with early identification and tracing of the ureter at the pelvic brim served as the consistent intraoperative safeguard. In a further case, despite preparedness and awareness, inadvertent left ureteric transection occurred during haemostasis from an extremely vascular broad ligament fibroid mass; the injury was recognised immediately, urological assistance was summoned intraoperatively, and successful ureteroureterostomy with DJ stent insertion was performed, with complete patient recovery. Based on this experience, we propose a structured six-step protocol for ureteric safeguarding in complex gynaecological surgery: (1) preoperative risk stratification, (2) targeted imaging, (3) selective prophylactic ureteric stenting in cases with hydronephrosis or significant ureteric displacement, (4) systematic retroperitoneal dissection with early ureteric identification, (5) adjunctive intraoperative cystoscopy, and (6) preparedness for immediate surgical repair. This series demonstrates that a multimodal, anatomy-guided approach can substantially reduce the risk of ureteric injury in high-complexity cases, and that when injury occurs despite precautions, immediate intraoperative recognition and definitive repair are the most critical determinants of outcome.

Torsion of the vermiform appendix is rare. When torsion involves an appendiceal mucocele, timely surgical management, and avoidance of rupture are essential to prevent intraperitoneal mucin spillage. A 68-year-old woman presented with 12 h history of severe lower abdominal pain. Examination revealed marked lower abdomen rebound tenderness and her laboratory tests showed leukocytosis and elevated C-reactive protein. Urgent computed tomography demonstrated a 9 × 3.4 cm predominantly cystic mass posterior to the uterus with mural calcifications, consistent with an appendiceal mucocele. Emergency laparotomy revealed a necrotic appendiceal mucocele with complete torsion. The lesion was resected intact. Histopathology confirmed an appendiceal mucocele. The patient had an uncomplicated recovery and remains in excellent condition 3 months postoperatively. Appendiceal mucocele torsion should be considered in acute abdomen with a cystic pelvic mass on computed tomography. Intact resection is a key operative principle.

This study proposes a CT number (CTN)-to-stopping power ratio (SPR) calibration method that can be directly integrated into the photon therapy workflows and evaluates its robustness against tissue variations, as well as dosimetric deviations compared with current calibration methods for scanned proton therapy. To develop the CTN-to-SPR calibration curve, relative electron densities (REDs) derived from a phantom with tissue-substitute inserts were applied to the parametric regression model (PRM) constructed from 53 standard human tissues. PRM stability was tested by varying the mass density and elemental composition of the reference tissues and recalculating SPRs from RED and CTN. For dosimetric evaluation, treatment plans for head-and-neck, chest, and pelvis were recalculated using a PRM-derived HLUT (CTN-to-SPRPRM) without re optimization on the Siemens SOMATOM X.cite and GE Revolution CT ES, and compared with CTN-to-SPRclin. Dose-volume histograms (DVHs) assessed the dosimetric impact. RED-based SPR was expressed as SPR=-0.0173ρ_e^3+0.0057ρ_e^2+1.0163ρ_e, (RMSE ~0.82% (0.68% without air). CTN‑to‑SPRPRM and CTN‑to‑SPRclin showed similar shapes with minor head-body differences; averaged CTNs were used. CTN-to-SPRPRM gave higher SPRs in lung and bone, but lower in soft tissue, with differences within 3% between -200 and +200 HU, >25% at -800 HU, and 1.23% and 0.11% at 1000 HU for Siemens and GE, respectively. Hydrogen and calcium variations caused the largest RMSE increases (1.58% and 6.00%), and trends were consistent across sexes. DVH deviations were <3% overall, except -5% in left parotid and -4.2% in lung Dmean. The proposed CTN-to-SPRPRM method demonstrates clinical feasibility and ease of integration into the photon therapy workflows.

Pelvic ectopic kidney is a rare congenital anomaly, occurring in approximately 0.1% of the adult population, and is often asymptomatic. However, it can easily be mistaken for a pelvic tumor or lymph-node metastasis. This case report details a rare presentation of cytoreductive surgery for ovarian cancer with a pelvic ectopic kidney. A 56-year-old Chinese woman was incidentally found to have a pelvic mass accompanied by a pelvic ectopic kidney during evaluation for hip pain. Pathology following cervical lymph-node biopsy was consistent with high-grade serous adenocarcinoma. Comprehensive assessment via supraclavicular lymph-node biopsy, PET-CT, and multidisciplinary team (MDT) discussion confirmed ovarian cancer stage IVb with coexisting pelvic ectopic kidney. Treatment consisted of neoadjuvant chemotherapy with paclitaxel plus carboplatin followed by interval cytoreductive surgery achieving complete resection of all pelvic and abdominal lesions. Postoperative pathology verified high-grade serous ovarian carcinoma, stage IVb. Serum creatinine on postoperative day 1 was 78 µmol/L and remained stable; the patient was discharged on day 12. Post-discharge renal scintigraphy showed no decline in total GFR, and no renal or surgical complications occurred. This case underscores the importance of MDT management and thorough diagnostic work-up when performing cytoreductive surgery for ovarian cancer in the setting of pelvic ectopic kidney. Increased clinical awareness of this scenario helps avoid misdiagnosis, optimizes patient outcomes, and provides a reproducible technical roadmap for similar complex cases.

Cesarean section is among the most frequently performed surgical procedures worldwide. In recent years, the increasing rate of cesarean deliveries has led to an increased incidence of post-operative complications. The present case report describes a rare case of a post-operative pelvic abscess located at the uterine scar following a cesarean section, managed successfully via laparotomy. The patient, a 17-year-old woman, was admitted 1 week after undergoing a cesarean delivery. She presented with abdominal pain, fever and chills. Blood tests revealed elevated inflammatory markers and a mild coagulation disorder, consistent with an ongoing infectious process. The results of urinalysis did not reveal any notable findings. A transvaginal ultrasound and an abdominal computed tomography scan revealed a large, mixed echogenic mass with irregular borders and the presence of intralesional air bubbles, localized at the uterine scar anterior to the bladder. Given the persistence of clinical symptoms, supportive imaging and laboratory findings, and the failure of conservative management of the post-operative intra-abdominal infection, surgical intervention was deemed necessary. A laparotomy was performed through the previous cesarean incision. Intraoperatively, an abscess was identified at the site of the uterine scar and was surgically drained. Samples were collected for aerobic and anaerobic cultures, and the cavity was irrigated thoroughly to remove purulent and hemorrhagic material. A drainage tube was placed before closure. The postoperative course of the patient was uneventful, with complete clinical resolution. Following the case presentation, a brief review of the current diagnostic and therapeutic strategies for this uncommon post-operative complication is also provided. On the whole, the present case report underscores the importance of timely surgical intervention via laparotomy when image-guided drainage or laparoscopy is not feasible.

Intussusception occurs when a segment of the bowel telescopes into an adjacent segment, potentially leading to obstruction and intestinal ischemia. Intussusception in adults is likely caused by a pathological lead point (PLP), and it can be challenging to diagnose due to its broad clinical presentation, which requires a high degree of clinical suspicion. This case report describes a rare presentation of cecal adenocarcinoma in a young patient that caused ileocolic intussusception. A 31-year-old woman presented to the emergency department with progressively worsening intermittent abdominal pain, nausea, and bloating. She denied fever, chills, vomiting, hematochezia, and unintentional weight loss. Computed tomography (CT) scan of the abdomen and pelvis suggested ileocecal intussusception and two irregular cystic masses in the liver. After a colonoscopy showed a necrotic intraluminal mass, the patient underwent an exploratory laparotomy with right hemicolectomy due to the high risk of malignancy-associated intussusception. Pathology results from the hemicolectomy were consistent with adenocarcinoma of colonic origin. Furthermore, a liver biopsy was conducted to confirm metastases. The recovery was uncomplicated, with a gradual return of bowel function and tolerance of oral intake. A central venous port was placed for anticipated systemic chemotherapy, and the patient was referred for outpatient oncology follow-up, including positron emission tomography (PET)-CT imaging and initiation of chemotherapy. This case highlights the importance of considering colorectal malignancy in the differential diagnosis of young adults presenting with nonspecific gastrointestinal symptoms. Early diagnosis with high-contrast CT imaging is critical for identifying intussusception, evaluating for PLPs, and detecting metastatic disease, while prompt surgical intervention remains essential given the rarity of adult intussusception and the high likelihood of an underlying malignant etiology.

This study examined the associations between phase-specific kinematic variables and discus throw performance in elite throwers. Video recordings of 23 male (63.39 ± 4.19 m) and 16 female (59.74 ± 7.25 m) discus throwers were analysed to obtain kinematic variables describing phase durations, centre-of-mass (COM) velocities, discus paths and velocities, torso and hip-shoulder-arm positions, and pelvis and torso rotational velocities. Linear mixed models were used to identify phase-specific kinematic variables associated with throwing distance while accounting for repeated trials within athletes. Phase-specific kinematic variables positively associated with throwing distance were 1) a longer entry phase paired with shorter transition and delivery phases, 2) faster horizontal COM velocity during the flight phase, 3) peak horizontal discus velocity during the delivery, and 4) slower pelvis rotational velocity during the transition and faster torso rotational velocity during the delivery. Measures of torso lean and hip-shoulder-arm separation angles were not associated with throwing performance. These findings indicate that elite discus throw performance is governed more by phase-specific timing as well as control and regulation of linear and rotational velocities than by isolated postural characteristics. Further, effective technique appears to reflect the ability to establish favourable mechanical conditions early and express them efficiently during the delivery phase.