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Concept: Pubic symphysis

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OBJECTIVE: Pelvic girdle pain (PGP) is a disabling condition affecting 30% of pregnant women. The aim of this study was to investigate the efficacy of craniosacral therapy as an adjunct to standard treatment compared to standard treatment alone for PGP during pregnancy. DESIGN: Randomised, multicentre, single blind, controlled trial. SETTING: University hospital, a private clinic and 26 maternity care centres in Gothenburg, Sweden. POPULATION: 123 pregnant women with PGP. METHODS: Participants were randomly assigned to standard treatment (control group, n=60) or standard treatment plus craniosacral therapy (intervention group, n=63). MAIN OUTCOME MEASURES: Primary outcome measures: Pain intensity (Visual Analogue Scale 0-100mm) and sick leave. Secondary outcomes: function (Oswestery Disability Index), health-related quality of life (European Quality of Life measure), unpleasantness of pain (Visual Analogue Scale), and assessment of the severity of PGP by an independent examiner. RESULTS: Between-group differences for morning pain, symptom-free women and function in the last treatment week were in favor of the intervention group. Visual Analogue Scale median was 27 mm (95% confidence interval 24.6-35.9) vs. 35 mm (95% confidence interval 33.5-45.7)(p=0.017) and the function disability index was 40 (range 34-46) vs. 48 (range 40-56)(p=0.016). CONCLUSIONS: Lower morning pain intensity and lesser deteriorated function was seen after craniosacral therapy in conjunction with standard treatment compared to standard treatment alone, but no effects regarding evening pain and sick-leave. Treatment effects were small and clinically questionable and conclusions should be drawn carefully. Further studies are warranted before reccomending craniosacral therapy for pelvic girdle pain. © 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

Concepts: Pregnancy, Childbirth, Randomized controlled trial, Obstetrics, Normal distribution, Pubic symphysis, Gynaecology, Pelvic girdle pain

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Management of complex lumbosacral neoplastic disease presents unique challenges and requires a multidisciplinary approach. Large pelvic tumors may require external hemipelvectomy where an entire lower extremity including the hemipelvis is removed with disarticulation of the sacroiliac joint and symphysis pubis. When external hemipelvectomy is performed, the reconstructive surgeon must consider osseous reconstruction for structural pelvic support, the elimination of dead space, protection of implanted hardware, intra-abdominal support, and skin coverage. Reconstruction must minimize wound healing morbidity, operative time and the number of operative sites, and maximize the potential for rehabilitation. We present a case demonstrating use of a rotational chimeric flap for the reconstruction of an external hemipelvectomy defect.

Concepts: Cancer, Wound healing, Tumor, Neoplasm, Joint, Pelvis, Sacroiliac joint, Pubic symphysis

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The most frequent causes of chronic instability of the pubic symphysis are sports-related continual overload and traumatic symphyseal injuries. Acute injury of the pubic symphysis may be the result of external forces acting on the anterior pelvic ring or the result of internal forces, such as those arising during parturition. The postpartum form of instability following a complication-free birth is reversible and usually returns to normal within a few months through strengthening of the pelvic floor muscles. Residual instability of the pubis symphysis is on the whole a rare complication. Although established therapy options for acute symphyseal separation can be found in the literature, there are only a few case reports on chronic symphyseal instability. There are no guidelines on standardized therapy options. This review article examines the etiology, clinical findings, diagnostic techniques and management options for patients suffering from chronic symphyseal instability.

Concepts: Medicine, Childbirth, Medical terms, Injury, Pelvis, Pelvic floor, Pubic symphysis, Pubis

24

Pelvic ring injuries are associated with significant morbidity and mortality. Understanding the anatomy of the pelvic ring is essential for accurate diagnosis and treatment. A systematic approach taking into account the mechanism of injury, physical examination, and radiographic assessment is important to quickly identify unstable pelvic disruptions and associated injuries. Because the pelvis is a ring structure, isolated pubic rami fractures on plain radiographs are unusual and should warrant careful evaluation for posterior pelvic disruption with computed tomography. Hemorrhagic shock can occur in about 10% of pelvic ring injuries. Immediate recognition and treatment of this life-threatening condition is critical in emergency management. In addition to fluid resuscitation and blood transfusion, circumferential wrapping, angiographic embolization, laparotomy with pelvic packing, and external fixation can be important life-saving adjuncts in the setting of hemodynamic instability.

Concepts: Blood, Surgery, Medical imaging, Radiography, Pelvis, Pubic symphysis, Pubis, Physical trauma

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BACKGROUND The aim of this study was to use a three-dimensional (3D) visualization technology to illustrate and describe the anatomical features of the penile suspensory ligamentous system based on the Visible Human data sets and to explore the suspensory mechanism of the penis for the further improvement of the penis-lengthening surgery. MATERIAL AND METHODS Cross-sectional images retrieved from the first Chinese Visible Human (CVH-1), third Chinese Visible Human (CVH-3), and Visible Human Male (VHM) data sets were used to segment the suspensory ligamentous system and its adjacent structures. The magnetic resonance imaging (MRI) images of this system were studied and compared with those from the Visible Human data sets. The 3D models reconstructed from the Visible Human data sets were used to provide morphological features of the penile suspensory ligamentous system and its related structures. RESULTS The fundiform ligament was a superficial, loose, fibro-fatty tissue which originated from Scarpa’s fascia superiorly and continued to the scrotal septum inferiorly. The suspensory ligament and arcuate pubic ligament were dense fibrous connective tissues which started from the pubic symphysis and terminated by attaching to the tunica albuginea of the corpora cavernosa. Furthermore, the arcuate pubic ligament attached to the inferior rami of the pubis laterally. CONCLUSIONS The 3D model based on Visible Human data sets can be used to clarify the anatomical features of the suspensory ligamentous system, thereby contributing to the improvement of penis-lengthening surgery.

Concepts: Magnetic resonance imaging, Computer graphics, Pelvis, Penis, Male reproductive system, Pubic symphysis, Corpus cavernosum penis, Suspensory ligament of the penis

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To examine whether an association exists between exercise levels pre-pregnancy and pelvic girdle pain in pregnancy. Pelvic girdle pain in pregnancy has been associated with physical inactivity, a risk factor for adverse pregnancy outcomes.

Concepts: Cohort study, Childbirth, Epidemiology, Pubic symphysis, Pelvic girdle pain

10

Adductor longus injuries are complex. The conflict between views in the recent literature and various nineteenth-century anatomy books regarding symphyseal and perisymphyseal anatomy can lead to difficulties in MRI interpretation and treatment decisions. The aim of the study is to systematically investigate the pyramidalis muscle and its anatomical connections with adductor longus and rectus abdominis, to elucidate injury patterns occurring with adductor avulsions.

Concepts: Radiology, Injury, Anatomy, Pubic symphysis, Rectus abdominis muscle, Muscles of the torso, Rectus sheath, Pyramidalis muscle

8

To study the associations of patterns and duration of breastfeeding with the persistence of pelvic girdle pain 18 months after delivery.

Concepts: Childbirth, Pelvis, Pubic symphysis, Pelvic girdle pain

4

The Neanderthal remains from Shanidar Cave, excavated between 1951 and 1960, have played a central role in debates concerning diverse aspects of Neanderthal morphology and behavior. In 2015 and 2016, renewed excavations at the site uncovered hominin remains from the immediate area where the partial skeleton of Shanidar 5 was found in 1960. Shanidar 5 was a robust adult male estimated to have been aged over 40 years at the time of death. Comparisons of photographs from the previous and recent excavations indicate that the old and new remains were directly adjacent to one another, while the disturbed arrangement and partial crushing of the new fossils is consistent with descriptions and photographs of the older discoveries. The newly discovered bones include fragments of several vertebrae, a left hamate, part of the proximal left femur, a heavily crushed partial pelvis, and the distal half of the right tibia and fibula and associated talus and navicular. All these elements were previously missing from Shanidar 5, and morphological and metric data are consistent with the new elements belonging to this individual. A newly discovered partial left pubic symphysis indicates an age at death of 40-50 years, also consistent with the age of Shanidar 5 estimated previously. Thus, the combined evidence strongly suggests that the new finds can be attributed to Shanidar 5. Ongoing analyses of associated samples, including for sediment morphology, palynology, and dating, will therefore offer new evidence as to how this individual was deposited in the cave and permit new analyses of the skeleton itself and broader discussion of Neanderthal morphology and variation.

Concepts: Femur, Pelvis, Tibia, Pubic symphysis, Pubis, Iraq, Fibula, Ralph Solecki

3

The Pelvic Girdle Questionnaire is the only instrument designed to assess pain and disability specifically in pregnant or postpartum women with pelvic girdle pain. The objective of this study was the adaptation to the Spanish language and analysis of the psychometric properties of the Pelvic Girdle Questionnaire.

Concepts: Childbirth, Educational psychology, Spanish language, Spain, Pubic symphysis, Pelvic girdle pain, Languages of the United States