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Vempalli SR, Meshram V, Singh Shekhawat R, Sureka B, Shedge R, Akbar M, Setia P, Kanchan T. 3D CT based age estimation from the pubic symphyseal surface in an Indian population using the Chen et al. method. Anthropol Anz 2024; 81:315-325. [PMID: 38321940 DOI: 10.1127/anthranz/2024/1744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/08/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024]
Abstract
The pubic symphyseal surface is one of the reliable parameters used to estimate age, as it consistently shows degenerative observational variations throughout the lifespan, particularly from the 3rd decade onwards. These changes have been extensively studied to generate population-specific models for forensic age estimation. In the past, there have been many studies used to estimate age at death from the pubis symphysis using skeletal remains. However, due to dearth of contemporary skeletal repositories, and the resource intensive maceration process required for obtaining examination quality bones, studies on cadaver are difficult to conduct. Moreover, due to recent advancements in the science of medical imaging, newer radiological modalities like computed tomography (CT) can be used to visualize previously inaccessible areas such as the pubic symphysis in cadavers and the living alike, and subsequent age estimation is feasible. Recently, Chen et al. (2008, 2011) conducted a study on the cadaveric Chinese Han population in both males and females separately by using nine morphological changes and scoring them according to the changes that occurred. The present study aimed to estimate an individual's age using CT images of the pubic symphysis, by applying the scoring method for its morphological changes given by Chen et al. The present study was conducted on 263 randomly selected participants (Males = 154, Females = 109), who came for diagnostic purposes to the hospital. The CT images of these individuals were collected after obtaining ethical approval and proper consent from the study participants. Each of the morphological indicators was assessed, and appropriate scores were given according to criteria given by Chen et al. In the present study, both linear and multiple regression models to estimate age using the pubic symphyseal morphological changes were developed. From the results of the present study, it was concluded that the Chen et al. scoring method can be used to accurately estimate age from 3DCT images of the living, and the models derived in the present study could be applicable to individuals from the Indian subcontinent.
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Affiliation(s)
- Seshagiri Raju Vempalli
- Senior Resident, Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Vikas Meshram
- Additional Professor, Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Raghvendra Singh Shekhawat
- Additional Professor, Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Binit Sureka
- Additional Professor, Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Rutwik Shedge
- Assistant Professor, School of Forensic Sciences, National Forensic Sciences University, Tirpura, 799006, India
| | - Mohammed Akbar
- Senior Resident, Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Puneet Setia
- Professor, Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Tanuj Kanchan
- Professor, Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, 342005, India
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Ou Z, Bai J, Chen Z, Lu Y, Wang H, Long S, Chen G. RTSeg-net: A lightweight network for real-time segmentation of fetal head and pubic symphysis from intrapartum ultrasound images. Comput Biol Med 2024; 175:108501. [PMID: 38703545 DOI: 10.1016/j.compbiomed.2024.108501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/19/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Abstract
The segmentation of the fetal head (FH) and pubic symphysis (PS) from intrapartum ultrasound images plays a pivotal role in monitoring labor progression and informing crucial clinical decisions. Achieving real-time segmentation with high accuracy on systems with limited hardware capabilities presents significant challenges. To address these challenges, we propose the real-time segmentation network (RTSeg-Net), a groundbreaking lightweight deep learning model that incorporates innovative distribution shifting convolutional blocks, tokenized multilayer perceptron blocks, and efficient feature fusion blocks. Designed for optimal computational efficiency, RTSeg-Net minimizes resource demand while significantly enhancing segmentation performance. Our comprehensive evaluation on two distinct intrapartum ultrasound image datasets reveals that RTSeg-Net achieves segmentation accuracy on par with more complex state-of-the-art networks, utilizing merely 1.86 M parameters-just 6 % of their hyperparameters-and operating seven times faster, achieving a remarkable rate of 31.13 frames per second on a Jetson Nano, a device known for its limited computing capacity. These achievements underscore RTSeg-Net's potential to provide accurate, real-time segmentation on low-power devices, broadening the scope for its application across various stages of labor. By facilitating real-time, accurate ultrasound image analysis on portable, low-cost devices, RTSeg-Net promises to revolutionize intrapartum monitoring, making sophisticated diagnostic tools accessible to a wider range of healthcare settings.
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Affiliation(s)
- Zhanhong Ou
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Information Technology, Jinan University, Guangzhou, 510632, China
| | - Jieyun Bai
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Information Technology, Jinan University, Guangzhou, 510632, China; Auckland Bioengineering Institute, University of Auckland, Auckland, 1010, New Zealand.
| | - Zhide Chen
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Information Technology, Jinan University, Guangzhou, 510632, China
| | - Yaosheng Lu
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Information Technology, Jinan University, Guangzhou, 510632, China
| | - Huijin Wang
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Information Technology, Jinan University, Guangzhou, 510632, China
| | - Shun Long
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Information Technology, Jinan University, Guangzhou, 510632, China
| | - Gaowen Chen
- Obstetrics and Gynecology Center, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
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Chen G, Bai J, Ou Z, Lu Y, Wang H. PSFHS: Intrapartum ultrasound image dataset for AI-based segmentation of pubic symphysis and fetal head. Sci Data 2024; 11:436. [PMID: 38698003 PMCID: PMC11066050 DOI: 10.1038/s41597-024-03266-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 04/16/2024] [Indexed: 05/05/2024] Open
Abstract
During the process of labor, the intrapartum transperineal ultrasound examination serves as a valuable tool, allowing direct observation of the relative positional relationship between the pubic symphysis and fetal head (PSFH). Accurate assessment of fetal head descent and the prediction of the most suitable mode of delivery heavily rely on this relationship. However, achieving an objective and quantitative interpretation of the ultrasound images necessitates precise PSFH segmentation (PSFHS), a task that is both time-consuming and demanding. Integrating the potential of artificial intelligence (AI) in the field of medical ultrasound image segmentation, the development and evaluation of AI-based models rely significantly on access to comprehensive and meticulously annotated datasets. Unfortunately, publicly accessible datasets tailored for PSFHS are notably scarce. Bridging this critical gap, we introduce a PSFHS dataset comprising 1358 images, meticulously annotated at the pixel level. The annotation process adhered to standardized protocols and involved collaboration among medical experts. Remarkably, this dataset stands as the most expansive and comprehensive resource for PSFHS to date.
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Affiliation(s)
- Gaowen Chen
- Obstetrics and Gynecology Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jieyun Bai
- Department of Electronic Engineering, College of Information Science and Technology, Jinan University, Guangzhou, China.
- Auckland Bioengineering Institute, the University of Auckland, Auckland, New Zealand.
| | - Zhanhong Ou
- Department of Electronic Engineering, College of Information Science and Technology, Jinan University, Guangzhou, China
| | - Yaosheng Lu
- Department of Electronic Engineering, College of Information Science and Technology, Jinan University, Guangzhou, China.
| | - Huijin Wang
- Department of Electronic Engineering, College of Information Science and Technology, Jinan University, Guangzhou, China
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Warrier V, Shedge R, Garg PK, Dixit SG, Krishan K, Kanchan T. Applicability of the Suchey-Brooks method for age estimation in an Indian population: A computed tomography-based exploration using Bayesian analysis and machine learning. Med Sci Law 2024; 64:126-137. [PMID: 37491861 DOI: 10.1177/00258024231188799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Age estimation occupies a prominent niche in the identification process. In cases where skeletal remains present for examination, age is often estimated from markers distributed throughout the skeletal framework. Within the pelvis, the pubic symphysis constitutes one of the more commonly utilized skeletal markers for age estimation, with the Suchey-Brooks method comprising one of the more commonly employed methods for pubic symphyseal age estimation. The present study was targeted towards assessing the applicability of the Suchey-Brooks method for pubic symphyseal age estimation, an aspect largely unreported for an Indian population. In order to do so, clinically undertaken pelvic computed tomography scans of individuals were evaluated using the Suchey-Brooks method, and the error associated with the method was established using Bayesian analysis and different machine learning regression models. Amongst different supervised machine learning models, support vector regression and random forest furnished lowest error computations in both sexes. Using both Bayesian analysis and machine learning, lower error computations were observed in females, suggesting that the method demonstrates greater applicability for this sex. Inaccuracy and root mean square error obtained with Bayesian analysis and machine learning illustrates that both statistical modalities furnish comparable error computations for pubic symphyseal age estimation using the Suchey-Brooks method. However, given the numerous advantages associated with machine learning, it is recommended to use the same within medicolegal settings. Error computations obtained with the Suchey-Brooks method, regardless of the statistical modality utilized, indicate that the method should be used in amalgamation with additional markers to garner accurate estimates of age.
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Affiliation(s)
- Varsha Warrier
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India
| | - Rutwik Shedge
- School of Forensic Sciences, National Forensic Sciences University, Tripura, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Shilpi Gupta Dixit
- Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, India
| | - Kewal Krishan
- Department of Anthropology, UGC Centre of Advanced Study, Panjab University, Chandigarh, India
| | - Tanuj Kanchan
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India
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Vallée M, Knecht S, Blum A, Henriques M, Savall F, Chaumoitre K, Adalian P, Martrille L. Technical note: Interest of focused fields in post-mortem computed tomography using photorealistic images for age at death estimation from the pubic symphysis. Forensic Sci Int 2024; 354:111903. [PMID: 38096752 DOI: 10.1016/j.forsciint.2023.111903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION The morphological assessment of the pubic symphysis using the Suchey-Brooks method is considered a reliable age at death indicator. Age at death estimation methods can be adapted to the images obtained from post-mortem computed tomography (PMCT). The aim of this study is to evaluate the utility of pubic symphysis photorealistic images obtained through Global illumination rendering (GIR) for age at death estimation from whole-body PMCT and from focused PMCT on the pubic bone. MATERIALS AND METHODS We performed virtual age at death estimation using the Suchey Brooks method from both the whole-body field of view (Large Field of View: LFOV) and the pubis-focused field of view (Small and Field of View: SFOV) of 100 PMCT. The 3D photorealistic images were evaluated by three forensic anthropologists and the results were statistically evaluated for accuracy of the two applied PMCT methods and the intra- and inter-observer errors. RESULTS When comparing the two acquisitions of PMCT, the accuracy rate reaches 98.5% when using a pubic-focused window (SFOV) compared to 86% with a whole-body window (LFOV). Additionally, the intra- and inter-observer variability has demonstrated that the focused window provides better repeatability and reproducibility. CONCLUSION Adding a pubic-focused field of view to standard PMCT and processing it with GIR appears to be an applicable technique that increases the accuracy rate for age at death estimation from the pubic symphysis.
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Affiliation(s)
- Marion Vallée
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Siam Knecht
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, Nancy CEDEX 54035, France
| | | | - Frédéric Savall
- Service de Médecine Légale, Hôpital de Rangueil, Toulouse, France; Laboratory Centre for Anthropology and Genomics of Toulouse, Université Paul Sabatier, Toulouse, France, Hôpital de Rangueil, Toulouse, France
| | - Kathia Chaumoitre
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France; Aix Marseille Univ, APHM, Hôpital Nord, Service de Radiologie, Marseille, France
| | | | - Laurent Martrille
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France; EDPFM, Univ Montpellier, Department of legal medicine CHU Montpellier, Montpellier, France
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Broida SE, Kemble JP, Wahlig BD, Cross WW, Viers BR, Houdek MT. Sacral insufficiency fractures are a frequent and painful consequence of pubic symphysis osteomyelitis. Eur J Orthop Surg Traumatol 2024; 34:647-652. [PMID: 37673832 DOI: 10.1007/s00590-023-03707-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Pubic symphysis osteomyelitis can result from urosymphyseal fistula formation. High rates of sacropelvic insufficiency fractures have been reported in this population. The aim of this study was to describe the presentation and risk factors for sacral insufficiency fractures (SIF) associated with surgical treatment of pubic symphysis osteomyelitis. METHODS A retrospective review was performed for 54 patients who underwent surgery for pubic symphysis osteomyelitis associated with a urosymphyseal fistula at a single institution from 2009 to 2022. Average age was 71 years and 53 patients (98%) were male. All patients underwent debridement or partial resection of the pubic symphysis at the time of fistula treatment. Average width of the symphyseal defect was 65 mm (range 9-122) after treatment. RESULTS Twenty patients (37%) developed SIF at a mean time of 4 months from osteomyelitis diagnosis. Rate of sacral fracture on Kaplan-Meier analysis was 31% at 6 months, 39% at 12 months, and 41% at 2 years. Eleven patients developed SIF prior to pubic debridement and 12 patients developed new or worsening of pre-existing SIF following surgery. Width of pubic resection was higher in patients who developed SIF (76 mm vs. 62 mm), but this did not meet statistical significance (p = 0.18). CONCLUSION Sacral insufficiency fracture is a common sequela of pubic symphysis osteomyelitis. These fractures are often multifocal within the pelvis and can occur even prior to pubic resection. Pubectomy further predisposes these patients to fracture. Clinicians should maintain a high index of suspicion for these injuries in patients with symphyseal osteomyelitis.
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Affiliation(s)
- Samuel E Broida
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | | | - Brian D Wahlig
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - William W Cross
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Kuo LY, Silverman J, Morgan S, Steer R. Unrecognised entrapment of a herniated bladder at the pubic symphysis following reduction and external fixation of an unstable pelvic fracture. BMJ Case Rep 2023; 16:e258147. [PMID: 38056932 PMCID: PMC10711860 DOI: 10.1136/bcr-2023-258147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Bladder injury is frequently associated with complex pelvic fractures with men being the predominant population to sustain such injuries. Entrapment of the bladder through the site of pelvic fracture is a rare clinical entity. We report a case of an entrapped bladder post closed reduction and external fixation of an unstable anteroposterior compression type 3 (APC-3) fracture. This report highlights the diagnostic difficulty with identifying an entrapped bladder and the patient's functional outcome after 1 year of follow-up.
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Affiliation(s)
- Lu Yu Kuo
- Gold Coast University Hospital, Department of Surgery/Urology, Queensland Health, Southport, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, City of Brisbane, Queensland, Australia
| | - Joshua Silverman
- Gold Coast University Hospital, Department of Surgery/Urology, Queensland Health, Southport, Queensland, Australia
| | - Samuel Morgan
- Gold Coast University Hospital, Department of Orthopaedics, Queensland Health, Southport, Queensland, Australia
| | - Richard Steer
- Faculty of Medicine, The University of Queensland, Herston, City of Brisbane, Queensland, Australia
- Gold Coast University Hospital, Department of Orthopaedics, Queensland Health, Southport, Queensland, Australia
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Jadzic J, Mijucic J, Bracanovic D, Nikolic S, Bracanovic M, Djuric M, Djonic D. Age-at-death estimation based on micro-CT assessment of pubic symphysis: Potentially new methodological approach. Forensic Sci Int 2023; 352:111851. [PMID: 37801865 DOI: 10.1016/j.forsciint.2023.111851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/28/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Although various methods for age-at-death estimation of skeletal remains are available, this is still an unsolved issue in forensic anthropology, especially concerning elderly individuals. Moreover, the lack of population-specific methods often made age-at-death estimation unreliable in other populations. AIM Our study aimed to examine whether micro-computed tomography (micro-CT) analysis of pubic bone samples obtained from the contemporary Serbian population could be used in anthropological and forensic practice for age-at-death estimation. METHODOLOGY This study encompassed 62 pubic samples obtained from 26 adult male and 36 adult female cadaveric donors (age range: 22-91 years). Initially, staging according to the Suchey-Brooks phases was performed by two experienced investigators, followed by micro-CT assessment of pubic bone trabecular and cortical compartments (spatial resolution of the scans was 10 µm). RESULTS Our results revealed an age-associated decline in trabecular and cortical micro-architecture of elderly male and female individuals, with the most prominent changes present in trabecular bone volume fraction and total porosity of the anterior and posterior cortical surface of the pubic bone. Those parameters were used to generate age-at-death estimation equations. One sample t-test did not reveal a significant difference between estimated age-at-death and real (known) age-at-death in the overall sample (mean absolute error [MAE] of 4.76 years), female (MAE of 9.66 years) and male cadaveric donors (MAE of 6.10 years, p > 0.05). CONCLUSION Our data indicated that micro-architectural features of trabecular and cortical compartments of pubic bone could potentially be applied as an additional reliable method for age-at-death estimation in the Serbian population.
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Affiliation(s)
- Jelena Jadzic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovana Mijucic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Djurdja Bracanovic
- Department of Radiology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Slobodan Nikolic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milos Bracanovic
- Clinic for Emergency Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Marija Djuric
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Djonic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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Xiong J, Ma Y, Cao Y, Yang X, Ma J, Zhang J, Wan C, Huang P. Age estimation by modified Suchey-Brooks method using three-dimensional reconstructed CT images of Chinese Han population. Leg Med (Tokyo) 2023; 65:102304. [PMID: 37562072 DOI: 10.1016/j.legalmed.2023.102304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 07/07/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023]
Abstract
The method proposed by Suchey-Brooks for adult age estimation based on the surface morphology of the pubic symphysis has been widely accepted. The applicability of the method varies considerably in different populations. The present study established a virtual reference sample and aimed to develop population-specific criteria that can be used for age estimation in different skeletal samples. First, The dry bone specimens from 100 individuals were compared with their corresponding three-dimensional (3D) reconstruction model and showed high inter-method agreement (k = 0.743-0.811), suggesting that the virtual bone model and physical bone specimens have comparable performances in describing the surface morphology of the pubic symphysis. We retrospectively collected clinical computed tomography (CT) data from 895 Chinese patients to create a virtual reference sample of the pubic symphysis. Based on the original Suchey-Brooks method, each of the 895 reference samples was assigned a phase, for each sex and phase, data on the mean age, standard deviation, and 95% age range of the corresponding sample were obtained, which was then used as the "method modified for Chinese" (modified method) and compared to the "SB method". Compared to the SB method, modified method had a lower inaccuracy in dry bones for males over 35 years and females over 45 years, in dry bone CT test sample for males over 55 years and females over 45 years, and in postmortem CT test sample for males over 35 years and females over 55 years. The modified method can improve the accuracy of age estimation for older samples over 40 years. It has shown considerable reliability when applied as a population-specific criterion, but its accuracy is still not sufficient, and caution is needed when using it.
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Affiliation(s)
- Jian Xiong
- Department of Forensic Medicine, Guizhou Medical University, Guizhou Guiyang 550004, PR China; Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai 200063, PR China
| | - Yonggang Ma
- Department of Medical Imaging, 3201 Hospital Affiliated, Xi'an Jiaotong University School of Medicine, Hanzhong 723000, PR China
| | - Yongjie Cao
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai 200063, PR China
| | - Xiaotong Yang
- School of Forensic Medicine, Shanxi Medical University, Taiyuan, Shanxi 030001, PR China
| | - Jiwei Ma
- School of Basic Medical Science, Inner Mongolia Medical University, Hohhot, Inner Mongolia Nei Mongol 010110, PR China
| | - Ji Zhang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai 200063, PR China.
| | - Changwu Wan
- Department of Forensic Medicine, Guizhou Medical University, Guizhou Guiyang 550004, PR China.
| | - Ping Huang
- Department of Forensic Medicine, Guizhou Medical University, Guizhou Guiyang 550004, PR China; Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai 200063, PR China.
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van Ovost A, Hanff DF, Serner A, van Klij P, Agricola R, Weir A. Radiographic assessment of the pubic symphysis in elite male adolescent football players: Development and reliability of the Maturing Adolescent Pubic Symphysis (MAPS) classification. Eur J Radiol 2023; 167:111068. [PMID: 37666074 DOI: 10.1016/j.ejrad.2023.111068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION The pubic symphysis is susceptible to growth related injuries long after the adolescent growth spurt. Our study describes the radiographic maturation of the pubic symphysis on pelvic radiographs in adolescent football players and introduces the Maturing Adolescent Pubic Symphysis classification (MAPS classification). METHODS Anteroposterior pelvic radiographs of 105 healthy adolescent male football players between 12 and 24 years old were used to develop the classification system. The radiological scoring of the symphyseal joint was developed over five rounds. The final MAPS classification items were scored in random order by two experienced readers, blinded to the age of the participant and to each other's scoring. The inter- and intra-rater reliability were examined using weighted kappa (κ). RESULTS We developed a classification system with descriptive definitions and an accompanying pictorial atlas. The symphyseal joint was divided into three regions: the superior corners, and the upper and lower regions of the joint line. Inter-rater reliability was substantial to almost perfect: superior region: κ = 0.70 (95% CI 0.60---0.79), upper region of the joint line: κ = 0.89 (95% CI 0.86---0.92), lower region of the joint line: κ = 0.65 (95% CI 0.55---0.75). The intra-observer reliability showed similar results. CONCLUSION The Maturing Adolescent Pubic Symphysis classification (MAPS classification) is a reliable descriptive classification of the radiographic maturation of the pubic symphysis joint in athletic males. The stages can provide a basis for understanding in clinical practice and will allow future research in this field.
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Affiliation(s)
- Astrid van Ovost
- Erasmus MC, Erasmus University, Medical Center Department of Orthopaedics and Sports Medicine, Rotterdam the Netherlands
| | - David Frederikus Hanff
- Erasmus MC, Radiology & Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, the Netherland.
| | - Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich Switzerland
| | - Pim van Klij
- Department of Sports Medicine, Isala Hospital, Zwolle, the Netherlands
| | - Rintje Agricola
- Erasmus MC, Erasmus University, Medical Center Department of Orthopaedics and Sports Medicine, Rotterdam the Netherlands
| | - Adam Weir
- Erasmus MC, Erasmus University, Medical Center Department of Orthopaedics and Sports Medicine, Rotterdam the Netherlands; Sport Medicine and Exercise Clinic Haarlem (SBK), Haarlem, the Netherlands
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Holl N, Gerhardt JS, Tischer T, Krüger J, Arevalo-Hernandez A, Lenz R, Weber MA. Comparison between dedicated MRI and symphyseal fluoroscopic guided contrast agent injection in the diagnosis of cleft sign in athletic groin pain and association with pelvic ring instability. Eur Radiol 2023; 33:7321-7329. [PMID: 37145146 PMCID: PMC10511360 DOI: 10.1007/s00330-023-09666-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/07/2023] [Accepted: 03/31/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To compare dedicated MRI with targeted fluoroscopic guided symphyseal contrast agent injection regarding the assessment of symphyseal cleft signs in men with athletic groin pain and assessment of radiographic pelvic ring instability. METHODS Sixty-six athletic men were prospectively included after an initial clinical examination by an experienced surgeon using a standardized procedure. Diagnostic fluoroscopic symphyseal injection of a contrast agent was performed. Additionally, standing single-leg stance radiography and dedicated 3-Tesla MRI protocol were employed. The presence of cleft injuries (superior, secondary, combined, atypical) and osteitis pubis was recorded. RESULTS Symphyseal bone marrow edema (BME) was present in 50 patients, bilaterally in 41 patients and in 28 with an asymmetrical distribution. Comparison of MRI and symphysography was as followed: no clefts: 14 cases (MRI) vs. 24 cases (symphysography), isolated superior cleft sign: 13 vs. 10, isolated secondary cleft sign: 15 vs. 21 cases and combined injuries: 18 vs. 11 cases. In 7 cases a combined cleft sign was observed in MRI but only an isolated secondary cleft sign was visible in symphysography. Anterior pelvic ring instability was observed in 25 patients and was linked to a cleft sign in 23 cases (7 superior cleft sign, 8 secondary cleft signs, 6 combined clefts, 2 atypical cleft injuries). Additional BME could be diagnosed in 18 of those 23. CONCLUSION Dedicated 3-Tesla MRI outmatches symphysography for purely diagnostic purposes of cleft injuries. Microtearing at the prepubic aponeurotic complex and the presence of BME is a prerequisite for the development of anterior pelvic ring instability. CLINICAL RELEVANCE STATEMENT For diagnostic of symphyseal cleft injuries dedicated 3-T MRI protocols outmatch fluoroscopic symphysography. Prior specific clinical examination is highly beneficial and additional flamingo view x-rays are recommended for assessment of pelvic ring instability in these patients. KEY POINTS • Assessment of symphyseal cleft injuries is more accurate by use of dedicated MRI as compared to fluoroscopic symphysography. • Additional fluoroscopy may be important for therapeutic injections. • The presence of cleft injury might be a prerequisite for the development of pelvic ring instability.
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Affiliation(s)
- Norman Holl
- Institute of Diagnostic and Interventional Radiology, Paediatric and Neuroradiology, University Medicine Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
| | - Judith Sarah Gerhardt
- Institute of Diagnostic and Interventional Radiology, Paediatric and Neuroradiology, University Medicine Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Thomas Tischer
- Department of Orthopaedics, Rostock University Medical Center, Doberanerstr. 142, 18057, Rostock, Germany
| | - Jens Krüger
- Sportchirurgische Praxis Dr. Jens Krüger, Potsdamer Straße 132, 10783, Berlin, Germany
| | - Andres Arevalo-Hernandez
- Institute of Diagnostic and Interventional Radiology, Paediatric and Neuroradiology, University Medicine Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Robert Lenz
- Department of Orthopaedics, Rostock University Medical Center, Doberanerstr. 142, 18057, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric and Neuroradiology, University Medicine Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
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12
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Kim N, Hance F, Barsi J. Septic Arthritis of the Pubic Symphysis in a 16-Year-Old Male Adolescent: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00038. [PMID: 38048409 DOI: 10.2106/jbjs.cc.23.00475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
CASE A 16-year-old male adolescent presented with 4 weeks of right-sided hip pain and fever in the setting of recent groin trauma. He was diagnosed with septic arthritis of the pubic symphysis (SAPS) and was treated nonoperatively with antibiotics. Symptoms recurred, and he underwent surgical drainage of the pubic symphysis followed by a prolonged course of antibiotics. Follow-up at 12 months indicated complete symptom resolution. CONCLUSION This is the ninth reported adolescent case of SAPS. Although the presentation and disease course closely resembled those reported in the literature, this is the only case that required surgical intervention after failed nonoperative management.
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Affiliation(s)
- Noah Kim
- Department of Pediatric Orthopedic Surgery, Stony Brook University Hospital, Stony Brook, New York
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13
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Balandina IA, Klimets AV, Balandin AA, Terekhin AS, Zhigulev AN. [Comparative characterization of the linear dimensions of the pubic symphysis in women in the first period of adulthood, elderly age and old age according to computed tomography data.]. Adv Gerontol 2023; 36:855-858. [PMID: 38426923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The paper is based on the results of a CT study of 71 women with normal pelvic dimensions without pelvic bone or pelvic organ pathology who underwent the study in 2022-2023. All subjects consented to the study, which was performed according to the indications. The CT study consisted of determining the width, height, and thickness of the pubic symphysis in 3D reconstruction mode. The subjects were divided into three groups according to the anatomical age classification. The first group consisted of 23 first-age adults (21-35 years old); the second group included 25 elderly people (56-74 years old); the third group consisted of 23 elderly people (75-88 years old). The results obtained are the basis for further research and can be used by doctors of such clinical specialties as sports medicine, traumatology, forensics, forensic medicine, obstetrics and many others.
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Affiliation(s)
- I A Balandina
- E.A.Vagner Perm State Medical University, 26 Petropavlovskaya str., Perm 414099, Russian Federation, e mail:
| | - A V Klimets
- E.A.Vagner Perm State Medical University, 26 Petropavlovskaya str., Perm 414099, Russian Federation, e mail:
| | - A A Balandin
- E.A.Vagner Perm State Medical University, 26 Petropavlovskaya str., Perm 414099, Russian Federation, e mail:
| | - A S Terekhin
- E.A.Vagner Perm State Medical University, 26 Petropavlovskaya str., Perm 414099, Russian Federation, e mail:
| | - A N Zhigulev
- E.A.Vagner Perm State Medical University, 26 Petropavlovskaya str., Perm 414099, Russian Federation, e mail:
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14
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Warrier V, Shedge R, Krishan K, Kanchan T. McKern-Stewart method as a technique for analysing age related pubic symphyseal changes: A systematic review and meta-analysis. Med Sci Law 2023; 63:31-41. [PMID: 35392731 DOI: 10.1177/00258024221092196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Age estimation is one of the essential criteria in the identification process. The method of age estimation employed depends on the availability of skeletal material brought for forensic examination. McKern and Stewart's method constitutes one of the principal approaches towards pubic symphyseal age estimation. The method entails evaluating morphological changes within the pubic symphysis and subsequently allotting a specific score corresponding to the observed changes. Based on the obtained scores, an age range is then assigned to the remains presenting for examination. The present systematic review was undertaken to ascertain the applicability of the McKern-Stewart method for age estimation. Studies pertaining to the use of the McKern-Stewart method for age estimation in skeletal remains were retrieved by keying in a combination of MeSH terms and other free terms from four databases. The retrieved articles were subjected to a stringent inclusion and exclusion criteria, following which the risk of bias was assessed and the overall quality of evidence was established. Once the final tally of relevant articles was obtained, data specific to the mean age corresponding to each score was extracted. Non-parametric tests and boxplots were employed to compare the mean ages reported across multiple studies. The present systematic review concludes that the McKern-Stewart method can be applied for the purpose of age estimation in skeletal remains. Broader age cohorts for higher scores, as well as, overlapping values for age ranges in relation to the cumulative scores, however, can be considered a limitation for its applicability in forensic case work.
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Affiliation(s)
- Varsha Warrier
- Department of Forensic Medicine and Toxicology, 410730All India Institute of Medical Sciences, Jodhpur, India, 342005
| | - Rutwik Shedge
- School of Forensic Sciences, National Forensic Sciences University, Tripura, India, 799001
| | - Kewal Krishan
- Department of Anthropology, Panjab University, Chandigarh, India, 160014
| | - Tanuj Kanchan
- Department of Forensic Medicine and Toxicology, 410730All India Institute of Medical Sciences, Jodhpur, India, 342005
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15
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Whelan R, Schaeffer L, Olson I, Folger LV, Alam S, Ajaz N, Ladhani K, Rosner B, Wylie BJ, Lee ACC. Measurement of symphysis fundal height for gestational age estimation in low-to-middle-income countries: A systematic review and meta-analysis. PLoS One 2022; 17:e0272718. [PMID: 36007078 PMCID: PMC9409500 DOI: 10.1371/journal.pone.0272718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/25/2022] [Indexed: 11/19/2022] Open
Abstract
In low- and middle-income countries (LMIC), measurement of symphysis fundal height (SFH) is often the only available method of estimating gestational age (GA) in pregnancy. This systematic review aims to summarize methods of SFH measurement and assess the accuracy of SFH for the purpose of GA estimation. We searched PubMed, EMBASE, Cochrane, Web of Science, POPLINE, and WHO Global Health Libraries from January 1980 through November 2021. For SFH accuracy, we pooled the variance of the mean difference between GA confirmed by ultrasound versus SFH. Of 1,003 studies identified, 37 studies were included. Nineteen different SFH measurement techniques and 13 SFH-to-GA conversion methods were identified. In pooled analysis of five studies (n = 5838 pregnancies), 71% (95% CI: 66-77%) of pregnancies dated by SFH were within ±14 days of ultrasound confirmed dating. Using the 1 cm SFH = 1wk assumption, SFH underestimated GA compared with ultrasound-confirmed GA (mean bias: -14.0 days) with poor accuracy (95% limits of agreement [LOA]: ±42.8 days; n = 3 studies, 2447 pregnancies). Statistical modeling of three serial SFH measurements performed better, but accuracy was still poor (95% LOA ±33 days; n = 4 studies, 4391 pregnancies). In conclusion, there is wide variation in SFH measurement and SFH-to-GA conversion techniques. SFH is inaccurate for estimating GA and should not be used for GA dating. Increasing access to quality ultrasonography early in pregnancy should be prioritized to improve gestational age assessment in LMIC.
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Affiliation(s)
- Rachel Whelan
- Global Advancement of Infants and Mothers (AIM) Lab, Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Lauren Schaeffer
- Global Advancement of Infants and Mothers (AIM) Lab, Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Ingrid Olson
- Global Advancement of Infants and Mothers (AIM) Lab, Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Lian V. Folger
- Global Advancement of Infants and Mothers (AIM) Lab, Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- Department of Maternal and Child Health, University of North Carolina Chapel, Hill Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Saima Alam
- Berkshire Medical Center, Pittsfield, MA, United States of America
| | - Nayab Ajaz
- Tufts University School of Medicine, Boston, MA, United States of America
| | - Karima Ladhani
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Bernard Rosner
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Blair J. Wylie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Anne C. C. Lee
- Global Advancement of Infants and Mothers (AIM) Lab, Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
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Abstract
A man in his 80s presented to the emergency department with a 5-week history of lower abdominal and groin pain which had substantially affected his mobility. He practised intermittent self-catheterisation following radiotherapy for prostate cancer. Multiple suggestive features led to initial treatment for a urinary tract infection (UTI). However, CT imaging revealed pubic symphysis osteomyelitis with associated abdominal wall abscesses and fistulation to the prostate. This case illustrates the need to consider osteomyelitis as a differential for pain in previously irradiated body areas and to beware of diagnosing UTI where pain affects mobility.
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Affiliation(s)
- Aryeh Dworkin
- Accident and Emergency, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK
| | - Ehsan Riaz
- Accident and Emergency, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK
| | - Nikhil Vasdev
- Urology, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
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17
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Ohashi Y, Koito S, Matono T. Pubic bacterial osteomyelitis in a soccer player: a diagnostic pitfall. BMJ Case Rep 2022; 15:e246480. [PMID: 35039361 PMCID: PMC8768496 DOI: 10.1136/bcr-2021-246480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yusuke Ohashi
- Department of Infectious Diseases, Aso Iizuka Hospital, Iizuka, Japan
| | - Shu Koito
- Department of General Internal Medicine, Aso Iizuka Hospital, Iizuka, Japan
| | - Takashi Matono
- Department of Infectious Diseases, Aso Iizuka Hospital, Iizuka, Japan
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18
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Youssef A, Brunelli E, Fiorentini M, Lenzi J, Pilu G, El-Balat A. Breech progression angle: new feasible and reliable transperineal ultrasound parameter for assessment of fetal breech descent in birth canal. Ultrasound Obstet Gynecol 2021; 58:609-615. [PMID: 33847431 DOI: 10.1002/uog.23649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/20/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the feasibility and reliability of transperineal ultrasound in the assessment of fetal breech descent in the birth canal, by measuring the breech progression angle (BPA). METHODS Women with a singleton pregnancy with the fetus in breech presentation between 34 and 41 weeks' gestation were recruited. Transperineal ultrasound images were acquired in the midsagittal view for each woman, twice by one operator and once by another. Each operator measured the BPA after anonymization of the transperineal ultrasound images. BPA was defined as the angle between a line running along the long axis of the pubic symphysis and another line extending from the most inferior portion of the pubic symphysis tangentially to the lowest recognizable fetal part in the maternal pelvis. Each operator was blinded to all other measurements performed for each woman. Intra- and interobserver reproducibility of BPA measurement was evaluated using the intraclass correlation coefficient (ICC). To investigate the presence of any bias, intra- and interobserver agreement was also analyzed using Bland-Altman analysis. Student's t-test and Levene's W0 test were used to investigate whether a number of different clinical factors had an effect on systematic differences and homogeneity, respectively, between BPA measurements. RESULTS Overall, 44 women were included in the analysis. BPA was measured successfully by both operators on all images. Both intra- and interobserver agreement analyses showed excellent reproducibility in BPA measurement, with ICCs of 0.88 (95% CI, 0.80-0.93) and 0.83 (95% CI, 0.71-0.90), respectively. The mean difference between measurements was 0.4° (95% CI, -1.4 to 2.2°) for intraobserver repeatability and -0.4° (95% CI, -2.6 to 1.8°) for interobserver repeatability. The upper limits of agreement were 12.0° (95% CI, 8.9-15.1°) and 13.6° (95% CI, 9.9-17.3°) for intra- and interobserver repeatability, respectively. The lower limits of agreement were -11.2° (95% CI, -14.3 to -8.1°) and -14.4° (95% CI, -18.2 to -10.7°) for intra- and interobserver repeatability, respectively. No systematic difference between BPA measurements was found on either intra- or interobserver agreement analysis. None of the clinical factors examined (maternal body mass index, maternal age, gestational age at the ultrasound scan and parity) showed a statistically significant effect on intra- or interobserver reliability. CONCLUSIONS BPA represents a new feasible and highly reproducible measurement for the evaluation of fetal breech descent in the birth canal. Future studies assessing its usefulness in the prediction of successful external cephalic version and breech vaginal delivery are needed. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Youssef
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Brunelli
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - M Fiorentini
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - J Lenzi
- Section of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - G Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - A El-Balat
- Department of Obstetrics and Gynecology, Goethe University Frankfurt, Frankfurt, Germany
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19
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Wechsler B, Devries J, Yim D. Pubic symphysis osteomyelitis with associated vesico-symphyseal fistula: a difficult diagnosis. BMJ Case Rep 2021; 14:e244336. [PMID: 34544709 PMCID: PMC8454438 DOI: 10.1136/bcr-2021-244336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/04/2022] Open
Abstract
Pubic symphysis osteomyelitis is an infectious complication that rarely arises in men who have undergone treatment for prostate cancer. This process may more rarely arise from a fistulous tract between the pubic symphysis and the urinary tract. In this case report, we discuss the most common clinical presentations and laboratory findings that lead to the diagnosis of this disease process, as well as the role of MRI and other imaging modalities in confirmation of the diagnosis. This case serves as a reminder to clinicians to have earlier consideration of pubic symphysis osteomyelitis in their differential diagnosis to reduce the risk of long-term complications associated with undertreatment.
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Affiliation(s)
- Brendan Wechsler
- Medical Student Affairs, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Jonah Devries
- Medical Student Affairs, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Douglas Yim
- Interventional Radiology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
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20
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Heim JA, Vang S, Lips E, Asche SE, Ly T, Das K. Pubic Symphysis Separation and Regression in Vaginal versus Cesarean Delivery. J Obstet Gynaecol Can 2021; 44:42-47. [PMID: 34416357 DOI: 10.1016/j.jogc.2021.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To quantify the association of pubic symphysis separation with mode of delivery and follow the resolution of this physiologic separation in the postpartum period. METHODS Prospective observational cohort study that recruited two cohorts of primiparous women: those undergoing vaginal and cesarean delivery (45 and 46 patients, respectively). Chart review collected intrapartum factors. Patients were followed with serial anterior-posterior radiographs within 48 hours of delivery and at 6, 12, and 24 weeks postpartum, to evaluate the extent of pubic symphysis separation. Differences between the two cohorts in intrapartum factors were assesses as was pubic symphysis separation at each time point. RESULTS Mean age of women was 25.8 (SD 5.1) years, and 56% were White. Mean birth weight was 3.5 (SD 0.52) kg. Mean immediate postpartum pubic symphysis separation was 7.6 (SD 2.2) mm and did not differ between groups, at 7.18 mm for vaginal delivery versus 8.04 mm for cesarean delivery (CD; P = 0.08). Pubic symphysis separation was not significantly different for CD with and without labour. Black race and obesity were associated with increased pubic symphysis separation. No intrapartum events were related to extent of separation. Normalization of pregnancy pubic symphysis separation to 4-5 mm occurred by 6 weeks postpartum. Separation of >10mm and <15mm occurred in 10 of the 91 women and occurred after vaginal and cesarean delivery. The widest pubic symphysis separation was observed in 3 patients after vaginal delivery. CONCLUSION Physiological pubic symphysis separation occurs during pregnancy and regresses postpartum with minimal effects from labour and delivery. Cesarean delivery does not prevent physiological pubic symphysis separation.
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Affiliation(s)
- Jennifer A Heim
- Department of Obstetrics & Gynecology, Kaiser Permanente (TPMG), Santa Clara, CA
| | - Sandy Vang
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Erin Lips
- Department of Obstetrics & Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI
| | | | - Thuan Ly
- Department of Orthopaedic Trauma, Massachusetts General Hospital, Boston, MA
| | - Kamalini Das
- Department of Obstetrics, Gynecology and Women's Health, Regions Hospital, St. Paul, MN.
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21
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Wu M, Wang X, Lin X, Fu Y, Chen H, Guan X, Huang W, Chen Y, Zhang L, Jing C, Wei J, Tian J, Zhang X. Cut-offs for defining uterine prolapse using transperineal ultrasound in Chinese women: prospective multicenter study. Ultrasound Obstet Gynecol 2021; 58:127-132. [PMID: 33094536 DOI: 10.1002/uog.23524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Transperineal ultrasound is a simple and highly repeatable method that has been used increasingly in the quantification of pelvic organ prolapse, but abnormal uterine descent on ultrasound in Chinese women is still poorly defined. We aimed to determine the optimal cut-off to define abnormal uterine descent on transperineal ultrasound in Chinese women. METHODS This prospective multicenter study recruited women who were examined in tertiary-level gynecological centers, due to symptoms of lower urinary tract and/or pelvic floor dysfunction, between February 2017 and September 2018. All recruited women underwent a standardized interview, pelvic organ prolapse quantification (POP-Q) examination, and four-dimensional transperineal ultrasound examination. On ultrasound, uterine descent was measured relative to the posteroinferior margin of the symphysis pubis during maximum Valsalva maneuver. The optimal cut-off value for definition of abnormal uterine descent was selected as the value with the highest Youden index and the diagnostic performance of this cut-off for the prediction of prolapse symptoms and POP-Q stage was assessed and compared by means of the area under the receiver-operating-characteristics curve (AUC). RESULTS In total, 538 Chinese women, with a mean age of 39.4 (range, 18-81) years, were enrolled into the study. Both uterine descent on transperineal ultrasound (P < 0.001) and POP-Q stage (P < 0.001) were associated strongly with presence of prolapse symptoms. Uterine descent on ultrasound was associated significantly with POP-Q stage for apical compartment prolapse (P < 0.001). The optimal cut-off value for the definition of abnormal uterine descent on transperineal ultrasound during maximum Valsalva maneuver in the prediction of prolapse symptoms was 4.79 mm above the symphysis pubis (AUC, 0.75 (95% CI, 0.71-0.78)), while the optimal cut-off values in the prediction of prolapse of POP-Q Stage ≥ 1 and POP-Q Stage ≥ 2 were 6.63 mm above the symphysis pubis (AUC, 0.83 (95% CI, 0.80-0.86)) and 8.42 mm below the symphysis pubis (AUC, 0.85 (95% CI, 0.82-0.88)), respectively. CONCLUSIONS The optimal cut-off value to define abnormal uterine descent on transperineal ultrasound during maximum Valsalva maneuver for the prediction of prolapse symptoms in this population of Chinese women was 4.79 mm above the symphysis pubis, close to that for predicting apical compartment prolapse of POP-Q Stage ≥ 1 (6.63 mm above the symphysis pubis). These are somewhat different from values described previously in mainly Caucasian populations. Ethnic differences should be taken into account in the evaluation of pelvic organ prolapse using transperineal ultrasound. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Wu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - X Wang
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - X Lin
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Y Fu
- Department of Ultrasound, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - H Chen
- Department of Ultrasound, Zhongshan People's Hospital, Zhongshan, Guangdong Province, China
| | - X Guan
- Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, The Third Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - W Huang
- Department of Ultrasound, The First People's Hospital of Foshan, Foshan, Guangdong Province, China
| | - Y Chen
- Department of Medical Ultrasound, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
| | - L Zhang
- Department of Ultrasound Diagnosis, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - C Jing
- Department of Ultrasound, Dalian Maternal and Child Health Care Hospital, Dalian, Liaoning Province, China
| | - J Wei
- Department of Ultrasound, Jiujiang City Maternal and Child Health Care Hospital, Jiujiang, Jiangxi Province, China
| | - J Tian
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - X Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
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Hriň T, Gajdoš R, Dókuš K. Combined peripartal pubic symphysis and sacroiliac joint separation. Ceska Gynekol 2021; 86:30-35. [PMID: 33752406 DOI: 10.48095/cccg202130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We present a case and provide an overview of the literature on rare pelvic girdle injury following spontaneous delivery with combined transsymphyseal and transiliosacral instability, its diagnosis and surgical treatment. CASE REPORT Injury of the pelvic girdle during childbirth is one of the rare obstetric complications. Due to its low prevalence, the standard treatment algorithm is not defined. We present the case of a 27-year-old primipara with a combined separation of the symphysis and sacroiliac joint after spontaneous childbirth, which did not become clinically apparent until several hours later. After the assessment of clinical findings and results of imaging examinations, we indicated the patient for surgical revision due to significant pain syndrome and movement restrictions. Under general anesthesia, we reduced symphysis in an open manner and fixed it with a pelvic plate. We also fixed the injured sacroiliac joint after a closed reduction with a percutaneously inserted iliosacral screw. On the second postoperative day, the patient was mobilized on crutches. On the fourth postoperative day, the patient was discharged from the hospital. The patient was followed up at regular intervals postoperatively. One year after the injury, the pelvic girdle is clinically stable and the patient has no complaints. CONCLUSION An injury of the pelvic girdle should be considered whenever postpartum patient complains of pain in the area of the symphysis or sacroiliacal joints after natural delivery. In such a case, after a basic imaging diagnosis, a consultation with a specialist with experience in the treatment of pelvic injuries is appropriate. When selecting the most appropriate surgical technique, the nature of injury itself and also early patient mobilisation to be able provide adequate care for her newborn, should be taken into account. Early surgical treatment using stable osteosynthesis helps to address this requirement.
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Ianniello S, Conte P, Di Serafino M, Miele V, Trinci M, Vallone G, Galluzzo M. Diagnostic accuracy of pubic symphysis ultrasound in the detection of unstable pelvis in polytrauma patients during e-FAST: the value of FAST-PLUS protocol. A preliminary experience. J Ultrasound 2020; 24:423-428. [PMID: 32519303 DOI: 10.1007/s40477-020-00483-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Extended focused abdominal sonography for trauma (e-FAST) is part of the primary survey in patients with high-energy trauma. However, it does not identify patients with retroperitoneal haemorrhage associated with significant pelvic trauma. A traumatic diastasis of pubic symphysis, as well as an 'open book' (OB) pelvic injury, is a diagnostic clue to recognize unstable pelvis with higher risk of bleeding. FAST-PLUS (FAST-PL pleural -US ultrasound of symphysis) protocol is an addendum to the e-FAST, which takes into account the study of the pubic symphysis in a single transverse scan after the traditional focused evaluation of the abdomen and thorax. OBJECTIVES The aim of this study is to determine the value of FAST-PLUS protocol in the evaluation of pubic symphysis injuries and the identification of 'open book' (OB) unstable pelvic fractures. METHODS Between January 2018 and December 2019, we retrospectively reviewed 67 polytraumatised patients with clinical suspicion of pelvic instability and with known anteroposterior pelvis compression injuries who underwent e-FAST with an additional transverse scan of the pubic symphysis, named the FAST-PLUS protocol and computed tomography (CT) exam in order to assess the correlation between them in defining the presence or absence of pubic symphyseal widening (SW). A cutoff value of 2.5 cm in transverse diameter was used to diagnose OB unstable pelvic injury. The results were analysed using Cohen's test, which uses the Kappa value as the reference index. RESULTS The analysis carried out to assess the degree of agreement between FAST-PLUS and CT showed 5/67 patients (7.5%) with a critical pubic SW (> 2.5 cm transverse diameter) suggestive of unstable OB pelvic injury and 62/67 (92,5%) without any signs of SW at FAST-PLUS. At CT, findings of unstable OB pelvic fracture were confirmed in all patients with positive results at FAST-PLUS. Similarly, all patients with negative results for critical pubic SW (< 2.5 cm in transverse diameter) at FAST-PLUS were found to be negative at CT exam. The level of correlation between the two methods was high (Kappa value = 1) CONCLUSION: The FAST-PLUS protocol shows a high correlation with CT exam, which is the gold standard for the detection of unstable pubic SW, as well as OB pelvic injury, in polytraumatised patients. Inclusion of FAST-PLUS in patient management in the shock room may lead to a quicker identification of patients with unstable pelvis and to faster therapeutic work-up.
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Affiliation(s)
- Stefania Ianniello
- Department of Emergency Radiology, S. Camillo Hospital, C.ne Gianicolense, 87, 00152, Rome, Italy.
| | - Paola Conte
- Department of Emergency Radiology, S. Camillo Hospital, C.ne Gianicolense, 87, 00152, Rome, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Margherita Trinci
- Department of Emergency Radiology, S. Camillo Hospital, C.ne Gianicolense, 87, 00152, Rome, Italy
| | - Gianfranco Vallone
- Department of Life and Health, "Vincenzo Tiberio" University of Molise, Campobasso, Italy
| | - Michele Galluzzo
- Department of Emergency Radiology, S. Camillo Hospital, C.ne Gianicolense, 87, 00152, Rome, Italy
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Pushpasekaran N, Thampy S, Khaleel VM, Joseph S. Treatment of Locked Pubic Symphysis by Distraction Osteotomy of the Superior Pubic Ramus: A Case Report. JBJS Case Connect 2020; 10:e0196. [PMID: 32649101 DOI: 10.2106/jbjs.cc.19.00196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE An 18-year-old adolescent sustained a lateral compression injury to the pelvis that featured a locked pubic symphysis with plastic deformation of the sacrum. The pubic bone was entrapped in the opposite obturator foramen and required a novel distraction osteotomy of the superior ramus to restore the symphysis. The patient developed a urethral stricture 3 months after injury that required urethroplasty. The symphysis remained in alignment without any morbidity at the osteotomy site over 13 months of follow-up. CONCLUSION Locked pubic symphysis is frequently associated with urethral injuries. The distraction osteotomy of the superior pubic ramus described is a viable reduction maneuver that neutralizes the plastic deformation forces.
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Affiliation(s)
- Narendran Pushpasekaran
- 1Department of Orthopaedics, Medical Trust Hospital, Cochin, Kerala, India 2Department of Urology, Medical Trust Hospital, Cochin, Kerala, India
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Ramonda R, Cristiani B, Oliviero F, Felicetti M, Ortolan A, Iaccarino L. Severe Abdominal Pain as a Manifestation of Pseudogout in Pubic Symphysis. J Clin Rheumatol 2020; 26:e30-e31. [PMID: 32073523 DOI: 10.1097/rhu.0000000000000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Roberta Ramonda
- From the Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
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Cosma S, Borella F, Carosso A, Ingala A, Fassio F, Robba T, Maina A, Bertero L, Benedetto C. Osteomyelitis of the pubic symphysis caused by methicillin-resistant Staphylococcus aureus after vaginal delivery: a case report and literature review. BMC Infect Dis 2019; 19:952. [PMID: 31703612 PMCID: PMC6842141 DOI: 10.1186/s12879-019-4595-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/24/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Osteomyelitis of the pubic symphysis is a rare cause of pelvic pain after delivery, mainly caused by Staphylococcus aureus and Pseudomonas aeruginosa. The clinical context is the same as the more common diastasis of the pubic bone, but the presence of intense local pain in association with fever should prompt further clinical work-up based on blood chemistry, microbiology and diagnostic imaging. We report the first case of methicillin-resistant Staphylococcus aureus osteomyelitis of the pubic symphysis occuring after the delivery. CASE PRESENTATION A 39-year-old woman developed pain over the pubic bone 12 h after the delivery. After 72 h fever rose and laboratory examination showed elevation of C-reactive protein and procalcitonin levels. Pelvic x-rays and magnetic resonance showed pubic diastasis, joint effusion, tiny irregularities of articular surfaces and, severe bone edema. The patient was started on broad spectrum intravenous (IV) antibiotics (piperacillin-tazobactam) and then replaced to IV vancomycin and oral levofloxacin based on antibiogram result. She was then discharged with oral antibiotic therapy and fully recovered. CONCLUSIONS Due to the rarity of this disease, we compared our experience with the other cases of osteomyelitis of pubic symphysis occurring in peri-postpartum reported in the literature. The course of osteomyelitis was favourable in all patients, and only in one case an additional orthopedic procedure for symphysis fixation was necessary. Knowledge of this rare condition is important to enable prompt diagnosis and treatment.
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Affiliation(s)
- Stefano Cosma
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Fulvio Borella
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy.
| | - Andrea Carosso
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Agata Ingala
- Gynecology and Obstetrics 2, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Federica Fassio
- Gynecology and Obstetrics 2, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Tiziana Robba
- Department of Radiology, City of Health and Science, CTO Hospital, Torino, Italy
| | - Aldo Maina
- General Medicine Unit, City of Health and Science, Sant'Anna Hospital, Torino, Italy
| | - Luca Bertero
- Department of Medical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
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Pushkar DY, Kasyan GR, Dzhuraeva MD. [Suprapubic cartilaginous cyst]. Urologiia 2019:122-123. [PMID: 31356024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Suprapubic cartilaginous cyst represents a rare disease. Considering its low prevalence, only 9 clinical case have been described in literature. This lesion is often overlooked due to absence of clinical manifestations, incomplete diagnosis or the lack of necessary information about the disease. We observed a 74-year-old woman whose diagnosis of suprapubic cartilaginous cyst was confirmed by biopsy, as well as ultrasound, computer tomography and MRI results.
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Affiliation(s)
- D Yu Pushkar
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - G R Kasyan
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - M D Dzhuraeva
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Boinpally H, Howell RS, Ram B, Donovan V, Castellano M, Woods JS, Gorenstein S. Necrotizing Myositis: A Rare Necrotizing Soft Tissue Infection Involving Muscle. Wounds 2018; 30:E116-E120. [PMID: 30561371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Necrotizing myositis (NM) is an extremely rare necrotizing soft tissue infection involving muscle. Unlike similar infections (eg, necrotizing fasciitis, clostridial myonecrosis) that can be more readily diagnosed, NM can have a benign presentation then rapidly progress into a life-threatening condition with a mortality rate of 100% without surgical intervention. CASE REPORT A 74-year-old man with a history of prostate cancer with radiation therapy, seed implants, and 2 transurethral resection procedures presented to the emergency department after a fall. He was initially diagnosed and treated for urosepsis. Sixteen hours after presentation, he complained of pain and swelling of his right groin. Computed tomography of the abdomen and pelvis showed gas findings suspicious for necrotizing infection of the bilateral thighs. Surgical exploration revealed NM. Separate cultures from the left thigh and bladder grew Streptococcus intermedius, Clostridium clostridioforme, and Peptostreptococcus, suggesting a possible common source of infection from the prostate gland or the osteomyelitic pubic symphysis, which subsequently spread to the bilateral thighs. CONCLUSIONS To the best of the authors' knowledge, this is the first reported case of S intermedius and C clostridioforme causing NM. A high index of suspicion is required for extremely rare conditions like NM, because early diagnosis and surgical intervention significantly reduce mortality.
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Affiliation(s)
| | | | - Bebu Ram
- Department of Pathology, NYU Winthrop Hospital, Mineola, NY
| | | | | | - John S Woods
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY
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Maas KJ, Avanesov M, Laqmani A, Weinrich J, Sauer M, Kaul MG, Adam G, Regier M, Behzadi C. Inter- and Intraobserver reproducibility of T2 relaxation times of the discus interpubicus: A feasibility study at 3 Tesla. PLoS One 2018; 13:e0202698. [PMID: 30133521 PMCID: PMC6105013 DOI: 10.1371/journal.pone.0202698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/06/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To quantify standard values of the discus interpubicus in healthy subjects and to determine reliability and repeatability using T2 relaxation time measurements at 3T. Methods 20 asymptomatic participants (10 male, 10 female; mean age: 27.3 years ±4.1, BMI: 22.2 ±1.8) underwent a 3T Magnetic Resonance Imaging (MRI) of the pelvic region in a supine position. We included sagittal and para-axial T2w sequences centred over the pubic symphysis in order to identify the complete discus interpubicus. For quantitative analysis, a multi-echo Turbo Spin Echo (TSE) sequence (including 12 echo times between 6.4 and 76.8 ms) was acquired and analysed by using an in-house developed quantification plugin tool (qMapIt) extending ImageJ. Two readers in consensus defined three central slices of the pubic symphysis with the greatest length. For each slice, both readers separately placed three regions-of-interest (ROI) covering the whole discus interpubicus. Both readers repeated the ROI placements in identical fashion after a four-week interval on the original MRI images. Statistical analysis included intraclass correlation coefficient (ICC), nonparametric Wilcoxon test, Fisher exact test and mean relaxation time in ms and 95% confidence intervals. Results T2 relaxation time analysis was performed for all 20 participants. In total, a mean relaxation time of all analysed segments for both observers was 48.6 (±6.3 ms), with a mean relaxation time for observer 1 of 48.7 (±6.0 ms) and for observer 2 of 48.5 ms (±6.6ms). The calculated ICC comparing inter- and intrarater reproducibility was excellent in all segments (≥0.75). Conclusion T2 mapping of the discus interpubicus demonstrates good inter- and intrarater repeatability as well as reliability. Mean relaxation times were calculated with 48.6ms in healthy volunteers.
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Affiliation(s)
- Kai-Jonathan Maas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Azien Laqmani
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julius Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Sauer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael G. Kaul
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Regier
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cyrus Behzadi
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
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Fang JJ, Qin M, Xiao SB, Chen L, Liu B. [Age Estimation of Adult Living Donor by Pubic MSCT Three-dimensional Reconstruction]. Fa Yi Xue Za Zhi 2018; 34:150-153. [PMID: 29923380 DOI: 10.3969/j.issn.1004-5619.2018.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To establish a method for the age estimation of adult living donor based on pubic MSCT three-dimensional reconstruction and verify its accuracy and reliability. METHODS The volume rendering (VR) image data of pubic symphysis surface were collected from 300 volunteers aged over 17 years old. According to different age groups, the age estimation of these volunteers was performed by the method and formula of pubic symphysis surface. RESULTS In the 300 volunteers, the difference between biological age and actual age was <1 year in 117 cases, >1-2 years in 178 cases, >2 years in 5 cases. CONCLUSIONS MSCT three-dimensional reconstruction technology of pubic symphysis surface can be used to estimate the age of adult living donor, which can provide a high accurate and reliable result.
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Affiliation(s)
- J J Fang
- Key Laboratory of Forensic Examination and Identification of National Public Security Organs, Institute of Forensic Science of Anhui Public Security Department, Hefei 230061, China
| | - M Qin
- Key Laboratory of Forensic Examination and Identification of National Public Security Organs, Institute of Forensic Science of Anhui Public Security Department, Hefei 230061, China
| | - S B Xiao
- Key Laboratory of Forensic Examination and Identification of National Public Security Organs, Institute of Forensic Science of Anhui Public Security Department, Hefei 230061, China
| | - L Chen
- Key Laboratory of Forensic Examination and Identification of National Public Security Organs, Institute of Forensic Science of Anhui Public Security Department, Hefei 230061, China
| | - B Liu
- The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
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Arthuis CJ, Perrotin F, Patat F, Brunereau L, Simon EG. Computed tomographic study of anatomical relationship between pubic symphysis and ischial spines to improve interpretation of intrapartum translabial ultrasound. Ultrasound Obstet Gynecol 2016; 48:779-785. [PMID: 26678354 DOI: 10.1002/uog.15842] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To analyze the anatomical relationship between the pubic symphysis and the ischial spines to determine reliable landmarks for the assessment of fetal head descent by intrapartum translabial ultrasound (ITU). METHODS All computed tomography (CT) scans performed for breech presentation and for twin delivery between 2006 and 2014 in a tertiary university hospital were obtained for measurement and analysis by two operators. The symphysis-left ischial spine angle (SIA) and the symphysis-left ischial spine distance (SID) were measured on three-dimensional reconstructions from the CT volume dataset. We calculated intra- and interobserver agreements for SIA and SID with 95% prediction intervals, created Bland-Altman plots with 95% limits of agreement and estimated the intraclass correlation coefficient (ICC). A sagittal plane projection from the SIA enabled calculation of a sagittal angle, corresponding to the angle of progression (AoP) on ITU. RESULTS SIA and SID were obtained from CT images from 458 women. Reproducibility was good for both SIA (intraobserver ICC, 0.94 (95% CI, 0.88-0.97) and interobserver ICC, 0.81 (95% CI, 0.66-0.92)) and SID (intraobserver ICC, 0.92 (95% CI, 0.82-0.97) and interobserver ICC, 0.83 (95% CI, 0.73-0.92)). The median SIA was 106° (interquartile range (IQR), 105-109°) and median SID was 26.1 (IQR, 23.4-29.5) mm. SIA and SID were not correlated with pelvic diameter or height. The 50th percentile of AoP was 110°. CONCLUSION Knowledge of the anatomical relationship between the pubic symphysis and ischial spines makes it possible to establish a sonographic method for assesssing fetal head descent by taking into account the level of the ischial spines. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C J Arthuis
- University Hospital Center of Tours, Department of Obstetrics, Gynecology and Fetal Medicine, Tours, France
- Inserm U930, François-Rabelais University, Tours, France
| | - F Perrotin
- University Hospital Center of Tours, Department of Obstetrics, Gynecology and Fetal Medicine, Tours, France
- Inserm U930, François-Rabelais University, Tours, France
| | - F Patat
- Inserm U930, François-Rabelais University, Tours, France
- Centre Investigation Clinique-Innovation Technologique, CIC 1415 Inserm - University Hospital Center of Tours, Tours, France
| | - L Brunereau
- University Hospital Center of Tours, Department of Diagnostic and Interventional Radiology-Neuroradiology, Center for Medical Imaging, Tours, France
| | - E G Simon
- University Hospital Center of Tours, Department of Obstetrics, Gynecology and Fetal Medicine, Tours, France
- Inserm U930, François-Rabelais University, Tours, France
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Abstract
Purpose: To evaluate the symphyseal changes in patients with ankylosing spondylitis. Material and Methods: Radiological-morphological changes of the symphysis were studied in 68 patients (66 men, 2 women) with ankylosing spondylitis whose age ranged from 21 to 75 years. The duration of the disease was from 2 to 50 years. Results and Conclusion: Changes in the symphysis were found in 16 patients (23.5%) and were less prominent than findings in the sacroiliac joints. We classified these changes into four stages: minimal changes, apparent destruction, reparation and ankylosis. The third and the fourth stages of the changes in the symphsis were found more frequently in patients who suffered from the disease for more than 15 years. Radiological evaluation of symphyseal changes can be helpful in the evaluation of disease progression as well as in establishing a differential diagnosis.
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Affiliation(s)
- Z Jajić
- Department of Rheumatology and Physical Medicine, University Hospital, Sestre Milosrdnice, Zagreb, Croatia
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Phillips E, Khoury V, Wilmot A, Kelly JD. Correlation Between Cam-Type Femoroacetabular Impingement and Radiographic Osteitis Pubis. Orthopedics 2016; 39:e417-22. [PMID: 27064783 DOI: 10.3928/01477447-20160404-03] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/04/2015] [Indexed: 02/03/2023]
Abstract
A mechanistic link has been suggested between cam-type femoroacetabular impingement and increased stress on the symphysis pubis. This retrospective study was conducted to determine whether there is an increased prevalence of osteitis pubis, as evidenced by imaging, in patients with femoroacetabular impingement compared with age-matched control subjects. Search of a radiologic database of a large academic health institution for all patients with cam-type femoroacetabular impingement diagnosed by magnetic resonance imaging or magnetic resonance arthrogram between January 2000 and October 2013 identified 46 cases. Two radiologists reviewed these cases independently and confirmed the presence of femoroacetabular impingement based on alpha angle and other characteristics of cam morphology. The imaging studies were further evaluated for characteristics of osteitis pubis, with severity graded from minimal to severe on a 4-point Likert scale. A control group composed of age-matched subjects without diagnosed femoroacetabular impingement was also evaluated for osteitis pubis. A statistically significant increase in the prevalence of osteitis pubis was found in patients with femoroacetabular impingement compared with age-matched control subjects, with a prevalence of 43.48% in the femoroacetabular impingement group compared with 12.77% in the control group (P=.0012). On the 4-point Likert scale, the average severity of osteitis pubis in the group with femoroacetabular impingement was 1.5 (minimal to mild) compared with 0.53 (no osteitis pubis to minimal findings) in the control population. This significant increase in osteitis pubis in patients with femoroacetabular impingement supports the clinical link between these 2 processes. [Orthopedics. 2016; 39(3):e417-e422.].
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Griffin M, Seed PT, Webster L, Myers J, MacKillop L, Simpson N, Anumba D, Khalil A, Denbow M, Sau A, Hinshaw K, von Dadelszen P, Benton S, Girling J, Redman CWG, Chappell LC, Shennan AH. Diagnostic accuracy of placental growth factor and ultrasound parameters to predict the small-for-gestational-age infant in women presenting with reduced symphysis-fundus height. Ultrasound Obstet Gynecol 2015; 46:182-190. [PMID: 25826778 PMCID: PMC4744762 DOI: 10.1002/uog.14860] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To assess the diagnostic accuracy of placental growth factor (PlGF) and ultrasound parameters to predict delivery of a small-for-gestational-age (SGA) infant in women presenting with reduced symphysis-fundus height (SFH). METHODS This was a multicenter prospective observational study recruiting 601 women with a singleton pregnancy and reduced SFH between 24 and 37 weeks' gestation across 11 sites in the UK and Canada. Plasma PlGF concentration < 5(th) centile, estimated fetal weight (EFW) < 10(th) centile, umbilical artery Doppler pulsatility index > 95(th) centile and oligohydramnios (amniotic fluid index < 5 cm) were compared as predictors for a SGA infant < 3(rd) customized birth-weight centile and adverse perinatal outcome. Test performance statistics were calculated for all parameters in isolation and in combination. RESULTS Of the 601 women recruited, 592 were analyzed. For predicting delivery of SGA < 3(rd) centile (n = 78), EFW < 10(th) centile had 58% sensitivity (95% CI, 46-69%) and 93% negative predictive value (NPV) (95% CI, 90-95%), PlGF had 37% sensitivity (95% CI, 27-49%) and 90% NPV (95% CI, 87-93%); in combination, PlGF and EFW < 10(th) centile had 69% sensitivity (95% CI, 55-81%) and 93% NPV (95% CI, 89-96%). The equivalent receiver-operating characteristics (ROC) curve areas were 0.79 (95% CI, 0.74-0.84) for EFW < 10(th) centile, 0.70 (95% CI, 0.63-0.77) for low PlGF and 0.82 (95% CI, 0.77-0.86) in combination. CONCLUSIONS For women presenting with reduced SFH, ultrasound parameters had modest test performance for predicting delivery of SGA < 3(rd) centile. PlGF performed no better than EFW < 10(th) centile in determining delivery of a SGA infant.
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Affiliation(s)
- M. Griffin
- Women's Health Academic CentreKing's College LondonLondonUK
| | - P. T. Seed
- Women's Health Academic CentreKing's College LondonLondonUK
| | - L. Webster
- Women's Health Academic CentreKing's College LondonLondonUK
| | - J. Myers
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science CentreUniversity of ManchesterManchesterUK
| | | | - N. Simpson
- Section of Obstetrics & Gynaecology, Institute of Biochemical & Clinical SciencesUniversity of LeedsLeedsUK
| | - D. Anumba
- Academic Unit of Reproductive and Developmental MedicineUniversity of SheffieldSheffieldUK
| | - A. Khalil
- St George's Hospital Medical SchoolUniversity of LondonLondonUK
| | | | - A. Sau
- University HospitalLewishamLondonUK
| | | | - P. von Dadelszen
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverCanada
| | - S. Benton
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverCanada
| | - J. Girling
- West Middlesex University HospitalIsleworthMiddlesexUK
| | - C. W. G. Redman
- Nuffield Department of Obstetrics and GynaecologyUniversity of OxfordOxfordUK
| | - L. C. Chappell
- Women's Health Academic CentreKing's College LondonLondonUK
| | - A. H. Shennan
- Women's Health Academic CentreKing's College LondonLondonUK
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Hennemann J, Kennes LN, Maass N, Najjari L. Evaluation of established and new reference lines for the standardization of transperineal ultrasound. Ultrasound Obstet Gynecol 2014; 44:610-616. [PMID: 24481671 DOI: 10.1002/uog.13318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 12/22/2013] [Accepted: 01/18/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To examine the performance of a new reference line for the assessment of pelvic organ descent by transperineal ultrasound. METHODS We compared our newly proposed reference line, between two hyperechoic contours of the symphysis pubis (Line 3), with the horizontal reference line proposed by Dietz and Wilson (Line 1) and the central pubic line proposed by Schaer et al. (Line 2). Ultrasound volumes of 94 women obtained in routine clinical practice were analyzed. The perpendicular distance from the reference lines to the internal sphincter and the most dependent part of the bladder base was measured for volumes obtained at rest, on pelvic floor muscle contraction, on Valsalva maneuver and during coughing. Measurements were repeated 4 months later by the same examiner. Rates of assessment were calculated, and intrarater reliability was evaluated using Bland-Altman plots and intraclass correlation coefficients. RESULTS Line 2 had to be excluded from reliability analysis because of an assessment rate of only 12%, whereas Lines 1 and 3 could be assessed in 100% of volumes. The intrarater repeatability of Lines 1 and 3 was shown to be very similar. CONCLUSION In this comparison of three potential reference lines for the assessment of pelvic organ descent by transperineal ultrasound, the central pubic line was shown to be inferior owing to poor visibility in our volumes. Inter-rater reliability analysis and validation studies are required to confirm our results.
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Affiliation(s)
- J Hennemann
- Department of Gynaecology and Obstetrics, University Hospital Aachen, Aachen, Germany
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Lee HN, Ahn SE, Park JS, Park SY, Jin W, Ryu KN. Sonographic appearance of a cartilaginous cyst from the symphysis pubis mimicking a mass in the urinary bladder. J Clin Ultrasound 2014; 42:562-564. [PMID: 24975663 DOI: 10.1002/jcu.22197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 03/09/2014] [Accepted: 06/08/2014] [Indexed: 06/03/2023]
Abstract
A suprapubic cartilaginous cyst from the symphysis pubis is a rare lesion, which may be asymptomatic or cause symptoms such as urinary retention and pelvic pain. It is thought to be secondary to degenerative changes in the symphysis pubis and usually occurs in multiparous women. We report the case of a suprapubic cartilaginous cyst in a 76-year-old asymptomatic woman, which mimicked a bladder mass on ultrasonography.
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Affiliation(s)
- Han Na Lee
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, South Korea
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Grasland A, Dion E, Mahé I. Hydroxyapatite arthropathy of the symphysis pubis. J Emerg Med 2014; 46:693-694. [PMID: 24612631 DOI: 10.1016/j.jemermed.2013.08.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 08/20/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Anne Grasland
- Service de Médecine Interne, Hôpital Louis Mourier, Université Paris VII, APHP, Colombes, France
| | - Elisabeth Dion
- Service d'Imagerie Médicale, Hôpital Louis Mourier, Université Paris VII, APHP, Colombes, France
| | - Isabelle Mahé
- Service de Médecine Interne, Hôpital Louis Mourier, Université Paris VII, APHP, Colombes, France
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Youssef A, Bellussi F, Montaguti E, Maroni E, Salsi G, Morselli-Labate AM, Paccapelo A, Rizzo N, Pilu G, Ghi T. Agreement between two- and three-dimensional transperineal ultrasound methods for assessment of fetal head-symphysis distance in active labor. Ultrasound Obstet Gynecol 2014; 43:183-188. [PMID: 24006290 DOI: 10.1002/uog.13204] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/24/2013] [Accepted: 08/30/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To assess the intermethod agreement between two-dimensional (2D) and three-dimensional (3D) transperineal ultrasound methods in measuring a new index of fetal head station (the fetal head-symphysis distance (HSD)) in active labor, and to assess potential factors that may affect their agreement. METHODS HSD was measured by transperineal ultrasound in 86 women in active labor, once using a 2D and once using a 3D technique. 2D images were acquired first in 43 cases and 3D images were acquired first in the other 43 women. Intermethod agreement between 2D and 3D methods was analyzed by means of intraclass correlation coefficient (ICC) and Bland-Altman analysis. In addition, potential factors affecting the intermethod reproducibility were investigated including fetal occiput position, order of acquisition, fetal head station, stage of labor, maternal body mass index and use of epidural analgesia, using the ANOVA test to check for systematic bias and Levene's test for homoscedasticity. RESULTS Good agreement was demonstrated between 2D and 3D measurements of HSD (ICC, 0.949 (95% CI, 0.914-0.984)). No evidence of systematic difference was shown between the two methods (average difference ± SD = 0.03 ± 2.29 mm; P = 0.888). The only factor that had a significant effect on systematic difference between 2D and 3D methods was order of acquisition (P = 0.042); the first observation was higher regardless of the method used. Fetal head station had a significant effect on the homogeneity between the two methods (P = 0.004) with a better 2D-3D agreement obtained at lower head stations (SD of differences: 1.63 vs 2.59 mm). CONCLUSIONS There is very good agreement between 2D and 3D methods of assessing HSD. Agreement is better in lower fetal head stations.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
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Abstract
This study was undertaken to determine incidence, associated risk factors, and clinical outcomes of a diastasis of pubic symphysis. Among 4,151 women, who delivered 4,554 babies at the Department of Obstetrics of Seoul National University Bundang hospital from January 2004 to December 2006, eleven women were diagnosed as having a symptomatic diastasis of pubic symphysis. We estimated the incidence of the diastasis and identified the associated risk factors. To evaluate the pain relief and reduction of diastasis we followed up the 11 diastatic patients. The incidence of the diastasis was 1/385. Primiparity (P = 0.010) and twin gestation (P = 0.016) appeared as risk factors for diastasis by univairable analysis; and twin gestation appeared to be the only risk factor (P = 0.006) by logistic analysis. Two patients were operated due to intractable pain; and the remaining nine patients were treated conservatively. The diastatic gap decreased to less than 1.5 cm by 2 to 6 weeks after the diagnosis and then remained stationary. At a mean follow-up of 22.1 months (range, 12 to 47 months), five of 11 patients had persistent symphysis pubis dysfunction. Diastasis is more frequent than generally acknowledged. Pregnant women with multiple gestations should be informed about the potential risk of pubic symphysis diastasis.
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Affiliation(s)
- Jeong Joon Yoo
- Department of Orthopedic Surgery, National University College of Medicine, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, National University College of Medicine, Seoul, Korea
| | - Joon Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Bun-Jung Kang
- Department of Orthopedic Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, National University College of Medicine, Seoul, Korea
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Simon EG, Arthuis CJ, Perrotin F. Ultrasound in labor monitoring: how to define the plane of ischial spines? Ultrasound Obstet Gynecol 2013; 42:722-723. [PMID: 23893667 DOI: 10.1002/uog.12569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/17/2013] [Indexed: 06/02/2023]
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Albrich S, Laterza RM, Merinsky A, Skala C, Koelbl H, Naumann G. [Measurement of the infrapubic angle using 3D perineal ultrasound and its relationship to obstetrical parameters]. Ultraschall Med 2012; 33:E95-E100. [PMID: 22723036 DOI: 10.1055/s-0031-1299053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE Ultrasound has achieved an indispensable role in urogynecology. The introduction of 3 D technology has enabled sonographers to visualize structures in the axial plane. The angle of the infrapubic arc may enable us to presume the shape of the pelvis. Our aim was to describe a method for measuring the infrapubic angle and the interpubic space with 3 D perineal ultrasound through 3 D rotation, correlating them with the length of the 2nd stage of labor and the rate of levator defects. MATERIALS AND METHODS Women after vaginal delivery were recruited and underwent a 3 D perineal ultrasound on 2nd - 3 rd day postpartum. Volume datasets were analyzed to measure the infrapubic angle and the interpubic space independently by 2 urogynecologists. The interobserver reliability and the correlation between infrapubic arc angle and the length of the 2nd stage of labor and the occurrence of levator defects were calculated. RESULTS 110 women were enrolled. With a correlation coefficient of 0.76, the relationship between the infrapubic angle measurements of the two observers was very good. A moderate to good correlation was found for the assessment of the interpubic gap, with r = 0.69. Between the infrapubic angle and length of the 2nd stage of labor, no statistical correlation for both observer measurements (p = 0.31; p = 0.78, respectively) was found. Also the correlation between the infrapubic arc angle and the occurrence of levator avulsions was not significant (p = 0.59; p = 0.39, respectively). CONCLUSION 3 D ultrasound technology enables us to identify and evaluate the interpubic gap and the infrapubic arc with a high inter-observer reproducibility. However, from our data, the infrapubic angle does not seem to influence the length of the 2nd stage of labor and the occurrence of levator defects.
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Affiliation(s)
- S Albrich
- Klinik und Poliklinik für Geburtshilfe und Frauenkrankheiten, Universitätsmedizin Mainz, Johannes-Gutenberg-Universität
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Makridis KG, Ahmad MA, Kanakaris NK, Fragkakis EM, Giannoudis PV. Reconstruction of iliac crest with bovine cancellous allograft after bone graft harvest for symphysis pubis arthrodesis. Int Orthop 2012; 36:1701-7. [PMID: 22729663 DOI: 10.1007/s00264-012-1572-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 05/01/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to evaluate the safety and efficiency, as well as the incorporation characteristics of a specific type of xenograft used for iliac crest defects post-harvesting tri-cortical iliac crest bone graft. METHODS Sixteen patients diagnosed with chronic anterior pelvic pain were operated for pubic symphysis fusion. The tri-cortical graft harvested from the iliac crest was inserted into the pubic symphysis and compressed with a reconstruction plate. The defect in the iliac crest was filled with a block of cancellous bovine substitute (Tutobone®). The length of iliac crest defect, time to fusion of pubic symphysis, time to incorporation of the graft and complications were recorded. The postoperative pain and patients' satisfaction were evaluated. RESULTS The median age of patients was 36.5 years (range 27-75). Fusion was obtained in 15 patients (94 %). The median time to fusion was four months (range three to seven). The length of the iliac crest bone defect ranged from 40 to 70 mm. Integration of the bovine substitute was achieved in 15 patients (94 %) over a median period of three months (range two to six). The postoperative median pain score was 2 (range 1-5). Twelve patients (75 %) reported good satisfaction. No major complications or allergic reactions were observed. CONCLUSIONS The xenograft used in this study provided a safe and effective method of reconstruction of iliac crest donor site defects. It has satisfactory incorporation, high biocompatibility and no signs of inflammatory reactions. This new technique is simple and easily reproducible in routine clinical practice.
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Affiliation(s)
- Konstantinos G Makridis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Clarendon Wing Level A, Great George Street, LS1 3EX, Leeds, West Yorkshire, UK
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Tan TJ, Wong SK, Foo LSS. A parasymphyseal pubic cartilaginous cyst masquerading as a chondrosarcoma. Clin Radiol 2012; 67:508-10. [PMID: 22305258 DOI: 10.1016/j.crad.2011.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 12/12/2011] [Indexed: 11/18/2022]
Affiliation(s)
- T J Tan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
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Oh J, Jung DC, Choi CH. Locating the reference point of symphysis pubis in axial CT images. J Digit Imaging 2012; 25:110-20. [PMID: 21494903 PMCID: PMC3264719 DOI: 10.1007/s10278-011-9384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
In this paper, we present an effective method to determine the reference point of symphysis pubis (SP) in an axial stack of CT images to facilitate image registration for pelvic cancer treatment. In order to reduce the computational time, the proposed method consists of two detection parts, the coarse detector, and the fine detector. The detectors check each image patch whether it contains the characteristic structure of SP. The coarse detector roughly determines the location of the reference point of SP using three types of information, which are the location and intensity of an image patch, the SP appearance, and the geometrical structure of SP. The fine detector examines around the location found by the coarse detection to refine the location of the reference point of SP. In the experiment, the average location error of the propose method was 2.23 mm, which was about the side length of two pixels. Considering that the average location error by a radiologist is 0.77 mm, the proposed method finds the reference point quite accurately. Since it takes about 10 s to locate the reference point from a stack of CT images, it is fast enough to use in real time to facilitate image registration of CT images for pelvic cancer treatment.
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Affiliation(s)
- Jiyong Oh
- School of Electrical Engineering and Computer Science, ASRI, Seoul National University, Seoul, 151-744, South Korea.
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Idrees A. Management of chronic symphysis pubis pain following child birth with spinal cord stimulator. J PAK MED ASSOC 2012; 62:71-73. [PMID: 22352111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The case of a 39 year old woman who had diastasis of pubic symphysis following childbirth and later developed severe chronic neuropathic pain and disability is presented. She received extensive surgical and medical treatment for 6 years with no improvement of symptoms. The VNRS (Visual Numerical Rating Scale) pain score was 7/10 or more most of the time. This was quite disabling in terms of her quality of life. A spinal cord stimulator was inserted after failure of other modalities of pain management which resulted in dramatic improvement in the quality of life measured with SF-36 questionnaire. Her pain score became 0/10 VNRS and she was free from opioids and psychotropic medications within 3 months post insertion. Spinal cord stimulator can be considered for the management of pain due to diastasis of pubic symphysis, not amenable to other therapies.
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Affiliation(s)
- Ahsan Idrees
- Department of Anaesthesia & Pain, Our Lady of Lourdes Hospital, Drogheda, Ireland
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Botanlioğlu H, Bilsel N, Kaynak G, Unlü MC. Open reduction technique for overlapping and locked pubic symphysis. Acta Orthop Traumatol Turc 2012; 46:77-81. [PMID: 22441457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A locked pubic symphysis can occur following a lateral compression injury of the pelvic ring when one pubic bone becomes entrapped behind the contralateral pubis or obturator foramen. In selecting the treatment modality, it is important to know the mechanism of injury. We presented the use of an open reduction technique in the treatment of a locked pubic symphysis in which open reduction external fixation application failed in the emergency department.
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Affiliation(s)
- Hüseyin Botanlioğlu
- Department of Orthopedics and Traumatology, Cerrahpaşa Medical Faculty, İstanbul University, Turkey.
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Nouta KA, Van Rhee M, Van Langelaan EJ. [Symphysis rupture during partus]. Ned Tijdschr Geneeskd 2011; 155:A2802. [PMID: 21426597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A few hours after the birth of her first child a 36-year-old woman developed anterior pelvic pain. The pain worsened on walking. It proved that during the birth the patient had felt something 'give'. On X-ray a diastasis of 50 mm was seen in the symphysis and symphysis rupture was diagnosed. The patient was treated conservatively with bed rest and pelvic stabilisation. After 17 weeks she was symptom-free. Symphysis rupture during partus is rare. It is characterised by pain around the symphysis and/or the sacro-iliac joints during the first 24 hours post partum. Diagnosis can be made by X-ray. Treatment is predominantly conservative comprising pelvic stabilisation and bed rest.
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Affiliation(s)
- Klaas-Auke Nouta
- Rijnland Ziekenhuis, afd. Orthopaedie, Leiderdorp en Alphen aan de Rijn.
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Dimitrakopoulou A, Schilders E, Bismil Q, Talbot JC, Kazakos K. An unusual case of enthesophyte formation following an adductor longus rupture in a high-level athlete. Knee Surg Sports Traumatol Arthrosc 2010; 18:691-3. [PMID: 20076946 DOI: 10.1007/s00167-009-1029-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Accepted: 12/14/2009] [Indexed: 11/25/2022]
Abstract
We present a case of a high-level rugby player with severe groin pain following a partial rupture of his left adductor longus enthesis during a game. Conservative treatment proved unsuccessful and the athlete had persistent symptoms, affecting his quality of life and ability to play sports. Further assessments revealed a large bony spur/enthesophyte at adductor longus origin. The patient underwent a successful surgical resection of the active bone formation.
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Affiliation(s)
- Alexandra Dimitrakopoulou
- Department of Orthopaedic Surgery, Bradford Royal Infirmary Hospital, Duckworth Lane, Bradford, W Yorkshire BD9 6RJ, UK.
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