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Journal of Bone and Joint Infection 2022: Septic arthritis and osteomyelitis of the pubic symphysis (SAS) are rare conditions with nonspecific symptoms leading to diagnostic delay and treatment. : We draw...
: Septic arthritis and osteomyelitis of the pubic symphysis (SAS) are rare conditions with nonspecific symptoms leading to diagnostic delay and treatment. : We draw awareness to this condition elucidating the diagnostic procedures, surgical intervention and antibiotic management. : This entail a retrospective follow-up study of 26 consecutive patients, median age of 71 years (range: 48-89) surgically treated for septic arthritis of the pubic symphysis between 2009 and 2020. Patient files, diagnostic imaging and bacterial cultures were evaluated. : Before diagnosed with SAS, 21 of the patients had previous pelvic surgery (16 due to malign conditions, 5 due to benign conditions), while 5 of the patients were not previously operated. Median follow-up period after SAS surgery was 18.5 months (range: 8 to 144.5 months). Dominating symptoms were severe suprapubic/pubic pain ( 26), gait difficulties ( 10) and intermittent fever ( 9). Diagnostic delay was between 1 and 12 months. The diagnostic imaging included magnetic resonance imaging (MRI) ( 24), computer tomography (CT) ( 17) and/or PET-CT ( 10), predominantly displaying bone destruction/erosion of the symphysis ( 13), abscess ( 12) and/or fistula ( 5) in the adjacent muscles. All patients underwent surgical debridement with resection of the symphysis and received a minimum of 6 weeks antibiotic treatment. Fourteen patients presented with monocultures and 4 patients with polycultures. Five patients underwent at least one revision surgery. Twenty-three patients experienced postoperative pain relief at 6 weeks follow-up, and 19 patients were ambulant without walking aids. : SAS are rare conditions and should be suspected in patients with infection, pubic pain and impaired gait, especially after pelvic surgery. Bone infection, abscess and fistula near the symphysis can be visualized with proper imaging, most frequently with MRI. For most patients in this cohort surgical debridement combined with a minimum of 6 weeks antibiotic treatment resulted in pain relief, improved walking ability and a low recurrence rate.
PubMed: 35251903
DOI: 10.5194/jbji-7-35-2022 -
Journal of Obstetrics and Gynaecology... Aug 2022Symphysis pubis diastasis (SPD) is an uncommon peripartum complication which can have short-term morbidities secondary to pain and restricted movements as well as...
BACKGROUND
Symphysis pubis diastasis (SPD) is an uncommon peripartum complication which can have short-term morbidities secondary to pain and restricted movements as well as long-term complications. It is important to diagnose this condition as it causes significant discomfort to the nursing mothers. We present our experience in five patients with SPD who were managed successfully.
METHODS
Present study is an observation of five cases of SPD managed in a single unit in a tertiary care center over three years from January 2017 to December 2019. All women with symptoms of SPD with inter-pubic distance of more than 10 mm were selected for the study. The demographic profile, clinical details, diagnostic imaging findings, and treatment provided for such patients were noted down from the individual case records. Follow-up of each patient for improvement in the symptoms and X-ray findings was available till 3 months for each case.
RESULTS
Mean age of the women with SPD was 29.8 ± 5.4 years. Four women had vaginal delivery and one had vacuum delivery. Average birth weight is 3.26 ± 0.85 kg. Mean duration of first stage of labor is 6.6 ± 0.89 h and median of second stage is 35 min. Average inter-pubic distance at the time of diagnosis on X-ray was 1.84 ± 0.2 cm. All women were managed conservatively with bed rest, analgesics, pelvic binder and physiotherapy. Improvement in the range of movement was noted over average of 21.8 ± 3.7 days and symptoms resolved over 14.4 ± 2.6 weeks.
CONCLUSION
Treating obstetrician should be aware of this condition as simple treatment measures can avoid the long-term morbidities and complications.
PubMed: 35928090
DOI: 10.1007/s13224-021-01590-y -
World Journal of Clinical Cases Jan 2021Separation of the pubic symphysis can occur during the peripartum period. Relaxin (RLX) is a hormone primarily secreted by the corpus luteum that can mediate hemodynamic...
BACKGROUND
Separation of the pubic symphysis can occur during the peripartum period. Relaxin (RLX) is a hormone primarily secreted by the corpus luteum that can mediate hemodynamic changes during pregnancy as well as loosen the pelvic ligaments. However, it is unknown whether RLX is associated with peripartum pubic symphysis separation and if the association is affected by other factors.
AIM
To study the association between RLX and peripartum pubic symphysis separation and evaluate other factors that might affect this association.
METHODS
We performed a cross-sectional study of pregnant women between April 2019 and January 2020. Baseline demographic characteristics, including gestational age, weight, neonatal weight, delivery mode and duration of the first and second stages of labor, were recorded. The clinical symptoms were used as a screening index during pregnancy, and the patients with pubic symphysis and inguinal pain were examined by color Doppler ultrasonography to determine whether there was pubic symphysis separation. Serum RLX concentrations were evaluated 1 d after delivery using an enzyme-linked immunosorbent assay, and pubic symphysis separation was diagnosed based on postpartum X-ray examination. We used an independent-sample test to analyze the association between serum RLX levels and peripartum pubic symphysis separation. Multivariate regression analysis was used to evaluate whether the association between RLX and peripartum pubic symphysis separation was confounded by other factors, and the association between RLX and the severity of pubic symphysis separation was also assessed. We used Pearson correlation analysis to determine the factors related to RLX levels as well as the correlation between the degree of pubic symphysis separation and activities of daily living (ADL) and pain.
RESULTS
A total of 54 women were enrolled in the study, with 15 exhibiting (observational group) and 39 not exhibiting (control group) peripartum pubic symphysis separation. There were no statistically significant differences in terms of maternal age, gestational age, pre-pregnancy weight, weight gain during pregnancy, delivery modes, or duration of the first or second stages of labor between the 2 groups. We did, however, note a statistically significant difference in serum RLX concentrations and neonatal weight between the observational and control groups (122.3 ± 0.7 µg/mL 170.4 ± 42.3 µg/mL, < 0.05; 3676.000 ± 521.725 g 3379.487 ± 402.420 g, < 0.05, respectively). Multivariate regression analyses showed that serum RLX level [odds ratio (OR): 1.022) and neonatal weight (OR: 1.002) were associated with pubic symphysis separation peripartum. The degree of separation of the pubic symphysis was negatively correlated with ADL and positively correlated with pain. There was no statistically significant association between serum RLX levels and the severity of pubic symphysis separation after adjusting for confounding factors.
CONCLUSION
Serum RLX levels and neonatal weight were associated with the occurrence, but not the severity, of peripartum pubic symphysis separation.
PubMed: 33511175
DOI: 10.12998/wjcc.v9.i1.91 -
Ultrasound in Obstetrics & Gynecology :... Jul 2021Transperineal ultrasound is a simple and highly repeatable method that has been used increasingly in the quantification of pelvic organ prolapse, but abnormal uterine...
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.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; China; Female; Humans; Lower Urinary Tract Symptoms; Middle Aged; Pelvic Floor; Pelvic Floor Disorders; Perineum; Predictive Value of Tests; Prospective Studies; Pubic Symphysis; ROC Curve; Reference Values; Ultrasonography; Uterine Prolapse; Uterus; Valsalva Maneuver; Young Adult
PubMed: 33094536
DOI: 10.1002/uog.23524 -
The Journal of the Canadian... Jun 2012Two case reports review the chiropractic treatment and rehabilitation management of Symphysis Pubis Dysfunction (SPD).
OBJECTIVE
Two case reports review the chiropractic treatment and rehabilitation management of Symphysis Pubis Dysfunction (SPD).
CLINICAL FEATURES
Patient 1: a 35-year-old female presented at 30 weeks pregnant with severe left sided Symphysis Pubis Dysfunction and low back pain. Patient 2: a 33-year-old female also 30 weeks pregnant, presented with right sided Symphysis Pubis Dysfunction and sacroiliac pain.
INTERVENTION AND OUTCOME
Treatment included soft tissue therapy, pregnancy support belt, side-lying mobilizations, pelvic blocks and instrument-assisted pubic symphysis adjustments. Home advice included: ice, staying active, moving as a unit, stretching, use of a pillow between the knees while sleeping, regular breaks from sitting and pelvic floor (Kegel) exercises. Both patients reported some relief with treatment and home care. Post-partum, rehabilitation exercises were prescribed to restore muscular endurance, control and pelvic stability. On long-term follow-up patient 1 reported no pubic symphysis pain, but some low back pain secondary to a subsequent knee injury. Patient 2 reported being mostly pain free with a rare re-exacerbation of pubic symphysis pain.
SUMMARY
Conservative chiropractic management appears to reduce pain and improve mobility and function for SPD. Post partum rehabilitation of the associated lumbo-pelvic musculature with specific stabilization exercises is recommended to reduce pain, improve long term outcomes and prevent chronicity.
PubMed: 22675223
DOI: No ID Found -
Sports Health 2017Evaluation of groin pain in athletes may be challenging as pain is typically poorly localized and the pubic symphyseal region comprises closely approximated tendons and... (Review)
Review
CONTEXT
Evaluation of groin pain in athletes may be challenging as pain is typically poorly localized and the pubic symphyseal region comprises closely approximated tendons and muscles. As such, magnetic resonance imaging (MRI) and ultrasound (US) may help determine the etiology of groin pain.
EVIDENCE ACQUISITION
A PubMed search was performed using the following search terms: ultrasound, magnetic resonance imaging, sports hernia, athletic pubalgia, and groin pain. Date restrictions were not placed on the literature search.
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 4.
RESULTS
MRI is sensitive in diagnosing pathology in groin pain. Not only can MRI be used to image rectus abdominis/adductor longus aponeurosis and pubic bone pathology, but it can also evaluate other pathology within the hip and pelvis. MRI is especially helpful when groin pain is poorly localized. Real-time capability makes ultrasound useful in evaluating the pubic symphyseal region, as it can be used for evaluation and treatment.
CONCLUSION
MRI and US are valuable in diagnosing pathology in athletes with groin pain, with the added utility of treatment using US-guided intervention. Strength-of Recommendation Taxonomy: C.
Topics: Athletic Injuries; Groin; Humans; Magnetic Resonance Imaging; Pain; Pubic Symphysis; Ultrasonography
PubMed: 28850315
DOI: 10.1177/1941738117694841 -
Urologia Internationalis 2023The sheep was evaluated as a potential model for preclinical evaluation of urethral slings in vivo based on: (1) anatomical measurements of the sheep vagina and (2)...
INTRODUCTION
The sheep was evaluated as a potential model for preclinical evaluation of urethral slings in vivo based on: (1) anatomical measurements of the sheep vagina and (2) histological tissue integration and host response to polypropylene (PP) slings.
METHODS
Eight female, multiparous sheep were utilized. Three of 8 animals underwent surgery mimicking human tension-free vaginal tape protocols for midurethral slings and were euthanized at 6 months. The following measurements were obtained: vaginal length, maximum vaginal width with retraction, symphysis pubis length, and distance from the pubic bone to incision. Explanted sling samples from sheep and human were stained with hematoxylin and eosin for host reaction assessment.
RESULTS
Geometric measurements were similar between humans and sheep. Sheep vaginal anatomy allowed sling placement similar to procedures in human surgeries, and all sheep recovered without problems. Comparative histology between the sheep and human indicated similar host reaction and collagen deposition around implants, confirming suitability of the sheep model for biomaterial response assessment.
CONCLUSION
Sheep vaginal length is comparable to humans. Tissue integration and host response to PP slings showed chronic inflammation with rich collagen deposition around the material in both sheep and human specimens, highlighting the sheep as a potential animal model for preclinical testing of midurethral slings.
Topics: Humans; Female; Animals; Sheep; Suburethral Slings; Urinary Incontinence, Stress; Vagina; Urologic Surgical Procedures; Polypropylenes
PubMed: 35220315
DOI: 10.1159/000522138 -
Annals of Translational Medicine Dec 2019Accurate diagnosis of labor onset is especially important for the counseling about elective induction of labor. The study aimed to evaluate whether transperineal...
BACKGROUND
Accurate diagnosis of labor onset is especially important for the counseling about elective induction of labor. The study aimed to evaluate whether transperineal ultrasound could better predict the timing and likelihood of spontaneous labor at term.
METHODS
This single-center study was conducted between 2018 and 2019.Data on singleton pregnant women after 39 weeks and before labor onset were retrospectively reviewed.
RESULTS
All the transperineal ultrasound parameters were well reproducible between the two doctors [intraclass correlation coefficient (ICC) for progression distance(PD) was 0.892, P<0.001], [ICC for angle of progression (AoP) was 0.881, P<0.001], [ICC for subpubic arch angle (SPA) was 0.766, P<0.001], [ICC for width of symphysis pubis (WSP) was 0.803, P<0.001]. For the pregnant women before 40 weeks, the width of symphysis pubis changed gradually with the of spontaneous labor (WSP) (r=0.33, P<0.05). For all included women, the SPA correlated with the time of spontaneous labor (SPA) (r=0.31, P<0.05).
CONCLUSIONS
The antepartum transperineal ultrasound is a simple and objective technique that better observes the initiation of labor. And with the WSP and SPA we were able to predict labor onset and help in counseling about elective induction of labor.
PubMed: 32042734
DOI: 10.21037/atm.2019.12.11 -
Fa Yi Xue Za Zhi Oct 2020Adult age determination plays an important role in individual identification, criminal investigation and social welfare. The most popular adult age determination... (Review)
Review
Adult age determination plays an important role in individual identification, criminal investigation and social welfare. The most popular adult age determination indicators are pubic symphysis, iliac auricular surface, costal cartilage, cranial sutures, teeth, laryngeal cartilage, etc. In recent years, with the progress of CT imaging and 3D reconstruction technology, the adult age determination study gradually has transferred from a time-consuming general observation of bones with complex pre-processing in the past to the non-destructive, convenient, time-saving and easy to store image analysis technology. To explore more accurate, rapid and convenient adult age determination methods, multiple imaging methods and artificial intelligence have been applied in adult age determination. This paper reviews the common methods and research progress of adult age determination at home and abroad, infers the development direction of adult age determination, in order to provide reference for the improvement and optimization of forensic adult age determination.
Topics: Age Determination by Skeleton; Artificial Intelligence; Forensic Anthropology; Imaging, Three-Dimensional; Pubic Symphysis; Research
PubMed: 33295159
DOI: 10.12116/j.issn.1004-5619.2020.05.002