- MeSH
- Anal Canal pathology MeSH
- Humans MeSH
- Pubic Bone pathology MeSH
- Digital Rectal Examination methods MeSH
- Pelvic Floor * pathology MeSH
- Trigger Points physiopathology MeSH
- Muscles pathology MeSH
- Myofascial Pain Syndromes * diagnosis physiopathology rehabilitation MeSH
- Physical Therapy Modalities MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
INTRODUCTION: The goal of this study was to investigate prevalence and morphometric parameters of pubic ligaments and the interpubic disk and its cavity using imaging methods for use in clinical medicine. METHODS: Pubic symphysis morphology was investigated in 652 patients (348 women and 304 men), from which 449 CT scans and 203 MR scans were available. The average age of men was 48 years and women 39 years. Investigated parameters included dimensions of the interpubic disk, visibility and width of the reinforcing ligaments, and visibility, dimensions, and location of the symphysial cavity. The results were compared with MR scans of 20 healthy volunteers and 21 dissected anatomic specimens. RESULTS: The craniocaudal, ventrodorsal, and mediolateral diameters of the pubic disk were 36 to 37.7, 14.8 to 15.2, and 2.2 to 4.2 mm in women and 42 to 42.3, 18.6 to 19, and 2.4 to 4.5 mm in men, respectively. Higher age correlated with shorter mediolateral diameter and larger craniocaudal and ventrodorsal diameters. The superior pubic ligament was visible in 93.1% of men (1.44 mm thick) and in 100% of women (1.7 mm); the inferior pubic ligament in 89.7% of men (1.74 mm) and 88% of women (1.95 mm), the anterior pubic ligament in 96.6% of men (1.5 mm) and 82% of women (1.34 mm); and the posterior pubic ligament in 65.5% of men (1.18 mm) and 63.7% of women (0.83 mm). A symphysial cavity was found in 24% of men and 22.9% of women, with craniocaudal, ventrodorsal, and mediolateral dimensions of 13, 10.7, and 3.2 mm in men and 9.5, 10.7, and 3 mm in women, respectively. CONCLUSION: The presented morphologic parameters provide an anatomic reference for diagnostics of pathologic conditions of the pubic symphysis. The following anatomic structures should be added to the official anatomic terminology: symphysial cavity (cavitas symphysialis), retropubic eminence (eminentia retropubica), anterior pubic ligament (ligamentum pubicum anterius), and posterior pubic ligament (ligamentum pubicum posterius). LEVEL OF EVIDENCE: II-III.
- MeSH
- Ligaments, Articular anatomy & histology MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Pubic Bone diagnostic imaging MeSH
- Tomography, X-Ray Computed MeSH
- Pubic Symphysis * diagnostic imaging MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Insuficientné zlomeniny vznikajú pri normálnej záťaži na patologicky oslabenú kosť, predovšetkým v dôsledku osteoporózy. Atypické zlomeniny femuru sú popísané ako komplikácia dlhodobého užívania bisfosfonátov. Vzhľadom k starnutiu populácie sa incidencia insuficientných fraktúr, ako aj atypických zlomenín femuru, zvyšuje. Rovnako problémom je ich včasná diagnostika, keďže na prvotnej natívnej RTG-snímke bývajú často prehliadnuté. Prezentujeme prípad pacientky, dlhodobo liečenej denosumabom, s atraumatickou zlomeninou dolného ramienka lonovej kosti. Vzhľadom k predĺženému kostnému hojeniu s neobvyklým obrazom hojenia uvažujeme nad dlhodobou antiresopčnou liečbou ako možnou príčinou vzniku zlomeniny ramienka lonovej kosti a faktorom ovplyvňujúcim hojenie insuficientnej fraktúry.
Insufficiency fractures occur in normal load on pathologically weak bone, as a result of osteoporosis. Atypical femoral fractures are well described complication of long term bisphosphonate use. With a growing geriatric population, the incidence of insufficiency fractures, as well as atypical femoral fractures, has increased. Also their early diagnostics is a problem, because they are often overlooked on first native X-ray. We present a case of patient, longterm treated with denosumab, who developed fracture of the pubic ramus. Because of delayed bone healing with unusual pattern we consider long-term anti-resorption therapy as a potentional cause of the pubic ramus fracture or factor affecting the healing of insufficiency fracture.
- MeSH
- Fracture Healing MeSH
- Bone Density Conservation Agents adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Musculoskeletal Pain etiology MeSH
- Pubic Bone * diagnostic imaging injuries MeSH
- Osteoporosis drug therapy complications MeSH
- Pelvis diagnostic imaging injuries MeSH
- Pelvic Pain etiology MeSH
- Radiography MeSH
- Fractures, Stress * diagnostic imaging therapy MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Fractures, Bone diagnostic imaging etiology MeSH
- Laparoscopy MeSH
- Humans MeSH
- Urinary Bladder * diagnostic imaging surgery injuries MeSH
- Pubic Bone diagnostic imaging injuries MeSH
- Multiple Trauma MeSH
- Rupture MeSH
- Aged, 80 and over MeSH
- Sutures MeSH
- Accidental Falls * MeSH
- Check Tag
- Humans MeSH
- Aged, 80 and over MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Fibrous dysplasia (FD) is a benign bone lesion in which normal bone marrow is replaced by fibro-osseous tissue. The usual high fluorodeoxyglucose (F-FDG) uptake in FD may lead to the misdiagnosis of bone malignancy. Herein, we describe the case of a 42-year old man with histologically verified FD of the pubic bone, which has been subsequently examined during follow-up for rectal cancer, using both F-FDG and fluorothymidine (F-FLT) PET/CT imaging. The FD lesion was characterized by a high uptake of F-FDG (hot spot) but very low uptake of F-FLT (cold spot) as compared with the contralateral unaffected pubic bone.
- MeSH
- Dideoxynucleosides MeSH
- Adult MeSH
- Fibrous Dysplasia of Bone diagnostic imaging MeSH
- Fluorodeoxyglucose F18 MeSH
- Humans MeSH
- Pubic Bone diagnostic imaging MeSH
- Positron Emission Tomography Computed Tomography MeSH
- Radiopharmaceuticals MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
To present clinical and radiographic findings of iliopectineal bursitis and draw attention to some related etiopathogenetic factors. MATERIAL AND METHODS Six patients followed up between 2005 and 2007 were evaluated. They included four women and two men (average age, 58 years; range, 35 to 80 years) who presented with a tender mass in the hip region (four right and two left sides). Each patient underwent an examination involving a clinical check-up, imaging methods (CT, MR, angio-CT) and standard laboratory tests. RESULTS Iliopectineal bursitis clinically manifested as a tender mass in the groin and hip region in five patients; in one it was pulsating. The sixth case was asymptomatic. In three patients iliopectineal bursitis was found in association with steroid therapy and subsequent avascular necrosis of the femoral head and chronic synovitis. It followed tularemia with hip joint involvement in one patient, salmonella arthritis in one, and kidney transplant rejection in one. Also, iliopectineal bursitis was diagnosed in a patient with rheumatoid arthritis treated with steroids, but without femoral head avascular necrosis, and was incidentally found in another patient examined for digestive problems. Of the six cases of swollen bursa detected by the imaging methods used, five were found to communicate with the hip joint cavity, with four being so large that the bursa extended into the retroperitoneum. Two patients underwent excision or resection of the bursa; in addition, one of them had revitalizing graft surgery for femoral head necrosis. The patient with salmonella arthritis had to undergo a Girdlestone procedure. One patient was treated by draining of the bursa and, after inflammation resolved, total hip replacement surgery was carried out during which the iliopectineal bursa was removed. The patient with rheumatoid arthritis was treated by bursa draining and refused further surgical therapy (total hip replacement). DISCUSSION In our group of six patients, bursitis was symptomatic in five and was associated with chronic hip synovitis accompanying femoral head necrosis following steroid therapy or inflamation, either non-specific or arthitic. Bursitis was asymptomatic in one patient and was diagnosed only incidentally on CT examination done for another reason. The communication between the bursa and the hip joint cavity, found on CT scans and magnetic resonance images, was a radiographic factor important for differential diagnosis. The underlying disease of the hip joint plays a key role in the etiopathogenesis of iliopectineal bursitis. Therefore, surgical treatment should be comprehensible and, in addition to bursa resection or excision, should also include treatment of the affected joint (alloplasty, femoral head resection or revitalization). CONCLUSION Iliopectineal bursitis is associated with chronic hip synovitis present in degenerative, infectious or rheumatic joint diseases. When a lump is diagnosed in the inguinal or hip region, iliopectineal bursitis should always be considered in addition to conditions such as abscess, cyst, hernia, pseudoaneurysm, lymphocele, etc. The finding of communication beteen the bursa and hip joint cavity, made on CT scans or magnetic resonance images, is a radiographic factor important in terms of differential diagnosis. The surgical treatment of iliopectineal bursitis includes excision or resection of the bursa and therapy for the hip joint (alloplasty, femoral head resection or revitalization).
Sulcus nervi dorsalis penis/clitoridis je žlábek na ramus inferior ossis pubis a ventrální ploše corpus ossis pubis, ve kterém probíhá u muže nervus dorsalis penis a u ženy nervus et arteria dorsalis clitoridis. Těsný vztah nervus dorsalis penis/clitoridis a os pubis, představovaný průběhem sulcus nervi dorsalis penis/clitoridis má značný význam v chirurgických oborech. Jemná a šetrná preparace nervus dorsalis penis je klíčová pro správné provedení chirurgické konverze genitálií u pacientů s transsexualismem, při rekonstrukci zadní uretry, hypospádii, při provádění penilní blokády během cirkumcize a revaskularizační chirurgii erektilní dysfunkce. Je diskutována role sulcus nervi dorsalis penis při vzniku Alcockova syndromu. Obdobně je třeba v místě sulcus nervi dorsalis clitoridis šetřit nervus dorsalis clitoridis při redukční klitoridoplastice u dívek s adrenogenitálním syndromem a při zavádění transobturátorové vaginální pásky. Poškození nervus dorsalis penis/clitoridis vede k hypestezii až anestezii glans penis/glans clitoridis. Poškození arteria dorsalis clitoridis způsobuje hematom. Sulcus nervi dorsalis penis/clitoridis je možno rovněž využít při určování pohlaví izolované os pubis z forenzních nebo antropologických důvodů. Laterální okraj sulcus nervi dorsalis penis přesně odpovídá „vertikální hraně“ a laterální okraj sulcus nervi dorsalis clitoridis „ventrálnímu oblouku“ – dvěma parametrům, které jsou součástí tzv. Pheniceho metody určování pohlaví izolované os pubis.
Sulcus nervi dorsalis penis/clitoridis is a groove on inferior ramus of pubis and ventral surface of the body of pubis, where dorsal nerve of penis in male and dorsal nerve and artery of clitoris in female run. Close relation of the dorsal nerve of penis/clitoris and pubis, represented by the course of sulcus nervi dorsalis penis/clitoridis has a major impact in surgical disciplines. Exact preparation of the dorsal nerve of penis is crucial in correct performance of conversion of genitalia in patients with transsexualism, in reconstruction of posterior urethra, in hypospadia, during performance of penile blockade during circumcision and in revascularization surgery of erectile dysfunction. The role of sulcus nervi dorsalis penis in the Alcock’s syndrome is discussed. Similarly, it is advisable to take care of the dorsal nerve of clitoris inside sulcus nervi dorsalis clitoridis during reduction clitoridoplasty in patients with adrenogenital syndrome and during the insertion of transobturator vaginal tape. Injury of dorsal nerve of penis/clitoridis leads to hypestesia or anestesia of glans penis/clitoridis. The injury of dorsal artery of clitoris leads to hematoma. It is possible to use sulcus nervi dorsalis penis/clitoridis in sexing of isolated pubis from antropological or forensic purposes. Lateral border of sulcus nervi dorsalis penis/clitoridis corresponds to vertical ridge and lateral border of sulcus nervi dorsalis clitoridis to ventral arc – two parameters, which are part of the Phenice’s method for sexing of isolated pubis.
- MeSH
- Gynecologic Surgical Procedures MeSH
- Clitoris anatomy & histology innervation MeSH
- Humans MeSH
- Pubic Bone anatomy & histology physiology MeSH
- Penis anatomy & histology innervation MeSH
- Sex Characteristics MeSH
- Review Literature as Topic MeSH
- Urologic Surgical Procedures, Male MeSH
- Urologic Surgical Procedures MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
