Complete Pelvis Research Articles

A new pelican (Aves: Pelecanidae) from the Upper Miocene of Argentina: new clues about the origin of the New World lineages

ABSTRACT Pelecanus paranensis sp. nov., a new pelican (Aves, Pelecanidae) from the marine Upper Miocene Paraná Formation, which crops out in the Province of Entre Ríos, Argentina, is described. This record constitutes the first report of a fossil pelican from Argentina and the southernmost from South America. The holotypical specimen consists of a very large and nearly complete pelvis, which is characterized by having the cristae iliacae dorsales continuous throughout its entire length and a large foramen acetabuli. The U-shaped morphology of the postacetabular section of the pelvis of the new species as well as the wide incisura sutura iliosynsacralis, allow to infer its phylogenetic position within the New World pelican species clade, showing a close relationship with the clade (P. occidentalis + P. thagus). A probable trans-Atlantic dispersal route for the ancestor of the New World pelicans is thus inferred. The inland Paranaense Sea, which flooded the South American Chaco-Paraná basin during the mid-Neogene, is proposed as a south-north pathway for ancestral forms of the clade (P. occidentalis + P. thagus). These regressive marine paleoenvironments of the Late Miocene may have acted as the evolutionary driver for the transition of pelican species from brackish or freshwater habitats to those inhabiting strictly marine coastlines.

Three-dimensional finite element analysis with different internal fixation methods through the anterior approach.

BACKGROUNDWith the modernization of society and transportation in the last decades in China, the incidence of high-energy trauma increased sharply in China, including that of acetabular fractures.AIMTo establish different finite element models for acetabular posterior column fractures involving the quadrilateral area of the acetabulum.METHODSThe three-dimensional models of the normal and fractured pelvis and the five internal fixations were established using the computed tomography data of the pelvis of a living volunteer. After the vertebral body model was inserted in the way of origin matching and all cancellous bones were copied using the duplicated cancellous bone model as the subtractive entity, the Boolean operation was performed on the pelvis model to obtain the model of the complete pelvis cortical and cancellous bones.RESULTSIn the standing position, the maximum stress was 46.21 MPa. In the sitting position, the sacrum bore the simulated gravity load at the upper end. When comparing the five fixations, there were no significant differences in the stress mean values among groups (sitting: P = 0.9794; standing: P = 0.9741). In terms of displacement, the average displacement of the internal iliac plate group was smaller than that of the spring plate group (P = 0.002), and no differences were observed between the other pairs of groups (all P > 0.05). In the standing position, there were no significant differences in the mean value of displacement among the groups (P = 0.2985). It can be seen from the stress nephogram of the internal fixations in different positions that the stress of the internal fixation was mainly concentrated in the fracture segment.CONCLUSIONThere were no significant differences among the fixations for acetabular posterior column fractures involving the quadrilateral area of the acetabulum.

Virtual reconstruction of the Kebara 2 Neanderthal pelvis

The paucity of well-preserved pelvises in the hominin fossil record has hindered robust analyses of shifts in critical biological processes throughout human evolution. The Kebara 2 pelvis remains one of the best preserved hominin pelvises, providing a rare opportunity to assess Neanderthal pelvic morphology and function. Here, we present two new reconstructions of the Kebara 2 pelvis created from CT scans of the right hip bone and sacrum. For both reconstructions, we proceeded as follows. First, we virtually reconstructed the right hip bone and the sacrum by repositioning the fragments of the hip bone and sacrum. Then, we created a mirrored copy of the right hip bone to act as the left hip bone. Next, we 3D printed the three bones and physically articulated them. Finally, we used fiducial points collected from the physically articulated models to articulate the hip bones and sacrum in virtual space. Our objectives were to (1) reposition misaligned fragments, particularly the ischiopubic ramus; (2) create a 3D model of a complete pelvis; and (3) assess interobserver reconstruction variation. These new reconstructions show that, in comparison with previous measurements, Kebara 2 possessed a higher shape index (maximum anteroposterior length/maximum mediolateral width) for the pelvic inlet and perhaps the outlet and a more anteriorly positioned sacral promontory and pubic symphysis relative to the acetabula. The latter differences result in a lower ratio between the distances anterior and posterior to the anterior margins of the acetabula. Generally, the new reconstructions tend to accentuate features of the Kebara 2 pelvis––the long superior pubic ramus and anteriorly positioned pelvic inlet––that have already been discussed for Kebara 2 and other Neanderthals.

Diagnostic Accuracy of Short Tau Inversion Recovery as a Limited Protocol for Diagnosing Perianal Fistula.

IntroductionPerianal fistula refers to abnormal communication between perianal skin and anal canal. Magnetic resonance imaging (MRI) and endoanal ultrasound have been used in the evaluation of perianal fistula. Endoanal ultrasound is a cost-effective but operator-dependent technique. MRI provides accurate details regarding anal canal anatomy and effectively identifies the fistulae. For evidence-based care, a cost-effective and an accurate imaging modality is required in a developing country. Therefore, the aim of this study was to determine the diagnostic accuracy of short tau inversion recovery (STIR) as a limited protocol MRI pelvis in diagnosing perianal fistula taking surgical findings as the gold standard.Materials and methodsA retrospective review of MRI pelvis from 1st February 2018 to 1st July 2018 was undertaken. Patients of any age or gender suspected to have perianal fistula were included. One radiologist interpreted the complete MRI pelvis and the other radiologist only viewed axial and coronal STIR sequences as a limited protocol. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of axial and coronal STIR sequence were calculated taking surgical findings as the gold standard.ResultsIn total, 150 patients were included in this study. The mean age of the patients was 43.20 ± 13.75 years. In total, 122 (81.3%) were males and 28 (18.7%) were females. Using STIR as a limited protocol, fistulae were found in 125 (83.3%) patients, whereas on surgery, the fistulae were found in 119 (79.3%) patients. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy of STIR as limited protocol MRI pelvis in diagnosing perianal fistulae was found to be 96.6%, 67.7%, 92.0%, 84.0%, and 90.6%, respectively, taking surgical findings as the gold standard.ConclusionSTIR has high sensitivity and diagnostic accuracy in diagnosing in the perianal fistula. Using STIR as a limited protocol in a developing country can help improving patient care by accurately diagnosing perianal fistulae. Moreover, it is recommended that further studies for identifying internal opening on STIR should also be carried out to improve patient care.

Finite element modeling and static/dynamic validation of thoracolumbar-pelvic segment

Finite element method is an efficient tool to investigate the biomechanics of human spine. The key to finite element method is to reconstruct a complete and accurate finite element model. In this study, a three-dimensional finite element model of thoracolumbar structure including complete pelvis (T12-pelvis) was built using computed tomography technology. The modeling process has been explained in detailed. During the process of validation, the model was assigned with non-linear material property for static or dynamic analyses. In static analysis, the vertebral geometry parameters of T12-L5, the axial displacement, the posterior disc bulge and the intradiscal pressure of intervertebral disc, range of motion under six loading cases and facet joint forces were obtained and compared with the experimental data. In dynamic analysis, motion segments were loaded with sinusoidal displacement at 1 Hz in the anterior–posterior and axial directions to verify the reaction force. The first-order resonant frequencies in the vertical direction from one motion segment and two motion segments to the entire model were obtained. The study provides a detailed and accurate method of validation to verify the finite element model of thoracolumbar spine.

Easternmost occurrences of Neocnus (Mammalia, Pilosa, Megalonychidae) from the late Pleistocene–early Holocene of the Dominican Republic (Hispaniola)

ABSTRACTFossil sloths from Hispaniola are predominantly represented by records from Haiti. Recent exploration of underwater caves in the Dominican Republic has produced many new sloth specimens, including specimens from two sites that represent the easternmost record for the genus Neocnus. Upper Pleistocene specimens from the localities of Padre Nuestro and Oleg’s Bat House are considered to be N. cf. dousman, based on size and comparison with other Neocnus specimens; they differ strongly from those of Acratocnus and Parocnus. Padre Nuestro produced a right radius and a right femur. The Oleg’s Bat House specimen is a partial skeleton comprising four vertebrae, first ribs with fused sternebrae, a complete pelvis, a scaphoid, and a phalanx. The Oleg’s Bat House specimen also demonstrates a developmental pathology, with the preservation of a cervical rib in association with a vertebra that morphologically is more akin to a thoracic than a cervical vertebra. The pelvis exhibits a number of morphological characteristics that distinguish it from the other island sloths: flattening of the sacral crests and the shape and orientation of the iliac blades. The distal radius and scaphoid morphology indicate a greater range of wrist motion in Neocnus versus that of Parocnus and likely made this sloth more arboreally capable than the more terrestrial Parocnus.

Statistical shape modelling versus linear scaling: Effects on predictions of hip joint centre location and muscle moment arms in people with hip osteoarthritis

Marker-based dynamic functional or regression methods are used to compute joint centre locations that can be used to improve linear scaling of the pelvis in musculoskeletal models, although large errors have been reported using these methods. This study aimed to investigate if statistical shape models could improve prediction of the hip joint centre (HJC) location. The inclusion of complete pelvis imaging data from computed tomography (CT) was also explored to determine if free-form deformation techniques could further improve HJC estimates. Mean Euclidean distance errors were calculated between HJC from CT and estimates from shape modelling methods, and functional- and regression-based linear scaling approaches. The HJC of a generic musculoskeletal model was also perturbed to compute the root-mean squared error (RMSE) of the hip muscle moment arms between the reference HJC obtained from CT and the different scaling methods. Shape modelling without medical imaging data significantly reduced HJC location error estimates (11.4 ± 3.3 mm) compared to functional (36.9 ± 17.5 mm, p = <0.001) and regression (31.2 ± 15 mm, p = <0.001) methods. The addition of complete pelvis imaging data to the shape modelling workflow further reduced HJC error estimates compared to no imaging (6.6 ± 3.1 mm, p = 0.002). Average RMSE were greatest for the hip flexor and extensor muscle groups using the functional (16.71 mm and 8.87 mm respectively) and regression methods (16.15 mm and 9.97 mm respectively). The effects on moment-arms were less substantial for the shape modelling methods, ranging from 0.05 to 3.2 mm. Shape modelling methods improved HJC location and muscle moment-arm estimates compared to linear scaling of musculoskeletal models in patients with hip osteoarthritis.

Anthropometric analysis of mandible: an important step for sex determination.

The first step in the forensic identification is sex determination followed by age and stature estimation, as both are sex-dependent. The mandible is the largest, strongest and most durable bone in the face. Mandible is important for sex confirmation in absence of a complete pelvis and skull. The aim of the present study was to determine sex of human mandible from morphology, morphometric measurements as well as discriminant function analysis from the CT scan. The present retrospective study comprised 79 subjects (48 males, 31 females), with age group between 18 and 74 years, and were obtained from the post mortem computed tomography data in the Hospital Kuala Lumpur. The parameters were divided into three morphologic and nine morphometric parameters, which were measured by using Osirix MD Software 3D Volume Rendering. The Chi-square test showed that men were significantly association with square-shaped chin (92%), prominent muscle marking (85%) and everted gonial glare, whereas women had pointed chin (84%), less prominent muscle marking (90%) and inverted gonial glare (80%). All parameter measurements showed significantly greater values in males than in females by independent t-test (p< 0.01). By discriminant analysis, the classification accuracy was 78.5%, the sensitivity was 79.2% and the specificity was 77.4%. The discriminant function equation was formulated based on bigonial breath and condylar height, which were the best predictors. In conclusion, the mandible could be distinguished according to the sex. The results of the study can be used for identification of damaged and/or unknown mandible in the Malaysian population.

Overall Treatment Time Assessment of Locally Advanced Cervix Cancer

BACKGROUND: Overall treatment time is an important factor in the outcome of cervix cancer treatment. However, in daily clinical practice, unplanned treatment interruptions are inevitable for many reasons. We performed a prospective study to assess the overall treatment time for patients treated in our department and identify the causes of treatment prolongation. Material and methods: Between first January and 30 April 2016, a group of patients with locally advanced cervix cancer were interviewed at the end of treatment. Data was collected using a questionnaire containing important study parameters. Results: 100 patients were interviewed. The mean age of women was 55,08 ± 12,43 years. Seventy-five patients (75%) were illiterate. Ninety-six patients (96%) has a low socio-economic level. Ninety patients (90%) has squamous cell carcinoma. The stage IIIB represented the majority of cases (90%). All patients were treated with concurrent chemoradiation except one patient. Pelvic radiation at the dose of 46 Gy was performed for all patients. The median time to complete pelvis RT was 37 days (34-42 days). Only seventy-seven patients (77%) were treated by BT. A median time of the first brachytherapy insertion was 13,50 days (0-20 days). The median of OTT was 71 days (64-78 days). This prolongation was mainly due to the delay of the first brachytherapy insertion. In the univariate and multivariate analysis, two factors were associated with longer overall treatment time: age (p=0,006) and stage (p=0,001). Conclusion: In our country, cervical cancer outcomes are still poor. To improve the prognosis, overall treatment time should be given in timely manner (8weeks).

Biomechanical characteristics of four fixation methods in treatment of pubic symphysis disruption: a finite element analysis

Objective To evaluate the biomechanical characteristics of 4 fixation methods (single reconstruction plate, dual reconstruction plates, single cannulated screw and dual cannulated screws) in the treatment of pubic symphysis disruption. Methods Miniature spiral CT scans were performed on the complete pelvis in 5 healthy volunteers. The primary two-dimensional CT scan data at DICOM format were imported into software Mimics 15.0 for three-dimensional reconstruction of bilateral hips and sacrums. The finite element model of skeletal pelvis was obtained by grid partitioning and assignment using software Abqus 6.13. Models of pubic symphysis disruption were simulated by cutting off the unilateral sacroiliac ligament, sacral spine ligament, sacral tuberosity ligament, pubic ligament and pubic arch. Four implants(single reconstruction plate, dual reconstruction plates, single cannulated screw and dual cannulated screws) were simulated and emplaced onto the models according to standard surgical procedures. Compressive and rotational loads were implemented in all models for finite element analysis. The biomechanical properties were recorded and analyzed, including construct stiffness, micromotion of the pubic symphysis and von Misses stress. Results Under vertical load, the space of pubic symphysis disruption >25 mm. The vertical stiffness and rotational construct stiffness of the pelvis decreased significantly from 442.738±29.946 N/mm and 10.118±1.432 N·m/Deg in the normal group to 14.754±0.876 N/mm and 0.328±0.119 N·m/Deg, respectively. Dual reconstruction plates and dual cannulated screws displayed the best vertical tensile strength; their construct stiffness achieved 117.647±9.193 N/mm and 131.443±4.348 N/mm, respectively. Under anti-rotation load, dual cannulated screws displayed the best performance because they rebuilt 68.6% of the whole structural stiffness. For the local stability of the pubic symphysis, dual reconstruction plates showed a strong local anti-rotation capability and dual cannulated screws a good local anti-tensile capability. The displacement in the dual cannulated screws group was only -0.240±0.119 mm under vertical load while the angular displacement in the dual reconstruction plates group only 0.218°±0.182°. Single reconstruction plate endured the maximum von Misses stress which was obviously concentrated. Conclusion Dual cannulated screws may have biome-chanical advantages for treatment of pubic symphysis disruption. Key words: Pelvis; Finite element analysis; Biomechanical characteristics; Fractures fixation, internal; Comparative study

Remembering the Alamosaurus: Jensen Relocates Gilmore's Alamosaurus Quarry, USNM 15560, North Horn Formation, Emery County, Utah, and Discovers a Second Individual Alamosaurus

Alamosaurus sanjuanensis was originally described from a left scapula (USNM 10846) and right ischium (USNM 10847) discovered in the Late Cretaceous Ojo Alamo Formation of New Mexico in 1921 (USNM quarry 15560). In 1937 a second specimen was found in the North Horn Formation of Utah, consisting of a partial skeleton (USNM 15560), comprised of a mostly complete pelvis and caudal vertebral series, from the Late Cretaceous. A sacral complex with five vertebrae was observed in the field but was not collected. In 1966 James “Jim” Jensen of the Brigham Young University Earth Science Museum relocated the Gilmore quarry and found the sacrum, which, by then, had “rotted down into brown soil” and could not be recovered. Nearby, Jensen discovered the proximal heads of a humerus and femur and an isolated proximal caudal vertebra, none of which belonged to USNM 15560. Mike Morales and a team from the University of California at Berkeley discovered additional caudal vertebrae in the vicinity also, none of which belonged to the specimen collected by Gilmore. The specimens recovered by Jensen and Morales are significant because they indicate the presence of additional Alamosaurus specimens in the North Horn Formation. Additionally, the humerus is the most complete Alamosaurus humeral head yet discovered.

Impact of Treatment Duration on Cervical Cancer Outcomes: Results from a Single Institution

Introduction: Treatment duration has always been related to treatment outcomes in cervical cancer. Our study is aiming to evaluate this parameter and its effect on treatments’ results in patients with locally advanced cervical cancer treated with concurrent chemo radiation. Patients and methods: Between January 2011 and December 2011, all patients diagnosed with cervical cancer and treated with concurrent chemo radiotherapy were retrieved. Treatment duration was calculated from the first day of EBRT to the last day of brachytherapy or EBRT, whichever was last to complete, Fifty-six days (8 weeks) was used as a limit, we analyzed the impact of treatment duration on the overall survival and local control. Results: The median time to complete pelvis RT was 37 days (34-42 days). A median of 15 days (13-26 days) between the last day of Pelvic RT and the start of the first Brachytherapy fraction (Pelvis RT-BT interval) was noted. The median time to complete EBRT in association with BT was55 days (50-69 days) while the median total treatment duration was 61 days (53-71 days). At 3 years the overall survival (OS) rate of the studied cohort was 89.8% and local control (LC) rate was 80.8%. In the univariate analysis, total treatment duration (>56 days) was found to be a significant factor impacting both OS (P=0.014)), and LC (P=0.014). Also in the multivariate analysis, total treatment duration was associated independently with prognosis, and affected both OS (hazard ratio [HR], 2.8; 95% CI, 1.07-7.54, P=0.035) and LC (hazard ratio [HR] 3.2; 95% CI, 1.57-6.64, P=0.001). Conclusion: Extended treatment duration significantly affects treatment outcomes in cervical cancer, efforts should be made to shorten it in a way to improve cancer prognosis.

Sexual Dimorphism in Adult Human Mandible of North Indian Origin

Background: In forensic science the identification of a human is based on three important factors: Age, Sex and Stature. Bones are an important tool for it and among human bones the pelvis and the skull are the most reliable source for sex determination. In the absence of complete pelvis, mandi-ble becomes the important source for sex determination since mandible is the most durable and movable part of skull that can resist postmortem changes. The present study is conducted to assess the accuracy and role of few metric and morphological parameters in determination of the sex of dry adult human mandible of North Indian origin. Material & Methods: The Study is conducted on 50 dry intact human adult mandibles of North Indian origin. The metric parameters i.e. bigonial breadth, bicondylar breadth are measured with a Vernier Calliper by two observers. Non-metric parameters being observed are the morphological features like gonion flaring, muscular markings and shape of angle of symphysis menti. Result & Conclusion: It is concluded that bigonial breadth and bicondylar breadth exhibit the sexual dimorphism. Morphological Parameters: Gonion flaring, muscular markings and shape of angle of symphysis menti also demonstrate the sexual dimorphism. These parameters taken together may determine the sex of adult human mandibles. The present study shows that the mandible is an important tool in the determination of gender with high accuracy.

A complete-pelvis segmentation framework for image-free total hip arthroplasty (THA): methodology and clinical study.

Complete-pelvis segmentation in antero-posterior pelvic radiographs is required to create a patient-specific three-dimensional pelvis model for surgical planning and postoperative assessment in image-free navigation of total hip arthroplasty. A fast and robust framework for accurately segmenting the complete pelvis is presented, consisting of two consecutive modules. In the first module, a three-stage method was developed to delineate the left hemi-pelvis based on statistical appearance and shape models. To handle complex pelvic structures, anatomy-specific information processing techniques were employed. As the input to the second module, the delineated left hemi-pelvis was then reflected about an estimated symmetry line of the radiograph to initialize the right hemi-pelvis segmentation. The right hemi-pelvis was segmented by the same three-stage method, Two experiments conducted on respectively 143 and 40 AP radiographs demonstrated a mean segmentation accuracy of 1.61±0.68 mm. A clinical study to investigate the postoperative assessment of acetabular cup orientations based on the proposed framework revealed an average accuracy of 1.2°±0.9° and 1.6°±1.4° for anteversion and inclination, respectively. Delineation of each radiograph costs less than one minute. Despite further validation needed, the preliminary results implied the underlying clinical applicability of the proposed framework for image-free THA.

Pelvic girdle and fin ofTiktaalik roseae

A major challenge in understanding the origin of terrestrial vertebrates has been knowledge of the pelvis and hind appendage of their closest fish relatives. The pelvic girdle and appendage of tetrapods is dramatically larger and more robust than that of fish and contains a number of structures that provide greater musculoskeletal support for posture and locomotion. The discovery of pelvic material of the finned elpistostegalian, Tiktaalik roseae, bridges some of these differences. Multiple isolated pelves have been recovered, each of which has been prepared in three dimensions. Likewise, a complete pelvis and partial pelvic fin have been recovered in association with the type specimen. The pelves of Tiktaalik are paired and have broad iliac processes, flat and elongate pubes, and acetabulae that form a deep socket rimmed by a robust lip of bone. The pelvis is greatly enlarged relative to other finned tetrapodomorphs. Despite the enlargement and robusticity of the pelvis of Tiktaalik, it retains primitive features such as the lack of both an attachment for the sacral rib and an ischium. The pelvic fin of Tiktaalik (NUFV 108) is represented by fin rays and three endochondral elements: other elements are not preserved. The mosaic of primitive and derived features in Tiktaalik reveals that the enhancement of the pelvic appendage of tetrapods and, indeed, a trend toward hind limb-based propulsion have antecedents in the fins of their closest relatives.

AnIchthyosaurus brevicepscollected by Mary Anning: new information on the species

AbstractAn ichthyosaur in the collections of the Sedgwick Museum, Cambridge (CAMSMX.50187) was collected in the nineteenth century by the renowned fossil collector Mary Anning, but has never been adequately described in the literature. As an Anning specimen, it is certainly from the Lower Jurassic of Lyme Regis, west Dorset. The near complete presacral skeleton is lying on its left side and includes a complete skull, one complete and one partial forefin, pectoral bones, all six elements of the pelvic girdle, and both hindfins. The centra in the anterior caudal region, however, are from another individual and may have replaced the original ones. The specimen is identified asIchthyosaurusbased on the morphology of the humerus and forefin. It is assigned toI. brevicepson the basis of the relatively short snout, large eye, and tall neural spines. This is the only known specimen ofI. brevicepsto preserve a complete pelvis. Notably, the ilium is longer than the pubis and ischium, and the pubis is longer than the ischium. This individual is the largestI. brevicepsreported in the literature, with jaw length of 33.5 cm and estimated length from snout to tail bend of 1.6 m.

A new reconstruction of Sts 14 pelvis ( Australopithecus africanus) from computed tomography and three-dimensional modeling techniques

The purpose of this study is to propose a new reconstruction of the australopithecine Sts 14 pelvis from original fossils. Digital models created from CT images allow us to perform mirroring operations, select valid regions after digital interposition, and reassemble parts. The key-element of the reconstruction is the sacroiliac joint, restored from right and left articular surfaces, which places of the pubic symphysis close to the sagittal plane. The complete pelvis is obtained by 3D model mirroring of hip-bone and sacrum. The present reconstruction of the Sts 14 pelvis is consistent with Schmid's (1983) [Folia Primatol. 40, 283–306, 1983] and Häusler and Schmid's A.L. 288–1 [J. Hum. Evol. 29, 363–383, 1995] pelvic reconstructions by illustrating a relatively platypelloid shape of the pelvic cavity and laterally inclined iliac blades. The pelvic morphology suggests that australopithecines had a less posteriorly tilted sacrum in erect posture than modern humans. As compared with Lovejoy's [Am. J. Phys. Anthropol. Suppl. 50, 460, 1979] A.L. 288-1 pelvic reconstruction, the less transversely flattened shape of the Sts 14 pelvic cavity led to obstetrical mechanics characterized as in humans by ante-ischiatic birth and a curved trajectory. We deduce a human-like movement of rotation and flexion of the fetal skull in the Sts 14 pelvic cavity.

Tubo-ovarian abscess in woman with an intrauterine device forgotten for 22 years

We report on a case of pelvic inflammatory disease in a 53 year old woman using an intrauterine contraceptive device (IUD) for a time period of 22 years. Clinical symptoms were fever up to 38°C and severe abdominal pain. Endoscopic findings were a tubo-ovarian abscess of the complete pelvis and a forgotten IUD with a smear positive for Escherichia coli and Candida albicans. The patient was treated with a surgical therapy and by antibiotic combination. Diagnosis was performed by histopathological examination.

Anatomical approach for surgery of the male posterior urethra

To investigate, in a morphological study, the anatomy of the male rhabdosphincter and the relation between the membranous urethra, the rhabdosphincter and the neurovascular bundles (NVBs) to provide the anatomical basis for surgical approach of the posterior urethra as successful outcomes in urethral reconstructive surgery still remain a challenging issue. In all, 11 complete pelves and four tissue blocks of prostate, rectum, membranous urethra and the rhabdosphincter were studied. Besides anatomical preparations, the posterior urethra and their relationship were studied by means of serial histological sections. In the histological cross-sections, the rhabdosphincter forms an omega-shaped loop around the anterior and lateral aspects of the membranous urethra. Ventrally and laterally, it is separated from the membranous urethra by a delicate sheath of connective tissue. Through a midline approach displacing the nerves and vessels laterally, injuries to the NVBs can be avoided. With meticulous dissection of the delicate ventral connective tissue sheath between the ventral wall of the membranous urethra and the rhabdosphincter, the two structures can be separated without damage to either of them. This anatomical approach can be used for dissection of the anterior urethral wall in urethral surgery. Based on precise anatomical knowledge, the ventral wall of the posterior urethra can be dissected and exposed without injuring the rhabdosphincter and the NVBs. This approach provides the basis for sparing of the rhabdosphincter and for successful outcomes in urethral surgery for the treatment of bulbo-membranous urethral strictures.

Abnormal uterine bleeding: Imaging techniques for evaluation of the uterine cavity and endometrium before minimally invasive surgery—the case for transvaginal ultrasonography

Transvaginal ultrasound has been utilized for first line evaluation of abnormal uterine bleeding since its development in the early 1980's. The benefits and diagnostic effectiveness of transvaginal ultrasound in assessing the uterus, unlike hysteroscopy, extends to the complete pelvis. The ease of application, patient acceptance, and immediacy of results are rapidly apparent. Comparisons with hysteroscopic evaluation are discussed. While tissue diagnosis is still the gold standard, transvaginal sonography lets one know what surgical procedure to plan for from hysteroscopy to Endoscopy or laparotomy, including when no further surgical evaluation is necessary.