Pregnancy-related pubic symphysis pain is relatively common and can significantly interfere with daily activities. Physiotherapist-prescribed pelvic support belts are a treatment option, but little evidence exists to support their use. This pilot compared two pelvic belts to determine effectiveness (symptomatic relief), tolerance (comfort) and adherence (frequency, duration of use).

The surface anatomy of the saphenofemoral junction (SFJ) is especially relevant to surgeons. It is variably described in contemporary anatomy and clinical texts but is usually stated to lie 2.5–4 cm below and lateral to the pubic tubercle. The aim of this study was to map the SFJ accurately in healthy adults using ultrasound. One hundred healthy adults (mean age 27 years; 64 men) were scanned by an experienced sonographer using a 13–5 MHz linear probe. The center of the SFJ was recorded bilaterally in relation to the most superficial point of the pubic tubercle. The SFJ was readily identified in all participants. Its center was a mean of 2.4 ± 0.6 cm lateral (range 1–4.5 cm) and 1 ± 0.9 cm inferior to the pubic tubercle (range 2.5 above to 4 cm caudal to it). The junction was inferior to the pubic tubercle in 90% of lower limbs and at or above that level in 10%. In men, the SFJ was a mean of 2.6 cm lateral to the pubic tubercle and 1.2 cm inferior to it, compared with 2.2 and 0.6 cm, respectively, in women (P < 0.001). The SFJ was also slightly nearer the pubic tubercle in younger and thinner participants (P < 0.01). The center of the SFJ lies in a square extending 1–4 cm lateral and up to 3 cm below the pubic tubercle in >90% of adults. The junction is slightly closer to the pubic tubercle in women. These results provide a more robust guide to the surface anatomy of the normal SFJ. Clin. Anat. 27:915–919, 2014. © 2014 Wiley Periodicals, Inc.

The coccygeal plexus is variably described in anatomy texts and has rarely been studied despite the idiopathic nature of coccydynia in up to one-third of affected patients. The plexus was therefore investigated using a combination of microdissection and histology. The distal sacrum and coccyx in continuity with ischiococcygeus were removed en bloc from 16 embalmed cadavers (mean age 78 ± 10 years, 7 females) with no local disease. Ten specimens underwent microdissection of the coccygeal plexus and the remaining six were examined histologically after staining with hematoxylin and eosin and S100 immunohistochemistry to demonstrate nerve fibers. The coccygeal plexus is formed within ischiococcygeus from the ventral rami of S4, S5, and Co1 with a contribution (gray rami communicantes) from the sacral sympathetic trunk. It gives rise to anococcygeal nerves which pierce ischiococcygeus and the sacrospinous ligament to supply the subcutaneous tissue on the dorsal aspect of the coccyx. Some branches from the plexus pass medially anterior to the coccyx. The coccycgeal plexus is formed within ischiococcygeus rather than on its pelvic surface and appears to supply skin in the anococcygeal region. It probably also contributes to the innervation of ischiococcygeus, the sacrospinous ligament, coccygeal ligaments, and periosteum. It deserves to be considered as a potential pain generator that may be implicated in some patients with coccydynia.

BACKGROUND:Immunosenescence may contribute to an observed increase in infections and specific cancers in the elderly. Lymph nodes play a key role in the body's immune system. A systematic review was undertaken to investigate the effects of senescence on lymph node number and morphology. METHODS:Electronic databases Ovid MEDLINE, Embase and Google Scholar were searched for relevant articles examining normal lymph node number and morphology with senescence. Data on lymph node number, gross anatomy and histo-architecture were collated and analysed. RESULTS:A total of 20 articles (15 human and 5 animal studies) were eligible for inclusion; many were limited by poorly standardized methods and relatively small sample sizes. However, there is evidence to suggest both a decrease in lymph node number and histological lymph node degeneration with senescence, at least in some lymph node basins. Degenerative changes include loss of lymphoid tissue from both the cortex and the medulla of lymph nodes, a reduction in the number and size of germinal centres, and changes such as hyalinization, fibrosis, fat deposition, a decrease in high endothelial venules and 'transparency'. CONCLUSION:In this first systematic review to examine changes in lymph nodes with senescence, evidence was accrued to suggest a decline in lymph node number and morphological degeneration in older age groups. These changes might adversely affect immune function and the prognosis of infections and selected cancers in the elderly. Further research is required to confirm these morphological changes and to explore their potential immunological and functional effects.

Descriptions of clinically important surface landmarks often vary between and within contemporary anatomical texts. The aim of this study was to investigate the surface anatomy of major abdominal vessels, kidneys, spleen, gastroesophageal junction, and duodenojejunal flexure in living adults using computed tomography (CT). After excluding patients with distorting space‐occupying lesions, scoliosis, abnormal lordosis, and obvious visceromegaly, 108 abdominal CT scans of supine adults (mean age 60 years, range 18–97 years; 64 female) at end tidal inspiration were available for analysis by dual consensus reporting. Intra‐observer agreement was assessed by repeat blind assessment of a random sample of scans. The vertebral level of the aortic bifurcation and almost all of its major branches, and the origin of the inferior vena cava were consistent with current descriptions. Important differences from contemporary descriptions of surface anatomy were as follows: the renal arteries were most commonly at the L1 vertebral level (left 55%, right 43%); the midpoint of the renal hila was most frequently at L2 (left 68%, right 40%); the 11th rib was a posterior relation of the left kidney in only 28% of scans; and the spleen was most frequently located between the 10th and 12th ribs (48%) with its long axis in line with the 11th rib (55%). Although the majority of vascular surface landmarks are consistent with standard descriptions, the surface anatomy of the kidneys, renal arteries, and spleen needs to be revised in accordance with observations using modern imaging techniques in vivo. Clin. Anat. 25:844–850, 2012.© 2012 Wiley Periodicals, Inc.

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Presented in a question-and-answer format, Anatomy Vivas for the Intercollegiate MRCS will help candidates prepare for the anatomy section of the new Intercollegiate MRCS exam and will aid their learning in the format in which they will be tested. The book is unique in that it is based on the new examination. It is divided into the specialty areas and is based on clinical scenarios. Featuring photographs of dissections, detailed diagrams and radiographic images, the book is the most concise and accurate anatomy aid for the MRCS examination. Written by recent candidates, experienced surgical anatomists and authors of other successful MRCS guides, it features explanations presented in a memorable, logical and easy to learn manner, and highlights areas that regularly feature in the exam. Past questions, core topics and recurring themes are discussed in detail, ensuring that candidates are as prepared as possible. It is an indispensable guide to success.

Accurate surface anatomy is essential for safe clinical practice. Numerous inconsistencies in clinically important surface markings exist between and within anatomical reference texts. The aim of this study was to investigate key thoracic surface anatomical landmarks in vivo using computed tomographic (CT) imaging. High‐resolution thoracic CT scans from 153 supine adults (mean age 63, range 19–89 years; 53% female) taken at end tidal inspiration were analyzed by dual consensus reporting to determine the surface anatomy of the sternal angle, central veins, heart, lungs, and diaphragm. Patients with kyphosis/scoliosis, distorting space‐occupying lesions, or visceromegaly were excluded. The position of the cardiac apex, formation of the brachiocephalic veins, and vertebral levels of the sternal angle, xiphisternal joint, and aortic hiatus were consistent with commonly accepted surface markings although there was a wide range of normal variation. In contrast, common surface markings were markedly inaccurate for the following: the position of the tracheal bifurcation, aortic arch, and azygos vein termination (below the plane of the sternal angle at T5‐T6 vertebral level in most individuals); the superior vena cava/right atrial junction (most often behind the fourth costal cartilage); the lower border of the lung (adjacent to T12 vertebra posteriorly); and the level at which the inferior vena cava and esophagus traverse the diaphragm (T11 in most). Surface anatomy must be reappraised using modern imaging in vivo if it is to be evidence based and fit for purpose. The effects of gender, age, posture, respiration, build, and ethnicity also deserve greater emphasis. Clin. Anat. 25:827–834, 2012. © 2012 Wiley Periodicals, Inc.

Anatomical planes used in clinical practice and teaching anatomy are largely derived from cadaver studies. Numerous inconsistencies in clinically important surface markings exist between and within anatomical reference texts. The aim of this study was to reassess the accuracy of common anatomical planes in vivo using computed tomographic (CT) imaging. CT scans of the trunk in supine adults at end tidal inspiration were analyzed by dual consensus reporting to determine the anatomy of five anatomical planes: sternal angle, transpyloric, subcostal, supracristal, and the plane of the pubic crest. Patients with kyphosis, scoliosis, or abnormal lordosis, distorting space‐occupying lesions, or visceromegaly were excluded. Among 153 thoracic CT scans (mean age 63 years, 53% female), the sternal angle was most common at T4 (females) or T4/5 (males) vertebral level, and the tracheal bifurcation, aortic arch, and pulmonary trunk were most often below this plane. In 108 abdominal CT scans (mean age 60 years, 59% female), the subcostal and supracristal planes were most often at L2 (58%) and L4 (69%), respectively. In 52 thoracoabdominal CT scans (mean age 61 years, 56% female), the transpyloric plane was between lower L1 and upper L2 (75%); in this plane were the superior mesenteric artery (56%), formation of the portal vein (53%), tip of the ninth rib (60%), and the left renal hilum (54%), but the right renal hilum and gallbladder fundus were more often below. The surface anatomy of anatomical planes needs revising in the light of results from living subjects using modern imaging techniques. Clin. Anat. 25:819–826, 2012. © 2012 Wiley Periodicals, Inc

Objectives: The differentiation of potential pain generating structures in the sacro-iliac region remains a diagnostic challenge. The aim of this proof of concept study was to evaluate the feasibility of using Doppler ultrasound to image the vascular components of dorsal sacral rami and their associated medial and lateral branches. Using the vascular signature of the dorsal sacral arteries to identify the dorsal sacral rami could assist with the diagnosis and treatment of localisable, extra-articular, posterior sacro-iliac joint pain.Methods: The posterior sacral region was scanned in 30 healthy adults using an Acuson X300 ultrasound machine with 7.5 MHz high-resolution linear transducer in spectral Doppler mode to assess the feasibility of identifying and measuring the Resistive Index (RI) of the dorsal sacral arteries.Results: The vascular signature of the dorsal sacral rami and associated branches was identified in 62% of participants; S2 70%, S1 57% and S3 59%. More than two vascular signatures were recorded in 23 (76.7%) cases; in only two (6.67%) were no vascular signatures detected. Mean RI was 0.82 +/- 0.11, increasing significantly (P < 0.05) at each caudal sacral level. No statistically significant difference in RI was observed between rami arteries and their branches or between genders.Conclusions: Doppler ultrasound may be useful in identifying the individual dorsal sacral rami (S1-3) and their associated branches. This may assist with selective imaging of the dorsal sacral rami and their branches in the diagnosis and treatment of chronic localisable pain in the posterior sacro-iliac region and facilitate investigation of the hypothesis of entrapment neuropathy in this region. (C) 2011 Elsevier Ltd. All rights reserved.

ANZ Journal of SurgeryVolume 81, Issue 11 p. 842-842 Google's body browser: a useful addition to electronic anatomy resources? Richard G. McGee PGDipSurgAnat, MM(ClinEpi), Richard G. McGee PGDipSurgAnat, MM(ClinEpi) Sydney School of Public Health, University of Sydney Centre for Kidney Research and Cochrane Renal Group, The Children's Hospital at Westmead, Westmead, New South Wales, AustraliaSearch for more papers by this authorMark D. Stringer MS, FRCS, Mark D. Stringer MS, FRCS Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New ZealandSearch for more papers by this author Richard G. McGee PGDipSurgAnat, MM(ClinEpi), Richard G. McGee PGDipSurgAnat, MM(ClinEpi) Sydney School of Public Health, University of Sydney Centre for Kidney Research and Cochrane Renal Group, The Children's Hospital at Westmead, Westmead, New South Wales, AustraliaSearch for more papers by this authorMark D. Stringer MS, FRCS, Mark D. Stringer MS, FRCS Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New ZealandSearch for more papers by this author First published: 24 October 2011 https://doi.org/10.1111/j.1445-2197.2011.05866.x Support: Richard McGee is a recipient of a postgraduate research scholarship from the National Health and Medical Research Council, Australia. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Reference 1 Choi A-RA, Tamblyn R, Stringer MD. Electronic resources for surgical anatomy. ANZ J. Surg. 2008; 78: 1082–91. Volume81, Issue11November 2011Pages 842-842 ReferencesRelatedInformation

BACKGROUND:Inadvertent injury of the spinal accessory nerve during surgical procedures is a cause of significant morbidity with medicolegal repercussions. Surface anatomy is an unreliable guide to the nerve's location. We suggest that ultrasound can be used to map the course of the nerve in the posterior triangle of the neck. MATERIALS AND METHODS:Fifty healthy subjects (28 females, mean age 37 y) were scanned using a VF13-5 linear probe and a Siemens Sonoline Antares ultrasound machine (Siemens Medical Solutions USA Inc., Malvern, PA). The caliber, course, and distribution of the nerve in the posterior triangle of the neck were recorded. RESULTS:The nerve was visualized bilaterally in all subjects, running superficially across the posterior triangle with either a straight (56%) or tortuous (44%) course at a depth of about 3 mm beneath the skin surface. It had a mean caliber of 0.76 ± 0.12 mm. It exited the posterior border of sternocleidomastoid at a mean of 6.7 (4.0-9.4) cm below the mastoid process and 1.1 (0.1-2.1) cm above the great auricular point and penetrated the anterior border of trapezius 5.4 (2.1-9.2) cm above the clavicle. Importantly, 58% of nerves divided into 2-4 branches before penetrating trapezius; the nerve branched on at least one side in 49 of 50 individuals. CONCLUSIONS:The spinal accessory nerve and its anatomical variants can be consistently and reliably demonstrated by ultrasound in normal individuals. Surface anatomical landmarks are not a reliable guide to the position and course of the nerve in the posterior triangle. Preoperative mapping of the nerve with ultrasound may reduce the risk of iatrogenic injury.

Identification of the second dorsal sacral foramen (S2F) by sonographic imaging is a possible first step in localising the branches of the dorsal sacral rami. The aim of this investigation is to develop an imaging approach to assist the rapid identification of S2F using a well-known regional landmark, the posterior superior iliac spine (PSIS).

Clinical AnatomyVolume 25, Issue 2 p. 260-262 Letter to the Editor The orientation of the tympanic membrane Lauren J. McManus, Lauren J. McManus Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New ZealandSearch for more papers by this authorPatrick J. D. Dawes, Patrick J. D. Dawes Otorhinolaryngology and Head and Neck Surgery, Department Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New ZealandSearch for more papers by this authorMark D. Stringer, Corresponding Author Mark D. Stringer [email protected] Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New ZealandUniversity of Otago, Department of Anatomy & Structural Biology, PO Box 913, Dunedin 9054, New ZealandSearch for more papers by this author Lauren J. McManus, Lauren J. McManus Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New ZealandSearch for more papers by this authorPatrick J. D. Dawes, Patrick J. D. Dawes Otorhinolaryngology and Head and Neck Surgery, Department Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New ZealandSearch for more papers by this authorMark D. Stringer, Corresponding Author Mark D. Stringer [email protected] Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New ZealandUniversity of Otago, Department of Anatomy & Structural Biology, PO Box 913, Dunedin 9054, New ZealandSearch for more papers by this author First published: 02 December 2011 https://doi.org/10.1002/ca.22014Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume25, Issue2March 2012Pages 260-262 RelatedInformation

The coccyx has been relatively neglected in anatomical research which is surprising given the population prevalence of coccydynia and our inadequate understanding of its etiology. This systematic review analyzes available information on the clinical anatomy of the coccyx. A literature search using five electronic databases and standard anatomy reference texts was conducted yielding 61 primary and 7 secondary English‐language sources. This was supplemented by a manual search of selected historical foreign language articles. The coccygeal vertebrae, associated joints, ligaments and muscles, coccygeal movements, nerves, and blood supply were analyzed in detail. Although the musculoskeletal aspects of the coccyx are reasonably well described, the precise anatomy of the coccygeal plexus and its distribution, the function of the coccygeal body, and the anatomy of the sacrococcygeal zygapophyseal joints are poorly documented. Further research into the anatomy of the coccyx may clarify the etiopathogenesis of coccydynia which remains uncertain in one‐third of affected patients. Clin. Anat. 25:158–167, 2012. © 2011 Wiley‐Liss, Inc.

PURPOSE:Peripheral nerve injuries are among the most frequent iatrogenic complications and are responsible for considerable morbidity and litigation. Most occur within surgical settings and upper limb nerves are most frequently involved. METHODS:A systematic review of major iatrogenic upper limb nerve injuries was undertaken to evaluate the contemporary spectrum of such injuries. The electronic databases MEDLINE, PubMed, Cochrane Library and Google Scholar were searched for relevant articles listed between January 2000 and May 2010. Iatrogenic injuries to the brachial plexus, radial, axillary, ulnar, median, musculocutaneous and major cutaneous nerves were analysed, focusing on context, mechanisms of injury and incidence. RESULTS:Iatrogenic upper limb nerve injuries are relatively common and can affect patients in any surgical specialty. Even patients undergoing diagnostic procedures under general anaesthesia are at risk. Orthopaedic surgery and plastic and reconstructive surgery figure prominently in these complications. The spectrum of iatrogenic peripheral nerve injuries has changed in parallel with technological advances in surgery, anaesthesia and medicine. CONCLUSIONS:Some iatrogenic upper limb peripheral nerve injuries may be unavoidable, but most cases are probably preventable by an adequate knowledge of surgical anatomy and an awareness of the types of procedures in which peripheral nerves are particularly vulnerable.