Postpartum coccydynia: a case series study of 57 women.
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BACKGROUND: Although childbirth is a well-known cause of coccydynia, this condition has not been studied previously. AIM: To explore the characteristics of postpartum coccydynia and identify risk factors. DESIGN: A case series study. SETTING: A specialist coccydynia clinic in a department of physical medicine in a university hospital. METHODS: A series of 57 women suffering from postpartum coccydynia was analyzed and compared with a control group of 192 women suffering from coccydynia due to other causes. Dynamic radiography enabled a comparison of the coccygeal mobility in the two groups. RESULTS: 7.3% of the cases of coccydynia in female patients seen in our clinic were related to childbirth. The pain appeared as soon as the patient adopted the sitting position after delivery. The deliveries had often been performed with instruments (forceps deliveries: 50.8%; vacuum-assisted deliveries: 7.0%) or were spontaneous but described as "difficult" (12.3%). Luxation of the coccyx was observed in 43.9% of the cases and 17.0% of the controls. Fracture of the coccyx was involved in 5.3% of the cases. A body mass index >27 and >/=2 vaginal deliveries were associated with a higher prevalence of luxation of the coccyx. CONCLUSION: Postpartum coccydynia is often associated with a difficult delivery, with the use of forceps in 50.8% of cases. Luxation and fracture of the coccyx are the two most characteristic lesions. CLINICAL REHABILITATION IMPACT: Our results bring a better knowledge and should allow a better management of this specific etiology of coccydynia. (+info)
CT morphology and morphometry of the normal adult coccyx.
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Manipulation of the coccyx with anesthesia for the management of coccydynia.
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Coccydynia is pain in and around the coccyx, with trauma being the most common etiologic factor. The authors describe the case of a 60-year-old woman who was injured in an automobile accident several months before consultation. After the physician recorded the patient's history, performed a physical examination, and reviewed imaging reports, lumbar radiculopathy and somatic dysfunction of the lumbar and sacral vertebrae were diagnosed as the cause of her coccydynia. During a 6-week period, the patient underwent a series of 3 epidural steroid injections, osteopathic mobilization of the lumbar and sacral spine, and manual manipulation of the coccyx with anesthesia. After each treatment session, the patient reported a substantial improvement in radicular pain as well as a subjective increase in her lower extremity range of motion. (+info)
High complete response rate in children with advanced germ cell tumors using cisplatin-containing combination chemotherapy.
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A consecutive series of 13 children (five girls) with advanced malignant germ cell tumors (MGCTs) were treated with between four and seven (median, six) courses of cisplatin, bleomycin, and either vinblastine (BVP) or VP-16 (BEP). There were seven gonadal primaries (four testis, three ovary) and six at extragonadal sites (three sacrococcyx, two thoracic, one extradural). Total or subtotal removal of primary tumor was carried out in nine patients at diagnosis and two others after some chemotherapy. Clinical complete remission (CR) was achieved in nine of ten patients with measurable disease and serum markers returned to normal in all 13 patients. Eleven remain disease-free 17 to 48 months (median, 28 months) after diagnosis. One patient (stage IV sacrococcygeal tumor) relapsed at the primary site 3 months after completing treatment, but is disease-free after further surgery, radiotherapy, and chemotherapy. Serial glomerular filtration rates were performed during treatment. Audiometry and pulmonary function tests were carried out where possible. Toxicity led to alteration of drug scheduling in two cases, but there were no permanent clinical renal, auditory, or pulmonary sequelae. These encouraging results confirm that MGCTs in children are as responsive as those in adults to cisplatin-containing chemotherapy and indicate that they may be as curable. The regimens are relatively well-tolerated and, with close monitoring, clinically significant toxicity should be avoidable. (+info)
Ruptured urinary bladder attributable to urethral compression by a haematoma after vertebral fracture in a bull.
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The incidence of ossification of the sacrococcygeal joint.
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It is well known that the sacrococcygeal joint may be obliterated by ossification, producing fusion of the first coccygeal segment with the sacrum. There is a conspicuous lack of quantitative information on the occurrence of such bony fusion. It is generally regarded to be characteristic of old age, whilst conflicting statements surround the question of sex differences in its frequency. This report describes the occurrence of sacrococcygeal fusion in two adult British populations, one from Aberdeen and the other from London. In the Aberdeen group, both males and females had a similarly high incidence. In the London group, the males exhibited an intermediate rate whereas the females showed a relatively low occurrence. In London, the males showed a delayed onset of sacrococcygeal fusion with significantly fewer cases occurring below 40 years of age. In contrast, the London females showed a similar frequency of fusion below and above age 40. The effects of age could not be analysed in the Aberdeen group owing to the paucity of subjects below middle age. The findings of this investigation indicate that the occurrence of sacrococcygeal fusion is not related exclusively to age and sex. It is postulated that other factors of a genetic and/or environmental nature are involved. (+info)