Two cases of sacral agenesis

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Choi, J Y; Bae, Y K; Hahm, C K; Kang, S R [Hanyang University College of Medicine, Seoul (Korea, Republic of)

1979-06-15

Sacral agenesis is a central component in the spectrum of anomalies comprising the caudal regression syndrome. Sacral agenesis occurs more frequently in an infant born to mother of diabetes, rubella infection in first trimester than normal mothers. In a patient of sacral agenesis, it is important to recognize the neurologic deficit, neurogenic bladder dysfunction and other congenital anomalies. A case of partial sacral agenesis of 10 years old girl and another case of complete total agenesis associated with multiple anomalies in autopsied newborn are reported.

Two cases of sacral agenesis

International Nuclear Information System (INIS)

Choi, J. Y.; Bae, Y. K.; Hahm, C. K.; Kang, S. R.

1979-01-01

Sacral agenesis is a central component in the spectrum of anomalies comprising the caudal regression syndrome. Sacral agenesis occurs more frequently in an infant born to mother of diabetes, rubella infection in first trimester than normal mothers. In a patient of sacral agenesis, it is important to recognize the neurologic deficit, neurogenic bladder dysfunction and other congenital anomalies. A case of partial sacral agenesis of 10 years old girl and another case of complete total agenesis associated with multiple anomalies in autopsied newborn are reported.

Recurrent meningitis in a case of congenital anterior sacral meningocele and agenesis of sacral and coccygeal vertebrae Meningite recorrente em um paciente com meningocele sacral anterior e agenesia sacral e coccigea

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Carolina A. R. Funayama

1995-12-01

Full Text Available A rare case of recurrent meningitis due to congenital anterior sacral meningocele and agenesis of the sacral and coccygeal vertebrae is described. An autosomal dominant inheritance is demonstrated for lower cord malformation, and environmental factors (chromic acid or fumes are discussed.Um caso raro de meningite recorrente devido a meningocele sacral anterior e agenesia das vértebras sacras coccígeas é descrito. Herança autossômica dominante para malformação medular caudal é demonstrada e, possíveis fatores ambientais (ligados ao cromo, são discutidos.

Sacral-neuromodulation CT-guided

International Nuclear Information System (INIS)

Amoroso, Lamberto; Ricci, Stefano; Pelliccioni, Giuseppe; Scarpino, Osvaldo; Ghiselli, Roberto; Saba, Vittorio

2005-01-01

Purpose: Sacral neuromodulation is a new treatment for refractory voiding disorders such as urge incontinence, urinary retention, frequency-urgency syndromes and faecal incontinence. The current approach to sacral nerve stimulation consists of a two-stage procedure. The first is a PNE test (Percutaneous Nerve Evaluation) by a provisional electrically stimulated spinal needle, placed percutaneously in the S3 foramina for four of ten days. If successful, the second stage, permanent implantation, is carried out. The PNE test is performed under fluoroscopic control using the palpable bony sacral foramina as referral points. This technique can show some limitations, such as operator Rx exposure, poor visualization of sacral foramina because of bowel gas artefacts or sacral malformation. In order to reduce these inconveniences and to improve efficiency of the test we tried an alternative technique. The purpose of our study was to test the use of CT as an alternative technique in order to evaluate its advantages and possible routine use. Materials and methods: We tested 30 patients with the PNE test under CT guidance (16 males and 14 females) suffering from serious pelvic disorders and not responding to the normal therapeutic regime. Twenty-seven patient showed relative anatomical integrity of the pelvis and the sacrum, the remaining 3 patients presented morphological anormalities of the sacral foramina. With the patient in the prone position the sacral foramina were identified with CT volumetric scanning using a spiral CT scanner equipped with a second console for the three-dimensional reconstructions. Having identified the location of the S3 foramina, a sterile field was prepared and the spiral needle introduced checking correct positioning with a CT control scan. An electrode was inserted after having checked correct muscular contractile response and the precise position with a further CT scan. Results: Thirty patients were subjected to PNE under CT guidance for a

Osteolytic extra-axial sacral myxopapillary ependymoma.

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Biagini, R; Demitri, S; Orsini, U; Bibiloni, J; Briccoli, A; Bertoni, F

1999-10-01

The authors report an unusual case of sacral osteolytic myxopapillary ependymoma treated with curettage and radiotherapy. There is no evidence of recurrence 8 years after treatment. A review of the literature is presented on sacral ependymomas presenting with an osteolytic radiographic appearance (24 cases in 18 reports). The differential diagnosis with other sacral neoplasms is discussed.

Osteolytic extra-axial sacral myxopapillary ependymoma

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Biagini, R.; Demitri, S.; Orsini, U. [Clinica Ortopedica, Istituto Ortopedico Rizzoli, Bologna (Italy); Bibiloni, J. [Medical Sciences Campus San Juan, University of Puerto Rico (Puerto Rico); Briccoli, A. [Istituto di Patologia Chirurgica, University of Modena (Italy); Bertoni, F. [Servizio di Anatomia Patologica, Istituto Ortopedico Rizzoli Bologna (Italy)

1999-10-01

The authors report an unusual case of sacral osteolytic myxopapillary ependymoma treated with curettage and radiotherapy. There is no evidence of recurrence 8 years after treatment. A review of the literature is presented on sacral ependymomas presenting with an osteolytic radiographic appearance (24 cases in 18 reports). The differential diagnosis with other sacral neoplasms is discussed. (orig.)

Osteolytic extra-axial sacral myxopapillary ependymoma

International Nuclear Information System (INIS)

Biagini, R.; Demitri, S.; Orsini, U.; Bibiloni, J.; Briccoli, A.; Bertoni, F.

1999-01-01

The authors report an unusual case of sacral osteolytic myxopapillary ependymoma treated with curettage and radiotherapy. There is no evidence of recurrence 8 years after treatment. A review of the literature is presented on sacral ependymomas presenting with an osteolytic radiographic appearance (24 cases in 18 reports). The differential diagnosis with other sacral neoplasms is discussed. (orig.)

Laparoscopic mesh explantation and drainage of sacral abscess remote from transvaginal excision of exposed sacral colpopexy mesh.

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Roth, Ted M; Reight, Ian

2012-07-01

Sacral colpopexy may be complicated by mesh exposure, and the surgical treatment of mesh exposure typically results in minor postoperative morbidity and few delayed complications. A 75-year-old woman presented 7 years after a laparoscopic sacral colpopexy, with Mersilene mesh, with an apical mesh exposure. She underwent an uncomplicated transvaginal excision and was asymptomatic until 8 months later when she presented with vaginal drainage and a sacral abscess. This was successfully treated with laparoscopic enterolysis, drainage of the abscess, and explantation of the remaining mesh. Incomplete excision of exposed colpopexy mesh can lead to ascending infection and sacral abscess. Laparoscopic drainage and mesh removal may be considered in these patients.

Storytelling: Performance, Presentations and Sacral Communication

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Zoltán Bódis

2013-12-01

Full Text Available Various schools of tale research manifested the relationship of tales of the sacred based on their ideological preconceptions: the relationship between tales and the sacred is refused or accepted. In this article tales are investigated not from the perspective of the possible sacral referent(s but rather it looks at them as a kind of communicational subsystem that is part of human culture. The focus is on revealing the specific features of sacral communication in the communication system of tales. Sacral communication is a special form of communication in which the elements of the communication model are transformed. The goal of sacral communication is exactly this kind of identity creation. This may be oriented towards creating a personal or a communal self-identity. Among its characteristics we may find the special type of language forms in which the predominance of linguistic elements pushes the sense conveying possibilities more into the background than usual, and those linguistic forms that restructure consciousness become emphasized. In this communication the tale telling is transformed by a language use characteristic of sacral communication (rhythm, repetition and rhetorical forms. Various examples explain that traditional tale telling creates a complex effect related to the visual, auditory, and kinetic senses: a modification and transformation of the self-understanding and self-identity that connect the world of tale telling to sacral communication.

Sacral-neuromodulation CT-guided; Nuova tecnica di centraggio TC-assistista nella neuromodulazione sacrale

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Amoroso, Lamberto; Ricci, Stefano [INRCA, Ancona (Italy). Dipartimento di radiologia e medicina nucleare; Pelliccioni, Giuseppe; Scarpino, Osvaldo [INRCA, Ancona (Italy). Unita' operativa di radiologia; Ghiselli, Roberto; Saba, Vittorio [INRCA, Ancona (Italy). Dipartimento di chirurgia

2005-04-01

Purpose: Sacral neuromodulation is a new treatment for refractory voiding disorders such as urge incontinence, urinary retention, frequency-urgency syndromes and faecal incontinence. The current approach to sacral nerve stimulation consists of a two-stage procedure. The first is a PNE test (Percutaneous Nerve Evaluation) by a provisional electrically stimulated spinal needle, placed percutaneously in the S3 foramina for four of ten days. If successful, the second stage, permanent implantation, is carried out. The PNE test is performed under fluoroscopic control using the palpable bony sacral foramina as referral points. This technique can show some limitations, such as operator Rx exposure, poor visualization of sacral foramina because of bowel gas artefacts or sacral malformation. In order to reduce these inconveniences and to improve efficiency of the test we tried an alternative technique. The purpose of our study was to test the use of CT as an alternative technique in order to evaluate its advantages and possible routine use. Materials and methods: We tested 30 patients with the PNE test under CT guidance (16 males and 14 females) suffering from serious pelvic disorders and not responding to the normal therapeutic regime. Twenty-seven patient showed relative anatomical integrity of the pelvis and the sacrum, the remaining 3 patients presented morphological anormalities of the sacral foramina. With the patient in the prone position the sacral foramina were identified with CT volumetric scanning using a spiral CT scanner equipped with a second console for the three-dimensional reconstructions. Having identified the location of the S3 foramina, a sterile field was prepared and the spiral needle introduced checking correct positioning with a CT control scan. An electrode was inserted after having checked correct muscular contractile response and the precise position with a further CT scan. Results: Thirty patients were subjected to PNE under CT guidance for a

Safe Zone Quantification of the Third Sacral Segment in Normal and Dysmorphic Sacra.

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Hwang, John S; Reilly, Mark C; Shaath, Mohammad K; Changoor, Stuart; Eastman, Jonathan; Routt, Milton Lee Chip; Sirkin, Michael S; Adams, Mark R

2018-04-01

To quantify the osseous anatomy of the dysmorphic third sacral segment and assess its ability to accommodate internal fixation. Retrospective chart review of a trauma database. University Level 1 Trauma Center. Fifty-nine patients over the age of 18 with computed tomography scans of the pelvis separated into 2 groups: a group with normal pelvic anatomy and a group with sacral dysmorphism. The sacral osseous area was measured on computed tomography scans in the axial, coronal, and sagittal planes in normal and dysmorphic pelves. These measurements were used to determine the possibility of accommodating a transiliac transsacral screw in the third sacral segment. In the normal group, the S3 coronal transverse width averaged 7.71 mm and the S3 axial transverse width averaged 7.12 mm. The mean S3 cross-sectional area of the normal group was 55.8 mm. The dysmorphic group was found to have a mean S3 coronal transverse width of 9.49 mm, an average S3 axial transverse width of 9.14 mm, and an S3 cross-sectional area of 77.9 mm. The third sacral segment of dysmorphic sacra has a larger osseous pathway available to safely accommodate a transiliac transsacral screw when compared with normal sacra. The S3 segment of dysmorphic sacra can serve as an additional site for screw placement when treating unstable posterior pelvic ring fractures.

Surgical techniques for lumbo-sacral fusion.

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Tropiano, P; Giorgi, H; Faure, A; Blondel, B

2017-02-01

Lumbo-sacral (L5-S1) fusion is a widely performed procedure that has become the reference standard treatment for refractory low back pain. L5-S1 is a complex transition zone between the mobile lordotic distal lumbar spine and the fixed sacral region. The goal is to immobilise the lumbo-sacral junction in order to relieve pain originating from this site. Apart from achieving inter-vertebral fusion, the main challenge lies in the preoperative determination of the fixed L5-S1 position that will be optimal for the patient. Many lumbo-sacral fusion techniques are available. Stabilisation can be achieved using various methods. An anterior, posterior, or combined approach may be used. Recently developed minimally invasive techniques are gaining in popularity based on their good clinical outcomes and high fusion rates. The objective of this conference is to resolve the main issues faced by spinal surgeons in their everyday practice. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Feasibility of Using Ultrasonography to Establish Relationships Among Sacral Base Position, Sacral Sulcus Depth, Body Mass Index, and Sex.

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Lockwood, Michael D; Kondrashova, Tatyana; Johnson, Jane C

2015-11-01

Identifying relationships among anatomical structures is key in diagnosing somatic dysfunction. Ultrasonography can be used to visualize anatomical structures, identify sacroiliac landmarks, and validate anatomical findings and measurements in relation to somatic dysfunction. As part of the osteopathic manipulative medicine course at A.T. Still University-Kirksville College of Osteopathic Medicine, first-year students are trained to use ultrasonography to establish relationships among musculoskeletal structures. To determine the ability of first-year osteopathic medical students to establish sacral base position (SBP) and sacral sulcus depth (SSD) using ultrasonography and to identify the relationship of SBP and SSD to body mass index (BMI) and sex. Students used ultrasonography to obtain the distance between the skin and the sacral base (the SBP) and the distance between the skin and the tip of the posterior superior iliac spine bilaterally. Next, students calculated the SSD (the distance between the tip of the posterior superior iliac spine and the SBP). Data were analyzed with respect to side of the body, BMI, sex, and age. The BMI data were subdivided into normal (18-25 mg/kg) and overweight (25-30 mg/kg) groups. Ultrasound images of 211 students were included in the study. The SBP was not significantly different between the left and right sides (36.5 mm vs 36.5 mm; P=.95) but was significantly different between normal and overweight BMI categories (33.0 mm vs 40.0 mm; Psex may point to more soft tissue overlaying the sacrum in these groups. Further research is needed on the use of ultrasonography to establish criteria for somatic dysfunction.

Evaluation of the diagnostic accuracy of four-view radiography and conventional computed tomography analysing sacral and pelvic fractures in dogs.

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Stieger-Vanegas, S M; Senthirajah, S K J; Nemanic, S; Baltzer, W; Warnock, J; Bobe, G

2015-01-01

The purpose of our study was (1) to determine whether four-view radiography of the pelvis is as reliable and accurate as computed tomography (CT) in diagnosing sacral and pelvic fractures, in addition to coxofemoral and sacroiliac joint subluxation or luxation, and (2) to evaluate the effect of the amount of training in reading diagnostic imaging studies on the accuracy of diagnosing sacral and pelvic fractures in dogs. Sacral and pelvic fractures were created in 11 canine cadavers using a lateral impactor. In all cadavers, frog-legged ventro-dorsal, lateral, right and left ventro-45°-medial to dorsolateral oblique frog leg ("rollover 45-degree view") radiographs and a CT of the pelvis were obtained. Two radiologists, two surgeons and two veterinary students classified fractures using a confidence scale and noted the duration of evaluation for each imaging modality and case. The imaging results were compared to gross dissection. All evaluators required significantly more time to analyse CT images compared to radiographic images. Sacral and pelvic fractures, specifically those of the sacral body, ischiatic table, and the pubic bone, were more accurately diagnosed using CT compared to radiography. Fractures of the acetabulum and iliac body were diagnosed with similar accuracy (at least 86%) using either modality. Computed tomography is a better method for detecting canine sacral and some pelvic fractures compared to radiography. Computed tomography provided an accuracy of close to 100% in persons trained in evaluating CT images.

Osteoporotic compression fracture of the thoracolumbar spine and sacral insufficiency fracture: incidence and analysis of the relationship according to the clinical factors

International Nuclear Information System (INIS)

Kong, Jeong Hwa; Park, Ji Sun; Ryu, Kyung Nam

2006-01-01

To evaluate the incidence of sacral insufficiency fracture in osteoporotic patient with compression fracture of the thoracolumbar (T-L) spine on magnetic resonance image (MRI), and to analyze the correlation of variable clinical factors and the incidence of sacral insufficiency fracture. We retrospectively reviewed 160 patients (27 men, 133 women; age range of 50 to 89 years) who underwent spinal MRI and had compression fracture of the T-L spine. Compression fractures due to trauma or tumor were excluded. We evaluated the incidence of sacral insufficiency fracture according to the patients' age, sex, number of compression fractures, and the existence of bone marrow edema pattern of compression fracture. During the same period, we evaluated the incidence of spinal compression fracture in the patients of pelvic insufficiency fracture. Out of the 160 patients who had compression fracture in the T-L spine, 17 (10.6%) had insufficiency fracture of the sacrum. Compression fracture occurred almost 5 times more frequently in women (27:133), but the incidence of sacral insufficiency fracture was 2/27 for men (7.4%) and 15/133 for women (11.3%), with no statistically significant difference (ρ = 0.80). According to age, the ratio of insufficiency fracture to compression fracture was 0% (0/23) in the 50's, 10.6% (7/66) in the 60's, 12.5% (7/56) in the 70's, and 20.0% (3/15) in the 80's. In respect of single and multiple compression fracture, the incidence of sacral insufficiency fracture was 8/65 for men (12.3%) and 9/95 for women (9.5%), showing no significant difference (ρ = 0.37). In the patients with and without compression fracture with bone marrow edema, insufficiency fracture occurred in 5/76 (6.6%) and 12/84 (14.3%), respectively. On the other hand, of the 67 patients who had pelvic insufficiency fracture, 27 (40.3%) also had spinal compression fracture. About 10% of the patients with osteoporotic compression fracture in the T/L spine also had pelvic sacral

Postpartum Sacral Stress Fracture: An Atypical Case Report

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Andrea Speziali

2015-01-01

Full Text Available Sacral stress fractures are common in elderly people. However, sacral stress fracture should be always screened in the differential diagnoses of low back pain during the postpartum period. We present a case of sacral fracture in a thirty-six-year-old woman with low back pain and severe right buttock pain two days after cesarean section delivery of a 3.9 Kg baby. The diagnosis was confirmed by MRI and CT scan, while X-ray was unable to detect the fracture. Contribution of mechanical factors during the cesarean section is not a reasonable cause of sacral fracture. Pregnancy and lactation could be risk factors for sacral stress fracture even in atraumatic delivery such as cesarean section. Our patient had no risk factors for osteoporosis except for pregnancy and lactation. Transient or focal osteoporosis is challenging to assess and it cannot be ruled out even if serum test and mineral density are within the normal range.

Local effect of zoledronic acid on new bone formation in posterolateral spinal fusion with demineralized bone matrix in a murine model.

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Zwolak, Pawel; Farei-Campagna, Jan; Jentzsch, Thorsten; von Rechenberg, Brigitte; Werner, Clément M

2018-01-01

Posterolateral spinal fusion is a common orthopaedic surgery performed to treat degenerative and traumatic deformities of the spinal column. In posteriolateral spinal fusion, different osteoinductive demineralized bone matrix products have been previously investigated. We evaluated the effect of locally applied zoledronic acid in combination with commercially available demineralized bone matrix putty on new bone formation in posterolateral spinal fusion in a murine in vivo model. A posterolateral sacral spine fusion in murine model was used to evaluate the new bone formation. We used the sacral spine fusion model to model the clinical situation in which a bone graft or demineralized bone matrix is applied after dorsal instrumentation of the spine. In our study, group 1 received decortications only (n = 10), group 2 received decortication, and absorbable collagen sponge carrier, group 3 received decortication and absorbable collagen sponge carrier with zoledronic acid in dose 10 µg, group 4 received demineralized bone matrix putty (DBM putty) plus decortication (n = 10), and group 5 received DBM putty, decortication and locally applied zoledronic acid in dose 10 µg. Imaging was performed using MicroCT for new bone formation assessment. Also, murine spines were harvested for histopathological analysis 10 weeks after surgery. The surgery performed through midline posterior approach was reproducible. In group with decortication alone there was no new bone formation. Application of demineralized bone matrix putty alone produced new bone formation which bridged the S1-S4 laminae. Local application of zoledronic acid to demineralized bone matrix putty resulted in significant increase of new bone formation as compared to demineralized bone matrix putty group alone. A single local application of zoledronic acid with DBM putty during posterolateral fusion in sacral murine spine model increased significantly new bone formation in situ in our model. Therefore, our

Bone scanning in patients with low back pain following minimal trauma

International Nuclear Information System (INIS)

Weidinger, W.; Hatzl-Griesenhofer, M.; Pichler, R.; Huber, H.; Maschek, W.

2002-01-01

Full text: Low back pain following minimal trauma may be caused by insufficiency fracture of the sacrum, which is often radiographically occult. Bone scintigraphy is a method of reference for the diagnosis; the results have been analyzed retrospectively. Bone scintigraphy was done on 228 patients treated by the departments of orthopedics at the General Hospital Linz. Predominantly after (minor) trauma, they suffered from lower back pain and their conventional radiographic findings were negative. During a 24 month period, a sacral insufficiency fracture was diagnosed in 68 patients (29,8 %). H-shaped hyperfixation of the tracer - described as typical - was present in only 12 % of the gases. Tracer accumulation was found as follows: located uni/bilateral in the sacral wings (39 % / 9 %), horizontal (31 %) and half H-shaped (9 %). In the majority of the gases bone scan detected farther fractures with main localization in the pubic bones, in the spine and the ribs. The insufficiency fracture of the sacrum as cause of lower back pain is not uncommon, especially in postmenopausal women with risk factors. Bone scintigraphy is not only an adequate procedure for the detection of often radiographically occult sacral fractures, but also an easy method to reveal the often concomitand fractures. (author)

Sacrality and worldmaking: new categorial perspectives

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William E. Paden

1999-01-01

The category of the sacred in particular and the role of transcultural concept-formation in general have undergone an obvious crisis. For the most part, "the sacred," if not an empty label, has been linked with theologism, and transcultural concepts have been condemned for their general non-comparability and colonialist intent. The author approaches the matter of transcultural templates through an analysis of certain concepts of sacrality. With some exceptions, the discourse of sacrality has ...

Parasacral Perforator Flaps for Reconstruction of Sacral Pressure Sores.

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Lin, Chin-Ta; Chen, Shih-Yi; Chen, Shyi-Gen; Tzeng, Yuan-Sheng; Chang, Shun-Cheng

2015-07-01

Despite advances in reconstruction techniques, pressure sores continue to present a challenge to the plastic surgeon. The parasacral perforator flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. We present our experience of using parasacral perforator flaps in reconstructing sacral defects. Between August 2004 and January 2013, 19 patients with sacral defects were included in this study. All the patients had undergone surgical reconstruction of sacral defects with a parasacral perforator flap. The patients' sex, age, cause of sacral defect, flap size, flap type, numbers of perforators used, rotation angle, postoperative complications, and hospital stay were recorded. There were 19 parasacral perforator flaps in this series. All flaps survived uneventfully except for 1 parasacral perforator flap, which failed because of methicillin-resistant Staphylococcus aureus infection. The overall flap survival rate was 95% (18/19). The mean follow-up period was 17.3 months (range, 2-24 months). The average length of hospital stay was 20.7 days (range, 9-48 days). No flap surgery-related mortality was found. Also, there was no recurrence of sacral pressure sores or infected pilonidal cysts during the follow-up period. Perforator-based flaps have become popular in modern reconstructive surgery because of low donor-site morbidity and good preservation of muscle. Parasacral perforator flaps are durable and reliable in reconstructing sacral defects. We recommend the parasacral perforator flap as a good choice for reconstructing sacral defects.

Sacral Variability in Tailless Species: Homo sapiens and Ochotona princeps.

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Tague, Robert G

2017-05-01

Homo sapiens is variable in number of sacral vertebrae, and this variability can lead to obstetrical complication. This study uses the comparative method to test the hypothesis that sacral variability in H. sapiens is associated with absence of a tail. Three species of lagomorphs are studied: Ochotona princeps (N = 271), which is tailless, and Lepus californicus (N = 212) and Sylvilagus audubonii (N = 206), which have tails. Results show that O. princeps has (1) higher diversity index for number of sacral vertebrae (0.49) compared to L. californicus (0.25) and S. audubonii (0.26) and (2) significantly higher percentage of individuals with the species-specific nonmodal number of sacral vertebrae (43.9%) compared to L. californicus (14.2%) and S. audubonii (15.5%). Comparison of H. sapiens (N = 1,030; individuals of age 20-39 years) with O. princeps shows similarities between the species in diversity index (also 0.49 in H. sapiens) and percentage of individuals with nonmodal number of sacral vertebrae (37.3% in H. sapiens). Homeotic transformation best explains the results. H. sapiens and O. princeps show propensity for caudal shift at the sacral-caudal border (i.e., homeotic transformation of the first caudal vertebra to a sacral vertebra). Caudal and cranial shift among presacral vertebrae increases or decreases this propensity, respectively. Increase in number of sacral vertebrae in H. sapiens by homeotic transformation reduces pelvic outlet capacity and can be obstetrically hazardous. Anat Rec, 300:798-809, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Bilateral chronic sacral neuromodulation for treatment of lower urinary tract dysfunction.

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Hohenfellner, M; Schultz-Lampel, D; Dahms, S; Matzel, K; Thüroff, J W

1998-09-01

Chronic sacral neuromodulation aims at functional restoration of selected forms of nonneurogenic and neurogenic bladder dysfunction. The original technique, as described by Tanagho and Schmidt, provides unilateral sacral nerve stimulation via an implanted stimulator powering an electrode inserted into a sacral foramen. Its drawback was that the implant failed unpredictably in some patients despite previous successful percutaneous test stimulation. Therefore, we modified the stimulation technique to improve the efficacy of chronic sacral neuromodulation. Guarded bipolar electrodes powered by an implantable neurostimulator were attached bilaterally directly to the S3 nerves through a sacral laminectomy in 9 women and 2 men (mean age 43.4 years). Of the patients 5 had urinary incontinence due to detrusor hyperactivity and 6 had urinary retention from detrusor hypocontractility. Mean followup with repeated urodynamics was 13 months (range 9 to 28). Four significant complications were encountered in 4 patients. In 10 patients the urological sequelae of the neurological disorder were alleviated significantly (50% or more), including 5 who experienced complete relief of symptoms. The efficacy of chronic sacral neuromodulation can be improved by bilateral attachment of electrodes directly to the sacral nerves.

Descrição do esqueleto axial de Liolaemus arambarensis Verrastro, Veronese, Bujes & Dias Filho (Iguania, Liolaemidae: regiões pré-sacral e sacral Description of the axial skeleton of Liolaemus arambarensis Verrastro et al. (Iguania, Liolaemidae: pre-sacral and sacral regions

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Caroline M. da Silva

2007-03-01

Full Text Available Liolaemus arambarensis Verrastro, Veronese, Bujes & Dias Filho, 2003 (Iguania, Liolaemidae é um pequeno lagarto de areia, que vive nos ambientes de restingas da Laguna dos Patos. A descrição do esqueleto desta espécie pode elucidar algumas relações filogenéticas em relação a outras espécies do gênero. Tendo por objetivo a descrição das regiões pré-sacral e sacral do esqueleto axial de L. arambarensis, foram analisados sete exemplares da espécie. Observou-se que a maior estrutura axial é a coluna vertebral, que é dividida nas regiões: cervical, dorsal, sacral e caudal. A região cervical possui oito vértebras, e as costelas aparecem a partir da quarta vértebra. A região dorsal é dividida em: torácica, com cinco vértebras portando costelas unidas ao esterno; e pós-torácica, com 11 vértebras portando costelas livres. Segue-se a região sacral com duas vértebras fusionadas, que portam processos transversos fortemente expandidos lateralmente. O esterno de L. arambarensis constitui-se de uma placa cartilaginosa calcificada que se comunica com a região torácica da coluna vertebral e com a cintura escapular. Em vista do descrito anteriormente, pode-se dizer que L. arambarensis apresenta os padrões de esqueleto axial descritos para espécies de sua família e gênero.Liolaemus arambarensis Verrastro, Veronese, Bujes & Dias Filho, 2003 (Iguania: Liolaemidae is a small sand lizard that inhabits restingas in the Patos Lagoon, Southern Brazil. The description of the skeleton in this species could give some insights about the phylogenetic relationships with other species of the genus. With the main goal of describing the pre-sacral and sacral regions of the axial skeleton of L. arambarensis, a total of seven individuals were analyzed. It was observed that the largest axial structure is the vertebral column that is divided into four regions: cervical, dorsal, sacral and caudal. The cervical region presents eight vertebra and the

Sacral insufficiency fractures: a report of three cases; Fracturas por insuficiencia del sacro: a proposito de tres casos

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Armesto, V.; Pulpeiro, J. R.; Lauda Corchon, M. [Clinica Nosa Senora dos Ollos Grandes. Lugo (Spain)

2000-07-01

Sacral insufficiency fractures pose a diagnostic problem because of the nonspecific clinical signs and the absence of distinguishing features in standard radiological studies. The main causes are osteoporosis, making women reaching the age of menopause among the populations most commonly affected, and a history of radiotherapy, leading to the inclusion of neoplastic disease in the differential diagnosis. The characteristic site is ala sacralis, usually bilateral, and the fracture is vertical, running parallel to the sacroiliac joints. The sacral bone may also be involved (H pattern), as well as the medial region of the ilium. It is frequently associated with fractures of the supraacetabular region and the pubic symphysis. Computed tomography is the technique of choice for detecting the fracture line and/or sclerosis, although it is less sensitive than magnetic resonance (MR) imaging or scintigraphy during acute phases. MR of the above regions shows nonspecific edema, contrasting with hypointense signals indicating the general path of the fracture line in T2-weighted images. The use of gadolinium or fat suppression greatly increases the sensitivity. Bone scintigraphy is a highly sensitive diagnostic tool, although the H pattern occurs in less than 50% of cases. (Author) 24 refs.

Developmental identity versus typology: Lucy has only four sacral segments.

Science.gov (United States)

Machnicki, Allison L; Lovejoy, C Owen; Reno, Philip L

2016-08-01

Both interspecific and intraspecific variation in vertebral counts reflect the action of patterning control mechanisms such as Hox. The preserved A.L. 288-1 ("Lucy") sacrum contains five fused elements. However, the transverse processes of the most caudal element do not contact those of the segment immediately craniad to it, leaving incomplete sacral foramina on both sides. This conforms to the traditional definition of four-segmented sacra, which are very rare in humans and African apes. It was recently suggested that fossilization damage precludes interpretation of this specimen and that additional sacral-like features of its last segment (e.g., the extent of the sacral hiatus) suggest a general Australopithecus pattern of five sacral vertebrae. We provide updated descriptions of the original Lucy sacrum. We evaluate sacral/coccygeal variation in a large sample of extant hominoids and place it within the context of developmental variation in the mammalian vertebral column. We report that fossilization damage did not shorten the transverse processes of the fifth segment of Lucy's sacrum. In addition, we find that the extent of the sacral hiatus is too variable in apes and hominids to provide meaningful information on segment identity. Most importantly, a combination of sacral and coccygeal features is to be expected in vertebrae at regional boundaries. The sacral/caudal boundary appears to be displaced cranially in early hominids relative to extant African apes and humans, a condition consistent with the likely ancestral condition for Miocene hominoids. While not definitive in itself, a four-segmented sacrum accords well with the "long-back" model for the Pan/Homo last common ancestor. Am J Phys Anthropol 160:729-739, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Development and validation of a bowel-routine-based self-report questionnaire for sacral sparing after spinal cord injury

DEFF Research Database (Denmark)

Liu, N; Xing, H; Zhou, M-W

2017-01-01

-report questionnaire was developed based on several events that most patients might experience during bowel routine. 102 participants who sustained SCI within 12 months were asked to complete the questionnaire followed by an anorectal examination. Agreements of answers to the questionnaire and the physical examination......STUDY DESIGN: An observational study. OBJECTIVE: To develop a self-administered tool for assessment of sacral sparing after spinal cord injury (SCI) and to test its validity in individuals with SCI. SETTING: Peking University Third Hospital, Beijing, China. METHODS: A 5-item SCI sacral sparing self......: The validity of this questionnaire for the assessment of sacral sparing in up to 12 months post injury is good except for the motor function when there was increased AST. In some situations it could be considered as an alternative tool for digital rectal examination, especially when repeated examinations...

Bladder compliance after posterior sacral root rhizotomies and anterior sacral root stimulation

NARCIS (Netherlands)

Koldewijn, E. L.; van Kerrebroeck, P. E.; Rosier, P. F.; Wijkstra, H.; Debruyne, F. M.

1994-01-01

To evaluate the effects of central detrusor denervation on bladder compliance, we studied 27 patients with complete suprasacral spinal cord injury in whom intradural posterior sacral root rhizotomies from S2 to S5 in combination with implantation of an intradural Finetech-Brindley bladder stimulator

The sacral foramina

International Nuclear Information System (INIS)

Jackson, H.; Burke, J.T.

1984-01-01

The sacral foramina, particularly the first three, are not simple fenestrations. Each foramen is a Y-shaped complex of canals, all with indefinite margins. The complexes lie obliquely at approximately 45 0 to the coronal plane. An appreciation of these facts facilitates the recognition of the anatomy of plain films, tomographs, and computerized scans. (orig.)

Accessing 3D Location of Standing Pelvis: Relative Position of Sacral Plateau and Acetabular Cavities versus Pelvis

International Nuclear Information System (INIS)

Berthonnaud, E.; Hilmi, R.; Berthonnaud, E.; Berthonnaud, E.; Dimnet, J.

2012-01-01

The goal of this paper is to access to pelvis position and morphology in standing posture and to determine the relative locations of their articular surfaces. This is obtained from coupling bi planar radiography and bone modeling. The technique involves different successive steps. Punctual landmarks are first reconstructed, in space, from their projected images, identified on two orthogonal standing X-rays. Geometric models, of global pelvis and articular surfaces, are determined from punctual landmarks. The global pelvis is represented as a triangle of summits: the two femoral head centers and the sacral plateau center. The two acetabular cavities are modeled as hemispheres. The anterior sacral plateau edge is represented by an hemi-ellipsis. The modeled articular surfaces are projected on each X-ray. Their optimal location is obtained when the projected contours of their models best fit real outlines identified from landmark images. Linear and angular parameters characterizing the position of global pelvis and articular surfaces are calculated from the corresponding sets of axis. Relative positions of sacral plateau, and acetabular cavities, are then calculated. Two hundred standing pelvis, of subjects and scoliotic patients, have been studied. Examples are presented. They focus upon pelvis orientations, relative positions of articular surfaces, and pelvis asymmetries.

Formation of the sacrum requires down-regulation of sonic hedgehog signaling in the sacral intervertebral discs.

Science.gov (United States)

Bonavita, Raffaella; Vincent, Kathleen; Pinelli, Robert; Dahia, Chitra Lekha

2018-05-21

In humans, the sacrum forms an important component of the pelvic arch, and it transfers the weight of the body to the lower limbs. The sacrum is formed by collapse of the intervertebral discs (IVDs) between the five sacral vertebrae during childhood, and their fusion to form a single bone. We show that collapse of the sacral discs in the mouse is associated with the down-regulation of sonic hedgehog (SHH) signaling in the nucleus pulposus (NP) of the disc, and many aspects of this phenotype can be reversed by experimental postnatal activation of HH signaling. We have previously shown that SHH signaling is essential for the normal postnatal growth and differentiation of intervertebral discs elsewhere in the spine, and that loss of SHH signaling leads to pathological disc degeneration, a very common disorder of aging. Thus, loss of SHH is pathological in one region of the spine but part of normal development in another. © 2018. Published by The Company of Biologists Ltd.

Ipsilateral Hip Dysplasia in Patients with Sacral Hemiagenesis: A Report of Two Cases

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Tadatsugu Morimoto

2015-01-01

Full Text Available Sacral agenesis (SA is a rare condition consisting of the imperfect development of any part of the sacrum. This paper describes two cases of the rare cooccurrence of ipsilateral SA and developmental dysplasia of the hip (DDH and analyzes possible contributory factors for SA and DDH. Each of a 16-year-old female and 13-year-old female visited our hospital for left hip pain and limping. The findings of physical examinations showed a lower limb length discrepancy (left side in both cases, as well as left hip pain without limitations of the range of motion or neurological deficits. Initial radiographs demonstrated left subluxation of the left hip with associated acetabular dysplasia and partial left sacral agenesis. MRI revealed a tethering cord with a fatty filum terminale, and periacetabular osteotomy combined with allogeneic bone grafting was performed. After the surgery, the patients experienced no further pain, with no leg length discrepancy and were able to walk without a limp, being neurologically normal with a normal left hip range of motion. The cooccurrence of SA and DDH suggests a plausible hypothesis to explain the embryogenic relationship between malformation of the sacrum and hip.

Four Cases of Urinary Dysfunction Associated with Sacral Herpes Zoster

OpenAIRE

松尾, 朋博; 大庭, 康司郎; 宮田, 康好; 井川, 掌; 酒井, 英樹

2014-01-01

Herpes zoster is caused by the infection of Varicella-Zoster virus. The anatomical distribution of herpes zoster in the sacral area is only6. 9%1). Moreover, the onset rate of herpes zoster with urinary dysfunction is 0.6%1). The lesion sites of herpes zoster which cause urinary dysfunction are almost lumber and sacral areas. We describe four cases of sacral herpes zoster with urinary dysfunction in this report. All patients were elderly people (66-84 years old), and all patients were adminis...

Introduction of laparoscopic sacral colpopexy to a fellowship training program.

Science.gov (United States)

Kantartzis, Kelly; Sutkin, Gary; Winger, Dan; Wang, Li; Shepherd, Jonathan

2013-11-01

Minimally invasive sacral colpopexy has increased over the past decade, with many senior physicians adopting this new skill set. However, skill acquisition at an academic institution in the presence of postgraduate learners is not well described. This manuscript outlines the introduction of laparoscopic sacral colpopexy to an academic urogynecology service that was not performing minimally invasive sacral colpopexies, and it also defines a surgical learning curve. The first 180 laparoscopic sacral colpopexies done by four attending urogynecologists from January 2009 to December 2011 were retrospectively analyzed. The primary outcome was operative time. Secondary outcomes included conversion to laparotomy, estimated blood loss, and intra- and postoperative complications. Linear regression was used to analyze trends in operative times. Fisher's exact test compared surgical complications and counts of categorical variables. Mean total operative time was 250 ± 52 min (range 146-452) with hysterectomy and 222 ± 45 (range 146-353) for sacral colpopexy alone. When compared with the first ten cases performed by each surgeon, operative times in subsequent groups decreased significantly, with a 6-16.3% reduction in overall times. There was no significant difference in the rate of overall complications regardless of the number of prior procedures performed (p = 0.262). Introduction of laparoscopic sacral colpopexy in a training program is safe and efficient. Reduction in operative time is similar to published learning curves in teaching and nonteaching settings. Introducing this technique does not add additional surgical risk as these skills are acquired.

Sacral Myeloid Sarcoma Manifesting as Radiculopathy in a Pediatric Patient: An Unusual Form of Myeloid Leukemia Relapse

Directory of Open Access Journals (Sweden)

Joana Ruivo Rodrigues

2018-01-01

Full Text Available Myeloid sarcoma (MS, granulocytic sarcoma or chloroma, is defined as a localized extramedullary mass of blasts of granulocytic lineage with or without maturation, occurring outside the bone marrow. MS can be diagnosed concurrently with acute myeloid leukemia (AML or myelodysplastic syndrome (MDS. The authors report a case of sacral MS occurring as a relapse of myeloid leukemia in a 5-year-old girl who was taken to the emergency department with radiculopathy symptoms.

L5 radiculopathy due to sacral stress fracture

International Nuclear Information System (INIS)

Aylwin, Anthony; Saifuddin, Asif; Tucker, Stuart

2003-01-01

We report the case of a 70-year-old man who presented with a history of left buttock pain with radiation into the left leg in an L5 distribution. MRI of the lumbar spine revealed a left sacral stress fracture with periosteal reaction involving the left L5 nerve root anterior to the sacral ala. With spontaneous healing of the fracture, the patient's symptoms resolved completely. (orig.)

CT-guided fixation of sacral fractures and sacrolilac joint disruptions

International Nuclear Information System (INIS)

Nelson, D.W.; Duwelius, P.

1990-01-01

Placement of sacral fixation screws at surgery is performed blindly (ie, by palpation). The authors of this paper employed CT to localize the screw between the neutral foramina and anterior sacral cortex and to decrease the morbidity associated with general anesthesia and surgery. Six patients underwent CT-guided sacral fixation performed by means of the 7.0 mm A0 cannulated screw system. All patients had reducible vertical sacral fractures or sacroiliac joint disruptions. Following placement of an epidural catheter for anesthesia, patients were scanned in the prone or decubitus position. Measurements for placement of the guide pin were made from the preliminary scans. Following CT confirmation of satisfactory guide pin placement across the fracture, the screw track was drilled, the screw length was determined, and the fixation screw was placed in position. A CT scan was obtained to evaluate the final position of the screw

Extraosseous Ewing's sarcoma / primitive neuroectodermal tumor of the sacral nerve plexus

International Nuclear Information System (INIS)

Narula, MK; Gupta, Nishant; Anand, Rama; Kapoor, Sudhir

2009-01-01

We report an unusual case of Ewing's sarcoma / primitive neuroectodermal tumor (PNET) of the sacral nerve plexus in a 9-year-old boy who presented with a soft tissue swelling and severe piercing pain in the lower back region. MRI of the lumbosacral spine showed a lobulated soft tissue mass with clubbed finger-like projections along the path of the sacral nerves, which had caused widening of the spinal canal and the sacral foramina (S2–S4 level). There was presacral extension and posterior scalloping of the sacral vertebrae. Histopathology of the lesion confirmed Ewing's sarcoma / PNET of the sacral spinal nerve plexus. The patient responded favorably to chemotherapy and radiotherapy, showing clinical and radiological improvement

4. Primary Malignant Bone Tumours at the University Teaching ...

African Journals Online (AJOL)

46987.2

1Orthopaedic Unit Department of Surgery, University Teaching Hospital, Lusaka, Zambia. 2Department of ... primary malignant bone tumours at UTH and the hospital ..... unavailable resources. ... bone tumors in Mexico City: retrospective.

MR imaging of sacral and perisacral lesions

International Nuclear Information System (INIS)

Wetzel, L.H.; Levine, E.; Murphey, M.D.

1987-01-01

This exhibit demonstrates the utility of MR imaging in evaluating sacral and perisacral lesions. Thirty-two lesions were studied using a superconducting 1.0-T MR imager. Eleven primary and 13 metastatic tumors, four congenital lesions, and four arachnoid cysts were evaluated. MR did not usually enable a more specific histologic diagnosis than other imaging techniques. However, extraosseous and proximal spinal extent of tumors was well defined without use of oral or intravenous contrast material. MR imaging is an excellent noninvasive technique for evaluating most sacral and perisacral lesions and is particularly helpful when precise tumor extent must be determined for treatment planning

The application of sacral block anesthesia in pediatric interventional therapy

International Nuclear Information System (INIS)

Zhong Liang; Qin Zenghui

2009-01-01

Objective: To discuss the management and feasibility of sacral block anesthesia in pediatric interventional therapy. Methods: A total of 80 pediatric patients were randomly and equally divided into two groups. Patients in group A received sacral block anesthesia together with basic anesthesia with propofol, while patients in group B received intravenous anesthesia with propofol. Small amount of ketamine as maintaining dose was used in both groups when needed. Results: The interventional management was successfully completed in all patients. A marked decrease in blood pressure occurred in three patients of group A receiving sacral block anesthesia. In group B receiving intravenous anesthesia, a decrease of SpO 2 to below 90 percent was seen in 8 cases, and obvious bradycardia developed in 12 cases. All these patients were treated with intravenous medication or by reducing the dose of propofol. Additional small dose of ketamine was needed in 4 patients during the procedure. Conclusion: Sacral block anesthesia combined with intravenous anesthesia is one of the effective anesthesia management schemes for pediatric interventional therapy. (authors)

Presacral abscess as a rare complication of sacral nerve stimulator implantation.

Science.gov (United States)

Gumber, A; Ayyar, S; Varia, H; Pettit, S

2017-03-01

A 50-year-old man with intractable anal pain attributed to proctalgia fugax underwent insertion of a sacral nerve stimulator via the right S3 vertebral foramen for pain control with good symptomatic relief. Thirteen months later, he presented with signs of sepsis. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large presacral abscess. MRI demonstrated increased enhancement along the pathway of the stimulator electrode, indicating that the abscess was caused by infection introduced at the time of sacral nerve stimulator placement. The patient was treated with broad spectrum antibiotics, and the sacral nerve stimulator and electrode were removed. Attempts were made to drain the abscess transrectally using minimally invasive techniques but these were unsuccessful and CT guided transperineal drainage was then performed. Despite this, the presacral abscess progressed, developing enlarging gas locules and extending to the pelvic brim to involve the aortic bifurcation, causing hydronephrosis and radiological signs of impending sacral osteomyelitis. MRI showed communication between the rectum and abscess resulting from transrectal drainage. In view of the progressive presacral sepsis, a laparotomy was performed with drainage of the abscess, closure of the upper rectum and formation of a defunctioning end sigmoid colostomy. Following this, the presacral infection resolved. Presacral abscess formation secondary to an infected sacral nerve stimulator electrode has not been reported previously. Our experience suggests that in a similar situation, the optimal management is to perform laparotomy with drainage of the presacral abscess together with simultaneous removal of the sacral nerve stimulator and electrode.

[Sacral pressure sores and their treatment].

Science.gov (United States)

Bielecki, Marek; Skowroński, Rafał; Skowroński, Jan

2006-01-01

Sacral bed sores still present a serious problem in most surgery departments. They occur mainly in elderly patients of limited mobility. The treatment of such sores extends over long periods of time and therefore involves considerable costs. The material consisted of 11 sacral pressure ulcers treated surgically. The sores occurred in 4 severely disabled patients suffering from proximal third femur fractures, 4 patients with traumatic brain injury (treated in the Intensive Care Unit), and 3 patients suffering from bed sores after spinal cord injury. In 6 patients a fasciocutaneous flap was applied to the sores and in 5 cases a pedicled musculocutaneous gluteus maximus flap. The end results were assessed using Seiler's criteria. Complications of the "seroma" type were observed in 3 patients, and in 2 marginal necrosis. In all our patients complete healing was achieved within 2-4 weeks. On analysing our experience to date in surgical treatment of bed sores we are of the opinion that even extensive sacral sores can be covered with unilateral pedicled flaps provided that they are appropriately planned. Deep sores of the 4th degree sometimes with concomitant osteomyelitis require pedicled muscle flaps or in some cases musculocutaneous flaps to improve local circulation. The preparation of the patient for reconstruction surgery is just as important as the operation itself and therefore such preparation should never be neglected.

Cost of dressings for prevention of sacral pressure ulcers.

Science.gov (United States)

Inoue, Kelly Cristina; Matsuda, Laura Misue

2016-01-01

to identify costs of dressings to prevent sacral pressure ulcers in an adult intensive care unit in Paraná, Brazil. secondary analysis study with 25 patients admitted between October 2013 and March 2014, using transparent polyurethane film (n=15) or hydrocolloid dressing (n=10) on the sacral region. The cost of each intervention was based on the unit amount used in each type of dressing, and its purchase price (transparent film = R$15.80, hydrocolloid dressing = R$68.00). the mean cost/patient was R$23.17 for use of transparent film and R$190.40 for use of hydrocolloid dressing. The main reason for changing the dressing was detachment. the transparent film was the most economically advantageous alternative to prevent sacral pressure ulcers in critical care patients. However, additional studies should be carried out including assessment of the effectiveness of both dressings.

Improving patient knowledge about sacral nerve stimulation using a patient based educational video.

Science.gov (United States)

Jeppson, Peter Clegg; Clark, Melissa A; Hampton, Brittany Star; Raker, Christina A; Sung, Vivian W

2013-10-01

We developed a patient based educational video to address the information needs of women considering sacral nerve stimulation for overactive bladder. Five semistructured focus groups were used to identify patient knowledge gaps, information needs, patient acceptable terminology and video content preferences for a patient based sacral nerve stimulation educational video. Each session was transcribed, independently coded by 2 coders and examined using an iterative method. A 16-minute educational video was created to address previously identified knowledge gaps and information needs using patient footage, 3-dimensional animation and peer reviewed literature. We developed a questionnaire to evaluate participant sacral nerve stimulation knowledge and therapy attitudes. We then performed a randomized trial to assess the effect of the educational video vs the manufacturer video on patient knowledge and attitudes using our questionnaire. We identified 10 patient important domains, including 1) anatomy, 2) expectations, 3) sacral nerve stimulation device efficacy, 4) surgical procedure, 5) surgical/device complications, 6) post-procedure recovery, 7) sacral nerve stimulation side effects, 8) postoperative restrictions, 9) device maintenance and 10) general sacral nerve stimulation information. A total of 40 women with overactive bladder were randomized to watch the educational (20) or manufacturer (20) video. Knowledge scores improved in each group but the educational video group had a greater score improvement (76.6 vs 24.2 points, p <0.0001). Women who watched the educational video reported more favorable attitudes and expectations about sacral nerve stimulation therapy. Women with overactive bladder considering sacral nerve stimulation therapy have specific information needs. The video that we developed to address these needs was associated with improved short-term patient knowledge. Copyright © 2013 American Urological Association Education and Research, Inc

[Four cases of urinary dysfunction associated with sacral herpes zoster].

Science.gov (United States)

Matsuo, Tomohiro; Oba, Kojiro; Miyata, Yasuyoshi; Igawa, Tsukasa; Sakai, Hideki

2014-02-01

Herpes zoster is caused by the infection of Varicella-Zoster virus. The anatomical distribution of herpes zoster in the sacral area is only 6. 9%1). Moreover, the onset rate of herpes zoster with urinary dysfunction is 0.6%1). The lesion sites of herpes zoster which cause urinary dysfunction are almost lumber and sacral areas. We describe four cases of sacral herpes zoster with urinary dysfunction in this report. All patients were elderly people (66-84 years old), and all patients were administered anti-virus drugs and alpha 1-adrenergic receptor blockers. Because of urinary retention, three patients have performed clean intermittent self-catheterization (CIC) for several weeks. As the lesions of herpes zoster healed, each patient recovered from urinary dysfunction.

Detection of neurological deficits by computed tomography in sacral fracture patients

International Nuclear Information System (INIS)

Nakai, Daisuke; Numazaki, Shin; Katsumura, Tetsu; Tamaru, Tomohiko; Sugiyama, Mitsugi; Nakamura, Jun-ichiro; Saitoh, Tomoyuki

2006-01-01

The purpose of this study is to evaluate the correlation between sacral fractures and neurological deficits as complications. From November 2002 to February 2005, 12 patients (15 fractures) were found to have sacral fractures without other spinal injuries or brain injuries and were evaluated by plain CT scans immediately after trauma. This group included 6 males and 6 females, whose age ranged from 17 to 67 years with mean of 39.9±17.4. All patients were classified according to AO (Arbeitsgemeinschaft fuer Osteosynthesefragen) classification (pelvic ring fracture) and Denis's classification. Displacements of sacral fractures were evaluated by plain CT scans for all patients. We defined displacements using the key slice in CT scans that included the first foramen in the sacrum. Five cases, including 2 with bi-lateral sacral fractures, were complicated with neurological deficits. There was one case with a neurological deficit of 7 Type B fractures (14%) and 4 cases with neurological deficits of 5 Type C fractures (80%) in the AO classification. There were 6 fractures with neurological deficits of 12 Zone II fractures (50%) and one fracture with neurological deficits of one Zone III fractures (100%) in Denis's classification. There was a significant correlation between the extent in the displacement of the sacral fractures and neurological deficits. For more than 3 mm displacements in the medial or lateral or anterior directions, neurological deficits increased significantly. In emergency medicine, it is difficult to evaluate the neurological findings of patients with impaired consciousness. Our evaluation using CT scan is valuable as a predictor of neurological deficits and for an optimal reduction in sacral fractures in patients with in impaired consciousness. (author)

Computer Navigation-aided Resection of Sacral Chordomas

Directory of Open Access Journals (Sweden)

Yong-Kun Yang

2016-01-01

Full Text Available Background: Resection of sacral chordomas is challenging. The anatomy is complex, and there are often no bony landmarks to guide the resection. Achieving adequate surgical margins is, therefore, difficult, and the recurrence rate is high. Use of computer navigation may allow optimal preoperative planning and improve precision in tumor resection. The purpose of this study was to evaluate the safety and feasibility of computer navigation-aided resection of sacral chordomas. Methods: Between 2007 and 2013, a total of 26 patients with sacral chordoma underwent computer navigation-aided surgery were included and followed for a minimum of 18 months. There were 21 primary cases and 5 recurrent cases, with a mean age of 55.8 years old (range: 35-84 years old. Tumors were located above the level of the S3 neural foramen in 23 patients and below the level of the S3 neural foramen in 3 patients. Three-dimensional images were reconstructed with a computed tomography-based navigation system combined with the magnetic resonance images using the navigation software. Tumors were resected via a posterior approach assisted by the computer navigation. Mean follow-up was 38.6 months (range: 18-84 months. Results: Mean operative time was 307 min. Mean intraoperative blood loss was 3065 ml. For computer navigation, the mean registration deviation during surgery was 1.7 mm. There were 18 wide resections, 4 marginal resections, and 4 intralesional resections. All patients were alive at the final follow-up, with 2 (7.7% exhibiting tumor recurrence. The other 24 patients were tumor-free. The mean Musculoskeletal Tumor Society Score was 27.3 (range: 19-30. Conclusions: Computer-assisted navigation can be safely applied to the resection of the sacral chordomas, allowing execution of preoperative plans, and achieving good oncological outcomes. Nevertheless, this needs to be accomplished by surgeons with adequate experience and skill.

Transcutaneous sacral neurostimulation for irritative voiding dysfunction.

Science.gov (United States)

Walsh, I K; Johnston, R S; Keane, P F

1999-01-01

Patients with irritative voiding dysfunction are often unresponsive to standard clinical treatment. We evaluated the response of such individuals to transcutaneous electrical stimulation of the third sacral nerve. 32 patients with refractory irritative voiding dysfunction (31 female and 1 male; mean age 47 years) were recruited to the study. Ambulatory transcutaneous electrical neurostimulation was applied bilaterally to the third sacral dermatomes for 1 week. Symptoms of frequency, nocturia, urgency, and bladder pain were scored by each patient throughout and up to 6 months following treatment. The mean daytime frequency was reduced from 11.3 to 7.96 (p = 0.01). Nocturia episodes were reduced from a mean of 2.6 to 1.8 (p = 0.01). Urgency and bladder pain mean symptom scores were reduced from 5.97 to 4.89 and from 1.48 to 0.64, respectively. After stopping therapy, symptoms returned to pretreatment levels within 2 weeks in 40% of the patients and within 6 months in 100%. Three patients who continued with neurostimulation remained satisfied with this treatment modality at 6 months. Transcutaneous third sacral nerve stimulation may be an effective and noninvasive ambulatory technique for the treatment of patients with refractory irritative voiding dysfunction. Following an initial response, patients may successfully apply this treatment themselves to ensure long-term relief.

Sacral root neuromodulation in the treatment of various voiding and storage problems.

Science.gov (United States)

Shaker, H; Hassouna, M M

1999-01-01

This paper reviews the use of sacral neuromodulation as a treatment modality for patients with bladder dysfunction. The dual functions of the urinary bladder are to act as a reservoir and to evacuate under voluntary control. Bladder dysfunction is a descriptive term describing the loss or the impairment of one or both of these functions. In the first part of the manuscript we describe the different components of sacral neuromodulation: the screening test known as percutaneous nerve evaluation (PNE), which involves screening patients who could potentially benefit from the therapy. Those who show a satisfactory response will have a permanent neuroprosthesis implanted. The technical aspects of both components of neuromodulation are described in detail, as well as the technical difficulties encountered. In the second part we present our long-term results in patients with sacral neuromodulation. Sacral neuromodulation is a safe and efficient therapeutic modality that helps patients with refractory voiding dysfunction restore their bladder function.

MRI findings of type II sacral agenesis: A case report and literature review

Energy Technology Data Exchange (ETDEWEB)

Lee, Sang A; Kim, Myung Soon; Kwon, Woo Cheol [Dept. of Radiology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju (Korea, Republic of)

2016-07-15

Sacral agenesis (or caudal regression syndrome) is a rare congenital anomaly involving various levels of coccygeal, sacral, and even lumbar or lower thoracic vertebral dysgenesis, as well as spinal cord abnormalities. A few cases have been previously reported in Korea, especially based upon MRI findings. We describe a case of a 4-year-old girl with partially bilateral agenesis of the sacrum (type II), and club-shaped (chisel-shaped) spinal cord disruption. We also review MRI findings of sacral agenesis, focused on classification and radiological findings.

Primary malignant bone tumour in a tropical African University ...

African Journals Online (AJOL)

Bone tumours are relatively rare tumours as compared with all other tumours. The relative frequency has not been well documented in this environment. The aim of the study was to define the frequency of primary malignant bone tumours in an African University teaching hospital in Ibadan. The medical records of 114 ...

MR myelography of sacral meningeal cysts

International Nuclear Information System (INIS)

Tsuchiya, K.; Katase, S.; Hachiya, J.

1999-01-01

Purpose: To describe the findings of sacral meningeal cysts (SMCs) on MR myelography and assess its value for the diagnosis of SMCs. Material and Methods: We evaluated the MR images and MR myelograms obtained from 10 patients with SMC. MR myelograms were obtained using a 2D or 3D single-shot fast spin-echo sequence. In 5 patients, X-ray myelograms and postmyelographic CT images were compared with the MR myelograms. Results: A total of 33 SMCs were diagnosed within the spinal canal and/or sacral foramen. MR myelograms clearly revealed each cyst as a well-defined mass showing hyperintensity (10 cysts) or isointensity (23 cysts) compared to cerebrospinal fluid. MR myelograms demonstrated SMCs better than X-ray myelograms and postmyelographic CT images in 3 of the 5 patients. Conclusion: MR myelography can be an adjunct to conventional imaging techniques when surgical treatment is indicated, because it can precisely delineate the extent of SMCs. (orig.)

Sacrality and worldmaking: new categorial perspectives

Directory of Open Access Journals (Sweden)

William E. Paden

1999-01-01

Full Text Available The category of the sacred in particular and the role of transcultural concept-formation in general have undergone an obvious crisis. For the most part, "the sacred," if not an empty label, has been linked with theologism, and transcultural concepts have been condemned for their general non-comparability and colonialist intent. The author approaches the matter of transcultural templates through an analysis of certain concepts of sacrality. With some exceptions, the discourse of sacrality has indeed been dominated by a single model, where "the sacred" became a reified noun—a substantive term for a supernatural reality, a label for the transcendent, or even an epithet for divinity, mystery, the wholly other. As such, the expression has functioned to bestow a sense of unity to the diversity of cultures, link that unity with a transcendent reality, and offer a simple way of making sense of otherwise foreign beliefs and practices by giving them a familiar, generic referent.

Sacral root neuromodulation in idiopathic nonobstructive chronic urinary retention.

Science.gov (United States)

Shaker, H S; Hassouna, M

1998-05-01

Sacral root neuromodulation is becoming a superior alternative to the standard treatment of idiopathic nonobstructive urinary retention. We report results in 20 successive patients who underwent sacral foramen implantation to restore bladder function. After an initial, thorough baseline assessment 20 patients 19.43 to 55.66 years old with idiopathic nonobstructive urinary retention underwent percutaneous nerve evaluation. Response was assessed by a detailed voiding diary. Responders underwent implantation with an S3 foramen implant, and were followed 1, 3 and 6 months postoperatively, and every 6 months thereafter. Sacral root neuromodulation restored voiding capability in these patients. Bladders were emptied with minimal post-void residual urine, which decreased from 78.3 to 5.5 to 10.2% of the total voided volume from baseline to postoperative followup. These results were reflected in uroflowmetry and pressure-flow studies, which were almost normal after implantation. Furthermore, the urinary tract infection rate decreased significantly and associated pelvic pain improved substantially. The Beck depression inventory and SF-36 quality of life questionnaire indicated some improvement but reached significance in only 1 item. In addition, cystometrography showed no significant difference after 6 months of implantation compared with baseline values. Complications were minimal and within expectations. Sacral root neuromodulation is an appealing, successful modality for nonobstructive urinary retention. Only patients who have a good response to percutaneous nerve evaluation are candidates for implantation. The high efficacy in patients who undergo implantation, relative simplicity of the procedure and low complication rate make this a treatment breakthrough in this difficult group.

Dual-dermal-barrier fashion flaps for the treatment of sacral pressure sores.

Science.gov (United States)

Hsiao, Yen-Chang; Chuang, Shiow-Shuh

2015-02-01

The sacral region is one of the most vulnerable sites for the development of pressure sores. Even when surgical reconstruction is performed, there is a high chance of recurrence. Therefore, the concept of dual-dermal-barrier fashion flaps for sacral pressure sore reconstruction was proposed. From September 2007 to June 2010, nine patients with grade IV sacral pressures were enrolled. Four patients received bilateral myocutaneous V-Y flaps, four patients received bilateral fasciocutaneous V-Y flaps, and one patient received bilateral rotation-advanced flaps for sacral pressure reconstruction. The flaps were designed based on the perforators of the superior gluteal artery in one patient's reconstructive procedure. All flaps' designs were based on dual-dermal-barrier fashion. The mean follow-up time was 16 months (range = 12-25). No recurrence was noted. Only one patient had a complication of mild dehiscence at the middle suture line, occurring 2 weeks after the reconstructive surgery. The dual-dermal fashion flaps are easily duplicated and versatile. The study has shown minimal morbidity and a reasonable outcome.

Sacral neuromodulation in the treatment of the unstable bladder.

Science.gov (United States)

Bosch, J L

1998-07-01

Sacral neuromodulation as a treatment for urge incontinence in patients with an unstable bladder is the subject of ongoing clinical studies. Although approximately 75% of the patients treated with a permanent sacral foramen electrode implant have experienced significant improvements, it is now also clear that there is an initial failure rate of about 25%. Recent studies have pointed out the importance of improved patient selection on the basis of sex differences, urodynamic parameters and psychological factors. Also, newer forms of test stimulation and permanent electrode implantation are being explored in an effort to improve on the present results.

Sacral Neuromodulation in Patients With a Cardiac Pacemaker

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Abdullah A. Gahzi

2016-09-01

Full Text Available The objective of this study was to describe our experience using sacral neuromodulation to treat urinary urgency, frequency, urge incontinence, and chronic urinary retention in patients with cardiac pacemakers. With the increasingly widespread use of InterStim for bladder function restoration, we are seeing more complex patients with multiple comorbidities, including cardiac conditions. Herein, we report 3 cases of individuals with cardiac pacemakers who underwent InterStim implantation to treat urinary conditions. This study is a case series of 3 patients with cardiac pacemakers who underwent sacral neuromodulation to treat refractory voiding dysfunction. The initial patient screening for InterStim therapy involved percutaneous nerve evaluation (PNE, in which a temporary untined lead wire was placed through the S3 foramen. Patients who did not respond to PNE proceeded to a staged implant. All patients in this study had a greater than 50% improvement of their urinary symptoms during the initial trial and underwent placement of the InterStim implantable pulse generator (IPG. Postoperative programming was done under electrocardiogram monitoring by a cardiologist. No interference was observed between the Inter-Stim IPG and the cardiac pacemaker. In this group of patients, sacral neuromodulation in the presence of a cardiac pacemaker appears to have been safe.

The effect of radiation therapy for bone metastasis in urinary organ cancer

International Nuclear Information System (INIS)

Chikazawa, Ippei; Inoue, Shinya; Nakazawa, Yusuke

2016-01-01

Bone metastasis symptoms are complications that greatly reduce the quality of life (QOL) of cancer patients. We report a retrospective study on the efficacy of radiation therapy for patients with bone metastasis in urinary organ cancer. (Subjects and methods) Subjects are comprised of 17 patients; total irradiated areas consist of 25 sites. There are 5 patients diagnosed with renal cell carcinoma, 1 patient with bladder cancer and 11 patients with prostatic cancer. All of them have undergone radiation therapy for bone metastasis in urinary organ cancer between April 2007 and March 2014 in the Department of Urology, Kanazawa Medical University. The mean age of the patients was 66.7 years old. We looked at irradiated areas, exposure dose and changes of symptom in all patients. Irradiated areas are thoracolumbar vertebrae (14 sites), cranial base (2 sites), pubic bone (1 site), ilium bone (2 sites), sacral bone (1 site), rib bone (1 site) and hip joint (1 site). The mean exposure dose of one area is 37.5 Gy (13.5-60). 19 irradiated sites which were previously reported to have sharp pain have gained improvement at 16 sites. These 16 sites have comparatively lesser pain or no pain. 8 cases in acknowledgment of walk difficulty, it was with 7 cases walking alone possibility again. This study showed that radiation therapy have significant improvement in terms of symptoms and QOL for the patients with bone metastasis in urinary organ cancer. (author)

The predictive value of the sacral base pressure test in detecting specific types of sacroiliac dysfunction

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Mitchell, Travis D.; Urli, Kristina E.; Breitenbach, Jacques; Yelverton, Chris

2007-01-01

Abstract Objective This study aimed to evaluate the validity of the sacral base pressure test in diagnosing sacroiliac joint dysfunction. It also determined the predictive powers of the test in determining which type of sacroiliac joint dysfunction was present. Methods This was a double-blind experimental study with 62 participants. The results from the sacral base pressure test were compared against a cluster of previously validated tests of sacroiliac joint dysfunction to determine its validity and predictive powers. The external rotation of the feet, occurring during the sacral base pressure test, was measured using a digital inclinometer. Results There was no statistically significant difference in the results of the sacral base pressure test between the types of sacroiliac joint dysfunction. In terms of the results of validity, the sacral base pressure test was useful in identifying positive values of sacroiliac joint dysfunction. It was fairly helpful in correctly diagnosing patients with negative test results; however, it had only a “slight” agreement with the diagnosis for κ interpretation. Conclusions In this study, the sacral base pressure test was not a valid test for determining the presence of sacroiliac joint dysfunction or the type of dysfunction present. Further research comparing the agreement of the sacral base pressure test or other sacroiliac joint dysfunction tests with a criterion standard of diagnosis is necessary. PMID:19674694

Comparison of Aorta-sacral Promontory Distance with Age and BMI in Female Patients Undergoing CT

OpenAIRE

Sneha Mary Varghese; Suresh Sukumar; Abhimanyu Pradhan

2017-01-01

Introduction: Sacral colpopexy is the gold standard procedure for pelvic organ prolapse. During sacral colpopexy, various complications such as haemorrhage can occur. Careful dissection of presacral space is essential to minimize complications. Aim: The aim of the study was to compare patient age and Body Mass Index (BMI) with Computed Tomography (CT) measured aorta-sacral promontory distance. Materials and Methods: From 172 samples data such as age and BMI of female patients aged 18 ye...

Combined Therapy for Distant Metastasis of Sacral Chordoma

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Birol Özkal

2015-01-01

Full Text Available Chordomas are known as rare primary malign tumours that have formed from primitive notochord remains. Sacral chordomas grow slowly but locally and aggressively. Chordomas are locally invasive and have low tendency to metastasis and have a poor prognosis in long-term follow-up. Metastasis may be seen in a rate of 5–40% of the chordomas. Metastasis of chordomas is common in liver, lung, lymph nodes, peritoneum, and brain. The treatment approaches, including surgery, have been discussed in the literature before. Susceptibility to radiotherapy and chemotherapy is controversial in these tumours. The success of surgical treatment affects survival directly. In this report, we will report a sacral chordoma case in which an intraperitoneal distant metastasis occurred and discuss the surgical approach.

Sacral Stress Fracture in an Amateur Badminton Player

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Yusuke Yuasa

2017-01-01

Full Text Available Sacral stress fractures are rare among athletes but have been reported most frequently in long distance runners. We report herein the first case of a sacral stress fracture in an amateur badminton player. A 16-year-old, left-handed adolescent girl, who had just started to play badminton 3 months previously, complained of acute left buttock pain when she received a shuttlecock. Magnetic resonance imaging revealed a linear lesion of the left sacrum with low signal intensity on T1- and high signal intensity on T2-weighted images, which was consistent with a stress fracture. Conservative treatment with rest relieved her symptoms. Her fracture was considered to have occurred due to repetition of an exercise that caused excessive vertical power.

Restoration of bladder function in spastic neuropathic bladder using sacral deafferentation and different techniques of neurostimulation.

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Schumacher, S; Bross, S; Scheepe, J R; Alken, P; Jünemann, K P

1999-01-01

Conventional sacral anterior root stimulation (SARS) results in simultaneous activation of both the detrusor muscle and the external urethral sphincter. We evaluated the possibilities of different neurostimulation techniques to overcome stimulation induced detrusor-sphincter-dyssynergia and to achieve a physiological voiding. The literature was reviewed on different techniques of sacral anterior root stimulation of the bladder and the significance of posterior rhizotomy in patients with supraconal spinal cord injury suffering from the loss of voluntary bladder control, detrusor hyperreflexia and sphincter spasm. The achievement of selective detrusor activation would improve current sacral neurostimulation of the bladder, including the principle of "poststimulus voiding". This is possible with the application of selective neurostimulation in techniques of anodal block, high frequency block, depolarizing prepulses and cold block. Nowadays, sacral deafferentation is a standard therapy in combination with neurostimulation of the bladder because in conclusion advantages of complete rhizotomy predominate. The combination of sacral anterior root stimulation and sacral deafferentation is a successful procedure for restoration of bladder function in patients with supraconal spinal cord injury. Anodal block technique and cryotechnique are excellent methods for selective bladder activation to avoid detrusor-sphincter-dyssynergia and thus improve stimulation induced voiding.

Sacral Nerve Stimulation for Constipation: Suboptimal Outcome and Adverse Events

DEFF Research Database (Denmark)

Maeda, Yasuko; Lundby, Lilli; Buntzen, Steen

2010-01-01

Sacral nerve stimulation is an emerging treatment for patients with severe constipation. There has been no substantial report to date on suboptimal outcomes and complications. We report our experience of more than 6 years by focusing on incidents and the management of reportable events.......Sacral nerve stimulation is an emerging treatment for patients with severe constipation. There has been no substantial report to date on suboptimal outcomes and complications. We report our experience of more than 6 years by focusing on incidents and the management of reportable events....

Cytodiagnosis of Sacral Chordoma

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Saumya Shukla

2014-12-01

Full Text Available We report the cytological findings of a sacro-coccygeal chordoma in a 53 year male diagnosed preoperatively by guided fine needle aspiration cytology. The smears shows characteristic Physalliphorous cells in a metachromatic background of myxoid material entrapping cords of cuboidal cells. Differential diagnosis in cytology include conventional and myxoid chondrosarcoma, myxoid liposarcoma, myxoid malignant fibrous histiocytoma, metastatic mucinous carcinoma and myxo-papillary ependymoma. The distinguishing features between these neoplasms are discussed. Preoperative diagnosis of chordoma permits optimum planned surgery. Keywords: chordoma; myxoid; sacral.

Sacral nerve stimulation can be an effective treatment for low anterior resection syndrome.

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Eftaiha, S M; Balachandran, B; Marecik, S J; Mellgren, A; Nordenstam, J; Melich, G; Prasad, L M; Park, J J

2017-10-01

Sacral nerve stimulation has become a preferred method for the treatment of faecal incontinence in patients who fail conservative (non-operative) therapy. In previous small studies, sacral nerve stimulation has demonstrated improvement of faecal incontinence and quality of life in a majority of patients with low anterior resection syndrome. We evaluated the efficacy of sacral nerve stimulation in the treatment of low anterior resection syndrome using a recently developed and validated low anterior resection syndrome instrument to quantify symptoms. A retrospective review of consecutive patients undergoing sacral nerve stimulation for the treatment of low anterior resection syndrome was performed. Procedures took place in the Division of Colon and Rectal Surgery at two academic tertiary medical centres. Pre- and post-treatment Cleveland Clinic Incontinence Scores and Low Anterior Resection Syndrome scores were assessed. Twelve patients (50% men) suffering from low anterior resection syndrome with a mean age of 67.8 (±10.8) years underwent sacral nerve test stimulation. Ten patients (83%) proceeded to permanent implantation. Median time from anterior resection to stimulator implant was 16 (range 5-108) months. At a median follow-up of 19.5 (range 4-42) months, there were significant improvements in Cleveland Clinic Incontinence Scores and Low Anterior Resection Syndrome scores (P syndrome and may therefore be a viable treatment option. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

Esqueleto pré-sacral e sacral dos lagartos teiêdeos (Squamata, Teiidae Pressacral and sacral skeleton of teiids lizards (Squamata, Teiidae

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Lauren Betina Veronese

1997-01-01

Full Text Available The morphology of the axial skeleton -pressacral and sacral regions - of the nine genera of Teiidae Boulenger, 1885 comprising Ameiva Meyer, 1795, Callopistes Gravenhorst, 1838, Cnemidophorus Wagler, 1830, Crocodilurus Spix, 1825, Dicrodon Duméril & Bibron, 1839, Dracaena Daudin, 1802, Kenlropyx Spix, 1825, Teius Merrem, 1820 and Tupinambis Daudin, 1803 is here analysed under a comparative approach. The study is in a generic levei, and the principal conclusions reter to differences on the total number of vertebrae and some aspects of the ribs, especially their insertion and presence.

Retention of urine and sacral paraesthesia in anogenital herpes simplex infection.

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Edis, R H

1981-01-01

Two definite and 2 probable cases of anogenital herpes simplex and sacral radiculitis are described. Symptoms were typical and consisted of paraesthesia and neuralgic pain in the perineum and legs, urinary retention and constipation occurring within several days to a week after an anogenital herpetic eruption. However, at presentation only 1 case had an obvious history of anogenital herpes simplex. Neurological signs were not striking and consisted of a reduced appreciation of light touch and pin prick over the sacral dermatomes and in 2 cases reduced anal sphincter tone. CSF examination in 3 patients showed a lymphocytosis. Bladder catheterisation was required for up to 2 weeks in 2 patients. The paraesthesia persisted for weeks to months. It should be more widely recognised that anogenital herpes simplex, with sacral radiculitis, is probably the commonest cause of acute retention of urine in young sexually active people.

Surgically Treated Symptomatic Prolapsed Lumbar and Sacral ...

African Journals Online (AJOL)

Background and Objective: There are various postulated possible causes of surgically symptomatic prolapsed intervertebral discs in the lumbar and sacral regions. They may be acting singularly or collectively. Yet, these factors, which could vary in different environments, have not been satisfactorily confirmed. The intention ...

Clinical results of a brindley procedure: sacral anterior root stimulation in combination with a rhizotomy of the dorsal roots

NARCIS (Netherlands)

Martens, F.M.J.; Heesakkers, J.P.F.A.

2011-01-01

The Brindley procedure consists of a stimulator for sacral anterior-root stimulation and a rhizotomy of the dorsal sacral roots to abolish neurogenic detrusor overactivity. Stimulation of the sacral anterior roots enables micturition, defecation, and erections. This overview discusses the technique,

Pelvic X-ray misses out on detecting sacral fractures in the elderly - Importance of CT imaging in blunt pelvic trauma.

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Schicho, Andreas; Schmidt, Stefan A; Seeber, Kevin; Olivier, Alain; Richter, Peter H; Gebhard, Florian

2016-03-01

Patients aged 75 years and older with blunt pelvic trauma are frequently seen in the ER. The standard diagnostic tool in these patients is the plain a.p.-radiograph of the pelvis. Especially lesions of the posterior pelvic ring are often missed due to e.g. bowel gas projection and enteric overlay. With a retrospective study covering these patients over a 3 year period in our level I trauma centre, we were able to evaluate the rate of missed injuries in the a.p.-radiograph whenever a corresponding CT scan was performed. Age, gender, and accompanying fractures of the pelvic ring were recorded. The intrinsic test characteristics and the performance in the population were calculated according to standard formulas. Thus, 233 consecutive patients with blunt pelvic trauma with both conventional radiographic examination and computed tomography (CT) were included. Thereof, 56 (23%) showed a sacral fracture in the CT scan. Of 233 pelvic X-ray-images taken, 227 showed no sacral fracture. 51 (21.7%) of these were false negative, yielding a sensitivity of just 10.5%. Average age of patients with sacral fractures was 85.1±6.1 years, with 88% being female. Sacral fractures were often accompanied by lesions of the anterior pelvic ring with pubic bone fractures in 75% of sacrum fracture cases. Second most concomitant fractures are found at the acetabulum (23.3%). Plain radiographic imaging is especially likely to miss out fractures of the posterior pelvic ring, which nowadays can be of therapeutic consequence. Besides the physicians experience in the ED, profound knowledge of insensitivity of plain radiographs in finding posterior pelvic ring lesions is crucial for a reliable diagnostic routine. Since the high mortality caused by prolonged immobilisation due to pelvic ring injuries, all fractures should be identified. We therefore provide a diagnostic algorithm for blunt pelvic trauma in the elderly. Copyright © 2016 Elsevier Ltd. All rights reserved.

The analysis of the effective of preserving sacral nerve root during surgical treatment of chordoma

International Nuclear Information System (INIS)

Ji Yiming; Chen Kangwu; Yang Huilin; Zhu Lifan

2010-01-01

Objective: To analyze the effective of preserving sacral nerve root during surgical treatment of sacral chordoma. Methods: This retrospective study included 30 cases of sacral chordomas. All the cases were operated with posterior approach. The blood loss and blood transfusion during operation, the drainged blood after operation were reviewed. The sphincter muscle function of bladder and bowl were observed. Results: Tremendous reduction of blood loss during surgery was found in all cases, the blood loss was 1280 ml in average, the blood transfusion was 1080 ml in average, the drainged blood after ope-ration was 650 ml. Nine patients whose sacral nerve roots had been reserved bilaterally at and above S 3 level, the sphincter muscle function of bladder and bowl was good, whereas the function of sphincter muscle impaired in the other 21 patients and in one case colostomy and ureterocutaneostomy were used. Conclusion: Preoperative arterial embolization is effective method and can lead to excellent results. Even if the tumor is relatively huge and the upper resection margin is as high as at S 1 or S 2 level, the tumor can be removed successfully by posterior approach. Sacral nerve should be preserved as possible. (authors)

Relief of fecal incontinence by sacral nerve stimulation linked to focal brain activation

DEFF Research Database (Denmark)

Lundby, Lilli; Møller, Arne; Buntzen, Steen

2011-01-01

This study aimed to test the hypothesis that sacral nerve stimulation affects afferent vagal projections to the central nervous system associated with frontal cortex activation in patients with fecal incontinence.......This study aimed to test the hypothesis that sacral nerve stimulation affects afferent vagal projections to the central nervous system associated with frontal cortex activation in patients with fecal incontinence....

Treatment of aneurysmal bone cysts of the pelvis and sacrum.

Science.gov (United States)

Papagelopoulos, P J; Choudhury, S N; Frassica, F J; Bond, J R; Unni, K K; Sim, F H

2001-11-01

Aneurysmal bone cysts are benign, non-neoplastic, highly vascular bone lesions. The purpose of this study was to describe the prevalence, the clinical presentation, and the recurrence rate of aneurysmal bone cysts of the pelvis and sacrum and to examine the diagnostic and therapeutic options and prognosis for patients with this condition. Forty consecutive patients with an aneurysmal bone cyst of the pelvis and/or sacrum were treated from 1921 to 1996. Their medical records and radiographic and imaging studies were reviewed, and histological sections from the cysts were examined. Seventeen lesions were iliosacral, sixteen were acetabular, and seven were ischiopubic. Seven involved the hip joint, and two involved the sacroiliac joint. All twelve sacral lesions extended to more than one sacral segment and were associated with neurological signs and symptoms. Destructive acetabular lesions were associated with pathological fracture in five patients and with medial migration of the femoral head, hip subluxation, and hip dislocation in one patient each. The mean duration of follow-up was thirteen years (range, three to fifty-three years). Thirty-five patients who were initially treated for a primary lesion had surgical treatment (twenty-one had excision-curettage and fourteen had intralesional excision); two patients also had adjuvant radiation therapy. Of the thirty-five patients, five (14%) had a local recurrence noted less than eighteen months after the operation. Of five patients initially treated for a recurrent lesion, one had a local recurrence. At the latest follow-up examination, all forty patients were disease-free and twenty-eight (70%) were asymptomatic. There were two deep infections. Aneurysmal bone cysts of the pelvis and sacrum are usually aggressive lesions associated with substantial bone destruction, pathological fractures, and local recurrence. Current management recommendations include preoperative selective arterial embolization, excision

Effectiveness and Value of Prophylactic 5-Layer Foam Sacral Dressings to Prevent Hospital-Acquired Pressure Injuries in Acute Care Hospitals: An Observational Cohort Study.

Science.gov (United States)

Padula, William V

The purpose of this study was to examine the effectiveness and value of prophylactic 5-layer foam sacral dressings to prevent hospital-acquired pressure injury rates in acute care settings. Retrospective observational cohort. We reviewed records of adult patients 18 years or older who were hospitalized at least 5 days across 38 acute care hospitals of the University Health System Consortium (UHC) and had a pressure injury as identified by Patient Safety Indicator #3 (PSI-03). All facilities are located in the United States. We collected longitudinal data pertaining to prophylactic 5-layer foam sacral dressings purchased by hospital-quarter for 38 academic medical centers between 2010 and 2015. Longitudinal data on acute care, hospital-level patient outcomes (eg, admissions and PSI-03 and pressure injury rate) were queried through the UHC clinical database/resource manager from the Johns Hopkins Medicine portal. Data on volumes of dressings purchased per UHC hospital were merged with UHC data. Mixed-effects negative binomial regression was used to test the longitudinal association of prophylactic foam sacral dressings on pressure injury rates, adjusted for hospital case-mix and Medicare payments rules. Significant pressure injury rate reductions in US acute care hospitals between 2010 and 2015 were associated with the adoption of prophylactic 5-layer foam sacral dressings within a prevention protocol (-1.0 cases/quarter; P = .002) and changes to Medicare payment rules in 2014 (-1.13 cases/quarter; P = .035). Prophylactic 5-layer foam sacral dressings are an effective component of a pressure injury prevention protocol. Hospitals adopting these technologies should expect good value for use of these products.

Giant Sacral Chondrosarcoma in an Elderly Male : A Case Report

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HZ Chan

2014-03-01

Full Text Available Primary sacral tumours are rare, therefore experience of managing their associated complications are very limited. Effective surgical treatment of pelvic chondrosarcoma remains a major challenge for orthopaedic surgeons, due to the complex anatomic structure of the pelvis, the lack of defined compartment borders, the close vicinity to vital structures, and the risk of jeopardizing pelvic structural stability. We report a rare case of a giant sacral chondrosarcoma (100cm x 80cm in an elderly male who successfully underwent tumour resection with good functional outcome and recovery. Long term follow up is essential in view of the possibility of local tumour recurrence.

Sacral Ewing's Sarcoma and Challenges in it's Diagnosis on MRI

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Albert D'Souza

2009-01-01

Full Text Available A 15-yr old boy presented with low backache for 4 months associated with weakness of left lower limb. MRI of lumbosacral spine showed a sacral lesion with intraspinal and presacral soft tissue extension with neural compression. A diagnosis of tuberculosis was considered in the view of high prevalence in this part of the world, however biopsy revealed Ewing's sarcoma. Ewing's tumor of sacrum is rare, but should be suspected in low backache in children. Differential diagnosis for a sacral lesion includes tuberculosis, pyogenic osteomyelitis, lymphoma, chordoma, osteosarcoma and Ewing's sarcoma. MRI is sensitive in detecting these lesions but is nonspecific requiring histopathological examination for confirmation.

Specific Changes in Brain Activity During Urgency in Women with Overactive Bladder after Successful Sacral Neuromodulation: An fMRI Study.

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Weissbart, Steven J; Bhavsar, Rupal; Rao, Hengyi; Wein, Alan J; Detre, John A; Arya, Lily A; Smith, Ariana L

2018-04-06

The mechanism of sacral neuromodulation is poorly understood. We compared brain activity during urgency before and after sacral neuromodulation in women with overactive bladder and according to response to treatment. Women with refractory overactive bladder who elected for sacral neuromodulation were invited to undergo a functional magnetic resonance imaging exam before and after treatment. During the imaging exams, the bladder was filled until urgency was experienced. Regions of interest were identified a priori, and brain activity in these regions of interest was compared before and after treatment as well as according to treatment response. A whole brain exploratory analysis with an uncorrected voxel level threshold of pbrain regions that changed after sacral neuromodulation. Among 12 women who underwent a pretreatment functional magnetic resonance imaging exam, seven were successfully treated with sacral neuromodulation and underwent a posttreatment exam. After sacral neuromodulation, brain activity decreased in the left anterior cingulate cortex, bilateral insula, left dorsolateral prefrontal cortex and bilateral orbitofrontal cortex (all pbrain regions with increased activity after sacral neuromodulation. Pretreatment brain activity levels in the bilateral anterior cingulate cortex, right insula, bilateral dorsolateral prefrontal cortex, right orbitofrontal cortex, right supplementary motor area, and right sensorimotor cortex were higher in women who underwent successful treatment (all pBrain activity during urgency changes after successful sacral neuromodulation. Sacral neuromodulation may be more effective in women with higher levels of pretreatment brain activity during urgency. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

[PELVIS/SACRAL syndrome with livedoid haemangioma and amniotic band].

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Bourrat, E; Lemarchand-Venencie, F; Jacquemont, M-L; El Ghoneimi, A; Wassef, M; Leger, J; Morel, P

2008-12-01

PELVIS or SACRAL syndrome denotes the association of local haemangioma and malformation in the pelvic region. In this paper, we report a case noteworthy on account of the initially livedoid appearance of the haemangioma as well as associated amniotic banding of an upper limb. A newborn male infant underwent left colostomy on the day of birth due to anal imperforation and anomalies of the external genital organs with sexual ambiguity. Examination of the skin and appendages revealed poorly delineated hypopigmentation in the sacrolumbar region and a fibrous groove around the right arm characteristic of amniotic band syndrome. Sacrolumbar and pelvic MRI scans revealed deviation towards the left of the last three sacral vertebrae with no medullary anomalies. Retrograde cystography showed a recto-uretral fistula. Progression of the infant's condition was marked by the appearance during the first month of a flat, violaceous, angiomatous, livedoid lesion in the middle of the buttocks and the perineum and a linear lesion on the rear aspect of the right lower limb. The skin biopsy of this lesion revealed a single capillary lobule at the dermal-hypodermal junction of non-specific appearance but with marked Glut1 expression by endothelial cells highly evocative of infantile haemangioma. Segmented haemangiomas are commonly associated with extracutaneous abnormalities. By analogy with PHACE syndrome, defined as association of segmented facial haemangioma with cerebral, ocular and cardio-aortic abnormalities, PELVIS/SACRAL syndrome denotes the association of segmented haemangioma of the loins (sacrolumbar region, buttocks or perineum=napkin haemangioma) with spinal dysraphia affecting the sacrolumbar spine, the terminal medullary cone, the genitourinary organs and the anal region to different degrees. Diagnosis of haemangioma associated with PELVIS/SACRAL syndrome may be delayed or complicated due to the macular, telangiectasic or livedoid appearance commonly seen. To our

Rectal ulcer in a patient with VZV sacral meningoradiculitis (Elsberg syndrome).

Science.gov (United States)

Matsumoto, Hideyuki; Shimizu, Takahiro; Tokushige, Shin-ichi; Mizuno, Hideo; Igeta, Yukifusa; Hashida, Hideji

2012-01-01

This report describes the case of a 55-year-old woman with varicella-zoster virus (VZV) sacral meningoradiculitis (Elsberg syndrome) who presented with herpes zoster in the left S2 dermatome area, urinary retention, and constipation. Lumbar magnetic resonance imaging showed the left sacral nerve root swelling with enhancement. Thereafter, she suddenly showed massive hematochezia and hemorrhagic shock because of a rectal ulcer. To elucidate the relation between Elsberg syndrome and rectal ulcer, accumulation of similar cases is necessary. To avoid severe complications, attention must be devoted to the possibility of rectal bleeding in the early stage of Elsberg syndrome.

Surface localization of sacral foramina for neuromodulation of bladder function. An anatomical study.

Science.gov (United States)

Hasan, S T; Shanahan, D A; Pridie, A K; Neal, D E

1996-01-01

A method is described for percutaneous localization of the sacral foramina, for neuromodulation of bladder function. We carried out an anatomical study of 5 male and 5 female human cadaver pelves. Using the described surface markings, needles were placed percutaneously into all sacral foramina from nine different angles. Paths of needle entry were studied by subsequent dissection. We observed that although it was possible to enter any sacral foramen at a wide range of insertion angles, the incidence of nerve root/vascular penetration increased with increasing angle of needle entry. Also, the incidence of nerve root penetration was higher with the medial approach compared with lateral entry. The insertion of a needle into the S1 foramen was associated with a higher incidence of nerve root penetration and presents a potential for arterial haemorrhage. On the other hand the smaller S3 and S4 nerve roots were surrounded by venous plexuses, presenting a potential source of venous haemorrhage during procedures. Our study suggests a new method for identifying the surface markings of sacral foramina and it describes the paths of inserted needles into the respective foramina. In addition, it has highlighted some potential risk factors secondary to needle insertion.

Sacral electrical neuromodulation as an alternative treatment option for lower urinary tract dysfunction.

Science.gov (United States)

Grünewald, Volker; Höfner, Klaus; Thon, Walter F.; Kuczyk, Markus A.; Jonas, Udo

1999-01-01

Temporary electrical stimulation using anal or vaginal electrodes and an external pulse generator has been a treatment modality for urinary urge incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced chronic electrical stimulation of the sacral spinal nerves using a permanently implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refractory to conservative treatment. At our department chronic unilateral electrical stimulation of the S3 sacral spinal nerve has been used for treatment of vesi-courethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting symptomatic improvement by more than 50 % could be achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %). Implants offer a sustained therapeutic effect to treatment responders, which is not achieved by temporary neuromodulation. Chronic neuromodulation should be predominantly considered in patients with urinary retention. Furthermore in patients with motor urge incontinence, refusing temporary techniques or in those requiring too much effort to achieve a sustained clinical effect. Despite high initial costs chronic sacral neuromodulation is an economically reasonable treatment option in the long run, when comparing it to the more invasive remaining therapeutic alternatives.

Pneumorrhachis Secondary From Sacral Decubitus Ulcer

OpenAIRE

Moayedi, Siamak; Babin, Lisa

2016-01-01

An elderly woman with a chronic decubitus sacral ulcer presented to the emergency department with sepsis. A computed tomography of her abdomen showed diffuse gas extending throughout the thoracolumbar spinal canal. Pneumorrhachis is a rare radiographic finding defined as gas within the spinal canal. There are many causes of pneumorrhachis ranging from trauma to infection. In this case the pneumorrhachis was caused by direct spread of gas-forming organisms from vertebral osteomyelitis. Emergen...

Critical Anatomy Relative to the Sacral Suture: A Postoperative Imaging Study After Robotic Sacrocolpopexy.

Science.gov (United States)

Crisp, Catrina C; Herfel, Charles V; Pauls, Rachel N; Westermann, Lauren B; Kleeman, Steven D

2016-01-01

This study aimed to characterize pertinent anatomy relative to the sacral suture placed at time of robotic sacrocolpopexy using postoperative computed tomography and magnetic resonance imaging. A vascular clip was placed at the base of the sacral suture at the time of robotic sacrocolpopexy. Six weeks postoperatively, subjects returned for a computed tomography scan and magnetic resonance imaging. Ten subjects completed the study. The middle sacral artery and vein coursed midline or to the left of midline in all the subjects. The left common iliac vein was an average of 26 mm from the sacral suture. To the right of the suture, the right common iliac artery was 18 mm away. Following the right common iliac artery to its bifurcation, the right internal iliac was on average 10 mm from the suture. The bifurcations of the inferior vena cava and the aorta were 33 mm and 54 mm further cephalad, respectively.The right ureter, on average, was 18 mm from the suture. The thickness of the anterior longitudinal ligament was 2 mm.The mean angle of descent of the sacrum was 70 degrees. Lastly, we found that 70% of the time, a vertebral body was directly below the suture; the disc was noted in 30%. We describe critical anatomy surrounding the sacral suture placed during robotic sacrocolpopexy. Proximity of both vascular and urologic structures within 10 to 18 mm, as well as anterior ligament thickness of only 2 mm highlights the importance of adequate exposure, careful dissection, and surgeon expertise.

Jogger's fracture and other stress fractures of the lumbo-sacral spine

International Nuclear Information System (INIS)

Abel, M.S.

1985-01-01

The posterior rings of the lower lumbo-sacral vertebrae are subject to stress fractures at any part - pedicle, pars, or lamina. The site of fracture is apparently determined by the axis of weight bearing. The three illustrative clinical examples cited include a jogger with a laminar fracture, a ballet dancer with pedicle fractures, and a nine-year-old boy with fractures of pars and lamina. Chronic low back pain is the typical complaint with stress fractures of the lower lumbo-sacral spine. Special imaging techniques are usually needed to demonstrate these lesions, including vertebral arch views, multi-directional tomography, and computed tomography (CT). (orig.)

Sacral orientation and spondylolysis.

Science.gov (United States)

Peleg, Smadar; Dar, Gali; Steinberg, Nili; Masharawi, Youssef; Been, Ella; Abbas, Janan; Hershkovitz, Israel

2009-12-01

A descriptive study (based on skeletal material) was designed to measure sacral anatomic orientation (SAO) in individuals with and without spondylolysis. To test whether a relationship between SAO and spondylolysis exists. Spondylolysis is a stress fracture in the pars interarticularis (mainly of L5). The natural history of the phenomenon has been debated for years with opinions divided, i.e., is it a developmental condition or a stress fracture phenomenon. There is some evidence to suggest that sacral orientation can be a "key player" in revealing the etiology of spondylolysis. The pelvis was anatomically reconstructed and SAO was measured as the angle created between the intersection of a line running parallel to the superior surface of the sacrum and a line running between the anterior superior iliac spine (ASIS) and the anterior-superior edge of the symphysis pubis (PUBIS).SAO was measured in 99 adult males with spondylolysis and 125 adult males without spondylolysis. The difference between the groups was tested using an unpaired t test. Spondylolysis prevalence is significantly higher in African-Americans compared to European-Americans: 5.4% versus 2.04% in males (P < 0.001) and 2.31% versus 0.4%, P < 0.001 in females. SAO was significantly lower in the spondylolytic group (44.07 degrees +/- 11.46 degrees) compared to the control group (51.07 degrees +/- 8.46 degrees, P < 0.001). A more horizontally oriented sacrum leads to direct impingement on L5 pars interarticularis by both L4 inferior articular facet superiorly and S1 superior articular facet inferiorly. Repetitive stress due to standing (daily activities) or sitting increases the "pincer effect" on this area, and eventually may lead to incomplete synostosis of the neural arch.

Effect of surgical approach on physical activity and pain control after sacral colpopexy.

Science.gov (United States)

Collins, Sarah A; Tulikangas, Paul K; O'Sullivan, David M

2012-05-01

We sought to compare recovery of activity and pain control after robotic (ROB) vs abdominal (ABD) sacral colpopexy. Women undergoing ROB and ABD sacral colpopexy wore accelerometers for 7 days preoperatively and the first 10 days postoperatively. They completed postoperative pain diaries and Short Form-36 questionnaires before and after surgery. At 5 days postoperatively, none of the 14 subjects in the ABD group and 4 of 28 (14.3%) in the ROB group achieved 50% total baseline activity counts (P = .283). At 10 days, 5 of 14 (35.7%) in the ABD group and 8 of 26 (30.8%) in the ROB group (P = .972) achieved 50%. Postoperative pain was similar in both groups. Short Form-36 vitality scores were lower (P = .017) after surgery in the ABD group, but not in the ROB group. Women undergoing ROB vs ABD sacral colpopexy do not recover physical activity faster, and pain control is not improved. Copyright © 2012 Mosby, Inc. All rights reserved.

Neurological presentations, imaging, and associated anomalies in 50 patients with sacral agenesis.

Science.gov (United States)

Emami-Naeini, Parisa; Rahbar, Ziba; Nejat, Farideh; Kajbafzadeh, Abdolmohammad; El Khashab, Mostafa

2010-10-01

Sacral agenesis is an uncommon congenital disorder that involves multiple organs. We studied neurological manifestations of the disease, common associated disorders, and their relation with extent of bony malformation. We investigated neurological manifestations of 50 patients with sacral agenesis. Patients were evaluated for previous procedures, ambulation, limb abnormalities, vertebral alignment, recurrent urinary tract infection, urinary incontinence, dribbling, dimple, lower extremities weakness, myelomeningocele (MMC), and lipomyelomenangocele. Weakness of lower extremities was seen in 37 (74%) patients. Concurrent weakness of proximal and distal muscles of the lower limb was statistically associated with a type of bony aplasia (P = .001). However, paraplegia was seen in only 2 of 44 children over the age of 1, and the rest could walk. Myelodysplastic syndromes were seen in 21 patients. Sacral agenesis is diagnosed in children with concomitant MMC at younger ages and reveals more severe symptoms. Progression of neurological disorders was seen in 19 patients, in all of whom MRI showed tethering of the spinal cord. Urinary disorders including diurnal urinary incontinence (in 30 of 35 children over age 4) and recurrent urinary tract infections (in 37) were also common. Imperforate anus was seen in 11 patients. Twelve children over age 4 reported fecal incontinence, a problem that had statistically significant association with imperforate anus (P = .013). Different disorders can concurrently affect patients with sacral agenesis that may have profound impressions on patients and their families. Early diagnosis, thorough evaluation, and proper intervention are of utmost importance as they can prevent or lessen future complications.

National trends in the usage and success of sacral nerve test stimulation.

Science.gov (United States)

Cameron, Anne P; Anger, Jennifer T; Madison, Rodger; Saigal, Christopher S; Clemens, J Quentin

2011-03-01

Little is known about outcomes of sacral neuromodulation in the general community, with published reports to date limited to case series or randomized, controlled trials. The goal of this analysis was to identify the national sacral neuromodulation test phase success rate and patient factors that contribute to success. Medical claims data were obtained from a 5% sample of Medicare beneficiaries (1997 to 2007) and from employees of 25 large (Fortune 500) companies (Ingenix®, 2002 to 2007). Using billing codes for the sacral neuromodulation procedure, success was defined as progressing from test phase (percutaneous or staged) to battery implantation. The rate of success was compared based on age, race, gender and diagnosis. In the Medicare sample 358 patients received percutaneous test stimulation and 1,132 underwent 2-stage lead placement, of whom 45.8% and 35.4%, respectively, underwent subsequent battery implantation. In the privately insured sample there were 266 percutaneous procedures and 794, 2-stage procedures. Percutaneous procedures were followed by battery placement in 24.1% of cases, whereas 50.9% of staged procedures resulted in battery implantation. Gender was the only consistent predictor of success, with female patients demonstrating higher success rates in each data set. The sacral neuromodulation success rates in these data sets are inferior to those published in case series and small randomized, controlled trials. Women had significantly better results than men and privately insured individuals had better results than those with Medicare, indicating a potential age effect. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

The Termination Level of the Dural Sac Relevant to Caudal Epidural Block in Lumbosacral Transitional Vertebrae: A Comparison between Sacralization and Lumbarization Groups.

Science.gov (United States)

Jeon, Ji Young; Jeong, Yu Mi; Lee, Sheen-Woo; Kim, Jeong Ho; Choi, Hye-Young; Ahn, Yong

2018-01-01

Lumbosacral transitional vertebrae (LSTV) are a relatively common variant and have been considered as one of the reasons for back pain. It is not unusual for clinicians to encounter patients with LSTV who require caudal epidural block (CEB) for pain management. We investigated the termination level of the dural sac (DS) and anatomical features of the lumbosacral region relevant to CEB in patients with LSTV and compared these findings between sacralization and lumbarization groups. A retrospective evaluation. A university hospital with inpatient and outpatient LSTV cases presenting low back pain. Four hundred ninety-four LSTV patients were included and categorized into sacralization (n = 201) or lumbarization groups (n = 293). Magnetic resonance imaging (MRI) of all of the LSTV patients were reviewed to determine the level of DS termination, the shortest distance between the apex of the sacral hiatus and DS, and the presence and the caudal level of sacral perineural cysts. Each lumbosacral vertebra column was divided into 3 equal portions (upper, middle, and lower thirds). The MRI findings in both of the groups were compared and analyzed. The distribution frequency of the levels of DS termination demonstrated a significant difference between the 2 groups. The mean caudal DS level in the lumbarization group was significantly lower than the sacralization group (lower third of the S2 [131 {44.7%} of 293 patients] vs. lower third of the S1 [78 {38.8%} of 201 patients]). The DS terminated at the S3 in more than 19% of the lumbarization group, whereas in only one case of the sacralization group. Although the incidence of perineural cysts was not significantly different between the 2 groups, the mean level of caudal margin of perineural cysts in the lumbarization group was significantly lower than the sacralization group (middle third of the S3 [10 {35.7%} of 28 cases] vs. middle third of the S2 [11 {44%} of 25 cases]). This study reveals several limitations including the

Sacral insufficiency fractures: an easily overlooked cause of back pain in the ED.

LENUS (Irish Health Repository)

Galbraith, John G

2011-03-01

Sacral insufficiency fractures are an important and treatable cause of severe back pain. Despite publication of several case reports since its original description in 1982, awareness of these injuries remains inadequate in emergency medicine. Most patients are elderly women presenting with intractable lower back pain. Postmenopausal osteoporosis is the most significant risk factor. Marked sacral tenderness is common. Neurologic impairment is rarely detectable. Routine radiography of the spine and pelvis is usually inconclusive. Computed tomography remains the diagnostic modality of choice. Treatment is usually conservative.

Acute urinary retention attributable to sacral herpes zoster.

Science.gov (United States)

Acheson, J; Mudd, D

2004-11-01

Acute urinary retention in women is uncommon. A 63 year old woman presented with suprapubic pain, a palpable bladder, and multiple grouped vesicles on the right buttock. Catheterisation showed a residual of 2000 ml. A case is reported of acute urinary retention secondary to herpes zoster infection of the sacral nerves (S2-4).

Sacrococcygeal chordoma: increased 99mTc methylene diphosphonate uptake on single photon emission computed tomography/computed tomography bone scintigraphy

International Nuclear Information System (INIS)

Kamaleshwaran, Koramadai Karuppuswamy; Bhattacharya, Anish; Harisankar, Chidambaram Natarajan Balasubramaniam; Mittal, Bhagwant Rai; Goni, Vijay

2012-01-01

Chordoma is a malignant tumor arising from the remnants of the notochord, and is the most frequent primitive tumor of the sacrum. While most sacral tumors show increased concentration of bone-seeking radiopharmaceuticals, chordomas usually exhibit decreased uptake. The authors present an image of a sacrococcygeal chordoma with osteolysis and increased uptake of 99m Tc methylene diphosphonate on planar and single photon emission computed tomography/computed tomography bone scintigraphy. (author)

Prevalence of sacral dysmorphia in a prospective trauma population: Implications for a "safe" surgical corridor for sacro-iliac screw placement

Directory of Open Access Journals (Sweden)

Newman Justin T

2011-05-01

Full Text Available Abstract Background Percutaneous sacro-iliac (SI screw fixation represents a widely used technique in the management of unstable posterior pelvic ring injuries and sacral fractures. The misplacement of SI-screws under fluoroscopic guidance represents a critical complication for these patients. This study was designed to determine the prevalence of sacral dysmorphia and the radiographic anatomy of surgical S1 and S2 corridors in a representative trauma population. Methods Prospective observational cohort study on a consecutive series of 344 skeletally mature trauma patients of both genders enrolled between January 1, 2007, to September 30, 2007, at a single academic level 1 trauma center. Inclusion criteria included a pelvic CT scan as part of the initial diagnostic trauma work-up. The prevalence of sacral dysmorphia was determined by plain radiographic pelvic films and CT scan analysis. The anatomy of sacral corridors was analyzed on 3 mm reconstruction sections derived from multislice CT scan, in the axial, coronal, and sagittal plane. "Safe" potential surgical corridors at S1 and S2 were calculated based on these measurements. Results Radiographic evidence of sacral dysmorphia was detected in 49 patients (14.5%. The prevalence of sacral dysmorphia was not significantly different between male and female patients (12.2% vs. 19.2%; P = 0.069. In contrast, significant gender-related differences were detected with regard to radiographic analysis of surgical corridors for SI-screw placement, with female trauma patients (n = 99 having significantly narrower corridors at S1 and S2 in all evaluated planes (axial, coronal, sagittal, compared to male counterparts (n = 245; P P = 0.06, implying S2 as a safe surgical corridor of choice in patients with sacral dysmorphia. Conclusions These findings emphasize a high prevalence of sacral dysmorphia in a representative trauma population and imply a higher risk of SI-screw misplacement in female patients

Subarachnoid and basal cistern navigation through the sacral hiatus with guide wire assistance.

Science.gov (United States)

Layer, Lauren; Riascos, Roy; Firouzbakht, Farhood; Amole, Adewumi; Von Ritschl, Rudiger; Dipatre, Pier; Cuellar, Hugo

2011-07-01

Intraspinal navigation with catheters and fiberscopes has shown feasible results for diagnosis and treatment of intraspinal and intracranial lesions. The most common approach, lumbar puncture, has allowed access to the spinal cord, however, coming with the difficulties of fiberscope damage and decreased torque for guidance. Our objective in this study is to allow an alternate access, the sacral hiatus, with guide wire assistance into the subarachnoid and intracranial structures, while easing the angle of entry and increasing torque. We advanced catheters with guide wire and fluoroscopy assistance into the sacral hiatus of three cadavers. After entry, the thecal sac was punctured and the catheter with guide wire was advanced rostrally until positioned in the basal cisterns of the brain. We confirmed catheter placement with contrast injection, autopsy, and dissection. In our study, the sacral hiatus was easily accessed, but resistance was found when attempting to puncture the thecal sac. The advancement of the catheter with guide wire assistance glided easily rostrally until some mild resistance was discovered at entry into the foramen magnum. With redirection, all catheters passed with ease into the basal cisterns. Positioning was confirmed with contrast injection with fluoroscopy evidence, autopsy, and dissection. There was no macroscopic or microscopic evidence of damage to the spinal roots, spinal cord, or cranial nerves. The sacral hiatus with guide wire assistance is an accessible conduit for uncomplicated entry into the subarachnoid and basal cistern space without damaging surrounding structures.

Postoperative Issues of Sacral Nerve Stimulation for Fecal Incontinence and Constipation: A Systematic Literature Review and Treatment Guideline

DEFF Research Database (Denmark)

Maeda, Yasuko; Matzel, Klaus; Lundby, Lilli

2011-01-01

BACKGROUND: There is a lack of knowledge on the incidence and management of suboptimal therapeutic effect and the complications associated with sacral nerve stimulation for fecal incontinence and constipation. OBJECTIVE: This study aimed to review current literature on postoperative issues...... and to propose a treatment algorithm. DATA SOURCE: PubMed, MEDLINE, and EMBASE were searched using the keywords “sacral nerve stimulation,” “sacral neuromodulation,” “fecal incontinence,” and “constipation” for English-language articles published from January 1980 to August 2010. A further search was conducted...

Prevalence of sacral dysmorphia in a prospective trauma population: Implications for a "safe" surgical corridor for sacro-iliac screw placement.

Science.gov (United States)

Hasenboehler, Erik A; Stahel, Philip F; Williams, Allison; Smith, Wade R; Newman, Justin T; Symonds, David L; Morgan, Steven J

2011-05-10

Percutaneous sacro-iliac (SI) screw fixation represents a widely used technique in the management of unstable posterior pelvic ring injuries and sacral fractures. The misplacement of SI-screws under fluoroscopic guidance represents a critical complication for these patients. This study was designed to determine the prevalence of sacral dysmorphia and the radiographic anatomy of surgical S1 and S2 corridors in a representative trauma population. Prospective observational cohort study on a consecutive series of 344 skeletally mature trauma patients of both genders enrolled between January 1, 2007, to September 30, 2007, at a single academic level 1 trauma center. Inclusion criteria included a pelvic CT scan as part of the initial diagnostic trauma work-up. The prevalence of sacral dysmorphia was determined by plain radiographic pelvic films and CT scan analysis. The anatomy of sacral corridors was analyzed on 3 mm reconstruction sections derived from multislice CT scan, in the axial, coronal, and sagittal plane. "Safe" potential surgical corridors at S1 and S2 were calculated based on these measurements. Radiographic evidence of sacral dysmorphia was detected in 49 patients (14.5%). The prevalence of sacral dysmorphia was not significantly different between male and female patients (12.2% vs. 19.2%; P = 0.069). In contrast, significant gender-related differences were detected with regard to radiographic analysis of surgical corridors for SI-screw placement, with female trauma patients (n = 99) having significantly narrower corridors at S1 and S2 in all evaluated planes (axial, coronal, sagittal), compared to male counterparts (n = 245; P dysmorphia. These findings emphasize a high prevalence of sacral dysmorphia in a representative trauma population and imply a higher risk of SI-screw misplacement in female patients. Preoperative planning for percutaneous SI-screw fixation for unstable pelvic and sacral fractures must include a detailed CT scan analysis to determine

Evaluation of Partial Cut-out of Sacroiliac Screws From the Sacral Ala Slope via Pelvic Inlet and Outlet View.

Science.gov (United States)

Zhang, Jingwei; Hamilton, Ryan; Li, Ming; Ebraheim, Nabil A; He, Xianfeng; Liu, Jiayong; Zhu, Limei

2015-12-01

An anatomic and radiographic study of placement of sacroiliac screws. The aim of this study was to quantitatively assess the risk of partial cut-out of sacroiliac screws from the sacral ala slope via inlet and outlet view. The partial cut-out of sacroiliac screws from the superior surface of sacral ala can jeopardize the L5 nerve root, which is difficult to identify on the pelvic inlet and outlet views. Computed tomography images of 60 patients without pelvic ring deformity or injury were used to measure the width (on inlet view) and height (on outlet view) of the sacral ala. The angle of the sacral ala slope was measured on lateral view. According to the measured parameters, the theoretical safe trajectories of screw placement were calculated using inverse trigonometric functions. Under fluoroscopic guidance, a sacroiliac screw was placed close to the midline on both inlet and outlet views, including posterosuperior, posteroinferior, anterosuperior, and anteroinferior regions to the midline. The incidence of screw partial cut-out from the superior surface of sacral ala was identified. The measured widths and heights of the sacral alas were 28.1 ± 2.8 and 29.8 ± 3.1 mm, respectively. The average angle between the superior aspect of the S1 vertebral body and the superior aspect of the sacral ala was 37.2 ± 2.5 degrees. The rate of partial cut-out of the screws from the superior surface of sacral ala slope was 12.5% (5/40) in posterosuperior, 0% (0/40) in posteroinferior, 70% (28/40) in anterosuperior, and 20% (8/40) in anteroinferior. To avoid the risk of partial cut-out from sacroiliac screw placement, more precise description should be added to the conventional description: the sacroiliac screws should be placed at the inferior half portion on outlet view and at the posterior half portion on inlet view. 4.

Sacral myeloradiculitis complicating genital herpes in a HIV-infected patient.

Science.gov (United States)

Corral, I; Quereda, C; Navas, E; Pérez-Elias, M J; Jover, F; Moreno, S

2005-02-01

Myeloradiculitis is a rare neurological complication of herpes simplex type 2 (HSV-2) infection, frequently associated with a fatal outcome. Among patients with HIV infection, HSV-2 myeloradiculitis has occasionally been reported, always associated with advanced immunosuppression and AIDS. We report a patient with HIV infection but no history of previous opportunistic infections, who developed sacral myeloradiculitis immediately after an episode of genital herpes. Magnetic resonance imaging with gadolinium showed necrotizing myelitis in the conus medullaris and enhancement of sacral roots. CD4 lymphocyte count was 530/mm3. Other possible causes of myeloradiculitis in HIV-infected patients were appropriately excluded. Acyclovir therapy resulted in partial clinical improvement. This report shows that myeloradiculitis as a complication of genital herpes may occur in the early stages of HIV infection and may have a favourable outcome with antiviral treatment.

Sacral pressure sore reconstruction – the pedicled superior gluteal ...

African Journals Online (AJOL)

Pressure sore reconstruction has always been challenging. Immobile patients are prone to develop pressure sores from unre- lieved pressure on tissue over the sacral area, with shear, friction, moisture and malnutrition as contributing factors. Up to one-third of immobilised patients in long-term care facilities will develop.

The Unresolved Case of Sacral Chordoma: From Misdiagnosis to Challenging Surgery and Medical Therapy Resistance

Science.gov (United States)

Garofalo, Fabio; Christoforidis, Dimitrios; di Summa, Pietro G.; Gay, Béatrice; Cherix, Stéphane; Raffoul, Wassim; Matter, Maurice

2014-01-01

Purpose A sacral chordoma is a rare, slow-growing, primary bone tumor, arising from embryonic notochordal remnants. Radical surgery is the only hope for cure. The aim of our present study is to analyse our experience with the challenging treatment of this rare tumor, to review current treatment modalities and to assess the outcome based on R status. Methods Eight patients were treated in our institution between 2001 and 2011. All patients were discussed by a multidisciplinary tumor board, and an en bloc surgical resection by posterior perineal access only or by combined anterior/posterior accesses was planned based on tumor extension. Results Seven patients underwent radical surgery, and one was treated by using local cryotherapy alone due to low performance status. Three misdiagnosed patients had primary surgery at another hospital with R1 margins. Reresection margins in our institution were R1 in two and R0 in one, and all three recurred. Four patients were primarily operated on at our institution and had en bloc surgery with R0 resection margins. One had local recurrence after 18 months. The overall morbidity rate was 86% (6/7 patients) and was mostly related to the perineal wound. Overall, 3 out of 7 resected patients were disease-free at a median follow-up of 2.9 years (range, 1.6-8.0 years). Conclusion Our experience confirms the importance of early correct diagnosis and of an R0 resection for a sacral chordoma invading pelvic structures. It is a rare disease that requires a challenging multidisciplinary treatment, which should ideally be performed in a tertiary referral center. PMID:24999463

Transsacral colon fistula: late complication after resection, irradiation and free flap transfer of sacral chondrosarcoma

Directory of Open Access Journals (Sweden)

Schildhauer Thomas A

2008-11-01

Full Text Available Abstract Background Primary sacral tumors are rare and experience related to accompanying effects of these tumors is therefore limited to observations on a small number of patients. Case presentation In this case report we present a patient with a history of primary sacral chondrosarcoma, an infection of an implanted spinal stabilization device and discuss the challenges that resulted from a colonic fistula associated with large, life threatening abscesses as late complications of radiotherapy. Conclusion In patients with sacral tumors enterocutaneous fistulas after free musculotaneous free flaps transfer are rare and can occur in the setting of surgical damage followed by radiotherapy or advanced disease. They are associated with prolonged morbidity and high mortality. Identification of high-risk patients and management of fistulas at an early stage may delay the need for subsequent therapy and decrease morbidity.

Effect of spinal anterior root stimulation and sacral deafferentation on bladder and sexual dysfunction in spinal cord injury

DEFF Research Database (Denmark)

Zaer, Hamed; Rasmussen, Mikkel Mylius

2018-01-01

Spinal cord injury (SCI) is a highly devastating injury with a variety of complications; among them are neurogenic bladder, bowel, and sexual dysfunction. We aimed to evaluate the effect of sacral anterior root stimulation with sacral deafferentation (SARS-SDAF) on neurogenic bladder and sexual d...

MRI of occult sacral insufficiency fractures following radiotherapy

International Nuclear Information System (INIS)

Mammone, J.F.; Schweitzer, M.E.

1995-01-01

Following radiation therapy, marrow abnormalities noted on magnetic resonance imaging (MRI) are frequent and may mimic metastases. Specific radiotherapy changes are usually easily identifiable; however, traumatic lesions cause more interpretive difficulties. We assessed the incidence and MRI characteristics of insufficiency fractures in this population. During a 5-year span (1987-1991), 546 patients received pelvic radiotherapy for primary malignancies. MRI was performed in 25 of these patients at least 3 months after treatment. The mean dose in this group was 53 Gy. These MRI scans were retrospectively reviewed for the appearance of the sacrum with particular attention to the presence of insufficiency fractures. This was correlated with clinical course and scintigraphic findings. Presumed insufficiency fractures on MRI paralleled the sacral side of the sacroiliac joint, enhanced with Gd-DTPA, were most prominent or initially seen anteriorly, and had ill-defined margins on all imaging sequences. The incidence of occult sacral insufficiency fractures was at least 20%. Insufficiency fractures of the sacrum in the post-radiotherapy patient are a relatively frequent occurrence which can mimic metastases. Consideration of this phenomenon and knowledge of differential features may avoid overdiagnosis of osseous metastases. (orig.)

U-shaped sacral fractures: Surgical treatment and quality of life

NARCIS (Netherlands)

Gribnau, A. J. G.; Boele van Hensbroek, P.; Haverlag, R.; Ponsen, K. J.; Been, H. D.; Goslings, J. C.

2009-01-01

Background: U-shaped sacral fractures are rare and highly unstable pelvic ring fractures. They are not recognised in the standard classification systems of these fractures. The fracture pattern is associated with significant neurological injury and can lead to progressive deformity and chronic pain

Imperfuração anal associada à agenesia parcial do sacro e lipoma pré-sacral: síndrome de Currarino Imperforate anus associated with partial sacral agenesis and presacral lipoma: Currarino syndrome

Directory of Open Access Journals (Sweden)

Paulo Ricardo G. Zen

2010-09-01

Full Text Available OBJETIVO: Relatar o caso de uma criança com síndrome de Currarino diagnosticada após avaliação por episódios recorrentes de infecção urinária. DESCRIÇÃO DE CASO: Menina branca de dois anos, única filha de pais hígidos e sem história familiar de defeitos congênitos. A criança nasceu com imperfuração anal e com fístula retovestibular diagnosticadas no primeiro dia de vida. Por volta dos sete meses, começou a apresentar episódios recorrentes de infecção urinária, estabelecendo-se o diagnóstico de bexiga neurogênica. Na mesma ocasião, foi constatada a presença de agenesia parcial do sacro. A avaliação pela tomografia computadorizada e ressonância nuclear magnética de coluna identificou presença de fístula coincidente com a fosseta da transição lombo-sacral, observada ao exame físico; amputação da porção inferior da medula, com diminuição do número de raízes nervosas da cauda equina e massa pré-sacral de aspecto lipomatoso. Esta foi confirmada durante a cirurgia de correção do ânus imperfurado. A criança não apresentava outras dismorfias e a avaliação radiológica dos pais não identificou anormalidades sacrais. COMENTÁRIOS: A síndrome de Currarino é uma doença genética autossômica, dominante e rara caracterizada pela tríade formada por atresia anal, agenesia parcial do sacro e tumoração pré-sacral. Inclui teratomas, meningoceles, cistos entéricos e lipomas, como observado em nossa paciente. Crianças apresentando anormalidades anorretais deveriam ser sempre cuidadosamente avaliadas quanto à presença da síndrome de Currarino. A agenesia parcial do sacro é um forte indicativo da doença.OBJECTIVE: To report a patient with Currarino syndrome diagnosed after evaluation for recurrent urinary infections. CASE DESCRIPTION: This is a Caucasian two-year-old girl, the only daughter of healthy unrelated parents with no family history of congenital defects. The patient was born with imperforate

The sacral autonomic outflow is parasympathetic: Langley got it right.

Science.gov (United States)

Horn, John P

2018-04-01

A recent developmental study of gene expression by Espinosa-Medina, Brunet and colleagues sparked controversy by asserting a revised nomenclature for divisions of the autonomic motor system. Should we re-classify the sacral autonomic outflow as sympathetic, as now suggested, or does it rightly belong to the parasympathetic system, as defined by Langley nearly 100 years ago? Arguments for rejecting Espinosa-Medina, Brunet et al.'s scheme subsequently appeared in e-letters and brief reviews. A more recent commentary in this journal by Brunet and colleagues responded to these criticisms by labeling Langley's scheme as a historical myth perpetuated by ignorance. In reaction to this heated exchange, I now examine both sides to the controversy, together with purported errors by the pioneers in the field. I then explain, once more, why the sacral outflow should remain known as parasympathetic, and outline suggestions for future experimentation to advance the understanding of cellular identity in the autonomic motor system.

Evaluation of the rostral projection of the sacral lamina as a component of degenerative lumbosacral stenosis in German shepherd dogs.

Science.gov (United States)

Saunders, Harvey; Worth, Andrew J; Bridges, Janis P; Hartman, Angela

2018-05-20

To determine the association between a greater rostral projection of the sacral lamina and clinical signs of cauda equina syndrome (CES) in German shepherd dogs (GSD) with presumptive degenerative lumbosacral disease (DLSS). Retrospective cohort study. One hundred forty-three GSD (125 police dogs and 18 pet dogs) presenting for either CES or prebreeding evaluation. Fifty-five were classified as affected by CES and diagnosed with DLSS, and 88 were classified as unaffected on the basis of clinical and imaging findings. The position of the rostral edge of the sacral lamina was measured from radiographs and/or computed tomography (CT) scans. This position was compared between affected and unaffected dogs. In dogs that underwent both radiography and CT scanning, the agreement between sacral lamina localization using each imaging modality was determined. Owners/handlers were contacted to determine whether dogs subsequently developed clinical signs compatible with CES at a mean of 29 months (unaffected). The sacral lamina did not extend as far rostrally in affected dogs, compared to unaffected dogs (P = .04). Among the 88 dogs unaffected by CES at initial evaluation, 2 developed clinical signs consistent with CES at follow-up. Rostral projection of the sacral lamina, previously proposed as a potential risk factor in dogs with CES due to lumbosacral degeneration, was not associated with a diagnosis of DLSS in this study; the opposite was true. Rostral projection of the sacral lamina may not be a predisposing factor in the development of CES due to DLSS in GSD. © 2018 The American College of Veterinary Surgeons.

Development of Marjolin's ulcer following successful surgical treatment of chronic sacral pressure sore

DEFF Research Database (Denmark)

Knudsen, M.A.; Biering-Sørensen, Fin

2008-01-01

of surgical excision and successful closure of the wound, the patient developed Marjolin's ulcer 2.5 years later. Yet it illustrates the primary importance of preventing the development pressure sores, of aggressive (surgical) therapy with healing when they do arise and of taking frequent biopsies......STUDY DESIGN: Case report. OBJECTIVE: Report of an unusual case, where a Marjolin's ulcer that developed 2.5 years after surgical excision and successful closure. SETTING: Department of Plastic and Reconstructive Surgery and Burn Unit and the Clinic for Spinal Cord Injuries, Copenhagen University...... Hospital, Rigshospitalet, Copenhagen, Denmark. METHODS AND RESULTS: A 22-year-old man sustained a fracture with luxation of the 5th and 6th cervical vertebrae and loss of sensory and motor function after a diving accident (complete C8 lesion). During initial hospitalization, he developed a sacral ulcer...

Diffusion tensor MRI and fiber tractography of the sacral plexus in children with spina bifida

DEFF Research Database (Denmark)

Haakma, Wieke; Dik, Pieter; ten Haken, Bennie

2014-01-01

anatomical and microstructural properties of the sacral plexus of patients with spina bifida using diffusion tensor imaging and fiber tractography. MATERIALS AND METHODS: Ten patients 8 to 16 years old with spina bifida underwent diffusion tensor imaging on a 3 Tesla magnetic resonance imaging system...... diffusivity values at S1-S3 were significantly lower in patients. CONCLUSIONS: To our knowledge this 3 Tesla magnetic resonance imaging study showed for the first time sacral plexus asymmetry and disorganization in 10 patients with spina bifida using diffusion tensor imaging and fiber tractography...

Sacral nerve root neuromodulation: an effective treatment for refractory urge incontinence.

Science.gov (United States)

Shaker, H S; Hassouna, M

1998-05-01

Sacral foramina implants have been recognized recently as a method for treatment of refractory urinary urge incontinence. We study the outcome of the procedure with in-depth analysis of the results of 18 implanted cases. Patients with urinary urge incontinence were subjected to percutaneous nerve evaluation of the S3 roots as a temporary screening test to determine response to neuromodulation. Satisfactory responders were implanted with permanent sacral root neuroprosthesis. The study design included comprehensive voiding diaries for 4 consecutive days twice as a baseline, 1 with percutaneous nerve evaluation screening, 1 after the percutaneous nerve evaluation, 1 at the 1, 3 and 6 post-implantation visits, and every 6 months thereafter. Uroflowmetry and quality of life questionnaires were performed at the same intervals. Urodynamic study was done as a baseline and 6 months after implantation of the neuroprosthesis. All 18 patients (16 women and 2 men) with refractory urge incontinence received a sacral foramina neuroprosthesis after demonstrating a good response to the percutaneous nerve evaluation. Average patient age at presentation was 42.3+/-3.3 years (range 22 to 67) and duration of urinary symptoms was 6.6+/-1.3 years (range 1.2 to 18.8). Average followup was 18.8 months (range 3 to 83). Neuromodulation in these patients showed a marked reduction in leakage episodes from 6.49 to 1.98 times per 24 hours and in the leakage severity score. Eight patients became completely dry and 4 had average leakage episodes of 1 or less daily. Patients showed as well a decrease in urinary frequency with an increase in functional bladder capacity. Associated pelvic pain improved substantially. Cystometrograms demonstrated increased volume at first sensation by 50% and increased cystometric capacity by 15% with the disappearance of uninhibited contractions in 1 of the 4 patients who presented with it preoperatively. There was also noticeable improvement in the quality of life

Rare location of spondylitis tuberculosis;atlanto-axial, sacral and cervico-thoracic junction

Science.gov (United States)

Victorio; Nasution, M. D.; Ibrahim, S.; Dharmajaya, R.

2018-03-01

Three cases of rare location spondylitis tuberculosis are reported, each in atlantoaxial, cervico-thoracic junction,and sacral. The complaints were aweakness of motoric strength and local back pain. Patients’thoracal x-ray was normal, there was no complaint of acough, PCR forTB was early diagnostic and positive in all three cases, HIV negative, intraoperative tissue samplings were sent for histopathology examination and the results showed thespecific inflammatory process. Lesions were evaluated with computer tomography and/or MRI imaging.Preoperative TB regimens therapy were given for 2 weeks and continued for nine months. The surgical procedurewas done in all cases with excellent improvement of symptoms and motoric strength. In our institution,25 cases of total TB spondylitis were performed in 2 years, only 1 case eachwas found in atlanto-axial, cervico-thoracic and sacral.

[Primary genital herpes with sacral meningoradiculitis].

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Carron, P-N; Anguenot, J-L; Dubuisson, J-B

2004-02-01

Herpetic genital infection is a common sexually transmitted disease, caused in most cases by type 2 Herpes simplex virus (HSV2). This virus is characterized by its neurotropic properties and its ability to establish latency in sacral sensory ganglions. Some cases of genital primo-infection are complicated by viral replication dissemination to neigbhoring nerve structures like meninges and radicular terminations. In such cases muco-cutaneous manifestations are associated with peripheral neurological impairment in the form of meningo-radiculitis. Physicians should be familiar with these neurological symptoms knowing that they always regress completely. The present report illustrates these complications and reviews the potential neurological implications described in the literature.

[The reference of normal values of the sacroiliac joint index in bone scintigraphy].

Science.gov (United States)

Sebastjanowicz, Przemysław; Iwanowski, Jacek; Piwowarska-Bilska, Hanna; Elbl, Bogumiła; Birkenfeld, Bożena

Scintigraphy of sacroiliac joints as functional imaging provides unique information on the existing disease process. By using radiopharmaceuticals that allow imaging of the metabolic activity within the joint, it is possible to assess the stage of the disease, even when there are no lesions in radiological images. Quantitative analysis of scintigrams of sacroiliac joints is performed by comparing the uptake in both of them in relation to the uptake in the sacral bone area. The values of sacroiliac (SI/S) indices are influenced by the age of the patient, sex, state of health, and a range of individual biological features. Therefore, reference values of SI/S ratios are very important for medical specialists who describe and diagnose locomotor system diseases. The aim of this paper is to develop a reference range of sacroiliac ratios. The innovativeness of this paper involves examining sacroiliac ratios for various age groups, in children and adult patients, taking their sex into consideration. The study comprised a group of 335 people with proper bone scintigraphy. These people were divided into children and patients aged ≥21. Children were divided into 4 age groups (1–5; 6–10; 11–15; 16–20) and adults into 6 age groups (21–30; 31–40; 41–50; 51–60; 61–70; ≥71). Sacroiliac ratios were calculated using the method of three rectangular region of interests located on the left and right sacroiliac joint and on the sacral bone. The sacroiliac ratio was calculated for both joints by dividing the average number of counts within a selected sacroiliac joint by the average number of counts within the sacral bone. SI/S borderline reference values covered the range of 1.18÷2.28 that was obtained for children aged ≤5 and for the group of 11–15-year-olds. Considerable discrepancies in the values of the coefficient for women and men were seen among 31–50-year-olds. Borderline reference results for the entire control group cover the range of 1.18 ±2

Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies.

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König, M A; Jehan, S; Boszczyk, A A; Boszczyk, B M

2012-05-01

U-shaped sacral fractures usually result from axial loading of the spine with simultaneous sacral pivoting due to a horizontal fracture which leads to a highly unstable spino-pelvic dissociation. Due to the rarity of these fractures, there is lack of an agreed treatment strategy. A thorough literature search was carried out to identify current treatment concepts. The studies were analysed for mechanism of injury, diagnostic imaging, associated injuries, type of surgery, follow-up times, complications, neurological, clinical and radiological outcome. Sixty-three cases were found in 12 articles. No Class I, II or III evidence was found in the literature. The most common mechanism of injury was a fall or jump from height. Pre-operative neurological deficit was noted in 50 (94.3%) out of 53 cases (not available in 10 patients). The most used surgical options were spino-pelvic fixation with or without decompression and ilio-sacral screws. Post-operative complications occurred in 24 (38.1%) patients. Average follow-up time was 18.6 months (range 2-34 months). Full neurological recovery was noted in 20 cases, partial recovery in 14 and 9 patients had no neurological recovery (5 patients were lost in follow-up). Fracture healing was mentioned in 7 articles with only 1 case of fracture reduction loss. From the current available data, an evidence based treatment strategy regarding outcome, neurological recovery or fracture healing could not be identified. Limited access and minimal-invasive surgery focussing on sacral reduction and restoration seems to offer comparable results to large spino-pelvic constructs with fewer complications and should be considered as the method of choice. If the fracture is highly unstable and displaced, spino-pelvic fixation might offer better stability.

Pneumorrhachis Secondary to a Sacral Decubitus Ulcer

Directory of Open Access Journals (Sweden)

Siamak Moayedi

2016-06-01

Full Text Available An elderly woman with a chronic decubitus sacral ulcer presented to the emergency department with sepsis. A computed tomography of her abdomen showed diffuse gas extending throughout the thoracolumbar spinal canal. Pneumorrhachis is a rare radiographic finding defined as gas within the spinal canal. There are many causes of pneumorrhachis ranging from trauma to infection. In this case the pneumorrhachis was caused by direct spread of gas-forming organisms from vertebral osteomyelitis. Emergency physicians should know about the implication of gas in the spinal canal in the setting of sepsis. [West J Emerg Med. 2016;17(4:466-468.

Perineal colostomy prolapse: a novel application of mesh sacral pexy.

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Landen, S; Ursaru, D; Delugeau, V; Landen, C

2018-01-01

Full thickness colonic prolapse following pseudocontinent perineal colostomy has not been previously reported. Possible contributing factors include a large skin aperture at the site of the perineal stoma, the absence of anal sphincters and mesorectal attachments and the presence of a perineal hernia. A novel application of sacral pexy combined with perineal hernia repair using two prosthetic meshes is described.

Updated Outcome and Analysis of Tumor Response in Mobile Spine and Sacral Chordoma Treated With Definitive High-Dose Photon/Proton Radiation Therapy

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Kabolizadeh, Peyman, E-mail: peyman.kabolizadeh@beaumont.org [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Chen, Yen-Lin; Liebsch, Norbert [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Hornicek, Francis J.; Schwab, Joseph H. [Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Choy, Edwin [Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Rosenthal, Daniel I. [Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Niemierko, Andrzej; DeLaney, Thomas F. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)

2017-02-01

Purpose: Treatment of spine and sacral chordoma generally involves surgical resection, usually in conjunction with radiation therapy. In certain circumstances where resection may result in significant neurologic or organ dysfunction, patients can be treated definitively with radiation therapy alone. Herein, we report the outcome and the assessment of tumor response to definitive radiation therapy. Methods and Materials: A retrospective analysis was performed on 40 patients with unresected chordoma treated with photon/proton radiation therapy. Nineteen patients had complete sets of imaging scans. The soft tissue and bone compartments of the tumor were defined separately. Tumor response was evaluated by the modified Response Evaluation Criteria in Solid Tumors (RECIST) and volumetric analysis. Results: With a median follow-up time of 50.3 months, the rates of 5-year local control, overall survival, disease-specific survival, and distant failure were 85.4%, 81.9%, 89.4%, and 20.2%, respectively. Eighty-four computed tomographic and magnetic resonance imaging scans were reviewed. Among the 19 patients, only 4 local failures occurred, and the median tumor dose was 77.4 GyRBE. Analysis at a median follow-up time of 18 months showed significant volumetric reduction of the total target volume (TTV) and the soft tissue target volume (STTV) within the first 24 months after treatment initiation, followed by further gradual reduction throughout the rest of the follow-up period. The median maximum percentage volumetric regressions of TTV and STTV were 43.2% and 70.4%, respectively. There was only a small reduction in bone target volume over time. In comparison with the modified RECIST, volumetric analysis was more reliable, more reproducible, and could help in measuring minimal changes in the tumor volume. Conclusion: These results continue to support the use of high-dose definitive radiation therapy for selected patients with unresected spine and sacral chordomas

Updated Outcome and Analysis of Tumor Response in Mobile Spine and Sacral Chordoma Treated With Definitive High-Dose Photon/Proton Radiation Therapy

International Nuclear Information System (INIS)

Kabolizadeh, Peyman; Chen, Yen-Lin; Liebsch, Norbert; Hornicek, Francis J.; Schwab, Joseph H.; Choy, Edwin; Rosenthal, Daniel I.; Niemierko, Andrzej; DeLaney, Thomas F.

2017-01-01

Purpose: Treatment of spine and sacral chordoma generally involves surgical resection, usually in conjunction with radiation therapy. In certain circumstances where resection may result in significant neurologic or organ dysfunction, patients can be treated definitively with radiation therapy alone. Herein, we report the outcome and the assessment of tumor response to definitive radiation therapy. Methods and Materials: A retrospective analysis was performed on 40 patients with unresected chordoma treated with photon/proton radiation therapy. Nineteen patients had complete sets of imaging scans. The soft tissue and bone compartments of the tumor were defined separately. Tumor response was evaluated by the modified Response Evaluation Criteria in Solid Tumors (RECIST) and volumetric analysis. Results: With a median follow-up time of 50.3 months, the rates of 5-year local control, overall survival, disease-specific survival, and distant failure were 85.4%, 81.9%, 89.4%, and 20.2%, respectively. Eighty-four computed tomographic and magnetic resonance imaging scans were reviewed. Among the 19 patients, only 4 local failures occurred, and the median tumor dose was 77.4 GyRBE. Analysis at a median follow-up time of 18 months showed significant volumetric reduction of the total target volume (TTV) and the soft tissue target volume (STTV) within the first 24 months after treatment initiation, followed by further gradual reduction throughout the rest of the follow-up period. The median maximum percentage volumetric regressions of TTV and STTV were 43.2% and 70.4%, respectively. There was only a small reduction in bone target volume over time. In comparison with the modified RECIST, volumetric analysis was more reliable, more reproducible, and could help in measuring minimal changes in the tumor volume. Conclusion: These results continue to support the use of high-dose definitive radiation therapy for selected patients with unresected spine and sacral chordomas

Comparison of gluteal perforator flaps and gluteal fasciocutaneous rotation flaps for reconstruction of sacral pressure sores.

Science.gov (United States)

Chen, Yen-Chou; Huang, Eng-Yen; Lin, Pao-Yuan

2014-03-01

The gluteus maximus myocutaneous flap was considered the workhorse that reconstructed sacral pressure sores, but was gradually replaced by fasciocutaneous flap because of several disadvantages. With the advent of the perforator flap technique, gluteal perforator (GP) flap has gained popularity nowadays. The aim of this study was to compare the complications and outcomes between GP flaps and gluteal fasciocutaneous rotation (FR) flaps in the treatment of sacral pressure sores. Between April 2007 and June 2012, 63 patients underwent sacral pressure sore reconstructions, with a GP flap used in 31 cases and an FR flap used in 32 cases. Data collected on the patients included patient age, gender, co-morbidity for being bedridden and follow-up time. Surgical details collected included the defect size, operative time and estimated blood loss. Complications recorded included re-operation, dehiscence, flap necrosis, wound infection, sinus formation, donor-site morbidity and recurrence. The complications and clinical outcomes were compared between these two groups. We found that there was no significant difference in patient demographics, surgical complications and recurrence between these two groups. In gluteal FR flap group, all recurrent cases (five) were treated by reuse of previous flaps. Both methods are comparable, good and safe in treating sacral pressure sores. Gluteal FR flap can be performed without microsurgical dissection, and re-rotation is feasible in recurrent cases. The authors suggest using gluteal FR flaps in patients with a high risk of sore recurrence. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

[Sacral neuromodulation in urology - development and current status].

Science.gov (United States)

Schwalenberg, T; Stolzenburg, J-U; Kriegel, C; Gonsior, A

2012-01-01

Sacral neuromodulation (SNM) in urology is employed to treat refractory lower urinary tract dysfunction as well as chronic pelvic pain. Electrical stimulation of the sacral afferents (S2 - S4) causes activation and conditioning of higher autonomic and somatic neural structures and thereby influences the efferents controlling the urinary bladder, the rectum and their related sphincter systems. It is therefore possible to treat overactivity as well as hypocontractility and functional bladder neck obstruction. SNM treatment is conducted biphasically. Initially, test electrodes are placed to evaluate changes in micturition and pain parameters. If, in this first phase - called peripheral nerve evaluation (PNE test) - sufficient improvements are observed, the patient progresses to phase two which involves implantation of the permanent electrodes and impulse generator system. In recent years, the "two stage approach" with initial implantation of the permanent electrodes has been favoured as it increases treatment success rates. Long-term success rates of SNM vary significantly in the literature (50 - 80 %) due to heterogeneous patient populations as well as improved surgical approaches. With the introduction of "tined lead electrodes" (2002), tissue damage is reduced to a minimum. Technical innovation, financial feasibility (reimbursed in Germany since 2004) and wider application, especially in otherwise therapy-refractory patients or complex dysfunctions of the pelvis, have established SNM as a potent treatment option in urology. © Georg Thieme Verlag KG Stuttgart · New York.

Diffusion tensor magnetic resonance imaging and fiber tractography of the sacral plexus in children with spina bifida

DEFF Research Database (Denmark)

Haakma, Wieke; Dik, Pieter; ten Haken, Bennie

2014-01-01

anatomical and microstructural properties of the sacral plexus of patients with spina bifida using diffusion tensor imaging and fiber tractography. MATERIALS AND METHODS: Ten patients 8 to 16 years old with spina bifida underwent diffusion tensor imaging on a 3 Tesla magnetic resonance imaging system...... diffusivity values at S1-S3 were significantly lower in patients. CONCLUSIONS: To our knowledge this 3 Tesla magnetic resonance imaging study showed for the first time sacral plexus asymmetry and disorganization in 10 patients with spina bifida using diffusion tensor imaging and fiber tractography...

Neurostimulation for bladder evacuation: is sacral root stimulation a substitute for microstimulation?

Science.gov (United States)

Probst, M; Piechota, H J; Hohenfellner, M; Gleason, C A; Tanagho, E A

1997-04-01

To determine by anatomical and functional studies whether stimulation of sacral rootlets might permit selective stimulation of autonomic fibres, thus avoiding the detrusor/sphincter dyssynergia characteristic of current techniques of neurostimulation for bladder evacuation. In 10 male mongrel dogs, the S2 root was isolated and its constituent rootlets followed from their origin in the spinal cord to the point of exit from the dura. The entire root and the individual rootlets were then stimulated, including intra- and extra-dural stimulation and at proximal, mid and distal levels. Neuroanatomical and histological findings showed that rootlets of ventral S2 maintain their identity throughout their intradural course; some carry predominantly autonomic fibres, some predominantly somatic and some a mixture of the two. It appears surgically feasible to identify, isolate and sever the predominantly somatic rootlets intradurally, sparing the predominantly autonomic rootlets for inclusion in extradural electrode placement around the entire sacral root, thus eliminating sphincteric interference with detrusor contraction for voiding at low pressure.

Selective detrusor activation by electrical sacral nerve root stimulation in spinal cord injury

NARCIS (Netherlands)

Rijkhoff, N. J.; Wijkstra, H.; van Kerrebroeck, P. E.; Debruyne, F. M.

1997-01-01

Electrical sacral nerve root stimulation can be used in spinal cord injury patients to induce urinary bladder contraction. However, existing stimulation methods activate simultaneously both the detrusor muscle and the urethral sphincter. Urine evacuation is therefore only possible using poststimulus

Techniques of lumbar-sacral spine fusion in spondylosis: systematic literature review and meta-analysis of randomized clinical trials.

Science.gov (United States)

Umeta, Ricardo S G; Avanzi, Osmar

2011-07-01

Spine fusions can be performed through different techniques and are used to treat a number of vertebral pathologies. However, there seems to be no consensus regarding which technique of fusion is best suited to treat each distinct spinal disease or group of diseases. To study the effectiveness and complications of the different techniques used for spinal fusion in patients with lumbar spondylosis. Systematic literature review and meta-analysis. Randomized clinical studies comparing the most commonly performed surgical techniques for spine fusion in lumbar-sacral spondylosis, as well as those reporting patient outcome were selected. Identify which technique, if any, presents the best clinical, functional, and radiographic outcome. Systematic literature review and meta-analysis based on scientific articles published and indexed to the following databases: PubMed (1966-2009), Cochrane Collaboration-CENTRAL, EMBASE (1980-2009), and LILACS (1982-2009). The general search strategy focused on the surgical treatment of patients with lumbar-sacral spondylosis. Eight studies met the inclusion criteria and were selected with a total of 1,136 patients. Meta-analysis showed that patients who underwent interbody fusion presented a significantly smaller blood loss (p=.001) and a greater rate of bone fusion (p=.02). Patients submitted to fusion using the posterolateral approach had a significantly shorter operative time (p=.007) and less perioperative complications (p=.03). No statistically significant difference was found for the other studied variables (pain, functional impairment, and return to work). The most commonly used techniques for lumbar spine fusion in patients with spondylosis were interbody fusion and posterolateral approach. Both techniques were comparable in final outcome, but the former presented better rates of fusion and the latter the less complications. Copyright © 2011 Elsevier Inc. All rights reserved.

The Effect of Early Complications on Flap Selection on Sacral Pressure Sores

Directory of Open Access Journals (Sweden)

Musa Kemal Keleş

2017-06-01

Full Text Available Objective: Pressure sores occur in bedridden patients in intensive care units, clinics, and even at their own places. Care for sick relatives and working with doctors to address treatment options and ensure proper follow-up are some of the problems associated with these types of wounds. Surgical therapy in the treatment of pressure ulcers is associated with significant complications. In comparison to non-surgical treatment, surgical treatment has a low complication rate and is more cost-effective. The surgical treatment enables the patients to return to their social life sooner than non-surgical treatment. Patient's ability to early return to their social life is advantageous in terms of reducing morbidity and the need for additional operations. This study is aimed to review the flap choices used to treat sacral pressure sores and the resulting acute complications rates retrospectively. Material and Methods: Patients treated for stage 3 and stage 4 sacral pressure sores in our clinic in the past 5 years were included in the study. Patient records were analyzed retrospectively. Patients' demographic data and surgical treatment they received were documented. Surgical method and surgical outcomes were evaluated and early complication rates were determined. Result: Fifty patients were included in the study; 10 of them were female, 40 of were male cases. The most common causative agent was paraplegia after traffic accident. Conclusion: A significant difference was not observed between the type of flap used in the surgical treatment and the rate of complications. Consequently, the surgical treatment of pressure ulcers in the sacral region depends on the patient's individual situation, the cooperation of the family, and previously applied treatments

The Thoracic Lordosis Correction Improves Sacral Slope and Walking Ability in Neuromuscular Scoliosis.

Science.gov (United States)

Kim, Do Yeon; Moon, Eun Su; Park, Jin Oh; Chong, Hyon Su; Lee, Hwan Mo; Moon, Seong Hwan; Kim, Sung Hoon; Kim, Hak Sun

2016-10-01

Retrospective study. To report on neuromuscular patients with preserved walking ability, but forward bending of the body due to thoracic lordosis, and to suggest thoracic lordosis correction as the surgical treatment. It is an established fact that lumbar lordosis or pelvic parameter is directly related to thoracic sagittal balance. However, the reverse relationship has not been fully defined yet. Loss of thoracic kyphosis results in positive sagittal balance, which causes walking difficulty. Neuromuscular patients with thoracic lordosis have not been reported yet, and there have been no reports on their surgical treatments. This study analyzed 8 patients treated with thoracic lordosis correction surgery. Every patient was diagnosed with muscular dystrophy. In thoracic lordosis correction surgery, anterior release was performed in the first stage and posterior segmental instrumentation was performed in the second stage. Radiographic parameters were compared and walking ability was evaluated with gait analysis. All patients were classified according to the modified Rancho Los Amigos Hospital system preoperatively and 2 years postoperatively to evaluate functional ability. The average follow-up period was 2.9 years. Before surgery, the mean thoracic sagittal alignment was -2.1-degree lordosis, the mean Cobb angle and sacral slope increased to 36.3 and 56.6 degrees, respectively. The anterior pelvic tilt in gait analysis was 29.3 degrees. At last follow-up after surgery, the mean thoracic sagittal alignment changed to 12.6-degree kyphosis, and the Cobb angle and sacral slope decreased to 18.9 and 39.5 degrees, respectively. Lumbar lordosis and the sacral slope showed significant positive correlation (Plordosis showed a significant correlation to the preoperative flexibility of the major curve (P=0.028). The anterior pelvic tilt in gait analysis improved to 15.4 degrees. The functional ability improved in 2 (50%) of 4 patients in class 2 and maintained in remaining 6

Comparative sacral morphology and the reconstructed tail lengths of five extinct primates: Proconsul heseloni, Epipliopithecus vindobonensis, Archaeolemur edwardsi, Megaladapis grandidieri, and Palaeopropithecus kelyus.

Science.gov (United States)

Russo, Gabrielle A

2016-01-01

This study evaluated the relationship between the morphology of the sacrum-the sole bony link between the tail or coccyx and the rest of the body-and tail length (including presence/absence) and function using a comparative sample of extant mammals spanning six orders (Primates, Carnivora, Rodentia, Diprotodontia, Pilosa, Scandentia; N = 472). Phylogenetically-informed regression methods were used to assess how tail length varied with respect to 11 external and internal (i.e., trabecular) bony sacral variables with known or suspected biomechanical significance across all mammals, only primates, and only non-primates. Sacral variables were also evaluated for primates assigned to tail categories ('tailless,' 'nonprehensile short-tailed,' 'nonprehensile long-tailed,' and 'prehensile-tailed'). Compared to primates with reduced tail lengths, primates with longer tails generally exhibited sacra having larger caudal neural openings than cranial neural openings, and last sacral vertebrae with more mediolaterally-expanded caudal articular surfaces than cranial articular surfaces, more laterally-expanded transverse processes, more dorsally-projecting spinous processes, and larger caudal articular surface areas. Observations were corroborated by the comparative sample, which showed that shorter-tailed (e.g., Lynx rufus [bobcat]) and longer-tailed (e.g., Acinonyx jubatus [cheetah]) non-primate mammals morphologically converge with shorter-tailed (e.g., Macaca nemestrina) and longer-tailed (e.g., Macaca fascicularis) primates, respectively. 'Prehensile-tailed' primates exhibited last sacral vertebrae with more laterally-expanded transverse processes and greater caudal articular surface areas than 'nonprehensile long-tailed' primates. Internal sacral variables performed poorly compared to external sacral variables in analyses of extant primates, and were thus deemed less useful for making inferences concerning tail length and function in extinct primates. The tails lengths of

Cancer of the breast and anterior sacral meningeal in a patient with Marfan syndrome

International Nuclear Information System (INIS)

Cataldi, S.; Laureiro, E.; Musetti, C.; Vázquez, A.; Cabovianco, A.

2004-01-01

Introduction. Breast cancer is the most common malignancy of women in the world Western. It is rare below 30 years. Marfan syndrome (MS) is an entity clinically characterized by cardiovascular, ocular and skeletal genetic base. Its prevalence is estimated at 4-6 per 100,000 births. In the literature there are few reports of cancers diagnosed in association with SM, and after a thorough review, we found only two communications association with malformations such as dural sac meningocele. Objective. The aim of this study was to review the literature from communication A case report of a patient with SM in which the age of 24 he diagnosed with breast cancer and a previous sacral meningocele. Case. Female patient 24 years old, with SM, who consulted a tumor of right breast. Was studied with mammography and cytological puncture were positive for malignancy. Local treatment consisted of modified radical mastectomy and chest wall radiotherapy. The pathology corresponded to ductal carcinoma Infiltrating (CDI) NOS 27mm diameter greater final histologic grade II carcinoma in situ solid and cribriform intermediate grade without necrosis greater than 30%; 10 axillary lymph resected, all free of metastases. The dosage of hormone receptors was frankly positive for both estrogen and progesterone. In sum CDI NOS stage IIA. the chest radiograph and bone scan showed no abnormalities and abdominal ultrasound He requested postoperatively revealed an abdominopelvic image 13 x 16 cm. positron abdomen and pelvis confirmed a predominantly cystic mass in the pelvis and abdomen lower. Exploratory laparotomy revealed that the tumor corresponded to a meningocele before and proceeded to peritoneal cyst resection and closure of the sacral gap. At the time of writing, the patient is free and without neurological deficit disease, low adjuvant Tamoxifen for 3 years. Conclusions. The SM as breast cancer in younger women is uncommon. Few cancers have been reported in association with SM. Some of

CT-guided percutaneous injection of the fibrin glue by 'double needle' technique for the treatment of sacral cysts

International Nuclear Information System (INIS)

Wang Ganggang; Chen Long; Yang Chao; Ni Caifang

2013-01-01

Objective: To analyze the efficacy and safety of CT-guided percutaneous injection of the fibrin glue by 'double needle' technique to treat sacral cyst. Methods: Clinical data of 20 cases with 'double-needle' injection of fibrin glue technology to treat sacral cyst were retrospectively analyzed. All patients had varying degrees of sacral nerve root compression symptoms. The treatment for sacral cyst was carried out after clear diagnosis was made. On the basis of CT-guided percutaneous injection of fibrin glue, the improved CT-guided percutaneous injection of fibrin glue by 'double-needle' technique was used to treat these patients. The average dose of fibrin glue was (5.9 ± 2.4) ml. The clinical results of improvement as to pain and neurological function were evaluated after follow-up of an average of 17 months. The assessment criteria were as follows: excellent, complete resolution of signs and symptoms, with the patient returning to his or her regular employment and no recurrence of cysts during 1 year of follow-up, good, symptoms and signs in the legs and perineal region resolved but with persistent pain in the lumbosacral region, which did not interfere with the patient's regular work (the cysts did not recur for 6 months during follow-up), fair, no improvement in clinical symptoms, but a decrease in cyst size on the imaging study, poor, no improvement in clinical symptoms and no observed changes in cyst size in imaging studies or recurrence. Results: Most patients experienced some degree of pain relief and functional improvement after fibrin glue therapy, with most experiencing complete or marked resolution of clinical symptoms. Nine patients reported excellent recovery, 8 reported good recovery, 2 reported fair recovery, and 1 reported poor recovery. The overall percentage of positive outcomes (excellent and good recovery) was 85%. No serious postoperative complications were discovered. Conclusions: CT guided percutaneous injection of the fibrin glue by

Rectal motility after sacral nerve stimulation for faecal incontinence

DEFF Research Database (Denmark)

Michelsen, H B; Worsøe, J; Krogh, K

2010-01-01

Sacral nerve stimulation (SNS) is effective against faecal incontinence, but the mode of action is obscure. The aim of this study was to describe the effects of SNS on fasting and postprandial rectal motility. Sixteen patients, 14 women age 33-73 (mean 58), with faecal incontinence of various...... contractions, total time with cyclic rectal contractions, the number of aborally and orally propagating contractions, the number of anal sampling reflexes or rectal wall tension during contractions. Postprandial changes in rectal tone were significantly reduced during SNS (P

Evidence to justify retention of transvaginal mesh: comparison between laparoscopic sacral colpopexy and transvaginal Elevate™ mesh.

Science.gov (United States)

To, Valérie; Hengrasmee, Pattaya; Lam, Alan; Luscombe, Georgina; Lawless, Anna; Lam, Justin

2017-12-01

To determine if laparoscopic sacral colpopexy (LSC) offers better apical support with a lower exposure rate than transvaginal mesh surgery with Elevate™. This was a retrospective cohort study comparing patients with apical prolapse (POP-Q point C ≥ -1) who underwent Elevate™ mesh repair (n = 146) with patients who underwent laparoscopic sacral colpopexy (n = 267). The sacral colpopexy group had a mean age of 59 years and a BMI of 25.7. Patients in the Elevate™ group were older, with a mean age of 63 and a BMI of 26.3. Most of the patients of both groups presented with pelvic organ prolapse stage III (LSC 73.8% and Elevate™ 87.0%) and their mean POP-Q point C were not significantly different (LSC 1.4 vs Elevate™ 1.2 cm). Operative time was longer in the LSC group (113 vs 91 min, p < 0.001), but estimated blood loss was lower (75 cm 3 vs 137 cm 3 , p < 0.001). No difference in mesh exposure rate could be found between the two groups at one year (Elevate™ 0.7% vs LSC 2.6%, OR 0.26, 95% CI 0.03 to 2.10, p = 0.21). One-year objective cure rate, defined as no descent beyond the hymen, was 97.0% in the LSC group and 96.6% in the Elevate™ group (p = .81). The overall recurrence (objective, subjective recurrence or reoperation) was also not different between the groups (LSC 4.5% vs Elevate 4.8%, p = 0.89). Transvaginal Elevate™ mesh delivers comparable apical support with a low exposure rate similar to that of laparoscopic sacral colpopexy.

Characterization of herpes simplex virus type 2 latency-associated transcription in human sacral ganglia and in cell culture.

Science.gov (United States)

Croen, K D; Ostrove, J M; Dragovic, L; Straus, S E

1991-01-01

The ability of herpes simplex virus type 2 (HSV-2) to establish latency in and reactivate from sacral dorsal root sensory ganglia is the basis for recurrent genital herpes. The expression of HSV-2 genes in latently infected human sacral ganglia was investigated by in situ hybridization. Hybridizations with a probe from the long repeat region of HSV-2 revealed strong nuclear signals overlying neurons in sacral ganglia from five of nine individuals. The RNA detected overlaps with the transcript for infected cell protein O but in the opposite, or "anti-sense," orientation. These observations mimic those made previously with HSV-1 in human trigeminal ganglia and confirm the recent findings during latency in HSV-2-infected mice and guinea pigs. Northern hybridization of RNA from infected Vero cells showed that an HSV-2 latency-associated transcript was similar in size to the larger (1.85 kb) latency transcript of HSV-1. Thus, HSV-1 and HSV-2 latency in human sensory ganglia are similar, if not identical, in terms of their cellular localization and pattern of transcription.

Primary Malignant Bone Tumours at the University Teaching ...

African Journals Online (AJOL)

Introduction: Primary malignant bone tumours include malignancies arising primarily from bone tissue. This is opposed to secondary bone tumours in which case the neoplastic elements arise primarily from other sites within the body and secondarily spread to bone. Primary malignant bone tumours are generally ...

Hypointensity on postcontrast MR imaging from compression of the sacral promontory in enlarged uterus with huge leiomyoma and adenomyosis

International Nuclear Information System (INIS)

Uotani, Kensuke; Monzawa, Shuichi; Adachi, Shuji; Takemori, Masayuki; Kaji, Yasushi; Sugimura, Kazuro

2007-01-01

In patients with huge leiomyoma and with adenomyosis of the uterus, a peculiar area of hypointensity was occasionally observed on postcontrast magnetic resonance (MR) imaging in the dorsal portion of the enlarged uterus near the sacral promontory. We describe the imaging characteristics of these MR findings and correlate them with histopathological findings to examine whether the areas represent specific pathological changes. Ten patients with huge leiomyomas and two with huge adenomyotic lesions whose imaging revealed the hypointensity were enrolled. All had enlarged uteri that extended beyond the sacral promontory. MR findings of the hypointense areas were evaluated and correlated with histopathological findings in 5 patients with leiomyoma and two with adenomyosis who had hysterectomy. The ten patients with leiomyoma showed flare-shaped hypointensity arising from the dorsal surface of the uterine body that extended deep into the tumor. The base of the hypointense areas was narrow in 5 patients with intramural leiomyoma and broad in five with subserosal leiomyoma. Two patients with adenomyosis showed nodular-shaped areas of hypointensity in front of the sacral promontory. Precontrast T 1 - and T 2 -weighted MR images showed no signal abnormalities in the portions corresponding to the hypointensity in any of the 12 patients. Pathological examinations showed no specific findings in the portions corresponding to the hypointensity in the 7 patients who had hysterectomy. The areas of hypointensity may represent functional changes, such as decreased localized blood flow caused by compression of the sacral promontory. (author)

Comparison of fasciocutaneous V-Y and rotational flaps for defect coverage of sacral pressure sores: a critical single-centre appraisal.

Science.gov (United States)

Djedovic, Gabriel; Metzler, Julia; Morandi, Evi M; Wachter, Tanja; Kühn, Shafreena; Pierer, Gerhard; Rieger, Ulrich M

2017-12-01

Pressure sore rates remain high in both nursing homes as well as in hospitals. Numerous surgical options are available for defect coverage in the sacral region. However, objective data is scarce as to whether a specific flap design is superior to another. Here, we aim to compare two fasciocutaneous flap designs for sacral defect coverage: the gluteal rotation flap and the gluteal V-Y flap. All primary sacral pressure sores of grades III-IV that were being covered with gluteal fasciocutaneous rotational or V-Y flaps between January 2008 and December 2014 at our institution were analysed. A total of 41 patients received a total of 52 flaps. Of these, 18 patients received 20 gluteal rotational flaps, and 23 patients received 32 V-Y flaps. Both groups were comparable with regards to demographics, comorbidities and complications. Significantly more V-Y flaps were needed to cover smaller defects. Mean length of hospital stay was significantly prolonged when surgical revision had to be carried out. Both flap designs have proven safe and reliable for defect coverage after sacral pressure sores. Gluteal rotational flaps appear to be more useful for larger defects. Both flap designs facilitate their reuse in case of pressure sore recurrence. Complication rates appear to be comparable in both designs and to the current literature. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Selective stimulation of sacral nerve roots for bladder control: a study by computer modeling

NARCIS (Netherlands)

Rijkhoff, N. J.; Holsheimer, J.; Koldewijn, E. L.; Struijk, J. J.; van Kerrebroeck, P. E.; Debruyne, F. M.; Wijkstra, H.

1994-01-01

The aim of this study was to investigate theoretically the conditions for the activation of the detrusor muscle without activation of the urethral sphincter and afferent fibers, when stimulating the related sacral roots. Therefore, the sensitivity of excitation and blocking thresholds of nerve

Progressive bilateral anterior sacral meningoceles in Marfan syndrome

International Nuclear Information System (INIS)

Scheck, R.J.; Schramm, T.; Gloning, K.P.; Vogl, T.; Ostermayer, E.

1995-01-01

Anterior sacral meningoceles (ASM) in Marfan syndrome are rare. They may cause constipation, urinary frequency, dysmenorrhoea, and low back pain or numbness. This report describes bilateral ASM at the level of S1, S2 and S3 in a woman with Marfan syndrome who was admitted to the gynaecology department for evaluation of left lower abdominal pain. The magnetic resonance appearance of the meningoceles is discussed and compared with findings from transvaginal ultrasound and CT. As MRI offers excellent delineation of spinal and pelvic structures, it is the most useful technique available in establishing the diagnosis and planning the treatment of ASM. (orig.)

Progressive bilateral anterior sacral meningoceles in Marfan syndrome

Energy Technology Data Exchange (ETDEWEB)

Scheck, R J [Dept. of Radiology, Univ. Muenchen (Germany); Schramm, T [Dept. of Gynaecology and Obstetrics, 1. Frauenklinik, Univ. Muenchen (Germany); Gloning, K P [Dept. of Gynaecology and Obstetrics, 1. Frauenklinik, Univ. Muenchen (Germany); Vogl, T [Dept. of Radiology, Univ. Muenchen (Germany); Ostermayer, E [Dept. of Gynaecology and Obstetrics, 1. Frauenklinik, Univ. Muenchen (Germany)

1995-08-01

Anterior sacral meningoceles (ASM) in Marfan syndrome are rare. They may cause constipation, urinary frequency, dysmenorrhoea, and low back pain or numbness. This report describes bilateral ASM at the level of S1, S2 and S3 in a woman with Marfan syndrome who was admitted to the gynaecology department for evaluation of left lower abdominal pain. The magnetic resonance appearance of the meningoceles is discussed and compared with findings from transvaginal ultrasound and CT. As MRI offers excellent delineation of spinal and pelvic structures, it is the most useful technique available in establishing the diagnosis and planning the treatment of ASM. (orig.)

Sacral herpes-zoster infection presenting as sciatic pain.

Science.gov (United States)

Ablin, J; Symon, Z; Mevorach, D

1996-06-01

Acute herpes-zoster infection is a painful dermatomal lesion that can be manifested by a wide array of neurologic symptoms. We present a 55-year-old female with non-Hodgkin's lymphoma, who developed a left sciatic pain involving the S roots. Two weeks later, the patient developed fever and vesicular rash over the left gluteal area. Herpes-zoster infection was diagnosed and confirmed by the presence of immunoglobulin M (IgM) antibodies against varicella-zoster. The pain and rash resolved, after treatment with acyclovir. In the appropriate clinical setting, sacral herpes-zoster infection ought to be considered in the differential diagnosis of new-onset sciatic pain.

Ten-year experience of superior gluteal artery perforator flap for reconstruction of sacral defects in Tri-Service General Hospital

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Chin-Ta Lin

2014-01-01

Full Text Available Background: Despite advances in reconstruction techniques, sacral sores continue to present a challenge to the plastic surgeon. The superior gluteal artery perforator (SGAP flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. However, the dissection of the perforator is tedious and carries a risk of compromising the perforator vessels. Patients and Methods: During the period between April 2003 and March 2013, 30 patients presented to our section with sacral wounds causing by pressure sores or infected pilonidal cysts. Of a total of 30 patients, 13 were female and 17 were male. Their ages ranged from 22 to 92 years old (mean 79.8 years old. Surgical intervention was performed electively with immediate or delayed reconstruction using a SGAP flap. The characteristics of patients′ age, and sex, and cause of sacral defect, co-morbidities, wound culture, flap size, perforator number, hospital stay, and outcome were reviewed. Results: For all operations, the length of the pedicle dissection will not exceed 1 cm because of the vascular anatomy of the SGAP, which lies adjacent to the sacral region. Due to short pedicle dissection, all SGAP flap were elevated around an hour. All flaps survived except two, which had partial flap necrosis and were finally treated by contralateral V-Y advancement flaps coverage. The mean follow-up period was 14.8 months (range 3-24. No flap surgery-related mortality was found. Conclusion: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Our study shows that deep pedicle dissection is unnecessary when the surgery involves an accurate indicating perforator, adequate flap size design, and correct selection of flap utilization between tunnel and rotation. The

A Novel Collaborative Protocol for Successful Management of Penile Pain Mediated by Radiculitis of Sacral Spinal Nerve Roots From Tarlov Cysts.

Science.gov (United States)

Goldstein, Irwin; Komisaruk, Barry R; Rubin, Rachel S; Goldstein, Sue W; Elliott, Stacy; Kissee, Jennifer; Kim, Choll W

2017-09-01

Since 14 years of age, the patient had experienced extreme penile pain within seconds of initial sexual arousal through masturbation. Penile pain was so severe that he rarely proceeded to orgasm or ejaculation. After 7 years of undergoing multiple unsuccessful treatments, he was concerned for his long-term mental health and for his future ability to have relationships. To describe a novel collaboration among specialists in sexual medicine, neurophysiology, and spine surgery that led to successful management. Collaborating health care providers conferred with the referring physician, patient, and parents and included a review of all medical records. Elimination of postpubertal intense penile pain during sexual arousal. The patient presented to our sexual medicine facility at 21 years of age. The sexual medicine physician identifying the sexual health complaint noted a pelvic magnetic resonance imaging report of an incidental sacral Tarlov cyst. A subsequent sacral magnetic resonance image showed four sacral Tarlov cysts, with the largest measuring 18 mm. Neuro-genital testing result were abnormal. The neurophysiologist hypothesized the patient's pain at erection was produced by Tarlov cyst-induced neuropathic irritation of sensory fibers that course within the pelvic nerve. The spine surgeon directed a diagnostic injection of bupivacaine to the sacral nerve roots and subsequently morphine to the conus medullaris of the spinal cord. The bupivacaine produced general penile numbness; the morphine selectively decreased penile pain symptoms during sexual arousal without blocking penile skin sensation. The collaboration among specialties led to the conclusion that the Tarlov cysts were pathophysiologically mediating the penile pain symptoms during arousal. Long-term follow-up after surgical repair showed complete symptom elimination at 18 months after treatment. This case provides evidence that (i) Tarlov cysts can cause sacral spinal nerve root radiculitis through

Clinical application of preoperative embolization of tumor feeding artery combined with intraoperative balloon occlusion of the abdominal aorta in the resection of sacral tumors

International Nuclear Information System (INIS)

Chen Wenhua; Wang Qi; He Zhongming; Zhou Jian; Wang Yimin; Wang Jie

2012-01-01

Objective: To investigate the clinical application of preoperative embolization of tumor feeding artery combined with intraoperative balloon occlusion of the abdominal aorta in performing the surgical resection of sacral tumors. Methods: Conventional surgical excision of sacral tumors was employed in 24 patients with sacral tumors (control group), while preoperative embolization of tumor feeding artery combined with intraoperative balloon occlusion of the abdominal aorta was carried out in 32 patients with sacral tumors (study group). The operation time, blood loss during the surgery and the one-year recurrence rate of both groups were documented, and the results were statistically analyzed. Results: Angiography showed that in the study group the sacral tumors were supplied by several vessels, and these feeding arteries were occluded separately. The tumors were successfully removed in all patients with the help of intraoperative balloon occlusion of the abdominal aorta. During the surgery, the surgical area was clearly exposed and the blood loss wa remarkably reduced. After the surgery, no ectopic vascular embolization, renal ischemia, limb ischemia or other complications occurred. Statistically significant difference in the operation time, blood loss during the surgery and the one-year recurrence rate existed between the two groups (P<0.05). Conclusion: Preoperative embolization of tumor feeding artery combined with intraoperative balloon occlusion of the abdominal aorta can effectively shorten the operation time, reduce the blood loss during the surgery and provide a clear surgical field, and thus the surgical safety can be significantly ensured. (authors)

The influence of sacral nerve stimulation on gastrointestinal motor function in patients with fecal incontinence

DEFF Research Database (Denmark)

Damgaard, M; Thomsen, F G; Sørensen, Michael

2011-01-01

Sacral nerve stimulation (SNS) is a well-established treatment for fecal incontinence of various etiologies. However, the mechanism of action remains unclear. The aim of the present study was to determine whether SNS affects gastric emptying, small intestinal transit or colonic transit times....

The feasibility and radiological features of sacral alar iliac fixation in an adult population: a 3D imaging study

Directory of Open Access Journals (Sweden)

Ai-Min Wu

2016-01-01

Full Text Available Background: Surgical treatments for adult spinal deformities often include pelvic fixation, and the feasibility of sacral-2 alar iliac (S2AI screw fixation has been shown previously. However, sometimes S2AI screw fixation cannot be applied due to the presence of an osteolytic lesion or trauma or because the biomechanical properties of only an S2AI screw is insufficient. Therefore, we questioned the feasibility of using sacral AI screws in other segments and determined whether S3AI and S4AI screws have the potential to be used for sacral fractures. The aim of this study was to investigate the feasibility and radiological features of sacral AI fixation in S1–S4 in an adult population using 3D imaging techniques. Methods: Computed tomography (CT scans were taken of 45 patients and were imported into Mimics (Version 10.01, Materialise, Belgium software to reconstruct the 3D digital images. Next, a cylinder (radius of 3.5 mm was drawn to imitate the screw trajectory of a S1–4 AI screw, and every imitated screw in each segment was adjusted to a maximum upward and downward angle to acquire the feasible region. The parameters of the S1–4AI screw trajectories were measured. Results: Sacral AI screws could be successfully imitated using 3D digital imaging. The S4AI screw trajectory could be obtained in 19 of 45 patient images (42.2%, while the feasibility rates of S1AI, S2AI, and S3AI screw fixation were 100%, 100%, and 91.1% (41/45, respectively. The feasible regions of S1AI, S2AI, and S3AI screw trajectories were wide enough, while the adjustable angle of S4AI screws was very small. Conclusion: It is feasible to place S1–2AI screws in the entire adult population and S3–4AI screws in some of the adult population. Furthermore, our study suggested that 3D digital images are suitable to study the feasibility of new screw fixation.

Synchronous Multicentric Giant Cell Tumour of Distal Radius and Sacrum with Pulmonary Metastases

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Varun Sharma Tandra

2015-01-01

Full Text Available Giant cell tumour (GCT is an uncommon primary bone tumour, and its multicentric presentation is exceedingly rare. We report a case of a 45-year-old female who presented to us with GCT of left distal radius. On the skeletal survey, osteolytic lesion was noted in her right sacral ala. Biopsy confirmed both lesions as GCT. Pulmonary metastasis was also present. Resection-reconstruction arthroplasty for distal radius and thorough curettage and bone grafting of the sacral lesion were done. Multicentric GCT involving distal radius and sacrum with primary sacral involvement is not reported so far to our knowledge.

Primary atypical sacral meningioma- not always benign

International Nuclear Information System (INIS)

Bhadra, A.K.; Casey, A.T.H.; Saifuddin, A.; Briggs, T.W.

2007-01-01

We present a case of an atypical recurrent meningioma of the sacrum with pulmonary metastasis in a 31-year-old man. He presented with deep-seated buttock pain and urinary hesitancy for 3 months. MRI revealed a lesion occupying the central and left side of the sacral canal at the S1-S2 level. Surgical excision of the lesion via a posterior approach was undertaken, and the patient became symptom-free post-operatively. Histology confirmed atypical meningioma. Eight months later he re-presented with similar symptoms, and MRI confirmed local recurrence. The patient underwent left hemisacrectomy. Six months later he again presented with low back pain and MRI confirmed a second local recurrence. A CT scan of the chest showed multiple lung metastases. The patient died of a severe chest infection 18 months later. (orig.)

Primary atypical sacral meningioma- not always benign

Energy Technology Data Exchange (ETDEWEB)

Bhadra, A.K.; Casey, A.T.H.; Saifuddin, A.; Briggs, T.W. [Royal National Orthopaedic Hospital, Stanmore, London (United Kingdom)

2007-06-15

We present a case of an atypical recurrent meningioma of the sacrum with pulmonary metastasis in a 31-year-old man. He presented with deep-seated buttock pain and urinary hesitancy for 3 months. MRI revealed a lesion occupying the central and left side of the sacral canal at the S1-S2 level. Surgical excision of the lesion via a posterior approach was undertaken, and the patient became symptom-free post-operatively. Histology confirmed atypical meningioma. Eight months later he re-presented with similar symptoms, and MRI confirmed local recurrence. The patient underwent left hemisacrectomy. Six months later he again presented with low back pain and MRI confirmed a second local recurrence. A CT scan of the chest showed multiple lung metastases. The patient died of a severe chest infection 18 months later. (orig.)

Effects of acute urinary bladder overdistension on bladder response during sacral neurostimulation.

Science.gov (United States)

Bross, S; Schumacher, S; Scheepe, J R; Zendler, S; Braun, P M; Alken, P; Jünemann, K

1999-10-01

Urinary retention and micturition disorders after overdistension are clinically well-known complications of subvesical obstruction. We attempted to evaluate whether bladder overdistension influences bladder response and whether overdistension supports detrusor decompensation. Following lumbal laminectomy in 9 male foxhounds, the sacral anterior roots S2 and S3 were placed into a modified Brindley electrode for reproducible and controlled detrusor activation. The bladder was filled in stages of 50 ml from 0 to 700 ml, corresponding to an overdistension. At each volume, the bladder response during sacral anterior root stimulation was registered. After overdistension, the bladder was refilled stepwise from 0 to 300 ml and stimulated. In all dogs, the bladder response was influenced by the intravesical volume. The maximum pressure (mean 69.1 cm H(2)O) was observed at mean volume of 100 ml. During overdistension, a significant reduction in bladder response of more than 80% was seen. After overdistension, a significant reduction in intravesical pressure of 19.0% was observed. In 2 cases, reduction in bladder response was more than 50% after a single overdistension. We conclude that motoric bladder function is influenced during and after overdistension. A single bladder overdistension can support acute and long-lasting detrusor decompensation. In order to protect motoric bladder function, bladder overdistension must be prevented.

Value of MRI in the diagnosis of non-clival, non-sacral chordoma

International Nuclear Information System (INIS)

Smolders, D.; Wang, X.; Vanhoenacker, F.; De Schepper, A.M.; Drevelengas, A.

2003-01-01

To determine the MR features of non-sacral, non-clival chordoma and to describe a MR prototype of the lesion.Design and patients We reviewed the MR findings of 10 patients with a histologically proven chordoma (6 cervical spine, 1 thoracic spine, 3 lumbar spine). There were three female and seven male patients. Age ranged from 12 to 66 years with a mean age of 44.6 years. The MR images were reviewed for signal intensity (SI) and morphology. All lesions showed a soft tissue extension spanning several vertebral segments. Most of the lesions exhibited a so-called collar button appearance (sagittal images). Two cases of cervical chordoma displayed a ''dumbbell morphology'' (axial images) or ''mushroom'' appearance without bone involvement and with enlargement of the neuroforamen mimicking a neurogenic tumor. Although the region of the nucleus pulposus is the last part of the fetal notochord in the adult to involute, disks were surprisingly spared in all patients. Eight of 10 patients showed heterogeneous SI on all sequences. The overall SI of all lesions was isointense or slightly higher than that of muscle on T1-weighted images. All lesions exhibited high SI on T2-weighted images. After gadolinium contrast administration there was a moderate enhancement in most cases. Although the SI on MR imaging is not specific, chordoma should be considered when a destructive lesion of a vertebral body is associated with a soft tissue mass with a collar button or mushroom appearance and dumbbell morphology, spanning several vertebral segments and sparing the disk(s). (orig.)

Bone-marrow imaging with indium-111 chloride in aplastic anemia and myelofibrosis: concise communication

International Nuclear Information System (INIS)

Sayle, B.A.; Helmer, R.E.; Birdsong, B.A.; Balachandran, S.; Gardner, F.H.

1982-01-01

Twenty-nine patients with aplastic anemia and 11 patients with myelofibrosis were evaluated with indium-111 chloride bone-marrow imaging, ferrokinetics, and bone-marrow core biopsies. There was good correlation between the erythrocyte cellularity of the marrow and the In-111 bone-marrow scan grades in most patients. In some, the overall scan grade tended to underestimate the erythroid elements because the core biopsy had been taken from the area of the greatest radionuclide concentration on the scan. In patients with aplastic anemia, there was good correlation between the plasma iron clearance t1/2 and the scan grade. Less agreement was found in the comparison between the Fe-59 sacral and organ counts and the red-cell iron utilization. In patients with myelofibrosis, there was poor correlation between the surface counts over the sacrum and the red-cell iron utilization. Plasma iron clearances were abnormally short and were unrelated to the transferrin saturation levels. Eighteen patients were studied several times to evaluate their responses to steroid therapy. In all, there was good correlation between the bone-marrow imaging, the erythrocyte cellularity, ferrokinetics, and the patient's response to therapy. Indium-111 bone-marrow imaging is useful both in evaluating marrow erythroid activity and in following the response to therapy in patients with these diseases

Morphological evaluation of the thoracic, lumbar and sacral column of the giant anteater (Myrmecophaga tridactyla Linnaeus, 1758

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Naida C. Borges

Full Text Available ABSTRACT: This study aimed to describe the number of thoracic, lumbar and sacral vertebrae in tridactyla through radiographic examinations associated with gross anatomy determination. For this purpose, 12 adult specimens of M. tridactyla were analyzed, assigned to the Screening Center of Wild Animals (CETAS, IBAMA-GO, and approved by the Ethics Committee on the Use of Animals (Process CEUA-UFG nr 018/2014. In the radiographic examinations the following numbers of thoracic (T and lumbar (L vertebrae were observed: 16Tx2L (n=7, 15Tx2L (n=3, and 15Tx3L (n=2. In contrast, the numbers of vertebrae identified by anatomical dissection were as follows: 16Tx2L (n=4, 15Tx2L (n=3, and 15Tx3L (n=5. This difference occurred in cases of lumbarization of thoracic vertebrae, as seen in three specimens, and was explained by changes in regional innervations identified by anatomical dissection and the presence of floating ribs (right unilateral=1, left unilateral=1 and bilateral=1, which were not identified by radiographic exams. Regarding the sacral vertebrae there was no variation depending on the methods used, which allowed the identification of 4 (n=1 or 5 (n=11 vertebrae. Thus, we concluded that there is variation in the number of thoracic, lumbar and sacral vertebrae, in addition to lumbarization, which must be considered based on the presence of floating ribs, in this species.

Survival of Dental Implants Placed in Grafted and Nongrafted Bone: A Retrospective Study in a University Setting.

Science.gov (United States)

Tran, Duong T; Gay, Isabel C; Diaz-Rodriguez, Janice; Parthasarathy, Kavitha; Weltman, Robin; Friedman, Lawrence

2016-01-01

To compare dental implant survival rates when placed in native bone and grafted sites. Additionally, risk factors associated with dental implant loss were identified. This study was based on the hypothesis that bone grafting has no effect on implant survival rates. A retrospective chart review was conducted for patients receiving dental implants at the University of Texas, School of Dentistry from 1985 to 2012. Exclusion criteria included patients with genetic diseases, radiation and chemotherapy, or an age less than 18 years. To avoid misclassification bias, implants were excluded if bone grafts were only done at the same time of placement. Data on age, sex, tobacco use, diabetes, osteoporosis, anatomical location of the implant, implant length and width, bone graft, and professional maintenance were collected for analysis. A total of 1,222 patients with 2,729 implants were included. The cumulative survival rates at 5 and 10 years were 92% and 87% for implants placed in native bone and 90% and 79% for implants placed in grafted bone, respectively. The results from multivariate analysis (Cox regression) indicated no significant difference in survival between the two groups; having maintenance therapy after implant placement reduced the failure rate by 80% (P dental implant survival rate when implants were placed in native bone or bone-grafted sites. Smoking and lack of professional maintenance were significantly related to increased implant loss.

Doença de Paget com acometimento sacral: relato de caso Paget's disease with sacral involvement: a case report

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Fernanda Nogueira Holanda Ferreira Braga

2010-10-01

Full Text Available Os autores relatam o caso de um paciente do sexo masculino, 71 anos de idade, com diagnóstico de doença de Paget óssea sacral. Foi realizado estudo com radiografia, cintilografia, tomografia computadorizada e ressonância magnética, e o diagnóstico foi confirmado por análise histopatológica. O paciente evoluiu com boa resposta ao uso de ibandronato 150 mg, mensalmente, com redução significativa dos marcadores bioquímicos da doença.The authors report a case of a 71-year-old male patient diagnosed with Paget's disease of sacrum. Imaging study was performed with radiography, scintigraphy, computed tomography and magnetic resonance imaging, and the diagnosis was confirmed by biopsy. The patient progressed with a good response to monthly treatment with ibandronate 150 mg, presenting a significant reduction in biochemical markers of disease.

Exhausted implanted pulse generator in sacral nerve stimulation for faecal incontinence: What next in daily practice for patients?

Science.gov (United States)

Duchalais, Emilie; Meurette, Guillaume; Perrot, Bastien; Wyart, Vincent; Kubis, Caroline; Lehur, Paul-Antoine

2016-02-01

The efficacy of sacral nerve stimulation in faecal incontinence relies on an implanted pulse generator known to have a limited lifespan. The long-term use of sacral nerve stimulation raises concerns about the true lifespan of generators. The aim of the study was to assess the lifespan of sacral nerve stimulation implanted pulse generators in daily practice, and the outcome of exhausted generator replacement, in faecal incontinent patients. Faecal incontinent patients with pulse generators (Medtronic Interstim™ or InterstimII™) implanted in a single centre from 2001 to 2014 were prospectively followed up. Generator lifespan was measured according to the Kaplan-Meier method. Patients with a generator explanted/turned off before exhaustion were excluded. Morbidity of exhausted generator replacement and the outcome (Cleveland Clinic Florida Faecal Incontinence (CCF-FI) and Faecal Incontinence Quality of Life (FIQL) scores) were recorded. Of 135 patients with an implanted pulse generator, 112 (InterstimII 66) were included. Mean follow-up was 4.9 ± 2.8 years. The generator reached exhaustion in 29 (26%) cases. Overall median lifespan of an implanted pulse generator was approximately 9 years (95% CI 8-9.2). Interstim and InterstimII 25th percentile lifespan was 7.2 (CI 6.4-8.3) and 5 (CI 4-not reached) years, respectively. After exhaustion, generators were replaced, left in place or explanted in 23, 2 and 4 patients, respectively. Generator replacement was virtually uneventful. CCF-FI/FIQL scores remained unchanged after generator replacement (CCF-FI 8 ± 2 vs 7 ± 3; FIQL 3 ± 0.6 vs 3 ± 0.5; p = ns). In this study, the implanted pulse generator observed median lifespan was 9 years. After exhaustion, generators were safely and efficiently replaced. The study also gives insight into long-term needs and costs of sacral nerve stimulation (SNS) therapy.

Clinical results of sacral neuromodulation for chronic voiding dysfunction using unilateral sacral foramen electrodes.

Science.gov (United States)

Weil, E H; Ruiz-Cerdá, J L; Eerdmans, P H; Janknegt, R A; Van Kerrebroeck, P E

1998-01-01

The aim of this study was to determine the long-term clinical efficacy and complications of neuromodulation with a unilateral sacral foramen electrode in 36 patients with chronic voiding dysfunction. Following a positive effect of a percutaneous nerve evaluation test, patients underwent open surgery. A permanent electrode was implanted in 24 patients with urge incontinence, in 6 with urgency-frequency syndrome, and in 6 with nonobstructive urinary retention. After an average follow-up period of 37.8 months, 19 patients (52.8%) continue to benefit from the neuromodulation with a significant improvement of symptoms and urodynamic parameters. The median duration of the therapeutic effect for the total study population was longer than 60 months. No significant difference in the median duration of therapeutic effect with regard to sex, the type of voiding disorder, or the implant pulse generator was found. However, in patients with previous psychological disorders the median duration of therapeutic effect was only 12 months (P = 0.008). Complications were mild. In the group of patients in whom the therapeutic effect remains, 37 reoperations have had to be performed. We conclude that although reoperations were needed to overcome technical problems, patients can achieve lasting symptomatic improvement. Since technical changes in the equipment have reduced the number of complications, even better results can be expected in terms of the reoperation rate.

Value of MRI in the diagnosis of non-clival, non-sacral chordoma

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Smolders, D.; Wang, X.; Vanhoenacker, F.; De Schepper, A.M. [Department of Radiology, University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem (Belgium); Drevelengas, A. [Department of Radiology, University of Thessaloniki, Thessaloniki (Greece)

2003-06-01

To determine the MR features of non-sacral, non-clival chordoma and to describe a MR prototype of the lesion.Design and patients We reviewed the MR findings of 10 patients with a histologically proven chordoma (6 cervical spine, 1 thoracic spine, 3 lumbar spine). There were three female and seven male patients. Age ranged from 12 to 66 years with a mean age of 44.6 years. The MR images were reviewed for signal intensity (SI) and morphology. All lesions showed a soft tissue extension spanning several vertebral segments. Most of the lesions exhibited a so-called collar button appearance (sagittal images). Two cases of cervical chordoma displayed a ''dumbbell morphology'' (axial images) or ''mushroom'' appearance without bone involvement and with enlargement of the neuroforamen mimicking a neurogenic tumor. Although the region of the nucleus pulposus is the last part of the fetal notochord in the adult to involute, disks were surprisingly spared in all patients. Eight of 10 patients showed heterogeneous SI on all sequences. The overall SI of all lesions was isointense or slightly higher than that of muscle on T1-weighted images. All lesions exhibited high SI on T2-weighted images. After gadolinium contrast administration there was a moderate enhancement in most cases. Although the SI on MR imaging is not specific, chordoma should be considered when a destructive lesion of a vertebral body is associated with a soft tissue mass with a collar button or mushroom appearance and dumbbell morphology, spanning several vertebral segments and sparing the disk(s). (orig.)

Physical Activity, Physical Fitness, Body Composition, and Nutrition Are Associated with Bone Status in University Students.

Science.gov (United States)

Hervás, Gotzone; Ruiz-Litago, Fátima; Irazusta, Jon; Fernández-Atutxa, Ainhoa; Fraile-Bermúdez, Ana Belen; Zarrazquin, Idoia

2018-01-10

Understanding the modifiable factors that improve and maximize peak bone mass at an early age is necessary to design more effective intervention programs to prevent osteoporosis. To identify these modifiable factors, we analyzed the relationship of physical activity (PA), physical fitness, body composition, and dietary intake with bone stiffness index (SI), measured by quantitative ultrasonometry in young university students (18-21 years). Moderate-to-vigorous PA (MVPA) was the strongest predictor of SI (β = 0.184; p = 0.035). SI was most closely related with very vigorous PA in males (β = 0.288; p = 0.040) and with the number of steps/day in females (β = 0.319; p = 0.002). An association between thigh muscle and SI was consistent in both sexes (β = 0.328; p < 0.001). Additionally, extension maximal force was a bone SI predictor factor in females (β = 0.263; p = 0.016) independent of thigh muscle perimeter. Calcium intake was the only nutrition parameter that had a positive relationship with SI ( R = 0.217; p = 0.022). However, it was not included as a predictor for SI in our regression models. This study identifies predictors of bone status in each sex and indicates that muscle and bone interrelate with PA and fitness in young adults.

Treatment of intractable chronic pelvic pain syndrome by injecting a compound of Bupivacaine and Fentanyl into sacral spinal space

Institute of Scientific and Technical Information of China (English)

ZHOU Zhan-song; SONG Bo; NIE Fa-chuan; CHEN Jin-mei

2006-01-01

Objective:To investigate the effect of injecting a compound of Bupivacaine and Fentanyl into sacral spinal space to treat chronic pelvic pain syndrome (CPPS). Methods: A total of 36 men with recalcitrant CPPS refractory to multiple prior therapies were treated with the injection of a compound of Bupivacaine and Fentanyl (10 ml of 0. 125% upivacaine, .05 mg Fentanyl, 5 mg Dexamethasone, 100 mg Vitamin B1 and 1 mg Vitamin B12) into sacral space once a week for 4 weeks. The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), maximum and average flow rate were performed at the start and the end of 4 weeks' therapy. Results :Mean NIH-CPSI total score was decreased from 26.5±.6 to 13.4±2.0 (P＜0. 001). Significant improvement was seen in each subscore domain. A total of 32 patients (89%) had at least 25% improvement on NIH-CPSI and 22 (61%) had at least 50% improvement. Maximal and average flow rate were increased from 19. 5±3.8 to 23. 6±4. 2 and 10. 9±2.6 to 14.3± 2.4 respectively. Conclusion: Injection of this compound of Bupivacaine, Fentanyl and Dexamethasone into sacral spinal space is an effective and safe approach for recalcitrant CPPS. Further study of the mechanisms and prospective placebo controlled trials are warranted.

Incidence, treatment, and survival patterns for sacral chordoma in the United States, 1974-2011

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Esther Yu

2016-09-01

Full Text Available IntroductionSacral chordomas represent one half of all chordomas, a rare neoplasm of notochordal remnants. Current NCCN guidelines recommend surgical resection with or without adjuvant radiotherapy, or definitive radiation for unresectable cases. Recent advances in radiation for chordomas include conformal photon and proton beam radiation. We investigated incidence, treatment, and survival outcomes to observe any trends in response to improvements in surgical and radiation techniques over a near 40 year time period.Materials and Methods345 microscopically confirmed cases of sacral chordoma were identified between 1974 and 2011 from the Surveillance, Epidemiology, and End Results (SEER program of the National Cancer Institute. Cases were divided into three cohorts by calendar year, 1974-1989, 1990-1999, and 2000-2011, as well as into two groups by age less than or equal to 65 versus greater than 65 to investigate trends over time and age via Chi-square analysis. Kaplan-Meier analyses were performed to determine effects of treatment on survival. Multivariate Cox regression analysis was performed to determine predictors of overall survival.Results5-year overall survival for the entire cohort was 60.0%. Overall survival correlated significantly with treatment modality, with 44% surviving at 5 years with no treatment, 52% with radiation alone, 82% surgery alone, and 78% surgery and radiation (p<.001. Age greater than 65 was significantly associated with non-surgical management with radiation alone or no treatment (p<.001. Relatively fewer patients received radiation between 2000 and 2011 compared to prior time periods (p=.03 versus surgery, for which rates which did not vary significantly over time (p=.55. However, 5-year overall survival was not significantly different by time period. Age group and treatment modality were predictive for overall survival on multivariate analysis (p<.001. ConclusionSurgery remains an important component in the

The performance of MRI in detecting subarticular bone erosion of sacroiliac joint in patients with spondyloarthropathy: A comparison with X-ray and CT

International Nuclear Information System (INIS)

Hu, Libin; Huang, Zhenguo; Zhang, Xuezhe; Chan, Queenie; Xu, Yanyan; Wang, Guochun; Wang, Wu

2014-01-01

Highlights: • MRI 3D-WS-bSSFP sequence has high spatial resolution and short scanning time. • This is the first time this sequence was applied to detect bone erosion of SI joint. • Its performance was compared with other commonly used diagnostic methods. • Result shows that this sequence is better than X-ray and T1W in the detection of bone erosion. • This sequence can be considered an alternative to CT in showing erosion in SpA patients. - Abstract: Objective: To assess the sensitivity and specificity of detecting subarticular bone erosion of sacroiliac (SI) joint in patients with spondyloarthritis (SpA) using MRI three-dimensional water selective balanced steady-state free precession sequence (3D-WS-bSSFP) and T1-weighted (T1W) sequence. Materials and methods: Radiography, CT and MRI of SI joint from 43 SpA patients were retrospectively analyzed. MRI examination sequences include T1W, short tau inversion recovery (STIR) and 3D-WS-bSSFP. Two radiologists, blinded to clinical data, independently determined bone erosion at bilateral sacral and iliac sides of the SI joint on radiography, CT, T1W and 3D-WS-bSSFP respectively. X 2 test was used to compare the sensitivity of detecting bone erosion among different diagnostic methods. Results: Of the 86 sacral and 86 iliac articular surfaces from the 43 cases, radiography, CT, MRI T1W and 3D-WS-bSSFP showed the presence of bone erosion in 40, 74, 50 and 71 articular surfaces respectively. CT and MRI 3D-WS-bSSFP demonstrated similar sensitivity (x 2 = 0.11, P = 0.74), and both were superior to radiography (x 2 = 15.17, P < 0.01 and x 2 = 12.78, P < 0.01, respectively) and T1W (x 2 = 7.26, P < 0.01 and x 2 = 5.62, P < 0.05). Using CT diagnosis as the gold standard, the sensitivity and specificity of detecting bone erosion for MRI 3D-WS-bSSFP and T1W sequences were 91.8%, 96.9%, and 60.8%, 94.9% respectively. Conclusion: MRI 3D-WS-bSSFP sequence is associated with short scanning time, zero ionizing radiation, high

The performance of MRI in detecting subarticular bone erosion of sacroiliac joint in patients with spondyloarthropathy: A comparison with X-ray and CT

Energy Technology Data Exchange (ETDEWEB)

Hu, Libin [Department of Radiology, China-Japan Friendship Hospital, Beijing (China); Huang, Zhenguo, E-mail: zhuang680911@163.com [Department of Radiology, China-Japan Friendship Hospital, Beijing (China); Zhang, Xuezhe [Department of Radiology, China-Japan Friendship Hospital, Beijing (China); Chan, Queenie [Philips Healthcare, Hong Kong (China); Xu, Yanyan [Department of Radiology, China-Japan Friendship Hospital, Beijing (China); Wang, Guochun [Department of Rheumatology, China-Japan Friendship Hospital, Beijing (China); Wang, Wu [Department of Radiology, China-Japan Friendship Hospital, Beijing (China)

2014-11-15

Highlights: • MRI 3D-WS-bSSFP sequence has high spatial resolution and short scanning time. • This is the first time this sequence was applied to detect bone erosion of SI joint. • Its performance was compared with other commonly used diagnostic methods. • Result shows that this sequence is better than X-ray and T1W in the detection of bone erosion. • This sequence can be considered an alternative to CT in showing erosion in SpA patients. - Abstract: Objective: To assess the sensitivity and specificity of detecting subarticular bone erosion of sacroiliac (SI) joint in patients with spondyloarthritis (SpA) using MRI three-dimensional water selective balanced steady-state free precession sequence (3D-WS-bSSFP) and T1-weighted (T1W) sequence. Materials and methods: Radiography, CT and MRI of SI joint from 43 SpA patients were retrospectively analyzed. MRI examination sequences include T1W, short tau inversion recovery (STIR) and 3D-WS-bSSFP. Two radiologists, blinded to clinical data, independently determined bone erosion at bilateral sacral and iliac sides of the SI joint on radiography, CT, T1W and 3D-WS-bSSFP respectively. X{sup 2} test was used to compare the sensitivity of detecting bone erosion among different diagnostic methods. Results: Of the 86 sacral and 86 iliac articular surfaces from the 43 cases, radiography, CT, MRI T1W and 3D-WS-bSSFP showed the presence of bone erosion in 40, 74, 50 and 71 articular surfaces respectively. CT and MRI 3D-WS-bSSFP demonstrated similar sensitivity (x{sup 2} = 0.11, P = 0.74), and both were superior to radiography (x{sup 2} = 15.17, P < 0.01 and x{sup 2} = 12.78, P < 0.01, respectively) and T1W (x{sup 2} = 7.26, P < 0.01 and x{sup 2} = 5.62, P < 0.05). Using CT diagnosis as the gold standard, the sensitivity and specificity of detecting bone erosion for MRI 3D-WS-bSSFP and T1W sequences were 91.8%, 96.9%, and 60.8%, 94.9% respectively. Conclusion: MRI 3D-WS-bSSFP sequence is associated with short scanning time

Medium-Term Outcome of Sacral Nerve Modulation for Constipation

DEFF Research Database (Denmark)

Govaert, Bastiaan; Maeda, Yasuko; Alberga, Job

2012-01-01

was percutaneous nerve evaluation. If this was successful, patients underwent sacral nerve modulation therapy with an implanted device (tined-lead and implantable pulse generator). MAIN OUTCOME MEASURE: Follow-up was performed at 1, 3, 6, and 12 months, and yearly thereafter. Outcome was assessed with the Wexner...... constipation score. RESULTS: A total of 117 patients (13 men, 104 women) with a mean age of 45.6 (SD, 13.0) years underwent percutaneous nerve evaluation. Of these, 68 patients (58%) had successful percutaneous nerve evaluation and underwent implantation of a device. The mean Wexner score was 17.0 (SD, 3.......8) at baseline and 10.2 (SD 5.3) after percutaneous nerve evaluation (p latest follow-up (median, 37 months; range, 4–92) was only 61 (52% of all patients who...

Bi-iliac distance and iliac bone position compared to the vertebral column in normal fetal development

DEFF Research Database (Denmark)

Hartling, U B; Fischer Hansen, B; Skovgaard, L T

2001-01-01

Prenatal standards of bi-iliac width were not found in the literature based on autopsy investigations, nor was the caudo-cranial position of the ilia compared to the vertebral column. The first purpose of the present study was to establish normal standard values for the bi-iliac distance in fetal...... life, the second to evaluate the level of the iliac bones proportional to the ossified vertebral column. Whole body radiographs in antero-posterior projections from 98 human fetuses (36 female and 44 male fetuses, as well as 18 fetuses on which the sex had not been determined) were analyzed...... caliper. The caudo-cranial position of the iliac bones was evaluated. The present study shows that in normal fetal development there is a continuous linear enlargement of the pelvic region in the transverse and vertical planes. The upper iliac contour stays at the level of the first sacral vertebral body...

Does Sacral Nerve Stimulation Improve Continence Through Enhanced Sensitivity of the Anal Canal?

DEFF Research Database (Denmark)

Haas, S; Brock, C; Krogh, K

2016-01-01

. DESIGN: This is an explorative study. PATIENTS: Fifteen women with idiopathic fecal incontinence (mean age, 58 ± 12.2 years) were selected. INTERVENTIONS: Cortical evoked potentials were recorded during repeated rapid balloon distension of the rectum and the anal canal both before and during temporary...... the threshold for urge to defecate elicited from the anal canal, whereas supraspinal responses remained unaltered. This may suggest that sacral nerve stimulation, at least in part, acts via somatic afferent fibers enhancing anal sensation....

Sacral nerve stimulation increases activation of the primary somatosensory cortex by anal canal stimulation in an experimental model.

LENUS (Irish Health Repository)

Griffin, K M

2011-08-01

Sacral and posterior tibial nerve stimulation may be used to treat faecal incontinence; however, the mechanism of action is unknown. The aim of this study was to establish whether sensory activation of the cerebral cortex by anal canal stimulation was increased by peripheral neuromodulation.

A multi-level rapid prototyping drill guide template reduces the perforation risk of pedicle screw placement in the lumbar and sacral spine.

Science.gov (United States)

Merc, Matjaz; Drstvensek, Igor; Vogrin, Matjaz; Brajlih, Tomaz; Recnik, Gregor

2013-07-01

The method of free-hand pedicle screw placement is generally safe although it carries potential risks. For this reason, several highly accurate computer-assisted systems were developed and are currently on the market. However, these devices have certain disadvantages. We have developed a method of pedicle screw placement in the lumbar and sacral region using a multi-level drill guide template, created with the rapid prototyping technology and have validated it in a clinical study. The aim of the study was to manufacture and evaluate the accuracy of a multi-level drill guide template for lumbar and first sacral pedicle screw placement and to compare it with the free-hand technique under fluoroscopy supervision. In 2011 and 2012, a randomized clinical trial was performed on 20 patients. 54 screws were implanted in the trial group using templates and 54 in the control group using the fluoroscopy-supervised free-hand technique. Furthermore, applicability for the first sacral level was tested. Preoperative CT-scans were taken and templates were designed using the selective laser sintering method. Postoperative evaluation and statistical analysis of pedicle violation, displacement, screw length and deviation were performed for both groups. The incidence of cortex perforation was significantly reduced in the template group; likewise, the deviation and displacement level of screws in the sagittal plane. In both groups there was no significantly important difference in deviation and displacement level in the transversal plane as not in pedicle screw length. The results for the first sacral level resembled the main investigated group. The method significantly lowers the incidence of cortex perforation and is therefore potentially applicable in clinical practice, especially in some selected cases. The applied method, however, carries a potential for errors during manufacturing and practical usage and therefore still requires further improvements.

Nanotechnology in the targeted drug delivery for bone diseases and bone regeneration

Directory of Open Access Journals (Sweden)

Gu W

2013-06-01

Full Text Available Wenyi Gu,1,2 Chengtie Wu,3 Jiezhong Chen,1 Yin Xiao1 1Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia; 2Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD, Australia; 3State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, People's Republic of China Abstract: Nanotechnology is a vigorous research area and one of its important applications is in biomedical sciences. Among biomedical applications, targeted drug delivery is one of the most extensively studied subjects. Nanostructured particles and scaffolds have been widely studied for increasing treatment efficacy and specificity of present treatment approaches. Similarly, this technique has been used for treating bone diseases including bone regeneration. In this review, we have summarized and highlighted the recent advancement of nanostructured particles and scaffolds for the treatment of cancer bone metastasis, osteosarcoma, bone infections and inflammatory diseases, osteoarthritis, as well as for bone regeneration. Nanoparticles used to deliver deoxyribonucleic acid and ribonucleic acid molecules to specific bone sites for gene therapies are also included. The investigation of the implications of nanoparticles in bone diseases have just begun, and has already shown some promising potential. Further studies have to be conducted, aimed specifically at assessing targeted delivery and bioactive scaffolds to further improve their efficacy before they can be used clinically. Keywords: nanoparticles, nanostructured scaffold, cancer bone metastasis, bone diseases, target drug delivery, bone regeneration

A Randomized Comparison Between Ultrasound- and Fluoroscopy-Guided Sacral Lateral Branch Blocks.

Science.gov (United States)

Finlayson, Roderick J; Etheridge, John-Paul B; Elgueta, Maria Francisca; Thonnagith, Atikun; De Villiers, Frederick; Nelems, Bill; Tran, De Q

This randomized trial compared ultrasound (US)- and fluoroscopy-guided sacral lateral branch (SLB) blocks. We hypothesized that US would require a shorter performance time. Forty patients who required unilateral sacral lateral branch blocks for chronic low back pain were randomized to US or fluoroscopy guidance. Before the performance of the assigned block, an investigator who was not involved in patient care carried out baseline analgesic testing. With US, the dorsal sacroiliac ligament, the sacroiliac joint, and the interosseous ligament were probed with a 22-gauge block needle. The patient was asked to rate the level of discomfort using an 11-point numerical rating scale.After the analgesic test, attending anesthesiologists or supervised trainees carried out the SLB blocks. The local anesthetic agent (lidocaine 2%) was identical in all subjects. In the US group, local anesthetic (1.5 mL) was first injected on the lateral crest at the mid-point between S2 and S3. Subsequently, 2 more injections of 0.5 mL were carried out on the lateral crest, immediately cephalad to S2 and at the S1 level. In the fluoroscopy group, SLB blocks were performed according to a previously described 17-injection technique, which involves 9 skin entry sites and the targeting of the L5 posterior root and S1-S3 sacral lateral branches. A 0.4-mL volume of local anesthetic was deposited at each target point. The performance time, number of needle passes, and the incidence of vascular breach were recorded during the performance of the block.Twenty minutes after the end of local anesthetic injection, the same investigator who performed preblock analgesic testing carried out postblock testing in an identical manner. Compared with fluoroscopy, the US technique was associated with a shorter performance time (267.5 ± 99.3 vs 628.7 ± 120.3 seconds; P < 0.001), fewer needle passes and a lower incidence of vascular breach (0 vs 10 occurrences; P = 0.001). However, the block effect (ie, the

A new technique for long time catheterization of sacral epidural canal in rabbits.

Science.gov (United States)

Erkin, Yüksel; Aydın, Zeynep; Taşdöğen, Aydın; Karcı, Ayşe

2013-01-01

In this study we aimed to develop a simple and practical technique for chronic sacral epidural catheterization of rabbits. We included ten rabbits weighing 2-2.5 kg in the study. After anesthesia and analgesia, we placed an epidural catheter by a 2 cm longitudinal skin incision in the tail above the sacral hiatus region. We confirmed localization by giving 1% lidocaine (leveling sensory loss and motor function loss of the lower extremity). The catheter was carried forward through a subcutaneous tunnel and fixed at the neck. Chronic caudal epidural catheter placement was succesful in all rabbits. The catheters stayed in place effectively for ten days. We encountered no catheter complications during this period. The localization of the catheter was reconfirmed by 1% lidocaine on the last day. After animals killing, we performed a laminectomy and verified localization of the catheter in the epidural space. Various methods for catheterization of the epidural space in animal models exist in the literature. Epidural catheterization of rabbits can be accomplished by atlanto-occipital, lumbar or caudal routes by amputation of the tail. Intrathecal and epidural catheterization techniques defined in the literature necessitate surgical skill and knowledge of surgical procedures like laminectomy and tail amputation. Our technique does not require substantial surgical skill, anatomical integrity is preserved and malposition of the catheter is not encountered. In conclusion, we suggest that our simple and easily applicable new epidural catheterization technique can be used as a model in experimental animal studies.

Bacteriological findings in patients with bone marrow transplantation (Karl Marx University Leipzig, 1985-1987).

Science.gov (United States)

Wonitzki, C; Hoffmann, F A

1989-01-01

The results of the bacteriological surveillance cultures for 26 patients with bone marrow transplantation (Karl Marx University Leipzig, G.D.R., 1985-1987) are presented. 5.9% of all surveillance cultures contained facultatively pathogenic germs (with Pseudomonas aeruginosa as the most frequent representative, which was the reason of a sepsis in two patients). Coagulasenegative Staphylococci and other germs with an obscure pathogenicity were isolated upon a large scale, especially from the mucous membrane regions. There are hints, that above all special strains of coagulasenegative Staphylococci "colonize" the patient's body (also for longer periods) and turn into the blood too. During the total decontamination intestinal anaerobic flora is absent. After closing of total decontamination Clostridium perfringens is the first detectable anaerobic species. During the selective decontamination systemic applications of antibiotics are able to obliterate anaerobic findings for certain periods. Recommendations for an effective arrangement of the surveillance cultures of bone marrow transplantation patients are given.

Comparative study between fasciocutaneous and myocutaneous flaps in the surgical treatment of pressure ulcers of the sacral region

Directory of Open Access Journals (Sweden)

D. Oksman

2018-06-01

Full Text Available Introduction: Decubitus ulcers of the sacral region are common conditions in bedridden patients. Deep lesions (Stages III and IV often require surgical treatment for closure. Flaps of the region are the first choice for treatment. We present our experience in the treatment of these lesions and compare two different approaches: local fasciocutaneous flap and gluteus maximus myocutaneous flap with V-Y advancement. Method: From March 2009 to May 2014, 32 patients underwent closure of sacral pressure ulcers by flaps, 17 of them with rotational local fasciocutaneous flaps and 15 with myocutaneous flaps of the gluteus maximus muscle with V-Y advancement. Evolution regarding complications and rate of success after two months was compared between the groups. Results: Out of the 32 operated patients we obtained resolution of lesions after two months in 23 (71.8%, 10 patients in the fasciocutaneous flap group (58.8% and 13 cases in the myocutaneous flap group (86.6%. The most common complication was partial dehiscence of sutures in 12 patients (37.5%, 8 patients in the fasciocutaneous flap group (47% and 4 patients in the myocutaneous flap group (26.6%. The group of patients reconstructed with local fasciocutaneous flaps presented 3 cases with seroma, one with hematoma and 6 with partial cutaneous necrosis; these patients also required more drainage time. Conclusions: Both the local rotational fasciocutaneous flap and the myocutaneous flap of the gluteus maximus muscle in V-Y flap can be used in the surgical treatment of sacral ulcers. In our experience, a reduced success rate and more complications were found in the local fasciocutaneous reconstructive method. Keywords: Pressure ulcer, Fasciocutaneous flap, Myocutaneous flap, Gluteus maximus muscle

Surgical anesthesia with a combination of T12 paravertebral block and lumbar plexus, sacral plexus block for hip replacement in ankylosing spondylitis: CARE-compliant 4 case reports.

Science.gov (United States)

Ke, Xijian; Li, Ji; Liu, Yong; Wu, Xi; Mei, Wei

2017-06-26

Anesthesia management for patients with severe ankylosing spondylitis scheduled for total hip arthroplasty is challenging due to a potential difficult airway and difficult neuraxial block. We report 4 cases with ankylosing spondylitis successfully managed with a combination of lumbar plexus, sacral plexus and T12 paravertebral block. Four patients were scheduled for total hip arthroplasty. All of them were diagnosed as severe ankylosing spondylitis with rigidity and immobilization of cervical and lumbar spine and hip joints. A combination of T12 paravertebral block, lumbar plexus and sacral plexus block was successfully used for the surgery without any additional intravenous anesthetic or local anesthetics infiltration to the incision, and none of the patients complained of discomfort during the operations. The combination of T12 paravertebral block, lumbar plexus and sacral plexus block, which may block all nerves innervating the articular capsule, surrounding muscles and the skin involved in total hip arthroplasty, might be a promising alternative for total hip arthroplasty in ankylosing spondylitis.

Effects of Low-frequency Current Sacral Dermatome Stimulation on Idiopathic Slow Transit Constipation.

Science.gov (United States)

Kim, Jin-Seop; Yi, Seung-Ju

2014-06-01

[Purpose] This study aimed to determine whether low-frequency current therapy can be used to reduce the symptoms of idiopathic slow transit constipation (ISTC). [Subjects] Fifteen patients (ten male and five female) with idiopathic slow transit constipation were enrolled in the present study. [Results] Bowel movements per day, bowel movements per week, and constipation assessment scale scores significantly improved after low-frequency current simulation of S2-S3. [Conclusion] Our results show that stimulation with low-frequency current of the sacral dermatomes may offer therapeutic benefits for a subject of patients with ISTC.

Spatial Narrative As Feature Of Singularity In Sacral Architecture

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Gytis Oržikauskas

2014-05-01

Full Text Available The paper analyses architectural compositions of various religious complexes – historical and contemporary – apart from their stylistic features. The most prominent ensembles under analysis have one noticeably common feature – spatial narrative. The foreseen sequence of forms of experience and spatial structure tell different religious narratives depending on which different aspects of faith were actualized in a given period. The analyzed examples stand in proof that suggestibility of religious aspects in sacral architecture are inseparable from their artistic suggestibility aspects. In some cases, these aspects are less related to architectural stylistic means, but have a direct connection to such components of architectural compositions as foreseen sequence of a visitor’s experience and semantics of particular forms, i.e. architectural narrative, which is achieved not only through the means of perception of space, but also by the relationship to social and cultural meanings and subtext of architecture.

Imaging of painful solitary lesions of the sacrum

International Nuclear Information System (INIS)

Peh, W. C. G.; Koh, W. L.; Kwek, J. W.; Htoo, M. M.; Tan, P. H.

2007-01-01

Full text: In patients with sacral pain, the painful symptoms may be caused by a variety of bony and soft tissue lesions. Benign lesions include giant cell tumour, neurogenic tumour, insufficiency fracture, infection and giant bone island. Malignant lesions include primary bone tumours, Ewing sarcoma, plasmacytoma, lymphoma and chordoma. Soft tissue tumours adjacent to or involving the sacrum may cause painful symptoms. A multimodality approach to imaging is required for full assessment of these lesions. This pictorial essay describes a range of common solitary sacral lesions that may cause pain, with emphasis on imaging features

Coronal MR imaging of the normal 3rd, 4th, and 5th lumbar and 1st sacral nerve roots

International Nuclear Information System (INIS)

Hald, J.K.; Nakstad, P.H.; Hauglum, B.E.

1991-01-01

Seven healthy volunteers underwent coronal MR imaging at 1.5 tesla of the normal 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots. Coronal slices, 3-mm-thick with a 0.3-mm gap between the slices were obtained (TR/TE 600/22) through the lumbar spinal canal. All the nerve roots were visible on at least one image. One can routinely expect to demonstrate the 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots on T1-weighted, 3-mm-thick coronal MR scans. We found no correlation between the degree of lumbar lordosis and the lengths of the visible nerve roots. Five patients with one of the following spinal problems: anomaly, tumor, disk herniation, and failed back surgery syndrome were examined according to our protocol. In all these cases coronal MR imaging gave the correct diagnosis. (orig.)

Coronal MR imaging of the normal 3rd, 4th, and 5th lumbar and 1st sacral nerve roots

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Hald, J K; Nakstad, P H; Hauglum, B E [National Hospital, Oslo (Norway). Dept. of Radiology

1991-05-01

Seven healthy volunteers underwent coronal MR imaging at 1.5 tesla of the normal 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots. Coronal slices, 3-mm-thick with a 0.3-mm gap between the slices were obtained (TR/TE 600/22) through the lumbar spinal canal. All the nerve roots were visible on at least one image. One can routinely expect to demonstrate the 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots on T1-weighted, 3-mm-thick coronal MR scans. We found no correlation between the degree of lumbar lordosis and the lengths of the visible nerve roots. Five patients with one of the following spinal problems: anomaly, tumor, disk herniation, and failed back surgery syndrome were examined according to our protocol. In all these cases coronal MR imaging gave the correct diagnosis. (orig.).

Preoperative embolization of hypervascular thoracic, lumbar, and sacral spinal column tumors: technique and outcomes from a single center.

Science.gov (United States)

Nair, Sreejit; Gobin, Y Pierre; Leng, Lewis Z; Marcus, Joshua D; Bilsky, Mark; Laufer, Ilya; Patsalides, Athos

2013-09-01

The existing literature on preoperative spine tumor embolization is limited in size of patient cohorts and diversity of tumor histologies. This report presents our experience with preoperative embolization of hypervascular thoracic, lumbar, and sacral spinal column tumors in the largest series to date. We conducted a retrospective review of 228 angiograms and 188 pre-operative embolizations for tumors involving thoracic, lumbar and sacral spinal column. Tumor vascularity was evaluated with conventional spinal angiography and was graded from 0 (same as normal adjacent vertebral body) to 3 (severe tumor blush with arteriovenous shunting). Embolic materials included poly vinyl alcohol (PVA) particles and detachable platinum coils and rarely, liquid embolics. The degree of embolization was graded as complete, near-complete, or partial. Anesthesia records were reviewed to document blood loss during surgery. Renal cell carcinoma (44.2%), thyroid carcinoma (9.2%), and leiomyosarcoma (6.6%) were the most common tumors out of a total of 40 tumor histologies. Hemangiopericytoma had the highest mean vascularity (2.6) of all tumor types with at least five representative cases followed by renal cell carcinoma (2.0) and thyroid carcinoma (2.0). PVA particles were used in 100% of cases. Detachable platinum coils were used in 51.6% of cases. Complete, near-complete, and partial embolizations were achieved in 86.1%, 12.7%, and 1.2% of all cases, respectively. There were no new post-procedure neurologic deficits or other complications with long-term morbidity. The mean intra-operative blood loss for the hypervascular tumors treated with pre-operative embolization was 1745 cc. Preoperative embolization of hypervascular thoracic, lumbar, and sacral spine tumors can be performed with high success rates and a high degree of safety at high volume centers.

Sacral Herpes Zoster Associated with Voiding Dysfunction in a Young Patient with Scrub Typhus

OpenAIRE

Hur, Jian

2015-01-01

When a patient presents with acute voiding dysfunction without a typical skin rash, it may be difficult to make a diagnosis of herpes zoster. Here, we present a case of scrub typhus in a 25-year-old man with the complication of urinary dysfunction. The patient complained of loss of urinary voiding sensation and constipation. After eight days, he had typical herpes zoster eruptions on the sacral dermatomes and hypalgesia of the S1-S5 dermatomes. No cases of dual infection with varicella zoster...

[Pelvic reconstructions after bone tumor resection].

Science.gov (United States)

Anract, Philippe; Biau, David; Babinet, Antoine; Tomeno, Bernard

2014-02-01

The three more frequent primitive malignant bone tumour which concerned the iliac bone are chondrosarcoma, following Ewing sarcoma and osteosarcoma. Wide resection remains the most important part of the treatment associated with chemotherapy for osteosarcoma and the Ewing sarcoma. Iliac wing resections and obdurate ring don't required reconstruction. However, acetabular resections and iliac wing resection with disruption of the pelvic ring required reconstruction to provide acceptable functional result. Acetabular reconstruction remains high technical demanding challenge. After isolated acetabular resection or associated to obdurate ring, our usual method of reconstruction is homolateral proximal femoral autograft and total hip prosthesis but it is possible to also used : saddle prosthesis, Mac Minn prosthesis with auto or allograft, modular prosthesis or custom made prosthesis, massive allograft with or without prosthesis and femoro-ilac arthrodesis. After resection of the iliac wing plus acetabulum, reconstruction can be performed by femoro-obturatrice and femora-sacral arthrodesis, homolateral proximal femoral autograft and prosthesis, femoral medialisation, massive allograft and massive allograft. Carcinological results are lesser than resection for distal limb tumor, local recurrence rate range 17 to 45%. Functional results after Iliac wing and obdurate ring are good. However, acetabular reconstruction provide uncertain functional results. The lesser results arrive after hemipelvic or acetabular and iliac wing resection-reconstruction, especially when gluteus muscles were also resected. The most favourable results arrive after isolated acetabular or acetabular plus obturateur ring resection-reconstruction.

SU-F-J-222: Using PET Imaging to Evaluate Proliferation and Blood Flow in Irradiated and Non-Irradiated Bone Marrow 1 Year After Chemoradiation Therapy

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McGuire, S; Ponto, L; Menda, Y [University Of Iowa, Iowa City, IA (United States)

2016-06-15

Purpose: To compare proliferation and blood flow in pelvic and thoracic bone marrow 1 year after pelvic chemoradiation. Methods: Sixteen pelvic cancer patients were enrolled in an IRB-approved protocol to acquire FLT PET images during radiation therapy simulation (baseline) and 1 year after chemoradiation therapy. Three subjects also had optional O-15 water PET images acquired 1 year after chemoradiation therapy. Baseline FLT PET images were used to create IMRT plans to spare pelvic bone marrow identified as regions with FLT SUV ≥ 2 without compromising PTV coverage or OAR sparing. Marrow VOIs were defined using a 50% maximum pixel value threshold on baseline FLT PET images (VIEW, PMOD version 3.5) in the sacrum and thoracic spine representing irradiated and non-irradiated regions, respectively. FLT PET and O-15 water PET images acquired 1 year after therapy were co-registered to baseline images (FUSION PMOD) and the same VOIs were used to measure proliferation (FLT SUV) and blood flow (O-15 water uptake). Separate image-based input functions were used for blood flow quantitation in each VOI. Results: Mean 1 year FLT SUV in sacral and thoracic VOIs for were 1.1 ± 0.4 and 6.5 ± 1.7, respectively for N = 16 subjects and were 1.2 ± 0.2 and 5.6 ± 1.6, respectively for N = 3 subjects who also underwent O-15 water imaging. Blood flow measures in equivalent sacral and thoracic marrow regions (N = 3) were 21.3 ± 8.7 and 18.3 ± 4.9 mL/min/100mL respectively. Conclusion: Decreased bone marrow proliferation measured by FLT SUV does not appear to correspond to decreased blood flow as measured by O-15 water PET imaging. Based on this small sample at a single time point, reduced blood supply does not explain reductions in bone marrow proliferative activity 1 year after chemoradiation therapy.

Median Sacral Artery, Sympathetic Nerves, and the Coccygeal Body: A Study Using Serial Sections of Human Embryos and Fetuses.

Science.gov (United States)

Jin, Zhe Wu; Cho, Kwang Ho; Jang, Hyung Suk; Murakami, Gen; Rodríguez-Vázquez, Jose Francisco

2016-07-01

To examine how the median sacral artery (MSA) is involved with the coccygeal body or glomus coccygeum, we studied serial frontal or sagittal sections of 14 embryos (approximately 5-6 weeks of gestation) and 12 fetuses (10-18 weeks). At five weeks, the caudal end of the dorsal aorta (i.e., MSA) accompanied putative sympathetic ganglion cells in front of the upper coccygeal and lower sacral vertebrae. At six weeks, a candidate for the initial coccygeal body was identified as a longitudinal arterial plexus involving nerve fibers and sympathetic ganglion cells between arteries. At 10-18 weeks, the MSA exhibited a highly tortuous course at the lower sacral and coccygeal levels, and was attached to and surrounded by veins, nerve fibers, and sympathetic ganglion cells near and between the bilateral origins of the levator ani muscle. Immunohistochemistry demonstrated expression of tyrosine hydroxylase and chromogranin A in the nerves. However, throughout the stages examined, we found no evidence suggestive of an arteriovenous anastomosis, such as well-developed smooth muscle. An acute anterior flexure of the vertebrae at the lower sacrum, as well as regression of the secondary neural tube, seemed to induce arterial plexus formation from an initial straight MSA. Nerves and ganglion cells were likely to be secondarily involved with the plexus because of the close topographical relationship. However, these nerves might play a major role in the extreme change into adult morphology. An arteriovenous anastomosis along the MSA might be an overinterpretation, at least in the prenatal human. Anat Rec, 299:819-827, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

An audit of the physiotherapy management of paraplegic patients with sacral pressure sores

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D. Pather

2013-01-01

Full Text Available Introduction: Pressure sores are the most common complication post spinal cord injury that requires patients to be on bed rest. Patient bed rest delay rehabilitation and may lead to other complications associated with immobility. This study sought to establish the treatment interventions physiotherapists provide to patients with sacral pressure sores and the factors that they consider when deciding whether the patient should receive physiotherapy in the ward or gym. Methods: This was a questionnaire based survey of physiotherapists working in spinal cord injury rehabilitation units in South Africa. The self-designed questionnaire was sent to all the main spinal rehabilitation units in the country (14 located in Gauteng, Kwa-Zulu Natal, Western Cape, Eastern Cape and Free State provinces. Results: Thirty-nine physiotherapists from a total of 51 completed the questionnaires (76% response rate. The most common treatment practice for patients with sacral pressure sores was bed rest (98%. The most common physio-therapy practices (70% included were upper limb muscle strengthening, upper and lower limb passive movements, positioning into prone and side lying and passive stretching. The choice of treatment environment was influenced by doctors’ orders and the size, grade and duration of the pressure sores. Conclusion: Direct involvement in pressure sore management in South Africa seem to be less than in other parts of the world. If we are to minimise the pressure sore impact, it appears like we need more focus on gait re-education and standardised ADL programmes and patient treatment in the gym to possibly maximise healing and rehabilitation.

[An adult case of intradural lumbo-sacral lipoma].

Science.gov (United States)

Hatayama, T; Sakoda, K; Tokuda, Y; Uozumi, T

1992-10-01

A rare case of lumbo-sacral lipoma in an adult case is reported. A 55-year-old male was admitted to the Department of Neurosurgery, Mazda Hospital, after a history of one year of urinary incontinence. Neurologically, no motor or sensory disturbance of the lower extremities was found in this patient. MRI showed a mass with high signal intensity on T2-weighted image, located between L3 to S2 vertebral segments. Metrizamide-CT scan demonstrated the outline of this hypodense mass at the same location as shown on MRI image. A L3 through L5 laminectomy was performed and the tumor was subtotally removed. Microscopic examination revealed that the tumor mass was made up of mature lipoma cells. Postoperative course of the patient was uneventful. The urinary incontinence was improved slightly. No motor or sensory deficit was found. We thought that MRI was useful for the correct diagnosis of lumbosacral lipoma. And it is best managed by operative removal of the tumor as early as possible after it is diagnosed.

A Novel Collaborative Protocol for Successful Management of Penile Pain Mediated by Radiculitis of Sacral Spinal Nerve Roots From Tarlov Cysts

Directory of Open Access Journals (Sweden)

Irwin Goldstein, MD

2017-09-01

Goldstein I, Komisaruk BR, Rubin RS, et al. A Novel Collaborative Protocol for Successful Management of Penile Pain Mediated by Radiculitis of Sacral Spinal Nerve Roots From Tarlov Cysts. Sex Med 2017;5:e203–e211.

Delivery of bone morphogenetic protein-2 and substance P using graphene oxide for bone regeneration

Directory of Open Access Journals (Sweden)

La WG

2014-05-01

Full Text Available Wan-Geun La,1 Min Jin,1 Saibom Park,1,2 Hee-Hun Yoon,1 Gun-Jae Jeong,1 Suk Ho Bhang,1 Hoyoung Park,1,2 Kookheon Char,1,2 Byung-Soo Kim1,31School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea; 2The National Creative Research Initiative Center for Intelligent Hybrids, Seoul National University, Seoul, Republic of Korea; 3Institute of Bioengineering, Institute of Chemical Processes, Engineering Research Institute, Seoul National University, Seoul, Republic of KoreaAbstract: In this study, we demonstrate that graphene oxide (GO can be used for the delivery of bone morphogenetic protein-2 (BMP-2 and substance P (SP, and that this delivery promotes bone formation on titanium (Ti implants that are coated with GO. GO coating on Ti substrate enabled a sustained release of BMP-2. BMP-2 delivery using GO-coated Ti exhibited a higher alkaline phosphatase activity in bone-forming cells in vitro compared with bare Ti. SP, which is known to recruit mesenchymal stem cells (MSCs, was co-delivered using Ti or GO-coated Ti to further promote bone formation. SP induced the migration of MSCs in vitro. The dual delivery of BMP-2 and SP using GO-coated Ti showed the greatest new bone formation on Ti implanted in the mouse calvaria compared with other groups. This approach may be useful to improve osteointegration of Ti in dental or orthopedic implants.Keywords: bone morphogenetic protein-2, bone regeneration, graphene oxides, stem cell recruitment, substance P

Combined V-Y Fasciocutaneous Advancement and Gluteus Maximus Muscle Rotational Flaps for Treating Sacral Sores

Directory of Open Access Journals (Sweden)

Hyun Ho Han

2016-01-01

Full Text Available The sacral area is the most common site of pressure sore in bed-ridden patients. Though many treatment methods have been proposed, a musculocutaneous flap using the gluteus muscles or a fasciocutaneous flap is the most popular surgical option. Here, we propose a new method that combines the benefits of these 2 methods: combined V-Y fasciocutaneous advancement and gluteus maximus muscle rotational flaps. A retrospective review was performed for 13 patients who underwent this new procedure from March 2011 to December 2013. Patients’ age, sex, accompanying diseases, follow-up duration, surgical details, complications, and recurrence were documented. Computed tomography was performed postoperatively at 2 to 4 weeks and again at 4 to 6 months to identify the thickness and volume of the rotational muscle portion. After surgery, all patients healed within 1 month; 3 patients experienced minor complications. The average follow-up period was 13.6 months, during which time 1 patient had a recurrence (recurrence rate, 7.7%. Average thickness of the rotated muscle was 9.43 mm at 2 to 4 weeks postoperatively and 9.22 mm at 4 to 6 months postoperatively (p=0.087. Muscle thickness had not decreased, and muscle volume was relatively maintained. This modified method is relatively simple and easy for reconstructing sacral sores, provides sufficient padding, and has little muscle donor-site morbidity.

Clinical Outcome of Sacral Chordoma With Carbon Ion Radiotherapy Compared With Surgery

International Nuclear Information System (INIS)

Nishida, Yoshihiro; Kamada, Tadashi; Imai, Reiko; Tsukushi, Satoshi; Yamada, Yoshihisa; Sugiura, Hideshi; Shido, Yoji; Wasa, Junji; Ishiguro, Naoki

2011-01-01

Purpose: To evaluate the efficacy, post-treatment function, toxicity, and complications of carbon ion radiotherapy (RT) for sacral chordoma compared with surgery. Methods and Materials: The records of 17 primary sacral chordoma patients treated since 1990 with surgery (n = 10) or carbon ion RT (n = 7) were retrospectively analyzed for disease-specific survival, local recurrence-free survival, complications, and functional outcome. The applied carbon ion dose ranged from 54.0 Gray equivalent (GyE) to 73.6 GyE (median 70.4). Results: The mean age at treatment was 55 years for the surgery group and 65 years for the carbon ion RT group. The median duration of follow-up was 76 months for the surgery group and 49 months for the carbon ion RT group. The local recurrence-free survival rate at 5 years was 62.5% for the surgery and 100% for the carbon ion RT group, and the disease-specific survival rate at 5 years was 85.7% and 53.3%, respectively. Urinary-anorectal function worsened in 6 patients (60%) in the surgery group, but it was unchanged in all the patients who had undergone carbon ion RT. Postoperative wound complications requiring reoperation occurred in 3 patients (30%) after surgery and in 1 patient (14%) after carbon ion RT. The functional outcome evaluated using the Musculoskeletal Tumor Society scoring system revealed 55% in the surgery group and 75% in the carbon ion RT group. Of the six factors in this scoring system, the carbon ion RT group had significantly greater scores in emotional acceptance than did the surgery group. Conclusion: Carbon ion RT results in a high local control rate and preservation of urinary-anorectal function compared with surgery.

Sacral chordomas: Impact of high-dose proton/photon-beam radiation therapy combined with or without surgery for primary versus recurrent tumor

International Nuclear Information System (INIS)

Park, Lily; De Laney, Thomas F.; Liebsch, Norbert J.; Hornicek, Francis J.; Goldberg, Saveli; Mankin, Henry; Rosenberg, Andrew E.; Rosenthal, Daniel I.; Suit, Herman D.

2006-01-01

Purpose: To assess the efficacy of definitive treatment of sacral chordoma by high-dose proton/photon-beam radiation therapy alone or combined with surgery. Methods and Materials: The records of 16 primary and 11 recurrent sacral chordoma patients treated from November 1982 to November 2002 by proton/photon radiation therapy alone (6 patients) or combined with surgery (21 patients) have been analyzed for local control, survival, and treatment-related morbidity. The outcome analysis is based on follow-up information as of 2005. Results: Outcome results show a large difference in local failure rate between patients treated for primary and recurrent chordomas. Local control results by surgery and radiation were 12/14 vs. 1/7 for primary and recurrent lesions. For margin-positive patients, local control results were 10 of 11 and 0 of 5 in the primary and recurrent groups, respectively; the mean follow-up on these locally controlled patients was 8.8 years (4 at 10.3, 12.8, 17, and 21 years). Radiation alone was used in 6 patients, 4 of whom received ≥73.0 Gy (E); local control was observed in 3 of these 4 patients for 2.9, 4.9, and 7.6 years. Conclusion: These data indicate a high local control rate for surgical and radiation treatment of primary (12 of 14) as distinct from recurrent (1 of 7) sacral chordomas. Three of 4 chordomas treated by ≥73.0 Gy (E) of radiation alone had local control; 1 is at 91 months. This indicates that high-dose proton/photon therapy offers an effective treatment option

Mechanical comparison between lengthened and short sacroiliac screws in sacral fracture fixation: a finite element analysis.

Science.gov (United States)

Zhao, Y; Zhang, S; Sun, T; Wang, D; Lian, W; Tan, J; Zou, D; Zhao, Y

2013-09-01

To compare the stability of lengthened sacroiliac screw and standard sacroiliac screw for the treatment of unilateral vertical sacral fractures; to provide reference for clinical applications. A finite element model of Tile type C pelvic ring injury (unilateral Denis type II fracture of the sacrum) was produced. The unilateral sacral fractures were fixed with lengthened sacroiliac screw and sacroiliac screw in six different types of models respectively. The translation and angle displacement of the superior surface of the sacrum (in standing position on both feet) were measured and compared. The stability of one lengthened sacroiliac screw fixation in S1 or S2 segment is superior to that of one sacroiliac screw fixation in the same sacral segment. The stability of one lengthened sacroiliac screw fixation in S1 and S2 segments respectively is superior to that of one sacroiliac screw fixation in S1 and S2 segments respectively. The stability of one lengthened sacroiliac screw fixation in S1 and S2 segments respectively is superior to that of one lengthened sacroiliac screw fixation in S1 or S2 segment. The stability of one sacroiliac screw fixation in S1 and S2 segments respectively is markedly superior to that of one sacroiliac screw fixation in S1 or S2 segment. The vertical and rotational stability of lengthened sacroiliac screw fixation and sacroiliac screw fixation in S2 is superior to that of S1. In a finite element model of type C pelvic ring disruption, S1 and S2 lengthened sacroiliac screws should be utilized for the fixation as regularly as possible and the most stable fixation is the combination of the lengthened sacroiliac screws of S1 and S2 segments. Even if lengthened sacroiliac screws cannot be systematically used due to specific conditions, one sacroiliac screw fixation in S1 and S2 segments respectively is recommended. No matter which kind of sacroiliac screw is used, if only one screw can be implanted, the fixation in S2 segment is more recommended

Bone mineral density and bone scintigraphy in adult Saudi female patients with Osteomalacia

International Nuclear Information System (INIS)

El-Desouki, Mahmoud I.; Othman, Saleh M.; Fouda, Mona A.

2004-01-01

This prospective study was conducted to demonstrate the role of bone mineral density (BMD) and bone scan in the management of adult Saudi female patients with established diagnosis of osteomalacia. Bone scan using Tc99m methylene diphosphate (MDP) and BMD of the lumbar spine and femoral neck using dual x-ray absorptiometry (DXA) were performed at the time of diagnosis 6 months and one year after therapy in 96 Saudi female patients attending the metabolic bone disease clinic at King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia, between January 1997 through to June 1999, aged between 20 and 73 years (mean 42 years). Alkaline phosphates, calcium and inorganic phosphorus were measured for all patients before and after treatment. 25 Hydroxy vitamin D was only measured with the first BMD measurements. A bone profile showed typical biochemical abnormalities of osteomalacia.The bone scan showed features of superscan in all patients and pseudofractures in 43 patients. BMD measures were compared with that of normal Saudi subjects matched for age and sex. The BMD was low at diagnosis and showed significant improvement after therapy. The improvement of bone density in response to therapy was more evident in lumbar spine than in femoral neck bone.Our results showed that BMD in adult Saudi female patients with osteomalacia was markedly affected probably due to specific constitutional and environmental factors ( inadeqate exercise, lack of sun exposure and lack of intake of milk and dairy products). In addition, lumbar BMD and serum calcium appeared to be better markers to monitor therapy.Bone scan helped in demonstrating disease activity, the presence of pseudofractures. (author)

The effect of Hydroxyapatite/collagen I composites, bone marrow aspirate and bone graft on fixation of bone implants in sheep

DEFF Research Database (Denmark)

Babiker, Hassan

  The effect of Hydroxyapatite/collagen I composites, bone marrow aspirate and bone graft on fixation of bone implants IN SHEEP   Ph.D. Student, Hassan Babiker; Associate Professor, Ph.D. Ming Ding; Professor, dr.med., Soren Overgaard. Department of Orthopaedic Surgery, Odense University Hospital......, Odense, Denmark   Background: Hydroxyapatite and collagen composites (HA/coll) have the potential in mimicking and replacing skeletal bones. This study attempted to determine the effect of newly developed HA/coll-composites with and without bone marrow aspirate (BMA) in order to enhance the fixation...... of bone implants.   Materials and Methods: Titanium alloy implants were inserted into bilateral femoral condyles of 8 skeletally mature sheep, four in each sheep. The implant has a circumferential gap of 2 mm. The gap was filled with: HA/coll; HA/coll-BMA; autograft or allograft. Allograft was served...

CT-guided screw fixation of vertical sacral fractures in local anaesthesia using a standard CT; CT-kontrollierte Schraubenosteosynthese von vertikalen Frakturen des hinteren Beckenringes in Lokalanaesthesie

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Reuther, G.; Dehne, I. [Thueringen-Klinik, Saalfeld (Germany). Radiologische Klinik; Roehner, U.; Will, T.; Petereit, U. [Thueringen-Klinik, Saalfeld (Germany). Orthopaedics and Trauma Surgery

2014-12-15

To evaluate time efficiency, radiation dose, precision and complications of percutaneous iliosacral screw placement under CT-guidance in local anaesthesia. Retrospective analysis of 143 interventions in 135 patients during a period of 42 months. Implant failures could be evaluated in 85/182 screws and bony healing or refracturing in 46/182 screws. A total of 182 iliosacral screw placements in 179 vertical sacral fractures (105 unilateral, 37 bilateral) took place in 135 patients. 166/179 of the sacral fractures were detected in Denis zone 1, 10 in Denis zone 2 and 3 in Denis zone 3. No screw misplacements including the simultaneous bilateral procedures were noted. The average time for a unilateral screw placement was 23 minutes (range: 14-52 minutes) and 35 minutes (range: 21-60 minutes) for simultaneous bilateral screwing. The dose length product was 365 mGy x cm (range: 162-1014 mGy x cm) for the unilateral and 470 mGy x cm (range: 270-1271 mGy x cm) for the bilateral procedure. 1 gluteal bleeding occurred as the only acute minor complication (0.7%). Fracture healing was verified with follow-up CTs in 42/46 sacral fractures after screw placement. Backing out occurred in 12/85 screws between 6 and 69 days after intervention. In 8 patients contralateral stress fractures were detected after unilateral screw placement between day 10 and 127 (average: 48 days). CT-guided iliosacral screw placement in sacral fractures is a safe tool providing a very high precision. The radiation dose is in the order of a diagnostic CT of the pelvis for both unilateral and bilateral screws. Contralateral stress fractures in unilateral screw placements have to be considered during the first weeks after intervention.

Morphometric study of the true S1 and S2 of the normal and dysmorphic sacralized sacra.

Science.gov (United States)

Firat, Ayşegül; Alemdaroğlu, Kadir Bahadır; Özmeriç, Ahmet; Yücens, Mehmet; Göksülük, Dinçer

2017-06-12

This study aimed to generate data for the S1 and S2 alar pedicle and body and the alar orientations for both dysmorphic and normal sacra. The study comprised two groups: Group N consisted of 53 normal sacra and Group D included 10 dysmorphic sacra. Various features such as alar pedicle circumference; anterior, middle, and posterior axis of the sacral ala; sacral body height and width; and sagittal thickness were measured. In group N, the median anterior axis of the alae was observed to be 30° on the right and 25° on the left, the median midline axis was found to be 20° on the right and 15° on the left, and the median posterior alar axis was -15° on the right and -20° on the left. The true S1 and S2 alar pedicle circumferences were observed to be significantly smaller in group D, which demonstrated a shorter S1 alar pedicle mean circumference, significantly narrower S1 body mean width, and considerably tapered sagittal thickness. Our analysis indicated that dysmorphic sacra have a lower sagittal thickness and width of bodies and smaller alar pedicles, which explains the difficulties in their percutaneous fixation.

Clinical outcome of trans-sacral interbody fusion after partial reduction for high-grade l5-s1 spondylolisthesis.

Science.gov (United States)

Smith, J A; Deviren, V; Berven, S; Kleinstueck, F; Bradford, D S

2001-10-15

A clinical retrospective study was conducted. To evaluate the clinical and radiographic outcome of reduction followed by trans-sacral interbody fusion for high-grade spondylolisthesis. In situ posterior interbody fusion with fibula allograft has improved the fusion rates for patients with high-grade spondylolisthesis. The use of this technique in conjunction with partial reduction has not been reported. Nine consecutive patients underwent treatment of high-grade (Grade 3 or 4) spondylolisthesis with partial reduction followed by posterior interbody fusion using cortical allograft. The average age at the time of surgery was 27 years (range, 8-51 years), and the average follow-up period was 43 months (range, 24-72 months). Before surgery, eight patients had low back pain, seven patients had radiating leg pain, and five patients had hamstring tightness. The average grade of spondylolisthesis by Meyerding grading was 3.9 (range, 3-5). Charts and radiographs were evaluated, and outcomes were collected by use of the modified SRS outcomes instrument. Radiographic indexes demonstrated significant improvement with partial reduction and fusion. The slip angle, as measured from the inferior endplate of L5, improved from 41.2 degrees (range, 24-82 degrees ) before surgery to 21 degrees (range, 5-40 degrees ) after surgery. All the patients were extremely or somewhat satisfied with surgery. The two patients who underwent this operation without initial instrumentation experienced fractures of their interbody grafts. Both of these patients underwent repair of the pseudarthrosis with placement of trans-sacral pedicle screw instrumentation and subsequent fusion. Partial reduction followed by posterior interbody fusion is an effective technique for the management of high-grade spondylolisthesis in pediatric and adult patient populations, as assessed by radiographic and clinical criteria. Pedicle screw instrumentation with the sacral screws capturing L5 is recommended when this

Selective arterial embolization of 36 aneurysmal bone cysts of the skeleton with N-2-butyl cyanoacrylate

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Rossi, Giuseppe [Rizzoli Orthopaedic Institute, Department of Interventional Angiographic Radiology, Bologna (Italy); Rimondi, Eugenio; Vanel, Daniel [Rizzoli Orthopaedic Institute, Department of Radiology, Bologna (Italy); Bartalena, Tommaso [University of Bologna, Bologna (Italy); Gerardi, Antonio [Rizzoli Orthopaedic Institute, Department of Anatomical Human Science and Physiopathology of the Musculoskeletal System, Bologna (Italy); Alberghini, Marco [Rizzoli Orthopaedic Institute, Department of Pathological Anatomy, Bologna (Italy); Staals, Eric Lodwijk; Errani, Costantino; Bianchi, Giuseppe; Toscano, Angelo; Mercuri, Mario [Rizzoli Orthopaedic Institute, V Division of Musculoskeletal Tumors, Bologna (Italy)

2010-02-15

Aneurysmal bone cyst (ABC) is a lytic benign bone lesion representing about 1% of all primary bone tumors. The lesion causes pain and swelling, which are generally present for less than 3 months. From April 2003 to April 2008 36 patients affected by aneurysmal bone cysts were treated by selective arterial embolization with N-2-butyl cyanoacrylate. The study population comprised 20 male and 16 female patients with an age range of 3.3-60.8 years. Nine lesions were localized in the appendicular skeleton (1 in the upper and 8 in the lower limb), 4 in the thoracic cage (1 rib lesion and 3 scapular lesions), 17 in the pelvis and 6 in the spine (1 thoracic and 5 sacral localizations). A total of 55 embolizations were performed: in 22 cases (61%) only one embolization was needed, whilst two embolizations were necessary in 9 cases (25%) and 3 in the remaining 5 patients (14%). The treatment was effective in 32 patients (94%): follow-up was 0.9-5 years. In one patient, previously surgically treated, only the cyanoacrylate embolization turned out to be useful for healing the lesion. Another 7 patients underwent surgery during the study period. In the 55 procedures we performed we had 3 complications (5%): 2 cases of skin necrosis and 1 of transient paresis. Arterial embolization with cyanoacrylate may be the treatment of choice for aneurysmal bone cysts. Embolization is a less invasive, lower cost, simpler procedure than surgery and is easily repeatable. (orig.)

Sacral colpopexy versus transvaginal mesh colpopexy in obese patients.

Science.gov (United States)

McDermott, Colleen D; Park, Jean; Terry, Colin L; Woodman, Patrick J; Hale, Douglass S

2013-05-01

Obesity can predispose women to pelvic organ prolapse and can also affect the success of pelvic organ prolapse surgery. The purpose of this study was to compare the postoperative anatomical outcomes following sacral colpopexy (SC) and transvaginal mesh colpopexy in a group of obese women with pelvic organ prolapse. We conducted a retrospective cohort study of obese women who underwent SC (n = 56) or transvaginal mesh colpopexy (n = 35). Follow-up ranged from 6 to 12 months. Preoperative, perioperative, and postoperative variables were compared using Student t, Mann-Whitney U, and Fisher exact tests, and by analysis of covariance. The women in the SC group had significantly higher mean apical vaginal measurements (P transvaginal mesh colpopexy group. There were no significant differences between the groups for other postoperative outcomes, including mesh erosion, recurrent prolapse symptoms, dyspareunia, and surgical satisfaction (P > 0.05). In these 91 obese patients with pelvic organ prolapse, SC resulted in better anatomical outcomes than transvaginal mesh colpopexy. However, the two procedures had similar outcomes with regard to recurrent symptoms and surgical satisfaction.

CT-based bone density assessment for iliosacral screw trajectories

Directory of Open Access Journals (Sweden)

Andreas Schicho

2016-01-01

Full Text Available Introduction: Sacroiliac screw placement is one standard treatment option for stabilization of posterior pelvic ring injuries encountering high intra- and inter-individual variations of bone stock quality as well as a vast variety and prevalence of sacral dysmorphism. An individual, easy-to-use preoperative bone stock quality estimation would be of high value for the surgeon. Materials and Methods: We analyzed 36 standard computed tomography datasets with the uninjured pelvic ring. Using a two-plane cross-referencing technique, we assessed the Hounsfield unit (HU mean values as well as standard deviation and minimum/maximum values within selected region of interests (ROIs at five key areas: os ilium left and right, massa lateralis of os sacrum left and right, and central vertebral body on levels S1 and S2. Results: Results showed no difference in mean HU at any ROI when comparing male and female data. For all ROIs set on S1 and S2, there was an age-related decline of HU with a calculated slope significantly different from zero. There was no statistical difference of slopes when comparing S1- and S2-level with respect to any distinct ROI. Comparison of levels S1 and S2 revealed differences at the vertebral body and at the right os ilium. The right and left massa lateralis of os sacrum had lower bone density than the center of the vertebral body, the right, or left os ilium on S1; right and left massa lateralis density did not differ significantly. On level S2, results were comparable with no difference of massa lateralis density. Conclusion: With our easy-to-use preoperative assessment of bone density of five key areas of sacroiliac screw anchoring we were able to find the lowest bone density in both the left and right massa lateralis on levels S1 and S2 with high inter- and intra-individual variations. Significantly lower bone density was found in the center of the vertebral bodies S2 in comparison to S1, which both are crucial for iliosacral

MRI and PET/CT of patients with bone metastases from breast carcinoma

International Nuclear Information System (INIS)

Grankvist, J.; Fisker, R.; Iyer, V.; Fründ, E.T.; Simonsen, C.; Christensen, T.; Stenbygaard, L.; Ewertz, M.; Larsson, E.-M.

2012-01-01

3.0 Tesla magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) was compared with combined 18F-fluorodeoxyglucose positron emission tomography and computed tomography (PET/CT) in patients with suspected bone metastases from breast cancer. A prospective clinical study was performed in 13 female breast cancer patients (mean age 61years; range 45–85 years). The spine was imaged in the sagittal plane with T1-weighted (T1), short tau inversion recovery (STIR), and T2-weighted fat-saturated (T2) sequences. The pelvis was imaged similarly in the coronal plane. Axial DWI was performed from the skull base to the mid-thigh. MRI and PET/CT were performed in all patients at a maximum interval of 10 working days and at least 14 days after chemotherapy. MRI was reviewed by two radiologists, and their consensus on potential metastases in 27 predefined locations was recorded. The predefined locations were the vertebral bodies (24), the left (1) and right (1) pelvic bones, and the sacral bone (1). The PET/CT was reviewed by a radiologists and a nuclear medicine physician. MRI detected 59 of the 60 active metastases found with our gold standard modality PET/CT. T1 had the highest sensitivity (98%) but rather low specificity (77%), but with the addition of STIR and DWI, the specificity increased to 95%. The additional metastases detected with MRI most likely represented postherapeutic residual scars without active tumour. In conclusion, 3.0 Tesla MRI with T1, STIR, and DWI is useful for the clinical evaluation of bone metastases from breast cancer and compares well to PET/CT.

Management of unicameral bone cyst by using freeze dried radiation sterilized bone allograft impregnate with autogenous bone marrow.

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Datta, N K; Das, K P; Alam, M S; Kaiser, M S

2014-07-01

Unicameral bone cyst is a common benign bone tumor and most frequent cause of the pathological fracture in children. We have started a prospective study for that treatment of unicameral bone cyst by using freeze dried radiation sterilized bone allograft impregnated with autogenous bone marrow in the department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University (BSMMU) during May 1999 to April 2012. Aim of this study was to see Freeze dried radiation sterilized bone allograft impregnate with autogenous bone marrow a satisfactory graft material in the treatment of unicameral bone cyst as well as factors such as patients age, sex, cyst size and site of lesion influence on cyst healing. A total 35 patients of unicameral bone cyst were operated. In this study out of 35 patients, male were 22(62.86%) and female were 13(37.14). Male Female ratio 22:13(1.70:1) Age of the patients ranging from 2 years 6 month to 20 years, mean age 12.18 years more common 11 years to 20 years 29(82.86%) patients. Common bones sites involvements are proximal end of Humerus 20(57.14%), proximal end of Femur 7(20 %), proximal end of Tibia 3(8.57%), Calcanium 2(5.71%), proximal end of Ulna 1(2.86%), shaft of Radius 1(2.86%) and Phalanx 1(2.86%). Final clinical outcome of unicameral bone cyst treated by thorough curettage of cavity and tightly filled with freeze dried radiation sterilized bone allograft impregnate with autogenous bone marrow in which healed (success rate) 88.57% (31) and recurrence rate is 11.43% (4). P value is unicameral bone cyst.

Comparison of Lumbar Lordosis in Lateral Radiographs in Standing Position with supine MR Imaging in consideration of the Sacral Slope.

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Benditz, Achim; Boluki, Daniel; Weber, Markus; Zeman, Florian; Grifka, Joachim; Völlner, Florian

2017-03-01

Purpose  To investigate the influence of sacral slope on the correlation between measurements of lumbar lordosis obtained by standing radiographs and magnetic resonance images in supine position (MRI). Little information is available on the correlation between measurements of lumbar lordosis obtained by radiographic and MR images. Most relevant studies have shown correlations for the thoracic spine, but detailed analyses on the lumbar spine are lacking. Methods  MR images and standing lateral radiographs of 63 patients without actual low back pain or radiographic pathologies of the lumbar spine were analyzed. Standing radiographic measurements included the sagittal parameters pelvic incidence (PI) pelvic tilt (PT), and sacral slope (SS); MR images were used to additionally measure lumbar L1-S1 lordosis and single level lordosis. Differences between radiographic and MRI measurements were analyzed and divided into 4 subgroups of different sacral slope according to Roussouly's classification. Results  Global lumbar lordosis (L1-S1) was 44.99° (± 10 754) on radiographs and 47.91° (± 9.170) on MRI, yielding a clinically relevant correlation (r = 0.61, p lordosis only showed minor differences. At all levels except for L5 / S1, lordosis measured by means of standing radiographs was higher than that measured by MRI. The difference in global lumbar L1-S1 lordosis was -2.9°. Analysis of the Roussouly groups showed the largest difference for L1-S1 (-8.3°) in group 2. In group 4, when measured on MRI, L5 / S1 lordosis (25.71°) was lower than L4 / L5 lordosis (27.63°) compared to the other groups. Conclusions  Although measurements of global lumbar lordosis significantly differed between the two scanning technologies, the mean difference was just 2.9°. MRI in supine position may be used for estimating global lumbar lordosis, but single level lordosis should be determined by means of standing radiographs. Key Points   · Large

MAdCAM-1 expressing sacral lymph node in the lymphotoxin beta-deficient mouse provides a site for immune generation following vaginal herpes simplex virus-2 infection.

Science.gov (United States)

Soderberg, Kelly A; Linehan, Melissa M; Ruddle, Nancy H; Iwasaki, Akiko

2004-08-01

The members of the lymphotoxin (LT) family of molecules play a critical role in lymphoid organogenesis. Whereas LT alpha-deficient mice lack all lymph nodes and Peyer's patches, mice deficient in LT beta retain mesenteric lymph nodes and cervical lymph nodes, suggesting that an LT beta-independent pathway exists for the generation of mucosal lymph nodes. In this study, we describe the presence of a lymph node in LT beta-deficient mice responsible for draining the genital mucosa. In the majority of LT beta-deficient mice, a lymph node was found near the iliac artery, slightly misplaced from the site of the sacral lymph node in wild-type mice. The sacral lymph node of the LT beta-deficient mice, as well as that of the wild-type mice, expressed the mucosal addressin cell adhesion molecule-1 similar to the mesenteric lymph node. Following intravaginal infection with HSV type 2, activated dendritic cells capable of stimulating a Th1 response were found in this sacral lymph node. Furthermore, normal HSV-2-specific IgG responses were generated in the LT beta-deficient mice following intravaginal HSV-2 infection even in the absence of the spleen. Therefore, an LT beta-independent pathway exists for the development of a lymph node associated with the genital mucosa, and such a lymph node serves to generate potent immune responses against viral challenge.

Differentiation of primary chordoma, giant cell tumor and schwannoma of the sacrum by CT and MRI

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Si, Ming-Jue, E-mail: smjsh@hotmail.com [Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025 (China); Wang, Cheng-Sheng [Department of Radiology, Union Hospital, Fujian Medical University, Fuzhou 350001 (China); Ding, Xiao-Yi, E-mail: dingxiaoyi1965@hotmail.com [Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025 (China); Yuan, Fei, E-mail: yuanfeirj@hotmail.com [Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025 (China); Du, Lian-Jun; Lu, Yong [Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025 (China); Zhang, Wei-Bin [Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025 (China)

2013-12-01

Objective: To evaluate criteria to differentiate sacral chordoma (SC), sacral giant cell tumor (SGCT) and giant sacral schwannoma (GSS) with CT and MRI. Materials and methods: CT and MR images of 22 SCs, 19 SGCTs and 8 GSSs were reviewed. The clinical and imaging features of each tumor were analyzed. Results: The mean ages of SC, SGCT and GSS were 55.1 ± 10.7, 34.3 ± 10.7 and 42.4 ± 15.7 years old. SCs (77.3%) were predominantly located in the midline of lower sacrum, while most SGCTs (73.7%) and GSSs (87.5%) were eccentrically located in upper sacrum. There were significant differences in age, location, eccentricity, morphology of bone residues, intratumoral bleeding and septations. Multiple small cysts were mainly observed in SGCTs (73.7%) with large central cysts in GSSs (87.5%). SGCTs expanded mainly inside sacrum while SCs and GSSs often extended into pelvic cavity (P = 0.0022). Involvement of sacroiliac joints and muscles were also different. Ascending extension within sacral canal was only displayed in SCs. The preservation of intervertebral discs showed difference between large and small tumors (P = 0.0002), regardless of tumor type (P = 0.095). No significant difference was displayed in gender (P = 0.234) or tumor size (P = 0.0832) among three groups. Conclusion: Age, epicenter of the lesion (midline vs. eccentric and upper vs. lower sacral vertebra), bone residues, cysts, bleeding, septation, expanding pattern, muscles and sacroiliac joint involvement can be criteria for diagnosis. Fluid–fluid level is specific for SGCTs and ascending extension within the sacral canal for SCs. The preservation of intervertebral discs is related to tumor size rather than tumor type.

VAC Therapy in Large Infected Sacral Pressure Ulcer Grade IV—Can Be an Alternative to Flap Reconstruction?

OpenAIRE

Batra, R. K.; Aseeja, Veena

2012-01-01

Vacuum-assisted closure (VAC) therapy is a new entrant in wound care after growth factors and alginate or hydrocolloid dressing, in the treatment of pressure ulcers. We have been using this technique for diabetic foot ulcers. A young nondiabetic man presented with a large sacral bed sore after high doses of ionotropes in an intensive care unit for treating severe hypotension. His wound was debrided, and instead of flap surgery in such infected wound, he was treated with VAC therapy. The compl...

The anatomy of the first sacral nerve root sheath shown by computed tomography.

Science.gov (United States)

Moore, N R; Dixon, A K; Freer, C E

1989-08-01

Analysis of 25 patients with normal computed tomographic appearances at the lumbosacral junction revealed wide variation in the anatomical level at which the first sacral nerve root sheaths were seen emerging from the theca. In nine patients (36%), the S1 nerve root sheaths were first recognized at the level of the lumbosacral disc. In 14 patients (56%), the sheaths emerged cranial to the disc; it is possible that these patients may be more prone to neurological complications related to disc or facet joint disease, especially if the sheath is laterally sited within the lateral recess. Conversely, that minority of patients (two, 8%) in whom the root sheaths emerge caudal to the disc level may be relatively protected from neurological complications.

Psoas compartment and sacral plexus block via electrostimulation for pelvic limb amputation in dogs.

Science.gov (United States)

Congdon, Jonathon M; Boscan, Pedro; Goh, Clara S S; Rezende, Marlis

2017-07-01

To assess the efficacy of psoas compartment and sacral plexus block for pelvic limb amputation in dogs. Prospective clinical study. A total of 16 dogs aged 8±3 years and weighing 35±14 kg (mean±standard deviation). Dogs were administered morphine (0.5 mg kg -1 ) and atropine (0.02 mg kg -1 ); anesthesia was induced with propofol and maintained with isoflurane. Regional blocks were performed before surgery in eight dogs with bupivacaine (2.2 mg kg -1 ) and eight dogs were administered an equivalent volume of saline. The lumbar plexus within the psoas compartment was identified using electrolocation lateral to the lumbar vertebrae at the fourth-fifth, fifth-sixth and sixth-seventh vertebral interspaces. The sacral plexus, ventrolateral to the sacrum, was identified using electrolocation. Anesthesia was monitored using heart rate (HR), invasive blood pressure, electrocardiography, expired gases, respiratory frequency and esophageal temperature by an investigator unaware of the group allocation. Pelvic limb amputation by coxofemoral disarticulation was performed. Dogs that responded to surgical stimulation (>10% increase in HR or arterial pressure) were administered fentanyl (2 μg kg -1 ) intravenously for rescue analgesia. Postoperative pain was assessed at extubation; 30, 60 and 120 minutes; and the morning after surgery using a visual analog scale (VAS). The number of intraoperative fentanyl doses was fewer in the bupivacaine group (2.7±1.1 versus 6.0±2.2; pdogs at extubation (0.8±1.9 versus 3.8±2.5) and at 30 minutes (1.0±1.4 versus 4.3±2.1; pdogs. Copyright © 2017 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

Imaging appearances and clinical outcome following sacrectomy and ilio-lumbar reconstruction for sacral neoplasia

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Thomas, Marianna; Davies, A.M.; James, Steven L.J. [Department of Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham (United Kingdom); Stirling, A.J.; Grainger, M. [Department of Spinal Surgery, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham (United Kingdom); Grimer, R.J. [Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham (United Kingdom)

2014-02-15

Sacrectomy and ilio-lumbar reconstruction is an uncommonly performed complex surgical procedure for the treatment of sacral neoplasia. There are many challenges in the post-operative period including the potential for tumor recurrence, infection, and construct failure. We present our experience of this patient cohort and describe the complications and imaging appearances that can be encountered during the follow-up period. Retrospective review of our Orthopaedic Oncology database was undertaken which has been collected over a 30-year period to identify patients that had undergone sacrectomy and ilio-lumbar reconstruction. Pre and post-operative imaging including radiographs, CT, and MRI was reviewed. These were viewed by two experienced musculoskeletal radiologists with consensus opinion if there was disagreement over the imaging findings. Data regarding patient demographics, tumor type, and dimensions was collected. Serial review of radiographs, CT, and MRI was performed to assess implant position and integrity, strut graft position and union, and for the presence of recurrence within the surgical bed. Five male and two female patients (mean age 36 years, age range 15-54 years) were treated with this procedure. Histological diagnoses included chordoma, chondrosarcoma, osteosarcoma, and spindle cell sarcoma. Mean maximal tumor size on pre-operative imaging was 10.7 cm (range, 6-16 cm). Post-operative follow-up ranged from 10-46 months. A total of 76 imaging studies were reviewed. Commonly identified complications included vertical rod and cross-connector fracture and screw loosening. Fibula strut graft non-union and fracture was also evident on imaging review. Two patients demonstrated disease recurrence during the follow-up period. This study demonstrates the spectrum and frequency of complications that can occur following sacrectomy and ilio-lumbar reconstruction for sacral neoplasia. (orig.)

Shrines and relics between Late Antiquity and Middle Ages: Christianization of the space or sacralization of the Christianity?

Directory of Open Access Journals (Sweden)

Luigi Canetti

2002-12-01

Full Text Available This essay analyzes the importance of relics and sanctuaries against the backdrop of the sacralization of Christianity and the latter’s re-elaboration into a religious system that occurred in urban milieux in the late ancient times. The main steps of this process, which came to a climax in the 4th century, are the Christianization of time and space as well as the reinterpretation of Christ’s death in terms of a sacrifice.

Sacral Theater, a code to simulate the propagation of the superconducting magnet LHC atlas barrel toroid transition

International Nuclear Information System (INIS)

Gastineau, B.

2000-06-01

Sacral Theater has been developed for the toroid magnet Atlas of the CERN LHC project. This three dimensional calculations code calculates the propagation of the transition of a superconducting coil in 25 m long hippodrome. Procedures to study low currents have been included. This work is a part of the magnet safety system because the coils protection is made by warmers activating the quench propagation in case of default detection. This allows the complete dissipation of storage energy that can reach 1080 MJ on Atlas. (N.C.)

Comparison of lumbar lordosis in lateral radiographs in standing position with supine MR imaging in consideration of the sacral slope

International Nuclear Information System (INIS)

Benditz, Achim; Boluki, Daniel; Weber, Markus; Grifka, Joachim; Voellner, Florian; Zeman, Florian

2017-01-01

To investigate the influence of sacral slope on the correlation between measurements of lumbar lordosis obtained by standing radiographs and magnetic resonance images in supine position (MRI). Little information is available on the correlation between measurements of lumbar lordosis obtained by radiographic and MR images. Most relevant studies have shown correlations for the thoracic spine, but detailed analyses on the lumbar spine are lacking. MR images and standing lateral radiographs of 63 patients without actual low back pain or radiographic pathologies of the lumbar spine were analyzed. Standing radiographic measurements included the sagittal parameters pelvic incidence (PI) pelvic tilt (PT), and sacral slope (SS); MR images were used to additionally measure lumbar L1-S1 lordosis and single level lordosis. Differences between radiographic and MRI measurements were analyzed and divided into 4 subgroups of different sacral slope according to Roussouly's classification. Global lumbar lordosis (L1-S1) was 44.99 (± 10754) on radiographs and 47.91 (±9.170) on MRI, yielding a clinically relevant correlation (r = 0.61, p < 0.01). Measurements of single level lordosis only showed minor differences. At all levels except for L5 / S1, lordosis measured by means of standing radiographs was higher than that measured by MRI. The difference in global lumbar L1-S1 lordosis was -2.9 . Analysis of the Roussouly groups showed the largest difference for L1-S1 (-8.3 ) in group 2. In group 4, when measured on MRI, L5 / S1 lordosis (25.71 ) was lower than L4 / L5 lordosis (27.63 ) compared to the other groups. Although measurements of global lumbar lordosis significantly differed between the two scanning technologies, the mean difference was just 2.9 . MRI in supine position may be used for estimating global lumbar lordosis, but single level lordosis should be determined by means of standing radiographs.

Comparison of lumbar lordosis in lateral radiographs in standing position with supine MR imaging in consideration of the sacral slope

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Benditz, Achim; Boluki, Daniel; Weber, Markus; Grifka, Joachim; Voellner, Florian [Regensburg Univ. Medical Center (Germany). Orthopedic Surgery; Zeman, Florian [Regensburg Univ. Medical Center (Germany). Center for Clinical Studies

2017-03-15

To investigate the influence of sacral slope on the correlation between measurements of lumbar lordosis obtained by standing radiographs and magnetic resonance images in supine position (MRI). Little information is available on the correlation between measurements of lumbar lordosis obtained by radiographic and MR images. Most relevant studies have shown correlations for the thoracic spine, but detailed analyses on the lumbar spine are lacking. MR images and standing lateral radiographs of 63 patients without actual low back pain or radiographic pathologies of the lumbar spine were analyzed. Standing radiographic measurements included the sagittal parameters pelvic incidence (PI) pelvic tilt (PT), and sacral slope (SS); MR images were used to additionally measure lumbar L1-S1 lordosis and single level lordosis. Differences between radiographic and MRI measurements were analyzed and divided into 4 subgroups of different sacral slope according to Roussouly's classification. Global lumbar lordosis (L1-S1) was 44.99 (± 10754) on radiographs and 47.91 (±9.170) on MRI, yielding a clinically relevant correlation (r = 0.61, p < 0.01). Measurements of single level lordosis only showed minor differences. At all levels except for L5 / S1, lordosis measured by means of standing radiographs was higher than that measured by MRI. The difference in global lumbar L1-S1 lordosis was -2.9 . Analysis of the Roussouly groups showed the largest difference for L1-S1 (-8.3 ) in group 2. In group 4, when measured on MRI, L5 / S1 lordosis (25.71 ) was lower than L4 / L5 lordosis (27.63 ) compared to the other groups. Although measurements of global lumbar lordosis significantly differed between the two scanning technologies, the mean difference was just 2.9 . MRI in supine position may be used for estimating global lumbar lordosis, but single level lordosis should be determined by means of standing radiographs.

Fibrous dysplasia of bone

International Nuclear Information System (INIS)

Kim, Kyung Soo; Lee, Sang Wook; Cho, Young Jun; Kim, Young Sook

1983-01-01

Fibrous dysplasia of bone is a skeletal development anomaly of unknown etiology characterized by single or multiple areas of fibrous tissue replacement of medullary cavity of one or more bones. The disease may be localized to single bone (monostotic form) or may affect multiple bones (polyostotic form). Eighteen cases of fibrous dysplasia diagnosed by roentgenlogic or histologic assessment at Chosun University Hospital, Chosun University Hospital and Kwangju Christian Hospital during recent ten tears were analyzed clinically and radiologically. The results were as follows: 1. 16 case of them had monostotic involvement, and 2 cases showed polyostotic disease, but none of our series presented Albright's syndrome. 2. The male to female ratio in this series was 10 : 8, but then 2 polyostotic forms of them were females. In age distribution, peak incidence at the time of diagnosis was in the age group of second decade (10 cases). 3. Maxilla (6 cases) and femur (4 case) were frequently involved sites in patients with monostotic lesion, whereas polyostotic lesions diffusely affected skull, pelvis, ribs and limb bones. 4. The clinical symptoms according to the extent and site of disease were very variable, which were localized painless or painful swelling, nasal obstruction, deformity of face or extremity and incidentally during routine roentgen study. 5. The chemical abnormality of blood serum was moderate degree of elevated serum alkaline phosphatase in only one patients with monostotic lesion. 6. The main radiologic findings of fibrous dysplasia were relatively well circumscribed single or multiloculated cystilike appearance, bone expansion, cortical thinning and/or erosion, bony deformity and pathologic fracture, but especially in maxilla, dense homogenous area with expanding lesion was observed in our series

Urinary retention, erectile dysfunction and meningitis due to sacral herpes zoster: a case report and review of the literature.

Science.gov (United States)

Erol, B; Avci, A; Eken, C; Ozgok, Y

2009-01-01

Zona zoster infection is often associated with painful erythematous vesicular eruptions of the skin or mucous membranes. Varicella zoster virus which stays latent in the sensorial root ganglia causes zona zoster infection. The most recognized feature of zona zoster is the dermatomal distribution of vesicular rashes. In the present case report, we state an unusual presentation of sacral zona zoster with urinary retention, erectile dysfunction and meningitis. Copyright 2009 S. Karger AG, Basel.

Magnetic resonance imaging of morphological and functional changes of the uterus induced by sacral surface electrical stimulation

International Nuclear Information System (INIS)

Ogura, Takahide; Murakami, Takashi; Ozawa, Yuka; Seki, Kazunori; Handa, Yasunobu

2006-01-01

The purpose of this study is to examine the morphological and kinematical changes of the uterus induced by electrical stimulation applied to the skin just above the second and fourth posterior sacral foramens (sacral surface electrical stimulation [ssES]) in 26 healthy subjects. Out of them, eight subjects who had severe pain subjectively during every menstruation received ssES just in menstruation. Morphological and functional changes of the uterus were examined by using T2-weighted magnetic resonance (MR) imaging and T1-weighted MR cinematography, respectively. Cyclic electrical stimulation for 15 min with 5 sec ON and 5 sec OFF was applied just before MR scanning. A decrease in thickness of the muscular layer of the uterus was observed in every subject after ssES for 15 min and was significant as compared with the thickness before ssES. Periodic uterine movement during menstruation was observed in the subjects with severe menstrual pain in MR cine and the power spectrum analysis of the movement showed a marked decrease in peak power and frequency after ssES treatment. We conclude that ssES causes a reduction of static muscle tension of the uterus in all menstrual cycle periods and suppression of uterine peristalsis during menstruation in the subjects with severe menstrual pain. Possible neural mechanisms for these static and dynamic effects of ssES on the uterus at spinal level are discussed. (author)

A radiographic study of solitary bone cysts

Energy Technology Data Exchange (ETDEWEB)

Kim, Kyung Rak; Hwang, Eui Hwan; Lee, Sang Rae [Dept. of Oral and Maxillofacial Radiology, Division of Dentistry, Kyung Hee University, Seoul (Korea, Republic of)

1994-02-15

The aim of this study was to evaluate the clinical, radiographic and histopathologic features of 23 cases of solitary bone cyst by means of the analysis of radiographs and biopsy specimens in 23 persons visited the Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University and Chunbuk National University. The obtained results were as follows; 1. The incidence of solitary bone cyst was almost equal in males (52.2%) and in females(42.8%) and the prevalent age of the solitary bone cyst were the second decade (47.8%) and the third decade (21.7%). 2. In the signs and symptoms of solitary bone cyst, pain or tenderness revealed in 17.4%, swelling revealed in 13.0%, pain and swelling revealed in 21.7%, paresthesia revealed in 4.4% and 43.5% were a symptom and the tooth vitality involved in the solitary bone cyst, 76.5% were posterior and 23.5% were either positive or negative. 3. In the location of the solitary bone cyst, 47.8% present posterior region, 21.7% present anterior region, 21.6% present anterior and posterior region, 4.4% present condylar process area. 4. In the hyperostotic border of the solitary bone cyst, 47.8% were seen entirely, 21.8% were seen partially, and 30.4% were not seen. 5. In the change of tooth, 59.1% were loss of the alveolar lamina dura, 13.6% were root resorption 4.55% were tooth displacement, 4.55% were root resorption and tooth displacement. 6. In the change of cortical bone of the solitary bone cyst, 39.1% were intact and 60.9% were thinning and expansion of cortical bone. 7. In the histopathologic findings of 9 cases, 33.3% were thin connective tissue wall, 11.1% were thickened myxo-fibromatous wall, 55.6% were thickened myxofibromatous wall with dysplastic bone formation.

A radiographic study of solitary bone cysts

International Nuclear Information System (INIS)

Kim, Kyung Rak; Hwang, Eui Hwan; Lee, Sang Rae

1994-01-01

The aim of this study was to evaluate the clinical, radiographic and histopathologic features of 23 cases of solitary bone cyst by means of the analysis of radiographs and biopsy specimens in 23 persons visited the Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University and Chunbuk National University. The obtained results were as follows; 1. The incidence of solitary bone cyst was almost equal in males (52.2%) and in females(42.8%) and the prevalent age of the solitary bone cyst were the second decade (47.8%) and the third decade (21.7%). 2. In the signs and symptoms of solitary bone cyst, pain or tenderness revealed in 17.4%, swelling revealed in 13.0%, pain and swelling revealed in 21.7%, paresthesia revealed in 4.4% and 43.5% were a symptom and the tooth vitality involved in the solitary bone cyst, 76.5% were posterior and 23.5% were either positive or negative. 3. In the location of the solitary bone cyst, 47.8% present posterior region, 21.7% present anterior region, 21.6% present anterior and posterior region, 4.4% present condylar process area. 4. In the hyperostotic border of the solitary bone cyst, 47.8% were seen entirely, 21.8% were seen partially, and 30.4% were not seen. 5. In the change of tooth, 59.1% were loss of the alveolar lamina dura, 13.6% were root resorption 4.55% were tooth displacement, 4.55% were root resorption and tooth displacement. 6. In the change of cortical bone of the solitary bone cyst, 39.1% were intact and 60.9% were thinning and expansion of cortical bone. 7. In the histopathologic findings of 9 cases, 33.3% were thin connective tissue wall, 11.1% were thickened myxo-fibromatous wall, 55.6% were thickened myxofibromatous wall with dysplastic bone formation.

Application of posterior pelvic tilt taping for the treatment of chronic low back pain with sacroiliac joint dysfunction and increased sacral horizontal angle.

Science.gov (United States)

Lee, Jung-hoon; Yoo, Won-gyu

2012-11-01

Kinesio Taping (KT) is a therapeutic method used by physical therapists and athletic trainers in combination with other treatment techniques for various musculoskeletal and neuromuscular problems. However, no research has evaluated the effect of KT in patients with low back pain (LBP). The purpose of this case was to describe the application of posterior pelvic tilt taping (PPTT) with Kinesio tape as a treatment for chronic LBP and to reduce the anterior pelvic tilt angle. Case report. The patien was a 20-year-old female amateur swimmer with a Cobb's angle (L1-S1) of 68°, a sacral horizontal angle of 45°, and pain in both medial buttock areas and sacroiliac joints. We performed PPTT with Kinesio tape for 2 weeks (six times per week for an average of 9 h each time). The patient’s radiographs showed that the Cobb's angle (L1-S1) had decreased from 68° to 47° and that the sacral horizontal angle had decreased from 45° to 31°. Reductions in hypomobility or motion asymmetry, as assessed by the motion palpation test, and in pain, as measured by the pain-provocation tests, were observed. On palpation for both medial buttock areas in the prone position, the patient felt no pain. The patient experienced no pain or stiffness in the low back area while performing forward flexion in the standing position with knees fully extended when washing dishes in the sink. The case study demonstrated that PPTT intervention favourably affected the pelvic inclination and sacral horizontal angle, leading to beneficial effects on sacroiliac joint dysfunction (SIJD) and medial buttock pain. Additional research on the clinical effects of this taping procedure requires greater numbers of athletes with SIJD or LBP who have inappropriate anterior pelvic tilt angles and hyperlordosis.

Demineralized bone matrix and human cancellous bone enhance fixation of titanium implants

DEFF Research Database (Denmark)

Babiker, Hassan; Ding, Ming; Overgaard, Søren

Best Poster 5Demineralized bone matrix and human cancellous bone enhance fixation of titanium implants AuthorsBabiker , H.; Ding M.; Overgaard S.InstitutionOrthopaedic Research Laboratory, Department of Orthopaedic Surgery, Odense University Hospital, Clinical Institute, University of Southern...... from human tissue were included (IsoTis OrthoBiologics, Inc. USA). Both materials are commercially available. Titanium alloy implants (Biomet Inc.) of 10 mm in length and 10 mm in diameter were inserted bilaterally into the femoral condyles of 8 skeletally mature sheep. Thus four implants...... with a concentric gap of 2 mm were implanted in each sheep. The gap was filled with: DBM; DBM/CB with ratio of 1/3; DBM/allograft with ratio of 1/3; or allograft (Gold standard), respectively. Standardised surgical procedure was used1. At sacrifice, 6 weeks after surgery, both distal femurs were harvested...

The toxicity of the bone seeking radionuclides

International Nuclear Information System (INIS)

Spiers, F.W.

1989-01-01

This editorial concludes that it is evident from work on radium dial painters at the Argonne National Laboratory and on beagles at the Universities of Utah and California that irradiation by α particles from 226 Ra and 239 Pu incorporated in bone results in tumours of bone but rarely if at all in tumours arising from bone marrow. The same can probably be said of α particle irradiation by other radionuclides deposited in bone or on bone surfaces. If α particles arise in bone or on bone surfaces, the trabecular marrow can be only partially irradiated with considerable fractions of marrow left intact. On the other hand it is evident from beagle data that when bone marrow is totally irradiated by the long range β particles from 90 Sr, whether fed orally or administered by single injection, both marrow neoplasms and bone tumours occur. Total irradiation of bone marrow by γ radiation, and some neutron radiation at Hiroshima and Nagasaki also resulted in leukaemia induction. (author)

Combination of calcium sulfate and simvastatin-controlled release microspheres enhances bone repair in critical-sized rat calvarial bone defects

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Fu YC

2015-12-01

Full Text Available Yin-Chih Fu,1–4 Yan-Hsiung Wang,1,5 Chung-Hwan Chen,1,3,4 Chih-Kuang Wang,1,6 Gwo-Jaw Wang,1,3,4 Mei-Ling Ho1,3,7,8 1Orthopaedic Research Center, 2Graduate Institute of Medicine, 3Department of Orthopaedics, 4Department of Orthopaedics, College of Medicine, 5School of Dentistry, College of Dental Medicine, 6Department of Medicinal and Applied Chemistry, 7Department of Physiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 8Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, TaiwanAbstract: Most allogenic bone graft substitutes have only osteoconductive properties. Developing new strategies to improve the osteoinductive activity of bone graft substitutes is both critical and practical for clinical application. Previously, we developed novel simvastatin-encapsulating poly(lactic-co-glycolic acid microspheres (SIM/PLGA that slowly release simvastatin and enhance fracture healing. In this study, we combined SIM/PLGA with a rapidly absorbable calcium sulfate (CS bone substitute and studied the effect on bone healing in critical-sized calvarial bone defects in a rat model. The cytotoxicity and cytocompatibility of this combination was tested in vitro using lactate dehydrogenase leakage and a cell attachment assay, respectively. Combination treatment with SIM/PLGA and the CS bone substitute had no cytotoxic effect on bone marrow stem cells. Compared with the control, cell adhesion was substantially enhanced following combination treatment with SIM/PLGA and the CS bone substitute. In vivo, implantation of the combination bone substitute promoted healing of critical-sized calvarial bone defects in rats; furthermore, production of bone morphogenetic protein-2 and neovascularization were enhanced in the area of the defect. In summary, the combination of SIM/PLGA and a CS bone substitute has osteoconductive and osteoinductive properties, indicating that it could be used for regeneration

Observation of the bone mineral density of newly formed bone using rabbits. Compared with newly formed bone around implants and cortical bone

International Nuclear Information System (INIS)

Nakada, Hiroshi; Numata, Yasuko; Sakae, Toshiro; Tamaki, Hiroyuki; Kato, Takao

2009-01-01

There have been many studies reporting that newly formed bone around implants is spongy bone. However, although the morphology is reported as being like spongy bone, it is difficult to discriminate whether the bone quality of newly formed bone appears similar to osteoid or cortical bone; therefore, evaluation of bone quality is required. The aims of this study were to measure the bone mineral density (BMD) values of newly formed bone around implants after 4, 8, 16, 24 and 48 weeks, to represent these values on three-dimensional color mapping (3Dmap), and to evaluate the change in bone quality associated with newly formed bone around implants. The animal experimental protocol of this study was approved by the Ethics Committee for Animal Experiments of our University. This experiment used 20 surface treatment implants (Ti-6Al-4V alloy: 3.1 mm in diameter and 30.0 mm in length) by grit-blasting. They were embedded into surgically created flaws in femurs of 20 New Zealand white rabbits (16 weeks old, male). The rabbits were sacrificed with an ear intravenous overdose of pentobarbital sodium under general anesthesia each period, and the femurs were resected. We measured BMD of newly formed bone around implants and cortical bone using Micro-CT, and the BMD distribution map of 3Dmap (TRI/3D Bon BMD, Ratoc System Engineering). The BMD of cortical bone was 1,026.3±44.3 mg/cm 3 at 4 weeks, 1,023.8±40.9 mg/cm 3 at 8 weeks, 1,048.2±45.6 mg/cm 3 at 16 weeks, 1,067.2±60.2 mg/cm 3 at 24 weeks, and 1,069.3±50.7 mg/cm 3 at 48 weeks after implantation, showing a non-significant increase each period. The BMD of newly formed bone around implants was 296.8±25.6 mg/cm 3 at 4 weeks, 525.0±72.4 mg/cm 3 at 8 weeks, 691.2±26.0 mg/cm 3 at 16 weeks, 776.9±27.7 mg/cm 3 at 24 weeks, and 845.2±23.1 mg/cm 3 at 48 weeks after implantation, showing a significant increase after each period. It was revealed that the color scale of newly formed bone was Low level at 4 weeks, and then it

Bone marrow examination findings at Aga Khan University Hospital ...

African Journals Online (AJOL)

Nutritional anaemia as a group was the most common haematological disorder ... examination in our patients with megaloblastic anaemia predominating. ... indication for bone marrow examination was anaemia followed by diagnostic work up ...

Bone mineral density scans in veterans

Directory of Open Access Journals (Sweden)

Elizabeth Bass

2007-07-01

Full Text Available Elizabeth Bass1,2, Etienne Pracht1,3, Philip Foulis4,51VISN 8 Patient Safety Center of Inquiry, Tampa, FL; 2School of Aging Studies, University of South Florida, Tampa, FL, USA; 3College of Public Health, University of South Florida, Tampa, FL, USA; 4James A Haley VA Hospital, Tampa, FL, USA; 5Pathology and Laboratory Medicine, College of Medicine, University of South Florida, Tampa, FL, USAGoals: Recent findings suggest the prevalence of osteoporosis among men is under-recognized. The patient population of the Veterans Health Administration (VA is predominantly male and many elderly veterans may be at risk of osteoporosis. Given the lack of data on male osteoporosis, we provide initial insight into diagnostic procedures for patients at one VA medical center. Procedures: A review and descriptive analysis of patients undergoing radiological evaluation for osteoporosis at one VA medical center.Results: We identified 4,919 patients who had bone mineral density scans from 2001–2004. VA patients receiving bone mineral density scans were commonly white, male, over age 70 and taking medications with potential bone-loss side effects.Conclusions: While further research is needed, preliminary evidence suggests that the VA screens the most vulnerable age groups in both genders. Heightened awareness among primary care providers of elderly male patients at risk of osteoporosis can lead to early intervention and improved management of this age-related condition.Keywords: bone mineral density scans, osteoporosis, veterans

Utilization of Samarium-153 in bone pain and bone tumours in dog

International Nuclear Information System (INIS)

Martin, V. de; Marques, F.L.N.; Okamoto, M.; Guimaraes, M.I.C.C.; Dias-Neto, A.; Fonseca, A.C.

1997-01-01

Full text: The experimental unit of of Centro de Medicina Nuclear of the University of Sao Paulo is working on the utilization of Sm-153-EDTMP, produced by IPEN/CNEN-SP (Brazil), for the treatment of bone pain due either inflammatory process or bone tumours spontaneously developed in dogs. The effect of the injection of the radiopharmaceutical (37 MBq/kg) were analysed by observing the animal behavior against the pain and the evolution of the clinical picture of the inflammatory process. The cases where tumours were diagnosed, bone scintigraphy was performed to follow-up the evolution of those tumours. Preliminary observations indicated that, especially in inflammatory process due to disc spondylitis, there was an improvement concerning pain and consequently a better condition of the life for those animals. Bone tumours even being more difficult to evaluate, have shown a favorable evolution concerning the reduction of pain and consequently the increase in the life span of the animals

Assessing the effects of lumbar posterior stabilization and fusion to vertebral bone density in stabilized and adjacent segments by using Hounsfield unit

Science.gov (United States)

Öksüz, Erol; Deniz, Fatih Ersay; Demir, Osman

2017-01-01

Background Computed tomography (CT) with Hounsfield unit (HU) is being used with increasing frequency for determining bone density. Established correlations between HU and bone density have been shown in the literature. The aim of this retrospective study was to determine the bone density changes of the stabilized and adjacent segment vertebral bodies by comparing HU values before and after lumbar posterior stabilization. Methods Sixteen patients who had similar diagnosis of lumbar spondylosis and stenosis were evaluated in this study. Same surgical procedures were performed to all of the patients with L2-3-4-5 transpedicular screw fixation, fusion and L3-4 total laminectomy. Bone mineral density measurements were obtained with clinical CT. Measurements were obtained from stabilized and adjacent segment vertebral bodies. Densities of vertebral bodies were evaluated with HU before the surgeries and approximately one year after the surgeries. The preoperative HU value of each vertebra was compared with postoperative HU value of the same vertebrae by using statistical analysis. Results The HU values of vertebra in the stabilized and adjacent segments consistently decreased after the operations. There were significant differences between the preoperative HU values and the postoperative HU values of the all evaluated vertebral bodies in the stabilized and adjacent segments. Additionally first sacral vertebra HU values were found to be significantly higher than lumbar vertebra HU values in the preoperative group and postoperative group. Conclusions Decrease in the bone density of the adjacent segment vertebral bodies may be one of the major predisposing factors for adjacent segment disease (ASD). PMID:29354730

Efficiently engineered cell sheet using a complex of polyethylenimine–alginate nanocomposites plus bone morphogenetic protein 2 gene to promote new bone formation

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Jin H

2014-05-01

Full Text Available Han Jin,1 Kai Zhang,2 Chunyan Qiao,1 Anliang Yuan,1 Daowei Li,1 Liang Zhao,1 Ce Shi,1 Xiaowei Xu,1 Shilei Ni,1 Changyu Zheng,3 Xiaohua Liu,4 Bai Yang,2 Hongchen Sun11Department of Pathology, School of Stomatology, Jilin University, Changchun, People’s Republic of China; 2State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, People’s Republic of China; 3Molecular Physiology and Therapeutics Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA; 4Department of Biomedical Sciences, Texas A&M University Baylor College of Dentistry, Dallas, TX, USAAbstract: Regeneration of large bone defects is a common clinical problem. Recently, stem cell sheet has been an emerging strategy in bone tissue engineering. To enhance the osteogenic potential of stem cell sheet, we fabricated bone morphogenetic protein 2 (BMP-2 gene-engineered cell sheet using a complex of polyethylenimine–alginate (PEI–al nanocomposites plus human BMP-2 complementary(cDNA plasmid, and studied its osteogenesis in vitro and in vivo. PEI–al nanocomposites carrying BMP-2 gene could efficiently transfect bone marrow mesenchymal stem cells. The cell sheet was made by culturing the cells in medium containing vitamin C for 10 days. Assays on the cell culture showed that the genetically engineered cells released the BMP-2 for at least 14 days. The expression of osteogenesis-related gene was increased, which demonstrated that released BMP-2 could effectively induce the cell sheet osteogenic differentiation in vitro. To further test the osteogenic potential of the cell sheet in vivo, enhanced green fluorescent protein or BMP-2-producing cell sheets were treated on the cranial bone defects. The results indicated that the BMP-2-producing cell sheet group was more efficient than other groups in promoting bone formation in the defect area. Our results suggested that PEI�

Browse Title Index

African Journals Online (AJOL)

2010), Solitary Sacral Bone Plasmacytoma (SBP) presenting as low back pain, Abstract ... Vol 2, No 1 (2003), The Diabetic Foot - A Review, Abstract ... Limb Trauma in a Developing Country - The Patient's Perspective ...

A review of fibrin and fibrin composites for bone tissue engineering

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Noori A

2017-07-01

Full Text Available Alireza Noori,1 Seyed Jamal Ashrafi,2 Roza Vaez-Ghaemi,3 Ashraf Hatamian-Zaremi,4 Thomas J Webster5 1Department of Tissue Engineering and Applied Cell Sciences, Faculty of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, 2School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran; 3Department of Chemical and Biological Engineering, Faculty of Biomedical Engineering, The University of British Columbia, Vancouver, BC, Canada; 4Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran; 5Department of Chemical Engineering, Northeastern University, Boston, MA, USA Abstract: Tissue engineering has emerged as a new treatment approach for bone repair and regeneration seeking to address limitations associated with current therapies, such as autologous bone grafting. While many bone tissue engineering approaches have traditionally focused on synthetic materials (such as polymers or hydrogels, there has been a lot of excitement surrounding the use of natural materials due to their biologically inspired properties. Fibrin is a natural scaffold formed following tissue injury that initiates hemostasis and provides the initial matrix useful for cell adhesion, migration, proliferation, and differentiation. Fibrin has captured the interest of bone tissue engineers due to its excellent biocompatibility, controllable biodegradability, and ability to deliver cells and biomolecules. Fibrin is particularly appealing because its precursors, fibrinogen, and thrombin, which can be derived from the patient’s own blood, enable the fabrication of completely autologous scaffolds. In this article, we highlight the unique properties of fibrin as a scaffolding material to treat bone defects. Moreover, we emphasize its role in bone tissue engineering nanocomposites where approaches further emulate the natural nanostructured features of bone when using fibrin and other nanomaterials. We also review the

Effect of spinal anterior root stimulation and sacral deafferentation on bladder and sexual dysfunction in spinal cord injury.

Science.gov (United States)

Zaer, Hamed; Rasmussen, Mikkel Mylius; Zepke, Franko; Bodin, Charlotte; Domurath, Burkhard; Kutzenberger, Johannes

2018-05-10

Spinal cord injury (SCI) is a highly devastating injury with a variety of complications; among them are neurogenic bladder, bowel, and sexual dysfunction. We aimed to evaluate the effect of sacral anterior root stimulation with sacral deafferentation (SARS-SDAF) on neurogenic bladder and sexual dysfunction in a large well-defined spinal cord injury cohort. In the manner of cross-sectional study, subjects undergone SARS-SDAF between September 1986 and July 2011 answered a questionnaire concerning conditions before and after surgery in the department of Neuro-Urology, Bad Wildungen, Germany. In total 287 of 587 subjects were analyzed. Median age was 49 years (range 19-80), median time from SCI to surgery was 10 years (range 0-49), and from surgery to follow-up 13 years (range 1-25). Of the analyzed subjects, 100% of both gender used SARS for bladder emptying. On the visual analogue scale (VAS) ranging from 0 to 10 (best), satisfaction with SARS-SDAF was 10 concerning bladder emptying, however 5 and 8 regarding sexual performance, for female and male users, respectively. Baseline and follow-up comparison showed a decline in self-intermittent catheterization (p < 0.0001), partial catheterization by attendant (p = 0.0125), complete catheterization and suprapubic catheterization (p < 0.0001), transurethral catheterization (p < 0.0011), and fewer cases of involuntary urine leakage (p < 0.0001). The SARS-SDAF is a beneficial multi-potential treatment method with simultaneous positive effect on multi-organ dysfunction among SCI subjects.

Bones and oil reservoirs : bioengineers use oilpatch technology to study fluid flow in bones

Energy Technology Data Exchange (ETDEWEB)

Marsters, S.

2003-06-01

The fact that porosity and the presence of channels are qualities that are common to oil reservoirs and bones, led to the use of reservoir modelling technology in investigating bone disorders and to the discovery of dramatic changes in the structure and blood supply of osteoarthritic bones that lie under degenerating cartilage. CMG (Computer Modelling Group) Ltd., developers of reservoir simulation software claim that their software packages can help with the modelling of cellular responses to strains and deformations that occur as fluid flows through bone after a traumatic event such as a tear in the anterior cruciate ligament, a common sports-related injury. Researchers at the University of Calgary expect that by looking at the changes in blood and fluid flow within the bone, they can attain a better understanding of the chain of events that leads to osteoarthritis. Better understanding of the progression of the disease could eventually lead to more precise administration of drugs to deal with osteoarthritic pain, and even to the prevention of painful arthritic joints.

Multifunctional materials for bone cancer treatment

Directory of Open Access Journals (Sweden)

Marques C

2014-05-01

Full Text Available Catarina Marques,1 José MF Ferreira,1 Ecaterina Andronescu,2 Denisa Ficai,2 Maria Sonmez,3 Anton Ficai21Department of Materials and Ceramics Engineering, Centre for Research in Ceramics and Composite Materials, University of Aveiro, Aveiro, Portugal; 2Faculty of Applied Chemistry and Material Science, University Politehnica of Bucharest, Bucharest, Romania; 3National Research and Development Institute for Textiles and Leather, Bucharest, RomaniaAbstract: The purpose of this review is to present the most recent findings in bone tissue engineering. Special attention is given to multifunctional materials based on collagen and collagen–hydroxyapatite composites used for skin and bone cancer treatments. The multifunctionality of these materials was obtained by adding to the base regenerative grafts proper components, such as ferrites (magnetite being the most important representative, cytostatics (cisplatin, carboplatin, vincristine, methotrexate, paclitaxel, doxorubicin, silver nanoparticles, antibiotics (anthracyclines, geldanamycin, and/or analgesics (ibuprofen, fentanyl. The suitability of complex systems for the intended applications was systematically analyzed. The developmental possibilities of multifunctional materials with regenerative and curative roles (antitumoral as well as pain management in the field of skin and bone cancer treatment are discussed. It is worth mentioning that better materials are likely to be developed by combining conventional and unconventional experimental strategies.Keywords: bone graft, cancer, collagen, magnetite, cytostatics, silver

VAC Therapy in Large Infected Sacral Pressure Ulcer Grade IV-Can Be an Alternative to Flap Reconstruction?

Science.gov (United States)

Batra, R K; Aseeja, Veena

2014-04-01

Vacuum-assisted closure (VAC) therapy is a new entrant in wound care after growth factors and alginate or hydrocolloid dressing, in the treatment of pressure ulcers. We have been using this technique for diabetic foot ulcers. A young nondiabetic man presented with a large sacral bed sore after high doses of ionotropes in an intensive care unit for treating severe hypotension. His wound was debrided, and instead of flap surgery in such infected wound, he was treated with VAC therapy. The complete wound healing was achieved in 6 weeks and at half the cost of flap surgery. Moreover, the chances of flap failure and its related complications were eliminated.

A Prospective, Descriptive, Quality Improvement Study to Investigate the Impact of a Turn-and-Position Device on the Incidence of Hospital-acquired Sacral Pressure Ulcers and Nursing Staff Time Needed for Repositioning Patients.

Science.gov (United States)

Hall, Kimberly D; Clark, Rebecca C

2016-11-01

Patients in critical care areas are at risk for developing hospital-acquired pressure ulcers (HAPUs) due to their physical conditions and limited ability to reposition themselves. A prospective, 2-phase quality improvement study was conducted from September to November 2011 and from February to April 2012 in 1 medical and 1 surgical ICU to investigate the impact of a turn-and-assist device on the incidence of HAPUs and the time and personnel required to reposition patients reported as person/minutes (staff x minutes). A consecutive, convenience sample of patients was selected from newly admitted ICU patients who were at least 18 years old, nonambulatory, and required 2 or more people to assist with turning and repositioning. Sociodemographic data (patient age, gender, height, weight, body mass index, incontinence status); total Braden score and subscores for Activity, Mobility, and Moisture on admission; length of ICU stay and ventilator days; and sacral pressure ulcer incidence and stage and turn-and-assist data were collected. Fifty (50) patients participated in each phase. In phase 1, standard care for positioning included pillows, underpads, standard low-air-loss beds and additional staff as required for turning. In phase 2, the study product replaced standard care repositioning products including pillows; and a larger disposable moisture-wicking underpad (included as part of the turn study project kit) was substituted for the smaller, standard moisture-wicking disposable underpad. Turning procedures were timed with a stopwatch. Data were collected for a total of 32 hours during the observation periods; all patients were followed from admission until discharge from the ICU for a maximum of 14 days. T-tests were used to compare patient characteristics and person-minutes needed for repositioning differences, and Fisher's exact test was used to compare the incidence of sacral HAPUs during phase 1 and phase 2 of the study. No statistically significant

Sacral neuromodulation effects on periurethral sensation and urethral sphincter activity.

Science.gov (United States)

Gleason, Jonathan L; Kenton, Kimberly; Greer, W Jerod; Ramm, Olga; Szychowski, Jeff M; Wilson, Tracey; Richter, Holly E

2013-06-01

To characterize the effect of sacral neuromodulation (SNM) on urethral neuromuscular function. Following IRB approval, women with refractory overactive bladder (OAB) underwent standardized urethral testing prior to and after Stage 1 SNM implantation. Periurethral sensation was measured using current perception thresholds (CPT). Striated urethral sphincter activity was quantified using concentric needle electromyography (CNE) and Multi-Motor Unit Action Potential (MUP) analysis software. Nonparametric analyses were used to characterize pre/post changes with intervention. Baseline CPT and CNE findings were compared between SNM responders and non-responders. Twenty-seven women were enrolled in this pilot study with a mean age of 61 ± 13 years. Twenty of 26 women (76.9%) responded to SNM and went to Stage 2 permanent implantation. Four (14.8%) withdrew after Stage 1 implantation; three of the four withdrawals had not had therapeutic responses to SNM. CPT and CNE parameters did not significantly differ from baseline 2 weeks after SNM. Pre-SNM urethral sensation was not significantly different between responders and non-responders. However, responders had larger amplitude, longer duration and more turns and phases at baseline approaching significance, reflecting more successful urethral reinnervation, than non-responders. SNM does not alter urethral neuromuscular function 2 weeks post Stage 1 implantation. Copyright © 2012 Wiley Periodicals, Inc.

Transcutaneous spinal direct current stimulation of the lumbar and sacral spinal cord: a modelling study

Science.gov (United States)

Fernandes, Sofia R.; Salvador, Ricardo; Wenger, Cornelia; de Carvalho, Mamede; Miranda, Pedro C.

2018-06-01

Objective. Our aim was to perform a computational study of the electric field (E-field) generated by transcutaneous spinal direct current stimulation (tsDCS) applied over the thoracic, lumbar and sacral spinal cord, in order to assess possible neuromodulatory effects on spinal cord circuitry related with lower limb functions. Approach. A realistic volume conductor model of the human body consisting of 14 tissues was obtained from available databases. Rubber pad electrodes with a metallic connector and a conductive gel layer were modelled. The finite element (FE) method was used to calculate the E-field when a current of 2.5 mA was passed between two electrodes. The main characteristics of the E-field distributions in the spinal grey matter (spinal-GM) and spinal white matter (spinal-WM) were compared for seven montages, with the anode placed either over T10, T8 or L2 spinous processes (s.p.), and the cathode placed over right deltoid (rD), umbilicus (U) and right iliac crest (rIC) areas or T8 s.p. Anisotropic conductivity of spinal-WM and of a group of dorsal muscles near the vertebral column was considered. Main results. The average E-field magnitude was predicted to be above 0.15 V m-1 in spinal cord regions located between the electrodes. L2-T8 and T8-rIC montages resulted in the highest E-field magnitudes in lumbar and sacral spinal segments (>0.30 V m-1). E-field longitudinal component is 3 to 6 times higher than the ventral-dorsal and right-left components in both the spinal-GM and WM. Anatomical features such as CSF narrowing due to vertebrae bony edges or disks intrusions in the spinal canal correlate with local maxima positions. Significance. Computational modelling studies can provide detailed information regarding the electric field in the spinal cord during tsDCS. They are important to guide the design of clinical tsDCS protocols that optimize stimulation of application-specific spinal targets.

The surgical treatment of sacral radiation ulcer-report of 5 patients

International Nuclear Information System (INIS)

Fukuzumi, Satoshi; Ootaka, Hitoshi; Suzuki, Fumio; Nishimoto, Kazumasa; Hayashi, Satoru; Fujioka, Toshio; Minabe, Toshiharu

2007-01-01

We have treated 5 cases of sacral radiation ulcer surgically. All patients with cervical or vulval cancer were treated with external radiotherapy more than 20 years ago. Three patients have rectovaginal fistulas and four patients have osteoradionecrosis of the sacrum. Fecal and/or urinary diversion were accomplished preoperatively in four patients. After debridement of ulcers, these defects were covered by pedicled musculocutaneous flaps. In two of five, marginal necrosis was seen in a great saphenous veno-neuro accompanying artery fasciocutaneous flap and an inferior gluteus maximus musculocutaneous flap. In two of five, seroma was seen. One patient died of the sepsis from pelvic infection with rectal fistula. Among the other four patients, there was no recurrence during the follow up period. The principle for surgically treating radiation ulcer is to completely resect all radionecrotic tissues and cover these defects with well vascularized tissues. It is useful to distinguish damaged tissue from health tissue by MRI. In a case having a rectovaginal fistula, it is recommended that fecal and urinary diversion will be done at first and debridement of ulcer and reconstructive surgery will be done later. (author)

Disabling Orthostatic Headache after Penetrating Stonemason Pencil Injury to the Sacral Region

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Carlo Brembilla

2015-01-01

Full Text Available Penetrating injuries to the spine, although less common than motor vehicle accidents and falls, are important causes of injury to the spinal cord. They are essentially of two varieties: gunshot or stab wounds. Gunshot injuries to the spine are more commonly described. Stab wounds are usually inflicted by knife or other sharp objects. Rarer objects causing incidental spinal injuries include glass fragments, wood pieces, chopsticks, nailguns, and injection needles. Just few cases of penetrating vertebral injuries caused by pencil are described. The current case concerns a 42-year-old man with an accidental penetrating stonemason pencil injury into the vertebral canal without neurological deficit. After the self-removal of the foreign object the patient complained of a disabling orthostatic headache. The early identification and treatment of the intracranial hypotension due to the posttraumatic cerebrospinal fluid (CSF sacral fistulae were mandatory to avoid further neurological complications. In the current literature acute pattern of intracranial hypotension immediately after a penetrating injury of the vertebral column has never been reported.

Percutaneous tibial nerve stimulation vs sacral nerve stimulation for faecal incontinence: a comparative case-matched study.

Science.gov (United States)

Al Asari, S; Meurette, G; Mantoo, S; Kubis, C; Wyart, V; Lehur, P-A

2014-11-01

The study assessed the initial experience with posterior tibial nerve stimulation (PTNS) for faecal incontinence and compared it with sacral nerve stimulation (SNS) performed in a single centre during the same timespan. A retrospective review of a prospectively collected database was conducted at the colorectal unit, University Hospital, Nantes, France, from May 2009 to December 2010. Seventy-eight patients diagnosed with chronic severe faecal incontinence underwent neurostimulation including PTNS in 21 and SNS in 57. The main outcome measures were faecal incontinence (Wexner score) and quality of life (Fecal Incontinence Quality of Life, FIQL) scores in a short-term follow-up. No significant differences were observed in patients' characteristics. Of 57 patients having SNS, 18 (32%) failed peripheral nerve evaluation and 39 (68%) received a permanent implant. Two (5%) developed a wound infection. No adverse effects were recorded in the PTNS group. There was no significant difference in the mean Wexner and FIQL scores between patients having PTNS and SNS at 6 (P = 0.39 and 0.09) and 12 months (P = 0.79 and 0.37). A 50% or more improvement in Wexner score was seen at 6 and 12 months in 47% and 30% of PTNS patients and in 50% and 58% of SNS patients with no significant difference between the groups. Posterior tibial nerve stimulation is a valid method of treating faecal incontinence in the short term when conservative treatment has failed. It is easier, simpler, cheaper and less invasive than SNS with a similar short-term outcome. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

Dietary arginine silicate inositol complex increased bone healing: histologic and histomorphometric study

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Yaman F

2016-06-01

Full Text Available Ferhan Yaman,1 Izzet Acikan,1 Serkan Dundar,2 Sercan Simsek,3 Mehmet Gul,4 İbrahim Hanifi Ozercan,3 James Komorowski,5 Kazim Sahin6 1Department of Oral-Maxillofacial Surgery, Faculty of Dentistry, Dicle University, Diyarbakir, Turkey; 2Department of Periodontology, Faculty of Dentistry, Firat University, Elazig, Turkey; 3Department of Pathology, Faculty of Medicine, Firat University, Elazig, Turkey; 4Department of Periodontology, Faculty of Dentistry, Dicle University, Diyarbakir, Turkey; 5Nutrition 21, LLC, Purchase, NY, USA; 6Department of Animal Nutrition, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey Background: Arginine silicate inositol complex (ASI; arginine 49.5%, silicon 8.2%, and inositol 25% is a novel material that is a bioavailable source of silicon and arginine. ASI offers potential benefits for vascular and bone health. Objective: The aim of this study was to evaluate the potential effects of ASI complex on bone healing of critical-sized defects in rats. Methods: The rats were randomly assigned to two groups of 21 rats each. The control group was fed a standard diet for 12 weeks; after the first 8 weeks, a calvarial critical-sized defect was created, and the rats were sacrificed 7, 14, and 28 days later. The ASI group was fed a diet containing 1.81 g/kg of ASI for 12 weeks; after the first 8 weeks, a calvarial critical-sized defect was created, and the rats were sacrificed 7, 14, and 28 days later. The calvarial bones of all the rats were then harvested for evaluation. Results: Osteoblasts and osteoclasts were detected at higher levels in the ASI group compared with the control group at days 7, 14, and 28 of the calvarial defect (P<0.05. New bone formation was detected at higher levels in the ASI group compared with the controls at day 28 (P<0.05. However, new bone formation was not detected at days 7 and 14 in both the groups (P>0.05. Conclusion: ASI supplementation significantly improved bone tissue

Autologous serum improves bone formation in a primary stable silica-embedded nanohydroxyapatite bone substitute in combination with mesenchymal stem cells and rhBMP-2 in the sheep model

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Boos AM

2014-11-01

Full Text Available Anja M Boos,1,* Annika Weigand,1,* Gloria Deschler,1 Thomas Gerber,2 Andreas Arkudas,1 Ulrich Kneser,1 Raymund E Horch,1 Justus P Beier11Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg FAU, Erlangen, 2Institute of Physics, University of Rostock, Rostock, Germany *These authors contributed equally to this work Abstract: New therapeutic strategies are required for critical size bone defects, because the gold standard of transplanting autologous bone from an unharmed area of the body often leads to several severe side effects and disadvantages for the patient. For years, tissue engineering approaches have been seeking a stable, axially vascularized transplantable bone replacement suitable for transplantation into the recipient bed with pre-existing insufficient conditions. For this reason, the arteriovenous loop model was developed and various bone substitutes have been vascularized. However, it has not been possible thus far to engineer a primary stable and axially vascularized transplantable bone substitute. For that purpose, a primary stable silica-embedded nanohydroxyapatite (HA bone substitute in combination with blood, bone marrow, expanded, or directly retransplanted mesenchymal stem cells, recombinant human bone morphogenetic protein 2 (rhBMP-2, and different carrier materials (fibrin, cell culture medium, autologous serum was tested subcutaneously for 4 or 12 weeks in the sheep model. Autologous serum lead to an early matrix change during degradation of the bone substitute and formation of new bone tissue. The best results were achieved in the group combining mesenchymal stem cells expanded with 60 µg/mL rhBMP-2 in autologous serum. Better ingrowth of fibrovascular tissue could be detected in the autologous serum group compared with the control (fibrin. Osteoclastic activity indicating an active bone remodeling process was observed after 4 weeks, particularly

Bone strength and management of postmenopausal fracture risk with antiresorptive therapies: considerations for women’s health practice

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Cheung AM

2016-09-01

Full Text Available Angela M Cheung,1–3 Heather Frame,4 Michael Ho,5 Erin S Mackinnon,6 Jacques P Brown7 1Department of Medicine, University of Toronto, 2Centre of Excellence in Skeletal Health Assessment, Joint Department of Medical Imaging, University Health Network (UHN, 3Mount Sinai Hospital, University of Toronto, Toronto, ON, 4Assiniboine Clinic, Winnipeg, MB, 5University Health Network, Toronto, 6Amgen Canada, Inc, Mississauga, ON, 7Rheumatology Division, CHU de Québec Research Centre, Laval University, Quebec City, QC, Canada Abstract: Bone strength – and, hence, fracture risk – reflects the structural and material properties of the skeleton, which changes with bone turnover during aging and following effective pharmacotherapy. A variety of powerful new techniques (quantitative computed tomography, as well as peripheral quantitative computed tomography and high-resolution peripheral quantitative computed tomography provide precise images of bone structure and can be used to model the response of specific bones to different types of mechanical load. This review explores the various components of bone strength and the clinical significance of measures, such as bone mineral density, bone turnover markers, and modern imaging data, with regard to fracture risk in women with postmenopausal osteoporosis, before and after initiating antiresorptive therapy. These imaging and related techniques offer an ever-clearer picture of the changes in bone structure and bone mineral metabolism during normal aging and in osteoporosis, as well as in response to treatment. However, because the newer techniques are not yet available in routine practice, validated tools for absolute fracture risk assessment remain essential for clinical decision making. These tools, which are tailored to patient risk data in individual countries, are based on bone mineral density and other readily available clinical data. In addition, bone turnover marker measurements can be useful in

GFAP and Fos immunoreactivity in lumbo-sacral spinal cord and medulla oblongata after chronic colonic inflammation in rats

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Sun, Yi-Ning; Luo, Jin-Yan; Rao, Zhi-Ren; Lan, Li; Duan, Li

2005-01-01

AIM: To investigate the response of astrocytes and neurons in rat lumbo-sacral spinal cord and medulla oblongata induced by chronic colonic inflammation, and the relationship between them. METHODS: Thirty-three male Sprague-Dawley rats were randomly divided into two groups: experimental group (n = 17), colonic inflammation was induced by intra-luminal administration of trinitrobenzenesulfonic acid (TNBS); control group (n = 16), saline was administered intra-luminally. After 3, 7, 14, and 28 d of administration, the lumbo-sacral spinal cord and medulla oblongata were removed and processed for anti-glial fibrillary acidic protein (GFAP), Fos and GFAP/Fos immunohistochemistry. RESULTS: Activated astrocytes positive for GFAP were mainly distributed in the superficial laminae (laminae I-II) of dorsal horn, intermediolateral nucleus (laminae V), posterior commissural nucleus (laminae X) and anterolateral nucleus (laminae IX). Fos-IR (Fos-immunoreactive) neurons were mainly distributed in the deeper laminae of the spinal cord (laminae III-IV, V-VI). In the medulla oblongata, both GFAP-IR astrocytes and Fos-IR neurons were mainly distributed in the medullary visceral zone (MVZ). The density of GFAP in the spinal cord of experimental rats was significantly higher after 3, 7, and 14 d of TNBS administration compared with the controls (50.4±16.8, 29.2±6.5, 24.1±5.6, P0.05). CONCLUSION: Astrocytes in spinal cord and medulla oblongata can be activated by colonic inflammation. The activated astrocytes are closely related to Fos-IR neurons. With the recovery of colonic inflammation, the activity of astrocytes in the spinal cord and medulla oblongata is reduced. PMID:16097052

Prognostic factors for survival among patients with primary bone sarcomas of small bones

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Wang Z

2018-05-01

Full Text Available Zhan Wang,1,* Shu Li,2,* Yong Li,1 Nong Lin,1 Xin Huang,1 Meng Liu,1 Weibo Pan,1 Xiaobo Yan,1 Lingling Sun,1 Hengyuan, Li,1 Binghao Li,1 Hao Qu,1 Yan Wu,1 Peng Lin,1 Zhaoming Ye1 1Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China; 2Key Laboratory of Cancer Prevention and Intervention, Key Laboratory of Molecular Biology in Medical Sciences, National Ministry of Education, Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Cancer Institute, Hangzhou, China *These authors contributed equally to this work Background: Primary bone sarcomas of the hands or feet are rare lesions and poorly documented. Moreover, the prognostic determinants of bone sarcomas of the hands or feet have not been reported. Materials and methods: The Surveillance, Epidemiology, and End Results (SEER program database was used to screen patients with bone sarcomas of the hands or feet from 1973 to 2013, with attention paid to chondrosarcoma, Ewing sarcoma, and osteosarcoma. The prognostic values of overall survival (OS and cancer-specific survival (CSS were assessed using Cox proportional hazards regression model with univariate and multivariate analyses. The Kaplan–Meier method was used to obtain OS and CSS curves. Results: A total of 457 cases were selected from the SEER database. Chondrosarcoma was the most common form of lesion in hands or feet or both, followed by Ewing sarcoma and osteosarcoma. The 5- and 10-year OS rates of the entire group were 75.7% and 66.1%, respectively. The 5- and 10-year CSS rates were 78.7% and 73.7%, respectively. Multivariate analysis revealed that age under 40 years, localized stage, low grade, surgical treatment, and first primary tumor were associated with improved OS, and decade of diagnosis, stage, grade, and surgery were independent

Sacral Herpes Zoster Associated with Voiding Dysfunction in a Young Patient with Scrub Typhus.

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Hur, Jian

2015-06-01

When a patient presents with acute voiding dysfunction without a typical skin rash, it may be difficult to make a diagnosis of herpes zoster. Here, we present a case of scrub typhus in a 25-year-old man with the complication of urinary dysfunction. The patient complained of loss of urinary voiding sensation and constipation. After eight days, he had typical herpes zoster eruptions on the sacral dermatomes and hypalgesia of the S1-S5 dermatomes. No cases of dual infection with varicella zoster virus and Orientia tsutsugamushi were found in the literature. In the described case, scrub typhus probably induced sufficient stress to reactivate the varicella zoster virus. Early recognition of this problem is imperative for prompt and appropriate management, as misdiagnosis can lead to long-term urinary dysfunction. It is important that a diagnosis of herpes zoster be considered, especially in patients with sudden onset urinary retention.

Insufficiency fracture of the pelvis after the radiotherapy for carcinoma of the uterine cervix

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Nishimura, Tetsuo; Shimizu, Teppei; Sugiyama, Akira; Ichinohe, Kenji; Teshima, Takeshi; Takahashi, Motoichiro; Takai, Michikatsu; Kaneko, Masao

1990-01-01

Bone injury after radiotherapy for carcinoma of the uterine cervix has been reported since early days of this century. Recently, the concept of insufficiency fracture has been confirmed. Insufficiency fracture is one of the stress fractures and occurs when the elastic resistance of bone is inadequate to withstand normal or physiological stress. In the American and European studies, radiotherapy is known as a cause of insufficiency fracture. There are no reports on insufficiency fracture in the Japanese literatures. Four cases of carcinomas of the uterine cervix presented pelvic insufficiency fractures following radiotherapy. In the pubic bone, a vertical parasymphyseal fracture with mixed lytic and sclerotic changes of surrounding tissue is characteristic. Sacral insufficiency fracture shows a vertical or horizontal line with lytic and sclerotic appearance. Bone scintigraphy is a sensitive modality for the early detection. H-shaped configuration is diagnostic for sacral insufficiency fracture. CT is an accurate technique demonstrating a vertical fracture and excluding the malignant bony lesion. Although radiological findings of insufficiency fracture are similar to bone malignancy, differential diagnosis from malignant lesions is possible. Bony symptoms of all patients disappeared without specific treatments. In the follow-up study of patients with carcinomas of the uterine cervix after radiotherapy, it is important to have the consideration on insufficiency fracture. (author)

Effect of Long Term Oral Warfarin Sodium Treatment on Bone Mineral Density Scores and Spinal Sagittal Alignment

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Kamil Eyvazov

2016-04-01

Full Text Available Objective: The aim of this study was to investigate the effect of long term oral warfarin sodium treatment on bone mineral density (BMD and spinal sagittal alignment. Materials and Methods: Sixty four participants were enrolled for this retrospective study. Participants were divided into two groups-participants who had taken warfarin sodium for at least two years (n=33 and participants who had never taken warfarin sodium (n=31. All of the individuals were evaluated at the same center. Dual X-ray absorptiometry (DXA was used for measuring BMD. Whole spine x-rays were obtained for sagittal assessment and the following parameters were measured: Cervical lordosis, thoracic kyphosis, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope and sagittal vertical axis (SVA. Results: The mean BMD value was significantly higher in participants who had not taken warfarin sodium compared to participants who had taken warfarin sodium. The differences between the average values were 0.1552 g/cm2 in BMD; 2.1 in T scores; 1.4 in Z scores. On the radiological evaluation of the spine, cervical lordosis was 7.1 degrees lower, lumbar lordosis was 4.7 degrees lower and thoracic kyphosis was 5.3 degrees higher in the patients using drug. C7 plumb line was interchanged forward in the patients using drug. Conclusions: This study shows that warfarin sodium use worsens bone quality in the lumbar region and does not affect bone quality in the femoral region. Furthermore, warfarin sodium use also reduces physiological lordosis and enhances thoracic kyphosis. Consequences of these changes are the likely cause of sagittal spinal anterior imbalance. Long-term oral warfarin sodium use affect bone mineral density and spinal alignment. Our conclusion about giving clear message and show exactly mechanism we need prospective randomized multicentre studies in future. We strongly believe this study will be pioneer for future researches.

Struniak w okolicy kości krzyżowej u 47 – letniej pacjentki – opis przypadku = Chordoma in the sacral spine in an 47-year-old woman – case report

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Kamila Woźniak

2016-09-01

• 2.        Katedra i Klinika Rehabilitacji, Collegium Medicum im. Ludwika Rydygiera w Bydgoszczy, Uniwersytet Mikołaja Kopernika w Toruniu     Streszczenie   Struniaki (łac. chordoma są rzadkimi, histologicznie łagodnymi, lecz klinicznie złośliwymi nowotworami szkieletu osiowego. Mogą powstać w dowolnym miejscu w linii środkowej ciała, gdzie istniała struna grzbietowa (np. stok, nosogardziel, siodło i okolica okołosiodłowa, otwór wielki kręgi i okolica krzyżowo-ogonowa. Struniaki to wolno rosnące nowotwory, wykazujące miejscową agresywność w stosunku do kości i tkanek miękkich. Struniaka po raz pierwszy opisał w 1856 roku Virchow i Luschke. Z kolei w 1858 roku Muller stwierdził, że nowotwór może pochodzić z pozostałości embrionalnych prymitywnej struny grzbietowej tzw. chorda dorsalis. Autorzy przedstawiają opis przypadku klinicznego leczonego operacyjne w Klinice Neurochirurgii, Neurotraumatologii i Neurochirurgii Dziecięcej Szpitala Uniwersyteckiego nr 1 im. dr A. Jurasza w Bydgoszczy z rozpoznanym w badaniu histopatologicznym struniakiem.   Słowa kluczowe: struniak, chrodoma, nowotwór, szkielet osiowy, neurochirurgia.     Abstract   Chordomas are rare, histologically benign but clinically malignant tumors of the axial skeleton. They can occur anywhere in the midline of the body where there notochord (clivus, nasopharynx, saddle and surroundings parasellar, the foramen vertebrae and surroundings sacral area. Chordomas are slow-growing cancer, showing local aggressiveness relative to bone and soft tissue. Chordoma was first described in 1856 by Virchow and Luschke. In turn, in 1858 Muller found that the cancer can come from embryonic remnants of the primitive notochord called chorda dorsalis. The authors present a clinical case operating treated in the Department of Neurosurgery, Neurotraumatology and Pediatric Neurosurgery, Dr Antoni Jurasz University Hospital No.1 in Bydgoszcz histopathological diagnosed

Enhancement of tendon–bone healing via the combination of biodegradable collagen-loaded nanofibrous membranes and a three-dimensional printed bone-anchoring bolt

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Chou YC

2016-08-01

Full Text Available Ying-Chao Chou,1,2 Wen-Lin Yeh,2 Chien-Lin Chao,1 Yung-Heng Hsu,1,2 Yi-Hsun Yu,1,2 Jan-Kan Chen,3 Shih-Jung Liu1,2 1Department of Mechanical Engineering, Chang Gung University, 2Department of Orthopedic Surgery, Chang Gung Memorial Hospital, 3Department of Physiology and Pharmacology, Chang Gung University, Taoyuan, Taiwan Abstract: A composite biodegradable polymeric model was developed to enhance tendon graft healing. This model included a biodegradable polylactide (PLA bolt as the bone anchor and a poly(D,L-lactide-co-glycolide (PLGA nanofibrous membrane embedded with collagen as a biomimic patch to promote tendon–bone interface integration. Degradation rate and compressive strength of the PLA bolt were measured after immersion in a buffer solution for 3 months. In vitro biochemical characteristics and the nanofibrous matrix were assessed using a water contact angle analyzer, pH meter, and tetrazolium reduction assay. In vivo efficacies of PLGA/collagen nanofibers and PLA bolts for tendon–bone healing were investigated on a rabbit bone tunnel model with histological and tendon pullout tests. The PLGA/collagen-blended nanofibrous membrane was a hydrophilic, stable, and biocompatible scaffold. The PLA bolt was durable for tendon–bone anchoring. Histology showed adequate biocompatibility of the PLA bolt on a medial cortex with progressive bone ingrowth and without tissue overreaction. PLGA nanofibers within the bone tunnel also decreased the tunnel enlargement phenomenon and enhanced tendon–bone integration. Composite polymers of the PLA bolt and PLGA/collagen nanofibrous membrane can effectively promote outcomes of tendon reconstruction in a rabbit model. The composite biodegradable polymeric system may be useful in humans for tendon reconstruction. Keywords: polylactide–polyglycolide nanofibers, PLGA, collagen, 3D printing, polylactide, PLA, bone-anchoring bolts, tendon healing

Objective evaluation by reflectance spectrophotometry can be of clinical value for the verification of blanching/non blanching erythema in the sacral area.

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Sterner, Eila; Fossum, Bjöörn; Berg, Elisabeth; Lindholm, Christina; Stark, André

2014-08-01

Early detection of non blanching erythema (pressure ulcer category I) is necessary to prevent any further skin damage. An objective method to discriminate between blanching/non blanching erythema is presently not available. The purpose of this investigation was to explore if a non invasive objective method could differentiate between blanching/non blanching erythema in the sacral area of patients undergoing hip fracture surgery. Seventy-eight patients were included. The sacral area of all patients was assessed using (i) conventional finger-press test and (ii) digital reading of the erythema index assessed with reflectance spectrophotometry. The patients were examined at admission and during 5 days postsurgery. Reflectance spectrophotometry measurements proved able to discriminate between blanching/non blanching erythema. The reliability, quantified by the intra-class correlation coefficient, was excellent between repeated measurements over the measurement period, varying between 0·82 and 0·96, and a significant change was recorded in the areas from day 1 to day 5 (P < 0·0001). The value from the reference point did not show any significant changes over the same period (P = 0·32). An objective method proven to identify early pressure damage to tissue can be a valuable tool in clinical practice. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

In vivo experimental study on bone regeneration in critical bone defects using PIB nanogels/boron-containing mesoporous bioactive glass composite scaffold

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Chen XH

2015-01-01

Full Text Available Xiaohui Chen,1,2,* Yanbing Zhao,3,* Shinan Geng,3 Richard J Miron,1 Qiao Zhang,1 Chengtie Wu,4 Yufeng Zhang1,2 1State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, People’s Republic of China; 2Department of Dental Implantology, School and Hospital of Stomatology, Wuhan University, People’s Republic of China; 3National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 4State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, People’s Republic of China *These authors contributed equally to this work Purpose: In the present study, the fabrication of novel p(N-isopropylacrylamide-co-butyl methylacrylate (PIB nanogels was combined with boron-containing mesoporous bioactive glass (B-MBG scaffolds in order to improve the mechanical properties of PIB nanogels alone. Scaffolds were tested for mechanical strength and the ability to promote new bone formation in vivo.Patients and methods: To evaluate the potential of each scaffold in bone regeneration, ovariectomized rats were chosen as a study model to determine the ability of PIB nanogels to stimulate bone formation in a complicated anatomical bone defect. PIB nanogels and PIB nanogels/B-MBG composites were respectively implanted into ovariectomized rats with critical-sized femur defects following treatment periods of 2, 4, and 8 weeks post-implantation.Results: Results from the present study demonstrate that PIB nanogels/B-MBG composites showed greater improvement in mechanical strength when compared to PIB nanogels alone. In vivo, hematoxylin and eosin staining revealed significantly more newly formed bone in defects containing PIB

Radiotherapy for bone metastases from cervical cancer

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Monzen, Yoshio; Nakanishi, Kazue; Ajimu, Akira; Morikawa, Minoru; Hayashi, Kuniaki

1989-03-01

The authors have investigated 6 cases of bone metastases from cervical cancer out of a total of 90 cases of metastatic bone tumors that were irradiated for relief of associated pain at the Department of Radiology, Nagasaki University Hospital from April 1977 to March 1987. In 2 of the 6 cases, a rare, delayed recurrence with paraaortic lymph node metastases was seen. An invasion to the proasmajor muscle, iliomajor muscle was demonstrated by Computed Tomography after the initiation of therapy, so that the size of the field was modified. Computed Tomography was found useful to determine the exact field size for radiotherapy of metastatic bone tumor.

Chordomas of the Skull Base, Mobile Spine, and Sacrum: An Epidemiologic Investigation of Presentation, Treatment, and Survival.

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Zuckerman, Scott L; Bilsky, Mark H; Laufer, Ilya

2018-05-01

Chordomas are rare primary bone tumors that arise from the axial skeleton. Our objective was to analyze trends in radiation and surgery over time and determine location-based survival predictors for chordomas of the skull base, mobile spine, and sacrum. A retrospective cohort study of the SEER (Surveillance Epidemiology and End Results) database from 1973 to 2013 was conducted. All patients had histologically confirmed chordomas. The principal outcome measure was overall survival (OS). The cohort included 1616 patients: skull base (664), mobile spine (444), and sacrum (508). Skull base tumors presented earliest in life (47.4 years) and sacral tumors presented latest (62.7 years). Rates of radiation remained stable for skull base and mobile spine tumors but declined for sacral tumors (P = 0.006). Rates of surgical resection remained stable for skull base and sacral tumors but declined for mobile spine tumors (P = 0.046). Skull base chordomas had the longest median survival (162 months) compared with mobile spine (94 months) and sacral tumors (87 months). Being married was independently associated with improved OS for skull base tumors (hazard ratio, 0.73; 95% confidence interval, 0.53-0.99; P = 0.044). Surgical resection was independently associated with improved OS for sacral chordomas (hazard ratio, 0.48; 95% confidence interval, 0.34-0.69; P mobile spine chordomas and radiation for sacral chordomas decreased over time. Patients with skull base tumors survived longer than did patients with mobile spine and sacral chordomas, and surgical resection was associated with improved survival in sacral chordomas only. Understanding the behavior of these tumors can help cranial and spinal surgeons improve treatment in this patient population. Copyright © 2018 Elsevier Inc. All rights reserved.

Transarticular invasion of bone tumours across the sacroiliac joint

International Nuclear Information System (INIS)

Chhaya, S.; White, L.M.; Kandel, R.; Wunder, J.S.; Ferguson, P.; Agur, A.

2005-01-01

The purpose of this study was to evaluate the pattern of tumour spread across the SI articulation, correlating with cadaveric anatomic observations, in order to better understand the local spread of tumour and to assist in the assessment of local staging. Twenty-four consecutive patients (14 male, 10 female; age range 22-89 years, mean 52 years) with primary bone tumours of the iliac bone or sacrum abutting the SI joint, in whom surgical resection of the SI joint was performed, were studied following institutional ethics approval. In all patients, preoperative magnetic resonance (MR) imaging studies of the pelvis and SI joint were reviewed for imaging evidence of transarticular extension across the SI joint. Gross pathologic and histologic assessment of possible transarticular SI joint tumour extension was performed in all patients. Nine cadaveric pelvic specimens without pelvic neoplastic disease (4 male, 5 female; age range 20-84 years, mean 59 years, median 58 years) were anatomically dissected and the articular anatomy of the SI joint examined macroscopically. Twelve of the twenty-four patients demonstrated imaging and histological evidence of transarticular SI joint invasion. Eight tumours infiltrated only the interosseous ligamentous aspect of the SI joint. In the remaining four cases, extensive tumour infiltrated both the cartilaginous and ligamentous aspects of the joint. No case showed tumour involvement isolated to the cartilaginous aspect of the joint. Among the cadaveric specimens studied, degenerative changes were found involving the majority of cases (6/9), with cartilage thinning and fibrillation and antero-superior marginal osteophytes seen involving the cartilaginous portion of the SI joint articulation. Four of the nine specimens demonstrated central ossification bridging the iliac and sacral aspects of the ligamentous (interosseous) SI joint. (orig.)

Transarticular invasion of bone tumours across the sacroiliac joint

Energy Technology Data Exchange (ETDEWEB)

Chhaya, S. [University of Toronto, Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, Toronto (Canada); University of Texas Health Science Centre, Department of Radiology, San Antonio, TX (United States); White, L.M. [University of Toronto, Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, Toronto (Canada); Kandel, R. [University of Toronto, Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto (Canada); Wunder, J.S.; Ferguson, P. [Univeristy of Toronto, University Musculoskeletal Oncology Unit, Department of Orthopedic Surgery, Mount Sinai Hospital, Toronto (Canada); Agur, A. [University of Toronto, Division of Anatomy, Department of Surgery, Toronto (Canada)

2005-12-01

The purpose of this study was to evaluate the pattern of tumour spread across the SI articulation, correlating with cadaveric anatomic observations, in order to better understand the local spread of tumour and to assist in the assessment of local staging. Twenty-four consecutive patients (14 male, 10 female; age range 22-89 years, mean 52 years) with primary bone tumours of the iliac bone or sacrum abutting the SI joint, in whom surgical resection of the SI joint was performed, were studied following institutional ethics approval. In all patients, preoperative magnetic resonance (MR) imaging studies of the pelvis and SI joint were reviewed for imaging evidence of transarticular extension across the SI joint. Gross pathologic and histologic assessment of possible transarticular SI joint tumour extension was performed in all patients. Nine cadaveric pelvic specimens without pelvic neoplastic disease (4 male, 5 female; age range 20-84 years, mean 59 years, median 58 years) were anatomically dissected and the articular anatomy of the SI joint examined macroscopically. Twelve of the twenty-four patients demonstrated imaging and histological evidence of transarticular SI joint invasion. Eight tumours infiltrated only the interosseous ligamentous aspect of the SI joint. In the remaining four cases, extensive tumour infiltrated both the cartilaginous and ligamentous aspects of the joint. No case showed tumour involvement isolated to the cartilaginous aspect of the joint. Among the cadaveric specimens studied, degenerative changes were found involving the majority of cases (6/9), with cartilage thinning and fibrillation and antero-superior marginal osteophytes seen involving the cartilaginous portion of the SI joint articulation. Four of the nine specimens demonstrated central ossification bridging the iliac and sacral aspects of the ligamentous (interosseous) SI joint. (orig.)

Celecoxib does not significantly delay bone healing in a rat femoral osteotomy model: a bone histomorphometry study

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Iwamoto J

2011-12-01

Full Text Available Jun Iwamoto1, Azusa Seki2, Yoshihiro Sato3, Hideo Matsumoto11Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan; 2Hamri Co, Ltd, Tokyo, Japan; 3Department of Neurology, Mitate Hospital, Fukuoka, JapanBackground and objective: The objective of the present study was to determine whether celecoxib, a cyclo-oxygenase-2 inhibitor, would delay bone healing in a rat femoral osteotomy model by examining bone histomorphometry parameters.Methods: Twenty-one 6-week-old female Sprague-Dawley rats underwent a unilateral osteotomy of the femoral diaphysis followed by intramedullary wire fixation; the rats were then divided into three groups: the vehicle administration group (control, n = 8, the vitamin K2 administration (menatetrenone 30 mg/kg orally, five times a week group (positive control, n = 5, and the celecoxib administration (4 mg/kg orally, five times a week group (n = 8. After 6 weeks of treatment, the wires were removed, and a bone histomorphometric analysis was performed on the bone tissue inside the callus. The lamellar area relative to the bone area was significantly higher and the total area and woven area relative to the bone area were significantly lower in the vitamin K2 group than in the vehicle group. However, none of the structural parameters, such as the callus and bone area relative to the total area, lamellar and woven areas relative to the bone area, or the formative and resorptive parameters such as osteoclast surface, number of osteoclasts, osteoblast surface, osteoid surface, eroded surface, and bone formation rate per bone surface differed significantly between the vehicle and celecoxib groups.Conclusion: The present study implies that celecoxib may not significantly delay bone healing in a rat femoral osteotomy model based on the results of a bone histomorphometric analysis.Keywords: femoral osteotomy, bone healing, callus, rat, celecoxib

Functionalized D-form self-assembling peptide hydrogels for bone regeneration

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He B

2016-04-01

Full Text Available Bin He,1 Yunsheng Ou,1 Ao Zhou,1 Shuo Chen,1 Weikang Zhao,1 Jinqiu Zhao,2 Hong Li,3 Yong Zhu,1 Zenghui Zhao,1 Dianming Jiang1 1Department of Orthopedics, 2Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 3School of Physical Science and Technology, Sichuan University, Chengdu, People’s Republic of China Abstract: Bone defects are very common in orthopedics, and there is great need to develop suitable bone grafts for transplantation in vivo. However, current bone grafts still encounter some limitations, including limited availability, immune rejection, poor osteoinduction and osteoconduction, poor biocompatibility and degradation properties, etc. Self-assembling peptide nanofiber scaffolds have emerged as an important substrate for cell culture and bone regeneration. We report on the structural features (eg, Congo red staining, circular dichroism spectroscopy, transmission electron microscopy, and rheometry assays and osteogenic ability of D-RADA16-RGD peptide hydrogels (with or without basic fibroblast growth factor due to the better stability of peptide bonds formed by these peptides compared with those formed by L-form peptides, and use them to fill the femoral condyle defect of Sprague Dawley rat model. The bone morphology change, two-dimensional reconstructions using microcomputed tomography, quantification of the microcomputed tomography analyses as well as histological analyses have demonstrated that RGD-modified D-form peptide scaffolds are able to enhance extensive bone regeneration. Keywords: bone defect, functionalized D-form self-assembling peptide, D-RADA16-RGD, peptide hydrogel, bone regeneration

Radiation therapy for pre-sacral recurrence of rectal carcinoma following primary surgery

International Nuclear Information System (INIS)

Yamanashi, Shunji; Yokoyama, Suguru; Kirita, Maruyuki; Katou, Yasuharu; Takeuchi, Kazuo; Kumamoto, Yoshikazu

2006-01-01

Between April 2002 and December 2005, we treated 15 patients who were suffering from pre-sacral recurrence of rectal cancer with or without liver metastases, using multi-portal irradiation and oral intake of tegafur-uracil (UFT) (300 mg/day), to assess pain relief and local control. Radiation therapy was given 2.1 to 2.4 Gy daily fractions, and total tumor dose was set up at a landmark of 66 Gy/30 fractions/6 weeks (time-dose-fractionation (TDF)=115, corresponding to 70 Gy), varying by recurrent tumor volume. The follow-up time was ranged from 3 to 37 months (median=14.7 months), and median survival was 14.8 months. Pain remission time was 3 to 36 months (median=10.4 months). No severe morbidity which induced by radiation therapy was observed in follow-up duration. The median survival has become unfavorite, but the multi-portal irradiation of high dose delivery is useful for improvement of quality of life (QOL) and beneficial as a palliative therapy. To improvement of local control and prognosis, combined modality with more effective regimen of chemotherapy is expected. (author)

Establishing a temporal bone laboratory: considerations for ENT specialist training.

LENUS (Irish Health Repository)

Fennessy, B G

2012-02-01

Cadaveric temporal bone dissection in a temporal bone laboratory is a vital component in training safe, competent otorhinolaryngologists. Recent controversies pertaining to organ retention have resulted in a more limited supply of temporal bones. Consequently, current trainees are dissecting far fewer bones than their consultants. We discuss the establishment of a temporal bone laboratory in the Department of Anatomy in the University College Cork, from the timely preparation and preservation of the tissue to its disposal. Comparisons are drawn between our experience and that of the United States training schemes. The temporal bone laboratory in Cork is the only one in existence in Ireland. The exposure and experience obtained by registrars rotating through Cork, has resulted in noticeable improvements in their operative abilities. The temporal bone laboratory remains a core component to training. It is hoped that this article may facilitate other units overcoming obstacles to establish a temporal bone laboratory.

Sirenomelia type VI (sympus apus) in one of dizygotic twins at Chiang Mai University Hospital.

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Nokeaingtong, Kwannapas; Kaewchai, Sirirat; Visrutaratna, Pannee; Khuwuthyakorn, Varangthip

2015-05-14

Those born with sirenomelia, a rare congenital anomaly, have features resembling a mermaid. Characteristics of sirenomelia are a single lower limb, sacral and pelvic bone defects, and anorectal and urogenital malformations. There is an increased incidence of sirenomelia in males and twins. This case was a preterm male, dizygotic twin and product of in vitro fertilisation. The baby was born by caesarean section due to breech presentation. He was found to have a fused lower extremity and absent external genitalia and anus. The baby passed away shortly after birth due to severe respiratory failure. Radiographic findings showed small lung volume and pneumothoraces. There were multiple segmental fusions of the vertebrae. Single femur and single tibia were presented in a fused lower limb. Autopsy demonstrated large intestinal atresia, intra-abdominal testes, absence of kidney, ureter and bladder, single umbilical artery, agenesis of blood vessels at lower extremity and agenesis of sacrum and coccyx. 2015 BMJ Publishing Group Ltd.

Bone marker gene expression in calvarial bones: different bone microenvironments.

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Al-Amer, Osama

2017-12-01

In calvarial mice, mesenchymal stem cells (MSCs) differentiate into osteoprogenitor cells and then differentiate into osteoblasts that differentiate into osteocytes, which become embedded within the bone matrix. In this case, the cells participating in bone formation include MSCs, osteoprogenitor cells, osteoblasts and osteocytes. The calvariae of C57BL/KaLwRijHsD mice consist of the following five bones: two frontal bones, two parietal bones and one interparietal bone. This study aimed to analyse some bone marker genes and bone related genes to determine whether these calvarial bones have different bone microenvironments. C57BL/KaLwRijHsD calvariae were carefully excised from five male mice that were 4-6 weeks of age. Frontal, parietal, and interparietal bones were dissected to determine the bone microenvironment in calvariae. Haematoxylin and eosin staining was used to determine the morphology of different calvarial bones under microscopy. TaqMan was used to analyse the relative expression of Runx2, OC, OSX, RANK, RANKL, OPG, N-cadherin, E-cadherin, FGF2 and FGFR1 genes in different parts of the calvariae. Histological analysis demonstrated different bone marrow (BM) areas between the different parts of the calvariae. The data show that parietal bones have the smallest BM area compared to frontal and interparietal bones. TaqMan data show a significant increase in the expression level of Runx2, OC, OSX, RANKL, OPG, FGF2 and FGFR1 genes in the parietal bones compared with the frontal and interparietal bones of calvariae. This study provides evidence that different calvarial bones, frontal, parietal and interparietal, contain different bone microenvironments.

Guided bone augmentation using ceramic space-maintaining devices: the impact of chemistry

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Anderud J

2015-03-01

Full Text Available Jonas Anderud,1,2 Peter Abrahamsson,2 Ryo Jimbo,1 Sten Isaksson,2 Erik Adolfsson,3 Johan Malmström,2 Yoshihito Naito,4 Ann Wennerberg1 1Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden; 2Maxillofacial Unit Halmstad, Region Halland, Halmstad, Sweden; 3Swedish Ceramic Institute, IVF, Mölndal, Sweden; 4Department of Oral and Maxillofacial Prosthodontics and Oral Implantology, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan Abstract: The purpose of the study was to evaluate histologically, whether vertical bone augmentation can be achieved using a hollow ceramic space maintaining device in a rabbit calvaria model. Furthermore, the chemistry of microporous hydroxyapatite and zirconia were tested to determine which of these two ceramics are most suitable for guided bone generation. 24 hollow domes in two different ceramic materials were placed subperiosteal on rabbit skull bone. The rabbits were sacrificed after 12 weeks and the histology results were analyzed regarding bone-to-material contact and volume of newly formed bone. The results suggest that the effect of the microporous structure of hydroxyapatite seems to facilitate for the bone cells to adhere to the material and that zirconia enhance a slightly larger volume of newly formed bone. In conclusion, the results of the current study demonstrated that ceramic space maintaining devices permits new bone formation and osteoconduction within the dome. Keywords: hydroxyapatite, zirconia, guided bone regeneration, GBR, histology, membrane

Characterization of drug-release kinetics in trabecular bone from titania nanotube implants

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Aw MS

2012-09-01

Full Text Available Moom Sinn Aw,1 Kamarul A Khalid,2,3 Karan Gulati,1 Gerald J Atkins,2 Peter Pivonka,4 David M Findlay,2 Dusan Losic11School of Chemical Engineering, 2Discipline of Orthopaedics and Trauma, The University of Adelaide, Adelaide, SA, Australia; 3Department of Orthopaedics, Traumatology and Rehabilitation, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia; 4Engineering Computational Biology Group, School of Computer Science and Software Engineering, The University of Western Australia, Perth, WA, AustraliaPurpose: The aim of this study was to investigate the application of the three-dimensional bone bioreactor for studying drug-release kinetics and distribution of drugs in the ex vivo cancellous bone environment, and to demonstrate the application of nanoengineered titanium (Ti wires generated with titania nanotube (TNT arrays as drug-releasing implants for local drug deliveryMethods: Nanoengineered Ti wires covered with a layer of TNT arrays implanted in bone were used as a drug-releasing implant. Viable bovine trabecular bone was used as the ex vivo bone substrate embedded with the implants and placed in the bone reactor. A hydrophilic fluorescent dye (rhodamine B was used as the model drug, loaded inside the TNT–Ti implants, to monitor drug release and transport in trabecular bone. The distribution of released model drug in the bone was monitored throughout the bone structure, and concentration profiles at different vertical (0–5 mm and horizontal (0–10 mm distances from the implant surface were obtained at a range of release times from 1 hour to 5 days.Results: Scanning electron microscopy confirmed that well-ordered, vertically aligned nanotube arrays were formed on the surface of prepared TNT–Ti wires. Thermogravimetric analysis proved loading of the model drug and fluorescence spectroscopy was used to show drug-release characteristics in-vitro. The drug release from implants inserted into bone ex

Bone marrow examination: Indications and diagnostic value

International Nuclear Information System (INIS)

Bashawri, Layla A.

2002-01-01

Objective was to identify the main indications for bone marrow examination in a University hospital setup and the most common diagnoses encountered. To also identify the extent of correlation, if any, between the preliminary diagnosis and the result of the final bone marrow diagnosis. The requests and reports of all bone marrow biopsies and aspirations carried out during a 12-year period from January 1988 through to December 1999, in King Fahd Hospital of the University, Al Khobar, Kingdom of Saudi Arabia were retrospectively reviewed. The information extracted included the main indications for performing this procedure, age groups involved, and the most common diagnoses encountered. A specially designed form was used for this purpose and the data was analyzed using the statistical package for social sciences. Randomly selected slides of the most common diagnoses were reviewed to concur with the diagnosis. There was a total of 1813 bone marrow biopsies or aspirations, or both, performed. The main indications for bone marrow examination in a descending order of frequency were the following: The diagnosis and management of acute leukemia 403 (22.2%), staging for lymphoma 276 (15.2%), evaluation of pancytopenia 215 (11.9%), thrombocytopenia 173 (9.5%), investigation of anemia 151 (8.3%), fever (pyrexia of unknown origin) 130 (7.2%), lymphadenopathy 120 (6.6%), and hepatosplenomegaly 80 (4.4%). The most common diagnoses encountered were: acute lymphoblastic leukemia 242 (13.3%), immune thrombocytopenia 123 (6.8%), acute myeloblastic leukemia 80 (4.4%), hypersplenism 79 (4.4%), chronic granulocytic leukemia 73 (4.0%), megaloblastic anemia 66 (3.6%), bone marrow positive for lymphomatous infiltration 63 (3.5%), chronic lymphocytic leukemia 40 (2.2%), and multiple myeloma 32 (1.8%). This study confirms that bone marrow examination is a very important investigation for establishing the diagnosis in many conditions, especially hematological neoplasms. The most common

Demineralization–remineralization dynamics in teeth and bone

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Abou Neel EA

2016-09-01

Full Text Available Ensanya Ali Abou Neel,1–3 Anas Aljabo,3 Adam Strange,3 Salwa Ibrahim,3 Melanie Coathup,4 Anne M Young,3 Laurent Bozec,3 Vivek Mudera4 1Division of Biomaterials, Operative Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 2Biomaterials Department, Faculty of Dentistry, Tanta University, Tanta, Egypt; 3Department of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, London, UK; 4UCL Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, London, UK Abstract: Biomineralization is a dynamic, complex, lifelong process by which living organisms control precipitations of inorganic nanocrystals within organic matrices to form unique hybrid biological tissues, for example, enamel, dentin, cementum, and bone. Understanding the process of mineral deposition is important for the development of treatments for mineralization-related diseases and also for the innovation and development of scaffolds. This review provides a thorough overview of the up-to-date information on the theories describing the possible mechanisms and the factors implicated as agonists and antagonists of mineralization. Then, the role of calcium and phosphate ions in the maintenance of teeth and bone health is described. Throughout the life, teeth and bone are at risk of demineralization, with particular emphasis on teeth, due to their anatomical arrangement and location. Teeth are exposed to food, drink, and the microbiota of the mouth; therefore, they have developed a high resistance to localized demineralization that is unmatched by bone. The mechanisms by which demineralization–remineralization process occurs in both teeth and bone and the new therapies/technologies that reverse demineralization or boost remineralization are also scrupulously discussed. Technologies discussed include composites with nano- and micron-sized inorganic minerals that can mimic mechanical properties

Pregnancy in women with Fowler's syndrome treated with sacral neuromodulation.

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Khunda, Azar; Karmarkar, Roopali; Abtahi, Bahareh; Gonzales, Gwen; Elneil, Sohier

2013-07-01

Our aim was to determine the impact of pregnancy on sacral neuromodulation (SNM) and vice versa in patients with Fowler's syndrome (FS), which is typified by chronic urinary retention (CUR). We performed a retrospective study of pregnancy in patients with FS who underwent a two-stage SNM implantation. Data were obtained using a standard questionnaire and clinical interview. There were a total of ten patients with 13 pregnancies. The SNM was switched off in ten of the 13 pregnancies, with CUR recurring in nine of the ten pregnancies and recurrent urinary tract infections (UTI) occurring in four of these pregnancies (more than three UTI in the pregnancy). Those in whom the device was left on continued to void normally. One woman had a first trimester miscarriage, eight pregnancies went to term, and four deliveries were premature. Caesarean section was performed in eight pregnancies for obstetric reasons. Four pregnancies resulted in a vaginal delivery. There were no congenital anomalies reported. Following delivery, four of nine women experienced dysfunction of their SNM device when it was switched back on. Turing off the SNM during pregnancy results in recurrence of CUR, with an increased risk of recurrent UTI associated with preterm delivery. This did not impact foetal well-being. The option of keeping the SNM on during pregnancy should therefore be considered, and as caesarean section affects the SNM device, we advise that caesarean section should only be performed for obstetric reasons.

Diagnostic value of whole-body low-dose computed tomography (WBLDCT) in bone lesions detection in patients with multiple myeloma (MM)

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Ippolito, Davide, E-mail: davide.atena@tiscalinet.it [School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza (MB) (Italy); Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy); Besostri, Valeria, E-mail: valeriabesostri@gmail.com [School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza (MB) (Italy); Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy); Bonaffini, Pietro Andrea, E-mail: pa.bonaffini@gmail.com [School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza (MB) (Italy); Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy); Rossini, Fausto, E-mail: valeriabesostri@hotmail.it [Department of Hematology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy); Di Lelio, Alessandro, E-mail: valebeso@libero.it [Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy); Sironi, Sandro, E-mail: sandrosironi@libero.it [School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza (MB) (Italy); Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy)

2013-12-01

Purpose: To assess the role of whole-body low-dose computed tomography (WBLDCT) in the diagnosis and staging of patients with suspicion of multiple myeloma (MM). Materials and methods: A total of 138 patients (76 male and 62 female; mean age 63.5 years, range 50–81 years), with early MM, underwent WBLDCT protocol study, performed on 16-slice scanner (Brilliance, Philips Medical System, Eindhoven, The Netherlands): tube voltage 120 kV; tube current time product 40 mAs. Diagnosis of osteolytic lesions was performed on the basis of axial and multiplanar reformatted images, whereas the assessment of spinal misalignment and fracture was done by using multiplanar reformatted images. The overall dose delivered to each patient was 4.2 mSv. Every patient gave personal informed consent, as required by our institution guidelines. Results: The diagnosis was established either by histopathology or imaging follow-up (size increase of over a period time). In all 138 patients, image resolution was diagnostic, enabling correct classification of multiple myeloma patients. WBLDCT showed a total of 328 pathologic bone findings in 81/138 patients. CT scanning resulted in complete evaluation of the bone lesions in these areas of the skeleton: skull (42), humerus (15), femur (20), ribs (7), scapulae (13), pelvis (35), clavicle (13), sternum (10), cervical (39), dorsal (65), lombar (48) and sacral rachis (21). In 40/81 bone involvement detected by CT was the only CRAB criterion present. Furthermore, WBLDCT demonstrated pleuro-pulmonary lesions in 20 patients (11 infective, 9 as MM localizations) and 1 renal neoplasia. Conclusion: WBLDCT, detecting bone marrow localizations and demonstrating extra-osseous findings, with a fast scanning time and high resolution images, is a reliable imaging-based tool for a proper management of MM patients.

Bone mineral density and bone turnover among young women in Chiang Mai, Thailand.

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Iwasaki, Eriko; Morakote, Nuntana; Chaovistsaree, Somsak; Matsuo, Hiroya

2014-03-12

The present study was carried out to investigate the influence of lifestyle on bone mineral density (BMD) and bone turnover among young women in Chiang Mai, Thailand. A total of 177 young women affiliated with Chiang Mai University hospital were enrolled. Firstly, questionnaires about their lifestyle and the Osteoporosis Knowledge Test (OKT) were examined. The measurement of BMD was assessed by Quantitative Ultrasound (QUS). Secondly, based on the measurement of BMD, the subjects were divided into 2 groups, a Low BMD group (L group: less than YAM-1.0SD) and a Normal BMD group (N group: more than YAM-1.0SD). L group (n=23) and N group (n=23) were examined using Osteocalcine (OC), type 1 collagen cross-linked N-telopeptide (NTx) and undercarboxylated osteocalcin (ucOC) as bone turnover markers, and serum Ca, 1,25-(OH)2Vitamin D, Vitamin K1 and Vitamin K2 (MK-4) as bone turnover related factors. Based on the results, the percentage of Low BMD group was 23.2%. Concerning lifestyle and BMD, the BMD of the low cheese intake group was 99.7± 17.0 and the BMD of the high cheese intake one was 110.0± 23.3 (pChiang Mai, Thailand.

Analisis Kadar HMF (Hidroxy Methyl Furfural pada Madu Bone

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Zakaria Zakaria

2014-07-01

Full Text Available This study aimed to determine the concentration of HMF ((hydroxy methyl furfural in Bone honey. Regency Bone with 145.073 ha of forest, of area 4,559 km² honey potential for livestock development. The quality of honey is determined  from the nectar source, geographic location, and the processing technology. HMF concentration is one of the indicators in honey to determine the quality marker and freshness of honey. This research was done in three stages, namely the stage of sample preparation, extraction phase, and phase identification. Stages of sample preparation were performed to determine sampling locations, the determination of the location of the extraction and identification. Extraction is done in analytical chemistry laboratorium Science Faculty, Hasanuddin University. Honey samples were extracted with methanol. The identification process carried out in an integrated laboratory Department of Chemical Science Faculty of Hasanuddin University to obtain the data of UV-Vis, HPLC performed while the data in an integrated laboratory public health, Hasanuddin University. The results obtained by HPLC showed the data HMF concentration of 0.264 mg/kg, while the data obtained by UV-Vis HMF concentration of 0.230 mg/kg. Based on these data concluded that honey Bone has a good quality in terms of content HMF.

What drives osteoarthritis?-synovial versus subchondral bone pathology.

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Hügle, Thomas; Geurts, Jeroen

2017-09-01

Subchondral bone and the synovium play an important role in the initiation and progression of OA. MRI often permits an early detection of synovial hypertrophy and bone marrow lesions, both of which can precede cartilage damage. Newer imaging modalities including CT osteoabsorptiometry and hybrid SPECT-CT have underlined the importance of bone in OA pathogenesis. The subchondral bone in OA undergoes an uncoupled remodelling process, which is notably characterized by macrophage infiltration and osteoclast formation. Concomitant increased osteoblast activity leads to spatial remineralization and osteosclerosis in end-stage disease. A plethora of metabolic and mechanical factors can lead to synovitis in OA. Synovial tissue is highly vascularized and thus exposed to systemic influences such as hypercholesterolaemia or low grade inflammation. This review aims to describe the current understanding of synovitis and subchondral bone pathology and their connection in OA. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Concurrent lumbosacral and sacrococcygeal fusion; a rare etiology of low back pain and coccygodynia?

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Kapetanakis, Stylianos; Gkasdaris, Grigorios; Pavlidis, Pavlos; Givissis, Panagiotis

2017-09-21

Sacrum is a triangular bone placed in the base of the spine and formed by the synostosis of five sacral vertebrae (S1-S5). Its upper part is connected with the inferior surface of the body of L5 vertebra forming the lumbosacral joint, while its lower part is connected with the base of the coccyx forming the sacrococcygeal symphysis, an amphiarthrodial joint. The existence of four pairs of sacral foramen in both anterior and posterior surface of the sacrum is the most common anatomy. Nevertheless, supernumerary sacral foramina are possible to be created by the synostosis of lumbosacral joint or sacrococcygeal symphysis. We present a case of an osseous cadaveric specimen of the sacrum belonging to a 79-year-old Caucasian woman. A rare variation of the anatomy of the sacrum is reported; in which, the simultaneous fusion of the sacrum with both the L5 vertebra and the coccyx has created six pairs of sacral foramen. This variation should be taken into serious consideration, especially in the domain of radiology, neurosurgery, orthopaedics and spine surgery, because low back pain, coccygodynia and other neurological symptoms may emerge due to mechanical compression.

Primary Hyperparathyroidism: The Influence of Bone Marrow Adipose Tissue on Bone Loss and of Osteocalcin on Insulin Resistance

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Maira L. Mendonça

Full Text Available OBJECTIVES: Bone marrow adipose tissue has been associated with low bone mineral density. However, no data exist regarding marrow adipose tissue in primary hyperparathyroidism, a disorder associated with bone loss in conditions of high bone turnover. The objective of the present study was to investigate the relationship between marrow adipose tissue, bone mass and parathyroid hormone. The influence of osteocalcin on the homeostasis model assessment of insulin resistance was also evaluated. METHODS: This was a cross-sectional study conducted at a university hospital, involving 18 patients with primary hyperparathyroidism (PHPT and 21 controls (CG. Bone mass was assessed by dual-energy x-ray absorptiometry and marrow adipose tissue was assessed by 1H magnetic resonance spectroscopy. The biochemical evaluation included the determination of parathyroid hormone, osteocalcin, glucose and insulin levels. RESULTS: A negative association was found between the bone mass at the 1/3 radius and parathyroid hormone levels (r = -0.69; p<0.01. Marrow adipose tissue was not significantly increased in patients (CG = 32.8±11.2% vs PHPT = 38.6±12%. The serum levels of osteocalcin were higher in patients (CG = 8.6±3.6 ng/mL vs PHPT = 36.5±38.4 ng/mL; p<0.005, but no associations were observed between osteocalcin and insulin or between insulin and both marrow adipose tissue and bone mass. CONCLUSION: These results suggest that the increment of adipogenesis in the bone marrow microenvironment under conditions of high bone turnover due to primary hyperparathyroidism is limited. Despite the increased serum levels of osteocalcin due to primary hyperparathyroidism, these patients tend to have impaired insulin sensitivity.

Bertolottis Syndrome: A cross sectional study to find out its prevalence in patients with low back pain and low bone mineral density

OpenAIRE

Agarwal, Saumya; Udapudi, Shailesh V.; Gupta, Srinath; Ameta, C K

2015-01-01

Background: Lower back ache is emerging as a major symptom among elderly, middle aged and adolescents. Lumbar sacral transitional vertebrae’s are congenital spinal anomalies defined as either sacralisation of the lowest lumbar segment or lumbaralisation of most superior sacral segment of spine. Variation in 5th lumbar vertebra having a spatulated transverse process on one side resulting in pseudoarticulation with sacrum or ileum including change in biochemical properties is known as Bertolott...

Neuromodulation of detrusor hyper-reflexia by functional magnetic stimulation of the sacral roots.

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Sheriff, M K; Shah, P J; Fowler, C; Mundy, A R; Craggs, M D

1996-07-01

To investigate the acute effects of functional magnetic stimulation (FMS) on detrusor hyper-reflexia using a multi-pulse magnetic stimulator. Seven male patients with established and intractable detrusor hyper-reflexia following spinal cord injury were studied. No patient was on medication and none had had previous surgery for detrusor hyper-reflexia. After optimization of magnetic stimulation of S2-S4 sacral anterior roots by recording toe flexor electromyograms, unstable detrusor activity was provoked during cystometry by rapid infusion of fluid into the bladder. The provocation test produced consistent and predictable detrusor hyper-reflexia. On some provocations, supramaximal FMS at 20 pulses/s for 5 s was applied at detrusor pressures which were > 15 cmH2O. Following FMS there was an obvious acute suppression of detrusor hyper-reflexia. There was a profound reduction in detrusor contraction, as assessed by the area under the curves of detrusor pressure with time. Functional magnetic stimulation applied over the sacrum can profoundly suppress detrusor hyper-reflexia in man. It may provide a non-invasive method of assessing patients for implantable electrical neuromodulation devices and as a therapeutic option in its own right.

Effects of Acute Sacral Neuromodulation at Different Frequencies on Bladder Overactivity in Pigs

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Xing Li

2017-06-01

Full Text Available Purpose We investigated the effects of different stimulation frequencies on the inhibition of bladder overactivity by sacral neuromodulation (SNM in pigs. Methods Implant-driven stimulators were used to stimulate the S3 spinal nerve in 13 pigs. Cystometry was performed by infusing normal saline (NS or acetic acid (AA. SNM (pulse width, 210 µsec at frequencies ranging from 5 to 50 Hz was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different frequencies on the micturition reflex. Results AA-induced bladder overactivity significantly reduced the bladder capacity (BC to 34.4%±4.7% of the NS control level (354.4±35.9 mL (P0.05, but SNM at 15, 30, and 50 Hz significantly increased the BC to 54.5%±7.1%, 55.2%±6.5%, and 57.2%±6.1% of the NS control level (P0.05. Conclusions This study demonstrated that 15 Hz was an appropriate frequency for SNM and that frequencies higher than 15 Hz did not lead to better surgical outcomes.

Idiopathic New Bone Formation in the Femoral Shafts of a Cynomolgus Monkey (Macaca fascicularis)

OpenAIRE

Lee, Jae-il; Kim, Young-suk; Kim, Myung-Jin; Hong, Sung-Hyeok

2008-01-01

A 6.5-y-old cynomolgus monkey was referred to the Veterinary Medical Teaching Hospital at Chungnam National University for suspected bone fracture. The monkey had been reared singly in a cage at a laboratory facility. An animal caretaker incidentally found a bone fragment protruding through the skin of the right leg. Radiographic examination revealed 2 new bone fragments clearly distinguishable from the original femurs; the fragments seemed to be inserted into both femurs. One of the new bone...

Production of irradiated bone derivatives for odontology and traumatology

International Nuclear Information System (INIS)

Martin, Hugo R.; Murature, D.A.

2004-01-01

In 2003, the National Atomic Energy Commission (CNEA), the Industrial Human Tissue Processing Plant of the Cordoba University and the Cordoba Science Agency analyzed the joint installation and operation of a Gamma Radiosterilization Module for the production of sterile human bone tissues as allografts for odontology and traumatology. The irradiation procedures were developed at the CNEA's Ezeiza Atomic Center. The irradiated bone tissues are being used in odontology with an excellent clinical behaviour. (author)

Sacral Nerve Stimulation For Urinary Urge Incontinence, Urgency-Frequency, Urinary Retention, and Fecal Incontinence

Science.gov (United States)

2005-01-01

Executive Summary Objective The aim of this review was to assess the effectiveness, safety, and cost of sacral nerve stimulation (SNS) to treat urinary urge incontinence, urgency-frequency, urinary retention, and fecal incontinence. Background: Condition and Target Population Urinary urge incontinence, urgency-frequency, urinary retention, and fecal incontinence are prevalent, yet rarely discussed, conditions. They are rarely discussed because patients may be uncomfortable disclosing their symptoms to a health professional or may be unaware that there are treatment options for these conditions. Briefly, urge incontinence is an involuntary loss of urine upon a sudden urge. Urgency-frequency is an uncontrollable urge to void, which results in frequent, small-volume voids. People with urgency-frequency may or may not also experience chronic pelvic pain. Urinary retention refers to the inability to void despite having the urge to void. It can be caused by a hypocontractile detrusor (weak or no bladder muscle contraction) or obstruction due to urethral overactivity. Fecal incontinence is a loss of voluntary bowel control. The prevalence of urge incontinence, urgency-frequency, and urinary retention in the general population is 3.3% to 8.2%, and the prevalence of fecal incontinence is 1.4% to 1.9%. About three-quarters of these people will be successfully treated by behaviour and/or drug therapy. For those who do not respond to these therapies, the options for treatment are management with diapers or pads, or surgery. The surgical procedures are generally quite invasive, permanent, and are associated with complications. Pads and/or diapers are used throughout the course of treatment as different therapies are tried. Patients who respond successfully to treatment may still require pads or diapers, but to a lesser extent. The Technology Being Reviewed: Sacral Nerve Stimulation Sacral nerve stimulation is a procedure where a small device attached to an electrode is

Tibial bone fractures occurring after medioproximal tibial bone grafts for oral and maxillofacial reconstruction.

Science.gov (United States)

Kim, Il-Kyu; Cho, Hyun-Young; Pae, Sang-Pill; Jung, Bum-Sang; Cho, Hyun-Woo; Seo, Ji-Hoon

2013-12-01

Oral and maxillofacial defects often require bone grafts to restore missing tissues. Well-recognized donor sites include the anterior and posterior iliac crest, rib, and intercalvarial diploic bone. The proximal tibia has also been explored as an alternative donor site. The use of the tibia for bone graft has many benefits, such as procedural ease, adequate volume of cancellous and cortical bone, and minimal complications. Although patients rarely complain of pain, swelling, discomfort, or dysfunction, such as gait disturbance, both patients and surgeons should pay close attention to such after effects due to the possibility of tibial fracture. The purpose of this study is to analyze tibial fractures that occurring after osteotomy for a medioproximal tibial graft. An analysis was intended for patients who underwent medioproximal tibial graft between March 2004 and December 2011 in Inha University Hospital. A total of 105 subjects, 30 females and 75 males, ranged in age from 17 to 78 years. We investigated the age, weight, circumstance, and graft timing in relation to tibial fracture. Tibial fractures occurred in four of 105 patients. There were no significant differences in graft region, shape, or scale between the fractured and non-fractured patients. Patients who undergo tibial grafts must be careful of excessive external force after the operation.

Insulin Resistance Is Associated With Smaller Cortical Bone Size in Nondiabetic Men at the Age of Peak Bone Mass.

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Verroken, Charlotte; Zmierczak, Hans-Georg; Goemaere, Stefan; Kaufman, Jean-Marc; Lapauw, Bruno

2017-06-01

In type 2 diabetes mellitus, fracture risk is increased despite preserved areal bone mineral density. Although this apparent paradox may in part be explained by insulin resistance affecting bone structure and/or material properties, few studies have investigated the association between insulin resistance and bone geometry. We aimed to explore this association in a cohort of nondiabetic men at the age of peak bone mass. Nine hundred ninety-six nondiabetic men aged 25 to 45 years were recruited in a cross-sectional, population-based sibling pair study at a university research center. Insulin resistance was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR), with insulin and glucose measured from fasting serum samples. Bone geometry was assessed using peripheral quantitative computed tomography at the distal radius and the radial and tibial shafts. In age-, height-, and weight-adjusted analyses, HOMA-IR was inversely associated with trabecular area at the distal radius and with cortical area, periosteal and endosteal circumference, and polar strength strain index at the radial and tibial shafts (β ≤ -0.13, P insulin-like growth factor 1, or sex steroid levels. In this cohort of nondiabetic men at the age of peak bone mass, insulin resistance is inversely associated with trabecular and cortical bone size. These associations persist after adjustment for body composition, muscle size or function, or sex steroid levels, suggesting an independent effect of insulin resistance on bone geometry. Copyright © 2017 Endocrine Society

Case report 544: Metastatic chordoma to humeri (originating in sacrum)

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Resnik, C.S.; Young, J.W.R. (Maryland Univ., Baltimore, MD (USA). Dept. of Diagnostic Radiology); Levine, A.M. (Maryland Univ., Baltimore, MD (USA). Div. of Orthopaedic Surgery); Aisner, S.C. (Maryland Univ., Baltimore (USA). Dept. of Pathology)

1989-07-01

An elderly woman develops metastases to both humeri from a sacral chordoma leading to pathological fractures. This represents only the second reported case of such metastasis to a long bone from this primary site. The incidence of skeletal metastasis from chordoma was considered and the literature was reviewed. (orig.).

The effects of glucocorticoid on microarchitecture, collagen, mineral and mechanical properties of sheep femur cortical bone

DEFF Research Database (Denmark)

Ding, Ming; Danielsen, Carl C; Overgaard, Søren

2010-01-01

The effects of glucocorticoid on microarchitecture, collagen, mineral and mechanical properties of sheep femur cortical bone – Validation of large animal model for tissue engineering and biomaterial research Ming Ding,1* Carl Christian Danielsen,2 Søren Overgaard1 1Orthopaedic Research Laboratory......, Department of Orthopaedics and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark 2Department of Connective Tissue Biology, Institute of Anatomy, University of Aarhus, Aarhus C, Denmark Osteopenia in sheep has been successfully induced...... by glucocorticoid treatment and the changes in properties of cancellous bone were comparable with those observed in humans after long-term glucocorticoid treatment. However, the influence on cortical bone has not been thoroughly elucidated. This study aimed to investigate the influence of glucocorticoid on sheep...

Recombinant human bone morphogenetic protein-2 in the treatment of bone fractures

Directory of Open Access Journals (Sweden)

Neil Ghodadra

2008-09-01

Full Text Available Neil Ghodadra, Kern SinghDepartment of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USAAbstract: Over one million fractures occur per year in the US and are associated with impaired healing increasing patient morbidity, stress, and economic costs. Despite improvements in surgical technique, internal fixation, and understanding of biologics, fracture healing is delayed or impaired in up to 4% of all fractures. Complications due to impaired fracture healing present therapeutic challenges to the orthopedic surgeon and often lead to chronic functional and psychological disability for the patient. As a result, it has become clinically desirable to augment mechanical fixation with biologic strategies in order to accelerate osteogenesis and promote successful arthrodesis. The discovery of bone morphogenic protein (BMP has been pivotal in understanding the biology of fracture healing and has been a source of intense clinical research as an adjunct to fracture treatment. Multiple in vitro and in vivo studies in animals have elucidated the complex biologic interactions between BMPs and cellular receptors and have convincingly demonstrated rhBMP-2 to be a safe, effective treatment option to enhance bone healing. Multiple clinical trials in trauma surgery have provided level 1 evidence for the use of rhBMP-2 as a safe and effective treatment of fractures. Human clinical trials have provided further insight into BMP-2 dosage, time course, carriers, and efficacy in fracture healing of tibial defects. These promising results have provided hope that a new biologic field of technology has emerged as a useful adjunct in the treatment of skeletal injuries and conditions.Keywords: bone morphogenic protein-2, bone fracture, bone healing

F-18 FDG PET/CT findings of a case of sacral nerve root neurolymphomatosis that occurred during chemotherapy.

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Suga, Kazuyoshi; Yasuhiko, Kawakami; Matsunaga, Naofumi; Yujiri, Toshiaki; Nakazora, Tatsuki; Ariyoshi, Kouichi

2011-01-01

Neurolymphomatosis (NL) is a rare, unique subtype of lymphomatous infiltration of peripheral nerves. Clinical/radiologic diagnosis of NL is challenging. We report F-18 FDG PET/CT findings of a case of breast diffuse large B-cell lymphoma, in which NL developed regardless of regression of systemic lesions during induction chemotherapy. FDG PET/CT showed characteristic findings of well-demarcated, linear abnormal FDG uptake along a sacral vertebral foramen, leading to diagnosis of NL, with the finding of thickened nerve roots on magnetic resonance imaging. Altered chemotherapeutic regimen resulted in disappearance of these abnormal FDG uptake, with recovery of neurologic symptoms. Peripheral nerve NL may occur during chemotherapy, and FDG PET/CT can be a useful imaging modality in diagnosis and monitoring of therapeutic response of this disease.

A median sacral artery anterior to the iliocaval junction: a case report-anatomical considerations and clinical relevance for spine surgery.

Science.gov (United States)

Chenin, Louis; Tandabany, Sharmila; Foulon, Pascal; Havet, Eric; Peltier, Johann

2018-01-01

The median sacral artery (MSA) is a relatively small vessel that always arises from the posterior, terminal part of the infrarenal aorta. In most cases, the MSA runs behind the iliocaval junction. Here, we describe a very rare case of an MSA running in front of this junction. During a human cadaveric dissection of the retroperitoneal area, we unexpectedly observed that the MSA passed in front of the left common iliac vein. The anatomy of the MSA has been extensively described and variations are quite rare. On the basis of this specific case, knowledge of the anatomic interactions between the MSA and other lumbar retroperitoneal vessels may help to avoid potential complications during surgery.

Dynamic Mechanical Testing Techniques for Cortical and Cancellous Bone

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Cloete, Trevor

2017-06-01

Bone fracture typically occurs as an impact loading event (sporting accidents, vehicle collisions), the simulation of which requires in-depth understanding of dynamic bone behavior. Bone is a natural composite material with a complex multi length-scale hierarchical microstructure. At a macroscopic level, it is classified into hard/compact cortical bone and soft/spongy cancellous (trabecular) bone, though both are low-impedance materials relative to steels. Cortical bone is predominant in long bones, while in complex bone geometries (joints, flat bones) a cancellous bone core supports a thin cortical shell. Bone has primarily been studied at quasi-static strain rates (ɛ˙ failure, with interrupted quasi-static tests revealing a strong microstructure dependence. However, bone specimens are typically destroyed during dynamic tests, leading to a lack of dynamic microstructural damage investigations. In this paper, a short overview of dynamic bone testing is presented to give context to the challenges of testing low impedance, strain-rate dependent, non-linear, visco-elastic-brittle materials. Recent state-of-the-art experimental developments in dynamic bone testing are reviewed, with emphasis on pulse shaping, momentum trapping and ISR testing. These techniques allow for dynamic bone testing at small strains and near-constant strain rates with intact specimen recovery. The results are compared to those obtained with varying strain rate tests. Interrupted dynamic test results with microstructural analysis of the recovered specimens are presented and discussed. The paper concludes with a discussion of the experimental and modeling challenges that lie ahead in the field of dynamic bone behavior. The financial assistance of the National Research Foundation and the University of Cape Town towards this research is hereby acknowledged. Opinions expressed and conclusions arrived at are those of the author alone.

Nanofunctionalized zirconia and barium sulfate particles as bone cement additives

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Riaz Gillani

2009-12-01

Full Text Available Riaz Gillani1, Batur Ercan1, Alex Qiao3, Thomas J Webster1,21Division of Engineering, 2Department of Orthopaedics, Brown University, Providence, RI, USA; 3G3 Technology Innovations, LLC, Pittsford, NY, USAAbstract: Zirconia (ZrO2 and barium sulfate (BaSO4 particles were introduced into a methyl methacrylate monomer (MMA solution with polymethyl methacrylate (PMMA beads during polymerization to develop the following novel bone cements: bone cements with unfunctionalized ZrO2 micron particles, bone cements with unfunctionalized ZrO2 nanoparticles, bone cements with ZrO2 nanoparticles functionalized with 3-(trimethoxysilylpropyl methacrylate (TMS, bone cements with unfunctionalized BaSO4 micron particles, bone cements with unfunctionalized BaSO4 nanoparticles, and bone cements with BaSO4 nanoparticles functionalized with TMS. Results demonstrated that in vitro osteoblast (bone-forming cell densities were greater on bone cements containing BaSO4 ceramic particles after four hours compared to control unmodified bone cements. Osteoblast densities were also greater on bone cements containing all of the ceramic particles after 24 hours compared to unmodified bone cements, particularly those bone cements containing nanofunctionalized ceramic particles. Bone cements containing ceramic particles demonstrated significantly altered mechanical properties; specifically, under tensile loading, plain bone cements and bone cements containing unfunctionalized ceramic particles exhibited brittle failure modes whereas bone cements containing nanofunctionalized ceramic particles exhibited plastic failure modes. Finally, all bone cements containing ceramic particles possessed greater radio-opacity than unmodified bone cements. In summary, the results of this study demonstrated a positive impact on the properties of traditional bone cements for orthopedic applications with the addition of unfunctionalized and TMS functionalized ceramic nanoparticles

High Prevalence of Vitamin D Deficiency in Patients with Bone Tumors.

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Horas, Konstantin; Maier, Gerrit; Jakob, Franz; Maus, Uwe; Kurth, Andreas; Jakuscheit, Axel; Rudert, Maximilian; Holzapfel, Boris Michael

2017-09-14

The aim of this study was to evaluate the prevalence of vitamin D deficiency in patients with different types of bone tumors and to elucidate whether or not there are differences in prediagnostic vitamin D levels in patients with malignant compared to benign bone tumors. Prediagnostic serum 25(OH)D levels of 105 consecutive patients that presented with bone tumors and tumor-like lesions to two Orthopedic Level I University Centers in Germany between 2011 and 2016 were measured on admission. We found an alarming and widespread rate of vitamin D deficiency in patients with bone tumors. Specifically, 83% of all patients had low vitamin D levels with a mean 25(OH)D level of 19.82 ng/ml. Notably, patients diagnosed with malignant bone tumors had significantly lower vitamin D levels compared to patients with benign bone lesions (p = 0.0008). In conclusion, it is essential to assess vitamin D levels in patients with tumors involving bone. In addition, there might be an association between vitamin D deficiency and the onset or course of primary malignant bone tumors.

Changes in distribution of bone densitometry equipment from 1996 to 2006 in Japan.

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Yamauchi, Hirose; Fukunaga, Masao; Nishikawa, Akira; Orimo, Hajime

2010-01-01

Many types of bone densitometry equipment are available in Japan, but the numbers of such machines and the numbers of institutions that offer bone densitometry have not been clarified. We analyzed the data from annual surveys conducted by the Japan Osteoporosis Foundation from 1996 to 2006, and we obtained the following results on the use of densitometry equipment: (1) In 1996 there were 6,687 units of bone densitometry equipment in 6,483 institutions in Japan; in 2006 there were 16,371 units in 15,020 institutions. (2) In 2006, of the types of institutions with bone densitometry equipment, the number of clinics was the highest, followed in order by general hospitals, other types of institutions, screening institutions and university hospitals. Rates of increase in the installation of equipment in clinics and other types of institutions were high during the 11-year period from 1996. (3) From 1996 to 2006 the region of interest most frequently used for bone densitometry was the radius. However, during the 11-year period, the proportion of radial densitometry equipment in all institutions with bone densitometry equipment decreased, whereas the proportion of calcaneal densitometry equipment increased. (4) The number of dual-energy X-ray absorptiometry (DXA) units was the highest from 1996 to 2006. However, the proportion of DXA machines in all institutions with bone densitometry equipment decreased over the 11-year period, whereas the proportion of quantitative ultrasound (QUS) machines increased. (5) In 2006, bone densitometry equipment was available in 118 institutions per million Japanese people. Central DXA (spine/hip) equipment was available in 15 per million, radial DXA equipment in 63 per million, and calcaneal QUS equipment in 44 per million. (6) In 2006, among those places with bone densitometry equipment, 46% of university hospitals, 14% of general hospitals, 12% of screening institutions, 5% of clinics, and 6% of other types of institutions possessed more

Phase contrast X-ray imaging at the bone-cartilage interface

International Nuclear Information System (INIS)

Che Ismail, E.; Gundogdu, O.; Bradley, D.A.

2008-01-01

Full text: Phase contrast X-ray imaging is a simple technique to investigate various biological samples. At Surrey, the bone-cartilage interface is one of the biological samples which actively been studied. Bone-cartilage interface study gives a particular interest in this research as the degeneration of cartilage is the hallmark of the degenerative joint disease such as osteoarthritis. We have been applying the phase contrast imaging technique in studying the bone-cartilage interface, obtaining information on anatomical features such as the cartilage, blood vessel, tide mark and cement line. Our samples range from dry bone-cartilage to wet bone-cartilage tissue. This work will briefly review the basic supporting physics of the study. It also shows some of the images and other results that we have obtained to-date. Fig. 1 shows examples obtained using the X-ray tube system at the University of Surrey

Vertebral hydatid disease

International Nuclear Information System (INIS)

Pasaoglu, E.; Boyacigil, S.; Damgaci, L.; Tokoglu, F.; Soydinc, P.; Yuksel, E.

1997-01-01

Hydatid disease (caused by Echinococcus granulosus) affecting the bones is a rare condition, its incidence ranging from 0.5-2% of all cases of hydatidosis. The bones most often involved are the vertebrae (44%). A 22-year-old man presented to the hospital with low back pain. A computed tomography scan was performed showing bone destruction and cord compression as well as soft-tissue involvement. It revealed intracanal and paravertebral cystic lesions at the level of L5-S1 with destruction of the corpus and lamina, and sacral foramen invasion. An operation was performed and histopathological findings confirmed the diagnosis

Bone and fat connection in aging bone.

Science.gov (United States)

Duque, Gustavo

2008-07-01

The fat and bone connection plays an important role in the pathophysiology of age-related bone loss. This review will focus on the age-induced mechanisms regulating the predominant differentiation of mesenchymal stem cells into adipocytes. Additionally, bone marrow fat will be considered as a diagnostic and therapeutic approach to osteoporosis. There are two types of bone and fat connection. The 'systemic connection', usually seen in obese patients, is hormonally regulated and associated with high bone mass and strength. The 'local connection' happens inside the bone marrow. Increasing amounts of bone marrow fat affect bone turnover through the inhibition of osteoblast function and survival and the promotion of osteoclast differentiation and activation. This interaction is regulated by paracrine secretion of fatty acids and adipokines. Additionally, bone marrow fat could be quantified using noninvasive methods and could be used as a therapeutic approach due to its capacity to transdifferentiate into bone without affecting other types of fat in the body. The bone and fat connection within the bone marrow constitutes a typical example of lipotoxicity. Additionally, bone marrow fat could be used as a new diagnostic and therapeutic approach for osteoporosis in older persons.

Giant Cell Tumors of the Axial Skeleton

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Maurice Balke

2012-01-01

Full Text Available Background. We report on 19 cases of giant cell tumor of bone (GCT affecting the spine or sacrum and evaluate the outcome of different treatment modalities. Methods. Nineteen patients with GCT of the spine (=6 or sacrum (=13 have been included in this study. The mean followup was 51.6 months. Ten sacral GCT were treated by intralesional procedures of which 4 also received embolization, and 3 with irradiation only. All spinal GCT were surgically treated. Results. Two (15.4% patients with sacral and 4 (66.7% with spinal tumors had a local recurrence, two of the letter developed pulmonary metastases. One local recurrence of the spine was successfully treated by serial arterial embolization, a procedure previously described only for sacral tumors. At last followup, 9 patients had no evidence of disease, 8 had stable disease, 1 had progressive disease, 1 died due to disease. Six patients had neurological deficits. Conclusions. GCT of the axial skeleton have a high local recurrence rate. Neurological deficits are common. En-bloc spondylectomy combined with embolization is the treatment of choice. In case of inoperability, serial arterial embolization seems to be an alternative not only for sacral but also for spinal tumors.

Intraoperative indocyanine green fluorescent angiography-assisted modified superior gluteal artery perforator flap for reconstruction of sacral pressure sores.

Science.gov (United States)

Chang, Chun-Kai; Wu, Chien-Ju; Chen, Chun-Yu; Wang, Chi-Yu; Chu, Tzi-Shiang; Hsu, Kuo-Feng; Chiu, Han-Ting; Liu, Hung-Hui; Chou, Chang-Yi; Wang, Chih-Hsin; Lin, Chin-Ta; Dai, Niann-Tzyy; Tzeng, Yuan-Sheng

2017-12-01

Pressure sores are often observed in patients who are bedridden. They can be a severe problem not only for patients and their caregivers but also for plastic surgeons. Here, we describe a new method of superior gluteal artery perforator flap harvesting and anchoring with the assistance of intraoperative indocyanine green fluorescent angiography. In this report, we describe the procedure and outcomes for 19 patients with grades III and IV sacral pressure sores who underwent the operation between September 2015 and November 2016. All flaps survived, and two experienced wound-edge partial dehiscence. With the assistance of this imaging device, we were able to acquire a reliable superior gluteal artery perforator flap and perform modified operations with it that are safe, easy to learn and associated with fewer complications than are traditional. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Current options for the treatment of Paget’s disease of the bone

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Daniela Merlotti

2009-07-01

Full Text Available Daniela Merlotti, Luigi Gennari, Giuseppe Martini, Ranuccio NutiDepartment of Internal Medicine, Endocrine-Metabolic Sciences and Biochemistry, University of Siena, Siena, ItalyAbstract: Paget’s disease of bone (PDB is a chronic bone remodeling disorder characterized by increased osteoclast-mediated bone resorption, with subsequent compensatory increases in new bone formation, resulting in a disorganized mosaic of woven and lamellar bone at affected skeletal sites. This disease is most often asymptomatic but can be associated with bone pain or deformity, fractures, secondary arthritis, neurological complications, deafness, contributing to substantial morbidity and reduced quality of life. Neoplastic degeneration of pagetic bone is a relatively rare event, occurring with an incidence of less than 1%, but has a grave prognosis. Specific therapy for PDB is aimed at decreasing the abnormal bone turnover and bisphosphonates are currently considered the treatment of choice. These treatments are associated with a reduction in plasma alkaline phosphatase (ALP activity and an improvement in radiological and scintigraphic appearance and with a reduction in bone pain and bone deformity, Recently, the availability of newer, more potent nitrogen-containing bisphosphonates has improved treatment outcomes, allowing a more effective and convenient management of this debilitating disorder.Keywords: Paget’s disease of bone, bisphosphonates, aminobisphosphonates, bone remodeling

Evolutionary patterns of bone histology and bone compactness in xenarthran mammal long bones.

Science.gov (United States)

Straehl, Fiona R; Scheyer, Torsten M; Forasiepi, Analía M; MacPhee, Ross D; Sánchez-Villagra, Marcelo R

2013-01-01

Bone microstructure reflects physiological characteristics and has been shown to contain phylogenetic and ecological signals. Although mammalian long bone histology is receiving increasing attention, systematic examination of the main clades has not yet been performed. Here we describe the long bone microstructure of Xenarthra based on thin sections representing twenty-two species. Additionally, patterns in bone compactness of humeri and femora are investigated. The primary bone tissue of xenarthran long bones is composed of a mixture of woven, parallel-fibered and lamellar bone. The vascular canals have a longitudinal, reticular or radial orientation and are mostly arranged in an irregular manner. Concentric rows of vascular canals and laminar organization of the tissue are only found in anteater bones. The long bones of adult specimens are marked by dense Haversian bone, a feature that has been noted for most groups of mammals. In the long bones of armadillos, secondary osteons have an oblique orientation within the three-dimensional bone tissue, thus resulting in their irregular shape when the bones are sectioned transversely. Secondary remodeling is generally more extensive in large taxa than in small taxa, and this could be caused by increased loading. Lines of arrested growth are assumed to be present in all specimens, but they are restricted to the outermost layer in bones of armadillos and are often masked by secondary remodeling in large taxa. Parameters of bone compactness show a pattern in the femur that separates Cingulata and Pilosa (Folivora and Vermilingua), with cingulates having a lower compactness than pilosans. In addition, cingulates show an allometric relationship between humeral and femoral bone compactness.

Evolutionary patterns of bone histology and bone compactness in xenarthran mammal long bones.

Directory of Open Access Journals (Sweden)

Fiona R Straehl

Full Text Available Bone microstructure reflects physiological characteristics and has been shown to contain phylogenetic and ecological signals. Although mammalian long bone histology is receiving increasing attention, systematic examination of the main clades has not yet been performed. Here we describe the long bone microstructure of Xenarthra based on thin sections representing twenty-two species. Additionally, patterns in bone compactness of humeri and femora are investigated. The primary bone tissue of xenarthran long bones is composed of a mixture of woven, parallel-fibered and lamellar bone. The vascular canals have a longitudinal, reticular or radial orientation and are mostly arranged in an irregular manner. Concentric rows of vascular canals and laminar organization of the tissue are only found in anteater bones. The long bones of adult specimens are marked by dense Haversian bone, a feature that has been noted for most groups of mammals. In the long bones of armadillos, secondary osteons have an oblique orientation within the three-dimensional bone tissue, thus resulting in their irregular shape when the bones are sectioned transversely. Secondary remodeling is generally more extensive in large taxa than in small taxa, and this could be caused by increased loading. Lines of arrested growth are assumed to be present in all specimens, but they are restricted to the outermost layer in bones of armadillos and are often masked by secondary remodeling in large taxa. Parameters of bone compactness show a pattern in the femur that separates Cingulata and Pilosa (Folivora and Vermilingua, with cingulates having a lower compactness than pilosans. In addition, cingulates show an allometric relationship between humeral and femoral bone compactness.

Micro-CT analyses of historical bone samples presenting with osteomyelitis

Energy Technology Data Exchange (ETDEWEB)

Lamm, C.; Pietschmann, P. [Medical University Vienna (MUV), Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Vienna (Austria); Dockner, M.; Weber, G.W. [University of Vienna, Department of Anthropology, Vienna (Austria); University of Vienna, Core Facility for Micro-Computed Tomography, Vienna (Austria); Pospischek, B.; Winter, E.; Patzak, B. [Museum of Natural History (NHM), Collection of Anatomical Pathology in the Madhouse Tower, Vienna (Austria); Pretterklieber, M. [Medical University of Vienna (MUV), Department of Applied Anatomy, Vienna (Austria)

2015-10-15

Osteomyelitis is an inflammation of the bone marrow mainly caused by bacteria such as Staphylococcus aureus. It typically affects long bones, e.g. femora, tibiae and humeri. Recently micro-computed tomography (μCT) techniques offer the opportunity to investigate bone micro-architecture in great detail. Since there is no information on long bone microstructure in osteomyelitis, we studied historic bone samples with osteomyelitis by μCT. We investigated 23 femora of 22 individuals suffering from osteomyelitis provided by the Collection of Anatomical Pathology, Museum of Natural History, Vienna (average age 44 ±19 years); 9 femora from body donors made available by the Department of Applied Anatomy, Medical University of Vienna (age range, 56-102 years) were studied as controls. Bone microstructure was assessed by μCT VISCOM X 8060 II with a minimal resolution of 18 μm. In the osteomyelitic femora, most prominent alterations were seen in the cortical compartment. In 71.4 % of the individuals with osteomyelitis, cortical porosity occurred. 57.1 % of the individuals showed cortical thinning. In 42.9 % trabecularisation of cortical bone was observed. Osteomyelitis is associated with severe alterations of cortical bone structure otherwise typically observed at old age such as cortical porosity and cortical thinning. (orig.)

Bone tumor

Science.gov (United States)

Tumor - bone; Bone cancer; Primary bone tumor; Secondary bone tumor; Bone tumor - benign ... The cause of bone tumors is unknown. They often occur in areas of the bone that grow rapidly. Possible causes include: Genetic defects ...

Super bone scans on bone scintigraphy in patients with metastatic bone tumor

International Nuclear Information System (INIS)

Morita, Koichi; Fukunaga, Masao; Otsuka, Nobuaki

1988-01-01

Eight patients with malignant tumor (3 with gastric cancer, 4 with prostatic cancer, 1 with transitional cell carcinoma), which showed diffusely increased uptake of 99m Tc labelled phosphorous compound in axial skeleton (''Super Bone Scan'') on bone scintigraphy were clinically studied. No relationship with its histological type of the tumor was recognized. All cases revealed extremely high serum ALP concentration, which might reflect increased osteoblastic activity. Furthermore, on bone roentgenograms all cases showed predominantly osteosclerotic change in the metastatic bones, while some did locally osteolytic change. In three cases with gastric cancer, although they had diffuse skeletal metastases, two had no evidence of liver metastases. Thus, it seemed that clinical study of patients with ''Super Bone Scan'' was interesting to evaluate the mechanism of accumulation of 99m Tc labelled phosphorous compound to bone and bone metabolism, and the pathophysiology in the pathway of bone metastases. (author)

Identification of viral microRNAs expressed in human sacral ganglia latently infected with herpes simplex virus 2.

Science.gov (United States)

Umbach, Jennifer L; Wang, Kening; Tang, Shuang; Krause, Philip R; Mont, Erik K; Cohen, Jeffrey I; Cullen, Bryan R

2010-01-01

Deep sequencing of small RNAs isolated from human sacral ganglia latently infected with herpes simplex virus 2 (HSV-2) was used to identify HSV-2 microRNAs (miRNAs) expressed during latent infection. This effort resulted in the identification of five distinct HSV-2 miRNA species, two of which, miR-H3/miR-I and miR-H4/miR-II, have been previously reported. Three novel HSV-2 miRNAs were also identified, and two of these, miR-H7 and miR-H9, are derived from the latency-associated transcript (LAT) and are located antisense to the viral transcript encoding transactivator ICP0. A third novel HSV-2 miRNA, miR-H10, is encoded within the unique long (U(L)) region of the genome, 3' to the U(L)15 open reading frame, and is presumably excised from a novel, latent HSV-2 transcript distinct from LAT.

Scapular Free Vascularised Bone Flaps for Mandibular Reconstruction: Are Dental Implants Possible?

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Martin Lanzer

2015-09-01

Full Text Available Objectives: Free fibula flap remains the flap of choice for reconstruction of mandibular defects. If free fibula flap is not possible, the subscapular system of flaps is a valid option. In this study, we evaluated the possibility of dental implant placement in patients receiving a scapular free flap for oromandibular reconstruction. Material and Methods: We retrospectively reviewed 10 patients undergoing mandible reconstruction with a subscapular system free-tissue (lateral border of the scapula transfer at the University Hospital Zürich between January 1, 2010 and January 1, 2013. Bone density in cortical and cancellous bone was measured in Hounsfield units (HU. Changes of bone density, height and width were analysed using IBM SPSS Statistics 22. Comparisons of bone dimensions as well as bone density were performed using a chi-square test. Results: Ten patients were included. Implantation was conducted in 50%. However, all patients could have received dental implants considering bone stock. Loss of bone height and width were significant (P < 0.001. There was a statistical significant increase in bone density in cortical (P < 0.001 and cancellous (P = 0.004 bone. Conclusions: Dental implants are possible after scapular free flap reconstruction of oromandibular defects. Bone height and width were reduced, while bone density increased with time.

Aging and bone. X-ray bone densitometry

Energy Technology Data Exchange (ETDEWEB)

Morita, Rikushi (Shiga Univ. of Medical Sciences, Otsu (Japan))

1994-01-01

Bone mass at all ages of the individuals is the integration of genetic factors, nutrition, physical exercise, hormonal environments, and other factors influencing the bone. It is also a measurable risk factor for osteoporosis which may subsequently cause bone fractures. Thus measuring bone mass is required to predict the probability of developing bone fractures subsequent to osteoporosis, and to diagnose osteoporosis, and to manage the osteoporosis patient. This paper discusses bone mineral measurements according to their characteristics and clinical application. Methodology for measuring bone mass has rapidly progressed during the past 15 years, which covers photodensitometry, photon absorptiometry (single energy X-ray absorptiometry and dual energy X-ray absorptiometry), quantitative CT, and ultrasound. These techniques have allowed noninvasive measurement of bone mineral density in any site of the skeleton with high accuracy and precision, although a single use of the technique cannot satisfy the complete clinical requirements. Thus the most appropriate method for measuring bone mineral density is important to monitor bone mass change and according to the specific site. (N.K.).

Aging and bone. X-ray bone densitometry

International Nuclear Information System (INIS)

Morita, Rikushi

1994-01-01

Bone mass at all ages of the individuals is the integration of genetic factors, nutrition, physical exercise, hormonal environments, and other factors influencing the bone. It is also a measurable risk factor for osteoporosis which may subsequently cause bone fractures. Thus measuring bone mass is required to predict the probability of developing bone fractures subsequent to osteoporosis, and to diagnose osteoporosis, and to manage the osteoporosis patient. This paper discusses bone mineral measurements according to their characteristics and clinical application. Methodology for measuring bone mass has rapidly progressed during the past 15 years, which covers photodensitometry, photon absorptiometry (single energy X-ray absorptiometry and dual energy X-ray absorptiometry), quantitative CT, and ultrasound. These techniques have allowed noninvasive measurement of bone mineral density in any site of the skeleton with high accuracy and precision, although a single use of the technique cannot satisfy the complete clinical requirements. Thus the most appropriate method for measuring bone mineral density is important to monitor bone mass change and according to the specific site. (N.K.)

Morphology of bone defects in patient with unilateral cleft lip and palate. Cone beam x-ray CT evaluation

International Nuclear Information System (INIS)

Kyo, Iyu; Kubota, Masato; Sato, Yuki; Nakano, Haruhisa; Maki, Koutaro

2006-01-01

Orthodontic treatment planning of the cleft lip and palate vary according to the morphology of the alveolar bone and palatal bone. The purpose of this study is to evaluate the three-dimensional anatomy of the alveolar and palatal bone in children with complete unilateral cleft lip and palate. Thirty-three nonsyndromic consecutive patients with complete unilateral cleft lip and palate were treated by the cleft palate team at Showa University. Each patient had lip and palate surgeries at Showa University. Cone beam CT radiographs (CB MercuRay, Hitachi) were taken prior to secondary bone grafting, and were classified according to the method of Kita et al. 1997. Cone beam CT radiographs showed multiple types of alveolar and palatal bone morphology, and focused on special types described in the method of Kita et al. It was most frequently found that bone defects in the alveolar crest showed similar patterns in both buccal and palatal aspect, and the buccal bone defect in the nasal floor was larger than the palatal bone defect in the nasal floor. In 80% of the patients, the palatal bone defect showed similar patterns in both anterior and posterior aspects, and the anterior palatal bone defect was smaller than the posterior palatal bone defect. In addition, inadequate bone bridges were frequently found at the cleft site. It is suggested that patients with unilateral cleft lip and palate have various types of alveolar and palatal bone morphology, and are required to take three-dimensional radiographic X-rays prior to any orthodontic treatment. (author)

Extraskeletal and intraskeletal new bone formation induced by demineralized bone matrix combined with bone marrow cells

International Nuclear Information System (INIS)

Lindholm, T.S.; Nilsson, O.S.; Lindholm, T.C.

1982-01-01

Dilutions of fresh autogenous bone marrow cells in combination with allogeneic demineralized cortical bone matrix were tested extraskeletally in rats using roentgenographic, histologic, and 45 Ca techniques. Suspensions of bone marrow cells (especially diluted 1:2 with culture media) combined with demineralized cortical bone seemed to induce significantly more new bone than did demineralized bone, bone marrow, or composite grafts with whole bone marrow, respectively. In a short-term spinal fusion experiment, demineralized cortical bone combined with fresh bone marrow produced new bone and bridged the interspace between the spinous processes faster than other transplantation procedures. The induction of undifferentiated host cells by demineralized bone matrix is further complemented by addition of autogenous, especially slightly diluted, bone marrow cells

Nanogel-crosslinked nanoparticles increase the inhibitory effects of W9 synthetic peptide on bone loss in a murine bone resorption model

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Sato T

2015-05-01

Full Text Available Toshimi Sato,1 Neil Alles,1,2 Masud Khan,1,3 Kenichi Nagano,1,4 Mariko Takahashi,1 Yukihiko Tamura,1 Asako Shimoda,5,6 Keiichi Ohya,1 Kazunari Akiyoshi,5,6 Kazuhiro Aoki1 1Department of Bio-Matrix (Pharmacology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan; 2Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; 3Department of Dental Pharmacology, City Dental College and Hospital, Dhaka, Bangladesh; 4Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA; 5Department of Polymer Chemistry, Graduate School of Engineering, Kyoto University, Katsura, 6ERATO Akiyoshi Bio-Nanotransporter Project, Japan Science and Technology Agency, Katsura Int’tech Center Kyotodaigaku-Katsura, Nishikyo-ku, Kyoto, Japan Abstract: We investigated the biological activity of W9, a bone resorption inhibitor peptide, using NanoClik nanoparticles as an injectable carrier, where acryloyl group-modified cholesterol-bearing pullulan (CHPOA nanogels were crosslinked by pentaerythritol tetra (mercaptoethyl polyoxyethylene. Thirty 5-week-old male C57BL/6J mice were fed a low calcium diet and received once-daily subcutaneous injections of the carrier alone, W9 24 mg/kg/day alone, W9 24 mg/kg/day incorporated in cholesterol bearing pullulan (CHP nanogels, or W9 (8 and 24 mg/kg/day incorporated in NanoClik nanoparticles for 4 days (n=5. Mice that received a normal calcium diet with NanoClik nanoparticle injections without W9 were used as a control group. Radiological analyses showed that administration of W9 24 mg/kg/day significantly prevented low calcium-induced reduction of bone mineral density in the long bones and lumbar vertebrae, but only when the NanoClik nanoparticles were used as a carrier. Histomorphometric analyses of the proximal tibiae revealed that W9 24 mg/kg/day incorporated in NanoClik nanoparticles prevented the increase in bone resorption indices

3D conductive nanocomposite scaffold for bone tissue engineering

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Shahini A

2013-12-01

Full Text Available Aref Shahini,1 Mostafa Yazdimamaghani,2 Kenneth J Walker,2 Margaret A Eastman,3 Hamed Hatami-Marbini,4 Brenda J Smith,5 John L Ricci,6 Sundar V Madihally,2 Daryoosh Vashaee,1 Lobat Tayebi2,7 1School of Electrical and Computer Engineering, Helmerich Advanced Technology Research Center, 2School of Chemical Engineering, 3Department of Chemistry, 4School of Mechanical and Aerospace Engineering, 5Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA; 6Department of Biomaterials and Biomimetics, New York University, New York, NY; 7School of Material Science and Engineering, Helmerich Advanced Technology Research Center, Oklahoma State University, Tulsa, OK, USA Abstract: Bone healing can be significantly expedited by applying electrical stimuli in the injured region. Therefore, a three-dimensional (3D ceramic conductive tissue engineering scaffold for large bone defects that can locally deliver the electrical stimuli is highly desired. In the present study, 3D conductive scaffolds were prepared by employing a biocompatible conductive polymer, ie, poly(3,4-ethylenedioxythiophene poly(4-styrene sulfonate (PEDOT:PSS, in the optimized nanocomposite of gelatin and bioactive glass. For in vitro analysis, adult human mesenchymal stem cells were seeded in the scaffolds. Material characterizations using hydrogen-1 nuclear magnetic resonance, in vitro degradation, as well as thermal and mechanical analysis showed that incorporation of PEDOT:PSS increased the physiochemical stability of the composite, resulting in improved mechanical properties and biodegradation resistance. The outcomes indicate that PEDOT:PSS and polypeptide chains have close interaction, most likely by forming salt bridges between arginine side chains and sulfonate groups. The morphology of the scaffolds and cultured human mesenchymal stem cells were observed and analyzed via scanning electron microscope, micro-computed tomography, and confocal fluorescent

Polyether ether ketone implants achieve increased bone fusion when coated with nano-sized hydroxyapatite: a histomorphometric study in rabbit bone

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Johansson P

2016-04-01

Full Text Available Pär Johansson,1 Ryo Jimbo,1 Yoshihito Naito,2 Per Kjellin,3 Fredrik Currie,3 Ann Wennerberg1 1Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden; 2Oral Implant Center, Tokushima University Hospital, Tokushima, Japan; 3Promimic AB, Stena Center, Göteborg, Sweden Abstract: Polyether ether ketone (PEEK possesses excellent mechanical properties similar to those of human bone and is considered the best alternative material other than titanium for orthopedic spine and trauma implants. However, the deficient osteogenic properties and the bioinertness of PEEK limit its fields of application. The aim of this study was to limit these drawbacks by coating the surface of PEEK with nano-scaled hydroxyapatite (HA minerals. In the study, the biological response to PEEK, with and without HA coating, was investigated. Twenty-four screw-like and apically perforated implants in the rabbit femur were histologically evaluated at 3 weeks and 12 weeks after surgery. Twelve of the 24 implants were HA coated (test, and the remaining 12 served as uncoated PEEK controls. At 3 weeks and 12 weeks, the mean bone–implant contact was higher for test compared to control (P<0.05. The bone area inside the threads was comparable in the two groups, but the perforating hole showed more bone area for the HA-coated implants at both healing points (P<0.01. With these results, we conclude that nano-sized HA coating on PEEK implants significantly improved the osteogenic properties, and in a clinical situation this material composition may serve as an implant where a rapid bone fusion is essential. Keywords: HA, PEEK, osseointegration, histology, orthopedics, in vivo

Dynamics of indicators of a metabolic exchange and condition of blood circulation of the bottom extremities after traction extension at patients with lumbar and sacral dorsopathy

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Kotenko К.V.

2013-12-01

Full Text Available Aim: to study influence of traction therapy in a pulse mode in a complex with electrotherapy on a condition of blood circulation of the bottom extremities and level of a metabolic exchange. Material and methods. There had been examined 120 patients with a lumbar and sacral dorsopathy aged from 22 to 69 years (middle age of 49,5 years with prescription of a disease from 1 to 5 years, among them men of 34,2%, women of 65,8%. Results. The analysis of effects of various medical methods on a condition of local blood circulation in the bottom extremities showed that the most expressed its compensation is noted at complex application of mechanical pulse traction influence and electrotherapy for patients with a dorsopathy of lumbar and sacral department of a backbone that is confirmed by restoration to normal values of all indicators rheovasogramm. Conclusion. High clinical results of application of the combined medical and rehabilitation complex are based on compensation of local blood circulation that is shown in elimination of deficiency of blood supply due to improvement of a tone of arterial vessels and elimination of venous stagnation, and also due to increase of linear speed of a blood-groove and development of collateral blood circulation. Application of electrical impulse and mechanical traction influences, more at their combination promotes fermentative activity of the systems responsible for a protein exchange that is important for prevention of degenerate and dystrophic process progressing.

Chronological Age as Factor Influencing the Dental Implant Osseointegration in the Jaw Bone

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Jan Papež

2018-04-01

Full Text Available The objectives of this study were to evaluate osseointegration of dental implant in the jaw bone in the young and elderly population and comparing the results to assess indicators and risk factors as age for the success or failure of dental implants. A retrospective study of 107 implants (Impladent, LASAK, Czech Republic was prepared. The patients at implants surgery were divided in three groups. The patients were followed-up for a 7-year period. We evaluated osseointegration from long term point of view as a change of marginal bone levels close to dental implant. Marginal bone levels were recorded and analysed with regard to different patient- and implant-related factors. An influence of chronological age on change of marginal bone levels during 6-year retrospective study vas evaluated. The study examined 47 patient charts and 107 implants from the Second Faculty of Medicine, Charles University and University Hospital Motol. We proved that young healthy patients with long bridges or Branemarks have the same progression of marginal bone levels changes. The chronological age hasn’t therefore direct influence on the osseointegration from long term point of view. But we found that the length of dental suprastrucure-prosthetic construction negatively influences marginal bone changes, though these results weren’t statistically significant. More extensive dental implant suprastrucure undergoes smaller osseointegration. On the other hand the length of dental suprastrucure (prosthetic construction negatively influences dental osseointegration in both groups of patient.

Sexual response in patients treated with sacral neuromodulation for lower urinary tract symptoms or fecal incontinence.

Science.gov (United States)

van Voskuilen, A C; Oerlemans, D J; Gielen, N; Lansen-Koch, S M P; Weil, E H J; van Lankveld, J J D M; van den Hombergh, U; Baeten, C G M I; van Kerrenbroeck, P E V

2012-01-01

To determine whether sacral neuromodulation (SNM) for urinary symptoms or fecal incontinence gives improvement of female sexual function and whether improvement is due to physiological or psychological factors. Between 2002 and 2008, 8 patients had an array of questionnaires before and after SNM implantation. The questionnaires were: the Questionnaire for Screening for Sexual Dysfunctions, the Golombok Rust Inventory of Sexual Satisfaction, the Symptom Checklist-90, the Maudsley Marital Questionnaire and the McGill-Mah Orgasm Questionnaire. Three of these 8 patients underwent vaginal plethysmography before and after implantation. No statistically significant changes were found, although there seems to be a trend toward improvement in orgasm scores. In plethysmography all 3 patients showed increased vaginal pulse amplitude with the stimulator turned on with both erotic and non-erotic stimuli. This study does not show a clear effect of SNM on sexual function, although there seems to be an improvement in orgasm scores. The lack of response on psychological questionnaires and the increase in vaginal pulse amplitude after SNM implantation indicate that there might be a physiological response. Copyright © 2012 S. Karger AG, Basel.

Fatigue stress fractures of the sacrum: diagnosis with MR imaging

International Nuclear Information System (INIS)

Ahovuo, J.A.; Vusuri, T.

2004-01-01

The aim of this study was to describe the MRI findings and clinical observations in a fatigue stress fracture of the sacrum. In this retrospective study, 380 conscripts (53 women, 327 men; age range 18-29 years, mean age 20.7 years) who suffered from stress-related hip pain were studied with MRI of the pelvis. The findings of MRI were evaluated with regard to stress fracture of the sacrum. Thirty-one (8%) patients had MRI changes in signal intensity of the cranial part of the sacrum, extending to the first and second sacral foramina. The MRI changes in signal intensity were intermediate on T1-weighted images, and high on short tau inversion recovery or T2-weighted fat-suppressed images. A linear signal void fracture line was also seen. Multiple stress injuries to the pelvic bones were also seen in 7 of 31 (23%) patients. Five patients (16%) had bilateral sacral stress fracture. Fatigue sacral stress fractures appeared more commonly in women than in men (p<0.001). During recovery time 20 of the 31 patients underwent control MRI, and fatty marrow conversion was seen in 8 (40%) cases as high signal intensity on T1-weighted images, which disappeared 5-6 months after the onset of symptoms. Fatigue sacral stress fractures are associated with stress-related hip pain. These fractures were more common in women than in men. Other stress injuries of the pelvis may be seen simultaneously with sacral stress fractures. Signal intensity of the sacrum was normal after 5-6 months

Radiation induced fractures of sacrum: CT diagnosis

International Nuclear Information System (INIS)

Rafii, M.; Firooznia, H.; Golimbu, C.; Horner, N.

1988-01-01

Sacral insufficiency fracture due to bone atrophy may develop as a complication of irradiation of pelvic malignancies. Pain is the presenting symptom and the clinical diagnoses most often considered are recurrence of the original malignancy and metastatic disease. Computed tomography provides the most specific information helpful for the detection of these fractures and for exclusion of recurrent malignancy

S3 Dorsal Root Ganglion/Nerve Root Stimulation for Refractory Postsurgical Perineal Pain: Technical Aspects of Anchorless Sacral Transforaminal Lead Placement

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X. Zuidema

2016-01-01

Full Text Available Chronic perineal pain limits patients in physical and sexual activities, leading to social and psychological distress. In most cases, this pain develops after surgery in the urogenital area or as a consequence of trauma. Neuromodulation is one of the options in chronic postsurgical perineal pain treatment. We present a case of refractory perineal pain after right sided surgical resection of a Bartholin’s cyst which was treated with third sacral nerve root/dorsal root ganglion stimulation using the transforaminal approach. We describe a new anchorless lead placement technique using a unique curved lead delivery sheath. We postulate that this new posterior foraminal technique of lead placement is simple, safe, and reversible and may lower the occurrence of lead related complications.

A universal scaling relationship between body mass and proximal limb bone dimensions in quadrupedal terrestrial tetrapods.

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Campione, Nicolás E; Evans, David C

2012-07-10

Body size is intimately related to the physiology and ecology of an organism. Therefore, accurate and consistent body mass estimates are essential for inferring numerous aspects of paleobiology in extinct taxa, and investigating large-scale evolutionary and ecological patterns in the history of life. Scaling relationships between skeletal measurements and body mass in birds and mammals are commonly used to predict body mass in extinct members of these crown clades, but the applicability of these models for predicting mass in more distantly related stem taxa, such as non-avian dinosaurs and non-mammalian synapsids, has been criticized on biomechanical grounds. Here we test the major criticisms of scaling methods for estimating body mass using an extensive dataset of mammalian and non-avian reptilian species derived from individual skeletons with live weights. Significant differences in the limb scaling of mammals and reptiles are noted in comparisons of limb proportions and limb length to body mass. Remarkably, however, the relationship between proximal (stylopodial) limb bone circumference and body mass is highly conserved in extant terrestrial mammals and reptiles, in spite of their disparate limb postures, gaits, and phylogenetic histories. As a result, we are able to conclusively reject the main criticisms of scaling methods that question the applicability of a universal scaling equation for estimating body mass in distantly related taxa. The conserved nature of the relationship between stylopodial circumference and body mass suggests that the minimum diaphyseal circumference of the major weight-bearing bones is only weakly influenced by the varied forces exerted on the limbs (that is, compression or torsion) and most strongly related to the mass of the animal. Our results, therefore, provide a much-needed, robust, phylogenetically corrected framework for accurate and consistent estimation of body mass in extinct terrestrial quadrupeds, which is important for a

A universal scaling relationship between body mass and proximal limb bone dimensions in quadrupedal terrestrial tetrapods

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Campione Nicolás E

2012-07-01

Full Text Available Abstract Background Body size is intimately related to the physiology and ecology of an organism. Therefore, accurate and consistent body mass estimates are essential for inferring numerous aspects of paleobiology in extinct taxa, and investigating large-scale evolutionary and ecological patterns in the history of life. Scaling relationships between skeletal measurements and body mass in birds and mammals are commonly used to predict body mass in extinct members of these crown clades, but the applicability of these models for predicting mass in more distantly related stem taxa, such as non-avian dinosaurs and non-mammalian synapsids, has been criticized on biomechanical grounds. Here we test the major criticisms of scaling methods for estimating body mass using an extensive dataset of mammalian and non-avian reptilian species derived from individual skeletons with live weights. Results Significant differences in the limb scaling of mammals and reptiles are noted in comparisons of limb proportions and limb length to body mass. Remarkably, however, the relationship between proximal (stylopodial limb bone circumference and body mass is highly conserved in extant terrestrial mammals and reptiles, in spite of their disparate limb postures, gaits, and phylogenetic histories. As a result, we are able to conclusively reject the main criticisms of scaling methods that question the applicability of a universal scaling equation for estimating body mass in distantly related taxa. Conclusions The conserved nature of the relationship between stylopodial circumference and body mass suggests that the minimum diaphyseal circumference of the major weight-bearing bones is only weakly influenced by the varied forces exerted on the limbs (that is, compression or torsion and most strongly related to the mass of the animal. Our results, therefore, provide a much-needed, robust, phylogenetically corrected framework for accurate and consistent estimation of body mass in

Evolutionary Patterns of Bone Histology and Bone Compactness in Xenarthran Mammal Long Bones

OpenAIRE

Straehl, Fiona; Scheyer, Torsten; Forasiepi, Analia Marta; Macphee, Ross; Sanchez-Villagra, Marcelo

2015-01-01

Bone microstructure reflects physiological characteristics and has been shown to contain phylogenetic and ecological signals. Although mammalian long bone histology is receiving increasing attention, systematic examination of the main clades has not yet been performed. Here we describe the long bone microstructure of Xenarthra based on thin sections representing twenty-two species. Additionally, patterns in bone compactness of humeri and femora are investigated. The primary bone tissue of xen...

Bone damage of mandibles after radiotherapy for carcinoma of the tongue

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Nakamura, Motoyasu; Kubo, Kazuko; Furukawa, Sohei; Fuchihata, Hajime; Shimizutani, Kiminari; Inoue, Takehiro; Nishiyama, Kinji; Ikeda, Hiroshi; Masaki, Norie

1987-10-01

At Osaka University Hospital, the 5-year survival rate for carcinoma of the tongue, treated by radiotherapy, is almost 60 % and in early cases, around 80 %. However, with this improvement in the survival rate, an increase in the incidence of various complications (xerostomia, soft tissue ulcer, bone damage, etc.) has been observed. Because of these circumstances, a radiographic analysis on the bone damage of the mandibles after radiotherapy was made. Only those patients whose progress had been followed for more than one year and whose disease was well controlled were selected for this study. Early radiographic signs of bone damages showed an enlargement of the periodontal space and a loss of lamina dura. From the results of the study it has been found that bone damage is less common in patients treated by interstitial radiotherapy alone. Bone damage seems to develope more frequently in patients who receive about 30 Gy by external radiotherapy, followed by more than 2,000 mgh. Ra. eq. of interstitial radiotherapy.

Chronic monitoring of lower urinary tract activity via a sacral dorsal root ganglia interface

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Khurram, Abeer; Ross, Shani E.; Sperry, Zachariah J.; Ouyang, Aileen; Stephan, Christopher; Jiman, Ahmad A.; Bruns, Tim M.

2017-06-01

Objective. Our goal is to develop an interface that integrates chronic monitoring of lower urinary tract (LUT) activity with stimulation of peripheral pathways. Approach. Penetrating microelectrodes were implanted in sacral dorsal root ganglia (DRG) of adult male felines. Peripheral electrodes were placed on or in the pudendal nerve, bladder neck and near the external urethral sphincter. Supra-pubic bladder catheters were implanted for saline infusion and pressure monitoring. Electrode and catheter leads were enclosed in an external housing on the back. Neural signals from microelectrodes and bladder pressure of sedated or awake-behaving felines were recorded under various test conditions in weekly sessions. Electrodes were also stimulated to drive activity. Main results. LUT single- and multi-unit activity was recorded for 4-11 weeks in four felines. As many as 18 unique bladder pressure single-units were identified in each experiment. Some channels consistently recorded bladder afferent activity for up to 41 d, and we tracked individual single-units for up to 23 d continuously. Distension-evoked and stimulation-driven (DRG and pudendal) bladder emptying was observed, during which LUT sensory activity was recorded. Significance. This chronic implant animal model allows for behavioral studies of LUT neurophysiology and will allow for continued development of a closed-loop neuroprosthesis for bladder control.

A case of von Willebrand disease discovered during treatment of a sacral pressure ulcer.

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Murakami, Masahiro; Fukaya, Sumiko; Furuya, Masaichi; Hyakusoku, Hiko

2010-12-01

A sacral pressure ulcer developed in a patient hospitalized for cerebral infarction. Each time necrotic tissue was debrided from the ulcer, pressure hemostasis was necessary to stop the bleeding. As treatment continued, the pressure required to stop the bleeding caused the ulcer to worsen, leading to a downward spiral in the patient's condition. While trying to determine the cause of this problem, we discovered that the patient had von Willebrand disease. Medication controlled the bleeding, and the pressure ulcer began to heal at the same time. It was clear to us that conservative treatment would lead to a complete cure but that the healing process would take a long time and require continued administration of an expensive drug. We decided, therefore, to close the wound with a fasciocutaneous flap so that the patient could be quickly transferred to a rehabilitation hospital. About 1 month after surgery, epithelialization was complete, we were able to discontinue medication, and the patient was discharged. This experience demonstrates the importance of determining the cause of any deviation from the normal course of healing in pressure ulcers. It also indicates that the use of fasciocutaneous flaps, which involve little intraoperative bleeding in short surgeries, is appropriate in cases like this one.

Sacral nerve stimulation for constipation: do we still miss something? Role of psychological evaluation.

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Carriero, Alfonso; Martellucci, Jacopo; Talento, Pasquale; Ferrari, Carlo Andrea

2010-08-01

The aim of this study was to try to understand if psychological evaluation of patients candidate to sacral nerve stimulation (SNS) could be a potential selection criterion to identify those patients who could successfully respond to this treatment. From 2005 to 2007, 68 patients with slow transit constipation were identified, and all of them fulfill the selection criteria for the SNS treatment. The MMPI-2 test was purposed to all the patients. Wexner score, bowel movements, and SF36 were recorded in all the patients. Twenty-three patients (33.8%) refused the psychological evaluation. Forty-five patients completed the test: only 13 patients (19.1%) had a score in the normal range of the scales of the MMPI-2 and were implanted with the temporary test for SNS. After the screening period, 11 patients (84.6%) reported more than 50% improvement of bowel movements per week and no need of laxatives, so they were definitively implanted. The mean follow-up period was 22 months (range 12-36). The mean number of bowel movements per week and Wexner score were significantly improved after 1 year (p < 0.001). A complete and accurate psychological evaluation could be very important in the selection of the patients with STC that could benefit from SNS.

Distribution pattern of surgically treated symptomatic prolapsed lumbar and sacral intervertebral discs in males.

Science.gov (United States)

Nnamdi, Ibe Michael Onwuzuruike

2013-09-01

The pattern of distribution of surgically treated symptomatic prolapsed lumbar and sacral intervertebral discs has been published, though scantily, especially in males. We decided to look at our own series, compare and contrast ours with some of those published. We treated 88 locations of this lesion in 68 males. The clinical features were those of lower back pains, with or without radiation into the lower extremities, sensory loss and paresis of the limbs. There was a case of loss of urinary bladder and ano-rectal control. All lesions were confirmed through cauda-equinograms and treated under general anaesthesia in knee-chest position (MECCA position). The patients were followed up for 3-6 months post-operatively. There were 88 locations in 68 males of 21-70 years of age, with 29 prolapses occurring during the age range 31-40 years, while 54 locations were on the left and 48 at L4/5. The procedures were well tolerated by all patients and there were no post-operative complications. This lesion in our series occurred mostly on the left, at the L4/5 level and peaked at 31-40 years age range. The predictability of occurrence of this disease, using side, level and age is still not feasible in males from our series.

Vertebral hydatid disease

Energy Technology Data Exchange (ETDEWEB)

Pasaoglu, E.; Boyacigil, S.; Damgaci, L.; Tokoglu, F.; Soydinc, P.; Yuksel, E.

1997-05-01

Hydatid disease (caused by Echinococcus granulosus) affecting the bones is a rare condition, its incidence ranging from 0.5-2% of all cases of hydatidosis. The bones most often involved are the vertebrae (44%). A 22-year-old man presented to the hospital with low back pain. A computed tomography scan was performed showing bone destruction and cord compression as well as soft-tissue involvement. It revealed intracanal and paravertebral cystic lesions at the level of L5-S1 with destruction of the corpus and lamina, and sacral foramen invasion. An operation was performed and histopathological findings confirmed the diagnosis. 8 refs., 3 figs.

Recombinant human bone morphogenetic protein induces bone formation

International Nuclear Information System (INIS)

Wang, E.A.; Rosen, V.; D'Alessandro, J.S.; Bauduy, M.; Cordes, P.; Harada, T.; Israel, D.I.; Hewick, R.M.; Kerns, K.M.; LaPan, P.; Luxenberg, D.P.; McQuaid, D.; Moutsatsos, I.K.; Nove, J.; Wozney, J.M.

1990-01-01

The authors have purified and characterized active recombinant human bone morphogenetic protein (BMP) 2A. Implantation of the recombinant protein in rats showed that a single BMP can induce bone formation in vivo. A dose-response and time-course study using the rat ectopic bone formation assay revealed that implantation of 0.5-115 μg of partially purified recombinant human BMP-2A resulted in cartilage by day 7 and bone formation by day 14. The time at which bone formation occurred was dependent on the amount of BMP-2A implanted; at high doses bone formation could be observed at 5 days. The cartilage- and bone-inductive activity of the recombinant BMP-2A is histologically indistinguishable from that of bone extracts. Thus, recombinant BMP-2A has therapeutic potential to promote de novo bone formation in humans

Bone tumors

International Nuclear Information System (INIS)

Unni, K.K.

1988-01-01

This book contains the proceedings on bone tumors. Topics covered include: Bone tumor imaging: Contribution of CT and MRI, staging of bone tumors, perind cell tumors of bone, and metastatic bone disease

ALVEOLAR BONE REGENERATION AFTER DEMINERALIZED FREEZE DRIED BONE ALOGRAFT (DFDBA BONE GRAFTING

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Sri Oktawati

2006-04-01

Full Text Available Periodontal treatment by conventional way will result in healing repair, which easily cause recurrence. Modification of treatment should be done to get an effective result, that is the regeneration of alveolar bone and to reduce inflammation. The objective of this study is to determine the alveolar bone regeneration after using DFDBA (Demineralized Freeze Dried Bone Allograft. Quasi experimental designs with pre and post test method was used in this study. From 13 patients, 26 defects got conventional or regenerative treatment. The indicator of alveolar bone regenaration in bone height in radiographic appearance and level of osteocalsin in gingival crevicular fluid (GCF were checked before and after the treatment, then the changes that occurred were analyzed. The result of the research showed that alveolar bone regeneration only occurred to the group of regenerative treatment using DFDBA. The conclusion is the effective periodontal tissue regeneration occurred at regenerative treatment by using DFDBA, and the osteocalsin in GCF can be used as indicator of bone growth.

From bone biology to bone analysis.

NARCIS (Netherlands)

Schoenau, E.; Saggese, G.; Peter, F.; Baroncelli, G.I.; Shaw, N.J.; Crabtree, N.J.; Zadik, Z.; Neu, C.M.; Noordam, C.; Radetti, G.; Hochberg, Z.

2004-01-01

Bone development is one of the key processes characterizing childhood and adolescence. Understanding this process is not only important for physicians treating pediatric bone disorders, but also for clinicians and researchers dealing with postmenopausal and senile osteoporosis. Bone densitometry has

Peripheral injury of pelvic visceral sensory nerves alters GFRa (GDNF family receptor alpha localization in sensory and autonomic pathways of the sacral spinal cord

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Shelley Lynne Forrest

2015-04-01

Full Text Available GDNF (glial cell line-derived neurotrophic factor, neurturin and artemin use their co-receptors (GFRα1, GFRα2 and GFRα3, respectively and the tyrosine kinase Ret for downstream signalling. In rodent dorsal root ganglia (DRG most of the unmyelinated and some myelinated sensory afferents express at least one GFRα. The adult function of these receptors is not completely elucidated but their activity after peripheral nerve injury can facilitate peripheral and central axonal regeneration, recovery of sensation, and sensory hypersensitivity that contributes to pain. Our previous immunohistochemical studies of spinal cord and sciatic nerve injuries in adult rodents have identified characteristic changes in GFRα1, GFRα2 or GFRα3 in central spinal cord axons of sensory neurons located in dorsal root ganglia. Here we extend and contrast this analysis by studying injuries of the pelvic and hypogastric nerves that contain the majority of sensory axons projecting to the pelvic viscera (e.g., bladder and lower bowel. At 7 d, we detected some effects of pelvic but not hypogastric nerve transection on the ipsilateral spinal cord. In sacral (L6-S1 cord ipsilateral to nerve injury, GFRα1-immunoreactivity (IR was increased in medial dorsal horn and CGRP-IR was decreased in lateral dorsal horn. Pelvic nerve injury also upregulated GFRα1- and GFRα3-IR terminals and GFRα1-IR neuronal cell bodies in the sacral parasympathetic nucleus that provides the spinal parasympathetic preganglionic output to the pelvic nerve. This evidence suggests peripheral axotomy has different effects on somatic and visceral sensory input to the spinal cord, and identifies sensory-autonomic interactions as a possible site of post-injury regulation.

Perfluoroalkyl substances in human bone: concentrations in bones and effects on bone cell differentiation.

Science.gov (United States)

Koskela, A; Koponen, J; Lehenkari, P; Viluksela, M; Korkalainen, M; Tuukkanen, J

2017-07-28

Perfluoroalkyl substances (PFAS), including two most commonly studied compounds perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA), are widely distributed environmental pollutants, used extensively earlier. Due to their toxicological effects the use of PFAS is now regulated. Based on earlier studies on PFOA's distribution in bone and bone marrow in mice, we investigated PFAS levels and their possible link to bone microarchitecture of human femoral bone samples (n = 18). Soft tissue and bone biopsies were also taken from a 49-year old female cadaver for PFAS analyses. We also studied how PFOA exposure affects differentiation of human osteoblasts and osteoclasts. PFAS were detectable from all dry bone and bone marrow samples, PFOS and PFOA being the most prominent. In cadaver biopsies, lungs and liver contained the highest concentrations of PFAS, whereas PFAS were absent in bone marrow. Perfluorononanoic acid (PFNA) was present in the bones, PFOA and PFOS were absent. In vitro results showed no disturbance in osteogenic differentiation after PFOA exposure, but in osteoclasts, lower concentrations led to increased resorption, which eventually dropped to zero after increase in PFOA concentration. In conclusion, PFAS are present in bone and have the potential to affect human bone cells partly at environmentally relevant concentrations.

Neuromodulation: urodynamic effects of sacral (S3) spinal nerve stimulation in patients with detrusor instability or detrusor hyperflexia.

Science.gov (United States)

Bosch, J L; Groen, J

1998-05-01

The aim of this study was to determine the urodynamic effects of sacral (S3) nerve stimulation in patients with urge incontinence due to detrusor overactivity which has been refractory to conservative treatment. A total of 24 patients with idiopathic detrusor instability and five with neurogenic hyperreflexia were studied urodynamically before and 6 months after a permanent S3 foramen electrode implant. The urodynamic studies at follow-up were done with the stimulus on. Clinically, the average voiding frequency, the number of leakage episodes and pad use per 24 h decreased significantly. Improvement in several urodynamic parameters was noted. In the idiopathic as well as in the neurogenic group, the correlation between symptomatic and urodynamic improvement was incomplete. Neuromodulation leads to improvement of several urodynamic parameters in patients with urge incontinence due to detrusor overactivity which has been refractory to conservative treatment and appears to be a valuable treatment option in these patients.

Identification of Viral MicroRNAs Expressed in Human Sacral Ganglia Latently Infected with Herpes Simplex Virus 2▿

Science.gov (United States)

Umbach, Jennifer L.; Wang, Kening; Tang, Shuang; Krause, Philip R.; Mont, Erik K.; Cohen, Jeffrey I.; Cullen, Bryan R.

2010-01-01

Deep sequencing of small RNAs isolated from human sacral ganglia latently infected with herpes simplex virus 2 (HSV-2) was used to identify HSV-2 microRNAs (miRNAs) expressed during latent infection. This effort resulted in the identification of five distinct HSV-2 miRNA species, two of which, miR-H3/miR-I and miR-H4/miR-II, have been previously reported. Three novel HSV-2 miRNAs were also identified, and two of these, miR-H7 and miR-H9, are derived from the latency-associated transcript (LAT) and are located antisense to the viral transcript encoding transactivator ICP0. A third novel HSV-2 miRNA, miR-H10, is encoded within the unique long (UL) region of the genome, 3′ to the UL15 open reading frame, and is presumably excised from a novel, latent HSV-2 transcript distinct from LAT. PMID:19889786

A novel bio-inorganic bone implant containing deglued bone

Indian Academy of Sciences (India)

With the aim of developing an ideal bone graft, a new bone grafting material was developed using deglued bone, chitosan and gelatin. Deglued bone (DGB) which is a by-product of bone glue industries and has the close crystallographic similarities of hydroxyapatite was used as main component in the preparation of bone ...

Bone healing and bone substitutes.

Science.gov (United States)

Costantino, Peter D; Hiltzik, David; Govindaraj, Satish; Moche, Jason

2002-02-01

With the advent of new biomaterials and surgical techniques, the reconstructive surgeon has a wider range of treatment modalities for the rehabilitation and reconstruction of craniofacial skeletal deformities than ever before. These innovative substances act as true bone graft substitutes, thereby allowing the surgeon to avoid the use of autogenous bone grafts and their associated donor site morbidity. Surgeons have long been interested in producing a composite graft that can heal faster by induction, incorporate with surrounding tissues, and be remodeled to resemble native bone. Currently, there are a host of bone graft substitutes available that vary in both their composition and properties. Craniomaxillofacial surgeons must therefore become comfortable with numerous biomaterials to best tailor the treatment for each patient individually. Ongoing investigations into the next phase of tissue engineering will continue to bring us closer to the ability to regenerate or replace bone.

Bone healing around nanocrystalline hydroxyapatite, deproteinized bovine bone mineral, biphasic calcium phosphate, and autogenous bone in mandibular bone defects

DEFF Research Database (Denmark)

Broggini, Nina; Bosshardt, Dieter D; Jensen, Simon S

2015-01-01

The individual healing profile of a given bone substitute with respect to osteogenic potential and substitution rate must be considered when selecting adjunctive grafting materials for bone regeneration procedures. In this study, standardized mandibular defects in minipigs were filled...... with nanocrystalline hydroxyapatite (HA-SiO), deproteinized bovine bone mineral (DBBM), biphasic calcium phosphate (BCP) with a 60/40% HA/β-TCP (BCP 60/40) ratio, or particulate autogenous bone (A) for histological and histomorphometric analysis. At 2 weeks, percent filler amongst the test groups (DBBM (35.65%), HA......-SiO (34.47%), followed by BCP 60/40 (23.64%)) was significantly higher than the more rapidly substituted autogenous bone (17.1%). Autogenous bone yielded significantly more new bone (21.81%) over all test groups (4.91%-7.74%) and significantly more osteoid (5.53%) than BCP 60/40 (3%) and DBBM (2...

Roentgenological semiotics of bone and bone joints pathology

International Nuclear Information System (INIS)

Zedgenidze, G.A.; Kishkovskij, A.N.; Elashov, Yu.G.

1984-01-01

Physiologic and pathologic processes in bones followed by alternations of bone structure and reflected on roentgenograms are considered and described. Most frequent reasons for roentgenodiagnosis errors in diseases of bone and bone joint apparatus are presented

Long term effects of formaldehyde preservation on subsequent bone ...

African Journals Online (AJOL)

This study was conducted to compare the effectiveness of cold and hot water maceration techniques for the development of bone specimens from cadavers. Three already dissected bodies of both sexes (two males and a female) obtained from the Department of Anatomy, Bowen University, Iwo, Osun State, Nigeria were ...

Percutaneous cannulated screw fixation of sacral fractures and sacroiliac joint disruptions with CT-controlled guidewires performed by interventionalists: single center experience in treating posterior pelvic instability.

Science.gov (United States)

Fischer, Sebastian; Vogl, Thomas J; Marzi, Ingo; Zangos, Stephan; Wichmann, Julian L; Scholtz, Jan-Erik; Mack, Martin G; Schmidt, Sven; Eichler, Katrin

2015-02-01

The purpose of our study was to evaluate minimally invasive sacroiliac screw fixation for treatment of posterior pelvic instability with the help of CT controlled guidewires, assess its accuracy, safety and effectiveness, and discuss potential pitfalls. 100 guidewires and hollow titan screws were inserted in 38 patients (49.6±19.5 years) suffering from 35 sacral fractures and/or 16 sacroiliac joint disruptions due to 33 (poly-)traumatic, 2 osteoporotic and 1 post-infectious conditions. The guidewire and screw positions were analyzed in multiplanar reconstructions. The mean minimal distance between guidewire and adjacent neural foramina was 4.5±2.01mm, with a distinctly higher precision in S1 than S2. Eight guidewires showed cortical contacts, resulting in a total of 2% mismatched screws with subsequent wall violation. The fracture gaps were reduced from 3.6±0.53mm to 1.2±0.54mm. During follow-up 3 cases of minor iatrogenic sacral impaction (<5mm) due to the bolting and 2 cases of screw loosening were observed. Interventional time was 84.0min with a mean of 2.63 screws per patient whilst acquiring a mean of 93.7 interventional CT-images (DLP 336.7mGycm). The treatment of posterior pelvic instability with a guidewire-based screw insertion technique under CT-imaging results in a very high accuracy and efficacy with a low complication rate. Careful attention should be drawn to radiation levels. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

In vivo x-ray fluorescence of bone lead in the study of human lead metabolism: Serum lead, whole blood lead, bone lead, and cumulative exposure

International Nuclear Information System (INIS)

Cake, K.M.; Chettle, D.R.; Webber, C.E.; Gordon, C.L.

1995-01-01

Traditionally, clinical studies of lead's effect on health have relied on blood lead levels to indicate lead exposure. However, this is unsatisfactory because blood lead levels have a half-life of approximately 5 weeks, and thus reflect recent exposure. Over 90% of the lead body burden is in bone, and it is thought to have a long residence time, thus implying that measurements of bone lead reflect cumulative exposure. So, measurements of bone lead are useful in understanding the long-term health effects of lead. Ahlgren reported the first noninvasive measurements of bone lead in humans, where γ-rays from 57 Co were used to excite the K series x-rays of lead. The lead detection system at McMaster University uses a 109 Cd source which is positioned at the center of the detector face (HPGe) and a near backscatter (∼160 degrees) geometry. This arrangement allows great flexibility, since one can sample lead in a range of different bone sites due to a robust normalization technique which eliminates the need to correct for bone geometry, thickness of overlying tissue, and other related factors. The effective radiation dose to an adult during an x-ray fluorescence bone lead measurement is extremely low, being 35 nSv. This paper addresses the issue of how bone, whole blood, and serum lead concentrations can be related in order to understand a person's lead exposure history

Bone cysts: unicameral and aneurysmal bone cyst.

Science.gov (United States)

Mascard, E; Gomez-Brouchet, A; Lambot, K

2015-02-01

Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which may be unicameral (UBC) or partially separated. UBC can involve all bones, but usually the long bone metaphysis and otherwise primarily the proximal humerus and proximal femur. The classic aneurysmal bone cyst (ABC) is an expansive and hemorrhagic tumor, usually showing characteristic translocation. About 30% of ABCs are secondary, without translocation; they occur in reaction to another, usually benign, bone lesion. ABCs are metaphyseal, excentric, bulging, fluid-filled and multicameral, and may develop in all bones of the skeleton. On MRI, the fluid level is evocative. It is mandatory to distinguish ABC from UBC, as prognosis and treatment are different. UBCs resolve spontaneously between adolescence and adulthood; the main concern is the risk of pathologic fracture. Treatment in non-threatening forms consists in intracystic injection of methylprednisolone. When there is a risk of fracture, especially of the femoral neck, surgery with curettage, filling with bone substitute or graft and osteosynthesis may be required. ABCs are potentially more aggressive, with a risk of bone destruction. Diagnosis must systematically be confirmed by biopsy, identifying soft-tissue parts, as telangiectatic sarcoma can mimic ABC. Intra-lesional sclerotherapy with alcohol is an effective treatment. In spinal ABC and in aggressive lesions with a risk of fracture, surgical treatment should be preferred, possibly after preoperative embolization. The risk of malignant transformation is very low, except in case of radiation therapy. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

[The injection of acrylic bone cement prevents bone collapse in the intercalar bones lacking bony support: an experimental sheep semilunar bone model].

Science.gov (United States)

Unsal, Murat; Tetik, Cihangir; Erol, Bülent; Cabukoğlu, Cengiz

2003-01-01

In a sheep semilunar bone model, we investigated whether collapse in the intercalar bones lacking bony support could be prevented by the injection of acrylic bone cement. The study included 16 limbs of eight sheep. Preoperatively, anteroposterior and lateral views of the carpal joints in the fore limbs were obtained. The animals were divided into four groups. In group 1 (n=3) no surgical procedure was performed in the right semilunar bones, whereas the periosteum on the contralateral side was elevated (group 2; n=3). The first two groups were left as controls. In Group 3 (n=5) the left semilunar bones were filled with acrylic bone cement following decancellation of the bone, while the right semilunar bones were left decancellated (group 4; n=5). The sheep were monitored for three months. Radiographs of the carpal joints were obtained to evaluate collapse occurrence in the semilunar bones. Thereafter, the animals were sacrificed and the semilunar bones were excised for biomechanical and histological examinations. Osteonecrosis and cartilage damage were sought and resistance to compressive forces was investigated. Radiologically, the extent of collapse was statistically significant in the semilunar bones in group 4 (pbone cement was found to prevent collapse in group 3, with no significant difference being noted between preoperative and postoperative semilunar bone heights (p>0.05). Biomechanically, the least resistance to compressive forces was measured in group 4 (pbone cement prevents collapse in the semilunar bones, without inducing any cartilage damage or osteonecrosis.

[Shushu (ancient Chinese numerology) in Lingshu: Gudu (Miraculous Pivot: Bone-Length Measurement)].

Science.gov (United States)

Zhuo, Lian-Shi

2010-10-01

Lingshu: Gudu (Miraculous Pivot: Bone-Length Measurement) is compared with literatures concerning the Shushu (ancient Chinese numerology) of the Qin Dynasty (221 B. C. - 206 B. C. ) and the Han Dynasty (206 B. C.-220 A. D.) in this article. And it is discovered that "the number of heaven and earth" in Yijing (The Book of Change) was implied in the bone-length measurement. The theory of Shushu is hidden in the sized of head, neck, chest, abdomen, back and 4 extremities according to the measurement. The meaning of establishment of bone-length measurement, which is found to have universality, laid in setting down the measurement of meridians. And it is the origin of the proportional measurement of locating acupoints. Checked with the theory of Shushu, errors in the description of bone-length measurement could also be found in Lingshu: Gudu (Miraculous Pivot: Bone-Length Measurement) of the present edition, which is helpful for the modern study on the measurement.

Low Bone Density

Science.gov (United States)

... Density Exam/Testing › Low Bone Density Low Bone Density Low bone density is when your bone density ... people with normal bone density. Detecting Low Bone Density A bone density test will determine whether you ...

Re-evaluation of bone pain in patients with type 1 Gaucher disease suggests that bone crises occur in small bones as well as long bones.

Science.gov (United States)

Baris, Hagit N; Weisz Hubshman, Monika; Bar-Sever, Zvi; Kornreich, Liora; Shkalim Zemer, Vered; Cohen, Ian J

2016-09-01

Bone crises in type 1 Gaucher disease are reported in long bones and occasionally in weight bearing bones and other bones, but rarely in small bones of the hands and feet. We retrospectively examined the incidence of bone pain in patients followed at the Rabin Medical Center, Israel, before and following the initiation of enzyme replacement therapy (ERT) and evaluated them for bone crises. Of 100 type I Gaucher disease patients, 30 (30%) experienced one or more bone crises. Small bone crises represented 31.5% of all bone crises and were always preceded by crises in other bones. While the incidence of long bone crises reduced after the initiation of ERT, small bone crises increased. Almost 60% of patients with bone crises were of the N370S/84GG genotype suggesting a greater susceptibility of N370S/84GG patients to severe bone complications. These patients also underwent the greatest number of splenectomies (70.6% of splenectomised patients). Splenectomised patients showed a trend towards increased long and small bone crises after surgery. Active investigation of acute pain in the hands and feet in patients in our cohort has revealed a high incidence of small bone crises. Physicians should consider imaging studies to investigate unexplained pain in these areas. Copyright © 2015 Elsevier Inc. All rights reserved.

Receptor tyrosine kinase inhibition causes simultaneous bone loss and excess bone formation within growing bone in rats

International Nuclear Information System (INIS)

Nurmio, Mirja; Joki, Henna; Kallio, Jenny; Maeaettae, Jorma A.; Vaeaenaenen, H. Kalervo; Toppari, Jorma; Jahnukainen, Kirsi; Laitala-Leinonen, Tiina

2011-01-01

During postnatal skeletal growth, adaptation to mechanical loading leads to cellular activities at the growth plate. It has recently become evident that bone forming and bone resorbing cells are affected by the receptor tyrosine kinase (RTK) inhibitor imatinib mesylate (STI571, Gleevec (registered) ). Imatinib targets PDGF, ABL-related gene, c-Abl, c-Kit and c-Fms receptors, many of which have multiple functions in the bone microenvironment. We therefore studied the effects of imatinib in growing bone. Young rats were exposed to imatinib (150 mg/kg on postnatal days 5-7, or 100 mg/kg on postnatal days 5-13), and the effects of RTK inhibition on bone physiology were studied after 8 and 70 days (3-day treatment), or after 14 days (9-day treatment). X-ray imaging, computer tomography, histomorphometry, RNA analysis and immunohistochemistry were used to evaluate bone modeling and remodeling in vivo. Imatinib treatment eliminated osteoclasts from the metaphyseal osteochondral junction at 8 and 14 days. This led to a resorption arrest at the growth plate, but also increased bone apposition by osteoblasts, thus resulting in local osteopetrosis at the osteochondral junction. The impaired bone remodelation observed on day 8 remained significant until adulthood. Within the same bone, increased osteoclast activity, leading to bone loss, was observed at distal bone trabeculae on days 8 and 14. Peripheral quantitative computer tomography (pQCT) and micro-CT analysis confirmed that, at the osteochondral junction, imatinib shifted the balance from bone resorption towards bone formation, thereby altering bone modeling. At distal trabecular bone, in turn, the balance was turned towards bone resorption, leading to bone loss. - Research highlights: → 3-Day imatinib treatment. → Causes growth plate anomalies in young rats. → Causes biomechanical changes and significant bone loss at distal trabecular bone. → Results in loss of osteoclasts at osteochondral junction.

The risk of eating disorders and bone health in young adults: the mediating role of body composition and fitness.

Science.gov (United States)

Garrido-Miguel, Miriam; Torres-Costoso, Ana; Martínez-Andrés, María; Notario-Pacheco, Blanca; Díez-Fernández, Ana; Álvarez-Bueno, Celia; García-Prieto, Jorge Cañete; Martínez-Vizcaíno, Vicente

2017-11-13

To analyze the independent relationship between the risk of eating disorders and bone health and to examine whether this relationship is mediated by body composition and cardiorespiratory fitness (CRF). In this cross-sectional study, bone-related variables, lean mass, fat mass (by DXA), risk of eating disorders (SCOFF questionnaire), height, weight, waist circumference and CRF were measured in 487 university students aged 18-30 years from the University of Castilla-La Mancha, Spain. ANCOVA models were estimated to test mean differences in bone mass categorized by body composition, CRF or risk of eating disorders. Subsequently, linear regression models were fitted according to Baron and Kenny's procedures for mediation analysis. The marginal estimated mean ± SE values of total body bone mineral density for the categories "no risk of eating disorders" and "risk of eating disorders" were 1.239 ± 0.126 eating disorders and bone health in young adults. Body composition and CRF mediate the association between the risk of eating disorders and bone health. These findings highlight the importance of maintaining a healthy weight and good CRF for the prevention of the development of eating disorders and for the maintenance of good bone health in young adults. Level V, cross-sectional descriptive study.

Monitoring of bone healing by piezoelectric-EMI method

Science.gov (United States)

Mazlina, M. H.; Sarpinah, Bibi; Tawie, Rudy; Daho, Claira Dalislone; Annuar, Ishak

2016-02-01

Smart Piezoelectric devices which have excellent piezoelectric properties have been employed for various sensor and actuators applications. The work presented here is an attempt to demonstrate the feasibility of bone healing monitoring by using piezoelectric-electromechanical impedance (EMI) method that have several advantages such as low cost, portable, light weight and simplicity in measurement. A Piezoelectric sensor (PZT) has been widely used in damage detection of various structures including concrete, pipes and bones due to their unique sensing and actuating properties. The EMI technique has emerged as a universal Structural Health Monitoring (SHM) tool suitable for almost all engineering materials and structures. The method used for this proposed study consists of put healing agent in the host structure in particular cracks bone to be monitored by PZT-needle sensor which is embedded to the host structure. The measurements were taken in the frequency range between 0.04 to 100 kHz at 1 kHz interval using AD5933 evaluation board. The signals retrieved from the AD5933 evaluation board, were quantify and analyse to obtain Root Mean Square Deviation (RMSD) percentage value. Measurements were taken every hour for 12 hours. The result from the study shows the feasibility of the piezoelectric-EMI method to effectively detect changes during bone-cracks healing process until the cracks bone is fully recovered.

Chemical Makeup of Microdamaged Bone Differs from Undamaged Bone

International Nuclear Information System (INIS)

Ruppel, M.; Burr, D.; Miller, L.

2006-01-01

Microdamage naturally occurs in bone tissue as a result of cyclic loading placed on the body from normal daily activities. While it is usually repaired through the bone turnover process, accumulation of microdamage may result in reduced bone quality and increased fracture risk. It is unclear whether certain areas of bone are more susceptible to microdamage than others due to compositional differences. This study examines whether areas of microdamaged bone are chemically different than undamaged areas of bone. Bone samples (L3 vertebrae) were harvested from 15 dogs. Samples were stained with basic fuchsin, embedded in poly-methylmethacrylate, and cut into 5-(micro)m-thick sections. Fuchsin staining was used to identify regions of microdamage, and synchrotron infrared microspectroscopic imaging was used to determine the local bone composition. Results showed that microdamaged areas of bone were chemically different than the surrounding undamaged areas. Specifically, the mineral stoichiometry was altered in microdamaged bone, where the carbonate/protein ratio and carbonate/phosphate ratio were significantly lower in areas of microdamage, and the acid phosphate content was higher. No differences were observed in tissue mineralization (phosphate/protein ratio) or crystallinity between the microdamaged and undamaged bone, indicating that the microdamaged regions of bone were not over-mineralized. The collagen cross-linking structure was also significantly different in microdamaged areas of bone, consistent with ruptured cross-links and reduced fracture resistance. All differences in composition had well-defined boundaries in the microcrack region, strongly suggesting that they occurred after microcrack formation. Even so, because microdamage results in an altered bone composition, an accumulation of microdamage might result in a long-term reduction in bone quality

Carbon Ion Radiation Therapy for Unresectable Sacral Chordoma: An Analysis of 188 Cases

Energy Technology Data Exchange (ETDEWEB)

Imai, Reiko, E-mail: r_imai@nirs.go.jp [Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Kamada, Tadashi [Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Araki, Nobuhito [Department of Orthopedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan); Abe, Satoshi; Iwamoto, Yukihide; Ozaki, Toshifumi; Kanehira, Chihiro; Kaya, Mitsunori; Takahashi, Kazuhisa; Chuman, Hirokazu; Tsujii, Hirohiko; Tsuneyoshi, Masazumi; Nishida, Yoshihiro; Hiraga, Hiroaki; Hiruma, Toru; Machinami, Rikuo; Matsumine, Akihiko; Matsumoto, Seiichi; Morioka, Hideo; Yamaguchi, Takehiko; and others

2016-05-01

Purpose: To evaluate the results of carbon ion radiation therapy administered to 188 patients with unresectable primary sacral chordomas. Patients and Methods: One hundred eighty-eight patients were treated with carbon ion radiation therapy at a single institute between 1996 and 2013 and retrospectively analyzed. The median age was 66 years. The highest proximal invasion reached past S2 level in 137 patients. The median clinical target volume was 345 cm{sup 3}. One hundred six patients received 67.2 gray equivalents (GyE)/16 fractions (fr), 74 patients received 70.4 GyE/16 fr, 7 patients received 73.6 GyE/16 fr, and 1 patient received 64.0 GyE/16 fr. Results: The median follow-up period was 62 months (range, 6.8-147.5 months). Seventy percent of patients were followed for 5 years or until death. The 5-year local control, overall survival, and disease-free survival rates were 77.2%, 81.1%, and 50.3%, respectively. Forty-one patients had a local recurrence. Sex, tumor volume, level of proximal invasion, and irradiated dose were unrelated to local control. There was grade 3 toxicity of the peripheral nerves in 6 patients and grade 4 toxicity of the skin in 2 patients. Ambulation remained in 97% of patients. Conclusions: Carbon ion radiation therapy was safe and effective for unresectable chordoma and provided good local control and survival while preserving ambulation.

Guided bone regeneration : the influence of barrier membranes on bone grafts and bone defects

NARCIS (Netherlands)

Gielkens, Pepijn Frans Marie

2008-01-01

Guided bone regeneration (GBR) can be described as the use of a barrier membrane to provide a space available for new bone formation in a bony defect. The barrier membrane protects the defect from in-growth of soft tissue cells and allows bone progenitor cells to develop bone within a blood clot

Multicellular tumor spheroid interactions with bone cells and bone

International Nuclear Information System (INIS)

Wezeman, F.H.; Guzzino, K.M.; Waxler, B.

1985-01-01

In vitro coculture techniques were used to study HSDM1C1 murine fibrosarcoma multicellular tumor spheroid (HSDM1C1-MTS) interactions with mouse calvarial bone cells having osteoblastic characteristics and mouse bone explants. HSDM1C1-MTS attached to confluent bone cell monolayers and their attachment rate was quantified. HSDM1C1-MTS interaction with bone cells was further demonstrated by the release of 3 H-deoxyuridine from prelabeled bone cells during coculture with multicellular tumor spheroids. HSDM1C1-MTS-induced cytotoxicity was mimicked by the addition of 10(-5) M prostaglandin E2 (PGE2) to 3 H-deoxyuridine-labeled bone cells. The effects of low (10(-9) M) and high (10(-5) M) concentrations of PGE2 on bone cell proliferation were also studied. Higher concentrations of PGE2 inhibited bone cell proliferation. HSDM1C1-MTS resorbed living explants in the presence of indomethacin, suggesting that other tumor cell products may also participate in bone resorption. HSDM1C1-MTS caused direct bone resorption as measured by the significantly elevated release of 45 Ca from prelabeled, devitalized calvaria. However, the growth of a confluent bone cell layer on devitalized, 45 Ca-prelabeled calvaria resulted in a significant reduction in the amount of 45 Ca released subsequent to the seeding of HSDM1C1-MTS onto the explants. Bone cells at the bone surface may act as a barrier against invasion and tumor cell-mediated bone resorption. Violation of this cellular barrier is achieved, in part, by tumor cell products

A study of 23 unicameral bone cysts of the calcaneus: open chip allogeneic bone graft versus percutaneous injection of bone powder with autogenous bone marrow.

Science.gov (United States)

Park, Il-Hyung; Micic, Ivan Dragoljub; Jeon, In-Ho

2008-02-01

The treatment of unicameral bone cyst varies from percutaneous needle biopsy, aspiration and local injection of steroid, autologous bone marrow, or demineralized bone matrix to curettage and open bone-grafting. The purpose of this study was to compare the results of open chip allogeneic bone graft versus percutaneous injection of demineralized bone powder with autogenous bone marrow in management of calcaneal cysts. Twenty-three calcaneal unicameral cysts in 20 patients were treated. Lyophilized irradiated chip allogeneic bone (CAB) and autogenous bone marrow were used for treatment of 13 cysts in 11 patients, and 10 cysts in 9 patients were treated with percutaneous injection of irradiated allogeneic demineralized bone powder (DBP) and autogenous bone marrow. There were 11 males and 9 female patients with mean age of 17 years. The patients were followed for an average of 49.4 months. Complete healing was achieved in 9 cysts treated with chip allogeneic bone and in 5 cysts treated with powdered bone. Four cysts treated with CAB and 3 cysts treated with DBP healed with a defect. Two cysts treated with powdered bone and autogenous bone marrow were classified as persistent. No infections or pathological fractures were observed during the followup period. Percutaneous injection of a mixture of allogeneic bone powder with autogenous bone marrow is a minimal invasive method and could be an effective alternative in the treatment of unicameral calcaneal bone cysts. The postoperative morbidity was low, the hospital stay was brief, and patient's comfort for unrestricted activity was enhanced.

The spectrum of bone disease in Jordanian hemodialysis patients

International Nuclear Information System (INIS)

Younes, Nidal A.; Al-Mansour, M.; Sroujieh, Ahmad S.; Wahbeh, A.; Ailabouni, W.; Hamzah, Y.; Mahafzah, W.

2006-01-01

To evaluate the spectrum of mineral abnormalities and bone disease (BD) in hemodialysis patients at Jordan University Hospital (JUH), Amman, Jordan. A cross-sectional study was conducted among 63 patients (38 males and 25 females), mean age 44.19 years (range 17-76 years), with chronic kidney disease (CKD) on regular hemodialysis at JUH between November 2004 and April 2005. All patients have undergone complete blood count, chemistry profile, alkaline phosphatase, serum albumin, intact parathyroid hormone (iPTH) and plain x-rays. Bone disorders were identified in 45 patients on x-rays (70%). Osteopenia was found in 43 patients (68.3%), subperiosteal resorption in 24 patients (38.3%) and metastatic calcification in 22 patients (35%). Hypocalcemia was found in 28.6% and hypercalcemia in 7.9%. All patients were taking calcium carbonate, and 55.5% of patients were on vitamin D supplements. The calcium levels in 63.5% and the phosphorus levels in 50.8% of patients were within the recommended guidelines of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI). Serum i-PTH level was above 300 pg/ml high turnover bone disease in 24.6% of patients, 21.3% had iPTH of 150-300 pg/ml target, and 44.3% had i-PTH levels below 100 pg/mL suggesting a dynamic bone disease. Patients with severe bone disease had a statistically significant higher iPTH levels (p<0.005). Bone disease and mineral abnormalities are common in hemodialysis patients at JUH. Earlier detection of bone disease and better overall management strategy may reduce the frequency and severity of bone disease in CKD patients in Jordan. (author)

Chronic obstructive pulmonary disease and low bone mass: A case-control study

Directory of Open Access Journals (Sweden)

Rakesh K Gupta

2014-01-01

Full Text Available Background and Objective: Low bone mass (osteopenia and osteoporosis is one of the effects associated with chronic obstructive pulmonary disease (COPD. There is very little data from Saudi Arabia on COPD and low bone mass. This retrospective study was done to assess the prevalence of osteoporosis and osteopenia in COPD patients attending King Fahd Hospital of the University (KFHU, Alkhobar. Patients and Methods: After obtaining the ethical approval from the research committee, all patients seen between at the King Fahd Hospital of the University between January 2010 and December 2012 were included. The inclusion criteria included a follow up of a minimum 2 years, and the Medical Records should have the details of forced expiratory volume in one second (FEV 1 , blood bone profile and bone biomarkers and dual-energy X-ray absorptiometry (DEXA scan. Patients were labeled as osteopenia if the T score was -<1 to <-2.5 and osteoporosis of <-2.5 as per the WHO definition of osteopenia and osteoporosis. Results: Seventy-three patients were being followed in the clinics and 49 patients satisfied the inclusion criteria. The average age was 60.6 ± 10.47 years; males were 43 and females 6. Three (6.1% were normal and the remaining 46 (93.9% were with low bone mass. Thirty-two (65.3% were osteoporotic and 14 (28.57% were osteopenic. The average duration of COPD was 4.5 ± 6.2 years. Majority (n = 36, 73.4% of patients were in the Global Initiative for COPD (GOLD class II and III. FEV 1 was significantly lower in the patients with low bone mass 1.66 ± 0.60 versus 3.61 ± 0.58 (P < 0.001. Conclusions: Our study shows that over 90% of Saudi Arabian patients with COPD suffer from osteopenia and osteoporosis and unfortunately they remain under-diagnosed and undertreated.

Muscle-splitting approach to superior and inferior gluteal vessels: versatile source of recipient vessels for free-tissue transfer to sacral, gluteal, and ischial regions.

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Park, S

2000-07-01

The superior gluteal vessel has been reported as a recipient in free-tissue transfer for the coverage of complex soft-tissue defects in the lumbosacral region, where a suitable recipient vessel is difficult to find. The characteristics of proximity, vessel caliber, and constancy make the superior gluteal vessel preferable to previously reported recipient vessels. However, there are technical difficulties in microsurgery (e.g., short pedicle length and deep location) and muscle injury (transection of the muscle) associated with use of the superior gluteal vessel. The purpose of this article is to present a modification of an approach to the gluteal vessel to alleviate technical difficulties and minimize muscle injury. From August of 1997 to January of 1999, six patients received microvascular transfer of the latissimus dorsi muscle or myocutaneous flap to the sacral (4) and ischial (2) regions. The causes of defects were tumor (1), trauma (1), and pressure sores (4). A muscle-splitting approach was used on the superior gluteal vessel and was later applied to the inferior gluteal vessel. The gluteus maximus muscle was split as needed in the direction of its fibers, and the perforators were dissected down to the superior or inferior gluteal artery and vein deep into the muscle. The follow-up period ranged from 6 to 22 months, and all of the flaps survived with complete recovery of the lesion. The major drawbacks of using the superior and inferior gluteal vessels can be overcome with the muscle-splitting approach, which provides increased accessibility and additional length to the vascular pedicle while causing minimal injury to the muscle itself. It also proves to be an easy, safe, and reliable method of dissection. When free-tissue transfer to sacral, gluteal, and ischial regions is indicated, the muscle-splitting approach to the superior and inferior gluteal vessels is a recommended option in the selection of a recipient vessel.

Bone mineral content and bone metabolism in young adults with severe periodontitis

DEFF Research Database (Denmark)

Wowern von, N.; Westergaard, J.; Kollerup, G.

2001-01-01

Bone loss, bone markers, bone metabolism, bone mineral content, osteoporosis, severe periodontitis......Bone loss, bone markers, bone metabolism, bone mineral content, osteoporosis, severe periodontitis...

Reconstruction of segmental bone defect of long bones after tumor resection by devitalized tumor-bearing bone.

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Qu, Huayi; Guo, Wei; Yang, Rongli; Li, Dasen; Tang, Shun; Yang, Yi; Dong, Sen; Zang, Jie

2015-09-24

The reconstruction of an intercalary bone defect after a tumor resection of a long bone remains a challenge to orthopedic surgeons. Though several methods have been adopted to enhance the union of long segmental allografts or retrieved segmental autografts to the host bones, still more progresses are required to achieve a better union rate. Several methods have been adopted to devitalize tumor bone for recycling usage, and the results varied. We describe our experiences of using devitalized tumor-bearing bones for the repairing of segmental defects after tumor resection. Twenty-seven eligible patients treated from February 2004 to May 2012 were included. The segmental tumor bone (mean length, 14 cm) was resected, and then devitalized in 20% sterile saline at 65 °C for 30 min after the tumor tissue was removed. The devitalized bone was implanted back into the defect by using nails or plates. Complete healing of 50 osteotomy ends was achieved at a median time of 11 months (interquartile range (IQR) 9-13 months). Major complications included bone nonunion in four bone junctions (7.4%), devitalized bone fracture in one patient (3.7%), deep infection in three patients (11.1%), and fixation failure in two patients (7.4%). The bone union rates at 1 and 2 years were 74.1 and 92.6%, respectively. The average functional score according to the Musculoskeletal Tumor Society (MSTS) 93 scoring system was 93 % (IQR 80-96.7%). Incubation in 20% sterile saline at 65 °C for 30 min is an effective method of devitalization of tumor-bearing bone. The retrieved bone graft may provide as a less expensive alternative for limb salvage. The structural bone and the preserved osteoinductivity of protein may improve bone union.

Sirenomelia (Mermaid baby).

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Akhtar, Jamshed; Shaikh, Muhammad Ali; Saleem, Nasir; Taqvi, Syed Raees; Jehan, Yaqoot; Batool, Tayyaba; Zameer, Naima; Mirza, Farhat

2005-11-01

Sirenomelia is a rare anomaly that rarely occurs as an isolated lesion. Several theories have been proposed regarding the etiopathogenesis. In this communication, we report a case of sirenomelia. Our patient was referred to hospital at the age of four hours. On examination, fusion of both lower limbs with hook shaped appendage, attached distally, absent genitalia and absent anal orifice was found. Spine was deficient in sacral region. Upper torso looked normal. Baby also had frothing from mouth. Abdomen was non-distended. Feeding tube no.10 was tried to pass through mouth, which got obstructed at the level of upper esophagus that suggested oesophageal atresia. The skeletogram revealed absence of pelvic bones, sacral agenesis, absent fibulae and fracture of both femora. The patient died at the age of 12 hours.

Spinal CT scan, 2

International Nuclear Information System (INIS)

Nakagawa, Hiroshi

1982-01-01

Plain CT described fairly accurately the anatomy and lesions of the lumbar and sacral spines on their transverse sections. Since hernia of the intervertebral disc could be directly diagnosed by CT, indications of myelography could be restricted. Spinal-canal stenosis of the lumbar spine occurs because of various factors, and CT not only demonstrated the accurate size and morphology of bony canals, but also elucidated thickening of the joints and yellow ligament. CT was also useful for the diagnosis of tumors in the lumbar and sacral spines, visualizing the images of bone changes and soft tissues on the trasverse sections. But the diagnosis of intradural tumors required myelography and metrizamide CT. CT has become important for the diagnosis of spinal and spinal-cord diseases and for selection of the route of surgical arrival. (Chiba, N.)

Is cortical bone hip? What determines cortical bone properties?

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Epstein, Sol

2007-07-01

Increased bone turnover may produce a disturbance in bone structure which may result in fracture. In cortical bone, both reduction in turnover and increase in hip bone mineral density (BMD) may be necessary to decrease hip fracture risk and may require relatively greater proportionate changes than for trabecular bone. It should also be noted that increased porosity produces disproportionate reduction in bone strength, and studies have shown that increased cortical porosity and decreased cortical thickness are associated with hip fracture. Continued studies for determining the causes of bone strength and deterioration show distinct promise. Osteocyte viability has been observed to be an indicator of bone strength, with viability as the result of maintaining physiological levels of loading and osteocyte apoptosis as the result of a decrease in loading. Osteocyte apoptosis and decrease are major factors in the bone loss and fracture associated with aging. Both the osteocyte and periosteal cell layer are assuming greater importance in the process of maintaining skeletal integrity as our knowledge of these cells expand, as well being a target for pharmacological agents to reduce fracture especially in cortical bone. The bisphosphonate alendronate has been seen to have a positive effect on cortical bone by allowing customary periosteal growth, while reducing the rate of endocortical bone remodeling and slowing bone loss from the endocortical surface. Risedronate treatment effects were attributed to decrease in bone resorption and thus a decrease in fracture risk. Ibandronate has been seen to increase BMD as the spine and femur as well as a reduced incidence of new vertebral fractures and non vertebral on subset post hoc analysis. And treatment with the anabolic agent PTH(1-34) documented modeling and remodelling of quiescent and active bone surfaces. Receptor activator of nuclear factor kappa B ligand (RANKL) plays a key role in bone destruction, and the human monoclonal

Bone position emission tomography with or without CT Is more accurate than bone scan for detection of bone metastasis

International Nuclear Information System (INIS)

Lee, Soo Jin; Lee, Wom Woo; Kim, Sang Eun

2013-01-01

Na1 8F bone positron emission tomography (bone PET) is a new imaging modality which is useful for the evaluation of bone diseases. Here, we compared the diagnostic accuracies between bone PET and bone scan for the detection of bone metastasis (BM). Sixteen cancer patients (M:F = 10:6, mean age = 60 ± 12 years) who underwent both bone PET and bone scan were analyzed. Bone PET was conducted 30 minutes after the injection of 370 MBq Na1 8F , and a bone scan was performed 3 hours after the injection of 1295 MBq 9 9mT c-hydroxymethylene diphosphonate. In the patient-based analysis (8 patients with BM and 8 without BM), the sensitivities of bone PET (100% 8/8) and bone scan (87.5% = 7/8) were not significantly different (p > 0.05), whereas the specificity of bone PET (87.5% = 7/8) was significantly greater than that of the bone scan (25% = 2/8) (p 8F bone PET is more accurate than bone scan for BM evaluation.

Porous surface modified bioactive bone cement for enhanced bone bonding.

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Qiang He

Full Text Available Polymethylmethacrylate bone cement cannot provide an adhesive chemical bonding to form a stable cement-bone interface. Bioactive bone cements show bone bonding ability, but their clinical application is limited because bone resorption is observed after implantation. Porous polymethylmethacrylate can be achieved with the addition of carboxymethylcellulose, alginate and gelatin microparticles to promote bone ingrowth, but the mechanical properties are too low to be used in orthopedic applications. Bone ingrowth into cement could decrease the possibility of bone resorption and promote the formation of a stable interface. However, scarce literature is reported on bioactive bone cements that allow bone ingrowth. In this paper, we reported a porous surface modified bioactive bone cement with desired mechanical properties, which could allow for bone ingrowth.The porous surface modified bioactive bone cement was evaluated to determine its handling characteristics, mechanical properties and behavior in a simulated body fluid. The in vitro cellular responses of the samples were also investigated in terms of cell attachment, proliferation, and osteoblastic differentiation. Furthermore, bone ingrowth was examined in a rabbit femoral condyle defect model by using micro-CT imaging and histological analysis. The strength of the implant-bone interface was also investigated by push-out tests.The modified bone cement with a low content of bioactive fillers resulted in proper handling characteristics and adequate mechanical properties, but slightly affected its bioactivity. Moreover, the degree of attachment, proliferation and osteogenic differentiation of preosteoblast cells was also increased. The results of the push-out test revealed that higher interfacial bonding strength was achieved with the modified bone cement because of the formation of the apatite layer and the osseointegration after implantation in the bony defect.Our findings suggested a new bioactive

An economic appraisal of the Australian Medical Sheepskin for the prevention of sacral pressure ulcers from a nursing home perspective

Science.gov (United States)

2010-01-01

Background Many devices are in use to prevent pressure ulcers, but from most little is known about their effects and costs. One such preventive device is the Australian Medical Sheepskin that has been proven effective in three randomized trials. In this study the costs and savings from the use of the Australian Medical Sheepskin were investigated from the perspective of a nursing home. Methods An economic model was developed in which monetary costs and monetary savings in respect of the sheepskin were balanced against each other. The model was applied to a fictional (Dutch) nursing home with 100 beds for rehabilitation patients and a time horizon of one year. Input variables for the model consisted of investment costs for using the sheepskin (purchase and laundry), and savings through the prevented cases of pressure ulcers. The input values for the investment costs and for the effectiveness were empirically based on a trial with newly admitted rehabilitation patients from eight nursing homes. The input values for the costs of pressure ulcer treatment were estimated by means of four different approaches. Results Investment costs for using the Australian Medical Sheepskin were larger than the monetary savings obtained by preventing pressure ulcers. Use of the Australian Medical Sheepskin involves an additional cost of approximately €2 per patient per day. Preventing one case of a sacral pressure ulcer by means of the Australian Medical Sheepskin involves an investment of €2,974 when the sheepskin is given to all patients. When the sheepskin is selectively used for more critical patients only, the investment to prevent one case of sacral pressure ulcers decreases to €2,479 (pressure ulcer risk patients) or €1,847 (ADL-severely impaired patients). The factors with the strongest influence on the balance are the frequency of changing the sheepskin and the costs of washing related to this. The economic model was hampered by considerable uncertainty in the

An economic appraisal of the Australian Medical Sheepskin for the prevention of sacral pressure ulcers from a nursing home perspective

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Achterberg Wilco

2010-08-01

Full Text Available Abstract Background Many devices are in use to prevent pressure ulcers, but from most little is known about their effects and costs. One such preventive device is the Australian Medical Sheepskin that has been proven effective in three randomized trials. In this study the costs and savings from the use of the Australian Medical Sheepskin were investigated from the perspective of a nursing home. Methods An economic model was developed in which monetary costs and monetary savings in respect of the sheepskin were balanced against each other. The model was applied to a fictional (Dutch nursing home with 100 beds for rehabilitation patients and a time horizon of one year. Input variables for the model consisted of investment costs for using the sheepskin (purchase and laundry, and savings through the prevented cases of pressure ulcers. The input values for the investment costs and for the effectiveness were empirically based on a trial with newly admitted rehabilitation patients from eight nursing homes. The input values for the costs of pressure ulcer treatment were estimated by means of four different approaches. Results Investment costs for using the Australian Medical Sheepskin were larger than the monetary savings obtained by preventing pressure ulcers. Use of the Australian Medical Sheepskin involves an additional cost of approximately €2 per patient per day. Preventing one case of a sacral pressure ulcer by means of the Australian Medical Sheepskin involves an investment of €2,974 when the sheepskin is given to all patients. When the sheepskin is selectively used for more critical patients only, the investment to prevent one case of sacral pressure ulcers decreases to €2,479 (pressure ulcer risk patients or €1,847 (ADL-severely impaired patients. The factors with the strongest influence on the balance are the frequency of changing the sheepskin and the costs of washing related to this. The economic model was hampered by considerable

Posttranslational heterogeneity of bone alkaline phosphatase in metabolic bone disease.

Science.gov (United States)

Langlois, M R; Delanghe, J R; Kaufman, J M; De Buyzere, M L; Van Hoecke, M J; Leroux-Roels, G G

1994-09-01

Bone alkaline phosphatase is a marker of osteoblast activity. In order to study the posttranscriptional modification (glycosylation) of bone alkaline phosphatase in bone disease, we investigated the relationship between mass and catalytic activity of bone alkaline phosphatase in patients with osteoporosis and hyperthyroidism. Serum bone alkaline phosphatase activity was measured after lectin precipitation using the Iso-ALP test kit. Mass concentration of bone alkaline phosphatase was determined with an immunoradiometric assay (Tandem-R Ostase). In general, serum bone alkaline phosphatase mass and activity concentration correlated well. The activity : mass ratio of bone alkaline phosphatase was low in hyperthyroidism. Activation energy of the reaction catalysed by bone alkaline phosphatase was high in osteoporosis and in hyperthyroidism. Experiments with neuraminidase digestion further demonstrated that the thermodynamic heterogeneity of bone alkaline phosphatase can be explained by a different glycosylation of the enzyme.

[Electrocoagulation on a fragment of anterior abdominal rectal muscle for the control of presacral bleeding during rectal resection].

Science.gov (United States)

Casal Núñez, José Enrique; Martínez, María Teresa García; Poblador, Alejandro Ruano

2012-03-01

Presacral venous haemorrhage during rectal movement is low, but is often massive, and even fatal. Our objective is the "in vitro" determination of the results of electrocoagulation applied to a fragment of muscle on the sacral bone surface during rectal resection due to a malignant neoplasm of the rectum. Single-pole coagulation was applied "in vitro" with the selector at maximum power on a 2×2 cms muscle fragment, applied to the anterior side of the IV sacral vertebra until reaching boiling point. The method was used on 6 patients with bleeding of the presacral venous plexus. In the "in vitro" study, boiling point was reached in 90 seconds from applying the single-pole current on the muscle fragment. Electrocoagulation was applied to a 2×2 cm rectal muscle fragment in 6 patients with presacral venous haemorrhage, using pressure on the surface of the presacral bone, with the stopping of the bleeding being achieved in all cases. The use of indirect electrocoagulation on a fragment of the rectus abdominis muscle is a straightforward and highly effective technique for controlling presacral venous haemorrhage. Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.

Bone banking.

Science.gov (United States)

Howard, W

1999-04-01

The use of human organs and tissues for transplantation in Australia has increased significantly over the past 30 years. In 1997, the Australian Coordinating Committee on Organ Registries and Donation (ACCORD) reported a total number of 190 organ donors, 636 corneal donors and 1509 bone donors Australia wide. Of the 1509 bone donations, 143 came from cadaveric sources and 1366 were made by living donors. Bone transplantation is not as widely recognised as solid organ or corneal transplantation. Due to improved technology and surgical skills, the demand for bone transplantation has increased markedly. This Clinical Update will provide an overview of the physiological aspects of bone transplantation and explore bone banking, a key step in the complex and critical process of bone transplantation.

Using Micro-CT Derived Bone Microarchitecture to Analyze Bone Stiffness - A Case Study on Osteoporosis Rat Bone

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Yuchin eWu

2015-05-01

Full Text Available Micro-computed tomography images can be used to quantitatively represent bone geometry through a range of computed attenuation-based parameters. Nonetheless, those parameters remain indirect indices of bone micro-architectural strength and require further computational tools to interpret bone structural stiffness and potential for mechanical failure. Finite element analysis (FEA can be applied to measure trabecular bone stiffness and potentially predict the location of structural failure in preclinical animal models of osteoporosis, although that procedure from image segmentation of micro-CT derived bone geometry to FEA is often challenging and computationally expensive, resulting in failure of the model to build. Notably, the selection of resolution and threshold for bone segmentation are key steps that greatly affect computational complexity and validity. In the following study, we evaluated an approach whereby Micro-CT derived greyscale attenuation and segmentation data guided the selection of trabecular bone for analysis by FEA. We further correlated those FEA results to both two and three dimensional bone microarchitecture from sham and ovariectomized (OVX rats (n=10/group. A virtual cylinder of vertebral trabecular bone 40% in length from the caudal side was selected for FEA because micro-CT based image analysis indicated the largest differences in microarchitecture between the two groups resided there. Bone stiffness was calculated using FEA and statistically correlated with the three dimensional values of bone volume/tissue volume, bone mineral density, fractal dimension, trabecular separation and trabecular bone pattern factor. Our method simplified the process for the assessment of trabecular bone stiffness by FEA from Micro-CT images and highlighted the importance of bone microarchitecture in conferring significantly increased bone quality capable of resisting failure due to increased mechanical loading.

The usefulness of bone and bone-marrow scintigraphy in the detection of bone involvement in patients with multiple myeloma

International Nuclear Information System (INIS)

Otsuka, Nobuaki; Fukunaga, Masao; Sone, Teruki

1986-01-01

We used a combination of bone and bone-marrow scintigraphy to evaluate bone involvement in 15 patients with multiple myeloma (7 in untreated group and 8 in chemotherapy group). Of the 3 cases in untreated group whose 99m Tc-methylene diphosphonate (MDP) bone scans showed no abnormality, one had abnormal 99m Tc-suffer colloid bone-marrow scintigraphy. In other 4 cases of untreated group whose bone scan showed cold defects, bone-marrow scintigraphy delineated clearly the areas of tumor-cell invasion. On the other hand, in all chemotherapy cases, multiple hot spots were observed on bone scintigram, but on bone-marrow scintigram abnormalities were not recognized. In conclusion, the combination scintigraphy of bone and bone-marrow was a useful method in evluating bone involvement in patients with multiple myeloma. (author)

Influence of Screw Length and Bone Thickness on the Stability of Temporary Implants

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Daniel Jogaib Fernandes

2015-09-01

Full Text Available The purpose of this work was to study the influence of screw length and bone thickness on the stability of temporary implants. A total of 96 self-drilling temporary screws with two different lengths were inserted into polyurethane blocks (n = 66, bovine femurs (n = 18 and rabbit tibia (n = 12 with different cortical thicknesses (1 to 8 mm. Screws insertion in polyurethane blocks was assisted by a universal testing machine, torque peaks were collected by a digital torquemeter and bone thickness was monitored by micro-CT. The results showed that the insertion torque was significantly increased with the thickness of cortical bone from polyurethane (p < 0.0001, bovine (p = 0.0035 and rabbit (p < 0.05 sources. Cancellous bone improved significantly the mechanical implant stability. Insertion torque and insertion strength was successfully moduled by equations, based on the cortical/cancellous bone behavior. Based on the results, insertion torque and bone strength can be estimate in order to prevent failure of the cortical layer during temporary screw placement. The stability provided by a cortical thickness of 2 or 1 mm coupled to cancellous bone was deemed sufficient for temporary implants stability.

Bone marrow aspiration

Science.gov (United States)

Iliac crest tap; Sternal tap; Leukemia - bone marrow aspiration; Aplastic anemia - bone marrow aspiration; Myelodysplastic syndrome - bone marrow aspiration; Thrombocytopenia - bone marrow aspiration; Myelofibrosis - bone marrow aspiration

Depot injectable biodegradable nanoparticles loaded with recombinant human bone morphogenetic protein-2: preparation, characterization, and in vivo evaluation

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Hassan AH

2015-07-01

Full Text Available Ali Habiballah Hassan,1 Khaled Mohamed Hosny,2,3 Zuahir A Murshid,1 Adel Alhadlaq,4 Ahmed Alyamani,5 Ghada Naguib6 1Department of Orthodontics, Faculty of Dentistry, 2Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni Suef University, Beni Suef, Egypt; 4Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, 5Department of Oral Surgery, 6Department of Restorative Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia Objective: The aim of this study is to utilize the biocompatibility characteristics of biodegradable polymers, viz, poly lactide-co-glycolide (PLGA and polycaprolactone (PCL, to prepare sustained-release injectable nanoparticles (NPs of bone morphogenetic protein-2 (BMP-2 for the repair of alveolar bone defects in rabbits. The influence of formulation parameters on the functional characteristics of the prepared NPs was studied to develop a new noninvasive injectable recombinant human BMP-2 (rhBMP-2 containing grafting material for the repair of alveolar bone clefts.Materials and methods: BMP-2 NPs were prepared using a water-in-oil-in-water double-emulsion solvent evaporation/extraction method. The influence of molar ratio of PLGA to PCL on a suitable particle size, encapsulation efficiency, and sustained drug release was studied. Critical size alveolar defects were created in the maxilla of 24 New Zealand rabbits divided into three groups, one of them treated with 5 µg/kg of rhBMP-2 NP formulations.Results: The results found that NPs formula prepared using blend of PLGA and PCL in 4:2 (w/w ratio showed the best sustained-release pattern with lower initial burst, and showed up to 62.7% yield, 64.5% encapsulation efficiency, 127 nm size, and more than 90% in vitro release. So, this formula was selected for

Normal bone mineral content but unfavourable muscle/fat ratio in Klinefelter syndrome

DEFF Research Database (Denmark)

Aksglaede, L.; Mølgaard, Christian; Skakkebaek, N.E.

2008-01-01

OBJECTIVE: To evaluate body composition and bone mineral content (BMC) in children and adolescents with Klinefelter syndrome (KS). DESIGN: Retrospective cross-sectional study. SETTING: Tertiary endocrine clinic at the University Hospital, Copenhagen. PATIENTS: Eighteen untreated boys with KS...

3D artificial bones for bone repair prepared by computed tomography-guided fused deposition modeling for bone repair.

Science.gov (United States)

Xu, Ning; Ye, Xiaojian; Wei, Daixu; Zhong, Jian; Chen, Yuyun; Xu, Guohua; He, Dannong

2014-09-10

The medical community has expressed significant interest in the development of new types of artificial bones that mimic natural bones. In this study, computed tomography (CT)-guided fused deposition modeling (FDM) was employed to fabricate polycaprolactone (PCL)/hydroxyapatite (HA) and PCL 3D artificial bones to mimic natural goat femurs. The in vitro mechanical properties, in vitro cell biocompatibility, and in vivo performance of the artificial bones in a long load-bearing goat femur bone segmental defect model were studied. All of the results indicate that CT-guided FDM is a simple, convenient, relatively low-cost method that is suitable for fabricating natural bonelike artificial bones. Moreover, PCL/HA 3D artificial bones prepared by CT-guided FDM have more close mechanics to natural bone, good in vitro cell biocompatibility, biodegradation ability, and appropriate in vivo new bone formation ability. Therefore, PCL/HA 3D artificial bones could be potentially be of use in the treatment of patients with clinical bone defects.

Biology of Bone Tissue: Structure, Function, and Factors That Influence Bone Cells.

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Florencio-Silva, Rinaldo; Sasso, Gisela Rodrigues da Silva; Sasso-Cerri, Estela; Simões, Manuel Jesus; Cerri, Paulo Sérgio

2015-01-01

Bone tissue is continuously remodeled through the concerted actions of bone cells, which include bone resorption by osteoclasts and bone formation by osteoblasts, whereas osteocytes act as mechanosensors and orchestrators of the bone remodeling process. This process is under the control of local (e.g., growth factors and cytokines) and systemic (e.g., calcitonin and estrogens) factors that all together contribute for bone homeostasis. An imbalance between bone resorption and formation can result in bone diseases including osteoporosis. Recently, it has been recognized that, during bone remodeling, there are an intricate communication among bone cells. For instance, the coupling from bone resorption to bone formation is achieved by interaction between osteoclasts and osteoblasts. Moreover, osteocytes produce factors that influence osteoblast and osteoclast activities, whereas osteocyte apoptosis is followed by osteoclastic bone resorption. The increasing knowledge about the structure and functions of bone cells contributed to a better understanding of bone biology. It has been suggested that there is a complex communication between bone cells and other organs, indicating the dynamic nature of bone tissue. In this review, we discuss the current data about the structure and functions of bone cells and the factors that influence bone remodeling.

Radiotherapy Results of Breast Cancer Patients with Metastatic Bone Disease

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Ahmet Dirier

2006-01-01

Full Text Available Breast cancer patients with bone metastasis who had admitted to Dicle University Department of Radiation Oncology for palliative radiation therapy between September 2001 and December 2003 were evaluated. There were 31 patients (26 female, 5 male. Median age was 43 years (range 23-79. Histopathological subtypes were infiltrating ductal carcinoma (88%, tubulolobuler carcinoma (6% and inflammatory carcinoma (6%. Loci of bone metastasis were vertebra only in twelve patients (39%, non-vertebral bones only in 8 patients (26% and both vertebral and nonvertebral bones in 11 patients (35%. Two patients had refused radiotherapy. Radiation doses were 3000 cGy with 10 fractions in 15 patients, 2000 cGy with 5 fractions in 6 patients and 800 cGy single fraction in eight patients. Complete palliation of pain was achieved in 18 patients (62% and partial palliation was achieved in 11 patients (38%. Treatment related toxicity was grade I-II dermatitis. In conclusion; same respons rates in terms of palliation can be achieved in the three radiotherapy schedules.

Kidney transplantation restored uncoupled bone turnover in end-stage renal disease.

Science.gov (United States)

Kawarazaki, Hiroo; Shibagaki, Yugo; Kido, Ryo; Nakajima, Ichiro; Fuchinoue, Shohei; Ando, Katsuyuki; Fujita, Toshiro; Fukagawa, Masafumi; Teraoka, Satoshi; Fukumoto, Seiji

2012-07-01

While kidney transplantation (KTx) reverses many disorders associated with end-stage renal disease (ESRD), patients who have received KTx often have chronic kidney disease and bone and mineral disorder (CKD-MBD). However, it is unknown how bone metabolism changes by KTx. Living donor-KTx recipients (n = 34) at Tokyo Women's Medical University were prospectively recruited and the levels of bone-specific alkaline phosphatase (BAP) and serum cross-linked N-telopeptides of Type 1 collagen (NTX) were measured before, 6 and 12 months after transplantation. Before KTx, serum BAP was within the reference range in more than half of patients while NTX was high in most patients. Serum NTX was higher in patients with longer dialysis durations compared to that with shorter durations before KTx. However, there was no difference in serum BAP between these patients. After KTx, BAP increased while NTX decreased along with the decline of PTH. In addition, the numbers of patients who showed high BAP and NTX were comparable after KTx. These results suggest that bone formation is suppressed and uncoupled with bone resorption in patients with ESRD and this uncoupling is restored by KTx. Further studies are necessary to clarify the mechanism of bone uncoupling in patients with ESRD.

Osteoinductive peptide-functionalized nanofibers with highly ordered structure as biomimetic scaffolds for bone tissue engineering

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Gao X

2015-11-01

Full Text Available Xiang Gao,1,2,* Xiaohong Zhang,3,* Jinlin Song,1,2 Xiao Xu,4 Anxiu Xu,1 Mengke Wang,4 Bingwu Xie,1 Enyi Huang,2 Feng Deng,1,2 Shicheng Wei2–41College of Stomatology, 2Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Medical University, Chongqing, 3Center for Biomedical Materials and Tissue Engineering, Academy for Advanced Interdisciplinary Studies, Peking University, 4Department of Oral and Maxillofacial Surgery, Laboratory of Interdisciplinary Studies, Peking University School and Hospital of Stomatology, Beijing, People’s Republic of China*These authors contributed equally to this workAbstract: The construction of functional biomimetic scaffolds that recapitulate the topographical and biochemical features of bone tissue extracellular matrix is now of topical interest in bone tissue engineering. In this study, a novel surface-functionalized electrospun polycaprolactone (PCL nanofiber scaffold with highly ordered structure was developed to simulate the critical features of native bone tissue via a single step of catechol chemistry. Specially, under slightly alkaline aqueous solution, polydopamine (pDA was coated on the surface of aligned PCL nanofibers after electrospinning, followed by covalent immobilization of bone morphogenetic protein-7-derived peptides onto the pDA-coated nanofiber surface. Contact angle measurement, Raman spectroscopy, and X-ray photoelectron spectroscopy confirmed the presence of pDA and peptides on PCL nanofiber surface. Our results demonstrated that surface modification with osteoinductive peptides could improve cytocompatibility of nanofibers in terms of cell adhesion, spreading, and proliferation. Most importantly, Alizarin Red S staining, quantitative real-time polymerase chain reaction, immunostaining, and Western blot revealed that human mesenchymal stem cells cultured on aligned nanofibers with osteoinductive peptides exhibited enhanced osteogenic differentiation potential than

Evaluation of zinc-doped mesoporous hydroxyapatite microspheres for the construction of a novel biomimetic scaffold optimized for bone augmentation

Directory of Open Access Journals (Sweden)

Yu W

2017-03-01

Full Text Available Weilin Yu,1,* Tuan-Wei Sun,2,3,* Chao Qi,2,3 Zhenyu Ding,1 Huakun Zhao,1 Shichang Zhao,1 Zhongmin Shi,1 Ying-Jie Zhu,2,3 Daoyun Chen,1 Yaohua He1,4 1Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 2State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 3University of Chinese Academy of Sciences, Beijing, 4School of Biomedical Engineering, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China *These authors contributed equally to this work Abstract: Biomaterials with high osteogenic activity are desirable for sufficient healing of bone defects resulting from trauma, tumor, infection, and congenital abnormalities. Synthetic materials mimicking the structure and composition of human trabecular bone are of considerable potential in bone augmentation. In the present study, a zinc (Zn-doped mesoporous hydroxyapatite microspheres (Zn-MHMs/collagen scaffold (Zn-MHMs/Coll was developed through a lyophilization fabrication process and designed to mimic the trabecular bone. The Zn-MHMs were synthesized through a microwave-hydrothermal method by using creatine phosphate as an organic phosphorus source. Zn-MHMs that consist of hydroxyapatite nanosheets showed relatively uniform spherical morphology, mesoporous hollow structure, high specific surface area, and homogeneous Zn distribution. They were additionally investigated as a drug nanocarrier, which was efficient in drug delivery and presented a pH-responsive drug release behavior. Furthermore, they were incorporated into the collagen matrix to construct a biomimetic scaffold optimized for bone tissue regeneration. The Zn-MHMs/Coll scaffolds showed an interconnected pore structure in the range of 100–300 µm and a sustained release of Zn ions. More importantly, the Zn-MHMs/Coll scaffolds could enhance the osteogenic differentiation

Prevalence of bone and soft tissue tumors.

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Yücetürk, Güven; Sabah, Dündar; Keçeci, Burçin; Kara, Ahmet Duran; Yalçinkaya, Selçuk

2011-01-01

Multidisciplinary approach is a necessity for the appropriate diagnosis and treatment of bone and soft tissue tumors. The Ege University Musculoskeletal Tumor Council offers consultation services to other hospitals in the Aegean region. Since 1988 the Council has met weekly and spent approximately 1,500 hours evaluating almost 6,000 patients with suspected skeletal system tumors. Our objective was to present the data obtained from this patient group. A total of 5,658 patients, suspected to have a musculoskeletal tumor, were evaluated retrospectively. Multiple records of the patients due to multiple attendance to the Council were excluded. The prevalance of the bone and soft tissue tumors in these patients were analysed. Malignant mesenchymal tumors accounted for 39.7% of the total patients, benign tumors for 17%, tumor-like lesions for 17.8% and metastatic carsinomas for 8.6%. Malignant bone tumors were 50.2% and malignant soft tissue tumors were 49.8% of all the sarcomas. Among the malignant bone tumors the most common was osteosarcomas at a rate of 33.6%, followed by Ewing-PNET at 25.5%, chondrosarcomas at 19.4% and haematopoietic tumors at 17.6%. Pleomorphic sarcomas (24.5%), liposarcoma (16.4%), synovial sarcoma (13%) and undifferential sarcomas (8.8%) were the most common types of malignant sof tissue tumors. Benign soft tissue tumors (48%), benign cartilage tumors (28%), giant cell tumor (15%) and osteogenic tumors (9%) were found among the benign tumors. Hemangioma, lipoma, agressive fibromatosis, enchondroma, solitary chondroma and osteoid osteoma were the most common tumors in their groups. Lung (27%), breast (24%), gastrointestinal system (10.5%) and kidney (8.2%) carcinomas were the most common primary sites of the bone metastasis. Turkey still lacks a comprehensive series indicating the incidence and diagnostic distribution of bone and soft tissue tumors. The presented data would add to our knowledge on the specific rates of the bone and soft tissue

Glucocorticoid-Induced Avascular Bone Necrosis: Diagnosis and Management

Science.gov (United States)

Chan, KL; Mok, CC

2012-01-01

Glucocorticoid use is one of the most important causes of avascular bone necrosis (AVN). The pathogenesis of glucocorticoid-induced AVN is not fully understood but postulated mechanisms include fat hypertrophy, fat emboli and intravascular coagulation that cause impedance of blood supply to the bones. Data regarding the relationship between AVN and dosage, route of administration and treatment duration of glucocorticoids are conflicting, with some studies demonstrating the cumulative dose of glucocorticoid being the most important determining factor. Early recognition of this complication is essential as the prognosis is affected by the stage of the disease. Currently, there is no consensus on whether universal screening of asymptomatic AVN should be performed for long-term glucocorticoid users. A high index of suspicion should be exhibited for bone and joint pain at typical sites. Magnetic resonance imaging (MRI) or bone scintigraphy is more sensitive than plain radiograph for diagnosing early-stage AVN. Conservative management of AVN includes rest and reduction of weight bearing. Minimization of glucocorticoid dose or a complete withdrawal of the drug should be considered if the underlying conditions allow. The efficacy of bisphosphonates in reducing the rate of collapse of femoral head in AVN is controversial. Surgical therapy of AVN includes core decompression, osteotomy, bone grafting and joint replacement. Recent advances in the treatment of AVN include the use of tantalum rod and the development of more wear resistant bearing surface in hip arthroplasty. PMID:23115605

Glucocorticoid-induced avascular bone necrosis: diagnosis and management.

Science.gov (United States)

Chan, K L; Mok, C C

2012-01-01

Glucocorticoid use is one of the most important causes of avascular bone necrosis (AVN). The pathogenesis of glucocorticoid-induced AVN is not fully understood but postulated mechanisms include fat hypertrophy, fat emboli and intravascular coagulation that cause impedance of blood supply to the bones. Data regarding the relationship between AVN and dosage, route of administration and treatment duration of glucocorticoids are conflicting, with some studies demonstrating the cumulative dose of glucocorticoid being the most important determining factor. Early recognition of this complication is essential as the prognosis is affected by the stage of the disease. Currently, there is no consensus on whether universal screening of asymptomatic AVN should be performed for long-term glucocorticoid users. A high index of suspicion should be exhibited for bone and joint pain at typical sites. Magnetic resonance imaging (MRI) or bone scintigraphy is more sensitive than plain radiograph for diagnosing early-stage AVN. Conservative management of AVN includes rest and reduction of weight bearing. Minimization of glucocorticoid dose or a complete withdrawal of the drug should be considered if the underlying conditions allow. The efficacy of bisphosphonates in reducing the rate of collapse of femoral head in AVN is controversial. Surgical therapy of AVN includes core decompression, osteotomy, bone grafting and joint replacement. Recent advances in the treatment of AVN include the use of tantalum rod and the development of more wear resistant bearing surface in hip arthroplasty.

Skeletal development of the hand and wrist: digital bone age companion - a suitable alternative to the Greulich and Pyle atlas for bone age assessment?

International Nuclear Information System (INIS)

Bunch, Paul M.; Altes, Talissa A.; McIlhenny, Joan; Gaskin, Cree M.; Patrie, James

2017-01-01

To assess reader performance and subjective workflow experience when reporting bone age studies with a digital bone age reference as compared to the Greulich and Pyle atlas (G and P). We hypothesized that pediatric radiologists would achieve equivalent results with each method while digital workflow would improve speed, experience, and reporting quality. IRB approval was obtained for this HIPAA-compliant study. Two pediatric radiologists performed research interpretations of bone age studies randomized to either the digital (Digital Bone Age Companion, Oxford University Press) or G and P method, generating reports to mimic clinical workflow. Bone age standard selection, interpretation-reporting time, and user preferences were recorded. Reports were reviewed for typographical or speech recognition errors. Comparisons of agreement were conducted by way of Fisher's exact tests. Interpretation-reporting times were analyzed on the natural logarithmic scale via a linear mixed model and transformed to the geometric mean. Subjective workflow experience was compared with an exact binomial test. Report errors were compared via a paired random permutation test. There was no difference in bone age determination between atlases (p = 0.495). The interpretation-reporting time (p < 0.001) was significantly faster with the digital method. The faculty indicated preference for the digital atlas (p < 0.001). Signed reports had fewer errors with the digital atlas (p < 0.001). Bone age study interpretations performed with the digital method were similar to those performed with the Greulich and Pyle atlas. The digital atlas saved time, improved workflow experience, and reduced reporting errors relative to the Greulich and Pyle atlas when integrated into electronic workflow. (orig.)

Differential diagnosis of metastases in bone scans: chemotherapy induced bone necrosis

International Nuclear Information System (INIS)

Reuland, P.

1999-01-01

Aim: Influenced by the incorrect diagnosis of a bone metastasis caused by bone necrosis we evaluated reasons and frequency of bone necrosis in patients referred for bone scanning in follow-up of tumors. Methods: Bone scans performed within two years on patients with primary bone tumors or tumors metastatic to bone were reviewed in respect to the final diagnosis bone necrosis. Results: We found the cases of three young patients who presented the appearance of hot spots on bone scintigrams which were finally diagnosed as bone necrosis. In two cases the diagnosis was based on histological findings, in one case the diagnosis was made evident by follow-up. All the three patients had been treated by chemotherapy and presented no other reason for the development of bone necrosis. Enhanced tracer uptake in all sites decreased within eight weeks up to two years without therapy. Conclusion: Single and multiple hot spots after chemotherapy may be originated by bone necrosis but mimikry metastases. (orig.) [de

Space Maintenance and New Bone Formation with Polyurethane Biocomposites in a Canine Saddle Defect

Science.gov (United States)

2014-05-01

Vanderbilt University, Nashville, TN 2. Medtronic Spinal and Biologics, Memphis, TN 3. US Army Institute of Surgical Research, Fort Sam Houston, TX...and 15% hydroxyapatite (HA) that is similar in mineral content to natural bone.3 45S5 Bioactive glass (BG) is a resorbable material that has been... used effectively in a variety of bone regeneration applications.4 In the present study, we investigated the ability of injectable PUR/MG and PUR/BG

Biology of Bone Tissue: Structure, Function, and Factors That Influence Bone Cells

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Rinaldo Florencio-Silva

2015-01-01

Full Text Available Bone tissue is continuously remodeled through the concerted actions of bone cells, which include bone resorption by osteoclasts and bone formation by osteoblasts, whereas osteocytes act as mechanosensors and orchestrators of the bone remodeling process. This process is under the control of local (e.g., growth factors and cytokines and systemic (e.g., calcitonin and estrogens factors that all together contribute for bone homeostasis. An imbalance between bone resorption and formation can result in bone diseases including osteoporosis. Recently, it has been recognized that, during bone remodeling, there are an intricate communication among bone cells. For instance, the coupling from bone resorption to bone formation is achieved by interaction between osteoclasts and osteoblasts. Moreover, osteocytes produce factors that influence osteoblast and osteoclast activities, whereas osteocyte apoptosis is followed by osteoclastic bone resorption. The increasing knowledge about the structure and functions of bone cells contributed to a better understanding of bone biology. It has been suggested that there is a complex communication between bone cells and other organs, indicating the dynamic nature of bone tissue. In this review, we discuss the current data about the structure and functions of bone cells and the factors that influence bone remodeling.

Treatment of active unicameral bone cysts with percutaneous injection of demineralized bone matrix and autogenous bone marrow.

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Rougraff, Bruce T; Kling, Thomas J

2002-06-01

The treatment of unicameral bone cysts varies from open bone-grafting procedures to percutaneous injection of corticosteroids or bone marrow. The purpose of this study was to evaluate the feasibility and effectiveness of percutaneous injection of a mixture of demineralized bone matrix and autogenous bone marrow for the treatment of simple bone cysts. Twenty-three patients with an active unicameral bone cyst were treated with trephination and injection of allogeneic demineralized bone matrix and autogenous bone marrow. The patients were followed for an average of fifty months (range, thirty to eighty-one months), at which time pain, function, and radiographic signs of resolution of the cyst were assessed. The average time until the patients had pain relief was five weeks, and the average time until the patients returned to full, unrestricted activities was six weeks. Bone-healing at the site of the injection was first seen radiographically at three to six months. No patient had a pathologic fracture during this early bone-healing stage. Cortical remodeling was seen radiographically by six to nine months, and after one year the response was usually complete, changing very little from then on. Five patients required a second injection because of recurrence of the cyst, and all five had a clinically and radiographically quiescent cyst after an average of thirty-six additional months of follow-up. Seven of the twenty-three patients had incomplete healing manifested by small, persistent radiolucent areas within the original cyst. None of these cysts increased in size or resulted in pain or fracture. Percutaneous injection of allogeneic demineralized bone matrix and autogenous bone marrow is an effective treatment for unicameral bone cysts.

Bone metastases from gastric cancer. Clinical evaluation on bone scintigram

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Seto, Mikito; Tonami, Norihisa; Koizumi, Kiyoshi; Sui, Osamu; Hisada, Kinichi [Kanazawa Univ. (Japan). School of Medicine

1983-07-01

We have studied bone scintigrams in 60 patients with gastric cancer. Of these 60 patients, bone metastases were found in 15 patients (25 %). There were no evidence of bone metastases in polypoid lesions, cancers of the antrum, carcinomas in situ, advanced cancers without invasion to serosa, cancer with N/sub 0/ or N/sub 1/ regional lymph node metastases, highly differentiated adenocarcinomas and papillary adenocarcinomas. On the contrary, high rates of bone metastases were seen in cancers of the corpus, advanced cancers with invasion to neighbouring structures and tubular adenocarcinomas. Of these 15 patients with bone metastasis, 3 patients showed very similar clinical features and the findings of ''diffuse bone metastases on bone scintigrams.'' Cancer of the antrum showed high rates of liver metastases, while cancers of the corpus showed high rates of bone metastases. Sixty percent of the patients with bone metastases did not have liver metastases and there seemed to be no significant relationship between liver metastases and bone metastases. From these results we suppose that non-portal tract through the vertebral venous plexus instead of portal tract may be the other route of bone metastases from gastric cancer.

Dose reduction of bone morphogenetic protein-2 for bone regeneration using a delivery system based on lyophilization with trehalose

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Zhang X

2018-01-01

Full Text Available Xiaochen Zhang,1,* Quan Yu,2,* Yan-an Wang,1 Jun Zhao2 1Department of Oral and Maxillofacial-Head and Neck Oncology, 2Department of Orthodontics, College of Stomatology, Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China *These authors contributed equally to this work Introduction: To induce sufficient new bone formation, high doses of bone morphogenetic protein-2 (BMP-2 are applied in regenerative medicine that often induce serious side effects. Therefore, improved treatment strategies are required. Here, we investigate whether the delivery of BMP-2 lyophilized in the presence of trehalose reduced the dose of BMP-2 required for bone regeneration. Materials and methods: A new growth factor delivery system was fabricated using BMP-2-loaded TiO2 nanotubes by lyophilization with trehalose (TiO2-Lyo-Tre-BMP-2. We measured BMP-2 release characteristics, bioactivity, and stability, and determined the effects on the osteogenic differentiation of bone marrow stromal cells in vitro. Additionally, we evaluated the ability of this formulation to regenerate new bone around implants in rat femur defects by micro-computed tomography (micro-CT, sequential fluorescent labelling, and histological analysis. Results: Compared with absorbed BMP-2-loaded TiO2 nanotubes (TiO2-BMP-2, TiO2-Lyo-Tre-BMP-2 exhibited sustained release, consistent bioactivity, and higher stability of BMP-2, and resulted in greater osteogenic differentiation of BMSCs. Eight weeks post-operation, TiO2-Lyo-Tre-BMP-2 nanotubes, with various dosages of BMP-2, regenerated larger amounts of new bone than TiO2-BMP-2 nanotubes. Conclusion: Our findings indicate that delivery of BMP-2 lyophilized with trehalose may be a promising method to reduce the dose of BMP-2 and avoid the associated side effects. Keywords: bone morphogenetic protein-2, dose reduction, delivery system, trehalose, lyophilization, TiO2 nanotubes, BMP-2, regenerative medicine, surface

Chronic Alcohol Abuse Leads to Low Bone Mass with No General Loss of Bone Structure or Bone Mechanical Strength

DEFF Research Database (Denmark)

Ulhøi, Maiken Parm; Meldgaard, Karoline; Steiniche, Torben

2017-01-01

Chronic alcohol abuse (CAA) has deleterious effects on skeletal health. This study examined the impact of CAA on bone with regard to bone density, structure, and strength. Bone specimens from 42 individuals with CAA and 42 individuals without alcohol abuse were obtained at autopsy. Dual-energy X......-ray absorptiometry (DEXA), compression testing, ashing, and bone histomorphometry were performed. Individuals with CAA had significantly lower bone mineral density (BMD) in the femoral neck and significantly lower bone volume demonstrated by thinner trabeculae, decreased extent of osteoid surfaces, and lower mean...... wall thickness of trabecular osteons compared to individuals without alcohol abuse. No significant difference was found for bone strength and structure. Conclusion: CAA leads to low bone mass due to a decrease in bone formation but with no destruction of bone architecture nor a decrease in bone...

Radionuclide bone image in growing and stable bone island

International Nuclear Information System (INIS)

Go, R.T.; El-Khoury, G.Y.; Iowa Univ., Iowa City; Wehbe, M.A.

1980-01-01

A normal radionuclide bone image can facilitate distinction between a bone island and significant pathologic processes, especially an osteoblastic metastasis. This distinction becomes more crucial when growth is detected in an isolated sclerotic bone lesion or if a relatively large sclerotic lesion is detected de novo in patients with a known neoplasm. This report presents three patients with isolated bone islands: two with interval growth, the other with a relatively large stable lesion; all showing a normal radionuclide bone image. (orig.) [de

Rapid prototyping for tissue-engineered bone scaffold by 3D printing and biocompatibility study.

Science.gov (United States)

He, Hui-Yu; Zhang, Jia-Yu; Mi, Xue; Hu, Yang; Gu, Xiao-Yu

2015-01-01

The prototyping of tissue-engineered bone scaffold (calcined goat spongy bone-biphasic ceramic composite/PVA gel) by 3D printing was performed, and the biocompatibility of the fabricated bone scaffold was studied. Pre-designed STL file was imported into the GXYZ303010-XYLE 3D printing system, and the tissue-engineered bone scaffold was fabricated by 3D printing using gel extrusion. Rabbit bone marrow stromal cells (BMSCs) were cultured in vitro and then inoculated to the sterilized bone scaffold obtained by 3D printing. The growth of rabbit BMSCs on the bone scaffold was observed under the scanning electron microscope (SEM). The effect of the tissue-engineered bone scaffold on the proliferation and differentiation of rabbit BMSCs using MTT assay. Universal testing machine was adopted to test the tensile strength of the bone scaffold. The leachate of the bone scaffold was prepared and injected into the New Zealand rabbits. Cytotoxicity test, acute toxicity test, pyrogenic test and intracutaneous stimulation test were performed to assess the biocompatibility of the bone scaffold. Bone scaffold manufactured by 3D printing had uniform pore size with the porosity of about 68.3%. The pores were well interconnected, and the bone scaffold showed excellent mechanical property. Rabbit BMSCs grew and proliferated on the surface of the bone scaffold after adherence. MTT assay indicated that the proliferation and differentiation of rabbit BMSCs on the bone scaffold did not differ significantly from that of the cells in the control. In vivo experiments proved that the bone scaffold fabricated by 3D printing had no acute toxicity, pyrogenic reaction or stimulation. Bone scaffold manufactured by 3D printing allows the rabbit BMSCs to adhere, grow and proliferate and exhibits excellent biomechanical property and high biocompatibility. 3D printing has a good application prospect in the prototyping of tissue-engineered bone scaffold.

Study of bone metastasis of cervical carcinoma by bone scintigraphy

Energy Technology Data Exchange (ETDEWEB)

Okamura, Shinsuke; Okamoto, Yoshiaki; Maeda, Takayoshi; Sano, Takashi; Ueki, Minoru; Sugimoto, Osamu; Sakata, Tsunehiko; Yamasaki, Kouichi; Akagi, Hiroaki

1985-04-01

In carrying out bone scintigraphy in 224 cases over the 5 years from June, 1978 to May, 1983 as a part of the post-treatment management of cervical carcinoma. Bone metastases were seen in 12.5% (28 cases) of the subjects, about 6% of the total post-treatment cases of cervical carcinoma in the corresponding period (466 cases). Bone metastases were seen in 9.3% (16/172) of post-operative cases, compared with 23.1% (12/52) of non-operative cases. Bone metastases were not seen in clinical stages Ia through IIa (49 cases) but were seen in IIb or higher stages. Bone metastasis rates by histological type, according to WHO classification, were 12.8% (26/203) in squamous cell carcinoma, 5.9% (1/17) in adenocarcinoma, and 25% (1/4) in adenosquamous carcinoma. Among the squamous cell carcinoma cases, small cell non-keratinizing type had the highest bone metastasis rate. Of 172 post-operative cases, 20.8% (11/53) of those with lymph node metastasis exhibited bone metastasis, higher than the 4.2% (5/119) in cases without lymph node metastasis. As to CPL classification, bone metastasis was seen more often in L type (18.8%) than C(0.0%) or P types (6.6%). Our risk classification of 168 cases demonstrated that bone metastasis was not seen in risk I group (74 cases), but was seen in 6.7% (1/17) of risk II group and in 19.0% (15/79) of risk III group. Twenty-eight cases with bone metastasis included 11 cases with local recurrence, 8 with pulmonary metastases, 4 with hepatic metastases and 4 with Virchow's lymphnode metastases. The 28 bone metastasis cases included 10 cases with multiple bone metastases and 5 with only a single bone metastasis. Most bone metastases were seen in the lumbar vertebrae and the pelvic bone. Post-operative cases had more distant metastases than non-operative cases. On diagnosis of bone metastases and 17 of the 28 patients had pain, 6 of the remaining 11 patients developing pain thereafter. (J.P.N.).

Aging, human immunodeficiency virus, and bone health

Directory of Open Access Journals (Sweden)

Kim C Mansky

2010-09-01

Full Text Available Kim C ManskyDivision of Orthodontics, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USAAbstract: Highly active antiretroviral therapy (HAART has had a profound impact on improving the long-term prognosis for individuals infected with human immunodeficiency virus (HIV. HAART has been available for close to two decades, and now a significant number of patients with access to HAART are over the age of 50 years. Many clinical studies have indicated that HIV infection, as well as components of HAART, can increase the risk in these individuals to a variety of noninfectious complications, including a risk to bone health. There is a significant need for detailed mechanistic analysis of the aging, HIV-infected population regarding the risk of HIV infection and therapy in order to maintain bone health. Insights from basic mechanistic studies will help to shed light on the role of HIV infection and the components of HAART that impact bone health, and will help in identifying preventative countermeasures, particularly for individuals 50 years of age and older.Keywords: osteopenia, osteomalacia, osteoporosis, bisphosphonates, tenofovir, osteoimmunology

Scintigraphic findings of bone and bone-marrow and determination of bone mineral density using photon absorptiometry in osteopetrosis

International Nuclear Information System (INIS)

Otsuka, Nobuaki; Fukunaga, Masao; Morita, Koichi

1988-01-01

On a 15-year-old girl with osteopetrosis, bone and bonemarrow scintigraphy were performed. Also, bone mineral density (BMD) with quantitative CT (QCT), single photon absorptiometry (SPA) and dual photon absorptiometry (DPA) were measured. On bone scintigraphy the diffusely increased skeletal uptake and relatively diminished renal uptake were noted. On the other hand, on bone marrow scintigraphy poor accumulation in central marrow and peripheral expansion were shown. BMD value by QCT and DPA (mainly trabecular bone) was markedly high, while BMD by SPA (mainly cortical bone) was within normal range. Thus, it was shown that bone and bone-marrow scintigraphy combined with BMD measurement by photon absorptiometry were useful and essential in evaluating the pathophysiology of osteosclerosis. (author)

Bone-composition imaging using coherent-scatter computed tomography: Assessing bone health beyond bone mineral density

International Nuclear Information System (INIS)

Batchelar, Deidre L.; Davidson, Melanie T.M.; Dabrowski, Waldemar; Cunningham, Ian A.

2006-01-01

Quantitative analysis of bone composition is necessary for the accurate diagnosis and monitoring of metabolic bone diseases. Accurate assessment of the bone mineralization state is the first requirement for a comprehensive analysis. In diagnostic imaging, x-ray coherent scatter depends upon the molecular structure of tissues. Coherent-scatter computed tomography (CSCT) exploits this feature to identify tissue types in composite biological specimens. We have used CSCT to map the distributions of tissues relevant to bone disease (fat, soft tissue, collagen, and mineral) within bone-tissue phantoms and an excised cadaveric bone sample. Using a purpose-built scanner, we have measured hydroxyapatite (bone mineral) concentrations based on coherent-scatter patterns from a series of samples with varying hydroxyapatite content. The measured scatter intensity is proportional to mineral density in true g/cm 3 . Repeated measurements of the hydroxyapatite concentration in each sample were within, at most, 2% of each other, revealing an excellent precision in determining hydroxyapatite concentration. All measurements were also found to be accurate to within 3% of the known values. Phantoms simulating normal, over-, and under-mineralized bone were created by mixing known masses of pure collagen and hydroxyapatite. An analysis of the composite scatter patterns gave the density of each material. For each composite, the densities were within 2% of the known values. Collagen and hydroxyapatite concentrations were also examined in a bone-mimicking phantom, incorporating other bone constituents (fat, soft tissue). Tomographic maps of the coherent-scatter properties of each specimen were reconstructed, from which material-specific images were generated. Each tissue was clearly distinguished and the collagen-mineral ratio determined from this phantom was also within 2% of the known value. Existing bone analysis techniques cannot determine the collagen-mineral ratio in intact specimens

Pühaduse performatiivsus ja kristlik teater / The Performativity of Sacrality and Christian Theatre

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Madis Kolk

2015-06-01

Full Text Available Teesid: 20. sajandil on esile kerkinud mitmeid teatrisuundi, mis on kritiseerinud ja püüdnud ületada Lääne traditsioonilise teatri väidetavat sõnakesksust ning samuti selle võimetust täita n-ö püha kunsti funktsioone. Kuigi seda pühadusedefitsiiti on püütud leevendada ennekõike orientaalsetest teatrivormidest inspiratsiooni ammutades, aitab selle võimalikku tekkelugu mõista ka katoliikliku kultuuri mõjuväljas võrsunud teatrikunsti ning teatrivaenulikuma ortodoksi teoloogia kontekstis välja töötatud ikooniteoloogia võrdlus. Kõrvutades nende kahe konfessiooni teoloogilis-esteetilisi arusaamu, saame analüüsida ka performatiivsuse esteetika seisukohast olulisi kunstiteose loome- ja tajutingimuste vormilisi ja meelelisi aspekte ning nende toimet sakraalse kunsti sihtide seisukohast. SU M M A R Y In the 21st century Western society has seen an increasing interest in topics related to religion. In this context, the connection between the concept of sacrality in Western culture and freedom of verbal and artistic expression has been reconsidered; the very possibility of so-called sacred art within Western culture has been called into question. Already in the 20th century several theatrical movements in the West have expressed the need to strive for religious (or at least quasi-religious goals by means of the stage. This can already be seen in the work of the symbolists, but such experiments accelerated and became more forceful under the influence of Antonin Artaud’s visions and under the aegis of intercultural theatre. In all of these different quests one can find common elements: discontent with the discursivity of the theatrical canon, a need for a metaphysical dimension in the theatre, and the belief that channels of perception can be opened through contact with exotic ritual cultures. In his book Sacred Theatre Ralph Yarrow has attempted to define the criteria of sacrality in the theatre, drawing upon William S. Haney�

Repair of microdamage in osteonal cortical bone adjacent to bone screw.

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Lei Wang

Full Text Available Up to date, little is known about the repair mode of microdamage in osteonal cortical bone resulting from bone screw implantation. In this study, self-tapping titanium cortical bone screws were inserted into the tibial diaphyses of 24 adult male rabbits. The animals were sacrificed at 1 day, 2 weeks, 1 month and 2 months after surgery. Histomorphometric measurement and confocal microscopy were performed on basic fuchsin stained bone sections to examine the morphological characteristics of microdamage, bone resorption activity and spatial relationship between microdamage and bone resorption. Diffuse and linear cracks were coexisted in peri-screw bone. Intracortical bone resorption was significantly increased 2 weeks after screw installation and reach to the maximum at 1 month. There was no significant difference in bone resorption between 1-month and 2-months groups. Microdamage was significantly decreased within 1 month after surgery. Bone resorption was predisposed to occur in the region of <100 µm from the bone-screw interface, where had extensive diffuse damage mixed with linear cracks. Different patterns of resorption cavities appeared in peri-screw bone. These data suggest that 1 the complex microdamage composed of diffuse damage and linear cracks is a strong stimulator for initiating targeted bone remodeling; 2 bone resorption activities taking place on the surfaces of differently oriented Haversian and Volkmann canals work in a team for the repair of extensive microdamage; 3 targeted bone remodeling is a short-term reaction to microdamage and thereby it may not be able to remove all microdamage resulting from bone screw insertion.

Bad to the bone crafting electronic systems with beaglebone and beaglebone black

CERN Document Server

Barrett, Steven F

2013-01-01

This comprehensive book provides detailed materials for both novice and experienced programmers using all BeagleBone variants which host a powerful 32-bit, super-scalar TI Sitara ARM Cortex A8 processor. Authored by Steven F. Barrett and Jason Kridner, a seasoned ECE educator along with the founder of Beagleboard.org, respectively, the work may be used in a wide variety of projects from science fair projects to university courses and senior design projects to first prototypes of very complex systems. Beginners may access the power of the ""Bone"" through the user-friendly Bonescript examples.

Vertebral lesion distribution in multiple myeloma - assessed by reduced-dose whole-body MDCT

International Nuclear Information System (INIS)

Bier, Georg; Kloth, Christopher; Schabel, Christoph; Bongers, Malte; Nikolaou, Konstantin; Horger, Marius

2016-01-01

To observe the distribution and potential distribution patterns of osteolytic and sclerotic vertebral involvement in a representative collective of multiple myeloma patients. A total of 66 consecutive patients with a diagnosis of multiple myeloma at initial diagnosis or during follow-up were examined by multidetector reduced-dose computed tomography to evaluate the distribution of bone lesions along the spine with focus on size, location, and lesion character. Confirmation of diagnosis was performed by comparison to follow-up computed tomography or magnetic resonance tomography. If >50 % of all detected malignant lesions occurred in one spinal segment, the distribution pattern was called cervical, thoracic, lumbar, or sacral, otherwise a ''mixed'' pattern was classified. Of a total number of 933 osseous spine lesions, 632 (67.7 %) were classified as malignant (98.9 % of them osteolytic) and 293 (31.5 %) as benign. The distribution pattern analysis yielded two patients (3.8 %) with a cervical, 26 (50 %) with a thoracic, 4 (7.7 %) with a lumbar, one (1.9 %) with a sacral pattern, and 19 cases (36.6 %) showed a mixed distribution pattern. Segment-wise, the mean lesion size was 6.52 ± 2.76 mm (cervical), 8.97 ± 5.43 mm (thoracic), 11.97 ± 7.11 mm (lumbar), and 17.5 ± 16.465 (sacral), whilst, related to the vertebra size, the lesion/vertebra size ratio is decreasing through the whole spine beginning from the top. Multiple myeloma bone lesions occur preferably and are larger in the thoracic and lumbar spine. Moreover, a specific distribution pattern is present in about 60 %. (orig.)

Vertebral lesion distribution in multiple myeloma - assessed by reduced-dose whole-body MDCT

Energy Technology Data Exchange (ETDEWEB)

Bier, Georg; Kloth, Christopher; Schabel, Christoph; Bongers, Malte; Nikolaou, Konstantin; Horger, Marius [Eberhard-Karls-University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany)

2016-01-15

To observe the distribution and potential distribution patterns of osteolytic and sclerotic vertebral involvement in a representative collective of multiple myeloma patients. A total of 66 consecutive patients with a diagnosis of multiple myeloma at initial diagnosis or during follow-up were examined by multidetector reduced-dose computed tomography to evaluate the distribution of bone lesions along the spine with focus on size, location, and lesion character. Confirmation of diagnosis was performed by comparison to follow-up computed tomography or magnetic resonance tomography. If >50 % of all detected malignant lesions occurred in one spinal segment, the distribution pattern was called cervical, thoracic, lumbar, or sacral, otherwise a ''mixed'' pattern was classified. Of a total number of 933 osseous spine lesions, 632 (67.7 %) were classified as malignant (98.9 % of them osteolytic) and 293 (31.5 %) as benign. The distribution pattern analysis yielded two patients (3.8 %) with a cervical, 26 (50 %) with a thoracic, 4 (7.7 %) with a lumbar, one (1.9 %) with a sacral pattern, and 19 cases (36.6 %) showed a mixed distribution pattern. Segment-wise, the mean lesion size was 6.52 ± 2.76 mm (cervical), 8.97 ± 5.43 mm (thoracic), 11.97 ± 7.11 mm (lumbar), and 17.5 ± 16.465 (sacral), whilst, related to the vertebra size, the lesion/vertebra size ratio is decreasing through the whole spine beginning from the top. Multiple myeloma bone lesions occur preferably and are larger in the thoracic and lumbar spine. Moreover, a specific distribution pattern is present in about 60 %. (orig.)

Bone allografts sterilized by irradiation for the treatment of benign bone tumors

International Nuclear Information System (INIS)

Wakita, Ryuji; Izumi, Toshihiro; Watanabe, Tetsuya; Sekiguchi, Masakazu; Nasuno, Shuji; Ohno, Tsukasa; Kobayashi, Akimasa; Itoman, Moritoshi; Minamisawa, Ikuo

1998-01-01

In bone allografts, osteogenesis potential of gamma-ray sterilized bone was compared with that of freezing bone. For the benign bone tumor (enchondroma) which occurred in short bone of hands and feet of adult, gamma-ray sterilized bone (3 cases) or frozen bone (6 cases) was allografted after the curettage. Development locus of tumor was metacarpus (3 cases), ossa digitorum manus (4 cases), phalanx (2 cases). Gamma-ray sterilized bone was used after defatting, freeze-drying, and irradiation with the dose of 25 kGy by Co-60. Frozen bone was picked with aseptic processing manipulation, refrigerated and stored. Synostosis stage was 3-7 months (an average of 4.3) in frozen bone group and 2-5 months (an average of 3.3) in gamma-ray sterilized bone group. In gamma-ray sterilized bone group, bone shadow in osseous graft part increased until the time of adhesion, and the peak time was two or three months (an average of 2.3) after surgery. In frozen bone group, bone shadow increased in 4 of 6 cases, but peak time was 0.5-7 months (an average of 2.6). Gamma-ray sterilized bone is useful for rather good case of graft condition such as supplement of deficiency of allografts or packing of bone absence after dilatation and curettage of lesion in bone, but it is required more examination to applicate to wide area bone absence part and site which requires physical intensity. (K.H.)

Can the possibility of transverse iliosacral screw fixation for first sacral segment be predicted preoperatively? Results of a computational cadaveric study.

Science.gov (United States)

Jeong, Jin-Hoon; Jin, Jin Woo; Kang, Byoung Youl; Jung, Gu-Hee

2017-10-01

The purpose of this study was to predict the possibility of transverse iliosacral (TIS) screw fixation into the first sacral segment (S 1 ) and introduce practical anatomical variables using conventional computed tomography (CT) scans. A total of 82 cadaveric sacra (42 males and 40 females) were used for continuous 1.0-mm slice CT scans, which were imported into Mimics ® software to produce a three-dimensional pelvis model. The anterior height (BH) and superior width (BW) of the elevated sacral segment was measured, followed by verification of the safe zone (SZ S1 and SZ S2 ) in a true lateral view. Their vertical (VD S1 and VD S2 ) and horizontal (HD S1 and HD S2 ) distances were measured. VD S1 less than 7mm was classified as impossible sacrum, since the transverse fixation of 7.0 mm-sized IS screw could not be done safely. Fourteen models (16.7%; six females, eight males) were assigned as the impossible sacrum. There was no statistical significance regarding gender (p=0.626) and height (p=0.419). The average values were as follows: BW, 31.4mm (SD 2.9); BH, 16.7mm (SD 6.8); VD S1 , 13.4mm (SD 6.1); HD S1 , 22.5mm (SD 4.5); SZ S1 , 239.5mm 2 (SD 137.1); VD S2 , 15.5mm (SD 3.0); HD S2 , 18.3mm (SD 2.9); and SZ S2 , 221.1mm 2 (SD 68.5). Logistic regression analysis identified BH (p=0.001) and HD S1 (p=0.02) as the only statistically significant variables to predict the possibility. Receiver operating characteristic curve analysis established a cut-off value for BH and HD S1 of impossible sacrum of 20.6mm and 18.6mm, respectively. BH and HD S1 could be used to predict the possibility of TIS screw fixation. If the BH exceeds 20.6mm or HD S1 is less than 18.6mm, TIS screw fixation for S 1 should not be undertaken because of narrowed SZ. Copyright © 2017 Elsevier Ltd. All rights reserved.

Bone graft viability evaluated by three phase bone scan

International Nuclear Information System (INIS)

Ljiljana Jaukovic Rajko Spaic; Marijan Novakovic; Srbislav Stosic

2004-01-01

Bone defects resulting war injury can be replaced by microvascular bone grafts from fibula. Aim: The aim of this study was to assess the value of three phase (3P) bone scintigraphy in the early detection of the bone graft complications. Method: 3P bone scans were performed in four patients (two after mandible reconstruction with micro vascular fibular bone grafts, one after fibular transplantation for ulnar and one with humeral reconstruction). First dynamic phase scan was performed immediately after iv injection of 740 MBq Tc- 99m DPD, acquiring 15 two seconds duration frames. Second, early static scan was performed during next 300 seconds, and third, delayed scan three hours later. All scans were obtained under the bone graft region. The scans were evaluated using ROI under graft region and the corresponding contra lateral area. Blood flow in graft region was determined using first phase scan, and tracer uptake in the same region was determined using second and third phase scans. Results: in all patients blood flow in graft region was particularly normal. Tracer uptake in one of two patients with mandible reconstruction was diffusely increased in graft, strongly suggesting infection; In the other patient delayed scan showed no tracer uptake in graft center .Both patients with ulnar and humeral reconstruction showed only slightly decreased tracer uptake in bone grafts. 3 phase bone scintigraphy may play a role in the evaluation of bone graft viability by predicting the infection and necrosis. (authors)

Association of pioglitazone treatment with decreased bone mineral density in obese premenopausal patients with polycystic ovary syndrome: a randomized, placebo-controlled trial

DEFF Research Database (Denmark)

Glintborg, D.; Andersen, Mikael; Hagen, C.

2008-01-01

OBJECTIVE: Our objective was to investigate the effect of pioglitazone on bone mineral density (BMD) and bone turnover markers in polycystic ovary syndrome (PCOS). DESIGN AND SETTING: We conducted a randomized, placebo-controlled study at an outpatient clinic at a university hospital. PATIENTS......, sex hormones, and body composition. CONCLUSION: Pioglitazone treatment was followed by decreased lumbar and hip BMD and decreased measures of bone turnover in a premenopausal study population relatively protected from bone mineral loss Udgivelsesdato: 2008/5...

Functional Outcome With Percutaneous Ilio-sacral Screw Fixation For Posterior Pelvic Ring Injuries In Patients Involved In Heavy Manual Laboring

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Abhishek SM

2015-11-01

Full Text Available Introduction: Unstable posterior pelvic ring injuries are best treated with operative methods due to better post-op functional score. Our patient cohort was involved in heavy manual laboring frequently required ground level work in their activities of daily living. There are very few outcome studies dealing exclusively with such patients. Materials & Methods: Forty one patients who were treated with percutaneous sacroiliac screw fixation under fluoroscopic guidance and were followed-up for at least one year were analyzed retrospectively for functional outcome using the Majeed score. Results: Twenty one (51.22% and thirteen (31.70% patients were found to be in excellent and good categories respectively and majority of the patients (thirty/73.17% were able to return to their original occupation with or without minor adjustments. Conclusion: Percutaneous ilio-sacral screw fixation for posterior pelvic unstable injuries is an acceptable mode of treatment in patients involved in heavy manual laboring.

Osteoclasts secrete non-bone derived signals that induce bone formation

DEFF Research Database (Denmark)

Karsdal, Morten A; Neutzsky-Wulff, Anita V; Dziegiel, Morten Hanefeld

2008-01-01

Bone turnover is a highly regulated process, where bone resorption in the normal healthy individual always is followed by bone formation in a manner referred to as coupling. Patients with osteopetrosis caused by defective acidification of the resorption lacuna have severely decreased resorption......) from human osteoclasts cultured on either bone or plastic, and tested their effects on bone nodule formation by osteoblasts. Both types of CM were shown to dose-dependently induce bone nodule formation, whereas non-conditioned osteoclast culture medium had no effects. These data show that osteoclasts...

Osteogenic capacity of nanocrystalline bone cement in a weight-bearing defect at the ovine tibial metaphysis

Directory of Open Access Journals (Sweden)

Mittlmeier T

2012-06-01

Full Text Available Christoph Harms,1 Kai Helms,1 Tibor Taschner,1 Ioannis Stratos,1 Anita Ignatius,5 Thomas Gerber,2 Solvig Lenz,3 Stefan Rammelt,6 Brigitte Vollmar,4 Thomas Mittlmeier11Department of Trauma and Reconstructive Surgery, 2Department for Materials Research and Nanostructures, Institute for Physics, 3Department of Oral and Maxillofacial Plastic Surgery, 4Institute for Experimental Surgery, University of Rostock, Rostock, 5Institute of Orthopaedic Research and Biomechanics, University of Ulm, Ulm, 6Clinic of Trauma and Reconstructive Surgery, University Hospital "Carl Gustav Carus", Dresden, GermanyAbstract: The synthetic material Nanobone® (hydroxyapatite nanocrystallines embedded in a porous silica gel matrix was examined in vivo using a standardized bone defect model in the ovine tibial metaphysis. A standardized 6 × 12 × 24-mm bone defect was created below the articular surface of the medial tibia condyles on both hind legs of 18 adult sheep. The defect on the right side was filled with Nanobone®, while the defect on the contralateral side was left empty. The tibial heads of six sheep were analyzed after 6, 12, and 26 weeks each. The histological and radiological analysis of the defect on the control side did not reveal any bone formation after the total of 26 weeks. In contrast, the microcomputed tomography analysis of the defect filled with Nanobone® showed a 55%, 72%, and 74% volume fraction of structures with bone density after 6, 12, and 26 weeks, respectively. Quantitative histomorphological analysis after 6, and 12 weeks revealed an osteoneogenesis of 22%, and 36%, respectively. Hematoxylin and eosin sections demonstrated multinucleated giant cells on the surface of the biomaterial and resorption lacunae, indicating osteoclastic resorptive activity. Nanobone® appears to be a highly potent bone substitute material with osteoconductive properties in a loaded large animal defect model, supporting the potential use of Nanobone® also in

Bone transplantation in limb saving surgeries: Philippine experience

International Nuclear Information System (INIS)

Wang, Edward H.M.

1998-01-01

Until the turn of the decade, Filipino patients afflicted with malignant and aggressive extremity tumors were almost uniformly treated with mutilating amputations. Limb saving surgery only recently became an option locally - this resulting not only from a better comprehension of surgical oncologic principles but also from the development and refinement of reconstructive procedures following such surgeries. Foremost among the latter is the use of long bone transplants, otherwise known as large segment bone allografts. Large segment allografts are available from the Tissue and Bone Bank of the University of the Philippines- the only bank of its kind in the country. All allografts are harvested from appropriate donors (both cadaveric and live), processed at the bank, radiation-sterilized at the Philippine Nuclear Research Institute (PNRI), and finally brought back to and stored in a -80 degrees centigrade deep freezer at the Bank. This paper presents our 4-year experience with large-segment allografts for extensive defects of limbs salvage surgery in musculoskeletal tumors. All patients included in this presentation had : (1) malignant or aggressive extremity tumors; (2) surgery performed by the University of the Philippines-Musculoskeletal Tumor Unit (UP-MuST Unit); (3) follow-up at least one year or until death; and (4) available pre-and post-operative radiographs for review. Over a period of 4 years (January 1993-January 1997), 63 patients with malignant or aggressive extremity tumors (who formerly would have been amputated) underwent limb salvage surgery by the UP-MuST Unit. Twenty (20) of these patients had reconstructions utilizing irradiated large-segment allografts and fulfilled the above criteria for inclusion in this review. Limb saving surgery for Filipino patients with musculoskeletal tumors continues to be a challenge because of both tumor size and the size of the defect requiring reconstruction. Large-segment allografts from the UP-Tissue and Bone Bank

Bone metastasis target redox-responsive micell for the treatment of lung cancer bone metastasis and anti-bone resorption.

Science.gov (United States)

Ye, Wei-Liang; Zhao, Yi-Pu; Cheng, Ying; Liu, Dao-Zhou; Cui, Han; Liu, Miao; Zhang, Bang-Le; Mei, Qi-Bing; Zhou, Si-Yuan

2018-01-16

In order to inhibit the growth of lung cancer bone metastasis and reduce the bone resorption at bone metastasis sites, a bone metastasis target micelle DOX@DBMs-ALN was prepared. The size and the zeta potential of DOX@DBNs-ALN were about 60 nm and -15 mV, respectively. DOX@DBMs-ALN exhibited high binding affinity with hydroxyapatite and released DOX in redox-responsive manner. DOX@DBMs-ALN was effectively up taken by A549 cells and delivered DOX to the nucleus of A549 cells, which resulted in strong cytotoxicity on A549 cells. The in vivo experimental results indicated that DOX@DBMs-ALN specifically delivered DOX to bone metastasis site and obviously prolonged the retention time of DOX in bone metastasis site. Moreover, DOX@DBMs-ALN not only significantly inhibited the growth of bone metastasis tumour but also obviously reduced the bone resorption at bone metastasis sites without causing marked systemic toxicity. Thus, DOX@DBMs-ALN has great potential in the treatment of lung cancer bone metastasis.

Histologic diagnosis of metabolic bone diseases: bone histomorphometry

Directory of Open Access Journals (Sweden)

L. Dalle Carbonare

2011-09-01

Full Text Available Histomorphometry or quantitative histology is the analysis on histologic sections of bone resorption parameters, formation and structure. It is the only technique that allows a dynamic evaluation of the activity of bone modelling after labelling with tetracycline. Moreover, the new measurement procedures through the use of the computer allow an assessment of bone microarchitecture too. Histomorphometric bone biopsy is a reliable and well-tolerated procedure. Complications are reported only in 1% of the subjects (hematoma, pain, transient neuralgia. Histomorphometry is used to exclude or confirm the diagnosis of osteomalacia. It is employed in the evaluation of bone damage associated with particular treatments (for example, anticonvulsants or in case of rare bone diseases (osteogenesis imperfecta, systemic mastocytosis. It is also an essential approach when clinical, biochemical and other diagnostic data are not consistent. Finally, it is a useful method to understand the pathophysiologic mechanisms of drugs. The bone sample is taken at the level of iliac crest under local anesthesia. It is then put into methyl-metacrilate resin where the sections are prepared for the microscopic analysis of the various histomorphometric parameters.

Postmodernism and Education Postmodernism and Education

Directory of Open Access Journals (Sweden)

Vera Helena Gomes Wielewicki

2008-04-01

Full Text Available How related are postmodernism and education? If we bear in mind the traditional concept of education, with sacralized institutions, like universities, imposing rules to be followed, no easy connection can be made with the postmodern moment. Fragmentation and inconsistency, ideas associated with postmodernism, do not seem to match education. Usher and Edwards are aware of the troublesome task they have settled themselves to. How related are postmodernism and education? If we bear in mind the traditional concept of education, with sacralized institutions, like universities, imposing rules to be followed, no easy connection can be made with the postmodern moment. Fragmentation and inconsistency, ideas associated with postmodernism, do not seem to match education. Usher and Edwards are aware of the troublesome task they have settled themselves to.

Bone Cancer

Science.gov (United States)

Cancer that starts in a bone is uncommon. Cancer that has spread to the bone from another ... more common. There are three types of bone cancer: Osteosarcoma - occurs most often between ages 10 and ...

Analysis of the relationships between edentulism, periodontal health, body composition, and bone mineral density in elderly women

Directory of Open Access Journals (Sweden)

Ignasiak Z

2016-03-01

Full Text Available Zofia Ignasiak,1 Malgorzata Radwan-Oczko,2 Krystyna Rozek-Piechura,3 Marta Cholewa,4 Anna Skrzek,5 Tomasz Ignasiak,6 Teresa Slawinska1 1Department of Biostructure, University School of Physical Education, Wroclaw, Poland; 2Department of Periodontology, Wroclaw Medical University, Wroclaw, Poland; 3Department of Physiotherapy and Occupation Therapy in Internal Diseases, University School of Physical Education, Wroclaw, Poland; 4DENTARAMA Dentistry Center, Walbrzych, Poland; 5Department of Physiotherapy and Ocupation Therapy in Motor-System Dysfunction, University School of Physical Education, Wroclaw, Poland; 6Karkonosze State Higher School in Jelenia Gora, Jelenia Gora, Poland Objective: The relationship between bone mineral density (BMD and tooth loss in conjunction with periodontal disease is not clear. The suggested effects include alteration in bone remodeling rates as well as the multifaceted etiology of edentulism. There is also a question if other body-related variables besides BMD, such as body composition, may be associated with tooth number and general periodontal health. The aim of this study was to evaluate if tooth number and marginal periodontal status are associated with body composition and BMD in a sample of elderly women. Materials and methods: The study involved 91 postmenopausal women. Data included basic anthropometric characteristics, body composition via bioelectrical impedance analysis, and BMD analysis at the distal end of the radial bone of the nondominant arm via peripheral dual-energy X-ray absorptiometry. A dental examination was performed to assess tooth number, periodontal pocket depth (PD, and gingival bleeding. Results: In nonosteoporotic women, a significant positive correlation was found between BMD and lean body mass, total body water, and muscle mass. The indicators of bone metabolism correlated negatively with PD. Such relationships did not appear in osteoporotic women. In both groups, basic anthropometric

Bone Diseases

Science.gov (United States)

Your bones help you move, give you shape and support your body. They are living tissues that rebuild constantly ... childhood and your teens, your body adds new bone faster than it removes old bone. After about ...

Paget's disease of bone resembling bone metastasis from gastric cancer.

Science.gov (United States)

Shimoyama, Yasuyuki; Kusano, Motoyasu; Shimoda, Yoko; Ishihara, Shingo; Toyomasu, Yoshitaka; Ohno, Tetsuro; Mochiki, Erito; Sano, Takaaki; Hirato, Junko; Mori, Masatomo

2011-08-01

A 74-year-old man had an endoscopic type 0'-IIc tumor in the upper gastric body on the greater curvature and biopsy showed the tumor to be a well-differentiated adenocarcinoma (Group 5). He was referred to us for endoscopic submucosal dissection (ESD). Endoscopy revealed fold convergency, fold swelling, and fusion of the fold, indicating tumor invasion into the submucosa, which was outside the indications for ESD. In addition, there was an increase of serum bone-type alkaline phosphatase (ALP-III and ALP-IV) and urinary cross-linked N-terminal telopeptide of type I collagen (a bone metabolism marker), while (18)F-fluorodeoxyglucose positron emission tomography showed increased uptake in the left pelvis and Th10, suggesting bone metastases. We first diagnosed gastric cancer with bone metastases; however, the symptoms suggested pathological bone fracture and no bone pain. Therefore, a computed tomography-guided aspiration bone biopsy was performed to exclude the possibility of Paget's disease of bone. Biopsy specimens revealed no tumor and a mosaic pattern. No increased uptake of (18)F-FAMT (L-[3-(18)F] α-methyltyrosine) supported a diagnosis of no bone metastases from gastric cancer. We finally diagnosed gastric cancer accompanied by Paget's disease of bone and performed a laparoscopy-assisted proximal gastrectomy. The pathological diagnosis was U less 0-IIb, and U post 0-IIc ypT1a (M) N0H0P0M0 yp stage IA. In gastric cancer patients with suspected bone metastasis, we also need to consider Paget's disease of bone.

Prevalence of bone marrow necrosis in Egyptian cancer patients referring to the National Cancer Institute

International Nuclear Information System (INIS)

Elgamal, B.M.; Rashed, R.A.; Raslan, H.N.

2011-01-01

Bone marrow necrosis; Egyptian cancer patients Abstract Background: Bone marrow necrosis is a relatively rare entity which has been associated with a poor prognosis. It is most commonly found in patients with neoplastic disorders and severe infections. Methods: study comprised examination of 5043 bone marrow biopsy specimens performed at the National Cancer Institute, Cairo University, over 7 years period (March 2004-March 2011). It included 5 years retrospective (2867 archived samples) and 2 years prospective (2176 samples). Results: Bone marrow necrosis was diagnosed in fifteen out of 5043 examined specimens with a percentage of 0.3% and ranged from mild to massive according to semiquantitative estimation. Prognosis of all patients was poor with survival not exceeding 6 months from the date of marrow necrosis diagnosis. Conclusion: In Egyptian patients, bone marrow necrosis in association with malignancy is a rare disorder which is accompanied by a poor outcome

Mechanotransduction by bone cells in vitro: mechanobiology of bone tissue

NARCIS (Netherlands)

Mullender, M.; El Haj, A.J.; Yang, Y.; van Duin, M.A.; Burger, E.H.; Klein-Nulend, J.

2004-01-01

Mechanical force plays an important role in the regulation of bone remodelling in intact bone and bone repair. In vitro, bone cells demonstrate a high responsiveness to mechanical stimuli. Much debate exists regarding the critical components in the load profile and whether different components, such

Bone- and bone marrow scintigraphy in Gaucher disease type 1

International Nuclear Information System (INIS)

Mikosch, P.; Zitter, F.; Gallowitsch, H.J.; Lind, P.; Wuertz, F.; Mehta, A.B.; Hughes, D.A.

2008-01-01

Scintigraphy is a method for imaging metabolism and should be viewed as complimentary to morphological imaging. Bone and bone marrow scintigraphy can particularly contribute to the detection of focal disease in Gaucher disease. In bone crises it can discriminate within three days after pain onset between local infection and aseptic necrosis. A further advantage of bone- and bone marrow scintigraphy is the visualization of the whole skeleton within one setting. Whole body imaging for focal lesions might thus be an objective in GD, in particular in patients complaining of several painful sites. Direct imaging of bone marrow deposits in GD by MIBI scintigraphy might be of special interest in children in whom bone marrow undergoes a developmental conversion from red to yellow marrow in the ap-pendicular skeleton. MRI interpretation in young GD patients is thus difficult in order to estimate the exact amount and extent of bone marrow infiltration by Gaucher cells. 99mTc-MIBI scintigraphy with its direct visualization of lipid storage could thus add interesting additional information not shown with other methods including MRI. Although MRI is the most accepted imaging modality in assessing the skeletal status in GD, a selective use of scintigraphy for imaging bone and bone marrow may add information in the evaluation of patients with Gaucher disease

Skeletal development of the hand and wrist: digital bone age companion - a suitable alternative to the Greulich and Pyle atlas for bone age assessment?

Energy Technology Data Exchange (ETDEWEB)

Bunch, Paul M. [Massachusetts General Hospital, Department of Radiology, Boston, MA (United States); Altes, Talissa A. [University of Missouri, Department of Radiology, Columbia, MO (United States); McIlhenny, Joan; Gaskin, Cree M. [University of Virginia Health System, Department of Radiology and Medical Imaging, PO Box 800170, Charlottesville, VA (United States); Patrie, James [University of Virginia Health System, Department of Health Evaluation Sciences, PO Box 800717, Charlottesville, VA (United States)

2017-06-15

To assess reader performance and subjective workflow experience when reporting bone age studies with a digital bone age reference as compared to the Greulich and Pyle atlas (G and P). We hypothesized that pediatric radiologists would achieve equivalent results with each method while digital workflow would improve speed, experience, and reporting quality. IRB approval was obtained for this HIPAA-compliant study. Two pediatric radiologists performed research interpretations of bone age studies randomized to either the digital (Digital Bone Age Companion, Oxford University Press) or G and P method, generating reports to mimic clinical workflow. Bone age standard selection, interpretation-reporting time, and user preferences were recorded. Reports were reviewed for typographical or speech recognition errors. Comparisons of agreement were conducted by way of Fisher's exact tests. Interpretation-reporting times were analyzed on the natural logarithmic scale via a linear mixed model and transformed to the geometric mean. Subjective workflow experience was compared with an exact binomial test. Report errors were compared via a paired random permutation test. There was no difference in bone age determination between atlases (p = 0.495). The interpretation-reporting time (p < 0.001) was significantly faster with the digital method. The faculty indicated preference for the digital atlas (p < 0.001). Signed reports had fewer errors with the digital atlas (p < 0.001). Bone age study interpretations performed with the digital method were similar to those performed with the Greulich and Pyle atlas. The digital atlas saved time, improved workflow experience, and reduced reporting errors relative to the Greulich and Pyle atlas when integrated into electronic workflow. (orig.)

Effects of spaceflight and Insulin-like Growth Factor-1 on rat bone properties

Energy Technology Data Exchange (ETDEWEB)

Bateman, T.A.; Ayers, R.A.; Spetzler, M.L.; Simske, S.J. [BioServe Space Technologies University of Colorado Boulder, Colorado80309-0429 (United States); Zimmerman, R.J. [Chiron Corporation 4560 Horton Street Emeryville, California94608-2916 (United States)

1997-01-01

Spaceflight induces bone degradation which is analogous to an accelerated onset of osteoporosis in humans (Tilton {ital et al.}, 1980). In rats, decreased bone formation is indicative of reduced osteoblast activity (Morey and Baylink, 1978). Chiron Corporation (Emeryville, CA) is interested in using the microgravity environment of low-Earth-orbit to test its therapeutic drug, Insulin-like Growth Factor-1 (IGF-1). This pharmaceutic is known to promote osteoblast activity (Schmid {ital et al.}, 1984) and therefore may encourage bone growth in rats. Chiron sponsored the Immune.3 payload on STS-73 (May 19{endash}29, 1996) through its Center for Space Commercialization (CSC) partner BioServe Space Technologies (University of Colorado and Kansas State University) to investigate the effects of IGF-1 on mitigating the skeletal degradation that affects rats and humans during spaceflight. Twelve rats were flown for 10 days using two Animal Enclosure Modules (AEMs) provided by NASA Ames Research Center. Of the twelve, six received 1.4 mg/day of IGF-1; the other six saline. Sixteen vivarium ground controls received the same treatment on a one day delay. Rat femora and tibiae were examined for bone mineral density via DXA scan. Femora and humeri were measured for physical and compositional properties, as well as mechanically tested in three point flexure. Quantitative histomorphometric examination of tibiae, humeri, fibulae, ribs and cranial bone; and microhardness testing on tibiae and humeri are currently in progress. Flight humeri and vivarium femora were significantly larger than their counterparts; however, significant differences in mechanical properties and mineral density were not concurrent to these mass changes. {copyright} {ital 1997 American Institute of Physics.}

High-resolution CT of temporal bone trauma: review of 38 cases

International Nuclear Information System (INIS)

Hiroual, M.R.; Zougarhi, A.; Cherif Idrissi El Ganouni, N.; Essadki, O.; Ousehal, A.; Tijani Adil, O.; Maliki, O.; Aderdour, L.; Raji, A.

2010-01-01

Purpose Temporal bone trauma is frequent but difficult to assess due to the diversity of clinical presentations and complex anatomy. We have sought to assess the different types of fractures and complications on high-resolution CT. Materials and methods Descriptive retrospective study over a 24 month period performed in the ENT radiology section of the Mohammed 6 university medical center in Marrakech. A total of 38 cases of temporal bone trauma were reviewed. All patients underwent ENT evaluation and high-resolution CT of the temporal bone using 1 mm axial and coronal sections. Results Mean patient age was 33 years (range: 14-55 years) with male predominance (sex ratio: 36/2). Clinical symptoms were mainly otorrhagia and conductive hearing loss. Oblique extra-labyrinthine fractures were most frequent. Two cases of pneumo-labyrinth were noted. Management was conservative in most cases with deafness in 3 cases. Conclusion High-resolution CT of the temporal bone provides accurate depiction of lesions explaining the clinical symptoms and helps guide management. MRI is complimentary to further assess the labyrinth and VII-VIII nerve complex. (author)

Impact of bone graft harvesting techniques on bone formation and graft resorption

DEFF Research Database (Denmark)

Saulacic, Nikola; Bosshardt, Dieter D; Jensen, Simon S

2015-01-01

BACKGROUND: Harvesting techniques can affect cellular parameters of autogenous bone grafts in vitro. Whether these differences translate to in vivo bone formation, however, remains unknown. OBJECTIVE: The purpose of this study was to assess the impact of different harvesting techniques on bone fo......: Transplantation of autogenous bone particles harvested with four techniques in the present model resulted in moderate differences in terms of bone formation and graft resorption.......BACKGROUND: Harvesting techniques can affect cellular parameters of autogenous bone grafts in vitro. Whether these differences translate to in vivo bone formation, however, remains unknown. OBJECTIVE: The purpose of this study was to assess the impact of different harvesting techniques on bone...... formation and graft resorption in vivo. MATERIAL AND METHODS: Four harvesting techniques were used: (i) corticocancellous blocks particulated by a bone mill; (ii) bone scraper; (iii) piezosurgery; and (iv) bone slurry collected from a filter device upon drilling. The grafts were placed into bone defects...

Development of 3D printing system for human bone model manufacturing using medical images

International Nuclear Information System (INIS)

Oh, Wang Kyun

2017-01-01

The 3D printing selective laser sintering (SLS) and stereo lithography apparatus (SLA) method used for bone model production has good precision and resolution, but the printers are expensive and need professional knowledge for operation. The program that converts computed tomography digital imaging and communications in medicine (DICOM) file into STL (stereolithography) file is also expensive so requesting 3D printing companies takes a lot of time and cost, which is why they are not generally utilized in surgery. To produce bone models of fractured patients, the use of 3D imaging conversion program and 3D printing system should be convenient, and the cost of device and operation should be low. Besides, they should be able to produce big size bone models for application to surgery. Therefore, by using an fused deposition modeling (FDM) method 3D printer that uses thermoplastic materials such as DICOM Viewer OsiriX and plastic wires, this study developed 3D printing system for Fracture surgery Patients customized bone model production for many clinics to use for surgery of fracture patients by universalizing with no limit in printing sizes and low maintenance and production cost. It is expected to be widely applied to the overall areas of orthopedics' education, research and clinic. It is also expected to be conveniently used in not only university hospitals but also regular general hospitals

Development of 3D printing system for human bone model manufacturing using medical images

Energy Technology Data Exchange (ETDEWEB)

Oh, Wang Kyun [Dept. of Radiology, Chungcheongbuk-do Cheongju Medical Center, Cheongju (Korea, Republic of)

2017-09-15

The 3D printing selective laser sintering (SLS) and stereo lithography apparatus (SLA) method used for bone model production has good precision and resolution, but the printers are expensive and need professional knowledge for operation. The program that converts computed tomography digital imaging and communications in medicine (DICOM) file into STL (stereolithography) file is also expensive so requesting 3D printing companies takes a lot of time and cost, which is why they are not generally utilized in surgery. To produce bone models of fractured patients, the use of 3D imaging conversion program and 3D printing system should be convenient, and the cost of device and operation should be low. Besides, they should be able to produce big size bone models for application to surgery. Therefore, by using an fused deposition modeling (FDM) method 3D printer that uses thermoplastic materials such as DICOM Viewer OsiriX and plastic wires, this study developed 3D printing system for Fracture surgery Patients customized bone model production for many clinics to use for surgery of fracture patients by universalizing with no limit in printing sizes and low maintenance and production cost. It is expected to be widely applied to the overall areas of orthopedics' education, research and clinic. It is also expected to be conveniently used in not only university hospitals but also regular general hospitals.

Percutaneous cannulated screw fixation of sacral fractures and sacroiliac joint disruptions with CT-controlled guidewires performed by interventionalists: Single center experience in treating posterior pelvic instability

International Nuclear Information System (INIS)

Fischer, Sebastian; Vogl, Thomas J.; Marzi, Ingo; Zangos, Stephan; Wichmann, Julian L.; Scholtz, Jan-Erik; Mack, Martin G.; Schmidt, Sven; Eichler, Katrin

2015-01-01

Highlights: • Minimally invasive sacroiliac screw fixation can be performed under CT-imaging. • Guidewires help in precise placement of cannulated sacroiliac screw. • Only a diminishing rate of misplacements can be seen. • The method appears to be a safe and very accurate procedure. - Abstract: Objective: The purpose of our study was to evaluate minimally invasive sacroiliac screw fixation for treatment of posterior pelvic instability with the help of CT controlled guidewires, assess its accuracy, safety and effectiveness, and discuss potential pitfalls. Methods: 100 guidewires and hollow titan screws were inserted in 38 patients (49.6 ± 19.5 years) suffering from 35 sacral fractures and/or 16 sacroiliac joint disruptions due to 33 (poly-)traumatic, 2 osteoporotic and 1 post-infectious conditions. The guidewire and screw positions were analyzed in multiplanar reconstructions. Results: The mean minimal distance between guidewire and adjacent neural foramina was 4.5 ± 2.01 mm, with a distinctly higher precision in S1 than S2. Eight guidewires showed cortical contacts, resulting in a total of 2% mismatched screws with subsequent wall violation. The fracture gaps were reduced from 3.6 ± 0.53 mm to 1.2 ± 0.54 mm. During follow-up 3 cases of minor iatrogenic sacral impaction (<5 mm) due to the bolting and 2 cases of screw loosening were observed. Interventional time was 84.0 min with a mean of 2.63 screws per patient whilst acquiring a mean of 93.7 interventional CT-images (DLP 336.7 mGy cm). Conclusions: The treatment of posterior pelvic instability with a guidewire-based screw insertion technique under CT-imaging results in a very high accuracy and efficacy with a low complication rate. Careful attention should be drawn to radiation levels

Percutaneous cannulated screw fixation of sacral fractures and sacroiliac joint disruptions with CT-controlled guidewires performed by interventionalists: Single center experience in treating posterior pelvic instability

Energy Technology Data Exchange (ETDEWEB)

Fischer, Sebastian, E-mail: sebastian.fischer@kgu.de [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Vogl, Thomas J. [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Marzi, Ingo [Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Zangos, Stephan; Wichmann, Julian L.; Scholtz, Jan-Erik; Mack, Martin G. [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Schmidt, Sven [Orthopaedic University Hospital Friedrichsheim, Marienburgstraße, 260528 Frankfurt (Germany); Eichler, Katrin [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany)

2015-02-15

Highlights: • Minimally invasive sacroiliac screw fixation can be performed under CT-imaging. • Guidewires help in precise placement of cannulated sacroiliac screw. • Only a diminishing rate of misplacements can be seen. • The method appears to be a safe and very accurate procedure. - Abstract: Objective: The purpose of our study was to evaluate minimally invasive sacroiliac screw fixation for treatment of posterior pelvic instability with the help of CT controlled guidewires, assess its accuracy, safety and effectiveness, and discuss potential pitfalls. Methods: 100 guidewires and hollow titan screws were inserted in 38 patients (49.6 ± 19.5 years) suffering from 35 sacral fractures and/or 16 sacroiliac joint disruptions due to 33 (poly-)traumatic, 2 osteoporotic and 1 post-infectious conditions. The guidewire and screw positions were analyzed in multiplanar reconstructions. Results: The mean minimal distance between guidewire and adjacent neural foramina was 4.5 ± 2.01 mm, with a distinctly higher precision in S1 than S2. Eight guidewires showed cortical contacts, resulting in a total of 2% mismatched screws with subsequent wall violation. The fracture gaps were reduced from 3.6 ± 0.53 mm to 1.2 ± 0.54 mm. During follow-up 3 cases of minor iatrogenic sacral impaction (<5 mm) due to the bolting and 2 cases of screw loosening were observed. Interventional time was 84.0 min with a mean of 2.63 screws per patient whilst acquiring a mean of 93.7 interventional CT-images (DLP 336.7 mGy cm). Conclusions: The treatment of posterior pelvic instability with a guidewire-based screw insertion technique under CT-imaging results in a very high accuracy and efficacy with a low complication rate. Careful attention should be drawn to radiation levels.

Metastatic mediastinal mature teratoma with malignant transformation in a young man with an adenocarcinoma in a Klinefelter's syndrome: Case report and review of the literature.

Science.gov (United States)

Le Fèvre, C; Vigneron, C; Schuster, H; Walter, A; Marcellin, L; Massard, G; Lutz, P; Noël, G

2018-05-01

Malignant transformation of mediastinal mature teratoma is extremely rare and worsens the prognosis of the disease. Transformation can appear synchronously to or several years after the initial diagnosis. Clinical and radiological signs can orientate the clinician but the definitive diagnosis is obtained thanks to histology. An 11 year-old boy presented with a mediastinal mature teratoma and bone and pulmonary metastases. He received six cycles of chemotherapy combining etoposide, ifosfamide, cisplatin, followed by resection of a 16×14×9cm mediastinal mass. Karyotype analysis revealed the presence of an additional sex chromosome X (47 XXY) pathognomonic of Klinefelter's syndrome. Ten years later, sciatalgia revealed malignant transformation of a pre-existing sacral bone metastasis into gastrointestinal adenocarcinoma. The patient received four cycles of chemotherapy combining oxaliplatin, 5-fluorouracil and cetuximab. This treatment was followed by a complete resection of the sacral metastasis and completed with adjuvant irradiation of 54Gy in 30 daily fractions. Twelve months after the diagnosis of relapse, the patient remained alive without disease. To our knowledge, this is the first case of adenocarcinoma developed in bone metastases of a mediastinal mature teratoma in a boy with a Klinefelter's syndrome. We propose a review of the literature and an analysis of 20 others published cases of mediastinal teratoma with malignant transformation into adenocarcinoma. Copyright © 2018 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

Intraoperative bone and bone marrow sampling: a simple method for accurate measurement of uptake of radiopharmaceuticals in bone and bone marrow

International Nuclear Information System (INIS)

Oyen, W.J.G.; Buijs, W.C.A.M.; Kampen, A. van; Koenders, E.B.; Claessens, R.A.M.J.; Corstens, F.H.M.

1993-01-01

Accurate estimation of bone marrow uptake of radiopharmaceuticals is of crucial importance for accurate whole body dosimetry. In this study, a method for obtaining normal bone marrow and bone during routine surgery without inconvenience to volunteers is suggested and compared to an indirect method. In five volunteers (group 1), 4 MBq 111 In-labelled human polyclonal IgG ( 111 In-IgG) was administered 48h before placement of a total hip prosthesis. After resection of the femoral head and neck, bone marrow was aspirated from the medullary space with a biopsy needle. In five patients, suspected of having infectious disease (group 2), bone marrow uptake was calculated according to a well-accepted method using regions of interest over the lumbar spine, 48h after injection of 75 MBq 111 In-IgG. Bone marrow uptake in group 1 (4.5 ±1.3%D kg -1 ) was significantly lower than that in group 2 (8.5 ± 2.1%D kg -1 ) (P<0.01). Blood and plasma activity did not differ significantly for both groups. This method provides a system for directly and accurately measuring uptake and retention in normal bone marrow and bone of all radiopharmaceuticals at various time points. It is a safe and simple procedure without any discomfort to the patient. Since small amounts of activity are sufficient, the radiation dose to the patient is low. (author)

Modified Kidner procedure utilizing a Mitek bone anchor.

Science.gov (United States)

Dawson, D M; Julsrud, M E; Erdmann, B B; Jacobs, P M; Ringstrom, J B

1998-01-01

The recent development of small bone suture anchors has created several potential applications in reconstructive surgery of the foot. Mitek bone anchors are simple to insert, require less aggressive dissection and surgical time than reefing of the redundant posterior tibial tendon, and are a reliable method of tendon-to-bone fixation. Mitek bone anchors are an excellent technique for the treatment of redundant tibialis posterior tendon following a modified Kidner procedure. In modified Kidner procedures involving an excessively large os tibiale externum, Mitek anchoring of the redundant tibialis posterior tendon to the navicular bone is an excellent means for secure plication of the posterior tibial tendon in cases involving intraoperative tendon laxity. A description of the Mitek Anchor System and technique of application in a modified Kinder procedure is presented. The purpose of this study was to describe patient satisfaction and long-term clinical outcomes of the modified Kinder procedure with and without the Mitek bone anchoring system. A retrospective study of the modified Kinder procedure was performed with 13 patients being evaluated, seven with Mitek anchoring and six without. The University of Maryland 100-point Painful Foot Center Scoring System was modified to be more specific to the modified Kinder procedure for assessment of subjective long-term results. Patient overall satisfaction was rated good to excellent by 85.6% of patients in the Mitek group and by 100% of patients in the non-Mitek group. Use of the Mitek anchor allowed for quicker postoperative recovery to resumption of ambulation without assistive devices (average of 3 weeks vs. 4.42 weeks) and a quicker return to pain-free ambulation in normal shoegear (average of 4 weeks vs. 6 weeks). Mitek anchoring of the tibialis posterior tendon, theoretically, increases medial arch support as evidenced by 14% of the Mitek group and 67% of the non-Mitek group requiring postoperative orthotics.

Engineering bone grafts with enhanced bone marrow and native scaffolds.

Science.gov (United States)

Hung, Ben P; Salter, Erin K; Temple, Josh; Mundinger, Gerhard S; Brown, Emile N; Brazio, Philip; Rodriguez, Eduardo D; Grayson, Warren L

2013-01-01

The translation of tissue engineering approaches to the clinic has been hampered by the inability to find suitable multipotent cell sources requiring minimal in vitro expansion. Enhanced bone marrow (eBM), which is obtained by reaming long bone medullary canals and isolating the solid marrow putty, has large quantities of stem cells and demonstrates significant potential to regenerate bone tissues. eBM, however, cannot impart immediate load-bearing mechanical integrity or maintain the gross anatomical structure to guide bone healing. Yet, its putty-like consistency creates a challenge for obtaining the uniform seeding necessary to effectively combine it with porous scaffolds. In this study, we examined the potential for combining eBM with mechanically strong, osteoinductive trabecular bone scaffolds for bone regeneration by creating channels into scaffolds for seeding the eBM. eBM was extracted from the femurs of adult Yorkshire pigs using a Synthes reamer-irrigator-aspirator device, analyzed histologically, and digested to extract cells and characterize their differentiation potential. To evaluate bone tissue formation, eBM was seeded into the channels in collagen-coated or noncoated scaffolds, cultured in osteogenic conditions for 4 weeks, harvested and assessed for tissue distribution and bone formation. Our data demonstrates that eBM is a heterogenous tissue containing multipotent cell populations. Furthermore, coating scaffolds with a collagen hydrogel significantly enhanced cellular migration, promoted uniform tissue development and increased bone mineral deposition. These findings suggest the potential for generating customized autologous bone grafts for treating critical-sized bone defects by combining a readily available eBM cell source with decellularized trabecular bone scaffolds. © 2013 S. Karger AG, Basel

The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within-trial analysis of the Border Trial.

Science.gov (United States)

Santamaria, Nick; Liu, Wei; Gerdtz, Marie; Sage, Sarah; McCann, Jane; Freeman, Amy; Vassiliou, Theresa; DeVincentis, Stephanie; Ng, Ai W; Manias, Elizabeth; Knott, Jonathan; Liew, Danny

2015-06-01

Little is known about the cost-benefit of soft silicone foam dressings in pressure ulcer (PU) prevention among critically ill patients in the emergency department (ED) and intensive care unit (ICU). A randomised controlled trial to assess the efficacy of soft silicone foam dressings in preventing sacral and heel PUs was undertaken among 440 critically ill patients in an acute care hospital. Participants were randomly allocated either to an intervention group with prophylactic dressings applied to the sacrum and heels in the ED and changed every 3 days in the ICU or to a control group with standard PU prevention care provided during their ED and ICU stay. The results showed a significant reduction of PU incidence rates in the intervention group (P = 0·001). The intervention cost was estimated to be AU$36·61 per person based on an intention-to-treat analysis, but this was offset by lower downstream costs associated with PU treatment (AU$1103·52). Therefore, the average net cost of the intervention was lower than that of the control (AU$70·82 versus AU$144·56). We conclude that the use of soft silicone multilayered foam dressings to prevent sacral and heel PUs among critically ill patients results in cost savings in the acute care hospital. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

[Frontier in bone biology].