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Sample records for huge anterior sacral

  1. Anterior sacral meningocele presenting as constipation

    Directory of Open Access Journals (Sweden)

    Anup Mohta

    2011-01-01

    Full Text Available Anterior sacral meningocele (ASM is a rare form of spinal dysraphism in children. Usually asymptomatic, it can present as constipation, urinary problems or rarely neurological symptoms. High index of suspicion with careful clinical examination is necessary to make early diagnosis. Magnetic resonance imaging is the investigation of choice. We describe a successfully managed young child with ASM associated with rib and vertebral defects.

  2. Anterior sacral meningocoele presenting as a peri-anal abscess.

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    Buxton, N; Bassi, S; Firth, J

    2002-06-01

    Anterior sacral meningoceole is a rare occurrence and presentation as a perianal abscess has not been previously reported. The case is presented and the condition discussed. The potential risks of failing to establish the diagnosis, prior to surgery, are outlined.

  3. 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

    Directory of Open Access Journals (Sweden)

    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.

  4. Computer-Assisted Navigation During an Anterior-Posterior En Bloc Resection of a Sacral Tumor.

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    Al Eissa, Sami; Al-Habib, Amro F; Jahangiri, Faisal R

    2015-11-04

    Previously, a computer-based navigation system has not been used routinely for en-bloc resection of sacral tumors. In order to improve the accuracy of tumor resection, O-arm navigation was used to join anterior and posterior osteotomies during an en-bloc resection of a sacral Ewing's sarcoma. This case study describes the technique for en-bloc resection of a sacral Ewing's sarcoma guided by O-arm computer navigation and intraoperative neurophysiological monitoring (IONM). An 18-year-old male presented with weakness in his left lower extremity. MRI of the patient's spine showed a sacral mass causing compression of left S1 and S2 roots. A surgical resection was planned with anterior and posterior approaches. An O-arm computer navigation system was used to assist in meeting anterior osteotomy cuts with the posterior cuts to ensure complete resection of the sacral tumor with a safe margin. Computer-assisted navigation was used along with IONM during this procedure to help guide the surgical team in an adequate tumor resection. There were no complications related to the use of the O-arm or the navigation system. Computer navigation guidance is both useful and safe in sacral tumor resections. It enhanced the accuracy of the en-bloc removal of a sacral tumor with safe margins while protecting neural function and minimizing recurrence.

  5. Long-term anodal block stimulation at sacral anterior roots promoted recovery of neurogenic bladder function in a rabbit model of complete spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    Xiaoran Wang; Yongjie Wang; Jihu Lian; Chaoling Shi; Yao Wang; Li Fan; Qi Gao; Xiaoyu Yang; Weihua Wang; Xinquan Gu; Guifeng Liu; Peng Yan; Ge Gao; Xin Yu

    2012-01-01

    A complete spinal cord injury model was established in experimental rabbits using the spinal cord clip compression method. Urodynamic examination was performed 2 weeks later to determine neurogenic bladder status. The rabbits were treated with anodal block stimulation at sacral anterior roots for 4 weeks. Electrical stimulation of sacral anterior roots improved urodynamic parameters of neurogenic bladder in rabbit models of complete spinal cord injury, effectively promoted urinary function, and relieved urinary retention. Immunohistochemistry results showed that a balance was achieved among expression of muscarinic receptor subunits M2, M3, ATP-gated ion channel P2X3 receptors, and β2-adrenergic receptor, and nerve growth factor expression decreased. These results suggested that long-term sacral anterior root stimulation of anodal block could be used to treat neurogenic bladder in a rabbit model of complete spinal cord injury.

  6. Sacral anterior root stimulated defecation in spinal cord injuries: An experimental study in canine model

    Institute of Scientific and Technical Information of China (English)

    Shi-Min Chang; Guang-Rong Yu; Ying-Min Diao; Meng-Jie Zhang; Shi-Bo Wang; Chun-Lin Hou

    2005-01-01

    AIM: To investigate whether there was a dominant sacral root for the motive function of rectum and anal sphincter,and to provide an experimental basis for sacral root electrically stimulated defecation in spinal cord injuries.METHODS: Eleven spinal cord injured mongrel dogs were included in the study. After L4-L7 laminectomy, the bilateral L7-S3 roots were electrostimulated separately and rectal and sphincter pressure were recorded synchronously. Four animals were implanted electrodes on bilateral S2 roots.RESULTS: For rectal motorial innervation, S2 was the most dominant (mean 15.2 kPa, 37.7% of total pressure),S1 (11.3kPa, 27.6%) and S3 (10.9 kPa, 26.7%) contributed to a smaller part. For external anal sphincter, S3 (mean 17.2 kPa, 33.7%) was the most dominant, S2 (16.2 kPa,31.6%) and S1 (14.3 kPa, 27.9%) contributed to a lesser but still a significant part. Above 85% L7 roots provided some functional contribution to rectum and anal sphincter.For both rectum and sphincter, the dght sacral roots provided more contribution than the left roots. Postoperatively, the 4 dogs had electrically stimulated defecation and micturition under the control of the neuroprosthetic device.CONCLUSION: S2 root is the most dominant contributor to rectal pressure in dogs. Stimulation of bilateral S2 with implanted electrodes contributes to good micturition and defecation in dogs.

  7. [COMBINED POSTERIOR AND ANTERIOR APPROACHES FOR RESECTION OF THORACOLUMBAR SPINAL HUGE DUMBBELL-SHAPED TUMOR].

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    Shi, Jiandang; Zhao, Chen; Ding, Huiqiang; Fu, Bin; Niu, Ningkui; Yue, Xuefeng; Yang, Zongqiang; He, Yin

    2016-02-01

    To investigate the surgical outcome of combined posterior and anterior approaches for the resection of thoracolumbar spinal canal huge dumbbell-shaped tumor. Between January 2009 and March 2015, 12 patients with thoracolumbar spinal canal huge dumbbell-shaped tumor were treated by posterior approach and anterolateral approach through diaphragmatic crura and thoracoabdominal incision for complete resection. There were 9 males and 3 females, with an average age of 45 years (range, 30-65 years). The disease duration was 8-64 weeks (mean, 12.7 weeks). The tumor was located at T(12), L1 in 6 cases, at L(1,2) in 5 cases, and at L(2,3) in 1 case. The tumor size ranged from 4.3 cm x 4.0 cm x 3.5 cm to 7.5 cm x 6.3 cm x 6.0 cm. According to tumor outside the spinal involvement scope and site and based on the typing of Eden, 5 cases were rated as type b, 2 cases as type d, 4 cases as type e, and 1 case as type f in the transverse direction; two segments were involved in 8 cases, and more than two segments in 4 cases. The degree of tumor excision, tumor recurrence, and the spine stability were observed during follow-up. The verbal rating scale (VRS) was used to evaluate pain improvement. The average surgical time was 170 minutes (range, 150-230 minutes); the average intraoperative blood loss was 350 mL (range, 270-600 mL). All incisions healed by first intention, and no thoracic cavity infection and other operation related complication occurred. Of 12 cases, 10 were histologically confirmed as schwannoma, and 2 as neurofibroma. The patients were followed up 6 months to 6 years (mean, 31 months). Neurological symptoms were significantly improved in all patients, without lower back soreness. The thoracolumbar X-ray film and MRI showed no tumor residue. No tumor recurrence, internal fixator loosening, scoliosis, and other complications were observed during follow-up. VRS at last follow-up was significantly improved to grade 0 (10 cases) or grade 1 (2 cases) from preoperative

  8. Lumbar-sacral dysplasias

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    Schumacher, M.; Thron, A.

    1984-09-01

    By means of some selected examples, the myelographic and CT characteristics are presentated of different lumbar-sacral dysplasias. The advantage of the different methods of examination (CT, CT myelography and myelography) and the improved presentation of pathological-anatomical details by means of a combination of these methods in the diagnosis of hyperplasia of the filum terminale, diastematomyelia, tethered conus, intracorporal and anterior sacral meningocele have been shown.

  9. Review of integrated neuromusculoskeletal release and the novel application of a segmental anterior/posterior approach in the thoracic, lumbar, and sacral regions.

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    Danto, Jay B

    2003-12-01

    Integrated neuromusculoskeletal release (INR) using a segmental anterior/posterior approach is an osteopathic manipulative treatment technique that is easily learned and applied. The segmental anterior/posterior approach to INR was developed as a practical osteopathic manipulative treatment procedure for the inpatient setting, but also has equal efficacy in the outpatient setting. It builds on the principles of INR and myofascial release techniques, as well as other techniques. This approach focuses on both the anterior and posterior connectivity of the body through the neuromusculoskeletal system and uses this connectivity to effectively treat somatic dysfunctions. The principles of INR are discussed, as well as the role of INR in the diagnosis and treatment of somatic dysfunctions in the thoracic, lumbar, and sacral regions.

  10. 先天性骶前脊膜膨出的手术治疗%Surgical treatment of congenital anterior sacral meningomyelocele

    Institute of Scientific and Technical Information of China (English)

    陶本章; 王伟君; 高海浩; 程诚; 尚爱加

    2016-01-01

    目的 探讨先天性骶前脊膜膨出的临床特点和外科治疗方法,旨在通过选择合适的手术入路及手术方式,减少手术并发症并改善预后.方法 回顾性分析2014年2月至2015年4月解放军总医院神经外科收治的4例先天性骶前脊膜膨出患者的临床资料.临床表现包括腹痛、肢体麻木、便秘、尿急和尿频等症状.所有病例均采用骶部后正中入路显微手术治疗.随访时间为2~15个月,平均6.5个月.结果 4例患者术后症状较术前均有不同程度的改善,复查MRI均提示骶前脊膜膨出消失.术后未见脑脊液漏、腹腔积液、伤口感染等并发症发生.结论 先天性骶前脊膜膨出的临床表现以盆腔脏器压迫症状为主,经骶部后正中入路显微手术可达到良好效果.术中妥善处理瘘口及保护骶神经可避免术后脑脊液漏的发生.%Objective To investigate the clinical characteristics and surgical treatment method of congenital anterior sacral meningomyelocele in order to reduce surgical complications and improve prognosis by selecting the appropriate surgical approaches and surgical methods.Methods The clinical data of 4 patients with congenital anterior sacral meningomyelocele treated at the Department of Neurosurgery,Chinese PLA General Hospital from February 2014 to April 2015 were analyzed retrospectively.The clinical manifestations included abdominal pain,numbness of limbs,constipation,urinary urgency,urinary frequency,and other symptoms.The follow-up time ranged from 2 to 12 months (mean 6.5 months).Results The postoperative symptoms of the 4 patients had different degrees of improvement compare with the before procedure.The MRI reexamination revealed that the anterior sacral meningocele disappeared.No postoperative cerebrospinal fluid leakage,peritoneal effusion,wound infection,and other complications were found.Conclusions The clinical manifestation of congenital anterior sacral meningocele is mainly pelvic

  11. Minimally Invasive Anterior Decompression Technique without Instrumented Fusion for Huge Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine: Technical Note And Literature Review.

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    Yu, Jae Won; Yun, Sang-O; Hsieh, Chang-Sheng; Lee, Sang-Ho

    2017-09-01

    Several surgical methods have been reported for treatment of ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. Despite rapid innovation of instruments and techniques for spinal surgery, the postoperative outcomes are not always favorable. This article reports a minimally invasive anterior decompression technique without instrumented fusion, which was modified from the conventional procedure. The authors present 2 cases of huge beak-type OPLL. Patients underwent minimally invasive anterior decompression without fusion. This method created a space on the ventral side of the OPLL without violating global thoracic spinal stability. Via this space, the OPLL and anterior lateral side of the dural sac can be seen and manipulated directly. Then, total removal of the OPLL was accomplished. No orthosis was needed. In this article, we share our key technique and concepts for treatment of huge thoracic OPLL. Case 1. 51-year-old female was referred to our hospital with right lower limb radiating pain and paresis. Thoracic OPLL at T6-7 had been identified at our hospital, and conservative treatment had been tried without success. Case 2. This 54-year-old female with a 6-month history of progressive gait disturbance and bilateral lower extremity radiating pain (right>left) was admitted to our institute. She also had hypoesthesia in both lower legs. Her symptoms had been gradually progressing. Computed tomography scans showed massive OPLL at the T9-10 level. Magnetic resonance imaging of the thoracolumbar spine demonstrated ventral bony masses with severe anterior compression of the spinal cord at the same level. We used this surgical method in 2 patients with a huge beaked-type OPLL in the thoracic level. Complete removal of the OPLL via anterior decompression without instrumented fusion was accomplished. The 1st case had no intraoperative or postoperative complications, and the 2nd case had 1 intraoperative complication (dural tear) and no

  12. A cost-utility analysis of sacral anterior root stimulation (SARS) compared with medical treatment in patients with complete spinal cord injury with a neurogenic bladder.

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    Morlière, Camille; Verpillot, Elise; Donon, Laurence; Salmi, Louis-Rachid; Joseph, Pierre-Alain; Vignes, Jean-Rodolphe; Bénard, Antoine

    2015-12-01

    Sacral anterior root stimulation (SARS) and posterior sacral rhizotomy restores the ability to urinate on demand with low residual volumes, which is a key for preventing urinary complications that account for 10% of the causes of death in patients with spinal cord injury with a neurogenic bladder. Nevertheless, comparative cost-effectiveness results on a long time horizon are lacking to adequately inform decisions of reimbursement. This study aimed to estimate the long-term cost-utility of SARS using the Finetech-Brindley device compared with medical treatment (anticholinergics+catheterization). The following study design is used for the paper: Markov model elaborated with a 10-year time horizon; with four irreversible states: (1) initial treatment, (2) year 1 of surgery for urinary complication, (3) year >1 of surgery for urinary complication, and (4) death; and reversible states: urinary calculi; Finetech-Brindley device failures. The sample consisted of theoretical cohorts of patients with a complete spinal cord lesion since ≥1 year, and a neurogenic bladder. Effectiveness was expressed as quality adjusted life years (QALYs). Costs were valued in EUR 2013 in the perspective of the French health system. A systematic review and meta-analyses were performed to estimate transition probabilities and QALYs. Costs were estimated from the literature, and through simulations using the 2013 French prospective payment system classification. Probabilistic analyses were conducted to handle parameter uncertainty. In the base case analysis (2.5% discount rate), the cost-utility ratio was 12,710 EUR per QALY gained. At a threshold of 30,000 EUR per QALY the probability of SARS being cost-effective compared with medical treatment was 60%. If the French Healthcare System reimbursed SARS for 80 patients per year during 10 years (anticipated target population), the expected incremental net health benefit would be 174 QALYs, and the expected value of perfect information (EVPI

  13. Anterior Reduction, Discectomy, and Three Cortical Iliac Bone Grafting With Instrumentation to Treat A Huge Tear Drop Fracture of the Axis: A Case Report and Literature Review.

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    Ma, Litai; Yang, Yi; Gong, Quan; Ding, Chen; Liu, Hao; Hong, Ying

    2016-04-01

    Fractures of the axis body have been little reported and treatment strategies remain controversial and individualized. Not more than 10 cases of huge tear drop fracture of the axis (HTDFA) have been reported in previous studies and the treatment method varies from conservative treatment to an anterior, or posterior, approach surgery. Considering the sparse knowledge of HTDFA, we present a special case report to share our experience and to explore the safety and effectiveness of anterior reduction and fusion to treat HTDFA. A 24-year-old man was referred to our department; he presented with neck pain lasting for 12 h since being involved in a roll-over motor vehicle accident. His neck movement was limited but there was no neurological compromise. Physical examination of the patient showed myodynamia of four limbs Grade 5, Hoffmann sign (-), and Babinski sign (-). Three-dimensional reconstruction computed tomography (CT) confirmed a huge tear drop fracture of the anterior-inferior corner of the axis and discontinuity of the cortex of the axis. After discussion with the spinal surgeon team in the department and an effective conversation with the patient, surgery involving anterior reduction, discectomy, and three cortical iliac bone grafts with instrumentation after transnasal induction of general anesthesia was performed. The patient was instructed to wear a cervical collar until he returned to our department for a follow-up examination some 3 months after surgery. The 3-month postoperative x-ray and CT scan showed a good position of the implant and bony fusion at the C2/3 segment. Anterior reduction, discectomy, and three cortical iliac bone grafts with instrumentation to treat HTDFA are effective, safe, and simple. Of course, longer follow-up duration and more cases are warranted to verify this procedure. Anterior reduction, discectomy, and bone grafting with instrumentation are warranted for most HTDFA cases. However, if HTDFA incorporates other complex

  14. Anterior Reduction, Discectomy, and Three Cortical Iliac Bone Grafting With Instrumentation to Treat A Huge Tear Drop Fracture of the Axis

    Science.gov (United States)

    Ma, Litai; Yang, Yi; Gong, Quan; Ding, Chen; Liu, Hao; Hong, Ying

    2016-01-01

    Abstract Fractures of the axis body have been little reported and treatment strategies remain controversial and individualized. Not more than 10 cases of huge tear drop fracture of the axis (HTDFA) have been reported in previous studies and the treatment method varies from conservative treatment to an anterior, or posterior, approach surgery. Considering the sparse knowledge of HTDFA, we present a special case report to share our experience and to explore the safety and effectiveness of anterior reduction and fusion to treat HTDFA. A 24-year-old man was referred to our department; he presented with neck pain lasting for 12 h since being involved in a roll-over motor vehicle accident. His neck movement was limited but there was no neurological compromise. Physical examination of the patient showed myodynamia of four limbs Grade 5, Hoffmann sign (–), and Babinski sign (–). Three-dimensional reconstruction computed tomography (CT) confirmed a huge tear drop fracture of the anterior–inferior corner of the axis and discontinuity of the cortex of the axis. After discussion with the spinal surgeon team in the department and an effective conversation with the patient, surgery involving anterior reduction, discectomy, and three cortical iliac bone grafts with instrumentation after transnasal induction of general anesthesia was performed. The patient was instructed to wear a cervical collar until he returned to our department for a follow-up examination some 3 months after surgery. The 3-month postoperative x-ray and CT scan showed a good position of the implant and bony fusion at the C2/3 segment. Anterior reduction, discectomy, and three cortical iliac bone grafts with instrumentation to treat HTDFA are effective, safe, and simple. Of course, longer follow-up duration and more cases are warranted to verify this procedure. Anterior reduction, discectomy, and bone grafting with instrumentation are warranted for most HTDFA cases. However, if HTDFA incorporates other

  15. 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.

  16. Sacral nerve stimulation.

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    Matzel, K E; Stadelmaier, U; Besendörfer, M

    2004-01-01

    The current concept of recruiting residual function of an inadequate pelvic organ by electrostimulation involves stimulation of the sacral spinal nerves at the level of the sacral canal. The rationale for applying SNS to fecal incontinence was based on clinical observations of its effect on bowel habits and anorectal continence function in urologic patients (increased anorectal angulation and anal canal closure pressure) and on anatomic considerations: dissection demonstrated a dual peripheral nerve supply of the striated pelvic floor muscles that govern these functions. Because the sacral spinal nerve site is the most distal common location of this dual nerve supply, stimulating here can elicit both functions. Since the first application of SNS in fecal incontinence in 1994, this technique has been improved, the patient selection process modified, and the spectrum of indications expanded. At present SNS has been applied in more than 1300 patients with fecal incontinence limited.

  17. 脊神经前根对大鼠排尿和勃起功能的选择性支配机制%Selective innervation of sacral anterior rootlets to micturition and erection function in rats

    Institute of Scientific and Technical Information of China (English)

    王文婷; 周谋望; 黄红拾; 陈亚平; 杨延砚; 曾凡硕

    2010-01-01

    Objective To investigate the selective innervation of sacral anterior rootlets to micturition and erection function in SD rats. Methods Forty male SD rats of clean grade, aged 6 weeks old, were selected. Ten rats received a retrograde nerve tract tracing study. Thirty rats were chosen for an electro-physiological study. The L6, S1 spinal cord segment anterior rootlets of anesthetic rats were electrostimulated respectively. The intravesical pressure, urethral perfusion pressure and intracarvernerous pressure were recorded simultaneously and innervation effectiveness was analyzed. Results CB-HRP labeled neurons were observed mainly in L6 and S1 spinal cords. When some anterior rootlets of L6 and S1were electrostimulated, the intravesical pressure rose gradually, but the urethral perfusion pressure and the intracavernous pressure curve changed slightly; when other rootlets of the same anterior root were stimulated,the urethral perfusion pressure could reach the peak; while others were stimulated, the intracavernours pressure rose quickly, but there were no great changes in intravesical pressure and urethral perfusion pressure. Some other rootlets might lead to the simultaneous changes of 2 or 3 above-mentioned pressures.Conclusion The innervations of L6 and S1 anterior rootlets to rats' bladder detrusor, external urethral sphincter and penile cavernous body are significantly distinct. Different rootlets may be distinguished by microanatomy and electrostimulation.%目的 探讨脊神经前根小束对SD大鼠膀胱和勃起功能的选择性支配机制.方法 成年雄性SD大鼠40只,10只行逆行神经示踪,30只行电生理研究:分别刺激大鼠排尿及勃起反射中枢所在脊髓节段的脊神经前根神经小束,同时记录膀胱内压、尿道灌注压和阴茎海绵体内压的变化.结果 SD大鼠排尿和勃起功能的低级中枢主要位于L6、S1脊髓节段,电刺激L6、S1脊神经前根某些小束分别引起膀胱内压、尿道灌注压

  18. Sacral fatigue fractures in children with sacral spina bifida occulta

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    Hama, Shingo; Sakai, Toshinori; Higashino, Kosaku; Abe, Mitsunobu; Nagamachi, Akihiro; Sairyo, Koichi

    2016-01-01

    In this report, we present two cases of 9-year-old children with spina bifida occulta (SBO) of the sacrum, who were diagnosed with sacral fatigue fractures. In both patients, MRI showed a linear signal void and high signal in sacral ala on the short tau inversion recovery sequence. Sacral SBO at the same level of the sacral fracture was observed in each patient on computed tomography images. These lesions healed with rest. This is the first literature reporting cases with sacral stress fractures who had SBO at the same level of fracture. PMID:26196371

  19. Anterior Reconstruction of C2–C3 Bodies in a 6-Year-Old Patient with a Huge Osteoblastoma: A Novel Technique

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    Haghnegahdar, Ali; Sedighi, Mahsa

    2015-01-01

    Study Design Case report. Objective We report the youngest child diagnosed with upper cervical osteoblastoma and the first case operated on with our novel surgical approach. Methods Our patient underwent a two-stage surgery. During the first operation via a posterior approach, a subtotal resection of a C2 bony mass was performed. C3 was also subtotally resected due to tumor extension. Posterior fixation of C1–C5 was performed by C1 sublaminar hooks and C4 and C5 lateral mass screws. Ten days later, a total resection of the residual bony mass was performed through an anterior approach (between the sternocleidomastoid muscle and carotid sheath). Reconstruction of C1–C3 was performed with C1 anterior sublaminar wiring and an expandable titanium cage. Results Successful reconstruction of C2–C3 vertebral bodies was achieved. At 2-year follow-up, the child was symptom-free. Imaging studies revealed no recurrence of tumor or instability. Conclusion A novel technique for reconstruction of C2–C3 vertebral bodies is demonstrated for the youngest case (a 6-year-old boy) of osteoblastoma in the literature. We recommend this approach for cervical spine reconstruction in patients who have an intact C1 arc and resected lower bodies. PMID:26835212

  20. Anterior Reconstruction of C2-C3 Bodies in a 6-Year-Old Patient with a Huge Osteoblastoma: A Novel Technique.

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    Haghnegahdar, Ali; Sedighi, Mahsa

    2016-02-01

    Study Design Case report. Objective We report the youngest child diagnosed with upper cervical osteoblastoma and the first case operated on with our novel surgical approach. Methods Our patient underwent a two-stage surgery. During the first operation via a posterior approach, a subtotal resection of a C2 bony mass was performed. C3 was also subtotally resected due to tumor extension. Posterior fixation of C1-C5 was performed by C1 sublaminar hooks and C4 and C5 lateral mass screws. Ten days later, a total resection of the residual bony mass was performed through an anterior approach (between the sternocleidomastoid muscle and carotid sheath). Reconstruction of C1-C3 was performed with C1 anterior sublaminar wiring and an expandable titanium cage. Results Successful reconstruction of C2-C3 vertebral bodies was achieved. At 2-year follow-up, the child was symptom-free. Imaging studies revealed no recurrence of tumor or instability. Conclusion A novel technique for reconstruction of C2-C3 vertebral bodies is demonstrated for the youngest case (a 6-year-old boy) of osteoblastoma in the literature. We recommend this approach for cervical spine reconstruction in patients who have an intact C1 arc and resected lower bodies.

  1. 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.

  2. Imaging of sacral tumours

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    Gerber, S.; Ollivier, L.; Brisse, H.; Neuenschwander, S. [Institut Curie, Department of Radiology, Paris (France); Leclere, J. [Institut Gustave Roussy, Department of Radiology, Villejuif (France); Vanel, D. [The Rizzoli Institute, Department of Radiology, Bologna (Italy); Missenard, G. [Institut Gustave Roussy, Comite de pathologie tumorale de l' appareil locomoteur, Villejuif (France); Pinieux, G. de [CHRU de Tours, Department of Pathology, Hopital Trousseau, Tours (France)

    2008-04-15

    All components of the sacrum (bone, cartilage, bone marrow, meninges, nerves, notochord remnants, etc.) can give rise to benign or malignant tumours. Bone metastases and intraosseous sites of haematological malignancies, lymphoma and multiple myeloma are the most frequent aetiologies, while primary bone tumours and meningeal or nerve tumours are less common. Some histological types have a predilection for the sacrum, especially chordoma and giant cell tumour. Clinical signs are usually minor, and sacral tumours are often discovered in the context of nerve root or pelvic organ compression. The roles of conventional radiology, CT and MRI are described and compared with the histological features of the main tumours. The impact of imaging on treatment decisions and follow-up is also reviewed. (orig.)

  3. Variation of the Lateral Sacral Artery in relation to Sciatic Neuropathy

    Directory of Open Access Journals (Sweden)

    Waseem Al Talalwah

    2014-01-01

    Full Text Available The lateral sacral artery usually originates from the posterior trunk of the internal iliac artery. The current study of 342 specimens from 171 cadavers (79 male, 92 female investigated the origin and course of the lateral sacral artery. It was observed to arise from the posterior trunk in 79.1%. Occasionally it originated from the anterior trunk that occurred in 1%. It arose from the sciatic artery in 8.8%, from the superior gluteal artery in 16.8%, and from the inferior gluteal artery in 5.4%. Conversely, the lateral sacral artery is congenital absence in 0.3%. In addition, the lateral sacral artery was single, double, triple, and quadruple in 77.2%, 19.8%, 2.3%, and 0.3%, respectively. Consequently, variability of the lateral sacral artery origin is due to vascular demand as the lateral sacral artery plexus does arise from the earlier trunk development. With variability of the lateral sacral artery origin, there is a variability of the sciatic nerve supply. Knowing the variability of origins, surgeons have to avoid prolonged ligation of the internal iliac artery or its posterior trunk during surgical procedures which may lead to sciatic neuropathy. Therefore, the lateral sacral artery origin, course, and branches are important for clinicians to improve their knowledge and patient management.

  4. [Sacral hitch vesical pexy: a new ancillary technique for ureteroneocystostomy].

    Science.gov (United States)

    Pini, Giovannalberto; Leoni, Sergio

    2011-01-01

    To describe the Sacral Hitch, vesical pexys to sacral promontory, an alternative technique to the Psoas Hitch when this is impossible to perform. We report intraoperative complications, and long-term functional results. From 1989 to date we performed 66 ureteroneocystostomies (UNCS) (transbladder technique and Politano-Leadbetter antireflux plasty): 51 with ancillary "Psoas Hitch" (11 Casati-Boari); 15 with "Sacral Hitch" because of the intraoperative finding of deficiency or lack of psoas tendon. Note of technique. Ureter and bladder are dissected as usual. Sacral Hitch: left lateralization of sigmoid and exposition of sacral promontory; longitudinal incision and divarication of peritoneum; smooth dissection of fat tissue, displacement of medium sacral vessels and visualization of neurovascular bundles. Direct fixation of the dome/posterior aspect of bladder to anterior longitudinal ligament above promontory. Among the patients who underwent the Psoas Hitch technique, 3 (5.4%) showed hypoesthesia, acute pain and impossible flexion of the thigh on hip with EMG positive for femoral (1) and genito-femoral (2) neuropathy. The re-operation in 2 cases solved the symptoms. One case resolved conservatively with corticoids, tricyclic antidepressants (Amitriptyline) and antiepileptics (gabapentin). Mean follow-up was 115 months (8-252); two stenosis of anastomosis. Sacral Hitch: (15 pts), mean follow-up: 47 months (range 4-110), no stenosis of anastomosis 0%; transfusion rate 0%. The psoas tendon deficiency or its congenital absence (children or women) requires the direct fixation to the muscle, an inadequate and weak target and housing of important sensitive-motor nerves (Genito-femoral, femoral and latero-cutaneous). A "Psoas-Syndrome" could be present in 5.1% and a re-operation could be necessary. The sacral promontory represents an affixation target already successfully adopted in other surgery specialties (Gynaecology, Orthopaedic and General Surgery) and gives to UNCS

  5. Symptomatic Sacral Perineurial (Tarlov) Cysts

    OpenAIRE

    Sajko, Tomislav; Kovač, Damir; Kudelić, Nenad; Kovač, Lana

    2009-01-01

    Sacral perineurial (Tarlov) cysts are rare lesions. Over a seven year period 4000 patients underwent surgery for lumbar disk herniation. In three patients neurological symptoms were caused by large sacral perineurial cysts. Methods of choice for diagnosis of Tarlov cysts are lumbosacral magnetic resonance imaging and computerized tomography myelography. The majority of Tarlov cysts are asymptomatic. In case of large (ł1.5 cm) and symptomatic perineurial cyst, as in three patients reported in ...

  6. Complex multilevel lumbar spine fractures with transverse sacral fracture

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    Kshitij Chaudhary

    2011-01-01

    Full Text Available We report an unusual and complex case of spinal trauma in a 17-year-old boy who presented with a transverse sacral fracture associated with multiple-level lumbar fractures, paraparesis, and bladder involvement. A two-stage surgery was performed. The lumbar spine fractures were treated with posterior instrumented correction of displacements, followed by anterior instrumentation and fusion. The sacral fracture was left untreated. At 5-year followup, the patient had complete neurological recovery except for the right L5 root function. The long-segment lumbar fusion and the untreated displaced sacral fracture contributed to spinal imbalance, due to which the patient is now able to stand only in a crouched posture. Determining the optimal treatment for the case is presented due to the relative rarity of transverse sacral fracture and paucity of evidence-based treatment approaches. In patients with associated lumbar spine fractures that require extension of instrumentation to the upper lumbar spine, it is critical to restore sacropelvic alignment to achieve spinal balance. Adequate reduction of sacropelvic anatomy can be achieved with iliac screw fixation.

  7. Sacral Rachipagus Parasite: A Case Report.

    Science.gov (United States)

    Rattan, Kamal Nain; Singh, Jasbir; Dalal, Poonam; Sonika, Pallavi; Rattan, Ananta

    2016-01-01

    We are reporting a case of sacral rachipagus parasite which was vaginally delivered as a large irregular mass attached to the sacral region by a vascular pedicle. This case was managed successfully by surgical excision of parasite.

  8. Sacral Rachipagus Parasite: A Case Report

    Directory of Open Access Journals (Sweden)

    Kamal Nain Rattan

    2016-03-01

    Full Text Available We are reporting a case of sacral rachipagus parasite which was vaginally delivered as a large irregular mass attached to the sacral region by a vascular pedicle. This case was managed successfully by surgical excision of parasite.

  9. Symptomatic sacral perineurial (Tarlov) cysts.

    Science.gov (United States)

    Sajko, Tomislav; Kovać, Damir; Kudelić, Nenad; Kovac, Lana

    2009-12-01

    Sacral perineurial (Tarlov) cysts are rare lesions. Over a seven year period 4000 patients underwent surgery for lumbar disk herniation. In three patients neurological symptoms were caused by large sacral perineurial cysts. Methods of choice for diagnosis of Tarlov cysts are lumbosacral magnetic resonance imaging and computerized tomography myelography. The majority of Tarlov cysts are asymptomatic. In case of large (> or = 1.5 cm) and symptomatic perineurial cyst, as in three patients reported in this article, microsurgical treatment was successful. Although rare, perineurial (Tarlov) cysts must be taken into consideration when approaching to patient with low back and radicular pain. Authors review the medical literature, pathological and pathophysiological features and treatment options of sacral perineurial cysts.

  10. Osteolytic extra-axial sacral myxopapillary ependymoma

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  11. Postpartal sacral fracture without osteoporosis.

    Science.gov (United States)

    Rousière, M; Kahan, A; Job-Deslandre, C

    2001-02-01

    Stress fractures of the sacrum during pregnancy or the postpartum seem uncommon. We report a new case of nontrauma-related postpartal sacral fracture. Only four similar cases have been reported to date. The patient was 36 years of age and her fracture was diagnosed four weeks after her first delivery. Vitamin D levels were low, but there was no osteomalacia. Other standard laboratory tests were normal, as were absorptiometry measurements at the lumbar spine and femur. Rheumatologists should consider sacral fracture in pregnant or nursing patients with buttock pain. Magnetic resonance imaging is the diagnostic investigation of choice.

  12. Prolonged electrical stimulation causes no damage to sacral nerve roots in rabbits.

    Science.gov (United States)

    Yan, Peng; Yang, Xiaohong; Yang, Xiaoyu; Zheng, Weidong; Tan, Yunbing

    2014-06-15

    Previous studies have shown that, anode block electrical stimulation of the sacral nerve root can produce physiological urination and reconstruct urinary bladder function in rabbits. However, whether long-term anode block electrical stimulation causes damage to the sacral nerve root remains unclear, and needs further investigation. In this study, a complete spinal cord injury model was established in New Zealand white rabbits through T9-10 segment transection. Rabbits were given continuous electrical stimulation for a short period and then chronic stimulation for a longer period. Results showed that compared with normal rabbits, the structure of nerve cells in the anterior sacral nerve roots was unchanged in spinal cord injury rabbits after electrical stimulation. There was no significant difference in the expression of apoptosis-related proteins such as Bax, Caspase-3, and Bcl-2. Experimental findings indicate that neurons in the rabbit sacral nerve roots tolerate electrical stimulation, even after long-term anode block electrical stimulation.

  13. MANAGEMENT OF HUGE ENCEPHALOCELE

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    Rajeev

    2015-11-01

    Full Text Available Among all neural tube defects, encephalocele incidents are 1 in 5000 live births. (1 Newborn with encephalocele may be associated with other congenital malformations. Encephalocele patient’s management pose many challenge to neurosurgeon due to other associated anomalies that may present like ventriculocele, Dandy Walker and Arnold-Chiari malformation, and difficult positioning airway management to anaesthesiologist. We discuss a case of huge encephalocele and its management

  14. 高位骶骨肿瘤前后联合入路局部刮除置管灌注化疗放疗术对骶神经功能影响的评价%The influence on the functions of the sacral nerves by curettage and local pouring chemotherapy and radiotherapy to treat the high sacral tumors

    Institute of Scientific and Technical Information of China (English)

    周勇; 马保安; 范清宇; 张明华; 沈万安

    2002-01-01

    Objective To analyze the influence on the functions of the sacral nerves after curettage and local pouring chemotherapy and radiotherapy by the approach in anterior with posterior to treat the high sacral tumors. Methods 24 cases, include their oncology results and functions of the sacral nerves were analyzed. Results Average follow up 56 months, 3 malignant cases were died of the tumor metastasis. 4 recurrent cases were recurred after treatment between 13 to 32 months. For the tumor curettage demand, the one side S2 nerve of 2 cases and the S2, 3 nerve of 1 case were cut off. The other case's sacral nerves were reserved completely. Conclusions This treatment method by local chemotherapy and radiotherapy to treat the high sacral tumors was not influence on the functions of the sacral nerves.

  15. Clinical experience of symptomatic sacral perineural cyst.

    Science.gov (United States)

    Jung, Ki Tae; Lee, Hyun Young; Lim, Kyung Joon

    2012-07-01

    Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion and are usually asymptomatic. Symptomatic sacral perineural cysts are uncommon but sometimes require surgical treatment. A 69-year-old male presented with pain in the buttock. He was diagnosed as having a sacral cyst with magnetic resonance imaging. For the nonoperative diagnosis and treatment, caudal peridurography and block were performed. After the treatment, the patient's symptom was relieved. We suggest a caudal peridural block is effective in relieving pain from a sacral cyst.

  16. Clinical Experience of Symptomatic Sacral Perineural Cyst

    Science.gov (United States)

    Jung, Ki Tae; Lee, Hyun Young

    2012-01-01

    Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion and are usually asymptomatic. Symptomatic sacral perineural cysts are uncommon but sometimes require surgical treatment. A 69-year-old male presented with pain in the buttock. He was diagnosed as having a sacral cyst with magnetic resonance imaging. For the nonoperative diagnosis and treatment, caudal peridurography and block were performed. After the treatment, the patient's symptom was relieved. We suggest a caudal peridural block is effective in relieving pain from a sacral cyst. PMID:22787551

  17. Diagnosis and surgical strategy for sacral meningeal cysts with check-valve mechanism: technical note.

    Science.gov (United States)

    Asamoto, Shunji; Fukui, Yasuyuki; Nishiyama, Makoto; Ishikawa, Masayuki; Fujita, Nobuyuki; Nakamura, Satoshi; Muto, Jun; Shiono, Yuta; Doi, Hiroshi; Kubota, Motoo; Ishii, Kazuhiko

    2013-02-01

    There is agreement that symptomatic sacral meningeal cysts with a check-valve mechanism and/or large cysts representing space-occupying lesions should be treated surgically. This study investigated factors indicating a need for surgical intervention and surgical techniques for sacral meningeal cysts with a check-valve mechanism. In ten patients presenting with sciatica and neurological deficits, myelography, computed tomography (CT) myelography, and magnetic resonance imaging (MR imaging) detected sacral meningeal cysts with a check-valve mechanism. One patient had two primary cysts. Ten cysts were type 2 and one cyst was type 1. Nine of the ten patients had not undergone previous surgery, while the remaining case involved recurrent cyst. For the seven patients with normal (i.e., not huge or recurrent) type 2 cysts and no previous surgery (eight cysts), suture after collapse of the cyst wall was performed. For the recurrent type 2 cyst, duraplasty and suture with collapse of the cyst wall were performed to eliminate the check-valve mechanism. For the remaining type 2 cyst, a primary root was sacrificed because of the huge size of the cyst. For the type 1 cyst, the neck of the cyst was ligated. In all cases, chief complaints disappeared immediately postoperatively and no deterioration of clinical symptoms has been seen after a mean follow-up of 27 months. The presence or absence of a check-valve mechanism is very important in determining the need for surgical intervention for sacral meningeal cysts.

  18. Intrasacral meningeal cyst demonstrated by sacral epidurography

    Energy Technology Data Exchange (ETDEWEB)

    Roosen, N.; Vyve, M. van; Moor, J. de

    1985-03-01

    A case of intrasacral meningeal cyst is reported in which radiculography and computed tomography were not conclusive in diagnosing the lesion. Sacral epidurography delineated the cyst very clearly and is proposed as a complementary imaging technique in lesions of the sacral canal.

  19. The association between sacralization and spondylolisthesis.

    Science.gov (United States)

    Dar, Gali; Peled, Nathan

    2014-06-01

    The role of transitional vertebra in spondylolisthesis is still an enigma. Theoretically, obstruction of movements in the L5-S1 joint should provoke hypermobility at the L4-L5 vertebrae, thus leading to the development of spondylolisthesis. The aim of this study was to inquire whether a positive association exists between sacralization and spondylolisthesis. For this purpose, CT images of 436 consecutive patients were examined for the presence of sacralization and spondylolisthesis. The sample was divided into two groups: a sacralization group and non-sacralization group. Independent variables considered were age, sex and degree of lordosis. Sacralization was found in 13.1% of the individuals examined. It was found to be gender- and age-independent (P>0.05), Spondylolisthesis was identified in 7.3% of the individuals examined and found to be gender independent (P>0.05), and age dependent (Pspondylolisthesis was found. The mean lordosis angle in the spondylolisthesis group was 60.41° compared with 50.84° in patients without spondylolisthesis. No association was found between sacralization and the angle of lordosis (P>0.05). The current study did not reveal an association between sacralization and spondylolisthesis and as such sacralization should not be considered an etiology for the development of degenerative spondylolisthesis.

  20. Sacral rib: an uncommon congenital anomaly.

    Science.gov (United States)

    Miyakoshi, Naohisa; Kobayashi, Akira; Hongo, Michio; Shimada, Yoichi

    2015-06-01

    Sacral rib represents an uncommon pathology in which rib-like structures arise from the sacrum. Supernumerary ribs may occur at any level of the spine, but supernumerary ribs in the sacrococcygeal area are extremely rare. To present the case of a patient with sacral rib and to discuss this entity with reference to the literature. A case report and literature review. A 17-year-old girl presented with low back pain and discomfort in bilateral gluteal regions. Radiographs and computed tomography (CT) of the pelvis showed a smooth-surfaced, rod-like bony structure attaching to the sacrum on the left side. The appearance was consistent with sacral rib. The sacrum was hypoplastic and deviated to the right. Magnetic resonance imaging (MRI) showed insertion of the gluteus maximus (GM) onto the coccyx only on the right side. The sacral rib existed beneath the left GM muscle and received a partial insertion from the left GM muscle. No ligamentous continuation between the sacral rib and coccyx was observed. Conservative treatment relieved symptoms, so no surgical intervention was performed. Sacral rib is a rare congenital anomaly for which surgical intervention is usually unnecessary. However, appropriate workups with CT and/or MRI should be considered for women, because sacral rib may cause complications during childbirth. In the literature, sacral/coccygeal rib is sometimes called "pelvic rib." However, sacral/coccygeal rib should be distinguished from pelvic rib, because pelvic rib originating from the ilium is considered to represent a different entity. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Anatomical Study of Sacral Hiatus for Caudal Epidural Block

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    Dhananjay S Patil

    2012-06-01

    Full Text Available Introduction: Anatomy of the sacral hiatus is having clinical importance during caudal epidural block. Present study is aimed at determining anatomy of sacrum specially sacral hiatus for caudal epidural block, with the help of morphometric measurements of the sacrum in relation to sacral hiatus in dry sacral bones. Material & method: Total 103 complete and undamaged adult, dry sacral bones were measured with Vernier caliper (accuracy 0.1 mm and anatomical measurements were obtained. Results: Three bones were excluded because of total posterior closure defect. Agenesis of the sacral hiatus was detected in three sacral bones. Right and left superolateral sacral crests of the sacrum were taken as two points on dorsal surface of sacrum (forming the base of a triangle because posterior superior iliac spines impose on the superolateral sacral crests. The distance between the two superolateral sacral crests (base of a triangle, the distances between the right and left superolateral sacral crest and the sacral apex were on average 60.61(SD 6.71, 61.95 (11.71 and 61.4 (11.98 mm respectively.. Summary: An equilateral triangle formed between the apex of the sacral hiatus and right and left superolateral sacral crests. This equilateral triangle will help in determining the location of the sacral hiatus during caudal epidural block. [National J of Med Res 2012; 2(3.000: 272-275

  2. Lateral sacral lipomyelomeningocele : a rare anomaly.

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    Shetty D

    2002-04-01

    Full Text Available Lateral sacral lipomyelomeningocele is a rare spinal developmental anomaly. In the case under report, the fat attached to the neural placode was blending with the gluteal fat externally. The cord was tethered at this level. Multiple bony anomalies and diastematomyelia were associated findings. A case of lateral sacral lipomyelomeningocele with excellent imaging detail provided by the multiplanar magnetic resonance (MR scan is reported.

  3. Laparoscopic Sacral Uteropexy with Cravat Technique--Experience and Results

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    Murat Api

    2014-08-01

    Full Text Available Objective The aim of the present study was to evaluate the safety and efficacy of a “Cravat’’ technique for the management of uterine prolapse in patients who want to preserve uterus, involving suspension of the uterus from the sacral promontory by using polypropylene mesh. Materials and Methods A prospective observational study between January 2011 and September 2013 was conducted. Prior to surgery, prolapse assessment was undertaken with Baden-Walker halfway system to grade the degree of prolapse at all sites. Patients with severe uterine prolapse (stage II-IV who want to preserve uterus, were operated with Cravat technique. All patients were evaluated at 2 weeks and 6 weeks after surgery and followed for 6 months. Outcomes were evaluated objectively by vaginal examination using Baden-Walker halfway classification, and subjectively classifying patients as ‘very satisfied’, ‘satisfied’ and ‘not satisfied’ at the 6th month postoperatively. Results Sacral uteropexy was successfully performed by laparoscopy in 32/33 patients (one needed to be converted to laparotomy. Nine patients also had a concurrent procedure as colporaphy anterior, colporaphy posterior or transobturator tape. Postoperative recovery has been uneventful with subjective and objective cure rates were 96.9% and 93.9%, respectively at six month. One recurrence of total prolapse needed to be reoperated and two patients with sacrouteropexy still remained at stage 2 prolapse. There have been no cases of graft exposure, rejection or infection with a median follow-up of 23.9 months. Conclusions Laparoscopic sacral uteropexy with “Cravat technique” was found to be safe and simple procedure.

  4. Back bugged: A case of sacral hydatid cyst

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    Dipak Patel

    2010-01-01

    Full Text Available Hydatid cyst of bone constitutes only 0.5 - 2% of all hydatidoses. The thoracic spine is the most common site of spinal hydatidoses. Primary hydatid cyst of the sacral spinal canal is rare. A 23-year-old gentleman had back pain five years ago. At that time he was evaluated and found to have a small cyst in S1 spinal canal, which was presumed to be a benign Tarlov′s cyst; and no treatment was offered. He continued to have back pain and also developed sciatica on the right side. Neurological examination presently revealed right S1 radiculopathy. Magnetic resonance imaging (MRI showed a large multiloculated cystic lesion extending from L5 to S2 spinal canal with bone erosion, both anteriorly and posteriorly. He underwent L5 to S2 laminectomy and excision of multiple cysts. The whole cyst was excised and cavity irrigated with sterilized formalin. A laparoscope was introduced in the cavity to look for extension into the pelvis and to confirm complete excision. Postoperatively, the patient received albendazole for two months. At 16 months follow-up the patient was asymptomatic. Hydatid cyst of sacrum is rare and can be missed at initial presentation. If the patient with a cystic lesion of sacral continues to have symptoms the diagnosis should be revaluated and prompt treatment should be offered.

  5. MRI of occult sacral insufficiency fractures following radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Mammone, J.F. [Dept. of Radiology, Thomas Jefferson Univ. Hospital, and Jefferson Medical Coll., Philadelphia, PA (United States); Schweitzer, M.E. [Dept. of Radiology, Thomas Jefferson Univ. Hospital, and Jefferson Medical Coll., Philadelphia, PA (United States)

    1995-02-01

    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.)

  6. Lateral sacral artery supply to an intramedullary arteriovenous fistula at the conus medullaris

    Energy Technology Data Exchange (ETDEWEB)

    Mochizuki, T.; Nemoto, Y.; Inoue, Y.; Tashiro, T. (Osaka City Univ. Medical School (Japan). Dept. of Radiology); Sakanaka, H. (Osaka City Univ. Medical School (Japan). Dept. of Orthopedics)

    1991-10-01

    In this 25-year-old woman, severe low back pain, flaccid paraparesis, sensory disturbance of both legs and sphincter dysfunction resulted from an intramedullary conal arteriovenous malformation fed by an anterior spinal artery arising from the left sixth intercostal artery and by the left lateral sacral artery, a branch of the left internal iliac artery. Magnetic resonance (MR) images showed low signal (flow void) within an intramedullary mass that expanded the conus from T12 to L1. (orig./GDG).

  7. EXPERIMENTAL STUDY ON COMBINING SELECTIVE RHIZOTOMY OF DIFFERENT ANTERIOR AND POSTERIOR SACRAL ROOTS FOR RESTORATION OF BLADDER FUNCTION AFTER SPINAL CORD INJURY%选择性骶神经前后根组合切断恢复脊髓损伤后膀胱功能的实验研究

    Institute of Scientific and Technical Information of China (English)

    张世民; 侯春林; 徐瑞生; 傅晓辉

    2001-01-01

    Objective To investigate an alternative procedure for completedenervation of bladder in the supre-cone cord injury to restore the bladder function. Methods Sixteen dogs were included in this study after their spinal cords were transected above the cone. They were divided into 6 groups and performed the rhizotomy of L7 to S3 root in different combination respectively. The bladder and urethra pressure change by electrostimulation during operation and cystometrogram change after operation were tested. Results ①Electrostimulation study: for bladder innervation, S2 was the most important and S1 was secondary. While for urethra invervation, S1 was more important than S2. When the anterior and posterior roots of S1 and S2 were intact with rhizotomy of posterior roots of L7 and S3, stimulated the common or posterior root of S1 and S2, the change of pressure in bladder and urethra was the same. When the anterior roots of S1 and S2 were resected with rhizotomy of posterior roots of L7 and S3, the pressure in bladder and urethra was significant decreased compared to stimulating the corresponding posterior roots. ②Cystometrogram (CMG) study: in the complete deafferented group, resecting the posterior roots of L7 to S3, the bladder became flaccid. While resecting the posterior root of S2 and anterior root of S1 or, resecting the posterior root of S1 and anterior root of S2, combining with rhizotomy of posterior roots of L7 and S3, the CMG curve was similar to the complete deafferented group. In the S1 and S2 intact group, the bladder became spastic. Comclusion Combining rhizotomy of anterior and posterior sacral root in different level has the same effects on bladder as complete deafferentation.%目的 探讨内脊髓损伤后膀胱完全性去神经传入手术的替代方法。方法 健康杂种犬16只经T10平面截瘫后,按L2~S3神经根切断程度的不同,从完全保留到完全切断分成六组,比较术中神经根(总根和后根)电刺激时的

  8. Laparoscopic sacral suture hysteropexy for uterine prolapse.

    Science.gov (United States)

    Krause, Hannah G; Goh, Judith T W; Sloane, Kate; Higgs, Peta; Carey, Marcus P

    2006-06-01

    This study aims to describe and review a new method of uterine conservation in pelvic reconstruction for women with uterine prolapse. This is a prospective study of women who have undergone laparoscopic sacral suture hysteropexy. Structured questions, visual analogue patient satisfaction score (VAS), and vaginal examination were undertaken. Follow-up was performed by non-surgical reviewers. From July 2001 until August 2003, a total of 81 women underwent laparoscopic sacral suture hysteropexy for uterine prolapse. At a mean of 20.3 months follow-up, 76 women (93.8%) were available for questioning and 57 (70.3%) attended for examination. Sixty-five women (87.8%) had no symptoms of pelvic floor prolapse, 54 women (94.7%) had no objective evidence of uterine prolapse, and 61 women (82.4%) were satisfied with their surgery (VAS > or = 80%). Laparoscopic sacral suture hysteropexy attaches the posterior cervix to the sacral promontory via the right uterosacral ligament. Follow-up data of laparoscopic sacral suture hysteropexy indicate it to be an effective method in the management of uterine prolapse.

  9. Surgical results of sacral perineural (Tarlov) cysts.

    Science.gov (United States)

    Tanaka, Masato; Nakahara, Shinnosuke; Ito, Yasuo; Nakanishi, Kazuo; Sugimoto, Yoshihisa; Ikuma, Hisanori; Ozaki, Toshifumi

    2006-02-01

    The purpose of this study was to investigate the surgical outcomes and to determine indicators of the necessity of surgical intervention. Twelve consecutive patients harboring symptomatic sacral perineural cysts were treated between 1995 and 2003. All patients were assessed for neurological deficits and pain by neurological examination. Magnetic resonance of imaging, computerized tomography, and myelography were performed to detect signs of delayed filling of the cysts. We performed a release of the valve and imbrication of the sacral cysts with laminectomies in 8 cases or recapping laminectomies in 4 cases. After surgery, symptoms improved in 10 (83%) of 12 patients, with an average follow-up of 27 months. Ten patients had sacral perineural cysts with signs of positive filling defect. Two (17%) of 12 patients experienced no significant improvement. In one of these patients, the filling defect was negative. In conclusion, a positive filling defect may become an indicator of good treatment outcomes.

  10. Surgical results of sacral perineural (Tarlov cysts.

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    Tanaka,Masato

    2006-02-01

    Full Text Available

    The purpose of this study was to investigate the surgical outcomes and to determine indicators of the necessity of surgical intervention. Twelve consecutive patients harboring symptomatic sacral perineural cysts were treated between 1995 and 2003. All patients were assessed for neurological deficits and pain by neurological examination. Magnetic resonance of imaging, computerized tomography, and myelography were performed to detect signs of delayed filling of the cysts. We performed a release of the valve and imbrication of the sacral cysts with laminectomies in 8 cases or recapping laminectomies in 4 cases. After surgery, symptoms improved in 10 (83% of 12 patients, with an average follow-up of 27 months. Ten patients had sacral perineural cysts with signs of positive filling defect. Two (17% of 12 patients experienced no significant improvement. In one of these patients, the filling defect was negative. In conclusion, a positive filling defect may become an indicator of good treatment outcomes.

  11. Overall anatomical features and clinical value of the sacral nerve in high resolution computed tomography reconstruction

    Institute of Scientific and Technical Information of China (English)

    LIN Jing-fu; WANG Yan-hua; JIANG Bao-guo; ZHANG Pei-xun; LI Yan-ying; ZHANG Dian-ying

    2010-01-01

    > sagittal > transverse section. The S5 nerve was partially displayed from the starting point to the segment around the posterior sacral foramen. The overall anatomy of the triangular sacral plexus was only revealed in the oblique outward-rotated sagittal section, while 100% of its individual rami,as well as two or three of the adjacent rami, were displayed from their starting points to the anterior border of the piriformis. The abnormalities included 39 sides of morphological change (97.5%), 38 sides of compression (95.0%), 35sides of adhesion (87.5%), 32 sides of displacement (80.0%), 34 sides of shrinkage (85.0%), 6 sides of thickening (15.0%), and 2 sides of abruption (5.0%).Conclusions The 16-slice CT multiplanar reconstruction was able to reveal the overall anatomic features of the SN on the same slice. The section of reconstruction was a crucial factor in determining the display capability of various sacral nerves. This technology was valuable in the diagnosis and management of related diseases.

  12. The femoro-sacral posterior angle: an anatomical sagittal pelvic parameter usable with dome-shaped sacrum.

    Science.gov (United States)

    Legaye, Jean

    2007-02-01

    The sagittal pelvic morphology modulates the individual alignment of the spine. Anatomical angular parameters were described as follows: the "Pelvic Incidence" (PI) and the Jackson's angle "Pelvic Lordosis" (PR-S1). Significant chains of relationships were expressed connecting these angles with pelvic and spinal positional parameters. This allows an individual assessment of the harmony of the sagittal spinal balance. But in case of spondylolysis with high-grade listhesis, the upper plate of the sacrum shows a dome-shaped deformity. The previous anatomical parameters are therefore imprecise. Indeed, the anterior part of the sacrum being inaccurate, an exact assessment of these angles becomes impossible. Therefore, we propose a new angular parameter named "Femoro-Sacral Posterior Angle" (FSPA): the angle between the posterior wall of the first sacral vertebra, always well definite, and the line connecting the posterior part of the sacral plate to the femoral axis. The validation of this parameter was performed and compared with the classical published parameters. It showed good inter-observer reliability, even with dome-shaped sacral plate. In spite of lower correlation with the positional parameters than those observed with PI or PR-S1, the FSPA appeared to be reliable and precise for an exact evaluation of the sagittal spino-pelvic balance is case of spondylo-listhesis with dome-shaped sacral endplate.

  13. Morphometric study of the sacral hiatus in Nigerian dry human sacral bones

    Directory of Open Access Journals (Sweden)

    Ukoha Ukoha U, Okafor Joseph I, Anyabolu Arthur E, Ndukwe Godwin U, Eteudo Albert N, Okwudiba Nchedo J

    2014-03-01

    Full Text Available Background: The sacrum is a large triangular bone formed by the fusion of the five sacral vertebrae and forms the caudal region of the vertebral column. Aims: This was aimed at studying the morphometry of the sacral hiatus noting its anatomical variations that is useful in caudal epidural anaesthesia. Materials and Methods: Eighty three intact adult sacra of unknown sex were measured with vernier callipers and the various shapes of the sacral hiatus were also noted. Results: The findings revealed that inverted U (48.2% was the most predominant shape; followed by inverted V (34.9%, dumbbell (4.8%, bifid (4.8% and irregular (4.8%. The mean anteroposterior diameter at the apex was 5.52 ± 1.89mm. The mean length of the sacral hiatus was 20.05 ± 9.22mm and the transverse width at base of hiatus was 12.35 ± 3.12mm. There was complete spina bifida in 1.2% and absence of sacral hiatus in another 1.2%. Conclusion: The knowledge of anatomical variations of sacral hiatus is important in the administration of caudal epidural anaesthesia in the studied population and may help to reduce its failure rate.

  14. Morphometrical study of sacral hiatus in dry human sacra

    Directory of Open Access Journals (Sweden)

    Rajapur Parashuram

    2015-07-01

    Results: Various shapes of sacral hiatus were observed which included Inverted-U (50%, Inverted-V (27.5%, Irregular (15.5%, Dumb bell (2%, and Bifid (2%. The mean anteroposterior depth of sacral canal at the level of apex of sacral hiatus was 4.25mm. The mean length of sacral hiatus was 19.63 mm and the mean transverse width of sacral hiatus at the level of base was 11.42 mm. There was complete spina bifida in 4 (2% and absence of sacral hiatus in 2 (1% cases. Conclusion: The sacral hiatus has anatomical variations. Understanding of these variations may improve the reliability of caudal epidural anaesthesia. [Int J Res Med Sci 2015; 3(7.000: 1726-1733

  15. MR myelography of sacral meningeal cysts

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchiya, K.; Katase, S.; Hachiya, J. [Kyorin Univ. School of Medicine, Tokyo (Japan). Dept. of Radiology

    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.)

  16. 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.

  17. Abdominal sacral colpopexy for massive genital prolapse.

    Science.gov (United States)

    Powell; Joseph

    1998-07-01

    Objective: A retrospective study to determine the success and complications of abdominal sacral colpopexy in correcting massive genital prolapse over an 8-year period between September 1989 and January 1997.Methods: The charts were reviewed for 3 patients with massive procidentia and 15 patients with symptomatic posthysterectomy vaginal vault prolapse, who desired preservation of sexual function and underwent abdominal sacral colpopexy with Marlex mesh at two community teaching hospitals.Results: In 16 of the 18 patients, one or more concurrent procedures were performed at the same time, including three Burch colpocystourethropexies and one Raz bladder neck suspension, which successfully controlled urinary stress incontinence. In three cases, staging procedures were done for ovarian neoplasia. There were no intraoperative complications. One patient developed a superficial abdominal wound infection, one patient had a deep venous thrombosis in her left leg 7 days postoperatively, and one patient experienced a 1 cm area of graft erosion 10 months postoperative requiring partial resection. Duration of follow-up has varied from 8 months to 5 years. One patient died 43 months after surgery of unrelated causes. No patients developed recurrent prolapse.Conclusions: Abdominal sacral colpopexy is a successful operation for the correction of prolapse. Serious complications are infrequent. Photographs of the technique and a review of the literature are presented.

  18. Traditional and New Tendencies to Outdoor Sacral Spaces in Lithuania

    Directory of Open Access Journals (Sweden)

    Linas Krūgelis

    2011-03-01

    Full Text Available The article describes some features and traditions of outdoor sacral spaces in Lithuania, includes a historical analysis and various features of different historical periods and explains the new tendencies and possibilities of future development in contemporary Lithuania. By analysing the phenomenon of outdoor sacral spaces, some archaeological and historical data is used to identify the principles of creating such sacral space.Article in Lithuanian

  19. Mini-open anterior lumbar interbody fusion.

    Science.gov (United States)

    Gandhoke, Gurpreet S; Ricks, Christian; Tempel, Zachary; Zuckerbraun, Brian; Hamilton, D Kojo; Okonkwo, David O; Kanter, Adam S

    2016-07-01

    In deformity surgery, anterior lumbar interbody fusion provides excellent biomechanical support, creates a broad surface area for arthrodesis, and induces lordosis in the lower lumbar spine. Preoperative MRI, plain radiographs, and, when available, CT scan should be carefully assessed for sacral slope as it relates to pubic symphysis, position of the great vessels (especially at L4/5), disc space height, or contraindication to an anterior approach. This video demonstrates the steps in an anterior surgical procedure with minimal open exposure. The video can be found here: https://youtu.be/r3bC4_vu1hQ .

  20. Sacral nerve stimulation in patients after rectal resection--preliminary report.

    Science.gov (United States)

    Holzer, Brigitte; Rosen, Harald R; Zaglmaier, Wolfgang; Klug, Reinhold; Beer, Bernhard; Novi, Gabriele; Schiessel, Rudolf

    2008-05-01

    Sacral nerve stimulation is a widely accepted therapeutic option for neurogenic fecal incontinence. More recently, case reports showed a positive effect of sacral nerve stimulation in patients with fecal incontinence following low anterior resection. The purpose of this study was to gain more information for this selected indication for sacral nerve stimulation through a nationwide survey. In the period 2002 to 2005, three Austrian departments reported data of patients who underwent SNS for fecal incontinence following rectal resection. Data were available of seven patients (two female, five male) with a median age of 57 years (min 42; max 79). Six patients had undergone rectal resection as a treatment for low rectal cancer. One patient had undergone rectal resection for Crohn's disease, one patient subtotal colectomy and ileorectostomy for slow colon transit constipation. Test stimulation was performed in the foramen S3 unilaterally over a median period of 14 days (2-21 days). Seven patients reported a marked reduction of episodes of incontinence during the observation period and received a permanent stimulation system. After a median follow-up of 32 months (17-46), five patients reported a marked improvement of their continence situation. Despite a nationwide survey experiences with SNS as a treatment for fecal incontinence following rectal resection is still limited. Our observations show an improvement of the continence function following SNS. However, the promising results of our series as well as others need further research and more clinical data by a larger number of patients in a prospective trial.

  1. 前路病灶清除植骨内固定结合局部灌洗化疗治疗下颈椎结核伴巨大脓肿%Anterior debridement, autograft and internal fixation combined with postoperative local chemotherapy for lower cervical tuberculosis with huge abscesses

    Institute of Scientific and Technical Information of China (English)

    盛斌; 黄象望; 向铁城; 刘向阳; 肖晟; 张毅

    2013-01-01

    目的:评价前路病灶清除植骨内固定结合术后异烟肼生理盐水持续灌洗局部化疗治疗下颈椎结核伴巨大脓肿的临床疗效.方法:2001年6月~2010年6月收治下颈椎结核伴巨大脓肿患者13例,男8例,女5例;年龄28~62岁,平均44岁.病变累及部位:C3~C4 2例,C4~C5 3例,C5~C6 4例,C5 2例,C6 2例;脓肿累及节段:C3~C6 5例,C3~C7 3例,C4~C7 4例,C4~T1 1例.患者均存在颈部疼痛和不同程度的吞咽及呼吸困难,术前颈部疼痛VAS评分7~10分(8.1±1.3分).10例出现神经功能障碍,JOA评分5~12分(8.3±1.7分).术前血沉78±12mm/h,C反应蛋白65±17mg/L.均在全身抗结核药物治疗下采用颈前路结核病灶清除、钛网填充自体髂骨植骨内固定,术后异烟肼生理盐水持续局部灌洗化疗,并继续全身抗结核治疗12~18个月.随访观察患者临床症状改善、脓肿清除和植骨融合情况.结果:手术均顺利完成,所有患者无术中及术后并发症,术后异烟肼生理盐水持续灌洗14~26d,平均18d.未出现窦道、瘘管和脑脊膜感染.随访24~72个月,平均42个月,血沉和C反应蛋白在术后3个月内均恢复正常,手术节段在3~7个月(平均5.8个月)均得到骨性融合.颈部疼痛VAS评分末次随访时为0~3分(1.5±0.7分),与术前比较有显著性差异(P<0.05).末次随访时JOA评分为12~17分(14.6±1.5分),与术前比较有显著性差异(P<0.05).末次随访复查MRI均未见结核复发.结论:在全身规范抗结核药物治疗的前提下,采用前路病灶清除植骨内固定结合术后持续局部灌洗化疗治疗下颈椎结核伴巨大脓肿安全有效,临床效果满意.%Objectives:To evaluate the efficiency of anterior debridement,autograft,internal fixation combined with postoperative irrigation,drainage and local chemotherapy with isoniazid for cervical tuberculosis with huge tuberculous abscesses.Methods:From June 2001 to June 2010,13 inpatients(8 males and

  2. Sciatic nerve: beyond the sacral foramen

    Science.gov (United States)

    Sanal, Hatice Tuba

    2016-01-01

    Sciatica may result from pathologies affecting the nerve both in its intraspinal and extraspinal course. In daily routine, the vast majority of cases are caused by herniation of the lumbar discs compressing the neural roots. Extraspinal causes of sciatic pain are usually underestimated and the imaging study may be completed after reporting the lumbar MRIs. However, early diagnosis of the exact etiology of sciatica is paramount for both relieving the symptoms and preventing any additional neurologic injury. In this pictorial assay, some relatively rare causes of sciatic neuralgia along the route of the sciatic nerve after leaving the sacral foramen will be displayed. PMID:27670092

  3. Limbus lumbar and sacral vertebral fractures.

    Science.gov (United States)

    Mendez, Jorge S; Huete, Isidro L; Tagle, Patricio M

    2002-03-01

    We evaluated the fractures of the lumbar and sacral vertebral limbus by disc impingement at the peripheral ring apophysis in 23 adults associated with trauma in 16 of them. Lumbalgia, radicular pain and narrow canal symptoms are the presenting forms of this underdiagnosed pathology. CT is the best method of examination, while plain roentgenograms and MR are usually negative. Accurate diagnosis and surgical technique with larger exposure are needed to resect the fractured fragments and protruded disc material for decompressing the roots and the dural sac. Our results were very good on the majority of cases.

  4. Postpartum Sacral Stress Fracture: An Atypical Case Report

    Directory of Open Access Journals (Sweden)

    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.

  5. Huge mediastinal liposarcoma resected by clamshell thoracotomy: a case report.

    Science.gov (United States)

    Toda, Michihito; Izumi, Nobuhiro; Tsukioka, Takuma; Komatsu, Hiroaki; Okada, Satoshi; Hara, Kantaro; Ito, Ryuichi; Shibata, Toshihiko; Nishiyama, Noritoshi

    2017-12-01

    Liposarcoma is the single most common soft tissue sarcoma. Because mediastinal liposarcomas often grow rapidly and frequently recur locally despite adjuvant chemotherapy and radiotherapy, they require complete excision. Therefore, the feasibility of achieving complete surgical excision must be carefully considered. We here report a case of a huge mediastinal liposarcoma resected via clamshell thoracotomy. A 64-year-old man presented with dyspnea on effort. Cardiomegaly had been diagnosed 6 years previously, but had been left untreated. A computed tomography scan showed a huge (36 cm diameter) anterior mediastinal tumor expanding into the pleural cavities bilaterally. The tumor comprised mostly fatty tissue but contained two solid areas. Echo-guided needle biopsies were performed and a diagnosis of an atypical lipomatous tumor was established by pathological examination of the biopsy samples. Surgical resection was performed via a clamshell incision, enabling en bloc resection of this huge tumor. Although there was no invasion of surrounding organs, the left brachiocephalic vein was resected because it was circumferentially surrounded by tumor and could not be preserved. The tumor weighed 3500 g. Pathologic examination of the resected tumor resulted in a diagnosis of a biphasic tumor comprising dedifferentiated liposarcoma and non-adipocytic sarcoma with necrotic areas. The patient remains free of recurrent tumor 20 months postoperatively. Clamshell incision provides an excellent surgical field and can be performed safely in patients with huge mediastinal liposarcomas.

  6. Tarlov Cyst Causing Sacral Insufficiency Fracture.

    Science.gov (United States)

    Puffer, Ross C; Gates, Marcus J; Copeland, William; Krauss, William E; Fogelson, Jeremy

    2017-06-01

    Tarlov cysts, also known as perineural cysts, have been described as meningeal dilations of the spinal nerve root sheath between the peri- and endoneurium at the dorsal root ganglion. Most often they are found in the sacrum involving the nerve roots. Normally asymptomatic, they have been reported to present with radiculopathy, paresthesias, and even urinary or bowel dysfunction. Sacral insufficiency has not been a well-documented presentation. The patient is a 38-year-old female who started to develop left low back pain and buttock pain that rapidly progressed into severe pain with some radiation down the posterior aspect of her left leg. There was no recent history of spine or pelvic trauma. These symptoms prompted her initial emergency department evaluation, and imaging demonstrated a large Tarlov cyst with an associated sacral insufficiency fracture. She was noted to have a normal neurological examination notable only for an antalgic gait. She was taken to surgery via a posterior approach and the cyst was identified eccentric to the left. The cyst was fenestrated and the nerve roots identified. Given her large area of bone erosion and insufficiency fractures, fixation of the sacroiliac joints was deemed necessary. Fusion was extended to the L5 vertebral body to buttress the fixation. She tolerated the procedure well and was discharged from the hospital on postoperative day 3. Tarlov cysts of the sacrum can lead to significant bone erosion and subsequent insufficiency fractures, requiring fenestration and in some cases, complex sacropelvic fixation.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  8. Intelligent Classification in Huge Heterogeneous Data Sets

    Science.gov (United States)

    2015-06-01

    INTELLIGENT CLASSIFICATION IN HUGE HETEROGENEOUS DATA SETS JUNE 2015 FINAL TECHNICAL REPORT APPROVED FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED...To) JUL 2013 – APR 2015 4. TITLE AND SUBTITLE INTELLIGENT CLASSIFICATION IN HUGE HETEROGENEOUS DATA SETS 5a. CONTRACT NUMBER IN-HOUSE 5b. GRANT...signals and through data dimension reduction, and to develop and tailor algorithms for the extraction of intelligence from several huge heterogeneous

  9. SU-E-J-125: A Novel IMRT Planning Technique to Spare Sacral Bone Marrow in Pelvic Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    McGuire, S; Bhatia, S; Sun, W; Menda, Y; Ponto, L; Gross, B; Buatti, J [University Of Iowa, Iowa City, IA (United States)

    2015-06-15

    Purpose: Develop an IMRT planning technique that can preferentially spare sacral bone marrow for pelvic cancer patients. Methods: Six pelvic cancer patients (two each with anal, cervical, and rectal cancer) were enrolled in an IRB approved protocol to obtain FLT PET images at simulation, during, and post chemoradiation therapy. Initially, conventional IMRT plans were created to maintain target coverage and reduce dose to OARs such as bladder, bowel, rectum, and femoral heads. Simulation FLT PET images were used to create IMRT plans to spare bone marrow identified as regions with SUV of 2 or greater (IMRT-BMS) within the pelvic bones from top of L3 to 5mm below the greater trochanter without compromising PTV coverage or OAR sparing when compared to the initial IMRT plan. IMRT-BMS plans used 8–10 beam angles that surrounded the subject. These plans were used for treatment. Retrospectively, the same simulation FLT PET images were used to create IMRT plans that spared bone marrow located in the sacral pelvic bone region (IMRT-FAN) also without compromising PTV coverage or OAR sparing. IMRT-FAN plans used 16 beam angles every 12° anteriorly from 90° – 270°. Optimization objectives for the sacral bone marrow avoidance region were weighted to reduce ≥V10. Results: IMRT-FAN reduced dose to the sacral bone marrow for all six subjects. The average V5, V10, V20, and V30 differences from the IMRT-BMS plan were −2.2 ± 1.7%, −11.4 ± 3.6%, −17.6 ± 5.1%, and −19.1 ± 8.1% respectively. Average PTV coverage change was 0.5% ± 0.8% from the conventional IMRT plan. Conclusion: An IMRT planning technique that uses beams from the anterior and lateral directions reduced the volume of sacral bone marrow that receives ≤10Gy while maintaining PTV coverage and OAR sparing. Additionally, the volume of sacral bone marrow that received 20 or 30 Gy was also reduced.

  10. Traumatic sacral pseudomeningocele with spina bifida occulta.

    Science.gov (United States)

    Banno, Tomohiro; Ohishi, Tsuyoshi; Suzuki, Daisuke; Honda, Yosuke; Kobayashi, Sho; Matsuyama, Yukihiro

    2012-01-01

    Pseudomeningocele arises after spinal fracture and nerve root avulsion or after complications of spine surgery. However, traumatic pseudomeningocele with spina bifida occulta is rare. In this report, a traumatic pseudomeningocele in a patient with spina bifida occulta that required surgical treatment is documented. This 37-year-old man presented to the authors' hospital with headache and a fluctuant mass in the center of his buttocks. A CT scan with myelography and MR imaging of the sacral region revealed a large subcutaneous area of fluid retention communicating with the intradural space through a defect of the S-2 lamina. Because 3 months of conservative treatment was unsuccessful, a free fat graft was placed with fibrin glue to seal the closure of the defect, followed by 1 week of CSF drainage. This is the first report on traumatic pseudomeningocele with spina bifida occulta successfully treated in this manner.

  11. Mosaic trisomy 13 and a sacral appendage.

    Science.gov (United States)

    Pachajoa, Harry; Meza Escobar, Luis Enrique

    2013-07-31

    Mosaic trisomy 13 occurs when there is a percentage of trisomic cells for an entire chromosome 13, while the remaining percentage of cells is euploid. The prevalence of this syndrome ranges from 1 in 10 000 to 1 in 20 000 births. Complete, partial or mosaic forms of this disorder can occur. The phenotype of mosaic trisomy 13 patients varies widely. Patients with mosaic trisomy 13 usually have a longer survival and a less severe phenotype compared to patients with complete trisomy 13. Genetic counselling is difficult due to the wide variation among the clinical manifestations of these patients. There have been 49 cases of mosaic trisomy 13 reported in the literature. We report the case of a patient with mosaic trisomy 13, a sacral appendage and a cleft lip and palate.

  12. 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.)

  13. [Sacral neuromodulation for neurogenic bladder dysfunction].

    Science.gov (United States)

    Kessler, T M; Wöllner, J; Kozomara, M; Mordasini, L; Mehnert, U

    2012-02-01

    Sacral neuromodulation (SNM) represents a promising option for managing treatment-refractory neurogenic bladder dysfunction. It remains to be seen, however, which types of neurogenic bladder dysfunction and which underlying neurological disorders best respond to SNM. Constant improvements in SNM have been achieved and it is now a minimally invasive approach performed under local anesthesia which should be considered before undertaking larger reconstructive procedures. An electrode is implanted in the S3 or S4 sacral foramen and during a test phase lasting for days to weeks the patient keeps a bladder diary to determine whether SNM has provided a relevant benefit. If the results of the test phase are positive, a neuromodulator is implanted in the gluteal area (or more rarely in the abdominal wall).The mechanism of action of SNM has not been completely clarified, but the afferent nerves most likely play a key role. It appears that SNM produces a modulation of medullary reflexes and brain centers by peripheral afferents. The implanted neuromodulation system does not lead to limitation of the patient's activities. However, it should be noted that high-frequency diathermy and unipolar electrocauterization are contraindicated in patients with neuromodulators, that during extracorporeal shock wave lithotripsy the focal point should not be in the direct vicinity of the neuromodulator or the electrode, that ultrasound and radiotherapy in the region of the implanted components should be avoided, that the neuromodulation should be discontinued in pregnancy, and that MRI examinations should only be conducted when urgently indicated and the neuromodulator is turned off.

  14. Sacral Fracture Causing Neurogenic Bladder: A Case Report

    Directory of Open Access Journals (Sweden)

    Tatsuro Sasaji

    2012-01-01

    Full Text Available A 76-year-old man presented with a Denis Zone III sacral fracture after a traffic accident. He also developed urinary retention and perineal numbness. The patient was diagnosed with neurogenic bladder dysfunction caused by the sacral fracture. A computed tomogram (CT revealed that third sacral lamina was fractured and displaced into the spinal canal, but vertebral body did not displace. The fracture lines began at the center of lamina and extended bilateraly. The fracture pattern was unique. The sacrum was osteoporosis, and this fracture may be based on osteoporosis. We performed laminectomy to decompress sacral nerve roots. One month after surgery, the patient was able to urinate. Three months after surgery, his bladder function recovered normally. One year after surgery, he returned to a normal daily life and had no complaints regarding urination. One-year postoperative CT showed the decompressed third sacrum without displacement.

  15. Study of the morphology and biomechanics of sacral fracture

    Institute of Scientific and Technical Information of China (English)

    QUAN Ren-fu; YANG Di-sheng; WANG Yi-jin

    2006-01-01

    Objective: To observe the morphological characteristics of sacral fracture under different impact loads.Method: Ten fresh pelvic specimens were loaded in dynamic or static state. A series of mechanical parameters including the pressure strain and velocity were recorded.Morphological characteristics were observed under scanning electron microscope.Results: The form of sacral fracture was related to the impact energy. Under low-energy impact loads, ilium fracture, acetabulum fracture and crista iliaca fracture were found. Under high-energy impact loads, three types of sacral fracture occurred according to the classification of Denis: sacral ala fracture, Type Ⅰ fracture; sacral foramen cataclasm fracture, Type Ⅱ fracture; central vertebral canal fracture, Type Ⅲ fracture. Nerve injury of one or two sides was involved in all three types of sacral fracture.The fracture mechanism of sacrum between the dynamic impact and static compression was significantly different.When the impact energy was above 25 J, sacral foramen cataclasm fracture occurred, involving nerve root injury.When it was below 20 J, ilium and sacral fracture was most likely to occur. When it was 20 ~ 25 J, Type Ⅰ fracture would occur. While in the static test, most of the fracture belonged to ilium or acetabulum fracture. The cross section of sacrum was crackly and the bone board of Haversian system was brittle, which could lead to separation of bone boards and malposition of a few of cross bone boards.Conclusions: In dynamic state, sacrum fracture mostly belongs to Type Ⅰ and Type Ⅱ, and usually involves the nerve roots. Sacrum fracture is relevant to the microstructures, the distribution of the bone trabecula, the osseous lacuna and the Haversian system of sacrum. The fracture of ilium and acetabulum more frequently appears in static state, with slight wound of peripheral tissues.

  16. Sacral radicular cysts in autosomal dominant polycystic kidney disease.

    Science.gov (United States)

    Peces, Ramón; Peces, Carlos; Pérez-Dueñas, Virginia; Vega-Cabrera, Cristina; Campos, Isabel

    2009-10-01

    This is the first report of a case of sacral radicular cysts in a patient with autosomal dominant polycystic kidney disease (ADPKD). A 46-year-old woman with ADPKD was found to have bilateral sacral radicular cysts discovered incidentally by magnetic resonance imaging (MRI). Cysts arising from arachnoid or spinal meningeal sac should be considered one of the manifestations of a more widespread connective tissue disorder associated with ADPKD.

  17. Microsurgical excision of symptomatic sacral perineurial cyst with sacral recapping laminectomy : a case report in technical aspects.

    Science.gov (United States)

    Seo, Dae-Hyun; Yoon, Kyeong-Wook; Lee, Sang Koo; Kim, Young-Jin

    2014-02-01

    Perineurial cysts (Tarlov cysts) are lesions of the nerve root that are often observed in the sacral area. There is debate about whether symptomatic perineurial cysts should be treated surgically. We presented three patients with symptomatic perineurial cyst who were treated surgically, and introduced sacral recapping laminectomy. Patients complained of low back pain and hypesthesia on lower extremities. We performed operations with sacral recapping technique for all three. The outcome measure was baseline visual analogue score and post operative follow up magnetic resonance images. All patients were completely relieved of symptoms after operation. Although not sufficient to address controversies, this small case series introduces successful use of a particular surgical technique to treat sacral perineural cyst, with resolution of most symptoms and no sequelae.

  18. Microsurgical Excision of Symptomatic Sacral Perineurial Cyst with Sacral Recapping Laminectomy : A Case Report in Technical Aspects

    Science.gov (United States)

    Seo, Dae-Hyun; Yoon, Kyeong-Wook; Lee, Sang Koo

    2014-01-01

    Perineurial cysts (Tarlov cysts) are lesions of the nerve root that are often observed in the sacral area. There is debate about whether symptomatic perineurial cysts should be treated surgically. We presented three patients with symptomatic perineurial cyst who were treated surgically, and introduced sacral recapping laminectomy. Patients complained of low back pain and hypesthesia on lower extremities. We performed operations with sacral recapping technique for all three. The outcome measure was baseline visual analogue score and post operative follow up magnetic resonance images. All patients were completely relieved of symptoms after operation. Although not sufficient to address controversies, this small case series introduces successful use of a particular surgical technique to treat sacral perineural cyst, with resolution of most symptoms and no sequelae. PMID:24653808

  19. Cervicoplastia anterior Anterior cervicoplasty

    Directory of Open Access Journals (Sweden)

    Lucas Gomes Patrocínio

    2004-10-01

    Full Text Available Muitos pacientes buscam correção estética da frouxidão da pele do pescoço, depósito de gordura na região submentoneana ou bandas de platisma. Em grande parte dos casos a ação medial, via cervicoplastia anterior é necessária. OBJETIVO: Demonstrar a casuística e avaliar os resultados e complicações com a técnica de cervicoplastia anterior no Serviço de Otorrinolaringologia da Universidade Federal de Uberlândia. FORMA DE ESTUDO: Relato de série. PACIENTES E MÉTODOS: Quarenta e dois pacientes, entre 39 e 65 anos de idade, sendo 40 (95,2% do sexo feminino e 2 (4,8% do masculino, foram submetidos a cervicoplastia anterior. Retrospectivamente foram avaliados resultados e complicações. RESULTADOS: Destes, 34 apresentaram resultados satisfatórios, 4 apresentaram déficit estético notado somente pelo cirurgião, 3 apresentaram déficit estético notado somente pelo paciente e 1 apresentou déficit estético necessitando cirurgia revisional. Ao estudo fotográfico, todos os pacientes apresentaram melhora do perfil cervical, redução das bandas de platisma e da frouxidão da pele, estabilização da musculatura cervical e acentuação do ângulo cervicomental, em graus variados. Houve complicação em 2 casos (discreto serohematoma e cicatriz um pouco alargada. CONCLUSÃO: A cervicoplastia, associada ou não à tração lateral pela ritidoplastia, é uma técnica que produz resultados satisfatórios na grande maioria dos casos.Many patients look for aesthetic correction of the laxity of neck skin, submandibular fat deposit or platisma bands. In a large part of the cases, medial action, through anterior cervicoplasty is necessary. AIM: To demonstrate the casuistic and to evaluate the results and complications with anterior cervicoplasty technique in the Otorhinolaryngology Service of the Federal University of Uberlândia. STUDY DESIGN: Serie report. PATIENTS AND METHODS: Forty-two patients, between 39 and 65 years of age, being 40 (95

  20. Severe microphthalmos with cyst and unusually huge dermolipoma.

    Science.gov (United States)

    Li, Weidong; Zhang, Ping; Chen, Qiwen; Ye, Xuelian; Li, Jianqun; Yan, Jianhua

    2015-03-01

    The purpose of this study was to report an unusual case of severe microphthalmos, together with an orbital cyst and huge ocular surface dermolipoma. This is a clinical report relating clinical features as well as imaging and histopathologic findings, along with surgical management of the patient. A 5-month-old Chinese male infant was referred, with 2 large masses in the left eye that were present since birth. Ocular examination results revealed a complete absence of any eye structures in the left orbit. In its place were 2 large masses between the left upper and lower palpebral fissure. One was a 3 × 3 × 2.5-cm spherical red tumor with a smooth surface. The other was a large solid spherical tumor, 4 × 4 × 5 cm, covered with normal skin located in the temporal region and attached to the red mass by a pedicle. Orbital magnetic resonance imaging examination findings confirmed that no eye structures were present in the left orbit. However, a cystic lesion was found in the left orbit, with a low signal on T1-weighted imaging and high signal on T2-weighted imaging, and another huge spherical heterogeneous mass was located "outside" the left orbit. Anterior orbitotomy by conjunctival incision was performed under general anesthesia. A spherical cystic mass of 1.5 × 1.5 × 1.6 cm, a small eye of 0.7 × 0.7 × 0.6 cm, and a huge dermolipoma were removed completely. Pathologic examination results confirmed the diagnosis of severe microphthalmos, together with orbital dermoid cyst and dermolipoma. This rare case demonstrates that severe microphthalmos with a cyst may be completely covered by conjunctiva and associated with an unusually huge dermolipoma.

  1. Sacral Fracture Nonunion Treated by Bone Grafting through a Posterior Approach

    Directory of Open Access Journals (Sweden)

    Sang Yang Lee

    2013-01-01

    Full Text Available Nonunion of a sacral fracture is a rare but serious clinical condition which can cause severe chronic pain, discomfort while sitting, and significant restriction of the level of activities. Fracture nonunions reportedly occur most often after nonoperative initial treatment or inappropriate operative treatment. We report a case of fracture nonunion of the sacrum and pubic rami that resulted from non-operative initial treatment, which was treated successfully using bone grafting through a posterior approach and CT-guided percutaneous iliosacral screw fixation combined with anterior external fixation. Although autologous bone grafting has been the gold standard for the treatment of pelvic fracture nonunions, little has been written describing the approach. We utilized a posterior approach for bone grafting, which could allow direct visualization of the nonunion site and preclude nerve root injury. By this procedure, we were able to obtain the healing of fracture nonunion, leading to pain relief and functional recovery.

  2. Ultrasound localization of the sacral plexus using a parasacral approach.

    Science.gov (United States)

    Ben-Ari, Alon Y; Joshi, Rama; Uskova, Anna; Chelly, Jacques E

    2009-06-01

    In this report, we describe the feasibility of locating the sacral plexus nerve using a parasacral approach and an ultrasound-guided technique. The parasacral region using a curved probe (2-5 MHz) was scanned in 17 patients in search of the medial border of the ischial bone and the lateral border of the sacrum, which represent the limit of the greater sciatic foramen. In addition, attempts were made to identify the piriformis muscles and the gluteal arteries. The sacral plexus was identified at the level of the sciatic foramen as a round hyperechoic structure. The gluteal arteries were identified in 10 of 17 patients, but we failed to positively identify the piriformis muscle in any patient. To confirm localization of the sacral plexus, an insulated needle attached to a nerve stimulator was advanced and, in each case, a sacral plexus motor response was elicited (plantar flexion-12, dorsal flexion-1, hamstring muscle stimulation-3, gastrocnemius muscle stimulation-1-not recorded) at a current between 0.2 and 0.5 mA. No complications were observed. This report confirms the feasibility of using ultrasound to locate the sacral plexus using a parasacral approach.

  3. Clinical significance of sacral and pudendal nerve anatomy.

    Science.gov (United States)

    Juenemann, K P; Lue, T F; Schmidt, R A; Tanagho, E A

    1988-01-01

    The neuroanatomy and neurophysiology of the external urethral closure mechanisms still are under debate because the motor fibers that emanate from the sacral plexus and pudendal nerve to supply this segment have not been traced, nor has their functional interrelationship been established. Therefore, we dissected 3 male human cadavers (aged 31 to 69 years) by tracing the entire sacral plexus, particularly the pudendal nerve, from the cauda equina throughout the branching of the nerves to their final destination. The dissection demonstrated that the extrinsic urethral sphincter, formed by the rhabdosphincter around the membranous urethra as well as the levator ani muscle and pelvic floor (especially the transversus perinei muscle), is innervated by somatic nerve fibers that emanate primarily from sacral roots S2 and S3. In 5 patients with neurogenic lower urinary tract dysfunction electrostimulation of the sacral root and pudendal nerve markedly increased intraurethral closure pressures. Stimulation of the pudendal nerve or its transversus perinei branch alone resulted in an increase in intraurethral closure pressure to 60 to 70 cm. water--an increase similar to that produced by stimulation of the sacral root without neurotomy. By means of neurotomy and/or neural blockade with lidocaine we were able to differentiate between the contributions of each muscular element to the external sphincteric mechanism. Almost 70 per cent of the closure pressure of the external urethral sphincter is induced by stimulation of the S3 ventral root, while the other 30 per cent derives from S2 and S4 neuronal impulses.

  4. Cauda equina syndrome presentation of sacral insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Muthukumar, T.; Butt, S.H.; Cassar-Pullicino, V.N.; McCall, I.W. [The Robert Jones and Agnes Hunt Orthopaedic Hospital, Department of Radiology, Oswestry, Shropshire (United Kingdom)

    2007-04-15

    Sacral insufficiency fractures are a well recognised cause for low back, buttock and groin pain in the elderly. However, over a 4 year period, four patients have presented with symptoms of cauda equina syndrome, who were found on investigation to have acute sacral insufficiency fracture without any other aetiological spinal abnormality. Four patients who presented to the spinal surgeons of our institution with symptoms of cauda equina syndrome were referred for spinal MR. Sagittal and axial T1 and T2 weighted turbo spin echo sequences of the lower thoracic and lumbar spine were performed on all patients. Subsequent studies included MR of the sacrum supplemented where appropriate by CT and technetium MDP bone scintigraphy. No evidence of a compressive lesion of the lower thoracic or lumbar spine was present in any of the four patients. Dedicated MR examination of the sacrum in these patients revealed unilateral acute insufficiency fractures involving zone 1 from S1 to S3 extending from the sacro-iliac joint to the lateral margin of the sacral foramen. There was no evidence of compression of the sacral nerve roots. The possible mechanism for the symptomatic presentation is discussed. Sacral insufficiency fractures should be excluded in elderly or osteoporotic patients presenting with cauda equina syndrome who have no evidence of compression in the thoraco-lumbar MR studies. (orig.)

  5. Outcome of Hepatectomy for Huge Hepatocellular Carcinoma.

    Science.gov (United States)

    Jo, Sungho

    2011-05-01

    In spite of the recent improved results of hepatectomy for huge hepatocellular carcinomas (HCC), the prognosis of patients with huge HCCs is still poor compared to that of patients with small HCCs. This study was performed to compare the results of hepatectomy between patients with huge HCCs and those with small HCCs, to identify the prognostic factors in patients with huge HCCs, and to determine the preoperative selection criteria. We retrospectively analyzed 51 patients who underwent hepatectomy, between July 1994 and February 2009 at Dankook University Hospital. Patients with HCC≥10 cm were classified in large (L) group and others were classified in small (S) group. The clinicopathological features, operative procedures, and postoperative outcome were compared between both groups and various prognostic factors were investigated in group L. Eleven patients were classified in group L. Tumor size, vascular invasion, and tumor stage were higher in group L. Postoperative morbidity was higher in group L, but mortality was not different between the groups. Disease-free survivals were significantly lower in group L than in group S (36.4%, and 24.2% vs. 72.0%, and 44.0% for 1- and 3-year), but overall survival rates were similar in both groups (45.5%, and 15.2% in group L vs. 60.3%, and 41.3% in group S for 3- and 5-year). Presence of satellite nodules was the only prognostic factor in multivariate analysis after surgery for huge HCC. Regardless of tumor size, huge HCCs deserve consideration for surgery in patients with preserved liver function. Furthermore, the effect of surgery could be maximized with appropriate selection criteria, such as huge HCC without satellite nodules.

  6. The identification and characteristics of sacral parasympathetic preganglionic neurones.

    Science.gov (United States)

    De Groat, W C; Ryall, R W

    1968-06-01

    1. Sacral parasympathetic preganglionic neurones were identified by intracellular and extracellular micro-electrode recording of antidromic potentials in response to stimulation of the pelvic nerve or the second or third sacral ventral roots.2. The segmental distribution of autonomic neurones varied in different cats. In some cats they were mainly in S2 segment, in others in S3 and in the remainder, in both S2 and S3.3. The antidromic potentials showed initial segment-somadendritic (IS-SD) inflexions and delayed depolarizations and were slightly less prolonged than those of sympathetic neurones but more prolonged than those of spinal motoneurones. After-hyperpolarization was observed after the antidromic spike potential.4. The conduction velocities for sacral parasympathetic preganglionic fibres were less than 12.5 m/sec and thus were similar to those of sympathetic preganglionic fibres.5. Parasympathetic neurones were not excited by micro-electro-phoretically applied 5-hydroxytryptamine, noradrenaline or acetylcholine.

  7. A huge glandular odontogenic cyst occurring at posterior mandible

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Gi Chung; Han, Won Jeong; Kim, Eun Kyung [Dankook University College of Medicine, Seoul (Korea, Republic of)

    2004-12-15

    The glandular odontogenic cyst is a rare lesion described in 1987. It generally occurs at anterior region of mandible in adults over the age of 40 and has a slight tendency to recur. Histopathologically, a cystic cavity lined by a nonkeratinized, stratified squamous, or cuboidal epithelium varying in thickness is found including a superficial layer with glandular or pseudoglandular structures. A 21-year-old male visited Dankook University Dental Hospital with a chief complaint of swelling of the left posterior mandible. Radiographically, a huge multilocular radiolucent lesion involving impacted 3rd molar at the posterior mandible was observed. Buccolingual cortical expansion with partial perforation of buccal cortical bone was also shown. Histopathologically, this lesion was lined by stratified squamous epithelium with glandular structures in areas of plaque-like thickening. The final diagnosis was made as a glandular odontogenic cyst.

  8. Connecting slow earthquakes to huge earthquakes.

    Science.gov (United States)

    Obara, Kazushige; Kato, Aitaro

    2016-07-15

    Slow earthquakes are characterized by a wide spectrum of fault slip behaviors and seismic radiation patterns that differ from those of traditional earthquakes. However, slow earthquakes and huge megathrust earthquakes can have common slip mechanisms and are located in neighboring regions of the seismogenic zone. The frequent occurrence of slow earthquakes may help to reveal the physics underlying megathrust events as useful analogs. Slow earthquakes may function as stress meters because of their high sensitivity to stress changes in the seismogenic zone. Episodic stress transfer to megathrust source faults leads to an increased probability of triggering huge earthquakes if the adjacent locked region is critically loaded. Careful and precise monitoring of slow earthquakes may provide new information on the likelihood of impending huge earthquakes.

  9. Connecting slow earthquakes to huge earthquakes

    Science.gov (United States)

    Obara, Kazushige; Kato, Aitaro

    2016-07-01

    Slow earthquakes are characterized by a wide spectrum of fault slip behaviors and seismic radiation patterns that differ from those of traditional earthquakes. However, slow earthquakes and huge megathrust earthquakes can have common slip mechanisms and are located in neighboring regions of the seismogenic zone. The frequent occurrence of slow earthquakes may help to reveal the physics underlying megathrust events as useful analogs. Slow earthquakes may function as stress meters because of their high sensitivity to stress changes in the seismogenic zone. Episodic stress transfer to megathrust source faults leads to an increased probability of triggering huge earthquakes if the adjacent locked region is critically loaded. Careful and precise monitoring of slow earthquakes may provide new information on the likelihood of impending huge earthquakes.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Various sacral indices: role in study of sexual dimorphism

    Directory of Open Access Journals (Sweden)

    Uttama Umesh Joshi

    2016-03-01

    Results: The indices like sacral index, curvature index, corpobasal index and alar Index were found to be statistically significant with p value 0.05 and was statistically not significant. Conclusions: The most useful aspect of such studies was to determine appropriate indices of sexual dimorphism for sacral bone. The study concluded that no single index can identify sex of sacrum with 100% accuracy. So multiple indices should be used for determination of sex by sacrum with 100% accuracy. [Int J Res Med Sci 2016; 4(3.000: 841-846

  12. Sacral Neuromodulation for Bladder Atony – A Case Report

    Directory of Open Access Journals (Sweden)

    Joseph Sujka

    2014-01-01

    Full Text Available In most cases, sacral neuromodulation is used as a treatment for urge incontinence and symptoms of urgency and frequency. It is most used in those who are refractory to traditional management. It is much less common to be used for bladder atony. In this report, we present a case of a 24-year-old woman with a history of urinary retention and bladder atony who failed medical management and subsequently had an InterStim sacral neuromodulator implanted. After implantation, she was able to discontinue intermittent catheterization and had a decrease in her postvoid residual from 848 to 72 mL.

  13. RATIONAL INCREASING OF ENERGY EFFICIENCY OF SACRAL BUILDINGS

    Directory of Open Access Journals (Sweden)

    Aleksandra REPELEWICZ

    2017-04-01

    Full Text Available The paper presents the possibilities of increasing energy efficiency of sacral buildings. Churches in the Zawiercie pastoral district of the Archdiocese of Czestochowa have been used as examples of typical sacral buildings of low energy efficiency. Such structures need to be thermally insulated during their use. Certain possibilities of raisingthe energy efficiency of churches have been presented. The paper describes different systems: increasingof wall and roof insulation, installation of new windows, and modern heating systems. Installation of a new heating system has been considered the most effective and the easiest to be implemented one.

  14. 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....

  15. Treatment strategies for huge central neurocytomas.

    Science.gov (United States)

    Xiong, Zhong-wei; Zhang, Jian-jian; Zhang, Ting-bao; Sun, Shou-jia; Wu, Xiao-lin; Wang, Hao; You, Chao; Wang, Yu; Zhang, Hua-qiu; Chen, Jin-cao

    2015-02-01

    Central neurocytomas (CNs), initially asymptomatic, sometimes become huge before detection. We described and analyzed the clinical, radiological, operational and outcome data of 13 cases of huge intraventricular CNs, and discussed the treatment strategies in this study. All huge CNs (n=13) in our study were located in bilateral lateral ventricle with diameter ≥5.0 cm and had a broad-based attachment to at least one side of the ventricle wall. All patients received craniotomy to remove the tumor through transcallosal or transcortical approach and CNs were of typical histologic and immunohistochemical features. Adjuvant therapies including conventional radiation therapy (RT) or gamma knife radiosurgery (GKRS) were also performed postoperatively. Transcallosal and transcortical approaches were used in 8 and 5 patients, respectively. Two patients died within one month after operation and 3 patients with gross total resection (GTR) were additionally given a decompressive craniectomy (DC) and/or ventriculoperitoneal shunt (VPS) as the salvage therapy. Six patients received GTR(+RT) and 7 patients received subtotal resection (STR)(+GKRS). Eight patients suffered serious complications such as hydrocephalus, paralysis and seizure after operation, and patients who underwent GTR showed worse functional outcome [less Karnofsky performance scale (KPS) scores] than those having STR(+GKRS) during the follow-up period. The clinical outcome of huge CNs seemed not to be favorable as that described in previous reports. Surgical resection for huge CNs should be meticulously considered to guarantee the maximum safety. Better results were achieved in STR(+GKRS) compared with GTR(+RT) for huge CNs, suggesting that STR(+GKRS) may be a better treatment choice. The recurrent or residual tumor can be treated with GKRS effectively.

  16. A Huge Ancient Schwannoma of the Epiglottis.

    Science.gov (United States)

    Lee, Dong Hoon; Kim, Jo Heon; Yoon, Tae Mi; Lee, Joon Kyoo; Lim, Sang Chul

    2016-03-01

    Ancient schwannoma of the epiglottis is extremely rare. The authors report the first case of a patient with a huge ancient schwannoma of the epiglottis. Clinicians should consider the possibility that ancient schwannoma may originate in the epiglottis mimicking the other more frequently observed lesions.

  17. Electromyographic Abnormalities Associated with Symptomatic Sacral Tarlov Cysts.

    Science.gov (United States)

    Hulens, Mieke; Bruyninckx, Frans; Dankaerts, Wim; Vansant, Greet; De Mulder, Peter A

    2016-06-01

    Tarlov or perineural cysts (TC) are commonly overlooked as a cause of sacral and ischial pain, and urogenital and bowel problems. TC can be seen on MRI, but are often considered asymptomatic. This is especially true for smaller cysts. Moreover, there are only few diagnostic characteristics that can be used to confirm that the cysts are the cause of the symptoms. As a consequence, a lot of controversy remains regarding the clinical importance of TC. Because of this underdiagnosed condition, patients often suffer for several years from unrecognized chronic neuropathic pain and neurological conditions. In this article, case reports of three patients with giant and smaller symptomatic sacral cysts are presented, in which electromyographic testing was performed to demonstrate nerve damage. We suggest that electromyography of the sacral nerve roots can be a reasonable tool for the diagnosis of symptomatic TC, as well as for the differentiation from other pathological entities causing sacral and ischial pain. Moreover, using electromyography it was also documented that smaller cysts of < 1 cm can cause nerve damage. Therefore incidence of symptomatic TC may be higher than initially thought.

  18. What questionnaires to use when measuring quality of life in sacral tumor patients: the updated sacral tumor survey.

    Science.gov (United States)

    van Wulfften Palthe, Olivier D R; Janssen, Stein J; Wunder, Jay S; Ferguson, Peter C; Wei, Guo; Rose, Peter S; Yaszemski, Micheal J; Sim, Franklin H; Boland, Patrick J; Healey, John H; Hornicek, Francis J; Schwab, Joseph H

    2017-05-01

    Patient-reported outcomes are becoming increasingly important when investigating results of patient and disease management. In sacral tumor, the symptoms of patients can vary substantially; therefore, no single questionnaire can adequately account for the full spectrum of symptoms and disability. The purpose of this study is to analyze redundancy within the current sacral tumor survey and make a recommendation for an updated version based on the results and patient and expert opinions. A survey study from a tertiary care orthopedic oncology referral center was used. The patient sample included 70 patients with sacral tumors (78% chordoma). The following 10 questionnaires included in the current sacral tumor survey were evaluated: the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Item short form, PROMIS Pain Intensity short form, PROMIS Pain Interference short form, PROMIS Neuro-QOL v1.0 Lower Extremity Function short form, PROMIS v1.0 Anxiety short form, the PROMIS v1.0 Depression short form, the International Continence Society Male short form, the Modified Obstruction-Defecation Syndrome questionnaire, the PROMIS Sexual Function Profile v1.0, and the Stoma Quality of Life tool. We performed an exploratory factor analysis to calculate the possible underlying latent traits. Spearman rank correlation coefficients were used to measure to what extent the questionnaires converged. We hypothesized the existence of six domains based on current literature: mental health, physical health, pain, gastrointestinal symptoms, sexual function, and urinary incontinence. To assess content validity, we surveyed 32 patients, 9 orthopedic oncologists, 1 medical oncologist, 1 radiation oncologist, and 1 orthopedic oncology nurse practitioner with experience in treating sacral tumor patients on the relevance of the domains. Reliability as measured by Cronbach alpha ranged from 0.65 to 0.96. Coverage measured by floor and ceiling effects ranged from 0% to 52

  19. Sacral laminoplasty and cystic fenestration in the treatment of symptomatic sacral perineural (Tarlov) cysts: Technical case report.

    Science.gov (United States)

    Smith, Zachary A; Li, Zhenzhou; Raphael, Dan; Khoo, Larry T

    2011-01-01

    Perineural cysts of the sacrum, or Tarlov cysts, are cerebrospinal fluid (CSF)-filled sacs that commonly occur at the intersection of the dorsal root ganglion and posterior nerve root in the lumbosacral spine. Although often asymptomatic, these cysts have the potential to produce significant symptoms, including pain, weakness, and/or bowel or bladder incontinence. We present a case in which the sacral roof is removed and reconstructed via plated laminoplasty and describe how this technique could be of potential use in maximizing outcomes. We describe technical aspects of a sacral laminoplasty in conjunction with cyst fenestration for a symptomatic sacral perineural cyst in a 50-year-old female with severe sacral pain, lumbosacral radiculopathy, and progressive incontinence. This patient had magnetic resonance imaging (MRI) and computed tomography (CT)-myelographic evidence of a non-filling, 1.7 × 1.4 cm perineural cyst that was causing significant compression of the cauda equina and sacral nerve roots. This surgical technique was also employed in a total of 18 patients for symptomatic tarlov cysts with their radiographic and clinical results followed in a prospective fashion. Intraoperative images, drawings, and video are presented to demonstrate both the technical aspects of this technique and the regional anatomy. Postoperative MRI scan demonstrated complete removal of the Tarlov cyst. The patient's symptoms improved dramatically and she regained normal bladder function. There was no evidence of radiographic recurrence at 12 months. At an average 16 month followup interval 10/18 patients had significant relief with mild or no residual complaints, 3/18 reported relief but had persistent coccydynia around the surgical area, 2/18 had primary relief but developed new low back pain and/or lumbar radiculopathy, 2/18 remained at their preoperative level of symptoms, and 1/18 had relief of their preoperative leg pain but developed new pain and neurological deficits

  20. A huge presacral Tarlov cyst. Case report.

    Science.gov (United States)

    Ishii, Kazuhiko; Yuzurihara, Masahito; Asamoto, Shunji; Doi, Hiroshi; Kubota, Motoo

    2007-08-01

    Perineural cysts have become a common incidental finding during lumbosacral magnetic resonance (MR) imaging. Only some of the symptomatic cysts warrant treatment. The authors describe the successful operative treatment of a patient with, to the best of their knowledge, the largest perineural cyst reported to date. A 29-year-old woman had been suffering from long-standing constipation and low-back pain. During an obstetric investigation for infertility, the clinician discovered a huge presacral cystic mass. Computed tomography myelography showed the lesion to be a huge Tarlov cyst arising from the left S-3 nerve root and compressing the ipsilateral S-2 nerve. The cyst was successfully treated by ligation of the cyst neck together with sectioning of the S-3 nerve root. Postoperative improvement in her symptoms and MR imaging findings were noted. Identification of the nerve root involved by the cyst wall, operative indication, operative procedure, and treatment of multiple cysts are important preoperative considerations.

  1. From tiny microalgae to huge biorefineries

    OpenAIRE

    Gouveia, L.

    2014-01-01

    Microalgae are an emerging research field due to their high potential as a source of several biofuels in addition to the fact that they have a high-nutritional value and contain compounds that have health benefits. They are also highly used for water stream bioremediation and carbon dioxide mitigation. Therefore, the tiny microalgae could lead to a huge source of compounds and products, giving a good example of a real biorefinery approach. This work shows and presents examples of experimental...

  2. A rare clinic entity: Huge trichobezoar

    Directory of Open Access Journals (Sweden)

    Hidayatullah Hamidi, Dr, MD

    2016-01-01

    Conclusion: Trichobezoars should be suspected in young females with long standing upper abdominal masses; as the possibility of malignancy is not very common in this age group. While USG is inconclusive, trichobezoar can be accurately diagnosed with CT. In patient with huge trichobezoar, laparotomy can be performed firstly because of big size and location of mass, and psychiatric recommendation should be made to prevent relapse of this entity.

  3. VARIATIONS OF SACRAL HIATUS IN DRY HUMAN SACRA: AN ANATOMICAL STUDY

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    Rubi Saikia

    2016-07-01

    Full Text Available BACKGROUND Sacrum is a large triangular bone formed by the fusion of 5 sacral vertebrae. It lies obliquely at the posterior part of pelvic cavity between the two hip bones. It encloses a canal called the sacral canal. The lower opening of the sacral canal is called the sacral hiatus. It transmits the 5 th pair of sacral nerves, coccygeal nerves & filum terminale externa. AIMS & OBJECTIVES The aim of the present study is to find out the variations of sacral hiatus in this part of Northeast India. MATERIALS & METHODS The study was carried out in 104 dry human sacra to know the anatomical variations of sacral hiatus. The measurements were carried out with the help of a Vernier calliper, scale & a divider. RESULT & OBSERVATIONS Various shapes of sacral hiatus were observed as follows: Inverted U shaped (53.8%, inverted V shaped (29.8 %, irregular shaped (9.6 %, dumb-bell shaped (5.7 %, bifid (0.9%. The length of the sacral hiatus was found to be between 20-30 mm in 46.1% cases. The apex of the sacral hiatus was at the level of S4 vertebra in 46.1% specimens. The anteroposterior diameter of the sacral canal at the apex of the sacral hiatus ranged from 2-12 mm. CONCLUSIONS Variations of sacral hiatus is very common. The knowledge of such variations will definitely help the anaesthesiologists to take proper step while administering caudal epidural anaesthesia to increase the success rate of caudal epidural block.

  4. Sacral Fatigue Fracture in an Amateur Soccer Player

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    Georgios Tzoanos

    2013-01-01

    Full Text Available Sacral fatigue fractures represent a frequently overlooked cause of low-back and buttock pain in athletes. A high index of clinical suspicion and MRI utilization can provide the accurate diagnosis. A 38-year-old male amateur, midfielder, soccer player presented to our department with aggravating right buttock pain during the previous month, following an increase in training intensity and frequency on an artificial turf field. A point of maximal tenderness was demonstrated over the area of the right sacroiliac joint. No radiographic abnormalities were observed. MRI of the pelvis revealed the presence of a stress fracture in the right sacral ala. The patient underwent conservative treatment and resumed playing soccer 12 weeks later, with no residual or recurrent clinical complaints. Apart from the recent change in training regimen, decreased shock absorption related to the physical properties of old generation artificial turf may have also been involved in this case.

  5. 6.Sacralization: the structural complications and body biomechanics

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    A.P. Singh

    2014-01-01

    Full Text Available The lumbosacral region of the body not only protects the spinal cord and related structures but also transmits the body weight to the lower extremity and maintains or balances the body posture. The present study was carried out on 20 dry adult sacra (10 males +10 females to find out the incidence and type of sacralization using the score system developed by Khairnar and Rajale (2013 and classification proposed by Castellvi et al. (1984 for the degree of transition based on form and orientation of the transverse processes of LSTV. Results show the Type III LSTV in 20% of male sacra and 10% of female sacra and indicate more male predominance and suggested that sacralization bring remarkable changes in the structural organization of vertebral levels and highlighted its clinical impact on the body like low back pain, compression of nerves, pseudoarthrosis, etc.

  6. Spinal CT scan, 2. Lumbar and sacral spines

    Energy Technology Data Exchange (ETDEWEB)

    Nakagawa, Hiroshi (Aichi Medical Univ., Aichi (Japan))

    1982-08-01

    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.

  7. Giant cystic sacral schwannoma mimicking tarlov cyst: a case report.

    Science.gov (United States)

    Attiah, Mark A; Syre, Peter P; Pierce, John; Belyaeva, Elizaveta; Welch, William C

    2016-05-01

    To present a rare case of a giant schwannoma of the sacrum mimicking a Tarlov cyst. A 58-year-old woman had a 1-year history of low back pain. MRI revealed a large cystic mass in the sacral canal with bony erosion. Radiological diagnosis of Tarlov cyst was made. The patient underwent surgical treatment for the lesion, which revealed a solid mass. Histopathological examination of the tumor confirmed the diagnosis of schwannoma. The postoperative course was uneventful and the patient has had significant improvement in her pain 1 month postoperatively. Giant cystic schwannoma of the sacrum is a very rare diagnosis overlooked by practitioners for more common cystic etiologies, but its treatment is significantly different. Care should be taken to include this diagnosis in a differential for a cystic sacral mass.

  8. Medium-Term Outcome of Sacral Nerve Modulation for Constipation

    DEFF Research Database (Denmark)

    Govaert, Bastiaan; Maeda, Yasuko; Alberga, Job;

    2012-01-01

    BACKGROUND: Sacral nerve modulation has been reported as a minimally invasive and effective treatment for constipation refractory to conservative treatment. OBJECTIVE: This study aimed to evaluate the efficacy and sustainability of sacral nerve modulation for constipation in the medium term (up......: Patients were eligible if they had had symptoms of constipation persisting for at least 1 year, if conservative treatment (dietary modification, laxatives and biofeedback therapy) had failed, and if predefined excluded conditions were not present. INTERVENTION: The first phase of the treatment process...... 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...

  9. Laparoscopic Management of Huge Cervical Myoma.

    Science.gov (United States)

    Peker, Nuri; Gündoğan, Savaş; Şendağ, Fatih

    To demonstrate the feasibility of laparoscopic management of a huge cervical myoma. Step-by-step video demonstration of the surgical procedure (Canadian Task Force classification III-C). Uterine myoma is the most common benign neoplasm of the female reproductive tract, with an estimated incidence of 25% to 30% at reproductive age [1,2]. Patients generally have no symptoms; however, those with such symptoms as severe pelvic pain, heavy uterine bleeding, or infertility may be candidates for surgery. The traditional management is surgery; however, uterine artery embolization or hormonal therapy using a gonadotropin-releasing hormone agonist or a selective estrogen receptor modulator should be preferred as the medical approach. Surgical management should be performed via laparoscopy or laparotomy; however, the use of laparoscopic myomectomy is being debated for patients with huge myomas. Difficulties in the excision, removal, and repair of myometrial defects, increased operative time, and blood loss are factors keeping physicians away from laparoscopic myomectomy [1,2]. A 40-year-old gravida 0, para 0 woman was admitted to our clinic with complaints of chronic pelvic pain, dyspareunia, and infertility. Her health history was unremarkable. Ultrasonographic examination revealed a 14 × 10-cm myoma in the cervical region. On bimanual examination, an immobile solid mass originating from the uterine cervix and filling the pouch of Douglas was palpated. The patient was informed of the findings, and laparoscopic myomectomy was recommended because of her desire to preserve her fertility. Abdominopelvic examination revealed a huge myoma filling and enlarging the cervix. Myomectomy was performed using standard technique as described elsewhere. A transverse incision was made using a harmonic scalpel. The myoma was fixed with a corkscrew manipulator and enucleated. Once bleeding was controlled, the myoma bed was filled with Spongostan to prevent possible bleeding from leakage

  10. Huge music archives on mobile devices

    DEFF Research Database (Denmark)

    Blume, H.; Bischl, B.; Botteck, M.

    2011-01-01

    The availability of huge nonvolatile storage capacities such as flash memory allows large music archives to be maintained even in mobile devices. With the increase in size, manual organization of these archives and manual search for specific music becomes very inconvenient. Automated dynamic...... and difficult to tackle on mobile platforms. Against this background, we provided an overview of algorithms for music classification as well as their computation times and other hardware-related aspects, such as power consumption on various hardware architectures. For mobile platforms such as smartphones...

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Sacral plexus injury after radiotherapy for carcinoma of cervix

    Energy Technology Data Exchange (ETDEWEB)

    Stryker, J.A.; Sommerville, K.; Perez, R.; Velkley, D.E. (Pennsylvania State Univ., Hershey (USA))

    1990-10-01

    A 42-year-old woman developed lower extremity weakness and sensory loss 1 year after external and intracavitary radiotherapy for Stage IB carcinoma of cervix. She has been followed for 5 years posttreatment, and the neurologic abnormalities have persisted, but no evidence of recurrent carcinoma has been found. We believe this to be a rare case of sacral plexus radiculopathy developing as a late complication after radiotherapy. Suggestions are made for improving the radiotherapy technique to prevent this complication in future cases.

  13. Computer Navigation-aided Resection of Sacral Chordomas

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    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.

  14. Sacral neuromodulation of nociceptive bladder overactivity in cats.

    Science.gov (United States)

    Zhang, Zhaocun; Bandari, Jathin; Bansal, Utsav; Shen, Bing; Wang, Jicheng; Lamm, Vladimir; Roppolo, James R; de Groat, William C; Tai, Changfeng

    2017-06-01

    To investigate the effects of electrical stimulation of sacral dorsal/ventral roots on irritation-induced bladder overactivity, reveal possible different mechanisms under nociceptive bladder conditions, and establish a large animal model of sacral neuromodulation. Intravesical infusion of 0.5% acetic acid (AA) was used to irritate the bladder and induce bladder overactivity in cats under α-chloralose anesthesia. Electrical stimulation (5, 15, or 30 Hz) was applied to individual S1-S3 dorsal or ventral roots at or below motor threshold intensity. Repeated cystometrograms (CMGs) were performed with/without the stimulation to determine the inhibition of bladder overactivity. AA irritation induced bladder overactivity and significantly (P < 0.05) reduced the bladder capacity to 62.6 ± 11.7% of control capacity measured during saline CMGs. At threshold intensity for inducing reflex twitching of the anal sphincter or toe, S1/S2 dorsal root stimulation at 5 Hz but not at 15 or 30 Hz inhibited bladder overactivity and significantly (P < 0.05) increased bladder capacity to 187.3 ± 41.6% and 155.5 ± 9.7% respectively, of AA control capacity. Stimulation of S3 dorsal root or S1-S3 ventral roots was not effective. Repeated stimulation of S1-S3 dorsal root did not induced a post-stimulation inhibition. This study established a cat model of sacral neuromodualation of nociceptive bladder overactivity. The results revealed that the mechanisms underlying sacral neuromodulation are different for nociceptive and non-nociceptive bladder activity. © 2016 Wiley Periodicals, Inc.

  15. Image-guided percutaneous internal fixation of sacral fracture.

    Science.gov (United States)

    Kinon, Merritt D; Desai, Rupen; Loriaux, Daniel; Houten, John K

    2016-01-01

    Percutaneous iliosacral screw placement is a technically challenging procedure with a significant complication profile for misplaced screws. The use of stereotactic image guidance has been shown to provide superior accuracy in the placement of spinal instrumentation. Here, the authors describe a novel application of O-arm technology (Medtronic Sofamor Danek, Memphis, TN, USA) to help safely place iliosacral screws for the treatment of a traumatic sacral fracture. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Sacral neuromodulation in overactive bladder: a review and current perspectives

    Directory of Open Access Journals (Sweden)

    Sukhu T

    2016-10-01

    Full Text Available Troy Sukhu,1 Michael J Kennelly,2 Raj Kurpad1 1Department of Urology, University of North Carolina, Chapel Hill, 2Department of Urology, Carolinas Medical Center, Charlotte, NC, USA Abstract: Overactive bladder (OAB symptoms of urgency, frequency, and urge incontinence currently affect a substantial portion of the population, especially as age increases. Sacral neuromodulation has become a popular option for refractory OAB symptoms over the past 2 decades. Studies have demonstrated that it is an effective treatment for OAB and urge incontinence as indicated by decreased number of voids, increased bladder capacity, and fewer leakage events. In addition, the effects have proved to be durable to multiple years following implantation. These benefits come at the expense of a high rate of adverse events, although with comparable long-term cost-effectiveness to botulinum toxin A. We aimed to review the literature that demonstrates that sacral neuromodulation continues to be an efficacious treatment for refractory OAB wet and dry patients, with continuously expanding indications. Keywords: urge incontinence, sacral neuromodulation, overactive bladder, refractory, voiding dysfunction

  17. Perforator propeller flaps for sacral and ischial soft tissue reconstruction

    Directory of Open Access Journals (Sweden)

    Korambayil Pradeoth

    2010-01-01

    Full Text Available The perforator-based flaps in the sacral and ischial region is designed according to the localization of perforators that penetrate the gluteus maximus muscle, reach the intra-fascial and supra-fascial planes with the overlying skin forming a rich vascular plexus. The perforator-based flaps described in this article are highly vascularized, have minimal donor site morbidity, and do not require the sacrifice of the gluteus maximus muscle. In a period between April 2008 and March 2009, six patients with sacral pressure sore were reconstructed with propeller flap method based on superior gluteal and parasacral artery perforators. One flap loss was noted. Three cases of ischial pressure sore were reconstructed with longitudinal propeller flap cover, based on inferior gluteal artery perforator. One flap suffered wound infection and dehiscence. Two cases of pilonidal sinus were reconstructed with propeller flap based on parasacral perforators. Both the flaps survived without any complications. Donor sites were closed primarily. In the light of this, they can be considered among the first surgical choices to re-surface soft tissue defects of the sacral and ischial regions. In the series of 11 patients, two patients (18% suffered complications.

  18. Laparoscopic Management of Huge Myoma Nascendi.

    Science.gov (United States)

    Peker, Nuri; Gündoğan, Savas; Şendağ, Fatih

    To demonstrate the feasibility of laparoscopic management of a huge myoma nascendi. Step-by-step video demonstration of the surgical procedure (Canadian Task Force classification III-C). Uterine myoma is the most common benign neoplasm of the female reproductive tract, with an estimated incidence of 25% to 30% at reproductive age [1,2]. Patients generally have no symptoms; however, those with such symptoms as severe pelvic pain, heavy uterine bleeding, or infertility may be candidates for surgery. The traditional management is surgery; however, uterine artery embolization or hormonal therapy using a gonadotropin-releasing hormone agonist or a selective estrogen receptor modulator should be preferred as the medical approach. Surgical management should be performed via laparoscopy or laparotomy; however, the use of laparoscopic myomectomy is being debated for patients with huge myomas. Difficulties in the excision, removal, and repair of myometrial defects, increased operative time, and blood loss are factors keeping physicians away from laparoscopic myomectomy [1,2]. A 35-year-old woman was admitted to our clinic with complaints of chronic pelvic pain and heavy menstrual bleeding. Her medical history included multiple hospitalizations for blood transfusions, along with a recently measured hemoglobin level of 9.5 g/dL and a hematocrit value of 29%. She had never been married and had no children. Pelvic ultrasonography revealed a 12 × 10-cm uterine myoma located on the posterior side of the corpus uteri and protruding through to the cervical channel. This was a huge intramural submucous myoma in close proximity to the endometrial cavity and spreading through the myometrium. On vaginal examination, the myoma was found to extend into the vagina through the cervical channel. Laparoscopic myomectomy was planned because of the patient's desire for fertility preservation. Abdominopelvic exploration revealed a huge myoma filling the posterior side of the corpus uteri and

  19. STUDY OF SACRAL HIATUS IN DRY HUMAN SACRA IN NEPAL, PARSA REGION

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    Malarvani T

    2015-03-01

    Full Text Available Introduction: The sacrum is a large triangular bone, formed by the fusion of five sacral vertebrae. The opening at the caudal end of sacral canal is known as sacral hiatus. It is formed due to the failure of fusion of laminae of the fifth (occasionally fourth sacral vertebra. Sacrum is one of the bones which exhibit variations and the variation of sacral hiatus is of great clinical significance because it may also leads to mechanical low back pain. Previous works on the morphometrical study on the sacral hiatus is limited, especially in Nepal, Parsa population. The present study was undertaken to help in filling this gap at least to a certain extent and also made an attempt to find out the variations of sacrum. Materials: One hundred dry human sacra were collected from the Department of Anatomy of National medical college & Teaching Hospital, Nepal. Methods & Observations: The morphometrical studies were done, and the parameters (Shape, length, Transverse width & Antero-posterior width of sacral hiatus and level of apex & base of sacral hiatus were measured with the help of divider, the observations were recorded, tabulated & analyzed. Result: The study showed a significant co-relation between anatomical variations of sacral hiatus with the previous studies.

  20. Huge Tongue Lipoma: A Case Report

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    Mohammad Ali Damghani

    2015-03-01

    Full Text Available Introduction: Lipomas are among the most common tumors of the human body. However, they are uncommon in the oral cavity and are observed as slow growing, painless, and asymptomatic yellowish submucosal masses. Surgical excision is the treatment of choice and recurrence is not expected.    Case Report: The case of a 30-year-old woman with a huge lipoma on the tip of her tongue since 3 years, is presented. She had difficulty with speech and mastication because the tongue tumor was filling the oral cavity. Clinical examination revealed a yellowish lesion, measuring 8 cm in maximum diameter, protruding from the lingual surface. The tumor was surgically excised with restoration of normal tongue function and histopathological examination of the tumor confirmed that it was a lipoma.   Conclusion:  Tongue lipoma is rarely seen and can be a cause of macroglossia. Surgical excision for lipoma is indicated for symptomatic relief and exclusion of associated malignancy.

  1. Galaxies Collide to Create Hot, Huge Galaxy

    Science.gov (United States)

    2009-01-01

    This image of a pair of colliding galaxies called NGC 6240 shows them in a rare, short-lived phase of their evolution just before they merge into a single, larger galaxy. The prolonged, violent collision has drastically altered the appearance of both galaxies and created huge amounts of heat turning NGC 6240 into an 'infrared luminous' active galaxy. A rich variety of active galaxies, with different shapes, luminosities and radiation profiles exist. These galaxies may be related astronomers have suspected that they may represent an evolutionary sequence. By catching different galaxies in different stages of merging, a story emerges as one type of active galaxy changes into another. NGC 6240 provides an important 'missing link' in this process. This image was created from combined data from the infrared array camera of NASA's Spitzer Space Telescope at 3.6 and 8.0 microns (red) and visible light from NASA's Hubble Space Telescope (green and blue).

  2. A rare clinic entity: Huge trichobezoar.

    Science.gov (United States)

    Hamidi, Hidayatullah; Muhammadi, Marzia; Saberi, Bismillah; Sarwari, Mohammad Arif

    2016-01-01

    Trichobezoar is a rare clinical entity in which a ball of hair amasses within the alimentary tract. It can either be found as isolated mass in the stomach or may extend into the intestine. Trichobezoars mostly occur in young females with psychiatric disorders such as trichophagia and trichotillomania. Authors present a giant trichobezoar in an 18year old female presented with complaints of upper abdominal mass, epigastric area pain, anorexia and weight loss. The patient underwent trans-abdominal ultrasonography (USG), Computed tomography (CT), upper gastrointestinal endoscopy and subsequently laparotomy. USG was inconclusive due to non-specific findings. It revealed a thick echogenic layer with posterior dirty shadowing extending from the left sub-diaphragmatic area to the right sub hepatic region obscuring the adjacent structures. Abdominal CT images revealed a huge, well defined, multi-layered, heterogeneous, solid appearing, non-enhancing mass lesion in the gastric lumen extending from the gastric fundus to the pyloric canal. An endoscopic attempt was performed for removal of this intraluminal mass, but due to its large size, and hard nature, the endoscopic removal was unsuccessful. Finally the large trichobezoar was removed with open laparotomy. Trichobezoars should be suspected in young females with long standing upper abdominal masses; as the possibility of malignancy is not very common in this age group. While USG is inconclusive, trichobezoar can be accurately diagnosed with CT. In patient with huge trichobezoar, laparotomy can be performed firstly because of big size and location of mass, and psychiatric recommendation should be made to prevent relapse of this entity. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. A Huge Adenomatoid Odontogenic Tumor of Maxilla

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    Balasundari Shreedhar

    2012-01-01

    Full Text Available The adenomatoid odontogenic tumor (AOT is a benign, nonneoplastic (hamartomatous lesion with a slow progressing growth. It occurs in both intraosseous and peripheral forms. This paper reports the case of a female aged 16 years who presented with a swelling in anterior maxilla; canine was missing, and a supernumerary tooth was present in the mid line. Radiology revealed a well-defined radiolucent area associated with impacted canine and root resorption of adjacent teeth, which was diagnosed histopathologically as AOT. The patient was treated surgically and later rehabilitated with fixed prosthesis.

  4. Anterior dislocation of the sacroiliac joint with complex fractures of the pelvis and femur in children: a case report.

    Science.gov (United States)

    Zhang, Hua; Jin, Libin; Li, Wanli; Li, Hang

    2013-09-01

    Pediatric sacroiliac joint injuries are uncommon lesions, especially when combined with anterior sacroiliac dislocation. Here, we present a rare case of anterior dislocation of the sacroiliac joint associated with ipsilateral acetabulum, subtrochanteric, and pubic rami fractures combined with a contralateral sacral fracture. This appears to be the first such case reported in the literature. At the 6-month follow-up, a favorable clinical outcome was achieved, with radiological healing of the lesion.

  5. HUBBLE SPIES HUGE CLUSTERS OF STARS FORMED

    Science.gov (United States)

    2002-01-01

    BY ANCIENT ENCOUNTER This stunningly beautiful image [right] taken with the NASA Hubble Space Telescope shows the heart of the prototypical starburst galaxy M82. The ongoing violent star formation due to an ancient encounter with its large galactic neighbor, M81, gives this galaxy its disturbed appearance. The smaller picture at upper left shows the entire galaxy. The image was taken in December 1994 by the Kitt Peak National Observatory's 0.9-meter telescope. Hubble's view is represented by the white outline in the center. In the Hubble image, taken by the Wide Field and Planetary Camera 2, the huge lanes of dust that crisscross M82's disk are another telltale sign of the flurry of star formation. Below the center and to the right, a strong galactic wind is spewing knotty filaments of hydrogen and nitrogen gas. More than 100 super star clusters -- very bright, compact groupings of about 100,000 stars -- are seen in this detailed Hubble picture as white dots sprinkled throughout M82's central region. The dark region just above the center of the picture is a huge dust cloud. A collaboration of European and American scientists used these clusters to date the ancient interaction between M82 and M81. About 600 million years ago, a region called 'M82 B' (the bright area just below and to the left of the central dust cloud) exploded with new stars. Scientists have discovered that this ancient starburst was triggered by the violent encounter with M81. M82 is a bright (eighth magnitude), nearby (12 million light-years from Earth) galaxy in the constellation Ursa Major (the Great Bear). The Hubble picture was taken Sept. 15, 1997. The natural-color composite was constructed from three Wide Field and Planetary Camera 2 exposures, which were combined in chromatic order: 4,250 seconds through a blue filter (428 nm); 2,800 seconds through a green filter (520 nm); and 2,200 seconds through a red (820 nm) filter. Credits for Hubble image: NASA, ESA, R. de Grijs (Institute of

  6. Magnetic resonance imaging of the sacral plexus and piriformis muscles

    Energy Technology Data Exchange (ETDEWEB)

    Russell, J.M. [St. Vincent' s Medical Center, Department of Radiology, Jacksonville, FL (United States); Kransdorf, Mark J.; Bancroft, Laura W.; Peterson, Jeffrey J.; Berquist, Thomas H.; Bridges, Mellena D. [Mayo Clinic, Department of Radiology, Jacksonville, FL (United States)

    2008-08-15

    The objective was to evaluate the piriformis muscles and their relationship to the sacral nerve roots on T1-weighted MRI in patients with no history or clinical suspicion of piriformis syndrome. Axial oblique and sagittal T1-weighted images of the sacrum were obtained in 100 sequential patients (200 pairs of sacral roots) undergoing routine MRI examinations. The relationship of the sacral nerve roots to the piriformis muscles and piriformis muscle size were evaluated, as were clinical symptoms via a questionnaire. The S1 nerve roots were located above the piriformis muscle in 99.5% of cases (n=199). The S2 nerve roots were located above the piriformis muscle in 25% of cases (n=50), and traversed the muscle in 75% (n=150). The S3 nerve roots were located above the piriformis muscle in 0.5% of cases (n=1), below the muscle in 2.5% (n=5), and traversed the muscle in 97% (n=194). The S4 nerve roots were located below the muscle in 95% (n=190). The piriformis muscles ranged in size from 0.8-3.2 cm, with an average size of 1.9 cm. Nineteen percent of patients had greater than 3 mm of asymmetry in the size of the piriformis muscle, with a maximum asymmetry of 8 mm noted. The S1 nerve roots course above the piriformis muscle in more than 99% of patients. The S2 roots traverse the piriformis muscle in 75% of patients. The S3 nerve roots traverse the piriformis muscle in 97% of patients. Piriformis muscle size asymmetry is common, with muscle asymmetry of up to 8 mm identified. (orig.)

  7. Umbilicoplasty in children with huge umbilical hernia

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    Akakpo-Numado Gamedzi Komlatsè

    2014-01-01

    Full Text Available Background: Huge umbilical hernias (HUH are voluminous umbilical hernia (UH that are frequent in black African children. Several surgical techniques are used in their treatment for umbilical reconstruction, but techniques using skin flaps provide better aesthetic results. In this study, we presented our technique of umbilicoplasty in HUH, and its results. Patients and Methods: It is a retrospective study on children treated for HUH, from January 2012 to December 2013. The UH was called HUH when its basis diameter (BD exceeds 3 cm. Every HUH was characterised by its height, BD and morphology. Our technique was a two lateral flaps technique; the flaps are symmetrical and drawn so as to reconstitute the different parts of the umbilicus. The results were appreciated with criteria, including the peripheral ring and the central depression of the neo-umbilicus. Results : Twelve children were concerned (7 boys and 5 girls. Their mean age was 5 years and 6 months. The mean BD was 5.6 cm (extremes 3 and 8 cm, and the mean height of the HUH was 7.45 cm (extremes 3 and 9 cm. All underwent umbilicoplasty. In early post-operative period, two children presented a transitory subcutaneous hematoma. Late complications were granulation tissue with two children, and cheloid scar with one. With a mean follow-up of 10 months, we had 10 excellent results and two fair results according to our criteria. Conclusion: Our two lateral flaps umbilicoplasty is well-adapted to HUH in children. It is simple and assures a satisfactory anatomical and cosmetic result.

  8. Hepatectomy for huge hepatocellular carcinoma: single institute's experience.

    Science.gov (United States)

    Yang, Lianyue; Xu, Jiangfeng; Ou, Dipeng; Wu, Wei; Zeng, Zhijun

    2013-09-01

    The surgical resection of huge hepatocellular carcinoma (HCC) is still controversial. This study was designed to introduce our experience of liver resection for huge HCC and evaluate the safety and outcomes of hepatectomy for huge HCC. A total of 258 hepatic resections for the patients with huge HCC were analysed retrospectively from December 2002 to December 2011. The operative outcomes were compared with 293 patients with HCC >5.0 cm but huge HCC group and HCC >5.0 cm but huge HCC group has significantly a more longer overall and disease-free survival time than nodular huge HCC (P = 0.026, P = 0.022). Univariate and multivariate analysis revealed that the types of tumour, vascular invasion, and UICC stage were independent prognostic factors for overall survival (P = 0.047, P = 0.037, P = 0.033). Hepatic resection can be performed safely for huge HCC with a low mortality and favorable survival outcomes. Solitary huge HCC has the better surgical outcomes than nodular huge HCC.

  9. Imaging in isolated sacral tuberculosis: a review of 15 cases

    Energy Technology Data Exchange (ETDEWEB)

    Patankar, T.; Krishnan, A.; Kale, H.; Prasad, S. [Department of Radiology, King Edward Memorial Hospital, Bombay (India); Patkar, D.; Shah, J. [Department of Radiology, Dr. Balabhai Nanavati Hospital, Bombay (India); Castillo, M. [Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7510 (United States)

    2000-07-01

    Objective. To review imaging studies of isolated involvement of the sacrum due to tuberculosis and determine the role of imaging in the diagnosis and management of these patients.Design and patients. A retrospective analysis of 15 cases of isolated sacral tuberculosis imaged with MR imaging was performed. The CT images were also reviewed where available, and the various lesion characteristics were identified. We also reviewed the medical records in an attempt to determine the impact of the imaging studies on the management of these patients.Results. Fifteen patients (5 male, 10 female) presented with symptoms of 3-15 months' duration. Chronic localized backache with muscle spasm was the commonest presenting symptom; discharging sinuses with abscess formation was found in six patients, five of whom were children. MR imaging of the sacrum revealed a hypointense marrow signal on T1-weighted images and hyperintense signal on T2-weighted images in 14 of 15 patients, the S2 vertebra being always involved. CT revealed osteolytic changes in the sacrum in all the five patients in whom CT was performed. All patients showed marked clinical improvement within 1 year of anti-tuberculous chemotherapy.Conclusion. Isolated tuberculosis of the sacrum is uncommon but should be suspected in patients presenting with chronic low backache or children with discharging sinuses/abscesses and showing sacral destruction on CT or MR imaging. MR imaging can identify cases and enables early institution of anti- tuberculous chemotherapy. (orig.)

  10. Biliary obstruction due to a huge simple hepatic cyst treated with laparoscopic resection.

    Science.gov (United States)

    Kaneya, Yohei; Yoshida, Hiroshi; Matsutani, Takeshi; Hirakata, Atsushi; Matsushita, Akira; Suzuki, Seiji; Yokoyama, Tadashi; Maruyama, Hiroshi; Sasajima, Koji; Uchida, Eiji

    2011-01-01

    Most hepatic cysts are asymptomatic, but complications occasionally occur. We describe a patient with biliary obstruction due to a huge simple hepatic cyst treated with laparoscopic resection. A 60-year-old Japanese woman was admitted to our hospital because of a nontender mass in the right upper quadrant of the abdomen. Laboratory tests revealed the following: serum total bilirubin, 0.6 mg/dL; serum aspartate aminotransferase, 100 IU/L; serum alanine aminotransferase, 78 IU/L; serum alkaline phosphatase, 521 IU/L; and serum gamma glutamic transpeptidase, 298 IU/L. Abdominal computed tomography, ultrasonography, and magnetic resonance cholangiopancreatography revealed a huge hepatic cyst, 13 cm in diameter, at the hepatic hilum, accompanied by dilatation of the intrahepatic bile duct and obstruction of the common bile duct. We diagnosed biliary obstruction due to a huge hepatic cyst at the hepatic hilum, and laparoscopic surgery was performed. A huge hepatic cyst was seen at the hepatic hilum. After needle puncture of the huge cyst, the anterior wall of the cyst was unroofed, and cholecystectomy was done. Intraoperative cholangiography through a cystic duct revealed stenosis of the duct. Subsequent decapsulation of the cyst was performed in front of the common bile duct. After this procedure, cholangiography revealed that the stenosis of the common bile duct had resolved. Histopathological examination of the surgical specimen confirmed the hepatic cyst was benign. The postoperative course was uneventful, and the results of liver function tests normalized. The patient was discharged 7 days after operation. Computed tomography 3 months after operation revealed disappearance of the hepatic cyst and no dilatation of the intrahepatic bile duct.

  11. The Macroanatomy of the Sacral Plexus and Its Nerves in Eurasian Eagle Owls (Bubo bubo).

    Science.gov (United States)

    Akbulut, Y; Demiraslan, Y; Aslan, K; Coban, A

    2016-10-01

    This study was carried out to reveal the formation of the sacral plexus in the Eurasian Eagle Owls (Bubo bubo) and the nerves originating from this plexus. Five EEOs, three of them were male and two were female, were provided from Wildlife Rescue and Rehabilitation Center of Kafkas University and used as materials. Following the euthanizing of the animals, abdominal cavity was opened. The nerves of plexus sacrales were dissected and photographed. It was detected that the sacral plexus was formed by the ventral ramus of five synsacral nerves. Moreover, it was determined that the roots of the sacral plexus formed three trunks: the truncus cranialis, the truncus medius and the truncus caudalis in fossa renalis. The availability of the n. ischiofemoralis and the availability of n. parafibularis were detected in the EEOs. Five branches were specified as having segregated from the sacral plexus: the n. cutaneus femoralis caudalis, the mutual root of n. fibularis with n. tibialis (n. ischiadicus), the rami musculares, the n. coxalis caudalis and the ramus muscularis. It was observed that the sacral plexus was linked to the lumbar plexus by the n. furcalis, to the pudendus plexus via the n. bigeminus. Consequently, the anatomic structure of the EEO's sacral plexus, the participating synsacral nerves to plexus and the innervation areas of these nerves were revealed.

  12. 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.

  13. Sacral Stress Fracture Mimicking Lumbar Radiculopathy in a Mounted Police Officer: Case Report and Literature Review.

    Science.gov (United States)

    Bednar, Drew A; Almansoori, Khaled

    2015-10-01

    Study Design Case report and review of the literature. Objective To present a unique case of L5 radiculopathy caused by a sacral stress fracture without neurologic compression. Methods We present our case and its clinical evolution and review the available literature on similar pathologies. Results Relief of the unusual mechanical loading causing sacral stress fracture led to rapid resolution of radiculopathy. Conclusion L5 radiculopathy can be caused by a sacral stress fracture and can be relieved by simple mechanical treatment of the fracture.

  14. Sacral pressure sore reconstruction -- the pedicled superior gluteal artery perforator flap.

    Science.gov (United States)

    Hurbungs, A; Ramkalawan, H

    2012-02-14

    To report the use of the pedicled superior gluteal artery perforator (SGAP) fasciocutaneous flap as a reliable surgical option for sacral pressure sore reconstruction. A prospective study was conducted between September 2008 and September 2010 of 10 patients with stage 3 or 4 sacral pressure sores treated with a unilateral pedicled SGAP flap. All flaps survived completely with no complications in 9 patients. One patient had a haematoma below the flap that was easily drained. No recurrence of the bedsore occurred during follow-up. We suggest that the pedicled SGAP fasciocutaneous flap is a reliable surgical option for sacral pressure sore reconstruction.

  15. Specific Tips for General Controversies in Sacral Neuromodulation.

    Science.gov (United States)

    El-Azab, Ahmed S; Siegel, Steven W

    2016-11-01

    The field of Sacral Neuromodulation is continually evolving and still in its infancy. Common dilemmas experienced with this therapy will be discussed in this article, including ways to avoid and manage them. The focus will be on test evaluations performed with either peripheral nerve evaluation (PNE) or staged procedure, the clinical effectiveness and safety of unilateral versus bilateral test stimulation for both the PNE and staged procedures, and best methods to determine the success of the trial phase. We will also discuss how to deal with the problem of declining efficacy of the device over time. The article presents a discussion on future technological innovations to enhance techniques and mode of positioning and use of leads, which along with a refined understanding of how neuromodulation is effective for different problems, will lead to better outcomes.

  16. Fever, Sacral Pain, and Pregnancy: An Incarcerated Uterus

    Directory of Open Access Journals (Sweden)

    Sweigart, Amy N

    2008-11-01

    Full Text Available Uterine incarceration is an uncommon but serious presentation in the emergency department that requires early recognition to improve maternal and fetal outcomes.Case: A 29-year-old female, at 12 weeks gestation, presented to the emergency department (ED with complaints of fever, sacral pain and urgency. Based on history and physical examination, she was found to have a retroverted, incarcerated uterus. After a failed attempt at reduction in the ED, her uterus was successfully reduced under general anesthesia.Discussion: Pain and urinary difficulties, such as retention and hesitancy, are frequent in pregnancy, yet incarcerated uterus is an uncommon emergency department diagnosis that often presents with these symptoms. Clues to the diagnosis include a retroverted uterus, urinary retention, and pain in a patient presenting in the third to fourth months of gestation. Treatment is by manual reduction of the uterus. Complications range from spontaneous abortion to uterine rupture.[WestJEM. 2008;9:232-234.

  17. A Case of Huge Retroperitoneal Ganglioneuroma

    Directory of Open Access Journals (Sweden)

    Ali Akbarzadeh Pasha

    2009-01-01

    Full Text Available "nIntroduction: Ganglioneuroma is a rare, benign, fully differentiated tumor that contains mature schwann cells, ganglion cells, fibrous tissue and nerve fibers. This tumor has no immature elements, atypia, mitotic figures, intermediate cells or necrosis. This lesion can occur almost anywhere along the paravertebral sympathetic ganglia and sometimes in the adrenal medulla. This tumor can arise de novo and result from the maturation of a ganglioneuroblastoma or neuroblastoma; it may also develop within a neuroblastoma treated by chemotherapy. Metastasis is exceedingly rare. "nCase Presentation: The patient is a 7 year-old-girl living in Bam, Iran, presented with an abdominal mass 6 months ago. Physical examination revealed a very large, firm and painless abdominal mass in the right side of the abdomen with extension to the left side. She was otherwise well. In sonography, a very large heterogeneous retroperitoneal mass was seen arising on the right side crossing the midline. Dimensions were at least 170×160 mm. The right kidney and liver were displaced downward and upward, respectively. No liver metastasis or ascites was seen. In the colour Doppler ultrasonography, the lesion was hypervascular with a low resistance flow. The aorta was completely encased and displaced anteriorly but not invaded. Urinary VMA, bone marrow aspiration and biopsy were normal. A poor quality noncontrast CT scan revealed no more information than sonography (a hypodense noncalcified mass. The patient had tolerated two periods of chemotherapy with the impression of neuroblastoma without tissue diagnosis. Spiral CT scan performed at Pasteur hospital in Bam revealed a very large hypervascular hypodense retroperitoneal mass with complete encasement of the aorta and a large vessel originating from the aorta. The right kidney and liver were displaced downward and upward, respectively and the bowel loops were displaced to the left side. Sonography-guided needle biopsy was

  18. Treating Huge Tear-Drop Fracture of Axis With Trapezoidal Bone: A Case Report and Literature Review.

    Science.gov (United States)

    Yang, Xiaobin; Zheng, Bolong; Hao, Dingjun; Liu, Benyin; Yan, Liang; He, Baorong

    2015-11-01

    Case report and review of relevant literature. To discuss the surgical strategies and clinical outcome of managing huge tear drop fracture of axis. Teardrop fracture of axis is rarely seen, especially the huge type. The surgical technique is demanding because of the special anatomical structure and difficulty with bone grafting. Moreover, the surgical approach is controversial in the literature. A 51-year-old male patient suffered from neck pain after falling from the bicycle, neck movement was limited with no neurological compromise. X-ray suggested huge tear-drop fracture of anterior-inferior corner of axis, narrowing of C2/3 intervertebral disc. Fusion with self-designed tricortical trapezoidal iliac bone was performed. Treating huge teardrop fracture of axis by anterior bone grafting with self-designed tricortical trapezoidal iliac bone is effective and stable. A 3-month follow-up showed fusion was achieved, upper cervical curvature was restored, and neck pain disappeared. Self-designed tricortical trapezoidal iliac bone provided adequate fusion area of bone grafting, restoring the normal intervertebral height and cervical alignment, and the midterm outcome is satisfactory. 5.

  19. Optimization of Dynamically Generated SQL Queries for Tiny-Huge, Huge-Tiny Problem

    Directory of Open Access Journals (Sweden)

    Arjun K Sirohi

    2013-03-01

    Full Text Available In most new commercial business software applications like Customer Relationship Management, the datais stored in the database layer which is usually a Relational Database Management System (RDBMS likeOracle, DB2 UDB or SQL Server. To access data from these databases, Structured Query Language (SQLqueries are used that are generated dynamically at run time based on defined business models and businessrules. One such business rule is visibility- the capability of the application to restrict data access based onthe role and responsibility of the user logged in to the application. This is generally achieved by appendingsecurity predicates in the form of sub-queries to the main query based on the roles and responsibility of theuser. In some cases, the outer query may be more restrictive while in other cases, the security predicatesmay be more restrictive. This often results in a dilemma for the cost-based optimizer (CBO of the backenddatabase whether to drive from the outer query or drive from the security predicate sub-queries. Thisdilemma is sometimes called the “Tiny-Huge, Huge-Tiny” problem and results in serious performancedegradation by way of increased response times on the application User Interface (UI. This paperprovides a case study of a new approach to vastly reduce this CBO dilemma by a combination of denormalizedcolumns and re-writing of the security predicates’ sub-queries at run-time, thereby levelling theouter and security sub-queries. This approach results in more stable execution plans in the database andmuch better performance of such SQLs, effectively leading to higher performance and scalability of theapplication.

  20. Huge Intramural Hematoma in a Thrombosed Middle Cerebral Artery Aneurysm: A Case Report.

    Science.gov (United States)

    Kim, Hak Jin; Lee, Sang Won; Lee, Tae Hong; Kim, Young Soo

    2015-09-01

    We describe a case of a huge intramural hematoma in a thrombosed middle cerebral artery aneurysm. A 47-year-old female patient with liver cirrhosis and thrombocytopenia presented to the neurosurgical unit with a 5-day history of headache and cognitive dysfunction. Magnetic resonance imaging and computed tomography of the brain showed a thrombosed aneurysm located in the right middle cerebral artery with a posteriorly located huge intramural hematoma mimicking an intracerebral hematoma. Imaging studies and cerebrospinal fluid analysis showed no evidence of subarachnoid hemorrhage. Angiography showed a partially thrombosed aneurysm at the origin of the right anterior temporal artery and an incidental aneurysm at the bifurcation of the right middle cerebral artery. Both aneurysms were embolized by coiling. After embolization, the thrombosed aneurysmal sac and intramural hematoma had decreased in size 4 days later and almost completely disappeared 8 months later. This is the first reported case of a nondissecting, nonfusiform aneurysm with a huge intramural hematoma, unlike that of a dissecting aneurysm.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. the evaluation of unstable lumbar-sacral junction with function x-rays ...

    African Journals Online (AJOL)

    ... subjected to dynamic lumbar- sacral plain films as part of clinical evaluation. ... Key words: Lumbosacral spine, Dynamic radiography, Instability, Range of motion ... chronic low back pain studied were investigated for lumbosacral junction.

  3. 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....

  4. Sacral Insufficiency Fractures: Recognition and Treatment in Patients with Concurrent Lumbar Vertebral Compression Fractures

    Science.gov (United States)

    Granville, Michelle; Jacobson, Robert E; Berti, Aldo

    2017-01-01

    Introduction In reviewing a larger group of osteoporotic vertebral compression fractures (VCFs), we found that the overall incidence of sacral insufficiency fractures (SIFs) is higher than commonly reported values. This is especially seen in patients with previous or concurrent lumbar VCFs and also in a subgroup that had lumbar stenosis or hip arthroplasty. The altered biomechanics due to associated lumbar stenosis or hip arthroplasty lead to increased mechanical stress on already weakened and deficient sacral alae, which are more vulnerable to osteoporotic weakening than other parts of the sacrum. Materials & methods We studied an overall population of patients with VCF seen clinically and separated the patients into the following groups: patients not previously treated, patients treated with vertebroplasty or kyphoplasty at one or more levels, and patients diagnosed with sacral fractures and treated with vertebroplasty or kyphoplasty. We wanted to see if a pattern existed among the patients who had sacral symptoms, were diagnosed with sacral insufficiency fractures, and subsequently underwent sacroplasty. Results In a review of 79 consecutive patients, over a 24-month period, with VCF who underwent surgical treatment, there were 10 patients who also had sacral insufficiency fractures. Four of the patients had sacral insufficiency fractures without VCF. None of the patients with sacral insufficiency fractures were on treatment for osteoporosis at the time of diagnosis. The following symptoms indicated SIF: lower sacral pain (n = 10), buttock pain (n = 7), lateral hip pain (n = 5), and groin pain radiating to the thigh (n = 4). The average time to diagnose SIF was two months after the onset of pain. Conclusions Sacral insufficiency fractures are a frequent cause of both acute and chronic pain; however, they are often missed by the majority of physicians. The frequency of undetected sacral fractures is high. This is due to a number of potential pitfalls

  5. Assessment of the effectiveness and safety of epidural-sacral anesthesia during cesarean section

    OpenAIRE

    MATLUBOV MANSUR MURATOVICH; SEMENIHIN ARSENIY ARSENEVIC

    2016-01-01

    Investigation was carried out with the aim to determine reasonability of using epidural-sacral anesthesia during cesarean section and also to assess the effectiveness of such method. 19 women with supposed difficulties of traditional methods of anesthesia have been included in the investigation. The implementation method of epidural-sacral anesthesia and also subsequent monitoring of patients’ health status have been described in detail. The results of investigation allow us to consider that ...

  6. Anatomical Study of The Sacum for Transsacral Block of Sacral Nerves

    Directory of Open Access Journals (Sweden)

    D S Patil

    2012-08-01

    Full Text Available Inroduction: For transsacral block of sacral nerves in analgesia and anesthesia of the rectal, anal or urethral region the dorsal sacral foramina are used.To find solution of this by identifying additional anatomical landmarks and measurements of dorsal sacral foramina for transsacral nerve block. Materials & Method: Total 100 complete and undamaged adult, dry sacrums were measured with a vernier caliper (accurate to 0.1 mm. Dorsal sacral foramina of the sacrum were taken as points. Calculations and analyses were expressed as mean (SD, median and range using Open Office 3.2.0 spreadsheet version for Linux (Ubuntu 10.04. Results: The average distance between the two superolateral sacral crests was 60.61 (SD 6.71 mm. Distance between dorsal sacral foramina vertical right side 1st to 2nd 14.05 (SD 2.35mm, 2nd to 3rd 12.33 (SD 1.84mm, 3rd to 4th 11.26 (SD 2.35mm and vertical left side 1st to 2nd 14.18 (SD 2.61mm, 2nd to 3rd 12.18 (SD 1.95mm, 3rd to 4th 10.78 (SD2.42mm. Transverse distance between dorsal sacral foramina 1st to 1st 34.72 (SD 3.97mm, 2nd to 2nd 29.43 (SD 3.51mm, 3rd to 3rd 25.58 (SD 3.46mm, 4th to 4th 24.63 (SD 3.22mm. Conclusion: Measurements of dorsal sacral foramina can be used for transsacral nerve block. [Natl J of Med Res 2012; 2(4.000: 501-503

  7. COMPARISON OF SACRAL INDEX AND KIMURA BASE WING METHOD TO DETERMINE THE SEX OF SACRUM

    Directory of Open Access Journals (Sweden)

    Bichitrananda Roul

    2016-10-01

    Full Text Available BACKGROUND The sacrum (Vertebra Magnum is a large, flattened, triangular bone present at the base of spine, which is formed by fusion of sacral vertebra S1 to S5 and the fusion occurs between the age group of 18 to 30 years. It forms the posterosuperior part of bony pelvis articulating on either side with the corresponding hip bone at the sacroiliac joint. The dimensions of sacra vary in different sexes. Determination of sex of sacrum can be done by using various methods. In our study, comparison was done between sacral index and Kimura base wing method. MATERIALS AND METHODS A study to determine the sex of sacrum was carried on 50 sacra (25 male and 25 female sacra by two methods. One method used was sacral index and the other method was Kimura's base wing index. The measuring instrument used was sliding vernier caliper. Sacral index- the well-known method for determination of sex from sacrum and Kimura’s base wing method- another method for sex determination. Both are compared. The method of sacral index showed more accuracy rate as compared with Kimura's base wing index method. RESULTS By using sacral index, the % of bone identified as male sacrum was 64% and the % of bone identified as female sacrum was 68%. By using Kimura base wing method, 28% of male sacra and 24% of female sacra were identified in right side and 24% of male sacra and 20% of female sacra were identified in left side. CONCLUSIONS In our study, comparison was done between sacral index and Kimura base wing method in determining the sex of sacrum. From the above study, it was found that the method of sacral index showed more accuracy rate as compared with Kimura's base wing index method.

  8. Pressure changes under the ischial tuberosities during gluteal neuromuscular stimulation in spinal cord injury: a comparison of sacral nerve root stimulation with surface functional electrical stimulation.

    Science.gov (United States)

    Liu, Liang Qin; Ferguson-Pell, Martin

    2015-04-01

    To compare the magnitude of interface pressure changes during gluteal maximus contraction by stimulating sacral nerve roots with surface electrical stimulations in patients with spinal cord injuries (SCIs). Pilot interventional study. Spinal injury research laboratory. Adults (N=18) with suprasacral complete SCI. Sacral nerve root stimulation (SNRS) via a functional magnetic stimulator (FMS) or a sacral anterior root stimulator (SARS) implant; and surface functional electrical stimulation (FES). Interface pressure under the ischial tuberosity (IT) defined as peak pressure, gradient at peak pressure, and average pressure. With optimal FMS, a 29% average reduction of IT peak pressure was achieved during FMS (mean ± SD: 160.1±24.3mmHg at rest vs 114.7±18.0mmHg during FMS, t5=6.3, P=.002). A 30% average reduction of peak pressure during stimulation via an SARS implant (143.2±31.7mmHg at rest vs 98.5±21.5mmHg during SARS, t5=4.4, P=.007) and a 22% average decrease of IT peak pressure during FES stimulation (153.7±34.8mmHg at rest vs 120.5±26.1mmHg during FES, t5=5.3, P=.003) were obtained. In 4 participants who completed both the FMS and FES studies, the percentage of peak pressure reduction with FMS was slightly greater than with FES (mean difference, 7.8%; 95% confidence interval, 1.6%-14.0; P=.04). SNRS or surface FES can induce sufficient gluteus maximus contraction and significantly reduce ischial pressure. SNRS via an SARS implant may be more convenient and efficient for frequently activating the gluteus maximus. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  9. Is Lumbo-Sacral Angle Related to Plantar Loading Patterns in Patients with Ankylosing Spondylitis?

    Directory of Open Access Journals (Sweden)

    Elif Aydın

    2016-08-01

    Full Text Available Objective: Loss of lumbar lordosis is a clinical feature of ankylosing spondylitis (AS. Pedobarographic analysis assesses the interaction between the foot and the supporting surface. Postural abnormalities can reflect as pressure distribution deviations on pedobarography. The objective of the present study was to assess whether loss of lumbar lordosis detected with lumbo-sacral angle measurement is related to postural control assessed by plantar loading distribution in patients with AS. Materials and Methods: Thirty-two patients (two female, 30 male, mean age: 43.06±7.8 years with the diagnosis of AS, who already had a lateral lumbo-sacral X-ray performed within the past one year, were included in the study. Static and dynamic pedobarographic analyses of the patients were performed. The radiographic measurement of lumbo-sacral angle was done from lateral lumbo-sacral X-rays of the patients. Results: The static pedobarographic measurement revealed that lumbo-sacral angle was significantly correlated with forefoot plantar pressure (p=0.042; r=0.361. In the dynamic assessment, the maximum pressures were lower under the first metatarsal area in patients with lower lumbo-sacral angle (p=0.352; r=0.048. Conclusion: These findings suggest that foot joints may contribute to the compensation mechanism against the postural changes in patients with AS, statically and dynamically.

  10. 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.

  11. Scarless surgery for a huge liver cyst: A case report.

    Science.gov (United States)

    Kashiwagi, Hiroyuki; Kawachi, Jun; Isogai, Naoko; Ishii, Masanori; Miyake, Katsunori; Shimoyama, Rai; Fukai, Ryota; Ogino, Hidemitsu

    2017-09-01

    Symptomatic or complicated liver cysts sometimes require surgical intervention and laparoscopic fenestration is the definitive treatment for these cysts. We performed minimally invasive surgery, hybrid natural orifice transluminal endoscopic surgery (NOTES) without scarring, for a huge liver cyst. An 82-year-old female presented with a month-long history of right upper abdominal pain. We diagnosed her condition as a huge liver cyst by morphological studies. She denied any history of abdominal trauma. Her serum CEA and CA19-9 were normal and a serum echinococcus serologic test was negative. Laparoscopic fenestration, using a hybrid NOTES procedure via a transvaginal approach, was performed for a huge liver cyst because we anticipated difficulty with an umbilical approach, such as single incision laparoscopic surgery (SILS). Her post-operative course was uneventful and she was discharged from our hospital three days after surgery. Pain killers were not required during and after hospitalization. No recurrence of the liver cyst or bulging was detected by clinical examination two years later. A recent trend of laparoscopic procedure has been towards minimizing the number of incisions to achieve less invasiveness. This hybrid NOTES, with a small incision for abdominal access, along with vaginal access, enabled painless operation for a huge liver cyst. We report a huge liver cyst treated by hybrid NOTES. This approach is safe, less invasive, and may be the first choice for a huge liver cyst. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. 56例盆腔巨大肿瘤的外科治疗%Surgical management of huge pelvic tumor: a report of 56 cases

    Institute of Scientific and Technical Information of China (English)

    张健; 韩广森; 鲁朝敏; 王道海; 蒋志强

    2014-01-01

    .Methods The clinical data of 56 patients with huge pelvic tumor who were admitted to the Cancer Hospital of Henan Province from February 2005 to January 2012 were retrospectively analyzed.Tumor resectability was assessed via enhanced computed tomography or three-dimensional reconstruction,and the tumors were freed and resected by combination of muliiple surgical approaches.All the patients were followed up via telephone or re-examination at the out-patient department to learn the recurrence and metastasis of tumor.The survival rate was calculated using the life table.Results Fifty patients received preoperative computed tomography examination,and the imaging data of 6 patients were three-dimensionally reconstructed.Preoperative evaluation showed that 49 patients needed combined multivisceral resection,5 needed tumor resection,and the tumors of 2 patients were unresectable.Fourteen patients were diagnosed preoperatively,and 8 patients were diagnosed by intraoperative rapid frozen section examination,and the rest 34 patients were diagnosed by postoperative pathological examination.The surgical approaches including anterior median sacral approach combined with transperineal coccyx anterior approach (21 patients),anterior median sacral approach (11 patients),obturator approach (8 patients),retropubic approach (8 patients) and obturator approach combined with transperineal approach of coccyx (8 patients).Tumor and rectum resection was carried out on 18 patients,tumor and partial bladder resection on 12 patients,tumor,uterus and ovariectomization on 12 patients,tumor,part of the small intestine and colorectal resection on 10 patients,tumor and total pelvic exenteration on 4 patients.In all the 56 patients,53 achieved R0 resection,2 cases reached naked eye clean,1 case had residual tumor.The mean operation time was 100 minutes.Fifty patients recovered uneventfully.Six patients had postoperative complications,including 3 patients with intestinal obstruction (2 patients were cured by

  13. Denomination of the Sacral Building, its Innerspaces and Liturgical Articles

    Directory of Open Access Journals (Sweden)

    Laimutė Kitkauskienė

    2011-04-01

    Full Text Available Basing upon the material collected the article aims at reviewing denomination of liturgical – ritual objects. As to their meaning names are divided into groups depending upon what they name – a sacral object or its parts, liturgical books or articles, ritual clothes, etc. Concerning their origin there are Lithuanian and non-Lithuanian words. The latters may come from one language or be received through languages – intermediates. The conclusion is made that Latin or other foreign words remain important in the Lithuanian language as there are no proper Lithuanian words to name liturgical objects. The article has both practical and theoretical value. The data presented can be used when studying general laws of term origin and building as well as explaining the adaptation of borrowings in the Lithuanian language. It is relevant to continue the studies of this subject in order to encourage the building of Lithuanian equivalents both in this field and in those which lack Lithuanian names.

  14. Tarlov cysts: a controversial lesion of the sacral spine.

    Science.gov (United States)

    Lucantoni, Corrado; Than, Khoi D; Wang, Anthony C; Valdivia-Valdivia, Juan M; Maher, Cormac O; La Marca, Frank; Park, Paul

    2011-12-01

    The primary aim of our study was to provide a comprehensive review of the clinical, imaging, and histopathological features of Tarlov cysts (TCs) and to report operative and nonoperative management strategies in patients with sacral TCs. A literature review was performed to identify articles that reported surgical and nonsurgical management of TCs over the last 10 years. Tarlov cysts are often incidental lesions found in the spine and do not require surgical intervention in the great majority of cases. When TCs are symptomatic, the typical clinical presentation includes back pain, coccyx pain, low radicular pain, bowel/bladder dysfunction, leg weakness, and sexual dysfunction. Tarlov cysts may be revealed by MR and CT imaging of the lumbosacral spine and must be meticulously differentiated from other overlapping spinal pathological entities. They are typically benign, asymptomatic lesions that can simply be monitored. To date, no consensus exists about the best surgical strategy to use when indicated. The authors report and discuss various surgical strategies including posterior decompression, cyst wall resection, CT-guided needle aspiration with intralesional fibrin injection, and shunting. In operative patients, the rates of short-term and long-term improvement in clinical symptoms are not clear. Although neurological deficit frequently improves after surgical treatment of TC, pain is less likely to do so.

  15. Sacral Reconstruction with a 3D-Printed Implant after Hemisacrectomy in a Patient with Sacral Osteosarcoma: 1-Year Follow-Up Result.

    Science.gov (United States)

    Kim, Doyoung; Lim, Jun Young; Shim, Kyu Won; Han, Jung Woo; Yi, Seong; Yoon, Do Heum; Kim, Keung Nyun; Ha, Yoon; Ji, Gyu Yeul; Shin, Dong Ah

    2017-03-01

    Pelvic reconstruction after sacral resection is challenging in terms of anatomical complexity, excessive loadbearing, and wide defects. Nevertheless, the technological development of 3D-printed implants enables us to overcome these difficulties. Here, we present a case of sacral osteosarcoma surgically treated with hemisacrectomy and sacral reconstruction using a 3D-printed implant. The implant was printed as a customized titanium prosthesis from a 3D real-sized reconstruction of a patient's CT images. It consisted mostly of a porous mesh and incorporated a dense strut. After 3-months of neoadjuvant chemotherapy, the patient underwent hemisacretomy with preservation of contralateral sacral nerves. The implant was anatomically installed on the defect and fixed with a screw-rod system up to the level of L3. Postoperative pain was significantly low and the patient recovered sufficiently to walk as early as 2 weeks postoperatively. The patient showed left-side foot drop only, without loss of sphincter function. In 1-year follow-up CT, excellent bony fusion was noticed. To our knowledge, this is the first report of a case of hemisacral reconstruction using a custom-made 3D-printed implant. We believe that this technique can be applied to spinal reconstructions after a partial or complete spondylectomy in a wide variety of spinal diseases.

  16. Sacral Reconstruction with a 3D-Printed Implant after Hemisacrectomy in a Patient with Sacral Osteosarcoma: 1-Year Follow-Up Result

    Science.gov (United States)

    Kim, Doyoung; Lim, Jun-Young; Shim, Kyu-Won; Han, Jung Woo; Yi, Seong; Yoon, Do Heum; Kim, Keung Nyun; Ha, Yoon; Ji, Gyu Yeul

    2017-01-01

    Pelvic reconstruction after sacral resection is challenging in terms of anatomical complexity, excessive loadbearing, and wide defects. Nevertheless, the technological development of 3D-printed implants enables us to overcome these difficulties. Here, we present a case of sacral osteosarcoma surgically treated with hemisacrectomy and sacral reconstruction using a 3D-printed implant. The implant was printed as a customized titanium prosthesis from a 3D real-sized reconstruction of a patient's CT images. It consisted mostly of a porous mesh and incorporated a dense strut. After 3-months of neoadjuvant chemotherapy, the patient underwent hemisacretomy with preservation of contralateral sacral nerves. The implant was anatomically installed on the defect and fixed with a screw-rod system up to the level of L3. Postoperative pain was significantly low and the patient recovered sufficiently to walk as early as 2 weeks postoperatively. The patient showed left-side foot drop only, without loss of sphincter function. In 1-year follow-up CT, excellent bony fusion was noticed. To our knowledge, this is the first report of a case of hemisacral reconstruction using a custom-made 3D-printed implant. We believe that this technique can be applied to spinal reconstructions after a partial or complete spondylectomy in a wide variety of spinal diseases. PMID:28120579

  17. The Relation Between Sacral Angle and Vertical Angle of Sacral Curvature and Lumbar Disc Degeneration: A Case-Control Study.

    Science.gov (United States)

    Ghasemi, Ahmad; Haddadi, Kaveh; Khoshakhlagh, Mohammad; Ganjeh, Hamid Reza

    2016-02-01

    The purpose of this study is to determine the reliability and validity of a goniometric measurement of the vertical angle of the sacrum and sacral angle (SA), and their relationships to lumbar degeneration.A herniated lumbar disc is one of the most frequent medical issues. Investigators in a number of studies have reported associated risk factors for prevalent disc degeneration. Atypical lumbosacral angles and curvature are thought to contribute to the degradation of the spine by many researchers. This study analyzed 360 patients referred to our clinic from 2013 to 2015 due to low back pain. A cross-sectional case-control study was designed in order to compare the sagittal alignment of the lumbosacral area in 3 groups of patients suffering from LBP. A total 120 patients were in a control group with a normal lumbar magnetic resonance imaging (MRI), 120 patients had lumbar disk herniation (LDH), and 120 patients had spinal stenosis. From the sagittal plan of lumbar MRI, SA and vertical angle of sacral curvature (VASC) were determined and then analyzed.The means of VASC in these groups were: 38.98 (SD: 6.36 ± 0.58), 40.89 (SD: 7.69 ± 0.69), and 40.54 (SD: 7.13 ± 0.92), respectively (P = 0.089). Moreover, studies of SA in 3 groups showed that the means of SA were: 39.30 (SD: 6.69 ± 0.63), 40.52 (SD: 7.47 ± 0.65), and 35.63 (SD: 6.07 ± 0.79), respectively. Relation between SA and spinal stenosis was just statistically significant (P ≤ 0.05).One significant limitation of our study is the lack of standing MRI for increased accuracy of measurement. However, we were reluctant to give patients needless exposure to radiation from conventional X-ray, and instead used MRI scans. We did not find any significant correlation between the VASC and LDH in lumbar MRI. Also, SA is not an independent risk factor for LDH in men and women. We suggested that there are several biomechanical factors involved in LDH.

  18. Multi drug resistant tuberculosis presenting as anterior mediastinal mass

    Directory of Open Access Journals (Sweden)

    Parmarth Chandane

    2016-01-01

    Full Text Available Enlargement of the mediastinal lymphatic glands is a common presentation of intrathoracic tuberculosis (TB in children. However, usually, the mediastinal TB nodes enlarge to 2.8 ± 1.0 cm. In this report, we describe a case of anterior mediastinal lymphnode TB seen as huge mass (7 cm on computed tomography (CT thorax without respiratory or food pipe compromise despite anterior mediastinum being an enclosed space. CT guided biopsy of the mass cultured Mycobacterium TB complex which was resistant to isoniazide, rifampicin, streptomycin ofloxacin, moxifloxacin, and pyrazinamide. Hence, we report primary multi drug resistant TB presenting as anterior mediastinal mass as a rare case report.

  19. Prevalence of sacral spinal (Tarlov) cysts in persistent genital arousal disorder.

    Science.gov (United States)

    Komisaruk, Barry R; Lee, Huey-Jen

    2012-08-01

    Neither consistent etiology nor treatment have been established for Persistent Genital Arousal Disorder (PGAD), which is characterized by uninvited, unwelcome, and distressing genital sensation. Sacral (Tarlov) cysts, which form on dorsal (sensory) roots, most commonly of S2 and S3 in the sacral spine, are reported to produce genital symptoms that bear similarities to those described for PGAD. The present study ascertained the incidence of Tarlov cysts in the sacral spine of women with PGAD symptoms. Women in a PGAD internet support group were asked to submit MRIs of their sacral region to the investigators, who evaluated the MRIs for the presence or absence of Tarlov cysts. The presence or absence of Tarlov cysts at the level of the sacral spine. Tarlov cysts were present in 12 of the first 18 (66.7%) MRIs submitted to the investigators by women who suffer from PGAD symptoms. By contrast to this incidence, that of Tarlov cysts reported in the literature for large samples of the population observed for various disorders (e.g., lumbosacral pain) is 1.2-9.0%. Tarlov cysts have been described in the literature as producing paresthesias and genital sensory disturbances. Hence, at least some cases of PGAD might be considered to be a Tarlov cyst-induced paresthesia. Based on the relatively high occurrence of Tarlov cysts currently observed in women who suffer from PGAD symptoms, it would seem advisable to suspect Tarlov cysts as a possible organic etiological factor underlying PGAD. © 2012 International Society for Sexual Medicine.

  20. A case of a huge gastroepiploic arterial aneurysm.

    Science.gov (United States)

    Ikeda, Hirokuni; Takeo, Masahiko; Mikami, Ryuuichi; Yamamoto, Mistuo

    2015-08-05

    An 85-year-old man complaining of vague abdominal discomfort was admitted to our hospital. A pulsatile 8 × 7-cm mass in the right upper abdomen was noticed on clinical examination. Computed tomography of the abdomen showed a huge arterial aneurysm in the right gastroepiploic artery, and the left gastroepiploic artery was meandering and expanding. An image diagnosis of gastroepiploic arterial aneurysm (GEAA) was made. Because of the huge size of the aneurysm and the predicted high risk of perforation, surgical intervention was planned. The aneurysm was identified in the greater curve and was found to adhere firmly to the transverse colon. Partial resection of the stomach, aneurysmectomy and partial resection of the transverse colon were performed. Clinically, splanchnic arterial aneurysms are rare. Among them, GEAA is especially rare. We report a rare case of a huge GEAA that was treated successfully by surgery. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2015.

  1. Anaesthetic management in a case of huge plunging ranula.

    Science.gov (United States)

    Sheet, Jagabandhu; Mandal, Anamitra; Sengupta, Swapnadeep; Jana, Debaleena; Mukherji, Sudakshina; Swaika, Sarbari

    2014-01-01

    Plunging ranula is a rare form of mucous retention cyst arising from submandibular and sublingual salivary glands, which may occasionally become huge occupying the whole of the floor of the mouth and extending into the neck, thus, restricting the neck movement as well as disfiguring the normal airway anatomy. Without fiberoptic assistance, blind or retrograde nasal intubation remains valuable choices in this type of situation. Here, we present a case of successful management of airway by blind nasal intubation in a patient posted for excision of a huge plunging ranula.

  2. Huge Gastric Teratoma in an 8-Year Old Boy.

    Science.gov (United States)

    Sisodiya, Rajpal S; Ratan, Simmi K; Man, Parveen K

    2016-01-01

    Gastric teratoma is very rare tumor and usually presents in early infancy. An 8-year-old boy presented with a huge mass in abdomen extending from epigastrium to the pelvis. Ultrasound and CT scan of abdomen revealed a huge mass with solid and cystic components and internal calcifications. The preoperative diagnosis was a teratoma but not specifically gastric one. At operation, it was found to be gastric teratoma. The mass was excised completely with part of the stomach wall. The histopathology confirmed it to be mature gastric teratoma. The rarity of the teratoma with delayed presentation prompted us to report the case.

  3. Anaesthetic challenges in a patient presenting with huge neck teratoma

    Directory of Open Access Journals (Sweden)

    Gaurav Jain

    2013-01-01

    Full Text Available Paediatric airway management is a great challenge even for an experienced anaesthesiologist. Difficult airway in huge cervical teratoma further exaggerates the complexity. This case report is intended at describing the intubation difficulties that were confronted during the airway management of a three year old girl presenting with huge neck teratoma and respiratory distress. This patient was successfully intubated with uncuffed endotracheal tubes in second attempt under inhalational anaesthesia with halothane and spontaneous ventilation. This case exemplifies the importance of careful preoperative workup of an anticipated difficult airway in paediatric patients with neck swelling to minimize any perioperative complications.

  4. Huge pelvic mass secondary to wear debris causing ureteral obstruction.

    Science.gov (United States)

    Hananouchi, Takehito; Saito, Masanobu; Nakamura, Nobuo; Yamamoto, Tetsuya; Yonenobu, Kazuo

    2005-10-01

    We report an unusual granulomatous reaction of wear debris that produced a huge pelvic mass causing ureteral obstruction. A 72-year-old woman, who received a cemented total hip arthroplasty 30 years ago, was referred to the department of gynecology for examination of a pelvic mass. A computed tomography scan revealed a huge homogenous mass, measuring approximately 20 x 16 x 12 cm, including extensive osteolysis of the left pelvis around the acetabular component. Intravenous pyelogram revealed complete obstruction of the left ureter resulting in hydronephrosis of the left kidney. Histological examination from the biopsy specimen detected polyethylene wear debris in the mass.

  5. Anaesthetic management in a case of huge plunging ranula

    Science.gov (United States)

    Sheet, Jagabandhu; Mandal, Anamitra; Sengupta, Swapnadeep; Jana, Debaleena; Mukherji, Sudakshina; Swaika, Sarbari

    2014-01-01

    Plunging ranula is a rare form of mucous retention cyst arising from submandibular and sublingual salivary glands, which may occasionally become huge occupying the whole of the floor of the mouth and extending into the neck, thus, restricting the neck movement as well as disfiguring the normal airway anatomy. Without fiberoptic assistance, blind or retrograde nasal intubation remains valuable choices in this type of situation. Here, we present a case of successful management of airway by blind nasal intubation in a patient posted for excision of a huge plunging ranula. PMID:25886120

  6. 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

    PURPOSE: It is still largely unknown how neural tube defects in spina bifida affect the nerves at the level of the sacral plexus. Visualizing the sacral plexus in 3 dimensions could improve our anatomical understanding of neurological problems in patients with spina bifida. We investigated...... 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...... compared to 10 healthy controls. RESULTS: Nerves of patients with spina bifida showed asymmetry and disorganization to a large extent compared to those of healthy controls. Especially at the myelomeningocele level it was difficult to find a connection with the cauda equina. Mean, axial and radial...

  7. Computed tomography of the sacral plexus and sciatic nerve in the greater sciatic foramen

    Energy Technology Data Exchange (ETDEWEB)

    Lanzieri, C.F.; Hilal, S.K.

    1984-07-01

    The sacral plexus forms the sciatic nerve, which leaves the pelvis through the greater sciatic foramen. The anatomic boundaries of the greater sciatic foramen and the relation of the sacral plexus and sciatic nerve to the structures within are identified and described on axial computed tomography (CT). The piriform muscle, which passes through the center of the greater sciatic foramen, is a recognizable landmark that is extremely helpful in locating the sacral plexus and sciatic nerve on CT. The pelvic CT images of 25 patients studied for unrelated reasons and two patients studied for complaints related to the greater sciatic foramen were reviewed. CT was very useful in demonstrating the anatomy of this region and for the investigation of sciatic pain due to lesions outside the neural canal.

  8. Image-guided percutaneous lipiodol-pingyangmycin suspension injection therapy for sacral chordoma

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Dexiao; Chen, Yong; Zeng, Qingie; Li, Yanhao [Dept. of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou (China); Wu, Renhua [Dept. of of Medical Imaging, the 2nd Affiliated Hospital, Medical College of Shantou University, Shantou (China)

    2013-10-15

    A 74-year-old man presented with a progressively worsening pain in sacrum and was diagnosed to have a sacral chordoma by biopsy in May, 2004. Percutaneous intratumoral injection with lipiodol-pingyangmycin suspension (LPS) was carried out under image guidance and repeated when the pain in sacrum recurred and the tumor increased. During a 6-year follow-up period, three sessions of this treatment were executed. CT imaging and Karnofsky Performance Score were used to evaluate the size of tumor and quality of life, respectively. The patient was free of pain after each procedure and had a high quality of life with a Karnofsky Performance Score above 80 points. The tumor lesion in sacral area was effectively controlled. No complications were observed. Percutaneous intratumoral injection with LPS under image guidance may be an effective and safe alternative for the patients with sacral chordoma.

  9. 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.

  10. 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.

  11. Imaging of huge lingual thyroid gland with goitre

    Energy Technology Data Exchange (ETDEWEB)

    Lee, C.C.; Chen, C.Y.; Chen, F.H.; Lee, G.W.; Hsiao, H.S. [Nat. Defense Medical Centre, Taipei (Taiwan, Province of China). Dept. of Diagnostic Radiol.; Zimmermann, R.A. [Department of Radiology, The Children`s Hospital of Philadelphia, 34th St. and Civic Blvd., Philadelphia, PA 19014 (United States)

    1998-05-01

    We present the CT and MRI findings in a 75-year-old woman with a huge pathologically proven lingual thyroid which underwent goitrous degeneration. CT and MRI showed a midline, tongue-based, exophytic mass with areas of necrosis and heterogeneous contrast enhancement, as seen in large goitres in the normal thyroid gland. (orig.) With 1 fig., 7 refs.

  12. Smart Cities as Support and Legacy of Huge Sport Events

    Directory of Open Access Journals (Sweden)

    TAURION, C.

    2012-12-01

    Full Text Available In this paper we discuss the concept of a smart city and the importance of huge Sport events as an incentive to the creation of the infrastructure necessary for the development of cities that provide quality of life for all its citizens using information technology.

  13. The big, large and huge case of state-building

    DEFF Research Database (Denmark)

    Harste, Gorm

      Using communication theory as point of departure, it is not evident how to study macro phenomena. Michel Foucault limited his studies to a non-Grand Theory when studying discursive events. At the same time, Charles Tilly wrote about Big Structures, Large Processes, Huge Comparisons when trying...

  14. [Experience of surgical treatment of huge mediastinal tumors].

    Science.gov (United States)

    Li, Yuanbo; Zhang, Yi; Xu, Qingsheng; Su, Lei; Zhi, Xiuyi; Wang, Ruotian; Qian, Kun; Hu, Mu; Liu, Lei

    2014-09-23

    The diagnosis and surgical treatment of 36 huge mediastinal tumors were summarized in order to evaluate the effect and safety of the operation. Thirty-six huge mediastinal tumor patients treated in our department from June 2006 to June 2013 were retrospective analyzed, of whom clinical manifestations, diagnosis, surgical treatment and prognosis were carefully collected. Twenty-three cases were men and 13 were women. The average age was 39.2 years old. The pathology turned out to be benign in 23 cases and malignant in 13 cases. Complete resection was achieved in 34 cases while palliative resection in 2 cases with no perioperative death. Six cases had developed postoperative complications but all recovered after active treatment. Patients who had been diagnosed with benign tumors were all alive after follow-up periods of 6 months to 7 years. Nine malignat tumor patients developed recurrence or metastasis, including seven deaths. Surgery played a vital role in the diagnosis and treatment of huge mediastinal tumors. Preoperative diagnosis, accurate surgical approach and careful operation were the key to successful treatment. Benign huge mediastinal tumors had excellent prognosis with surgery.

  15. A Huge Ovarian Dermoid Cyst: Successful Laparoscopic Total Excision.

    Science.gov (United States)

    Uyanikoglu, Hacer; Dusak, Abdurrahim

    2017-08-01

    Giant ovarian cysts, ≥15 cm in diameter, are quite rare in women of reproductive age. Here, we present a case of ovarian cyst with unusual presentation treated by laparoscopic surgery. On histology, mass was found to be mature cystic teratoma. The diagnostic and management challenges posed by this huge ovarian cyst were discussed in the light of the literature.

  16. A comparative, descriptive study of systemic factors and survival in elderly patients with sacral pressure ulcers.

    Science.gov (United States)

    Jaul, Efraim; Menczel, Jacob

    2015-03-01

    Sacral pressure ulcers (PUs) are a serious complication in frail elderly patients. Thin tissue in the sacral area, low body mass index, and anatomical location contribute to the development of sacral PUs. A comparative, descriptive study was conducted to identify patient systemic factors associated with sacral PUs and to compare survival time in patients with and without PU. All consecutive patients with PUs (n = 77) and without sacral PUs (n = 53) admitted to the skilled nursing department of a geriatric hospital in Jerusalem, Israel between July 1, 2008 and December 31, 2011 were eligible to participate. Charts of previously admitted patients were abstracted and patients were prospectively followed until discharge, death, or the end of the study. Patient demographics, comorbidities, nutritional status, physical and cognitive function (measured using the Reisberg's Functional Assessment Staging Tool [FAST], Stages of Dementia of Alzheimer Scale, and the Glasgow Coma Scale), PU status, number of courses of antibiotic treatment during admission, length of hospitalization, and mortality were compared between patients admitted with and without a sacral PU using descriptive and univariate statistics. Logistic regression models were used to estimate the odds ratio (OR) and 95% confidence intervals (CI) for sacral PU versus without PU by study covariate. The association between sacral PU and survival time was assessed using Kaplan-Meier models. Patients with a sacral PU were significantly older (average age 81.60 ±10.78 versus 77.06±11.19 years old, P = 0.02) and had a higher prevalence of dementia (70% versus 30%, P = 0.007), Parkinson's disease (92.3% versus 7.7%, P = 0.03), and anemia (67.7% versus 32.3%, P = 0.06) than patients admitted without a PU. Patients with a sacral PU also had a lower body mass index (23.1 versus 25.4, P = 0.04), and lower hemoglobin (10.54 versus 11.11, P = 0.03), albumin (26.2 versus 29.7, P = 0.002), and total protein levels (61.3 versus

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

    NARCIS (Netherlands)

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

    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

  18. A steering electrode array for selective stimulation of sacral nerve roots

    NARCIS (Netherlands)

    Rodrigues, F.J.O.; Mendes, P.; Bartek, M.; Mimoun, B.A.Z.

    2011-01-01

    In this work a cylindrical electrode array to be used for electrical stimulation of sacral nerve roots is studied in respect to its ability to achieve selective stimulation of various spatial regions of the nerve bundle. Simulation results achieved on a simplified model consisting of 6 electrodes ev

  19. 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.

  20. 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....

  1. Misdiagnosis of sacral stress fracture: an underestimated cause of low back pain in pregnancy?

    Science.gov (United States)

    Deschamps Perdomo, Ambar; Tome-Bermejo, Felix; Piñera, Angel R; Alvarez, Luis

    2015-02-06

    Sacral stress fracture during pregnancy is an uncommon condition with unclear pathophysiology, presenting with non-specific symptoms and clinical findings. To date, few cases have been published in the literature describing the occurrence of sacral stress fracture during pregnancy. We report a 28-year-old primigravid patient who developed lumbosacral pain at the end of the second trimester. Symptoms were overlooked throughout pregnancy and the postpartum period, resulting in the development of secondary chronic gait and balance problems. Stress fracture of the sacrum should be included in the differential diagnosis of low back and sacral pain during pregnancy. Its prevalence is probably underestimated because of the lack of specificity of the symptoms. Plain radiographs are not appropriate due to radiation exclusion; magnetic resonance is the only method that can be applied safely. There is limited information on natural history but many patients are expected to have a benign course. However, misdiagnosis may lead to prolonged morbidity and the development of secondary gait abnormalities. Stress fracture of the sacrum should be included in the differential diagnosis of low back and sacral pain during pregnancy. A high index of suspicion is necessary to establish an early diagnosis and appropriate treatment.

  2. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study.

    NARCIS (Netherlands)

    Kerrebroeck, P.E.V.A. van; Voskuilen, A.C. van; Heesakkers, J.P.; Lycklama à Nijeholt, A.A.B.; Siegel, S.; Jonas, U.; Fowler, C.J.; Fall, M.; Gajewski, J.B.; Hassouna, M.M.; Cappellano, F.; Elhilali, M.M.; Milam, D.F.; Das, A.K.; Dijkema, H.E.; Hombergh, U. van den

    2007-01-01

    PURPOSE: This 5-year, prospective, multicenter trial evaluated the long-term safety and efficacy of sacral neuromodulation in patients with refractory urge incontinence, urgency frequency and retention. MATERIALS AND METHODS: A total of 17 centers worldwide enrolled 163 patients (87% female). Follow

  3. Use of Sacral Nerve Stimulation for the Treatment of Overlapping Constipation and Fecal Incontinence

    Science.gov (United States)

    Sreepati, Gouri; James-Stevenson, Toyia

    2017-01-01

    Patient: Female, 51 Final Diagnosis: Fecal incontinence Symptoms: Constipation • fecal incontinence Medication: — Clinical Procedure: Sacral nerve stimulator Specialty: Gastroenterology and Hepatology Objective: Rare co-existance of disease or pathology Background: Fecal incontinence and constipation are common gastrointestinal complaints, but rarely occur concurrently. Management of these seemingly paradoxical processes is challenging, as treatment of one symptom may exacerbate the other. Case Report: A 51-year-old female with lifelong neurogenic bladder secondary to spina bifida occulta presented with progressive symptoms of daily urge fecal incontinence as well as hard bowel movements associated with straining and a sensation of incomplete evacuation requiring manual disimpaction. Pelvic floor testing showed poor ability to squeeze the anal sphincter, which indicated sphincter weakness as a major contributor to her fecal incontinence symptoms. Additionally, on defecography she was unable to widen her posterior anorectal angle or relax the anal sphincter during defecation consistent with dyssynergic defecation. A sacral nerve stimulator was placed for management of her fecal incontinence. Interestingly, her constipation also dramatically improved with sacral neuromodulation. Conclusions: This unique case highlights the emerging role of sacral nerve stimulation in the treatment of complex pelvic floor dysfunction with improvement in symptoms beyond fecal incontinence in a patient with dyssynergic-type constipation. PMID:28265107

  4. A steering electrode array for selective stimulation of sacral nerve roots

    NARCIS (Netherlands)

    Rodrigues, F.J.O.; Mendes, P.; Bartek, M.; Mimoun, B.A.Z.

    2011-01-01

    In this work a cylindrical electrode array to be used for electrical stimulation of sacral nerve roots is studied in respect to its ability to achieve selective stimulation of various spatial regions of the nerve bundle. Simulation results achieved on a simplified model consisting of 6 electrodes

  5. STUDY OF SACRAL INDEX: COMPARISON BETWEEN DIFFERENT REGIONAL POPULATIONS OF INDIA AND ABROAD

    Directory of Open Access Journals (Sweden)

    Poornima Janipati

    2014-10-01

    Full Text Available Identification of sex by human skeletal remains is a critical problem and is very important in anthropological and medico legal works. Bones often survive the process of decay and therefore provide the major evidence of human age and sex after death. Over the years different authors had carried various types of measurements on human sacra of different races and regions. The present study carried out 81 sacra of unknown sex contains 45 male and 36 female sacra identified by physical characteristics. They were collected from Telangana and Andhra Pradesh region. India may be divided into four regions like North part, South part, West part, and East part for different study purpose on local population. In the present study mean sacral index in males is 104.08 and females are 115.72. The male mean sacral index value of present study is more than the values of Eastern part, north part, other worker of Southern part of India and western part except in Western part in Western Rajasthan population. The female mean sacral index value of present study is higher than the observation of Eastern part, other workers of Southern part of India, Varanasi and Jammu of north part of India and Saurashtra region of western region of India. Observations of the workers from remaining areas of Western part of India and Agra region of North India is higher than the present study. The studies on Indian population suggest that mean sacral index in females is higher than that of males.

  6. Spina bifida at the sacral level : more than minor gait disturbances

    NARCIS (Netherlands)

    Schoenmakers, MAGC; Gulmans, VAM; Gooskens, RHJM; Helders, PJM

    2004-01-01

    Objective: To investigate functional outcome in two groups of children with sacral level paralysis: myelomeningocele (MMC) versus lipomyelomeningocele (LMMC). Additionally both groups were compared with each other and when possible with reference values. Design: Cross-sectional study by means of ( 1

  7. Clinical Value of Interventional Embolization for Sacral Chordoma before Surgical Treatment

    Institute of Scientific and Technical Information of China (English)

    Zhihui CHANG; Zhaoyu LIU; Jiahe Zheng; Zaiming LU; Qiyong GUO

    2011-01-01

    Objetive:To evaluate the efficacy of preoperative transcatheter arterial embolization in the treatment of sacral chordoma,and to explore the choice of embolization timing. Methods:32 patients underwent the posterior approach after TAE of the main arteries that supplied the sacral chordoma. Intraoperative bleeding amount of each patient was recorded and compared between-group differences at different operation times. Results: After embolization, 12 patients were received resection within 24 hours (group A),that of 10 cases between 24 ~ 48h (group B), of another 10 cases between 48~ 72h (group C). All of the 32 tumors were removed intact with intraoperative bleeding about (894±199)ml, without any shock or death,nor injuries on abdominal organs such as rectum and ureter. There was no statistical significance in tumor size among group A,B and C (P>0.05). Data gave statistical significance in intraoperative blood loss between group A and B (P<0.01) ,there was no statistical differences between group B and C (P>0.05), in spite of group B slightly less than group C. Conclusion: Preoperative TAE for excising the sacral tumor can significantly decrease intraoperative blood loss, make the surgical field clear,and facilitate the maximal removal of the sacral chordoma. It would be best to select the embolization timing within 24 hours before surgical operation.

  8. [Preliminary study on clinical application of robotic sacral hysteropexy in treatment of uterine prolapse].

    Science.gov (United States)

    Li, Xiuli; Zhou, Ning; Yang, Yizhuo; Liu, Zhongyu; Yao, Yuanqing

    2014-06-01

    To study the clinical efficacy of robotic sacral hysteropexy in treatment of uterine prolapse. From January 2012 to December 2013, 3 patients undergoing robotic sacral hysteropexy in treatment of uterine prolapse in General Hospital of People's Liberation Army were studied retrospectively. Operation time, blood loss and postoperative recovery exhaust time and pelvic organ prolapse quantification (POP-Q) staging were evaluated. Three patients were treated by robotic sacral hysteropexy successfully. The mean operation time was 221 minutes (210-240 minutes), mean blood loss was 45 ml. One case with II degree perineal laceration patients simultaneously perineal repair, neither intra-nor post-operative complications occurred. The mean postoperative recovery exhaust time was 16 hours. At three months of follow-up, all 3 patients got satisfaction. Although one patient at the first six months of postoperation had leakage of urine when coughing, instruct exercise pelvic floor muscle function and acupuncture one month their symptoms disappear. Robotic sacral hysteropexy pave the way for an effective option in the management of uterine prolapse.

  9. 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.

  10. Sacral pseudotumor complicating iliac bone harvest: radiographic, CT and MRI appearances

    Energy Technology Data Exchange (ETDEWEB)

    Kavanagh, E.; Roth, C.; O' Connell, M.; Eustace, S. [Dept. of Radiology, Mater Misericordiae Hospital, Dublin (Ireland)

    2003-12-01

    We present the imaging appearances of a lytic pseudotumor in the right sacral ala presenting with referred pain to the right thigh. Subsequent imaging revealed the presence of a cystic lesion arising at the site of previous bone graft harvest; CT-guided aspiration yielded synovial fluid presumed to arise from the contiguous sacroiliac joint. (orig.)

  11. The sacral networks and neural pathways used to elicit lumbar motor rhythm in the rodent spinal cord

    Directory of Open Access Journals (Sweden)

    Meir eCherniak

    2014-12-01

    Full Text Available Identification of neural networks and pathways involved in activation and modulation of spinal central pattern generators (CPGs in the absence of the descending control from the brain is important for further understanding of neural control of movement and for developing innovative therapeutic approaches to improve the mobility of spinal cord injury patients. Activation of the hindlimb innervating segments by sacrocaudal afferent input and by specific application of neurochemicals to the sacral networks is feasible in the isolated spinal cord preparation of the newborn rat. Here we review our recent studies of sacral relay neurons with lumbar projections and evaluate their role in linking the sacral and thoracolumbar networks during different motor behaviors. Our major findings show that: 1 Heterogeneous groups of dorsal, intermediate and ventral sacral-neurons with ventral and lateral ascending funicular projections mediate the activation of the locomotor central pattern generators through sacral sensory input, and 2 Rhythmic excitation of lumbar flexor motoneurons, produced by bath application of alpha-1 adrenoceptor agonists to the sacral segments is mediated exclusively by ventral clusters of sacral-neurons with lumbar projections through the ventral funiculus.

  12. Morphometric study of sacral hiatus in adult human Egyptian sacra: Their significance in caudal epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Mohamed S Mustafa

    2012-01-01

    Full Text Available Background: The reliability and success of caudal epidural anesthesia depends on anatomic variations of sacral hiatus (SH as observed by various authors. SH is an important landmark during caudal epidural block (CEB.The purpose of the present study was to clarify the morphometric characteristics of the SH in human Egyptian dry sacra and pelvic radiographs and identification of nearest ony landmarks to permit correct and uncomplicated caudal epidural accesses. Methods: The present study was done on 46 human adult Egyptian dry sacra. The maximum height, midventral curved length, and maximum breadth of each sacrum were measured and sacral and curvature indices were calculated. According to sacral indices, sacra were divided into 2 groups (22 male and 24 female sacra. SH was evaluated in each sacrum according to its shape, level of its apex, and base according to sacral and coccygeal vertebrae, length, anteroposterior (AP diameter at its apex, and transverse width at its base. Linear distances were measured between the apex of SH and second sacral foramina, right and left superolateral sacral crests. The distance between the 2 superolateral sacral crests also was measured. Results: The most common types of SH were the inverted U and inverted V (in male and inverted V and dumbbell shaped (in female. Absent SH was observed in male group only. The most common location of SH apex was at the level of S4 in all groups of dry sacra and S3 in all groups of lumbosacral spine radiographs, whereas S5 was the common level of its base. The mean SH length, transverse width of its base, and AP diameter of its apex were 2.1±0.80, 1.7±0.26, and 0.48±0.19 cm. Female sacra showed narrower SH apex than male. The distance between the S2 foramen and the apex of the SH was 4.1±1.14, 3.67±1.21, and 4.48±1.01 cm in total, female and male sacra, respectively. Conclusion: Sacrum and SH showed morphometric variations in adult Egyptians. The equilateral triangle is an

  13. Huge uterine-cervical diverticulum mimicking as a cyst

    Directory of Open Access Journals (Sweden)

    S Chufal

    2012-01-01

    Full Text Available Here we report an incidental huge uterine-cervical diverticulum from a total abdominal hysterectomy specimen in a perimenopausal woman who presented with acute abdominal pain. The diverticulum was mimicking with various cysts present in the lateral side of the female genital tract. Histopathological examination confirmed this to be a cervical diverticulum with communication to uterine cavity through two different openings. They can attain huge size if left ignored for long duration and present a diagnostic challenge to clinicians, radiologists, as well as pathologists because of its extreme rarity. Therefore, diverticula should also be included as a differential diagnosis. Its histopathological confirmation also highlights that diverticula can present as an acute abdomen, requiring early diagnosis with appropriate timely intervention. Immunohistochemistry CD 10 has also been used to differentiate it from a mesonephric cyst.

  14. Huge uterine-cervical diverticulum mimicking as a cyst.

    Science.gov (United States)

    Chufal, S; Thapliyal, Naveen; Gupta, Manoj; Pangtey, Nirmal

    2012-01-01

    Here we report an incidental huge uterine-cervical diverticulum from a total abdominal hysterectomy specimen in a perimenopausal woman who presented with acute abdominal pain. The diverticulum was mimicking with various cysts present in the lateral side of the female genital tract. Histopathological examination confirmed this to be a cervical diverticulum with communication to uterine cavity through two different openings. They can attain huge size if left ignored for long duration and present a diagnostic challenge to clinicians, radiologists, as well as pathologists because of its extreme rarity. Therefore, diverticula should also be included as a differential diagnosis. Its histopathological confirmation also highlights that diverticula can present as an acute abdomen, requiring early diagnosis with appropriate timely intervention. Immunohistochemistry CD 10 has also been used to differentiate it from a mesonephric cyst.

  15. A case of huge primary liposarcoma in the liver

    Institute of Scientific and Technical Information of China (English)

    Liang-Mou Kuo; Hong-Shiue Chou; Kun-Ming Chan; Ming-Chin Yu; Wei-Chen Lee

    2006-01-01

    Primary liver liposarcoma is a rare disease. Because of its rarity, the knowledge of the clinical course, management, and prognosis of primary liver liposarcoma are all limited for clinicians. A 61-year-old female patient who suffered from a huge primary liposarcoma in the central portion of the liver had the clinical presentations of fever, nausea, vomiting, jaundice, and body weight loss.The huge tumor was resected successfully. However,the tumor recurred repeatedly and she had repeated hepatectomies to remove the tumor. Thetumor became aggravating after repeated surgeries. Eventually, the patient had cervical spinal metastasis of liposarcoma and she survived for 26 months after liver liposarcoma was diagnosed. Although the tumor may become aggravating after repeated surgeries, repeated hepatectomies are still the best policy to achieve a long-term survival for the patients.

  16. Black Hole Firewalls Require Huge Energy of Measurement

    CERN Document Server

    Hotta, Masahiro; Funo, Ken

    2013-01-01

    The unitary moving mirror model is one of the best quantum systems for checking the reasoning of the firewall paradox in quantum black holes. The reasoning of Almheiri et al. inevitably raises a firewall paradox in the model. We resolve this paradox from the viewpoint of the energy cost of quantum measurements. No firewall with a deadly, huge energy flux appears, as long as the energy for the measurement is much smaller than the ultraviolet cutoff scale.

  17. Huge plastic bezoar: a rare cause of gastrointestinal obstruction.

    Science.gov (United States)

    Yaka, Mbarek; Ehirchiou, Abdelkader; Alkandry, Tariq Tajdin Sifeddine; Sair, Khalid

    2015-01-01

    Bezoars are rare causes of gastrointestinal obstruction. Basically, they are of four types: trichobezoars, phytobezoars, pharmacobezoars, and lactobezoars. Some rare types of bezoars are also known. In this article a unique case of plastic bezoars is presented. We describe a girl aged 14 years who ingested large amounts of plastic material used for knitting chairs and charpoys. The conglomerate of plastic threads, entrapped food material and other debris, formed a huge mass occupying the whole stomach and extended into small bowel.

  18. A Huge Cystic Retroperitoneal Lymphangioma Presenting with Back Pain

    Science.gov (United States)

    Kubachev, Kubach; Abdullaev, Elbrus; Babyshin, Valentin; Neronov, Dmitriy; Abdullaev, Abakar

    2016-01-01

    Retroperitoneal lymphangioma is a rare location and type of benign abdominal tumors. The clinical presentation of this rare disease is nonspecific, ranging from abdominal distention to sepsis. Here we present a 73-year-old female patient with 3-month history of back pain. USG and CT revealed a huge cystic mass which was surgically excised and appeared to be lymphangioma on histopathology. PMID:27843456

  19. Huge Left Atrium Accompanied by Normally Functioning Prosthetic Valve.

    Science.gov (United States)

    Sabzi, Feridoun

    2015-01-01

    Giant left atria are defined as those measuring larger than 8 cm and are typically found in patients who have rheumatic mitral valve disease with severe regurgitation. Enlargement of the left atrium may create compression of the surrounding structures such as the esophagus, pulmonary veins, respiratory tract, lung, inferior vena cava, recurrent laryngeal nerve, and thoracic vertebrae and lead to dysphagia, respiratory dysfunction, peripheral edema, hoarse voice, or back pain. However, a huge left atrium is usually associated with rheumatic mitral valve disease but is very rare in a normally functioning prosthetic mitral valve, as was the case in our patient. A 46-year-old woman with a past medical history of mitral valve replacement and chronic atrial fibrillation was admitted to our hospital with a chief complaint of cough and shortness of breath, worsened in the last month. Physical examination showed elevated jugular venous pressure, respiratory distress, cardiac cachexia, heart failure, hepatomegaly, and severe edema in the legs. Chest radiography revealed an inconceivably huge cardiac sell-out. Transthoracic echocardiography demonstrated a huge left atrium, associated with thrombosis, and normal function of the prosthetic mitral valve. Cardiac surgery with left atrial exploration for the extraction of the huge thrombosis and De Vega annuloplasty for tricuspid regurgitation were carried out. The postoperative course was eventful due to right ventricular failure and low cardiac output syndrome; and after two days, the patient expired with multiple organ failure. Thorough literature review showed that our case was the largest left atrium (20 × 22 cm) reported thus far in adults with a normal prosthetic mitral valve function.

  20. Huge Left Atrium Accompanied by Normally Function- ing Prosthetic Valve

    Directory of Open Access Journals (Sweden)

    Feridoun Sabzi

    2015-10-01

    Full Text Available Giant left atria are defined as those measuring larger than 8 cm and are typically found in patients who have rheumatic mitral valve disease with severe regurgitation. Enlargement of the left atrium may create compression of the surrounding structures such as the esophagus, pulmonary veins, respiratory tract, lung, inferior vena cava, recurrent laryngeal nerve, and thoracic vertebrae and lead to dysphagia, respiratory dysfunction, peripheral edema, hoarse voice, or back pain. However, a huge left atrium is usually associated with rheumatic mitral valve disease but is very rare in a normally functioning prosthetic mitral valve, as was the case in our patient. A 46-year-old woman with a past medical history of mitral valve replacement and chronic atrial fibrillation was admitted to our hospital with a chief complaint of cough and shortness of breath, worsened in the last month. Physical examination showed elevated jugular venous pressure, respiratory distress, cardiac cachexia, heart failure, hepatomegaly, and severe edema in the legs. Chest radiography revealed an inconceivably huge cardiac sell-out. Transthoracic echocardiography demonstrated a huge left atrium, associated with thrombosis, and normal function of the prosthetic mitral valve. Cardiac surgery with left atrial exploration for the extraction of the huge thrombosis and De Vega annuloplasty for tricuspid regurgitation were carried out. The postoperative course was eventful due to right ventricular failure and low cardiac output syndrome; and after two days, the patient expired with multiple organ failure. Thorough literature review showed that our case was the largest left atrium (20 × 22 cm reported thus far in adults with a normal prosthetic mitral valve function.

  1. Huge Nevus Lipomatosus Cutaneous Superficialis on Back: An Unusual Presentation.

    Science.gov (United States)

    Das, Dipti; Das, Anupam; Bandyopadhyay, Debabrata; Kumar, Dhiraj

    2015-01-01

    Nevus lipomatosus cutaneous superficialis (NLCS) is a benign dermatosis, histologically characterized by the presence of mature ectopic adipocytes in the dermis. We hereby report a case of a 10-year-old boy who presented with multiple huge swellings on the scapular regions and lower back. The lesions were surmounted by small papules, along with peau-d orange appearance at places. Histology showed features consistent with NLCS. The case is being reported for the unusual clinical presentation.

  2. Huge nevus lipomatosus cutaneous superficialis on back: An unusual presentation

    Directory of Open Access Journals (Sweden)

    Dipti Das

    2015-01-01

    Full Text Available Nevus lipomatosus cutaneous superficialis (NLCS is a benign dermatosis, histologically characterized by the presence of mature ectopic adipocytes in the dermis. We hereby report a case of a 10-year-old boy who presented with multiple huge swellings on the scapular regions and lower back. The lesions were surmounted by small papules, along with peau-d orange appearance at places. Histology showed features consistent with NLCS. The case is being reported for the unusual clinical presentation.

  3. Huge Intravascular Tumor Extending to the Heart: Leiomyomatosis

    Directory of Open Access Journals (Sweden)

    Suat Doganci

    2015-01-01

    Full Text Available Intravenous leiomyomatosis (IVL is a rare neoplasm characterized by histologically benign-looking smooth muscle cell tumor mass, which is growing within the intrauterine and extrauterine venous system. In this report we aimed to present an unusual case of IVL, which is originating from iliac vein and extended throughout to right cardiac chambers. A 49-year-old female patient, who was treated with warfarin sodium due to right iliac vein thrombosis, was admitted to our department with intermittent dyspnea, palpitation, and dizziness. Physical examination was almost normal except bilateral pretibial edema. On magnetic resonance venography, there was an intravenous mass, which is originated from right internal iliac vein and extended into the inferior vena cava. Transthoracic echocardiography and transesophageal echocardiography revealed a huge mass extending from the inferior vena cava through the right atrium, with obvious venous occlusion. Thoracic, abdominal, and pelvic MR showed an intravascular mass, which is concordant with leiomyomatosis. Surgery was performed through median sternotomy. A huge mass with 25-cm length and 186-gr weight was excised through right atrial oblique incision, on beating heart with cardiopulmonary bypass. Histopathologic assessment was compatible with IVL. Exact strategy for the surgical treatment of IVL is still controversial. We used one-stage approach, with complete resection of a huge IVL extending from right atrium to right iliac vein. In such cases, high recurrence rate is a significant problem; therefore it should be kept in mind.

  4. Multimodality treatment with radiotherapy for huge hepatocellular carcinoma.

    Science.gov (United States)

    Han, Hee Ji; Kim, Mi Sun; Cha, Jihye; Choi, Jin Sub; Han, Kwang Hyub; Seong, Jinsil

    2014-01-01

    For huge hepatocellular carcinoma (HCC), therapeutic decisions have varied from local therapy to systemic therapy, with radiotherapy (RT) playing only a palliative role. In this study, we investigated whether multimodality treatment involving RT could be effective in huge HCC. This study was performed in 116 patients with HCC >10 cm. The number of patients in stage II, III and IV was 12, 54 and 50, respectively. RT was given as a combined modality in most patients. The median dose was 45 Gy, with 1.8 Gy per fraction. The median overall survival (OS) and progression-free survival (PFS) were 14.8 and 6.5 months, respectively. The median infield PFS was not reached. Infield failure, outfield intrahepatic and extrahepatic failure were observed in 8.6, 18.1, and 12.1% of patients, respectively. For OS and PFS, number of tumors, initial alpha-fetoprotein (AFP) level, treatment response, percent AFP decrement, and hepatic resection were significant prognostic factors. Tumor characteristics and treatment response were significantly different between long-term survivors and the other patients. Although huge HCC presents an aggressive clinical course, multimodality approaches involving RT can offer an opportunity for prolonged survival. © 2014 S. Karger AG, Basel.

  5. Huge Intravascular Tumor Extending to the Heart: Leiomyomatosis.

    Science.gov (United States)

    Doganci, Suat; Kaya, Erkan; Kadan, Murat; Karabacak, Kubilay; Erol, Gökhan; Demirkilic, Ufuk

    2015-01-01

    Intravenous leiomyomatosis (IVL) is a rare neoplasm characterized by histologically benign-looking smooth muscle cell tumor mass, which is growing within the intrauterine and extrauterine venous system. In this report we aimed to present an unusual case of IVL, which is originating from iliac vein and extended throughout to right cardiac chambers. A 49-year-old female patient, who was treated with warfarin sodium due to right iliac vein thrombosis, was admitted to our department with intermittent dyspnea, palpitation, and dizziness. Physical examination was almost normal except bilateral pretibial edema. On magnetic resonance venography, there was an intravenous mass, which is originated from right internal iliac vein and extended into the inferior vena cava. Transthoracic echocardiography and transesophageal echocardiography revealed a huge mass extending from the inferior vena cava through the right atrium, with obvious venous occlusion. Thoracic, abdominal, and pelvic MR showed an intravascular mass, which is concordant with leiomyomatosis. Surgery was performed through median sternotomy. A huge mass with 25-cm length and 186-gr weight was excised through right atrial oblique incision, on beating heart with cardiopulmonary bypass. Histopathologic assessment was compatible with IVL. Exact strategy for the surgical treatment of IVL is still controversial. We used one-stage approach, with complete resection of a huge IVL extending from right atrium to right iliac vein. In such cases, high recurrence rate is a significant problem; therefore it should be kept in mind.

  6. 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...

  7. CONGENITAL ANTERIOR TIBIOFEMURAL SUBLUXATION

    Directory of Open Access Journals (Sweden)

    A. Shahla

    2008-06-01

    Full Text Available Congenital anterior tibiofemoral subluxation is an extremely rare disorder. All reported cases accompanied by other abnormalities and syndromes. A 16-year-old high school girl referred to us with bilateral anterior tibiofemoral subluxation as the knees were extended and reduced at more than 30 degrees flexion. Deformities were due to tightness of the iliotibial band and biceps femuris muscles and corrected by surgical release. Associated disorders included bilateral anterior shoulders dislocation, short metacarpals and metatarsals, and right calcaneuvalgus deformity.

  8. Analyzing huge pathology images with open source software.

    Science.gov (United States)

    Deroulers, Christophe; Ameisen, David; Badoual, Mathilde; Gerin, Chloé; Granier, Alexandre; Lartaud, Marc

    2013-06-06

    Digital pathology images are increasingly used both for diagnosis and research, because slide scanners are nowadays broadly available and because the quantitative study of these images yields new insights in systems biology. However, such virtual slides build up a technical challenge since the images occupy often several gigabytes and cannot be fully opened in a computer's memory. Moreover, there is no standard format. Therefore, most common open source tools such as ImageJ fail at treating them, and the others require expensive hardware while still being prohibitively slow. We have developed several cross-platform open source software tools to overcome these limitations. The NDPITools provide a way to transform microscopy images initially in the loosely supported NDPI format into one or several standard TIFF files, and to create mosaics (division of huge images into small ones, with or without overlap) in various TIFF and JPEG formats. They can be driven through ImageJ plugins. The LargeTIFFTools achieve similar functionality for huge TIFF images which do not fit into RAM. We test the performance of these tools on several digital slides and compare them, when applicable, to standard software. A statistical study of the cells in a tissue sample from an oligodendroglioma was performed on an average laptop computer to demonstrate the efficiency of the tools. Our open source software enables dealing with huge images with standard software on average computers. They are cross-platform, independent of proprietary libraries and very modular, allowing them to be used in other open source projects. They have excellent performance in terms of execution speed and RAM requirements. They open promising perspectives both to the clinician who wants to study a single slide and to the research team or data centre who do image analysis of many slides on a computer cluster. The virtual slide(s) for this article can be found here

  9. Interneurones in pathways from group II muscle afferents in sacral segments of the feline spinal cord.

    Science.gov (United States)

    Jankowska, E; Riddell, J S

    1994-03-15

    1. Properties of dorsal horn interneurones that process information from group II muscle afferents in the sacral segments of the spinal cord have been investigated in the cat using both intracellular and extracellular recording. 2. The interneurones were excited by group II muscle afferents and cutaneous afferents but not by group I muscle afferents. They were most effectively excited by group II afferents of the posterior biceps, semitendinosus, triceps surae and quadriceps muscle nerves and by cutaneous afferents running in the cutaneous femoris, pudendal and sural nerves. The earliest synaptic actions were evoked monosynaptically and were very tightly locked to the stimuli. 3. EPSPs evoked monosynaptically by group II muscle afferents and cutaneous afferents of the most effective nerves were often cut short by disynaptic IPSPs. As a consequence of this negative feedback the EPSPs gave rise to single or double spike potentials and only a minority of interneurones responded with repetitive discharges. However, the neurones that did respond repetitively did so at a very high frequency of discharges (0.8-1.2 ms intervals between the first 2-3 spikes). 4. Sacral dorsal horn group II interneurones do not appear to act directly upon motoneurones because: (i) these interneurones are located outside the area within which last order interneurones have previously been found and (ii) the latencies of PSPs evoked in motoneurones by stimulation of the posterior biceps and semitendinosus, cutaneous femoris and pudendal nerves (i.e. the main nerves providing input to sacral interneurones) are compatible with a tri- but not with a disynaptic coupling. Spatial facilitation of EPSPs and IPSPs following synchronous stimulation of group II and cutaneous afferents of these nerves shows, however, that sacral interneurones may induce excitation or inhibition of motoneurones via other interneurones. 5. Comparison of the properties of group II interneurones in the sacral segments with

  10. A NOVEL APPROACH FOR PATTERN ANALYSIS FROM HUGE DATAWAREHOUSE

    Directory of Open Access Journals (Sweden)

    BABITA

    2014-05-01

    Full Text Available Due to the tremendous growth of data and large databases, efficient extraction of required data has become a challenging task. This paper propose a novel approach for knowledge discovery from huge unlabeled temporal databases by employing a combination of HMM and K-means technique. We propose to recursively divide the entire database into clusters having similar characteristics, this process is repeated until we get the cluster’s where no further diversification is possible. Thereafter, the clusters are labeled for knowledge extraction for various purposes.

  11. A young woman with a huge paratubal cyst

    Directory of Open Access Journals (Sweden)

    Ceren Golbasi

    2016-09-01

    Full Text Available Paratubal cysts are asymptomatic embryological remnants. These cysts are usually diagnosed during adolescence and reproductive age. In general, their sizes are small but can be complicated by rupture, torsion, or hemorrhage. Paratubal cysts are often discovered fortuitously on routine ultrasound examination. We report a 19-year-old female patient who presented with irregular menses and abdominal pain. Ultrasound examination revealed a huge cystic mass at the right adnexial area. The diagnosis was confirmed as paratubal cyst during laporotomy and, hence, cystectomy and right salpingectomy were performed. [Cukurova Med J 2016; 41(3.000: 573-576

  12. Modeling huge sound sources in a room acoustical calculation program

    DEFF Research Database (Denmark)

    Christensen, Claus Lynge

    1999-01-01

    A room acoustical model capable of modeling point sources, line sources, and surface sources is presented. Line and surface sources are modeled using a special ray-tracing algorithm detecting the radiation pattern of the surfaces of the room. Point sources are modeled using a hybrid calculation...... method combining this ray-tracing method with image source modeling. With these three source types it is possible to model huge and complex sound sources in industrial environments. Compared to a calculation with only point sources, the use of extended sound sources is shown to improve the agreement...

  13. A huge renal capsular leiomyoma mimicking retroperitoneal sarcoma

    Directory of Open Access Journals (Sweden)

    Lal Anupam

    2009-01-01

    Full Text Available A huge left renal capsular leiomyoma mimicking retroperitoneal sarcoma presented in a patient as an abdominal mass. Computed tomography displayed a large heterogeneous retro-peritoneal mass in the left side of the abdomen with inferior and medial displacement as well as loss of fat plane with the left kidney. Surgical exploration revealed a capsulated mass that was tightly adherent to the left kidney; therefore, total tumor resection with radical left nephrectomy was performed. Histopathology ultimately confirmed the benign nature of the mass. This is the largest leiomyoma reported in literature to the best of our knowledge.

  14. Huge pyometra in a postmenopausal age: a diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Pramila Yadav

    2015-10-01

    Full Text Available Pyometra in postmenopausal women is an extremely rare disease that hardly responds to the usual treatment of antibiotics therapy. Our case presented as a postmenopausal woman with a huge pyometra. Pyometra drainage was done with great difficulty after a blind biopsy. Endometrial and cervical biopsy followed by endometrial curettage was done. An intrauterine foley's catheter was kept for seven days and Histopathological report was suggestive of squamous cell carcinoma of cervix. [Int J Reprod Contracept Obstet Gynecol 2015; 4(5.000: 1549-1551

  15. Intracranial subarachnoid fat and hemorrhage secondary to sacral fracture with spondylopelvic dissociation.

    Science.gov (United States)

    Carreres Polo, J; Álvarez Martínez, M V; Sánchez Mateos, D

    2017-06-10

    We describe a case of fat droplets and blood in the cerebral subarachnoid space secondary in a patient with a complex sacral fracture without associated cranial trauma, a few days after admission. To our knowledge, there is only one published case with similar findings and without any other underlying lesion as cause. We explain the differences in the mechanism of production between this direct fat embolism and brain fat embolism syndrome, which is an intravascular embolism with different radiological appearance. The most important features of sacral fracture with spondylopelvic dissociation are described. Finally, this entity should be taken into account in the differential diagnosis of the few causes of fat in the subarachnoid space. In the context of high-energy trauma fractures of the sacrum or spine must be ruled out as a potential cause of this uncommon intracranial finding. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Diagnosis and management of sacral Tarlov cysts. Case report and review of the literature.

    Science.gov (United States)

    Acosta, Frank L; Quinones-Hinojosa, Alfredo; Schmidt, Meic H; Weinstein, Philip R

    2003-08-15

    Perineurial (Tarlov) cysts are meningeal dilations of the posterior spinal nerve root sheath that most often affect sacral roots and can cause a progressive painful radiculopathy. Tarlov cysts are most commonly diagnosed by lumbosacral magnetic resonance imaging and can often be demonstrated by computerized tomography myelography to communicate with the spinal subarachnoid space. The cyst can enlarge via a net inflow of cerebrospinal fluid, eventually causing symptoms by distorting, compressing, or stretching adjacent nerve roots. It is generally agreed that asymptomatic Tarlov cysts do not require treatment. When symptomatic, the potential surgery-related benefit and the specific surgical intervention remain controversial. The authors describe the clinical presentation, treatment, and results of surgical cyst fenestration, partial cyst wall resection, and myofascial flap repair and closure in a case of a symptomatic sacral Tarlov cyst. They review the medical literature, describe various theories on the origin and pathogenesis of Tarlov cysts, and assess alternative treatment strategies.

  17. Spina bifida with higher position of sacral hiatus: a case report with clinical implications.

    Science.gov (United States)

    Srijit, D; Shipra, P

    2007-01-01

    Spina bifida is a developmental defect in the vertebral column, in which the laminae fail to fuse and thereby the spinal cord is relatively unprotected. We report a case of spina bifida, in a dried specimen of sacrum, characterized by a prominent S1 spine and a higher sacral hiatus. Conventional textbooks of anatomy provide less information about the clinical implications of such anomalies and research studies are the only source of information. The present study, discusses in detail, the structural and radiological aspects of spina bifida, with a higher sacral hiatus. Precise knowledge of normal and abnormal anatomy of the sacrum may be clinically important for anesthetists, neurologists, radiologists and orthopedic surgeons, in their clinical practice (Fig. 3, Ref. 16). Full Text (Free, PDF) www.bmj.sk

  18. Pallister-Killian syndrome: additional manifestations of cleft palate and sacral appendage.

    OpenAIRE

    McLeod, D R; Wesselman, L R; Hoar, D I

    1991-01-01

    We report a case of Pallister-Killian syndrome in a 28 week gestation infant. In addition to the characteristic phenotype, this patient had a cleft palate, diaphragmatic hernia, sacral appendage, and imperforate anus. The lymphocyte karyotype showed 96% 46,XX/4% 47,XX+i (12p) and the fibroblast karyotype 47,XX,+marker (presumed i(12p]. Fibroblast cytogenetic studies should be considered in all cases of diaphragmatic hernia associated with other malformations.

  19. Migration pathways of sacral neural crest during development of lower urogenital tract innervation.

    Science.gov (United States)

    Wiese, Carrie B; Deal, Karen K; Ireland, Sara J; Cantrell, V Ashley; Southard-Smith, E Michelle

    2017-09-01

    The migration and fate of cranial and vagal neural crest-derived progenitor cells (NCPCs) have been extensively studied; however, much less is known about sacral NCPCs particularly in regard to their distribution in the urogenital system. To construct a spatiotemporal map of NCPC migration pathways into the developing lower urinary tract, we utilized the Sox10-H2BVenus transgene to visualize NCPCs expressing Sox10. Our aim was to define the relationship of Sox10-expressing NCPCs relative to bladder innervation, smooth muscle differentiation, and vascularization through fetal development into adulthood. Sacral NCPC migration is a highly regimented, specifically timed process, with several potential regulatory mileposts. Neuronal differentiation occurs concomitantly with sacral NCPC migration, and neuronal cell bodies are present even before the pelvic ganglia coalesce. Sacral NCPCs reside within the pelvic ganglia anlagen through 13.5 days post coitum (dpc), after which they begin streaming into the bladder body in progressive waves. Smooth muscle differentiation and vascularization of the bladder initiate prior to innervation and appear to be independent processes. In adult bladder, the majority of Sox10+ cells express the glial marker S100β, consistent with Sox10 being a glial marker in other tissues. However, rare Sox10+ NCPCs are seen in close proximity to blood vessels and not all are S100β+, suggesting either glial heterogeneity or a potential nonglial role for Sox10+ cells along vasculature. Taken together, the developmental atlas of Sox10+ NCPC migration and distribution profile of these cells in adult bladder provided here will serve as a roadmap for future investigation in mouse models of lower urinary tract dysfunction. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. First experience using navigation-guided radiofrequency kyphoplasty for sacroplasty in sacral insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Klingler, J.H.; Kluge, P.; Sircar, R.; Kogias, E.; Scholz, C.; Krueger, M.T.; Scheiwe, C.; Hubbe, U. [Freiburg Univ. Medical Center, Freiburg (Germany). Dept. of Neurosurgery

    2013-08-15

    Purpose: To evaluate the efficacy and safety of navigation-guided radiofrequency kyphoplasty for sacroplasty in patients with sacral insufficiency fractures. Methods: In this single-center retrospective observational study, four consecutive patients with sacral insufficiency fractures were treated with navigation-guided radiofrequency kyphoplasty for sacroplasty between April 2010 and May 2012. Symptom characteristics, pain duration and pain intensity were recorded for each patient. Cement extravasation was evaluated in thin-sliced and triplanar reconstructed CT scans of the sacrum. Results: Four female patients with painful sacral insufficiency fractures and extensive osteopenic areas significantly improved from an average pre-treatment VAS score of 8.3 {+-} 0.5 to 2.3 {+-} 1.0 (p < 0.001) on the first postoperative day and to 1.3 {+-} 1.9 (p < 0.004) at follow-up (mean, 20.1 weeks). Slight cement extravasations were observed without evidence of being symptomatic. No major complications or procedure-related morbidity were noted. Conclusion: From the limited experience in four patients, navigation-guided radiofrequency kyphoplasty appears to be a safe and effective treatment option for sacral insufficiency fractures even though asymptomatic cement extravasation was noted. The use of navigation based on intraoperative 3 D images simplifies the positioning of the navigated bone needles via the long axis approach. The radiofrequency kyphoplasty system provides the possibility to administer a sufficient amount of bone cement with a well-defined viscosity over the entire period of the procedure leading to high security and low cement extravasation. Sacroplasty provides rapid and enduring pain relief and facilitates prompt mobilization. (orig.)

  1. Sacral-Alar-Iliac Fixation in Children with Neuromuscular Scoliosis: Minimum 5-Year Follow-Up.

    Science.gov (United States)

    Jain, Amit; Sullivan, Brian T; Kuwabara, Anne; Kebaish, Khaled; Sponseller, Paul D

    2017-09-05

    The aim of our study was to investigate the 5-year outcomes of children with neuromuscular scoliosis treated with sacral-alar-iliac screws. We reviewed clinical and radiographic records of patients ≤18 years old treated by 1 pediatric orthopaedic surgeon for neuromuscular scoliosis with spinal fusion using sacral-alar-iliac pelvic anchors. Thirty-eight patients, with a minimum 5-year radiographic follow-up (6.0 ± 1.2 years), were studied. Mean patient age was 13 ± 2.0 years and 47% were female. The mean number of levels fused was 18 ± 0.7. The diagnosis was cerebral palsy in 66% of patients. Between the preoperative period and final follow-up there was a mean 79% correction of the major coronal curve (85° to 18°) and 57% correction of the pelvic obliquity (16° to 7°). Patients maintained correction of mean pelvic obliquity from the early postoperative period (6°) to final follow-up (7°). Preoperatively, 76% of patients had pelvic obliquity of >10°compared with 26% after surgery. There were no cases of neurologic or vascular complications or pseudarthrosis. Radiographs revealed bilateral sacral-alar-iliac screw lucency in 8 patients; 4 of these patients had deep wound infections, and the other 4 were asymptomatic. Unilateral screw fracture was found in 1 patient with an 8-mm screw diameter (1.3%, 1 of 76 screws); the patient was observed and remained asymptomatic. There were no cases of set screw displacement, screw back-out, or rod dislodgement. Sacral-alar-iliac screws are safe and effective pelvic anchors for use in children with neuromuscular scoliosis. Copyright © 2017. Published by Elsevier Inc.

  2. Painless legs and moving toes syndrome associated with a sacral Tarlov cyst: a case report.

    Science.gov (United States)

    Alrawashdeh, Omar

    2016-03-09

    Painless legs and moving toes syndrome is a very rare syndrome characterized by continuous and involuntary movement of the toes. The etiology of the disease is not clear though it has been linked to a wide range of neuronal insults including proximal root compression and neuropathy. A previous study has reported bilateral painful legs and moving toes syndrome in a patient with a sacral Tarlov cyst. In this report we present a case of unilateral painless legs and moving toes syndrome in a woman with a sacral Tarlov cyst. A 50-year-old Mediterranean woman presented with a 1-year history of involuntary sustained movement of her right toes. Her physical examination and laboratory findings did not show any remarkable abnormality. Her lumbosacral magnetic resonance imaging scan showed a sacral Tarlov cyst. Our patient was given gabapentin, 100 mg per day as a starting dose, and showed modest improvement. Our patient preferred not to continue with the treatment as her symptoms were not disabling and she was only concerned about the cosmetic appearance. This report presents a new case of a very rare syndrome called painless legs and moving toes syndrome, which is possibly a variant of painful legs and moving toes syndrome. This is considered to be the first case of unilateral painless legs and moving toes syndrome that is associated with a sacral Tarlov cyst. Although the disease etiology is still unknown and the presence of the cyst can be accidental, neurologists should be aware that Tarlov cyst is a possible cause. In addition, patients with the painless variant who are not disabled by movement of the toes may not require treatment.

  3. Long-term functional and radiological outcome after displaced sacral fractures

    OpenAIRE

    Adelved, Aron

    2015-01-01

    Background and objectives Displaced, unstable sacral fractures are severe injuries resulting in considerable morbidity and functional sequelae. Several authors report neurologic deficits, bladder, bowel, and sexual dysfunction, as well as residual pain and poor self-reported health, in short, and medium-term follow-up studies. However, there is a lack of information on long-term functional outcome following these injures, nor whether any changes occur in functional status many years after ...

  4. Tratamento de dor em paciente com tumor sacral inoperável: relato de caso Tratamiento de dolor en paciente con tumor sacral inoperable: relato de caso Management of pain in patient with inoperable sacral tumor: case report

    Directory of Open Access Journals (Sweden)

    Juliano Rodrigues Gasparini

    2004-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Diversas técnicas podem ser utilizadas no controle de dor em pacientes oncológicos. O objetivo deste relato é mostrar o uso de algumas medidas terapêuticas empregadas para tratar um paciente com quadro doloroso importante de difícil controle. RELATO DO CASO: Paciente do sexo masculino, 70 anos, com cordoma sacral e com possibilidade terapêutica muito difícil. Apresentava quadro de dor importante associado ao tumor. São relatadas diversas técnicas utilizadas no seu tratamento e os resultados obtidos. CONCLUSÕES: Os bloqueios neurolíticos, para o controle da dor em paciente com tumores cuja possibilidade terapêutica é difícil, constituem técnica eficaz quando bem indicados e realizados dentro de critérios estabelecidos.JUSTIFICATIVA Y OBJETIVOS: Diversas técnicas pueden ser utilizadas en el control de dolor en pacientes oncológicos. El objetivo de este relato es mostrar el uso de algunas medidas terapéuticas utilizadas para tratar un paciente con cuadro doloroso importante de difícil control. RELATO DE CASO: Paciente masculino, 70 años, con cordoma sacral y con posibilidad terapéutica muy difícil. Presentaba cuadro de dolor importante asociado al tumor. Se relatan diversas técnicas utilizadas en su tratamiento y los resultados obtenidos. CONCLUSIONES: Los bloqueos neurolíticos, para el control del dolor en paciente con tumores cuja posibilidad terapéutica es difícil, constituyen técnica eficaz cuando bien indicados y realizados dentro de criterios establecidos.BACKGROUND AND OBJECTIVES: Different techniques may be used to control cancer pain. This report aimed at describing some therapeutic measures used to treat a patient with a severe and bad responsive pain. CASE REPORT: A 70-year-old male patient a sacral chordoma of very difficult therapeutic. He referred major tumor-associated pain. Several techniques used to treat pain of this patient and results obtained are reported. CONCLUSIONS

  5. Low back pain during pregnancy caused by a sacral stress fracture: a case report

    Directory of Open Access Journals (Sweden)

    Pishnamaz Miguel

    2012-04-01

    Full Text Available Abstract Introduction Sacral stress fractures are a rare but well known cause of low back pain. This type of fracture has also been observed as a postpartum complication. To date, no cases of intrapartum sacral stress fractures have been described in the literature. Case presentation We report the case of a 26-year-old Caucasian European primigravid patient (30 weeks and two days of gestation who presented to our outpatient clinic with severe low back pain that had started after a downhill walk 14 days previously. She had no history of trauma. A magnetic resonance imaging scan revealed a non-displaced stress fracture of the right lateral mass of her sacrum. Following her decision to opt for non-operative treatment, our patient received an epidural catheter for pain control. The remaining course of her pregnancy was uneventful and our patient gave birth to a healthy child by normal vaginal delivery. Conclusions We conclude that a sacral stress fracture must be considered as a possible cause of low back pain during pregnancy.

  6. 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.

  7. Unusual case of extradural choroid plexus papilloma of the sacral canal. Case report.

    Science.gov (United States)

    Kurtkaya-Yapicier, Ozlem; Scheithauer, Bernd W; Van Peteghem, Karl Peter; Sawicki, John E

    2002-07-01

    An unusual case of a sacral, extradural choroid plexus papilloma involving the S1-3 level is described. This 50-year-old woman presented with a 4-month history of pain involving her right buttock, perineum, and leg. Contrast-enhanced magnetic resonance (MR) imaging of the spine revealed a well-defined, mildly enhancing sacral canal mass at the S1-3 level; its appearance was consistent with that of a benign tumor. Intraoperatively, the lesion was found to be extradural in location and was entwined among nerve roots in the sacral canal. Microscopic examination of the gross totally resected tumor revealed typical features of a choroid plexus papilloma. Despite performing a thorough neuroimaging workup (craniospinal contrast-enhanced MR imaging) for an intracranial or spinal primary mass, none was found. The choroid plexus appeared entirely normal; however, both a cavum septum pellucidum and a cavum vergae were noted. Extraneural choroid plexus papilloma, specifically intrasacral, extradural choroid plexus papilloma has not been previously reported. The present example is thought to have arisen either from ectopic choroid plexus tissue or perhaps by metaplasia from ependymal rests.

  8. Clinical value of ipsi- and contralateral sacral reflex latency measurement: a normative data study in man.

    Science.gov (United States)

    Amarenco, G; Kerdraon, J

    2000-01-01

    The latency of the bulbocavernosus reflex (BCR) evoked by electrical stimulation of the penis provides a measure of the conduction velocity over the sacral reflex arc at the S2-4 level but does not allow evaluation of the side affected since it results from the simultaneous excitation of both dorsal nerves of the penis (DNP) at the penile root. To evaluate the reliability of the side-to-side BCR latency measurement, this study compared the reflex characteristics of the response elicited by both DNP stimulation and unilateral DNP block. After a unilateral selective DNP anesthesic block, we found that the early response of the contralateral BCR is strictly ipsilateral with no differences in terms of latency, morphology, and reflex threshold from controls. This result may indicate that the side-to-side BCR latency measurement allows a comparative study of the respective right and left sacral reflex arcs in men. We found a mean inter-latency difference of 1.8 +/- 0.4 millisecond of the early BCR response after simultaneous recording of the right and left sides in 10 normal men. We established that an inter-latency difference >3 milliseconds may be indicative of a significant alteration in the conduction over the sacral reflex arc.

  9. Surgical excision of symptomatic sacral perineurial Tarlov cyst: case series and review of the literature.

    Science.gov (United States)

    Elsawaf, Ahmed; Awad, Tariq Elamam; Fesal, Salem S

    2016-11-01

    Symptomatic sacral perineural cysts are extremely rare. The aim of this retrospective study is to investigate the outcome of 15 consecutive patients treated by microsurgical resection of the cyst and to review the literature. The authors retrospectively reviewed their clinical data archive from 2002 to 2014. Fifteen patients who were operated on due to symptomatic sacral perineural cysts were enrolled in the study. Patients' symptoms, radiographs, intra-operative findings, and clinical results were evaluated. All 15 patients underwent microsurgical excision of the cyst. The literature on this topic available in PubMed was also reviewed. There were 5 men and 10 women included in the study, with a mean age of 31 years (range 7-60 years). Preoperative symptoms include low back pain, coccydynia, buttock pain, perianal pain and radicular pain. All of the patients underwent surgical resection. The mean follow-up was 54 months (range 3-160 months). All the patients experienced complete or substantial resolution of the preoperative local and radicular pain after surgery. Cyst excision is an effective and safe technique for symptomatic sacral perineural (Tarlov) cysts. Careful patient selection is vital to the management and treatment of this difficult and controversial pathology.

  10. Errors in Seismic Hazard Assessment are Creating Huge Human Losses

    Science.gov (United States)

    Bela, J.

    2015-12-01

    The current practice of representing earthquake hazards to the public based upon their perceived likelihood or probability of occurrence is proven now by the global record of actual earthquakes to be not only erroneous and unreliable, but also too deadly! Earthquake occurrence is sporadic and therefore assumptions of earthquake frequency and return-period are both not only misleading, but also categorically false. More than 700,000 people have now lost their lives (2000-2011), wherein 11 of the World's Deadliest Earthquakes have occurred in locations where probability-based seismic hazard assessments had predicted only low seismic low hazard. Unless seismic hazard assessment and the setting of minimum earthquake design safety standards for buildings and bridges are based on a more realistic deterministic recognition of "what can happen" rather than on what mathematical models suggest is "most likely to happen" such future huge human losses can only be expected to continue! The actual earthquake events that did occur were at or near the maximum potential-size event that either already had occurred in the past; or were geologically known to be possible. Haiti's M7 earthquake, 2010 (with > 222,000 fatalities) meant the dead could not even be buried with dignity. Japan's catastrophic Tohoku earthquake, 2011; a M9 Megathrust earthquake, unleashed a tsunami that not only obliterated coastal communities along the northern Japanese coast, but also claimed > 20,000 lives. This tsunami flooded nuclear reactors at Fukushima, causing 4 explosions and 3 reactors to melt down. But while this history of huge human losses due to erroneous and misleading seismic hazard estimates, despite its wrenching pain, cannot be unlived; if faced with courage and a more realistic deterministic estimate of "what is possible", it need not be lived again. An objective testing of the results of global probability based seismic hazard maps against real occurrences has never been done by the

  11. The relationship between sacral slope and symptomatic isthmic spondylolysis in a cohort of high school athletes: a retrospective analysis.

    Science.gov (United States)

    Hanke, Leigh F; Tuakli-Wosornu, Yetsa A; Harrison, Julian; Moley, Peter J

    2017-10-06

    Spondylolysis with and without anterolisthesis are the most common causes of structural back pain in children and adolescents, but few predictive factors have been confirmed. An association between abnormal sacro-pelvic orientation and both spondylolysis and spondylolisthesis has been supported in the literature. Sacral slope and other sacro-pelvic measurements are easily accessible variables that could aid clinicians in assessing active adolescents with low back pain, particularly when the diagnosis of spondylolysis is suspected. To examine the relationship between sacral slope and symptomatic spondylolysis in a cohort of active adolescents. Case-control retrospective study. Academic outpatient Physiatry practice. Seventy-four patients of primarily adolescent age (between 12-22 years old) with a chief complaint of low back pain and presence of lateral radiographs of the lumbar spine were enrolled. Cases (n=37) were defined as subjects with evidence of spondylolysis on both radiograph and magnetic resonance imaging of the lumbar spine. Controls (n=37) were defined as subjects without spondylolysis. Using a single sagittal radiograph, taken with the patient standing, a fellowship-trained interventional spine Physiatrist measured the sacral slope of each subject (angle between the superior plate of S1 and a horizontal reference on sagittal imaging of the lumbosacral spine). Ages and genders were collected from medical records. The primary outcome was mean sacral slope. Mean sacral slope of cases was compared to mean sacral slope of controls using the Student's t-test. Ages ranged from 12 to 22 for both groups, with no significant differences in age between the groups (cases: 16.8 ± 2.3 years; controls: 17.7 ± 2.7 years). The patients with spondylolysis (cases) consisted of 29 male and 8 female patients, whereas those without spondylolysis (controls) consisted of 15 male and 21 female patients. The mean sacral slope among cases was 42.4°, whereas the mean sacral

  12. Distributed and parallel approach for handle and perform huge datasets

    Science.gov (United States)

    Konopko, Joanna

    2015-12-01

    Big Data refers to the dynamic, large and disparate volumes of data comes from many different sources (tools, machines, sensors, mobile devices) uncorrelated with each others. It requires new, innovative and scalable technology to collect, host and analytically process the vast amount of data. Proper architecture of the system that perform huge data sets is needed. In this paper, the comparison of distributed and parallel system architecture is presented on the example of MapReduce (MR) Hadoop platform and parallel database platform (DBMS). This paper also analyzes the problem of performing and handling valuable information from petabytes of data. The both paradigms: MapReduce and parallel DBMS are described and compared. The hybrid architecture approach is also proposed and could be used to solve the analyzed problem of storing and processing Big Data.

  13. Anaethetic management of a neonate with huge cystic hygroma.

    Directory of Open Access Journals (Sweden)

    Bindi Palkhiwala

    2013-01-01

    Full Text Available We discuss here the case of a 7 day old neonate with huge cystic hygroma on the left side of the neck invading the major vessels of neck, facial nerve, strap muscles and sternocleidomastoid. Anasethtic implications in this case were maintaining airway patency after induction, difficult intubation, risk perioperative dislodgement of tube and judgement of proper time for extubation. Following gaseous induction and adequate mask ventilation, patient was intubated with muscle relaxant. peroperatively to avoid accidental extubation, we choose to manually hold the ET tube after fixing it. At the end of relatively uneventful surgery, we could extubate the patient in OT. patient was shifted to NICU for observation. Post operatively on 3rd day, facial palsy was observed. Ptient was discharged on 21st day.

  14. Huge Intracanal lumbar Disc Herniation: a Review of Four Cases

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    Farzad Omidi-Kashani

    2016-01-01

    Full Text Available Lumbar disc herniation (LDH is the most common cause of sciatica and only in about 10% of the affected patients, surgical intervention is necessary. The side of the patient (the side of most prominent clinical complaints is usually consistent with the side of imaging (the side with most prominent disc herniation on imaging scans. In this case series, we presented our experience in four cases with huge intracanal LDH that a mismatch between the patient’s side and the imaging’s side was present. In these cases, for deciding to do the operation, the physicians need to rely more on clinical findings, but for deciding the side of discectomy, imaging characteristic (imaging side may be a more important criterion.

  15. A parallel solver for huge dense linear systems

    Science.gov (United States)

    Badia, J. M.; Movilla, J. L.; Climente, J. I.; Castillo, M.; Marqués, M.; Mayo, R.; Quintana-Ortí, E. S.; Planelles, J.

    2011-11-01

    HDSS (Huge Dense Linear System Solver) is a Fortran Application Programming Interface (API) to facilitate the parallel solution of very large dense systems to scientists and engineers. The API makes use of parallelism to yield an efficient solution of the systems on a wide range of parallel platforms, from clusters of processors to massively parallel multiprocessors. It exploits out-of-core strategies to leverage the secondary memory in order to solve huge linear systems O(100.000). The API is based on the parallel linear algebra library PLAPACK, and on its Out-Of-Core (OOC) extension POOCLAPACK. Both PLAPACK and POOCLAPACK use the Message Passing Interface (MPI) as the communication layer and BLAS to perform the local matrix operations. The API provides a friendly interface to the users, hiding almost all the technical aspects related to the parallel execution of the code and the use of the secondary memory to solve the systems. In particular, the API can automatically select the best way to store and solve the systems, depending of the dimension of the system, the number of processes and the main memory of the platform. Experimental results on several parallel platforms report high performance, reaching more than 1 TFLOP with 64 cores to solve a system with more than 200 000 equations and more than 10 000 right-hand side vectors. New version program summaryProgram title: Huge Dense System Solver (HDSS) Catalogue identifier: AEHU_v1_1 Program summary URL:http://cpc.cs.qub.ac.uk/summaries/AEHU_v1_1.html Program obtainable from: CPC Program Library, Queen's University, Belfast, N. Ireland Licensing provisions: Standard CPC licence, http://cpc.cs.qub.ac.uk/licence/licence.html No. of lines in distributed program, including test data, etc.: 87 062 No. of bytes in distributed program, including test data, etc.: 1 069 110 Distribution format: tar.gz Programming language: Fortran90, C Computer: Parallel architectures: multiprocessors, computer clusters Operating system

  16. Does China's Huge External Surplus Imply an Undervalued Renminbi?

    Institute of Scientific and Technical Information of China (English)

    Anthony J. Makin

    2007-01-01

    A pegged exchange rate regime has been pivotal to China's export-led development strategy. However, its huge trade surpluses and massive build up of international reserves have been matched by large deficits for major trading partners, creating acute policy concerns abroad, especially in the USA. This paper provides a straightforward conceptual framework for interpreting the effect of China's exchange rate policy on its own trade balance and that of trading partners in the context of discrepant economic growth rates. It shows how pegging the exchange rate when output is outstripping expenditure induces China's trade surpluses and counterpart deficits for its trading partners. An important corollary is that given its strictly regulated capital account, China's persistently large surpluses imply a significantly undervalued renminbi, which should gradually become more flexible.

  17. Single-stage en bloc resection using a posterior approach for sacral tumors

    Institute of Scientific and Technical Information of China (English)

    Zhong Fang; Wei Wu; Wei Xiong; Guanghui Li; Hui Liao; Jun Xiao; Fengjing Guo; Anmin Chen; Feng Li 

    2016-01-01

    Objective This study aims to investigate the surgical results of single-stage en bloc resections using a posterior approach for sacral tumors and evaluate its benefit for these tumors. Methods A total of 32 cases involving patients with sacral tumors who were treated with single-stage en bloc resection by posterior approach from April 2004 to January 2010 were reviewed. The patient cohort included 20 males and 12 females. The average patient age was 49.1 years old (range, 18 to 75 years old). Twenty-seven patients suf ered from primary sacral tumors, including 17 patients with chordomas, 5 patients with giant cel tumors of the bone, 3 patients with chondrosarcoma, 1 patient with sarcoma of the nerve fibers, and 1 patient with neurofibromatosis. Five patients were diagnosed with sacral metastatic tumors, including 2 cases of breast cancer, 1 case of renal carcinoma, 1 case of thyroid cancer, and 1 case of lung cancer. According to the Frankel grading system, there were 3 Grade B tumors, 4 Grade C tumors, 10 Grade D tumors, and 15 Grade E tumors. Results The operation took 265 min on average (range, 130–360 min), and blood loss was 1676 mL on average (range, 800–1800 mL) during the operation. The fol ow-up period ranged from 6 months to 6.2 years. Al patients had pain prior to operation. Twenty-eight patients experienced complete pain-relief, and 4 patients experienced partial pain-relief after their operations. In al patients, neurological function was improved more than one grade using the Frankel grading system. Up to now, 5 patients experienced local recurrence after operation, and 2 patients were deceased. The remaining patients are stil alive without recurrence. Conclusion Single-stage en bloc resection through a posterior approach for sacral tumors is feasible, safe, and ef ective. It has many advantages, such as control ing local recurrence, thorough decompression of the spinal cord, relieving pain, improving quality of life, and prolonging survival.

  18. Anterior cervical plating

    Directory of Open Access Journals (Sweden)

    Gonugunta V

    2005-01-01

    Full Text Available Although anterior cervical instrumentation was initially used in cervical trauma, because of obvious benefits, indications for its use have been expanded over time to degenerative cases as well as tumor and infection of the cervical spine. Along with a threefold increase in incidence of cervical fusion surgery, implant designs have evolved over the last three decades. Observation of graft subsidence and phenomenon of stress shielding led to the development of the new generation dynamic anterior cervical plating systems. Anterior cervical plating does not conclusively improve clinical outcome of the patients, but certainly enhances the efficacy of autograft and allograft fusion and lessens the rate of pseudoarthrosis and kyphosis after multilevel discectomy and fusions. A review of biomechanics, surgical technique, indications, complications and results of various anterior cervical plating systems is presented here to enable clinicians to select the appropriate construct design.

  19. Late Intervention-Related Complication - A Huge Subepicardial Hematoma.

    Science.gov (United States)

    Ko, Po-Yen; Chang, Chih-Ping; Yang, Chen-Chia; Lin, Jen-Jyh

    2013-05-01

    A 75-year-old man had a history of triple vessel coronary artery disease. In August 2009, he had undergone successful percutaneous coronary intervention to the left circumflex coronary artery (LCX) for management of an in-stent restenosis (ISR) lesion. However, in September 2010, he began experiencing recurrent episodes of exertional chest pain. Chest radiography showed the left cardiac border bulging upwards. Transthoracic echocardiography and chest computed tomography revealed a huge oval mass of about 10.4 cm × 7.9 cm × 8.6 cm, which showed calcification and was obliterating the LCX. Subsequent coronary angiography revealed significant instent restenosis, with extravasation of a small amount of contrast material at the stent location, suggesting that the coronary artery had ruptured. We implanted a polytetrafluoroethylene-covered stent to seal the coronary perforation and to release the occlusion. The patient was symptom-free and had an uneventful outcome until the 1-year follow up. Coronary artery perforation; Covered stent; Hematoma.

  20. A huge posteromedial mediastinal cyst complicated with vertebral dislodgment

    Directory of Open Access Journals (Sweden)

    Manoussaridis Jordan T

    2006-08-01

    Full Text Available Abstract Background Mediastinal cysts compromise almost 20% of all mediastinal masses with bronchogenic subtype accounting for 60% of all cystic lesions. Although compression of adjoining soft tissues is usual, spinal complications and neurological symptoms are outmost rare and tend to characterize almost exclusively the neuroenteric cysts. Case presentation A young patient with intermittent, dull pain in his back and free medical history presented in the orthopaedic department of our hospital. There, the initial clinical and radiologic evaluation revealed a mediastinal mass and the patient was referred to the thoracic surgery department for further exploration. The following computed tomography (CT and magnetic resonance imaging (MRI shown a huge mediastinal cyst compressing the T4-T6 vertebral bodies. The neurological symptoms of the patient were attributed to this specific pathology due to the complete agreement between the location of the cyst and the nervous rule area of the compressed thoracic vertebrae. Despite our strongly suggestions for surgery the patient denied any treatment. Conclusion In controversy with the common faith that the spine plays the role of the natural barrier to the further expansion of cystic lesions, our case clearly indicates that, exceptionally, mediastinal cysts may cause severe vertebral complications. Therefore, early excision should be considered especially in young patients or where close follow up is uncertain.

  1. A probabilistic algorithm for interactive huge genome comparison.

    Science.gov (United States)

    Courtois, P R; Moncany, M L

    1995-12-01

    We designed a new probabilistic algorithm, named PAGEC (probabilistic algorithm for genome comparison), which allowed a highly interactive study of long genomic strings. The comparison between two nucleic acid sequences is based on the creation of multiple index tables, which drastically reduces processing time for huge genomes, e.g. 13 min for a 4 Mb/4 Mb comparison. PAGEC lowered the need for memory when compared with other types of algorithm and took into account the low resolution of the final representation (paper or computer screen). Considering that standard printers permit a 300 d.p.i. resolution, the loss of computed information due to the probabilistic conception of the algorithm was not usually noticeable in the present study, mainly due to increased genomic sizes. Refinement was possible through an interactive zooming system, which enabled the visualization of the lexical base sequences of a considered part of both of the studied genomes. Biological examples of computation based on yeast and animal nucleic acid sequences presented in this paper reveal the flexibility of the PAGEC program, which is a valuable tool for genetic studies as it offers a solution to an important problem that will become even more important as time passes.

  2. Repair of sacral plexus root avulsion with normal sacral nerve root transposition in rats%健侧骶神经根移位修复大鼠骶丛撕脱伤

    Institute of Scientific and Technical Information of China (English)

    张志凌; 郭清河; 杨迪; 江曦; 鹿楠; 陈爱民

    2011-01-01

    Objective To evaluate the efficiency of normal sacral nerve root transposition in repair of the sacral plexus root avulsion. Methods A total of 30 adult SD rats were chosen and divided into three groups,ie,group A(the sciatic nerve received no repair),group B(the autologous sacral plexus root nerve was bridged with the right L6 nerve root by the translocation of the left L6)and group C (the right L5 nerve root nerve was bridged by the translocation of the left L6),10 rats per group.The left side of the rats was used as the control side and the right one as the experimental side.Twelve weeks after operation,the rats in each group were selected for the histomorphological observation of the nerves under the microscope and the electron microscope.The models were evaluated by observing the survival rates of the rats,BBB scores,electron microscope weight and muscle fiber CSA(cross section area)of double biceps femoris,triceps surae and tibial muscle. Results Twelve weeks after operation,the BBB scores in groups B and C was higher than that in group A,with statistical difference(P<0.01)between three groups.A remarkable improvement was found in the ratio of weight and muscle fiber CSA of double biceps femoris,triceps surse and tibial muscle.The repair efficiency in the group C was better than that in the group B.In the group B,the biceps femoris,triceps surae and tibial muscle recovered at different degrees.The biceps femoris recovered the best,when a great deal of myelinated nerve fiber regeneration was observed under the microscope and the electromicroscope.Electromyography revealed the volatility in the muscles of three groups,with larger peak value for the proximal biceps femoris and the triceps muscle but smaller peak value for the distal anterior tibial muscle. Conclusions L6 transposition combined with auto-graft of nerve root or without the auto-graft can reconstruct the partial function of the sciatic nerve in the paraplegia rats,when the latter has the better

  3. Microsurgical Fenestration and Paraspinal Muscle Pedicle Flaps for the Treatment of Symptomatic Sacral Tarlov Cysts.

    Science.gov (United States)

    Potts, Matthew B; McGrath, Mary H; Chin, Cynthia T; Garcia, Roxanna M; Weinstein, Philip R

    2016-02-01

    Sacral Tarlov cysts are rare causes of sciatic and sacrococcygeal pain and neurologic deficits. Although several microsurgical treatments have been described, the optimal treatment has yet to be determined. We describe our initial experience with symptomatic lesions combining 1) cyst fenestration and imbrication and 2) filling the epidural space using vascularized paraspinous muscle flaps rotated into the cystic cavity. We retrospectively reviewed all consecutive cases of symptomatic giant sacral Tarlov cysts treated with microsurgery at our institution between 2003 and 2011. The main outcome measure was self-reported symptom relief. Postoperative imaging, surgical complications, and subsequent treatments were also recorded. Thirty-five patients were treated. Mean age was 52 years. All patients presented with a chief complaint of sacral-perineal pain. The mean cyst size was 3.6 cm (largest diameter). Follow-up beyond the initial hospital stay was available in 86% (median 8 months). Ninety-three percent reported improvement in pain at some point during the postoperative course but 50% of those developed recurrent pain symptoms. Postoperative imaging was available in 69% of the patients in whom 92% showed complete obliteration (25%) or reduction in cyst size (67%). The combination of microsurgical cyst fenestration and the use of vascularized muscle pedicle flaps to fill the cystic cavity and the epidural space results in obliteration or reduction in size of the majority of cysts and is associated with initial improvement in pain in most patients. However, delayed recurrence of pain was common with this technique. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. 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

  5. 骶椎隐球菌骨髓炎一例报告%Cryptococcus neoformans osteomyelitis of the sacral vertebrae:a case report

    Institute of Scientific and Technical Information of China (English)

    陈志源; 丁焕文; 涂强; 沈健坚; 刘辉亮; 王虹; 滕强; 贾军锋; 庾广文

    2014-01-01

    Objective To report a case of cryptococcus neoformans osteomyelitis of the sacral vertebrae and to analyze the cause of misdiagnosis. Methods The clinical data of a patient with cryptococcus neoformans osteomyelitis of the sacral vertebrae who was adopted in 2012 were retrospectively analyzed. Results Intermittent pain in the sacrum occurred to the patient without any obvious precipitating factors, which became worse at night. And meanwhile, the patient had low-grade fever. Whole body bone scan and single photon emission computed tomography ( SPECT )/CT showed abnormally active metabolism in the sacrum and bony defects and changes in the right margin. Therefore, bone tumors were considered. Sacral metastases was conifrmed using CT-guided needle aspiration biopsy. Debridement was performed after multidisciplinary consultation. The intraoperative frozen pathology presented fungal infections. The postoperative routine pathological examination showed pyogenic and inlfammatory granulomas and there were fungal spores in the histocytes. At last, sacral cryptococcus infections was diagnosed. Conclusions The partial performance of cryptococcus neoformans osteomyelitis of the sacral vertebrae is similar to that of malignant tumors of the sacral vertebrae. So clinical doctors should raise the awareness of the disease. It is necessary to ifrst rule out the possibility of cryptococcus neoformans osteomyelitis of the sacral vertebrae before making the diagnosis of malignant tumors of the sacral vertebrae.

  6. Modified lumbopelvic fixation for sacral and L5 fractures associated with spinopelvic instability: a case report and introduction of the surgical technique

    Directory of Open Access Journals (Sweden)

    YI Cheng-la

    2012-02-01

    Full Text Available 【Abstract】Posterior lumbopelvic fixation with iliac screws is the most commonly used method for unstable spinopelvic injuries. It has certain limitations including inability to use distraction along the spinopelvic rod as an indirect reduction maneuver, need for complex 3-dimensional rod contouring and complications such as hardware prominence and soft tissue coverage. In the present case report, we described a surgical technique of lumbopelvic fixation with sacral alar screws for traumatic spinopelvic instability resulted from a unilateral Denis-III comminuted sacral fracture and the L5 burst fracture. On the opposite side of the sacral fracture, caudal screws were implanted into the pedicle of the S1, whereas on the side of sacral fracture, two sacral alar screws were placed parallel to the superior sacral endplate as well as the plane of sacroiliac joint. In addition, horizontal stabilization was conducted with cross-link connections to maintain the longitudinal traction. For sacral fracture associated with traumatic spinopelvic instability, this modified lumbopelvic fixation technique using sacral alar screws makes longitudinal reduction easier, requires less rod contouring, and reduces hardware prominence without compromising the stability. Key words: Sacrum; Lumbar vertebrae; Fracture fixation

  7. Comparison of Therapeutic Effects Between Acupuncture plus Sacral Injection and Simple Acupuncture for Lumbar Intervertebral Disc Herniation

    Institute of Scientific and Technical Information of China (English)

    YAN Jie-ying; XU Yao

    2007-01-01

    To compare the therapeutic effects between acupuncture plus sacral injection and simple acupuncture for intervertebral disc hemia.Methods:The patients with lumbar intervertebral disc hernia at the age of 30-45 years old were divided into No.1-80 upon their visiting order,with odd number as Group A and even number as Group B.Group A was treated by acupuncture plus sacral injection,and Group B was treated by simple acupuncture.Results:The clinical effective rate was higher in Group A than in Group B,with significant difference (P<0.05).Conclusion:Acupuncture plus sacral injection had the better therapeutic effect than simple acupuncture in treating lumbar intervertebral disc hernia.

  8. A Pilot Randomized Controlled Trial Using Prophylactic Dressings to Minimize Sacral Pressure Injuries in High-Risk Hospitalized Patients.

    Science.gov (United States)

    Walker, Rachel; Huxley, Leisa; Juttner, Melanie; Burmeister, Elizabeth; Scott, Justin; Aitken, Leanne M

    2016-02-12

    This pilot randomized controlled trial examined the effect of prophylactic dressings to minimize sacral pressure injuries (PIs) in high-risk hospitalized patients and assessed feasibility criteria to inform a larger study. Eighty patients were recruited at admission points (the emergency department and surgical care unit) or directly from participating wards in the general medical-surgical setting following the assessment of high risk of sacral PI. Participants were randomized into either the routine care or routine care and silicone foam border dressing group. Outcome assessment comprised digital photographs of each participant's sacrum every 72 hr for evaluation by a blind-to-intervention assessor. Sixty-seven participants had at least one sacral photograph taken and assessed by a blind-to-intervention assessor. Three participants were assessed as having a Stage I PI. Although the use of photography was effective, feasibility criteria identified challenges related to bias, blinding, weight assessment, preparation of nursing staff, and sample size estimation.

  9. Lumbo-sacral radiculopathy referral decision-making and primary care management. A case report.

    Science.gov (United States)

    Haswell, Kate; Gilmour, John Martin; Moore, Barbara Joyce

    2015-04-01

    Low back pain guideline recommendations can inform a decision in primary care to refer for surgical assessment. The purpose of this report is to present a patient with clinical signs and symptoms of lumbo-sacral radiculopathy who experienced pain of high intensity, severe paresis and depression. The guideline informed decision-making process resulted in a decision not to refer. This case report aims to increase awareness of referral guidelines and to demonstrate radicular pain and weakness, disability and depression outcomes subsequent to primary care management. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Fatigue fracture of the sacral bone associated with septic arthritis of the symphysis pubis

    Energy Technology Data Exchange (ETDEWEB)

    Albertsen, A.M.B. [Department of Radiology, Odense University Hospital (Denmark); Egund, N. [Department of Radiology, Odense University Hospital (Denmark); Jurik, A.G. [Department of Radiology, Aarhus University Hospital (Denmark)

    1995-11-01

    Two women, aged 50 and 67 years, with septic arthritis of the symphysis pubis attended by severe low back pain, were followed with CT and MR imaging of the pelvis, as well as bone scintigraphy in one patient. In the first patient sacral fractures with severe displacement were revealed, prompting stabilizing symphysiodesis. In the second patient an undisplaced fatigue fracture was confirmed in the right half of the sacrum. In patients with pelvic laxity following arthritis of the symphysis and post-traumatic osteolysis associated with low back pain, displaced or occult fractures of the bones adjacent to the sacroiliac joints should be considered. (orig./MG)

  11. MRI Verification of a Case of Huge Infantile Rhabdomyoma

    Science.gov (United States)

    Ramadani, Naser; Kreshnike, Kreshnike Dedushi; Muçaj, Sefedin; Kabashi, Serbeze; Hoxhaj, Astrit; Jerliu, Naim; Bejiçi, Ramush

    2016-01-01

    Introduction: Cardiac rhabdomyoma is type of benign myocardial tumor that is the most common fetal cardiac tumor. Cardiac rhabdomyomas are usually detected before birth or during the first year of life. They account for over 60% of all primary cardiac tumors. Case report: A 6 month old child with coughing and obstruction in breathing, was hospitalized in the Pediatric Clinic in UCCK, Pristine. The difficulty of breathing was heard and the pathological noise of the heart was noticed from the pediatrician. In the echo of the heart at the posterior and apico-lateral part of the left ventricle a tumoral mass was presented with the dimensions of 56 × 54 mm that forwarded the contractions of the left ventricle, the mass involved also the left ventricle wall and was not vascularized. The right ventricle was deformed and with the shifting of the SIV on the right the contractility was preserved. Aorta, the left arch and AP were normal with laminar circulation. The pericard was presented free. Radiography of thoracic organs was made; it resulted on cardiomegaly and significant bronchovascular drawing. It was completed with an MRI and it resulted on: Cardiomegaly due to large tumoral mass lesion (60×34 mm) involving lateral wall of left ventricle. It was isointense to the muscle on T1W images, markedly hyperintense on T2W images. There were a few septa or bant like hypointensities within lesion. On postcontrast study it showed avid enhancement. The left ventricle volume was decreased. Mild pericardial effusion was also noted. Surgical intervention was performed and it resulted on the histopathological aspect as a huge infantile rhadbomyoma. Conclusion: In most cases no treatment is required and these lesions regress spontaneously. Patients with left ventricular outflow tract obstruction or refractory arrhythmias respond well to surgical excision. Rhabdomyomas are frequently diagnosed by means of fetal echocardiography during the prenatal period. PMID:27147810

  12. Single-Path Sigma from a Huge Dataset in Taiwan

    Science.gov (United States)

    Sung, Chih-Hsuan; Lee, Chyi-Tyi

    2014-05-01

    Ground-motion variability, which was used in the probabilistic seismic hazard analysis (PSHA) in computing annual exceedence probability, is composed of random variability (aleatory uncertainty) and model uncertainty (epistemic uncertainty). Finding random variability of ground motions has become an important issue in PSHA, and only the random variability can be used in deriving the annual exceedence probability of ground-motion. Epistemic uncertainty will be put in the logic tree to estimate the total uncertainty of ground-motion. In the present study, we used about 18,859 records from 158 shallow earthquakes (Mw > 3.0, focal depth ≤ 35 km, each station has at least 20 records) form the Taiwan Strong-Motion Instrumentation Program (TSMIP) network to analyse the random variability of ground-motion. First, a new ground-motion attenuation model was established by using this huge data set. Second, the residuals from the median attenuation were analysed by direct observation on inter-event variability and site-specific variability. Finally, the single-path variability was found by a moving-window method on either single-earthquake residuals or single-station residuals. A variogram method was also used to find minimum variability for intra-event residuals and inter-event residuals, respectively. Results reveal that 90% of the single-path sigma σSP are ranging from 0.219 to 0.254 (ln unit) and are 58% to 64% smaller than the total sigma (σT =0.601). The single-site sigma (σSS) are also 39%-43% smaller. If we use only random variability (single-path sigma) in PSHA, then the resultant hazard level would be 28% and 25% lower than the traditional one (using total sigma) in 475-year and in 2475-year return period, respectively, in Taipei.

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

    Science.gov (United States)

    Haakma, Wieke; Dik, Pieter; ten Haken, Bennie; Froeling, Martijn; Nievelstein, Rutger A J; Cuppen, Inge; de Jong, Tom P V M; Leemans, Alexander

    2014-09-01

    It is still largely unknown how neural tube defects in spina bifida affect the nerves at the level of the sacral plexus. Visualizing the sacral plexus in 3 dimensions could improve our anatomical understanding of neurological problems in patients with spina bifida. We investigated anatomical and microstructural properties of the sacral plexus of patients with spina bifida using diffusion tensor imaging and fiber tractography. Ten patients 8 to 16 years old with spina bifida underwent diffusion tensor imaging on a 3 Tesla magnetic resonance imaging system. Anatomical 3-dimensional reconstructions were obtained of the sacral plexus of the 10 patients. Fiber tractography was performed with a diffusion magnetic resonance imaging toolbox to determine fractional anisotropy, and mean, axial and radial diffusivity in the sacral plexus of the patients. Results were compared to 10 healthy controls. Nerves of patients with spina bifida showed asymmetry and disorganization to a large extent compared to those of healthy controls. Especially at the myelomeningocele level it was difficult to find a connection with the cauda equina. Mean, axial and radial diffusivity values at S1-S3 were significantly lower in patients. 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. The observed difference in diffusion values indicates that these methods may be used to identify nerve abnormalities. We expect that this technique could provide a valuable contribution to better analysis and understanding of the problems of patients with spina bifida in the future. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  14. Prevalence of simple and complex sacral perineural Tarlov cysts in a French cohort of adults and children.

    Science.gov (United States)

    Kuhn, Félix P; Hammoud, Sonia; Lefèvre-Colau, Marie-Martine; Poiraudeau, Serge; Feydy, Antoine

    2017-02-01

    To determine the prevalence of simple and complex sacral perineural Tarlov cysts (TCs) in a cohort of children and adults. Retrospective observational epidemiological study assessing 1100 consecutive sacral magnetic resonance (MR) studies, including 100 children and adolescents. All patients underwent 1.5T MR imaging with T1 and T2 weighted image acquisitions in sagittal and axial planes. All perineural cysts affecting the sacral nerve roots S1-S4 were quantitatively and qualitatively assessed. Two hundred and sixty-three sacral TCs were found in 132 adult patients (13.2%), with a female predominance (68%). None was found in children. The prevalence of TCs increased with age. The average number of cysts per patient was 2.0±1.2 with a maximum of 6 cysts in a single patient. Most of the cysts (87.5%) showed a homogenous central fluid collection and a parietal course of the nerve fibers. Complex patterns were present in 33 cysts (12.5%) within which 28 cysts showed endocystic crossing of nerve fibers and 5 cysts contained internal septations. Seventy cysts (26.6%) eroded the adjacent bone and 13 cysts (4.9%) extended to the pelvis. The prevalence of sacral TCs in our cohort corresponded to 13%, with a female predominance. Interestingly no TCs were found in children or adolescents (cysts with internal septations, or endocystic crossing of nerve fibers, pre-interventional characterization of sacral TCs might help to choose an appropriate procedure in the treatment of rare symptomatic variants. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  15. 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...

  16. Anterior Cervical Discectomy and Fusion Alters Whole-Spine Sagittal Alignment

    Science.gov (United States)

    Kim, Jang Hoon; Yi, Seong; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

    2015-01-01

    Purpose Anterior cervical discectomy and fusion (ACDF) has become a common spine procedure, however, there have been no previous studies on whole spine alignment changes after cervical fusion. Our purpose in this study was to determine whole spine sagittal alignment and pelvic alignment changes after ACDF. Materials and Methods Forty-eight patients who had undergone ACDF from January 2011 to December 2012 were enrolled in this study. Cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis (SVA), and pelvic parameters were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Clinical outcomes were assessed using Visual Analog Scale (VAS) scores and Neck Disability Index (NDI) values. Results Forty-eight patients were grouped according to operative method (cage only, cage & plate), operative level (upper level: C3/4 & C4/5; lower level: C5/6 & C6/7), and cervical lordosis (high lordosis, low lordosis). All patients experienced significant improvements in VAS scores and NDI values after surgery. Among the radiologic parameters, pelvic tilt increased and sacral slope decreased at 12 months postoperatively. Only the high cervical lordosis group showed significantly-decreased cervical lordosis and a shortened SVA postoperatively. Correlation tests revealed that cervical lordosis was significantly correlated with SVA and that SVA was significantly correlated with pelvic tilt and sacral slope. Conclusion ACDF affects whole spine sagittal alignment, especially in patients with high cervical lordosis. In these patients, alteration of cervical lordosis to a normal angle shortened the SVA and resulted in reciprocal changes in pelvic tilt and sacral slope. PMID:26069131

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

    Directory of Open Access Journals (Sweden)

    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.

  18. A novel technique to repair a transverse sacral fracture in a previously fused lumbosacral spondylolisthesis

    Science.gov (United States)

    Noh, Thomas; Chedid, Mokbel K.

    2016-01-01

    Background: Transverse fractures of the sacrum are rare, and surgical treatment for these fractures ranges from conservative to challenging. Transverse stress fractures of the sacrum after placement of lumbar-to-sacral instrumentation have been previously described. We report a new technique to repair a transverse Type-2 Roy-Camille fracture with spondylolisthesis of S1 over S2 in a previously fused instrumented high-grade L4-L5, L5-S1 spondylolisthesis. Case Description: A 64-year-old female who previously had an L4-L5, L5-S1 fusion for spondylolisthesis presented with excruciating lower back pain and radiculopathy for over 6 months. She was found to have an S1-S2 transverse fracture caused by previous implantation of pedicle screws. She underwent repositioning of several failed right lumbar and sacral screws and then had bilateral S1-S2 screws placed directly across the fracture line. The patient had an unremarkable postoperative course. She discontinued most of her pain medications within 6 weeks postoperatively. In the months following surgery, she reported only minimal lower back pain and no radiculopathy with the last appointment 5 years postoperatively. Conclusions: We describe a novel technique to reduce an iatrogenic transverse type-2 Roy-Camille fracture at S1-S2 in a previously instrumented high-grade L4-L5, L5-S1 spondylolisthesis. The patient's fracture achieved adequate reduction and fusion with symptomatic relief. PMID:28028448

  19. Evaluating formability of LCP plate for sacral fractures with one step inverse forming finite element analysis.

    Science.gov (United States)

    Li, Xiaoda; Zhang, Xiangkui; Hu, Ping; Liu, Weijie; Shen, Guozhe; Zhan, Xianghui

    2015-01-01

    The locking compression plate fixation treatment for the unstable sacral fractures is simple and effective, with less trauma and complications. Some locking compression plate parts have been made of high-strength Plate manufactured by hot stamping process since the demand for lightweight biomedical materials. Finite Element (FE) method of One-Step inverse forming based on deformation theory is the tool to evaluate the formability of locking compression plate panel quickly in initial design for reducing costs and development cycle of Plate. But current one-step inverse forming methods are all suitable for cold stamping, not hot-stamping. This paper proposed one-step inverse forming method and workflow for hot-stamping of locking compression Plate. And the B pillar of a sacral bone was simulated and its computing result was compared with experimental value. The result shows that the proposed method in this paper can quickly evaluate high temperature formability of high-strength Plate. And the method is proposed to be used in initial design.

  20. 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.

  1. 腹腔镜治疗盆腔、骶尾部巨大皮样囊肿一例%One case of laparoscopic treat huge sacrococcygeal region with pelvic cavity dermoid cyst

    Institute of Scientific and Technical Information of China (English)

    贾宝雷; 李虎城

    2014-01-01

    Dermoid cyst is a hamartoma,which can be discovered in many parts of the human body. But it is relatively rare in the rear of the sacral,huge sacrococcygeal region with pelvic cavity dermoid cyst is more rare.In the past,we often treated the huge of pelvic cavity neoplasm with open operation.Now laparoscopic is used in our operation successfully,and the effect is satisfied.%皮样囊肿是一种错构瘤,可发生在身体的许多部位,但发生在骶尾部的较为少见,骶尾部合并盆腔的巨大皮样囊肿则更为罕见。既往对盆腔的巨大肿物多采用开腹手术治疗,此病例我们成功的施行了腹腔镜微创治疗,效果满意。

  2. Pulmonary hypertension with a huge thrombosis in main stem of pulmonary artery

    Institute of Scientific and Technical Information of China (English)

    杨萍; 曾红; 孟繁波; 赵林阳

    2001-01-01

    @@A huge thrombosis in the main stem of the pulmonary artery (PA) with pulmonary hypertension has rarely been reported. We present two cases diagnosed and treated in our hospital. One suffered from polyarteritis with a huge thrombus in PA revealed at autopsy. The second case had congenital heart disease of the patent artery duct; and the huge thrombus was found on echocardiogram and extirpated in surgery.

  3. Huge ascending aortic aneurysm with an intraluminal thrombus in an embolic event-free patient.

    Science.gov (United States)

    Parato, Vito Maurizio; Prifti, Edvin; Pezzuoli, Franco; Labanti, Benedetto; Baboci, Arben

    2015-03-01

    We present a case of an 87-year-old male patient with a huge ascending aortic aneurysm, filled by a huge thrombus most probably due to previous dissection. This finding was detected by two-dimensional transthoracic echocardiography and contrast-enhanced computed tomography (CT) angiography scan. The patient refused surgical treatment and was medically treated. Despite the huge and mobile intraluminal thrombus, the patient remained embolic event-free up to 6 years later, and this makes the case unique.

  4. Efficacy of hepatic resection for huge (≥ 10 cm) hepatocellular carcinoma: good prognosis associated with the uninodular subtype.

    Science.gov (United States)

    Zhu, Shao-Liang; Chen, Jie; Li, Hang; Li, Le-Qun; Zhong, Jian-Hong

    2015-01-01

    The value of hepatic resection (HR) for huge hepatocellular carcinomas (HCC) (≥ 10 cm in diameter) remains controversial. The aim of this study is to evaluate the efficacy of hepatic resection (HR) for patients with huge HCC. A total of 739 patients with huge HCC (≥ 10 cm in diameter) (huge HCC group, n = 244) or small HCC (huge HCC were identified based on Cox regression analyses. The hospital mortality of these two groups were similar (P = 0.252). The 5-year OS of huge HCC group and small HCC group were 30.3% and 51.9%, respectively (P huge HCC had a significant higher 5-year OS (50.6%) than mutinodular huge HCC (26.9%) (P = 0.016). Multivariate analysis revealed that uninodular huge HCC and absence of PVTT independently predicted better OS for huge HCC patients. HR is a safe and effective approach for the treatment of huge HCC, especially for the uninodular subtype.

  5. Anterior crucate ligament (ACL) injury

    Science.gov (United States)

    ... An anterior cruciate ligament injury is the over-stretching or tearing of the anterior cruciate ligament (ACL) ... may be injured. This is a medical emergency. Prevention Use proper techniques when playing sports or exercising. ...

  6. Efficient visualization of unsteady and huge scalar and vector fields

    Science.gov (United States)

    Vetter, Michael; Olbrich, Stephan

    2016-04-01

    The simulation of climate data tends to produce very large data sets, which hardly can be processed in classical post-processing visualization applications. Within the most traditional post-processing scenarios the visualization pipeline consisting of the processes data generation, visualization mapping and rendering is distributed into two parts over the network or separated via file transfer: the data generation on a supercomputer on the one hand and the other tasks on a special visualization system on the other hand. That way either temporary data sets with huge volume have to be transferred over the network, which leads to bandwidth bottlenecks and volume limitations. As an alternative all simulation and visualization processes are integrated in a monolithic application, where just 2D pixel data is stored, which reduces the user's possibilities for 3D interaction with visualization to frame skipping. Within the Climate Visualization Lab - as part of the Cluster of Excellence "Integrated Climate System Analysis and Prediction" (CliSAP at the University of Hamburg, in cooperation with the German Climate Computing Center (DKRZ) - we plan to integrate a different approach, which has been proven to be successful in former meteorology applications, e.g. PALM (Parallel Large Eddy Simulation Model). Our software framework DSVR is based on the separation of the process chain between the mapping and the rendering processes. We have developed a parallelized visualization library based on MPI and evaluated on various supercomputers. DSVR can be used to integrate the visualization into a parallel simulation model to support in-situ processing, resulting in a sequence of time-based geometric 3D objects which can be interactively rendered in a separate 3D viewer application. To meet the actual requirements (a) to visualize existing data sets, (b) to support more than rectilinear grids, and (c) to integrate in-situ processing in the ICON model, all based on our DSVR framework

  7. 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.

  8. Preoperative Embolization of Hypervascular Thoracic, Lumbar, and Sacral Spinal Column Tumors: Technique and Outcomes from a Single Center

    OpenAIRE

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

    2013-01-01

    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.

  9. Neurons in the lateral sacral cord of the cat project to periaqueductal grey, but not to thalamus

    NARCIS (Netherlands)

    Klop, EM; Mouton, LJ; Kuipers, R; Holstege, G; Klop, [No Value

    2005-01-01

    Previous work of our laboratory has shown that neurons in the lateral sacral cord in cat project heavily to the periaqueductal grey (PAG), in all likelihood conveying information from bladder and genital organs. In humans this information usually does not reach consciousness, which raises the questi

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

    Science.gov (United States)

    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 consideration of the Sacral Slope. Fortschr Röntgenstr 2017; 189: 233 - 239.

  11. Facetas em dentes anteriores

    OpenAIRE

    Veloso, Helena Rafaela Lourenço Martins

    2015-01-01

    Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária A presente revisão bibliográfica aborda as facetas estéticas em dentes anteriores, pela crescente valorização de um sorriso esteticamente agradável, facto que faz com que as pessoas procurem cada vez mais alternativas de tratamento para melhorar a aparência do seu sorriso. Os dentes anteriores são decisivos na aparência estética e, c...

  12. Anterior Urethral Valves

    Directory of Open Access Journals (Sweden)

    Vidyadhar P. Mali

    2006-07-01

    Full Text Available We studied the clinical presentation and management of four patients with anterior urethral valves; a rare cause of urethral obstruction in male children. One patient presented antenatally with oligohydramnios, bilateral hydronephrosis and bladder thickening suggestive of an infravesical obstruction. Two other patients presented postnatally at 1 and 2 years of age, respectively, with poor stream of urine since birth. The fourth patient presented at 9 years with frequency and dysuria. Diagnosis was established on either micturating cystourethrogram (MCU (in 2 or on cystoscopy (in 2. All patients had cystoscopic ablation of the valves. One patient developed a postablation stricture that was resected with an end-to-end urethroplasty. He had an associated bilateral vesicoureteric junction (VUJ obstruction for which a bilateral ureteric reimplantation was done at the same time. On long-term follow-up, all patients demonstrated a good stream of urine. The renal function is normal. Patients are continent and free of urinary infections. Anterior urethral valves are rare obstructive lesions in male children. The degree of obstruction is variable, and so they may present with mild micturition difficulty or severe obstruction with hydroureteronephrosis and renal impairment. Hence, it is important to evaluate the anterior urethra in any male child with suspected infravesical obstruction. The diagnosis is established by MCU or cystoscopy and the treatment is always surgical, either a transurethral ablation or an open resection. The long-term prognosis is good.

  13. Intradural anterior transpetrosal approach.

    Science.gov (United States)

    Ichimura, Shinya; Hori, Satoshi; Hecht, Nils; Czabanka, Marcus; Vajkoczy, Peter

    2016-10-01

    The standard anterior transpetrosal approach (ATPA) for petroclival lesions is fundamentally an epidural approach and has been practiced for many decades quite successfully. However, this approach has some disadvantages, such as epidural venous bleeding around foramen ovale. We describe here our experience with a modified technique for anterior petrosectomy via an intradural approach that overcomes these disadvantages. Five patients with petroclival lesions underwent surgery via the intradural ATPA. The intraoperative hallmarks are detailed, and surgical results are reported. Total removal of the lesions was achieved in two patients with petroclival meningioma and two patients with pontine cavernoma, whereas subtotal removal was achieved in one patient with petroclival meningioma without significant morbidity. No patient experienced cerebrospinal fluid leakage. The intradural approach is allowed to tailor the extent of anterior petrosectomy to the individually required exposure, and the surgical procedure appeared to be more straightforward than via the epidural route. Caveats encountered with the approach were the temporal basal veins that could be spared as well as identification of the petrous apex due to the lack of familial epidural landmarks. The risk of injury to the temporal bridging veins is higher in this approach than in the epidural approach. Intradural approach is recommended in patients with a large epidural venous route, such as sphenobasal and sphenopetrosal vein. Navigation via bone-window computed tomography is useful to identify the petrous apex.

  14. Fibrous dysplasia of the rib presenting as a huge chest wall tumor: report of a case.

    Science.gov (United States)

    Chang, B S; Lee, S C; Harn, H J

    1994-07-01

    Fibrous dysplasia of the rib is not uncommon, but is rarely demonstrated as a huge chest wall mass with severe clinical symptoms. A 59-year-old patient, presenting with a huge, rapidly expanding chest wall tumor compressing the lung, liver and heart accompanied by chest pain and dyspnea, is reported. The tumor was success-fully excised by local radical resection.

  15. Huge van Bordeeus : een ridder van Karel de Grote op avontuur in het Oosten

    NARCIS (Netherlands)

    Lens, Maria Johanna

    2004-01-01

    'Huge van Bordeeus' is de dissertatie van Maria Lens. Hierin doet zij verslag van haar onderzoek naar de Middelnederlandse overlevering van een Franse tekst, 'Huon de Bordeaux', over de ridder Huge van Bordeeus. Deze veertiende-eeuwse ridder, leenman van Karel de Grote, moet de baard en vier tanden

  16. Pre-operative embolization facilitating a posterior approach for the surgical resection of giant sacral neurogenic tumors.

    Science.gov (United States)

    Chen, Kangwu; Zhou, Ming; Yang, Huilin; Qian, Zhonglai; Wang, Genlin; Wu, Guizhong; Zhu, Xiaoyu; Sun, Zhiyong

    2013-07-01

    The present study aimed to assess a posterior approach for the surgical resection of giant sacral neurogenic tumors, and to evaluate the oncological and functional outcomes. A total of 16 patients with giant sacral neurogenic tumors underwent pre-operative embolization and subsequent posterior sacral resection between January 2000 and June 2010. Benign tumors were identified in 12 cases, while four cases exhibited malignant peripheral nerve sheath tumors (MPNSTs). An evaluation of the operative techniques used, the level of blood loss, any complications and the functional and oncological outcomes was performed. All tumor masses were removed completely without intra-operative shock or fatalities. The mean tumor size was 17.5 cm (range, 11.5-28 cm) at the greatest diameter. The average level of intra-operative blood loss was 1,293 ml (range, 400-4,500 ml). Wound complications occurred in four patients (25%), including three cases of cutaneous necrosis and one wound infection. The mean follow-up time was 59 months (range, 24-110 months). Tumor recurrence or patient mortality as a result of the disease did not occur in any of the patients with benign sacral neurogenic tumors. The survival rate of the patients with malignant lesions was 75% (3/4 patients) since 25 % (1/4 patients) had multiple local recurrences and succumbed to the disease. The patients with benign tumors scored an average of 92.8% on the Musculoskeletal Tumor Society (MSTS) score functional evaluation, while the patients with malignant tumors scored an average of 60.3%. A posterior approach for the surgical resection of giant sacral neurogenic tumors, combined with pre-operative embolization may be safely conducted with satisfactory oncological and functional outcomes.

  17. Establishment of an animal model of sacral nerve root avulsion in rats%大鼠骶丛根性撕脱伤模型的建立

    Institute of Scientific and Technical Information of China (English)

    江曦; 陈爱民; 张志凌; 侯春林; 鹿楠

    2009-01-01

    目的 建立大鼠骶丛撕脱伤模唰并评价其有效性.方法 选用20只成年SD大鼠,雌雄不限,不打开椎板,在神经孔外撕断右侧L神经根,左侧为对照侧.术后观察各组大鼠的存活情况,对受试大鼠进行受试鼠行为学运动(Basso-Beattie-Bresnahan,BBB)评分.并对其进行体感诱发电位(SEP)及双侧股二头肌、小腿三头肌及胫前肌刺激电位检测,辣根过氧化酶(HRP)逆行永踪,双侧股二头肌、小腿三头肌及胫前肌称重及肌肉横截面行双侧对比研究,以评价造模效果.结果 (1)一般情况:19只大鼠存活,1只大鼠死亡,存活率为95.0%.实验大鼠BBB评分为(10.78±3.15)分,而正常大鼠为21分;(2)SEP检测:17只大鼠患肢未在双侧大脑皮层检测到SEP,造模成功率为89.5%;(3)HRP示踪:2只大鼠脊髓L4-6节段内可见阳性反应,17例阴性,造模成功率为89.5%;(4)双侧股二头肌,小腿三头肌及胫前肌称重及肌肉横截面对比,差异有统计学意义;(5)电镜检测撕脱侧肌肉出现萎缩、细胞核中间移位及出现肌卫星细胞等失神经支配征象.结论 通过大鼠椎管外撕脱L4-6造模,是建立大鼠骶丛撕脱伤模型的一种可而理想的方法.%Objective To establish an animal model of sacral nerve root avulsion in rats and e-valuate its efficiency. Methods A total of 20 adult SD rats (either sex) were chosen at random to es-tablish the sacral nerve root avulsion model by avulsing the fight L4-6 nerve roots out of intervertebral fo-ramina without laminectomy. The left side was set as control group. The models were evaluated in aspects of survival rate, Basso-Beattie-Bresnahan (BBB) scores, somatosensory evoked potential (SEP), horse radish peroxidase (HRP) tracing, bilateral weight and cross section area (CSA) of muscle biceps femo-ris, fiber of triceps surae and anterior tibial muscle. Results Of all, 19 rats were survived but one died, with survival rate of 95.0%. The BBB score was (10.78+3.15) points

  18. Transarterial chemoembolization for huge hepatocellular carcinoma with diameter over ten centimeters: a large cohort study.

    Science.gov (United States)

    Xue, Tongchun; Le, Fan; Chen, Rongxin; Xie, Xiaoying; Zhang, Lan; Ge, Ningling; Chen, Yi; Wang, Yanhong; Zhang, Boheng; Ye, Shenglong; Ren, Zhenggang

    2015-03-01

    Patients with huge hepatocellular carcinoma >10 cm in diameter represent a special subgroup for treatment. To date, there are few data and little consensus on treatment strategies for huge hepatocellular carcinoma. In this study, we summarized the effects and safety of transarterial chemoembolization for huge hepatocellular carcinoma. A retrospective study was performed based on a large cohort of patients (n = 511) with huge hepatocellular carcinoma who underwent serial transarterial chemoembolization between January 2008 to December 2011 and were followed up until March 2013. We found median survival time was 6.5 months. On multivariate analysis, Child-Pugh class (A versus B) (p huge hepatocellular carcinoma and is recommended as a component of combination therapy. In addition, patients with good liver function and low alpha-fetoprotein levels may acquire greater survival benefits from transarterial chemoembolization.

  19. Appraisal of efficacy and safety of intralesional injection of high concentration of bleomycin A5 for treatment of huge macrocystic lymphatic malformations in cervical region.

    Science.gov (United States)

    Xu, Da-Peng; Zhai, Qin-Kai; Cheng, Chen; Gong, He; Wang, Hong-Wei; Wang, Xu-Kai

    2014-09-01

    The objective of this study was to investigate the therapeutic effects and safety of intralesional injection of high concentration of bleomycin A5 for huge (more than 5 cm in diameter) macrocystic lymphatic malformations (LMs) in the cervical region. Thirty-two patients with huge macrocystic LMs were treated with percutaneous injection of bleomycin A5 in our department between 2006 and 2011. Among them, 13 patients had unilateral submandibular lesions, and 19 patients had lesions in anterior cervical regions. The age of patients ranged from 10 months to 29 years (mean age, 11.4 y). The concentration of the drug was as high as 2.7 mg/mL (8 mg/3 mL) with an addition of dexamethasone. The mean sessions of injection were 1.6 (1-3 sessions). Repeated injection interval was 4 to 6 weeks. The follow-up period was 6 months to 4 years after the last treatment, and the mean follow-up time was 18 months. The results were evaluated based on clinical examination and Doppler ultrasonography scan. The clinical follow-up showed excellent response in 28 of the 32 patients, whereas 4 of the 32 patients also had a satisfactory response. No serious complications were encountered. Intralesional injection of high concentration of bleomycin A5 was an effective and safe treatment of huge macrocystic LMs in the cervical region and can obtain satisfactory results esthetically and functionally without surgery.

  20. [Association of intercalary cervical bone and occult lumbar and sacral spina bifida. Case report].

    Science.gov (United States)

    Ruiz-Osuna, César; Avila-Zamorano, Myrna Lizeth; Suárez-Ahedo, Carlos; Trueba-Davalillo, Cesáreo

    2009-01-01

    The defects of the spinal cord enclose diverse malformations that go from spina bifida to myelomeningocele but there is also a rare variant that is the intercalary bone. The incidence of this phenomenon may vary in 1 to 1,000 to 5,000. At our knowledge, there are no cases reported where it can be an association of intercalary bone and a bifid spine in different levels. In this article we report the case of one patient that coincide with an intercalary cervical bone, bifid spine in lumbar column and bifid spine in sacral column. The objective of this article is also to comment how the clinical symptoms are unspecific, the chronic pain is the frequent symptom, and how the physiotherapy and anti-inflammatory drugs can provide excellent results in a short and medium term.

  1. Metrizamide lumbar epidurography with Seldinger technique through the sacral notch and selective nerve root injection

    Energy Technology Data Exchange (ETDEWEB)

    Hatten, H.P. Jr.

    1981-01-01

    Lumbar epidurography serves as an important radiographic procedure in the evaluation of patients with equivocal myelography and confusing or non-diagnostic physical findings. It is particularly valuable in patients with a wide ventral epidural space secondary to previous surgery, arachnoiditis or on a congenital basis. Several techniques and various contrast agents have been employed for the procedure. A pure Seldinger technique with a caudal approach through the sacral hiatus and injection of metrizamide gives excellent visualization of the epidural space and nerve root sleeves. The proper concentration of metrizamide is crucial for optimal results. Lateral, AP, and AP oblique radiographs, occasionally combined with lateral, complex motion tomography, clearly demonstrate the root sleeves and ventral epidural space. CT scanning, with present technology, does not provide the necessary detail for evaluating the epidural space.

  2. Trans-sacral screw fixation in the treatment of high dyplastic developmental spondylolisthesis.

    Science.gov (United States)

    Landi, Alessandro; Marotta, Nicola; Mancarella, Cristina; Tarantino, Roberto; Delfini, Roberto

    2013-06-16

    We describe the case of a 67-year-old woman with L5-S1 ontogenetic spondylolisthesis treated with pedicle fixation associated with interbody arthrodesis performed with S1-L5 trans-sacral screwing according to the technique of Bartolozzi. The procedure was followed by a wide decompressive laminectomy. The patient had a progressive improvement of the symptoms which gradually disappeared in 12 mo. The radiograph at 6 and 12 mo showed complete fusion system. The choice of treatment in L5-S1 ontogenetic spondylolithesis is related to a correct clinical and diagnostic planning (X-ray, computer tomography magnetic resonance imaging, Measurement). In particular, the severity index and the square of unstable zone, and the standard measurements already described in the literature, are important to understand and to plane the correct surgical strategy, that require, in most of the times, fusion and interbody artrodesis.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  4. Rapid rehabilitation programme following sacral stress fracture in a long-distance running female athlete.

    Science.gov (United States)

    Knobloch, Karsten; Schreibmueller, Louisa; Jagodzinski, Michael; Zeichen, Johannes; Krettek, Christian

    2007-11-01

    Stress fractures occur in normal bone due to mechanical overload by cyclic stress increasing the osteoclastic activity, thus facilitating weakening leading to fracture of bones. Long-distance running may lead to stress fractures of the mid- and distal tibia and of the metatarsal bones. Stress fractures to the sacrum are rare. Certain factors for stress fractures in runners have been identified, such as leg-length inequality, a high longitudinal arch of the foot, forefoot varus, and menstrual irregularities in case of female athlete triad. We report on a 22-year-old female runner (usually training 140 km/week) suffering a sacral fatigue-type fracture. The female athlete triad with eating disorders, dysmenorrhea, and osteopenia was ruled out. Sexual hormone blood samples proofed normal values. The diagnosis was performed using magnetic resonance imaging 2 weeks after the onset of buttock pain. A conservative treatment regimen was initiated with strict physical rest for the first 2 weeks, and then gradual increase of physical activity with 60-90 min of daily cycling and moderate 2 x 60 min cross-training. After another 2 weeks time, daily 60-90 min of walking, Nordic pole walking, and moderate strength training two times a week was performed. At 7 weeks running was started, gradually increased to 90 km/week without any pain. A rapid rehabilitation programme after sacral stress fractures involving low impact physical activity, such as Walking and Nordic pole walking, is applicable to female athletes after ruling out the female athlete triad.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Anterior knee pain

    Energy Technology Data Exchange (ETDEWEB)

    LLopis, Eva [Hospital de la Ribera, Alzira, Valencia (Spain) and Carretera de Corbera km 1, 46600 Alzira Valencia (Spain)]. E-mail: ellopis@hospital-ribera.com; Padron, Mario [Clinica Cemtro, Ventisquero de la Condesa no. 42, 28035 Madrid (Spain)]. E-mail: mario.padron@clinicacemtro.com

    2007-04-15

    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries.

  7. The anterior cingulate cortex

    Directory of Open Access Journals (Sweden)

    Pavlović D.M.

    2009-01-01

    Full Text Available The anterior cingulate cortex (ACC has a role in attention, analysis of sensory information, error recognition, problem solving, detection of novelty, behavior, emotions, social relations, cognitive control, and regulation of visceral functions. This area is active whenever the individual feels some emotions, solves a problem, or analyzes the pros and cons of an action (if it is a right decision. Analogous areas are also found in higher mammals, especially whales, and they contain spindle neurons that enable complex social interactions. Disturbance of ACC activity is found in dementias, schizophrenia, depression, the obsessive-compulsive syndrome, and other neuropsychiatric diseases.

  8. 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

  9. Multidisciplinary management of anterior diastemata

    DEFF Research Database (Denmark)

    Furuse, Adilson Yoshio; Herkrath, Fernando José; Franco, Eduardo Jacomino

    2007-01-01

    Anterior diastemata may compromise the harmony of a patient's smile. Consideration of etiologic factors, previous gingival conditioning, and individual treatment planning are essential in the proper management of anterior diastemata. An integrated orthodontic-restorative approach may enhance...... the aesthetic results when orthodontic therapy itself is not feasible. This article presents integrated orthodonticrestorative solutions of anterior diastemata, associated with the conditioning of the gingival tissue with composite resin, and discusses the most relevant aspects related to their etiology...

  10. Anterior knee pain: uncommon aetiologies

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    Q. Louw

    2003-02-01

    Full Text Available The aim of this review is to inform clinicians of less common causes of anterior knee pain. Relatively less common conditions leading to anterior knee pain include infra-patellar contracture syndrome, conditions affecting the fat pad, saphenous nerve entrapment, prepatellar neuromas, increased intraosseous pressure of the patella, ganglions of the anterior cruciate ligament and cysts. The aetiology, clinical presentation, risk factors and management  of each condition are outlined. Due to the common occurrence of anterior knee pain clinicians must remain vigilant in assessing the cause of this clinical presentation.

  11. Huge hepatocellular carcinoma with multiple intrahepatic metastases: An aggressive multimodal treatment

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    Satoshi Yasuda

    2015-01-01

    Conclusion: Multimodal treatment involving hepatectomy and TACE might be a good treatment strategy for patients with huge HCC with multiple intrahepatic metastases if the tumors are localized in the liver without distant or peritoneal metastasis.

  12. 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.).

  13. A huge ovarian mucinous cystadenoma causing virilization, preterm labor, and persistent supine hypotensive syndrome during pregnancy.

    Science.gov (United States)

    Kucur, Suna Kabil; Acar, Canan; Temizkan, Osman; Ozagari, Aysim; Gozukara, Ilay; Akyol, Atif

    2016-01-01

    Mucinous cystadenoma (MC) of the ovary is an unilateral, multilocular cystic benign epithelial tumor. Supposed to be hormone responsive, MC reaches huge sizes during pregnancy. Aortocaval compression is common during pregnancy, especially when the pregnant woman is in the supine position. However, the compression recovers with a change in position. The authors report the first case of a huge mucinous cystadenoma of the ovary complicating pregnancy and causing virilization, premature labor, and persistent supine hypotensive syndrome.

  14. Robot-assisted laparoscopic resection of a huge pelvic tumor: A case report.

    Science.gov (United States)

    Jia, Zhuomin; Lyu, Xiangjun; Xu, Yong; Leonardi, Rosario; Zhang, Xu

    2016-07-04

    The traditional open surgery, for the treatment of huge tumor in the narrow space of pelvic cavity and in close proximity to pelvic organs and neurovascular structures, is very difficult and challenging. We report a case of huge neurilemmoma operated using the robot-assisted laparoscopy. We used interventional pre-operation embolization to control blood supply of tumor because MRI showed the tumor had a sufficient blood supply.

  15. The HUGE formula (hematocrit, urea and gender): association with cardiovascular risk.

    Science.gov (United States)

    Robles, N R; Felix, F J; Fernandez-Berges, D; Perez-Castán, J; Zaro, M J; Lozano, L; Alvarez-Palacios, P; Garcia-Trigo, A; Tejero, V; Morcillo, Y; Hidalgo, A B

    2013-07-01

    To evaluate the relationship between chronic renal failure (CFR) defined through HUGE (hematocrit, urea and gender) formula score and the patient's cardiovascular risk measured through cardiovascular disease antecedents such as ischemic cardiopathy, cerebrovascular disease and peripheral arterial disease. The sample consisted of 2,831 subjects. Mean age was 51.2±14.7 years and 53.5% were female. Serum creatinine, urea, hematocrit and 24h proteinuria were analyzed. HUGE score was calculated from gender, urea and hematocrit. GFR was estimated from uncalibrated serum creatinine using the abbreviated Modification of Diet in Renal Disease equation (MDRD-4). UAE was measured in first morning urine sample. Using HUGE formula 2.2% (n = 61) of subjects had CRF. Of them, 12 (19.7%) had cardiovascular disease history. Among patients without CRF (n = 2770), 194 subjects had history of previous cardiovascular diseases (0.07%; p HUGE definition of CRF was 3.25 (p = 0.001, Mantel-Haenszel test). CFR was associated to higher pulse pressure (PP) and increased urinary albumin excretion. A significant cardiovascular risk was associated to the diagnosis of CRF through HUGE formula. This relation was closer than the obtained using MDRD estimated GFR in spite of a bigger sample. HUGE formula seems to be a useful tool for diagnosing CRF and evaluate the cardiovascular risk of these patients.

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

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    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.

  17. 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.

  18. [Deep acupuncture at Baliao points (eight sacral foramina) by Professor WANG Ling-Ling and its clinical application].

    Science.gov (United States)

    Cai, Hai-Hong; Wang, Ling-Ling

    2014-03-01

    With deep acupuncture at Baliao points (eight sacral foramina) as the core, Professor WANG Ling-ling has treated diseases of urinary, digestive and reproductive systems with superior therapeutic effect. The key for efficacy of Baliao points is deep acupuncture. Only deeply insert into acupoints with long needles and directly stimulate at sacral nerves, could Baliao points play a superior role in treatment effect. Searching acupoints is the basis of deep acupuncture, and superficial anatomy should be combined to summarize the methods of searching Baliao points. The premise of deep acupuncture is needling manipulation. The angles of needles must be adjusted according to morphological features of posterior sacral foramina, or it is hard to practice deep acupuncture into Baliao points. The description of location and manipulation on Baliao points in ancient and modern literature was vague, which restricts clinical application of Baliao points. A lot of research on location, manipulation and clinical application of Baliao points has performed by Professor WANG Ling-ling, and its manipulation and clinical cases are introduced to make a positive effect on its application and popularization.

  19. Prevalence of sacral spina bifida occulta and its relationship to age, sex, race, and the sacral table angle: an anatomic, osteologic study of three thousand one hundred specimens.

    Science.gov (United States)

    Eubanks, Jason David; Cheruvu, Vinay K

    2009-07-01

    An anatomic, osteologic study of spina bifida occulta (SBO). To determine the prevalence and patterns of SBO in a large population and examine its relationship to age, sex, and race; then to evaluate SBOs relationship to the sacral table angle (STA) when compared with an age-matched control group. SBO has a reported prevalence of 1.2% to 50% and has been implicated in various pathologic problems. SBO is often associated with spondylolysis or spondylolithesis. The STA has been implicated as an etiologic or predictive factor in the presence of pars defects. Three thousand one hundred osteologic specimens were evaluated for the presence of SBO. SBO was graded on a scale from 0 to III. Information on the age, sex, race, and STA of each specimen was recorded and measured, respectively. Prevalence and patterns of SBO were enumerated. The STAs of an age-matched control group of 355 specimens were examined. The SBO group and control groups were compared in regards to STA, controlling for age, sex, and race. Overall, 355 specimens displayed SBO, for an overall prevalence of 12.4%. Of the SBO specimens, 68.7% were white, 88.2% were men, 53% were grade I, 37% II, and 10% III. All 3 grades of SBO were more common in men than women (88.2% vs. 11.8%) and more prevalent in whites than blacks (68.7% vs. 31.3%) (P = 0.01). SBO decreased in prevalence with increasing age. The average STA in SBO specimens was 95.9 degrees . This differed from an age-matched control group, 92.1 degrees (P < 0.0001). Every 1 degrees increase in STA resulted in a 6% increased likelihood of SBO. In SBO specimens, the STA decreased with increasing age, contrary to age-matched controls. SBO has an overall prevalence of 12.4% in a large, diverse population. SBO is more common in men and whites and decreases in prevalence with increasing age. The STA is greater in SBO when compared with controls and an increased STA predicts SBO. In SBO, the STA decreases with increasing age.

  20. Sacral nerve stimulation enhances early intestinal mucosal repair following mucosal injury in a pig model.

    Science.gov (United States)

    Brégeon, Jérémy; Coron, Emmanuel; Da Silva, Anna Christina Cordeiro; Jaulin, Julie; Aubert, Philippe; Chevalier, Julien; Vergnolle, Nathalie; Meurette, Guillaume; Neunlist, Michel

    2016-08-01

    Reducing intestinal epithelial barrier (IEB) dysfunctions is recognized as being of major therapeutic interest for various intestinal disorders. Sacral nerve stimulation (SNS) is known to reduce IEB permeability. Here, we report in a pig model that SNS enhances morphological and functional recovery of IEB following mucosal injury induced via 2,4,6-trinitrobenzenesulfonic acid. These effects are associated with an increased expression of tight junction proteins such as ZO-1 and FAK. These results establish that SNS enhances intestinal barrier repair in acute mucosal injury. They further set the scientific basis for future use of SNS as a complementary or alternative therapeutic option for the treatment of gut disorders with IEB dysfunctions such as inflammatory bowel diseases or irritable bowel syndrome. Intestinal epithelial barrier (IEB) dysfunctions, such as increased permeability or altered healing, are central to intestinal disorders. Sacral nerve stimulation (SNS) is known to reduce IEB permeability, but its ability to modulate IEB repair remains unknown. This study aimed to characterize the impact of SNS on mucosal repair following 2,4,6-trinitrobenzenesulfonic acid (TNBS)-induced lesions. Six pigs were stimulated by SNS 3 h prior to and 3 h after TNBS enema, while sham animals (n = 8) were not stimulated. The impact of SNS on mucosal changes was evaluated by combining in vivo imaging, histological and functional methods. Biochemical and transcriptomic approaches were used to analyse the IEB and mucosal inflammatory response. We observed that SNS enhanced the recovery from TNBS-induced increase in transcellular permeability. At 24 h, TNBS-induced alterations of mucosal morphology were significantly less in SNS compared with sham animals. SNS reduced TNBS-induced changes in ZO-1 expression and its epithelial pericellular distribution, and also increased pFAK/FAK expression compared with sham. Interestingly, SNS increased the mucosal density of neutrophils

  1. [Anterior cervical hypertrichosis: case report].

    Science.gov (United States)

    Orozco-Gutiérrez, Mario H; Sánchez-Corona, José; García-Ortiz, José E; Castañeda-Cisneros, Gema; Dávalos-Rodríguez, Nory O; Corona-Rivera, Jorge R; García-Cruz, Diana

    2016-10-01

    The non-syndromic anterior cervical hypertrichosis (OMIM N° 600457) is a genetic disorder characterized by a patch of hair at the level of the laryngeal prominence. We present a 12-year-old boy with anterior cervical hypertrichosis and mild generalized hypertrichosis. He has no neurological, ophthalmological or skeletal anomalies. The clinical follow up is 10 years.

  2. Inestabilidad Anterior de Hombro

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    Pablo David Flint Kuran

    2013-11-01

    Full Text Available In­tro­duc­ción La luxación recidivante de hombro es una patología frecuente en pacientes jóvenes, laboralmente activos. Existen numerosas técnicas quirúrgicas para la inestabilidad glenohumeral. La técnica de Bristow, discutida por no ser anatómica y por sus complicaciones, continúa vigente debido al bajo índice de reluxaciones. Los objetivos fueron determinar el índice de recidiva, alteraciones funcionales e índice de consolidación del injerto. Materiales­ y­ Métodos Se evaluaron 24 pacientes del sexo masculino, de entre 19 y 40 años, operados por luxación anterior recidivante de hombro según la técnica de Bristow, entre enero de 2003 y agosto de 2011. Se evaluó la tasa de reluxación, la función articular según el puntaje de Constant y el posicionamiento del injerto con respecto a la superficie articular con tomografía y radiografías para evaluar la consolidación del injerto. Se registraron las complicaciones quirúrgicas. Resultados ­Todos los pacientes eran hombres, con rango de edad de 19 a 40 años. La causa fue traumática en 24 pacientes. Dieciséis pacientes presentaron más de 3 episodios de luxación prequirúrgicos. Según la escala de Constant, 21 obtuvieron entre 96 y 100 puntos, y los restantes, entre 90 y 95 puntos. No hubo nuevos episodios de luxaciones. La tomografía mostró la consolidación en todos los casos. Un paciente tuvo una imagen osteolítica alrededor del tornillo, sin compromiso funcional del hombro. Conclusión La técnica de Bristow para tratar la luxación anterior recidivante de hombro provocó un bajo índice de complicaciones, con resultados funcionales entre excelentes y buenos. No hubo episodios de reluxación y se logró la consolidación del injerto óseo en todos los casos.

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

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    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

  6. Assessment of spinal movement reduction by thoraco-lumbar-sacral orthoses.

    Science.gov (United States)

    van Leeuwen, P J; Bos, R P; Derksen, J C; de Vries, J

    2000-01-01

    Bracing is a common modality in treating spinal fractures. Its objective is to reduce spinal movements and to stabilize the fracture. Until now, factual insight into the movement-reducing properties of Thoraco-Lumbar-Sacral Orthoses (TLSOs) has been missing. Two common TLSOs (e.g., Jewett and Voigt-Bähler) were tested for their movement-reducing properties in two small groups of healthy subjects. In the first study, maximal gross spinal movements, with and without a TLSO, were measured by means of a Portable Posture Registration Set (PPRS) in three different planes. In the second study, maximal segmental vertebral movements in the regions T10 to L4 were measured via X-rays. With few notable exceptions, wearing a TLSO, as measured by the PPRS and X-ray techniques, significantly reduced the segmental as well as gross spinal movements. However, the amount of movement reduction varied greatly from subject-to-subject and was sometimes small. Unfortunately, data are lacking on the amount of movement reduction that is clinically relevant.

  7. [Gluteal artery based perforator flaps for sacral pressure sore reconstruction in children].

    Science.gov (United States)

    Berenguer, B; Simal, I; Marín, M C; E de Tomás; Riquelme, O; García Martín, A; González, J L

    2014-10-01

    Children have much lower incidence of pressure sores (PS) than adults and furthermore, they are diagnosed in earlier stages. Therefore, the reported experience with surgical treatment of advanced pediatric PS is scarce. We present the surgical treatment of 2 chronic PS stage IV in children aged 11 and 14 years, by means of perforator flaps based on the gluteal arteries: in the first case we used a free-style flap based on a left medial gluteal perforator and in the second a large reusable rotation-advancement flap based on both right superior and inferior gluteal artery perforators. In both patients we achieved a rapid cure with 100% survival of the flaps and a stable cover over a 6 month and 1 year follow-up respectively. Gluteal artery perforator flaps can produce excellent and durable results in the reconstructive treatment of sacral pressure sores in children. These flaps carry lower morbidity than musculocutaneous flaps and are more reliable than traditional fasciocutaneous flaps. Furthermore they preserve more reconstructive options in case of recurrence during the children's lifetime.

  8. 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

  9. Newtonian self-gravitating system in a relativistic huge void universe model

    Science.gov (United States)

    Nishikawa, Ryusuke; Nakao, Ken-ichi; Yoo, Chul-Moon

    2016-12-01

    We consider a test of the Copernican Principle through observations of the large-scale structures, and for this purpose we study the self-gravitating system in a relativistic huge void universe model which does not invoke the Copernican Principle. If we focus on the the weakly self-gravitating and slowly evolving system whose spatial extent is much smaller than the scale of the cosmological horizon in the homogeneous and isotropic background universe model, the cosmological Newtonian approximation is available. Also in the huge void universe model, the same kind of approximation as the cosmological Newtonian approximation is available for the analysis of the perturbations contained in a region whose spatial size is much smaller than the scale of the huge void: the effects of the huge void are taken into account in a perturbative manner by using the Fermi-normal coordinates. By using this approximation, we derive the equations of motion for the weakly self-gravitating perturbations whose elements have relative velocities much smaller than the speed of light, and show the derived equations can be significantly different from those in the homogeneous and isotropic universe model, due to the anisotropic volume expansion in the huge void. We linearize the derived equations of motion and solve them. The solutions show that the behaviors of linear density perturbations are very different from those in the homogeneous and isotropic universe model.

  10. Colonic Angiodysplasia with a Huge Submucosal Hematoma in the Sigmoid Colon.

    Science.gov (United States)

    Shimizu, Takayuki; Koike, Daisuke; Nomura, Yukihiro; Ooe, Kenji

    2016-01-01

    Colonic angiodysplasia (AD) with bleeding as a comorbidity in the aging population is being increasingly reported. However, to our knowledge, there is no report on colonic AD accompanied by a huge hematoma. Herein, we report a case of colonic AD with a huge submucosal hematoma. A 75-year-old man with sudden melena was referred to our hospital. Helical computed tomographic angiography (CTA) revealed bleeding from the sigmoid colon. Additionally, colonoscopy showed a huge submucosal hematoma with bleeding in the sigmoid colon. As endoscopic hemostasis was difficult, sigmoidectomy was performed. The pathological diagnosis was colonic AD. The present case indicates that colonic AD should be considered in the differential diagnosis for melena. In addition, the case shows that helical CTA, which is a noninvasive imaging modality, is useful for the diagnosis of colonic AD and is as effective as colonoscopy and angiography for diagnosis.

  11. Robotic resection of huge presacral tumors: case series and comparison with an open resection.

    Science.gov (United States)

    Oh, Jae Keun; Yang, Moon Sool; Yoon, Do Heum; Rha, Koon Ho; Kim, Keung Nyun; Yi, Seong; Ha, Yoon

    2014-06-01

    Clinical case series and analysis. The purpose of the present study is to evaluate the advantages and disadvantages of robotic presacral tumor resection compared with conventional open approach. Conventional open approach for huge presacral tumors in the retroperitoneal space often demands excessive hospitalization and poor cosmesis. Furthermore, narrow surgical field sometimes interrupt delicate procedures. Nine patients with huge (diameter >10 cm) presacral tumors underwent surgery. Five patients among them had robotic procedure and the others had open transperitoneal tumor resection. Operation time, blood loss, hospitalization, and complications were analyzed. Robotic presacral tumor resection showed shorter operation time, less bleeding, and shorter hospitalization. Moreover, there was no complication related to abdominal adhesion. Although robotic resection for presacral tumor still has limitations technically and economically, robotic resection for huge presacral tumors demonstrated advantages over open resection specifically for benign neurogenic tumors.

  12. Giant pulmonary teratoma with huge splenic lymphangiomatosis: a very rare case.

    Science.gov (United States)

    Alsubaie, Hemail M; Alsubaie, Khaled M; Mahfouz, Mohammed Eid

    2017-09-01

    Teratomas are tumors composed of tissues derived from more than one germ cell line. They manifested with a great variety of clinical and radiological features. We report a case of a giant left hemithorax teratoma in a female with huge spleen tumor and review the relevant literature. A 38-year-old female with progressively aggravating dyspnea at rest from a mild trauma. Absent breath sounds on the left side. There was splenomegaly. Computed tomography scan revealed a huge mass (20 × 15 × 18 cm), containing elements of heterogeneous density in the left hemithorax. The spleen tumor was occupying most of the spleen without any other abdominal manifestations. The patient underwent left thoracotomy and laparoscopic splenectomy. Histopathological examination revealed a benign mature teratoma and cystic lymphangiomatosis of the spleen. To the best of our knowledge and after reviewing the available literature this is the first case of huge mature pulmonary teratoma with large cystic spleen lymphangiomatosis.

  13. Huge splenic epidermoid cyst with elevation of serum CA19-9 level.

    Science.gov (United States)

    Matsumoto, Sayo; Mori, Toshifumi; Miyoshi, Jinsei; Imoto, Yoshitaka; Shinomiya, Hirohiko; Wada, Satoshi; Nakao, Toshihiro; Shinohara, Hisamitsu; Yoshida, Sadahiro; Izumi, Keisuke; Okazaki, Jun; Muguruma, Naoki; Takayama, Tetsuji

    2015-01-01

    A 30-year-old female was referred to our hospital for further examination of liver dysfunction. A huge, soft mass was noted in her left upper quadrant on physical examination. Abdominal ultrasonography and computed tomography revealed a huge cystic tumor of 20 cm in the hilus of the spleen. Serum CA19-9 was 491 U/ml, and splenectomy was performed under suspicion of a malignant cystic tumor. The inner surface of the cyst was lined by squamous epithelial cells that were immunohistochemically positive for CA19-9. Serum CA19-9 level was normalized after the surgery. Our case of a very rare, huge epidermoid cyst of the spleen suggests that measurement of the serum CA19-9 level is useful for evaluating therapeutic efficacy of a splenic epidermoid cyst.

  14. Endovascular Treatment of a Huge Hepatic Artery Aneurysm by Coil Embolization Method: A Case Report.

    Science.gov (United States)

    Hemmati, Hossein; Karimian, Mehdi; Moradi, Habibollah; Farid Marandi, Kambiz; Haghdoost, Afrooz

    2015-07-01

    Hepatic artery aneurysms are rare but potentially life threatening. We describe a novel case of a successful endovascular coil embolization of a huge hepatic artery aneurysm. A 67-year-old woman presented with recent abdominal pain that had begun from 2 weeks before referring to our hospital. Sonographic and computerized tomographic (CT) findings revealed a huge hepatic artery aneurysm with 95 mm × 83 mm diameter. The patient underwent an endovascular technique. In aortic angiography, the celiac artery orifice and superior mesenteric artery were so narrow, so sonography was used in order to determine the exact position of the catheter in the celiac artery orifice. The aneurysm was thrombosed using coil embolization. Pulsation of the aneurysm immediately disappeared. Huge hepatic artery aneurysm can be safely treated using coil embolization.

  15. Collaborative treatment of huge intrathoracic meningoceles associated with neurofibromatosis type 1: a case report.

    Science.gov (United States)

    Cho, Deog Gon; Chang, Yong Jin; Cho, Kyu Do; Hong, Jae Taek

    2015-11-10

    An intrathoracic meningocele is a relatively rare disease, and it commonly accompanies neurofibromatosis type 1. Patients tend to have no symptom but if its size is too large and compresses a lung and neighboring organs, it needs shunt drainage or surgical resection. Herein, we present the case of a 52 year-old female patient with huge intrathoracic meningoceles associated with neurofibromatosis type 1, who has complained about chest discomfort and dyspnea at rest. As for a preliminary treatment, a neurosurgeon had performed a cystoperitoneal shunt, but the symptoms continued and the size of mass and the amount of pleural effusion did not change significantly. Therefore, the huge thoracic meningoceles were successfully treated through the thoracotomic approach in combination with lumbar puncture and cerebrospinal fluid drainage. It is reported that double huge intrathoracic meningoceles associated with neurofibromatosis type 1 was successfully treated by a shunting procedure followed by thoracotomic resection with collaboration of a neurosurgeon.

  16. Huge Bilateral Paramesonephric Cysts in a 25 year old Nulliparous woman

    Science.gov (United States)

    Sagili, Haritha; Krishnan, Manikandan; Dasari, Papa

    2013-01-01

    Paraovarian cysts are uncommon adnexal masses which are usually asymptomatic. We describe a case of bilateral huge paramesonephric cysts in a nulliparous woman. A 25-year-old lady presented with abdominal distension for one year duration. Examination and imaging revealed large abdominopelvic cystic masses with no solid areas or septations. Intraoperatively there were huge bilateral paraovarian cysts which were excised. Histopathology revealed low cuboidal to ciliated columnar epithelium with no evidence of ovarian parenchyma suggestive of paramesonephric cyst. Paraovarian cyst should be included in the differential diagnosis of a cystic mass visualised on ultrasound. PMID:24392412

  17. Huge dissected ascending aorta associated with pseudo aneurysm and aortic coarctation feridoun.

    Science.gov (United States)

    Sabzi, Feridoun; Khosravi, Donya

    2015-07-01

    We report a unique case of chronic dissection of the ascending aorta complicated with huge and thrombotic pseudoaneurysm in a patient with coarctation of descending aorta. Preoperative investigations such as transesophageal echocardiography (TEE) confirmed the diagnosis of dissection. Intraoperative findings included a12 cm eccentric bulge of the right lateral side of dilated the ascending aorta filled with the clot and a circular shaped intimal tear communicating with an extended hematoma and dissection of the media layer. The rarity of the report is an association of the chronic dissection with huge pseudoaneurysm and coarctation. The patient underwent staged repair of an aneurysm and coarctation and had an uneventful postoperative recovery period.

  18. Anterior Knee Pain (Chondromalacia Patellae).

    Science.gov (United States)

    Garrick, James G.

    1989-01-01

    This article presents a pragmatic approach to the definition, diagnosis, and management of anterior knee pain. Symptoms and treatment are described. Emphasis is on active involvement of the patient in the rehabilitation exercise program. (IAH)

  19. Diffuse anterior retinoblastoma: current concepts

    Directory of Open Access Journals (Sweden)

    Yang J

    2015-07-01

    Full Text Available Jing Yang,1–3 Yalong Dang,1–3 Yu Zhu,1 Chun Zhang2,3 1Department of Ophthalmology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, 2Department of Ophthalmology, Peking University Third Hospital, 3Clinical Stem Cell Research Center, Peking University Third Hospital, Beijing, People’s Republic of China Abstract: Diffuse anterior retinoblastoma is a rare variant of retinoblastoma seeding in the area of the vitreous base and anterior chamber. Patients with diffuse anterior retinoblastoma are older than those with the classical types, with the mean age being 6.1 years. The original cells of diffuse anterior retinoblastoma are supposed to be cone precursor. Patients most commonly present with pseudouveitis, pseudohypopyon, and increased intraocular pressure. The retina under fundus examination is likely to be normal, and the clinical features mimic the inflammation progress, which can often lead to misdiagnosis. The published diffuse anterior retinoblastoma cases were diagnosed after fine-needle aspiration biopsy running the potential risk of inducing metastasis. The most common treatment for diffuse anterior retinoblastoma is enucleation followed by systematic chemotherapy according to the patient’s presentation and clinical course. This review summarizes the recent advances in etiology (including tumorigenesis and cell origin, pathology, diagnosis, differential diagnosis, and new treatment. The challenges of early diagnosis and prospects are also discussed. Keywords: pathology, microenvironment, treatment, diagnosis 

  20. Anterior chamber depth during hemodialysis

    Directory of Open Access Journals (Sweden)

    Gracitelli CPB

    2013-08-01

    Full Text Available Carolina Pelegrini Barbosa Gracitelli,1 Francisco Rosa Stefanini,1 Fernando Penha,1 Miguel Ângelo Góes,2 Sérgio Antonio Draibe,2 Maria Eugênia Canziani,2 Augusto Paranhos Junior1 1Ophthalmology Department, 2Division of Nephrology, Federal University of São Paulo – UNIFESP, São Paulo, Brazil Background: Exacerbation of chronic glaucoma or acute glaucoma is occasionally observed in patients undergoing hemodialysis (HD because of anterior chamber depth changes during this therapy. Purpose: To evaluate anterior chamber depth and axial length in patients during HD sessions. Methods: A total of 67 eyes of 35 patients were prospectively enrolled. Axial length and anterior chamber depth were measured using ultrasonic biometry, and these measures were evaluated at three different times during HD sessions. Body weight and blood pressure pre- and post-HD were also measured. Results: There was no difference in the axial length between the three measurements (P = 0.241. We observed a significantly decreased anterior chamber depth (P = 0.002 during HD sessions. Conclusion: Our results support the idea that there is a change in anterior chamber depth in HD sessions. Keywords: anterior chamber, hemodialysis, axial length, acute angle-closure glaucoma

  1. Sacral Theater, a code to simulate the propagation of the superconducting magnet LHC atlas barrel toroid transition; Sacral theater, un code pour simuler la propagation de la transition de l'aimant supraconducteur LHC atlas barrel toroid

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  2. Effect of sacral slope on the biomechanical behavior of the low lumbar spine.

    Science.gov (United States)

    Jiang, Yugang; Sun, Xiaojiang; Peng, Xiongqi; Zhao, Jie; Zhang, Kai

    2017-05-01

    The present study investigated the influence of sacral slope (SS) on the biomechanical responses of the lumbar spine under specific physiological conditions. Firstly, based on computed tomography scan images of a 30-year-old healthy male volunteer (SS, 55°), a three-dimensional finite element (FE) model including the L4-S1 segment was established. Flexion, extension, lateral bending and torsion motions were simulated and compared with cadaveric test data in the literature to validate the lumbar spine FE model. The model was then modified with different SS values (40 and 25°) for the same simulations to describe the process of structural compensation. Numerical results showed that with the reduction of SS, the range of motions (ROMs) reduced for flexion and lateral bending, but increased for extension and torsion. For displacement, the maximum magnitudes of L4/5 annulus fibrosus (AF) reduced by 10-25% in flexion, lateral bending and torsion, but less effect was observed for extension with only a 4% drop. Nearly the same displacement distribution appeared on the L5/S1 AF with small changes in the four motions. For the stress field of L4/5 AF, in contrast to flexion, the magnitudes for extension and lateral bending varied markedly, and under torsion the value increased by ~10%. For L5/S1 AF, the stresses changed little under flexion, extension and lateral bending, but strongly declined for torsion by ~71.8%. In conclusion, the present study indicates that the change in SS due to structural compensation affects the biomechanical behavior of the spine structure, and attention should be paid to SS when conducting surgical procedures or selecting intervertebral fusion implants.

  3. Microsurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature.

    Science.gov (United States)

    Burke, John F; Thawani, Jayesh P; Berger, Ian; Nayak, Nikhil R; Stephen, James H; Farkas, Tunde; Aschyan, Hovik John; Pierce, John; Kanchwala, Suhail; Long, Donlin M; Welch, William C

    2016-05-01

    OBJECTIVE Tarlov cysts (TCs) occur most commonly on extradural components of the sacral and coccygeal nerve roots. These lesions are often found incidentally, with an estimated prevalence of 4%-9%. Given the low estimated rates of symptomatic TC and the fact that symptoms can overlap with other common causes of low-back pain, optimal management of this entity is a matter of ongoing debate. Here, the authors investigate the effects of surgical intervention on symptomatic TCs and aim to solidify the surgical criteria for this disease process. METHODS The authors performed a retrospective review of data from consecutive patients who were surgically treated for symptomatic TCs from September 2011 to March 2013. Clinical evaluations and results from surveying pain and overall health were used. Univariate statistical analyses were performed. RESULTS Twenty-three adults (4 males, 19 females) who had been symptomatic for a mean of 47.4 months were treated with laminectomy, microsurgical exposure and/or imbrication, and paraspinous muscle flap closure. Eighteen patients (78.3%) had undergone prior interventions without sustained improvement. Thirteen patients (56.5%) underwent lumbar drainage for an average of 8.7 days following surgery. The mean follow-up was 14.4 months. Univariate analyses demonstrated that an advanced age (p = 0.045), the number of noted perineural cysts on preoperative imaging (p = 0.02), and the duration of preoperative symptoms (p = 0.03) were associated with a poor postoperative outcome. Although 47.8% of the patients were able to return to normal activities, 93.8% of those surveyed reported that they would undergo the operation again if given the choice. CONCLUSIONS This is one of the largest published studies on patients with TCs treated microsurgically. The data suggest that patients with symptomatic TCs may benefit from open microsurgical treatment. Although outcomes seem related to patient age, duration of symptoms, and extent of disease

  4. Pühaduse performatiivsus ja kristlik teater / The Performativity of Sacrality and Christian Theatre

    Directory of Open Access Journals (Sweden)

    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

  5. Lumbar lordosis and sacral slope in lumbar spinal stenosis: standard values and measurement accuracy.

    Science.gov (United States)

    Bredow, J; Oppermann, J; Scheyerer, M J; Gundlfinger, K; Neiss, W F; Budde, S; Floerkemeier, T; Eysel, P; Beyer, F

    2015-05-01

    Radiological study. To asses standard values, intra- and interobserver reliability and reproducibility of sacral slope (SS) and lumbar lordosis (LL) and the correlation of these parameters in patients with lumbar spinal stenosis (LSS). Anteroposterior and lateral X-rays of the lumbar spine of 102 patients with LSS were included in this retrospective, radiologic study. Measurements of SS and LL were carried out by five examiners. Intraobserver correlation and correlation between LL and SS were calculated with Pearson's r linear correlation coefficient and intraclass correlation coefficients (ICC) were calculated for inter- and intraobserver reliability. In addition, patients were examined in subgroups with respect to previous surgery and the current therapy. Lumbar lordosis averaged 45.6° (range 2.5°-74.9°; SD 14.2°), intraobserver correlation was between Pearson r = 0.93 and 0.98. The measurement of SS averaged 35.3° (range 13.8°-66.9°; SD 9.6°), intraobserver correlation was between Pearson r = 0.89 and 0.96. Intraobserver reliability ranged from 0.966 to 0.992 ICC in LL measurements and 0.944-0.983 ICC in SS measurements. There was an interobserver reliability ICC of 0.944 in LL and 0.990 in SS. Correlation between LL and SS averaged r = 0.79. No statistically significant differences were observed between the analyzed subgroups. Manual measurement of LL and SS in patients with LSS on lateral radiographs is easily performed with excellent intra- and interobserver reliability. Correlation between LL and SS is very high. Differences between patients with and without previous decompression were not statistically significant.

  6. Re: Effect of Sacral Neuromodulation on Female Sexual Function and Quality of Life: Are They Correlated?

    Directory of Open Access Journals (Sweden)

    Mai Banakhar

    2015-06-01

    Full Text Available Sacral neuromodulation (SNM has become an established therapy for voiding dysfunction (VD. There have been published papers that documented improvement in bowel functions and bladder pain via SNM. However, improvement in female sexual function (FSF after SNM treatment remains unclear. Recently, Banakhar et al. evaluated the effects of SNM on FSF and its impact on quality of life (QoL and analyzed any correlation. They evaluated 33 female patients who were treated with SNM for VD. All patients completed the Female Sexual Function Index (FSFI, the 36-Item Short-Form Health Survey (SF-36, and incontinence questionnaires (the Urinary Distress Inventory [UDI-6] preoperatively and 4 months postoperatively. Ten patients were excluded from the study because they were not sexually active. The indications were: refractory overactive bladder in 19, frequency urgency syndrome in 2, and non-obstructive urinary retention in another 2 patients. SNM therapy significantly improved the total FSFI score (p=0.011. When the SF-36 and UDI-6 scores were compared, QoL showed significant improvement after SNM treatment. However, improvement in FSFI scores was not correlated with improvement in QoL. SNM therapy is an effective treatment modality in selected patient groups. In our country, SNM therapy has become a new option in the treatment of lower urinary tract problems. According to the results of this study, it is too early to conclude that SNM certainly improve FSF and QoL. The study just evaluated 23 cases. In order to have a more discrete conclusion, we need prospective trials with larger series

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  9. 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

    2013-01-01

    Summary 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. PMID:24070089

  10. Endovascular repair for a huge vertebral artery pseudoaneurysm caused by Behcet's disease

    Institute of Scientific and Technical Information of China (English)

    DONG Zhi-hui; FU Wei-guo; GUO Da-qiao; XU Xin; CHEN Bin; JIANG Jun-hao; YANG Jue; SHI Zheng-yu; WANG Yu-qi

    2006-01-01

    @@ Behcet's disease (BD), a multisystem chronic autoimmune process of unknown etiology,usually leads to arterial impairment. Isolated case reports have described BD-related arterial dissections, pseudoaneurysms or aneurysms.1-4 Recently, we successfully treated a huge vertebral artery pseudoaneurysm (VAPA) in a patient with BD by stent-grafting with preservation of the affected vertebral artery.

  11. Unusual Huge Keratoacanthoma in Sites of in the Previous Split-Thickness Skin Grafted Area

    Directory of Open Access Journals (Sweden)

    Fatih Uygur

    2009-09-01

    Full Text Available Keratoacanthoma (KA is a fairly common keratinizing, squamous neoplasm. The exact etiology of KA is unknown. However, ultraviolet radiation, trauma, chemical carcinogens, viral infections, immunosuppression, genetic factors, radiation and thermal burns have been accused of pathogenesis. In here, we represent an unusual huge KA arising from the previous reconstructed with split-thickness skin graft on the dorsal foot.

  12. Constructing Optimal Coarse-Grained Sites of Huge Biomolecules by Fluctuation Maximization.

    Science.gov (United States)

    Li, Min; Zhang, John Zenghui; Xia, Fei

    2016-04-12

    Coarse-grained (CG) models are valuable tools for the study of functions of large biomolecules on large length and time scales. The definition of CG representations for huge biomolecules is always a formidable challenge. In this work, we propose a new method called fluctuation maximization coarse-graining (FM-CG) to construct the CG sites of biomolecules. The defined residual in FM-CG converges to a maximal value as the number of CG sites increases, allowing an optimal CG model to be rigorously defined on the basis of the maximum. More importantly, we developed a robust algorithm called stepwise local iterative optimization (SLIO) to accelerate the process of coarse-graining large biomolecules. By means of the efficient SLIO algorithm, the computational cost of coarse-graining large biomolecules is reduced to within the time scale of seconds, which is far lower than that of conventional simulated annealing. The coarse-graining of two huge systems, chaperonin GroEL and lengsin, indicates that our new methods can coarse-grain huge biomolecular systems with up to 10,000 residues within the time scale of minutes. The further parametrization of CG sites derived from FM-CG allows us to construct the corresponding CG models for studies of the functions of huge biomolecular systems.

  13. Anatomic trisegmentectomy: An alternative treatment for huge or multiple hepatocellular carcinoma of right liver.

    Science.gov (United States)

    Jia, Changku; Weng, Jie; Qin, Qifan; Chen, Youke; Huang, Xiaolong; Fu, Yu

    2017-04-01

    The patients with huge (≥10cm) or multiple hepatocellular carcinoma (HCC) in the right liver and insufficient size of the remnant left liver can not be performed an operation of right hemihepatectomy because of that liver failure will occur post operation. We designed anatomic trisegmentectomy in right liver to increase the ratio of future liver remnant volume (%FLRV), thus increasing resectability of huge or multiple HCC. Thirteen patients were analyzed by preoperative CT scan for liver and tumor volumetries. If the right hemihepatectomy was done, %FLRV would be at the range of 29.6%-37.5%. However, if trisegmentectomy was done, %FLRV would increase by an average of 14.0%. So patients will not undergo postoperative liver failure due to sufficient %FLRV. Therefore, we designed anatomic trisegmentectomy, with retention of segment 5 or segment 8, to increase %FLRV and increase the resectability for huge or multiple HCC. After trisegmentectomy, the inflow and outflow of remnant liver were maintained well. Severe complications and mortality were not happened post operation. Of the 13 patients, 10 survived up to now. Of the 10 living cases, postoperative lung metastasis was found in 2 and intrahepatic recurrence was found in 1. These 3 patients survive with tumor after comprehensive therapies including oral administration of Sorafenib. Compared to right hemihepatectomy, anatomic trisegmentectomy in right liver guarantees the maximum preservation of %FLRV to increase the resectability of huge or multiple HCC, thus improving the overall resection rate. Copyright © 2017. Published by Elsevier Masson SAS.

  14. Huge hepatocellular carcinoma with multiple intrahepatic metastases: An aggressive multimodal treatment.

    Science.gov (United States)

    Yasuda, Satoshi; Nomi, Takeo; Hokuto, Daisuke; Yamato, Ichiro; Obara, Shinsaku; Yamada, Takatsugu; Kanehiro, Hiromichi; Nakajima, Yoshiyuki

    2015-01-01

    Huge hepatocellular carcinoma (HCC) possesses a potential risk for spontaneous rupture, which leads to a life-threatening complication with a high mortality rate. In addition, a large HCC is frequently accompanied by intrahepatic metastases. We describe, the case of a 74-year-old woman with a huge extrahepatically expanding HCC with multiple intrahepatic metastases who was treated by liver resection with repeated transcatheter arterial chemoembolization (TACE). To prevent tumor rupture or bleeding, we performed right hepatectomy. After the operation, TACE was applied for multiple intrahepatic metastases in the remnant liver. Furthermore, the elevated protein induced vitamin K absence (PIVKA II) level had decreased to limits within the normal range. Three months after the first TACE, computed tomography revealed several recurrences in the liver. TACE was applied for the second and third time and the tumors were well controlled. Although, liver resection is occasionally performed for patients with huge HCC to avoid spontaneous tumor rupture, only surgical approach might not be sufficient for such advanced HCC. To achieve long-term survival, it is necessary to control the residual intrahepatic tumors. We could control multiple intrahepatic metastases with repeated TACEs after hepatectomy. Multimodal treatment involving hepatectomy and TACE might be a good treatment strategy for patients with huge HCC with multiple intrahepatic metastases if the tumors are localized in the liver without distant or peritoneal metastasis. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Hepatic arterial infusion chemotherapy for patients with huge unresectable hepatocellular carcinoma.

    Science.gov (United States)

    Tsai, Wei-Lun; Lai, Kwok-Hung; Liang, Huei-Lung; Hsu, Ping-I; Chan, Hoi-Hung; Chen, Wen-Chi; Yu, Hsien-Chung; Tsay, Feng-Woei; Wang, Huay-Min; Tsai, Hung-Chih; Cheng, Jin-Shiung

    2014-01-01

    The optimal treatment for huge unresectable hepatocellular carcinoma (HCC) remains controversial. The outcome of transcatheter arterial chemoembolization (TACE) for patients huge unresectable HCC is generally poor and the survival benefit of TACE in these patients is unclear. The aim of the study is to compare the effect of hepatic arterial infusion chemotherapy (HAIC) versus symptomatic treatment in patients with huge unresectable HCC. Since 2000 to 2005, patients with huge (size >8 cm) unresectable HCC were enrolled. Fifty-eight patients received HAIC and 44 patients received symptomatic treatment. In the HAIC group, each patient received 2.4+1.4 (range: 1-6) courses of HAIC. Baseline characteristics and survival were compared between the HAIC and symptomatic treatment groups. The HAIC group and the symptomatic treatment group were similar in baseline characteristics and tumor stages. The overall survival rates at one and two years were 29% and 14% in the HAIC group and 7% and 5% in the symptomatic treatment group, respectively. The patients in the HAIC group had significantly better overall survival than the symptomatic treatment group (Phuge unresectable HCC.

  16. A Computational Method for Enabling Teaching-Learning Process in Huge Online Courses and Communities

    Science.gov (United States)

    Mora, Higinio; Ferrández, Antonio; Gil, David; Peral, Jesús

    2017-01-01

    Massive Open Online Courses and e-learning represent the future of the teaching-learning processes through the development of Information and Communication Technologies. They are the response to the new education needs of society. However, this future also presents many challenges such as the processing of online forums when a huge number of…

  17. A Huge Subcutaneous Hematoma in an Adult with Kasabach-Merritt Syndrome.

    Science.gov (United States)

    Wu, Kuan-Lin; Liao, Chiung-Ying; Chang, Chen-Kuang; Ho, Shang-Yun; Tyan, Yeu-Sheng; Huang, Yuan-Chun

    2017-06-19

    BACKGROUND Kasabach-Merritt syndrome is a potentially fatal disease that consists of hemangioma(s) with thrombocytopenia, microangiopathic hemolytic anemia, and coagulopathy. Extensive hemangiomatosis is rare. We present the radiological features and treatment strategy of a young adult suffering from Kasabach-Merritt syndrome with widespread hemangiomas and an infected huge hematoma in the right thigh. CASE REPORT A 33-year-old Taiwanese male presented with a painful 20-cm mass over his right thigh and gross hematuria for 2 days. Hemangiomatosis was bioptically proven in infancy and the patient was under regular follow-up. Physical examination revealed normal heart rate, respiratory rate, and body temperature. Multiple palpable lumps with brown and purple areas of skin over the neck, trunk, and right thigh were noted. Laboratory examinations revealed thrombocytopenia anemia and elevated fibrin degradation products. There were no signs of sepsis. Blood transfusion and steroid therapy were executed. Computed tomography showed a huge complicated subcutaneous hematoma in the right thigh. Drainage of the huge hematoma was performed and antibiotics were prescribed. After the local infection in the right thigh and the bleeding tendency were controlled, the patient was discharged in a stable condition two weeks later. CONCLUSIONS A huge infected hematoma and widespread hemangiomas are extremely rare complications of Kasabach-Merritt syndrome. There are no known treatment guidelines currently available. Our patient was successfully treated with steroids, drainage, and antibiotics.

  18. A Huge Ovarian Cyst in a Middle-Aged Iranian Female

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem Moslemi

    2010-05-01

    Full Text Available A 38-year-old Iranian woman was found to have a huge ovarian cystic mass. Her presenting symptom was vague abdominal pain and severe abdominal distention. She underwent laparotomy and after surgical removal, the mass was found to be mucinous cystadenoma on histology.

  19. Huge right atrial myxoma causing fixed tricuspid stenosis with constitutional symptoms.

    Science.gov (United States)

    Kuralay, Erkan; Cingöz, Faruk; Günay, Celalettin; Demirkiliç, Ufuk; Tatar, Harun

    2003-01-01

    Nonspecific constitutional symptoms are reported mostly in patients with left-atrial myxomas, which occur five times as often as its right-atrial counterpart. We present huge right-atrial myxoma, which obstructs tricuspid orifice with nonspecific constitutional symptoms without any pulmonary embolism attack.

  20. Preserving stability of huge agriculture machines with internal mobilities: Application to a grape harvester

    OpenAIRE

    Dieumet, D.; Thuilot, B.; Lenain, R.; Berducat, M.

    2012-01-01

    International audience; This paper proposes an algorithm for estimating on-line the rollover risk of huge machine moving on natural ground. The approach is based on the reconstruction of lateral load transfer thanks to an observer, able to take into account terrain specificities (grip conditions and geometry). Capabilities are tested through experiments on a grape harvester.

  1. Use of a sacral silicone border foam dressing as one component of a pressure ulcer prevention program in an intensive care unit setting.

    Science.gov (United States)

    Walsh, Nancy S; Blanck, Alyson W; Smith, Lisa; Cross, Maribeth; Andersson, Liane; Polito, Carol

    2012-01-01

    In 2008, patients in the intensive care unit (ICU) at Danbury Hospital, Danbury, Connecticut, experienced 79 pressure ulcers. As a result, pressure ulcer-prevention interventions were standardized in critical care and medical-surgical units and education was provided to all direct patient care staff about principles of skin care and prevention. Following these efforts, 53 ICU patients developed pressure ulcers in the sacral area in fiscal year 2009, representing a 12.5% incidence for the ICU as compared to a 3.4% overall pressure ulcer incidence for the total hospital. In order to achieve additional reduction in pressure ulcer incidence, we replicated an initiative that called for application of a silicone foam dressing every 3 days to determine its effect on sacral pressure ulcer incidence in the ICU. We found that the use of the dressing further diminished the incidence of sacral pressure ulcers in our patients.

  2. Introduction to Professor HUA Yan-ling's Acupuncture Experience: Ⅱ .Paravertebral Acupuncture, Sacroiliac Acupuncture and Sacral Acupuncture

    Institute of Scientific and Technical Information of China (English)

    QI Li-zhen; XIAO Yuan-chun

    2003-01-01

    @@ Pro. HUA had practiced traditional Chinese medicine and acupuncture for about 50 years, borne excellent medical skills and was then highly respected by his colleagues and patients. In his large amount of practice, he combined syndrome differentiation in Chinese medicine and disease differentiation in western medicine in order to work hard on acupuncture indications and some stubborn diseases. With the time going on and medical cases accumulating, some unique treatment styles had been formed, such as Jiaji (paravertebral) acupuncture, sacroiliac acupuncture and sacral acupuncture. They are briefly introduced as follows.

  3. Giant Coronary Artery Aneurysm Causing Acute Anterior Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Ahmet Yanık

    2016-01-01

    Full Text Available A 70-year-old man with hypertension was admitted to our coronary ICU with acute anterior MI. Emergent primary PCI was planned and coronary angiography was performed. LAD artery was totally occluded in the proximal segment just after a huge 32 × 26 mm sized aneurysm. Emergent CABG operation was performed in 75 minutes because of multivessel disease including the RCA and left circumflex artery. Aneurysm was ligated and coronary bypass was performed using LIMA and saphenous grafts. The postoperative course of the patient was uneventful. He was discharged with medical therapy including ASA, clopidogrel, and atorvastatin. He was asymptomatic at his polyclinic visit in the first month.

  4. Application of navigation template to fixation of sacral fracture using three-dimensional reconstruction and re-verse engineering technique

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yuan-zhi; LU Sheng; XU Yong-qing; SHI Ji-hong; LI Yan-bing; FENG Zi-liang

    2009-01-01

    Objective: To provide a new method in the fixation of sacral fracture by means of three-dimensional reconstruc-tion and reverse engineering technique.Methods: Pelvis image data were obtained from three-dimensional CT scan in patients with sacral fracture. The data were transferred into a computer workstation. The three-dimensional models of pelvis were reconstructed using Amira 3.1 software and saved in STL format. Then the three-dimensional fracture models were imported into Imageware 9.0 software. Different situations of reduction (total reduction, half reduction and non-reduction) were simulated using Imageware 9.0 software. The best direction and loca-tion of extract iliosacral lag screws were defined using re-verse engineering according to these three situations and navigation templates were designed according to the ana-tomic features of the postero-iliac part and the channel. The exact navigational template was made by rapid prototyping.Drill guides were sterilized and used intraoperatively to as-sist in surgical navigation and the placement of iliosacral lag screws.Results: Accurate screw placement was confirmed with postoperative X-ray and CT scanning. The navigation template was found to be highly accurate. Conclusion: The navigation template may be a useful method in minimal-invasive fixation of sacroiliac joint fracture.

  5. [CT-guided electrode placement for sacral nerve stimulation in the treatment of faecal incontinence (cSNS)].

    Science.gov (United States)

    Goos, M; Ruf, G; Jargon, D; Trummer, C; Thomusch, O; Grüneberger, J; Bulla, S; Kotter, E; Ruthmann, O

    2014-12-01

    The sacral nerve stimulation (SNS) can be performed in the screening phase under local anaesthesia. Implantation of the tined-lead electrodes is usually performed in an inpatient setting under general anaesthesia. An outpatient procedure for both PNE and implantation of the electrodes offers decisive advantages with respect to the accuracy of electrode placement. From 2006 to 2011 a total of 51 patients was treated with SNS in an outpatient setting. Of 51 patients having the PNE, in four patients the procedure could not successfully be completed. In 39 of the 47 patients screened, the testing was positive. Eight times the screening was negative. The functional results show a significant decline in the Cleveland scores from 14.9 to 6.4. The manometric resting pressure improved from 23.4 mmHg to 43.81 mmHg, the squeezing pressure improved from 42.2 mmHg to 76.12 mmHg. Due to patients' perception and according to the response on the stimulus, the electrodes were placed on the left in S4 11 times, 23 times in the left S3, 3 times in the right S3, once in the left S2 and once in the right S2. CT-guided electrode placement is safe for temporary (subchronic) and permanent (chronic) sacral nerve stimulation and provides a valuable means for placement of the stimulating material. Georg Thieme Verlag KG Stuttgart · New York.

  6. Increased yield pressure in the anal canal during sacral nerve stimulation: a pilot study with the functional lumen imaging probe.

    Science.gov (United States)

    Haas, S; Liao, D; Gregersen, H; Lundby, L; Laurberg, S; Krogh, K

    2017-02-01

    Sacral nerve stimulation (SNS) is a well-established treatment for fecal incontinence but its mode of action remains obscure. Anal sphincter function is usually evaluated with manometry but resistance to distension may be a more appropriate parameter than luminal pressure. The functional lumen imaging probe allows detailed description of distension properties of the anal canal. Our objective in this study was to characterize the impact of SNS on distension properties of the anal canal in patients with idiopathic fecal incontinence. We studied 10 women (median age 64 [44-79] years) with idiopathic fecal incontinence at baseline and during SNS. The luminal geometry of the anal canal was examined with the FLIP at rest and during squeeze and the distensibility of the anal canal was investigated during filling of the bag. All patients were successfully treated with SNS and the mean Wexner Incontinence Score was reduced from 14.9 ± 4 to 7.1 ± 4.8 (Panal canal during distension (yield pressure) increased from 14.5 ± 12.2 mmHg at baseline to 20.5 ± 13.3 mmHg during SNS (Panal canal. The yield pressure and the resistance to distension increased in response to SNS for idiopathic fecal incontinence. This will inevitably increase the resistance to flow through the anal canal, which may contribute to the benefits of sacral nerve stimulation. © 2016 John Wiley & Sons Ltd.

  7. High incidence of persistence of sacral and coccygeal intervertebral discs in South Indians – a cadaveric study

    Science.gov (United States)

    Satheesha Nayak, B; Ashwini Aithal, P; Kumar, Naveen; George, Bincy M; Deepthinath, R; Shetty, Surekha D

    2016-01-01

    The sacrum, by virtue of its anatomic location plays a key role in providing stability and strength to the pelvis. Presence of intervertebral discs in sacrum and coccyx is rare. Knowledge of its variations is of utmost importance to surgeons and radiologists. The current study focused on the presence of intervertebral discs between the sacral and coccygeal vertebrae in south Indian cadaveric pelvises. We observed 56 adult pelvises of which, 34 (61%) pelvises showed the presence of intervertebral discs between the sacral vertebrae and between the coccygeal vertebrae, while 22 (39%) pelvises did not have the intervertebral discs either in the sacrum or the coccyx. We also found that most of the specimens had discs between S1 and S2 vertebrae (39%), followed by, between S4 and S5 (18%), between S2–S3 (14%) and least being between S3–S4 (13%). In the coccyx it was found that 7% of pelvises had disc between Co1-Co2, 4% of them had between Co2-Co3 and 4% had between Co3-Co4. Knowledge regarding such anatomic variations in the sacro-coccygeal region is important to note because they require alterations in various instrumentation procedures involving the sacrum. PMID:27385838

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  9. Custos de coberturas para a prevenção de úlcera por pressão sacral

    Directory of Open Access Journals (Sweden)

    Kelly Cristina Inoue

    2016-08-01

    Full Text Available RESUMO Objetivo: identificar os custos com coberturas na prevenção de úlcera por pressão sacral em uma Unidade de Terapia Intensiva para Adultos do Paraná, Brasil. Métodos: pesquisa de análise secundária com 25 pacientes internados entre outubro/2013 e março/2014, que utilizaram filme transparente de poliuretano (n=15 ou placa hidrocoloide (n=10 na região do sacro. O custo de cada intervenção se baseou na quantidade unitária utilizada, em cada tipo de cobertura e seu preço de aquisição (filme transparente = R$15,80, hidrocoloide = R$68,00. Resultados: O custo médio/paciente foi de R$23,17 para uso do filme transparente e de R$190,40 para uso de hidrocoloide. O principal motivo para a troca de cobertura foi o descolamento. Conclusão: O filme transparente consistiu na alternativa economicamente mais vantajosa para a prevenção de úlcera por pressão sacral em pacientes críticos; mas são necessários estudos adicionais que incluam a avaliação da efetividade de ambas as coberturas.

  10. Adverse events of sacral neuromodulation for fecal incontinence reported to the federal drug administration

    Institute of Scientific and Technical Information of China (English)

    Klaus Bielefeldt

    2016-01-01

    AIM:To investigate the nature and severity of AE related to sacral neurostimulation(SNS).METHODS:Based on Pubmed and Embase searches,we identified published trials and case series of SNS for fecal incontinence(FI)and extracted data on adverse events,requiring an active intervention.Those problems were operationally defined as infection,device removal explant or need for lead and/or generator replacement.In addition,we analyzed the Manufacturer and User Device Experience registry of the Federal Drug Administration for the months of August-October of2015.Events were included if the report specifically mentioned gastrointestinal(GI),bowel and FI as indication and if the narrative did not focus on bladder symptoms.The classification,reporter,the date of the recorded complaint,time between initial implant and report,the type of AE,steps taken and outcome were extracted from the report.In cases of device removal or replacement,we looked for confirmatory comments by healthcare providers or the manufacturer.RESULTS:Published studies reported adverse events and reoperation rates for 1954 patients,followed for 27(1-117)mo.Reoperation rates were 18.6%(14.2-23.9)with device explants accounting for 10.0%(7.8-12.7)of secondary surgeries;rates of device replacement or explant or pocket site and electrode revisions increased with longer follow up.During the period examined,the FDA received 1684 reports of AE related to SNS with FI or GI listed as indication.A total of 652 reports met the inclusion criteria,with 52.7%specifically listing FI.Lack or loss of benefit(48.9%),pain or dysesthesia(27.8%)and complication at the generator implantation site(8.7%)were most commonly listed.Complaints led to secondary surgeries in 29.7%of the AE.Reoperations were performed to explant(38.2%)or replace(46.5%)the device or a lead,or revise the generator pocket(14.6%).Conservative management changes mostly involved changes in stimulation parameters(44.5%),which successfully addressed concerns in 35

  11. Performances Evaluation of a Novel Hadoop and Spark Based System of Image Retrieval for Huge Collections

    Directory of Open Access Journals (Sweden)

    Luca Costantini

    2015-01-01

    Full Text Available A novel system of image retrieval, based on Hadoop and Spark, is presented. Managing and extracting information from Big Data is a challenging and fundamental task. For these reasons, the system is scalable and it is designed to be able to manage small collections of images as well as huge collections of images. Hadoop and Spark are based on the MapReduce framework, but they have different characteristics. The proposed system is designed to take advantage of these two technologies. The performances of the proposed system are evaluated and analysed in terms of computational cost in order to understand in which context it could be successfully used. The experimental results show that the proposed system is efficient for both small and huge collections.

  12. A New Pixels Flipping Method for Huge Watermarking Capacity of the Invoice Font Image

    Directory of Open Access Journals (Sweden)

    Li Li

    2014-01-01

    Full Text Available Invoice printing just has two-color printing, so invoice font image can be seen as binary image. To embed watermarks into invoice image, the pixels need to be flipped. The more huge the watermark is, the more the pixels need to be flipped. We proposed a new pixels flipping method in invoice image for huge watermarking capacity. The pixels flipping method includes one novel interpolation method for binary image, one flippable pixels evaluation mechanism, and one denoising method based on gravity center and chaos degree. The proposed interpolation method ensures that the invoice image keeps features well after scaling. The flippable pixels evaluation mechanism ensures that the pixels keep better connectivity and smoothness and the pattern has highest structural similarity after flipping. The proposed denoising method makes invoice font image smoother and fiter for human vision. Experiments show that the proposed flipping method not only keeps the invoice font structure well but also improves watermarking capacity.

  13. Huge mucinous cystadenoma of ovary, describing a young patient: case report

    Directory of Open Access Journals (Sweden)

    Soheila Aminimoghaddam

    2017-08-01

    Conclusion: Ovarian cysts in young women who are associated with elevated levels of tumor markers and ascites require careful evaluation. Management of ovarian cysts depends on patient's age, size of the cyst, and its histopathological nature. Conservative surgery such as ovarian cystectomy or salpingo-oophorectomy is adequate in mucinous tumors of ovary. Multiple frozen sections are very important to know the malignant variation of this tumor and helps accurate patient management. Surgical expertise is required to prevent complications in huge tumors has distorted the anatomy, so gynecologic oncologist plays a prominent role in management. In this case, beside of the huge tumor and massive ascites uterine and ovaries were preserved by gynecologist oncologist and patient is well up to now.

  14. Huge gastric diospyrobezoars successfully treated by oral intake and endoscopic injection of Coca-Cola.

    Science.gov (United States)

    Chung, Y W; Han, D S; Park, Y K; Son, B K; Paik, C H; Jeon, Y C; Sohn, J H

    2006-07-01

    A diospyrobezoar is a type of phytobezoar that is considered to be harder than any other types of phytobezoars. Here, we describe a new treatment modality, which effectively and easily disrupted huge gastric diospyrobezoars. A 41-year-old man with a history of diabetes mellitus was admitted with lower abdominal pain and vomiting. Upper gastrointestinal endoscopy revealed three huge, round diospyrobezoars in the stomach. He was made to drink two cans of Coca-Cola every 6 h. At endoscopy the next day, the bezoars were partially dissolved and turned to be softened. We performed direct endoscopic injection of Coca-Cola into each bezoar. At repeated endoscopy the next day, the bezoars were completely dissolved.

  15. Successful Vaginal Delivery despite a Huge Ovarian Mucinous Cystadenoma Complicating Pregnancy: A Case Report

    Directory of Open Access Journals (Sweden)

    Dipak Mandi

    2013-12-01

    Full Text Available A 22-year-old patient with 9 months of amenorrhea and a huge abdominal swelling was admitted to our institution with an ultrasonography report of a multiloculated cystic space-occupying lesion, almost taking up the whole abdomen (probably of ovarian origin, along with a single live intrauterine fetus. She delivered vaginally a boy baby within 4 hours of admission without any maternal complication, but the baby had features of intrauterine growth restriction along with low birth weight. On the 8th postpartum day, the multiloculated cystic mass, which arose from the right ovary and weighed about 11 kg, was removed via laparotomy. A mucinous cystadenoma with no malignant cells in peritoneal washing was detected in histopathology examination. This report describes a rare case of a successful vaginal delivery despite a huge cystadenoma of the right ovary complicating the pregnancy.

  16. Huge Neck Masses Causing Respiratory Distress in Neonates: Two Cases of Congenital Cervical Teratoma.

    Science.gov (United States)

    Gezer, Hasan Özkan; Oğuzkurt, Pelin; Temiz, Abdulkerim; Bolat, Filiz Aka; Hiçsönmez, Akgün

    2016-12-01

    Congenital cervical teratomas are rare and usually large enough to cause respiratory distress in the neonatal period. We present two cases of congenital huge cystic neck masses in which distinguishing cervical cystic hygroma and congenital cystic teratoma was not possible through radiologic imaging techniques. Experience with the first case, which was initially diagnosed and treated as cystic hygroma by injection sclerotherapy, led to early suspicion and surgery in the second case. The masses were excised completely and histopathologic diagnoses were congenital teratoma in both patients. Our aim is to review congenital huge neck masses causing respiratory distress in early neonatal life to highlight this dilemma briefly with these interesting cases. Copyright © 2014. Published by Elsevier B.V.

  17. Huge echinococcal cyst of the liver managed by hepatectomy: Report of two cases.

    Science.gov (United States)

    Pavlidis, Efstathios T; Symeonidis, Nikolaos; Psarras, Kyriakos; Pavlidis, Theodoros E

    2017-01-01

    Echinococcocal cysts are predominantly located in the right liver. They are usually solitary and asymptomatic, but large cysts can cause compression symptoms. We report two cases of huge (25cm and 20cm in diameter, respectively) echinococcal cysts located in the left liver, which presented as a large palpable mass causing compression symptoms. Diagnosis was established with CT scan showing a cystic mass with the characteristic daughter cysts and reactive layer (pericystic wall) consisting of fibrous connective tissue and calcifications. Both patients were treated radically with left hepatectomy and had uneventful postoperative course and no recurrence upon follow-up. The treatment of liver echinococcal cysts represent a unique surgical challenge. Even though conservative approaches are less technically demanding, the radical approach with resection has better outcome with less recurrences, when performed by experienced surgeons. Resection rather than drainage is the management of choice for such huge liver echinococcal cysts. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  18. The huge Package for High-dimensional Undirected Graph Estimation in R

    Science.gov (United States)

    Zhao, Tuo; Liu, Han; Roeder, Kathryn; Lafferty, John; Wasserman, Larry

    2015-01-01

    We describe an R package named huge which provides easy-to-use functions for estimating high dimensional undirected graphs from data. This package implements recent results in the literature, including Friedman et al. (2007), Liu et al. (2009, 2012) and Liu et al. (2010). Compared with the existing graph estimation package glasso, the huge package provides extra features: (1) instead of using Fortan, it is written in C, which makes the code more portable and easier to modify; (2) besides fitting Gaussian graphical models, it also provides functions for fitting high dimensional semiparametric Gaussian copula models; (3) more functions like data-dependent model selection, data generation and graph visualization; (4) a minor convergence problem of the graphical lasso algorithm is corrected; (5) the package allows the user to apply both lossless and lossy screening rules to scale up large-scale problems, making a tradeoff between computational and statistical efficiency. PMID:26834510

  19. Mitral valve regurgitation due to annular dilatation caused by a huge and floating left atrial myxoma.

    Science.gov (United States)

    Kaya, Mehmet; Ersoy, Burak; Yeniterzi, Mehmet

    2015-09-01

    We describe a case of mitral valve annular dilatation caused by a huge left atrial myxoma obstructing the mitral valve orifice. A 50-year-old man presenting with palpitation was found to have a huge left atrial myxoma protruding into the left ventricle during diastole, causing severe mitral regurgitation. The diagnosis was made with echocardiogram. Transoesophageal echocardiography revealed a solid mass of 75 × 55 mm. During operation, the myxoma was completely removed from its attachment in the atrium. We preferred to place a mechanical heart valve after an annuloplasty ring because of severely dilated mitral annulus and chordae elongation. The patient had an uneventful recovery. Our case suggests that immediate surgery, careful evaluation of mitral valve annulus preoperatively is recommended.

  20. [Resection of a Huge Gastrointestinal Stromal Tumor of the Stomach Following Neoadjuvant Chemotherapy with Imatinib].

    Science.gov (United States)

    Sato, Yoshihiro; Karasawa, Hideaki; Aoki, Takeshi; Imoto, Hirofumi; Tanaka, Naoki; Watanabe, Kazuhiro; Abe, Tomoya; Nagao, Munenori; Ohnuma, Shinobu; Musha, Hiroaki; Takahashi, Masanobu; Motoi, Fuyuhiko; Naitoh, Takeshi; Ishioka, Chikashi; Unno, Michiaki

    2016-11-01

    We report a case of a huge gastric gastrointestinal stromal tumor(GIST)that was safely resected followingpreoperative imatinib therapy. A 72-year-old woman was hospitalized with severe abdominal distension. Computed tomography revealed a 27×17 cm tumor in the left upper abdominal cavity. The patient was diagnosed with high risk GIST by EUS-FNA. We initiated preoperative adjuvant chemotherapy with imatinib to achieve a reduction of operative risks and functional preservation. After 6 months of chemotherapy, CT showed a reduction in the tumor size and the patient underwent partial gastrectomy and partial resection of the diaphragm. Histologically, most of the tumor cells were replaced by hyalinized collagen and viable cells were scattered only around the blood vessels. Neoadjuvant chemotherapy with imatinib has the potential to become an important therapeutic option for the treatment of huge GISTs.

  1. Huge mass in right side of the heart: A rare case report.

    Science.gov (United States)

    Ghasemi, Reza; Ghanei-Motlagh, Fahimeh; Nazari, Susan; Yaghubi, Mohsen

    2016-11-01

    The presence of primary intracardiac tumors are scarce, and most of them are myxomas. We reported, in this paper, a case with huge mass in the right side of the heart. A 45-year-old man, with a complaint of bilateral lower limbs edema and exertional dyspnea, was admitted to intensive cardiac care unit. Cardiac auscultation revealed soft grade systolic murmur without any evidence of "tumor plop." Echocardiography showed a huge mobile mass in right side of the heart that suggested myxoma. Our patient underwent cardiac surgery with excision of 13 cm mass. Histopathological study was confirmed the diagnosis of mass type. In this case report, it shows that in the differential diagnosis of right-sided heart failure, the right sided myxoma must be considered. The preferable approach in patient with cardiac myxomas is surgical excision to alleviate symptoms, early identification, and removal.

  2. Huge Dissected Ascending Aorta Associated with Pseudo Aneurysm and Aortic Coarctation Feridoun

    Directory of Open Access Journals (Sweden)

    Feridoun Sabzi

    2015-10-01

    Full Text Available We report a unique case of chronic dissection of the ascending aorta complicated with huge and thrombotic pseudoaneurysm in a patient with coarctation of descending aorta. Preoperative investigations such as transesophageal echocardiography (TEE confirmed the diagnosis of dissection. Intraoperative findings included a12 cm eccentric bulge of the right lateral side of dilated the ascending aorta filled with the clot and a circular shaped intimal tear communicating with an extended hematoma and dissection of the media layer. The rarity of the report is an association of the chronic dissection with huge pseudoaneurysm and coarctation. The patient underwent staged repair of an aneurysm and coarctation and had an uneventful postoperative recovery period.

  3. A new pixels flipping method for huge watermarking capacity of the invoice font image.

    Science.gov (United States)

    Li, Li; Hou, Qingzheng; Lu, Jianfeng; Xu, Qishuai; Dai, Junping; Mao, Xiaoyang; Chang, Chin-Chen

    2014-01-01

    Invoice printing just has two-color printing, so invoice font image can be seen as binary image. To embed watermarks into invoice image, the pixels need to be flipped. The more huge the watermark is, the more the pixels need to be flipped. We proposed a new pixels flipping method in invoice image for huge watermarking capacity. The pixels flipping method includes one novel interpolation method for binary image, one flippable pixels evaluation mechanism, and one denoising method based on gravity center and chaos degree. The proposed interpolation method ensures that the invoice image keeps features well after scaling. The flippable pixels evaluation mechanism ensures that the pixels keep better connectivity and smoothness and the pattern has highest structural similarity after flipping. The proposed denoising method makes invoice font image smoother and fiter for human vision. Experiments show that the proposed flipping method not only keeps the invoice font structure well but also improves watermarking capacity.

  4. Air conditioning management of huge rooms; Gestion climatique des locaux de grande dimension

    Energy Technology Data Exchange (ETDEWEB)

    Guitton, P. [Electricite de France (EDF), 78 - Chatou (France); Izard, J.L. [Ecole d`Architecture de Marseille-Luminy, 13 - Marseille-Luminy (France); Wurtz, E. [La Rochelle Universite, 17 - La Rochelle, LEPTAB (France)] [and others

    1999-09-01

    This conference was organized by the section `air-conditioning engineering` of the French society of thermal engineers (SFT). This document comprises the abridged versions of the communications and deals with: air-conditioning using displacement: experience feedback on tertiary applications and development of a dimensioning tool, thermal response of linear atria, application of the zonal method to the description of the temperature field and flows pattern inside an auditorium, theoretical and experimental study of air renewal inside industrial rooms, management of huge rooms, design of new optimized buildings and use of the TAS software, can TRNSYS and Comis codes be used for huge spaces?, experimental study of the thermal-aeraulic conditions generated by a displacement air-conditioning device. (J.S.)

  5. Stochastic Huge-Resonance Caused by Coupling for a Globally Coupled Linear System

    Institute of Scientific and Technical Information of China (English)

    LI Jing-Hui

    2009-01-01

    In the paper, we investigate a globally coupled linear system with finite subunits subject to temporal periodic force and with multiplicative dichotomous noise.It is shown that, the global coupling among the subunits can hugely enhance the phenomenon of SR for the amplitude of the average mean field as the functions of the transition rate of the noise and that as the function of the frequency of the signal respectively.

  6. Therapeutic benefit of radiotherapy in huge (≥10 cm) unresectable hepatocellular carcinoma.

    Science.gov (United States)

    Kim, Kyung Hwan; Kim, Mi Sun; Chang, Jee Suk; Han, Kwang-Hyub; Kim, Do Young; Seong, Jinsil

    2014-05-01

    Huge (≥10 cm) hepatocellular carcinomas (HCCs) show dismal prognosis and only a limited number of cases are eligible for curative resection. We studied the therapeutic benefit of radiotherapy (RT) in patients with huge unresectable HCCs. Data from 283 patients with huge HCCs and preserved liver function who underwent non-surgical treatment from July 2001 to March 2012 were retrospectively reviewed. Patients were divided into 4 groups according to the initial treatment: Group A (N= 49), transarterial chemoembolization (TACE); Group B (N = 35), TACE + RT; Group C (N = 50), hepatic arterial infusion chemotherapy; and Group D (n = 149), concurrent chemoradiotherapy (CCRT). The median follow-up period was 27.8 months (range, 12.9-121.9 months). The median overall survival (OS) was longer in Groups B (15.3 months) and D (12.8 months) than in Groups A (7.5 months) and C (8.2 months; Group B vs. A, Bonferroni corrected P [P(c)] = 0.04; Group B vs. C, P(c) = 0.02; Group D vs. A, P(c) = 0.01; Group D vs. C, Pc = 0.006). Groups B and D also showed superior progression-free survival (PFS) and intrahepatic control than Groups A and C. In multivariate analysis, tumour multiplicity, serum alpha-foetoprotein level (≥200 ng/ml) and initial treatment were independent prognostic factors for OS and PFS. Patients with huge unresectable HCCs treated with RT, either as CCRT or in combination with TACE, showed excellent intrahepatic control and prolonged survival. RT could be considered a promising treatment modality in these patients. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Interaction-induced huge magnetoresistance in a high mobility two-dimensional electron gas

    Energy Technology Data Exchange (ETDEWEB)

    Bockhorn, L.; Haug, R. J. [Institut für Festkörperphysik, Leibniz Universität Hannover, D-30167 Hannover (Germany); Gornyi, I. V. [Institut für Nanotechnologie, Karlsruher Institut of Technology, D-76021 Karlsruhe (Germany); Schuh, D. [Institut für Experimentelle und Angewandte Physik, Universität Regensburg, D-93053 Regensburg (Germany); Wegscheider, W. [ETH Zürich (Switzerland)

    2013-12-04

    A strong negative magnetoresistance is observed in a high-mobility two-dimensional electron gas in a GaAs/Al{sub 0.3}Ga{sub 0.7}As quantum well. We discuss that the negative magnetoresistance consists of a small peak induced by a combination of two types of disorder and a huge magnetoresistance explained by the interaction correction to the conductivity for mixed disorder.

  8. A HUGE SILENT INTRACRANIA L HYDATID CYST IN AN ADULT MALE: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Sonal

    2015-04-01

    Full Text Available Hydatid disease of the brain is a rare parasitic infestation caused by larval stage of Echinococcus granulosus. It has an insidious onset with a slow rate of growth resulting in late diagnosis. Its occurence is rare in India, being endemic in Mediterranean countries and Middle East. We report a case of a huge, slow - growing, silent intracranial left parieto - temporo - occipital hydatid cyst in an 18 year old male presenting as a large cystic space occupying lesion.

  9. Post-renal acute renal failure due to a huge bladder stone.

    Science.gov (United States)

    Celik, Orcun; Suelozgen, Tufan; Budak, Salih; Ilbey, Yusuf Ozlem

    2014-06-30

    A 63-year old male was referred to our emergency unit due to acute renal failure. The level of serum renal function tests levels, blood urea nitrogen (BUN)/creatinine, were 63 mmol/L/848 μmol/L. CT (Computarised Tomography) scan showed a huge bladder stone (5 cm x 6 cm x 5 cm) with increased bladder wall thickness. Post-renal acute renal failure due to bilateral ureterohydronephrosis was diagnosed. The huge bladder stone was considered to be the cause of ureterohydronephrosis and renal failure. The patient was catheterised and received haemodialysis immediately. He received haemodialysis four times during ten days of hospitalization and the level of serum renal function tests levels (BUN/ creatinine) decreased 18 mmol/L/123 μmol/L. After improvement of renal function, we performed cystoscopy that demonstrated normal prostatic urethra and bladder neck and bilaterally normal ureteral orifices. Bladder wall was roughly trabeculated and Bladder outlet was completely obstructed by a huge bladder stone. After cystoscopy open, cystolithotomy was performed to remove calcium phosphate and magnesium ammonium phosphate stone weighing 200 g removed. Four days after operation the patient was discharged uneventfully and urethral catheter was removed on the seventh day. Post-renal acute renal failure due to large bladder stones is rare in literature. According to the our knowledge; early diagnosis of the stone avoid growth to large size and prevent renal failure.

  10. Safety and efficacy of partial hepatectomy for huge (≥10 cm) hepatocellular carcinoma: A systematic review

    Science.gov (United States)

    Zhou, Yan-Ming; Li, Bin; Xu, Dong-Hui; Yang, Jia-Mei

    2011-01-01

    Summary Huge (≥10 cm) hepatocellular carcinoma (HCC) is not uncommon at clinical presentation, and the surgical outcomes of such tumors are poor. This systematic review aimed to assess the safety and efficacy of partial hepatectomy for huge HCC. We performed a search on Medline and PubMed databases for all relevant studies published prior to December 2009. After exclusions, 21 studies remained for appraisal and data extraction. All studies were classified as level-4 evidence. The median overall perioperative morbidity and mortality rates were 29.2% (range: 13.6–72%) and 3.5% (range: 0–18.2%), respectively. The overall median survival since the partial hepatectomy was 20.7 months (range: 10.1–32 months), with median 1-, 3- and 5-year survival of 60.7% (range: 41–72.2%), 34% (range: 0–60.3%) and 28.6% (range: 0–54%), respectively. The median disease-free survival since the partial hepatectomy was 11.3 months (range: 5.5–32months), with median 1-, 3- and 5-year disease-free survival rates of 48.7% (range: 32–65.4%), 27.5% (range: 14.1–49%) and 20.7% (range: 9.5–43%), respectively. Partial hepatectomy can be performed safely and is associated with long-term survival in a subset of patients with huge HCC, but the evidence of benefit is currently weak. PMID:21358616

  11. Huge focal nodular hyperplasia presenting in a 6-year-old child: A case presentation.

    Science.gov (United States)

    Zhuang, Lin; Ni, Chuangye; Din, Wenbing; Zhang, Feng; Zhuang, Yi; Sun, Yawei; Xi, Dong

    2016-01-01

    Focal nodular hyperplasia (FNH) is a benign lesion of the liver which is usually found in healthy adults, however, FNH is rare in children, and comprises only 2% of all pediatric liver tumors. Herein, we report the case of a 6-year-old child (male) with a huge FNH which size is more than 10cm. This could be the biggest FNH among all children's FNH cases ever reported. A 6-year-old boy was found a hepatic space-occupying lesion two years ago. As the time went by, the lesion became bigger gradually. The last CT examination showed the size of the tumor to be 10.5×9.9cm in the right hepatic lobe. This child underwent surgical resection of the tumor which was confirmed as FNH (11×8×7cm) by pathology. FNH is a benign lesion of the liver, and it is characterized by hepatocyte hyperplasia and a central stellate scar. It is uncommon for FNH to be diagnosed in children. Such huge FNH (about 11cm) is extremely rare. Surgical operation may be the effective method to cure huge FNH. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. Modified concentric craniotomy for the removal of a huge calvarial metastatic tumor: technical note.

    Science.gov (United States)

    Kao, Ying; Yang, Shih-Hung; Kuo, Meng-Fai

    2016-02-01

    It is challenging for neurosurgeons to remove huge tumors involving the skull that may possibly invade the dura or intracranial neural tissue. In this situation, excision of the tumor may cause profound blood loss, unexpected opening of the dura, or neurological injury. We describe a technique of craniotomy in a pediatric patient to avoid surgical complications. A 15-year-old boy had a huge metastatic calvarial Ewing's sarcoma. We removed the tumor successfully with modified concentric craniotomy. First, two oval burr holes are made on both sides of the tumor. The inner craniotomy uses the internal margin of the oval holes, while the outer cut uses the outer margins. The skull bone in between the two craniotomies is removed easily in two pieces and the dura surrounding the tumor can be exposed early in the procedure. In this way, the huge skull tumor can be removed en bloc under direct vision to avoid unwanted complications. Minimal blood and bone loss can be achieved. Blood transfusion was not necessary during the surgery. The patient did not have new neurological symptoms and signs after surgery. The goal of the modified concentric craniotomy is to develop an accessible margin of the dura surrounding the bulky tumor in the early phase of surgery. Blood and bone loss can be reduced significantly.

  13. Intraoperative fluorescent cholangiography using indocyanine green for laparoscopic fenestration of nonparasitic huge liver cysts.

    Science.gov (United States)

    Kitajima, Toshihiro; Fujimoto, Yasuhiro; Hatano, Etsuro; Mitsunori, Yusuke; Tomiyama, Koji; Taura, Kojiro; Mizumoto, Masaki; Uemoto, Shinji

    2015-02-01

    Bile duct injury is one of the known serious complications of laparoscopic fenestration for nonparasitic liver cysts. Herein, we report the case of a huge liver cyst for which we performed laparoscopic fenestration using intraoperative fluorescent cholangiography with indocyanine green. A 71-year-old woman with abdominal distention was referred to our hospital. CT demonstrated a 17 × 11.5-cm simple cyst replacing the right lobe of the liver, so laparoscopic fenestration was performed. Although the biliary duct could not be detected because of compression by the huge cyst, fluorescent cholangiography with indocyanine green through endoscopic naso-biliary drainage tube clearly delineated the intrahepatic bile duct in the remaining cystic wall. The patient had no complications at 3 months after surgery. Fluorescent cholangiography using indocyanine green is a safe and effective procedure to avoid bile duct injury during laparoscopic fenestration, especially in patients with a huge liver cyst. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  14. Efficacy of hepatic resection vs transarterial chemoembolization for solitary huge hepatocellular carcinoma.

    Science.gov (United States)

    Zhu, Shao-Liang; Zhong, Jian-Hong; Ke, Yang; Ma, Liang; You, Xue-Mei; Li, Le-Qun

    2015-08-28

    To compare the efficacy of hepatic resection (HR) and transarterial chemoembolization (TACE) for patients with solitary huge (≥ 10 cm) hepatocellular carcinoma (HCC). Records were retrospectively analyzed of 247 patients with solitary huge HCC, comprising 180 treated by HR and 67 by TACE. Long-term overall survival (OS) was compared between the two groups using the Kaplan-Meier method, and independent predictors of survival were identified by multivariate analysis. These analyses were performed using all patients in both groups and/or 61 pairs of propensity score-matched patients from the two groups. OS at 5 years was significantly higher in the HR group than the TACE group, across all patients (P = 0.002) and across propensity score-matched pairs (36.4% vs 18.2%, P = 0.039). The two groups showed similar postoperative mortality and morbidity. Multivariate analysis identified alpha-fetoprotein ≥ 400 ng/mL, presence of vascular invasion and TACE treatment as independent predictors of poor OS. Our findings suggest that HR can be safe and more effective than TACE for patients with solitary huge HCC.

  15. Anterior cruciate ligament - updating article

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Malheiros Luzo

    2016-08-01

    Full Text Available ABSTRACT This updating article on the anterior cruciate ligament (ACL has the aim of addressing some of the most interesting current topics in this field. Within this stratified approach, it contains the following sections: ACL remnant; anterolateral ligament and combined intra and extra-articular reconstruction; fixation devices; and ACL femoral tunnel creation techniques.

  16. Anterior cruciate ligament - updating article.

    Science.gov (United States)

    Luzo, Marcus Vinicius Malheiros; Franciozi, Carlos Eduardo da Silveira; Rezende, Fernando Cury; Gracitelli, Guilherme Conforto; Debieux, Pedro; Cohen, Moisés

    2016-01-01

    This updating article on the anterior cruciate ligament (ACL) has the aim of addressing some of the most interesting current topics in this field. Within this stratified approach, it contains the following sections: ACL remnant; anterolateral ligament and combined intra and extra-articular reconstruction; fixation devices; and ACL femoral tunnel creation techniques.

  17. Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients.

    NARCIS (Netherlands)

    Middendorp, J.J. van; Hosman, A.J.F.; Pouw, M.H.; Meent, H. van de

    2009-01-01

    STUDY DESIGN: Prospective multicenter longitudinal cohort study. OBJECTIVE: To validate the prognostic value of the acute phase sacral sparing measurements with regard to chronic phase-independent ambulation in patients with traumatic spinal cord injury (SCI). SETTING: European Multicenter Study of

  18. Prospective Randomized Trial Comparing the 1-Stage with the 2-Stage Implantation of a Pulse Generator in Patients with Pelvic Floor Dysfunction Selected for Sacral Nerve Stimulation.

    NARCIS (Netherlands)

    Everaert, Karel; Kerckhaert, Wim; Caluwaerts, Hilde; Audenaert, M; Vereecke, Hugo Eric Marc; De Cuypere, G; Boelaert, A; Van den Hombergh, U; Oosterlinck, Wim A

    2004-01-01

    Abstract Objective: The aim of this study was to evaluate in a prospective, randomized setting if the 2-stage implant, compared to a 1-stage implant, leads to a superior subjective or objective outcome of sacral nerve stimulation after implantation of the pulse generator in patients with lower urina

  19. Enkephalin-, thyrotropin-releasing hormone- and substance P-immunoreactive axonal innervation of the ventrolateral dendritic bundle in the cat sacral spinal cord: An ultrastructural study

    NARCIS (Netherlands)

    V. Ramírez-León (V.); T. Hökfelt (T.); A.C. Cuello (A.); T.J. Visser (Theo); B. Ulfhake (B.)

    1994-01-01

    textabstractThe distribution and synaptic arrangement of thyrotropin-releasing hormone-, substance P- and enkephalin-immunoreactive axonal boutons have been studied in the ventrolateral nucleus (Onuf's nucleus) of the upper sacral spinal cord segments in the cat. For this purpose, the

  20. Differential Fos expression in the paraventricular nucleus of the hypothalamus, sacral parasympathetic nucleus and colonic motor response to water avoidance stress in Fischer and Lewis rats.

    Science.gov (United States)

    Million, M; Wang, L; Martinez, V; Taché, Y

    2000-09-22

    The responsiveness of hypothalamic CRF to various stressors is reduced in the young female Lewis relative to the histocompatible Fischer rat. Whether such a difference impacts the brain-gut response to water avoidance stress was investigated by monitoring Fos immunoreactivity in the brain and sacral spinal cord and fecal pellet output. Exposure for 60 min to water avoidance stress increased the number of Fos positive cells in the paraventricular nucleus of the hypothalamus (PVN), nucleus tractus solitarius (NTS), and the parasympathetic nucleus of the lumbo-sacral spinal cord (L6-S1) in both Lewis and Fischer rats compared with non stress groups. The Fos response was lower by 32.0% in the PVN, and 63% in sacral parasympathetic nucleus in Lewis compared with Fischer rats while similar Fos expression was observed in the NTS. Stress-induced defecation was reduced by 52% in Lewis compared with Fischer rats while colonic motor response to CRF injected intracisternally resulted in a similar pattern and magnitude of defecation in both strains. The CRF receptor antagonist [D-Phe12,Nle(21,38)C(a)MeLeu(37)]-CRF(12-41) injected intracisternally antagonized partly the defecation response in Lewis and Fischer rats. These data indicate that a lower activation of PVN and sacral parasympathetic nuclei in Lewis compared with Fisher rats may contribute to the differential colonic motor response and that the blunted CRF hypothalamic response to stress, unlike responsiveness to central CRF plays a role.

  1. Prospective Randomized Trial Comparing the 1-Stage with the 2-Stage Implantation of a Pulse Generator in Patients with Pelvic Floor Dysfunction Selected for Sacral Nerve Stimulation.

    NARCIS (Netherlands)

    Everaert, Karel; Kerckhaert, Wim; Caluwaerts, Hilde; Audenaert, M; Vereecke, Hugo Eric Marc; De Cuypere, G; Boelaert, A; Van den Hombergh, U; Oosterlinck, Wim A

    2004-01-01

    Abstract Objective: The aim of this study was to evaluate in a prospective, randomized setting if the 2-stage implant, compared to a 1-stage implant, leads to a superior subjective or objective outcome of sacral nerve stimulation after implantation of the pulse generator in patients with lower urina

  2. 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

    2017-03-06

    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.

  3. Quantitative assessment of bone marrow attenuation values at MDCT: An objective tool for the detection of bone bruise related to occult sacral insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Henes, F.O.; Groth, M.; Bley, T.A.; Regier, M.; Ittrich, H.; Adam, G.; Bannas, P. [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Nuechtern, J.V. [University Medical Center Hamburg-Eppendorf, Department of Trauma, Hand and Reconstructive Surgery, Hamburg (Germany); Treszl, A. [University Medical Center Hamburg-Eppendorf, Center for Experimental Medicine, Department of Medical Biometry and Epidemiology, Hamburg (Germany)

    2012-10-15

    To prove the feasibility of using Hounsfield attenuation values at MDCT to detect bone bruises related to sacral insufficiency fractures. Twenty-two patients with acute sacrum trauma and no fracture findings at MDCT were included in our prospective study. Two observers independently reviewed CTs regarding visual signs of bone bruises in 132 defined regions of the sacral alae. Interobserver agreement was tested by {kappa} statistics. Subsequently, HU values were obtained in the same regions, and attenuation differences between the two sides were calculated. Validity and reliability were assessed by intraclass correlation coefficient and Bland-Altman analysis. HU differences were subjected to ROC curve analysis to determine sensitivity, specificity, PPV and NPV. MRI served as standard reference. MRI revealed 19 regions with bone bruises and associated sacral insufficiency fractures. HU measurements demonstrated good validity and reliability (r = 0.989). ROC curve analysis exhibited an ideal cutoff value of 35.7 HU density difference between affected and non-affected regions. Visual evaluation revealed moderate agreement ({kappa} = 0.48); diagnostic accuracy was inferior to objective evaluation. Assessment of differences in bone marrow density by HU measurements is an objective and reliable tool for detection of bone bruises associated with occult sacral insufficiency fractures. (orig.)

  4. 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.

  5. Válvula de uretra anterior Anterior urethral valves

    Directory of Open Access Journals (Sweden)

    Silvio Tucci Jr.

    2003-02-01

    Full Text Available Objetivo: apresentar os aspectos clínicos, diagnósticos e terapêuticos de pacientes portadores de válvula da uretra anterior. Descrição: em dois neonatos, o diagnóstico presuntivo de patologia obstrutiva do trato urinário foi sugerido pela ultra-sonografia realizada no período pré-natal, confirmando-se o diagnóstico de válvula de uretra anterior pela avaliação pós-natal. Os pacientes foram submetidos a tratamento cirúrgico paliativo, com vesicostomia temporária e, posteriormente, definitivo, pela fulguração endoscópica das válvulas. Ambos evoluíram com função renal normal. Comentários: a válvula da uretra anterior é anomalia rara que deve ser considerada em meninos com quadro radiológico pré-natal sugestivo de obstrução infravesical, secundariamente à hipótese mais comum de válvula da uretra posterior. Ressaltamos a utilização da vesicostomia como derivação urinária temporária nestes casos, prevenindo potenciais complicações pela manipulação da uretra do recém-nascido.Objective: to discuss clinical signs, diagnostic tools and therapeutics of anterior urethral valves, an obstructive anomaly of the urinary system in males. Description: signs of urinary tract obstruction were identified on pre-natal ultrasound in two male fetuses and the diagnosis of anterior urethral valves was made through post-natal evaluation. As an initial treatment, vesicostomy was performed in both patients. Later, the valves were fulgurated using an endoscopic procedure. During the follow-up period both patients presented normal renal function. Comments: anterior urethral valves are a rare form of urethral anomaly that must be ruled out in boys with pre-natal ultrasound indicating infravesical obstruction. Vesicostomy used as an initial treatment rather than transurethral fulguration may prevent potential complications that can occur due to the small size of the neonatal urethra.

  6. Disaster Characteristics and Mitigation Measures of Huge Glacial Debris Flows along the Sichuan-Tibet Railway

    Science.gov (United States)

    Liu, Jinfeng; You, Yong; Zhang, Guangze; Wang, Dong; Chen, Jiangang; Chen, Huayong

    2017-04-01

    The Ranwu-Tongmai section of the Sichuan-Tibet Railway passes through the Palongzangbu River basin which locates in the southeast Qinghai-Tibetan Plateau. Due to widely distributed maritime glacier in this area, the huge glacier debris flows are very developed. Consequently, the disastrous glacier debris flows with huge scale (106-108 m3 for one debris flow event) and damage become one of the key influencing factors for the route alignment of the Sichuan-Tibet Railway. The research on disaster characteristics and mitigation measures of huge glacial debris flows in the study area were conducted by the remote sensing interpretation, field investigation, parameter calculation and numerical simulation. Firstly, the distribution of the glaciers, glacier lakes and glacier debris flows were identified and classified; and the disaster characteristics for the huge glacier debris flow were analyzed and summarized. Secondly, the dynamic parameters including the flood peak discharge, debris flow peak discharge, velocity, total volume of a single debris flow event were calculated. Based on the disaster characteristics and the spatial relation with the railway, some mitigation principles and measures were proposed. Finally, the Guxiang Gully, where a huge glacier debris flow with 2*108m3 in volume occurred in 1953, was selected as a typical case to analyze its disaster characteristics and mitigation measures. The interpretation results show that the glacier area is about 970 km2 which accounts for 19% of the total study area. 130 glacier lakes and 102 glacier debris flows were identified and classified. The Sichuan-Tibet Railway passes through 43 glacier debris flows in the study area. The specific disaster characteristics were analyzed and corresponding mitigation measures were proposed for the route selection of the railway. For the Guxiang Gully, a numerical simulation to simulate the deposition condition at the alluvial fan was conducted. the simulation results show that the

  7. Minimally invasive approaches for histological diagnosis of anterior mediastinal masses

    Institute of Scientific and Technical Information of China (English)

    FANG Wen-tao; XU Mei-ying; CHEN Gang; CHEN Yong; CHEN Wen-hu

    2007-01-01

    Background Anterior mediastinal masses include a wide variety of diseases from benign lesions to extremely malignant tumors. Management strategies are highly diverse and depend strongly on the histological diagnosis as well as the extent of the disease. We reported a prospective study comparing the usefulness of core needle biopsy and mini-mediastinotomy under local anesthesia for histological diagnosis in anterior mediastinal masses.Methods A total of 40 patients with masses of unknown histology and located either at or near the anterior mediastinum received biopsy prior to treatment. The diagnostic methods were core needle biopsy in 28 patients and biopsy through mini-mediastinotomy under local anesthesia in 15 patients (including 3 patients for whom core needle biopsy failed to yield a definite diagnosis).Results Histological diagnosis was achieved in 18 of the 28 patients receiving core needle biopsy. Of them, all 4 patients with pleural fibromas and 9 of the 12 patients (75%) with pulmonary mass were diagnosed definitively. In the remaining 12 patients with mediastinal mass, histological diagnosis was achieved in only 5 patients (41.7%). In contrast,biopsy through a mini-mediastinotomy failed in only 3 patients. In the remaining 12 patients with huge mediastinal masses, who underwent mini-mediastinotomy, a definitive histological diagnosis was reached by pathological and/or immunohistochemical study (diagnostic yield 85.7% in 12 of 14 cases of mediastinal mass, P=0.038 vs core needle biopsy). For the 9 patients with thymic epithelial tumors, the diagnostic yield was 40% (2 in 5 cases) for core needle biopsy and 83.3% (5 in 6 cases) for mini-mediastinotomy. There was no morbidity in patients receiving mini-mediastinotomy. In the 30 patients with biopsy-proven histological diagnosis, the results contributed to therapeutic decision making in 25 cases (83.3%).Conclusions Core needle biopsy is effective in the diagnosis of pulmonary and pleural diseases. Yet its

  8. Relative Importance of Hip and Sacral Pain Among Long-Term Gynecological Cancer Survivors Treated With Pelvic Radiotherapy and Their Relationships to Mean Absorbed Doses

    Energy Technology Data Exchange (ETDEWEB)

    Waldenstroem, Ann-Charlotte, E-mail: ann-charlotte.waldenstrom@oncology.gu.se [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg (Sweden); Department of Oncology, Sahlgrenska University Hospital, Gothenburg (Sweden); Olsson, Caroline [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg (Sweden); Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg (Sweden); Wilderaeng, Ulrica [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg (Sweden); Dunberger, Gail; Lind, Helena; Alevronta, Eleftheria [Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm (Sweden); Al-Abany, Massoud [Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm (Sweden); Department of Hospital Physics, Karolinska University Hospital, Stockholm (Sweden); Tucker, Susan [Department of Bioinformatics and Computational Biology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Avall-Lundqvist, Elisabeth [Department of Gynecologic Oncology, Karolinska University Hospital, Stockholm (Sweden); Johansson, Karl-Axel [Department of Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg (Sweden); Steineck, Gunnar [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm (Sweden)

    2012-10-01

    Purpose: To investigate the relative importance of patient-reported hip and sacral pain after pelvic radiotherapy (RT) for gynecological cancer and its relationship to the absorbed doses in these organs. Methods and Materials: We used data from a population-based study that included 650 long-term gynecological cancer survivors treated with pelvic RT in the Gothenburg and Stockholm areas in Sweden with a median follow-up of 6 years (range, 2-15) and 344 population controls. Symptoms were assessed through a study-specific postal questionnaire. We also analyzed the hip and sacral dose-volume histogram data for 358 of the survivors. Results: Of the survivors, one in three reported having or having had hip pain after completing RT. Daily pain when walking was four times as common among the survivors compared to controls. Symptoms increased in frequency with a mean absorbed dose >37.5 Gy. Also, two in five survivors reported pain in the sacrum. Sacral pain also affected their walking ability and tended to increase with a mean absorbed dose >42.5 Gy. Conclusions: Long-term survivors of gynecological cancer treated with pelvic RT experience hip and sacral pain when walking. The mean absorbed dose was significantly related to hip pain and was borderline significantly related to sacral pain. Keeping the total mean absorbed hip dose below 37.5 Gy during treatment might lower the occurrence of long-lasting pain. In relation to the controls, the survivors had a lower occurrence of pain and pain-related symptoms from the hips and sacrum compared with what has previously been reported for the pubic bone.

  9. Epidermoid cyst in Anterior, Middle

    Directory of Open Access Journals (Sweden)

    Kankane Vivek Kumar

    2016-09-01

    Full Text Available Epidermoid cysts are benign slow growing more often extra-axial tumors that insinuate between brain structures, we present the clinical, imaging, and pathological findings in 35 years old female patients with atypical epidermoid cysts which was situated anterior, middle & posterior cranial fossa. NCCT head revealed hypodense lesion over right temporal and perisylvian region with extension in prepontine cistern with mass effect & midline shift and MRI findings revealed a non-enhancing heterogeneous signal intensity cystic lesion in right frontal & temporal region extending into prepontine cistern with restricted diffusion. Patient was detoriated in night of same day of admission, emergency Fronto-temporal craniotomy with anterior peterousectomy and subtotal resection was done. The histological examination confirms the epidermoid cyst. The timing of ectodermal tissue sequestration during fetal development may account for the occurrence of atypical epidermoid cysts.

  10. 38 CFR 3.379 - Anterior poliomyelitis.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Anterior poliomyelitis. 3... Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a veteran within 35 days of termination of active military service, it...

  11. Fenestration of the anterior cerebral artery

    Energy Technology Data Exchange (ETDEWEB)

    Ito, J.; Washiyama, K.; Hong, K.C.; Ibuchi, Y.

    1981-08-01

    Three cases of angiographically demonstrated fenestration of the anterior cerebral artery are reported. Fenestration occurred at the medial half of the horizontal segment of the anterior cerebral artery in all cases. Its embryology and clinical significance are briefly discussed, and the anatomical and radiological literature on fenestration of the anterior cerebral artery is reviewed.

  12. Combined Lumbar-Sacral Plexus Block in High Surgical Risk Geriatric Patients undergoing Early Hip Fracture Surgery

    Directory of Open Access Journals (Sweden)

    Petchara S

    2015-11-01

    Full Text Available Objective: To evaluate the postoperative outcome after using combined lumbar and sacral plexus block (CLSB, as a sole anesthetic method in hip fracture (HF surgery in highrisk geriatric patients. Materials and Methods: A single-center retrospective study was conducted, between 2010 and 2012, on 70 elderly HF patients with American Society of Anesthesiologists grading III-IV who underwent early surgical intervention with our CLSB protocol. Perioperative data, outcome, and complications were recorded. Results: Forty-eight patients (69% had ongoing anticoagulant medication. Postoperatively, all patients were hemodynamically stable and awake. None of them required general anesthesia conversion. Minor anesthetic-related complications were found in nine patients. One patient (1% died from sepsis due to pneumonia. Patients’ satisfactions were all rated as very good or excellent. Conclusion: CLSB is an interesting anesthetic option in HF surgery, especially in high surgical risk geriatric patients. This method offers an excellent clinical efficiency and high patients’ satisfaction without serious complications.

  13. Primary sacral hydatid cyst mimicking a neurogenic tumor in chronic low back pain: Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Manuel Segura-Trepichio

    2016-01-01

    Full Text Available Hydatid disease is caused by infection of Echinococcus granulosus. Bone hydatid cyst presentation without hepatic affectation is infrequent and occurs in 0,5-2% of cases. This rare condition makes clinicians not always aware of the disease, and as a result, misdiagnosis of spinal echinococcosis is common. We present a case of a 48-year-old female patient with primary sacral hydatidosis. Chronic low back pain radiating to the left buttock was the only symptom. The magnetic resonance imaging (MRI suggested a neurogenic tumor versus giant cell tumor. Biopsy and pathological study revealed a hydatid cyst. Anthelmintic and surgical treatment was performed. At 12 months after surgery, the patient is free of recurrence. In patients with chronic low back pain and a MR suggestive of neurogenic tumor, spinal hydatid cyst should be considered in the differential diagnosis. It is recommended the assistance of an anesthesiologist during biopsy to avoid an anaphylactic shock.

  14. Primary Sacral Hydatid Cyst Mimicking a Neurogenic Tumor in Chronic Low Back Pain: Case Report and Review of the Literature

    Science.gov (United States)

    Segura-Trepichio, Manuel; Montoza-Nuñez, Jose Manuel; Candela-Zaplana, David; Herrero-Santacruz, Josefa; Pla-Mingorance, Fernando

    2016-01-01

    Hydatid disease is caused by infection of Echinococcus granulosus. Bone hydatid cyst presentation without hepatic affectation is infrequent and occurs in 0,5-2% of cases. This rare condition makes clinicians not always aware of the disease, and as a result, misdiagnosis of spinal echinococcosis is common. We present a case of a 48-year-old female patient with primary sacral hydatidosis. Chronic low back pain radiating to the left buttock was the only symptom. The magnetic resonance imaging (MRI) suggested a neurogenic tumor versus giant cell tumor. Biopsy and pathological study revealed a hydatid cyst. Anthelmintic and surgical treatment was performed. At 12 months after surgery, the patient is free of recurrence. In patients with chronic low back pain and a MR suggestive of neurogenic tumor, spinal hydatid cyst should be considered in the differential diagnosis. It is recommended the assistance of an anesthesiologist during biopsy to avoid an anaphylactic shock. PMID:28163523

  15. Severe progressive scoliosis due to huge subcutaneous cavernous hemangioma: A case report

    Directory of Open Access Journals (Sweden)

    Toyama Yoshiaki

    2011-03-01

    Full Text Available Abstract Cavernous hemangioma consists mainly of congenital vascular malformations present before birth and gradually increasing in size with skeletal growth. A small number of patients with cavernous hemangioma develop scoliosis, and surgical treatment for the scoliosis in such cases has not been reported to date. Here we report a 12-year-old male patient with severe progressive scoliosis due to a huge subcutaneous cavernous hemangioma, who underwent posterior correction and fusion surgery. Upon referral to our department, radiographs revealed a scoliosis of 85° at T6-L1 and a kyphosis of 58° at T4-T10. CT and MR images revealed a huge hemangioma extending from the subcutaneous region to the paraspinal muscles and the retroperitoneal space and invading the spinal canal. Posterior correction and fusion surgery using pedicle screws between T2 and L3 were performed. Massive hemorrhage from the hemangioma occurred during the surgery, with intraoperative blood loss reaching 2800 ml. The scoliosis was corrected to 59°, and the kyphosis to 45° after surgery. Seven hours after surgery, the patient suffered from hypovolemic shock and disseminated intravascular coagulation due to postoperative hemorrhage from the hemangioma. The patient developed sensory and conduction aphasia caused by cerebral hypoxia during the shock on the day of the surgery. At present, two years after the surgery, although the patient has completely recovered from the aphasia. This case illustrates that, in correction surgery for scoliosis due to huge subcutaneous cavernous hemangioma, intraoperative and postoperative intensive care for hemodynamics should be performed, since massive hemorrhage can occur during the postoperative period as well as the intraoperative period.

  16. High platelet counts increase metastatic risk in huge hepatocellular carcinoma undergoing transarterial chemoembolization.

    Science.gov (United States)

    Xue, Tong-Chun; Ge, Ning-Ling; Xu, Xin; Le, Fan; Zhang, Bo-Heng; Wang, Yan-Hong

    2016-09-01

    Accumulating evidence suggests platelets play critical roles in tumor metastasis. Moreover, the role of platelets in metastasis is partially correlated with inflammation. However, evidence regarding the contribution of platelets to hepatocellular carcinoma (HCC) metastasis is lacking. This study investigated the association between platelets and metastatic risk in HCC. We used huge HCC (diameter over 10 cm), a tumor subgroup with a strong inflammatory background, as a model to evaluate the potential predictive role of platelets and platelet-related biomarkers for metastasis in HCC patients undergoing transarterial chemoembolization. A logistic regression model was used to analyze risk factors for metastasis. Patients with huge HCC (n = 178) were enrolled, and 24.7% (44/178) of patients had remote metastases after treatment. Univariate analyses showed high platelet counts (P = 0.012), pretreatment platelet-to-lymphocyte ratios (pre-PLR) of 100 or more (P = 0.018) and post-PLR of 100 or more (P = 0.013) were potential risk factors for metastasis. Furthermore, multivariate analyses showed high platelet counts (odds ratio, 2.18; 95% confidence interval, 1.074-4.443; P = 0.031) and platelet-related biomarkers were independent risk factors for HCC metastasis. Particularly, the risk of metastasis in patients with high post-PLR values was significantly greater than patients with low post-PLR values. For tumor response and survival, patients with high platelet counts had faster disease progression (P = 0.002) and worse survival (P huge HCC undergoing chemoembolization, which supply clinical verification of the association between high platelet counts and HCC metastasis. © 2016 The Japan Society of Hepatology.

  17. The efficacy of stereotactic body radiation therapy on huge hepatocellular carcinoma unsuitable for other local modalities.

    Science.gov (United States)

    Que, Jenny Y; Lin, Li-Ching; Lin, Kuei-Li; Lin, Chia-Hui; Lin, Yu-Wei; Yang, Ching-Chieh

    2014-05-28

    To evaluate the safety and efficacy of Cyberknife stereotactic body radiation therapy (SBRT) and its effect on survival in patients with unresectable huge hepatocellular carcinoma (HCC) unsuitable of other standard treatment option. Between 2009 and 2011, 22 patients with unresectable huge HCC (≧10 cm) were treated with SBRT. dose ranged from 26 Gy to 40 Gy in five fractions. Overall survival (OS) and disease-progression free survival (DPFS) were determined by Kaplan-Meier analysis. Tumor response and toxicities were also assessed. After a median follow-up of 11.5 month (range 2-46 months). The objective response rate was achieved in 86.3% (complete response (CR): 22.7% and partial response (PR): 63.6%). The 1-yr. local control rate was 55.56%. The 1-year OS was 50% and median survival was 11 months (range 2-46 months). In univariate analysis, Child-Pugh stage (p = 0.0056) and SBRT dose (p = 0.0017) were significant factors for survival. However, in multivariate analysis, SBRT dose (p = 0.0072) was the most significant factor, while Child-Pugh stage of borderline significance. (p = 0.0514). Acute toxicities were mild and well tolerated. This study showed that SBRT can be delivered safely to huge HCC and achieved a substantial tumor regression and survival. The results suggest this technique should be considered a salvage treatment. However, local and regional recurrence remain the major cause of failure. Further studies of combination of SBRT and other treatment modalities may be reasonable.

  18. Progenitor cell therapy for sacral pressure sore: a pilot study with a novel human chronic wound model.

    Science.gov (United States)

    Wettstein, Reto; Savic, Miodrag; Pierer, Gerhard; Scheufler, Oliver; Haug, Martin; Halter, Jörg; Gratwohl, Alois; Baumberger, Michael; Schaefer, Dirk Johannes; Kalbermatten, Daniel Felix

    2014-01-29

    Chronic wounds are a major health-care issue, but research is limited by the complexity and heterogeneity in terms of wound etiology as well as patient-related factors. A suitable animal model that replicates the situation in humans is not available. Therefore, the aim of the present work is to present a standardized human wound model and the data of a pilot study of topically applied progenitor cells in a sacral pressure sore. Three patients underwent cell harvest from the iliac crest at the time of the initial debridement. Forty-eight hours after bone marrow harvest and debridement, the CD34+ selected cell suspension was injected into the wound. With the aid of a laser scanner, three-dimensional analyses of wound morphometry were performed until the defect was reconstructed with a local flap 3 weeks after debridement. Decreases in volume to 60%±6% of baseline on the sham side and to 52%±3% of baseline on the cell side were measured. Histologic work-up revealed no signs of metaplastic, dysplastic, or neoplastic proliferation/differentiation after progenitor cell treatment. CD34+ cells were detected in the biopsies of day 0. The pressure sore wound model allows investigation of the initial 3 weeks after cell-based therapy. Objective outcome analysis in terms of wound volume and histology can be performed without, or with, minimal additional morbidity, and the anatomy of the sacral area allows a control and study side in the same patient. Therefore, this model can serve as a standard for wound-healing studies. ClinicalTrials.gov NCT00535548.

  19. The big, large and huge case of state-building

    DEFF Research Database (Denmark)

    Harste, Gorm

      Using communication theory as point of departure, it is not evident how to study macro phenomena. Michel Foucault limited his studies to a non-Grand Theory when studying discursive events. At the same time, Charles Tilly wrote about Big Structures, Large Processes, Huge Comparisons when trying...... to establish a perspective on a macro phenomena as European state formation. With Luhmann's system theory, the claim is that there is no such contradiction between Grand evolution and particular semantic history. Passing through some classic studies of the historical establishment of interaction systems...

  20. The  Big, Large and Huge Case of State-Building

    DEFF Research Database (Denmark)

    Harste, Gorm

    2009-01-01

      Using communication theory as point of departure it is not evident how to study macro phenomena. Michel Foucault delimited his studies to a non-Grand Theory when he studied discursive events. At the same time Charles Tilly wrote about Big Structures, Large Processes, Huge Comparisons when he...... tried to establish a perspective on a macro phenomena as European state formation. With Luhmann's system theory, the claim is that there is no such contradiction between Grand evolution and particular semantic history. Passing through some classic studies of the historical establishment of interaction...

  1. Huge malignant phyllodes breast tumor: a real entity in a new era of early breast cancer.

    Science.gov (United States)

    Testori, Alberto; Meroni, Stefano; Errico, Valentina; Travaglini, Roberto; Voulaz, Emanuele; Alloisio, Marco

    2015-02-27

    Phyllodes tumor is an extremely rare tumor of the breast. It occurs in females in the third and fourth decades. The difficulty in distinguishing between phyllodes tumors and benign fibroadenoma may lead to misdiagnosis. Lymph node involvement is rarely described in phyllodes tumors; for this reason, sentinel node biopsy may be warranted. We present a case of a 33-year-old woman affected by huge tumor of the right breast with ulceration in the skin with a rapid tumor growth and with omolateral axillary metastasis.

  2. Huge Benign Ovarian Cystic Teratoma in a Patient with a History of Hansen's Disease.

    Science.gov (United States)

    Okonta, Patrick I; Mofon, Chukwuemeke

    2014-01-01

    Mature ovarian cystic teratomas are common benign ovarian neoplasm derived from germ cells. With increasing availability of ultrasound services even in developing countries, the diagnosis of benign ovarian tumour is made earlier and the size of the ovarian tumour at diagnosis is relatively small. It is unusual to find an ovarian cystic teratoma larger than 10 cm. We report a huge mature ovarian cystic teratoma in a multipara with a history of Hansen's disease. We conclude that, in circumstances where women have restricted access to health care, the unusual finding of mature ovarian cystic teratoma larger than 10 cm is possible due to delayed presentation for diagnosis and treatment.

  3. Creating and Exploring Huge Parameter Spaces: Interactive Evolution as a Tool for Sound Generation

    DEFF Research Database (Denmark)

    Dahlstedt, Palle

    2001-01-01

    of huge synthesis parameter spaces, and presents a possibility for the sound artist to create new sound engines customized for this kind of creation and exploration – sound engines too complex to control in any other way. Different sound engines are presented, together with a discussion of compositional......In this paper, a program is presented that applies interactive evolution to sound generation, i.e., preferred individuals are repeatedly selected from a population of genetically bred sound objects, created with various synthesis and pattern generation algorithms. This simplifies aural exploration...

  4. Huge capacity fiber-optic sensing network based on ultra-weak draw tower gratings

    Science.gov (United States)

    Yang, Minghong; Bai, Wei; Guo, Huiyong; Wen, Hongqiao; Yu, Haihu; Jiang, Desheng

    2016-03-01

    This paper reviews the work on huge capacity fiber-optic sensing network based on ultra-weak draw tower gratings developed at the National Engineering Laboratory for Fiber Optic Sensing Technology (NEL-FOST), Wuhan University of Technology, China. A versatile drawing tower grating sensor network based on ultra-weak fiber Bragg gratings (FBGs) is firstly proposed and demonstrated. The sensing network is interrogated with time- and wavelength-division multiplexing method, which is very promising for the large-scale sensing network.

  5. En bloc resection of huge cemento-ossifying fibroma of mandible: avoiding lower lip split incision.

    Science.gov (United States)

    Ayub, Tahera; Katpar, Shahjahan; Shafique, Salman; Mirza, Talat

    2011-05-01

    Cemento-ossifying Fibroma (COF) is an osteogenic benign neoplasm affecting the jaws and other craniofacial bones. It commonly presents as a progressively slow growing pathology, which can sometimes attain an enormous size, causing facial deformity. A case of a huge cemento-ossifying fibroma, appearing as a mandibular dumbell tumour in a male patient is documented, which caused massive bone destruction and deformity. It was surgically removed by performing en bloc resection of mandible avoiding the splitting of lower lip incision technique, thereby maintaining his normal facial appearance.

  6. Huge Intrathoracic Malignant Peripheral Nerve Sheath Tumor in an Adolescent with Neurofibromatosis Type 1

    Directory of Open Access Journals (Sweden)

    Jong Hyung Yoon

    2014-01-01

    Full Text Available Malignant peripheral nerve sheath tumor (MPNST is a rare soft tissue malignancy usually found in patients with neurofibromatosis type 1 (NF1 with a poor outcome. Although MPNST can be found in any part of the body including head and neck or extremities, intrathoracic MPNST with or without NF1 is uncommon, especially in children or adolescents. Reported herein is a case of huge intrathoracic MPNST in a 16-year-old girl with NF1, and a brief review of the literature.

  7. Huge gastric bezoar caused by honeycomb, an unusual complication of health faddism: a case report

    Science.gov (United States)

    Katsinelos, Panagiotis; Pilpilidis, Ioannis; Katsinelos, Taxiarchis; Lazaraki, Georgia; Fasoulas, Kostas; Zavos, Christos; Kountouras, Jannis

    2009-01-01

    We report a young healthy woman, who believed that the consumption of large amounts of honeycomb would lead to good health and who finally developed a huge gastric bezoar of hard consistency. The conventional endoscopic techniques failed to manage the bezoar. Using the combination of injection of hydrogen peroxide 3% solution inside the bezoar to induce disintegration and a special designed needle-knife sphincterotome (bezotome) we managed to remove the bezoar in fragments. To the best of our knowledge this is the first reported bezoar caused by honeycomb. PMID:19829904

  8. A huge chondromyxoid fibroma of the nasal cavity in a newborn baby.

    Science.gov (United States)

    Yoo, Young Tae; Park, Joo Hyun; Sunwoo, Woong Sang; Rhee, Chae-Seo

    2012-08-01

    Chondromyxoid fibroma is a rare benign tumor that usually occurs in the long bones. A 2-month newborn presented with huge masses in the both nasal cavities, which turned out to be chondromyxoid fibroma. The masses originated from both inferior turbinates. Total turbinectomy on the left side and submucosal mass excision on the right side were performed. No recurrence or new lesion was observed during the 2 years of follow up. We report here on a rare case of nasal cavity chondromyxoid fibroma in a neonate and we review the relevant literature.

  9. Totally laparoscopic gastrectomy for early gastric cancer accompanied by huge hiatal hernia: A case report.

    Science.gov (United States)

    Hagiwara, Chie; Yajima, Kazuhito; Iwasaki, Yoshiaki; Oohinata, Ryouki; Yuu, Ken; Ishiyama, Satoshi; Amaki, Misato; Nakano, Daisuke; Yamaguchi, Tatsuro; Matsumoto, Hiroshi; Takahashi, Keiichi

    2016-02-01

    We herein present a case in which we used a totally laparoscopic approach for early gastric cancer accompanied by a huge hiatal hernia. An 80-year-old Japanese woman was referred with a chief complaint of dysphagia. A clinical diagnosis of early gastric cancer, T1b (SM) N0M0, stage IA, accompanied by hiatal hernia, was made. Distal gastrectomy with D1 plus lymphadenectomy was carried out. After the gastrectomy, the hernial sac was excised and the hernial orifice was closed. Reconstruction using the Roux-en-Y method was selected. The postoperative course was uneventful and she was discharged on postoperative day 10.

  10. Huge aneurysm and coronary-cameral fistula from right coronary branch: First case.

    Science.gov (United States)

    Ahmad, Tanveer; Pasarad, Ashwini Kumar; Kishore, Kolkebaile Sadanand; Maheshwarappa, Nandakumar Neralakere

    2016-02-01

    Coronary-cameral fistulas are rare cardiovascular anomalies. A giant coronary artery aneurysm associated with a coronary-cameral fistula is a very rare condition, with an estimated prevalence of 0.02%. We report the case of middle-aged woman who presented with a huge extracardiac aneurysmal mass and a coronary-cameral fistula from a right coronary artery branch. It was successfully repaired by ligation and excision plus marsupialization of the aneurysm. We believe this is the first such a case reported in literature.

  11. Design of a superluminal ring laser gyroscope using multilayer optical coatings with huge group delay.

    Science.gov (United States)

    Qu, Tianliang; Yang, Kaiyong; Han, Xiang; Wu, Suyong; Huang, Yun; Luo, Hui

    2014-01-01

    We propose and analyze a superluminal ring laser gyroscope (RLG) using multilayer optical coatings with huge group delay (GD). This GD assisted superluminal RLG can measure the absolute rotation with a giant sensitivity-enhancement factor of ~10(3); while, the broadband FWHM of the enhancement factor can reach 20 MHz. This superluminal RLG is based on a traditional RLG with minimal re-engineering, and beneficial for miniaturization according to theoretical calculation. The idea of using GD coatings as a fast-light medium will shed lights on the design and application of fast-light sensors.

  12. Long-term survival after surgical resection for huge hepatocellular carcinoma: comparison with transarterial chemoembolization after propensity score matching.

    Science.gov (United States)

    Min, Yang Won; Lee, Jun Hee; Gwak, Geum-Youn; Paik, Yong Han; Lee, Joon Hyoek; Rhee, Poong-Lyul; Koh, Kwang Cheol; Paik, Seung Woon; Yoo, Byung Chul; Choi, Moon Seok

    2014-05-01

    Surgical resection (SR) and transarterial chemoembolization (TACE) have been commonly applied for patients with huge hepatocellular carcinoma (HCC). However, optimal treatment has not been established. Between 2000 and 2009, 267 patients with huge HCC (≥ 10 cm) underwent TACE and 84 underwent SR as the first treatment. Propensity score matching generated a matched cohort composed of 152 patients. We investigated overall survival and possible prognostic factors. At baseline, the surgery group showed a tendency to have solitary tumor (72.6% vs 39.3%, P huge HCC. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  13. A huge 6.2 kilogram uterine myoma coinciding with omental leiomyosarcoma: case report.

    Science.gov (United States)

    Ruan, C W; Lee, C L; Yen, C F; Wang, C J; Soong, Y K

    1999-12-01

    Surgery for massive abdominal tumors is both interesting and challenging. We present a case involving a multiple uterine myoma weighing 6.2 Kg which coincided with omental leiomyosarcoma. To our knowledge, this is the first report of this type of condition in the English literature. A 44-year-old nulliparous woman had suffered from abdominal pain for a long time. A huge abdominal mass was palpated on physical examination. Computed tomography scanning revealed a huge pelvic-abdominal mass with the possibility of small bowel loops invaded by the mass. A 6-cm omental mass was incidentally found during the subsequent hysterectomy procedure. Perforation of the urinary bladder occurred during the dissection of adhesion. Resection of the omental mass, wide wedge resection of the invaded small bowel, primary repair of the bladder, and hysterectomy were performed. The final pathologic diagnosis was uterine leiomyomata with omental leiomyosarcoma. The patient returned home on postoperative day 14 and was well at the 18-month follow-up examination. The challenge of these tumors lies in their proper diagnosis and surgical management. More case reports and follow-up studies are needed to confirm the efficacy of their management.

  14. Treatment of Huge Hepatocellular Carcinoma Using Cinobufacini Injection in Transarterial Chemoembolization: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Jun Dong

    2016-01-01

    Full Text Available The aim of this study is to examine the safety and efficacy of Cinobufacini injection in transarterial chemoembolization (TACE for treatment of huge hepatocellular carcinoma (HCC. Clinical data of 56 consecutive patients with HCC larger than 10 cm who had been treated with TACE between December 2010 and August 2014 were retrospectively analyzed. Among these patients, 31 belonged to the Cinobufacini group and 25 belonged to the epirubicin group. The clinical efficacy, survival time, and adverse events in patients in the two groups were compared. The objective response rate in the Cinobufacini group was significantly higher than that in the epirubicin group (53.6% versus 23.1%, P=0.022. The median survival time (10.6 versus 14.1 months, χ2=0.092, P=0.762 and the median time to progression (4.9 versus 5.7 months, χ2=0.097, P=0.756 were similar between the groups. The incidence rate of adverse events was lower in the Cinobufacini group than in the epirubicin group (P<0.05. The short-term clinical efficacy of Cinobufacini is better than that of epirubicin in TACE for treating huge HCC, while their long-term clinical efficacy is similar. However, lower incidence of adverse events was noted in TACE using Cinobufacini rather than epirubicin.

  15. Surgical resection of a huge cemento-ossifying fibroma in skull base by intraoral approach.

    Science.gov (United States)

    Cheng, Xiao-Bing; Li, Yun-Peng; Lei, De-Lin; Li, Xiao-Dong; Tian, Lei

    2011-03-01

    Cemento-ossifying fibroma, also known as ossifying fibroma, usually occurs in the mandible and less commonly in the maxilla. The huge example in the skull base is even rare. We present a case of a huge cemento-ossifying fibroma arising below the skull base of a 30-year-old woman patient. Radiologic investigations showed a giant, lobulated, heterogeneous calcified hard tissue mass, which is well circumscribed and is a mixture of radiolucent and radiopaque, situated at the rear of the right maxilla to the middle skull base. The tumor expands into the right maxillary sinus and the orbital cavity, fusing with the right maxilla at the maxillary tuberosity and blocking the bilateral choanas, which caused marked proptosis and blurred vision. The tumor was resected successfully by intraoral approach, and pathologic examination confirmed the lesion to be a cemento-ossifying fibroma. This case demonstrates that cemento-ossifying fibroma in the maxilla, not like in the mandible, may appear more aggressive because the extensive growth is unimpeded by anatomic obstacles and that the intraoral approach can be used to excise the tumor in the skull base.

  16. The technical research on the huge glazed brick from the relic of Nanyue Kingdom Palace

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    'Qin brick and Han tile' has a great worldwide reputation in the architectural history of China. According to the former archaeological materials, the big hollow brick is usually one meter long and thirty to forty centimeters wide, while the solid brick is generally much smaller. But in 1995, large scale vestiges and structures were unearthed at the center of Guangzhou's old district, from the relic of Nanyue Kingdom Palace, which was built some 2000 years ago during the Western-Han Dynasty, A great number of earthen structural members were discovered, especially the solid glazed bricks in various beautiful patterns with an astonishing thickness and size. Some of them are one meter square, more than 20 centimeters thick, and weight half a ton, which are named ‘Brick No.1 in the world' by excavators. People have shown great interest in how to make these huge glazed bricks at the ancient technical conditions, because it is very difficult to manufacture such huge bricks even with the modern technology. At the request of Guangdong Nanyue Kingdom Palace Museum, Shanghai Institute of Ceramics carried out systematical measurements and analysis on these bricks and studied the physical and chemical forming mechanisms from their chemical compositions, structure, and physical characteristics. Here the technical characteristics of the bricks are also discussed.

  17. The technical research on the huge glazed brick from the relic of Nanyue Kingdom Palace

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    ‘Qin brick and Han tile’ has a great worldwide reputation in the architectural history of China. According to the former archaeological materials, the big hollow brick is usually one meter long and thirty to forty centimeters wide, while the solid brick is generally much smaller. But in 1995, large scale vestiges and structures were un- earthed at the center of Guangzhou’s old district, from the relic of Nanyue Kingdom Palace, which was built some 2000 years ago during the Western-Han Dynasty. A great number of earthen structural members were discovered, especially the solid glazed bricks in various beautiful patterns with an astonishing thickness and size. Some of them are one meter square, more than 20 centimeters thick, and weight half a ton, which are named ‘Brick No.1 in the world’ by excavators. People have shown great interest in how to make these huge glazed bricks at the ancient tech- nical conditions, because it is very difficult to manufacture such huge bricks even with the modern technology. At the request of Guangdong Nanyue Kingdom Palace Museum, Shanghai Institute of Ceramics carried out systematical measurements and analysis on these bricks and studied the physical and chemical forming mechanisms from their chemical compositions, structure, and physical character- istics. Here the technical characteristics of the bricks are also discussed.

  18. Treatment of Huge Hepatocellular Carcinoma Using Cinobufacini Injection in Transarterial Chemoembolization: A Retrospective Study.

    Science.gov (United States)

    Dong, Jun; Zhai, Xiaofeng; Chen, Zhe; Liu, Qun; Ye, Hua; Chen, Wei; Ling, Changquan

    2016-01-01

    The aim of this study is to examine the safety and efficacy of Cinobufacini injection in transarterial chemoembolization (TACE) for treatment of huge hepatocellular carcinoma (HCC). Clinical data of 56 consecutive patients with HCC larger than 10 cm who had been treated with TACE between December 2010 and August 2014 were retrospectively analyzed. Among these patients, 31 belonged to the Cinobufacini group and 25 belonged to the epirubicin group. The clinical efficacy, survival time, and adverse events in patients in the two groups were compared. The objective response rate in the Cinobufacini group was significantly higher than that in the epirubicin group (53.6% versus 23.1%, P = 0.022). The median survival time (10.6 versus 14.1 months, χ (2) = 0.092, P = 0.762) and the median time to progression (4.9 versus 5.7 months, χ (2) = 0.097, P = 0.756) were similar between the groups. The incidence rate of adverse events was lower in the Cinobufacini group than in the epirubicin group (P huge HCC, while their long-term clinical efficacy is similar. However, lower incidence of adverse events was noted in TACE using Cinobufacini rather than epirubicin.

  19. Addressing huge spatial heterogeneity induced by virus infections in lentil breeding trials.

    Science.gov (United States)

    Kargiotidou, Anastasia; Vlachostergios, Dimitrios N; Tzantarmas, Constantinos; Mylonas, Ioannis; Foti, Chrysanthi; Menexes, George; Polidoros, Alexios; Tokatlidis, Ioannis S

    2016-12-01

    Spatial heterogeneity can have serious effects on the precision of field experimentation in plant breeding. In the present study the capacity of the honeycomb design (HD) to sample huge spatial heterogeneity was appraised. For this purpose, four trials were conducted each comprising a lentil landrace being screened for response to viruses. Huge spatial heterogeneity was reflected by the abnormally high values for coefficient of variation (CV) of single-plant yields, ranging 123-162 %. At a given field area, increasing the number of simulated entries was followed by declined effectiveness of the method, on account of the larger circular block implying greater intra-block heterogeneity; a hyperbolic increasing pattern of the top to bottom entry mean gap (TBG) indicated that a number of more than 100 replicates (number of plants per entry) is the crucial threshold to avoid significant deterioration of the sampling degree. Nevertheless, the honeycomb model kept dealing with variation better than the randomized complete block (RCB) pattern, thanks to the circular shape and standardized type of block that ensure the less possible extra heterogeneity with expanding the area of the block. Owing to the even and systematic entry allocation, breeders do not need to be concerned with the extra spatial heterogeneity that might induce the extra surface needed to expand the size of the block when many entries are considered. Instead, they could improve accuracy of comparisons with increasing the number of replicates (circular blocks) despite the concomitant greater overall spatial heterogeneity.

  20. Challenging the time complexity of exact subgraph isomorphism for huge and dense graphs with VF3.

    Science.gov (United States)

    Carletti, Vincenzo; Foggia, Pasquale; Saggese, Alessia; Vento, Mario

    2017-04-24

    Graph matching is essential in several fields that use structured information, such as biology, chemistry, social networks, knowledge management, document analysis and others. Except for special classes of graphs, graph matching has in the worst-case an exponential complexity; however, there are algorithms that show an acceptable execution time, as long as the graphs are not too large and not too dense. In this paper we introduce a novel subgraph isomorphism algorithm, VF3, particularly efficient in the challenging case of graphs with thousands of nodes and a high edge density. Its performance, both in terms of time and memory, has been assessed on a large dataset of 12700 random graphs with a size up to 10000 nodes, made publicly available. VF3 has been compared with four other state-of-the-art algorithms, and the huge experimentation required more than two years of processing time. The results confirm that VF3 definitely outperforms the other algorithms when the graphs become huge and dense, but also has a very good performance on smaller or sparser graphs.

  1. Strontium-89 therapy for the treatment of huge osseous metastases in prostate carcinoma: A case report.

    Science.gov (United States)

    Zhang, Wenjie; Zhao, Weiwei; Jia, Zhiyun; Deng, Houfu

    2013-02-01

    Prostate cancer is a growing public health problem. The palliation of pain in patients with painful bone metastases is of primary importance in the clinical management of advanced cancer. Internal therapy with radionuclides, which concentrate at sites of increased bone turnover, is used to control pain and improve quality of life as an alternative to conventional therapies. In the present study, we report the case of a 52-year-old male who had been diagnosed with prostate cancer. The patient presented with severe pain in multiple areas, but particularly in the right hip. A whole-body bone scan revealed that the right hip, ilium and ischium were covered with huge metastatic lesions. Treatment with radionuclide strontium-89 chloride ((89)Sr) resulted in a partial response which was confirmed by the successful relief of pain and other imaging modalities. No significant change in the leukocyte or thrombocyte levels was observed. The results of the present study indicate that systemic radionuclide therapy using (89)Sr is an effective, well-tolerated and safe palliative treatment in patients with huge osseous metastases in prostate carcinoma.

  2. Resection of Huge Liver Cancer Involving the Second Porta Hepatis:A Report of 55 Cases

    Institute of Scientific and Technical Information of China (English)

    CHENHan; WUMengchao; WANGYi; WEIGongtian; HULei

    2002-01-01

    Objective To investigate the possibility and surgical procedures for huge liver cancer involving the second porta hepatis.Methods 55 cases of huge liver cancer, with the diameter of 8-28 cm(mean 12.7 cm) were studied. Right subcostal or “rooftop” incision was made, the liver ligments were divided, good exposure of the tumor and access to retrohepatic inferior vena cava were achieved.Hepatectomies were completed under intermittent interruption of first porta hepatis. Occluding tape around vena cava was applied before liver resection if necessary.Results All tumors were successfully resected without death during operation.The longest survival time was now 4 years in one case. The 1-4 year postoperative survival rates were 63%,50%,50% and 30% respectively.Conclusion Young patients with solitary large liver tumor, which grows slowly over a long period on basis of non-cirrhotic or mild cirrhotic liver, should undergo an exploration in an attempt of resection irrespective of the image contraindication, provided that there is no extra-hepatic metastasis.

  3. [One case of huge cyst at the back end of nasal septum].

    Science.gov (United States)

    Zang, Jian; Liu, Qian; Jiang, Xuejun

    2014-04-01

    A male of 17 years old complained of bilateral nasal congestion with mouth breathing for half a year. The physical examination showed patency of bilateral nasal cavity. Nasopharyngeal fiberscope revealed a huge spherical smooth reddish mass at the nasopharyngeal posterior wall and the back-end of nasal cavity blocking the entire postnaris and contacting with bilateral tubal tori, the size of which is about 3.5 cm x 2.5 cm. The nasopharyngeal 3D-CT showed a low density cystic mass area in the nasopharynx with smooth edges, and the CT value is approximately 32.4 HU. No exact enhancement was observed. The cystic mass originated from and compressed the back end of nasal septum. A semicircular defect in the leading edge of clivus was observed, and the inferior wall of sphenoid sinus is compressed uplifted upwards. The nasopharyngeal MR showed that the nasopharyngeal lesion presented short T1 and long T2 signals with multiple small wall nodules around. Neither the lesion nor the peripheral nodules can be significantly enhanced by enhancement scan. After a nasal endoscopic surgery, the case was definitely diagnosed as nasal septum back-end huge cyst.

  4. 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

  5. Anterior-to-Posterior Migration of a Lumbar Disc Sequestration: Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy

    Directory of Open Access Journals (Sweden)

    Alessandro Frati

    2017-01-01

    Full Text Available Extrusion of disc material within the spinal canal complicates up to 28.6% of lumbar disc herniations. Due to the anatomical “corridors” created by the anterior midline septum and lateral membranes, relocation occurs with an anterior and anterolateral axial topography. Posterior migration is an extremely rare condition and anterior-to-posterior circumferential migration is an even rarer condition. Its radiological feature can be enigmatic and since, in more than 50% of cases, clinical onset is a hyperacute cauda equina syndrome, it may imply a difficult surgical decision in emergency settings. Surgery is the gold standard but when dealing with such huge sequestrations, standard microdiscectomy must be properly modified in order to minimize the risk of surgical trauma or traction on the nerve roots.

  6. Anterior-to-Posterior Migration of a Lumbar Disc Sequestration: Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy

    Science.gov (United States)

    Frati, Alessandro; Palmieri, Mauro; Vangelista, Tommaso; Caruso, Riccardo; Salvati, Maurizio; Raco, Antonino

    2017-01-01

    Extrusion of disc material within the spinal canal complicates up to 28.6% of lumbar disc herniations. Due to the anatomical “corridors” created by the anterior midline septum and lateral membranes, relocation occurs with an anterior and anterolateral axial topography. Posterior migration is an extremely rare condition and anterior-to-posterior circumferential migration is an even rarer condition. Its radiological feature can be enigmatic and since, in more than 50% of cases, clinical onset is a hyperacute cauda equina syndrome, it may imply a difficult surgical decision in emergency settings. Surgery is the gold standard but when dealing with such huge sequestrations, standard microdiscectomy must be properly modified in order to minimize the risk of surgical trauma or traction on the nerve roots. PMID:28163949

  7. The HUGE formula (hematocrit, urea, gender) for screening for chronic kidney disease in elderly patients: a study of diagnostic accuracy.

    Science.gov (United States)

    Musso, Carlos G; de Los Rios, Eduardo; Vilas, Manuel; Terrasa, Sergio; Bratti, Griselda; Varela, Federico; Diez, Guillermo Rosa; Jauregui, Jose; Luna, Daniel

    2017-04-01

    Chronically reduced glomerular filtration rate (GFR) in old people does not always mean that they suffer from chronic kidney disease (CKD) since their GFR can just be reduced by aging. The HUGE equation has been recently described and validated in Spain for screening CKD without taking into account the patient's GFR value. This equation is based on patient's hematocrit, plasma urea levels and gender. The present study documented that the HUGE equation had and acceptable performance for screening CKD in elderly Argentine patients.

  8. 巨大阑尾黏液性囊腺瘤1例%1 case of huge appendiceal mucinous cystadenoma

    Institute of Scientific and Technical Information of China (English)

    王磊; 刘雯雯

    2016-01-01

    Huge appendiceal mucinous cystadenoma is rare in clinic,and the preoperative misdiagnosis rate is high.The data of 1 case of huge appendiceal mucinous cystadenoma was introduced in this paper.%巨大阑尾黏液性囊腺瘤临床较少见,术前误诊率高。本文对巨大阑尾黏液性囊腺瘤1例的病例资料进行介绍。

  9. Huge hepatocellular carcinoma greater than 10 cm in diameter worsens prognosis by causing distant recurrence after curative resection.

    Science.gov (United States)

    Wakayama, Kenji; Kamiyama, Toshiya; Yokoo, Hideki; Orimo, Tatsuya; Shimada, Shingo; Einama, Takahiro; Kamachi, Hirofumi; Taketomi, Akinobu

    2017-03-01

    This study aimed to evaluate the impact of huge (≥10 cm) hepatocellular carcinoma (HCC) to the recurrence pattern and the prognosis after hepatectomy. 574 patients who underwent hepatectomy by 17 surgeons (Open 536 and Laparoscopic 38) for HCC without major vascular invasion from 1990 to 2013 at single institute were retrospectively analyzed. Huge tumor, age, HCV, multiple tumors and microscopic portal invasion are independent risk factors for overall survival (OS), and huge tumor, ICGR15 ≥16%, multiple tumors, moderate/poor histology, microscopic portal invasion and a positive pathological margin are risk factors for relapse-free survival (RFS). The 5-year OS and RFS of patients with huge HCC (n = 53) (42.9 and 14.2%) were significantly worse than those of patients with HCC Huge tumor is an independent risk factor for initial extra-hepatic recurrence (Hazard ratio 7.86, P Huge HCC (≥10 cm) is an independent risk factor due to a high risk for initial extra-hepatic recurrence. Future systemic adjuvant therapy is needed for these patients. J. Surg. Oncol. 2017;115:324-329. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  10. Treatment of huge hypertensive putaminal hemorrhage by surgery and cerebrospinal fluid drainage.

    Science.gov (United States)

    Zhang, Hong-Tian; Xue, Sha; Li, Pei-Jian; Fu, Yan-Bin; Xu, Ru-Xiang

    2013-09-01

    There is limited information available regarding the treatment of huge hypertensive putaminal hemorrhage (HPH). This study aimed to evaluate our experience of 33 patients with huge HPH who were treated by open surgery (decompressive craniectomy and hematoma evacuation) and external cerebrospinal fluid (CSF) drainage. We reviewed the records of 33 consecutive patients admitted to our hospital with huge HPH (≥ 60 cm(3)). All patients were treated by decompressive craniectomy, hematoma evacuation, and CSF drainage. Data collected included age, gender, blood pressure at admission, Glasgow Coma Scale (GCS) score, intracranial hemorrhage (ICH) location, ICH volume, degree of midline shift, presence/absence of basal cistern obliteration at admission and before surgery, and presence/absence of intraventricular hemorrhage (IVH). Outcome was assessed by the Glasgow Outcome Scale score at 30 days after surgery. The median GCS score was 5.0 at admission, and improved to 8.0 at 1 week after surgery. The median ICH volume was 95 cm(3) before surgery and 4 cm(3) after surgery. IVH was observed in 93.9% of patients. The overall survival rate to discharge was 75.6% (25/33), including 15.1% (4/33) with good function, 36.4% (12/33) with disability, and 24.3% (8/33) in a vegetative state. The mortality rate was 24.3% (8/33). Patients with right-sided ICH had better outcomes than those with left-sided ICH. No patients with GCS score ≤ 6 and ICH volume ≥ 90cm(3) at admission achieved good postoperative function. Operative time was significantly shorter with hematoma evacuation via the transcortical approach than via the transsylvian approach (3.41 ± 0.75 h vs. 4.14 ± 0.59 h, Phuge HPH by decompressive craniectomy, hematoma evacuation, and CSF drainage is life-saving. Patients with GCS score 7-8, ICH volume 60-90 cm(3), and right-sided ICH may achieve good recovery. The transcortical approach appears to be more effective than the transsylvian approach for rapid decompression of

  11. [Anterior skull-base schwannoma].

    Science.gov (United States)

    Esquivel-Miranda, Miguel; De la O Ríos, Elier; Vargas-Valenciano, Emmanuelle; Moreno-Medina, Eva

    2017-06-24

    Schwannomas are nerve sheath tumours that originate in Schwann cells. They are usually solitary and sporadic and manifest on peripheral, spinal or cranial nerves. Intracranial schwannomas tend to manifest on the eighth cranial nerve, particularly in patients with neurofibromatosis type2. Anterior skull-base schwannomas represent less than 1% of all intracranial schwannomas. They are more frequent in young people and are typically benign. These tumours represent a diagnostic challenge due to their rarity and difficult differential diagnosis, and numerous theories have been postulated concerning their origin and development. In this article, we present the case of a 13-year-old male with a single anterior cranial-base tumour not associated with neurofibromatosis who presented with headache, papilloedema, eye pain and loss of visual acuity. Complete resection of the tumour was performed, which was histopathologically diagnosed as a schwannoma. The patient made a complete clinical recovery with abatement of all symptoms. We conducted a review of the literature and found 66 cases worldwide with this diagnosis. We describe the most relevant epidemiological and clinical characteristics of this kind of tumour and its relation with the recently discovered and similar olfactory schwannoma. Copyright © 2017 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Anterior chest wall examination reviewed

    Directory of Open Access Journals (Sweden)

    F. Trotta

    2011-09-01

    Full Text Available Anterior chest wall involvement is not infrequently observed within inflammatory arthropaties, particularly if one considers seronegative spondiloarthritides and SAPHO syndrome. Physical examination is unreliable and conventional X-rays analysis is an unsatisfactory tool during diagnostic work-up of this region. Scintigraphic techniques yield informations both on the activity and on the anatomical extent of the disease while computerized tomography visualize the elementary lesions, such as erosions, which characterize the process. Moreover, when available, magnetic resonance imaging couple the ability to finely visualize such lesions with the possibility to show early alterations and to characterize the “activity” of the disease, presenting itself as a powerful tool both for diagnosis and follow-up. This review briefly shows the applications of imaging techniques for the evaluation of the anterior chest wall focusing on what has been done in the SAPHO syndrome which can be considered prototypical for this regional involvement since it is the osteo-articular target mainly affected by the disease.

  13. Huge pelvic parachordoma: fine needle aspiration cytology and histological differential diagnosis

    Directory of Open Access Journals (Sweden)

    Mona A. Kandil

    2012-10-01

    Full Text Available Parachordoma is an extremely rare soft tissue tumor of unknown lineage. Parachordoma develops most often on the extremities. Only 2 cases have been reported as pelvic parachordoma. A 46-year old Egyptian woman with a huge painful pelvic mass was found to have a parachordoma with ectopic pelvic right kidney. There is only one report in the literature of fine needle aspiration cytology in this setting. The microscopic picture of parachordoma is not new to pathologists but the gross picture of this rare tumor has not previously been published; not even in the World Health Organization classification of soft tissues tumors. Diagnosis was confirmed by immuno-histochemistry. The patient is in good clinical condition without any evidence of recurrence or metastasis after 84 months of follow up.

  14. Shape Memory and Huge Superelasticity in Ni–Mn–Ga Glass-Coated Fibers

    Directory of Open Access Journals (Sweden)

    Lei Shao

    2017-01-01

    Full Text Available Ni–Mn–Ga polycrystalline alloy fibers with diameters of 33 μm are reported to exhibit significantly improved ductility and huge superelastic and shape memory strains in comparison to conventional brittle bulk polycrystalline alloys. Particularly, the recoverable strain of the Ni54.9–Mn23.5–Ga21.6 fiber can be as high as 10% at 40 °C. Such optimized behavior has been achieved by a suitable fabrication process via a glass-coating melt spinning method. The superelastic properties at different temperatures and the shape memory effect of Ni54.9–Mn23.5–Ga21.6 fibers were investigated.

  15. Tiny grains give huge gains: nanocrystal-based signal amplification for biomolecule detection.

    Science.gov (United States)

    Tong, Sheng; Ren, Binbin; Zheng, Zhilan; Shen, Han; Bao, Gang

    2013-06-25

    Nanocrystals, despite their tiny sizes, contain thousands to millions of atoms. Here we show that the large number of atoms packed in each metallic nanocrystal can provide a huge gain in signal amplification for biomolecule detection. We have devised a highly sensitive, linear amplification scheme by integrating the dissolution of bound nanocrystals and metal-induced stoichiometric chromogenesis, and demonstrated that signal amplification is fully defined by the size and atom density of nanocrystals, which can be optimized through well-controlled nanocrystal synthesis. Further, the rich library of chromogenic reactions allows implementation of this scheme in various assay formats, as demonstrated by the iron oxide nanoparticle linked immunosorbent assay (ILISA) and blotting assay developed in this study. Our results indicate that, owing to the inherent simplicity, high sensitivity and repeatability, the nanocrystal based amplification scheme can significantly improve biomolecule quantification in both laboratory research and clinical diagnostics. This novel method adds a new dimension to current nanoparticle-based bioassays.

  16. Development of a huge varix following endovascular embolization for cerebellar arteriovenous malformation

    Energy Technology Data Exchange (ETDEWEB)

    Mineura, K.; Sasajima, H.; Itoh, Y.; Kowada, M. [Akita Univ. Hospital (Japan). Neurosurgical Service; Tomura, N. [Akita Univ. Hospital (Japan). Dept. of Radiology; Goto, K. [Iizuka Hospital, Fukuoka (Japan). Dept. of Interventional Neuroradiology

    1998-03-01

    We report on the case of a huge varix that developed after the endovascular embolization of a cerebellar arteriovenous malformation (AVM) with a single drainer. A 21-year-old male presented with trigeminal neuralgia which was caused by the dilated drainer of the AVM. A varix was found at the basal vein of Rosenthal 2 months after an initial stage of embolization with polyvinyl alcohol particles; it diminished after the surgical extirpation of the AVM. The varix formation might have been facilitated by the stenosis in the vein of Galen and by the dynamic changes that followed the embolization. This rare complication should be kept in mind when embolization is performed for AVMs with impaired venous outlets. (orig.).

  17. Huge spin-transfer torque in a magnetic tunnel junction by a superlattice barrier

    Science.gov (United States)

    Chen, C. H.; Tseng, P.; Ko, C. W.; Hsueh, W. J.

    2017-09-01

    Huge spin-transfer torque (STT) in a magnetic tunnel junction (MTJ) achieved by superlattice barrier composed of alternate layers of a nonmagnetic metal and an insulator is proposed. The magnitude of the STT depends on the number of cells in the superlattice barrier and the nonmagnetic metal layer's thickness. The result shows that the STT of the novel superlattice-barrier MTJ can reach values up to four orders of magnitude greater than those of traditional single-barrier stacks based on three cells superlattice by designing the nonmagnetic metal layer's thickness. In addition, the spin-transfer torque of the proposed MTJ can also be thousands of magnitude greater than those of traditional double-barrier MTJs.

  18. Unusual Large Sporadic Angiomyolipoma Co-existing with Huge Simple Renal Cyst

    Directory of Open Access Journals (Sweden)

    Sunil V Jagtap

    2011-07-01

    Full Text Available Renal Angiomyolipoma (AML is an unusual benign mesenchymal tumor with no malignant potential. It is composed of adipose tissue, smooth muscle and abnormal thick walled blood vessels. It can occur sporadically or may be associated with tuberous sclerosis. Sporadic angiomyolipoma (AML coexisting with simple renal cyst is extremely rare and only one case report is available in the literature. In our case, unique combination of sporadic AML along with simple renal cyst with huge size and weight was noted. To the best of our knowledge, ours is the second such case and first case from India. Due to its large size, complete nephrectomy was performed to avoid chances of rupture and retroperitoneal hemorrhage. Post-operative period was uneventful and the patient ahs been on regular follow-up.

  19. Bilateral ureteral complete obstruction with huge spontaneous urinoma formation in a patient with advanced bladder cancer.

    Science.gov (United States)

    Jou, Yeong-Chin; Shen, Cheng-Huang; Cheng, Ming-Chin; Lin, Chang-Te; Chen, Pi-Che

    2012-02-01

    Spontaneous rupture of the collecting system with extravasation of urine and urinoma formation is usually associated with urinary tract obstruction by a ureteral calculus. Tumor growth is an extremely rare cause of urinary extravasation. Here we report a case of bilateral obstructive uropathy with a huge spontaneous left retroperitoneal urinoma caused by advanced infiltrative transitional cell carcinoma of the urinary bladder. The point of leakage was located in the left renal pelvis. The urinary leakage ceased after percutaneous nephrostomy drainage, and the patient subsequently underwent radical cystoprostatectomy. Histopathology revealed a high-grade urothelial carcinoma of the urinary bladder with pelvic lymph node metastasis. The patient refused any adjuvant treatment and expired 6 months after the operation from disseminated metastasis from bladder cancer. Copyright © 2011. Published by Elsevier B.V.

  20. Bilateral ureteral complete obstruction with huge spontaneous urinoma formation in a patient with advanced bladder cancer

    Directory of Open Access Journals (Sweden)

    Yeong-Chin Jou

    2012-02-01

    Full Text Available Spontaneous rupture of the collecting system with extravasation of urine and urinoma formation is usually associated with urinary tract obstruction by a ureteral calculus. Tumor growth is an extremely rare cause of urinary extravasation. Here we report a case of bilateral obstructive uropathy with a huge spontaneous left retroperitoneal urinoma caused by advanced infiltrative transitional cell carcinoma of the urinary bladder. The point of leakage was located in the left renal pelvis. The urinary leakage ceased after percutaneous nephrostomy drainage, and the patient subsequently underwent radical cystoprostatectomy. Histopathology revealed a high-grade urothelial carcinoma of the urinary bladder with pelvic lymph node metastasis. The patient refused any adjuvant treatment and expired 6 months after the operation from disseminated metastasis from bladder cancer.

  1. 犬马尾与骶神经根的解剖学观察%Anatomical observation of the cauda equina and sacral roots in canine

    Institute of Scientific and Technical Information of China (English)

    张世民; 侯春林; 徐瑞生

    2001-01-01

    Objective:To provide anatomical basis for the neurourological study of the cauda equina and sacral roots in canine.Methods:Anatomical character of the cauda equina and sacral roots were observed and summaried on 22 dogs when they are dissecting after perfusion.Results:The neural innervations of pelvic were provided by S1-S3 spinal cord segments and corresponding sacral roots.The conus medullary were long and teminated at the 6th lumbar vertebrae.The ventral and dorsal foots of spinal nerves were surrounded by meningeal tubes separately for 1~1.5 cm,till the point of dorsal root ganglion.Conclusion:There are some difference in anatomical character of cauda equina and sacral roots between dog and human.%目的:为从马尾和骶神经根途径开展犬的神经泌尿学研究提供解剖依据。方法:对3只犬灌注后进行解剖,并对22只犬进行术中观察,总结马尾、骶神经根的解剖特征。结果:犬的盆底器官由S1~S2脊髓节段和神经根支配;脊髓圆锥延续较长,达L6椎体下缘,而马尾神经较短;髓神经前后根出硬膜后,有各自独立的硬膜囊包绕直至后根神经节处,长1~1.5 cm。结论:犬马尾和骶神经根的解剖特征与人类不同。

  2. Spatial segregation within the sacral parasympathetic nucleus of neurons innervating the bladder or the penis of the rat as revealed by three-dimensional reconstruction.

    Science.gov (United States)

    Banrezes, B; Andrey, P; Maschino, E; Schirar, A; Peytevin, J; Rampin, O; Maurin, Y

    2002-01-01

    The purpose of the present investigations was (1) to examine the spatial organization of preganglionic neurons of the sacral parasympathetic nucleus in the lumbosacral spinal cord of male adult rats and (2) to search, in this nucleus, for a possible segregation of sub-populations of neurons innervating the penis or the bladder, respectively. To estimate their spatial organization, neurons of the sacral parasympathetic nucleus were retrogradely labeled by wheat germ agglutinin coupled to horseradish peroxidase applied to the central end of the sectioned pelvic nerve. The sub-populations of lumbosacral neurons innervating the corpus cavernosum of the penis or the dome of the bladder were identified using transsynaptic retrograde labeling by pseudorabies virus injected into these organs in different rats. In both wheat germ agglutinin-labeled and pseudorabies virus-labeled rats, serial coronal sections were cut through the spinal L5-S1 segments. Labeled neurons were revealed by histochemistry (peroxidase experiments) or immunohistochemistry (pseudorabies virus experiments). By means of a three-dimensional reconstruction software developed in our laboratory, three-dimensional models were calculated from each spinal section image series. They revealed the spatial organization of (i) preganglionic neurons and (ii) neurons innervating the bladder or the penis. The different three-dimensional models were subsequently merged into a single one which revealed the segregation, within the sacral parasympathetic nucleus, of the sub-populations of neurons. Neurons labeled by virus injected into the penis extended predominantly from the rostral part of the L6 segment to the rostral part of the S1 segment while those labeled by bladder injections were distributed predominantly from the caudal part of the L6 segment to the caudal part of the S1 segment. These results support the hypothesis of a viscerotopic organization of sacral neurons providing the spinal control of pelvic organs.

  3. 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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  4. PRS: PERSONNEL RECOMMENDATION SYSTEM FOR HUGE DATA ANALYSIS USING PORTER STEMMER

    Directory of Open Access Journals (Sweden)

    T N Chiranjeevi

    2016-04-01

    Full Text Available Personal recommendation system is one which gives better and preferential recommendation to the users to satisfy their personalized requirements such as practical applications like Webpage Preferences, Sport Videos preferences, Stock selection based on price, TV preferences, Hotel preferences, books, Mobile phones, CDs and various other products now use recommender systems. The existing Pearson Correlation Coefficient (PCC and item-based algorithm using PCC, are called as UPCC and IPCC respectively. These systems are mainly based on only the rating services and does not consider the user personal preferences, they simply just give the result based on the ratings. As the size of data increases it will give the recommendations based on the top rated services and it will miss out most of user preferences. These are main drawbacks in the existing system which will give same results to the users based on some evaluations and rankings or rating service, they will neglect the user preferences and necessities. To address this problem we propose a new approach called, Personnel Recommendation System (PRS for huge data analysis using Porter Stemmer to solve the above challenges. In the proposed system it provides a personalized service recommendation list to the users and recommends the most useful services to the users which will increase the accuracy and efficiency in searching better services. Particularly, a set of suggestions or keywords are provided to indicate user preferences and we used Collaborative Filtering and Porter Stemmer algorithm which gives a suitable recommendations to the users. In real, the broad experiments are conducted on the huge database which is available in real world, and outcome shows that our proposed personal recommender method extensively improves the precision and efficiency of service recommender system over the KASR method. In our approach mainly consider the user preferences so it will not miss out the any of the data

  5. Huge epithelial nonparasitic splenic cyst: A case report and a review of treatment methods.

    Science.gov (United States)

    Farhangi, Bahman; Farhangi, Arezo; Firouzjahi, Alireza; Jahed, Babak

    2016-01-01

    Splenic cysts are rare in all age groups and there are a few reports in the world literature. Primary cysts occur most frequently in children and young adults, comprising around 25% of all nonparasitic splenic cysts. Various techniques are suggested for the treatment of splenic cysts. In this case report, a huge epithelial splenic cyst in a 17-year-old female is presented and different treatment methods of splenic cysts are evaluated. A 17-year-old female presented with progressive abdominal mass in left upper quadrant associated with abdominal pain and food intolerance of duration of several months. There was no history of trauma. On physical examination, there was a huge mass located in the upper left side of abdomen. Computerized tomography scan revealed that a large cystic lesion had occupied the spleen with dimensions of 32x21xI5.6 cm. After patient preparation laparotomy was performed and complete cyst excision was done with splenectomy, patient was discharged after 2 days. This is a report of a case of epithelial splenic cyst of the spleen in a 17-year old female. The management of splenic cysts continues to evolve and the optimum treatment of patients with nonparasitic splenic cysts is controversial, as a principle preservation technique of the spleen with minimally invasive methods such as laparoscopy is preferred to splenectomy with the exception of very large cysts and when splenic hilum is involved in cyst wall. However, significant cyst recurrences were encountered with these techniques. Recently open partial splenectomy has been proposed as a safe and effective method in the management of NPSCs it ensures complete cyst removal, lack of cyst recurrence, and preservation of the spleen functions.

  6. Bioinspired oil strider floating at the oil/water interface supported by huge superoleophobic force.

    Science.gov (United States)

    Liu, Xueli; Gao, Jun; Xue, Zhongxin; Chen, Li; Lin, Ling; Jiang, Lei; Wang, Shutao

    2012-06-26

    Oil pollution to aquatic devices, especially to those oil-cleaning devices and equipment-repairing robots during oil spill accidents, has drawn great attention and remains an urgent problem to be resolved. Developing devices that can move freely in an oil/water system without contamination from oil has both scientific and practical importance. In nature, the insect water strider can float on water by utilizing the superhydrophobic supporting force received by its legs. Inspired by this unique floating phenomenon, in this article, we designed a model device named "oil strider" that could float stably at the oil/water interface without contamination by oil. The floating capability of the oil strider originated from the huge underwater superoleophobic supporting force its "legs" received. We prepared the micro/nanohierarchical structured copper-oxide-coated copper wires, acting as the artificial legs of oil strider, by a simple base-corrosion process. The surface structures and hydrophilic chemical components of the coatings on copper wires induced the huge superoleophobic force at the oil/water interface, to support the oil strider from sinking into the oil. Experimental results and theoretical analysis demonstrate that this supporting force is mainly composed of three parts: the buoyancy force, the curvature force, and the deformation force. We anticipate that this artificial oil strider will provide a guide for the design of smart aquatic devices that can move freely in an oil/water system with excellent oil repellent capability, and be helpful in practical situations such as oil handling and oil spill cleanup.

  7. Sacral nerve stimulation for fecal incontinence Neuromodulación de raíces sacras en incontinencia fecal

    Directory of Open Access Journals (Sweden)

    Isabel Pascual

    2011-07-01

    Full Text Available Objective: to analyze short-term outcomes and complications for our first fifty patients with fecal incontinence undergoing sacral root stimulation. Patients: fifty patients with fecal incontinence receiving sacral neuromodulation in 4 hospitals are reviewed. Discussed variables include: age, sex, incontinence duration, incontinence cause, prior surgery for incontinence, Wexner scale score, anorectal manometry parameters, and endoanal ultrasonographic findings. Following the procedure Wexner scale score, anorectal manometry parameters, and associated complications are reviewed. Results: mean age of patients is 59.9 years, with females predominating. Most common causes of incontinence include obstetric procedures, idiopathic origin, and prior anal surgery. Mean follow-up is 17.02 months. Follow-up revealed a statistically significant reduction in Wexner scale score and increase in voluntary anal pressure. Technique-derived minor complications included: 2 surgical wound infections that led to stimulator withdrawal; 2 patients with pain who were managed conservatively; 1 case of externalization in a gluteal stimulator; and 1 broken tetrapolar electrode. Conclusions: sacral nerve stimulation is a simple technique that improves Wexner scores in a statistically significant manner with a low complications rate.Objetivo: analizar los resultados y complicaciones a corto plazo de nuestros primeros cincuenta pacientes con incontinencia fecal tratados mediante estimulación de raíces sacras. Pacientes: se revisan cincuenta pacientes con incontinencia fecal tratados mediante neuromodulación de raíces sacras en 4 centros hospitalarios. Las variables analizadas son: edad, sexo, tiempo de evolución de la incontinencia, causa de la incontinencia, cirugías previas para tratar la incontinencia, puntuación en la escala de Wexner, parámetros de la manometría anorrectal y los hallazgos en la ecografía endoanal. Tras la intervención se revisa la puntuaci

  8. Simultaneously anterior decompression and posterior instrumentation by extrapleural retroperitoneal approach in thoracolumbar lesions

    Directory of Open Access Journals (Sweden)

    Jain Anil

    2010-01-01

    6 month of follow-up respectively. The mean preoperative loss of the anterior vertebral height improved from 44.7% to 18.4% immediate postoperatively and was 17.5% at final follow-up at 1 year. The means preoperative kyphus angle also improved from 23.3° to 9.3° immediately after surgery, which deteriorated to 11.5° at final follow-up. One patient developed deep wound infection at the operative site as well as flap necrosis, which needed debridement and removal of hardware. Five patients had bed sore in the sacral region, which healed uneventfully. In tubercular spine (n=25 group, mean operating time was approximately 45 minutes less than traumatic group. The mean intraoperative blood loss was 1100 ml (750-2200 ml. The mean preoperative kyphosis was corrected from 55° to 23°. Wound healing occurred uneventful in 23 cases and wound dehiscence occurred in only 2 cases. Nine out of 11 cases with paraplegia showed excellent neural recovery while 2 with panvertebral disease showed partial neural recovery. None of the patients in both groups required intensive unit care. Conclusions: Simultaneous exposure of both posterior and anterior column of the spine for posterior instrumentation and anterior decompression and fusion in single stage by extra pleural retroperitoneal approach by "T" incision in thoracolumbar spinal lesions is safe, an easy alternative with reduced morbidity as chest and abdominal cavities are not violated, ICU care is not required and diaphragm is not cut.

  9. Outcome of long-axis percutaneous sacroplasty for the treatment of sacral insufficiency fractures with a radiofrequency-induced, high-viscosity bone cement

    Energy Technology Data Exchange (ETDEWEB)

    Eichler, Katrin [University of Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); J. W. Goethe University of Frankfurt, Institute for Diagnostic and Interventional Radiology, Frankfurt (Germany); Zangos, Stephan; Vogl, Thomas J. [University of Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Mack, Martin G. [Radiology Munich, Munich (Germany); Marzi, Ingo [University of Frankfurt, Department of Trauma, Hand and Reconstructive Surgery, Frankfurt (Germany)

    2014-04-15

    Our goal was to assess the technical results in patients who underwent long-axis sacroplasty for the treatment of sacral insufficiency fractures (SIF) by radiofrequency-induced high-viscosity bone cement augmentation. Twelve patients with bilateral sacral fractures were treated by augmentation with radiofrequency-activated, high-viscosity polymethylmethacrylate (PMMA) bone cement under local anesthesia. CT-guided sacroplasty was performed by using a long-axis approach through a single entry point. Thirty-six vertebrae were treated in 12 sessions under a combination of CT and fluoroscopic guidance using a bilateral access and a cavity-creating osteotome prior to remote-controlled, hydraulically driven cement injection. The visual analogue scale (VAS) score before sacroplasty and at 1 and 3 months after the treatment was obtained. PMMA leaks were evaluated retrospectively using the post-interventional CT. The mean amount of high-viscosity PMMA injected per patient was 7.8 ml. No major adverse events were observed. In the first 4 days after the procedure, the mean VAS score decreased from 8.1 ± 1.9 to mean 3.1 ± 1.2 and was followed by a gradual but continuous decrease throughout the rest of the follow-up period at 24 weeks (mean 2.2 ± 1.1) and 48 weeks (mean 2.1 ± 1.4). CT fluoroscopy-guided sacral augmentation was safe and effective in all 12 patients with osteoporotic SIF. (orig.)

  10. Imaging findings of anterior hip dislocations

    Energy Technology Data Exchange (ETDEWEB)

    Pfeifer, Kyle [Mallinckrodt Institute of Radiology, Department of Radiology, St. Louis, MO (United States); Leslie, Michael [Yale School of Medicine, Department of Orthopedics and Rehabilitation, New Haven, CT (United States); Menn, Kirsten; Haims, Andrew [Yale University School of Medicine, Department of Radiology and Biomedical Imaging, New Haven, CT (United States)

    2017-06-15

    Anterior hip dislocations are rare orthopedic emergencies resulting from high-energy trauma and have unique imaging characteristics on radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Imaging findings on CT and MRI allow for the prompt recognition and classification of anterior hip dislocations, which guides patient management and reduces complications. The purpose of this article is to review imaging findings of anterior hip dislocations, specifically focusing on CT and MRI. (orig.)

  11. Positioning of anterior teeth in removable dentures

    Directory of Open Access Journals (Sweden)

    Strajnić Ljiljana

    2002-01-01

    Full Text Available Introduction The aim of this paper was to present methods of placement of artificial anterior teeth in edentulous individuals. The following review takes account of the majority of papers published during the last 100 years. The review has been divided into sections regarding the method used to determine the position of artificial anterior teeth. Geometric aspect Gysi (1895-1920 produced the first scientific theory about the position of artificial anterior teeth. Physiognomic theory The aim of this theory is to find the most natural position for artificial anterior teeth for each individual. Camper's "face angle" as a physiognomic criterion, has been introduced in papers of Wehrli (1961, Marxhors (1966, Tanzer (1968, Lombardi (1973. Esthetic aspect Important names in the field of dental esthetics are: Schön and Singer (1961, Arnheim (1965, Krajiček (1969, Tanzer (1968, Lombardi (1973, Goldstein (1976. They have introduced principles of visual aspects for selection of contours, dimension and position of artificial anterior teeth. Constitution aspect Flagg (1880, Williams (1913 and Hrauf (1957, 1958, have considered body constitution and individual characteristics regarding position of artificial anterior teeth. Physiological theory In 1971, Marxhors pointed to the fact that the position of artificial teeth corresponds with the function of the surrounding soft tissue and from the aspect of physiognomy as well. Phonetic aspect According to Silverman (1962 artificial anterior teeth are nearest when we pronounce the sound "S". Cephalometrical research Rayson (1970, Watson (1989, Strajnić Lj. (1999, Bassi F. (2001 have presented cephalometric radiographic analyses of natural anterior teeth compared with cephalometric radiographic analyses of artificial anterior teeth. A review of dental literature shows several factors suggesting modalities which should determine the position of artificial anterior teeth. Numerous methods have been designed for

  12. Incidental Anterior Cruciate Ligament Calcification: Case Report.

    Science.gov (United States)

    Hayashi, Hisami; Fischer, Hans

    2016-03-01

    The calcification of knee ligaments is a finding noted only in a handful of case reports. The finding of an anterior cruciate ligament calcification has been reported once in the literature. Comparable studies involving the posterior cruciate ligament, medial collateral ligament and an ossicle within the anterior cruciate ligament are likewise discussed in reports of symptomatic patients. We report a case of incidentally discovered anterior cruciate ligament calcification. We discuss the likely etiology and clinical implications of this finding.

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

    Institute of Scientific and Technical Information of China (English)

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

    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, P<0.05). The density of GFAP in MVZ was significantly higher after 3 d of TNBS administration (34.3±2.5, P<0.05). After 28 d of TNBS administration,the density of GFAP in the spinal cord and MVZ decreased and became comparable to that of the controls (18.0±4.9,14.6±6.4, P>0.05).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.

  14. Nova técnica de cateterização de uso prolongado em canal peridural sacral de coelhos

    Directory of Open Access Journals (Sweden)

    Yüksel Erkin

    2013-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi desenvolver uma técnica simples e prática para a cateterização crônica em canal peridural sacral de coelhos. MÉTODOS: O estudo incluiu dez coelhos com peso entre 2 e 2,5 kg. Após a anestesia e a analgesia, colocamos um cateter peridural através de uma incisão longitudinal de 2 cm na cauda acima da região do hiato sacral. Confirmamos a localização com a administração de lidocaína a 1% (nivelamento da perda sensorial e da função motora dos membros inferiores. O cateter foi introduzido através de um túnel subcutâneo até o pescoço, onde foi fixado. RESULTADOS: A implantação de cateter crônico peridural caudal foi bem-sucedida em todos os coelhos. Os cateteres permaneceram eficazmente no lugar por dez dias, sem intercorrências durante esse período. A localização do cateter foi reconfirmada por lidocaína a 1% no último dia. Após matar os animais, procedeu-se laminectomia para localização do cateter no espaço peridural. CONCLUSÕES: Há vários métodos de cateterização do espaço peridural em modelos animais na literatura. A cateterização do espaço peridural em coelhos pode ser feita através das vias atlanto-occipital, lombar ou caudal por amputação da cauda. As técnicas de cateterização intratecal e peridural descritas na literatura exigem perícia cirúrgica e conhecimento de procedimentos cirúrgicos, como laminectomia e amputação da cauda. A nossa técnica não requer grande habilidade cirúrgica, a integridade anatômica foi preservada e não houve mau posicionamento de cateter. Em conclusão, podemos sugerir que a nova técnica de cateterização peridural é simples, facilmente aplicável e pode ser usada em estudos experimentais de modelos animais.

  15. An economic appraisal of the Australian Medical Sheepskin for the prevention of sacral pressure ulcers from a nursing home perspective

    Directory of Open Access Journals (Sweden)

    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

  16. Unilateral anterior ischemic optic neuropathy

    DEFF Research Database (Denmark)

    Herbst, Kristina; Sander, Birgit; Lund-Andersen, Henrik

    2013-01-01

    The intrinsically photosensitive retinal ganglion cells (ipRGCs) express the photopigment melanopsin, which is sensitive to blue light. Previous chromatic pupillometry studies have shown that the post-illumination response is considered an indicator of the melanopsin activation. The aim......-affected eyes, compared with the non-affected fellow eyes, suggesting dysfunction of the ipRGCs. Compared with the responses of the healthy controls, the blue light post-illumination pupil responses were similar in the affected eyes and increased in the fellow non-affected eyes. This suggests a possible...... of this study was to investigate the ipRGC mediated pupil response in patients with a unilateral non-arteritic anterior ischemic optic neuropathy (NAION). Consensual pupil responses during and after exposure to continuous 20 s blue (470 nm) or red (660 nm) light of high intensity (300 cd/m(2)) were recorded...

  17. Toxic Anterior Segment Syndrome (TASS

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    Özlem Öner

    2011-12-01

    Full Text Available Toxic anterior segment syndrome (TASS is a sterile intraocular inflammation caused by noninfectious substances, resulting in extensive toxic damage to the intraocular tissues. Possible etiologic factors of TASS include surgical trauma, bacterial endotoxin, intraocular solutions with inappropriate pH and osmolality, preservatives, denatured ophthalmic viscosurgical devices (OVD, inadequate sterilization, cleaning and rinsing of surgical devices, intraocular lenses, polishing and sterilizing compounds which are related to intraocular lenses. The characteristic signs and symptoms such as blurred vision, corneal edema, hypopyon and nonreactive pupil usually occur 24 hours after the cataract surgery. The differential diagnosis of TASS from infectious endophthalmitis is important. The main treatment for TASS formation is prevention. TASS is a cataract surgery complication that is more commonly seen nowadays. In this article, the possible underlying causes as well as treatment and prevention methods of TASS are summarized. (Turk J Oph thal mol 2011; 41: 407-13

  18. The influence of sacral morphology on the existence of secure S1 and S2 transverse bone corridors for iliosacroiliac screw fixation.

    Science.gov (United States)

    Mendel, T; Noser, H; Kuervers, J; Goehre, F; Hofmann, G O; Radetzki, F

    2013-12-01

    Sacroiliac (SI) screw fixation for unstable pelvic fractures stands out as the only minimally invasive method among all other ORIF procedures. A strictly transverse screw trajectory is needed for central or bilateral fracture patterns up to a complete iliosacroiliac fixation. However, secure screw insertion is aggravated by a narrow sacroiliac bone stock. This study investigates the influence of a highly variable sacral morphology to the existence of S1 and S2 transverse corridors. The analysis contained in this study is based on 125 CT datasets of intact human pelvises. First, sacral dysplasia was identified using the "lateral sacral triangle" method in a lateral 3-D semi-transparent pelvic view. Second, 3-D corridors for a 7.3mm screw in the upper two sacral levels were visualised using a proprietary IT workflow of custom-made programme scripts based on the Amira(®)-software. Shape-describing measurement variables were calculated as output variables. The results show a significant linear correlation between ratioT and the screw-limiting S1 isthmus height (Pearson coefficient of 0.84). A boundary ratio of 1.5 represented a positive predictive value of 96% for the existence of a transverse S1-corridor for at least one 7.3mm screw. In 100 out of 125 pelvises (80%), a sufficient S1 corridor existed, whereas in 124 specimens (99%), an S2 corridor was found. Statistics revealed significantly larger S1 and S2 corridors in males compared to females (pS1 and 1 screw in S2. The expanse of the S1 corridor is highly influenced by the dimensions of the dysplastic elevated upper sacrum, whereas the S2 corridor is not affected. Hence, in dysplastic pelvises, sacroiliac screw insertion should be recommended into the 2nd sacral segment. Our IT workflow for the automatic computation of 3-D corridors may assist in surgical pre-operative planning. Furthermore, the workflow could be implemented in computer-assisted surgery applications involving pelvic trauma.

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

    Directory of Open Access Journals (Sweden)

    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

  20. The platelet-to-lymphocyte ratio predicts poor survival in patients with huge hepatocellular carcinoma that received transarterial chemoembolization.

    Science.gov (United States)

    Xue, Tong-Chun; Jia, Qing-An; Ge, Ning-Ling; Zhang, Bo-Heng; Wang, Yan-Hong; Ren, Zheng-Gang; Ye, Sheng-Long

    2015-08-01

    Inflammation is particularly strong in huge hepatocellular carcinoma (HCC). However, it is unclear whether the platelet-to-lymphocyte ratio (PLR), as an inflammatory-related marker, can predict survival of patients with huge HCC. In this study, we enrolled 291 patients with huge HCC (diameter over 10 cm) who were undergoing repeated transarterial chemoembolization (TACE) at our institute. The baseline PLR was calculated from complete serum blood counts before the first chemoembolization. We found that a baseline PLR cutoff value over 150 best predicted huge HCC survival. The 12, 24, and 36 months survival rates in the high PLR group (22.6, 8.1, and 4.1 %, respectively) were significantly lower than in the low PLR group (35.6, 22.4, and 14 %, respectively). Thus, a significant difference was found in overall survival (log-rank test, p huge HCC, a high baseline PLR is a useful predictor of poor survival in patients undergoing chemoembolization. Additional anti-inflammatory or anti-platelet treatments, in combination with TACE, may improve survival in HCC patients with high PLR.

  1. The value of a formula including haematocrit, blood urea and gender (HUGE) as a screening test for chronic renal insufficiency.

    Science.gov (United States)

    Alvarez-Gregori, J A; Robles, N R; Mena, C; Ardanuy, R; Jauregui, R; Macas-Nu Nunez, J F

    2011-06-01

    Despite increasing use in clinical practice, an estimated glomerular filtration rate value (eGFR) of HUGE formula. A formula including haematocrit , blood urea, and gender (HUGE), diagnoses CRI regardless of the variables of age, blood creatinine, creatinine clearance, or other eGFR. The HUGE formula is: L = 2.505458 - (0.264418 x Hematocrit) + (0.118100 x Urea) [+ 1.383960 if male]. If L is a negative number the individual does not have CRI; if L is a positive number, CRI is present. Our data demonstrate that the HUGE formula is more reliable than MDRD and CKD-EPI, particularly in persons aged over 70. Our HUGE screening formula offers a straightforward, easily available and inexpensive method for differentiating between CRI and eGFR < 60 ml/min/1.73 m2 that will prevent a considerable number of aged healthy persons, as much as 1.700.000 in Spain and 2.600.000 in U.K., to be excluded from clinical assays or treatments contraindicated in CRI.

  2. Mild toxic anterior segment syndrome mimicking delayed onset toxic anterior segment syndrome after cataract surgery

    Directory of Open Access Journals (Sweden)

    Su-Na Lee

    2014-01-01

    Full Text Available Toxic anterior segment syndrome (TASS is an acute sterile postoperative anterior segment inflammation that may occur after anterior segment surgery. I report herein a case that developed mild TASS in one eye after bilateral uneventful cataract surgery, which was masked during early postoperative period under steroid eye drop and mimicking delayed onset TASS after switching to weaker steroid eye drop.

  3. Comparative outcomes of the two types of sacral extradural spinal meningeal cysts using different operation methods: a prospective clinical study.

    Science.gov (United States)

    Sun, Jian-Jun; Wang, Zhen-Yu; Teo, Mario; Li, Zhen-Dong; Wu, Hai-Bo; Yen, Ru-Yu; Zheng, Mei; Chang, Qing; Yisha Liu, Isabelle

    2013-01-01

    This prospective study compares different clinical characteristics and outcomes of patients with two types of sacral extradural spinal meningeal cysts (SESMC) undergoing different means of surgical excision. Using the relationship between the cysts and spinal nerve roots fibers (SNRF) as seen under microscope, SESMCs were divided into two types: cysts with SNRF known as Tarlov cysts and cysts without. The surgical methods were tailored to the different types of SESMCs. The improved Japanese Orthopedic Association (IJOA) scoring system was used to evaluate preoperative and postoperative neurological function of the patients. Preoperative IJOA scores were 18.5 ± 1.73, and postoperative IJOA scores were 19.6 ± 0.78. The difference between preoperative and postoperative IJOA scores was statistically significant (t = -4.52, p = 0.0001), with a significant improvement in neurological function after surgery. Among the improvements in neurological functions, the most significant was sensation (z=-2.74, p=0.006), followed by bowel/bladder function (z=-2.50, p=0.01). There was a statistically significant association between the types of SESMC and the number (F=12.57, p=0.001) and maximum diameter (F=8.08, p=0.006) of the cysts. SESMC with SNRF are often multiple and small, while cysts without SNRF tend to be solitary and large. We advocate early surgical intervention for symptomatic SESMCs in view of significant clinical improvement postoperatively.

  4. Does patterned afferent stimulation of sacral dermatomes suppress urethral sphincter reflexes in individuals with spinal cord injury?

    Science.gov (United States)

    McCoin, Jaime L; Bhadra, Narendra; Brose, Steven W; Gustafson, Kenneth J

    2015-03-01

    Dyssynergic contractions of the external urethral sphincter prevent efficient bladder voiding and lead to numerous health concerns. Patterned electrical stimulation of the sacral dermatomes reduces urethral sphincter spasms and allows functional bladder emptying in cats after chronic SCI. Reflex suppression in animals is strongly dependent on stimulus location and pattern. The purpose of this study was to determine whether the stimulation patterns and locations effective in animals suppress urethral sphincter spasms in humans with SCI. Ten subjects with chronic SCI underwent bladder filling to elicit distention-evoked contractions. During reflex contractions patterned electrical stimulation was applied to the S2 or S3 dermatome in random 25-sec intervals. Bladder and sphincter pressures were simultaneously recorded and compared between control and afferent stimulation periods. Six of the 10 subjects demonstrated both reflex bladder and sphincter contractions with bladder filling. No significant reduction in urethral pressure was observed during stimulation for any stimulus locations and patterns tested. Stimulation parameters and locations effective in SCI animals did not suppress reflex sphincter activity in these human subjects. It is likely that a broader set of stimulus patterns and dermatome locations will need to be tested to find the effective combination in humans. © 2014 Wiley Periodicals, Inc.

  5. Coordination impairment between the somatic and parasympathetic nervous system divisions in the human sacral micturition centre following spinal cord injury.

    Science.gov (United States)

    Schalow, G

    2009-01-01

    The detrusor-sphincteric dyssynergia is analyzed by comparing the natural impulse patterns of secondary muscle spindle afferents (SP2) contributing to continence (SP2 fibre activity changes are similar to detrusor pressure changes) and sphincteric motoneurons in a brain-dead human with those in patients with spinal cord injuries. In the brain-dead the sphincteric motoneurons, subserving continence, were inhibited at a time, when preganglionic parasympathetic efferents and a SP2 fibre increased their activity (physiologic). In paraplegics the sphincteric motoneurons were not inhibited (pathophysiologic). In the brain-dead, an SP2 fibre showed doublet firing (interspike interval (II) 10 to 14 ms) for low level parasympathetic activation and multi-ending regular firing for high parasympathetic activation. In one paraplegic with strong bladder dysfunction, the multi-ending regular firing was replaced by a repeated burst firing with a shortest II of 0.2 ms (transmission frequency = 5000 Hz). The pathologic firing patterns of the SP2 fibres, the detrusor-sphincteric dyscoordination, and hyperreflexia in paraplegics are most likely a result of neuronal network changes in the parasympathetic and somatic nervous system divisions of the sacral micturition center after spinal cord injury. It is discussed that urinary bladder functions can be re-learned.

  6. Abscess formation in vertebral canal and presacral area following penetrating injury of rectum and sacral vertebra by a steel rod

    Institute of Scientific and Technical Information of China (English)

    TAN Hao; GUO Qing-shan; ZHANG Lian-yang; SUN Shi-jin; YAO Yuan-zhang; HUANG Xiao-ying

    2012-01-01

    Penetrating injury to the rectum,vertebral body and spinal cord by a steel rod is a rare condition.Treatment of this kind of injury is very challenging.Rectal injury requires repair and fecal diversion,while debridement of the spine is difficult,especially when the injury site is very long.Here we report a case of penetrating injury of rectum and sacral vertebra by a steel rod after falling onto the ground from 1 m height.The abscess cavity was irrigated with 3% hydrogen peroxide and physiological saline repeatedly.The bony canal was carefully debrided,curetted and bony fragments were removed.Spinal irrigation and drainage lasted for 2 months and sensitive antibiotic (amikacin sulfate) was given 7 days after surgery,but abscess was still formed in the vertebral canal.At 6-month follow-up,the patient was paralyzed without any neurological improvement,and the pain in low back and lower limb still continued.

  7. Sacral nerve stimulation for urinary urge incontinence, urgency-frequency, urinary retention, and fecal incontinence: an evidence-based analysis.

    Science.gov (United States)

    2005-01-01

    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. 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. SACRAL NERVE STIMULATION Sacral nerve stimulation is a procedure where a small device attached to an electrode is implanted in the abdomen or buttock to stimulate the sacral nerves in an

  8. Partial reactivation of a huge deep-seated ancient rock slide: recognition, formation mechanism, and stability

    Science.gov (United States)

    Tang, Minggao; Xu, Qiang; Li, Yusheng; Huang, Runqiu; Rengers, Niek; Zhu, Xing

    2016-08-01

    About 18 years ago, a large-scale discontinuous layer in properties and colour was found in the new Fengjie town at the shore of the Three Gorges Reservoir area in China. There are many resettled residents and buildings on the sloping area, the safety of which is potentially affected by this layer, so it has become the focus of attention. Before this study started there were two viewpoints regarding the origin of this layer. One was that is was from a huge ancient slide and the other was that is was from a fault graben. In order to find out how it was formed and to be able to carry out a stability analysis of the slope the authors have carried out a research program, including geological field investigations and mapping, a deep drilling hole, a geotechnical centrifuge model test, and a simulation analysis. The results of the research led to the conclusion that the layer is the sliding plane of a huge deep-seated ancient rock slide, which we called the Sanmashan landslide. An important argument for the conclusion is the recognition of a regional compressive tectonic stress field in this area, which cannot lead to the formation of a fault graben because it needs a tensional tectonic stress field. Moreover, numerous unique geological features, sliding marks, and other relics of the ancient slide have been discovered in the field. The formation process of the ancient slide could be repeated in a large geotechnical centrifuge model test. The test shows that a deformation and failure process of "creep-crack-cut" has occurred. The type of the ancient slide can be classified as a "successive rotational rock slide". Finally, the role of seepage in the stability of the Sanmashan landslide has been analysed. Our final conclusions are that, during rainfall and filling-drawdown cycles in the Three Gorges Reservoir, the Sanmashan landslide as a whole is dormant and stable and the secondary landslides in the toe area of the slope are presently stable but can be reactivated. This

  9. Basic principles of aggressive rehabilitation after anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Dubljanin-Raspopović Emilija

    2005-01-01

    Full Text Available Rehabilitation after ACL (anterior cruciate ligament reconstruction has drastically changed over the last decade, with the adoption of a more aggressive approach, right from the first day after surgery. Progress in the effectiveness of rehabilitation is based on improvements in operative techniques, as well as on the encouraging results of histological studies regarding graft healing. Despite a huge amount of research papers on this topic, a rehabilitation golden standard still has not been established, due to the complexity of this problem. In this review, we point out the basic principles of rehabilitation after arthroscopically assisted ACL reconstruction based on actual practices, as well as the importance of specific procedures for the prevention of complications during the postoperative period. The importance of range-of-motion exercises, early weight bearing, an appropriate gait scheme, patella mobilisation, pain and oedema control, as well as stretching and balance exercises is explained. The functional advantages of closed kinetic chain exercises, as well as their influence on the graft are also described, in comparison to open kinetic chain exercises. The fundamentals of returning to sports are revealed and the specific aspects of rehabilitation regarding graft choice are pointed out. While waiting for new clinical investigations, which are expected to enable the establishment of a rehabilitation golden standard, the outlined principles should be followed. The complexity of this injury requires treatment in highly specialised institutions.

  10. Anterior segment complications of retinal photocoagulation.

    Science.gov (United States)

    Kanski, J J

    1975-03-01

    Seven patients had anterior segment complications following xenon arc retinal photocoagulation. Irreversible keratopathy was induced in two cases; all patients showed evidence of iris injury. The absorption of radiation by the iris was considered the main factor in producing overheating of the anterior segment.

  11. Anterior cervical hypertrichosis: a sporadic case.

    Science.gov (United States)

    Bostan, Sezen; Yaşar, Şirin; Serdar, Zehra Aşiran; Gizlenti, Sevda

    2016-03-01

    Anterior cervical hypertrichosis is a very rare form of primary localized hypertrichosis. It consists of a tuft of terminal hair on the anterior neck just above the laryngeal prominence. The etiology is still unknown. In this article, we reported a 15-year-old female patient who presented to our clinic with a complaint of hypertrichosis on the anterior aspect of the neck for the last five years. Her past medical history revealed no pathology except for vesicoureteral reflux. On the basis of clinical presentation, our patient was diagnosed with anterior cervical hypertrichosis and she was considered to be a sporadic case due to lack of other similar cases in familial history. To date, 33 patients with anterior cervical hypertrichosis have been reported. Anterior cervical hypertrichosis can be associated with other abnormalities, but it frequently presents as an isolated defect (70%). The association of vesicoureteral reflux and anterior cervical hypertrichosis which was observed in our patient might be coincidental. So far, no case of anterior cervical hypertrichosis associated with vesicoureteral reflux has been reported in the literature.

  12. Recurrent anterior uveitis in Henoch Schonlein's vasculitis.

    Science.gov (United States)

    Erer, Burak; Kamali, Sevil; Cingu, Kursat; Kilicaslan, Isin; Gul, Ahmet; Inanc, Murat; Aral, Orhan; Tugal-Tutkun, Ilknur

    2010-08-01

    Uveitis is an important component of many rheumatic diseases. The main causes of recurrent uveitis are seronegative spondylarthropathies and Behçet's disease. We describe a rare case of Henoch Schönlein vasculitis (HSV) along with multiple recurrences of acute anterior uveitis. In cases of skin rash and recurrent anterior uveitis, HSV should be considered in the differential diagnosis.

  13. Totally thrombosed giant anterior communicating artery aneurysm

    Directory of Open Access Journals (Sweden)

    V R Roopesh Kumar

    2015-01-01

    Full Text Available Giant anterior communicating artery aneurysmsarerare. Apatient presented with visual dysfunction, gait ataxia and urinary incontinence. MRI showed a giant suprasellar mass.At surgery, the lesion was identified as being an aneurysm arising from the anterior communicating artery.The difficulty in preoperative diagnosis and relevant literature are reviewed.

  14. Anterior urethral diverticulum: A rare presentation

    Directory of Open Access Journals (Sweden)

    Annavarupu Gopalkrishna

    2016-01-01

    Full Text Available Congenital anomalies of the urogenital tract are the most common anomalies found in the foetus, neonates and infants, but anterior urethral valves and diverticula are rare. Here, we present a case with congenital anterior urethral diverticulum associated with patent ductus arteriosus and polydactyly.

  15. Modified simultaneous integrated boost radiotherapy for an unresectable huge refractory pelvic tumor diagnosed as a rectal adenocarcinoma.

    Science.gov (United States)

    Nomiya, Takuma; Akamatsu, Hiroko; Harada, Mayumi; Ota, Ibuki; Hagiwara, Yasuhito; Ichikawa, Mayumi; Miwa, Misako; Kawashiro, Shouhei; Hagiwara, Motohisa; Chin, Masahiro; Hashizume, Eiji; Nemoto, Kenji

    2014-12-28

    A clinical trial of radiotherapy with modified simultaneous integrated boost (SIB) technique against huge tumors was conducted. A 58-year-old male patient who had a huge pelvic tumor diagnosed as a rectal adenocarcinoma due to familial adenomatous polyposis was enrolled in this trial. The total dose of 77 Gy (equivalent dose in 2 Gy/fraction) and 64.5 Gy was delivered to the center of the tumor and the surrounding area respectively, and approximately 20% dose escalation was achieved with the modified SIB technique. The tumor with an initial maximum size of 15 cm disappeared 120 d after the start of the radiotherapy. Performance status of the patient improved from 4 to 0. Radiotherapy with modified SIB may be effective for patients with a huge tumor in terms of tumor shrinkage/disappearance, improvement of QOL, and prolongation of survival.

  16. MR-based truncation and attenuation correction in integrated PET/MR hybrid imaging using HUGE with continuous table motion.

    Science.gov (United States)

    Lindemann, Maike E; Oehmigen, Mark; Blumhagen, Jan O; Gratz, Marcel; Quick, Harald H

    2017-09-01

    The objective of this study was to introduce and evaluate a method for MR-based attenuation and truncation correction in phantom and patient measurements to improve PET quantification in PET/MR hybrid imaging. The fully MR-based method HUGE (B0 Homogenization using gradient enhancement) provides field-of-view extension in MR imaging, which can be used for truncation correction and improved PET quantification in PET/MR hybrid imaging. The HUGE method in this recent implementation is combined with continuously moving table data acquisition to provide a seamless nontruncated whole-body data set of the outer patient contours to complete the established standard MR-based Dixon-VIBE data for attenuation correction. The method was systematically evaluated in NEMA standard phantom experiments to investigate the impact of HUGE truncation correction on PET quantification. The method was then applied to 24 oncologic patients in whole-body PET/MR hybrid imaging. The impact of MR-based truncation correction with HUGE on PET data was compared to the impact of the established PET-based MLAA algorithm for contour detection. In phantom and in all patient measurements, the standard Dixon-VIBE attenuation correction data show geometric distortions and signal truncations at the edges of the MR imaging field-of-view. In contrast, the Dixon-VIBE-based attenuation correction data additionally extended by applying HUGE shows significantly less distortion and truncations and due to the continuously moving table acquisition robustly provides smooth outer contours of the patient arms. In the investigated patient cases, MLAA frequently showed an overestimation of arm volume and associated artifacts limiting contour detection. When applying HUGE, an average relative increase in SUVmean in patients' lesion of 4.2% and for MLAA of 4.6% were measured, when compared to standard Dixon-VIBE only. In specific lesions maximal differences in SUVmean up to 13% for HUGE and 14% for MLAA were measured

  17. Anterior Segment Imaging in Combat Ocular Trauma

    Directory of Open Access Journals (Sweden)

    Denise S. Ryan

    2013-01-01

    Full Text Available Purpose. To evaluate the use of ocular imaging to enhance management and diagnosis of war-related anterior segment ocular injuries. Methods. This study was a prospective observational case series from an ongoing IRB-approved combat ocular trauma tracking study. Subjects with anterior segment ocular injury were imaged, when possible, using anterior segment optical coherence tomography (AS-OCT, confocal microscopy (CM, and slit lamp biomicroscopy. Results. Images captured from participants with combat ocular trauma on different systems provided comprehensive and alternate views of anterior segment injury to investigators. Conclusion. In combat-related trauma of the anterior segment, adjunct image acquisition enhances slit lamp examination and enables real time In vivo observation of the cornea facilitating injury characterization, progression, and management.

  18. 骶骨肿瘤切除术辅助氩氦刀的临床疗效分析%An analysis of clinical effects of surgical resection of sacral tumors adjuvant with Cryo-Hit

    Institute of Scientific and Technical Information of China (English)

    彭智恒; 王吉兴; 江建明; 瞿东滨; 鲁凯伍; 蒋晖; 王海明; 陈建庭

    2014-01-01

    Objective To evaluate the clinical effects of surgical resection of sacral tumors adjuvant with Cryo-Hit. Methods From January 2007 to December 2012, the clinical data of 15 consecutive patients with sacral tumors who were treated with resection adjuvant with Cryo-Hit and were followed up were retrospectively analyzed. There were 9 males and 6 females, whose average age was 51.3 years old ( range;38-78 years ). There were 12 cases of chordomas, 1 case of giant cell tumor of bone, 1 case of ifbromatosis in the sacroiliac region and 1 case of metastatic tumor in the sacrum, which were conifrmed by the postoperative pathology. Tumors were found in S2 ( n=8 ) and below S3 ( n=6 ). Recurrence was noticed in the buttock in 1 case. The course ranged from 2 months to 9 years. Sacrococcygeal pain occurred in 90%of all the patients, sciatica in 6 patients, and bladder and ( or ) rectal dysfunction in varying degrees in 12 patients. All the patients received surgical resection of sacral tumors adjuvant with Cryo-Hit. A combination of anterior and posterior approaches was adopted in 14 patients. In the anterior approach isolation and exposure of tumors was performed under laparoscope, and in the posterior approach Cryo-Hit was used to freeze and completely resect tumors. Palliative posterior surgery was performed alone on 1 patient with metastatic tumor in the sacrum, due to the poor body condition. Results The mean operation time was 315 min, and the mean blood loss was 1065 ml. The mean drainage lfow was 635 ml, and the mean postoperative hospital stay was 19.2 days. All the patients were followed up for an average period of 26 months ( range;5-48 months ). There were 14 patients alive, and the total survival rate was 93.3%. The bilateral nerve roots in S2 and above were successfully spared in all the patients, and no motor or sensory disturbances of lower limbs were noticed. The Visual Analogue Scale ( VAS ) scores were ( 6.80±1.52 ) points and ( 2.33±0.90 ) points

  19. Huge nanodielectric effects in polyimide/boron nitride nanocomposites revealed by the nanofiller size

    Science.gov (United States)

    Diaham, S.; Saysouk, F.; Locatelli, M.-L.; Lebey, T.

    2015-09-01

    The dielectric properties of polyimide/boron nitride (PI/BN) nanocomposite films are investigated as a function of the BN nanofiller size from 20 to 350 °C and at low filler content (1-2 vol.%). The role of the BN nanofiller size on the large reduction of the electrode polarization relaxation phenomenon due to ionic movements is reported. For the two smallest BN nanoparticles (95 nm and 35 nm), the permittivity, dielectric losses and dc conductivity are strongly attenuated above 200 °C by a factor of 10 to 1000 compared to neat PI. Thus, the dc conductivity at 350 °C is reduced from 4   ×   10-8 Ω-1 cm-1 for neat PI to 3   ×   10-11 Ω-1 cm-1 for PI/BN (35 nm). Moreover, a further decrease is obtained by functionalizing the nanofiller surface with a silane coupling agent which improves the grafting of PI chains on those latter nanoparticles. These results highlight the trapping efficiency in the interphase region introduced by the small BN nanofillers (<100 nm) and provides evidence as to the huge nanodielectric effects on the charge carrier transport controlled by the nanoparticle diameter. This finding should be of great importance for advanced high temperature electrical insulation in the future.

  20. Huge thermal conductivity enhancement in boron nitride – ethylene glycol nanofluids

    Energy Technology Data Exchange (ETDEWEB)

    Żyła, Gaweł, E-mail: gzyla@prz.edu.pl [Department of Physics and Medical Engineering, Rzeszow University of Technology, Rzeszow, 35-905 (Poland); Fal, Jacek; Traciak, Julian [Department of Physics and Medical Engineering, Rzeszow University of Technology, Rzeszow, 35-905 (Poland); Gizowska, Magdalena; Perkowski, Krzysztof [Department of Nanotechnology, Institute of Ceramics and Building Materials, Warsaw, 02-676 (Poland)

    2016-09-01

    Paper presents the results of experimental studies on thermophysical properties of boron nitride (BN) plate-like shaped particles in ethylene glycol (EG). Essentially, the studies were focused on the thermal conductivity of suspensions of these particles. Nanofluids were obtained with two-step method (by dispersing BN particles in ethylene glycol) and its’ thermal conductivity was analyzed at various mass concentrations, up to 20 wt. %. Thermal conductivity was measured in temperature range from 293.15 K to 338.15 K with 15 K step. The measurements of thermal conductivity of nanofluids were performed in the system based on a device using the transient line heat source method. Studies have shown that nanofluids’ thermal conductivity increases with increasing fraction of nanoparticles. The results of studies also presented that the thermal conductivity of nanofluids changes very slightly with the increase of temperature. - Highlights: • Huge thermal conductivity enhancement in BN-EG nanofluid was reported. • Thermal conductivity increase very slightly with increasing of the temperature. • Thermal conductivity increase linearly with volume concentration of particles.

  1. Synovial sarcoma presenting with huge mediastinal mass: a case report and review of literature

    Science.gov (United States)

    2013-01-01

    Background Synovial sarcoma presenting in the mediastinum is exceedingly rare. Furthermore, data addressing optimal therapy is limited. Herein we present a case where an attempt to downsize the tumor to a resectable state with chemotherapy was employed. Case presentation A 32 year female presented with massive pericardial effusion and unresectable huge mediastinal mass. Computed axial tomography scan - guided biopsy with adjunctive immunostains and molecular studies confirmed a diagnosis of synovial sarcoma. Following three cycles of combination Ifosfamide and doxorubicin chemotherapy, no response was demonstrated. The patient refused further therapy and had progression of her disease 4 months following the last cycle. Conclusion Synovial sarcoma presenting with unresectable mediastinal mass carry a poor prognosis. Up to the best of our knowledge there are only four previous reports where primary chemotherapy was employed, unfortunately; none of these cases had subsequent complete surgical resection. Identification of the best treatment strategy for patients with unresectable disease is warranted. Our case can be of benefit to medical oncologists and thoracic surgeons who might be faced with this unique and exceedingly rare clinical scenario. PMID:23800262

  2. Unexpected Huge Dimerization Ratio in One-Dimensional Carbon Atomic Chains.

    Science.gov (United States)

    Lin, Yung-Chang; Morishita, Shigeyuki; Koshino, Masanori; Yeh, Chao-Hui; Teng, Po-Yuan; Chiu, Po-Wen; Sawada, Hidetaka; Suenaga, Kazutomo

    2017-01-11

    Peierls theory predicted atomic distortion in one-dimensional (1D) crystal due to its intrinsic instability in 1930. Free-standing carbon atomic chains created in situ in transmission electron microscope (TEM)1-3 are an ideal example to experimentally observe the dimerization behavior of carbon atomic chain within a finite length. We report here a surprisingly huge distortion found in the free-standing carbon atomic chains at 773 K, which is 10 times larger than the value expected in the system. Such an abnormally distorted phase only dominates at the elevated temperatures, while two distinct phases, distorted and undistorted, coexist at lower or ambient temperatures. Atom-by-atom spectroscopy indeed shows considerable variations in the carbon 1s spectra at each atomic site but commonly observes a slightly downshifted π* peak, which proves its sp(1) bonding feature. These results suggest that the simple model, relaxed and straight, is not fully adequate to describe the realistic 1D structure, which is extremely sensitive to perturbations such as external force or boundary conditions.

  3. A Huge Capital Drop with Compression of Femoral Vessels Associated with Hip Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Tomoya Takasago

    2015-01-01

    Full Text Available A capital drop is a type of osteophyte at the inferomedial portion of the femoral head commonly observed in hip osteoarthritis (OA, secondary to developmental dysplasia. Capital drop itself is typically asymptomatic; however, symptoms can appear secondary to impinge against the acetabulum or to irritation of the surrounding tissues, such as nerves, vessels, and tendons. We present here a case of unilateral leg edema in a patient with hip OA, caused by a huge bone mass occurring at the inferomedial portion of the femoral head that compressed the femoral vessels. We diagnosed this bone mass as a capital drop secondary to hip OA after confirming that the mass occurred at least after the age of 63 years based on a previous X-ray. We performed early resection and total hip arthroplasty since the patient’s hip pain was due to both advanced hip OA and compression of the femoral vessels; moreover, we aimed to prevent venous thrombosis secondary to vascular compression considering the advanced age and the potent risk of thrombosis in the patient. A large capital drop should be considered as a cause of vascular compression in cases of unilateral leg edema in OA patients.

  4. Acute abdomen in early pregnancy caused by torsion of bilateral huge multiloculated ovarian cysts

    Directory of Open Access Journals (Sweden)

    Sathiyakala Rajendran

    2015-10-01

    Full Text Available The association of pregnancy and torsion of bilateral huge benign ovarian cyst is rare. We report a case of multigravida at 13 weeks of pregnancy presenting with acute onset of lower abdominal pain. Ultrasound revealed bilateral multiloculated ovarian cysts of size 10x10 cm on right side and 15x10cm on left side with evidence of torsion and a single live intrauterine fetus of gestational age 13 weeks 4 days. Emergency laparotomy was done with vaginal susten 200 mg as perioperative tocolysis. Intra operatively, uterus was enlarged to 14 weeks size. Both ovaries were replaced with multiloculated cysts of size 15x10 cm on left side and 10x10 cm on right side. Ovarian pedicle was found to be twisted once on right side and twice on left side. On right side, untwisting of pedicle was done and the ovarian cyst was punctured at multiple sites to drain the clear fluid. Biopsy was taken from the right ovarian cyst wall. On left side, ovariotomy was done. Histopathology revealed mucinous cyst adenoma of left ovary and multiple corpus luteum in right ovarian biopsy specimen. The patient was followed up with regular antenatal check-ups and ultrasound to rule out the recurrence of ovarian cyst on right side. The patient successfully delivered a term male baby at 39 weeks. [Int J Reprod Contracept Obstet Gynecol 2015; 4(5.000: 1598-1601

  5. Propranolol in Treatment of Huge and Complicated Infantile Hemangiomas in Egyptian Children

    Directory of Open Access Journals (Sweden)

    Basheir A. Hassan

    2014-01-01

    Full Text Available Background. Infantile hemangiomas (IHs are the most common benign tumours of infancy. Propranolol has recently been reported to be a highly effective treatment for IHs. This study aimed to evaluate the efficacy and side effects of propranolol for treatment of complicated cases of IHs. Patients and Methods. This prospective clinical study included 30 children with huge or complicated IHs; their ages ranged from 2 months to 1 year. They were treated by oral propranolol. Treatment outcomes were clinically evaluated. Results. Superficial cutaneous hemangiomas began to respond to propranolol therapy within one to two weeks after the onset of treatment. The mean treatment period that was needed for the occurrence of complete resolution was 9.4 months. Treatment with propranolol was well tolerated and had few side effects. No rebound growth of the tumors was noted when propranolol dosing stopped except in one case. Conclusion. Propranolol is a promising treatment for IHs without obvious side effects. However, further studies with longer follow-up periods are needed.

  6. Computational AstroStatistics Fast and Efficient Tools for Analysing Huge Astronomical Data Sources

    CERN Document Server

    Nichol, R C; Connolly, A J; Davies, S; Genovese, C; Hopkins, A M; Miller, C J; Moore, A W; Pelleg, D; Richards, G T; Schneider, J; Szapudi, I; Wasserman, L H

    2001-01-01

    I present here a review of past and present multi-disciplinary research of the Pittsburgh Computational AstroStatistics (PiCA) group. This group is dedicated to developing fast and efficient statistical algorithms for analysing huge astronomical data sources. I begin with a short review of multi-resolutional kd-trees which are the building blocks for many of our algorithms. For example, quick range queries and fast n-point correlation functions. I will present new results from the use of Mixture Models (Connolly et al. 2000) in density estimation of multi-color data from the Sloan Digital Sky Survey (SDSS). Specifically, the selection of quasars and the automated identification of X-ray sources. I will also present a brief overview of the False Discovery Rate (FDR) procedure (Miller et al. 2001a) and show how it has been used in the detection of ``Baryon Wiggles'' in the local galaxy power spectrum and source identification in radio data. Finally, I will look forward to new research on an automated Bayes Netw...

  7. Distributed data organization and parallel data retrieval methods for huge laser scanner point clouds

    Science.gov (United States)

    Hongchao, Ma; Wang, Zongyue

    2011-02-01

    This paper proposes a novel method for distributed data organization and parallel data retrieval from huge volume point clouds generated by airborne Light Detection and Ranging (LiDAR) technology under a cluster computing environment, in order to allow fast analysis, processing, and visualization of the point clouds within a given area. The proposed method is suitable for both grid and quadtree data structures. As for distribution strategy, cross distribution of the dataset would be more efficient than serial distribution in terms of non-redundant datasets, since a dataset is more uniformly distributed in the former arrangement. However, redundant datasets are necessary in order to meet the frequent need of input and output operations in multi-client scenarios: the first copy would be distributed by a cross distribution strategy while the second (and later) would be distributed by an iterated exchanging distribution strategy. Such a distribution strategy would distribute datasets more uniformly to each data server. In data retrieval, a greedy algorithm is used to allocate the query task to a data server, where the computing load is lightest if the data block needing to be retrieved is stored among multiple data servers. Experiments show that the method proposed in this paper can satisfy the demands of frequent and fast data query.

  8. Anterior space management: interdisciplinary concepts.

    Science.gov (United States)

    Ittipuriphat, Iyarint; Leevailoj, Chalermpol

    2013-02-01

    This case report describes the treatment of one patient with maxillary anterior spacing, caused by bilateral lateral peg-shaped incisors, using a planned sequence of multidisciplinary approaches for esthetic treatment. An asymmetrical gingival line was visible when the patient smiled. To evaluate the desired gingival level and the proportion of restoration to be made using the recurring esthetic dental (RED) proportion method, a diagnostic wax-up model was fabricated. Esthetic crown lengthening corrected the gingival line. RED proportion analysis suggested minor tooth movement prior to any restoration. Two weeks' use of an orthodontic removable appliance with finger springs achieved the proper dental proportion. Home whitening was prescribed for 2 weeks, with an additional 2-week waiting period to ensure tooth color stability. Resin composite treatment corrected the mesial contour of the maxillary canines and reduced the space between the canines and lateral incisors. Final restoration was obtained by placing ceramic veneers on the lateral peg-shaped incisors. The esthetic treatment achieved excellent results; after veneer cementation, the patient exhibited greater confidence with a new smile. Esthetic dental treatment requires various disciplines to achieve the treatment goal. This case report is an example of well-planned sequences of treatment from the beginning to complete treatment. By conservative and practical treatment approaches used in this case, the clinician will be able to manage to obtain the highest result of esthetic treatment. © 2012 Wiley Periodicals, Inc.

  9. 家族性骶椎发育不全六例的临床及X线、MRI表现分析%Magnetic resonance imaging and radiological findings of familial sacral agenesis: a report of 6 cases

    Institute of Scientific and Technical Information of China (English)

    田彤彤; 吴海涛; 王守安; 陈文新; 胡晓华; 颜连启; 吴晶涛

    2014-01-01

    分析一家族内6例骶椎发育不全病例的临床和影像学资料.在MRI检查影像上,6例患者骶椎均不同程度缺如,其中2例伴有腰椎形态发育畸形,2例骶椎形态发育畸形.1例出现第4、5腰椎和第5腰椎、第1骶椎椎体骨质融合.在X线影像上,4例伴脊柱侧突.6例均未见脊髓栓系、脊髓纵裂及脊膜膨出的征象.%The clinical characteristics and radiological data of 6 cases of sacral agenesis in one single family were analyzed and a literature review was performed.On magnetic resonance imaging (MRI),all of them presented with a partial absence of sacral vertebra,including associations with lumbar abnormalities (n =2) and sacral agenesis (n =2).One case presented with fourth/fifth lumbar vertebra bone fusion and fifth lumbar/first sacral vertebra bone fusion.On radiology,4 cases had concurrent scoliosis.None of them had tethered cord,diastematomyelia or meningocele.The understanding of sacral agenesis may be improved after reviewing and summarizing clinical features and radiological findings.

  10. Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note

    Directory of Open Access Journals (Sweden)

    Shi-Qing Mu

    2015-01-01

    Full Text Available Background: The endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT technique. Methods: We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated. Results: All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months after the endovascular treatment (median 8 months, 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia. Conclusions: The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.

  11. Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note

    Institute of Scientific and Technical Information of China (English)

    Shi-Qing Mu; Xin-Jian Yang; You-Xiang Li; Chu-Han Jiang; Zhong-Xue Wu

    2015-01-01

    Background:The endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA) is controversial and challenging.This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT) technique.Methods:We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of lnterventional Neuroradiology of Beijing Tiantan Hospital.Clinical and angiographic data were reviewed and evaluated.Results:All patients were treated by the IT technique.That meant the dissecting artery and aneurysm segments were completed occlusion.After the procedure,the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion.Follow-up angiography was performed at 3-6 months or 12-18 months after the endovascular treatment (median 8 months),14 patients had a good recovery.Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA.After the second treatment,the patient died by the ventricular tachycardia.Conclusions:The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms,but it is not necessarily the safest or most definitive treatment modality.The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.

  12. Huge pseudomyxoma peritonei: Surgical strategies and procedures to employ to optimize the rate of complete cytoreductive surgery.

    Science.gov (United States)

    Benhaim, L; Honoré, C; Goéré, D; Delhorme, J-B; Elias, D

    2016-04-01

    Complete cytoreductive surgery (CCRS) plus Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is the best-known treatment for pseudomyxoma peritonei (PMP). In 30% of the cases, PMP realize a widespread involvement of the peritoneal cavity. In these extreme situations, we developed, devoted strategies to optimize the feasibility and safety of CCRS. This study describes the surgical resections required for CCRS and the consequent approaches that we propose to achieve CCRS. We defined "huge PMP" by a peritoneal cancer index (PCI) ≥ 28. Surgical procedures of patients operated on between 1994 and 2014 were retrospectively reviewed from a prospective database in a single institution. During this period, 311 patients were operated on and 247 (79%) underwent CCRS + HIPEC. Among them, 100 patients presented "huge" PMP and 54 patients underwent CCRS + HIPEC. In patients with "huge" PMP, the rate of CCRS + HIPEC was 25% before 2002 and reached 71% between 2011 and 2014. We identified 3 conditions for CCRS 1) to guaranty a sufficient length of residual small bowel 2) to preserve the left gastric vessels in order to preserve the superior third of the stomach 3) to ensure that the hepatic pedicle can be entirely cleared from its tumor involvement. None of the other peritonectomy procedures were decisional for CCRS. Our learning curve improved the selection and completion rate of CCRS + HIPEC for "huge PMP". Some anatomical and physiological prerequisites guarantee the feasibility and safety of such extensive surgeries. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note.

    Science.gov (United States)

    Mu, Shi-Qing; Yang, Xin-Jian; Li, You-Xiang; Jiang, Chu-Han; Wu, Zhong-Xue

    2015-07-20

    The endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA) is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT) technique. We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated. All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months after the endovascular treatment (median 8 months), 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia. The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.

  14. Is hepatectomy for huge hepatocellular carcinoma (≥ 10 cm in diameter) safe and effective? A single-center experience.

    Science.gov (United States)

    Yang, Jian; Li, Chuan; Wen, Tian-Fu; Yan, Lu-Nan; Li, Bo; Wang, Wen-Tao; Yang, Jia-Yin; Xu, Ming-Qing

    2014-01-01

    This retrospective study aimed to validate the safety and effectiveness of hepatectomy for huge hepatocellular carcinoma (HCC). Data of patients who underwent hepatectomy for HCC between January 2006 and December 2012 were reviewed. The patients were divided into three groups: huge HCC(≥ 10 cm in diameter), large HCC(≥ 5 buthuge and large HCC groups were lower than that of the small HCC group (OS: 32.5% vs 36.3% vs 71.2%, p=0.000; DFS: 20.0% vs 24.8% vs 40.7%, p=0.039), but there was no difference between the huge and large HCC groups (OS: 32.5% vs 36.3%, p=0.667; DFS: 20.0% vs 24.8%, p=0.540). In multivariate analysis, five independent poor prognostic factors that affected OS were significantly associated with worse survival (phuge HCC is similar to that for large and small HCC; and this approach for huge HCC may achieve similar long-term survival and disease-free survival as for large HCC.

  15. Flume tests to study the initiation of huge debris flows after the Wenchuan earthquake in S-WChina

    NARCIS (Netherlands)

    Hu, Wei; Xu, Qiang; van Asch, Theo.W.J.; Zhua, X; Xu, Q.Q.

    2014-01-01

    In the Wenchuan area in the southwest of China, a huge amount of loose co-seismic landslide material was deposited on slopes during the Wenchuan earthquake of May 2008. These loose deposits formed the source material for rainfall-induced debris flows or shallow landslides in the years after the eart

  16. Bladder response to acute sacral neuromodulation while treating rats in different phases of complete spinal cord injury: a preliminary study

    Directory of Open Access Journals (Sweden)

    Ping Shi

    2015-12-01

    Full Text Available Background: Compared to conventional therapies, sacral neuromodulation (SNM may offer an alternative, non-destructive treatment for SCI patients with bladder dysfunction. Understanding bladder response to SNM treatment for SCI in different phases may yield new insights for innovative use of this promising technique. Materials and Methods: Female Sprague-Dawley rats were used in this study to examine the effects of acute SNM on bladder reflex in complete SCI rats. All rats were anesthetized and set up for continuous saline infusion. Acute SNM treatment was implemented for about 6 hours for each rat. Cystometric parameters, including time between contractions, contraction duration, bladder peak pressure, and number of uninhibited contractions, were analyzed and compared within rats before and after SNM treatment. Results: For the spinally transected rats during early phase (less than two weeks post spinalization, the time between contractions and contraction duration both increased after SNM treatments, yet the increased amplitude was about or less than 20%. For the spinally transected rats with a longer days survival (about two to four weeks post spinalization, the time between contractions and contraction duration substantially increased after SNM treatment and the changes for their average values were more than 90%. For the spinally transected rats with a much longer days survival (more than five weeks post spinalization, the time between contractions and contraction duration increased after SNM treatments, yet the magnitude of changes were less than 30%. Conclusion: The present study suggested that the significant effectiveness of SNM for complete SCI played its role after the spinal shock phase and prior to the development of detrusor overactivity. It indicated that the time point of SNM treatment is necessary to be paid attention.

  17. Error rate of multi-level rapid prototyping trajectories for pedicle screw placement in lumbar and sacral spine

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

    Objective:Free-hand pedicle screw placement has a high incidence of pedicle perforation which can be reduced with fluoroscopy,navigation or an alternative rapid prototyping drill guide template.In our study the error rate of multi-level templates for pedicle screw placement in lumbar and sacral regions was evaluated.Methods:A case series study was performed on 11 patients.Seventy-two screws were implanted using multilevel drill guide templates manufactured with selective laser sintering.According to the optimal screw direction preoperatively defined,an analysis of screw misplacement was performed.Displacement,deviation and screw length difference were measured.The learning curve was also estimated.Results:Twelve screws (17%) were placed more than 3.125 mm out of its optimal position in the centre of pedicle.The tip of the 16 screws (22%) was misplaced more than 6.25 mm out of the predicted optimal position.According to our predefined goal,19 screws (26%) were implanted inaccurately.In 10 cases the screw length was selected incorrectly:1 (1%) screw was too long and 9 (13%) were too short.No clinical signs of neurovascular lesion were observed.Learning curve was insignificantly noticeable (P=0.129).Conclusion:In our study,the procedure of manufacturing and applying multi-level drill guide templates has a 26% chance of screw misplacement.However,that rate does not coincide with pedicle perforation incidence and neurovascular injury.These facts along with a comparison to compatible studies make it possible to summarize that multi-level templates are satisfactorily accurate and allow precise screw placement with a clinically irrelevant mistake factor.Therefore templates could potentially represent a useful tool for routine pedicle screw placement.

  18. How I do it: Anterior pull-through tympanoplasty for anterior eardrum perforations.

    Science.gov (United States)

    Harris, Jeffrey P; Wong, Yu-Tung; Yang, Tzong-Hann; Miller, Mia

    2016-01-01

    Conclusions This technique is offered as a convenient and reliable method for cases with anterior TM perforation and inadequate anterior remnant. Objectives Chronic otitis media surgery is one of the most common procedures in otology. Anterior tympanic membrane (TM) perforation with inadequate anterior remnant is associated with higher rates of graft failure. It was the goal of this series to evaluate the anatomical and functional outcomes of a modified underlay myringoplasty technique-the anterior pull-through method. Materials and methods In a retrospective clinical study, 13 patients with anterior TM perforations with inadequate anterior remnants underwent tympanoplasty with anterior pull-through technique. The anterior tip of the temporalis fascia was pulled through and secured in a short incision lateral to the anterior part of the annulus. Data on graft take rate, pre-operative, and post-operative hearing status were analyzed. Results A graft success rate of 84.6% (11 out of 13) was achieved, without lateralization, blunting, atelectasia, or epithelial pearls. The air-bone gap was 21.5 ± 6.8 dB before intervention and 11.75 ± 5.7 dB after surgery (p = 0.003).

  19. Quadriceps muscle contraction protects the anterior cruciate ligament during anterior tibial translation.

    Science.gov (United States)

    Aune, A K; Cawley, P W; Ekeland, A

    1997-01-01

    The proposed skiing injury mechanism that suggests a quadriceps muscle contraction can contribute to anterior cruciate ligament rupture was biomechanically investigated. The effect of quadriceps muscle force on a knee specimen loaded to anterior cruciate ligament failure during anterior tibial translation was studied in a human cadaveric model. In both knees from six donors, average age 41 years (range, 31 to 65), the joint capsule and ligaments, except the anterior cruciate ligament, were cut. The quadriceps tendon, patella, patellar tendon, and menisci were left intact. One knee from each pair was randomly selected to undergo destructive testing of the anterior cruciate ligament by anterior tibial translation at a displacement rate of 30 mm/sec with a simultaneously applied 889 N quadriceps muscle force. The knee flexion during testing was 30 degrees. As a control, the contralateral knee was loaded correspondingly, but only 5 N of quadriceps muscle force was applied. The ultimate load for the knee to anterior cruciate ligament failure when tested with 889 N quadriceps muscle force was 22% +/- 18% higher than that of knees tested with 5 N of force. The linear stiffness increased by 43% +/- 30%. These results did not support the speculation that a quadriceps muscle contraction contributes to anterior cruciate ligament failure. In this model, the quadriceps muscle force protected the anterior cruciate ligament from injury during anterior tibial translation.

  20. Comparative analysis between thoracic spinal cord and sacral neuromodulation in a rat spinal cord injury model: a preliminary report of a rat spinal cord stimulation model.

    Science.gov (United States)

    Hyun, Seung-Jae; Lee, Chang-Hyun; Kwon, Ji Woong; Yoon, Cheol-Yong; Lim, Jae-Young; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

    2013-03-01

    The purpose of this study is to compare a neuroprotective effect of thoracic cord neuromodulation to that of sacral nerve neuromodulation in rat thoracic spinal cord injury (SCI) model. Twenty female Sprague Dawley rats were randomly divided into 4 groups: the normal control group (n=5), SCI with sham stimulation group (SCI, n=5), SCI with electrical stimulation at thoracic spinal cord (SCI + TES, n=5), and SCI with electrical stimulation at sacral nerve (SCI + SES, n=5). Spinal cord was injured by an impactor which dropped from 25mm height. Electrical stimulation was performed by the following protocol: pulse duration, 0.1ms; frequency, 20 Hz; stimulation time, 30 minutes; and stimulation duration at thoracic epidural space and S2 or 3 neural foramina for 4 weeks. Locomotor function, urodynamic study, muscle weights, and fiber cross sectional area (CSA) were investigated. All rats of the SCI + TES group expired within 3 days after the injury. The locomotor function of all survived rats improved over time but there was no significant difference between the SCI and the SCI + SES group. All rats experienced urinary retention after the injury and recovered self-voiding after 3-9 days. Voiding contraction interval was 25.5±7.5 minutes in the SCI group, 16.5±5.3 minutes in the SCI+SES group, and 12.5±4.2 minutes in the control group. The recovery of voiding contraction interval was significant in the SCI + SES group comparing to the SCI group (pspinal cord stimulation model. However, sacral neuromodulation have a therapeutic potential to improve neurogenic bladder and muscle atrophy.