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Sample records for partial sacral agenesis

  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. Two cases of sacral agenesis

    International Nuclear Information System (INIS)

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

    1979-01-01

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

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

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    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.

  4. 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

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    Paulo Ricardo G. Zen

    2010-09-01

    anus and recto-vestibular fistula diagnosed in the first day after birth. At seven months of age, she started to present episodes of recurrent urinary infections and received a diagnosis of neurogenic bladder. At the same time, partial sacral agenesis was noted. Magnetic resonance imaging and computed tomography scan of the spine identified the presence of a fistula coincident with the lombo-sacral dimple described at clinical examination, amputation of the lower portion of the spinal cord with reduced number of nervous roots of the caudus equinus and lipomatous presacral mass. The patient did not present other dysmorphia. Parental radiologic evaluation did not identify sacral abnormalities. COMMENTS: Currarino syndrome is a rare autosomal dominant genetic disease characterized by the triad composed of anal atresia, partial sacral agenesis and presacral tumor. It includes, among others, teratomas, meningoceles, enteric cysts and lipomas, as observed in our patient. Children presenting anorectal abnormalities should be evaluated regarding the presence of Currarino syndrome. The partial sacral agenesis is a major sign of this disease.

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

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    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.

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

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    Carolina A. R. Funayama

    1995-12-01

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

  7. Caudal Regression Syndrome with Partial Agenesis of the Corpus callosum and Partial Lobar Holoprosencephaly

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    Hashami, Hilal Al; Bataclan, Maria F; Mathew, Mariam; Krishnan, Lalitha

    2010-01-01

    Caudal regression syndrome is a rare fetal condition of diabetic pregnancy. Although the exact mechanism is not known, hyperglycaemia during embryogenesis seems to act as a teratogen. Independently, caudal regression syndrome (CRS), agenesis of the corpus callosum (ACC) and partial lobar holoprosencephaly (HPE) have been reported in infants of diabetic mothers. To our knowledge, a combination of all these three conditions has not been reported so far. PMID:21509087

  8. Caudal Regression Syndrome with Partial Agenesis of the Corpus callosum and Partial Lobar Holoprosencephaly: Case report.

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    Hashami, Hilal Al; Bataclan, Maria F; Mathew, Mariam; Krishnan, Lalitha

    2010-04-01

    Caudal regression syndrome is a rare fetal condition of diabetic pregnancy. Although the exact mechanism is not known, hyperglycaemia during embryogenesis seems to act as a teratogen. Independently, caudal regression syndrome (CRS), agenesis of the corpus callosum (ACC) and partial lobar holoprosencephaly (HPE) have been reported in infants of diabetic mothers. To our knowledge, a combination of all these three conditions has not been reported so far.

  9. Sacral Neuromodulation

    DEFF Research Database (Denmark)

    Matzel, Klaus E; Chartier-Kastler, Emmanuel; Knowles, Charles H

    2017-01-01

    INTRODUCTION: Sacral neuromodulation (SNM) (sacral nerve stimulation SNS) has become an established therapy for functional disorders of the pelvic organs. Despite its overall success, the therapy fails in a proportion of patients. This may be partially due to inadequate electrode placement...... with suboptimal coupling of the electrode and nerve. Based on these assumptions the technique of sacral spinal neuromodulation has been redefined. All descriptions relate to the only currently available system licensed for all pelvic indications (Medtronic Interstim(®) ). METHOD: An international...

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

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

    2015-12-01

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

  11. Uterus didelphys with partial vaginal septum and distal vaginal agenesis: an unusual anomaly

    International Nuclear Information System (INIS)

    Singhal, S.R.; Lakra, P.; Bishnoi, P.; Rohilla, S.; Dahiya, P.

    2013-01-01

    Complex malformations of female genital tract are not so common. Their correct identification is of paramount importance for appropriate management. A thorough knowledge of embryology, pre-operative imaging with MRI and examination under anaesthesia is essential to identify accurately the constellation of anomalies and to plan appropriate management. This case reports the coexistence of Mullerian abnormality with vaginal agenesis in an 18 years old girl which was managed by dissecting the lower half of vagina and pull-through vaginoplasty. (author)

  12. MURCS Association with Partial Duplication of the Distal Long Chromosome 5 and Unilateral Ovarian Agenesis

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    Anna Dabkowska-Huc

    2013-01-01

    Full Text Available A combination of the congenital abnormalities, Müllerian duct aplasia, renal aplasia, and cervicothoracic somite dysplasia, is defined as the MURCS association. Various genetic defects have been described in the MURCS association so far, yet the unambiguous molecular basis of these disorders has not been established. We report the case of an 18-year-old woman who presented with primary amenorrhea, right kidney, Arnold-Chiari malformation, and Klippel-Feil syndrome. In addition, the patient showed the following unusual features: right ovarian and Skenes gland agenesis, cubitus valgus with hyperextension and decreased range of motion at elbows, and facial changes. Moreover, the performed DNA analysis showed interstitial duplication in chromosome 5 (5q35.1. In the duplicated region, there are genes whose function is not well known. It is thought that they have an influence on the early stages of development and their joining in the later period can lead to neoplastic disorders, especially leukemias.

  13. Pulmonary agenesis

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    Oyola, Mercedes; Pontificia Universidad Javeriana; Gordillo, Gisel; Pontificia Universidad Javeriana; García, Carlos A.; Pontificia Universidad Javeriana; Torres, David; Pontificia Universidad Javeriana

    2009-01-01

    Pulmonary agenesis is an infrequent pathology which occurs predominantly among females with no lateral preference. We report on the case of a newborn male diagnosed with prenatal diaphragm hernia though at birth seemed more likely either to be a congenital cystic adenomatoid malformation (congenital pulmonary airway malformation) or pulmonary agenesis. The patient died six days after birth and necropsy confirmed pulmonary agenesis. La agenesia pulmonar es una alteración poco frecuente, con...

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

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

    2001-10-15

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

  15. Congenital lumbar vertebrae agenesis in a lamb.

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    Farajli Abbasi, Mohammad; Shojaei, Bahador; Azari, Omid

    2017-01-01

    Congenital agenesis of lumbar vertebrae was diagnosed in a day-old female lamb based on radiology and clinical examinations. There was no neurological deficit in hindlimb and forelimb associated with standing disability. Radiography of the abdominal region revealed absence of lumbar vertebrae. Necropsy confirmed clinical and radiographic results. No other anomaly or agenesis was seen macroscopically in the abdominal and thoracic regions as well as vertebral column. Partial absence of vertebral column has been reported in human and different animal species, as an independent occurrence or associated with other organs anomalies. The latter has been designated as caudal regression syndrome. Vertebral agenesis may arise from irregularity in the differentiation of somites to the sclerotome or sclerotome to the vertebral primordium. Most of the previously reported cases of agenesis were related to the lumbosacral region, lonely or along with other visceral absences. This case was the first report of congenital agenesis of lumbar vertebrae in a lamb.

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

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    Tadatsugu Morimoto

    2015-01-01

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

  17. CT of tracheal agenesis

    International Nuclear Information System (INIS)

    Strouse, Peter J.; Hernandez, Ramiro J.; Newman, Beverley

    2006-01-01

    Tracheal agenesis is a rare and usually lethal anomaly. In the past, opaque contrast medium was injected via the esophagus to demonstrate the anatomy. To demonstrate the utility of helical and multidetector CT in delineating the aberrant anatomy in newborns with tracheal agenesis. Four newborns with tracheal agenesis were identified from three institutions. Imaging studies and medical records were reviewed. Each child was imaged with chest radiography. One child was imaged on a single-detector helical CT scanner and the other three on multidetector scanners. Helical and multidetector CT with 2D and 3D reconstructions clearly delineated the aberrant tracheobronchial and esophageal anatomy in each infant. Minimum intensity projection reformatted CT images were particularly helpful. One infant each had type I and type II tracheal agenesis. Two infants had type III tracheal agenesis. All four infants died. CT is a useful tool for delineating the aberrant anatomy of newborns with tracheal agenesis and thus helps in making rational clinical decisions. (orig.)

  18. Agenesis of pancreas

    DEFF Research Database (Denmark)

    Voldsgaard, P; Kryger-Baggesen, N; Lisse, I

    1994-01-01

    Complete agenesis of pancreas is a rare and lethal condition. Four cases have previously been reported in combination with other malformations, such as severe intrauterine growth retardation, hyperglycaemia and meconium ileus. We report a case of pancreatic agenesis as a single anomaly. The child...

  19. Lumbosacral agenesis in a cat

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    Gabrielle C Hybki

    2016-01-01

    Full Text Available Case summary Lumbosacral agenesis is a rare congenital condition reported in children. We report a 17-week-old female domestic shorthair cat with lumbosacral agenesis on whole-body radiographs. The cat was euthanized shortly thereafter presentation. A necropsy was not permitted. Relevance and novel information This is the first reported feline case of lumbosacral agenesis.

  20. Vermian agenesis without posterior fossa cyst

    International Nuclear Information System (INIS)

    Adamsbaum, C.; Moreau, V.; Bulteau, C.; Burstyn, J.; Lair Milan, F.; Kalifa, G.

    1994-01-01

    We report 11 cases of vermian partial agenesis without posterior fossa cyst or hemispheric abnormalities. Characteristic MR signs were: absence of the posterior lobe, hypoplasia of the anterior lobe, a narrow sagittal cleft separating the hemispheres (''buttocks sign'') and fourth ventricle deformity. The main clinical signs were complex oculomotor dysfunction and developmental delay. None of the patients had respiratory symptoms. Consideration is given to the relationship between Joubert syndrome and this entity as well as to embroyological data. (orig.)

  1. Total agenesis of the left pericardium

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    J. Glauco Lobo Fº

    1999-09-01

    Full Text Available This is the report of a 46-year-old patient with the preoperative diagnosis of an atrial septal defect (ASD of the ostium secudum type. After sternectomy, partial agenesis of the left pericardium was diagnosed. It is our opinion that, if the radiographic picture is suggestive of this entity, a clinical search for cardiopulmonary anomalies should be performed, because the majority of these associated anomalies can and should be surgically corrected.

  2. Complete dorsal pancreatic agenesis and unilateral renal agenesis.

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    Moreira, Adriana; Carvalho, André; Portugal, Inês; Jesus, José Miguel

    2018-02-01

    Dorsal pancreatic agenesis is a very rare congenital anomaly. Unilateral renal agenesis, on the other hand, is a relatively common congenital anomaly, although its etiology is not fully understood. Renal and pancreatic embryologic development appears to be nonrelated. We report a case of a 34-year-old man who was referred to our hospital for evaluation of cholestasis and microalbuminuria. Ultrasound and magnetic resonance imaging examinations showed empty right renal fossa and absence of the pancreatic neck, body, and tail. Our case report is the second case of a dorsal pancreatic agenesis and unilateral renal agenesis in a young male patient.

  3. Postmortem MRI of bladder agenesis

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    Barber, Brendan R. [St George' s Hospital, Radiology Department, London (United Kingdom); Weber, Martin A. [Great Ormond Street Hospital for Children, Department of Histopathology, London (United Kingdom); Bockenhauer, Detlef [Great Ormond Street Hospital for Children, Department of Nephrology, London (United Kingdom); Hiorns, Melanie P.; McHugh, Kieran [Great Ormond Street Hospital for Children, Radiology Department, London (United Kingdom)

    2011-01-15

    We report a 35-week preterm neonate with bladder agenesis and bilateral dysplastic kidneys. A suprapubic catheter was inadvertently inserted into one of the larger inferior cysts of the left dysplastic kidney. A postmortem MRI scan was performed with the findings being confirmed on autopsy. We are unaware of another postmortem MRI study demonstrating bladder agenesis. (orig.)

  4. Postmortem MRI of bladder agenesis

    International Nuclear Information System (INIS)

    Barber, Brendan R.; Weber, Martin A.; Bockenhauer, Detlef; Hiorns, Melanie P.; McHugh, Kieran

    2011-01-01

    We report a 35-week preterm neonate with bladder agenesis and bilateral dysplastic kidneys. A suprapubic catheter was inadvertently inserted into one of the larger inferior cysts of the left dysplastic kidney. A postmortem MRI scan was performed with the findings being confirmed on autopsy. We are unaware of another postmortem MRI study demonstrating bladder agenesis. (orig.)

  5. [A case of lingual agenesis].

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    Carinci, F; Felisatti, P; Curioni, C

    1996-01-01

    Lingual agenesis is a rare anomaly caused by failed morphogenesis of the lateral lingual swellings during embriogenesis. Most reported cases have been part of oromandibular limb hypogenesis syndrome (OLHS). A case of lingual agenesis associated with micrognathia and alteration of the hands is reported.

  6. Pulmonary agenesis: two cases reported

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    Denis Yaraví Solano-Vázquez

    2014-11-01

    Full Text Available Background: Pulmonary agenesis is a rare anomaly (1 in 15 000 live births which consists in a total absence or severe hypoplasia of one or both lungs. The clinical spectrum of the unilateral agenesis could vary from early and severe respiratory distress, recurrent pneumonia to being an incidental finding. The prognosis is based on the presence of associated congenital abnormalities. Material and methods: We present two cases of unilateral pulmonary agenesis in patients at Tlaxcala’s Children Hospital during 2012. Results: Report details the case of a one-month old boy with left pulmonary agenesis and interatrial communication and mild pulmonary arterial hypertension. He had two resolved pneumonia incidents. The other case was a one-month old girl with right pulmonary agenesis, associated to multiple heart malformations who evolved to respiratory failure, heart failure and death.Conclusions: Pulmonary agenesis is a rare anomaly. Its outcome and prognosis varies with the hemodynamics related to its location and associated malformations.

  7. Bilateral agenesis of the anterior cruciate ligament: MRI evaluation

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    Bedoya, Maria A.; Jaramillo, Diego [The Children' s Hospital of Philadelphia, Radiology Department, Philadelphia, PA (United States); McGraw, Michael H. [Hospitalof theUniversityof Pennsylvania, Divisionof Orthopaedics, Philadelphia, PA (United States); Wells, Lawrence [The Children' s Hospital of Philadelphia, Division of Orthopaedics, Philadelphia, PA (United States)

    2014-09-15

    Bilateral agenesis of the anterior cruciate ligament (ACL) is extremely rare. We describe a 13-year-old girl who presented with bilateral knee pain without history of trauma; she has two family members with knee instability. Magnetic resonance imaging showed bilateral absence of the ACL, and medial posterior horn meniscal tears. Bilateral arthroscopic partial meniscectomy and anterior cruciate ligament reconstruction was performed. (orig.)

  8. Heterotaxy syndrome with associated agenesis of dorsal pancreas and polysplenia: A case report

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    Syed Althaf Ali1

    2015-01-01

    Full Text Available Heterotaxy syndrome is a rare embryological disorder comprising of polysplenia, partial agenesis of dorsal pancreas, malrotation of gut, cardiac and vascular anomalies resulting from failure of development of the usual left–right asymmetry of organs. We report a rare case of heterotaxy syndrome with polysplenia, partial agenesis of dorsal pancreas and malrotation of gut in a 28 year female presenting with subacute intestinal obstruction along with imaging illustrations, brief discussion and thorough review of literature.

  9. Gallbladder Agenesis with Refractory Choledocholithiasis.

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    Tjaden, Jamie; Patel, Kevin; Aadam, Aziz

    2015-01-01

    Congenital agenesis of the gallbladder is a rare anomaly which is usually asymptomatic and found incidentally. In some cases, however, patients are symptomatic. Common symptoms include right upper quadrant abdominal pain, nausea, and vomiting. Jaundice is present in some symptomatic cases and is due to associated choledocholithiasis (Fiaschetti et al. 2009). In this case, a 63-year-old female presents with jaundice and episodic right upper quadrant abdominal pain with nausea and vomiting. Bilirubin and alkaline phosphatase were found to be markedly elevated. Upper endoscopic ultrasound (EUS) revealed choledocholithiasis, and the patient required multiple endoscopic retrograde cholangiopancreatography (ERCP) sessions before successful extraction of all stones. Subsequent surgical exploration revealed congenital agenesis of the gallbladder. Although this is a rare finding, patients with agenesis of the gallbladder are at increased risk of developing de novo choledocholithiasis which may be challenging to extract.

  10. Gallbladder Agenesis with Refractory Choledocholithiasis

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    Jamie Tjaden

    2015-01-01

    Full Text Available Congenital agenesis of the gallbladder is a rare anomaly which is usually asymptomatic and found incidentally. In some cases, however, patients are symptomatic. Common symptoms include right upper quadrant abdominal pain, nausea, and vomiting. Jaundice is present in some symptomatic cases and is due to associated choledocholithiasis (Fiaschetti et al. 2009. In this case, a 63-year-old female presents with jaundice and episodic right upper quadrant abdominal pain with nausea and vomiting. Bilirubin and alkaline phosphatase were found to be markedly elevated. Upper endoscopic ultrasound (EUS revealed choledocholithiasis, and the patient required multiple endoscopic retrograde cholangiopancreatography (ERCP sessions before successful extraction of all stones. Subsequent surgical exploration revealed congenital agenesis of the gallbladder. Although this is a rare finding, patients with agenesis of the gallbladder are at increased risk of developing de novo choledocholithiasis which may be challenging to extract.

  11. The sacral foramina

    International Nuclear Information System (INIS)

    Jackson, H.; Burke, J.T.

    1984-01-01

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

  12. Sacral-neuromodulation CT-guided

    International Nuclear Information System (INIS)

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

    2005-01-01

    total of 38 centering. Eight patients underwent the PNE procedure on both the S3 foramina. The sacral foramen was centred at the first attempt in 36 out of 38 cases. Two cases required several attempts to centre correctly the foramen. In 4 patients out of 30 a second electrode was implanted. In one patient who had a non consolidated sacral fracture, CT guidance enabled insertion of the electrode inside the only practicable foramen, a manoeuvre that would have been impossible with fluoroscopic guidance. Only once was repositioned after a CT control. During the whole trial period we had a positive response to the PNE test in 18 out of 30 patients (60%), a partial response in 4 out of 30 patients and a negative response in the remaining 8 patients. None of the patients who underwent the PNE test had infectious complications and the procedure was well tolerated by all. The procedure lasted about 45 minutes. Conclusions: The PNE test under Ct guidance proved to be more efficient compared with the traditional technique as the direct view of the electrode position helped to define with greater reliability the patients who were non-responsive to sacral stimulation. Moreover, this method was particularly efficient in patients with sacral anomalies where the traditional guide might fail. The operators' reduced exposure to radiation is an advantage to be taken into consideration. Finally, the usage of mobile CT apparatus in an operating theatre can improve the technique for permanent implantations [it

  13. Imaging findings of sacral tumors

    International Nuclear Information System (INIS)

    Kim, Seung Ho; Hong, Sung Hwan; Choi, Ja Young; Koh, Sung Hye; Chung, Hye Won; Choi, Jung Ah; Kang, Heung Sik

    2003-01-01

    The various pathologic conditions detected at CT and MRI and subsumed by the term 'sacral tumor' include primary bone tumors, sacral canal tumors and metastases. Among these, metastases are much more common than primary bone tumors, of which chordoma is the most common. Although the imaging findings of sacral tumors are nonspecific, a patient's age and sex, and specific findings such as calcification or fluid-fluid levels, can help radiologists in their differential diagnosis. We describe the imaging findings of primary sacral tumors, emphasizing the MRI findings

  14. Gallbladder Agenesis with Refractory Choledocholithiasis

    OpenAIRE

    Tjaden, Jamie; Patel, Kevin; Aadam, Aziz

    2015-01-01

    Congenital agenesis of the gallbladder is a rare anomaly which is usually asymptomatic and found incidentally. In some cases, however, patients are symptomatic. Common symptoms include right upper quadrant abdominal pain, nausea, and vomiting. Jaundice is present in some symptomatic cases and is due to associated choledocholithiasis (Fiaschetti et al. 2009). In this case, a 63-year-old female presents with jaundice and episodic right upper quadrant abdominal pain with nausea and vomiting. Bil...

  15. Agenesis of the dorsal pancreas

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    Schnedl, Wolfgang J; Piswanger-Soelkner, Claudia; Wallner, Sandra J; Krause, Robert; Lipp, Rainer W

    2009-01-01

    During the last 100 years in medical literature, there are only 54 reports, including the report of Pasaoglu et al (World J Gastroenterol 2008; 14: 2915-2916), with clinical descriptions of agenesis of the dorsal pancreas in humans. Agenesis of the dorsal pancreas, a rare congenital pancreatic malformation, is associated with some other medical conditions such as hyperglycemia, abdominal pain, pancreatitis and a few other diseases. In approximately 50% of reported patients with this congenital malformation, hyperglycemia was demonstrated. Evaluation of hyperglycemia and diabetes mellitus in all patients with agenesis of the dorsal pancreas including description of fasting blood glucose, oral glucose tolerance test, glycated hemoglobin and medical treatment would be a future goal. Since autosomal dominant transmission has been suggested in single families, more family studies including imaging technologies with demonstration of the pancreatic duct system are needed for evaluation of this disease. With this letter to the editor, we aim to increase available information for the better understanding of this rare disease. PMID:19140241

  16. Cytodiagnosis of Sacral Chordoma

    Directory of Open Access Journals (Sweden)

    Saumya Shukla

    2014-12-01

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

  17. Maxillary sinus agenesis - report of two cases

    International Nuclear Information System (INIS)

    Pierre, Jorge Henrique Arraes de Alencar; Santana, Expedito Araujo

    2000-01-01

    Agenesis or aplasia of the maxillary sinuses is an extremely rare condition, and only eight cases have been reported in the world medical literature. These malformations may arise as a result of developmental defects. Two cases of unilateral agenesis of the maxillary sinus are presented and the radiological abnormalities and the embryology are discussed. The literature is also reviewed. (author)

  18. Gallbladder agenesis in a Chihuahua.

    Science.gov (United States)

    Kamishina, Hiroaki; Katayama, Masaaki; Okamura, Yasuhiko; Sasaki, Jun; Chiba, Satoshi; Goryo, Masanobu; Sato, Reeko; Yasuda, Jun

    2010-07-01

    A 4-year-old neutered male Chihuahua was presented with a history of anorexia and vomiting. Continuous elevation of liver enzymes was found on repeated blood examinations and the dog was referred to us for further evaluation. The absence of gallbladder was suspected on ultrasonography. Exploratory laparotomy and retrograde cholangiography confirmed gallbladder agenesis and a possible hypoplasia of the right medial and lateral liver lobes. Histologically, proliferation of bile ductules associated with portal fibrosis and pseudolobular formation were apparent in the liver lobes.

  19. Imaging of sacral tumours

    International Nuclear Information System (INIS)

    Gerber, S.; Ollivier, L.; Brisse, H.; Neuenschwander, S.; Leclere, J.; Vanel, D.; Missenard, G.; Pinieux, G. de

    2008-01-01

    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.)

  20. Imaging of sacral tumours

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  1. Sacral orientation and spondylolysis.

    Science.gov (United States)

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

    2009-12-01

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

  2. Landmarks for Sacral Debridement in Sacral Pressure Sores.

    Science.gov (United States)

    Choo, Joshua H; Wilhelmi, Bradon J

    2016-03-01

    Most cases of sacral osteomyelitis arising in the setting of sacral pressure ulcers require minimal cortical debridement. When faced with advanced bony involvement, the surgeon is often unclear about how much can safely be resected. Unfamiliarity with sacral anatomy can lead to concerns of inadvertent entry into the dural space and compromise of future flap options. A cadaveric study (n = 6), in which a wide posterior dissection of the sacrum, was performed. Relationships of the dural sac to bony landmarks of the posterior pelvis were noted. The termination of the dural sac was found in our study to occur at the junction of S2/S3 vertebral bodies, which was located at a mean distance of 0.38 ± 0.16 cm distal to the inferior-most extent of the posterior superior iliac spine (PSIS). The mean thickness of the posterior table of sacrum at this level was 1.7 cm at the midline and 0.5 cm at the sacral foramina. The PSIS is a reliable landmark for localizing the S2/S3 junction and the termination of the dural sac. Sacral debridement medial to the sacral foramina above the level of PSIS must be conservative whenever possible. If aggressive debridement is necessary above this level, the surgeon must be alert to the possibility of dural involvement.

  3. Osteolytic extra-axial sacral myxopapillary ependymoma.

    Science.gov (United States)

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

    1999-10-01

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

  4. 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.)

  5. Osteolytic extra-axial sacral myxopapillary ependymoma

    International Nuclear Information System (INIS)

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

    1999-01-01

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

  6. 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

    total of 38 centering. Eight patients underwent the PNE procedure on both the S3 foramina. The sacral foramen was centred at the first attempt in 36 out of 38 cases. Two cases required several attempts to centre correctly the foramen. In 4 patients out of 30 a second electrode was implanted. In one patient who had a non consolidated sacral fracture, CT guidance enabled insertion of the electrode inside the only practicable foramen, a manoeuvre that would have been impossible with fluoroscopic guidance. Only once was repositioned after a CT control. During the whole trial period we had a positive response to the PNE test in 18 out of 30 patients (60%), a partial response in 4 out of 30 patients and a negative response in the remaining 8 patients. None of the patients who underwent the PNE test had infectious complications and the procedure was well tolerated by all. The procedure lasted about 45 minutes. Conclusions: The PNE test under Ct guidance proved to be more efficient compared with the traditional technique as the direct view of the electrode position helped to define with greater reliability the patients who were non-responsive to sacral stimulation. Moreover, this method was particularly efficient in patients with sacral anomalies where the traditional guide might fail. The operators' reduced exposure to radiation is an advantage to be taken into consideration. Finally, the usage of mobile CT apparatus in an operating theatre can improve the technique for permanent implantations. [Italian] Scopo: La neuromodulazione sacrale ? una nuova procedura diagnostico-terapeutica pe ri disturbi funzionali del basso tratto urinario come l'incontinenza urinaria da urgenza, la ritenzione urinaria non ostruttiva, la sindrome urgenza/frequenza, il dolore pelvico cronico intrattabile e, di recente, anche per il trattamento della stipsi e dell'incontinemza fecale. Il trattamento prevede una prima fase definita PNE test (Percutaneous Nerve Evaluation) che consiste

  7. Does asymptomatic septal agenesis exist? A review of 34 cases

    Energy Technology Data Exchange (ETDEWEB)

    Belhocine, Ouardia; Andre, Christine; Kalifa, Gabriel; Adamsbaum, Catherine [St Vincent de Paul Hospital, Radiology Department, Paris (France)

    2005-04-01

    Primary septal agenesis (PSA) is a rare brain malformation that can be isolated or part of developmental brain abnormalities (holoprosencephaly, septo-optic dysplasia or cortical malformation). Such associated malformation can be subtle, leading to difficulties in the prenatal management of PSA. Moreover, the neurological prognosis of isolated PSA remains debatable. The aims of the study were to specify the patterns and frequency of brain malformations associated with septal agenesis (SA), to identify the clinical prognosis, and to discuss the aetiology of PSA with the new insights provided by molecular genetics. The study consisted of a 14-year retrospective review of brain MRI in 34 patients having PSA (mean age, 5 years). Chiasm and optic nerves were not evaluated. Post-hydrocephalus SA or incomplete data were excluded. The clinical data were correlated to the MRI patterns. The study disclosed 82.5% associated lesions with MRI (28/34): 11 neuronal migration disorders, 9 holoprosencephalies (HP), 7 pituitary stalk interruptions, 1 corpus callosum partial agenesis; 17.5% (6/34) of cases were apparently isolated PAS. Clinically, the patients had motor dysfunction in 68% (23/34), mental retardation in 65% (22/34), blindness in 24% (8/34), endocrinological defects in 21% (7/34) and epilepsy in 18% (6/34) of cases. Nine percent of patients (3/34) were neurologically normal (including one with scoliosis and two infants younger than 2 years at the last follow-up). Patients with bilateral cortical anomalies and HP (even if mild) had the worst neurological prognosis. A severe motor impairment was present without evidence of hemispheric anomaly in 12% of patients (4/34). Interestingly, the frontal lobes were involved in 90% of cortical anomalies and HP, supporting the malformative aetiology of PSA. PSA rarely appears isolated and severe psychomotor impairment may occur in apparently isolated forms. These unfavourable results should be highlighted and need to be confirmed

  8. Pulmonary Artery Agenesis: A Case Series

    Directory of Open Access Journals (Sweden)

    Meltem Ağca

    2015-04-01

    Full Text Available Pulmonary artery agenesis is a rare congenital abnormality in which atresia was encountered in the short segment of the right or left pulmonary arteries. It can be isolated or associated with cardiac abnormalities such as tetralogy of Fallot, septal defects or pulmonary stenosis.The majority of cases are diagnosed in childhood whereas some cases yield no symptoms until adulthood. We evaluated retrospectively 5 pulmonary artery agenesis cases diagnosed in our clinics between 1998-2010 with respect to the literature.

  9. Agenesia pulmonar unilateral Unilateral pulmonary agenesis

    OpenAIRE

    Maura Cavada Malcon; Claudio Mattar Malcon; Marina Neves Cavada; Paulo Eduardo Macedo Caruso; Lara Flório Real

    2012-01-01

    A agenesia pulmonar é uma anomalia congênita rara. Relatamos um caso de um menino de 8 anos de idade com agenesia pulmonar à esquerda sem associação com outras malformações. O diagnóstico foi realizado por achados de imagem quando o paciente apresentou sintomas como tosse, sibilância e dispneia sem melhora do quadro clínico após evolução de 30 dias.Pulmonary agenesis is a rare congenital anomaly. We report the case of an 8-year-old boy with left lung agenesis, without any other congenital mal...

  10. Sirenomelia with agenesis of corpus callosum.

    Science.gov (United States)

    Shirani, Shapour; Rekabi, Vahab; Kamalian, Naser

    2006-07-01

    Sirenomelia is a very rare anomaly presented with fusion of the lower limbs. Genitourinary, neural tube, and vertebral anomalies are found in most cases. We report a case of sirenomelia with agenesis of corpus callosum, which has not been reported previously.

  11. [Is there either agenesis or regression of the Mullerian duct in female bird embryos under the influence of male hormone?].

    Science.gov (United States)

    Lutz-Ostertag, Y; Lutz, H

    1976-01-01

    The natural occurence of "Free-Martinism" in Birds and the chorio-allantoïc grafting experiments of testis fragments on female chick host-embryos allow to the authors to define the manner provoking the entire or partial disappearance of the müllerian ducts and to state exactly if the phenomenon is a agenesis or a regression.

  12. Agenesis of the Corpus Callosum

    Science.gov (United States)

    ... callosum, the structure that connects the two hemispheres (left and right) of the brain. In ACC the corpus callosum is partially or completely absent. It is caused by a disruption of brain cell migration during fetal development. ACC can occur as an isolated condition or ...

  13. Perawatan Teknik Begg Pada Maloklusi Klas I Dengan Kaninus Impaksi dan Insisivus Lateral Agenesis

    Directory of Open Access Journals (Sweden)

    Kristina Wijaya Gunawan

    2013-06-01

    , 13 labially vertical impacted, 42 agenesis, and partial edentulous 36. The correction was obtained through extraction 14 and 25, and the use of former space from extraction 36 and exposure of impacted canine. The first step of treatment using Begg technique is to leveling, unraveling, and bite opening. The second step is midline correction and space closure. Finally, it can be concluded that orthodontic treatment using Begg technique which is done simultaneously and exposure of labial- canine impaction with closed eruption technique can give satisfactory results.

  14. Agenesia pulmonar unilateral Unilateral pulmonary agenesis

    Directory of Open Access Journals (Sweden)

    Maura Cavada Malcon

    2012-08-01

    Full Text Available A agenesia pulmonar é uma anomalia congênita rara. Relatamos um caso de um menino de 8 anos de idade com agenesia pulmonar à esquerda sem associação com outras malformações. O diagnóstico foi realizado por achados de imagem quando o paciente apresentou sintomas como tosse, sibilância e dispneia sem melhora do quadro clínico após evolução de 30 dias.Pulmonary agenesis is a rare congenital anomaly. We report the case of an 8-year-old boy with left lung agenesis, without any other congenital malformations. When the patient presented symptoms, including cough, wheezing, and dyspnea, with no clinical improvement after a period of 30 days, imaging studies were conducted and the diagnosis was made.

  15. [Multiple agenesis and prosthetic restoration].

    Science.gov (United States)

    Renault, P

    1990-03-01

    Cases of multiple agenesia present some difficulties in the treatment planing. Three situations may be encountered: limited agenesia, restored by a fixed, bonded or cemented prosthesis, multiple uni- or bimaxillary agenesia without remaining of deciduous teeth, restored by a fixed, bonded or cemented prosthesis or the partial adjacent prosthesis, multiple uni- or bimaxillary agenesia with remaining of deciduous teeth, restored by means of a supra-dental prosthesis. The first two situations have been described in dental literature and are relatively easy to treat. The same is not true for the third situation, where the decision to keep the temporary teeth considerably increases the difficulty of prosthetic restoration. This subject will be illustrated by the presentation of a clinical case of multiple bi-maxillary agenesia. The patient has: on the maxilla: an absence of 9 permanent teeth (18, 15, 14, 12, 22, 23, 24, 25, 28) and the presence of 4 deciduous teeth (62, 63, 64, 65), on the mandible: an absence of all permanent teeth, with the exception of 36 and 46, and the remaining of 4 deciduous teeth (75, 73, 83, 84). The remaining of deciduous teeth and the presence of a very high inter-arch space led to opting for dental coverage so as to keep the deciduous teeth and a proper vertical dimension. The patient wished to solve his "problem" in the maxilla first, and is not wanting to undergo the extraction of his deciduous teeth. The following therapeutic proposal was adapted: On the maxilla, a three-step procedure: first step: building of metal copings on 13, 16 and 26 and metal-ceramic crowns on 11 and 21, second step: building of telescop crowns on 16 and 26 and clasps on 13, 11 and 21, third step: casting of the removable partial denture framework and soldering to the telescop crowns and clasps. On the mandible, a provisional restoration using a supra-dental resin removable partial denture with ceramic occlusal surfaces was adopted. The aesthetic and functional

  16. A rare case of Turner′s syndrome presenting with Mullerian agenesis

    Directory of Open Access Journals (Sweden)

    Suresh Vaddadi

    2013-01-01

    Full Text Available Turner′s syndrome also called as Ullrich Turner′s syndrome, is a disease of unclear pathogenesis characterized by complete or partial absence of one sex chromosome, with or without cell line mosaicism in a phenotypic female with short stature. Various anomalies result in a constellation of features, of which the most disturbing is primary amenorrhea due to gonadal dysgenesis. Hormone therapy in these patients can often result in successful menstruation, and scope for subsequent pregnancy because of anatomically normal uterus and vagina. Coexisting Mullerian agenesis in these patients can jeopardize the chances of future pregnancy as they have associated structural abnormalities of the uterus and vagina. We report a rare case of middle-aged female with Turner′s syndrome and Mullerian agenesis having absent secondary sexual characters and missing uterus with incompletely formed vagina.

  17. Isolated Unilateral Pulmonary Artery Agenesis complicated by Symptomatic Aspergilloma

    LENUS (Irish Health Repository)

    Daly, A

    2017-11-01

    Isolated unilateral pulmonary artery agenesis is a rare diagnosis. Poor blood flow to the lung parenchyma renders the tissue susceptible to opportunistic infections. We present the unusual case of isolated unilateral pulmonary artery agenesis complicated by aspergilloma. Management options and considerations are discussed.

  18. Agenesis of internal carotid artery associated with congenital anterior hypopituitarism

    International Nuclear Information System (INIS)

    Moon, W.-J.; Porto, L.; Lanfermann, H.; Zanella, F.E.; Weis, R.

    2002-01-01

    We report a rare case of unilateral agenesis of the internal carotid artery in association with congenital anterior hypopituitarism. The collateral circulation is supplied by a transsellar intercavernous anastomotic vessel connecting the internal carotid arteries. These abnormalities are well depicted on MRI and MRA. The agenesis of the internal carotid artery may explain the pathogenesis of some of congenital anterior hypopituitarism. (orig.)

  19. Agenesis of maxillary lateral incisors and associated dental anomalies.

    Science.gov (United States)

    Garib, Daniela Gamba; Alencar, Bárbara Maria; Lauris, José Roberto Pereira; Baccetti, Tiziano

    2010-06-01

    The objectives of this study were to evaluate the prevalence of dental anomalies in patients with agenesis of maxillary lateral incisors and to compare the findings with the prevalence of these anomalies in the general population. A sample of 126 patients, aged 7 to 35 years, with agenesis of at least 1 maxillary lateral incisor was selected. Panoramic and periapical radiographs and dental casts were used to analyze other associated dental anomalies, including agenesis of other permanent teeth, ectopia of unerupted permanent teeth, microdontia of maxillary lateral incisors, and supernumerary teeth. The occurrence of these anomalies was compared with prevalence data previously reported for the general population. Statistical testing was performed with the chi-square test (P <0.05) and the odds ratio. Patients with maxillary lateral incisor agenesis had a significantly increased prevalence rate of permanent tooth agenesis (18.2%), excluding the third molars. The occurrence of third-molar agenesis in a subgroup aged 14 years or older (n = 76) was 35.5%. The frequencies of maxillary second premolar agenesis (10.3%), mandibular second premolar agenesis (7.9%), microdontia of maxillary lateral incisors (38.8%), and distoangulation of mandibular second premolars (3.9%) were significantly increased in our sample compared with the general population. In a subgroup of patients aged 10 years or older (n = 115), the prevalence of palatally displaced canines was elevated (5.2%). The prevalences of mesioangulation of mandibular second molars and supernumerary teeth were not higher in the sample. Permanent tooth agenesis, maxillary lateral incisor microdontia, palatally displaced canines, and distoangulation of mandibular second premolars are frequently associated with maxillary lateral incisor agenesis, providing additional evidence of a genetic interrelationship in the causes of these dental anomalies. 2010 American Association of Orthodontists. Published by Mosby, Inc. All

  20. Sacrality and worldmaking: new categorial perspectives

    OpenAIRE

    William E. Paden

    1999-01-01

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

  1. Storytelling: Performance, Presentations and Sacral Communication

    Directory of Open Access Journals (Sweden)

    Zoltán Bódis

    2013-12-01

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

  2. Treatment of cervical agenesis with minimally invasive therapy: Case report

    Directory of Open Access Journals (Sweden)

    Azami Denas Azinar

    2017-11-01

    Full Text Available Cervical agenesis is very rare congenital disorder case with cervical not formed. Because of cervical clogged so that menstruation can not be drained. We Report the case of a19 years old women still single with endometrioma, hematometra, cervical agenesis and perform surgery combination laparoscopy and transvaginally with laparoscopic cystectomy, neocervix, and use catheter no 24f in the new cervix. And now she can currently be normal menstruation. Minimally invasive theraphy of congenital anomalies case is recommended to save reproductive function. Keywords: Cervical agenesis, minimal invasive theraphy

  3. Presentations of agenesis of the hemidiaphragm in an adult

    International Nuclear Information System (INIS)

    Izeldin, Osama M.; Ahmed, Mohamed E.

    2008-01-01

    A 67-year-old man was presented with chest tightness and vomiting of one-week duration. On physical examination bowel sounds were heard on the left chest. Plain chest x-ray, barium swallow and CT gastric scan suggested volvulus with diaphragmatic hernia. At laparotomy there was complete agenesis of the left hemidiaphragm with no diaphragmatic remnants seen and no associated lung hypoplasia. This is an extremely rare condition and careful assessment is needed to differentiate between diaphragmatic hernia and agenesis of diaphragm as more cases could be diagnosed in the future as a result of good perinatal care of agenesis of hemidiaphragm (AHD) and long term survival to adulthood. (author)

  4. Isolated Left Pulmonary Artery Agenesis: A Case Report

    Directory of Open Access Journals (Sweden)

    Tansel Ansal Balcı

    2012-08-01

    Full Text Available Unilateral pulmonary artery agenesis without any cardiovascular malformation is a rare anomaly. We present the imaging findings of a patient who was diagnosed as isolated left pulmonary artery agenesis. A 27-year-old female patient was admitted to our hospital due to dyspnea during exercise for five years. Chest X-ray revealed minimally small left pulmonary hilum and left lung. She was admitted to our clinic with the suspicion of pulmonary artery pathology. Absent perfusion of the left lung with normal ventilation was visualized on scintigraphy. MDCT angiography of pulmonary arteries showed absent left main pulmonary artery with systemic collaterals around left hemithorax. Pulmonary artery agenesis can be asymptomatic and isolated until adulthood. Both scintigraphy and CT angiography images of pulmonary artery agenesis of a patient are rare in the literature. Pulmonary ventilation- perfusion scintigraphy can be used not only for pulmonary embolism but also pathologies involving pulmonary artery and its branches. (MIRT 2012;21:80-83

  5. Agenesis of the corpus callosum with associated inter-hemispheric ...

    African Journals Online (AJOL)

    Adele

    developing countries should be alert to organic disorders presenting with ... CT Scan (Figures 1 and 2) of the head revealed agenesis ... co-existing lipoma is often seen with this type of ... childhood behavioural disorders, bipolar disorders,.

  6. MR imaging of sacral and perisacral lesions

    International Nuclear Information System (INIS)

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

    1987-01-01

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

  7. Prenatal exposure to antiepileptic drugs and dental agenesis.

    Directory of Open Access Journals (Sweden)

    Pernille E Jacobsen

    Full Text Available OBJECTIVE: The aim of the study was to investigate the association between prenatal exposure to AEDs and the risk of dental agenesis and to differentiate between the possible effects of the different drugs used. METHODS: Data on 214 exposed and 255 unexposed children, aged 12-18 years, were extracted from the Prescription Database of the Central Denmark Region and North Denmark Region and the Danish Medical Birth Registry. The children's dental charts were examined for the presence of dental agenesis. RESULTS: Overall, children exposed to AED in utero had an increased risk of developing dental agenesis, but as a group, the difference was not significant (OR = 1.7; [95% CI: 0.8-3.6]. The risk of developing dental agenesis was three-fold increased (OR = 3.1; [95% CI: 1.3-7.4] in children exposed to valproate in mono- or in poly-therapy with other AEDs than carbamazepine or oxcarbazepine. The risk was further increased (OR = 11.2; [95% CI: 2.4-51.9] in children exposed to valproate and carbamazepine or oxcarbazepine in combination. CONCLUSIONS: The present study shows that dental agenesis is a potential congenital abnormality that is related to prenatal exposure to valproate, and dental agenesis may be considered a sensitive marker for the teratogenicity of valproate.

  8. Radiographic Assessment of Dental Maturation in Children With Dental Agenesis.

    Science.gov (United States)

    Medina, Aida Carolina; Pozo, Rodrigo Del; de Cedres, Lucila Blanco

    Dental agenesis is the most common developmental anomaly in humans, frequently associated with disorders in dental development and maturation. The purpose of this study is to determine radiographic variations in dental maturation in a group of Venezuelan children with dental agenesis. 1,188 panoramic radiographs, from healthy patients ages 5 to 12 years old were studied for agenesis of permanent teeth. Dental maturation was assessed by relative eruption and dental age according to Nolla, comparing children affected with dental agenesis to a stratified control group selected from the same population, excluding children with premature loss of primary teeth in the left quadrants and unclear radiographs. Descriptive analysis, and differences between means and medians (Student t test, Kruskall-Wallis p=0.05) were performed. Medians for Nolla stages were similar between groups, with delay in tooth formation in the agenesis group for second molars (p<0.05) and maxillary lateral incisors and second premolars. Dental age was significantly underestimated for both groups, -0.89 (±0.78) for the control group and -1.20 (±0.95) for the study group. Tooth eruption was similar between groups. Dental age was significantly delayed in Venezuelan children with dental agenesis, with variable significance for tooth formation of studied teeth.

  9. Surgical techniques for lumbo-sacral fusion.

    Science.gov (United States)

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

    2017-02-01

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

  10. Surgically Treated Symptomatic Prolapsed Lumbar and Sacral ...

    African Journals Online (AJOL)

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

  11. Vaginal agenesis: Experience with sigmoid colon neovaginoplasty

    Directory of Open Access Journals (Sweden)

    Rawat Jiledar

    2010-01-01

    Full Text Available Aim: Objective of this study is to report our experience with sigmoid vaginoplasty in adolescents. Materials and Methods: A retrospective study of children with vaginal atresia and Mayer-Rokitansky-Kuster-Hauser syndrome. The sigmoid segment was used for vaginoplasty in all the cases. Results: Eight children were studied over a period of 7 years. The postoperative complications were ileus in 2, mucosal prolapse of the neovagina in 1, and minor wound infection in 1 patient. Seven patients are on regular follow-up. All the neovaginas were patent and functional. One patient had unacceptable perineal appearance, that is, badly scarred perineum as a late complication. None of the patients had vaginal stenosis or excessive mucus discharge, during follow-up visits. Out of the 7 patients, 2 patients are sexually active and satisfied. Conclusions: Sigmoid vaginoplasty is a safe and acceptable procedure for vaginal agenesis with good cosmetic results and acceptable complications rate. Sigmoid colon vaginoplasty is the treatment of choice because of its large lumen, thick walls resistant to trauma, adequate secretion allowing lubrication, not necessitating prolonged dilatation, and short recovery time.

  12.  Uterus Didelphys with Obstructed Right Hemivagina, Ipsilateral Renal Agenesis and Right Pyocolpos: A Case Report

    Directory of Open Access Journals (Sweden)

    Hansa Dhar

    2011-11-01

    Full Text Available  Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA Syndrome is a rare congenital anomaly of the female genital tract. Uterus didelphys occurs when the midline fusion of the mullerian ducts is arrested, either completely or incompletely. Women with didelphic uterus may be asymptomatic and unaware of having a double uterus. They may present with complaints of dysmenorrhoea and dyspareunia. A 25 year old woman attending the infertility clinic at Nizwa regional referral hospital presented with history of dysmenorrhoea and foul vaginal discharge with right cystic pelvic mass. She was diagnosed as a case of double uterus with obstructed right hemivagina and right pyocolpos with ipsilateral renal agenesis after routine ultrasonography in the clinic followed by MRI. Excision of the right vaginal septum with drainage of 200 ml of purulent discharge was performed. She was relieved of her symptoms and conceived promptly after the surgical excision of the partial vaginal septum.

  13. Isolated bilateral congenital lacrimal gland agenesis – Report of two cases

    Directory of Open Access Journals (Sweden)

    Manar Alwohaib

    2017-10-01

    Full Text Available Congenital lacrimal gland agenesis, also called congenital alacrima, is a rare cause of dry eye and is characterized by aplasia or hypoplasia of lacrimal glands. We present two 5-year old children with congenital lacrimal gland agenesis. The two cases had the final diagnosis of isolated bilateral congenital lacrimal gland agenesis and we document the clinical aspects, treatment and present a literature review related to this rare condition. Keywords: Alacrima, Lacrimal gland, Lacrimal gland agenesis, Punctal plugs

  14. Müllerian agenesis with hypohidrotic ectodermal dysplasia syndrome.

    Science.gov (United States)

    Whaley, Katie; Winter, Jordan; Eyster, Kathleen M; Hansen, Keith A

    2012-04-01

    To describe the association of müllerian agenesis with hypohidrotic ectodermal dysplasia. Case report. University medical center. A 17-year-old woman with hypohidrotic ectodermal dysplasia referred for evaluation of primary amenorrhea. History, physical examination, and ultrasound. Physical findings of these two syndromes. Physical examination and ultrasound demonstrated müllerian agenesis with findings of hypohidrotic ectodermal dysplasia. This is the first description of the association of müllerian agenesis with ectodermal dysplasia. This rare case might provide further insight into the development of the uterus and the ectoderm as well as its derivatives. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  15. MR myelography of sacral meningeal cysts

    International Nuclear Information System (INIS)

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

    1999-01-01

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

  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. Pneumorrhachis Secondary From Sacral Decubitus Ulcer

    OpenAIRE

    Moayedi, Siamak; Babin, Lisa

    2016-01-01

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

  18. Agenesis of the corpus callosum and autism: a comprehensive comparison.

    Science.gov (United States)

    Paul, Lynn K; Corsello, Christina; Kennedy, Daniel P; Adolphs, Ralph

    2014-06-01

    The corpus callosum, with its ∼200 million axons, remains enigmatic in its contribution to cognition and behaviour. Agenesis of the corpus callosum is a congenital condition in which the corpus callosum fails to develop; such individuals exhibit localized deficits in non-literal language comprehension, humour, theory of mind and social reasoning. These findings together with parent reports suggest that behavioural and cognitive impairments in subjects with callosal agenesis may overlap with the profile of autism spectrum disorders, particularly with respect to impairments in social interaction and communication. To provide a comprehensive test of this hypothesis, we directly compared a group of 26 adults with callosal agenesis to a group of 28 adults with a diagnosis of autism spectrum disorder but no neurological abnormality. All participants had full-scale intelligence quotient scores >78 and groups were matched on age, handedness, and gender ratio. Using the Autism Diagnostic Observation Schedule together with current clinical presentation to assess autistic symptomatology, we found that 8/26 (about a third) of agenesis subjects presented with autism. However, more formal diagnosis additionally involving recollective parent-report measures regarding childhood behaviour showed that only 3/22 met complete formal criteria for an autism spectrum disorder (parent reports were unavailable for four subjects). We found no relationship between intelligence quotient and autism symptomatology in callosal agenesis, nor evidence that the presence of any residual corpus callosum differentiated those who exhibited current autism spectrum symptoms from those who did not. Relative to the autism spectrum comparison group, parent ratings of childhood behaviour indicated children with agenesis were less likely to meet diagnostic criteria for autism, even for those who met autism spectrum criteria as adults, and even though there was no group difference in parent report of current

  19. [Sacral pressure sores and their treatment].

    Science.gov (United States)

    Bielecki, Marek; Skowroński, Rafał; Skowroński, Jan

    2006-01-01

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

  20. Transcutaneous sacral neurostimulation for irritative voiding dysfunction.

    Science.gov (United States)

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

    1999-01-01

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

  1. Bicornuate unicollis uterus with left renal agenesis | Adeyinka ...

    African Journals Online (AJOL)

    This is a case report of a 30 year old lady with 8 years history of 2 Infertility. Radiological findings by Hystero-salpingography (HSG) revealed a Bicornuate Unicolis uterus. This was further confirmed by Ultrasound, which also demonstrated a Left Renal agenesis inclusive. Radiological features, clinical presentation and ...

  2. Rare and Common Variants Conferring Risk of Tooth Agenesis

    DEFF Research Database (Denmark)

    Jonsson, L; Magnusson, T E; Thordarson, A

    2018-01-01

    We present association results from a large genome-wide association study of tooth agenesis (TA) as well as selective TA, including 1,944 subjects with congenitally missing teeth, excluding third molars, and 338,554 controls, all of European ancestry. We also tested the association of previously ...

  3. Mutations in PTF1A cause pancreatic and cerebellar agenesis

    NARCIS (Netherlands)

    Sellick, GS; Barker, KT; Stolte-Dijkstra, [No Value; Fleischmann, C; Coleman, RJ; Garrett, C; Gloyn, AL; Edghill, EL; Hattersley, AT; Wellauer, PK; Goodwin, G; Houlston, RS

    2004-01-01

    Individuals with permanent neonatal diabetes mellitus usually present within the first three months of life and require insulin treatment(1,2). We recently identified a locus on chromosome 10p13-p12.1 involved in permanent neonatal diabetes mellitus associated with pancreatic and cerebellar agenesis

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

    Science.gov (United States)

    Roth, Ted M; Reight, Ian

    2012-07-01

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

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

    Science.gov (United States)

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

    2005-02-01

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

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

    NARCIS (Netherlands)

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

    1994-01-01

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

  7. Pneumorrhachis Secondary to a Sacral Decubitus Ulcer

    Directory of Open Access Journals (Sweden)

    Siamak Moayedi

    2016-06-01

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

  8. [Primary genital herpes with sacral meningoradiculitis].

    Science.gov (United States)

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

    2004-02-01

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

  9. 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.

  10. Dental anomalies in an orthodontic patient population with maxillary lateral incisor agenesis.

    Science.gov (United States)

    Citak, Mehmet; Cakici, Elif Bahar; Benkli, Yasin Atakan; Cakici, Fatih; Bektas, Bircan; Buyuk, Suleyman Kutalmış

    2016-01-01

    The purpose of this study was to evaluate the prevalence of dental anomalies in a subpopulation of orthodontic patients with agenesis of maxillary lateral incisors (MLI). The material of the present study included the records of the 1964 orthodontic patients. Panoramic radiographs and dental casts were used to analyze other associated eight dental anomalies, including agenesis of other teeth, dens invaginatus, dens evaginatus, peg shaped MLI, taurodontism, pulp stone, root dilaceration and maxillary canine impaction. Out of the 1964 patients examined, 90 were found to have agenesis of MLI, representing a prevalence of 4.6%. The most commonly found associated-anomalies were agenesis of other teeth (23.3%), peg-shaped MLIs (15.6%), taurodontism (42.2%), and dilacerated teeth (18.9%). Permanent tooth agenesis, taurodontism, peg-shaped maxillary lateral incisor, and root dilacerations are frequently associated with maxillary lateral incisor agenesis.

  11. Corpus callosum agenesis: Role of fetal magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Achour Radhouane

    2016-05-01

    Full Text Available Corpus callosum agenesis (CCA was evaluated by ultrasound examination and magnetic resonance imaging (MRI with many studies. Ultrasonography was able to suspect CCA by indirect signs but a definitive diagnosis of CCA was achieved in rare cases. MRI was able to diagnose complete CCA in majority of cases. Additional neurological abnormalities including heterotopia, gyration anomaly, asymmetry of the cerebral hemispheres, and Dandy-Walker variant were documented, as well as an ocular anomaly which was described, by MRI examination. Prenatal counseling for fetal agenesis of the corpus callosum is difficult as the prognosis is uncertain. The association with other cerebral abnormalities increases the likelihood of a poor outcome and ultrasonographic assessment of the fetal brain is limited. We found MRI to be a safe and useful additional procedure to complement ultrasonographic diagnosis or suspicion of CCA.

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

    Science.gov (United States)

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

    2012-05-01

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

  13. Tooth agenesis: from molecular genetics to molecular dentistry

    Czech Academy of Sciences Publication Activity Database

    Matalová, Eva; Fleischmannová, Jana; Sharpe, P. T.; Tucker, A. S.

    2008-01-01

    Roč. 87, č. 7 (2008), s. 617-623 ISSN 0022-0345 R&D Projects: GA AV ČR KJB500450802; GA MŠk OC B23.001; GA ČR GC524/08/J032 Institutional research plan: CEZ:AV0Z50450515 Keywords : tooth agenesis Subject RIV: FF - HEENT, Dentistry Impact factor: 3.142, year: 2008

  14. Waardenburg syndrome with familial unilateral renal agenesis: a new syndrome variant?

    Science.gov (United States)

    Webb, Katie M; Smith, Alisha J; Dansby, Linda M; Diskin, Charles J

    2015-06-01

    A 64-year-old man with Waardenburg syndrome presented with anuria and was subsequently discovered by renal ultrasound to have unilateral renal agenesis. The patient is one of three generations with incidental finding of renal agenesis also marked by the presence of Waardenburg syndrome. To our knowledge, there has been no mention elsewhere in the scientific literature of a variant of Waardenburg syndrome with associated renal agenesis. © 2014 The Authors. Therapeutic Apheresis and Dialysis © 2014 International Society for Apheresis.

  15. A case of total agenesis of the corpus callosum

    International Nuclear Information System (INIS)

    Sakamoto, Masanobu; Takeda, Katsuhiko; Bandou, Mitsuaki; Murayama, Shigeo; Sakuta, Manabu

    1985-01-01

    We have reported a case of agenesis of the corpus callosum, in which NMR-CT revealed a complete defect of it, and have examined the localization of the speech center of this patient. The patient is a right-handed 26-year-old man who has complained of headache on the parietal region. His neurological examination revealed only a mild mental difficulty (IQ 77). X-ray CT showed the lateral ventricles to be separated widely and the posterior horns dilated, which were compatible with the agenesis of the corpus callosum. Further, NMR-CT has revealed a total agenesis of the corpus callosum. NMR-CT seems to be highly useful for the detection of the degree of the callosal defect. We have carried out the intracarotid amobarbital injection (Wada's test) for the determination of the lateralization of cerebral speech dominance. It had been reported by some authors that when it comes to the cerebral speech dominance, acallosal patients had no difference between each hemisphere. However, our results have demonstrated a left sided dominance. (author)

  16. Hypohyperdontia: Agenesis of three third molars and mandibular centrals associated with midline supernumerary tooth in mandible

    Directory of Open Access Journals (Sweden)

    Sivakumar Nuvvula

    2010-01-01

    Full Text Available Agenesis of teeth in a patient who also presents with a supernumerary tooth is one of the rare numerical anomalies in human dentition. Agenesis of third molars was shown to be associated with other missing permanent teeth. A review of literature on hypodontia including third molar agenesis, hyperdontia and a concomitant presence of these two conditions which is termed as hypohyperdontia is presented along with a case showing agenesis of three third molars, both mandibular central incisors and a midline supernumerary tooth.

  17. Patterns of third-molar agenesis and associated dental anomalies in an orthodontic population.

    Science.gov (United States)

    Celikoglu, Mevlut; Bayram, Mehmet; Nur, Metin

    2011-12-01

    The aim of this study was to investigate the frequency of dental anomalies in orthodontic patients with different patterns of third-molar agenesis, comparing them with patients without third-molar agenesis. A sample of 374 patients with agenesis of at least 1 third molar was divided into 4 groups according to the third-molar agenesis pattern, and a control group of 98 patients without third-molar agenesis was randomly selected from the patient archives. Panoramic radiographs and cast models were used to determine the associated dental anomalies, such as hypodontia, hyperdontia, impaction, dilaceration, microdontia, ectopic eruption, transposition, and transmigration. The Pearson chi-square and Fisher exact tests were used to determine the differences in the distribution of the associated dental anomalies among the groups. The prevalence of agenesis of other teeth (11.2%, n = 42) was significantly greater in our study sample (groups 1-4) than in the control group (group 5) (4.1%, n = 4; P dental anomalies in patients with agenesis of 3 and 4 third molars compared with the control group. Permanent tooth agenesis, microdontia of maxillary lateral incisors, and total dental anomalies are more frequently associated with agenesis of 4 third molars than with the presence of third molars. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  18. The role of Msx1 and Pax9 in pathogenetic mechanisms of tooth agenesis

    Directory of Open Access Journals (Sweden)

    Yani Corvianindya Rahayu

    2009-09-01

    Full Text Available Background: Tooth agenesis is one of the most common developmental anomalies in human, which one or a few teeth are absent because they have never formed, may cause cosmetic or occlusal harm, while severe agenesis which are relatively rare require clinical attention to support and maintain the dental function. Molecular studies have demonstrated that tooth development is under strict genetic control. Purpose: This article want to review the genetic regulating that are responsible for tooth agenesis especially the role of Msx1 and Pax9 in pathogenetic mechanisms of tooth agenesis. Review: Tooth agenesis is a consequence of a qualitatively or quantitatively impaired function of genetic networks, which regulate tooth development. Mutations in Msx1 and Pax9 genes are dominant for tooth agenesis in humans. The Pax9 gene, which codes for a paired domain-containing transcription factor that plays an essential role in the development of mammal dentition, has been associated with selective tooth agenesis in humans and mice. Conclusion: Reduced amount of functional Msx1 or Pax9 protein in the tooth forming cells is able to cause severe and selective tooth agenesis. There are differences in the frequency of agenesis of specific teeth associated with the defects in Msx1 and defects in Pax9.

  19. Four Cases of Urinary Dysfunction Associated with Sacral Herpes Zoster

    OpenAIRE

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

    2014-01-01

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

  20. A 54 Mb 11qter duplication and 0.9 Mb 1q44 deletion in a child with laryngomalacia and agenesis of corpus callosum

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    Lall Meena

    2011-09-01

    Full Text Available Abstract Background Partial Trisomy 11q syndrome (or Duplication 11q has defined clinical features and is documented as a rare syndrome by National Organization of Rare Disorders (NORD. Deletion 1q44 (or Monosomy 1q44 is a well-defined syndrome, but there is controversy about the genes lying in 1q44 region, responsible for agenesis of the corpus callosum. We report a female child with the rare Partial Trisomy 11q syndrome and Deletion 1q44 syndrome. The genomic imbalance in the proband was used for molecular characterization of the critical genes in 1q44 region for agenesis of corpus callosum. Some genes in 11q14q25 may be responsible for laryngomalacia. Results We report a female child with dysmorphic features, microcephaly, growth retardation, seizures, acyanotic heart disease, and hand and foot deformities. She had agenesis of corpus callosum, laryngomalacia, anterior ectopic anus, esophageal reflux and respiratory distress. Chromosome analysis revealed a derivative chromosome 1. Her karyotype was 46,XX,der(1t(1;11(q44;q14pat. The mother had a normal karyotype and the karyotype of the father was 46,XY,t(1;11(q44;q14. SNP array analysis showed that the proband had a 54 Mb duplication of 11q14q25 and a 0.9 Mb deletion of the submicroscopic subtelomeric 1q44 region. Fluorescence Insitu Hybridisation confirmed the duplication of 11qter and deletion of 1qter. Conclusion Laryngomalacia or obstruction of the upper airway is the outcome of increased dosage of some genes due to Partial Trisomy 11q Syndrome. In association with other phenotypic features, agenesis of corpus callosum appears to be a landmark phenotype for Deletion 1q44 syndrome, the critical genes lying proximal to SMYD3 in 1q44 region.

  1. Primary atypical sacral meningioma- not always benign

    International Nuclear Information System (INIS)

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

    2007-01-01

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

  2. 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.)

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

    Science.gov (United States)

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

    2016-08-01

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

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

    Science.gov (United States)

    Tague, Robert G

    2017-05-01

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

  5. L5 radiculopathy due to sacral stress fracture

    International Nuclear Information System (INIS)

    Aylwin, Anthony; Saifuddin, Asif; Tucker, Stuart

    2003-01-01

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

  6. Introduction of laparoscopic sacral colpopexy to a fellowship training program.

    Science.gov (United States)

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

    2013-11-01

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

  7. Sacral Stress Fracture following the Bone Union of Lumbar Spondylolysis

    Directory of Open Access Journals (Sweden)

    Tatsuro Sasaji

    2016-01-01

    Full Text Available While 22 articles have reported on sacral stress fractures, it is a rare injury and its etiology is not well known. We present the case of a 16-year-old male who presented with low back pain in 2015. He was a high school soccer player with a previous history of a bilateral L5 lumbar spondylolysis in 2014. The patient refrained from soccer and wore a brace for six months. Two months after restarting soccer, he again complained of low back pain. After 1 year, a lumbar spine computed tomography revealed the bone union of the spondylolysis. At his first visit to our hospital, his general and neurological conditions were normal and laboratory data were within the normal range. Sacral coronal magnetic resonance imaging (MRI of the left sacral ala revealed an oblique lineal signal void surrounding bone marrow edema. Based on his symptoms, sports history, and MRI, he was diagnosed with a sacral stress fracture. He again refrained from soccer; his low back pain soon improved, and, after 1 year, the abnormal signal change had disappeared on sacral MRI. Recurrent low back pain case caused by a sacral stress fracture occurring after the bone union of lumbar spondylolysis is uncommon.

  8. Bilateral multicystic renal dysplasia with potter sequence: A case with penile agenesis

    International Nuclear Information System (INIS)

    Dursun, Ahmet; Ermis, Bahri; Bahadir, Burak; Seckiner, Ilker

    2006-01-01

    Hereditary renal adysplasia (HRA) is rare autosomal dominant condition. Patients have several other anomalies including Potter facies, thoracic, cardiac, and extremity deformities. The case present dysmorphic facial features such as hypertelorism, prominent epicanthic folds, a flat and broad nose, choanal stenosis, low set ears and a receding chin. He had femoral bowing, hypoplastic right tibia and agenesis of the right foot. He had rich and thin skin. He had also a dysplastic empty scrotum, penile agenesis, and anal atresia. The autopsy revealed pulmonary hypoplasia, ventricular septal defect, bilateral multicystic renal dysplasia, agenesis of ureter and bladder, intraabdominal testicles, and a single umbilical artery. The penile agenesis was first reported, and including the consanguinity in the parents might further delineate the bilateral multicystic HRA. Vater/caudal regression anomalies, Mullerian duct/aplasia, unilateral renal agenesis, and cervicothoracic somite anomalies association and Coloboma, heart anomaly, choanal atresia, retardation, retardation, genital and ear anomalies syndrome has been considered in differential diagnosis. (author)

  9. Prevalence of Third Molar Agenesis: Associated Dental Anomalies in Non-Syndromic 5923 Patients.

    Science.gov (United States)

    Sujon, Mamun Khan; Alam, Mohammad Khursheed; Rahman, Shaifulizan Abdul

    2016-01-01

    The aim of this study was to investigate the prevalence of third molar agenesis and other associated dental anomalies in Bangladeshi population and to investigate the relationship of other dental anomalies with the third molar presence/agenesis. A retrospective study was performed using panoramic radiographs of 5923 patients, who ranged in age from 10 to 50 years. All radiographs were analyzed by Planmeca Romexis® 3.0 software (Planmeca Oy, Helsinki, Finland). Pearson chi-square and one way ANOVA (Post Hoc) test were conducted. The prevalence of third molar agenesis was 38.4%. The frequency of third molar agenesis was significantly higher in females than males (p dental anomalies was 6.5%, among them hypodontia was 3.1%. Prevalence of third molar agenesis varies in different geographic region. Among the other dental anomalies hypodontia was more prevalent.

  10. Agenesis of the dorsal mesentery presenting in an adolescent

    Directory of Open Access Journals (Sweden)

    Anith Chacko

    2013-03-01

    Full Text Available Agenesis of the dorsal mesentery is a rare occurrence that usually presents in children. It is associated with proximal small bowel malrotation as well as high jejunal atresia with discontinuity of the small bowel. We present a case report of an adolescent presenting with clinical features of proximal small bowel obstruction (confirmed on imaging as well as acute pancreatitis. At laparotomy, he was found to have no dorsal mesentery, without small bowel atresia, and the duodenum was fixed to the posterior abdominal wall. The patient recovered well and remained symptom-free.

  11. Prenatal Diagnosis of Bilateral Pulmonary Agenesis: a Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung A; Cho, Jeong Yeon; Lee, Seung Mi; Jun, Jong Kwan; Kang, Ji Eun; Seo, Jeong Wook [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    We report a case of bilateral pulmonary agenesis (BPA), which was suspected during a prenatal US examination and diagnosed by fetal magnetic resonance imaging (MRI). BPA is an extremely rare congenital anomaly and, although many fetal structural defects can be detected with a high degree of confidence after introducing high-resolution US, the prenatal diagnosis of BPA remains problematic. Other thoracic abnormalities, such as a congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, and pulmonary sequestration, should be excluded from the list of possible diagnoses before coming to the conclusion of BPA, because BPA is absolutely incompatible with extrauterine life, and an accurate internal diagnosis can prevent a futile intervention from being performed.

  12. Multivariate analysis of factors affecting presence and/or agenesis of third molar tooth.

    Directory of Open Access Journals (Sweden)

    Mohammad Khursheed Alam

    Full Text Available To investigate the presence and/or agenesis of third molar (M3 tooth germs in orthodontics patients in Malaysian Malay and Chinese population and evaluate the relationship between presence and/or agenesis of M3 with different skeletal malocclusion patterns and sagittal maxillomandibular jaw dimensions. Pretreatment records of 300 orthodontic patients (140 males and 160 females, 219 Malaysian Malay and 81 Chinese, average age was 16.27±4.59 were used. Third-molar agenesis was calculated with respect to race, genders, number of missing teeth, jaws, skeletal malocclusion patterns and sagittal maxillomandibular jaw dimensions. The Pearson chi-square test and ANOVA was performed to determine potential differences. Associations between various factors and M3 presence/agenesis groups were assessed using logistic regression analysis. The percentages of subjects with 1 or more M3 agenesis were 30%, 33% and 31% in the Malaysian Malay, Chinese and total population, respectively. Overall prevalence of M3 agenesis in male and female was equal (P>0.05. The frequency of the agenesis of M3s is greater in maxilla as well in the right side (P>0.05. The prevalence of M3 agenesis in those with a Class III and Class II malocclusion was relatively higher in Malaysian Malay and Malaysian Chinese population respectively. Using stepwise regression analyses, significant associations were found between Mx (P<0.05 and ANB (P<0.05 and M3 agenesis. This multivariate analysis suggested that Mx and ANB were significantly correlated with the M3 presence/agenesis.

  13. Parasacral Perforator Flaps for Reconstruction of Sacral Pressure Sores.

    Science.gov (United States)

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

    2015-07-01

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

  14. The Prevalence of Palmaris longus agenesis among the Ghanaian population

    Directory of Open Access Journals (Sweden)

    Osonuga A

    2012-10-01

    Full Text Available Objective: Background: Studies have documented the agenesis of Palmaris longus muscle in different populations but none has included the Ghanaian population. Methods: The study involved 226 subjects (130 females and 96 males who are students of the University of Cape Coast, Cape Coast, Ghana. The presence of the PLM was clinically determined using the Schaeffer’s test. Subjects in which the tendon was not visualized or palpable, two other tests were performed to confirm the absence. Results: The total prevalence of absence of PLM was 3.1%; absence on the left hand was commoner than on the right hand. The frequency of PLM absence was also slightly higher in females than in males representing 1.8% and 1.3% respectively. One female had the PLM absent bilaterally whiles a male subject had a trifid tendon on the right forearm with a bifid on the left. Conclusion: The prevalence of PLM agenesis in the Ghanaian population is lower compared to values coated in standard textbook on surgery. PLM is not diminishing as fast as observed in some population hence it is can be readily used as donor tendon by Ghanaian surgeons.

  15. Associação de agenesia sacrococcígea e atresia anal em gato sem raça definida Sacrococcygeal agenesis association and anal atresia in mixed breed cats

    Directory of Open Access Journals (Sweden)

    Felipe Purcell de Araújo

    2009-09-01

    Full Text Available O presente trabalho teve como objetivo descrever o caso de um felino, que desde o nascimento apresentou atresia anal, ausência de cauda e malformação dos membros pélvicos. Ao exame radiográfico, pôde-se observar presença de agenesia da sétima vértebra lombar, sacro e vértebras coccígeas, espinha bífida, meningocele, hiperflexão dos joelhos e desvio valgo dos tarsos, diagnosticando-se agenesia sacrococcígea associada à atresia anal.This paper has the objective to report a case of a cat that since birth had anal atresia, absence of tail and malformation of the pelvic member. The radiographic examination revealed agenesis of the seventh lumbar vertebra, sacral and coccygeal vertebrae, spina bifida, meningocele, hyperflexion of the knees and tarsal valgus deviation, diagnosing sacrococcygeal agenesis associated with anal atresia.

  16. Cost of dressings for prevention of sacral pressure ulcers.

    Science.gov (United States)

    Inoue, Kelly Cristina; Matsuda, Laura Misue

    2016-01-01

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

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

    Science.gov (United States)

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

    2014-02-01

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

  18. 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....

  19. Giant Sacral Chondrosarcoma in an Elderly Male : A Case Report

    Directory of Open Access Journals (Sweden)

    HZ Chan

    2014-03-01

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

  20. Sacral neuromodulation in the treatment of the unstable bladder.

    Science.gov (United States)

    Bosch, J L

    1998-07-01

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

  1. 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.

  2. Agenesis of the posterior arch of the atlas

    Directory of Open Access Journals (Sweden)

    Torriani Martin

    2002-01-01

    Full Text Available PURPOSE: To illustrate the radiological findings and review the current literature concerning a rare congenital abnormality of the posterior arch of the atlas. CASE REPORT: An adult female without neurological symptoms presented with an absent posterior arch of the atlas, examined with plain films and helical computerized tomography. Complete agenesis of the posterior arch of the atlas is a rare entity that can be easily identified by means of plain films. Although it is generally asymptomatic, atlantoaxial instability and neurological deficits may occur because of structural instability. Computerized tomography provides a means of assessing the extent of this abnormality and can help evaluate the integrity of neural structures. Although considered to be rare entities, defects of the posterior arch of the atlas may be discovered as incidental asymptomatic findings in routine cervical radiographs. Familiarity with this abnormality may aid medical professionals in the correct management of these cases.

  3. A Case of a Newborn with Agenesis of the Corpus Callosum Complicated with Ocular Albinism

    Directory of Open Access Journals (Sweden)

    Michiko Miki

    2016-05-01

    Full Text Available Purpose: To report a case of ocular albinism found in a newborn infant in whom agenesis of the corpus callosum (ACC was indicated in utero. Case Report: This study involved a female newborn who was delivered after a gestational period of 41 weeks. The patient was referred to the Obstetrics Department at Takatsuki Hospital, Takatsuki City, Japan, after the indication of ACC by magnetic resonance imaging (MRI at a nearby clinic during the fetal period. At birth, the baby’s weight was 2,590 g, and ACC and ventricular enlargement were found by cranial sonography and cranial MRI. While initial ophthalmic findings noted partial loss of pigmentation of the iris and hypopigmentation of broad areas of the fundus in both eyes, nystagmus was not observed. The patient’s hair pigment was slightly diluted, and the color of her skin was slightly off-white. At 2 years after birth, obvious mental retardation was observed. With regard to other systemic findings, no apparent heart, kidney, or immune system abnormalities were found. Conclusion: Although the patient in question is presently growing without any major systemic problems, it will be necessary in the future to pay attention to any changes in systemic and ophthalmic findings.

  4. Left Pulmonary Artery Agenesis in a Pediatric Patient – Case Report

    Directory of Open Access Journals (Sweden)

    Blesneac Cristina

    2016-06-01

    Full Text Available Unilateral pulmonary artery agenesis is a rare congenital anomaly, that may develop in isolation, or in association with other congenital cardiovascular anomalies, such as tetralogy of Fallot, septal defects, right-sided aortic arch, or pulmonary atresia. Left-sided pulmonary artery agenesis is less frequent than the right-sided one. Diagnosis of unilateral pulmonary artery agenesis can be difficult. We report the case of a 15 year-old boy who presented with reduced exercise tolerance, shortness of breath and cyanosis. He was diagnosed with left pulmonary artery agenesis, associated with subaortic-ventricular septal defect, right-sided aortic arch, and severe pulmonary arterial hypertension (PAH, that precluded the surgical repair. Pulmonary vasodilator therapy was initiated in this case. The mortality rate of this rare anomaly is high due to its complications. It is essential to establish an early and correct diagnosis, in order to provide adequate treatment and prevent complications in this disease.

  5. Agenesis of dorsal pancreas with eventration of diaphragm and intrapancreatic pseudocyst: a rare entity

    Directory of Open Access Journals (Sweden)

    Poras Chaudhary

    2013-02-01

    Full Text Available A case of acute pancreatitis in a 43-year-old male patient, which was eventually diagnosed as agenesis of dorsal pancreas with eventration of left hemidiaphragm and intrapancreatic pseudocyst is being reported.

  6. Pancreas and gallbladder agenesis in a newborn with semilobar holoprosencephaly, a case report.

    Science.gov (United States)

    Hilbrands, Robert; Keymolen, Kathelijn; Michotte, Alex; Marichal, Miriam; Cools, Filip; Goossens, Anieta; Veld, Peter In't; De Schepper, Jean; Hattersley, Andrew; Heimberg, Harry

    2017-05-19

    Pancreatic agenesis is an extremely rare cause of neonatal diabetes mellitus and has enabled the discovery of several key transcription factors essential for normal pancreas and beta cell development. We report a case of a Caucasian female with complete pancreatic agenesis occurring together with semilobar holoprosencephaly (HPE), a more common brain developmental disorder. Clinical findings were later confirmed by autopsy, which also identified agenesis of the gallbladder. Although the sequences of a selected set of genes related to pancreas agenesis or HPE were wild-type, the patient's phenotype suggests a genetic defect that emerges early in embryonic development of brain, gallbladder and pancreas. Developmental defects of the pancreas and brain can occur together. Identifying the genetic defect may identify a novel key regulator in beta cell development.

  7. Triplets with growth failure, microcephaly, mental retardation, nail hypoplasia and corpus callosum agenesis: is it a variant of Coffin-Siris or a new syndrome?

    Science.gov (United States)

    Kirel, B; Kural, N; Yakut, A; Adapinar, B

    2000-01-01

    We report eight-year-old triplet girls whose clinical features included microcephaly, severe mental retardation, hypoplasia of distal phalanges of both fifth and second fingers and nail hypoplasia on second fingers, dysmorphic facial features, and partial corpus callosum agenesis. During infancy, a Pavlik harness was used for congenital hip dislocation, and they had difficulty in feeding. One had been operated for patent ductus arteriosus. To our knowledge, this rare combination has not been previously reported in triplets whose clinical features closely resemble those of Coffin-Siris syndrome. The other diagnostic possibilities are also reviewed.

  8. Middle fossa arachnoid cyst with temporal lobe agenesis accompanying isodense subdural hematoma -a case report-

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Soo; Choi, Hyung Sik; Kim, Myung Joon; Yang, Seoung Oh; Kim, Chang Jin [Capital Armed Forces General Hospital, Seongnam (Korea, Republic of)

    1987-12-15

    Cysts overlying the temporal lobes have been well described in literature. These are often associated with agenesis of the temporal lobes, and of major neurosurgical interest due to their frequent association with subdural hematoma, a combination that is rarely seen with cysts in other regions. Full features of plain, angiographic, and CT findings of arachnoid cyst with temporal lobe agenesis accompanying isodense subdural hematoma are presented, being very rare in radiologic literature.

  9. Agenesis of premolar associated with submerged primary molar and a supernumerary premolar: An unusual case report

    Directory of Open Access Journals (Sweden)

    S. V. S. G. Nirmala

    2012-01-01

    Full Text Available The combination of submerged primary molar, agenesis of permanent successor with a supernumerary in the same place is very rare. The purpose of this article is to report a case of submerged mandibular left second primary molar with supernumerary tooth in the same region along with agenesis of second premolar in an 11-year-old girl, its possible etiological factors, and a brief discussion on treatment options.

  10. Lumbosacral osteomyelitis after robot-assisted total laparoscopic hysterectomy and sacral colpopexy.

    Science.gov (United States)

    Muffly, Tyler M; Diwadkar, Gouri B; Paraiso, Marie Fidela R

    2010-12-01

    We report on the transabdominal resection of infected lumbosacral bone, synthetic mesh, and sinus tract following sacral colpopexy. A 45-year-old nulliparous patient who had undergone transvaginal mesh followed by robot-assisted sacral colpopexy presented with increasing back pain and foul-smelling vaginal drainage. An epidural abscess required surgical intervention, including diskectomy, sacral debridement, and mesh removal to drain the abscess and vaginal sinus tract. Recognized complications of open prolapse procedures also manifest following minimally invasive approaches. Osteomyelitis of the sacral promontory following sacral colpopexy may require gynecologic and neurosurgical management.

  11. The application of sacral block anesthesia in pediatric interventional therapy

    International Nuclear Information System (INIS)

    Zhong Liang; Qin Zenghui

    2009-01-01

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

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

    Science.gov (United States)

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

    2018-01-01

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

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

    African Journals Online (AJOL)

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

  14. Acute urinary retention attributable to sacral herpes zoster.

    Science.gov (United States)

    Acheson, J; Mudd, D

    2004-11-01

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

  15. Tooth agenesis and craniofacial morphology in pre-orthodontic children with and without morphological deviations in the upper cervical spine

    DEFF Research Database (Denmark)

    Jasemi, Ashkan; Sonnesen, Liselotte

    2016-01-01

    AIM: To analyze differences in prevalence and pattern of tooth agenesis and craniofacial morphology between non syndromic children with tooth agenesis with and without upper cervical spine morphological deviations and to analyze associations between craniofacial morphology and tooth agenesis...... in the two groups together. METHODS: One hundred and twenty-six pre-orthodontic children with tooth agenesis were divided into two groups with (19 children, mean age 11.9) and without (107 children, mean age 11.4) upper spine morphological deviations. Visual assessment of upper spine morphology...... and measurements of craniofacial morphology were performed on lateral cephalograms. Tooth agenesis was evaluated from orthopantomograms. RESULTS: No significant differences in tooth agenesis and craniofacial morphology were found between children with and without upper spine morphological deviations (2.2 ± 1.6 vs...

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

    Science.gov (United States)

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

    1998-01-01

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

  17. Incidence of agenesis of palmaris longus in the Andhra population of India

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    K Devi Sankar

    2011-01-01

    Full Text Available Background : The knowledge of Palmaris longus (PL is a growing interest for its wide role in reconstructive plastic surgeries as a donor tendon for transfer or transplant. The prevalence of the PL agenesis has been well-documented by many authors in different ethnic groups or populations. Many conventional tests for determining the presence of the PL has been described, but lamentably there are many discrepancies in confirming its presence or absence. Slight modifications of the prevailing methods can still give authenticate results. Aim : This prospective study was conducted to determine the incidence of unilateral and bilateral agenesis of PL and its association with sex and side of the limb in the Andhra population of India. Materials and Methods : A total of 942 subjects of both sexes belonging to 18-23 years were used to access the PL using various tendon examination techniques including our modified Schaeffer′s test. The data collected were analyzed by Pearsons χ2 test using SPSS software. Results : Overall agenesis of muscle in both sexes was 264 (28.0%, out of which 40.2% was seen in females and 14.7% in males with the ratio of 3:1. The unilateral agenesis was seen in 70.5% and bilateral agenesis in 29.5% subjects. The left side agenesis was seen in 51.6% and right side in 48.4% subjects. Conclusions : The prevalence of bilateral and unilateral agenesis was more common on left side with a greater likelihood in the female subjects. The proposed technique could bring better results in all subjects and can be implemented in manual examination of PL.

  18. Emotional Intelligence in Agenesis of the Corpus Callosum.

    Science.gov (United States)

    Anderson, Luke B; Paul, Lynn K; Brown, Warren S

    2017-05-01

    People with agenesis of the corpus callosum (AgCC) with normal general intelligence have deficits in complex cognitive processing, as well as in social cognition. It is uncertain the extent to which impoverished processing of emotions may contribute to social processing deficiencies. We used the Mayer-Salovey-Caruso Emotional Intelligence Test to clarify the nature of emotional intelligence in 16 adults with AgCC. As hypothesized, persons with AgCC exhibited greater disparities from norms on tests involving more socially complex aspects of emotions. The AgCC group did not differ from norms on the Experiential subscale, but they were significantly below norms on the Strategic subscale. These findings suggest that the corpus callosum is not essential for experiencing and thinking about basic emotions in a "normal" way, but is necessary for more complex processes involving emotions in the context of social interactions. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. 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.

  20. Combined Therapy for Distant Metastasis of Sacral Chordoma

    Directory of Open Access Journals (Sweden)

    Birol Özkal

    2015-01-01

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

  1. Sacral Stress Fracture in an Amateur Badminton Player

    Directory of Open Access Journals (Sweden)

    Yusuke Yuasa

    2017-01-01

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

  2. 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.

  3. Sacral root neuromodulation in idiopathic nonobstructive chronic urinary retention.

    Science.gov (United States)

    Shaker, H S; Hassouna, M

    1998-05-01

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

  4. Computer Navigation-aided Resection of Sacral Chordomas

    Directory of Open Access Journals (Sweden)

    Yong-Kun Yang

    2016-01-01

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

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

    Science.gov (United States)

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

    2008-12-01

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

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

    Science.gov (United States)

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

    2013-09-01

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

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

    Directory of Open Access Journals (Sweden)

    D. Oksman

    2018-06-01

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

  8. Ligament-induced sacral fractures of the pelvis are possible.

    Science.gov (United States)

    Steinke, Hanno; Hammer, Niels; Lingslebe, Uwe; Höch, Andreas; Klink, Thomas; Böhme, Jörg

    2014-07-01

    Pelvic ring stability is maintained passively by both the osseous and the ligamentous apparatus. Therapeutic approaches focus mainly on fracture patterns, so ligaments are often neglected. When they rupture along with the bone after pelvic ring fractures, disrupting stability, ligaments need to be considered during reconstruction and rehabilitation. Our aim was to determine the influence of ligaments on open-book injury using two experimental models with body donors. Mechanisms of bone avulsion related to open-book injury were investigated. Open-book injuries were induced in human pelves and subsequently investigated by anatomical dissection and endoscopy. The findings were compared to CT and MRI scans of open-book injuries. Relevant structures were further analyzed using plastinated cross-sections of the posterior pelvic ring. A fragment of the distal sacrum was observed, related to open-book injury. Two ligaments were found to be responsible for this avulsion phenomenon: the caudal portion of the anterior sacroiliac ligament and another ligament running along the ventral surface of the third sacral vertebra. The sacral fragment remained attached to the coxal bone by this second ligament after open-book injury. These results were validated using plastination and the structures were identified. Pelvic ligaments are probably involved in sacral avulsion caused by lateral traction. Therefore, ligaments should to be taken into account in diagnosis of open-book injury and subsequent therapy. Copyright © 2014 Wiley Periodicals, Inc.

  9. Sacral Neuromodulation in Patients With a Cardiac Pacemaker

    Directory of Open Access Journals (Sweden)

    Abdullah A. Gahzi

    2016-09-01

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

  10. Neurodevelopmental outcome in prenatally diagnosed isolated agenesis of the corpus callosum.

    Science.gov (United States)

    Folliot-Le Doussal, Lise; Chadie, Alexandra; Brasseur-Daudruy, Marie; Verspyck, Eric; Saugier-Veber, Pascale; Marret, Stéphane

    2018-01-01

    Neurodevelopmental outcome in children with agenesis of the corpus callosum (ACC) is correlated with the presence or absence of associated brain abnormalities. Indeed, neurodevelopmental outcome shows severe disabilities when the ACC is not isolated whereas in isolated forms, the neurologic development is mainly normal. Contrary to data in several published studies, the prognosis remains uncertain even in isolated forms, which may lead in France to medical termination of pregnancy. To evaluate long-term neurodevelopmental outcome in children with prenatally diagnosed isolated ACC. This is a follow-up study conducted in Normandy (France). It included a cohort of 25 children born between January 1991 and June 2016, with a prenatal diagnosis of isolated ACC and who were followed for at least two years. The average follow-up was 8±5years. ACC was complete in 17 patients (68%), partial in 5 (20%) and hypoplastic in 3 (12%). Whereas global motor development was normal in each case, normal neurodevelopmental outcome or mild disabilities occurred in 88% children and moderate/severe neuro-disabilities were present in 12% of children. Wechsler Intelligence Scale for Children-IV evaluations and Intellectual Total Quotients were within normal range, but we observed lower scores in verbal comprehension, social judgment, executive functions. A lower score in morphosyntax was observed among 52% of children with oral language disorders. Neurodevelopmental outcome was favorable in most of our patients with isolated ACC, but mild learning disabilities emerged in older children. Long-term follow-up until school age is essential to provide early diagnosis and appropriate care support. Copyright © 2017 Elsevier B.V. All rights reserved.

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

    OpenAIRE

    Sneha Mary Varghese; Suresh Sukumar; Abhimanyu Pradhan

    2017-01-01

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

  12. Gallbladder Agenesis in 17 Dogs: 2006-2016.

    Science.gov (United States)

    Sato, K; Sakai, M; Hayakawa, S; Sakamoto, Y; Kagawa, Y; Kutara, K; Teshima, K; Asano, K; Watari, T

    2018-01-01

    Gallbladder agenesis (GBA) is extremely rare in dogs. To describe the history, clinical signs, diagnosis, treatment, and outcomes of dogs with GBA. Seventeen client-owned dogs with GBA. Medical records from 2006 through 2016 were retrospectively reviewed. Dogs were included when GBA was suspected on abdominal ultrasonography and confirmed by gross evaluation. Signalment, clinical signs, clinicopathological data, diagnostic imaging, histopathology, treatment, and outcome were recorded. Dogs were of 6 different breeds, and Chihuahuas (10 of 17) were most common. Median age at presentation was 1.9 (range, 0.7-7.4) years. Clinical signs included vomiting (5 of 17), anorexia (2 of 17), ascites (2 of 17), diarrhea (1 of 17), lethargy (1 of 17), and seizures (1 of 17). All dogs had increased serum activity of at least 1 liver enzyme, most commonly alanine aminotransferase (15 of 17). Fifteen dogs underwent computed tomography (CT) cholangiography; common bile duct (CBD) dilatation was confirmed in 12, without evidence of bile duct obstruction. Gross evaluation confirmed malformation of the liver lobes in 14 of 17 dogs and acquired portosystemic collaterals in 5 of 17. Ductal plate malformation was confirmed histologically in 16 of 17 dogs. During follow-up (range, 4-3,379 days), 16 of 17 dogs remained alive. Dogs with GBA exhibit clinicopathological signs of hepatobiliary injury and hepatic histopathological changes consistent with a ductal plate abnormality. Computed tomography cholangiography was superior to ultrasound examination in identifying accompanying nonobstructive CBD distention. Computed tomography cholangiography combined with laparoscopic liver biopsy is the preferable approach to characterize the full disease spectrum accompanying GBA in dogs. Copyright © 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  13. Proverb comprehension in individuals with agenesis of the corpus callosum.

    Science.gov (United States)

    Rehmel, Jamie L; Brown, Warren S; Paul, Lynn K

    2016-09-01

    Comprehension of non-literal language involves multiple neural systems likely involving callosal connections. We describe proverb comprehension impairments in individuals with isolated agenesis of the corpus callosum (AgCC) and normal-range general intelligence. Experiment 1 compared Gorham Proverb Test (Gorham, 1956) performance in 19 adults with AgCC and 33 neurotypical control participants of similar age, sex, and intelligence. Experiment 2 used the Proverbs subtest of the Delis-Kaplan Executive Function System (D-KEFS, 2001) to compare 19 adults with AgCC and 17 control participants with similar age, sex, and intelligence. Gorham Proverbs performance was impaired in the AgCC group for both the free-response and multiple-choice tasks. On the D-KEFS proverbs test, the AgCC group performed significantly worse on the free-response task (and all derivative scores) despite normal levels of performance on the multiple-choice task. Covarying verbal intelligence did not alter these outcomes. However, covarying a measure of non-literal language comprehension considerably reduced group differences in proverb comprehension on the Gorham test, but had little effect on the D-KEFS group differences. The difference between groups seemed to be greatest when participants had to generate their own interpretation (free response), or in the multiple choice format when the test included many proverbs that were likely to be less familiar. Taken together, the results of this study clearly show that proverb comprehension is diminished in individuals with AgCC compared to their peers. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Securing the airway in a child with tracheal agenesis – an alternative perspective

    Directory of Open Access Journals (Sweden)

    Slavomir Nosal

    2011-03-01

    Full Text Available Tracheal agenesis is an extremely rare, typically fatal congenital anomaly characterised by typical clinical manifestation, failed endotracheal intubation and difficult emergency management. The prognosis and possibility of surgical correction rest on early diagnosis, anatomy, birth weight, and associated anomalies. Tracheal agenesis causes considerable resuscitation difficulties immediately after birth, as tracheal intubation is impossible. Although emergency management, by either bag and mask ventilation or oesophageal intubation, provides some pulmonary gas exchange through tracheo-oesophageal connection, they are associated with overdistension of the stomach and the risk of stomach perforation. We have performed selective intubation of the distal trachea in a child with tracheal agenesis through the tracheo-oesophageal connection with the help of a fibroendoscope. A standard guide wire was passed through the working port of the flexible endoscope and under direct vision was directed through the tracheo-oesophageal connection into the distal trachea. At this point, the endoscope was removed, leaving the guide wire in place. The endotracheal tube size 2 Fr was passed over the guide wire into the distal trachea. The infant showed dramatic improvement and maintained good saturations on mechanical ventilation. The infant was taken for a computed tomography (CT scan, which showed Floyd’s type II tracheal agenesis, the oesophagus connecting with the distal trachea before it bifurcates. The endotracheal tube was seen ending in the carina. Transoesophageal intubation of the short distal segment of the trachea through the tracheo-oesophageal connection might offer a new perspective for short-term securing of the airway in a child with tracheal agenesis and should be considered in any child with suspected tracheal agenesis to buy the time while evaluating the exact anatomy of the anomaly and the possibility of tracheal reconstruction in selected

  15. MR diagnosis of penile agenesis: is it just absence of a phallus?

    Energy Technology Data Exchange (ETDEWEB)

    Goenka, Ajit; Jain, Vaibhav; Sharma, Raju; Gupta, Arun K. [All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi (India); Bajpai, Minu [All India Institute of Medical Sciences, Department of Paediatric Surgery, New Delhi (India)

    2008-10-15

    Penile agenesis is an extremely rare anomaly that results from absence of the genital tubercle or its failure to develop into a penis during embryonic life. Associated anomalies of the genitourinary and distal gastrointestinal tracts are frequently present. Imaging modalities, particularly MRI and cystography, play a crucial role in establishing the diagnosis and guiding further management. We report a child with penile agenesis with a urethroanal fistula and a blind-ending anterior urethra who had been reared as a male until presentation. (orig.)

  16. Chronic renal failure due to unilateral renal agenesis and total renal dysplasia (=aplasia)

    International Nuclear Information System (INIS)

    Kroepelin, T.; Ziupa, J.; Wimmer, B.

    1983-01-01

    Three adult patients with unilateral renal agenesis/total dysplasia (= aplasia) and with an early chronic renal failure are presented. One patient had renal agenesis without ureter bud and ureteric ostium on one side, and reflux pyelonephritis on the other; one had small compact total renal dysplasia (= aplasia) on one side, while chronic uric acid nephropathy (chronic renal disease as a cause of gout) was diagnosed on the other; the third patient had a total large multicystic dysplasia on one side, and on the other a segmental large multicystic dysplasia. Radiological steps and radiodiagnostic criteria are discussed and the combination of urogenital and extraurogenital anomalies is referred to. (orig.)

  17. Rectal motility after sacral nerve stimulation for faecal incontinence

    DEFF Research Database (Denmark)

    Michelsen, H B; Worsøe, J; Krogh, K

    2010-01-01

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

  18. Progressive bilateral anterior sacral meningoceles in Marfan syndrome

    International Nuclear Information System (INIS)

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

    1995-01-01

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

  19. Progressive bilateral anterior sacral meningoceles in Marfan syndrome

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-08-01

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

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

    DEFF Research Database (Denmark)

    Lundby, Lilli; Møller, Arne; Buntzen, Steen

    2011-01-01

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

  1. Unilateral renal agenesis associated with ovarian cysts in a 19 year ...

    African Journals Online (AJOL)

    MJP

    2015-10-28

    379. doi: http://dx.doi.org/10.14194/ijmbr.4.3.2. How to cite this article: Anyabolu E.N,. Chukwuonye I.I, Anyabolu A.E, Enwere O.O.. Unilateral renal agenesis associated with ovarian cysts in a 19 year old woman in Orlu,.

  2. Evidence-based, ethically justified counseling for fetal bilateral renal agenesis

    Science.gov (United States)

    Thomas, Alana N.; McCullough, Laurence B.; Chervenak, Frank A.; Placencia, Frank X.

    2017-01-01

    Background Not much data are available on the natural history of bilateral renal agenesis, as the medical community does not typically offer aggressive obstetric or neonatal care asbilateral renal agenesis has been accepted as a lethal condition. Aim To provide an evidence-based, ethically justified approach to counseling pregnant women about the obstetric management of bilateral renal agenesis. Study design A systematic literature search was performed using multiple databases. We deploy an ethical analysis of the results of the literature search on the basis of the professional responsibility model of obstetric ethics. Results Eighteen articles met the inclusion criteria for review. With the exception of a single case study using serial amnioinfusion, there has been no other case of survival following dialysis and transplantation documented. Liveborn babies die during the neonatal period. Counseling pregnant women about management of pregnancies complicated by bilateral renal agenesis should be guided by beneficence-based judgment informed by evidence about outcomes. Conclusions Based on the ethical analysis of the results from this review, without experimental obstetric intervention, neonatal mortality rates will continue to be 100%. Serial amnioinfusion therefore should not be offered as treatment, but only as approved innovation or research. PMID:28222038

  3. Professional and patient-based evaluation of oral rehabilitation in patients with tooth agenesis

    DEFF Research Database (Denmark)

    Dueled, Erik; Gotfredsen, Klaus; Trab Damsgaard, Mogens

    2009-01-01

    OBJECTIVES: The outcome of oral rehabilitation is usually monitored with clinical tests rather than by patient's perception of change. The aim of this study was to describe the objective measure and subjective perception of oral rehabilitation in patients with tooth agenesis. MATERIAL AND METHODS...

  4. Novel PAX9 gene polymorphisms and mutations and susceptibility to tooth agenesis in the Czech population

    Czech Academy of Sciences Publication Activity Database

    Hloušková, A.; Bonczek, Ondřej; Izakovičová Hollá, L.; Lochman, J.; Šoukalová, J.; Štembírek, Jan; Míšek, Ivan; Černochová, P.; Krejčí, P.; Vaněk, J.; Šerý, Omar

    2015-01-01

    Roč. 36, č. 5 (2015), s. 101-106 ISSN 0172-780X R&D Projects: GA MZd(CZ) NT11420 Institutional support: RVO:67985904 Keywords : odontogenesis * tooth agenesis * PAX9 gene Subject RIV: FF - HEENT, Dentistry Impact factor: 0.946, year: 2015

  5. Didelphic uterus with imperforate unilateral vagina and ipsilateral renal agenesis: Magnetic resonance

    International Nuclear Information System (INIS)

    Rodrigo, R.M.; Saez, F.; Astigarraga, E.; Rodriguez, O.

    1993-01-01

    We present two cases of didelphic uterus with the clinical appearance of a pelvic mass produced by the hematometra-hematocolpos retained by an imperforate unilateral hemivagina. In both cases, this anomaly was accompanied by ipsilateral renal agenesis. We basically review the diagnosis of this disorder, focusing on magnetic resonance as the technique of choice. (Author) 10 refs

  6. Aicardi's syndrome: (agenesis of the corpus callosum, infantile spasms, and ocular anomalies).

    Science.gov (United States)

    Dinani, S; Jancar, J

    1984-06-01

    A case of Aicardi's syndrome is reported. A 12-year-old mentally handicapped female has all the characteristics of the syndrome: agenesis of the Corpus callosum; female infant with mental handicap, epilepsy, characteristic eye lesions, vertebral anomalies and abnormal EEG pattern. The results of supporting examination and investigations are noted.

  7. Imaging features of isolated unilateral pulmonary artery agenesis presenting in adulthood: a review of four cases

    International Nuclear Information System (INIS)

    Griffin, N.; Mansfield, L.; Redmond, K.C.; Dusmet, M.; Goldstraw, P.; Mittal, T.K.; Padley, S.

    2007-01-01

    Aim: To highlight the variation in clinical manifestations, imaging and management of four cases of unilateral pulmonary artery agenesis presenting in adulthood. Method: Four patients with unilateral pulmonary artery agenesis were referred to our institution between 1995 and 2005. They underwent a series of investigations, including chest radiography, echocardiography, ventilation perfusion scintigraphy, angiography, computed tomography (CT) and magnetic resonance imaging (MRI). Results: Two of the four patients had absence of the right main pulmonary artery, whilst the remaining two patients had absence of the left main pulmonary artery. One patient showed a restrictive defect on pulmonary function tests. Two patients who had ventilation perfusion scintigraphy showed absent perfusion and reduced ventilation on the affected side. Angiography (where performed), CT and MRI confirmed the anatomy and the presence of multiple collaterals. Bronchiectasis was demonstrated on CT in two patients, with one also demonstrating a mosaic attenuation pattern. One patient had an incidental lung tumour on the side of the agenesis, which was diagnosed as a chondroid hamartoma on histology. Three of the four patients eventually underwent resection of the affected lung. Conclusion: Isolated unilateral pulmonary artery agenesis has a non-specific presentation. Awareness of this condition can lead to earlier diagnosis, with cross-sectional imaging making an important contribution

  8. Tooth agenesis in osteogenesis imperfecta related to mutations in the collagen type I genes.

    Science.gov (United States)

    Malmgren, B; Andersson, K; Lindahl, K; Kindmark, A; Grigelioniene, G; Zachariadis, V; Dahllöf, G; Åström, E

    2017-01-01

    Osteogenesis imperfecta (OI) is a heterogeneous group of disorders of connective tissue, mainly caused by mutations in the collagen type I genes (COL1A1 and COL1A2). Tooth agenesis is a common feature of OI. We investigated the association between tooth agenesis and collagen type I mutations in individuals with OI. In this cohort study, 128 unrelated individuals with OI were included. Panoramic radiographs were analyzed regarding dentinogenesis imperfecta (DGI) and congenitally missing teeth. The collagen I genes were sequenced in all individuals, and in 25, multiplex ligation-dependent probe amplification was performed. Mutations in the COL1A1 and COL1A2 genes were found in 104 of 128 individuals. Tooth agenesis was diagnosed in 17% (hypodontia 11%, oligodontia 6%) and was more frequent in those with DGI (P = 0.016), and in those with OI type III, 47%, compared to those with OI types I, 12% (P = 0.003), and IV, 13% (P = 0.017). Seventy-five percent of the individuals with oligodontia (≥6 missing teeth) had qualitative mutations, but there was no association with OI type, gender, or presence of DGI. The prevalence of tooth agenesis is high (17%) in individuals with OI, and OI caused by a qualitative collagen I mutation is associated with oligodontia. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Deep venous thrombosis and agenesis of the intrahepatic segment of inferior vena cava

    International Nuclear Information System (INIS)

    Velasco, J.; Fernandez, M.M.; Manzanares, R.; Hernando, A.

    1997-01-01

    We present a case of agenesis of the intrahepatic segment of inferior vena cava (IVC) with drainage through the azygos and hemiazygos systems. The presenting sign was deep venous thrombosis (DVT) in both lower extremities. The different imaging studies led to the diagnosis of both the congenital and acquired venous abnormalities, which are discussed. (Author) 14 refs

  10. Imaging features of isolated unilateral pulmonary artery agenesis presenting in adulthood: a review of four cases

    Energy Technology Data Exchange (ETDEWEB)

    Griffin, N. [Royal Brompton and Harefield NHS Trust, London (United Kingdom)]. E-mail: nyreegriffin@hotmail.com; Mansfield, L. [Royal Brompton and Harefield NHS Trust, London (United Kingdom); Redmond, K.C. [Royal Brompton and Harefield NHS Trust, London (United Kingdom); Dusmet, M. [Royal Brompton and Harefield NHS Trust, London (United Kingdom); Goldstraw, P. [Royal Brompton and Harefield NHS Trust, London (United Kingdom); Mittal, T.K. [Royal Brompton and Harefield NHS Trust, London (United Kingdom); Padley, S. [Royal Brompton and Harefield NHS Trust, London (United Kingdom)

    2007-03-15

    Aim: To highlight the variation in clinical manifestations, imaging and management of four cases of unilateral pulmonary artery agenesis presenting in adulthood. Method: Four patients with unilateral pulmonary artery agenesis were referred to our institution between 1995 and 2005. They underwent a series of investigations, including chest radiography, echocardiography, ventilation perfusion scintigraphy, angiography, computed tomography (CT) and magnetic resonance imaging (MRI). Results: Two of the four patients had absence of the right main pulmonary artery, whilst the remaining two patients had absence of the left main pulmonary artery. One patient showed a restrictive defect on pulmonary function tests. Two patients who had ventilation perfusion scintigraphy showed absent perfusion and reduced ventilation on the affected side. Angiography (where performed), CT and MRI confirmed the anatomy and the presence of multiple collaterals. Bronchiectasis was demonstrated on CT in two patients, with one also demonstrating a mosaic attenuation pattern. One patient had an incidental lung tumour on the side of the agenesis, which was diagnosed as a chondroid hamartoma on histology. Three of the four patients eventually underwent resection of the affected lung. Conclusion: Isolated unilateral pulmonary artery agenesis has a non-specific presentation. Awareness of this condition can lead to earlier diagnosis, with cross-sectional imaging making an important contribution.

  11. Pancreas-specific deletion of mouse Gata4 and Gata6 causes pancreatic agenesis

    Science.gov (United States)

    Xuan, Shouhong; Borok, Matthew J.; Decker, Kimberly J.; Battle, Michele A.; Duncan, Stephen A.; Hale, Michael A.; Macdonald, Raymond J.; Sussel, Lori

    2012-01-01

    Pancreatic agenesis is a human disorder caused by defects in pancreas development. To date, only a few genes have been linked to pancreatic agenesis in humans, with mutations in pancreatic and duodenal homeobox 1 (PDX1) and pancreas-specific transcription factor 1a (PTF1A) reported in only 5 families with described cases. Recently, mutations in GATA6 have been identified in a large percentage of human cases, and a GATA4 mutant allele has been implicated in a single case. In the mouse, Gata4 and Gata6 are expressed in several endoderm-derived tissues, including the pancreas. To analyze the functions of GATA4 and/or GATA6 during mouse pancreatic development, we generated pancreas-specific deletions of Gata4 and Gata6. Surprisingly, loss of either Gata4 or Gata6 in the pancreas resulted in only mild pancreatic defects, which resolved postnatally. However, simultaneous deletion of both Gata4 and Gata6 in the pancreas caused severe pancreatic agenesis due to disruption of pancreatic progenitor cell proliferation, defects in branching morphogenesis, and a subsequent failure to induce the differentiation of progenitor cells expressing carboxypeptidase A1 (CPA1) and neurogenin 3 (NEUROG3). These studies address the conserved and nonconserved mechanisms underlying GATA4 and GATA6 function during pancreas development and provide a new mouse model to characterize the underlying developmental defects associated with pancreatic agenesis. PMID:23006325

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

    International Nuclear Information System (INIS)

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

    2009-01-01

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

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    Science.gov (United States)

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

    2015-11-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

  16. MRI of occult sacral insufficiency fractures following radiotherapy

    International Nuclear Information System (INIS)

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

    1995-01-01

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

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

    Science.gov (United States)

    Horn, John P

    2018-04-01

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

  18. PARTIAL TRISOMY 4p AND PARTIAL MONOSOMY 13q: CASE REPORT AND A LITERATURE REVIEW.

    Science.gov (United States)

    Puvabanditsin, S; Herrera-Garcia, G; Gengel, N; Hussein, K; February, M; Mayne, J; Mehta, R

    2016-01-01

    We report on a term first born dichorionic-diamniotic twin with deletion of the distal long arm of chromosome 13, partial trisomy of the short arm of chromosome 4, intrauterine growth retardation, and multiple anomalies including microcephaly, colpocephaly, absent corpus callosum, bulbous tip of the nose, large and low set ears, macroglossia, thin upper lip, double outlet right ventricle, atria/ventricular septal defect, cleft mitral valve, pulmonary stenosis, single umbilical artery, multicystic dysplastic left kidney, sacral dimple, anterior displacement of anus, simian creases, abnormal thumb (congenital clasped thumb), overlapping toes, and congenital hypothyroidism. This is the first report of a patient with partial trisomy 4p and partial monosomy 13q.

  19. A Case of Distal Vaginal Agenesis Presenting with Recurrent Urinary Tract Infection and Pyuria in a Prepubertal Girl.

    Science.gov (United States)

    Dural, Ozlem; Ugurlucan, Funda Gungor; Yasa, Cenk; Bastu, Ercan; Eren, Hulya; Yuksel, Bahar; Celik, Serdal; Akhan, Suleyman Engin

    2017-02-01

    Isolated distal vaginal agenesis is a rare anomaly and mostly becomes symptomatic after menarche. We describe an unusual presentation of this anomaly in a prepubertal girl. An 11-year-old prepubertal girl presented with recurrent urinary tract infection, pyuria, and right-sided renal agenesis. The findings of perineal inspection, ultrasonography, and magnetic resonance imaging were consistent with a distal vaginal agenesis with pyometrocolpos. Discharging pyometrocolpos with dissection of the atretic portion and a pull-through vaginoplasty were performed. A cystoscopy showed no sign of a vesicovaginal or uterine fistula. This rare presentation of distal vaginal agenesis reminds us that congenital malformations of the female genital tract should be considered in patients with congenital anomalies of the urinary system and/or recurrent urinary tract infection, even during the prepubertal period. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2007-01-01

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

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

    Science.gov (United States)

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

    1998-09-01

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

  2. Congenital agenesis of unilateral parotid gland with ipsilateral type I first branchial cleft anomaly: A rare presentation

    OpenAIRE

    Tripti Maithani; Apoorva Pandey; Seema Acharya

    2014-01-01

    Aim: To report a rare case of unilateral parotid agenesis with ipsilateral type I first branchial cleft anomaly. Material and methods: A case study with special emphasis on the embryology, outlining the complex developmental process of parotid and branchial arches and highlighting the probable reason for development of such anomalies. Results: The literature states that unilateral parotid agenesis is a rare entity with few reported cases occurring solely or in conjunction with other hea...

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

    DEFF Research Database (Denmark)

    Govaert, Bastiaan; Maeda, Yasuko; Alberga, Job

    2012-01-01

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

  4. Spatial Narrative As Feature Of Singularity In Sacral Architecture

    Directory of Open Access Journals (Sweden)

    Gytis Oržikauskas

    2014-05-01

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

  5. Sacral herpes-zoster infection presenting as sciatic pain.

    Science.gov (United States)

    Ablin, J; Symon, Z; Mevorach, D

    1996-06-01

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

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

    Science.gov (United States)

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

    2017-12-01

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

  7. Uterine conserving surgery in a case of cervicovaginal agenesis with unicornuate uterus

    Directory of Open Access Journals (Sweden)

    Vineet Mishra

    2016-01-01

    Full Text Available The presence of cervicovaginal agenesis with unicornuate uterus is a very rare mullerian anomaly. Its true incidence is still unknown. The presence of functioning unicornuate uterus poses a great challenge for a gynecologist because a successful repair could restore normal menses and may preserve a patient′s fertility. Hence, we report a case of 16-year-old unmarried female who presented with chief complaints of primary amenorrhea with cyclical lower abdominal pain. On clinical and radiological evaluation, she was diagnosed with complete cervicovaginal agenesis with right unicornuate uterus (hematometra and hematosalpinx. She underwent vaginoplasty (McIndoes method along with uterovaginal anastomosis by neocervix formation, in order to preserve her uterus. On follow-up, her vagina was completely healed, and she was menstruating normally.

  8. Hereditary motor and sensory neuropathy with agenesis of the corpus callosum.

    Science.gov (United States)

    Dupré, Nicolas; Howard, Heidi C; Mathieu, Jean; Karpati, George; Vanasse, Michel; Bouchard, Jean-Pierre; Carpenter, Stirling; Rouleau, Guy A

    2003-07-01

    Hereditary motor and sensory neuropathy associated with agenesis of the corpus callosum (OMIM 218000) is an autosomal recessive disease of early onset characterized by a delay in developmental milestones, a severe sensory-motor polyneuropathy with areflexia, a variable degree of agenesis of the corpus callosum, amyotrophy, hypotonia, and cognitive impairment. Although this disorder has rarely been reported worldwide, it has a high prevalence in the Saguenay-Lac-St-Jean region of the province of Quebec (Canada) predominantly because of a founder effect. The gene defect responsible for this disorder recently has been identified, and it is a protein-truncating mutation in the SLC12A6 gene, which codes for a cotransporter protein known as KCC3. Herein, we provide the first extensive review of this disorder, covering epidemiological, clinical, and molecular genetic studies.

  9. Isolated left-sided pulmonary artery agenesis with left lung hypoplasia: A report of two cases

    Directory of Open Access Journals (Sweden)

    V Govindaraj

    2017-01-01

    Full Text Available Unilateral absence of pulmonary artery or pulmonary artery agenesis (UAPA is a rare congenital malformation that can present as an isolated lesion or in association with other cardiac anomalies. Though congenital, presentation in adults are also reported. Most common presentation in adults is of exercise intolerance. The developing lung on the affected side is hypoplastic. Diagnosis of UAPA is established by imaging methods like CT and MRI . There is no specific treatment for this condition. Treatment depends on patients symptomatology, presence of pulmonary hypertension and collateral circulation. Presence of pulmonary hypertension carries a bad prognosis. We present two adult patients with isolated left sided unilateral pulmonary artery agenesis with ipsilateral lung hypoplasia. The diagnosis was confirmed by CT chest and perfusion scan.

  10. Dental root agenesis following radiation and antineoplastic therapy: A Case Report

    Directory of Open Access Journals (Sweden)

    Abdul Hafiz

    2016-01-01

    Full Text Available The survival rates of patients suffering from various childhood neoplasms have improved dramatically with the advent of chemo-radiation therapy. The harmful effects of chemo-radiation therapy in the oro-facial region such as root agenesis, short roots, impaired amelogenesis, dentinogenesis, radiation caries, and other soft tissue pathologies are well recognized. In spite of these documented risks, the antineoplastic treatment modalities continue to serve the patient for overall improvement in survival and quality of life. However, a thorough understanding of the growth and development process and its relation with the complex antineoplastic treatment is very important for all clinicians. Such awareness could significantly improve the status of patients in the posttreatment period with the implementation of proper preventive and interceptive measures. This article intends to document a case of root agenesis that developed secondary to chemo-radiation therapy in a 12-year-old girl.

  11. Agenesis of the dorsal pancreas: systematic review of a clinical challenge

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    Javier A. Cienfuegos

    Full Text Available Background: Agenesis of the dorsal pancreas is a rare malformation. Since 1911 and until 2008, 53 cases have been reported. Several authors have recently described the association of this anomaly with neoplasia of the ventral pancreas, thus we performed a systematic review of the literature from 2008 to 2015. Methods: A systematic review of the Medline and ISI Web of Science Databases from 2008 until 2015 was carried out, and 30 articles which met the inclusion criteria were identified that included a total of 53 patients: 7 children and 46 adults. Conclusions: Although dorsal pancreatic agenesis is a rare malformation, given its association with non-alcoholic pancreatitis and neoplasia of the residual pancreas, physicians should maintain an expectant attitude.

  12. Learning and memory in individuals with agenesis of the corpus callosum

    OpenAIRE

    Paul, Lynn K.; Erickson, Roger L.; Hartman, Jo Ann; Brown, Warren S.

    2016-01-01

    Damage to long white matter pathways in the cerebral cortex is known to affect memory capacity. However, the specific contribution of interhemispheric connectivity in memory functioning is only beginning to become understood. The present study examined verbal and visual memory processing in individuals with agenesis of the corpus callosum (AgCC) using the Wechsler Memory Scale-Third Edition (WMS-III; Wechsler, 1997b). Thirty participants with AgCC (FSIQ >78) were compared against 30 healthy a...

  13. Congenital scoliosis associated with agenesis of the uterine cervix. Case report

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    Monica Matteo

    2004-06-01

    Full Text Available Abstract Background Alterations in the normal sequence of development of müllerian ducts lead to a wide spectrum of reproductive tract abnormalities. A rare form of lack of development, regarding a short tract of the müllerian ducts, leads to the isolated agenesis of the uterine cervix. Anomalies identified among patients with müllerian agenesis include skeletal deformities (i.e., scoliosis of the spine and Klippel-Feil anomaly. Case presentation A 46 years old woman presenting cyphoscoliosis and very low stature (120 cm – 3,93 feet, came to our observation for acute pelvic pain; she also reported primary amenorrhoea associated with cyclic pelvic pain. Clinical and imaging evaluation, evidenced a blind vaginal duct of normal length, left cystic adnexal mass, and enlarged uterus with hematometra. FSH, LH, 17β estradiol and CA-125, karyotype and radiographic study of limbs and vertebral column were also evaluated. At laparotomy, a left ovarian cyst was found. Uterus ended at the isthmus; under this level a thin fibrous tissue band was found, joining the uterus to the vagina. Uterine cervix was replaced by fibrous tissue containing some dilated glands lined with müllerian epithelium. Karyotype resulted 46, XX. The described skeletal deformity, were consistent with Klippel-Feil syndrome. Conclusion We report a case of congenital scoliosis associated with müllerian agenesis limited to uterine cervix, association thus far seen only among patients with Mayer-Rokitansky-Kuster-Hauser syndrome (utero-vaginal agenesis. This case report supports the necessity to evaluate, for accompanying müllerian anomalies, all cases of congenital structural scoliosis in view of the possibility for many müllerian development abnormalities, if timely diagnosed, to be surgically corrected.

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

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    Fernanda Nogueira Holanda Ferreira Braga

    2010-10-01

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

  15. Genetic epidemiology of tooth agenesis in Japan: a population- and family-based study.

    Science.gov (United States)

    Machida, J; Nishiyama, T; Kishino, H; Yamaguchi, S; Kimura, M; Shibata, A; Tatematsu, T; Kamamoto, M; Yamamoto, K; Makino, S; Miyachi, H; Shimozato, K; Tokita, Y

    2015-08-01

    Tooth agenesis is one of the most common congenital anomalies in humans. However, the etiology of tooth agenesis remains largely unclear, as well as evidence base useful for genetic counseling. Therefore, we estimated the prevalence and sibling recurrence risk, and investigated agenetic patterns systematically. Tooth agenesis was classified into two subtypes: hypodontia (one to five missing teeth) and oligodontia (six or more missing teeth). The prevalence of these two subtypes were 6.8% [95% confidence interval (CI): 6.1-7.7%] and 0.1% (95% CI: 0.04-0.3%), respectively, and sibling recurrence risk of these were 24.5% (95% CI: 13.8-38.3%) and 43.8% (95% CI: 26.4-62.3%), respectively. This result suggests that the severe phenotype, oligodontia, might be mostly transmitted in a dominant fashion. Using a simple statistical modeling approach, our data were found to be consistent with a bilateral symmetry model, meaning that there was equal probability of missing teeth from the right and left sides. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Double uterus with obstructed hemivagina and ipsilateral renal agenesis: pelvic anatomic variants in 87 cases.

    Science.gov (United States)

    Fedele, L; Motta, F; Frontino, G; Restelli, E; Bianchi, S

    2013-06-01

    What are the anatomic variants (and their frequencies) of double uterus, obstructed hemivagina and ipsilateral renal agenesis? Most cases examined (72.4%) were of the classic anatomic variant of the Herlyn-Werner-Wunderlich syndrome (with didelphys uterus, obstructed hemivagina and ipsilateral renal agenesis) but the 27.6% of cases are of a rare variant of the syndrome (with uterus septum or cervical agenesis), showing relevant clinical and surgical implications. The extreme variability of anatomic structures involved in this syndrome (both uterus, cervico-vaginal and renal anomalies) is well known, even if a complete and uniform analysis of all its heterogeneous presentations in a large series is lacking. This is a retrospective study with 87 patients referred to our third level referral center between 1981 and 2011. We analyzed the laparoscopic and chart records of 87 women, who referred to our institute with double uterus, unilateral cervico-vaginal obstruction and ipsilateral renal anomalies. Sixty-three of 87 patients had the more classic variant of didelphys uterus with obstructed hemivagina; 10/87 patients had septate bicollis uterus with obstructed hemivagina; 9/87 patients had bicornuate bicollis uterus with obstructed hemivagina; 4/87 patients had didelphys uterus with unilateral cervical atresia; 1/87 patients had bicornuate uterus with one septate cervix and unilateral obstructed hemivagina. This is a retrospective study with a long enrolling period (30 years). New insights in the anatomic variants of this rare syndrome with their relevant surgical implications.

  17. Effect of Vestibulo-Proprioceptive Stimulations in a Child with Agenesis of the Corpus Callosum

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    Hamid Dalvand

    2010-06-01

    Full Text Available Background and Aim: The purpose of the present study was to investigate the effect of vestibulo-proprioceptive stimulations of sensory integration theory on the development of gross and fine motor, language and personal-social functions in a child with agenesis of the corpus callosum.Case: We report a 10.5 month old boy with agenesis of the corpus callosum. The intervention was administered based on sensory integration theory an hour a week for 20 weeks. The exercise intervention consisted of proprioceptive and linear, sustained and low frequency vestibular stimulations on suspension device and physio roll. A Denver Developmental Screening- II and milestones skill testing was completed pre-intervention and monthly. Post-intervention, age of gross motor, fine motor adaptive, language, and personal-social functions significantly improved. Based on milestones skills, maintenance of gross motor functions (e.g. sitting and quadruped position improved. The child could roll from side to side and released objects voluntarily. The reaction time to auditory stimulations became less than 2 seconds.Conclusion: vestibulo-proprioceptive stimulations using the neuroplasticity ability of the central nervous system is effective for development of gross and fine motor, language, and personal-social functions. These exercises can be administered for a child with agenesis of the corpus callosum.

  18. Use of physical therapy to augment dilator treatment for vaginal agenesis.

    Science.gov (United States)

    McVearry, Mary E; Warner, William B

    2011-05-01

    : Dilator therapy has been used successfully for many years to treat vaginal agenesis. Our objective was to show how established physical therapy techniques can be used to augment dilator therapy. : A 36-year-old woman desiring nonsurgical management of vaginal agenesis was instructed in the use of vaginal dilators by a pelvic-floor physical therapist. Manual stretching of the vaginal tissues was performed during office visits after application of heat and therapeutic ultrasound to the perineum. In addition, the patient's husband was taught how to perform the vaginal stretching at home in conjunction with dilator therapy. : The patient was able to attempt intercourse after 6 weeks of treatment and achieved full penetration by 9 weeks. At the completion of treatment, she scored 31.9 on the Female Sexual Function Index. The patient and her husband were very satisfied with the treatment approach, especially the encouragement and guidance received in physical therapy. : By using established physical therapy techniques in conjunction with dilator therapy, a faster time to intercourse may be achieved with high patient and spouse satisfaction. We recommend the involvement of a physical therapist specializing in the pelvic floor as an adjunct to standard dilator therapy in the treatment of vaginal agenesis.

  19. CT-guided fixation of sacral fractures and sacrolilac joint disruptions

    International Nuclear Information System (INIS)

    Nelson, D.W.; Duwelius, P.

    1990-01-01

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

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

    NARCIS (Netherlands)

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

    1997-01-01

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

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

    Science.gov (United States)

    Shaker, H; Hassouna, M M

    1999-01-01

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

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

    Science.gov (United States)

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

    2013-10-01

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

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

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    Chin-Ta Lin

    2014-01-01

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

  4. 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.

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

    Science.gov (United States)

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

    1999-01-01

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

  6. Position and Eruption of Permanent Maxillary Canines in Cases of Maxillary Lateral Incisor Agenesis in Mixed Dentition.

    Science.gov (United States)

    Lamas, Cátia; Lavall, Asela; Pinho, Teresa

    2018-01-01

    Assess whether the permanent maxillary canine (MC) has a natural tendency to erupt mesially in children with maxillary lateral incisors agenesis (MLIA), compared to children without agenesis. This retrospective, observational, cross-sectional study consisted of children between 5 and 12 years old divided into three groups: the first group with unilateral MLIA, in which an intraindividual analysis was performed, the second group presented bilateral MLIA, and the third group with patients without agenesis. These last two groups were matched for comparison interindividual, being pared by sex and maturation of the MC. The canine position in the horizontal sector showed a clear mesial positioning of the MC on the agenesis side in individuals with unilateral MLIA (group 1) when compared with the counter lateral side; and in individuals with bilateral MLIA (Group 2) compared with control Individuals without agenesis (group 3). Even with the maintenance of this deciduous tooth in the dental arch, the MC keeps its tendency to mesial eruption. There is a greater tendency for mesial angulation of the maxillary canine in patients with MLIA, regardless of the presence or absence of deciduous lateral incisor.

  7. Sacral neuromodulation effects on periurethral sensation and urethral sphincter activity.

    Science.gov (United States)

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

    2013-06-01

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

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

    Science.gov (United States)

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

    2013-07-01

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

  9. Sacral colpopexy versus transvaginal mesh colpopexy in obese patients.

    Science.gov (United States)

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

    2013-05-01

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

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

    Science.gov (United States)

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

    1992-10-01

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

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

    Science.gov (United States)

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

    2018-05-10

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

  12. Functional aspects of treatment with implant-supported single crowns: a quality control study in subjects with tooth agenesis

    DEFF Research Database (Denmark)

    Goshima, Kenichi; Lexner, Michala O; Thomsen, Carsten Eckhart

    2010-01-01

    -Related Quality of Life (OHRQoL) in subjects with tooth agenesis. MATERIAL AND METHODS: In nine females and nine males (32 + or - 10 years) with agenesis treated with one to four ISSC (68% in the premolar region), the treatment effect and masticatory function were assessed. The evaluation was performed first...... after implant placement shortly before crown cementation, and again 1 month after cementation. It consisted of questionnaires [including Oral Health Impact Profile (OHIP-49)] and functional examination with plastic strips, the Dental Prescale Film and the Occluzer system, Xylitol color-changeable gum...... with ISSCs in subjects with tooth agenesis significantly increased masticatory function subjectively and clinically as well as OHRQoL. However, as the functional parameters before replacement of the teeth corresponded to values in subjects with complete dentitions, the functional importance of the increase...

  13. Tooth agenesis in patients referred to an Irish tertiary care clinic for the developmental dental disorders.

    LENUS (Irish Health Repository)

    Hashem, Atef A

    2010-01-01

    PURPOSE: This study was carried out to determine the prevalence, severity and pattern of hypodontia in Irish patients referred to a tertiary care clinic for developmental dental disorders. MATERIALS AND METHODS: Details of 168 patients with hypodontia referred during the period 2002-2006 were entered in a database designed as a national record. Tooth charting was completed using clinical and radiographic examinations. The age of patients ranged from 7-50 years, with a median age of 20 years (Mean: 21.79; SD: 8.005). RESULTS: Hypodontia referrals constituted 65.5% of the total referrals. Females were more commonly affected than males with a ratio of 1.3:1. The number of referrals reflected the population density in this area; the majority were referrals from the public dental service. Mandibular second premolars were the most commonly missing teeth, followed by maxillary second premolars and maxillary lateral incisors; maxillary central incisors were the least affected. Symmetry of tooth agenesis between the right and left sides was an evident feature. Slightly more teeth were missing on the left side (n = 725) than on the right side (n = 706) and in the maxillary arch (n = 768) as compared to the mandibular arch (n = 663). Some 54% of patients had severe hypodontia with more than six teeth missing; 32% had moderate hypodontia, with four to six teeth missing. The most common pattern of tooth agenesis was four missing teeth. CONCLUSION: Hypodontia was a common presentation in a population referred to this tertiary care clinic. The pattern and distribution of tooth agenesis in Irish patients appears to follow the patterns reported in the literature.

  14. Prosthetic replacement vs space closure for maxillary lateral incisor agenesis: A systematic review.

    Science.gov (United States)

    Silveira, Giordani Santos; de Almeida, Natália Valli; Pereira, Daniele Masterson Tavares; Mattos, Cláudia Trindade; Mucha, José Nelson

    2016-08-01

    Defining the best treatment for maxillary lateral incisor agenesis is a challenge. Our aim in this study was to determine, with the evidence available in the literature, the best treatment for maxillary lateral incisor agenesis in the permanent dentition, evaluating the esthetic, occlusal (functional), and periodontal results between prosthetic replacement and orthodontic space closure. Electronic databases (CENTRAL, PubMed, Web of Science, Scopus, and LILACS) were searched in September 2014 and updated in January 2015, with no restriction on language or initial date. A manual search of the reference lists of the potential studies was performed. Risk of bias was assessed by the Newcastle Ottawa Scale. The search identified 2174 articles, of which 1196 were excluded because they were duplicates. Titles and abstracts of 978 articles were accessed, and 957 were excluded. In total, 21 articles were read in full, and 9 case-control studies were included after applying the inclusion and exclusion criteria. Data were extracted from the articles selected, and a table was compiled for comparison and analysis of the results. There were no randomization and blinding, and the risk of bias evaluation found gaps in compatibility and outcome domains in almost all selected studies. Tooth-supported dental prostheses of maxillary lateral incisor agenesis had worse scores in the periodontal indexes than did orthodontic space closure. Space closure is evaluated better esthetically than prosthetic replacements, and the presence or absence of a Class I relationship of the canines showed no relationship with occlusal function or with signs and symptoms of temporomandibular disorders. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  15. Fetal bilateral renal agenesis, phocomelia, and single umbilical artery associated with cocaine abuse in early pregnancy.

    Science.gov (United States)

    Kashiwagi, Maki; Chaoui, Rabih; Stallmach, Thomas; Hürlimann, Sandra; Lauper, Urs; Hebisch, Gundula

    2003-11-01

    Maternal cocaine abuse in pregnancy is associated with complications such as intrauterine growth retardation, abruptio placentae, and preterm delivery. We report what is, to our knowledge, the first published observation of fetal bilateral renal agenesis associated with a vascular disruption syndrome comprising upper limb reduction defect and a single umbilical artery following maternal cocaine abuse in early pregnancy. This constellation in a fetus aborted at 18 weeks extends the spectrum of complications possibly associated with cocaine abuse in pregnancy. Copyright 2003 Wiley-Liss, Inc.

  16. Cryptophthalmos and Bilateral Renal Agenesis with Cleft Lip and Palate: Fraser Syndrome: Case Report

    Directory of Open Access Journals (Sweden)

    Emre Pabuçcu

    2012-12-01

    Full Text Available Fraser syndrome is a rare autosomal recessive disorder consisting of multiple anomalies including variable expression of cryptophthalmos, syndactyly, abnormal genitalia, malformations of the nose, ear and larynx, renal agenesis, oro-facial clefts, skeletal defects, umbilical hernia and mental retardation. Antenatally detected multiple congenital fetal anomalies during 22nd week of gestation is reported in this paper. Fraser Syndrome was diagnosed according to major and minor criteria. Early antenatal detection is mandatory and clinician should be awere of the high recurrence rates of this syndrome among siblings threatening subsequent pregnancies and should inform affected families.

  17. Bilateral renal agenesis, a severe anomaly in a premature infant with VACTERL association: A case report

    Directory of Open Access Journals (Sweden)

    Erol Basuguy

    2017-11-01

    Full Text Available We report on a preterm male (birth weight 1,100 g with bilateral renal agenesis, a lethal malformation. Additionally, the child suffered from an atrial septal defect, ventricular septal defect, right aortic arch anomaly, a high type of anal atresia, vertebral anomalies, limbs defects (VACTERL association. The infant during first day of life was treated with an emergency sigmoid ostomy and peritoneal dialysis because of increasing abdominal dilatation and high urea and creatinine levels in blood. Important congenital anomalies associated with VACTERL association and prematurity are very serious causes of mortality in the early period

  18. Agenesis of mandibular second premolar in patient with dental bimaxillary protrusion

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Estevanell Tavares

    Full Text Available ABSTRACT The present study reports the treatment carried out in a patient with mandibular second premolar agenesis associated with early loss of a deciduous second molar, deep overbite, severe overjet and dentoalveolar bimaxillary protrusion, which led to lip incompetence and a convex facial profile. The main objectives of this treatment were: to eliminate the spaces in mandibular arch, correct overbite, as well as eliminate bimaxillary protrusion and lip incompetence, thus leading to a balanced profile. The case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO as part of the requirements to obtain the title of BBO diplomate.

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

    Science.gov (United States)

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

    2018-04-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    International Nuclear Information System (INIS)

    Ji Yiming; Chen Kangwu; Yang Huilin; Zhu Lifan

    2010-01-01

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

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

    Science.gov (United States)

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

    2017-10-01

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

  3. Intrapartum sacral stress fracture due to pregnancy-related osteoporosis: a case report.

    Science.gov (United States)

    Oztürk, Gülcan; Külcü, Duygu Geler; Aydoğ, Ece

    2013-01-01

    Low back pain (LBP) and hip pain frequently occur during pregnancy and postpartum period. Although pelvic and mechanic lesions of the soft tissues are most responsible for the etiology, sacral fracture is also one of the rare causes. A 32-year-old primigravid patient presented with LBP and right hip pain which started 3 days after vaginal delivery. Although direct radiographic examination was normal, magnetic resonance imaging of the sacrum revealed sacral stress fracture. Lumbar spine and femoral bone mineral density showed osteoporosis as a risk factor. There were no other risk factors such as trauma, excessive weight gain, and strenuous physical activity. It is considered that the patient had sacral fatigue and insufficiency fracture in intrapartum period. The patient's symptoms subsided in 3 months after physical therapy and rest. In conclusion, sacral fractures during pregnancy and postpartum period, especially resulting from childbirth, are very rare. To date, there are two cases in the literature. In cases who even do not have risk factors related to vaginal delivery such as high birth weight infant and the use of forceps, exc., sacral fracture should be considered in the differential diagnosis of LBP and hip pain started soon after child birth. Pregnancy-related osteoporosis may lead to fracture during vaginal delivery.

  4. Complex malformations of the urogenital tract in a female dog: Gartner duct cyst, ipsilateral renal agenesis, and ipsilateral hydrometra.

    Science.gov (United States)

    Fujita, Atsushi; Tsuboi, Masaya; Uchida, Kazuyuki; Nishimura, Ryohei

    2016-05-01

    A 10-month-old female toy poodle was referred to the University of Tokyo Veterinary Medical Center with a urogenital anomaly found during sterilization. An exploratory laparotomy revealed a cyst adhering to the cervix and a unilateral renal agenesis. Histopathology and immunohistochemical analysis of the cyst was consistent with remnants of the Wolffian duct or a Gartner duct cyst. This is a rare case of a canine Gartner duct cyst with renal agenesis and uterine anomaly. We discuss the similarity of this case to that of humans and introduce a classification in the literature for these complex urogenital malformations for further clinical research into the precise diagnosis and appropriate surgical planning.

  5. Orthodontic management of bilateral maxillary canine-first premolar transposition and bilateral agenesis of maxillary lateral incisors: a case report.

    Science.gov (United States)

    Di Palma, Elena; Di Giuseppe, Biagio; Tepedino, Michele; Chimenti, Claudio

    2015-01-01

    Maxillary canine-first premolar transposition (Mx.C.P1) is an uncommon dental positional anomaly that may create many orthodontic problems from both esthetic and functional points of view. In this report we show the orthodontic management of a case of Mx.C.P1 associated with bilateral maxillary lateral incisor agenesis and unilateral mandibular second premolar agenesis The patient was treated with a multibracket appliance and the extraction of the lower premolar. treatment was completed without the need for any prosthetic replacement.

  6. Herlyn-Werner-Wunderlich Syndrome Consisting of Uterine Didelphys, Obstructed Hemivagina and Ipsilateral Renal Agenesis in a Newborn

    Directory of Open Access Journals (Sweden)

    Tsung-Hsin Wu

    2012-02-01

    Full Text Available Herlyn-Werner-Wunderlich (HWW syndrome is a rare variant of Müllerian duct anomalies consisting of uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Patients with HWW syndrome are usually asymptomatic until menarche, when they present with acute lower abdominal pain. Here we report a case of a female newborn with right renal agenesis diagnosed during the pregnancy. The patient presented with a protruding mass over the vaginal introitus that was associated with an obstructed hemivagina and uterine didelphys.

  7. Unilateral Complete Agenesis of Mesonephric Duct Derivatives in an 82-year-Old Male Cadaver: Embryology, Anatomy and Clinical Considerations

    Directory of Open Access Journals (Sweden)

    David G. Darcy

    2017-11-01

    Full Text Available Development of urogenital anatomy in the human fetus is the result of a complex interplay between multiple different tissues. The time course of development is well documented and the morphologic outcomes of insults at various time points during development are predictable. We present a cadaveric case of unilateral agenesis of the left kidney, ureter, bladder hemitrigone, ureteric opening, seminal vesicle, vas deferens, and epididymis. Failure of development of the mesonephric duct early during embryogenesis, likely between the third and fifth week, caused ipsilateral urogenital organ agenesis.

  8. 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.

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

    Science.gov (United States)

    Edis, R H

    1981-01-01

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

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

    DEFF Research Database (Denmark)

    Zaer, Hamed; Rasmussen, Mikkel Mylius

    2018-01-01

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

  11. Detection of neurological deficits by computed tomography in sacral fracture patients

    International Nuclear Information System (INIS)

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

    2006-01-01

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

  12. Agenesis of the gallbladder with hypoplastic cystic duct diagnosed at laparoscopy.

    Science.gov (United States)

    Kwon, A-Hon; Yanagimoto, Hiroaki; Matsui, Yoichi; Imamura, Atsushi

    2006-08-01

    An 86-year-old man was admitted to our department with complaints of intermittent upper abdominal pain. Ultrasonography of the abdomen showed dilated extrahepatic bile ducts containing stones; however, the gallbladder was not clearly identified. Magnetic resonance cholangiopancreatography showed dilated extrahepatic ducts and choledocholithiasis without gallbladder visualization. The stone extraction was performed with endoscopic sphincterotomy. Three-dimensional images using spiral-computed tomography after intravenous-infusion cholangiography clearly demonstrated an obstruction of the cystic duct. The patient was scheduled for laparoscopic cholecystectomy. At laparoscopy, the gallbladder fossa was not identified on the undersurface of the liver. Despite a thorough examination of the intrahepatic (left-sided within the lesser omentum), retroperitoneal, retrohepatic (within the falciform ligament), retroduodenal, and retropancreatic areas using laparoscopic ultrasonography, the gallbladder was not found. After careful dissection of the hepatoduodenal ligament, the dilated extrahepatic bile duct and a 1-cm length of hypoplastic cystic duct were found. Gallbladder agenesis is usually accompanied by the lack of the cystic duct. The present case is the third report of gallbladder agenesis with a patent or hypoplastic cystic duct.

  13. Nonsyndromic tooth agenesis patterns and associated developmental dental anomalies: a literature review with radiographic illustrations.

    Science.gov (United States)

    Agarwal, P; Vinuth, D P; Dube, G; Dube, P

    2013-01-01

    Tooth agenesis is one of the most intriguing phenomena, because it is frequently associated with other oral anomalies, structural variations and malformations of other teeth, late eruption, transposition and crowding. The diagnosis can be quite challenging as radiographic examination is critical for the diagnosis but not always possible and the late developing teeth may be sometimes scored developmentally missing. Accurate diagnosis therefore requires radiographic, clinical, and dental cast examinations. It is an important clinical and public health problem. Patients with missing permanent teeth may suffer from a reduced chewing ability, inarticulate pronunciation, and an unfavorable aesthetic appearance. Clinically, early diagnosis of a dental anomaly can alert the clinician to the possible development of other associated dental anomalies in the same patient or family, and avoid the possible sequelae. Understanding of tooth agenesis patterns and their impact on diagnosis, prevention, and eventually therapeutics are becoming integral parts of comprehensive dental care. Dental examination with radiographic screening of hypodontia in early childhood should be emphasized as part of public oral health policy to allow early diagnosis and timely intervention.

  14. Prevalence and distribution of dental anomalies: a comparison between maxillary and mandibular tooth agenesis.

    Science.gov (United States)

    Al-Abdallah, Mariam; AlHadidi, Abeer; Hammad, Mohammad; Al-Ahmad, Hazem; Saleh, Raja'

    2015-11-01

    The aim of this study was to compare the pattern and prevalence of associated dental anomalies between maxillary and mandibular tooth agenesis (hypodontia). A sample of 3315 dental patients, aged 8.6 to 25.4 years, was surveyed for tooth agenesis (excluding third molars): 106 subjects were diagnosed with maxillary hypodontia (group 1) and 70 with mandibular hypodontia (group 2). Both groups were examined for the following dental anomalies: retained deciduous molars, infraocclusion of deciduous molars, impaction, microdontia of maxillary lateral incisors, supernumerary teeth, transposition, transmigration, and ectopic eruption of the permanent molars. For statistical testing, the chi-square test (P anomalies among the groups. We found that 77.5% of the patients in the mandibular hypodontia group had at least 1 dental anomaly compared with 49.5% in the maxillary hypodontia group (P dental anomaly with a significantly increased prevalence in the maxillary hypodontia group compared with the mandibular hypodontia group was microdontia of the maxillary lateral incisors (groups 1, 46.7%; group 2, 12.9%; P dental development in both jaws. Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

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

    International Nuclear Information System (INIS)

    Abel, M.S.

    1985-01-01

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

  16. 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.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

  19. Radiographic assessment of agenesis, impaction, and pararadicular radiolucencies in relation with third molar in Nashik City of Maharashtra

    Directory of Open Access Journals (Sweden)

    Bhushan Sukdeo Ahire

    2016-01-01

    Full Text Available Introduction: The third molar develops entirely after birth and also it is the last tooth to erupt in all ethnic groups despite racial variations in the eruption sequence. Tooth development with effects on tooth size, shape, position, and total absence is affected due to environmental factors, systemic diseases, genetic polymorphisms, and teratogens. Aims and Objectives: The aim of this study was to assess the prevalence of agenesis, impaction, and pararadicular radiolucencies in relation with third molars. Materials and Methods: One hundred digital orthopantomograph (OPG scans of patients of age ranging from 18 to 25 years were selected randomly from the digital OPG database of the Department of Oral Medicine and Radiology, and then assessment and analysis were carried out. Results: Overall agenesis rate was about 14.5%. Bilateral agenesis of maxillary and mandibular third molars was about 14% and 13%, respectively. Overall impaction rate was about 21.92%. Mesioangular impaction rate was about 57.33% whereas distoangular impaction rate was about 26.66%. Prevalence of pararadicular radiolucencies was only about 0.8% with mandibular predilection. Conclusion: As the agenesis of the third molars is increasing, they can be considered as vestigial. Prevalence of impaction of the third molars is increasing. Pararadicular radiolucencies are mostly seen with mandibular third molar.

  20. Analysis of the golden proportion and width/height ratios of maxillary anterior dentition in patients with lateral incisor agenesis.

    Science.gov (United States)

    Pini, Núbia Pavesi; de-Marchi, Luciana Manzotti; Gribel, Bruno Frazão; Ubaldini, Adriana Lemos Mori; Pascotto, Renata Corrêa

    2012-12-01

      The purpose of this study was to assess the presence of the golden proportion (GP) in the facial view tooth-to-tooth width proportion of the six maxillary anterior teeth and to evaluate the width/height (W/H) ratios of the incisors of patients with maxillary lateral incisor (LI) agenesis treated either with implants or orthodontically (by moving canines into the position of the laterals, recontouring them, and placing composite restorations over the repositioned teeth).   Forty-eight patients with LI agenesis were divided into four experimental groups: unilateral recontouring group (N = 10), bilateral recontouring group (BRG, N = 18), unilateral implant group (UIG, N = 10), bilateral implant group (N = 10), and a control group (CG, N = 25) of patients without agenesis. GP ratios were determined on patients' dental casts placed over Levin's grids, whereas W/H ratios were measured directly on the casts and a millimeter ruler to determine these distances. Statistical analysis was performed with Shapiro-Wilk, Kruskal-Wallis, Mann-Whitney, Friedman, and Wilcoxon tests (p mean W/H ratios of the laterals ranged between 0.75 and 0.90.   Although the GP may be a useful diagnostic guide, it was not observed in the majority of esthetic outcomes of patients treated with maxillary LI agenesis in this study. The assessment of the golden proportion and width/height ratio of upper anterior teeth in patients with upper lateral incisor agenesis treated with either implants or tooth re-contouring may assist dentists and patients in deciding the best treatment option based on the peculiarities of each case. © 2012 Wiley Periodicals, Inc.

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  2. 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....

  3. 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.)

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

    Science.gov (United States)

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

    2011-07-01

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

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

    NARCIS (Netherlands)

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

    1994-01-01

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

  6. 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.

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

    Science.gov (United States)

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

    1996-01-01

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

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

    Science.gov (United States)

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

    1999-01-01

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

  9. Mullerian agenesis associated with in-utero thalidomide exposure: A case report

    Directory of Open Access Journals (Sweden)

    Sarah Dotters-Katz

    2013-09-01

    Full Text Available Thalidomide is a well-known teratogen, which is experiencing resurgence as new uses are identified. Exposure is classically associated with limb deformities, such as: dysmelia, phocomelia, preaxial hypoplasia and polydactyly, in addition to visceral anomalies that have been documented as well. We report a case of a 38 year-old nulligravid female, who was previously evaluated for primary amenorrhea, and given the presumptive false diagnosis of an imperforate hymen. On magnetic resonance imaging (MRI exam, she was noted to have uterovaginal agenesis. The implications of thalidomide on women’s health extend beyond external birth defects. Although, most commonly associated with limb deformities, there may also be gynecologic implications of in utero exposure. As this medication is increasingly used for various medical conditions, obstetricians/gynecologists need to remain aware of this potential mullerian teratogenic effect.

  10. EARS2 mutations cause fatal neonatal lactic acidosis, recurrent hypoglycemia and agenesis of corpus callosum.

    Science.gov (United States)

    Danhauser, Katharina; Haack, Tobias B; Alhaddad, Bader; Melcher, Marlen; Seibt, Annette; Strom, Tim M; Meitinger, Thomas; Klee, Dirk; Mayatepek, Ertan; Prokisch, Holger; Distelmaier, Felix

    2016-06-01

    Mitochondrial aminoacyl tRNA synthetases are essential for organelle protein synthesis. Genetic defects affecting the function of these enzymes may cause pediatric mitochondrial disease. Here, we report on a child with fatal neonatal lactic acidosis and recurrent hypoglycemia caused by mutations in EARS2, encoding mitochondrial glutamyl-tRNA synthetase 2. Brain ultrasound revealed agenesis of corpus callosum. Studies on patient-derived skin fibroblasts showed severely decreased EARS2 protein levels, elevated reactive oxygen species (ROS) production, and altered mitochondrial morphology. Our report further illustrates the clinical spectrum of the severe neonatal-onset form of EARS2 mutations. Moreover, in this case the live-cell parameters appeared to be more sensitive to mitochondrial dysfunction compared to standard diagnostics, which indicates the potential relevance of fibroblast studies in children with mitochondrial diseases.

  11. Uterus bicornis bicollis, imperforate hemivagina and ipsilateral renal agenesis: case report and literature review.

    Science.gov (United States)

    DaCosta, V; Christie, L; Wynter, S; Harriott, J; Frederick, J

    2009-09-01

    We present a case of a patient with Uterus bicornis bicollis, imperforate hemivagina and ipsilateral renal agenesis. This group of congenital malformations is often asymptomatic until puberty, when it presents as cyclic dysmenorrhoea, leucorrhoea or a pelvic mass. Magnetic resonance imaging is becoming the preferred modality for delineation of uterine malformations. When congenital abnormalities of the reproductive tract are encountered, a search should also be made for renal anomalies. Patients with Uterus bicornis bicollis and unilateral imperforate vagina are often seen with pain severe enough to mimic an acute abdomen. It is important to keep this unusual congenital malformation in mind in the differential diagnosis of vaginal discharge, pelvic mass and/or abdominopelvic pain in young women so as to avoid inappropriate surgical procedures.

  12. Retrovesical cystic lesions in female patients with unilateral renal agenesis or dysplasia

    International Nuclear Information System (INIS)

    Shimada, Kenji; Matsumoto, Fumi; Matsui, Futosi; Obara, Takasi

    2010-01-01

    The objective of this study was to review our experience with female children who have unilateral renal agenesis or renal dysplasia associated with cystic lesions in the reproductive system. Between 1991 and 2007, we treated 26 patients with unilateral renal agenesis or renal dysplasia associated with pelvic, retrovesical or interlabial cystic lesions. In 16 patients, an abnormality either of the kidney or a cystic lesion was detected during the perinatal period. Another 10 patients presented clinical symptoms, including urinary incontinence in five, urinary tract infection in one, and vaginal discharge in four. Based on clinical features and imaging findings, the patients were divided into four groups: those with Gartner's duct cyst (Group 1, n=9); those with uterovaginal duplication with obstructed hemivagina (Herlyn-Werner-Wunderlich syndrome [HWW]; Group 2, n=3); those with both Gartner's duct cyst and HWW syndrome (Group 3, n=3); and those without definitive diagnosis (Group 4, n=11). In Group 1, leakage completely stopped after nephrectomy in three patients, whereas six patients continued to be incontinent despite the removal of dysgenetic kidneys. In Group 2, after the excision of a vaginal septum, no patient presented urinary incontinence. In patients in Group 3, both the mesonephric remnant and mullerian structures were confirmed on imaging or through endoscopy. Because of the high coincidence of genital and renal anomalies, it is recommended that genital systems in female patients with renal anomalies associated with cystic lesions behind the lower urinary tract be investigated. The best imaging modality to use remains under scrutiny. It is important to follow the patients until the age of puberty. The importance of a long-term follow-up in these patients needs to be emphasized. (author)

  13. 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...

  14. Case report 332: A complex anomaly of the craniovertebral junction representing a regressive malformation with agenesis of the neural arch of C-2, hypomorphogenesis at C5-C6 and instability of the upper cervical spine

    International Nuclear Information System (INIS)

    Bernini, F.P.; Muras, I.

    1985-01-01

    In summary, a very complex anomaly, including agenesis of the neural arch of the axis, hypomorphogenesis of the cervical spine at the C5-C6 level with a partial ''blocked'' vertebra and disability of the upper cervical spine, is reported in a 31-year-old man. The anomalies associated with these changes are described in detail in the text and illustrated radiologically. The relationship of the embryological alterations in contrast with the normal is described and emphasized, particularly in the upper cervical area. It is stressed that narrowing of the space from the back of the odontoid (or the posterior lip of the foramen magnum) is a direct result of the complex anomalies described in this case, producing compression of the medulla and/or the upper cervical spinal cord. The literature on this subject is reviewed in depth. (orig.)

  15. A cross-sectional analysis of the prevalence of tooth agenesis and structural dental anomalies in association with cleft type in non-syndromic oral cleft patients.

    Science.gov (United States)

    Konstantonis, Dimitrios; Alexandropoulos, Alexandros; Konstantoni, Nikoleta; Nassika, Maria

    2017-12-01

    The aim of this study was to investigate the prevalence of tooth agenesis, microdontia, and tooth malformation among non-syndromic oral cleft patients and their potential association with cleft type and gender. Intraoral records and radiographs of 154 patients (97 males and 57 females) were examined. The variables assessed were tooth agenesis, microdontia, dental malformations, and cleft types. The statistics included chi-square and Fisher's exact tests as well as logistic regression to assess any mutual effects of gender and cleft type on the dental variables. Tooth agenesis occurred in 50% of the sample and microdontia in 18%. Non-statistically significant odds ratios for the association of gender and cleft type with tooth agenesis were obtained. Tooth agenesis was substantially higher at the unilateral right CL + P and the bilateral CL + P in quadrant 1 and at the unilateral left CL + P and bilateral CL + P in quadrant 2. It was also higher, at the isolated cleft palate (CP) in quadrants 3 and 4. These results were attributed to teeth 22 (31.8%) and 12 (21.6%) in the maxilla and to teeth 35 (6.1%) and 45 (5.4%) in the mandible. In unilateral CL + P patients, the cleft quadrant that presented tooth agenesis was associated with the side of the cleft. Interdisciplinary treatment of the oral cleft patients should take into consideration the high prevalence of tooth agenesis and their association with the different cleft types. The most frequently affected teeth by cleft are by far the upper lateral incisors. Results indicate that tooth agenesis appears to be a genetically controlled anomaly related to the orofacial cleft development through various genetic links and not caused by the cleft disruptive process.

  16. Imaging Findings of Pelvic Tumor Thrombosis Extending from Sacral Bone Metastasis of Adrenocortical Carcinoma

    Directory of Open Access Journals (Sweden)

    Kenichiro Ishida

    2012-01-01

    Full Text Available We report the imaging findings of a patient with adrenocortical carcinoma who showed pelvic tumor thrombosis extending from sacral bone metastasis. Contrast-enhanced computed tomography demonstrated extensive intraluminal filling defects in the pelvic veins. A lytic lesion in the sacrum was also noted and continuity between the sacral lesion and the filling defect in the branch of pelvic veins was indicated. The filling defects showed increased uptake on positron emission tomography with 18F-fluorodeoxyglucose and single-photon emission computed tomography with 131I-iodomethylnorcholesterol, and fusion images with computed tomography aided the localization of the increased uptake areas. Multimodality imaging may be beneficial for the characterization and localization of lesions in patients suspected of having metastatic adrenocortical carcinoma.

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

    Science.gov (United States)

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

    2018-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Caroline M. da Silva

    2007-03-01

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

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

    Science.gov (United States)

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

    2017-12-01

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

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

    Science.gov (United States)

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

    2014-03-01

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

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

    DEFF Research Database (Denmark)

    Haas, S; Brock, C; Krogh, K

    2016-01-01

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

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

    Science.gov (United States)

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

    2011-03-01

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

  4. 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.

  5. Unilateral pulmonary agenesis associated with oesophageal atresia and tracheoesophageal fistula: A case report with prenatal diagnosis

    Directory of Open Access Journals (Sweden)

    Go Miyano

    2015-01-01

    Full Text Available We describe herein a case of unilateral pulmonary agenesis (PA with oesophageal atresia (EA/tracheoesophageal fistula (TEF that was diagnosed prenatally and repaired by esophagoesophagostomy with stable postoperative course. The patient was born at 34 weeks gestation, after ultrasonography at 22 weeks gestation showed possible right-sided diaphragmatic eventration or PA and EA was subsequently suspected due to hydramnios. The initial X-ray showed mediastinal shift to the right, and coil up sign of the nasogastric tube, without intracardiac anomaly. Immediately after the diagnosis of EA/TEF and unilateral PA on day 0, the patient was intubated in the operating room, and a gastrostomy tube was placed. After pulmonary status stabilized, at 4 days old, EA/TEF was repaired through a thoracotomy in the right 4 th intercostal space. The right main bronchus was noted to continue into the distal oesophagus; this fistula was ligated and divided, and a single-layer esophagoesophagostomy was performed under mild tension with one vertebral gap. The neonate was maintained on mechanical ventilation and gradually weaned to extubation at 7 days old. The postoperative course was uneventful, with the exception of prolonged jaundice that emerged at 3 months old. Laparoscopic cholangiography at that time excluded biliary atresia, and jaundice resolved spontaneously. The patient has not shown any respiratory symptoms or feeding difficulties as of the 12-month follow-up.

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

    Science.gov (United States)

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

    2018-04-06

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

  7. A comparison of skeletal maturation in patients with tooth agenesis and unaffected controls assessed by the cervical vertebral maturation (CVM) index.

    Science.gov (United States)

    Casey, Christine; Gill, Daljit S; Jones, Steven P

    2013-12-01

    The aims of this study were to (1) investigate if there is a difference in skeletal maturation between tooth agenesis and control patients and (2) whether skeletal maturation is affected by the severity of tooth agenesis. The cervical vertebral maturation (CVM) index can be used to assess skeletal maturation. A retrospective cross-sectional study. Eastman Dental Hospital, London, UK. A total of 360 cephalograms of patients aged 9-17 years (164 males and 196 females) allocated to four subgroups (mild, moderate and severe tooth agenesis patients, and controls) were assessed retrospectively. There were 90 patients in each of the four subgroups. The skeletal maturation of each subject was assessed both quantitatively and qualitatively using the CVM index. All patients in the study were either currently receiving treatment or had been discharged from the hospital. There was no statistically significant relationship between skeletal maturation and the presence of tooth agenesis. Furthermore, there was no statistically significant relationship between the skeletal maturity of patients and different severities of tooth agenesis. The data obtained from this group of patients and using this measurement tool alone does not supply sufficient reason to reject the null hypothesis. However, it suggests that it is possible that no difference exists between the groups.

  8. Providers' Experiences with Vaginal Dilator Training for Patients with Vaginal Agenesis.

    Science.gov (United States)

    Patel, Vrunda; Hakim, Julie; Gomez-Lobo, Veronica; Amies Oelschlager, Anne-Marie

    2018-02-01

    To examine providers' experiences with vaginal dilator training for patients with vaginal agenesis. Anonymous electronic survey. Members of the North American Society for Pediatric and Adolescent Gynecology. How providers learn about vaginal dilator training, common techniques, and methods used for patient training, assessment of patient readiness, common patient complaints, issues leading to early discontinuation. There were a total of 55 completed survey responses of which 31 respondents (56%) had been in practice for more than 10 years. Forty-nine were gynecologists (89%), 20 had completed a fellowship in pediatric and adolescent gynecology (36%), and 6 were reproductive endocrinologists (11%). Thirty-one respondents had first learned about vaginal dilator training through lectures (56%) whereas only 9 through mentorship and fellowship (16%). According to respondents, the most common issue leading to early discontinuation was lack of patient motivation and readiness (n = 42; 76%). The most common complication was pain or discomfort (n = 45; 82%). More than half of respondents determined dilator therapy was successful when patients reported comfortable sexual intercourse (n = 30; 55%) and 65% (n = 35) did not delineate any restrictions to initiation of sexual intercourse. Most respondents (87%) requested further vaginal dilator training at either a clinical meeting (n = 26; 47%) or with a training video (n = 22; 40%). Our study in an experienced cohort of pediatric gynecology providers highlights the need for further research and training on vaginal dilation education. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  9. Agenesis of the dorsal pancreas: a rare cause of insulin-dependent diabetes without abdominal pain: Case report.

    Science.gov (United States)

    Liang, Kaiyong; Ou, Xiaojuan; Huang, Xukai; Lan, Qunfang

    2018-03-01

    Agenesis of the dorsal pancreas is a very rare condition with an unknown pathology and etiology, although it may be associated with autosomal dominant or X-linked dominant inheritance or retinoic acid and hedgehog signaling pathway alterations. This condition usually manifests with abdominal pain or pancreatitis, although some cases are asymptomatic. Approximately 50% of affected patients with this disorder present with hyperglycemia or various other anomalies. We report the case of a 23-year-old Chinese woman who visited the Department of Endocrinology and Metabolism with insulin-dependent diabetes but no specific symptoms, signs, or other deformities. Severe diabetic retinopathy indicated a long period of hyperglycemia. Agenesis of the dorsal pancreas was observed incidentally during the common diagnosis of diabetes, and the diagnosis was established using magnetic resonance imaging, diffusion-weighted imaging, and magnetic resonance cholangiopancreatography. Following the diagnosis of diabetes, insulin replacement therapy was initiated at a dosage of up to 45 U per day. The patient's blood glucose level was monitored, and the insulin dosage was adjusted accordingly. The patient's blood glucose levels gradually normalized after insulin treatment and were subsequently maintained with intensive insulin therapy. Treatment for diabetic retinopathy was provided by the Ophthalmology Department. Agenesis of the dorsal pancreas should be considered in a young patient diagnosed with diabetes who presents with obvious diabetes-related complications (e.g., renal, retinal, or neurological) inconsistent with the course of the disease or a history of other congenital anomalies. We recommend the routine use of computed tomography or magnetic resonance imaging when examining young patients with diabetes.

  10. 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

  11. Does cortical bone thickness in the last sacral vertebra differ among tail types in primates?

    Science.gov (United States)

    Nishimura, Abigail C; Russo, Gabrielle A

    2017-04-01

    The external morphology of the sacrum is demonstrably informative regarding tail type (i.e., tail presence/absence, length, and prehensility) in living and extinct primates. However, little research has focused on the relationship between tail type and internal sacral morphology, a potentially important source of functional information when fossil sacra are incomplete. Here, we determine if cortical bone cross-sectional thickness of the last sacral vertebral body differs among tail types in extant primates and can be used to reconstruct tail types in extinct primates. Cortical bone cross-sectional thickness in the last sacral vertebral body was measured from high-resolution CT scans belonging to 20 extant primate species (N = 72) assigned to tail type categories ("tailless," "nonprehensile short-tailed," "nonprehensile long-tailed," and "prehensile-tailed"). The extant dataset was then used to reconstruct the tail types for four extinct primate species. Tailless primates had significantly thinner cortical bone than tail-bearing primates. Nonprehensile short-tailed primates had significantly thinner cortical bone than nonprehensile long-tailed primates. Cortical bone cross-sectional thickness did not distinguish between prehensile-tailed and nonprehensile long-tailed taxa. Results are strongly influenced by phylogeny. Corroborating previous studies, Epipliopithecus vindobonensis was reconstructed as tailless, Archaeolemur edwardsi as long-tailed, Megaladapis grandidieri as nonprehensile short-tailed, and Palaeopropithecus kelyus as nonprehensile short-tailed or tailless. Results indicate that, in the context of phylogenetic clade, measures of cortical bone cross-sectional thickness can be used to allocate extinct primate species to tail type categories. © 2017 Wiley Periodicals, Inc.

  12. Klippel-Feil syndrome with associated agenesis of lung and gall bladder presenting with asthma and allergic rhinitis

    International Nuclear Information System (INIS)

    Khanna, Puneet; Panjabi, Chandramani; Shah, Ashok

    2005-01-01

    Klippel-Feil syndrome (KFS), a triad of short neck, limitation of neck movement and low posterior hairline, is characterized by the presence of congenitally fused cervical vertebrae and is often associated with multiple congenital anomalies. A 35-year-old male was referred for evaluation of an 'opaque hemithorax'. This led to a diagnosis of KFS, agenesis of left lung and gall bladder. The patient had history of wheezing dyspnea with nasal symptoms, which were diagnosed as asthma and allergic rhinitis. A high index of suspicion is required to recognize such a patient, and efforts should be made to seek other congenital anomalies. (author)

  13. An Unusual Case of Recurrent Pyocolpos Following Midtrimester Miscarriage Revealed as Obstructed Hemivagina with Ipsilateral Renal Agenesis (OHVIRA Syndrome

    Directory of Open Access Journals (Sweden)

    Haldar M

    2014-08-01

    Full Text Available Obstructed hemivagina with ipsilateral renal agenesis (OHVIRA Syndrome is a rare congenital anomaly. It mostly presents with severe dysmenorrhea and a palpable mass due to unilateral hematocolpos. Sometime it presents in unusual way with prolonged vaginal bleeding and profuse vaginal discharge. Here we report case of an 18 years old married female with OHVIRA syndrome presenting late with symptoms of recurrent pyocolpos following dilatation and evacuation for midtrimester miscarriage that was diagnosed on the basis of MRI and managed by vaginal septotomy.

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

    Science.gov (United States)

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

    2016-10-01

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

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

    Science.gov (United States)

    Kim, Jin-Seop; Yi, Seung-Ju

    2014-06-01

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

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

    Science.gov (United States)

    Shaker, H S; Hassouna, M

    1998-05-01

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

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

    OpenAIRE

    Hur, Jian

    2015-01-01

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

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

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  19. Successful radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with dextrocardia due to unilateral pulmonary agenesis: a case report

    Directory of Open Access Journals (Sweden)

    Aksu T

    2015-02-01

    Full Text Available Tolga Aksu, Tumer Erdem Guler, Ebru Golcuk, Ismail Erden, Kazim Serhan Ozcan Department of Cardiology, Kocaeli Derince Education and Research Hospital, Derince, Kocaeli, Turkey Abstract: Radiofrequency catheter ablation of the slow pathway is considered to be the treatment of choice for patients with atrioventricular nodal reentrant tachycardia. We report a 34-year-old female with mirror image dextrocardia due to unilateral pulmonary agenesis who underwent successful slow pathway ablation for typical atrioventricular nodal reentrant tachycardia. Using contrast injection, cardiac anatomy was identified in a short time and successfully ablated. Keywords: dextrocardia, AVNRT, ablation, pulmonary agenesis

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

    Science.gov (United States)

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

    2018-05-20

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

  1. Partial Cancellation

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Partial Cancellation. Full Cancellation is desirable. But complexity requirements are enormous. 4000 tones, 100 Users billions of flops !!! Main Idea: Challenge: To determine which cross-talker to cancel on what “tone” for a given victim. Constraint: Total complexity is ...

  2. 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...

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

    Directory of Open Access Journals (Sweden)

    Hyun Ho Han

    2016-01-01

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

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

    Science.gov (United States)

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

    1999-10-01

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

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

    Science.gov (United States)

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

    1997-04-01

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

  6. 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.

  7. The relationship between smile attractiveness and esthetic parameters of patients with lateral agenesis treated with tooth recontouring or implants

    Science.gov (United States)

    De-Marchi, Luciana Manzotti; Pini, Núbia Inocencya Pavesi; Pascotto, Renata Corrêa

    2012-01-01

    Background The purpose of this study was to associate smile esthetic judgment with dentofacial attributes of patients with unilateral and bilateral agenesis of maxillary lateral incisors treated with recontouring of canines or implants and patients with no agenesis (control). Material and methods Forty-six participants were divided into two groups: those treated with recontouring (N = 26) and those treated with implants (N = 20). The participants in the control group (N = 22) were selected among dentistry students at the State University of Maringá, Brazil. Photographs of posed smiles (17 cm × 10 cm) were evaluated with a 100-mm Visual Analog Scale. Smile attractiveness was judged by two groups: laypersons and dentists (N = 20 in each group). Judgment was classified into Unpleasant and Pleasant. Measurements of 11 smile attributes were done with ImageTool Version 3.0. These measurements were correlated with the type of judgment using the Pearson correlation coefficient. Results The two groups of evaluators showed no rating difference (analysis of variance, P = 0.64), thus they were placed into a single group. No significant correlation was found between esthetic judgment and six smile attributes (incisor exposure, interlabial gap, width 3 to 3, smile index, right buccal corridor, and buccal corridor ratio). The control group showed more correlations with the unpleasant judgment type than the other groups. Conclusion Some correlations between smile attributes and esthetic judgment were found, but other features of smiles not evaluated in this study may interfere in smile attractiveness. PMID:23674925

  8. Agenesis of internal carotid artery associated with isolated growth hormone deficiency: a case report and literature review.

    Science.gov (United States)

    Stagi, Stefano; Traficante, Giovanna; Lapi, Elisabetta; Pantaleo, Marilena; Becciani, Sabrina; Mortilla, Marzia; Seminara, Salvatore; de Martino, Maurizio

    2015-10-19

    Agenesis of the internal carotid artery (ICA) is a rare congenital abnormality, sporadically reported to be associated with a combined congenital hypopituitarism. Nevertheless, only a few cases have been extensively described, and none of these have been characterized by an isolated growth hormone (GH) deficiency. Here, we describe a 17-year old boy referred to our hospital for fatigue, decreased muscle strength and severe headache reported after the cessation of rhGH treatment for a GH deficiency diagnosed at the age of 2 years and 3 months. Magnetic resonance imaging (MRI) showed an adenohypophyseal hypoplasia with a lack of posterior pituitary hyperintensity, whereas MRI angiography indicated the absence of a normal flow void in the left ICA. Endocrinological tests confirmed the GH deficiency (GH peak after growth-hormone-releasing hormone (GHRH) + arginine: 2.42 ng/mL) with a very low IGF-I value (31 ng/mL) and normal function of other pituitary axes. To the best of our knowledge this is the first confirmed case of an isolated GH deficiency in a patient with ICA agenesis. The presence of an isolated pituitary deficit is unlike to be considered only as an effect of hemodynamic mechanism, suggesting a role for genetic factor(s) as a common cause of these two rare birth defects. Further studies could clarify this issue and the underlying mechanisms to better understand the etiopathogenetic characteristics of this disorder.

  9. Partial processing

    International Nuclear Information System (INIS)

    1978-11-01

    This discussion paper considers the possibility of applying to the recycle of plutonium in thermal reactors a particular method of partial processing based on the PUREX process but named CIVEX to emphasise the differences. The CIVEX process is based primarily on the retention of short-lived fission products. The paper suggests: (1) the recycle of fission products with uranium and plutonium in thermal reactor fuel would be technically feasible; (2) it would, however, take ten years or more to develop the CIVEX process to the point where it could be launched on a commercial scale; (3) since the majority of spent fuel to be reprocessed this century will have been in storage for ten years or more, the recycling of short-lived fission products with the U-Pu would not provide an effective means of making refabrication fuel ''inaccessible'' because the radioactivity associated with the fission products would have decayed. There would therefore be no advantage in partial processing

  10. Partial gigantism

    Directory of Open Access Journals (Sweden)

    М.М. Karimova

    2017-05-01

    Full Text Available A girl with partial gigantism (the increased I and II fingers of the left foot is being examined. This condition is a rare and unresolved problem, as the definite reason of its development is not determined. Wait-and-see strategy is recommended, as well as correcting operations after closing of growth zones, and forming of data pool for generalization and development of schemes of drug and radial therapeutic methods.

  11. Relation between agenesis and shape anomaly of maxillary lateral incisors and canine impaction

    Directory of Open Access Journals (Sweden)

    Anísio Bueno de Carvalho

    2012-12-01

    Full Text Available OBJECTIVE: The purpose was to obtain information about the relation between agenesis and shape anomaly of maxillary lateral incisors and canine impaction. METHODS: Seventy-three patients with canine impaction and 73 control patients, without canine impaction, were evaluated. The mesiodistal distances of the maxillary lateral incisors adjacent to the impacted canines and the correspondent mandibular lateral incisors were measured. The adjacent lateral incisors were classified in: 1 - absent, 2 - small, 3 - peg-shaped, 4 - standard. RESULTS: The results showed that among the patients with impacted canines, there were 21 anomalous teeth (small and peg-shaped and among the control patients there were only three small and peg-shaped teeth, with a statistically significant difference (p = 0.001. No patients were found with impacted canines and absent lateral incisors. CONCLUSION: It was concluded that in patients with anomalous lateral incisors (small and peg-shaped there is a probability to present impacted canines and this must be considered.OBJETIVO: o objetivo foi obter informação sobre a relação existente entre a agenesia e/ou anomalia de forma de incisivos laterais superiores e impacção de caninos. MÉTODOS: foram avaliados 73 pacientes com impacção de caninos e 73 pacientes controle, sem impacção de caninos. Foram medidas as distâncias mesiodistais dos incisivos laterais superiores adjacentes aos caninos impactados e os incisivos laterais correspondentes inferiores. Os incisivos laterais adjacentes foram classificados em: 1 - ausentes; 2 - pequenos; 3 - conoides; 4 - normais. RESULTADOS: os resultados mostraram que no grupo de pacientes com caninos impactados foram encontrados 22 dentes anômalos (pequenos e conoides, e no grupo controle apenas três dentes pequenos e conoides, sendo uma diferença estatisticamente significativa (p=0,001. Não foram encontrados pacientes com canino impactado e incisivo lateral ausente. CONCLUS

  12. Deep Venous Thrombosis of the Leg, Associated with Agenesis of the Infrarenal Inferior Vena Cava and Hypoplastic Left Kidney (KILT Syndrome in a 14-Year-Old Child

    Directory of Open Access Journals (Sweden)

    Sakshi Bami

    2015-01-01

    Full Text Available Agenesis of the inferior vena cava (IVC is a rare anomaly which can be identified as incidental finding or can be associated with iliofemoral vein thrombosis. IVC agenesis has a known association with renal anomalies which are mainly confined to the right kidney. We describe a case of a 14-year-old male who presented with left leg swelling and pain. Ultrasonography confirmed the presence of left leg deep vein thrombosis (DVT. No underlying hematologic risk factors were identified. A CT scan was obtained which demonstrated absent infrarenal IVC and extensive thrombosis in the left deep venous system and development of collateral venous flow into the azygous/hemiazygous system, with extension of thrombus into paraspinal collaterals. An additional finding in the patient was an atrophic left kidney and stenosis of an accessory left renal artery. Agenesis of the IVC should be considered in a young patient presenting with lower extremity DVT, especially in patients with no risk factors for thrombosis. As agenesis of the IVC cannot be corrected, one should be aware that there is a lifelong risk of lower extremity DVT.

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

    International Nuclear Information System (INIS)

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

    2007-01-01

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

  14. 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.

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

    Science.gov (United States)

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

    2013-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Esther Yu

    2016-09-01

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

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

    Science.gov (United States)

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

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

  18. [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.

  19. 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.

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

    Science.gov (United States)

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

    1989-08-01

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

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

    DEFF Research Database (Denmark)

    Knudsen, M.A.; Biering-Sørensen, Fin

    2008-01-01

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

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

    Science.gov (United States)

    Hur, Jian

    2015-06-01

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

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

    Science.gov (United States)

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

    2017-07-01

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

  4. 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.)

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

    Science.gov (United States)

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

    2014-01-01

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

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

    International Nuclear Information System (INIS)

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

    2011-01-01

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

  8. Hippocampal agenesis in an individual who engaged in violent criminal behaviors after discontinuing carbamazepine and paroxetine treatment.

    Science.gov (United States)

    Hanada, Hiroaki; Akiyoshi, Jotaro; Kanehisa, Masayuki; Ishitobi, Yoshinobu; Tsuru, Jusen; Tanaka, Yoshihiro; Shimomura, Tsuyoshi; Kawano, Yoshihisa

    2013-01-01

    Antidepressant discontinuation syndrome (ADS) occurs after abrupt discontinuation of an antidepressant medication. A 23-year-old man with right hippocampal agenesis demonstrated sexual crime (hypersexuality) since the age of eight and had been successfully treated with carbamazepine since the age of 13. He had required increased doses of paroxetine and carbamazepine owing to the development of an unstable affect after quitting his job. He abruptly stopped taking his medication for 3 days and his criminal behaviors re-emerged. We examined changes in brain structure and activity before and after medication cessation, using MRI and functional MRI (fMRI). The image of a girl in a swimsuit increased activity in the thalamus only after medication discontinuation. The alteration in thalamic activity might induce hypersexuality. We conclude that a primary hypersexuality had been suppressed with carbamazepine and paroxetine treatment, and the discontinuation of the medication caused the hypersexuality. © 2012 American Academy of Forensic Sciences.

  9. Discordant tooth agenesis and peg-shaped in a pair of monozygotic twins: Clinical and molecular study

    Directory of Open Access Journals (Sweden)

    Lívia Azeredo Alves Antunes

    2013-01-01

    Full Text Available The present report aimed to study an uncommon case of a pair of twins that presented a discordant dental phenotype. Family investigation, clinical, radiographic examination and molecular analysis were performed in both girls. Molecular analysis confirmed the monozygosity by deoxyribonucleic acid chip technology. One twin presented tooth agenesis in left upper lateral incisor and peg-shaped on the contra lateral side while the other twin had no dental alterations. The dental casts study employed digital caliper to compare morphological dimensions and showed alteration only in peg-shaped tooth. In conclusion, this study provide support that one or more mutated gene could cause discordances in dental phenotype in these monozygotic twins.

  10. Bilateral Deep Vein Thrombosis Associated with Inferior Vena Cava Agenesis in a Young Patient Manifesting as Low Back Pain

    Directory of Open Access Journals (Sweden)

    Felipe Langer

    2017-04-01

    Full Text Available Congenital absence of the inferior vena cava is a rare vascular anomaly, and most cases are asymptomatic. Nevertheless, patients with inferior vena cava malformations may have increased risk of deep venous thrombosis. Particularly, cases of bilateral deep venous thrombosis may arise owing to an insufficient collateral venous drainage from the lower limbs. We hereby describe a case of a previously healthy young male patient presenting with bilateral lower limb deep venous thrombosis as the initial clinical manifestation of congenital inferior vena cava agenesis. We conclude that in young patients presenting with deep venous thrombosis, especially when thrombosis occurs spontaneously, bilaterally, or recurrently, inferior vena cava anomalies should be thoroughly investigated and ruled out as appropriate.

  11. 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.

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

    Science.gov (United States)

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

    2011-05-10

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    International Nuclear Information System (INIS)

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

    1991-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.).

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

    Directory of Open Access Journals (Sweden)

    Joana Ruivo Rodrigues

    2018-01-01

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

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

    OpenAIRE

    Batra, R. K.; Aseeja, Veena

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Luigi Canetti

    2002-12-01

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

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

    Science.gov (United States)

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

    2009-01-01

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

  20. Biallelic PMS2 Mutation and Heterozygous DICER1 Mutation Presenting as Constitutional Mismatch Repair Deficiency With Corpus Callosum Agenesis: Case Report and Review of Literature.

    Science.gov (United States)

    Cheyuo, Cletus; Radwan, Walid; Ahn, Janice; Gyure, Kymberly; Qaiser, Rabia; Tomboc, Patrick

    2017-10-01

    Constitutional mismatch repair deficiency syndrome is a cancer predisposition syndrome caused by autosomal recessive biallelic (homozygous) germline mutations in the mismatch repair genes (MLH1, MSH2, MSH6, and PMS2). The clinical spectrum includes neoplastic and non-neoplastic manifestations. We present the case of a 7-year-old boy who presented with T-lymphoblastic lymphoma and glioblastoma, together with non-neoplastic manifestations including corpus callosum agenesis, arachnoid cyst, developmental venous anomaly, and hydrocephalus. Gene mutation analysis revealed pathogenic biallelic mutations of PMS2 and heterozygous DICER1 variant predicted to be pathogenic. This report is the first to allude to a possible interaction of the mismatch repair system with DICER1 to cause corpus callosum agenesis.

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

    International Nuclear Information System (INIS)

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

    2012-01-01

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

  2. 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.

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

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    Naida C. Borges

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

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

    Science.gov (United States)

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

    1991-01-01

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

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

    Science.gov (United States)

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

    2018-06-01

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

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

    International Nuclear Information System (INIS)

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

    2004-01-01

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

  7. Agenesis of the internal carotid artery with a trans-sellar anastomosis: CT and MRI findings in late-onset congenital hypopituitarism

    International Nuclear Information System (INIS)

    Mellado, J.M.; Merino, X.; Ramos, A.; Salvado, E.; Sauri, A.

    2001-01-01

    A 29-year-old woman with a history of hypothyroidism since early childhood developed hypopituitarism. CT and MRI revealed anterior pituitary hypoplasia, an ectopic posterior lobe, a Chiari I malformation and agenesis of the right internal carotid artery with a trans-sellar anastomosis. This constellation of findings constitutes a previously unreported association in congenital hypopituitarism of late onset. The usefulness of imaging modalities and the pathogenic implications are also discussed. (orig.)

  8. Complete Familial Currarino Triad in Association with Hirschsprung's Disease: Magnetic Resonance Imaging Features and the Spectrum of Anorectal Malformations

    Energy Technology Data Exchange (ETDEWEB)

    Kilickesmez, O.; Hakki Gol, I.; Uzun, M.; Oruk, C. [Diyarbakir Military Hospital (Turkey). Dept. of Radiology

    2006-07-15

    Currarino syndrome, a rare hereditary condition, is defined as a partial sacral agenesis associated with a presacral mass and anorectal malformation. The authors present two siblings with complete Currarino triad and their mother with incomplete triad. The complete Currarino triad in the older sibling was associated with Hirschsprung's disease as the second reported case in the literature. Anorectal malformations, whether suspected of Currarino syndrome or not, should be examined with lumbosacral magnetic resonance imaging.

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

    Directory of Open Access Journals (Sweden)

    Ai-Min Wu

    2016-01-01

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

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

    International Nuclear Information System (INIS)

    Wang Ganggang; Chen Long; Yang Chao; Ni Caifang

    2013-01-01

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

  11. Analysis of width/height ratio and gingival zenith in patients with bilateral agenesis of maxillary lateral incisor

    Directory of Open Access Journals (Sweden)

    Núbia Inocencya Pavesi Pini

    2012-10-01

    Full Text Available OBJECTIVE: The purpose of this study was to evaluate the width/length ratio and the gingival zenith (GZ, by means of dental casts and digital caliper, in patients with missing maxillary lateral incisors after treatment. METHODS: The sample was composed of 52 subjects divided into 3 groups: BRG (n = 18, patients with bilateral agenesis treated with tooth re-contouring; BIG (n = 10 patients with agenesis treated with implants and CG (n = 24, control group. The data were analyzed using Shapiro-Wilk, Spearman correlation, Wilcoxon, Kruskal-Wallis, t test and ANOVA tests (p 0.05. GZ data for the right and left sides of the smile were not considered statistically different. CONCLUSION: Although no statistical difference was found in the comparison between the groups, analysis of the descriptive values showed that group BIG showed the greatest difference in values with regard to width/length ratio. Regarding gingival zenith, BRG showed the greatest difference.OBJETIVO: o propósito desse estudo foi analisar, por meio de modelos de estudo e paquímetro digital, a proporção largura/altura e o zênite gengival (ZG em pacientes com agenesia bilateral do incisivo lateral superior após o tratamento. MÉTODOS: a amostra consistiu de 52 voluntários divididos em 3 grupos: GBR (n=18, pacientes com agenesia bilateral tratados com reanatomizações dentárias; GBI (n=10, pacientes com agenesia bilateral tratados com implantes; e GC (n=24, grupo controle. Os dados foram avaliados por meio dos testes de Shapiro-Wilk, Wilcoxon, Kruskal-Wallis, teste t, ANOVA (p0,05. Os valores obtidos para os lados direito e esquerdo foram considerados iguais dentro de cada grupo. CONCLUSÃO: embora não tenham sido encontradas diferenças estatísticas na comparação entre os grupos, pela análise descritiva dos dados, o GBI foi o grupo que apresentou as medidas mais destoantes dos demais em relação à proporção largura/altura, sendo que, para o zênite gengival, a maior

  12. 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.

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

    Science.gov (United States)

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

    2010-12-01

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

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

    International Nuclear Information System (INIS)

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

    2007-01-01

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

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

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    Carlo Brembilla

    2015-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Science.gov (United States)

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

    1996-07-01

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

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

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

    2006-01-01

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

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

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    Xing Li

    2017-06-01

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

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

    Science.gov (United States)

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

    2010-08-01

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

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

    Science.gov (United States)

    Nnamdi, Ibe Michael Onwuzuruike

    2013-09-01

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

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

    Science.gov (United States)

    2005-01-01

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

  3. Esthetic Assessment of the Effect of Gingival Exposure in the Smile of Patients with Unilateral and Bilateral Maxillary Incisor Agenesis.

    Science.gov (United States)

    Pinho, Teresa; Bellot-Arcís, Carlos; Montiel-Company, José María; Neves, Manuel

    2015-07-01

    The aim of this study was to determine the dental esthetic perception of the smile of patients with maxillary lateral incisor agenesis (MLIA); the perceptions were examined pre- and post-treatment. Esthetic determinations were made with regard to the gingival exposure in the patients' smile by orthodontists, general dentists, and laypersons. Three hundred eighty one people (80 orthodontists, 181 general dentists, 120 laypersons) rated the attractiveness of the smile in four cases before and after treatment, comprising two cases with unilateral MLIA and contralateral microdontia and two with bilateral MLIA. For each case, the buccal photograph was adjusted using a computer to apply standard lips to create high, medium, and low smiles. A numeric scale was used to measure the esthetic rating perceived by the judges. The resulting arithmetic means were compared using an ANOVA test, a linear trend, and a Student's t-test, applying a significance level of p esthetic perception of smiles in post-treatment cases. © 2014 by the American College of Prosthodontists.

  4. Agenesis of the corpus callosum and gray matter heterotopia in three patients with constitutional mismatch repair deficiency syndrome.

    Science.gov (United States)

    Baas, Annette F; Gabbett, Michael; Rimac, Milan; Kansikas, Minttu; Raphael, Martine; Nievelstein, Rutger Aj; Nicholls, Wayne; Offerhaus, Johan; Bodmer, Danielle; Wernstedt, Annekatrin; Krabichler, Birgit; Strasser, Ulrich; Nyström, Minna; Zschocke, Johannes; Robertson, Stephen P; van Haelst, Mieke M; Wimmer, Katharina

    2013-01-01

    Constitutional mismatch repair deficiency (CMMR-D) syndrome is a rare inherited childhood cancer predisposition caused by biallelic germline mutations in one of the four mismatch repair (MMR)-genes, MLH1, MSH2, MSH6 or PMS2. Owing to a wide tumor spectrum, the lack of specific clinical features and the overlap with other cancer predisposing syndromes, diagnosis of CMMR-D is often delayed in pediatric cancer patients. Here, we report of three new CMMR-D patients all of whom developed more than one malignancy. The common finding in these three patients is agenesis of the corpus callosum (ACC). Gray matter heterotopia is present in two patients. One of the 57 previously reported CMMR-D patients with brain tumors (therefore all likely had cerebral imaging) also had ACC. With the present report the prevalence of cerebral malformations is at least 4/60 (6.6%). This number is well above the population birth prevalence of 0.09-0.36 live births with these cerebral malformations, suggesting that ACC and heterotopia are features of CMMR-D. Therefore, the presence of cerebral malformations in pediatric cancer patients should alert to the possible diagnosis of CMMR-D. ACC and gray matter heterotopia are the first congenital malformations described to occur at higher frequency in CMMR-D patients than in the general population. Further systematic evaluations of CMMR-D patients are needed to identify possible other malformations associated with this syndrome.

  5. Agenesia de veia cava inferior associada à trombose venosa profunda Agenesis of inferior vena cava associated with deep venous thrombosis

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    Clovis Luis Konopka

    2010-09-01

    Full Text Available A agenesia da veia cava inferior é uma anomalia congênita rara, que foi recentemente identificada como um importante fator de risco para o desenvolvimento e a recorrência de trombose venosa profunda de membros inferiores em jovens. O objetivo deste trabalho foi relatar o caso de uma paciente que apresentou trombose venosa profunda dois meses após a realização de cirurgia de varizes. A angiotomografia computadorizada demonstrou a presença de anomalia venosa complexa com ausência da veia cava inferior.The agenesis of the inferior vena cava is a rare congenital anomaly, which was recently identified as an important risk factor for the development and recurrence of deep venous thrombosis especially in young people. The goal of this work was to report the case of a patient who presented deep venous thrombosis approximately two months after varicose vein surgery. The computerized angiotomography demonstrated the presence of a complex venous anomaly with absence of the inferior vena cava.

  6. Impact of Local Management on Long-Term Outcomes in Ewing Tumors of the Pelvis and Sacral Bones: University of Florida Experience

    International Nuclear Information System (INIS)

    Indelicato, Daniel J.; Keole, Sameer R.; Shahlaee, Amir H.; Shi Wenyin; Morris, Christopher G.; Gibbs, C. Parker; Scarborough, Mark T.; Marcus, Robert B.

    2008-01-01

    Purpose: This retrospective analysis describes our 35-year experience with respect to disease control and functional status. Patients and Methods: Thirty-five patients with localized Ewing tumors of the pelvis and sacral bones were treated from 1970 to 2005. Twenty-six patients were treated with definitive radiotherapy (RT), and 9 patients were treated with combined local therapy in the form of surgery + RT. The median RT dose was 55.2 Gy. The patients who received RT alone were more likely to be older men with larger tumors exhibiting soft-tissue extension. Patients in the definitive RT group were more likely to receive etoposide and ifosfamide or undergo bone marrow transplant. Median potential follow-up was 19.4 years. Results: The 15-year actuarial cause-specific survival, freedom from relapse rate, and local control rates were 26% vs. 76% (p = 0.016), 28% vs. 78% (p = 0.015), and 64% vs. 100% (p = 0.087), respectively, for patients treated with definitive RT and combined therapy. Overall, tumors <8 cm had significantly better cause-specific survival, but this was unrelated to local control. The median Toronto Extremity Salvage Score for the definitive RT and combined therapy groups were 99 and 94, respectively (p = 0.19). Seven definitive RT patients (27%) had serious complications. Conclusion: Combined modality local therapy should be considered if pelvic Ewing tumors are resectable. However, because of the extent of local disease, most patients have unresectable or partially resectable tumors and therefore require RT in some capacity. For this reason, innovative RT strategies are needed to improve long-term disease outcomes and minimize side effects while maintaining an acceptable functional result

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

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    Newman Justin T

    2011-05-01

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

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

    International Nuclear Information System (INIS)

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

    2012-01-01

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

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

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    Madis Kolk

    2015-06-01

    Full Text Available Teesid: 20. sajandil on esile kerkinud mitmeid teatrisuundi, mis on kritiseerinud ja püüdnud ületada Lääne traditsioonilise teatri väidetavat sõnakesksust ning samuti selle võimetust täita n-ö püha kunsti funktsioone. Kuigi seda pühadusedefitsiiti on püütud leevendada ennekõike orientaalsetest teatrivormidest inspiratsiooni ammutades, aitab selle võimalikku tekkelugu mõista ka katoliikliku kultuuri mõjuväljas võrsunud teatrikunsti ning teatrivaenulikuma ortodoksi teoloogia kontekstis välja töötatud ikooniteoloogia võrdlus. Kõrvutades nende kahe konfessiooni teoloogilis-esteetilisi arusaamu, saame analüüsida ka performatiivsuse esteetika seisukohast olulisi kunstiteose loome- ja tajutingimuste vormilisi ja meelelisi aspekte ning nende toimet sakraalse kunsti sihtide seisukohast. SU M M A R Y In the 21st century Western society has seen an increasing interest in topics related to religion. In this context, the connection between the concept of sacrality in Western culture and freedom of verbal and artistic expression has been reconsidered; the very possibility of so-called sacred art within Western culture has been called into question. Already in the 20th century several theatrical movements in the West have expressed the need to strive for religious (or at least quasi-religious goals by means of the stage. This can already be seen in the work of the symbolists, but such experiments accelerated and became more forceful under the influence of Antonin Artaud’s visions and under the aegis of intercultural theatre. In all of these different quests one can find common elements: discontent with the discursivity of the theatrical canon, a need for a metaphysical dimension in the theatre, and the belief that channels of perception can be opened through contact with exotic ritual cultures. In his book Sacred Theatre Ralph Yarrow has attempted to define the criteria of sacrality in the theatre, drawing upon William S. Haney

  10. 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.

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

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

    2003-06-01

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

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

    International Nuclear Information System (INIS)

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

    2003-01-01

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

  13. Carbon Ion Radiation Therapy for Unresectable Sacral Chordoma: An Analysis of 188 Cases

    Energy Technology Data Exchange (ETDEWEB)

    Imai, Reiko, E-mail: r_imai@nirs.go.jp [Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Kamada, Tadashi [Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Araki, Nobuhito [Department of Orthopedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan); Abe, Satoshi; Iwamoto, Yukihide; Ozaki, Toshifumi; Kanehira, Chihiro; Kaya, Mitsunori; Takahashi, Kazuhisa; Chuman, Hirokazu; Tsujii, Hirohiko; Tsuneyoshi, Masazumi; Nishida, Yoshihiro; Hiraga, Hiroaki; Hiruma, Toru; Machinami, Rikuo; Matsumine, Akihiko; Matsumoto, Seiichi; Morioka, Hideo; Yamaguchi, Takehiko; and others

    2016-05-01

    Purpose: To evaluate the results of carbon ion radiation therapy administered to 188 patients with unresectable primary sacral chordomas. Patients and Methods: One hundred eighty-eight patients were treated with carbon ion radiation therapy at a single institute between 1996 and 2013 and retrospectively analyzed. The median age was 66 years. The highest proximal invasion reached past S2 level in 137 patients. The median clinical target volume was 345 cm{sup 3}. One hundred six patients received 67.2 gray equivalents (GyE)/16 fractions (fr), 74 patients received 70.4 GyE/16 fr, 7 patients received 73.6 GyE/16 fr, and 1 patient received 64.0 GyE/16 fr. Results: The median follow-up period was 62 months (range, 6.8-147.5 months). Seventy percent of patients were followed for 5 years or until death. The 5-year local control, overall survival, and disease-free survival rates were 77.2%, 81.1%, and 50.3%, respectively. Forty-one patients had a local recurrence. Sex, tumor volume, level of proximal invasion, and irradiated dose were unrelated to local control. There was grade 3 toxicity of the peripheral nerves in 6 patients and grade 4 toxicity of the skin in 2 patients. Ambulation remained in 97% of patients. Conclusions: Carbon ion radiation therapy was safe and effective for unresectable chordoma and provided good local control and survival while preserving ambulation.

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

    International Nuclear Information System (INIS)

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

    2017-01-01

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

  15. 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.

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

    Science.gov (United States)

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

    2016-07-01

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

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

    Science.gov (United States)

    Batra, R K; Aseeja, Veena

    2014-04-01

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

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

    International Nuclear Information System (INIS)

    Gastineau, B.

    2000-06-01

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

  19. 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 lordosis only showed minor differences. At all levels except for L5 / S1, lordosis measured by means of standing radiographs was higher than that measured by MRI. The difference in global lumbar L1-S1 lordosis was -2.9°. Analysis of the Roussouly groups showed the largest difference for L1-S1 (-8.3°) in group 2. In group 4, when measured on MRI, L5 / S1 lordosis (25.71°) was lower than L4 / L5 lordosis (27.63°) compared to the other groups. Conclusions  Although measurements of global lumbar lordosis significantly differed between the two scanning technologies, the mean difference was just 2.9°. MRI in supine position may be used for estimating global lumbar lordosis, but single level lordosis should be determined by means of standing radiographs. Key Points   · Large

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

    Science.gov (United States)

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

    2016-02-01

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

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

    Science.gov (United States)

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

    2017-06-26

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

  2. Two-unit cantilevered resin-bonded fixed partial denture as a substitute for a prosthodontic-orthodontic treatment plan: a 5-year case report.

    Science.gov (United States)

    Emami, Elham; St-Georges, Annie; de Grandmont, Pierre

    2012-01-01

    In this case report, we describe the successful long-term treatment of a patient with dental agenesis. The initial treatment plan included an orthodontic phase to provide adequate space for replacing missing lateral incisors with implants. However, because of some complications encountered after 2 years of orthodontic treatment, a revised treatment plan was considered to achieve functional and esthetic goals. The patient was completely satisfied 5 years after being treated with two 2-unit cantilevered resin-bonded fixed partial dentures supported by the cuspids. This conservative treatment plan was cost-effective without having any significant biological cost.

  3. Does the serum uric acid level have any relation to arterial stiffness or blood pressure in adults with congenital renal agenesis and/or hypoplasia?

    Science.gov (United States)

    Yazici, Raziye; Guney, İbrahim; Altintepe, Lutfullah; Yazici, Mehmet

    2017-01-01

    The relationship between serum uric acid and arterial stiffness or blood pressure is not clear. The serum uric acid level and its association with cardiovascular risk is not well known in patients with reduced renal mass. We aimed to investigate the relation between serum uric acid levels and arterial stiffness and also blood pressure in patients with congenital renal agenesis and/or hypoplasia. In this single center, cross-sectional study, a total of 55 patients (39 (% 70.9) with unilateral small kidney and 16 (%29.1) with renal agenesis) were included. The median age was 35 (21-50) years. The study population was divided into tertiles of serum uric acid (according to 2.40-3.96, 3.97-5.10, and 5.11-9.80 mg/dl cut-off values of serum uric acid levels). Official and 24-h ambulatory non-invasive blood pressures of all patients were measured. The arterial stiffness was assessed by pulse wave velocity (PWV). PWV values were increased from first to third tertile (5.5 ± 0.6, 5.7 ± 0.8, 6.1 ± 0.7, respectively), but this gradual increase between tertiles did not reach significance. Linear regression analyses showed a positive correlation between serum uric acid levels and PWV (β = 0.40, p = 0.010), but no correlation was found between uric acid and daytime systolic blood pressure (β = 0.24, p = 0.345). In congenital renal agenesis/hypoplasia, the serum uric acid level was positively correlated with arterial stiffness, but there was no correlation with blood pressure.

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

    Science.gov (United States)

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

    2017-06-12

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

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

    International Nuclear Information System (INIS)

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

    2006-01-01

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

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

    Science.gov (United States)

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

    2018-05-21

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

  7. 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.

  8. Partial tooth gear bearings

    Science.gov (United States)

    Vranish, John M. (Inventor)

    2010-01-01

    A partial gear bearing including an upper half, comprising peak partial teeth, and a lower, or bottom, half, comprising valley partial teeth. The upper half also has an integrated roller section between each of the peak partial teeth with a radius equal to the gear pitch radius of the radially outwardly extending peak partial teeth. Conversely, the lower half has an integrated roller section between each of the valley half teeth with a radius also equal to the gear pitch radius of the peak partial teeth. The valley partial teeth extend radially inwardly from its roller section. The peak and valley partial teeth are exactly out of phase with each other, as are the roller sections of the upper and lower halves. Essentially, the end roller bearing of the typical gear bearing has been integrated into the normal gear tooth pattern.

  9. 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.

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

    Science.gov (United States)

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

    2017-12-01

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

  11. 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.)

  12. Self-referential and social cognition in a case of autism and agenesis of the corpus callosum

    Directory of Open Access Journals (Sweden)

    Lombardo Michael V

    2012-11-01

    Full Text Available Abstract Background While models of autism spectrum conditions (ASC are emerging at the genetic level of analysis, clear models at higher levels of analysis, such as neuroanatomy, are lacking. Here we examine agenesis of the corpus callosum (AgCC as a model at the level of neuroanatomy that may be relevant for understanding self-referential and social-cognitive difficulties in ASC. Methods We examined performance on a wide array of tests in self-referential and social-cognitive domains in a patient with both AgCC and a diagnosis of ASC. Tests included a depth-of-processing memory paradigm with self-referential and social-cognitive manipulations, self-report measures of self-consciousness, alexithymia, and empathy, as well as performance measures of first-person pronoun usage and mentalizing ability. The performance of the AgCC patient was compared to a group of individuals with ASC but without AgCC and with neurotypical controls. These comparison groups come from a prior study where group differences were apparent across many measures. We used bootstrapping to assess whether the AgCC patient exhibited scores that were within or outside the 95% bias-corrected and accelerated bootstrap confidence intervals observed in both comparison groups. Results Within the depth-of-processing memory paradigm, the AgCC patient showed decreased memory sensitivity that was more extreme than both comparison groups across all conditions. The patient’s most pronounced difficulty on this task emerged in the social-cognitive domain related to information-processing about other people. The patient was similar to the ASC group in benefiting less from self-referential processing compared to the control group. Across a variety of other self-referential (i.e. alexithymia, private self-consciousness and social-cognitive measures (i.e. self-reported imaginative and perspective-taking subscales of empathy, mentalizing, the AgCC patient also showed more extreme scores than

  13. Essays on partial retirement

    NARCIS (Netherlands)

    Kantarci, T.

    2012-01-01

    The five essays in this dissertation address a range of topics in the micro-economic literature on partial retirement. The focus is on the labor market behavior of older age groups. The essays examine the economic and non-economic determinants of partial retirement behavior, the effect of partial

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

    Science.gov (United States)

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

    2018-01-01

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

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

    International Nuclear Information System (INIS)

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

    2006-01-01

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

  16. 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

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

    Science.gov (United States)

    Padula, William V

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

  18. Recurrent Partial Words

    Directory of Open Access Journals (Sweden)

    Francine Blanchet-Sadri

    2011-08-01

    Full Text Available Partial words are sequences over a finite alphabet that may contain wildcard symbols, called holes, which match or are compatible with all letters; partial words without holes are said to be full words (or simply words. Given an infinite partial word w, the number of distinct full words over the alphabet that are compatible with factors of w of length n, called subwords of w, refers to a measure of complexity of infinite partial words so-called subword complexity. This measure is of particular interest because we can construct partial words with subword complexities not achievable by full words. In this paper, we consider the notion of recurrence over infinite partial words, that is, we study whether all of the finite subwords of a given infinite partial word appear infinitely often, and we establish connections between subword complexity and recurrence in this more general framework.

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

    Science.gov (United States)

    Bosch, J L; Groen, J

    1998-05-01

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

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

    Science.gov (United States)

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

    2011-01-01

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

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

    Science.gov (United States)

    Umeta, Ricardo S G; Avanzi, Osmar

    2011-07-01

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

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

    Science.gov (United States)

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

    2005-01-01

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

  3. 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

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

    Science.gov (United States)

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

    2016-03-01

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

  5. 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.

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

    Science.gov (United States)

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

    2013-07-01

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

  7. Hyperbolic partial differential equations

    CERN Document Server

    Witten, Matthew

    1986-01-01

    Hyperbolic Partial Differential Equations III is a refereed journal issue that explores the applications, theory, and/or applied methods related to hyperbolic partial differential equations, or problems arising out of hyperbolic partial differential equations, in any area of research. This journal issue is interested in all types of articles in terms of review, mini-monograph, standard study, or short communication. Some studies presented in this journal include discretization of ideal fluid dynamics in the Eulerian representation; a Riemann problem in gas dynamics with bifurcation; periodic M

  8. Successful removable partial dentures.

    Science.gov (United States)

    Lynch, Christopher D

    2012-03-01

    Removable partial dentures (RPDs) remain a mainstay of prosthodontic care for partially dentate patients. Appropriately designed, they can restore masticatory efficiency, improve aesthetics and speech, and help secure overall oral health. However, challenges remain in providing such treatments, including maintaining adequate plaque control, achieving adequate retention, and facilitating patient tolerance. The aim of this paper is to review the successful provision of RPDs. Removable partial dentures are a successful form of treatment for replacing missing teeth, and can be successfully provided with appropriate design and fabrication concepts in mind.

  9. Beginning partial differential equations

    CERN Document Server

    O'Neil, Peter V

    2011-01-01

    A rigorous, yet accessible, introduction to partial differential equations-updated in a valuable new edition Beginning Partial Differential Equations, Second Edition provides a comprehensive introduction to partial differential equations (PDEs) with a special focus on the significance of characteristics, solutions by Fourier series, integrals and transforms, properties and physical interpretations of solutions, and a transition to the modern function space approach to PDEs. With its breadth of coverage, this new edition continues to present a broad introduction to the field, while also addres

  10. 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.)

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

    Science.gov (United States)

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

    2004-08-01

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

  12. An economic appraisal of the Australian Medical Sheepskin for the prevention of sacral pressure ulcers from a nursing home perspective

    Science.gov (United States)

    2010-01-01

    Background Many devices are in use to prevent pressure ulcers, but from most little is known about their effects and costs. One such preventive device is the Australian Medical Sheepskin that has been proven effective in three randomized trials. In this study the costs and savings from the use of the Australian Medical Sheepskin were investigated from the perspective of a nursing home. Methods An economic model was developed in which monetary costs and monetary savings in respect of the sheepskin were balanced against each other. The model was applied to a fictional (Dutch) nursing home with 100 beds for rehabilitation patients and a time horizon of one year. Input variables for the model consisted of investment costs for using the sheepskin (purchase and laundry), and savings through the prevented cases of pressure ulcers. The input values for the investment costs and for the effectiveness were empirically based on a trial with newly admitted rehabilitation patients from eight nursing homes. The input values for the costs of pressure ulcer treatment were estimated by means of four different approaches. Results Investment costs for using the Australian Medical Sheepskin were larger than the monetary savings obtained by preventing pressure ulcers. Use of the Australian Medical Sheepskin involves an additional cost of approximately €2 per patient per day. Preventing one case of a sacral pressure ulcer by means of the Australian Medical Sheepskin involves an investment of €2,974 when the sheepskin is given to all patients. When the sheepskin is selectively used for more critical patients only, the investment to prevent one case of sacral pressure ulcers decreases to €2,479 (pressure ulcer risk patients) or €1,847 (ADL-severely impaired patients). The factors with the strongest influence on the balance are the frequency of changing the sheepskin and the costs of washing related to this. The economic model was hampered by considerable uncertainty in the

  13. 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

  14. Partial knee replacement - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100225.htm Partial knee replacement - series—Normal anatomy To use the sharing ... A.M. Editorial team. Related MedlinePlus Health Topics Knee Replacement A.D.A.M., Inc. is accredited ...

  15. Beginning partial differential equations

    CERN Document Server

    O'Neil, Peter V

    2014-01-01

    A broad introduction to PDEs with an emphasis on specialized topics and applications occurring in a variety of fields Featuring a thoroughly revised presentation of topics, Beginning Partial Differential Equations, Third Edition provides a challenging, yet accessible,combination of techniques, applications, and introductory theory on the subjectof partial differential equations. The new edition offers nonstandard coverageon material including Burger's equation, the telegraph equation, damped wavemotion, and the use of characteristics to solve nonhomogeneous problems. The Third Edition is or

  16. The impact of office chair features on lumbar lordosis, intervertebral joint and sacral tilt angles: a radiographic assessment.

    Science.gov (United States)

    De Carvalho, Diana; Grondin, Diane; Callaghan, Jack

    2017-10-01

    The purpose of this study was to determine which office chair feature is better at improving spine posture in sitting. Participants (n = 28) were radiographed in standing, maximum flexion and seated in four chair conditions: control, lumbar support, seat pan tilt and backrest with scapular relief. Measures of lumbar lordosis, intervertebral joint angles and sacral tilt were compared between conditions and sex. Sitting consisted of approximately 70% of maximum range of spine flexion. No differences in lumbar flexion were found between the chair features or control. Significantly more anterior pelvic rotation was found with the lumbar support (p = 0.0028) and seat pan tilt (p < 0.0001). Males had significantly more anterior pelvic rotation and extended intervertebral joint angles through L1-L3 in all conditions (p < 0.0001). No one feature was statistically superior with respect to minimising spine flexion, however, seat pan tilt resulted in significantly improved pelvic posture. Practitioner Summary: Seat pan tilt, and to some extent lumbar supports, appear to improve seated postures. However, sitting, regardless of chair features used, still involves near end range flexion of the spine. This will increase stresses to the spine and could be a potential injury generator during prolonged seated exposures.

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

    Science.gov (United States)

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

    2010-01-01

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

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

    Science.gov (United States)

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

    2010-01-01

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

  19. Partial differential equations

    CERN Document Server

    Evans, Lawrence C

    2010-01-01

    This text gives a comprehensive survey of modern techniques in the theoretical study of partial differential equations (PDEs) with particular emphasis on nonlinear equations. The exposition is divided into three parts: representation formulas for solutions; theory for linear partial differential equations; and theory for nonlinear partial differential equations. Included are complete treatments of the method of characteristics; energy methods within Sobolev spaces; regularity for second-order elliptic, parabolic, and hyperbolic equations; maximum principles; the multidimensional calculus of variations; viscosity solutions of Hamilton-Jacobi equations; shock waves and entropy criteria for conservation laws; and, much more.The author summarizes the relevant mathematics required to understand current research in PDEs, especially nonlinear PDEs. While he has reworked and simplified much of the classical theory (particularly the method of characteristics), he primarily emphasizes the modern interplay between funct...

  20. Má oclusão Classe I de Angle com agenesia de incisivos laterais Angle Class I malocclusion and agenesis of lateral incisors

    Directory of Open Access Journals (Sweden)

    Fernanda Catharino Menezes Franco

    2011-08-01

    Full Text Available O planejamento ortodôntico de pacientes com agenesia de incisivos laterais envolve considerações estéticas e funcionais de grande relevância para um resultado clínico satisfatório. Tanto o fechamento dos espaços correspondentes aos dentes ausentes quanto sua abertura ou manutenção oferecem vantagens e desvantagens que devem ser avaliadas de acordo com as características individuais do paciente. Fatores importantes que influenciam o planejamento são o padrão esquelético, o tipo de má oclusão e a coloração e forma dos caninos, dentre outros. Neste artigo, teve-se como objetivo relatar o tratamento de uma paciente com má oclusão Classe I de Angle, agenesia de incisivos laterais, sobressaliência e sobremordida diminuídas, tendência à mordida aberta e mordida cruzada.A abordagem clínica foi realizada com expansão maxilar, seguida de fechamento dos espaços, com auxílio de ancoragem esquelética extrabucal. Esse caso foi apresentado à diretoria do Board Brasileiro de Ortodontia e Ortopedia Facial (BBO, como parte dos requisitos para a obtenção do título de Diplomado pelo BBO.Orthodontic planning for patients with agenesis of lateral incisors should include extremely relevant esthetic and functional considerations so that a satisfactory clinical result is achieved. Both space closure and space opening and maintenance have advantages and disadvantages that should be evaluated according to the patient's individual characteristics. Some of the important factors that affect planning are the skeletal pattern, the type of malocclusion and the color and shape of canines. This study reports on the treatment of a patients with Class I malocclusion and agenesis of lateral incisors, overjet, decreased overbite, and a tendency to open bite and crossbite. The clinical approach included palatal expansion followed by space closure using extraoral anchorage. This case was presented to the Committee of the Brazilian Board of Orthodontics

  1. Optimization of partial search

    International Nuclear Information System (INIS)

    Korepin, Vladimir E

    2005-01-01

    A quantum Grover search algorithm can find a target item in a database faster than any classical algorithm. One can trade accuracy for speed and find a part of the database (a block) containing the target item even faster; this is partial search. A partial search algorithm was recently suggested by Grover and Radhakrishnan. Here we optimize it. Efficiency of the search algorithm is measured by the number of queries to the oracle. The author suggests a new version of the Grover-Radhakrishnan algorithm which uses a minimal number of such queries. The algorithm can run on the same hardware that is used for the usual Grover algorithm. (letter to the editor)

  2. Auxiliary partial liver transplantation

    NARCIS (Netherlands)

    C.B. Reuvers (Cornelis Bastiaan)

    1986-01-01

    textabstractIn this thesis studies on auxiliary partial liver transplantation in the dog and the pig are reported. The motive to perform this study was the fact that patients with acute hepatic failure or end-stage chronic liver disease are often considered to form too great a risk for successful

  3. Partial Remission Definition

    DEFF Research Database (Denmark)

    Andersen, Marie Louise Max; Hougaard, Philip; Pörksen, Sven

    2014-01-01

    OBJECTIVE: To validate the partial remission (PR) definition based on insulin dose-adjusted HbA1c (IDAA1c). SUBJECTS AND METHODS: The IDAA1c was developed using data in 251 children from the European Hvidoere cohort. For validation, 129 children from a Danish cohort were followed from the onset...

  4. Fundamental partial compositeness

    DEFF Research Database (Denmark)

    Sannino, Francesco; Strumia, Alessandro; Tesi, Andrea

    2016-01-01

    We construct renormalizable Standard Model extensions, valid up to the Planck scale, that give a composite Higgs from a new fundamental strong force acting on fermions and scalars. Yukawa interactions of these particles with Standard Model fermions realize the partial compositeness scenario. Unde...

  5. Partially ordered models

    NARCIS (Netherlands)

    Fernandez, R.; Deveaux, V.

    2010-01-01

    We provide a formal definition and study the basic properties of partially ordered chains (POC). These systems were proposed to model textures in image processing and to represent independence relations between random variables in statistics (in the later case they are known as Bayesian networks).

  6. Partially Hidden Markov Models

    DEFF Research Database (Denmark)

    Forchhammer, Søren Otto; Rissanen, Jorma

    1996-01-01

    Partially Hidden Markov Models (PHMM) are introduced. They differ from the ordinary HMM's in that both the transition probabilities of the hidden states and the output probabilities are conditioned on past observations. As an illustration they are applied to black and white image compression where...

  7. Honesty in partial logic

    NARCIS (Netherlands)

    W. van der Hoek (Wiebe); J.O.M. Jaspars; E. Thijsse

    1995-01-01

    textabstractWe propose an epistemic logic in which knowledge is fully introspective and implies truth, although truth need not imply epistemic possibility. The logic is presented in sequential format and is interpreted in a natural class of partial models, called balloon models. We examine the

  8. Algebraic partial Boolean algebras

    International Nuclear Information System (INIS)

    Smith, Derek

    2003-01-01

    Partial Boolean algebras, first studied by Kochen and Specker in the 1960s, provide the structure for Bell-Kochen-Specker theorems which deny the existence of non-contextual hidden variable theories. In this paper, we study partial Boolean algebras which are 'algebraic' in the sense that their elements have coordinates in an algebraic number field. Several of these algebras have been discussed recently in a debate on the validity of Bell-Kochen-Specker theorems in the context of finite precision measurements. The main result of this paper is that every algebraic finitely-generated partial Boolean algebra B(T) is finite when the underlying space H is three-dimensional, answering a question of Kochen and showing that Conway and Kochen's infinite algebraic partial Boolean algebra has minimum dimension. This result contrasts the existence of an infinite (non-algebraic) B(T) generated by eight elements in an abstract orthomodular lattice of height 3. We then initiate a study of higher-dimensional algebraic partial Boolean algebras. First, we describe a restriction on the determinants of the elements of B(T) that are generated by a given set T. We then show that when the generating set T consists of the rays spanning the minimal vectors in a real irreducible root lattice, B(T) is infinite just if that root lattice has an A 5 sublattice. Finally, we characterize the rays of B(T) when T consists of the rays spanning the minimal vectors of the root lattice E 8

  9. SaFaRI: sacral nerve stimulation versus the FENIX magnetic sphincter augmentation for adult faecal incontinence: a randomised investigation.

    Science.gov (United States)

    Williams, Annabelle E; Croft, Julie; Napp, Vicky; Corrigan, Neil; Brown, Julia M; Hulme, Claire; Brown, Steven R; Lodge, Jen; Protheroe, David; Jayne, David G

    2016-02-01

    Faecal incontinence is a physically, psychologically and socially disabling condition. NICE guidance (2007) recommends surgical intervention, including sacral nerve stimulation (SNS), after failed conservative therapies. The FENIX magnetic sphincter augmentation (MSA) device is a novel continence device consisting of a flexible band of interlinked titanium beads with magnetic cores that is placed around the anal canal to augment anal sphincter tone through passive attraction of the beads. Preliminary studies suggest the FENIX MSA is safe, but efficacy data is limited. Rigorous evaluation is required prior to widespread adoption. The SaFaRI trial is a National Institute of Health Research (NIHR) Health Technology Assessment (HTA)-funded UK multi-site, parallel group, randomised controlled, unblinded trial that will investigate the use of the FENIX MSA, as compared to SNS, for adult faecal incontinence resistant to conservative management. Twenty sites across the UK, experienced in the treatment of faecal incontinence, will recruit 350 patients randomised equally to receive either SNS or FENIX MSA. Participants will be followed-up at 2 weeks post-surgery and at 6, 12 and 18 months post-randomisation. The primary endpoint is success, as defined by device in use and ≥50 % improvement in the Cleveland Clinic Incontinence Score (CCIS) at 18 months post-randomisation. Secondary endpoints include complications, quality of life and cost effectiveness. SaFaRI will rigorously evaluate a new technology for faecal incontinence, the FENIX™ MSA, allowing its safe and controlled introduction into current clinical practice. These results will inform the future surgical management of adult faecal incontinence.

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

    Science.gov (United States)

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

    2014-11-01

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

  11. Spinal cord anomalies in patients with anorectal malformations without severe sacral abnormalities or meningomyelocele: outcomes after expectant, conservative management.

    Science.gov (United States)

    Kyrklund, Kristiina; Pakarinen, Mikko P; Taskinen, Seppo; Kivisaari, Reetta; Rintala, Risto J

    2016-12-01

    OBJECTIVE The goal of this study was to determine the significance of spinal cord anomalies (SCAs) in patients with anorectal malformations (ARMs) by comparing the outcomes for bowel function, lower urinary tract symptoms (LUTS), and lower-limb neurological abnormalities to these outcomes in patients with similar ARMs and a normal spinal cord. METHODS The spinal cord MRI records of female patients treated for vestibular and perineal fistula (VF/PF) and male patients with rectourethral fistula (RUF) at a single center between 1983 and 2006 were reviewed. Bowel function and LUTS were assessed by questionnaire. Patients with extensive sacral anomalies or meningomyelocele were excluded. RESULTS Of 89 patients (median age 15 years, range 5-29 years), MRI was available in 90% (n = 80; 40 male patients with RUF), and 80% of patients returned the questionnaire (n = 64; 31 male patients with RUF). Spinal cord anomalies were found in 34%, comprising a filum terminale lipoma in 30%, low conus medullaris in 10%, and thoracolumbar syrinx in 6%. Bowel functional outcomes between patients with SCAs (n = 23) and those with a normal spinal cord (n = 41) were not significantly different for soiling (70% vs 63%), fecal accidents (43% vs 34%), and constipation (57% vs 39%; p = not significant for all). The LUTS, including urge (65% vs 54%), urge incontinence (39% vs 24%), stress incontinence (17% vs 22%), and straining (32% vs 29%) were also comparable between groups (p = not significant for all). No patients developed lower-limb neurological abnormalities. CONCLUSIONS The results suggest that the long-term functional outcomes for patients with SCAs who had VF/PF and RUF may not differ significantly from patients with the same type of ARMs and a normal spinal cord. The results favor a conservative approach to their management in the absence of abnormal neurological findings in the lower limbs.

  12. Turning off sacral nerve stimulation does not affect gastric and small intestinal motility in patients treated for faecal incontinence.

    Science.gov (United States)

    Worsøe, J; Fassov, J; Schlageter, V; Rijkhoff, N J M; Laurberg, S; Krogh, K

    2012-10-01

    Sacral nerve stimulation (SNS) reduces symptoms in up to 80% of patients with faecal incontinence (FI). Its effects are not limited to the distal colon and the pelvic floor. Accordingly, spinal or supraspinal neuromodulation have been suggested as part of the mode of action. The effect of SNS on gastric and small-intestinal motility was studied. Using the magnet tracking system, MTS-1, a small magnetic pill was tracked twice through the upper gastrointestinal tract of eight patients with FI successfully treated with SNS. Following a randomized double-blind crossover design, the stimulator was either left active or was turned off for 1 week before investigations with MTS-1. The median (range) frequency of gastric con-tractions was 3.05 (2.83-3.40) per min during SNS and 3.04 (2.79?-3.76) per min without (P=NS). The median (range) frequency of contractions in the small intestine during the first 2h after pyloric passage was 10.005 (9.68-10.70) per min during SNS and 10.09 (9.79-10.29) per min without SNS (P=NS). The median (range) velocity of the magnetic pill during the first 2h in the small intestine was 1.6 (1.2-2.8) cm/min during SNS and 1.7 (0.8-3.7) cm/min without SNS (P=NS). Small-intestinal propagation mainly occurred during very fast movements (>15cm/min), accounting for 51% (42-60%) of the distance 3% (2-4%) of the time during SNS and for 53% (18-73%) of the distance 3% (1-8%) of the time without SNS (P=NS). Turning off SNS for 1week did not affect gastric or small-intestinal motility patterns. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

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

    International Nuclear Information System (INIS)

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

    2006-01-01

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

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

    Science.gov (United States)

    Lee, Jung-hoon; Yoo, Won-gyu

    2012-11-01

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

  15. Partially composite Higgs models

    DEFF Research Database (Denmark)

    Alanne, Tommi; Buarque Franzosi, Diogo; Frandsen, Mads T.

    2018-01-01

    We study the phenomenology of partially composite-Higgs models where electroweak symmetry breaking is dynamically induced, and the Higgs is a mixture of a composite and an elementary state. The models considered have explicit realizations in terms of gauge-Yukawa theories with new strongly...... interacting fermions coupled to elementary scalars and allow for a very SM-like Higgs state. We study constraints on their parameter spaces from vacuum stability and perturbativity as well as from LHC results and find that requiring vacuum stability up to the compositeness scale already imposes relevant...... constraints. A small part of parameter space around the classically conformal limit is stable up to the Planck scale. This is however already strongly disfavored by LHC results. in different limits, the models realize both (partially) composite-Higgs and (bosonic) technicolor models and a dynamical extension...

  16. Photogenic partial seizures.

    Science.gov (United States)

    Hennessy, M J; Binnie, C D

    2000-01-01

    To establish the incidence and symptoms of partial seizures in a cohort of patients investigated on account of known sensitivity to intermittent photic stimulation and/or precipitation of seizures by environmental visual stimuli such as television (TV) screens or computer monitors. We report 43 consecutive patients with epilepsy, who had exhibited a significant EEG photoparoxysmal response or who had seizures precipitated by environmental visual stimuli and underwent detailed assessment of their photosensitivity in the EEG laboratory, during which all were questioned concerning their ictal symptoms. All patients were considered on clinical grounds to have an idiopathic epilepsy syndrome. Twenty-eight (65%) patients reported visually precipitated attacks occurring initially with maintained consciousness, in some instances evolving to a period of confusion or to a secondarily generalized seizure. Visual symptoms were most commonly reported and included positive symptoms such as coloured circles or spots, but also blindness and subjective symptoms such as "eyes going funny." Other symptoms described included nonspecific cephalic sensations, deja-vu, auditory hallucinations, nausea, and vomiting. No patient reported any clear spontaneous partial seizures, and there were no grounds for supposing that any had partial epilepsy excepting the ictal phenomenology of some or all of the visually induced attacks. These findings provide clinical support for the physiological studies that indicate that the trigger mechanism for human photosensitivity involves binocularly innervated cells located in the visual cortex. Thus the visual cortex is the seat of the primary epileptogenic process, and the photically triggered discharges and seizures may be regarded as partial with secondary generalization.

  17. Arthroscopic partial medial meniscectomy

    Directory of Open Access Journals (Sweden)

    Dašić Žarko

    2011-01-01

    Full Text Available Background/Aim. Meniscal injuries are common in professional or recreational sports as well as in daily activities. If meniscal lesions lead to physical impairment they usually require surgical treatment. Arthroscopic treatment of meniscal injuries is one of the most often performed orthopedic operative procedures. Methods. The study analyzed the results of arthroscopic partial medial meniscectomy in 213 patients in a 24-month period, from 2006, to 2008. Results. In our series of arthroscopically treated medial meniscus tears we noted 78 (36.62% vertical complete bucket handle lesions, 19 (8.92% vertical incomplete lesions, 18 (8.45% longitudinal tears, 35 (16.43% oblique tears, 18 (8.45% complex degenerative lesions, 17 (7.98% radial lesions and 28 (13.14% horisontal lesions. Mean preoperative International Knee Documentation Committee (IKDC score was 49.81%, 1 month after the arthroscopic partial medial meniscectomy the mean IKDC score was 84.08%, and 6 months after mean IKDC score was 90.36%. Six months after the procedure 197 (92.49% of patients had good or excellent subjective postoperative clinical outcomes, while 14 (6.57% patients subjectively did not notice a significant improvement after the intervention, and 2 (0.93% patients had no subjective improvement after the partial medial meniscectomy at all. Conclusion. Arthroscopic partial medial meniscetomy is minimally invasive diagnostic and therapeutic procedure and in well selected cases is a method of choice for treatment of medial meniscus injuries when repair techniques are not a viable option. It has small rate of complications, low morbidity and fast rehabilitation.

  18. Hierarchical partial order ranking

    International Nuclear Information System (INIS)

    Carlsen, Lars

    2008-01-01

    Assessing the potential impact on environmental and human health from the production and use of chemicals or from polluted sites involves a multi-criteria evaluation scheme. A priori several parameters are to address, e.g., production tonnage, specific release scenarios, geographical and site-specific factors in addition to various substance dependent parameters. Further socio-economic factors may be taken into consideration. The number of parameters to be included may well appear to be prohibitive for developing a sensible model. The study introduces hierarchical partial order ranking (HPOR) that remedies this problem. By HPOR the original parameters are initially grouped based on their mutual connection and a set of meta-descriptors is derived representing the ranking corresponding to the single groups of descriptors, respectively. A second partial order ranking is carried out based on the meta-descriptors, the final ranking being disclosed though average ranks. An illustrative example on the prioritisation of polluted sites is given. - Hierarchical partial order ranking of polluted sites has been developed for prioritization based on a large number of parameters

  19. Imaging of the cloacal malformation

    International Nuclear Information System (INIS)

    Jaramillo, D.; Lebowitz, R.L.; Hendren, W.H.

    1989-01-01

    Sixty-two newborns with the cloacal malformation were evaluated to define variation in cloacal configuration, associated anomalies, and optimal approach to imaging. Cloacal malformations were classified according to level of urethrovaginal confluence (47 low, 15 high); level of rectal communication (47 vaginal, seven cloacal, eight other); and cloacal appearance (34 urethral, 28 vaginal, 10 transistional). Lower urinary abnormalities included reflux, ureteral ectopia, bladder diverticula, bladder duplication (five), and urachal remnants (five). Uterovaginal abnormalities included duplication and partial agenesis. Anomalies were common in the upper urinary tract, spine (sacral agenesis, 20), and bony pelvis (pubic diastasis, 10). Gastrointestinal, cardiovascular, neurologic, and limb (seven) malformations were seen. Fluoroscopically monitored opacification of the cloacal components and voiding cystourethrogram were essential. Although sonography of the malformation was of limited usefulness, MR imaging seemed to be useful for evaluation of the spinal cord and pelvic musculature

  20. Partially ordered algebraic systems

    CERN Document Server

    Fuchs, Laszlo

    2011-01-01

    Originally published in an important series of books on pure and applied mathematics, this monograph by a distinguished mathematician explores a high-level area in algebra. It constitutes the first systematic summary of research concerning partially ordered groups, semigroups, rings, and fields. The self-contained treatment features numerous problems, complete proofs, a detailed bibliography, and indexes. It presumes some knowledge of abstract algebra, providing necessary background and references where appropriate. This inexpensive edition of a hard-to-find systematic survey will fill a gap i

  1. Infinite partial summations

    International Nuclear Information System (INIS)

    Sprung, D.W.L.

    1975-01-01

    This paper is a brief review of those aspects of the effective interaction problem that can be grouped under the heading of infinite partial summations of the perturbation series. After a brief mention of the classic examples of infinite summations, the author turns to the effective interaction problem for two extra core particles. Their direct interaction is summed to produce the G matrix, while their indirect interaction through the core is summed in a variety of ways under the heading of core polarization. (orig./WL) [de

  2. On universal partial words

    OpenAIRE

    Chen, Herman Z. Q.; Kitaev, Sergey; Mütze, Torsten; Sun, Brian Y.

    2016-01-01

    A universal word for a finite alphabet $A$ and some integer $n\\geq 1$ is a word over $A$ such that every word in $A^n$ appears exactly once as a subword (cyclically or linearly). It is well-known and easy to prove that universal words exist for any $A$ and $n$. In this work we initiate the systematic study of universal partial words. These are words that in addition to the letters from $A$ may contain an arbitrary number of occurrences of a special `joker' symbol $\\Diamond\

  3. Partial differential equations

    CERN Document Server

    Agranovich, M S

    2002-01-01

    Mark Vishik's Partial Differential Equations seminar held at Moscow State University was one of the world's leading seminars in PDEs for over 40 years. This book celebrates Vishik's eightieth birthday. It comprises new results and survey papers written by many renowned specialists who actively participated over the years in Vishik's seminars. Contributions include original developments and methods in PDEs and related fields, such as mathematical physics, tomography, and symplectic geometry. Papers discuss linear and nonlinear equations, particularly linear elliptic problems in angles and gener

  4. Partial differential equations

    CERN Document Server

    Levine, Harold

    1997-01-01

    The subject matter, partial differential equations (PDEs), has a long history (dating from the 18th century) and an active contemporary phase. An early phase (with a separate focus on taut string vibrations and heat flow through solid bodies) stimulated developments of great importance for mathematical analysis, such as a wider concept of functions and integration and the existence of trigonometric or Fourier series representations. The direct relevance of PDEs to all manner of mathematical, physical and technical problems continues. This book presents a reasonably broad introductory account of the subject, with due regard for analytical detail, applications and historical matters.

  5. Partial differential equations

    CERN Document Server

    Sloan, D; Süli, E

    2001-01-01

    /homepage/sac/cam/na2000/index.html7-Volume Set now available at special set price ! Over the second half of the 20th century the subject area loosely referred to as numerical analysis of partial differential equations (PDEs) has undergone unprecedented development. At its practical end, the vigorous growth and steady diversification of the field were stimulated by the demand for accurate and reliable tools for computational modelling in physical sciences and engineering, and by the rapid development of computer hardware and architecture. At the more theoretical end, the analytical insight in

  6. Elliptic partial differential equations

    CERN Document Server

    Han, Qing

    2011-01-01

    Elliptic Partial Differential Equations by Qing Han and FangHua Lin is one of the best textbooks I know. It is the perfect introduction to PDE. In 150 pages or so it covers an amazing amount of wonderful and extraordinary useful material. I have used it as a textbook at both graduate and undergraduate levels which is possible since it only requires very little background material yet it covers an enormous amount of material. In my opinion it is a must read for all interested in analysis and geometry, and for all of my own PhD students it is indeed just that. I cannot say enough good things abo

  7. Generalized Partial Volume

    DEFF Research Database (Denmark)

    Darkner, Sune; Sporring, Jon

    2011-01-01

    Mutual Information (MI) and normalized mutual information (NMI) are popular choices as similarity measure for multimodal image registration. Presently, one of two approaches is often used for estimating these measures: The Parzen Window (PW) and the Generalized Partial Volume (GPV). Their theoret...... of view as well as w.r.t. computational complexity. Finally, we present algorithms for both approaches for NMI which is comparable in speed to Sum of Squared Differences (SSD), and we illustrate the differences between PW and GPV on a number of registration examples....

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

    Science.gov (United States)

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

    2014-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Kotenko К.V.

    2013-12-01

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

  10. Novel EDA or EDAR Mutations Identified in Patients with X-Linked Hypohidrotic Ectodermal Dysplasia or Non-Syndromic Tooth Agenesis

    Directory of Open Access Journals (Sweden)

    Binghui Zeng

    2017-10-01

    Full Text Available Abstract: Both X-linked hypohidrotic ectodermal dysplasia (XLHED and non-syndromic tooth agenesis (NSTA result in symptoms of congenital tooth loss. This study investigated genetic causes in two families with XLHED and four families with NSTA. We screened for mutations of WNT10A, EDA, EDAR, EDARADD, PAX9, MSX1, AXIN2, LRP6, and WNT10B through Sanger sequencing. Whole exome sequencing was performed for the proband of NSTA Family 4. Novel mutation c.1051G>T (p.Val351Phe and the known mutation c.467G>A (p.Arg156His of Ectodysplasin A (EDA were identified in families with XLHED. Novel EDA receptor (EDAR mutation c.73C>T (p.Arg25*, known EDA mutation c.491A>C (p.Glu164Ala, and known Wnt family member 10A (WNT10A mutations c.511C>T (p.Arg171Cys and c.742C>T (p.Arg248* were identified in families with NSTA. The novel EDA and EDAR mutations were predicted as being pathogenic through bioinformatics analyses and structural modeling. Two variants of WNT10A, c.374G>A (p.Arg125Lys and c.125A>G (p.Asn42Ser, were found in patients with NSTA. The two WNT10A variants were predicted to affect the splicing of message RNA, but minigene experiments showed normal splicing of mutated minigenes. This study uncovered the genetic foundations with respect to six families with XLHED or NSTA. We identified six mutations, of which two were novel mutations of EDA and EDAR. This is the first report of a nonsense EDAR mutation leading to NSTA.

  11. A Neuropsychological Profile for Agenesis of the Corpus Callosum? Cognitive, Academic, Executive, Social, and Behavioral Functioning in School-Age Children.

    Science.gov (United States)

    Siffredi, Vanessa; Anderson, Vicki; McIlroy, Alissandra; Wood, Amanda G; Leventer, Richard J; Spencer-Smith, Megan M

    2018-05-01

    Agenesis of the corpus callosum (AgCC), characterized by developmental absence of the corpus callosum, is one of the most common congenital brain malformations. To date, there are limited data on the neuropsychological consequences of AgCC and factors that modulate different outcomes, especially in children. This study aimed to describe general intellectual, academic, executive, social and behavioral functioning in a cohort of school-aged children presenting for clinical services to a hospital and diagnosed with AgCC. The influences of age, social risk and neurological factors were examined. Twenty-eight school-aged children (8 to 17 years) diagnosed with AgCC completed tests of general intelligence (IQ) and academic functioning. Executive, social and behavioral functioning in daily life, and social risk, were estimated from parent and teacher rated questionnaires. MRI findings reviewed by a pediatric neurologist confirmed diagnosis and identified brain characteristics. Clinical details including the presence of epilepsy and diagnosed genetic condition were obtained from medical records. In our cohort, ~50% of children experienced general intellectual, academic, executive, social and/or behavioral difficulties and ~20% were functioning at a level comparable to typically developing children. Social risk was important for understanding variability in neuropsychological outcomes. Brain anomalies and complete AgCC were associated with lower mathematics performance and poorer executive functioning. This is the first comprehensive report of general intellectual, academic, executive social and behavioral consequences of AgCC in school-aged children. The findings have important clinical implications, suggesting that support to families and targeted intervention could promote positive neuropsychological functioning in children with AgCC who come to clinical attention. (JINS, 2018, 24, 445-455).

  12. Prevalência de agenesia do osso sesamóide da articulação metacarpofalangeana, em brasileiros adultos Agenesis prevalence of the adductor sesamoid of the thumb in Brazilians adults

    Directory of Open Access Journals (Sweden)

    Renata Rodrigues de Almeida-Pedrin

    2008-08-01

    Full Text Available OBJETIVO: diante da importância do sesamóide no emprego de métodos simplificados para a determinação da maturidade esquelética, julgamos necessário um estudo, em brasileiros adultos, para verificar a porcentagem de presença ou ausência deste ossículo. METODOLOGIA: a amostra constitui-se de 500 indivíduos brasileiros, com idade média de 22,5 (18-33 anos, de ambos os gêneros. A presença ou ausência do osso sesamóide foi verificada mediante a interpretação de radiografias periapicais, tomadas da articulação metacarpofalangena dos dois polegares de cada indivíduo da pesquisa. RESULTADOS E CONCLUSÃO: os resultados demonstraram que o osso sesamóide da articulação metacarpofalangeana esteve presente em todos os indivíduos (100% da amostra, concluindo, desta forma, que não houve agenesia deste osso nesta população avaliada.AIM: the purpose of this study was to verify the percentage of agenesis of sesamoid bone in a Brazilian adult population. METHODS: the sample consisted of 329 females and 171 males, with mean age of 22.5 (range from 18 to 33 years. The presence or agenesis of sesamoid bone was evaluated through periapical radiographs taken from the metacarpophalangeal joint of the thumb (left and right of each subject. RESULTS AND CONCLUSION: The results evidenced that the sesamoid bone was present in 100% of the sample, showing that was not found agenesis in these population.

  13. Unilateral removable partial dentures.

    Science.gov (United States)

    Goodall, W A; Greer, A C; Martin, N

    2017-01-27

    Removable partial dentures (RPDs) are widely used to replace missing teeth in order to restore both function and aesthetics for the partially dentate patient. Conventional RPD design is frequently bilateral and consists of a major connector that bridges both sides of the arch. Some patients cannot and will not tolerate such an extensive appliance. For these patients, bridgework may not be a predictable option and it is not always possible to provide implant-retained restorations. This article presents unilateral RPDs as a potential treatment modality for such patients and explores indications and contraindications for their use, including factors relating to patient history, clinical presentation and patient wishes. Through case examples, design, material and fabrication considerations will be discussed. While their use is not widespread, there are a number of patients who benefit from the provision of unilateral RPDs. They are a useful treatment to have in the clinician's armamentarium, but a highly-skilled dental team and a specific patient presentation is required in order for them to be a reasonable and predictable prosthetic option.

  14. Tutorial on Online Partial Evaluation

    Directory of Open Access Journals (Sweden)

    William R. Cook

    2011-09-01

    Full Text Available This paper is a short tutorial introduction to online partial evaluation. We show how to write a simple online partial evaluator for a simple, pure, first-order, functional programming language. In particular, we show that the partial evaluator can be derived as a variation on a compositionally defined interpreter. We demonstrate the use of the resulting partial evaluator for program optimization in the context of model-driven development.

  15. Type-Directed Partial Evaluation

    DEFF Research Database (Denmark)

    Danvy, Olivier

    1998-01-01

    Type-directed partial evaluation uses a normalization function to achieve partial evaluation. These lecture notes review its background, foundations, practice, and applications. Of specific interest is the modular technique of offline and online type-directed partial evaluation in Standard ML...

  16. Type-Directed Partial Evaluation

    DEFF Research Database (Denmark)

    Danvy, Olivier

    1998-01-01

    Type-directed partial evaluation uses a normalization function to achieve partial evaluation. These lecture notes review its background, foundations, practice, and applications. Of specific interest is the modular technique of offline and online type-directed partial evaluation in Standard ML of ...

  17. Applied partial differential equations

    CERN Document Server

    Logan, J David

    2004-01-01

    This primer on elementary partial differential equations presents the standard material usually covered in a one-semester, undergraduate course on boundary value problems and PDEs. What makes this book unique is that it is a brief treatment, yet it covers all the major ideas: the wave equation, the diffusion equation, the Laplace equation, and the advection equation on bounded and unbounded domains. Methods include eigenfunction expansions, integral transforms, and characteristics. Mathematical ideas are motivated from physical problems, and the exposition is presented in a concise style accessible to science and engineering students; emphasis is on motivation, concepts, methods, and interpretation, rather than formal theory. This second edition contains new and additional exercises, and it includes a new chapter on the applications of PDEs to biology: age structured models, pattern formation; epidemic wave fronts, and advection-diffusion processes. The student who reads through this book and solves many of t...

  18. Inductance loop and partial

    CERN Document Server

    Paul, Clayton R

    2010-01-01

    "Inductance is an unprecedented text, thoroughly discussing "loop" inductance as well as the increasingly important "partial" inductance. These concepts and their proper calculation are crucial in designing modern high-speed digital systems. World-renowned leader in electromagnetics Clayton Paul provides the knowledge and tools necessary to understand and calculate inductance." "With the present and increasing emphasis on high-speed digital systems and high-frequency analog systems, it is imperative that system designers develop an intimate understanding of the concepts and methods in this book. Inductance is a much-needed textbook designed for senior and graduate-level engineering students, as well as a hands-on guide for working engineers and professionals engaged in the design of high-speed digital and high-frequency analog systems."--Jacket.

  19. Fundamental partial compositeness

    CERN Document Server

    Sannino, Francesco

    2016-11-07

    We construct renormalizable Standard Model extensions, valid up to the Planck scale, that give a composite Higgs from a new fundamental strong force acting on fermions and scalars. Yukawa interactions of these particles with Standard Model fermions realize the partial compositeness scenario. Successful models exist because gauge quantum numbers of Standard Model fermions admit a minimal enough 'square root'. Furthermore, right-handed SM fermions have an SU(2)$_R$-like structure, yielding a custodially-protected composite Higgs. Baryon and lepton numbers arise accidentally. Standard Model fermions acquire mass at tree level, while the Higgs potential and flavor violations are generated by quantum corrections. We further discuss accidental symmetries and other dynamical features stemming from the new strongly interacting scalars. If the same phenomenology can be obtained from models without our elementary scalars, they would reappear as composite states.

  20. Fundamental partial compositeness

    International Nuclear Information System (INIS)

    Sannino, Francesco; Strumia, Alessandro; Tesi, Andrea; Vigiani, Elena

    2016-01-01

    We construct renormalizable Standard Model extensions, valid up to the Planck scale, that give a composite Higgs from a new fundamental strong force acting on fermions and scalars. Yukawa interactions of these particles with Standard Model fermions realize the partial compositeness scenario. Under certain assumptions on the dynamics of the scalars, successful models exist because gauge quantum numbers of Standard Model fermions admit a minimal enough ‘square root’. Furthermore, right-handed SM fermions have an SU(2)_R-like structure, yielding a custodially-protected composite Higgs. Baryon and lepton numbers arise accidentally. Standard Model fermions acquire mass at tree level, while the Higgs potential and flavor violations are generated by quantum corrections. We further discuss accidental symmetries and other dynamical features stemming from the new strongly interacting scalars. If the same phenomenology can be obtained from models without our elementary scalars, they would reappear as composite states.

  1. Sacralizing Reality Digitally

    DEFF Research Database (Denmark)

    Damgaard, Mads

    2014-01-01

    authenticity derived from scientific sources is analysed. The case is made that through hyperlinks, YouTube videos and discussion forums, religious communities such as the online Asatrú groups strategically assemble religious authority on a foundation of science, tapping into non-religious ecologies...

  2. The sacralization of information

    Directory of Open Access Journals (Sweden)

    Philippe BRETON

    2011-01-01

    Full Text Available The objective of the article is to describe some parts of the process of " regarding as sacred of the information " which was set up in the middle of the XXth century, within the cybernetics. It is also a question of showing that this original marking strongly influenced the speech which accompagnies the new technologies.

  3. Partial oxidation process

    International Nuclear Information System (INIS)

    Najjar, M.S.

    1987-01-01

    A process is described for the production of gaseous mixtures comprising H/sub 2/+CO by the partial oxidation of a fuel feedstock comprising a heavy liquid hydrocarbonaceous fuel having a nickel, iron, and vanadium-containing ash or petroleum coke having a nickel, iron, and vanadium-containing ash, or mixtures thereof. The feedstock includes a minimum of 0.5 wt. % of sulfur and the ash includes a minimum of 5.0 wt. % vanadium, a minimum of 0.5 ppm nickel, and a minimum of 0.5 ppm iron. The process comprises: (1) mixing together a copper-containing additive with the fuel feedstock; wherein the weight ratio of copper-containing additive to ash in the fuel feedstock is in the range of about 1.0-10.0, and there is at least 10 parts by weight of copper for each part by weight of vanadium; (2) reacting the mixture from (1) at a temperature in the range of 2200 0 F to 2900 0 F and a pressure in the range of about 5 to 250 atmospheres in a free-flow refactory lined partial oxidation reaction zone with a free-oxygen containing gas in the presence of a temperature moderator and in a reducing atmosphere to produce a hot raw effluent gas stream comprising H/sub 2/+CO and entrained molten slag; and where in the reaction zone and the copper-containing additive combines with at least a portion of the nickel and iron constituents and sulfur found in the feedstock to produce a liquid phase washing agent that collects and transports at least a portion of the vanadium-containing oxide laths and spinels and other ash components and refractory out of the reaction zone; and (3) separating nongaseous materials from the hot raw effluent gas stream

  4. Frankincense and myrrh essential oils and burn incense fume against micro-inhabitants of sacral ambients. Wisdom of the ancients?

    Science.gov (United States)

    Ljaljević Grbić, Milica; Unković, Nikola; Dimkić, Ivica; Janaćković, Peđa; Gavrilović, Milan; Stanojević, Olja; Stupar, Miloš; Vujisić, Ljubodrag; Jelikić, Aleksa; Stanković, Slaviša; Vukojević, Jelena

    2018-03-09

    (12.97%), β-elemene (12.70%), and germacrene B (12.15%). Burn incense fume and soot had α-pinene (68.6%) and incensole (28.6%) as the most dominant compounds, respectively. In vitro antimicrobial assays demonstrated high bacterial and fungal sensitivity to the liquid and vapour phases of EOs, and burn incense fume. In situ application of B. carteri EO vapour and incense fume resulted in reduction of air-borne viable microbial counts by up to 45.39 ± 2.83% for fungi and 67.56 ± 3.12% for bacteria (EO); and by up to 80.43 ± 2.07% for fungi and 91.43 ± 1.26% for bacteria (incense fume). The antimicrobial properties of essential oil derived from frankincense, a compound with well-known traditional use, showed that it possesses a clear potential as a natural antimicrobial agent. Moreover, the results suggest possible application of B. carteri EO vapour and incense fume as occasional air purifiers in sacral ambients, apart from daily church rituals. Copyright © 2018 Elsevier B.V. All rights reserved.

  5. Effect of Sacral Neuromodulation on Outcome Measures and Urine Chemokines in Interstitial Cystitis/Painful Bladder Syndrome Patients.

    Science.gov (United States)

    Peters, Kenneth M; Jayabalan, Nirmal; Bui, Don; Killinger, Kim; Chancellor, Michael; Tyagi, Pradeep

    2015-05-01

    Sacral neuromodulation (SNM) may improve interstitial cystitis/painful bladder syndrome (IC/BPS) symptoms of urinary frequency, urgency and perhaps even pain, but objective measures of improvement are lacking. We evaluated the potential for urinary chemokines to serve as measures of treatment response over time to SNM. Women with IC/BPS undergoing SNM consented for this study. Three-day bladder/pain diaries were collected at baseline and validated Interstitial Cystitis Symptom Problem Index (ICSPI) scores and mid-stream urine specimens were collected at baseline and at 24 weeks after successful implant. Collected urine was screened for infection by dipstick and analyzed for chemokines by luminex xMAP analysis. At baseline (n = 16), urine levels of CXCL-1 positively correlated with pain score (r = 0.63, P = 0.009), urgency (r = 0.61, P = 0.01), ICSPI (r = 0.43, P = 0.09) and daily voids (r = 0.44, P = 0.08). ICSPI and pain scores also positively correlated with sIL-1ra (r = 0.50, P = 0.04) and monocyte chemotactic protein-1 (MCP-1) or CCL2 positively correlated with daily voids (r = 0.45, P = 0.07) only. At 24 weeks, the median ICSPI index fell from 28 to 15 (n = 7, P = 0.008). Urine levels of sIL-1ra (633.8 ± 188.2 vs. 149.9 ± 41.62 pg/mL) and MCP-1 (448.3 ± 11.6 vs. 176.9 ± 46.16 pg/mL) and CCL5 (20.78 ± 4.09 vs. 11.21 ± 4.12 pg/mL) were also significantly reduced at the follow-up relative to baseline values (P = 0.04). Multivariable analysis of data revealed that sIL-1ra and MCP-1 together explained the majority of variance in data. Levels of CXCL-1, CXCL-10, interleukin (IL)-8, vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF) were also reduced at 24 weeks, but differences were not significant. Concomitant decrease in urine levels of chemokines especially MCP-1 was associated with treatment response of SNM. These results

  6. Experts' understanding of partial derivatives using the Partial Derivative Machine

    OpenAIRE

    Roundy, David; Dorko, Allison; Dray, Tevian; Manogue, Corinne A.; Weber, Eric

    2014-01-01

    Partial derivatives are used in a variety of different ways within physics. Most notably, thermodynamics uses partial derivatives in ways that students often find confusing. As part of a collaboration with mathematics faculty, we are at the beginning of a study of the teaching of partial derivatives, a goal of better aligning the teaching of multivariable calculus with the needs of students in STEM disciplines. As a part of this project, we have performed a pilot study of expert understanding...

  7. Stenting of the right ventricular outflow tract after thrombosis of the modified Blalock-Taussig shunt in a 8 month old infant with tetralogy of Fallot and right pulmonary artery agenesis

    Directory of Open Access Journals (Sweden)

    I. A. Soynov

    2017-01-01

    Full Text Available Pulmonary artery agenesis combined with tetralogy of Fallot is the most rarely seen congenital heart disease. Children with this anomaly are an especially problematic category of patients undergoing staged surgical repair. The postoperative period quite often is complicated with shunt thrombosis while a redo open surgery is associated with a very high risk; therefore, endovascular repair is a preferred procedure. We describe a case of right ventricular outflow tract stenting in a 8 month old girl with tetralogy of Fallot and right pulmonary artery agenesis. The patient was admitted at 3 month after performing of a left-sided modified Blalock-Taussig shunt with severe signs of heart failure and desaturation caused by shunt thrombosis. Assessments performed at 2 months after stenting of the outflow tract demonstrated good oxygen saturation in arterial blood (80% and above and improvement of heart failure symptoms to NYHA II class.

  8. Both rare and de novo copy number variants are prevalent in agenesis of the corpus callosum but not in cerebellar hypoplasia or polymicrogyria.

    Directory of Open Access Journals (Sweden)

    Samin A Sajan

    Full Text Available Agenesis of the corpus callosum (ACC, cerebellar hypoplasia (CBLH, and polymicrogyria (PMG are severe congenital brain malformations with largely undiscovered causes. We conducted a large-scale chromosomal copy number variation (CNV discovery effort in 255 ACC, 220 CBLH, and 147 PMG patients, and 2,349 controls. Compared to controls, significantly more ACC, but unexpectedly not CBLH or PMG patients, had rare genic CNVs over one megabase (p = 1.48×10⁻³; odds ratio [OR] = 3.19; 95% confidence interval [CI] = 1.89-5.39. Rare genic CNVs were those that impacted at least one gene in less than 1% of the combined population of patients and controls. Compared to controls, significantly more ACC but not CBLH or PMG patients had rare CNVs impacting over 20 genes (p = 0.01; OR = 2.95; 95% CI = 1.69-5.18. Independent qPCR confirmation showed that 9.4% of ACC patients had de novo CNVs. These, in comparison to inherited CNVs, preferentially overlapped de novo CNVs previously observed in patients with autism spectrum disorders (p = 3.06×10⁻⁴; OR = 7.55; 95% CI = 2.40-23.72. Interestingly, numerous reports have shown a reduced corpus callosum area in autistic patients, and diminished social and executive function in many ACC patients. We also confirmed and refined previously known CNVs, including significantly narrowing the 8p23.1-p11.1 duplication present in 2% of our current ACC cohort. We found six novel CNVs, each in a single patient, that are likely deleterious: deletions of 1p31.3-p31.1, 1q31.2-q31.3, 5q23.1, and 15q11.2-q13.1; and duplications of 2q11.2-q13 and 11p14.3-p14.2. One ACC patient with microcephaly had a paternally inherited deletion of 16p13.11 that included NDE1. Exome sequencing identified a recessive maternally inherited nonsense mutation in the non-deleted allele of NDE1, revealing the complexity of ACC genetics. This is the first systematic study of CNVs in congenital brain malformations, and

  9. A 3-year prospective study of implant-supported, single-tooth restorations of all-ceramic and metal-ceramic materials in patients with tooth agenesis.

    Science.gov (United States)

    Hosseini, Mandana; Worsaae, Nils; Schiødt, Morten; Gotfredsen, Klaus

    2013-10-01

    The purpose of this clinical study was to describe outcome variables of all-ceramic and metal-ceramic implant-supported, single-tooth restorations. A total of 59 patients (mean age: 27.9 years) with tooth agenesis and treated with 98 implant-supported single-tooth restorations were included in this study. Two patients did not attend baseline examination, but all patients were followed for 3 years. The implants supported 52 zirconia, 21 titanium and 25 gold alloy abutments, which retained 64 all-ceramic and 34 metal-ceramic crowns. At baseline and 3-year follow-up examinations, the biological outcome variables such as survival rate of implants, marginal bone level, modified Plaque Index (mPlI), modified Sulcus Bleeding Index (mBI) and biological complications were registered. The technical outcome variables included abutment and crown survival rate, marginal adaptation of crowns, cement excess and technical complications. The aesthetic outcome was assessed by using the Copenhagen Index Score, and the patient-reported outcomes were recorded using the OHIP-49 questionnaire. The statistical analyses were mainly performed by using mixed model of ANOVA for quantitative data and PROC NLMIXED for ordinal categorical data. The 3-year survival rate was 100% for implants and 97% for abutments and crowns. Significantly more marginal bone loss was registered at gold-alloy compared to zirconia abutments (P = 0.040). The mPlI and mBI were not significantly different at three abutment materials. The frequency of biological complications was higher at restorations with all-ceramic restorations than metal-ceramic crowns. Loss of retention, which was only observed at metal-ceramic crowns, was the most frequent technical complication, and the marginal adaptations of all-ceramic crowns were significantly less optimal than metal-ceramic crowns (P = 0.020). The professional-reported aesthetic outcome demonstrated significantly superior colour match of all-ceramic over metal

  10. Functional Outcome With Percutaneous Ilio-sacral Screw Fixation For Posterior Pelvic Ring Injuries In Patients Involved In Heavy Manual Laboring

    Directory of Open Access Journals (Sweden)

    Abhishek SM

    2015-11-01

    Full Text Available Introduction: Unstable posterior pelvic ring injuries are best treated with operative methods due to better post-op functional score. Our patient cohort was involved in heavy manual laboring frequently required ground level work in their activities of daily living. There are very few outcome studies dealing exclusively with such patients. Materials & Methods: Forty one patients who were treated with percutaneous sacroiliac screw fixation under fluoroscopic guidance and were followed-up for at least one year were analyzed retrospectively for functional outcome using the Majeed score. Results: Twenty one (51.22% and thirteen (31.70% patients were found to be in excellent and good categories respectively and majority of the patients (thirty/73.17% were able to return to their original occupation with or without minor adjustments. Conclusion: Percutaneous ilio-sacral screw fixation for posterior pelvic unstable injuries is an acceptable mode of treatment in patients involved in heavy manual laboring.

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

    Science.gov (United States)

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

    2018-01-01

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

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

    Directory of Open Access Journals (Sweden)

    X. Zuidema

    2016-01-01

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

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

    Science.gov (United States)

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

    2015-02-01

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

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

    International Nuclear Information System (INIS)

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

    2015-01-01

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

  15. Muscle-splitting approach to superior and inferior gluteal vessels: versatile source of recipient vessels for free-tissue transfer to sacral, gluteal, and ischial regions.

    Science.gov (United States)

    Park, S

    2000-07-01

    The superior gluteal vessel has been reported as a recipient in free-tissue transfer for the coverage of complex soft-tissue defects in the lumbosacral region, where a suitable recipient vessel is difficult to find. The characteristics of proximity, vessel caliber, and constancy make the superior gluteal vessel preferable to previously reported recipient vessels. However, there are technical difficulties in microsurgery (e.g., short pedicle length and deep location) and muscle injury (transection of the muscle) associated with use of the superior gluteal vessel. The purpose of this article is to present a modification of an approach to the gluteal vessel to alleviate technical difficulties and minimize muscle injury. From August of 1997 to January of 1999, six patients received microvascular transfer of the latissimus dorsi muscle or myocutaneous flap to the sacral (4) and ischial (2) regions. The causes of defects were tumor (1), trauma (1), and pressure sores (4). A muscle-splitting approach was used on the superior gluteal vessel and was later applied to the inferior gluteal vessel. The gluteus maximus muscle was split as needed in the direction of its fibers, and the perforators were dissected down to the superior or inferior gluteal artery and vein deep into the muscle. The follow-up period ranged from 6 to 22 months, and all of the flaps survived with complete recovery of the lesion. The major drawbacks of using the superior and inferior gluteal vessels can be overcome with the muscle-splitting approach, which provides increased accessibility and additional length to the vascular pedicle while causing minimal injury to the muscle itself. It also proves to be an easy, safe, and reliable method of dissection. When free-tissue transfer to sacral, gluteal, and ischial regions is indicated, the muscle-splitting approach to the superior and inferior gluteal vessels is a recommended option in the selection of a recipient vessel.

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

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Sebastian, E-mail: sebastian.fischer@kgu.de [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Vogl, Thomas J. [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Marzi, Ingo [Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Zangos, Stephan; Wichmann, Julian L.; Scholtz, Jan-Erik; Mack, Martin G. [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Schmidt, Sven [Orthopaedic University Hospital Friedrichsheim, Marienburgstraße, 260528 Frankfurt (Germany); Eichler, Katrin [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany)

    2015-02-15

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

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

    Directory of Open Access Journals (Sweden)

    Shelley Lynne Forrest

    2015-04-01

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

  18. Partial Actions and Power Sets

    Directory of Open Access Journals (Sweden)

    Jesús Ávila

    2013-01-01

    Full Text Available We consider a partial action (X,α with enveloping action (T,β. In this work we extend α to a partial action on the ring (P(X,Δ,∩ and find its enveloping action (E,β. Finally, we introduce the concept of partial action of finite type to investigate the relationship between (E,β and (P(T,β.

  19. Algorithms over partially ordered sets

    DEFF Research Database (Denmark)

    Baer, Robert M.; Østerby, Ole

    1969-01-01

    in partially ordered sets, answer the combinatorial question of how many maximal chains might exist in a partially ordered set withn elements, and we give an algorithm for enumerating all maximal chains. We give (in § 3) algorithms which decide whether a partially ordered set is a (lower or upper) semi......-lattice, and whether a lattice has distributive, modular, and Boolean properties. Finally (in § 4) we give Algol realizations of the various algorithms....

  20. Anatomic partial nephrectomy: technique evolution.

    Science.gov (United States)

    Azhar, Raed A; Metcalfe, Charles; Gill, Inderbir S

    2015-03-01

    Partial nephrectomy provides equivalent long-term oncologic and superior functional outcomes as radical nephrectomy for T1a renal masses. Herein, we review the various vascular clamping techniques employed during minimally invasive partial nephrectomy, describe the evolution of our partial nephrectomy technique and provide an update on contemporary thinking about the impact of ischemia on renal function. Recently, partial nephrectomy surgical technique has shifted away from main artery clamping and towards minimizing/eliminating global renal ischemia during partial nephrectomy. Supported by high-fidelity three-dimensional imaging, novel anatomic-based partial nephrectomy techniques have recently been developed, wherein partial nephrectomy can now be performed with segmental, minimal or zero global ischemia to the renal remnant. Sequential innovations have included early unclamping, segmental clamping, super-selective clamping and now culminating in anatomic zero-ischemia surgery. By eliminating 'under-the-gun' time pressure of ischemia for the surgeon, these techniques allow an unhurried, tightly contoured tumour excision with point-specific sutured haemostasis. Recent data indicate that zero-ischemia partial nephrectomy may provide better functional outcomes by minimizing/eliminating global ischemia and preserving greater vascularized kidney volume. Contemporary partial nephrectomy includes a spectrum of surgical techniques ranging from conventional-clamped to novel zero-ischemia approaches. Technique selection should be tailored to each individual case on the basis of tumour characteristics, surgical feasibility, surgeon experience, patient demographics and baseline renal function.

  1. Partial order infinitary term rewriting

    DEFF Research Database (Denmark)

    Bahr, Patrick

    2014-01-01

    We study an alternative model of infinitary term rewriting. Instead of a metric on terms, a partial order on partial terms is employed to formalise convergence of reductions. We consider both a weak and a strong notion of convergence and show that the metric model of convergence coincides with th...... to the metric setting -- orthogonal systems are both infinitarily confluent and infinitarily normalising in the partial order setting. The unique infinitary normal forms that the partial order model admits are Böhm trees....

  2. On Degenerate Partial Differential Equations

    OpenAIRE

    Chen, Gui-Qiang G.

    2010-01-01

    Some of recent developments, including recent results, ideas, techniques, and approaches, in the study of degenerate partial differential equations are surveyed and analyzed. Several examples of nonlinear degenerate, even mixed, partial differential equations, are presented, which arise naturally in some longstanding, fundamental problems in fluid mechanics and differential geometry. The solution to these fundamental problems greatly requires a deep understanding of nonlinear degenerate parti...

  3. [Acrylic resin removable partial dentures

    NARCIS (Netherlands)

    Baat, C. de; Witter, D.J.; Creugers, N.H.J.

    2011-01-01

    An acrylic resin removable partial denture is distinguished from other types of removable partial dentures by an all-acrylic resin base which is, in principle, solely supported by the edentulous regions of the tooth arch and in the maxilla also by the hard palate. When compared to the other types of

  4. Partial Epilepsy with Auditory Features

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2004-07-01

    Full Text Available The clinical characteristics of 53 sporadic (S cases of idiopathic partial epilepsy with auditory features (IPEAF were analyzed and compared to previously reported familial (F cases of autosomal dominant partial epilepsy with auditory features (ADPEAF in a study at the University of Bologna, Italy.

  5. Partial twisting for scalar mesons

    International Nuclear Information System (INIS)

    Agadjanov, Dimitri; Meißner, Ulf-G.; Rusetsky, Akaki

    2014-01-01

    The possibility of imposing partially twisted boundary conditions is investigated for the scalar sector of lattice QCD. According to the commonly shared belief, the presence of quark-antiquark annihilation diagrams in the intermediate state generally hinders the use of the partial twisting. Using effective field theory techniques in a finite volume, and studying the scalar sector of QCD with total isospin I=1, we however demonstrate that partial twisting can still be performed, despite the fact that annihilation diagrams are present. The reason for this are delicate cancellations, which emerge due to the graded symmetry in partially quenched QCD with valence, sea and ghost quarks. The modified Lüscher equation in case of partial twisting is given

  6. Cast Partial Denture versus Acrylic Partial Denture for Replacement of Missing Teeth in Partially Edentulous Patients

    Directory of Open Access Journals (Sweden)

    Pramita Suwal

    2017-03-01

    Full Text Available Aim: To compare the effects of cast partial denture with conventional all acrylic denture in respect to retention, stability, masticatory efficiency, comfort and periodontal health of abutments. Methods: 50 adult partially edentulous patient seeking for replacement of missing teeth having Kennedy class I and II arches with or without modification areas were selected for the study. Group-A was treated with cast partial denture and Group-B with acrylic partial denture. Data collected during follow-up visit of 3 months, 6 months, and 1 year by evaluating retention, stability, masticatory efficiency, comfort, periodontal health of abutment. Results: Chi-square test was applied to find out differences between the groups at 95% confidence interval where p = 0.05. One year comparison shows that cast partial denture maintained retention and stability better than acrylic partial denture (p< 0.05. The masticatory efficiency was significantly compromising from 3rd month to 1 year in all acrylic partial denture groups (p< 0.05. The comfort of patient with cast partial denture was maintained better during the observation period (p< 0.05. Periodontal health of abutment was gradually deteriorated in all acrylic denture group (p

  7. Physics of partially ionized plasmas

    CERN Document Server

    Krishan, Vinod

    2016-01-01

    Plasma is one of the four fundamental states of matter; the other three being solid, liquid and gas. Several components, such as molecular clouds, diffuse interstellar gas, the solar atmosphere, the Earth's ionosphere and laboratory plasmas, including fusion plasmas, constitute the partially ionized plasmas. This book discusses different aspects of partially ionized plasmas including multi-fluid description, equilibrium and types of waves. The discussion goes on to cover the reionization phase of the universe, along with a brief description of high discharge plasmas, tokomak plasmas and laser plasmas. Various elastic and inelastic collisions amongst the three particle species are also presented. In addition, the author demonstrates the novelty of partially ionized plasmas using many examples; for instance, in partially ionized plasma the magnetic induction is subjected to the ambipolar diffusion and the Hall effect, as well as the usual resistive dissipation. Also included is an observation of kinematic dynam...

  8. Partially massless fields during inflation

    Science.gov (United States)

    Baumann, Daniel; Goon, Garrett; Lee, Hayden; Pimentel, Guilherme L.

    2018-04-01

    The representation theory of de Sitter space allows for a category of partially massless particles which have no flat space analog, but could have existed during inflation. We study the couplings of these exotic particles to inflationary perturbations and determine the resulting signatures in cosmological correlators. When inflationary perturbations interact through the exchange of these fields, their correlation functions inherit scalings that cannot be mimicked by extra massive fields. We discuss in detail the squeezed limit of the tensor-scalar-scalar bispectrum, and show that certain partially massless fields can violate the tensor consistency relation of single-field inflation. We also consider the collapsed limit of the scalar trispectrum, and find that the exchange of partially massless fields enhances its magnitude, while giving no contribution to the scalar bispectrum. These characteristic signatures provide clean detection channels for partially massless fields during inflation.

  9. Introduction to partial differential equations

    CERN Document Server

    Greenspan, Donald

    2000-01-01

    Designed for use in a one-semester course by seniors and beginning graduate students, this rigorous presentation explores practical methods of solving differential equations, plus the unifying theory underlying the mathematical superstructure. Topics include basic concepts, Fourier series, second-order partial differential equations, wave equation, potential equation, heat equation, approximate solution of partial differential equations, and more. Exercises appear at the ends of most chapters. 1961 edition.

  10. [Acrylic resin removable partial dentures].

    Science.gov (United States)

    de Baat, C; Witter, D J; Creugers, N H J

    2011-01-01

    An acrylic resin removable partial denture is distinguished from other types of removable partial dentures by an all-acrylic resin base which is, in principle, solely supported by the edentulous regions of the tooth arch and in the maxilla also by the hard palate. When compared to the other types of removable partial dentures, the acrylic resin removable partial denture has 3 favourable aspects: the economic aspect, its aesthetic quality and the ease with which it can be extended and adjusted. Disadvantages are an increased risk of caries developing, gingivitis, periodontal disease, denture stomatitis, alveolar bone reduction, tooth migration, triggering of the gag reflex and damage to the acrylic resin base. Present-day indications are ofa temporary or palliative nature or are motivated by economic factors. Special varieties of the acrylic resin removable partial denture are the spoon denture, the flexible denture fabricated of non-rigid acrylic resin, and the two-piece sectional denture. Furthermore, acrylic resin removable partial dentures can be supplied with clasps or reinforced by fibers or metal wires.

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

    International Nuclear Information System (INIS)

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

    2017-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-02-01

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

  13. Can the possibility of transverse iliosacral screw fixation for first sacral segment be predicted preoperatively? Results of a computational cadaveric study.

    Science.gov (United States)

    Jeong, Jin-Hoon; Jin, Jin Woo; Kang, Byoung Youl; Jung, Gu-Hee

    2017-10-01

    The purpose of this study was to predict the possibility of transverse iliosacral (TIS) screw fixation into the first sacral segment (S 1 ) and introduce practical anatomical variables using conventional computed tomography (CT) scans. A total of 82 cadaveric sacra (42 males and 40 females) were used for continuous 1.0-mm slice CT scans, which were imported into Mimics ® software to produce a three-dimensional pelvis model. The anterior height (BH) and superior width (BW) of the elevated sacral segment was measured, followed by verification of the safe zone (SZ S1 and SZ S2 ) in a true lateral view. Their vertical (VD S1 and VD S2 ) and horizontal (HD S1 and HD S2 ) distances were measured. VD S1 less than 7mm was classified as impossible sacrum, since the transverse fixation of 7.0 mm-sized IS screw could not be done safely. Fourteen models (16.7%; six females, eight males) were assigned as the impossible sacrum. There was no statistical significance regarding gender (p=0.626) and height (p=0.419). The average values were as follows: BW, 31.4mm (SD 2.9); BH, 16.7mm (SD 6.8); VD S1 , 13.4mm (SD 6.1); HD S1 , 22.5mm (SD 4.5); SZ S1 , 239.5mm 2 (SD 137.1); VD S2 , 15.5mm (SD 3.0); HD S2 , 18.3mm (SD 2.9); and SZ S2 , 221.1mm 2 (SD 68.5). Logistic regression analysis identified BH (p=0.001) and HD S1 (p=0.02) as the only statistically significant variables to predict the possibility. Receiver operating characteristic curve analysis established a cut-off value for BH and HD S1 of impossible sacrum of 20.6mm and 18.6mm, respectively. BH and HD S1 could be used to predict the possibility of TIS screw fixation. If the BH exceeds 20.6mm or HD S1 is less than 18.6mm, TIS screw fixation for S 1 should not be undertaken because of narrowed SZ. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Hall, Kimberly D; Clark, Rebecca C

    2016-11-01

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

  15. Parachute technique for partial penectomy

    Directory of Open Access Journals (Sweden)

    Fernando Korkes

    2010-04-01

    Full Text Available PURPOSE: Penile carcinoma is a rare but mutilating malignancy. In this context, partial penectomy is the most commonly applied approach for best oncological results. We herein propose a simple modification of the classic technique of partial penectomy, for better cosmetic and functional results. TECHNIQUE: If partial penectomy is indicated, the present technique can bring additional benefits. Different from classical technique, the urethra is spatulated only ventrally. An inverted "V" skin flap with 0.5 cm of extension is sectioned ventrally. The suture is performed with vicryl 4-0 in a "parachute" fashion, beginning from the ventral portion of the urethra and the "V" flap, followed by the "V" flap angles and than by the dorsal portion of the penis. After completion of the suture, a Foley catheter and light dressing are placed for 24 hours. CONCLUSIONS: Several complex reconstructive techniques have been previously proposed, but normally require specific surgical abilities, adequate patient selection and staged procedures. We believe that these reconstructive techniques are very useful in some specific subsets of patients. However, the technique herein proposed is a simple alternative that can be applied to all men after a partial penectomy, and takes the same amount of time as that in the classic technique. In conclusion, the "parachute" technique for penile reconstruction after partial amputation not only improves the appearance of the penis, but also maintains an adequate function.

  16. Partial Transposition on Bipartite System

    International Nuclear Information System (INIS)

    Xi-Jun, Ren; Yong-Jian, Han; Yu-Chun, Wu; Guang-Can, Guo

    2008-01-01

    Many properties of partial transposition are unclear as yet. Here we carefully consider the number of the negative eigenvalues of ρ T (ρ's partial transposition) when ρ is a two-partite state. There is strong evidence to show that the number of negative eigenvalues of ρ T is N(N − 1)/2 at most when ρ is a state in Hilbert space C N C N . For the special case, the 2 × 2 system, we use this result to give a partial proof of the conjecture |ρ T | T ≥ 0. We find that this conjecture is strongly connected with the entanglement of the state corresponding to the negative eigenvalue of ρ T or the negative entropy of ρ

  17. Partial volume effect in MRI

    International Nuclear Information System (INIS)

    Maeda, Munehiro; Yoshiya, Kazuhiko; Suzuki, Eiji

    1989-01-01

    According to the direction and the thickness of the imaging slice in tomography, the border between the tissues becomes unclear (partial volume effect). In the present MRI experiment, we examined border area between fat and water components using phantom in order to investigate the partial volume effect in MRI. In spin echo sequences, the intensity of the border area showed a linear relationship with composition of fat and water. Whereas, in inversion recovery and field echo sequences, we found the parameters to produce an extremely low intensity area at the border region between fat and water. This low intensity area was explained by cancellation of NMR signals from fat and water due to the difference in the direction of magnetic vectors. Clinically, partial volume effect can cause of mis-evaluation of walls, small nodules, tumor capsules and the tumor invasion in the use of inversion recovery and field echo sequences. (author)

  18. Partially composite Goldstone Higgs boson

    DEFF Research Database (Denmark)

    Alanne, Tommi; Franzosi, Diogo Buarque; Frandsen, Mads T.

    2017-01-01

    We consider a model of dynamical electroweak symmetry breaking with a partially composite Goldstone Higgs boson. The model is based on a strongly interacting fermionic sector coupled to a fundamental scalar sector via Yukawa interactions. The SU(4)×SU(4) global symmetry of these two sectors...... is broken to a single SU(4) via Yukawa interactions. Electroweak symmetry breaking is dynamically induced by condensation due to the strong interactions in the new fermionic sector which further breaks the global symmetry SU(4)→Sp(4). The Higgs boson arises as a partially composite state which is an exact...... Goldstone boson in the limit where SM interactions are turned off. Terms breaking the SU(4) global symmetry explicitly generate a mass for the Goldstone Higgs boson. The model realizes in different limits both (partially) composite Higgs and (bosonic) technicolor models, thereby providing a convenient...

  19. Landsliding in partially saturated materials

    Science.gov (United States)

    Godt, J.W.; Baum, R.L.; Lu, N.

    2009-01-01

    [1] Rainfall-induced landslides are pervasive in hillslope environments around the world and among the most costly and deadly natural hazards. However, capturing their occurrence with scientific instrumentation in a natural setting is extremely rare. The prevailing thinking on landslide initiation, particularly for those landslides that occur under intense precipitation, is that the failure surface is saturated and has positive pore-water pressures acting on it. Most analytic methods used for landslide hazard assessment are based on the above perception and assume that the failure surface is located beneath a water table. By monitoring the pore water and soil suction response to rainfall, we observed shallow landslide occurrence under partially saturated conditions for the first time in a natural setting. We show that the partially saturated shallow landslide at this site is predictable using measured soil suction and water content and a novel unified effective stress concept for partially saturated earth materials. Copyright 2009 by the American Geophysical Union.

  20. Basic linear partial differential equations

    CERN Document Server

    Treves, Francois

    1975-01-01

    Focusing on the archetypes of linear partial differential equations, this text for upper-level undergraduates and graduate students features most of the basic classical results. The methods, however, are decidedly nontraditional: in practically every instance, they tend toward a high level of abstraction. This approach recalls classical material to contemporary analysts in a language they can understand, as well as exploiting the field's wealth of examples as an introduction to modern theories.The four-part treatment covers the basic examples of linear partial differential equations and their

  1. Elements of partial differential equations

    CERN Document Server

    Sneddon, Ian Naismith

    1957-01-01

    Geared toward students of applied rather than pure mathematics, this volume introduces elements of partial differential equations. Its focus is primarily upon finding solutions to particular equations rather than general theory.Topics include ordinary differential equations in more than two variables, partial differential equations of the first and second orders, Laplace's equation, the wave equation, and the diffusion equation. A helpful Appendix offers information on systems of surfaces, and solutions to the odd-numbered problems appear at the end of the book. Readers pursuing independent st

  2. Currarino triad: surgical management and follow-up results of four [correction of three] cases.

    Science.gov (United States)

    Isik, Nejat; Elmaci, Ilhan; Gokben, Bekir; Balak, Naci; Tosyali, Nadir

    2010-08-01

    The Currarino syndrome is a rare triad that is a combination of a presacral mass, a congenital sacral bony abnormality and an anorectal malformation. We present 4 children with complete Currarino triad who were diagnosed using MRI. Our aim was to report the neurosurgical management of Currarino syndrome in children. All of the patients had chronic constipation and pain in the lumbosacral region. In the plain radiograph, 3 patients had a sacral scimitar-shaped bony abnormality, and 1 patient had total sacral agenesis. There was a narrow anal canal or narrow ventrally displaced anus in all patients. Their anorectal malformations were characterized as anal stenoses (4 patients), associated with Hirschsprung's disease in 2 cases. In 3 patients, MRI showed tethered cord syndrome in addition to the presacral mass. There was hydrocephalus in 1 patient. Anal stenosis was treated by anal dilatation. In 2 patients, rectal biopsy and temporary colostomy (2 patients) had been performed previously due to Hirschsprung's disease. We performed a posterior procedure via lumbar and sacral partial laminectomy-laminoplasty and transdural ligation of the neck of the meningocele for anterior sacral meningoceles, or alternatively, tumor excision for other types of presacral lesions. Histopathologically, 3 were cases of anterior sacral meningoceles and 1 was a teratoma. One of them also had a spinal abscess. He required reoperation (twice) and appeared at the time to have improved with medical therapy. All patients improved and stabilized. There were no additional neurological deficits and no recurrence of the presacral mass over the follow-up period (6 years, on average). The family pedigree did not reveal any familial transmission pattern. In cases of Currarino triad, MRI can allow the characterization of the presacral masses. If it is an anterior sacral meningocele or a solid tumor without severe anorectal malformation, it can be managed with posterior lumbar and sacral procedures

  3. Timed Testing under Partial Observability

    DEFF Research Database (Denmark)

    David, Alexandre; Larsen, Kim Guldstrand; Li, Shuhao

    2009-01-01

    observability of SUT using a set of predicates over the TGA state space, and specify the test purposes in Computation Tree Logic (CTL) formulas. A recently developed partially observable timed game solver is used to generate winning strategies, which are used as test cases. We propose a conformance testing...

  4. Variable Selection via Partial Correlation.

    Science.gov (United States)

    Li, Runze; Liu, Jingyuan; Lou, Lejia

    2017-07-01

    Partial correlation based variable selection method was proposed for normal linear regression models by Bühlmann, Kalisch and Maathuis (2010) as a comparable alternative method to regularization methods for variable selection. This paper addresses two important issues related to partial correlation based variable selection method: (a) whether this method is sensitive to normality assumption, and (b) whether this method is valid when the dimension of predictor increases in an exponential rate of the sample size. To address issue (a), we systematically study this method for elliptical linear regression models. Our finding indicates that the original proposal may lead to inferior performance when the marginal kurtosis of predictor is not close to that of normal distribution. Our simulation results further confirm this finding. To ensure the superior performance of partial correlation based variable selection procedure, we propose a thresholded partial correlation (TPC) approach to select significant variables in linear regression models. We establish the selection consistency of the TPC in the presence of ultrahigh dimensional predictors. Since the TPC procedure includes the original proposal as a special case, our theoretical results address the issue (b) directly. As a by-product, the sure screening property of the first step of TPC was obtained. The numerical examples also illustrate that the TPC is competitively comparable to the commonly-used regularization methods for variable selection.

  5. Adaptive Partially Hidden Markov Models

    DEFF Research Database (Denmark)

    Forchhammer, Søren Otto; Rasmussen, Tage

    1996-01-01

    Partially Hidden Markov Models (PHMM) have recently been introduced. The transition and emission probabilities are conditioned on the past. In this report, the PHMM is extended with a multiple token version. The different versions of the PHMM are applied to bi-level image coding....

  6. Partially molten magma ocean model

    International Nuclear Information System (INIS)

    Shirley, D.N.

    1983-01-01

    The properties of the lunar crust and upper mantle can be explained if the outer 300-400 km of the moon was initially only partially molten rather than fully molten. The top of the partially molten region contained about 20% melt and decreased to 0% at 300-400 km depth. Nuclei of anorthositic crust formed over localized bodies of magma segregated from the partial melt, then grew peripherally until they coverd the moon. Throughout most of its growth period the anorthosite crust floated on a layer of magma a few km thick. The thickness of this layer is regulated by the opposing forces of loss of material by fractional crystallization and addition of magma from the partial melt below. Concentrations of Sr, Eu, and Sm in pristine ferroan anorthosites are found to be consistent with this model, as are trends for the ferroan anorthosites and Mg-rich suites on a diagram of An in plagioclase vs. mg in mafics. Clustering of Eu, Sr, and mg values found among pristine ferroan anorthosites are predicted by this model

  7. [Posterior ceramic bonded partial restorations].

    Science.gov (United States)

    Mainjot, Amélie; Vanheusden, Alain

    2006-01-01

    Posterior ceramic bonded partial restorations are conservative and esthetic approaches for compromised teeth. Overlays constitute a less invasive alternative for tooth tissues than crown preparations. With inlays and onlays they are also indicated in case of full arch or quadrant rehabilitations including several teeth. This article screens indications and realization of this type of restorations.

  8. Implementing circularity using partial evaluation

    DEFF Research Database (Denmark)

    Lawall, Julia Laetitia

    2001-01-01

    of an imperative C-like language, by extending the language with a new construct, persistent variables. We show that an extension of partial evaluation can eliminate persistent variables, producing a staged C program. This approach has been implemented in the Tempo specializer for C programs, and has proven useful...

  9. The partial-birth stratagem.

    Science.gov (United States)

    1998-06-01

    In Wisconsin, physicians stopped performing abortions when a Federal District Court Judge refused to issue a temporary restraining order against the state's newly enacted "partial birth" abortion ban that was couched in such vague language it actually covered all abortions. While ostensibly attempting to ban late-term "intact dilation and extraction," the language of the law did not refer to that procedure or to late terms. Instead, it prohibited all abortions in which a physician "partially vaginally delivers a living child, causes the death of the partially delivered child with the intent to kill the child and then completes the delivery of the child." The law also defined "child" as "a human being from the time of fertilization" until birth. It is clear that this abortion ban is unconstitutional under Row v. Wade, and this unconstitutionality is compounded by the fact that the law allowed no exception to protect a woman's health, which is required by Roe for abortion bans after fetal viability. Wisconsin is only one of about 28 states that have enacted similar laws, and only two have restricted the ban to postviability abortions. Many of these laws have been struck down in court, and President Clinton has continued to veto the Federal partial-birth bill. The Wisconsin Judge acknowledged that opponents of the ban will likely prevail when the case is heard, but his action in denying the temporary injunction means that many women in Wisconsin will not receive timely medical care. The partial birth strategy is really only another anti-abortion strategy.

  10. The strategic value of partial vertical integration

    OpenAIRE

    Fiocco, Raffaele

    2014-01-01

    We investigate the strategic incentives for partial vertical integration, namely, partial ownership agreements between manufacturers and retailers, when retailers privately know their costs and engage in differentiated good price competition. The partial misalignment between the profit objectives within a partially integrated manufacturer-retailer hierarchy entails a higher retail price than under full integration. This `information vertical effect' translates into an opposite ...

  11. 32 CFR 751.13 - Partial payments.

    Science.gov (United States)

    2010-07-01

    ... voucher and all other information related to the partial payment shall be placed in the claim file. Action... 32 National Defense 5 2010-07-01 2010-07-01 false Partial payments. 751.13 Section 751.13 National... Claims Against the United States § 751.13 Partial payments. (a) Partial payments when hardship exists...

  12. The validity of compliance monitors to assess wearing time of thoracic-lumbar-sacral orthoses in children with spinal cord injury.

    Science.gov (United States)

    Hunter, Louis N; Sison-Williamson, Mitell; Mendoza, Melissa M; McDonald, Craig M; Molitor, Fred; Mulcahey, M J; Betz, Randal R; Vogel, Lawrence C; Bagley, Anita

    2008-06-15

    Prospective multicenter observation. To determine the validity of 3 commercially available at recording thoracic-lumbar-sacral orthosis (TLSO) wearing time of children with spinal cord injury (SCI) and to assess each monitor's function during daily activities. A major limitation to studies assessing the effectiveness of spinal prophylactic bracing is the patient's compliance with the prescribed wearing time. Although some studies have begun to use objective compliance monitors, there is little documentation of the validity of the monitors during activities of daily life and no comparisons of available monitors. Fifteen children with SCI who wore a TLSO for paralytic scoliosis were observed for 4 days during their rehabilitation stay. Three compliance monitors (2 temperature and 1 pressure sensitive) were mounted onto each TLSO. Time of brace wear from the monitors was compared with the wear time per day recorded in diaries. Observed versus monitored duration of brace wear found the HOBO (temperature sensitive) to be the most valid compliance monitor. The HOBO had the lowest average of difference and variance of difference scores. The correlation between the recorded daily entries and monitored brace wear time was also highest for the HOBO in analysis of dependent and independent scores. Bland-Altman plots showed that the pressure sensitive monitor underestimated wear time whereas the temperature monitors overestimated wear time. Compliance to prescribed wearing schedule has been a barrier to studying TLSO efficacy. All 3 monitors were found to measure TLSO compliance, but the 2 temperature monitors were more in agreement with the daily diaries. Based on its functional advantages compared with the HOBO, the StowAway TidbiT will be used to further investigate the long-term compliance of TLSO bracing in children with SCI.

  13. Sacral neuromodulation and Botulinum toxin A for refractory idiopathic overactive bladder: a cost-utility analysis in the perspective of Italian Healthcare System.

    Science.gov (United States)

    Bertapelle, Maria Paola; Vottero, Mario; Popolo, Giulio Del; Mencarini, Marco; Ostardo, Edoardo; Spinelli, Michele; Giannantoni, Antonella; D'Ausilio, Anna

    2015-08-01

    To assess the relative cost-effectiveness of two therapeutic strategies: one starting with sacral neuromodulation (SNM) versus one starting with Botulinum toxin A (BTX-A) for the management of refractory incontinent idiopathic overactive bladder (OAB) patients, from the perspective of the Italian National Health Service (INHS). Direct medical costs (2011) and benefits (quality-adjusted life years-QALYs) were assessed over a ten-year time frame adapting to the Italian practice a published Markov model. Clinical inputs were based on the published literature and on the expert opinion. Resource consumption rates were provided by clinical experts; unit costs were collected from a single hospital accounting and from standard tariff lists and public prices. Interventional procedures and management of adverse events were costed through a micro-costing approach. The primary outcome was incremental costs per QALYs gained (i.e. differential costs divided by differential benefits). Deterministic (DSA) and probabilistic (PSA) sensitivity analyses were conducted to assess the robustness of the model. Starting with SNM appears to be cost effective (i.e. under 40.000/QALY) from year three (21,259/QALY) onwards and becomes dominant (i.e. more effective and less costly) at year ten: cumulative costs were 32,975 for early SNM and 33,309 for early BTX-A, while cumulative QALYs were 7.52 and 6.93, respectively. At year ten, DSA suggests the results robustness and 99.8 % of the PSA iterations fell within the cost-effectiveness threshold. A therapeutic strategy starting with SNM may be considered cost effective in the midterm and cost saving in the long-term treatment of idiopathic OAB from the INHS perspective.

  14. Removable partial dentures: clinical concepts.

    Science.gov (United States)

    Bohnenkamp, David M

    2014-01-01

    This article provides a review of the traditional clinical concepts for the design and fabrication of removable partial dentures (RPDs). Although classic theories and rules for RPD designs have been presented and should be followed, excellent clinical care for partially edentulous patients may also be achieved with computer-aided design/computer-aided manufacturing technology and unique blended designs. These nontraditional RPD designs and fabrication methods provide for improved fit, function, and esthetics by using computer-aided design software, composite resin for contours and morphology of abutment teeth, metal support structures for long edentulous spans and collapsed occlusal vertical dimensions, and flexible, nylon thermoplastic material for metal-supported clasp assemblies. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Partial scram incident in FBTR

    International Nuclear Information System (INIS)

    Usha, S.; Pillai, C.P.; Muralikrishna, G.

    1989-01-01

    Evaluation of a partial scram incident occurred at the Fast Breeder Test Reactor at Kalpakkam was carried out. Based on the observations of the experiments it was ascertained that the nonpersistant order was due to superimposed noise component on the channel that was close to the threshold and had resulted in intermittent supply to electro-magnetic (EM) coils. Owing to a larger discharge time and a smaller charge time, the EM coils got progressively discharged. It was confirmed that during the incident, partial scram took place since the charging and discharging patterns of the EM coils are dissimilar and EM coils of rods A, E and F had discharged faster than others for noise component of a particular duty cycle. However, nonlatching of scram order was because of the fact that noise pulse duration was less than latching time. (author)

  16. The marketing of partial hospitalization.

    Science.gov (United States)

    Millsap, P; Brown, E; Kiser, L; Pruitt, D

    1987-09-01

    Health-care professionals are currently operating in the context of a rapidly changing health-care delivery system, including the move away from inpatient services to outpatient services in order to control costs. Those who practice in partial-hospital settings are in a position to offer effective, cost-efficient services; however, there continue to be obstacles which hinder appropriate utilization of the modality. The development and use of a well-designed marketing plan is one strategy for removing these obstacles. This paper presents a brief overview of the marketing process, ideas for developing a marketing plan, and several examples of specific marketing strategies as well as ways to monitor their effectiveness. Partial-hospital providers must take an active role in answering the calls for alternative sources of psychiatric care. A comprehensive, education-oriented marketing approach will increase the public's awareness of such alternatives and enable programs to survive in a competitive environment.

  17. Introduction to partial differential equations

    CERN Document Server

    Borthwick, David

    2016-01-01

    This modern take on partial differential equations does not require knowledge beyond vector calculus and linear algebra. The author focuses on the most important classical partial differential equations, including conservation equations and their characteristics, the wave equation, the heat equation, function spaces, and Fourier series, drawing on tools from analysis only as they arise.Within each section the author creates a narrative that answers the five questions: (1) What is the scientific problem we are trying to understand? (2) How do we model that with PDE? (3) What techniques can we use to analyze the PDE? (4) How do those techniques apply to this equation? (5) What information or insight did we obtain by developing and analyzing the PDE? The text stresses the interplay between modeling and mathematical analysis, providing a thorough source of problems and an inspiration for the development of methods.

  18. Dynamics of partial differential equations

    CERN Document Server

    Wayne, C Eugene

    2015-01-01

    This book contains two review articles on the dynamics of partial differential equations that deal with closely related topics but can be read independently. Wayne reviews recent results on the global dynamics of the two-dimensional Navier-Stokes equations. This system exhibits stable vortex solutions: the topic of Wayne's contribution is how solutions that start from arbitrary initial conditions evolve towards stable vortices. Weinstein considers the dynamics of localized states in nonlinear Schrodinger and Gross-Pitaevskii equations that describe many optical and quantum systems. In this contribution, Weinstein reviews recent bifurcations results of solitary waves, their linear and nonlinear stability properties, and results about radiation damping where waves lose energy through radiation.   The articles, written independently, are combined into one volume to showcase the tools of dynamical systems theory at work in explaining qualitative phenomena associated with two classes of partial differential equ...

  19. Partial Cooperative Equilibria: Existence and Characterization

    Directory of Open Access Journals (Sweden)

    Amandine Ghintran

    2010-09-01

    Full Text Available We study the solution concepts of partial cooperative Cournot-Nash equilibria and partial cooperative Stackelberg equilibria. The partial cooperative Cournot-Nash equilibrium is axiomatically characterized by using notions of rationality, consistency and converse consistency with regard to reduced games. We also establish sufficient conditions for which partial cooperative Cournot-Nash equilibria and partial cooperative Stackelberg equilibria exist in supermodular games. Finally, we provide an application to strategic network formation where such solution concepts may be useful.

  20. Partial dependency parsing for Irish

    OpenAIRE

    Uí Dhonnchadha, Elaine; van Genabith, Josef

    2010-01-01

    In this paper we present a partial dependency parser for Irish, in which Constraint Grammar (CG) rules are used to annotate dependency relations and grammatical functions in unrestricted Irish text. Chunking is performed using a regular-expression grammar which operates on the dependency tagged sentences. As this is the first implementation of a parser for unrestricted Irish text (to our knowledge), there were no guidelines or precedents available. Therefore deciding what constitutes a syntac...