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Clinical Anatomy (New York, N.Y.) Apr 2023The subchondral lamella of the sacroiliac auricular surface is morphologically inconsistent. Its morpho-mechanical relationship with dysfunction (SIJD) remains...
The subchondral lamella of the sacroiliac auricular surface is morphologically inconsistent. Its morpho-mechanical relationship with dysfunction (SIJD) remains unstudied. Here, the iliac and sacral subchondral bone mineralization is compared between morphological subtypes and in large and small surfaces, in SIJD joints and controls. CT datasets from 29 patients with bilateral or unilateral SIJD were subjected to CT-osteoabsorptiometry. Surface areas and posterior angles were calculated and surfaces were classified by size: small (<15 cm ) and large (≥15 cm ), and morphological types: 1 (>160°), 2 (130°-160°), and 3 (<130°). Mineralization patterns were identified: two marginal (M1 and M2) and two non-marginal (N1 and N2). Each sacral and iliac surface was subsequently classified. Dysfunctional cohort area averaged 15.0 ± 2.4 cm (males 16.2 ± 2.5 cm , females 13.7 ± 1.6 cm ). No age correlations with surface area were found nor mean Hounsfield Unit differences when comparing sizes, sexes or morphology-type. Controls and dysfunctional cohort comparison revealed differences in female sacra (p = 0.02) and small sacra (p = 0.03). There was low-conformity in marginal and non-marginal patterns, 26% for contralateral non-dysfunctional joints, and 46% for dysfunctional joints. The majority of painful joints was of type 2 morphology (59%), equally distributed between small (49%) and large joints (51%). Larger joints had the highest frequency of dysfunctional joints (72%). Auricular surface morphology seems to have little impact on pain-related subchondral lamella adaptation in SIJD. Larger joints may be predisposed to the onset of pain due to the weakening of the extracapsular structures. Dysfunctional joints reflect common conformity patterns of sacral-apex mineralization with corresponding superior corner iliac mineralization.
Topics: Male; Humans; Female; Sacroiliac Joint; Bone Density; Low Back Pain; Sacrum; Sacrococcygeal Region
PubMed: 36399231
DOI: 10.1002/ca.23980 -
AORN Journal Sep 2022The purpose of this study was to describe patterns of intraoperative tissue interface pressure, identify the amount of time during which the pressure at four anatomical...
The purpose of this study was to describe patterns of intraoperative tissue interface pressure, identify the amount of time during which the pressure at four anatomical locations exceeded 32 mm Hg, and examine associations between patient- and surgery-related variables and peak tissue interface pressure. We used a pressure mapping system to measure the intraoperative tissue interface pressure of 150 patients. We implemented linear mixed-effects models to assess trends in the mean and peak tissue interface pressure. The percentage of time during which the interface pressure exceeded 32 mm Hg at the scapulae, interscapular area, and sacral area was 70%, 70%, and 90%, respectively. Body mass index, length of surgery, and intraoperative position were major predictors of increased pressure. Understanding patterns of tissue interface pressure of patients during surgery may help perioperative nurses develop strategies to attenuate pressure and protect skin integrity.
Topics: Humans; Pressure; Pressure Ulcer; Sacrococcygeal Region; Sacrum; Skin
PubMed: 36005880
DOI: 10.1002/aorn.13767 -
African Journal of Paediatric Surgery :... 2021There are some common genetic heritages between human and mammals. Human tail, though rare is one of the most noticeable. Till the date, around 60 cases reported in the...
There are some common genetic heritages between human and mammals. Human tail, though rare is one of the most noticeable. Till the date, around 60 cases reported in the literature. A true human tail is a benign vestigial caudal cutaneous structure composed of adipose, connective tissue, muscle, vessels and nerves. A true human tail can be distinguished from a pseudotail as the latter is commonly associated with underlying spinal dysraphism, which requires specialised management. We report a case series of four caudal appendages. Two clients were infants, while others two were toddler and presented with cutaneous appendage arising from the lumbosacral region. Out of four, only one had associated spinal dysraphism and neurological manifestation while others did not have spinal dysraphism and neurological manifestation. The appendage was removed by the surgical excision. Clinicians should emphasise the use of 'true tail' and 'pseudo-tail' as the specific disparate terms as the clinical, radiological and histological findings of these conditions differs significantly, along with the management strategies and outcomes.
Topics: Female; Humans; Infant; Neurosurgical Procedures; Sacrococcygeal Region; Spinal Dysraphism
PubMed: 33595541
DOI: 10.4103/ajps.AJPS_48_20 -
Annales de Pathologie Apr 2021
Topics: Humans; Neoplasms; Sacrococcygeal Region; Teratoma
PubMed: 33036799
DOI: 10.1016/j.annpat.2020.09.002 -
Journal of Gynecology Obstetrics and... May 2023
Topics: Humans; Robotic Surgical Procedures; Neurilemmoma; Sacrococcygeal Region; Sacrum
PubMed: 37028549
DOI: 10.1016/j.jogoh.2023.102585 -
Journal of Tissue Viability May 2023This study aimed to compare interface pressure and total contact area of the sacral region in different positions, including small-angle changes, in patients with spinal...
AIM OF THE STUDY
This study aimed to compare interface pressure and total contact area of the sacral region in different positions, including small-angle changes, in patients with spinal cord injury (SCI). Furthermore, we analyzed the clinical factors influencing pressure to identify the pressure injury (PI) high-risk group.
MATERIALS AND METHODS
An intervention was conducted for patients with paraplegia (n = 30) with SCI. In the first and second trials, interface pressure and total contact area of the sacral region were recorded from large- and small-angled positions using the automatic repositioning bed, which can change the angle of the back, lateral tilt, and knee.
RESULTS
Positions with back raised ≥45° showed significantly higher pressure on the sacrum than most other positions. The pressure and contact area differences were statistically insignificant for combinations of small-angled changes <30°. Additionally, the duration of injury (β = 0.51, p = 0.010) and neurological level of injury (NLI) (β = -0.47, p = 0.020) were significant independent predictors of average pressure. Similarly, the duration of injury (β = 0.64, p = 0.001), the Korean version of the spinal cord independence measure-III (β = -0.52, p = 0.017), and body mass index (BMI; β = -0.34, p = 0.041) were significant independent predictors of peak pressure.
CONCLUSIONS
For repositioning, combinations of small-angle changes <30° effectively reduce pressure on the sacral region in patients with SCI. Lower BMI, longer duration of injury, lower functioning score, and NLI ≥ T7 are predictors of high sacral pressures, which increase the risk for PI. Therefore, patients with these predictors require strict management.
Topics: Humans; Sacrococcygeal Region; Sacrum; Spinal Cord Injuries; Paraplegia; Lower Extremity; Pressure Ulcer
PubMed: 36894461
DOI: 10.1016/j.jtv.2023.02.008 -
Journal of Pediatric Urology Jun 2016Sacral agenesis (SA) is a rare congenital condition that refers to the absence of part or all of two or more lower sacral vertebral bodies. It can be associated with... (Comparative Study)
Comparative Study
BACKGROUND
Sacral agenesis (SA) is a rare congenital condition that refers to the absence of part or all of two or more lower sacral vertebral bodies. It can be associated with neurogenic bladder dysfunction that does not necessarily correlate with the level of spinal or skeletal defect. Patients with SA should undergo urodynamic studies (UDS) to guide lower urinary tract (LUT) management.
OBJECTIVE
This review aimed to update the present institutional experience since 1981 of this rare patient population with detailed, long-term follow-up of bladder and kidney function.
STUDY DESIGN
A single institution, retrospective, IRB-approved review was performed on patients born after January 1, 1981 with an isolated diagnosis of sacral agenesis without spina bifida, and followed with urologic involvement at Boston Children's Hospital. Records were reviewed for demographics, radiologic imaging, UDS including cystometrogram (CMG) and electromyography (EMG), surgery, and blood chemistries. Comparisons were made between groups of patients based on age at diagnosis, with specific focus on renal function and stability of neurogenic bladder lesion.
RESULTS
Forty-three patients were identified: 23 female and 20 male. Thirty-seven children (86%) had a known age of diagnosis. Nineteen were diagnosed before 2 months old, including five who were diagnosed prenatally, 11 were diagnosed between 2 and 18 months, and seven were diagnosed after 18 months. All 43 had UDS, with 24 (55.8%) studied at the time of diagnosis (Summary Table). Twenty had serial full UDS, with 30% demonstrating neurourologic instability. None developed end-stage renal disease (ESRD) or required spinal cord detethering.
DISCUSSION
Many children with SA appeared to be diagnosed prenatally or early in life; SA was mostly identified during evaluation of associated anomalies. Though UDS aid in urologic management, testing was not routinely utilized at the time of diagnosis.
CONCLUSIONS
This review of long-term follow-up in SA patients showed stable LUT and renal function, with minimal risk of progression to ESRD.
Topics: Abnormalities, Multiple; Female; Humans; Infant; Kidney; Male; Meningocele; Retrospective Studies; Sacrococcygeal Region; Time Factors; Treatment Outcome; Urinary Bladder; Urinary Bladder, Neurogenic
PubMed: 26897325
DOI: 10.1016/j.jpurol.2015.12.008 -
Female Pelvic Medicine & Reconstructive... 2014Robotic sacrocolpopexy has been rapidly incorporated into surgical practice without comprehensive and systematically published outcome data. The aim of this study was to... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Robotic sacrocolpopexy has been rapidly incorporated into surgical practice without comprehensive and systematically published outcome data. The aim of this study was to systematically review the currently published peer-reviewed literature on robotic-assisted laparoscopic sacrocolpopexy with more than 6 months of anatomic outcome data.
METHODS
Studies were selected after applying predetermined inclusion and exclusion criteria to a MEDLINE search. Two independent reviewers blinded to each other's results abstracted demographic data, perioperative information, and postoperative outcomes. The primary outcome assessed was anatomic success rate defined as less than or equal to pelvic organ prolapse quantification system (POP-Q) stage 1. A random effects model was performed for the meta-analysis of selected outcomes.
RESULTS
Thirteen studies were selected for the systematic review. Meta-analysis yielded a combined estimated success rate of 98.6% (95% confidence interval, 97.0%-100%). The combined estimated rate of mesh exposure/erosion was 4.1% (95% confidence interval, 1.4%-6.9%), and the rate of reoperation for mesh revision was 1.7%. The rates of reoperation for recurrent apical and nonapical prolapse were 0.8% and 2.5%, respectively. The most common surgical complication (excluding mesh erosion) was cystotomy (2.8%), followed by wound infection (2.4%).
CONCLUSIONS
The outcomes of this analysis indicate that robotic sacrocolpopexy is an effective surgical treatment of apical prolapse with high anatomic cure rate and low rate of complications.
Topics: Aged; Female; Gynecologic Surgical Procedures; Humans; Laparoscopy; Middle Aged; Pelvic Organ Prolapse; Postoperative Complications; Robotics; Sacrococcygeal Region; Surgical Mesh; Treatment Outcome
PubMed: 25181374
DOI: 10.1097/SPV.0000000000000070 -
Wound Management & Prevention Aug 2019Existing evidence is inadequate to assume increased skin temperature is a risk factor for the development of pressure ulcers (PUs).
UNLABELLED
Existing evidence is inadequate to assume increased skin temperature is a risk factor for the development of pressure ulcers (PUs).
PURPOSE
The purpose of this prospective, descriptive study was to examine the relationship between sacral skin temperature and PU development.
METHODS
Using convenience sampling methods, patients who were hospitalized in the tertiary intensive care unit (ICU) of the internal medicine department of a university hospital in İzmir, Turkey, between April and December 2015 were eligible to participate if they were ⟩18 years of age, had an expected hospital stay of at least 5 days, a Braden score ≤12, and were admitted without a PU. Demographic and clinical data collected included age, gender, body mass index, diagnosis, mattress type, length of follow-up (days), systolic and diastolic blood pressure, body temperature, hemoglobin level, sacral skin temperatures in the supine and lateral positions, room temperature, PU stage and duration, and Braden score. Temperature was measured the day of hospitalization as a baseline measurement (day 1) and once every day thereafter up to 22 days, until the patient did or did not develop a PU, died, was no longer undergoing position change, or was discharged. Sacral skin temperature was taken immediately after the patient was moved to a lateral position following 120 minutes of supine position (referred to as sacral skin temperature measurement) and after 30 minutes in lateral position (referred to as sacral skin temperature measurement). Data were collected using paper-and-pencil questionnaires and entered into a software program for analysis. Descriptive statistics, Student's test, one-way analysis of variance test, Pearson product-moment correlation analysis, and Spearman's rank-order correlation analysis were used for data analysis.
RESULTS
Of the 37 patients who met the inclusion criteria and were monitored for at least 5 days, 21 (56.8%) developed PUs. No statistically significant difference in supine position sacral skin temperature on day 1 or day 5 was found between patients who did and did not develop a PU (36.90° C ± 0.29° C and 37.15° C ± 0.53° C, respectively, on day 1; = -1.656, = .112; and 37.37° C ± 0.53° C and 37.30° C ± 0.79° C, respectively, on day 5; = 0.259, = .798). Day 5 lateral position skin temperatures also did not differ significantly between the 2 groups (37.44° C ± 0.44° C and 37.31° C ± 0.75° C, respectively; = 1.306, = .621). A statistically significant difference was noted between mean sacral skin temperature in the supine position among patients ages 75 to 90 years compared with patients 38 to 64 years and 65 to 74 years (36.93° C ± 0.39° C; F = 13.221, = .000) and with use of a viscoelastic mattress compared with an alternating pressure air mattress and continuous lateral rotation alternating pressure air mattress (37.85° C ± 0.54° C; F = 14.039, = .000). No statistically significant differences in sacral skin temperatures were found for any of the of the other variables assessed.
CONCLUSION
Sacral skin temperatures were not statistically different between ICU patients who did and did not develop a PU. Additional research may help increase understanding of the relationship between skin temperature and PU development.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Pressure Ulcer; Prospective Studies; Risk Factors; Sacrococcygeal Region; Skin Temperature; Turkey
PubMed: 31373568
DOI: No ID Found -
Diseases of the Colon and Rectum Dec 2020An 84-year-old male patient was complaining of constipation and rectal bleeding for 6 months. Colonoscopy and rigid sigmoidoscopy showed a posterior upper rectal mass...
An 84-year-old male patient was complaining of constipation and rectal bleeding for 6 months. Colonoscopy and rigid sigmoidoscopy showed a posterior upper rectal mass (13 cm from anus). Histopathology confirmed moderately differentiated adenocarcinoma. A CT scan of the thorax, abdomen, and pelvis, as well as pelvic magnetic nuclear resonance imaging, revealed midrectal cancer cT3N0M0 with clear predicted circumferential margin. The patient underwent anterior resection with tumor-specific total mesorectal excision and end colostomy. During the posterior rectal dissection, dilated fragile varicose presacral veins were damaged, and severe bleeding was observed. Initial pelvic packing was ineffective, as well as bone wax and clips. Internal iliac arteries were ligated, and additional packing was finally successful and the bleeding stopped. The patient was resuscitated with a total blood loss of 4.2 L. The bleeding did not recur, and the packs were removed on postoperative day 2. The postoperative course was uneventful, and the patient was discharged on postoperative day 13 from the initial operation and postoperative day 5 from packing removal.
Topics: Adenocarcinoma; Aged, 80 and over; Blood Loss, Surgical; Colostomy; Hemorrhage; Humans; Iliac Artery; Ligation; Male; Neoplasm Staging; Proctectomy; Rectal Neoplasms; Resuscitation; Sacrococcygeal Region; Treatment Outcome; Varicose Veins
PubMed: 33149018
DOI: 10.1097/DCR.0000000000001852