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PubMed1995

Insufficiency fractures of the sacrum in elderly subjects.

Elderly patients who develop insufficiency fractures of the sacrum usually have generalized bone loss and/or lesions of the pelvic bones (due to radiation therapy or previous fractures). The sacral fracture occurs either spontaneously or after a trivial traumatic episode. We compared patients admitted for sacral fractures (n = 12) or vertebral crush fractures (n = 56) in an effort to identify risk factors for sacral fractures. We conducted a retrospective review of the medical records of the 12 patients older than 70 years who were admitted to the rheumatology department of the Morvan Hospital between January 1, 1985 and December 31, 1994 for evaluation of a sacral fracture. The onset of symptoms was abrupt in 11 patients and occurred after an unremarkable fall in three. Patients admitted for sacral fractures were significantly more likely to have a positive history for a fracture, femoral surgery, or pelvic radiation therapy than patients admitted for vertebral fractures (58% versus 9%, p = 0.0005). In contrast, levels of calcium, phosphorus, 25-OH vitamin D and 1,25(OH)2 vitamin D were comparable in the two groups after exclusion of those patients with endocrine disorders or a history of calcium and vitamin D supplementation. In conclusion, populations of elderly patients with sacral fractures and crush fractures are comparable and the occurrence of a sacral fracture is dependent on the presence of pelvic and/or femoral osseous abnormalities.

Aged↗

PubMed1996

[Transiliacal screw fixation of the sacrum in unstable pelvic ring fractures].

This article presents our experiences from fixation of the sacrum by transiliacal screw in 13 patients with unstable fractures of the pelvic ring. Early mobilization, with no secondary dislocation or postoperative complications, was achieved in all patients. Sagittal instability in unstable pelvic ring fractures must be acknowledged. The transiliac screw offers the possibility of early mobilization of patients with this fracture. The procedure is demanding and patients selected for this treatment should be referred to hospitals with experience in the treatment of pelvic fractures.

Adult↗

PubMed1997

The relationship of lumbosacral plexus to the sacrum and the sacroiliac joint.

The lumbosacral plexus was dissected bilaterally in 20 adult cadavers to define the anatomic relationship of the lumbosacral plexus to the sacrum and the sacroiliac joint. All results are mean values +/- standard deviation. The length of the nerve roots of the lumbosacral plexus gradually decreased from L-4 to S-3 (from 93.8 +/- 6.9 mm in males and 108.7 +/- 7.7 mm in females at L-4 to 43.7 +/- 4.3 mm in males and 49.0 +/- 7.6 mm in females at S-3). The angle projected by the nerve roots of the lumbosacral plexus with respect to the sagittal plane gradually increased from L-4 to S-3 (from 14.3 degrees +/- 3.4 degrees in males and 16.7 degrees +/- 4.8 degrees in females at L-4 to 51.8 degrees +/- 9.0 degrees in males and 57.8 degrees +/- 9.1 degrees in females at S-3). The width of the nerve roots of the lumbosacral plexus was greatest at S-1 (9.8 +/- 1.8 mm in males, 8.6 +/- 1.5 mm in females). The L-5 nerve root was the thickest in males (4.4 +/- 0.5 mm), and the S-1 nerve root was thickest in females (4.3 +/- 0.4 mm). The lumbosacral trunk was 30.0 +/- 9.0 mm in length in males and 32.0 +/- 6.0 mm in females; 11.4 +/- 1.8 mm wide in males and 11.2 +/- 1.5 mm in females; and 4.4 +/- 0.5 mm thick in males and 4.0 +/- 0.6 mm in females. The fifth lumbar nerve root and lumbosacral trunk coursed across the sacroiliac at a level 2.0 +/- 0.2 cm below the pelvic brim and were relatively fixed to the sacral ala with fibrous connective tissue.

Aged↗

PubMed1997

Insufficiency fractures of the sacrum: a cause of low back pain after lung transplantation.

Insufficiency fractures of the sacrum were diagnosed during the first year after successful transplantation in four (5.6%) of 71 lung and heart-lung transplant recipients. Each patient had development of low back pain after minor or no trauma; all had osteoporosis. In each instance, plain radiographs failed to demonstrate the fracture, and the diagnosis was established by radionuclide bone scanning that demonstrated the characteristic "butterfly" (bilateral sacral fracture) or "half-butterfly" appearance (unilateral sacral fracture). Sacral insufficiency fractures, a significant cause of low back pain in lung transplant recipients, may be underdiagnosed in this population because routine radiographs do not usually reveal the fracture; bone scanning is the preferred diagnostic modality.

Absorptiometry, Photon↗

PubMed1997

[Fractures of the sacrum caused by bone insufficiency. Meta-analysis of 508 cases].

OBJECTIVES: Fractures of the sacrum due to bone deficiency are not extremely uncommon although this cause has been overlooked for many years. We performed a meta-analysis of reported cases in order to determine the specific characteristics. METHOD: The characteristics of 493 cases of sacral fractures reported in the literature and those of 15 personal cases were studied. RESULTS: Most of the fractures occurred in women over 60 years of age. No trauma was identified in two-thirds of the cases. Clinical expression was not specific (back pain, sciatica, pelvic pain). Standard x-ray showed a fracture of the obturator frame in 38.8% of the cases but no direct or indirect signs of sacral fracture were seen in more than two-thirds of the cases. Tc99m scintigraphy had excellent sensitivity; a characteristic hyperfixation pattern for ming an "H" was observed but only in 42.7% of the cases. Computed tomography had similar sensitivity and confirmed the diagnosis in doubtful cases. Treatment was usually bed rest until satisfactory pain relief. Of particular importance were neurological complications although they were exceptional. Several factors favoring sacral fracture were found, mainly osteoporosis and prior radiotherapy of the pelvis. CONCLUSION: Clinicians should be aware of this type of fracture which still remains largely over-looked in geriatric care units.

Aged↗

PubMed1998

[The use of computed and magnetic resonance tomography in the diagnosis of neoplasms of the pelvic bones and sacrum].

The experience of the computed tomography (CT) application in the pelvic bones and sacrum tumors diagnosis in 46 patients was summarized. The data obtained were defined more precisely using magnet-resonance tomography (MRT). MRT in contradistinction to permits to differentiate the soft tissues and reveal the tumoral invasion of dura mater and the spinal cord substance, the spinal cord nerves affection. Using CT it is possible to estimate more accurately the bone structure and tumoral elements, containing calcium.

Bone Neoplasms↗

PubMed1998

[Fractures of the sacrum and neurologic lesions. Apropos of a case].

Sacral fracture is a difficult diagnosis due to the lack of specific signs and the inaccuracy of conventional radiology. This kind of fracture affects either polytraumatised or aged patients, in whom the fracture can be diagnosed. However these fracture have to be recognized because of their potentially adverse consequences, particularly on neurological structures. The case of a 56 years old man who fell from his height is reported. Two weeks later, due to mild neurologic symptoms, an X-ray and CT of the pelvis were performed, showing a fracture of both sacral alae. A complex neurologic sensitive and motor impairement appeared involving S1 to S5 levels on the left side and L2 to S5 levels on the right side. Many investigations were done to rule out any other etiologic factor of this complex and progressive neurologic deficit. The probable cause was an iterative stretching of the lumbosacral roots ambulating with a floating sacrum fracture.

Humans↗

PubMed1998

[Results of interdisciplinary sacrum resection in sacral recurrence of rectal carcinoma].

The authors present a retrospective analysis of 12 consecutive patients surgically treated with curative intention for recurrent rectal cancer involving the sacrum. After radical partial sacral resection--extended resection in seven cases--the operative mortality rate was zero, postoperative long-term survival was reached in 17%, while effective palliation of pain was achieved in all cases. Nevertheless, 50% did not survive more than 1 year after the operation. The overall mean survival time was 22 months. Sacral recurrence can be resected safely and potentially curatively after careful patient selection.

Combined Modality Therapy↗

PubMed1977

Giant-cell tumor of vertebrae above the sacrum: a review of 31 cases.

A study of 31 cases of giant-cell tumor of vertebrae above the sacrum indicates that this unusual diagnosis is sometimes appropriate. Several entities, especially aneurysmal bone cyst and osteoblastoma, should be considered in the diffferential diagnosis. Evidence indicates that excision, sometimes with ancillary irradiation, provides a better chance for cure than would be expected with giant-cell tumor in other sites--sites where recurrent, generally large tumors develop in nearly half of the cases. Giant-cell tumors of vertebrae may affect vertebral bodies or arches and may cause irreversible damage to the spinal cord or to the emerging roots.

Adolescent↗

PubMedDate not supplied

Morphological aspects of dorsum and sacrum skin as related to liposuction.

Analysis of the dorsum's skin and sacrum region allowed the authors to evaluate regional characteristics of cutaneous skin integument, taking into consideration the age group most subjected to liposuction. Thus, it was attempted to establish rules to facilitate, in a comparative form, the evaluation of results related to cutaneous retraction in plastic surgery.

Adult↗

PubMed2001

Trans iliac-sacral-iliac bar stabilisation to treat bilateral lesions of the sacro-iliac joint or sacrum: anatomical considerations and clinical experience.

The use of trans iliac-sacral-iliac bars is an alternative to sacro-iliac screws in the treatment of bilateral lesions of the posterior pelvic ring, and the same biomechanical principles can be applied. Of 20 patients, ten men and ten women, a CT-scan of the pelvis was performed to study the individual and common safe area at the level of S1 and S2. The location and maximal diameter of the individual safe area were studied using a computer-navigation system, displaying images in sagittal, coronal and axial anatomic planes together with a 3-D reconstruction. The common safe area was studied using three points: upper- (UA) and lower anterior corner (DA) of S1 and S2, and the centre of the safe area. It would have been possible to place an iliac-sacral-iliac bar (5 mm or more) in S1 and S2 in all the men, but in the women a bar could only have been inserted in only five in S1 and eight in S2. A statistically significant difference between men and women was found at S1 (P=0.033) but not at S2 (P=0.211). No significant correlation was found between the diameter of the safe area at both levels in men and women and age, height, and weight. Furthermore, no common safe area of 5 mm or more was measured at the same levels.Four patients were treated using trans iliac-sacral-iliac bars. Three were placed under fluoroscopic control in combination with a frame, and in one patient an image-guided system was used. A postoperative CT confirmed the correct position of the bars in each patient. The complexity and individual variability of the sacrum makes complex preoperative planning of the iliac-sacral-iliac path mandatory.

Adult↗

PubMed1990

Structure of the [2Fe-2S] ferredoxin I from the blue-green alga Aphanothece sacrum at 2.2 A resolution.

Crystals of a [2Fe-2S] ferredoxin (Fd) I with a relative molecular mass of 10,480 were obtained from the blue-green alga Aphanothece sacrum. Each asymmetric unit of the crystal contains four molecules. An electron density map calculated by the single isomorphous replacement method with the anomalous dispersion at 2.5 A resolution was refined by averaging the four molecules in the asymmetric unit. Positional and isotropic thermal parameters for the non-hydrogen atoms of the four molecules and 158 water molecules were refined to an R-factor (R = sigma[Fo-Fc[/sigma Fo) of 0.23 by the restrained least-squares method. The estimated root-mean-square (r.m.s.) error for the atomic positions is 0.3 A. The r.m.s. deviations of equivalent C alpha atoms of the asymmetric-unit molecules superposed by the least-squares method average 0.35 A. The Fd molecule has a structure like the beta-barrel in the molecule of the [2Fe-2S] Fd from Spirulina platensis. A [2Fe-2S] cluster is bonded covalently to the protein molecule by four Fe-S, in which three of the Fe-S bonds are in a loop segment from position 38 to 47. The hydrophobic core inside the beta-barrel is formed by seven conservative residues: Val15, Val18, Ile24, Leu51, Ile74, Ala79 and Ile87. The molecular surface around Tyr23, Tyr80 and the active center may interact with ferredoxin-NADP+ reductase. One of the two iron atoms of the [2Fe-2S] cluster should be more easily reduced than the other because of differences in the hydrogen-bonding scheme and the hydrophobicity around the atoms.

Amino Acid Sequence↗

PubMed1988

Changes in transcutaneous oxygen tension as a result of prolonged pressures at the sacrum.

Prolonged pressures at the patient support interface can lead to the impairment of tissue viability resulting in tissue breakdown, particularly in debilitated individuals. However there are still few clinical guidelines to indicate safe levels of pressure and time for individual tissue areas. The effects of extended loading on transcutaneous oxygen tension (tcPO2) were examined at the sacrum of twenty debilitated subjects, prone to tissue breakdown. Each load was applied for a ten minute period through an indenter incorporating a commercial oxygen electrode. Loads were incremented until the tcPO2 levels were reduced below 2.7 kPa (20 mmHg), at which time the tissue was unloaded. The interface pressure for each applied load was measured. Results are presented in terms of relating applied pressure and time to relative changes in tcPO2. When all the results are combined it is clear that there is a range of applied pressures which significantly reduce the tcPO2 levels. The applied pressures to produce, for example, 50% reduction of the unloaded resting value, ranged from 3.0 kPa (22 mmHg) to 12.2 kPa (92 mmHg). This indicated the individual nature of the tissue response, which should be determined before clinical guidelines of safe pressure levels are established.

Adult↗

PubMed2000

Laparoscopic surgical management of giant post-traumatic lymphocele involving sacrum and the lower extremity.

Lymphocele (collection of lymphatic fluid) is not an uncommon occurrence after trauma, surgical or otherwise. It is commonly associated with kidney transplant surgery and trauma to soft tissues of an extensive nature. In this paper, we report the minimally invasive surgical management of an unusual case of a 30-year-old physician who was involved in a road traffic accident as a result of which he received extensive soft tissue injuries to the sacrum, the right buttock, and the right thigh. Over a period of 3 months, he developed a giant lymphocele that defied three attempts at excision and drainage. The patient underwent successful laparoscopic drainage of the collection with ablation of the lining. Video-assisted surgical drainage and ablation is a safe, effective, and minimally invasive procedure that should be put to wider use and can be used to treat very large lesions.

Adult↗

PubMed1975

A minor component of ferredoxin from Aphanothece sacrum cells.

About 20% of the total extractable ferredoxin from a blue-green alga, Aphanothece sacrum, was separated as a minor component on a DEAE-cellulose column during the preparation of the major component of the cells. It was always found in cells collected in three different seasons. The chemical properties of the minor component was different from those of the major one. The enzymatic activity and spectral properties were those of typical chloroplast-type ferredoxins. The significance of isozymes in ferredoxin is discussed.

Amino Acids↗

PubMed1976

Amino acid sequence of the major component of Aphanothece sacrum ferredoxin.

The amino acid sequence of the major ferredoxin component isolated from a blue-green alga, Aphanothece sacrum, has been fully determined. Chymotryptic and tryptic peptides of carboxymethyl-ferredoxin and chymotryptic peptides of oxidized ferredoxin were prepared and their sequences were analyzed...

Amino Acid Sequence↗

PubMed1978

Crystallization and a 5 A X-ray diffraction study of Aphanothece sacrum ferredoxin.

A chloroplast-type ferredoxin containing two non-heme iron and two labile sulfur atoms per molecule was prepared from Aphanothece sacrum. Crystals were obtained by dialysis against 75% saturated a-monium sulfate solution, and belong to the tetragonal system with cell dimensions a = b = 92.2 A and c = 47.6 A, containing four molecules in an asymmetric unit. The electron density map at 5 A resolution was calculated by using the best phase angles determined by the single isomorphous replacement method coupled with the anomalous dispersion effect. An anomalous dispersion difference Fourier map for the native crystal clearly showed four humps corresponding to the iron atoms in an asymmetric unit. The electron densis surface.

Binding Sites↗

PubMed1990

[A case of thoracic neurilemoma with neurilemomas of the upper limb and sacrum].

A 64-year-old male was admitted in February 24, 1988 because of an abnormal shadow on chest X-ray. The tumor in the thoracic wall was removed at the thoracotomy and histology showed neurilemoma. Aspiration biopsy of tumors on the left upper limb and sacrum revealed the typical histopathologic appearance of neurilemomas. The possibility of malignant transformation and sequential appearance of tumors in patients with a neurilemoma indicates that complete resection and thorough follow-up examination are important.

Humans↗