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1/5. Sacral hydatid cysts: an uncommon cause of neurogenic bladder.

    Hydatid cysts of the sacrum are rare entities, characterized by chronicity without any clinical manifestation and are usually misdiagnosed in the early stage resulting in significant loss of bone and destruction of surrounding tissue. One should keep this possibility in mind in cases of early sphincteric involvement with minimal sensorimotor deficit in the lower limbs and bone destruction on radiography.
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2/5. Occlusion of left common iliac vein by a distended urinary bladder in a male with paraplegia due to spinal cord injury.

    STUDY DESIGN: A report of a male subject who sustained paraplegia at T-5 level due to spinal cord injury (SCI) 18 years ago, and in whom, occlusion of the left common iliac vein by a distended bladder was detected during a routine follow-up. OBJECTIVES: To illustrate a rare complication of chronic distension of the urinary bladder viz occlusion of the left common iliac vein, which persisted even after providing adequate bladder drainage by intermittent catheterisation. SETTING: Regional spinal injuries Centre, Southport, UK. methods: As part of a routine follow-up, we performed intravenous urography by injecting 50 ml of Ultravist 300 in a vein over the dorsum of the left foot. Opacification of collateral veins in the pelvis was seen in the 5- and 10-min films, which suggested iliac venous occlusion. In order to confirm the diagnosis, contrast was injected intravenously in the left foot and venography was performed. RESULTS: Venography revealed a distended left common iliac vein with contrast flowing into the right internal iliac vein through collateral veins in the pelvis; the right common iliac vein and inferior vena cava were patent. Duplex Doppler sonography showed compression of left common iliac vein by the posterior wall of a distended bladder with absence of blood flow through the compressed segment. Computerised tomography (CT) confirmed the diagnosis of extrinsic compression of the left common iliac vein against the promontory of sacrum by a distended bladder. CT excluded other causes for iliac vein occlusion. CONCLUSION: In a male subject with SCI, chronic bladder distension produced occlusion of the left common iliac vein. health professionals caring for individuals with SCI should be aware that long-standing bladder distension could cause pressure effects upon adjacent structures in the pelvis.
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keywords = sacrum
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3/5. Nerve sheath tumors involving the sacrum. Case report and classification scheme.

    Nerve sheath tumors that involve the sacrum are rare. Delayed presentation is common because of their slow-growing nature, the permissive surrounding anatomical environment, and nonspecific symptoms. Consequently, these tumors are usually of considerable size at the time of diagnosis. The authors discuss a case of a sacral nerve sheath tumor. They also propose a classification scheme for these tumors based on their location with respect to the sacrum into three types (Types I-III). Type I tumors are confined to the sacrum; Type II originate within the sacrum but then locally metastasize through the anterior and posterior sacral walls into the presacral and subcutaneous spaces, respectively; and Type III are located primarily in the presacral/retroperitoneal area. The overwhelming majority of sacral nerve sheath tumors are schwannomas. Neurofibromas and malignant nerve sheath tumors are exceedingly rare. Regardless of their histological features, the goal of treatment is complete excision. Adjuvant radiotherapy may be used in patients in whom resection was subtotal. Approaches to the sacrum can generally be classified as anterior or posterior. Type I tumors may be resected via a posterior approach alone, Type III may require an anterior approach, and Type II tumors usually require combined anterior-posterior surgery.
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keywords = sacrum
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4/5. Conservative management of transverse fractures of the sacrum with neurological features. A report of four cases.

    Transverse fractures of the sacrum with neurological complications have been studied in four patients illustrating the following features: diagnosis is often delayed, there are radiological difficulties in making the diagnosis, and the indications for surgery are not well defined. Specific radiographic views are recommended. All the cases presented in this report responded well to conservative management.
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5/5. Sacral dysgenesis associated with occult spinal dysraphism causing neurogenic bladder dysfunction.

    A case of a neurogenic bladder in a 20-year-old man is described. The patient had difficulty in voiding and incontinence, with a history of several urinary infections. Misdiagnoses included stricture and posterior urethral valves. Early treatment included urethral dilation, a transurethral resection and a left ureteral implantation. Throughout this time the neurological examinations were essentially normal. Final diagnosis was sacral dysgenesis with associated occult spinal dysraphism, after the discovery of a small pock mark over the sacrum and an abnormal pelvic x-ray. urinary diversion was done.
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