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BMJ Case Reports Feb 2023Teratomas in the neonatal age group are mostly benign at first, and the common site is the sacrococcygeal region. They are rarely associated with HIV infection. We...
Teratomas in the neonatal age group are mostly benign at first, and the common site is the sacrococcygeal region. They are rarely associated with HIV infection. We report a case of an HIV-exposed newborn with a congenital teratoma at the post-auricular site who developed an infection. Early intervention by total surgical resection will prevent complications such as infections and malignant transformation. A term baby was delivered spontaneously by an HIV-positive mother who was on her regular medications. Prenatal ultrasound carried out in the third trimester showed a cyst swelling on the right post-auricular region. Radiological imaging and the histopathological result revealed a congenital teratoma. A wide major excision with preservation of the facial nerve was performed at the age of 8 weeks. Post-auricular teratomas are the rarest anatomical location and the prevalence of malignant transformation from benign is very low. If left untreated, this tumour is associated with high mortality and malignant transformation rates. An early complete surgical excision allows a good result with a low risk of complications and recurrence.
Topics: Infant; Infant, Newborn; Pregnancy; Female; Humans; HIV Infections; Teratoma; Mothers; Sacrococcygeal Region; Cell Transformation, Neoplastic
PubMed: 36746517
DOI: 10.1136/bcr-2022-252977 -
Clinical Anatomy (New York, N.Y.) May 2023During routine cadaveric dissection, Simonds et al. in 2019 found a previously undocumented ligament, which they termed the midline interlaminar ligament (MIL), in 24...
INTRODUCTION
During routine cadaveric dissection, Simonds et al. in 2019 found a previously undocumented ligament, which they termed the midline interlaminar ligament (MIL), in 24 out of 36 (76.5%) lumbar spinal levels. The MIL is an unpaired ligament located between and distinctly separate from the right and left ligamenta flava (LF). The purpose of this study was to identify the presence or absence of the MIL in the cervical, thoracic, and lumbar spinal regions and obtain detailed measurements of the ligaments' toughness (R) and elastic modulus (E).
MATERIALS AND METHODS
Intact preserved cadaveric vertebrae from C2 to the upper sacral region were dissected. Presence or absence of the MIL was documented, and length and width of each MIL were measured in situ. The R and E of the LFs from corresponding spinal segments were found for comparison.
RESULTS
At least one MIL was observed in 90.3% (28) of specimens. Eighty-eight MIL's were observed out of 186 cervical intervertebral levels (0.5%), 371 thoracic intervertebral levels (5.9%), and 101 lumbar intervertebral levels (63.4%). The mean width and length of the MIL were 1.21 ± 0.36 and 16.37 ± 2.17 mm, respectively. The mean R of the MIL and the LF were 1390.27 and 2068.04 J m , respectively. The mean E of the MILs and LFs was 46.78 ± 16.65 and 51.15 ± 21.68 MPa, respectively.
CONCLUSIONS
Based on our findings, the MIL was present in the majority of vertebrae in our cadaveric population with a predominance for the lumbar region.
Topics: Humans; Lumbar Vertebrae; Ligamentum Flavum; Lumbosacral Region; Neck; Cadaver
PubMed: 36598006
DOI: 10.1002/ca.24003 -
Child's Nervous System : ChNS :... Jan 2023Sacrococcygeal teratoma (SCT) is a rare congenital tumor originating from a variant of extragonadal germ cell neoplasm. Herein, we present three cases of neonatal SCTs... (Review)
Review
PURPOSE
Sacrococcygeal teratoma (SCT) is a rare congenital tumor originating from a variant of extragonadal germ cell neoplasm. Herein, we present three cases of neonatal SCTs undergoing surgical resection and reconstruction. We also review the literature to discuss the importance of proper perinatal management and timely surgical intervention depending on the tumor type and maturity to prevent malignant transformation and recurrence and ensure functional outcomes.
METHODS AND RESULTS
Three cases of SCT were retrospectively analyzed. All infants underwent complete surgical resection of the SCT and coccygectomy during their neonatal/infancy period, followed by pelvic floor and buttock reconstruction while minimizing buttock contour deformity and undesirable skin scar. Two of the cases were histopathologically diagnosed as predominantly cystic mature teratomas of Altman types I and IV, and the third was a mature teratoma of Altman type II. There were no complications or tumor recurrence during the average follow-up period of 5.3 years.
CONCLUSIONS
This case-based review highlights the role of multidisciplinary team approaches, including prenatal monitoring, oncologic resection, and adequate reconstruction according to the type of tumor and anomaly. Optimal perinatal evaluation allows promising oncologic and functional outcomes in terms of timely intervention to eliminate tumor recurrence and malignant transformation. Complete oncologic surgical resection of SCTs should also include proper functional preservation strategies, such as the reconstruction of the pelvic floor, cosmetic buttock contouring, and preservation of bladder and bowel sphincter function.
Topics: Infant; Infant, Newborn; Pregnancy; Female; Humans; Neoplasm Recurrence, Local; Retrospective Studies; Sacrococcygeal Region; Teratoma; Neoplasms, Germ Cell and Embryonal; Spinal Neoplasms; Dermoid Cyst
PubMed: 36422695
DOI: 10.1007/s00381-022-05768-1 -
Chirurgie (Heidelberg, Germany) Dec 2023The incidence of pilonidal sinus shows a steadily rising tendency, especially in the patient age group of up to 40 years. Treatment of this condition is often... (Review)
Review
BACKGROUND
The incidence of pilonidal sinus shows a steadily rising tendency, especially in the patient age group of up to 40 years. Treatment of this condition is often protracted involving lengthy sick leave and an increased risk of recurrence. The optimal treatment of pilonidal sinus remains open to debate, but it should focus on decreasing the length of hospitalization, promoting a rapid return to daily life, maintaining low pain levels, and keeping costs at a minimum.
MATERIALS AND METHODS
In our study conducted between 2017 and 2021, we focused on treatment of pilonidal sinus. We performed 50 elastic ligature procedures with a median observation time of 30 months. The patients were divided into three groups according to the characteristics of pilonidal sinus: (1) acute primary abscess; (2) acute recurrent abscess; and (3) chronic fistula.
RESULTS
Out of a total of 50 patients with a subsequent 30-month follow-up, we observed complete recovery in 47 patients and recurrence in three patients. Return to work was possible immediately after the operation, with an average total treatment time of 1 month for complete healing of the defect.
CONCLUSION
The current results suggest that the technique of elastic ligature is a desirable solution for pilonidal sinus, because of the initial low costs, no need for hospitalization, and good patient tolerance.
PubMed: 38097850
DOI: 10.1007/s00104-023-02014-5 -
Child's Nervous System : ChNS :... Jun 2024Sacral agenesis (SA) includes a range of clinical presentations of varying severity, with implications for function and quality of life (QoL). Diagnosis is often made...
INTRODUCTION
Sacral agenesis (SA) includes a range of clinical presentations of varying severity, with implications for function and quality of life (QoL). Diagnosis is often made perinatally, and prognostic discussions become an important aspect of parental counselling. This study engaged SA sufferers and their caregivers to obtain objective, long-term patient reported outcome data.
METHOD
Patients with radiologically confirmed SA from a single tertiary spinal unit underwent retrospective medical record review. Patients were then contacted by telephone to complete QoL questionnaires including EQ-ED-5L for adults and EQ-ED-Y for < 16-year-olds. Additional information including Renshaw grade, employment, living situation and bladder function was also collected.
RESULTS
Twenty-six patients with SA were identified. Mean age is 23.35 years (range 0.92-63.53), 13 M:17F. Renshaw grade ranged from 1 to 4. Sixty-eight percent had associated kyphoscoliotic deformities. The majority (70%) had either impaired or absent bladder control, and 80% need walking aids to mobilise. Twenty patients completed the questionnaire (10 adults and 10 < 16-year-olds). Mean EQ-ED-5L index for adults was +0.474 (range -0.1 to +0.089, 1 = best), with a lower mean value of +0.287 (range -0.54 to +1) for the < 16-year cohort. Those undergoing spinal fusion procedures had significantly lower scores (-0.08 v +0.44, p = 0.022).
CONCLUSION
This study provides an objective record of the QoL of individuals with SA, illustrating a wide variety of outcomes, with differences between younger and older individuals which may reflect the results of a long-term adaptive process. The implications for individuals should be carefully tailored to the specific deformity and the likely underlying neurological deficits.
Topics: Humans; Female; Male; Adolescent; Adult; Young Adult; Child; Quality of Life; Child, Preschool; Middle Aged; Retrospective Studies; Infant; Sacrum; Surveys and Questionnaires; Treatment Outcome; Abnormalities, Multiple; Meningocele; Sacrococcygeal Region
PubMed: 38411707
DOI: 10.1007/s00381-024-06326-7 -
Indian Journal of Thoracic and... Jan 2022Teratomas are tumors consisting of tissues derived from more than one germ cell line. Usual locations are sacrococcygeal region, intracranial, mediastinum, and gonads....
Teratomas are tumors consisting of tissues derived from more than one germ cell line. Usual locations are sacrococcygeal region, intracranial, mediastinum, and gonads. Entirely intrapulmonary teratomas, with no mediastinal component, are rarely reported. We present the case of a 37-year-old man who presented for evaluation due to persistent and progressive intermittent cough. There was no sputum or hemoptysis. Computed tomography (CT) revealed an irregular, cystic lesion in the upper lobe of his left lung, which raised suspicion for aspergilloma. The patient underwent a left thoracotomy and, after finding a completely collapsed and hypoplastic left lung almost entirely occupied by an irregular mass, a total left pneumonectomy was performed. Pathological review reported an entirely intrapulmonary mature teratoma. Intrapulmonary mature teratomas are extremely rare, although several have been reported. Trichoptysis (expectoration of hair) is a specific finding that may help distinguish this entity from mediastinal teratomas.
PubMed: 34898881
DOI: 10.1007/s12055-021-01180-7 -
Neurourology and Urodynamics Jun 2022To define radiologically anatomic measurements for the S3 foramen and develop an efficient and straightforward implantation protocol for sacral neuromodulation (SNM) in...
AIMS
To define radiologically anatomic measurements for the S3 foramen and develop an efficient and straightforward implantation protocol for sacral neuromodulation (SNM) in a southern Chinese population.
METHODS
We retrospectively reviewed 793 adults without sacrococcygeal abnormalities or bony injury. We generated CT-derived three-dimensional volumetric models and collected radiologically anatomic measurements of S3 foramen. A multiple generalized linear regression model was applied to evaluate implantation protocol for SNM.
RESULTS
Height, weight, and sacral height were significantly different between enrolled patients based on sex (p < 0.001 for all), while age and sacral width were similar. The measurements L1, L2, A1, and A2 on both sides were similar, while based on sex, those of L1, A1, A2 showed significant differences [7.02 ± 0.90 (M) vs. 6.10 ± 0.99 cm (F) (p < 0.001); 83.05 ± 6.23 (M) vs. 82.08 ± 7.53° (F) (p = 0.005); and 13.31 ± 5.69 (M) vs. 11.97 ± 4.91° (F) (p < 0.001), respectively]. The multiple generalized linear regression model demonstrated that sex was a common independent factor for estimating L1, L2, A1, A2, while the consistency rate between the estimated model and actual measurements was poor. The measurements L1, L2, A1, and A2 were approximately 7.0 cm (M) versus 6.1 cm (F), 1.8 cm (M) versus 1.8 cm (F), 83° (M) versus 82° (F), and 13° (M) versus 12° (F), respectively.
CONCLUSIONS
This retrospective study indicates that the radiologically anatomic measurements for the S3 foramen have unique characteristics. Our study provides an efficient and straightforward implantation protocol for SNM, improving its use in China.
Topics: Adult; China; Electric Stimulation Therapy; Humans; Retrospective Studies; Sacrococcygeal Region; Sacrum
PubMed: 35438814
DOI: 10.1002/nau.24933 -
Radiology Case Reports Jun 2024Ewing sarcoma is the second most frequent primary bone tumour of childhood and adolescence. The aim of this report is to describe the imaging, pathology, clinical...
Ewing sarcoma is the second most frequent primary bone tumour of childhood and adolescence. The aim of this report is to describe the imaging, pathology, clinical findings, and treatment of a primary intradural extramedullary Ewing sarcoma with a unique intracranial metastatic component in a pediatric patient. A 14-year-old girl with a history of mood disorders presented to the emergency department with a 3-week history of neck torticollis, cervical pain, paresis, and paresthesia of the upper and lower extremities on the left side. Initially, non-organic causes such as somatization or conversion disorder were suspected. She returned 3 months later when her symptoms worsened. MRI of the head and spine was performed, and demonstrated the presence of a suprasellar, retro-chiasmatic mass lesion. There was also diffuse leptomeningeal enhancement, another well-defined intradural extramedullary lesion the sacral region and several multifocal cauda equina soft tissue nodules. The patient first underwent surgery. The patient was also treated with a combination of chemotherapy (vincristine, doxorubicin and cyclophosphamide alternating with ifosfamide and etoposide (VDC/IE)) and radiation as per the Children's Oncology Group AEWS1221 protocol. Most recent imaging conducted 22 months after the initial mass discovery revealed improvement of the suprasellar mass lesion with residual stable appearance of the prominence and enhancement of the pituitary stalk and tuber cinereum. There was interval improvement of the spinal lesions with no convincing residual. Clinically, at almost three years since initial imaging findings, and 25 months since completing treatment, she is stable from an oncology perspective.
PubMed: 38572274
DOI: 10.1016/j.radcr.2024.02.101 -
Scientific Reports Apr 2021Sacroiliac joint dysfunction (SIJD) is an underappreciated source of back pain. Mineralization patterns of the sacroiliac (SIJ) subchondral bone plate (SCB) may reflect...
Sacroiliac joint dysfunction (SIJD) is an underappreciated source of back pain. Mineralization patterns of the sacroiliac (SIJ) subchondral bone plate (SCB) may reflect long-term adaptations to the loading of the joint. Mineralization densitograms of 27 SIJD patients and 39 controls, were obtained using CT osteoabsorptiometry. Hounsfield unit (HU) values of the SCB mineralization of superior, anterior and inferior regions on the iliac and sacral auricular surfaces were derived and statistically compared between SIJD-affected and control cohorts. Healthy controls showed higher HU values in the iliac; 868 ± 211 (superior), 825 ± 121 (anterior), 509 ± 114 (inferior), than in the sacral side; 541 ± 136 (superior), 618 ± 159 (anterior), 447 ± 91 (inferior), of all regions (p < 0.01). This was similar in SIJD; ilium 908 ± 170 (superior), 799 ± 166 (anterior), 560 ± 135 (inferior), sacrum 518 ± 150 (superior), 667 ± 151 (anterior), 524 ± 94 (inferior). In SIJD, no significant HU differences were found when comparing inferior sacral and iliac regions. Furthermore, HU values in the inferior sacral region were significantly higher when compared to the same region of the healthy controls (524 ± 94 vs. 447 ± 91, p < 0.01). Region mineralization correlated negatively with age (p < 0.01). SIJD-affected joints reflect a high mineralization of the sacral inferior region, suggesting increased SIJD-related mechanical stresses. Age-related SCB demineralization is present in all individuals, regardless of dysfunction.
Topics: Absorptiometry, Photon; Adult; Aged; Bone Density; Bone Plates; Case-Control Studies; Female; Humans; Ilium; Male; Middle Aged; Sacroiliac Joint; Sacrum; Temporomandibular Joint Disc; Tomography, X-Ray Computed
PubMed: 33883625
DOI: 10.1038/s41598-021-88049-2 -
Fetal Diagnosis and Therapy 2020To evaluate the efficiency of percutaneous intratumor laser ablation for fetal solid sacrococcygeal teratoma (SCT). (Comparative Study)
Comparative Study Review
OBJECTIVE
To evaluate the efficiency of percutaneous intratumor laser ablation for fetal solid sacrococcygeal teratoma (SCT).
SUBJECTS AND METHODS
We carried out percutaneous ultrasound-guided intratumor laser ablation through a 17-gauge needle using an output of 40 W in 7 fetuses with large solid SCT and reviewed the literature for minimally invasive therapy for this condition.
RESULTS
Laser ablation was carried out at a median gestational age of 20 (range 19-23) weeks, and in all cases there was elimination of obvious vascularization within the tumor and improvement in cardiac function. Three (43%) babies survived and had surgical excision of the tumor within 2 days of birth, 3 liveborn babies died within 5 days of birth and before surgery, and 1 fetus died within 2 weeks after the procedure. In previous series of various percutaneous interventions for predominantly solid SCT the survival rate was 33% (2/6) (95% CI 9.7-70%) for endoscopic laser to superficial vessels, 57% (4/7) (95% CI 25-84%) for intratumor laser, 67% (8/12) (95% CI 39-86%) for intratumor radiofrequency ablation, and 20% (1/5) (95% CI 3.6-62%) for intratumor injection of alcohol.
CONCLUSIONS
In solid SCT, the reported survival from intratumor laser or radiofrequency ablation is about 50%, but survival does not mean success, and it remains uncertain whether such interventions are beneficial or not because the number of fetuses is small and there were no controls that were managed expectantly.
Topics: Ethanol; Fetal Death; Fetal Diseases; Fetal Therapies; Gestational Age; Hospital Mortality; Humans; Infant; Infant, Newborn; Laser Therapy; Live Birth; Radiofrequency Ablation; Retrospective Studies; Risk Factors; Sacrococcygeal Region; Teratoma; Time Factors; Treatment Outcome
PubMed: 31291630
DOI: 10.1159/000500775