Rare sacral extradural grade II ependymoma: a comprehensive review of literature

Sacral spinal cord ependymoma is an uncommon pathology. Most of the reported cases are consistent with a myxopapillary ependymoma histopathologic subtype. Non-myxopapillary ependymomas rarely occur in the sacral region. Most lesions are intradural; however, rare extradural cases can occur. We present the case of a 46-year-old female patient diagnosed with a grade II sacral extradural ependymoma, emphasising the importance of an interdepartmental case approach for diagnosis and management. Even though grade II ependymomas are considered low grade, the potential for recurrence and metastatic disease has been reported. There are no treatment guidelines for these rare tumours besides gross total resection.

Feature selection to classify lameness using a smartphone-based inertial measurement unit

Background and objectives Gait can be severely affected by pain, muscle weakness, and aging resulting in lameness. Despite the high incidence of lameness, there are no studies on the features that are useful for classifying lameness patterns. Therefore, we aimed to identify features of high importance for classifying population differences in lameness patterns using an inertial measurement unit mounted above the sacral region. Methods Features computed exhaustively for multidimensional time series consisting of three-axis angular velocities and three-axis acceleration were carefully selected using the Benjamini–Yekutieli procedure, and multiclass classification was performed using LightGBM (Microsoft Corp., Redmond, WA, USA). We calculated the relative importance of the features that contributed to the classification task in machine learning. Results The most important feature was found to be the absolute value of the Fourier coefficients of the second frequency calculated by the one-dimensional discrete Fourier transform for real input. This was determined by the fast Fourier transformation algorithm using data of a single gait cycle of the yaw angular velocity of the pelvic region. Conclusions Using an inertial measurement unit worn over the sacral region, we determined a set of features of high importance for classifying differences in lameness patterns based on different factors. This completely new set of indicators can be used to advance the understanding of lameness.

A CASE STUDY: ANUVASANA BASTI WITH KETAKYADI TAILAM IN LOW BACKACHE

Low back ache is the pain in the lumbo-sacral region triggered by combination of factors like muscle strain, overuse, injury or trauma to muscles, ligaments and disc that support the spine. A diagnosed case of Low back ache came with complaints of pain over low back region, stiffness and limitation in the movements of lumbo-sacral joint since 2 years. There was no history of trauma or fall and other systemic illness. A positive family history was noted. In Ayurveda, it can be correlated with Asthigata vata and deranged Vata dosha is the main cause for pain. The primordial treatment for Vata dushti is Basti, especially Anuvasana vasti. Ketakyadi taila is very effective in Asthigata vata. So Anuvasana Basti with Ketakyadi tailam is administered continuous 9 days. The clinical symptoms like low back pain and stiffness got relieved markedly on 5th day itself. After the entire treatment the condition of the patient improved remarkably.

INCIDENCE AND FACTORS RELATED TO THE APPEARANCE OF PRESSURE INJURIES IN AN INTENSIVE CARE UNIT

Objectives: identify the incidence and characterize pressure injuries in an adult intensive care unit regarding the occurrence, locations and risk factors, and verify whether there is an association between these and the appearance of the injuries. Method: observational, cohort, prospective study, developed in an intensive care unit of a tertiary hospital, from October to December 2019. The population consists of adults on the first day of admission to the unit, without pressure injury at admission. Participants were monitored during hospitalization, sociodemographic and clinical variables, and risk assessment of developing a pressure injury, skin assessment and Braden scale were collected daily. Pearson’s chi-square tests and student’s t-test were used to assessing the relationship between variables and injuries. For the analyzes, a significance level (α) of 5% was considered. Results: 40 participants were included, 20% had pressure injuries with a predominance of stages 1 and 2; the main affected sites were the sacral region followed by the calcaneus. The average hospital stay was 23.38 days for the injured group and 5.77 days for the non-injured group; time showed a significant relationship with the appearance of lesions (p = 0.002). Conclusion: it was concluded that the most affected site was the sacral region and grade 1 was the most frequent staging; length of stay was the variable that influenced the appearance of injuries.

Subchondral Bone Changes Following Sacroiliac Joint Arthrodesis – A Morpho-mechanical Assessment of Surgical Treatment of the Painful Joint

Background: Sacroiliac joint arthrodesis is an ultima ratio treatment option for sacroiliac joint dysfunction. Fusion drastically reduces sacroiliac joint movement providing long-lasting pain-relief associated with tension-relief to the innervated sacroiliac joint structures involved in force closure. Objectives: To display the bone mineralization distribution patterns of the subchondral bone plate in 3 distinct regions (superior, anterior, and inferior) of the sacral and iliac counterparts of the sacroiliac joint pre- and post-sacroiliac joint arthrodesis and compare patterns of sacroiliac joint dysfunction postsacroiliac joint fusion with sacroiliac joint dysfunction pre- arthrodesis patterns and those from healthy controls. Study Design: An observational study. Setting: The research took place at the University of Basel, Switzerland, where the specific image analysis program (Analyze, v7.4, Biomedical Imaging Resources, Mayo Foundation, Rochester, NY, USA) was made available. Methods: Mineralization densitograms of 18 sacroiliac joint dysfunction patients pre- and post-sacroiliac joint arthrodesis (≥ 6, ≥ 12, and ≥ 24 months post-surgery) were obtained using computed tomography osteoabsorptiometry. For each patient, pre- vs. post-surgery statistical comparisons were undertaken, using the Hounsfield unit values derived from the subchondral mineralization of superior, anterior, and inferior regions on the iliac and sacral auricular surfaces. Post-operative values were also compared to those from a healthy control cohort (n = 39). Results: In the pre-operative cohort at all 3 follow-up times, the superior iliac region showed significantly higher Hounsfield unit values than the corresponding sacral region (P < 0.01). Mineralization comparisons were similar for the sacrum and ilium in the anterior and inferior regions at all follow-up points (P > 0.5) with no surgery-related changes. Sacral density increased significantly in the post-operative state; not observed on the ilium. Post-operative sacroiliac joints showed a significantly increased mineralization in the superior sacrum after ≥ 6 months (P < 0.05), not replicated after ≥ 12 nor ≥ 24 months. Further comparison of post-operative scans versus healthy controls revealed significantly increased mineralization in the superior sacral region at (≥) 6, 12, and 24 months (P < 0.01), likely related to bone grafting, and in the anterior and inferior regions in post-operative scans at ≥ 12 and ≥ 24 months follow-up (P < 0.05). Limitations: The given study is limited in sample size. Post-operative computed tomography scans had screws which may have left artifacts or partial volume effects on the surfaces. Healthy controls were different patients to the sacroiliac joint dysfunction and post-operative cohorts. Both cohorts were agematched but this comparison did not take into account potential population differences. Size differences in the regions may have also been an influencing factor of the results as the regions were based on the size and shape of the articular surface. Conclusions: Sacroiliac joint arthrodesis results in an increased morpho-mechanical conformity in the anterior and inferior sacrum and reflects variable morpho-mechanical density patterns compared to the healthy state due to permanent alterations in the kinematics of the posterior pelvis. Key words: Bone mineral density, bone mineralization, computed tomography, Hounsfield units, osteoabsorptiometry, sacroiliac, sacroiliac joint arthrodesis, sacroiliac joint fusion, sacroiliac joint dysfunction, subchondral bone plate

Spinal Perineural Cysts among European Patients

Background A perineural (Tarlov) cyst is a fluid-filled lesion occurring between the perineurium and the endoneurium of spinal nerve roots. The aim of the study was to evaluate the prevalence and morphology of perineural cysts, detected incidentally in patients with symptomatic degenerative disk disease. Materials/methods The study was based on the retrospective data gathered during magnetic resonance imaging (MRI) examinations. Results and Conclusions Out of 3,128 spinal MRI examinations, perineural cysts were detected in 286 patients (9%). The cysts were most commonly observed in the sacral region, followed by thoracic, cervical, and lumbar regions. Cysts were more common in women than in men and the average age of patients was 54.8 years. In the majority, a single cyst was found. The average longest dimension of the lesion was 11.72 mm.

Rare presentation of rectal duplication cyst as perineal hernia in an adult

Rectal duplication cysts are rare congenital anomalies of the gastrointestinal tract. They can present with pain, gastrointestinal bleeding, infection or compressive symptoms on the rectum and urinary bladder. A 79-year-old man presented with a 8×5 cm swelling in the sacral region above the natal cleft with a positive cough impulse. During surgical exploration, there were two cysts with the posterior one presenting as the hernia. The cyst was excised and histopathological examination confirmed a diagnosis of rectal duplication cyst. Rectal duplications can lie anterior or more commonly posterior to the rectum. Differential diagnoses include dermoid cyst, diverticular cyst, sacrococcygeal teratoma or meningocele and endoscopic ultrasound is imaging of choice for diagnosis. Surgical excision is the treatment of choice. This is a rare presentation of a rectal duplication cyst as a perineal hernia with only a handful of cases in literature.

Recurrent Sacral Chordoma: A Case Report

Chordoma is a rare and locally aggressive tumor that arises from the notochordal remnants and has an incidence of 0.1/100000 per year. It has a predilection for the axial skeleton and is the most common primary malignant tumor of sacrum. The mainstay of treatment is wide surgical excision but there is a risk of recurrence due to the infiltrating nature of the tumor. Here, we report a case of a 56-years male who complained of pain over his sacral region for the past two years along with episodic urinary symptoms, constipation, and weakness of both legs. Seven years after undergoing surgery and radiotherapy for his sacral chordoma, he was diagnosed with recurrent sacral chordoma and planned for reoperation. Subtotal excision of the chordoma was done which significantly alleviated his symptoms postoperatively. Timely intervention helps to improve the quality of life in patients with either primary or recurrent sacral chordomas.

A COMPARATIVE CLINICAL STUDY ON PARISHEKA SWEDA WITH VISHAGARBHA TAILA AND TILA TAILA IN KATIGRAHA

Swedana Karma is one among the Shadupakrama (Six treatment modalities), indicated in the management of various diseases caused by Vata. Parisheka Sweda is a type of Drava Sweda which can be applied as Ekanga (over a body part) or Sarvanga (whole body). Katigraha (low back pain with stiffness) is a condi-tion which is characterized by Shoola (pain) and Stabdhata (stiffness) in Kati Pradesha (lumbo - sacral region) due to vitiated Vata. Swedana helps to relieve the pain and stiffness. Parisheka Sweda acts over whole Kati Pradesha (lumbo - sacral region), hence it will be more beneficial in this condition. Vishagarbha Taila contains Tikshna and Ushna Guna drugs and is specially indicated in Katigraha (low back pain with stiffness). Tila Taila is best among Vatahara Dravyas. Hence this study was undertaken to compare the efficacy of Parisheka Sweda with Vishagarbha Taila and Tila Taila in the management of Katigraha (low back pain with stiffness) to ascertain the better modality. Total 40 patients were randomly selected and divided in two equal groups. Group VT patients were given Vishagarbha Taila Parisheka Sweda and group TT patients were given Tila Taila Parisheka Sweda for half an hour once a day for 1 week over Kati Pradesha (lumbo - sacral region). Statistical analysis showed that both groups showed good improvement in various parameters of Katigraha (low back pain with stiffness). When comparison was done between the groups, it revealed that there was no statistically significant difference between the groups except in stiffness (p<0.001) and left lateral flexion (p<0.05). Hence it can be concluded that both Vishagarbha Taila Parisheka Sweda and Tila Taila Parisheka Sweda may be accepted in treating patients with Katigraha (low back pain with stiffness) to reduce both signs and symptoms successfully.