Coccyx
Sacrum
Chordoma
Teratoma
Perforator Flap
Effects of short term sacral nerve stimulation on anal and rectal function in patients with anal incontinence. (1/166)
BACKGROUND: Some patients with faecal incontinence are not amenable to simple surgical sphincter repair, due to sphincter weakness in the absence of a structural defect. AIMS: To evaluate the efficacy and possible mode of action of short term stimulation of sacral nerves in patients with faecal incontinence and a structurally intact external anal sphincter. PATIENTS: Twelve patients with faecal incontinence for solid or liquid stool at least once per week. METHODS: A stimulating electrode was placed (percutaneously in 10 patients, operatively in two) into the S3 or S4 foramen. The electrode was left in situ for a minimum of one week with chronic stimulation. RESULTS: Evaluable results were obtained in nine patients, with early electrode displacement in the other three. Incontinence ceased in seven of nine patients and improved notably in one; one patient with previous imperforate anus and sacral agenesis had no symptomatic response. Stimulation seemed to enhance maximum squeeze pressure but did not alter resting pressure. The rectum became less sensitive to distension with no change in rectal compliance. Ambulatory studies showed a possible reduction in rectal contractile activity and diminished episodes of spontaneous anal relaxation. CONCLUSIONS: Short term sacral nerve stimulation notably decreases episodes of faecal incontinence. The effect may be mediated via facilitation of striated sphincter muscle function, and via neuromodulation of sacral reflexes which regulate rectal sensitivity and contractility, and anal motility. (+info)Subcutaneous sacrococcygeal myxopapillary ependymoma. (2/166)
We report a case of myxopapillary ependymoma presenting as a primary tumor of the subcutaneous tissue in the sacrococcygeal region. The mass was large, well-encapsulated, lobulated, and multiseptated, with varying signal intensity on T1- and T2-weighted MR images caused by hemorrhagic necrosis, blood degradation products, and calcification. Only a small viable portion enhanced after administration of contrast material. Multiple lobules formed from fibrous septa and dystrophic calcification also characterize this tumor. (+info)Chemical activation of cervical cell bodies: effects on responses to colorectal distension in lumbosacral spinal cord of rats. (3/166)
We have shown that stimulation of cardiopulmonary sympathetic afferent fibers activates relays in upper cervical segments to suppress activity of lumbosacral spinal cells. The purpose of this study was to determine if chemical excitation (glutamate) of upper cervical cell bodies changes the spontaneous activity and evoked responses of lumbosacral spinal cells to colorectal distension (CRD). Extracellular potentials were recorded in pentobarbital-anesthetized male rats. CRD (80 mmHg) was produced by inflating a balloon inserted in the descending colon and rectum. A total of 135 cells in the lumbosacral segments (L(6)-S(2)) were activated by CRD. Seventy-five percent (95/126) of tested cells received convergent somatic input from the scrotum, perianal region, hindlimb, and tail; 99/135 (73%) cells were excited or excited/inhibited by CRD; and 36 (27%) cells were inhibited or inhibited/excited by CRD. A glutamate (1 M) pledget placed on the surface of C(1)-C(2) segments decreased spontaneous activity and excitatory CRD responses of 33/56 cells and increased spontaneous activity of 13/19 cells inhibited by CRD. Glutamate applied to C(6)-C(7) segments decreased activity of 10/18 cells excited by CRD, and 9 of these also were inhibited by glutamate at C(1)-C(2) segments. Glutamate at C(6)-C(7) increased activity of 4/6 cells inhibited by CRD and excited by glutamate at C(1)-C(2) segments. After transection at rostral C(1) segment, glutamate at C(1)-C(2) still reduced excitatory responses of 7/10 cells. Further, inhibitory effects of C(6)-C(7) glutamate on excitatory responses to CRD still occurred after rostral C(1) transection but were abolished after a rostral C(6) transection in 4/4 cells. These data showed that C(1)-C(2) cells activated with glutamate primarily produced inhibition of evoked responses to visceral stimulation of lumbosacral spinal cells. Inhibition resulting from activation of cells in C(6)-C(7) segments required connections in the upper cervical segments. These results provide evidence that upper cervical cells integrate information that modulates activity of distant spinal neurons responding to visceral input. (+info)Non-linear membrane properties of sacral sphincter motoneurones in the decerebrate cat. (4/166)
1. Responses to pudendal afferent stimulation and depolarizing intracellular current injection were examined in sacral sphincter motoneurones in decerebrate cats. 2. In 16 animals examined, 2-10 s trains of electrical stimulation of pudendal afferents evoked sustained sphincter motoneurone activity lasting from 5 to >50 s after stimulation. The sustained response was observed in: 11 animals in the absence of any drugs; two animals after the intravenous administration of 5-hydroxytryptophan (5-HTP; <= 20 mg kg-1); one animal in which methoxamine was perfused onto the ventral surface of the exposed spinal cord; and two animals following the administration of intravenous noradrenergic agonists. 3. Extracellular and intracellular recordings from sphincter motoneurones revealed that the persistent firing evoked by afferent stimulation could be terminated by motoneurone membrane hyperpolarization during micturition or by intracellular current injection. 4. Intracellular recordings revealed that 22/40 sphincter motoneurones examined displayed a non-linear, steep increase in the membrane potential in response to depolarizing ramp current injection. The mean voltage threshold for this non-linear membrane response was -43 +/- 3 mV. Five of the 22 cells displaying the non-linear membrane response were recorded prior to the administration of 5-HTP; 17 after the intravenous administration of 5-HTP (<= 20 mg kg-1). 5. It is concluded that sphincter motoneurones have a voltage-sensitive, non-linear membrane response to depolarization that could contribute to sustained sphincter motoneurone firing during continence. (+info)Combined anomaly of intramedullary arteriovenous malformation and lipomyelomeningocele. (5/166)
We report a rare situation in which a lipomyelomeningocele and an intramedullary arteriovenous malformation (AVM) occurred together at the T11-L1 level in a 44-year-old man. MR images showed a hypervascular lesion intradurally and a fatty component extradurally. Spinal angiography revealed this lesion to be an intramedullary AVM with multiple feeding arteries from the right T12 and left T10 intercostal artery and the left L1 lumbar artery, drained by tortuous, dilated, perimedullary veins. (+info)Sacral chordoma--a case report. (6/166)
Chordoma, a rare malignant tumour of early adulthood, rarely presents in children. We report such a case of rare malignant tumour which was diagnosed in the first decade of life. (+info)Isolated cardiac metastasis from sacral chordoma. (7/166)
A 64-year-old woman presented with right heart failure caused by a cardiac tumor centered in the free wall of the right ventricle, accompanied by pericardial effusion. A match between the biopsy specimen and tissue removed 4 years earlier resulted in the diagnosis of a cardiac metastasis from a chordoma. Immunohistochemical staining was also useful in establishing the diagnosis. To alleviate the right ventricular outflow obstruction, a palliative operation was planned, resecting the tumor and performing a right ventriculoplasty, which was cancelled due to the extent of infiltration of the tumor, and instead a right atrium to pulmonary artery shunt was attempted using a vascular prosthesis, only to fail due to an inability to maintain blood flow through the prosthesis. Presently there are no definitive treatment options available, and some palliative chemotherapy is being performed. Single cardiac metastases from a chordoma are extremely rare. (+info)Infantile arachnoid cyst compressing the sacral nerve root associated with spina bifida and lipoma--case report. (8/166)
A 2-year-old boy presented with a rare sacral arachnoid cyst manifesting as gait disturbance. Neuroimaging revealed an intradural cyst in the sacral nerve root sheath associated with spina bifida occulta and a lipoma at the same level. At surgery, the conus medullaris was situated at the L-1 level and not tethered. The highly pressurized arachnoid cyst had exposed the dural sheath of the left S-2 nerve root and compressed the adjacent nerves. An S-2 nerve root pierced through the cyst. There was no communication between the cyst and spinal arachnoid space. We thought the one-way valve mechanism had contributed to the cyst enlargement and the nerve compression. Radical resection of the cyst was not attempted. A cyst-subarachnoid shunt was placed to release the intracystic pressure. Postoperatively, his gait disturbance improved and no deterioration occurred during the 4-year follow up. Both tethered cord syndrome and sacral arachnoid cyst in the nerve root sheath should be considered in pediatric progressive gait disturbance. Cyst-subarachnoid shunt is an alternative method to cyst resection or fenestration to achieve neurological improvement. (+info)The sacrococcygeal region is the lower part of the back where the spine ends, specifically referring to the area where the sacrum (a triangular bone at the base of the spine formed by the fusion of several vertebrae) meets the coccyx (also known as the tailbone). This region is located at the very bottom of the spine and is susceptible to injury or trauma due to its position and role in supporting the body's weight. It is also a common site for birth defects, particularly in newborns.
The coccyx, also known as the tailbone, is the small triangular bone at the bottom of the spine in humans and other primates. It is formed by the fusion of several small vertebrae and serves to attach muscles and ligaments in the pelvic region. The coccyx can be a source of pain and discomfort if it is injured or becomes inflamed.
A pilonidal sinus is a small hole or tunnel in the skin that usually develops in the cleft at the top of the buttocks. It can be painful and may become infected, causing symptoms such as redness, swelling, pain, and pus discharge. The condition often affects young adults and is more common in men than women.
The term "pilonidal" comes from the Latin words "pilus," meaning hair, and "nidus," meaning nest. This refers to the fact that the sinus often contains hairs that have become embedded in the skin. The exact cause of pilonidal sinuses is not known, but they are thought to develop as a result of ingrown hairs or chronic irritation in the affected area.
Treatment for pilonidal sinuses typically involves surgical removal of the sinus and any associated hair follicles. In some cases, this may be done using a minor procedure that can be performed in a doctor's office. More complex cases may require hospitalization and a more extensive surgical procedure. After surgery, patients will need to take steps to prevent the sinus from recurring, such as keeping the area clean and avoiding prolonged periods of sitting or driving.
The sacrum is a triangular-shaped bone in the lower portion of the human vertebral column, located between the lumbar spine and the coccyx (tailbone). It forms through the fusion of several vertebrae during fetal development. The sacrum's base articulates with the fifth lumbar vertebra, while its apex connects with the coccyx.
The sacrum plays an essential role in supporting the spine and transmitting weight from the upper body to the pelvis and lower limbs. It also serves as an attachment site for various muscles and ligaments. The sacral region is often a focus in medical and chiropractic treatments due to its importance in spinal stability, posture, and overall health.
A chordoma is a rare, slow-growing tumor that typically develops in the bones of the spine or skull. These tumors originate from remnants of the notochord, a structure that forms during embryonic development and eventually becomes part of the spinal cord. Chordomas are usually low-grade malignancies but can be aggressive and locally invasive, potentially causing pain, neurological symptoms, or structural damage to the spine or skull. Treatment typically involves surgical resection, often combined with radiation therapy.
A teratoma is a type of germ cell tumor, which is a broad category of tumors that originate from the reproductive cells. A teratoma contains developed tissues from all three embryonic germ layers: ectoderm, mesoderm, and endoderm. This means that a teratoma can contain various types of tissue such as hair, teeth, bone, and even more complex organs like eyes, thyroid, or neural tissue.
Teratomas are usually benign (non-cancerous), but they can sometimes be malignant (cancerous) and can spread to other parts of the body. They can occur anywhere in the body, but they're most commonly found in the ovaries and testicles. When found in these areas, they are typically removed surgically.
Teratomas can also occur in other locations such as the sacrum, coccyx (tailbone), mediastinum (the area between the lungs), and pineal gland (a small gland in the brain). These types of teratomas can be more complex to treat due to their location and potential to cause damage to nearby structures.
A perforator flap is a type of surgical tissue transfer that involves the relocation of skin, fat, and sometimes muscle or fascia (the layer of connective tissue surrounding muscles) based on a specific blood vessel called a perforator. These vessels pass through the deeper fascial layers to supply the overlying skin and subcutaneous tissues.
Perforator flaps are designed to minimize donor site morbidity by preserving the underlying muscle and maximizing functional outcomes, as only the necessary amount of tissue is taken along with the perforator vessel. The versatility and reliability of these flaps have expanded their application in various reconstructive procedures, such as breast reconstruction, extremity reconstruction, and head and neck reconstruction.
The success of a perforator flap depends on careful preoperative planning, precise identification, and preservation of the perforating vessels during surgery. Commonly used techniques for perforator flaps include the deep inferior epigastric artery perforator (DIEP) flap, superior gluteal artery perforator (SGAP) flap, and anterolateral thigh (ALT) perforator flap.
Spinal neoplasms refer to abnormal growths or tumors found within the spinal column, which can be benign (non-cancerous) or malignant (cancerous). These tumors can originate in the spine itself, called primary spinal neoplasms, or they can spread to the spine from other parts of the body, known as secondary or metastatic spinal neoplasms. Spinal neoplasms can cause various symptoms, such as back pain, neurological deficits, and even paralysis, depending on their location and size. Early diagnosis and treatment are crucial to prevent or minimize long-term complications and improve the patient's prognosis.