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The study investigates the effectiveness of blind and ultrasound-guided epidural injections in Egyptian donkeys in the sacrococcygeal region, a topic of limited research, by comparing and assessing their onset in 20 healthy adult donkeys of both sexes. In the first group, we used ten cadaver donkeys that were humanely euthanized. In the second group, we used 10 live, healthy adult donkeys to assess the efficacy and time of analgesia onset for blind and ultrasound-guided epidural injections at the sacrococcygeal region. Cadavers were randomly designated to blind (n = 5) or US-guided (n = 5) epidural injections at the sacrococcygeal region in sternal recumbency in donkeys using Methylene Blue (1%) as a diagnostic marker for caudal epidural injection. The injection criteria were comparatively assessed between the two techniques of injection. Our findings comparing the blind and US-guided injection approaches showed substantially higher needle accuracy penetration to comparatively assess these two injection techniques. Both injection difficulties and trial numbers were significantly greater in blind techniques as opposed to US-guided procedures. US-guided injection procedures revealed the effectiveness of the time needed for perfect placement of the needle was significantly less than with a blind one. A shorter time for the onset of analgesia was achieved with the ultrasound-guided method, although the difference was not statistically significant (P < 0.09). In conclusion, the ultrasound-guided technique of the epidural injection provided a number of benefits over the blind one, including the capacity to directly view the needle and distribute local anesthetic and avoid unintentional vascular damage, in comparison with traditional blind techniques. Our study aims to enhance the accuracy and safety of epidural anesthesia injection at the sacrococcygeal space in Egyptian donkeys using ultrasound guidance in the veterinary surgical field. [ABSTRACT FROM AUTHOR]

Sacral neuromodulation (SNM) as an advanced form of neuromodulation technique, which has demonstrated significant efficacy in alleviating clinical symptoms for patients with pelvic floor dysfunction (PFD) who do not respond to conventional treatments. This paper provides a comprehensive review of the application and progress of SNM in the treatment of PFD. It covers its historical development, mechanisms of action, clinical applications, optimization of stimulation parameters, and several technological innovations that have facilitated its clinical adoption. The aim is to promote wider clinical application of SNM and offer more precise treatment options for patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective To summarize the multidisciplinary treatment model for the whole process of prenatal and postpartum period and outcomes of fetal sacrococcygeal teratoma (FSCT). Methods A retrospective study was conducted for the relevant clinical data of FSCT neonates diagnosed antenatally and managed with a perinatal multidisciplinary diagnostic and therapeutic mode from January 2015 to June 2024. Prenatal data were collected, including ultrasonic assessment parameters during pregnancy such as tumor volume (TV), tumor volume index (TVI), tumor volume/fetal weight (TFR), SCT growth rate (SCTs), cardiac output (CCO), presence of fetal edema and polyhydramnios. Based upon the longest diameter of tumor measured during pregnancy, they were divided into two groups of high-risk (diameter > 10 cm, 11) and low-risk (diameter 10 cm, n=33). And general clinical profiles and perinatal clinical outcomes were compared between two groups. Results Among 44 neonates of FSCT, there were 28 live births with a median gestational age of 38.3(30.28- 44.28) week, including 10 preterm births. There were 27 survivors (96.43%) and 1 death (3.57%). Twenty- seven surviving neonates underwent complete surgical resection in neonatal period with a median operative age of 6(3-15) day and a median hospitalization stay of 15 (942) day. Two cases (7.4%) recurred. The high risk group had an earlier diagnosis of fetal age (19.57 s. 30. 428 week, P=0.009), larger maximum tumor diameter (140 vs 62 mm, P=0.001), maximal TV (1068.03 vs. 72.38 cm³, P=0.001), initial TVI (38.9 vs. 2.67,P=0.001), maximal TVI (124.25 vs. 8. 10, P=0.001), initial TFR (0.24 vs. 0.02, P=0.001), maximal TFR (0.38 vs. 0.03, P=0.001) and SCTs (181.04 vs. 15. 19 ³cm/week, P=0.001). All were significantly higher than those in low-risk group with statistically significant differences. The high-risk group had a significantly higher proportion of high combined cardiac index (CCO) (45.45% vs .8.11%,P=0.007), polyhydramnios (36.36% vs. 2.70%, P=0.005) and risk of preterm birth (63.64% vs. 16.67%,P=0.011) than low- risk group with statistically significant differences (P<0.05). No statistically significant inter-group difference existed in survival rate (72.73% vs. 57.58%,P=0.486). The multidisciplinary treatment model for the entire process of prenatal and postpartum has been in operation for nearly 10 years, and the induction and mortality rates of FSCT have gradually decreased, while the survival rate has continued to rise. Conclusions Prenatal diagnosis and precise assessment of tumors in FSCT shall facilitate appropriate counseling during prenatal period and post-delivery management. Early identification and refined management of high-risk FSCT cases, along with active exploration of delivery and surgical timing, are essential for optimizing clinical outcomes, With standardized management of multidisciplinary treatment throughout perinatal period, the prognosis for FSCT is excellent and such a practice is worthy of wider promotion. [ABSTRACT FROM AUTHOR]

Background: sacrococcygeal pilonidal disease is a common and frustrating problem, surgical and nonsurgical methods have been described for treatment of pilonidal disease, however the optimal treatment has yet to be found. There's variety of surgical procedures for managing this disease such as simple primary closure and rhomboid flap closure. Aim of the Study: to compare the outcome of simple excision with primary closure vs. excision and closure with rhomboid flap. Methodology: prospective study conducted at Shar Educational hospital/ Sulaymaniyah/ Iraq and involved 50 patients that were randomly divided into two equal groups: Group A: undergo simple primary closure, Group B: submitted to rhomboid flap closure. Results: the mean age of the study sample (n=50) was 28.67 ± 6.29 years with male predominancy, the mean operative times was 40.34 minutes for group A and 53.91 minutes for group B, Patients who undergo rhomboid flap procedures reported lower postoperative pain, earlier surgical drain removal, shorter post operative hospital stays, quicker return to daily activities with lower post operative complication and recurrence rate compared to group A patients. Conclusions: rhomboid flap procedures offer several potential advantages over simple closure surgeries despite longer operative time including lower postoperative pain levels, shorter hospital stays, quicker return to daily activities, and lower rates of postoperative complications [ABSTRACT FROM AUTHOR]

Extrarenal teratoid Wilms' tumor (TWT) is a variant of Wilms' tumor with fewer than 30 cases reported in the literature. It comprises more than 50% heterologous tissue and presents a significant diagnostic challenge due to its complex histology. We report an unusual case of mediastinal teratoma with nephroblastomatous elements in an 8-year-old female. The patient presented with respiratory distress, fever, weight loss, and a large anterior mediastinal mass. Imaging revealed a heterogeneous tumor containing fat, fluid, and calcification, suggestive of a teratoma. Surgical resection confirmed a mature cystic teratoma with foci of nephroblastoma. Pathological analysis demonstrated a mixture of ectodermal, mesodermal, and endodermal tissues alongside nephroblastomatous components. Immunohistochemistry was positive for Wilms Tumor 1 and other relevant markers, confirming the diagnosis. The patient had an uneventful postoperative course and was discharged after three days. This case adds to the growing body of research on extrarenal TWT, particularly its occurrence in the mediastinum, a rare site for such tumors. A literature review highlighted that extrarenal TWT often affects children, typically presenting in the retroperitoneum or sacrococcygeal regions, with varying recurrence rates and long-term outcomes. This case underscores the importance of histopathological and immunohistochemical analysis in diagnosing TWT and differentiating it from other mediastinal tumors to ensure appropriate treatment planning, emphasizing the need for long-term follow-up due to the potential for recurrence or metastasis. This paper also provides an in-depth look at nephron development and nephrogenic rests, highlighting the structural and functional aspects of nephrogenesis and the factors that disrupt it in fetal kidneys. [ABSTRACT FROM AUTHOR]

Germ cell tumors (GCTs) are categorized as gonadal or extra‐gonadal, based on the origin. Extra‐gonadal GCTs predominantly manifest within the central nervous system (CNS), mediastinum, retroperitoneum, and sacrococcygeal region. These malignancies are most frequently diagnosed in the pediatric, adolescent, and young adult demographics. Incidences of GCT within the nasal cavity are notably scarce, with only six cases documented. This report details the case of a 70‐year‐old man who presented with a left nasal mass ultimately diagnosed as immature teratoma. A remarkable aspect of this case was the detection of SMARCA4 (BRG1) loss through immunohistochemical analysis. In addition, methylation profiling aligned this case with CNS GCTs, specifically those classified as non‐germinomatous GCTs. This molecular characterization informed a tailored therapeutic strategy incorporating carboplatin and etoposide, alongside localized irradiation. This individualized treatment regimen achieved favorable outcomes, with the patient remaining recurrence free for over three years. This highlights the need for precise therapeutic approaches in the management of extragonadal GCTs, particularly those arising in atypical anatomical locations. The present case accentuates the significance of thorough diagnostic evaluations and customized treatment plans for rare GCT presentations. Further empirical and clinical investigations are warranted to enhance our understanding of and refine therapeutic protocols for such exceptional cases. [ABSTRACT FROM AUTHOR]

Presacral tumors are extremely rare tumors in adults. Such lesions are often found incidentally. The strange presentation of lesions in the pre-sacral space and the ambiguity of its clinical presentation makes it difficult to establish its diagnosis as the first possibility. Given that several germ lines converge in this presacral space, it is possible to find a variety of lesions, one of the rarest being neuroendocrine tumors. We present a case of 34-year-old female diagnosed with pre-sacral mass that was surgically resected, with histologic studies showing a mature cystic teratoma with neuroendocrine tumor.

Objective: Rare coexistence of disease or pathology Background: Epithelial neoplasms are the most common and heterogenous group of ovarian tumors. Approximately 10- 15% are primary ovarian mucinous neoplasms. Almost 80% of these consist of benign mucinous neoplasms, while the rest are borderline neoplasms, non-invasive (intraepithelial and intraglandular) carcinomas, and invasive carcinomas. Small ovarian cystadenomas are generally asymptomatic and are mainly found incidentally during an ultrasound examination for another gynecologic disorder. As their size increases, nonspecific symptoms and clinical signs develop as a result of mass effect to adjacent structures or because of tumor torsion. The main clinical symptoms are abdominal and/or pelvic pain, fullness, and discomfort. Large cystadenomas have also been associated with nausea and vomiting, urinary problems, persistent cough, back pain, metrorrhagia, and feminization. Case Report: We report a case of a 31-year-old woman with a body mass index of 39 who presented with increasing sacrococcygeal pain and right leg paresthesia over a 2-year period. She was treated for possible musculoskeletal and spine problems. She was finally diagnosed with a large right ovarian mucinous cystadenoma expanding in the sacrococcygeal region. She was successfully treated with complete excision of the tumor and achieved complete remission of all her symptoms. Conclusions: Large ovarian mucinous cystadenomas, which develop in the sacrococcygeal region, can lead to symptoms that mimic musculoskeletal and spine problems. Early diagnosis is of great importance towards the goal of implementing proper therapeutic approaches and achieve complete remission of all clinical symptoms. [ABSTRACT FROM AUTHOR]

Sacrococcygeal chordoma is a malignant, slow-growing, and locally aggressive bone tumor. A wide surgical margin is recommended to prevent local recurrence and metastasis. This disease tends to cause massive defects when rectal resection and sacrectomy are required. Therefore, soft tissue reconstruction is required and a pedicled vertical rectus abdominis muscle flap (VRAM) is a viable option. Important anatomical landmarks, advantages and limitations are discussed and the procedure is described step by step. This case report presents a two-stage operation with an anterior rectal resection and VRAM flap harvest followed by a complementary posterior approach with sacrectomy and soft tissue reconstruction: approach and results. The wound completely healed in six weeks. Three years after surgery, no local recurrence or distal metastasis was detected. This two-stage strategy presents a viable and safe option for large sacrococcygeal chordomas. [ABSTRACT FROM AUTHOR]

A mature cystic teratoma is a mass with heterogeneous appearance, consisting of adult tissue with two or three layers: endoderm, mesoderm, and ectoderm. It is a rare, benign transformation of somatic tissue most commonly found in the sacrococcygeal region and may resemble an uncomplicated spina bifida on prenatal ultrasonography. In this case report, we describe a female newborn with an extremely rare mature cystic teratoma in the thoracolumbar region. She presented prenatally with a preliminary diagnosis of meningomyelocele, diastematomyelia, and Chiari II malformation and a possible teratoma. However, a mass containing solid glandular tissues and bony calcifications approximately 3 × 4 cm in size was observed in the thoracolumbar region upon birth. During surgical resection, no nerve roots were found in the associated meningocele. The patient retained full lower body function postoperatively following surgical excision of the thecal sac and teratoma. [ABSTRACT FROM AUTHOR]

Chordomas are rare, low-grade malignant tumors often found in the sacrococcygeal region and prone to local recurrence. We report an atypical presentation of a 40-year-old patient with a symptomatic midline retrococcygeal lesion that was presumptively treated as a pilonidal cyst due to its clinical and imaging features. After surgical pathology rendered the diagnosis of chordoma, the patient required salvage surgery in the form of partial sacrectomy with soft tissue flap coverage. In addition to the unusually predominant retrococcygeal location, surgical pathology identified an intervertebral disc origin rather than the typical osseous origin. To our knowledge, this presentation of chordoma with coccygeal intervertebral origin and a large subcutaneous mass at imaging has rarely been reported in the literature. We describe this case to raise awareness of atypical presentations of sacrococcygeal chordoma that may lead to erroneous presumptive diagnosis and treatment. [ABSTRACT FROM AUTHOR]

To explore the value of ultrasound-guided radiofrequency ablation combined with puncture and aspiration in the intrauterine treatment of fetal sacrococcygeal cystic and solid teratoma. A 27-year-old pregnant woman was diagnosed with a cystic and solid tumor in the fetal sacrococcygeal region at 25 weeks of gestation. As the tumor grew, our clinical team creatively performed ultrasound-guided radiofrequency ablation combined with puncture and aspiration at 28 weeks of gestation, followed by puncture and aspiration only at 32 weeks of gestation, to reduce the tumor volume and control its growth rate. The fetus grew safely to term and underwent surgical excision of the tumor after 7 days of birth with a favorable prognosis. Ultrasound-guided radiofrequency ablation combined with puncture and aspiration is a safe and effective method for the treatment of fetal sacrococcygeal cystic-solid teratoma. [ABSTRACT FROM AUTHOR]

Objectives: Yolk sac tumors (YSTs) are rare and highly malignant ovarian malignancies that have a very poor prognosis. The aim of this study is to delineate the ultrasound and clinicopathological features of female pelvic YSTs to better understand the disease. Methods: This study was a retrospective analysis of the clinicopathological and ultrasound imaging data from 16 YST patients who received treatment at our hospital between January 2012 and August 2023. Then, the ultrasound imaging characteristics were compared with pathological findings. Results: Among the 16 patients, various degrees of serum AFP increase were observed, and CA125 levels increased in 58.33% (7 out of 12) of patients. Thirteen patients (81.25%) had tumors located in ovary, two patients (12.5%) had tumors located in the sacrococcygeal region, and one patient (6.25%) had tumors located in the mesentery. Pathologically, nine patients presented with simple yolk sac tumors and seven with mixed germ cell tumors. According to the ultrasound manifestations, YST lesions can be classified into three types. (1) the cystic type, was diagnosed in two patients who presented with a large cystic mass with regular morphology and clear boundary and dense liquid within the cyst; and (2) the cystic-solid mixed type, was diagnosed in 4 patients. On 2D ultrasound, the lesions showed a cystic-solid mixed echo, and color Doppler showed a rich blood flow signal in the solid region and cystic separation. made up of four cases. (3) In ten patients with the solid type, 2D ultrasound showed solid uniform echoes with clear boundaries. The “fissure sign” was observed in the lesion. Color Doppler displayed rich blood flow in the solid part, and PW showed low to moderate resistance index of artery (RI:0.21–0.63). On contrast-enhanced ultrasound (CEUS), rapid and high enhancement in the solid part and cystic separation was observed in 2 patients. Conclusions: Combining ultrasound features with clinical information and tumor markers provides reliable clues for the diagnosis of YST. The application of twodimensional ultrasound and CEUS combined with patient tumor marker levels can provide a robust reference for determining the necessity of fertilitypreserving surgery and postoperative chemotherapy, which can improve clinical decision-making and patient consultation. [ABSTRACT FROM AUTHOR]

Sacrococcygeal teratoma is a congenital tumor of early infancy. Eighty percent are present in the first month of life. It is considered to be an extragonadal germ cell tumor that can be diagnosed in utero. It is considered to be a rare tumor in infancy and childhood. Incidences in girls are more common as compared to boys. Association with other congenital abnormalities of the gastrointestinal system, cardiovascular system, and urological manifestations may be present. Association with spinal dysraphism may be present. A complete systemic evaluation needs to be done before any surgical intervention. We hereby present you a case of a 5-day-old male child, born from a non-consanguineous marriage, who presented to us with a large swelling at the coccygeal region. The mass had a variegated consistency with an ear-like appendage over it with associated hair, bones, and necrotic tissue in it. The patient was evaluated with imaging (MRI) which revealed a heterogeneously enhancing mass at the sacrococcygeal region with mild extension into the pre-sacral space suggesting sacrococcygeal teratoma. After a complete evaluation for congenital abnormal abnormalities of other sites, gross total excision of the mass was performed. The post-operative condition of the baby was uneventful. A biopsy of the mass revealed a mature cystic teratoma. The baby is under follow-up at present. [ABSTRACT FROM AUTHOR]

Background: Pilonidal sinus disease is a chronic inflammatory condition affecting the natal cleft in the sacrococcygeal region. The diagnosis is done by identifying a sinus or a network of sinuses in the skin of natal cleft. The basic principle of treatment now is excision of the sinus completely and covering the defect with a flap. Materials and methods Each patient underwent surgical excision followed by V-Y advancement flap cover. In the immediate post-operative period, the flap was monitored for any complications. The outcome was noted in terms offlap survival, successful coverage of the defect, and other complications. total hospital stay and chances of recurrence during follow up were documented. Results In our study, the youngest patient was 16 years and oldest was 56 years. The average age was 29 years. The male to female ratio was almost equal with 7 female patients and 6 male patients. Discharge was the most common complaint in 10 out of 13 patients (77%). The duration of symptoms ranged from 1 month to 2 years, average being 300 days. The time spent sitting by patients ranged from 6 hours per day to 12 hours per day, average being 8.7 hours. Wound swab culture was negative in 11 patients(85%) and Gram + organisms in 2 patients(15%). Healing time of the wound ranged from 8 days to 14 days, average being 10 days. Flap insert dehiscence was seen in 3 patients (23%). Itching was a post operative complaint in 7 patients (53%) and hypertrophic scar formed in same no of patients. Recurrence was seen in 2 patients (15%) with follow up upto 6 months Conclusion: V-Y advancement flap surgery has distinct advantages in terms of simple to learn, less demanding and safe technique for patients with primary pilonidal sinus disease compared to other complex procedures. [ABSTRACT FROM AUTHOR]

The sacrococcygeal area supports the lower body and endures mechanical forces during movement. However, current treatment methods for deep caudal sacrococcygeal defects have limitations, resulting in insufficient tissue for deep pocket obliteration and considering only the two-dimensional advancement plane in a three-dimensional defect topology. Our study proposes using a rotational V-Y fasciocutaneous advancement island flap to reconstruct deep caudal sacrococcygeal defects. By considering the three-dimensional nature of the defect, we distinguish a coccygeal plane of the V-Y flap from a sacral plane and set different directions and depths of movement for each plane. From March 2016 to July 2022, 12 patients underwent successful treatment with this surgery, and no complications or recurrences were observed in the study group. Our research found that patients in our study exhibited a smaller intercoccygeal angle than the average angle of the general Korean population, as previously reported. This implies a more pronounced curvature between the sacral and coccygeal planes. Therefore, our methods, which consider the three-dimensional structures of sacrococcygeal pathology, are significant. This technique provides a mechanically robust reconstruction after resecting deep sacrococcygeal pathology, with well-padded tissue to prevent dead space and wound disruption. [ABSTRACT FROM AUTHOR]

Background Erector spinae plane block (ESPB) is a well-established method for managing postoperative and chronic pain. ESPB applications for the sacral area procedures are called sacral ESPBs (SESPBs). This cadaveric study aimed to determine the distribution of local anesthesia using the median and intermediate approaches to the SESPB. Methods Four cadavers were categorized into the median and intermediate approach groups. Ultrasound-guided SESPBs were performed using a mixture of radiopaque agents and dye. Following confirmation of the solution distribution through computed tomography (CT), the cadavers were dissected to observe the solution distribution. Results CT images of the median group demonstrated subcutaneous pooling of the radiopaque solution between the S1 and S5 horizontal planes. Radiopaque solution also passed from the sacral foramina to the anterior sacrum via the spinal nerves between S2 and S5. In the intermediate group, the solution distribution was observed along the bilateral erector spinae muscle between the L2 and S3 horizontal planes; no anterior transition was detected. Dissection in the median group revealed blue solution distribution in subcutaneous tissue between horizontal planes S1 and S5, but no distribution in superficial fascia or muscle. In the intermediate group, red solution was detected in the erector spinae muscle between the L2 and S3 intervertebral levels. Conclusions Radiologic and anatomic findings revealed the presence of radiopaque dye in the superficial and erector spinae compartments in both the median and intermediate groups. However, anterior transition of the radiopaque dye was detected only in the median group.

The article discusses the use of T‐plasty as a surgical technique for managing recurrent pilonidal sinus disease (PSD). Various surgical techniques, such as Limberg flap, V–Y flap, and Z‐plasty, have been proposed for recurrence, taking into account factors like soft tissue deficiency and lack of tissue tension. T‐plasty is presented as a new technique that can help save the intergluteal cleft, close wounds after excising recurrent cysts, and reduce the risk of necrosis of angles, making it a feasible and cosmetically acceptable option for adults with unilateral orifices. [Extracted from the article]

Pilonidal sinus is a benign pathology that occurs especially in the sacrococcygeal region. Routine specimen examination is controversial because malignancy is very rare in histopathological examination. In this study, we aimed to discuss the pathological findings of patients who were operated for sacrococcygeal pilonidal sinus in our clinic in the light of the literature. Between May 2019 and December 2022, 257 patients who were operated on with the diagnosis of pilonidal sinus at the Samsun Training and Research Hospital General Surgery Clinic were retrospectively analyzed and included in the study. In the histopathological examination, it was reported that pilonidal sinus was found in 115 patients, chronic active inflammation in 79 patients, foreign body type inflammatory event in 60 patients, epidermal cyst in 1 patient, fibrolipoma in 1 patient, and Hidraadenitis Supurativa in 1 patient. In some recent studies, histopathological examination should be performed in patients over 50 years of age. Malignant pathology is mostly seen in males and. squamous cell carcinoma was seen in 76 of these patients and epidermoid carcinoma, basal cell carcinoma and malignant degeneration were seen in the others. Although our average age is low, our male / female ratio was found close to the literature. None of our pathology results were malignant. Pathologic examination of specimens removed in operation requires a certain workload and cost. We think that pathological examination is not required in every patient and that it is more effective in terms of both cost and workload to select the patients to be examined according to characteristics such as advanced age, chronic inflammation, suspicion of macroscopic malignancy and recurrent disease. [ABSTRACT FROM AUTHOR]

The term, pilonidal sinus describes a condition found in the natal cleft overlying the coccyx. It is usually treated by excision. A randomized controlled trial was conducted among 40 patients with pilonidal sinus presenting to the surgical outpatient department of Government General Hospital, Ananthapuramu over 1 year. Patients with H/O any previous surgery in the sacrococcygeal region, abscess formation, and any immunodeficiency were excluded from the study. Patients were selected by consecutive sampling. Patients were assigned either to the study group (Limberg flap technique) or the Control group (Excision with primary closure) randomly so that each group comprised 20 patients. All patients were operated under spinal anesthesia. Informed consent was obtained from patients. Patients were followed up 6 months postoperatively. Data was presented as mean (with standard deviation), percentages, and proportions. chi-square test and unpaired ttest were used to test the difference between groups. SPSS version 25 was used for statistical analysis. The mean age of patients in the study group was 25.2 + 5.3 years and the control group was 24.4 + 6.1 years. Post-operative pain on day 1 was higher among patients with the Limberg flap technique compared to excision with primary closure but on long-term follow-up, it declined gradually. The recurrence rate was 5% in the Limberg flap technique compared to 35% in excision with primary closure. Complications like seroma formation (5%), and stitch line infection (5%) were less in the Limberg flap technique as compared to primary closure (25% and 30% respectively). The Limberg flap method for the treatment of pilonidal sinus has low complication and recurrence rates compared to excision with the primary closure technique. [ABSTRACT FROM AUTHOR]

Background: Sacrococcygeal pilonidal sinus is a common surgical condition that requires various treatment options. This study aims to investigate the short and long‐term outcomes of the modified Karydakis flap method in patients with sacrococcygeal pilonidal sinus. Methods: A retrospective analysis was conducted on 175 patients who underwent the modified Karydakis flap method for sacrococcygeal pilonidal sinus by a single surgeon between September 2015 and February 2021. The patients' demographics, operative time, hospitalization time and complications were recorded. Results: Of the 175 patients, 125 (71.43%) were male and 50 (28.57%) were female, with a mean age of 24.93 ± 10.27 years. The mean operative time was 55.05 ± 12.33 min, the follow‐up time was 39.21 ± 17.58 months, and the mean hospitalization time was 3.4 ± 1.65 days. Complications were observed in 12 (6.85%) patients, including seroma (5.14%) and wound infection (1.71%), with no observed cases of flap necrosis or recurrence. Conclusion: The modified Karydakis flap method appears to be a safe and effective treatment option for sacrococcygeal pilonidal sinus, with an acceptable complication rate and no observed cases of recurrence. [ABSTRACT FROM AUTHOR]

Background: Erector spinae plane block (ESPB) is a well-established method for managing postoperative and chronic pain. ESPB applications for the sacral area procedures are called sacral ESPBs (SESPBs). This cadaveric study aimed to determine the distribution of local anesthesia using the median and intermediate approaches to the SESPB. Methods: Four cadavers were categorized into the median and intermediate approach groups. Ultrasound-guided SESPBs were performed using a mixture of radiopaque agents and dye. Following confirmation of the solution distribution through computed tomography (CT), the cadavers were dissected to observe the solution distribution. Results: CT images of the median group demonstrated subcutaneous pooling of the radiopaque solution between the S1 and S5 horizontal planes. Radiopaque solution also passed from the sacral foramina to the anterior sacrum via the spinal nerves between S2 and S5. In the intermediate group, the solution distribution was observed along the bilateral erector spinae muscle between the L2 and S3 horizontal planes; no anterior transition was detected. Dissection in the median group revealed blue solution distribution in subcutaneous tissue between horizontal planes S1 and S5, but no distribution in superficial fascia or muscle. In the intermediate group, red solution was detected in the erector spinae muscle between the L2 and S3 intervertebral levels. Conclusions: Radiologic and anatomic findings revealed the presence of radiopaque dye in the superficial and erector spinae compartments in both the median and intermediate groups. However, anterior transition of the radiopaque dye was detected only in the median group. [ABSTRACT FROM AUTHOR]

Background Due to aging characteristics such as dry, loose and inelastic skin, and decreased skin tolerance, the elderly are more vulnerable to injuries caused by pressure. An appropriate decompression mattress is the key to preventing pressure injury. Objective To compare the decompression effects of two types of mattresses by analyzing the pressures and temperatures of sacrococcygeal skin in bedridden elderly patients in the supine position. Methods By convenience sampling, 45 bedridden elderly patients who were admitted to Cadre Internal Medicine Ward, General Hospital of Eastern Theater Command from January 2021 to March 2022 were selected as the participants (all of them were male since most of the patients in the ward were male) . They were assigned to group A (n=23, use of gel mattress, repositioned every two hours for seven days) or group B (n=22, use of air mattress, repositioned every two hours for seven days) according to their willingness. The maximal sacrococcygeal pressure and skin temperature were measured at three fixed defined time points every day during supine position〔at the beginning (baseline) , and at one and two hours in the position〕. Maximal sacrococcygeal pressure was measured using a continuous bedside pressure mapping system, and the skin temperature in the same location was measured using a hand-held thermometer. The linear mixed-effects model was used to analyse the changes in sacrococcygeal pressure and skin temperature of the elderly bedridden patients and compare the decompression effects of the two mattresses. Results There were no pressure injuries in both groups during the intervention. The interaction effect between group and day was not statistically significant on the changes in sacrococcygeal pressure (Fgroup*day=0.07, Pgroup*day=0.999) , while the interaction effect between group and time on them was statistically significant (Fgroup*time =6.45, Pgroup*time=0.012) . Therefore, the mixed-effects model analysis was conducted again after removing the interaction between the group and day. The results indicated that the sacrococcygeal pressures in the gel mattress group were lower than those in the air mattress group after one and two hours after the supine position (P

The present study aimed to investigate the effect of local oxygen therapy combined with vacuum sealing drainage (VSD) on the healing of stage IV pressure ulcers sacrococcygeal. In this prospective study, we included a total of 98 patients with stage IV sacrococcygeal pressure ulcers in our hospital between February 2021 and June 2022. The patients enrolled were randomly and equally divided into two groups: the study group (undergoing local oxygen therapy combined with VSD treatment) and the control group (receiving conventional treatment). The wound healing time and hospital stay were compared between the two groups. Additionally, the wound area, tissue type, wound exudation and pain intensity were assessed before treatment, 10, 20, 30 and 40 days after treatment. The incidence of complications was also calculated. The study group demonstrated significantly shorter wound healing time and hospital stays compared to the control group (p < 0.05). Before treatment, there were no significant differences in terms of wound area, tissue type and wound exudation between the two groups (p > 0.05); after 10, 20, 30 and 40 days of treatment, however, evidently smaller wound areas, improved tissue types and reduced wound exudation were observed in the study group compared to the control group (p < 0.05). Furthermore, the study group exhibited increased microvascular count compared to the control group (p < 0.05). Before treatment, there was no significant difference in pain intensity between the two groups (p > 0.05), whereas markedly lower pain intensity was seen in the study group than in the control group after 10, 20, 30 and 40 days of treatment (p < 0.05). The incidence of complications did not significantly differ between the two groups after 40 days of treatment (p > 0.05). Local oxygen therapy combined with VSD was found to effectively accelerate the healing process of stage IV sacrococcygeal pressure ulcers, leading to shorter hospital stays and improved patient prognosis. This combined therapy shows promise for widespread application in clinical practice. [ABSTRACT FROM AUTHOR]

The main purpose of this study is to compare the efficacy of crystallized phenol and laser among treatment options in pilonidal sinus (SPS) discomfort in the sacrococcygeal region. A total of 190 patients were included in this retrospective archive research. Moreover, cases with missing or unclear data were not included in the study. Most patients were men [123 (64.3%) vs. 67 (35.3%); p<0.001]. There was no difference between the two groups in terms of age [31.37±8.92 vs. 31.20±8.85; p=0.92]. The majority of those who have applied laser were men [80 (80%) vs. 20 (20%); p<0.001]. It was determined that the majority of those who underwent laser were smokers [38 (67.9%) vs. 18 (32.1%); p<0.007]. The rate of phenol application was found to be slightly higher in females [47 (52.2%) vs. 43 (47.8%)]. In terms of comorbidity, there was no difference between the cases treated with phenol and laser [14 (40%) vs. 21 (60%); p=0.33]. There was no statistically significant difference in terms of the 12th month [84 (46.4%) vs. 97 (53.6%); p=0.312] or 24th month [82 (46.1%) vs. 92 (53.9%); p=0.167] recurrence rates for cases treated with phenol and laser. Moreover, there was no statistically significant difference between the two groups for cases who had reoperation [phenol: 13 (61.9%) vs. laser: 8 (38.1%); p=0.157]. Bleeding after the procedure was detected only in patients who underwent laser [0 (0.0%) vs. 6 (100%); p<0.03]. There was no difference in terms of infection in both groups [3 (50%) vs. 3 (50%); p=1.00]. With regard to the body mass index, no difference was found between the two groups that were treated with phenol or laser. However, regarding the visual analog scale (VAS), it was significantly lower in the phenol group [1.38±1.63 vs. 0.87±1.37; p=0.002]. In conclusion, while phenol is more advantageous in terms of pain and bleeding complications, laser treatment is preferred in men and smokers. [ABSTRACT FROM AUTHOR]

Teratomas are the most common congenital tumors and contain cells from the ectoderm, mesoderm, and endoderm. They are mainly located in the central axis of the body. The tumors are most commonly found in the sacrococcygeal region, followed by the gonadal site and mediastinum, and rarely in the head and neck. Teratomas can cause various clinical symptoms depending on the location of the mass and may result in feeding difficulties or respiratory distress. We present a case of oropharyngeal teratoma accompanied by respiratory distress and persistent feeding difficulties, leading to compression of the temporomandibular joint, which in turn caused subluxation. [ABSTRACT FROM AUTHOR]

Anterior dislocation of the coccyx is rare, but it can occur due to trauma. Conservative treatment is usually performed. However, dislocation reduction may be required to control severe pain in the acute phase or to prevent chronic complications. If manual reduction fails, open reduction is required. The extent of the incision and the method used to maintain the reduction should be considered during open reduction. A 56-year-old male patient experienced a dislocation of the sacrococcygeal joint after falling backwards. Despite conservative treatment, the patient complained of persistent pain during sitting and when using the bathroom. A manual reduction was attempted but failed. We performed joystick reduction via minimal incision and maintained the reduction using a one-strand trans-osseous suture passing through the skin. The patient was advised to use a soft cushion when sitting or lying down for four weeks after surgery. The supine position was not restricted. The patient's symptoms significantly improved after surgery. At the 6-month follow-up, the sacrococcygeal joint showed good alignment and no surgical complications occurred. During the treatment of sacrococcygeal dislocation, the rapid alleviation of acute pain and minimizing potential complications are key points. If open reduction is needed, the minimally invasive reduction technique with a one-strand trans-osseous suture may offer patient satisfaction and a good surgical outcome. [ABSTRACT FROM AUTHOR]

Background: Sacrococcygeal teratomas (SCTs) are known to cause urological complications, but urethrovaginal (UV) fistula as a complication of SCT is rare. We herein report a case of SCT with UV fistula and hydrocolpos. Case presentation: A 1-day-old female neonate presented to our department with prominent swelling in the sacrococcygeal region. She was born at 37 gestational weeks via spontaneous vaginal delivery from a 39-year-old woman. The weight of the baby was 2965 g, and her Apgar scores were 4/10 (at 1 and 5 min). An MRI examination confirmed an 11 × 11 cm Altman classification typeII SCT associated with hydrocolpos, a dilated urinary bladder, and bilateral hydronephrosis. When she was 5 days, the SCT was excised totally and a coccygectomy was performed. After the operation, as her urinary output appeared unstable, a cystoscopic examination was performed on the third postoperative day. This revealed that the UV fistula was located approximately 1 cm from the urethral opening. In addition, the proximal urethra was unobstructed and connected to the bladder. The cystoscope allowed for the passage of a urinary catheter through the urethra. After 1 month of catheter placement, she was discharged from the hospital at 57 days of age. Follow-up was uneventful, with neither urinary infection nor retention. Conclusions: SCTs are associated with not only trouble with rectal function and lower extremity movement but also urinary complications. The pathogenesis of this UV fistula is thought to be the rapid growth of the SCT that developed in the fetal period, resulting in obstruction of the urethra by the tumor and the pubic bone, which in turn caused urinary retention and the formation of a fistula as an escape route for the pressure. Because SCTs can cause a variety of complications depending on the course of the disease, careful examination and follow-up are necessary. [ABSTRACT FROM AUTHOR]

Background: Pilonidal sinus disease (PSD) is a tract in the sacrococcygeal region's subcutaneous tissue that presents with recurrent infection and persistent inflammation. The best surgical strategy for treating pilonidal sinus illness is still up for debate, despite the fact that several surgical techniques for treating the sacrococcygeal pilonidal sinus have been identified. Aims and Objectives: This study evaluated several intraoperative and post-operative constraints related to the surgical techniques of wide excision with lay open and Limberg flap transposition for treating pilonidal sinus. Materials and Methods: The division of 50 symptomatic pilonidal sinus patients into two equal groups was based on simple randomization. Patients in Group-A had wide local excisions with lay open, whereas those in Group-B received wide excisions with Limberg flaps. Operative time along with post-operative issues including pain, seroma, infection, necrosis of the flap's tip, gaping, loss of sensation, and recurrence was compared between the two groups. Results: When compared to the wide excision group, the mean operating time was substantially greater in the Limberg flap repair group. There was a significant difference between the groups in terms of the average number of days spent in the hospital (Group-B was 6.8±1.5 days and Group-A was 12.96±1.3 days), the average number of days it took for the wound to heal (Group B was 16.6±8.5 days and Group-A was 49.5±7.8 days), mean work-off periods (Limberg's rhomboid flap - 19.64±5.1 days and laying open technique - 52.6±8 days), and mean number of days pain lasted (Group-B - 14.8±5.7 days and Group-A - 45.6±7.5 days). Wide local excisions are associated with increased wound infection. Recurrence in Limberg's rhomboid flap group was less (4% vs. 16% with laying open approach). Conclusions: Low recurrence rates and comparably few complications are associated with rhomboid excision with Limberg flap repair transposition surgery. The primary course of action for pilonidal sinus illness should be Limberg flap repair. [ABSTRACT FROM AUTHOR]

Background: Pilonidal disease has numerous management techniques available to surgeons worldwide. Because of the variety of clinical manifestations, several methods of intervention are needed; as a result, we hope for careful selection of the best technique for the patient's severity and recurrence. Aim: To prevent possible recurrence after bilateral subcutaneous fatty flap(BSF), a novel method for treating pilonidal sinus illness and Z-Plasty(ZP) with fasciocutaneous flap. Patients and methods: All prospective patients having recurrent pilonidal sinus and operated on at our institute, Surgical Department from Jan. 2022 to Dec. 2023. In total, 50 cases have sacrococcygeal disease ( SCD), and 25 patients in Group A had bilateral subcutaneous fatty flap surgery. In contrast, the 25 patients in Group B were treated by Z-Plasty(ZP) with fasciocutaneous flap surgery. We assessed the length of the procedure, the level of postoperative pain, the length of the hospital stay, the postoperative complications, and the likelihood of recurrence. Results: The wound size was in the bilateral Subcutaneous fatty flap (BSF) 28.11 ± 8.48 mm relative to the (ZP) 23.84 ± 8.44 mm). Also, the complete healing was comparatively prolonged in the BSF (13days) relative to the ZP group (30 days). The surgery duration differs significantly (P < 0.001) between the groups; it was lower in the BSF group (29.15 ± 7.69 mins) than in the ZP (23.03 ± 6.06 mins). In the BSF group, the hospitalization was four days. Still, ZP group (11days), The time for work recovery or activity was shorter in the BSF (11 days) relative to the ZP group (36 days). BSF had more reasonable satisfaction than the ZP group, duration of wound healing in BSF being 11 days but in ZP 30 days. Additionally, the duration of pain in the group was ZP (38 days but in the BSF group (11 days). Return to work in BSF 11 days and in ZP 36 days; The median satisfaction scores attained 8 (28.1%) in BSF and 9 (37%) in the ZP (P = 0.046). The median VAS scores attained 37.8% BSF and 44% for ZP (P = 0.934). The highest VAS score was equal to group B, which was 6. Conclusion: when treating pilonidal sinus disease, the bilateral subcutaneous fatty flap is superior to the ZP flap. [ABSTRACT FROM AUTHOR]

Holt-Oram syndrome (HOS) is characterized by upper-limb defects and congenital heart malformation, and its prevalence is very rarely. Mature cystic teratoma is the most common tumor seen in neonates and its most common location is sacrococcygeal region. Diagnosis of a sacrococcygeal teratoma should be confirmed by pathology. Surgical resection is the mainstay therapeutic approach of this tumor. Some malformations such as genitourinary system, musculoskeletal anomalies, neural defects, cardiovascular anomalies, and pulmonary disorders associated with this tumor have been reported. Herein, we reported a male neonate diagnosed with HOS associated with sacrococcygeal teratoma. To our knowledge, it has been not reported a case with HOS associated with sacrococcygeal teratoma. Patients with sacrococcygeal teratomas (SCTs) may have multiple and extreme congenital abnormalities; therefore, patients with SCTs should be carefully evaluated clinically, laboratory, and radiologically and it should be also considered that HOS may accompany them. [ABSTRACT FROM AUTHOR]

Purpose: Myxopapillary ependymoma (MPE) was classified as grade 2 tumor in the 2021 World Health Organization central nervous system classification because of its high recurrence probability. This study aimed to investigate predictive factors and management of tumor recurrence. Methods: Seventy-two patients with spinal MPE underwent initial surgical treatment at our hospital between 2011 and 2021. Kaplan–Meier curves and Cox regression were used to analyze the correlation between clinical variables and progression-free survival (PFS). Results: The median age at diagnosis was 33.5 years (range 8–60 years). Twenty-one patients (29.2%) had preoperative spinal drop metastases. Gross total resection (GTR) was performed in 37 patients (51.4%). The median follow-up was 7.2 years, and the follow-up rate was 88.9% (64 of 72 cases). Twelve of the 64 patients (18.9%) relapsed, and preoperative drop metastasis occurred in 7 patients (58.3%). The estimated 5-year and 10-year PFS rates were 82% and 77%, respectively. Univariate analysis showed that GTR was associated with improved PFS (hazard ratio [HR] 0.149, p = 0.014), while preoperative drop metastasis (HR 3.648, p = 0.027) and tumor involvement sacrococcygeal region (HR 7.563, p = 0.003) were associated with tumor recurrence. Adjuvant radiotherapy (RT) was significantly associated with improved PFS in patients with preoperative drop metastasis (p = 0.039). Conclusion: Complete surgical resection under the premise of protecting neurological function is an important factor in reducing spinal MPE recurrence. Adjuvant RT is recommended when the tumor invades the capsule with preoperative drop metastasis or adhesion to the nerve and cannot reach GTR. [ABSTRACT FROM AUTHOR]

Background Spinal anesthesia is the most common anesthetic technique applied for patients undergoing surgery for pilonidal disease. However, it has multiple disadvantages like hypotension and headache. This prospective study was designed to compare the outcomes of sacrococcygeal local anesthesia technique versus spinal anesthesia for surgical treatment of patients with pilonidal disease. Patients and methods The included 220 patients diagnosed with the pilonidal disease were assigned into two groups according to the method of anesthesia, the spinal and local groups. The primary outcome was pain score, whereas other outcomes included duration of stay in the operative theater, recovery room, postoperative opioid consumption, time to first analgesic request, complications, and patient satisfaction. Results Age and sex distribution showed no significant difference between the two groups. Time spent inside the operative room and total hospital stay showed a significant decrease in the local group. Postoperative pain was statistically comparable between our groups, apart from the six-hour reading, which was higher in the local group. The spinal group showed superior analgesic outcomes regarding the first analgesic request and total opioid consumption. Likewise, patient satisfaction was significantly higher in the same group. Postoperative nausea was more encountered in the local group. Conclusion When compared with spinal anesthesia, sacrococcygeal local anesthesia seems to have a weaker analgesic profile manifested in increased opioid requirements and earlier rescue analgesia. However, it is associated with comparable pain scores, less operative time, and shorter hospitalization. [ABSTRACT FROM AUTHOR]

Coccydynia is a debilitating pain disorder. However, its pathophysiology is not well understood. When approaching coccydynia, the exact underlying cause of pain must be identified to develop an appropriate treatment plan. The specific approach to coccydynia can vary depending on an individual's condition and the underlying cause. Thorough evaluation by a pain physician is essential to determine the most appropriate course of treatment. The purpose of this review is to examine the various causes contributing to coccygeal pain and specifically focus on the exact anatomical neurostructures, such as the anococcygeal nerve, perforating cutaneous nerve, and ganglion impar. We also reviewed the relevant clinical outcomes and suggested recommendations for each anatomical structure. [ABSTRACT FROM AUTHOR]

We report the first cohort of children with spinal and sacrococcygeal chordomas (CH) and chondrosarcomas (CHS) treated with proton-based radiotherapy (PRT). Between 1988 and 2019, 52 pediatric patients with CH and CHS of the mobile spine and sacrum were treated with PRT at a single institution. Primary endpoints were overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). A univariate was performed to identify prognostic factors. There were 31 (60%) females and 21 (40%) males. Median age at diagnosis was 12.8 years (4-21). 43 (83%) patients were diagnosed with CH and 9 (17%) patients with CHS. The primary tumor originated in the C-spine (n=37, 71%), the T-spine (n=6, 12%), the L-spine (n=7, 14%), or the sacrococcygeal region (n=2, 3%). The majority of the CH patients were conventional type (n=33) while 10 had atypical/poorly differentiated CH. CHS patients included 4 mesenchymal, 3 mixed hyaline/myxoid, and 2 hyaline CHS. 32 (61%) patients underwent gross total resection, 19 (37%) patients underwent subtotal resection while 1 (2%) patient had a biopsy only. 8 (15%) patients were treated with pre- and post-op RT, while 44 (85%) patients received only post-op RT. 34 (65%) patients had spinal stabilization in place at the time of RT. 13 (25%) patients with high-risk pathological features received pre-RT chemotherapy. Due to radiation avoidance, 13 (25%) patients developed progressive disease prior to RT. 11 (21%) patients were treated with protons only and 41 (79%) patients received combined proton/photon RT. The median total dose was 74.5 Gy (RBE) [IQR, 69.8 - 76 Gy (RBE)] delivered in 1.8-2.5 Gy (RBE) daily fractions. The median maximum dose to the spinal cord was 62.6 Gy (RBE) [range, 30.6-69.2 Gy (RBE)]. At a median follow-up of 11.4 years (IQR, 5.7 – 19.8) from the date of diagnosis, 17 (32.7%) patients recurred (8 local, 7 distant and 2 iatrogenic seeding along the surgical tract). 15 of these patients died of disease. Median follow-up for surviving patients was 15.4 years (IQR, 10.9 – 22.9). The 5-, 10-, and 20-year OS were 82.7%, 72.3% and 72.3%, respectively. The 5-, 10-, and 20-year DSS were 86.1%, 77.5%, and 77.5%, respectively. The 5-, 10-, and 20-year PFS were 72.3%, 70.1% and 70.1%, respectively. The 10-year OS, DSS, and PFS for conventional CH were 84.3%, 90.5%, and 81.5%, respectively. The 10-year OS, DSS, and PFS for CHS were 77.8%, 77.8%, and 77.8%, respectively. Factors significantly associated with worse outcomes were poorly-diff CH subtype, receipt of pre-RT chemo, and low KPS (p<0.05). Pre-RT tumor progression was found to be a significant prognostic factor for PFS (p=0.05). No patients experienced late ≥ grade 2 toxicities. This is the largest study of pediatric spinal and sacrococcygeal CH/CHS in the literature. High-dose PRT following surgical resection offers high rates of disease control for conventional chordomas and low-grade chondrosarcomas. [ABSTRACT FROM AUTHOR]

Background: Infantile fibrosarcoma is a rare pediatric soft tissue tumor and usually appears in children before one year of age. Distal extremities constitute the most frequently affected locations, and other tissues such as the trunk, head and neck, gut, sacrococcygeal region, and viscera are uncommon sites. Case presentation: We describe a rare case of infantile fibrosarcoma arising from the perineum. First, a cystic mass was detected using prenatal ultrasonography, and then an echo was changed in serial ultrasound examinations. A solid cystic lesion was found at term; a hypoechoic lesion occurred in the back. The tumor became so large that massive bleeding occurred, which then underwent surgical resection. Pathological examination confirmed infantile fibrosarcoma. Conclusion: Our report demonstrates not all ultrasonographic findings in cases of infantile fibrosarcoma exhibit a solid mass during the initial examination — an early-stage lesion may reveal a cystic echo. Infantile fibrosarcoma has a good prognosis and surgery constitute the main treatment, with adjuvant chemotherapy being received if necessary. [ABSTRACT FROM AUTHOR]

Acardiac twin is a rare complication of monozygotic twin pregnancies. It accounts for 1% of monochorionic twin gestations with an incidence of 1 in 35,000 births. We report a rare case of acardiac twin with sacrococcygeal teratoma in a monochorionic twin gestation in view of rare incidence and diagnostic challenge. [ABSTRACT FROM AUTHOR]

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Teratomas are defined by the presence of cell types from different germ layers, they typically involve the gonads or the sacrococcygeal region and are rarely retroperitoneal. Prenatally detected adrenal teratomas are extremely uncommon. Aim of this paper is to share our experience with an adrenal antenatal mass initially diagnosed as a left adrenal neuroblastoma that turned out to be a mature teratoma after microscopical examination. We present the case of a male fetus with antenatal diagnosis of a left adrenal cystic image at the 22nd week of amenorrhea. The fetal magnetic resonance imaging showed a non-calcified cystic mass of the left adrenal gland, compatible with a neuroblastoma. At birth an ultrasound confirmed the presence of an anechogenic lesion of the left adrenal gland. The infant was closely monitored during his first year and in the absence of significant regression of the adrenal mass, it was decided to perform a laparoscopic left adrenalectomy. Unexpectedly, the final pathological diagnosis was mature cystic adrenal teratoma. In conclusion, an adrenal mass diagnosed antenatally is generally a hemorrhage or a neuroblastoma. Adrenal teratomas are very rare and those diagnosed antenatally even more. At present, we have no clinical, biological, or radiological evidence to suspect them before surgical removal. There are only two other cases of unexpected adrenal teratoma in infants described in Literature. [ABSTRACT FROM AUTHOR]

Sacrococcygeal teratoma is the most common congenital tumor in neonates, and is reported in approximately 1/35,000 to 1/40,000 live births. Oligodendroglioma is a rare central nervous system tumor that is usually found in the cerebral hemisphere of young and middle aged adults. When associated with a teratoma, it is mainly identified in ovarian teratoma in adolescents and adults. We describe a rare case of a preterm infant with oligodendroglioma in a mature sacrococcygeal teratoma. The male neonate was born at a gestational age of 30 weeks with a protruding mass in the sacrococcygeal region. Pelvic magnetic resonance imaging showed a sacrococcygeal teratoma of approximately 11 cm comprising fat components and skeletal structure, that extended from the anterior part of the sacrum to the abdominal cavity. Radical resection was performed at 36 days of age. Macroscopically, the resected intra-abdominal mass had the characteristics of a cystic lesion, and the intrapelvic mass was a predominantly solid mixed cystic-solid lesion. Histologically, this solid lesion in the intrapelvic mass was composed of mature glial tissue, which comprised as a proliferation of monotonous cells with small and round nuclei, surrounded by a perinuclear halo (“fried egg” appearance). Additionally, these cells were immunohistochemically positive for glial fibrillary acidic protein. These findings confirmed the diagnosis of oligodendroglioma in sacrococcygeal mature teratoma. After the treatment, no recurrence was observed during the follow-up period, and no additional intervention was required. However, the patient is undergoing treatment for voiding dysfunction caused by a neurogenic bladder.

Sacrococcygeal Pilonidal Sinus (PS) is common among the young male adult population. There are multiple treatment options available ranging from non medical and surgical procedures. Medical management is not in vogue. This case series is about 10 patients with a common manifestation of serous discharge from the sinus in the sacrococcygeal region. The patients warranted a definitive cure for their condition. Though not life-threatening, it is socially embarrassing and adversely affects the quality of life in terms of education and livelihood among the young. The Limberg flap technique was advocated in all these patients, only one out of 10 patients showed wound infection. All the patients were satisfied with the surgical outcome. The surgical choices varied from simple excision to flap procedures. Overall the Limberg (rhomboid) flap technique has fewer postoperative complications and low recurrence rate and has a shorter learning curve, and is emerging as the standard of care.

Neuroendocrine tumors (NETs) arising from tailgut cysts are a rare but increasingly reported entity with gene expression profiles that may be indicative of the gastrointestinal cell of origin. We present a case report describing the unique pathological and genomic characteristics of a tailgut cyst NET that metastasized to liver. The histologic and immunohistochemical findings were consistent with a well-differentiated NET. Genomic testing indicates a germline frameshift in BRCA1 and a few somatic mutations of unknown significance. Transcriptomic analysis suggests an enteroendocrine L cell in the tailgut as a putative cell of origin. Genomic profiling of a rare NET and metastasis provides insight into its origin, development, and potential therapeutic options.

Chordomas are rare primary malignant tumours of notochordal origin usually arising along the axial skeleton with particular predilection of the skull base and sacrococcygeal region. Albeit usually slow-growing, chordomas can be aggressive mostly depending on their invasive behaviour and according to different histotypes and molecular alterations, including TBXT duplication and SMARCB1 homozygous deletion. Partial or complete PTEN deficiency has also been observed. PTEN is a negative regulator of the Akt/mTOR pathway and hyperactivation of Akt/mTOR in cells lacking PTEN expression contributes to cell proliferation and invasiveness. This pathway is targeted by mTOR inhibitors and the availability of in vitro models of chordoma cells will aid in further investigating this issue. However, isolation and maintenance of chordoma cell lines are challenging and PTEN-deleted chordoma cell lines are exceedingly rare. Hereby, we established and characterized a novel human PTEN-deleted chordoma cell line (CH3) from a primary skull base chordoma. Cells exhibited morphological and molecular features of the parent tumour, including PTEN loss and expression of Brachyury and EMA. Moreover, we investigated the activation of the mTOR pathway and cell response to mTOR inhibitors. CH3 cells were sensitive to Rapamycin treatment suggesting that mTOR inhibitors may represent a valuable option for patients suffering from PTEN-deleted chordomas. [ABSTRACT FROM AUTHOR]

Background: Pilonidal sinus disease is a chronic disease of the sacrococcygeal region, which commonly occurs in young adults. The male population is affected more than the female one. Many surgical techniques have been described in the literature for the treatment of this disease. This study aimed to assess the effectiveness and short-term results of the modified Limberg flap technique in the treatment of pilonidal sinus disease. Methods: This randomized clinical trial study was carried out in Zagazig university hospital. It included eighteen patients with pilonidal sinus disease who attended GIT Unit, General Surgery Department, during the period from January 2020 to August 2020. The 18 patients underwent the modified limberg flap procedure. All patients were subjected to Demographic data taking, complete clinical examination and Laboratory investigations. Results: The mean operative time was 63.056±6.673 min. The healing time and duration of work-off were 15.833 ± 2.256 and 16.833 ± 2.256 days respectively. Two patients were complicated. Combined hematoma and dehiscense occurred in one patient (5.6%) and seroma occurred in one patient (5.6%). No patients had a recurrence. Conclusions: Modified Limberg flap technique showed early healing, short duration of work-off, and a low rate of complications and recurrence. [ABSTRACT FROM AUTHOR]

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Introduction: Pilonidal sinus is a benign inflammatory disease characterized by fistulas with exudative discharge. This disease is commonly seen in areas rich in hair follicles that penetrate the skin under direct pressure such as the sacrococcygeal region in the predominantly male population. Squamous cell carcinoma is a rare complication of pilonidal disease. Carcinoma in pilonidal disease mainly arises after 15-year disease history. The signs of malignant change are induration, rapid growth and sharp pain in ulcerated tumour. It can be detected incidentally on post-excisional histopathology. Wide excision with tumour-free margins remains the treatment of choice. Case report: We present a case of a 45 years old-man operated for the pilonidal sinus with discovery on the surgical specimen of a squamous cell carcinoma without idea on resection limits. The patient, who refused revision surgery, had presented a tumour progression becoming unresectable, thus he had received radiotherapy with concomitant chemotherapy with a complete clinical and radiological response of the tumour. Conclusion: the treatment by radiotherapy and chemotherapy as radio sensitizer can be proposed in unresectable locally advanced squamous cell carcinoma arising over pilonidal sinus. [ABSTRACT FROM AUTHOR]