Sacrococcygeal Areas Research Articles

Surgical treatment of late radiation injury of the soft tissues of the sacrococcygeal and perineal areas caused by combination treatment of the anal canal (clinical observation)

Chemoradiotherapy anal cancer is the main one at stages I–II. In some patients after radiation therapy, late radiation damage to soft tissues occurs. The article presents a clinical case of successful surgical treatment of extensive radionecrosis of the perianal region.

When Two Is Better Than One: A Pilot Study on Transcranial Magnetic Stimulation Plus Muscle Vibration in Treating Chronic Pelvic Pain in Women.

Chronic pelvic pain syndrome (CPPS) affects about 4–16% of adult women, and about one-third of them require medical assistance due to severe symptoms. Repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area (SMA) has been shown to manage pain in refractory CPPS. Focal muscle vibration (FMV) has also been reported to relieve pelvic pain. The objective of this study was to assess the feasibility and effect of rTMS coupled with FMV to reduce pain in seven adult women with refractory CPPS. This pilot, open-labeled, prospective trial examined treatment by 5 Hz rTMS over SMA and 150 Hz FMV over the perineum, suprapubic, and sacrococcygeal areas, with one daily session for five consecutive days for three weeks. We assessed tolerance and subjective pain changes (as per visual analog scale, VAS) until one month post-treatment, with a primary endpoint at day 7. No patients experienced serious adverse effects or a significant increase in pain. Six out of seven patients experienced a VAS improvement of at least 10% at T7; three of these individuals experienced a VAS improvement of more than 30%. Overall, we found a significant VAS reduction of 15 points (95% CI 8.4–21.6) at T7 (t = 6.3, p = 0.001; ES = 2.3 (1.1–3.9)). Three of the women who demonstrated a significant VAS reduction at T7 retained such VAS improvement at T30. VAS decreased by six points (95% CI 1.3–10.7) at T30 (t = 3.1, p = 0.02; ES = 1.5 (0.2–2.6)). This coupled approach seems promising for pain management in adult women with refractory CPPS and paves the way for future randomized controlled trials.

Improving Sexual Function by Using Focal Vibrations in Men with Spinal Cord Injury: Encouraging Findings from a Feasibility Study.

Erectile dysfunction (ED) is a frequent and disabling condition in patients with spinal cord injury (SCI). Spasticity can negatively affect sexual intercourse, as it may interfere with positioning, mobility, and muscle activation and strength, leading to ED. The aim of our study was to evaluate the feasibility and efficacy of muscle vibration (MV) applied to the pelvic muscles in improving ED in men with SCI. Ten adult men with traumatic SCI were submitted to 15 sessions of MV, applied on the perineum and the suprapubic and sacrococcygeal areas, using a pneumatic vibrator. MV was performed three times a week for five consecutive weeks, each session lasting 30 min. Muscle tone and sexual function were assessed before and after MV using the Modified Ashworth Scale (MAS) and International Index of Erectile Function (IIEF). We assessed the cremasteric and bulbocavernosus reflexes, as well as the electrophysiological bulbocavernosus reflex (eBCR) and pudendal nerve somatosensory-evoked potential (PSEP). MV was safe and well tolerated. All the patients reported an improvement in MAS and IIEF, with better reflexive responses, and a significant increase in eBCR and PSEP amplitude. In conclusion, MV of the pelvic floor is a promising method to reduce segmental spasticity and improve ED in men with incomplete SCI. However, our findings require confirmation through a randomized clinical trial with a larger sample size and longer trial period to examine long-term after effects.

Management and outcome of chordomas in the pediatric population: The Hospital for Sick Children experience and review of the literature

Chordomas are tumors arising from remnants of the embryological notochord, most commonly found in the spheno-occipital, spinal, or sacro-coccygeal areas. They are rare tumors in the pediatric population and are challenging to manage due to their difficult accessibility, proximity to important anatomy and extension into adjacent structures. We report a series of 10 children treated for chordoma at The Hospital for Sick Children focusing on their surgery, adjuvant therapy and long-term outcomes. A retrospective review involving patient charts, radiographic imaging, and pathology slides was performed for 10 chordoma patients during the period from 1987–2015. Important variables, including patient demographics, chordoma location, presentation, imaging characteristics, pathology subtype, treatment options, and long-term outcome were analysed. The series consists of seven girls and three boys with cranial or upper cervical spine chordomas. One patient presented with an extradural left cerebellopontine angle chordoma demonstrating aggressive and dedifferentiated features, which, to our knowledge, has not been previously described in the literature. All patients received surgical resection followed by photon or proton radiotherapy. Four patients with chondroid or atypical pathology also received chemotherapeutic adjuvants. All patients with classical pathology achieved favourable outcome, while the four patients with atypical pathology progressed quickly despite aggressive therapy, suggesting that pathology subtype is a crucial prognostic factor. This study summarizes 30years of surgical and adjuvant therapy experience in a large academic center for pediatric chordoma patients. Patient outcomes were dependent on pathology subtype, and a multidisciplinary approach involving surgery, radiotherapy, and chemotherapy can be considered on an individual basis.

Designing Flaps for Closure of Circular and Semicircular Skin Defects.

Summary:Removing skin lesions from the human body is a simple procedure, but closing the resulting defect may prove a difficult task. The surgeon quite often encounters a problem when the lesion is located in a confined anatomical area where the elasticity of the skin is limited or when the lesion is large. To obviate these difficulties, I present 4 new incisions for closure of circular and semicircular skin defects on difficult parts of the human body such as the scalp, face, axilla, back, and sacrococcygeal areas. This article describes a working model made of white bond paper that can be enlarged or reduced in size using a regular copying machine that can be prepared in advance of surgery to make sure that it adapts to a particular anatomical location. Also, it describes a geometrical analysis in order to determine the distortion of the minimal tension lines of the skin, skin wastage, and length of the suture lines. In summary, it is possible to use a variety of skin incisions, taking advantage of the minimal tension lines of the skin and also taking into consideration the anatomical characteristics of the region involved.

Treatment of ovarian endodermal sinus tumor to preserve fertility

Endodermal sinus tumor, also known as yolk sac tumor (YST), is a malignant germ cell tumor that most frequently occurs in the testis, the ovary, and sacrococcygeal areas in children. YSTs are highly aggressive and because of the early metastatic or invasive pattern, their prognosis has been poor. Treatment methods for YSTs are usually intensive, including multiagent chemotherapy, and have shown to improve patient survival significantly; therefore, it is important to consider the reproductive function of these patients with long-term survival. Herein, we present the case of a 31-year-old female, who was diagnosed with unilateral ovarian YST at the age of 13. The patient was treated with fertility-sparing surgery and postoperative adjuvant chemotherapy. During the subsequent long-term follow-up, she was not only free of disease, but also had a successful, naturally conceived pregnancy at 31 years of age. We, therefore, conclude that YST is a curable disease, and that fertility-preservation surgery and subsequent immediate combination chemotherapy is the treatment of choice.

Force on the sacrococcygeal and ischial areas during posterior pelvic tilt in seated posture

Most posture problems encountered in persons who use wheelchairs in a seated posture for extended periods are related to sacral sitting due to posterior pelvic tilt. Posterior pelvic tilt places pressure and shearing force on the sacrococcygeal area that can lead to pressure ulcers, but the relationship between pelvic tilt and force applied to the sacrococcygeal and ischial tuberosity areas has not yet been investigated. To investigate the relationships of posterior pelvic tilt in a seated posture with vertical force and horizontal force on the sacrococcygeal and ischial tuberosity areas. Repeated measures design. Thirty male and female subjects aged ≥60 years sat in a measurement chair at varying pelvic tilt angles, and force on the sacrococcygeal and ischial tuberosity areas was measured. The pressure on the sacrococcygeal area increased with pelvic tilt in all subjects, with vertical force averaging 19% of the body weight at a pelvic tilt angle of 30°. The horizontal force on the sacrococcygeal area increased in 93% of the subjects, with an average increase equal to 3% of the body weight. We confirmed changes in vertical and horizontal forces on the sacrococcygeal and ischial tuberosity areas with a change in seated posture (pelvic tilt). We propose guidelines for rehabilitation practitioners working with wheelchair users to suggest improved ways of sitting in wheelchairs that avoid pelvic tilt angles that might promote pressure ulcers on the buttocks.

The Influence of Backrest Inclination on Buttock Pressure

ObjectiveTo assess the effects of backrest inclination of a wheelchair on buttock pressures in spinal cord injured (SCI) patients and normal subjects.MethodThe participants were 22 healthy subjects and 22 SCI patients. Buttock pressures of the participants were measured by a Tekscan® pressure sensing mat and software while they were sitting in a reclining wheelchair. Buttock pressures were recorded for 90°, 100°, 110°, 120° and 130° seat-to-back angles at the ischial tuberosity (IT) and sacrococcygeal (SC) areas. Recordings were made at each angle over four seconds at a sampling rate of 10 Hz.ResultsThe side-to-side buttock pressure differences in the IT area for the SCI patients was significantly greater than for the normal subjects. There was no significant difference between the SCI patients and the normal subjects in the buttock pressure change pattern of the IT area. Significant increases in pressure on the SC area were found as backrest inclination angle was changed to 90°, 100° and 110° in the normal subjects, but no significant differences were found in the SCI patients.ConclusionMost of the SCI patients have freeform posture in wheelchairs, and this leads to an uneven distribution of buttock pressure. In the SCI patients, the peak pressure in the IT area reduced as the backrest angle was increased, but peak pressure at the SC area remained relatively unchanged. To reduce buttock pressure and prevent pressure ulcers and enhance ulcer healing, it can be helpful for tetraplegic patients, to have wheelchair seat-to-back angles above 120°.

頚椎に発生した脊索腫（Ｃｈｏｒｄｏｍａ）の１例について

We report a rare case of chordoma which occurred at cervical spine. A 84-year-old man had a numbness in upper extremities from 1986. Gradually he had difficulty of defecation, dysuria and gait disturbance. Plain X-rays of the cervical spine showed structural damage to the posterior side of the C4 body due to the tumor. Myelography demonstrated a complete block at C3-C4 level.A tumor of the cervical spine was suspected. Then in February 1987 the tumor resection and replacement of a vertebral body with ceramic implant were carried out. After surgery, the gait ability of the patient improved quite well.Pathological diagnosis obtained was the metastasis of parathyroid tumor. According to this diagnosis, resection of parathyroid was performed but there was no malignancy.Because the gait disturbance appeared again, the second surgery was carried out to replace the implant in the end of 1988. The pathological diagnosis obtained this time was chordoma. Now the patient is ambulating quite well.Chordoma is a rare tumor which arises from foetal notochordal rests. It accounts for about 0.8 percent of all primary bone tumors. It occurs mostly at the sacrococcygeal and cranial areas, but it is seldom found in the cervical spine. Generally 45-49 percent in the sacrococcygeal, 36-39 percent in the cranial, 14-18 percent in the spinal areas. Cervical chordoma presents formidable problems in diagnosis.

Ependymoma of the uterosacral ligament.

Extraspinal ependymomas have been described in the subcutaneous sacrococcygeal and presacral areas. Since 1984, eight pelvic ependymomas have been reported that have originated in the ovary, broad ligament, mesovarium, and omentum. This report documents an additional case arising from the right uterosacral ligament in a 48-year-old woman. The diagnosis of ependymoma was supported by a histologic pattern of true rosettes and pseudo-rosettes, glial fibrillary acidic protein (GFAP) positivity, and electron microscopic findings of cilia, blepharoplasts, and intermediate filaments. The tumor was positive for cytokeratin and vimentin. Ultrastructurally, neurosecretory granules were present within the cytoplasm. These features have not been described previously in pelvic ependymomas. These tumors, although easily confused with serous papillary carcinoma, should be distinguished from serous papillary carcinoma because of their apparently better prognosis and tendency for late recurrence.

Pilonidal Disease of the Abdominal Wall

Abstract 1. 1. The reported sites of extra sacrococcygeal areas of pilonidal disease are presented. 2. 2. A case of pilonidal sinus in a site of origin not previously described is reported. 3. 3. The accumulated evidence for pilonidal disease being acquired is briefly summarized.

Pilonidal disease of the abdominal wall

1. 1. The reported sites of extra sacrococcygeal areas of pilonidal disease are presented. 2. 2. A case of pilonidal sinus in a site of origin not previously described is reported. 3. 3. The accumulated evidence for pilonidal disease being acquired is briefly summarized.