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The clinical anatomy of the lumbosacral region has been presented to show the complexity of spinal pathology. Individual structures are described, but emphasis is placed on understanding the concept of the entire functional unit and how alteration can lead to pain and disability.
Different anesthetic drugs can produce different electroencephalographic (EEG) patterns. Nondrug induced influences, such as surgical stimulation, may also alter the EEG in anesthetized patients. Increases of delta activity are interpreted as signs of deepening of anesthesia. These EEG patterns are sometimes also found in frontal leads after surgical stimulation during isoflurane anesthesia. However, to avoid incorrect anesthetic management under EEG monitoring, this phenomenon of "paradoxical arousal" must be taken into consideration. This study demonstrates that, after surgical stimulation, frontal activity was enhanced in the 2-3 Hz and 3-4 Hz frequency bands. On the other hand, in the subdelta range (the 0.05-1 Hz and 1-2 Hz frequency bands), there was an opposite reaction. This significant (p<0.001, according to ANOVA and Dunn's method) reduction of EEG power as a result of the surgical stimuli was found in 25 patients (mean age, 49.1+/-16.3 years) scheduled for elective neurosurgical intervention in the lumbosacral region. This report shows some of the problems arising from the common practice of arbitrarily subdividing a power spectrum in frequency bands.
A unique dermal and subcutaneous botryoid rhabdomyosarcoma admixed with ectopic mature renal tissue, overlying the left lateral lumbosacral region of a 41/2-year-old girl is reported. The tumor was devoid of blastemal or immature epithelial elements and nephrogenic rests. The relationship of this lesion to an extrarenal Wilms' tumor with exclusive myogenous differentiation is discussed.
Innervation of the ventral spinal artery from the lumbosacral region of dogs was studied using light, scanning, and transmission microscopy. Microscopy revealed myelinated fibers, a new observation, in addition to unmyelinated fibers expected on the basis of previous studies of autonomic innervation of this blood vessel. The myelinated axons may be sensory fibers.
An accident model was used to analyze data in terms of the first event in all reported accidents occurring in a gearbox factory during 1974. The data were used to study the causes of lumbosacral injuries. A labor force of 2000 men sustained 99 lumbosacral injuries, 54 of which led to absence of one or more days. Twenty of the 54 were initiated by slipping, and 17 presented as a sudden onset of low-back pain without any preceding accidental event. A review of all patients who were absent following a slipping accident disclosed that the lumbosacral region was by far the commonest part of the body injured. Tripping was an infrequent cause of these injuries. Slipping rarely features in the literature as a cause of low-back pain. It is suggested that this is due to confusion between various contributory factors and events forming an accident.
The investigator studied schistosomiasis of central nervous system in human cadavers and hamsters. He found out that 13.3% of the spinal cords of the human cadavers were infected by Schistosoma ova. The lesion was confined to the lumbosacral region of the cord in cases of advanced bilharziasis. The cords of infected Hamsters showed only diffuse cell infilterate without ova. The possible pathways of ova from the final habitats of the parasites to the cord are pelvivertebral and portovertebral connections as shown from the discovered pathological changes in the blood vessels of these areas.
UNLABELLED: Occurrence of extrarenal Wilms' tumour (WT) is very exceptional and the diagnosis is almost always made after surgical intervention. The tumour can be located in the retroperitoneum, uterus, cervix, testes, skin and even in the thorax. The exact mechanism whereby a WT occurs in extrarenal tissues is not known. The presence of ectopic metanephric blastema cells or the WT gene that cause transformation of extrarenal primitive mesonephric or pronephric remnants into WT are both considered in the embryogenesis. Although ultrasonography and CT scan are both helpful in the definition of retroperitoneal tumours, there is no characteristic finding to diagnose an extrarenal WT before surgery. However the histological characteristics are the same as in intrarenal WT, a retroperitoneal teratoma should be clearly investigated for a possible admixture of WT cells. Patients with extrarenal WT are given the same treatment protocol as patients with stage III WT. In this paper, a 5-year-old female patient with an extrarenal WT located in the lumbosacral region is presented. CONCLUSION: as a rule, diagnosis of extrarenal Wilms' tumour is made after surgery. Surgical excision is the treatment of choice and the same general therapeutic rules should be followed as when the kidney were affected. Stage III guidelines for chemotherapy and radiotherapy are appropriate in these patients.
BACKGROUND: Basal cell carcinomas (BCC) are the most frequently diagnosed skin cancers. The relationships between some clinical parameters, such as sex, age, and location of the tumor, and the histologic patterns play an important role as factors predictive of recurrence and treatment implications. METHODS: A total of 693 patients with BCC, divided according to sex, age, and location of the tumor were studied. The histologic patterns considered were nodular, superficial, and morpheiform BCC and fibroepithelioma. The correlation between clinical and histologic parameters was analyzed. RESULTS: All histologic patterns considered were most commonly represented in the 7th and 8th decades. There were no sex differences. A prevalence of a superficial pattern for sun-unexposed areas and of a nodular pattern for sun-exposed areas was observed. The morpheiform pattern showed no correlation with any body site. The fibroepithelioma showed an absolute prevalence for the lumbosacral region. CONCLUSIONS: Age does not seem to be a discriminant or permissive factor for a particular histologic pattern of BCC. The prevalence of some subtypes for a particular body area may be explained on the basis of local predisposing conditions affecting the histologic development of the tumor.
The effect of the last developmental phase of the warble fly (Hypoderma bovis de Greer) larvas was studied as exerted on some health indices of milk in 20 experimental (treated) and 18 control (untreated) first-calvers of the Pinzgau breed at two localities of an area affected by bovine hypodermosis in the period from May to June, 1975. The preparation Hypocid, at a dose of 15 ml per 100 kg of body weight, was applied externally in the lumbosacral region to the experimental animals in November, 1974. Throughout the experimental period (61 days) the milk was repeatedly examined bacteriologically and cytologically, the content of chlorides and the milk electric conductivity were determined. In none of the followed health indices of milk were significant differences in the values obtained from experimental and control first-calvers proved statistically.
A 61-year-old man presented with repeated back pain and progressive anesthesia of both lower limbs. MR images and myelography showed an intradural, extramedullary tumor at the Th8-9 level. Surgery revealed a thin membrane containing xanthochromic cerebrospinal fluid behind the spinal cord. Microscopically, the excised lesions contained columnar epithelium with goblet cells. Spinal neurenteric cysts are a rare anomaly, especially solitary cysts located in the thoracic spine. The neurenteric canal transiently develops in the lumbosacral region during the 3rd week of gestation. Thus, it is difficult to claim that the neurenteric cyst in our case originated in a remnant of the neurenteric canal. As Bentley and Smith (1960) suggested, thoracic solitary neurenteric cysts may develop from a remnant of adhesion between ectoderm and endoderm during the 3rd week of gestation as a result of splitting of the notochord.
We describe a 74-year-old woman with extensive pelvic leiomyosarcoma presenting with uncharacteristic musculoskeletal pain of the lumbosacral region and left lower extremity. Hemipelvectomy was considered the treatment of choice, and a model for a pelvic prosthesis was constructed based on imaging analysis. However, the tumour (and the complaints) responded surprisingly well to a combined treatment regimen including superselective arterial catheter embolization, which led to tumour regression to such a degree that aggressive surgical treatment became unnecessary.
Failure of separation of the neuroectoderm from the epithellal ectoderm to proceed in an orderly and complete fashion results in a wide variety of defects involving the skin, spinal cord, and cauda equina, as well as the surrounding structures of mesodermal origin. Congenital dermal sinuses occur most commonly in the lumbosacral region, are usually associated with a spina bifida, and may connect the skin directly to the spinal canal. Epidermoid or dermoid cysts may form at any point along a dermal sinus. Four types of cutaneous or subcutaneous abnormalities commonly seen associated with occult spinal disorders are abnormal hair, angioma, lipoma, and dimple. It is essential that these lesions are investigated at an early age, since surgical excision may prevent future neurologic deficits.
Dermal sinus tracts are common skin manifestations seen with spinal dysraphism. Most of these dermal sinus tracts occur in the lumbosacral region. Though dermal sinus tracts are a common manifestation, their presentation with CSF leak is rare and important as they predispose to recurrent meningitis along with neurological deficits. Here we present an interesting case of a 33-month-old female child with dermal sinus CSF leak, tethered cord and intradural dermoid who presented with meningitis and was treated with excision of the tract, removal of the dermoid and detethering of the cord.
A rare case of a newborn girl presenting with a mass representing an aborted parasitic twin attached to the back in the midline over the lumbosacral region (parasitic rachipagus) is reported. Rudimentary digits were attached to the mass, and in one area, the overlying skin resembled scrotal skin. A depression resembling an anal dimple was also present on the surface of the mass. Investigations showed a well-developed long bone and other small bones within the parasite, and sacral spina bifida in the autosite. Successful surgical excision of the parasitic mass was performed. A review of the literature pertaining to parasitic rachipagus twinning is presented.
Axial computed tomographic (CT) scan of the lumbosacral region was performed in 220 patients. The patient population was divided into three groups. The control group included 40 elderly patients without calcification of the ligamenta flava. The second group included 150 patients with posterior protrusion of the intervertebral discs. The third group included 30 patients with spinal stenosis. More than 80% of the patients of the second and the third group had calcification of the ligamenta flava. The diagnostic and practical importance of these findings is discussed.
Computerized tomography (CT) of lumbosacral region and lumbar myelograms of 100 patients with primary tumours were evaluated independently for evidence of epidural metastases. An attempt was made to predict myelographic abnormalities (or absence of such) on the basis of CT appearance at the spine and spinal canal contents. The overall accuracy of computed tomography was found to be 80%. There was a good correlation with myelography in patients without evidence of epidural lesions (79%). However, in group of patients with positive myelograms, CT was rather unreliable with high number of false negative studies (50%).
Malignant eccrine poroma is a rare skin appendage tumour, originating from the intraepidermal and upper dermal eccrine ducts. The tumour either arises spontaneously or develops in a long-standing eccrine poroma, generally in elderly people over 60. Clinically, it tends to be a localized lesion, which manifests itself as a nodule or ulcerated tumour, favouring extremities. We report an 83-year-old female with an enlarging and bleeding tumour on her lumbosacral region. This lesion first appeared as a small pigmented papule and progressed to an erythematous patch with central papular portion and some peripheral pigmentation. Histopathology revealed malignant eccrine poroma. Also, immunohistochemically, diffuse and intense p53 staining was observed. Regular pigment pattern, brown globules and black dots were seen in dermoscopic examination. After performing a wide excision, 20 months of follow-up revealed no recurrence or metastasis of the tumour. This case represents an unusually located malignant eccrine poroma with some pigmentation.
The effects of acetylsalicylate and metamizol on spinal monosynaptic reflexes were tested in spinal rats. Adult rats were anesthetized with ketamine, artificially ventilated, and spinalized at the C1 level. A laminectomy was performed in the lumbosacral region. Following electrical stimulation of the sciatic nerve by single pulses, the reflex potentials were recorded from the ipsilateral L5 ventral root. Acetylsalicylate was administered orally via nasogastric tube and metamizol intramuscularly. Acetylsalicylate (50 and 100 mg/kg) and metamizol (15 mg/kg) significantly decreased the amplitude of the reflex response (p < 0.05). But the 10-mg/kg metamizol dose did not significantly decrease the amplitude of the reflex response. The cyclooxygenase products of arachidonic acid may play an important role in regulating the reflex potential.