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The prevalence of anaerobic infection in pilonidal sinus of the sacrococcygeal region and its effect on the complications.

Bacteriologic characteristics of pilonidal disease of the sacrococcygeal region were assessed in two groups of patients: patients with disease recurrence (group A), and patients who first ever presented for surgical treatment (group B). The frequency of anaerobic colonization was studied. Bacterial colonization is frequently present in patients with pilonidal disease of the sacrococcygeal region. Samples of the skin over the sacrococcygeal sinus showed the presence of bacterial colonization in 78% and 70% of group A and group B patients, respectively. Analysis of sinus fluid samples revealed the presence of bacteria in 88% of group A patients and 78% of group B patients. Anaerobic colonization in the content of pilonidal sinus was found in approximately 2/3 (64%) group A patients and about a half (52%) group B patients. Considerable bacterial colonization was also recorded in skin swab samples, i.e. in 48% of group A patients and 38% of group B patients. Anaerobic bacteria were rarely detected in pure cultures (in group A 6% skin swab, and 20% of sinus fluid samples, and in group B, 4% of skin swab and 12% of sinus fluid samples). Anaerobes were mostly detected in combined cultures (42% of skin swab and 44% of sinus fluid samples from group A, 32% of skin swab and 40% of sinus fluid samples from group B). Surgical methods to considerably reduce the conditions for anaerobic bacterial colonization of the wound should be the methods of choice in the management of pilonidal disease of the sacrococcygeal region.

Adult↗

Pathogenesis of congenital tumors and malformations of the sacrococcygeal region.

Skin-covered lesions in the sacrococcygeal region include an unusual array of congenital tumors and malformations. Excluding the easily recognized meningomyelocele, there are over 50 other conditions that occur, many of which seem to be important in linking the disciplines of teratology and oncology. While it is impossible to precisely determine the manner in which these arise, there is suggestive evidence that early structures incorporated within the caudal cell mass of the embryonic tail may play an important role. The present paper reviews the basis for this speculation from both the literature and a series of 136 cases.

Ependyma↗

Germ cell tumors of the sacrococcygeal region: radiologic-pathologic correlation.

Germ cell tumors of the sacrococcygeal region include mature and immature teratomas and endodermal sinus tumor. Most sacrococcygeal teratomas are discovered in the newborn period as an obvious mass, but they may be detected prenatally. Endodermal sinus tumors are usually discovered later in early childhood. Pathologically and radiologically, teratomas are either both cystic and solid, predominantly cystic, or rarely solid. Over 50% have calcification or ossification. Most malignant teratomas have substantial solid components and may contain calcification. Treatment is surgical excision including coccygectomy. Malignant tumors are treated with both surgery and chemotherapy. Prognosis is excellent for teratoma, although local recurrences may occur. Malignant teratomas have had a dismal prognosis in the past, which has been improved with multiagent chemotherapy.

Child↗

Extraspinal ependymoma presenting as a subcutaneous mass posterior to the sacrococcygeal region. Case report.

Ependymal cells may be found within the coccygeal ligament as well as in heterotopic positions and therefore ependymomas may rarely occur in extraspinal locations. Although the cauda equina is the most common location, less than 5% of all spinal ependymomas occur extradurally in the sacrococcygeal region. We report a case of extraspinal myxopapillary ependymoma arising in the subcutaneous soft tissue posterior to the sacrococcygeal region and review the relevant literature.

Adult↗

[Results of treatment of primary bone neoplasms of the sacrococcygeal region].

In the clinic 53 patients with primary bone tumors of the sacrococcygeal region and sacroiliac junctions were observed. Surgical methods of treatment were used in 33, combined--in 7, radiation therapy--in 10, drug therapy--in 3. Recurrences developed in 7 cases, metastases were revealed in 14. The results of treatment in patients with neoplasms in this region were studied. Twenty five patients died from generalization of the process, metastases, intestinal obstruction and uremia. The remaining 28 patients have been followed up within the terms from 1 to 5 years and longer.

Adolescent↗

Myxopapillary ependymoma of the sacrococcygeal region. Report of a case.

A case of subcutaneous myxopapillary ependymoma arising in the sacrococcygeal region of a 42-year-old woman is reported. Less than 60 cases of such tumors have so far been described in locations outside the central nervous system. Sacrococcygeal ependymomas are locally aggressive tumors that require a complete and wide surgical excision to prevent recurrences. They tend to metastasize in about 17% of cases.

Adult↗

[Tumors of the sacrococcygeal region (author's transl)].

In the world literature is reported about 584 tumors of the sacrococcygeal region, 484 of them are analysed exactly. The symptoms of the various tumors are about the same, pain and nerval irritation were seen in the most cases. Rectal-digital examination mostly leads to diagnosis. Computertomography is of special diagnostic value since some years. Because of the localisation of the tumor therapy often is difficult. Operation is the only way to remove the tumor and should be done so radically as possible. Radiation therapy may induce malignant degeneration. Adjuvant chemotherapy till now is without of any any effect. In the paper we report about the very seldom malignant meningeoma of the sacrum, in the literature we could not find any other case. Besides this and the 584 cases of the literature there is reported about 4 other own cases of sacrococcygeal tumors, one neurofibroma and three giant cell tumors of the Os sacrum.

Adolescent↗

[A chordoma of sacrococcygeal region as a cause of nephrotic syndrome (author's transl)].

A case of nephrotic syndrome connected with a chordoma of the sacrococcygeal region in a man aged 27 is described. Biopsy of the kidney revealed a diffuse membranous glomerulonephritis. Immunofluoresecenc showed deposits of IgG immunoglobulin on the basal membrane of glomeruli. In the patient's serum autoantibodies against chordoma cells were found. Those were also IgG globulins. To our knowledge such a relation of chordoma and nephrotic syndrome has not been described yet.

Adult↗

[Teratomas of the sacrococcygeal region in newborn infants and infants].

The clinical manifestations, diagnosis and results of the treatment of 52 children, suffering from teratomas of the sacrococcygeal region, are presented. The optimal time for the performance of surgical intervention is defined. Three newborns and 3 children, operated on at the age over 1 year with malignization of teratoma, died.

Female↗

Metastasizing myxopapillary ependymoma of the sacrococcygeal region. A clinico-pathologic, light- and electronmicroscopic, immunohistochemical, tissue culture, and cytogenetic analysis of a case.

A case of recurrent and metastasizing subcutaneous myxopapillary ependymoma of the sacrococcygeal region in a 44-year-old man is reported. The tumor was characterized light microscopically by numerous papillary projections, lined by epithelium-like cells, with a variable degree of polymorphism. Histochemical analysis relating to glucosaminoglycans indicated the presence of hyaluronic acid and chondroitin-4- and/or 6-sulfate. Using immunoperoxidase techniques, glial fibrillary acidic protein (GFAP) and S-100 protein were demonstrated within the tumor cells. Ultrastructurally, the tumor cells were characterized by an abundance of intermediate cytoplasmic filaments, prominent interdigitating cytoplasmic projections, the formation of desmosomes and external lamina-like material. The growth pattern in the tissue culture of this tumor is described, and the ultrastructural appearance of the cultured cells revealed features similar to the primary and recurrent tumor. Chromosome analyses by the G-banding technique of early generations of cultured tumor cells revealed a normal diploid stemline without gross chromosomal deviations. Among the different variant cells and clones recorded, those with X chromosome deviations were of special interest since gonosomal deviations have previously been observed in other types of glioma. The differential diagnosis against adenopapillary carcinoma, chordoma and malignant teratoma is briefly discussed.

Adult↗

[Treatment of pustular lesions of the perineum and sacrococcygeal region].

The results of treatment of 316 patients with chronic pustular lesions of the perineum and sacrococcygeal region are discussed. It is shown that the only radical measure in this category of patients is total excision of the involved tissues and, in combined variants, simultaneous performance of typical operations for rectal fistula or coccygeal pilonidal fistula. In localized and mostly in regional forms of the disease one-stage surgical interventions are expedient. Many-stage operations are indicated in extensive and, less frequently, in regional forms. Postoperative complications occurred in 5.3% of cases and were associated with wound suppuration. The late-term results were studied in 71.7% of patients who underwent operation: recurrences developed in 3.7% of cases.

Chronic Disease↗

The effect of cisplatin dose and surgical resection in children with malignant germ cell tumors at the sacrococcygeal region: a pediatric intergroup trial (POG 9049/CCG 8882).

PURPOSE: This study was designed to evaluate (1) the efficacy of standard or high-dose cisplatin with etoposide and bleomycin and (2) the role of surgical resection in infants and children with malignant germ cell tumors of the sacrococcygeal region (SCT). METHODS: Seventy-four of 317 children presenting to Pediatric Oncology Group (POG)/Children's Cancer Group (CCG) institutions from 1990 through 1996 with malignant germ cell tumors had malignant SCT. There were 62 girls and 12 boys with a median age of 21 months (range, 3 days to 37 months) and median serum alpha-fetoprotein of 35,500 ng/mL. Twelve had undergone resection of a benign SCT as a newborn. Forty-four (59%) had evidence of metastatic disease at time of diagnosis. Presentation by type (Altman classification) was I, 0; II, 2; III, 30; and IV, 42. The initial procedure was biopsy in 45 and resection in 29. Patients were assigned randomly to receive 4 cycles of chemotherapy with etoposide (E) and bleomycin (B) and either high-dose cisplatin (200 mg/m(2) per cycle; HDP) or standard dose cisplatin (100 mg/m(2) per cycle; P). After completion of chemotherapy, 42 of 45 initially treated with biopsy underwent resection. RESULTS: Overall 4-year survival rate is 90% (SE = 4%) and 4-year event-free survival (EFS) is 84% (SE = 6%). Event-free survival data for subgroups of interest are as follows: 4-yr EFS% (SE) P Values Mets (44) 88 (6).48 No Mets (30) 80 (8) HDP EB (37) 89 (6).21 P EB (37) 78 (7) Initial Resection (29) 90 (7).50 Delayed Resection (42) 83 (7) Complete Resection (49) 90 (5).19 CR/PR Partial Resection (22) 77 (10) Biopsy Only (3) 33 (27).005 (3 way) CONCLUSIONS: (1) The current survival rate of malignant sacrococcygeal tumors is excellent even with metastases. (2) Delayed surgical resection is not associated with an adverse outcome. (3) In this subset the treatment comparison was inconclusive however, followed the trend in the overall study of more than 300 children in which the high-dose cisplatin group had superior EFS (P<.05).

Antineoplastic Combined Chemotherapy Protocols↗