Ancient Soil-Transmitted Parasite Eggs Detected from the Sixth Century Three Kingdom Period Silla Tomb

The parasitic infection patterns of the Joseon period have begun to be revealed in a series of paleoparasitological studies. However, parasitism prevailing during or before the Three Kingdom period is still relatively unexplored. In the present study, we therefore conducted parasitological examinations of soil and organic-material sediments precipitated upon human hipbone and sacrum discovered inside an ancient Mokgwakmyo tomb dating to the Silla Dynasty (57 BCE-660 CE). Within the samples, we discovered ancient Ascaris lumbricoides (eggs per gram [EPG], 46.6-48.3) and Trichuris trichiura (EPG, 32.8-62.1) eggs, the species commonly detected among Korean populations until just prior to the 1970s. These findings show that soil-transmitted parasitic infection among the Silla nobility might not have been uncommon. This is the first-ever report on the presence of ancient parasite eggs in the samples obtained from a Three Kingdom period tomb; and it also presents the earliest positive results for any of the ancient South Korean tombs paleoparasitologically examined to date.

Combined anterior and posterior approach for sacral/retroperitoneal hydatid cyst disease: case report

Achieving complete resolution of spinal hydatid cyst disease is quite challenging when bone is involved. Many authors reported the poor outcome of posterior decompression and laminectomy for intraosseous spinal hydatid disease. In an attempt to avoid a similar poor outcome, hydatid cysts were reached via both anterior and posterior surgical approaches in our patient. A 73-year-old man presented with complaints of low back and right leg pain. Symptoms or signs of systemic hydatid cyst disease were absent. MRI demonstrated a cystic lesion in the presacral/retroperitoneal region, involving the body of the sacrum and sacral canal. Computed tomography images showed enlargement of the sacral foraminae. The multiseptated cysts and their contents were isodense with cerebrospinal fluid. The cysts were removed via an anterior extraperitoneal approach, using a paramedian vertical incision, and then were also approached posteriorly via bilateral S1 hemilaminectomy. No neurological deficits occurred following surgery. The patient's symptoms completely disappeared after this combination of aggressive surgery and antihelminthic therapy. The application of both anterior and posterior approaches to intraosseous sacral hydatid cysts may be preferred when faced with hydatid disease in this location.

Primary sacral hydatid cyst. A case report

This case report highlights an unusual osseous spinal presentation of a well described disease, hydatidosis. A 59-year-old woman presented with increasing back pain and bilateral radiculopathy. Examination disclosed symptoms of spinal stenosis and urinary incontinence. Radiographs showed an expansive lytic lesion affecting the pelvic bones with destruction of the bone cortex. Laboratory analyses were performed and the patient underwent CT and MRI studies. Serology for Echinococcus was positive. When assessing sciatica, low back pain or lower limb weakness the pelvic cavity should be examined for hidden disease that might explain the neurological symptoms. Hydatid disease of bone should be considered in the differential diagnosis of any bone mass discovered in the human body. Diagnosis was delayed in this case because the pelvic cavity was not studied when radiculopathy symptoms started and there was no coexisting visceral involvement.

Long term follow-up of a patient with disseminated spinal hydatidosis

A rare case of a 27-year-old male patient with disseminated sacral hydatidosis is presented. Because the diagnosis was missed initially, the patient underwent only partial resection of the tumour to obtain tissue for histology. The resection was followed by deep wound infection, and re-exploration had to be performed, thereby resecting the remaining cyst tissue and the S1-S3 vertebral bodies. Adjuvant anti-helminthic therapy was started postoperatively. Unfortunately, the hydatid cyst further progressed and could only be controlled with multiple decompression procedures and continuance of anti-helminthic therapy. We review the diagnosis, treatment and prognosis of this uncommon condition, which is a serious challenge for the spinal surgeon.

Quantitative paleoparasitology applied to archaeological sediments

Three techniques to extract parasite remains from archaeological sediments were tested. The aim was to improve the sensibility of recommended paleoparasitological techniques applied in archaeological remains. Sediment collected from the pelvic girdle of a human body found in Cabo Vírgenes, Santa Cruz, Argentina, associated to a Spanish settlement founded in 1584 known as Nombre de Jesús, was used to search for parasites. Sediment close to the skull was used as control. The techniques recommended by Jones, Reinhard, and Dittmar and Teejen were used and compared with the modified technique presented here, developed to improve the sensibility to detect parasite remains. Positive results were obtained only with the modified technique, resulting in the finding of Trichuris trichiura eggs in the sediment.

An extensive vertebral hydatidosis revealed by a lumbosciatica

The vertebral hydatidosis is uncommon. It causes problems in diagnosis and in management. A case of an extensive vertebral hydatidosis with few symptoms is reported. A 21-year-old man has consulted for recurrent lumbosciatica that has been evolving for 1 year. Clinical exam was normal. Plain radiographic films disclosed a lytic lesion throughout the bodies of L4 and L5 and calcifications thrown on the liver area. The computed tomography (CT) and the magnetic resonance (MR) images revealed multicystic bony lesions involving the lumbar spine with extension into the spinal canal. Abdominal ultrasound showed also cyst lesions in the right kidney and in the liver. The diagnosis of vertebral and abdominal (liver and kidney) hydatidosis was retained. Four sets of 4-week albendazole cures were given with a 2-week interval in between. Our case of extended vertebral hydatidosis with few symptoms confirms the clinical latency and diagnosis difficulties usually encountered in this disease. This often leads to a late diagnosis of the stage of spinal cord compression. Radiological diagnosis and determination of extension of the hydatid cyst are usually provided by CT and MRI. Vertebral hydatidosis should be evoked in lumbosciatica especially in endemic regions.

High-grade dysplastic spondylolisthesis and spondyloptosis: report of three cases with surgical treatment and review of the literature

High-grade dysplastic spondylolisthesis is extremely rare and always involves the L5-S1 level. It is attributed to congenital dysplasia of the superior articular process of the sacrum. It can remain asymptomatic for a long time and can progress to a more severe grade of olisthesis and spondyloptosis. Surgical treatment has varied from posterior-only in situ fusion to anterior and posterior fusion with complete reduction. Three cases of symptomatic high-grade (4th and 5th grade) dysplastic spondylolisthesis treated surgically with reduction and fusion are presented. Interbody fusion at the level of olisthesis is crucial.

Kyste hydatique épidural sacré primitif : à propos d’un cas

Primary epidural hydatid cyst of the spinal canal without bone involvement is very rare. The authors report the case of a 35 year old man presenting with lower cauda equina compression. MRI showed a cystic lesion with signal characteristics similar to cerebrospinal fluid. Surgical exploration through a midline posterior approach was used which confirmed the hydatid nature of the cyst. There was no bone lesion. Histological examination confirmed the diagnosis. Hydatid cyst should be suspected in case of cystic lesion causing cord compression or cauda equina syndrome.

New indications for computer-assisted surgery: tumor resection in the pelvis

The resection of recurrent malignant pelvic tumors was supported by a commercially available navigation system in three patients. Preoperatively three-dimensional images from the pelvis were obtained by computed tomography or magnetic resonance imaging to identify the tumor extension. During surgery navigated tools oriented the surgeon to excise the tumor with adequate virtual margins. Navigation was helpful for tumor identification in one patient with a recurrent presacral mesenchymal chondrosarcoma. In the other two patients the tumor resection in the bone was done with three-dimensional observation of the osteotomies in the sacrum. In all three patients the histopathologic analysis confirmed that the neoplasms were excised accurately within their margins. We think that computer-assisted surgery is a potential method to increase the accuracy of tumor resections.

A lasting solution is hard to achieve in primary hydatid disease of the spine: long-term results and an overview

STUDY DESIGN

Retrospective evaluation of patients with primary hydatid disease was done, with an overview of the pertinent literature. OBJECTIVES.: To determine the results of surgical decompression and antihelminthic treatment.

SUMMARY OF BACKGROUND DATA

Bone involvement in hydatid disease has been reported to be only 0.5 to 4%. Spinal involvement is found in 50% of these cases, with mortality over 50%. Paraplegia is the most serious complication of the disease, caused by compression of the spinal cord by the cysts. Aggressive surgery combined with antihelminthic therapy is recommended to eradicate the disease and prevent recurrence.

METHODS

Three patients with primary spinal hydatid disease were operated on several times for multiple recurrences. Combined chemotherapy with either mebendazole or albendazole was also given. The mean age was 52 years, and the mean follow-up time was 92 months.

RESULTS

Surgery and chemotherapy improved the symptoms in all cases but could not prevent recurrences and multiple operations.

CONCLUSIONS

Primary spinal echinococcosis must be considered in the preoperative differential diagnosis of the atypical presentation of vertebral lesions, especially in patients with risk factors. Early diagnosis and preferably anterior radical surgery combined with antihelminthic therapy of sufficient duration are mandatory to at least halt the progression of symptoms, but these measures could not provide a lasting solution for the patients described here.

Nerve sheath tumors involving the sacrum. Case report and classification scheme

Nerve sheath tumors that involve the sacrum are rare. Delayed presentation is common because of their slow-growing nature, the permissive surrounding anatomical environment, and nonspecific symptoms. Consequently, these tumors are usually of considerable size at the time of diagnosis. The authors discuss a case of a sacral nerve sheath tumor. They also propose a classification scheme for these tumors based on their location with respect to the sacrum into three types (Types I-III). Type I tumors are confined to the sacrum; Type II originate within the sacrum but then locally metastasize through the anterior and posterior sacral walls into the presacral and subcutaneous spaces, respectively; and Type III are located primarily in the presacral/retroperitoneal area. The overwhelming majority of sacral nerve sheath tumors are schwannomas. Neurofibromas and malignant nerve sheath tumors are exceedingly rare. Regardless of their histological features, the goal of treatment is complete excision. Adjuvant radiotherapy may be used in patients in whom resection was subtotal. Approaches to the sacrum can generally be classified as anterior or posterior. Type I tumors may be resected via a posterior approach alone, Type III may require an anterior approach, and Type II tumors usually require combined anterior-posterior surgery.

Image-guided endoscopic spine surgery: Part II: clinical applications

STUDY DESIGN

Endoscopic spinal procedures were performed under computed-tomography-based, image-guided assistance.

OBJECTIVE

To assess the clinical feasibility of applying a methodology that allows image-guided assistance in endoscopic spinal surgery.

SUMMARY OF BACKGROUND DATA

Endoscopic spinal procedures have become a part of the minimal invasive approaches to the spine. The main disadvantage of these techniques is the long learning curve and the lack of peroperative monitoring. Fluoroscopy does have disadvantages, such as positioning during surgery and the risk for radiation exposure. Fluoroscopy-based navigation has many advantages, however it is still based on preselected fluoroscopic images. There is no method that allows computed-tomography-based navigation in endoscopic conditions.

METHODS

Two patients have been operated on using endoscopic approaches assisted by computed-tomography-based navigational system. One had a thoracoscopic approach for median calcified disc herniation and another one had an endoscopic posterior approach for resection of a sacro-iliac osteophyte. For each patient, a frame of reference had been placed percutaneously and scanned. The computed tomography images were registered to the anatomy using the geometry of the frame as fiducials. Navigation through endoscopic approaches was possible in both cases.

RESULTS

In both cases navigation was reliable and a helpful monitoring to achieve the surgical goals through endoscopic approaches.

CONCLUSIONS

There are some factors that make endoscopic spine surgery a difficult start. Image-guided spine surgery is technically feasible and clinically applicable in endoscopic approaches.

Hydatid cyst of the sacrum. Report of a case

An unusual case of hydatid cyst of the sacrum revealed by low back pain and sciatica in a 16-year-old is reported. Computed tomography and a surgical biopsy provided the diagnosis. The outcome was favorable one year after mebendazole therapy initiation.

Case report 833: Primary spinal echinococcosis (Echinococcus granulosus) of lumbosacral spine with destruction of the left pedicles of L3-5 and extension of a large paraspinal cystic mass into the spinal canal

CT is helpful in recognizing the occurrence of hydatid cysts. The increased spatial resolution allows better visualization of details of bone destruction and spinal canal involvement. Paraspinal cystic disease may also show typical and/or characteristic signs of hydatid disease even if serological findings are falsely negative or inconclusive. In the postoperative follow-up, CT may be helpful in assessing residual hydatid cysts and/or in detecting recurrence at an earlier stage.