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.

A man with disabling low back pain: Echinococcus of the sacrum.

Bone involvement in hydatid disease is rare, and when it does occur, the most common sites of involvement are the spine and pelvis. A case of bone hydatid disease involving the sacrum is reported here.

Paleoparasitological evidence of pinworm (Enterobius vermicularis) infection in a female adolescent residing in ancient Tehran (Iran) 7000 years ago.

BACKGROUND: The Molavi street archeological site south of Tehran accidentally provided a unique opportunity for paleoparasitological studies in Iran. A female skeleton was unearthed and evaluated to be 7000 years old. Soil samples were collected around the pelvic and sacrum bones. FINDINGS: Careful microscopic investigation of rehydrated soil samples revealed the presence of one Enterobius vermicularis egg attached to the skeleton sacral region. CONCLUSION: The present finding likely represents the oldest evidence of a human pinworm infection in Asia.

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.

Spontaneous drainage of an asymptomatic recurrent hydatid cyst of the sacrum.

STUDY DESIGN: A case report. OBJECTIVE: This is an unusual presentation of recurrent hydatid disease. Spillage of a hydatid cyst was previously reported in a symptomatic case of primary spinal hydatid disease. However, we did not find any examples of spontaneous discharge of hydatid cyst fluid in an asymptomatic case in the literature. SUMMARY OF BACKGROUND DATA: Bone hydatid cysts occur in 1% to 2.5% of all patients with hydatid cyst disease, whereas 50% of bone hydatidosis cases are spinal. Diagnosis is difficult and patients usually present with neural compression symptoms. Surgery and antihelmintic medicine administration are considered as the treatments of choice. METHODS: In this report, a 35-year-old male patient, who underwent surgical and antihelmintic medical treatment 2 years previously, had a leaking cyst without neurologic symptoms. The patient underwent excision of multiple parasacral cysts from a posterior approach. Medical antihelmintic treatment was used after surgery. RESULTS: The postoperative period was uneventful. Follow-up MRI scans were performed at 6, 12, and 18 months after surgery. The few residual anterior perisacral cysts had, in fact, become smaller. CONCLUSION: The recurrence period of spinal hydatid disease may be silent without any neurologic deficits or pain; the only clinical manifestation may be leakage from a cyst. Curative therapies remain unlikely, but periodic follow-up MR images are advisable for early diagnosis of recurrence in order to obtain effective treatment.

Hypoplasia of L5 and wedging and pseudospondylolisthesis in patients with spondylolysis: study with MR imaging.

BACKGROUND AND PURPOSE: The association between L5 hypoplasia and bilateral spondylolysis was described earlier on conventional radiographs of the lumbar spine. The purpose of this study was to describe the findings on MR imaging in patients with hypoplasia of L5 and to correlate these findings with the presence of bilateral spondylolysis of L5. MATERIAL AND METHODS: We studied the MR images of 22 patients with hypoplasia and posterior wedging of L5 and with bilateral spondylolysis at L5. The anteroposterior diameter of L4, L5, and S1 were measured and compared. The degree of posterior wedging of L5 was calculated. The degree of anterolisthesis was determined. The intervertebral disks of L4-L5 and L5-S1 were studied. RESULTS: The mean difference between the anteroposterior diameter of L4 and L5 was 3.0 mm, or 8.8% shortening of L5 compared with L4. The mean difference between the anteroposterior diameter of L5 and S1 was 4.4 mm, or 12.3% shortening of L5 compared with S1. The mean percentage posterior wedging was 24.7%. In 13 patients, there was no anterior vertebral slipping. True anterolisthesis grade I was seen in 5 patients and anterolisthesis grade II in 4 patients. Diskarthrosis with disk dehydration of L4-L5 was seen in 20 of the 22 patients. CONCLUSIONS: It is confirmed that hypoplasia of L5 can simulate anterolisthesis. Hypoplasia of the vertebral body of L5 can predict the presence of bilateral spondylolysis.

Hydatid cysts in uncommon locations in the same patient: simultaneous cardiac and spinal involvement.

INTRODUCTION: The spine and cardiac cavities are uncommon locations for hydatid disease. Spinal and cardiac hydatid cases separately constitute only 0.5-1% of all hydatid cases. We reported a case with spinal and cardiac involvement simultaneously. Clinical and radiological findings of this unique case are discussed. CASE REPORT: A thirty-four-year-old male patient was admitted to hospital with pain at the low back and left thigh. He had undergone surgery for lumbosacral hydatidosis twice before. Cysts had been removed totally in the last operation. The disease relapsed with widespread involvement of the sacropelvic region. During the investigation, we diagnosed a cyst in the cardiac cavity, incidentally. The cyst in the cardiac cavity was removed totally. DISCUSSION: Hydatid disease is still an endemic disease in South America and some Mediterranean countries including Turkey. Cysts rarely involve the spine and cardiac cavities. The simultaneous involvement of the sacropelvic region and the cardiac cavity is an extremely rare condition. Cardiac cysts have a poor prognosis. Prompt surgical extraction of the cyst is a critical mainstay of the management.

Cauda equina syndrome caused by primary lumbosacral and pelvic hydatid cyst: a case report.

INTRODUCTION: Hydatid disease occurs in humans as a result of faeco-oral contamination and spinal echinococcosis is rare even in areas where echinococcosis is endemic. Hydatid cyst primarily occurs in the liver and lungs. Bone involvement constitutes only 0.5-2% of all hydatidoses. About half of the bone involvement occurs in vertebrae. The thoracic spine is the most common site of the spinal hydatidosis. Primary hydatid cysts of the lumbar and sacral spinal canal are very rare. CASE REPORT: We present a 31-year-old man with cauda equina syndrome caused by a primary hydatid cyst of the lumbosacral and pelvic areas. He had been admitted to hospital with left foot and low back pain three years ago. Magnetic resonance imaging revealed an intraspinal hydatid cyst extending from L2 to S2. The cyst had been totally removed. He was symptom-free for three years. After three years, he presented with acute cauda equina syndrome. His neurological examination revealed total plegia of dorsal flexion of the left foot and perianal hypoaesthesia. MRI showed lumbosacral and pelvic hydatidosis again. After total removal of the cyst, his neurological status revealed immediately relief. DISCUSSION: Hydatid cyst is an important health problem in some countries including Turkey. Bone involvement is seen in only 0.5-2% of cases. Furthermore sacral and lumber vertebral involvement is extremely rare. We presented a case with a spinal hydatid cyst which classified as a combination of intraspinal extradural, vertebral and paravertebral forms according to the Braitwate and Lees classification. Surgical excision and additional medical treatment is still the most effective treatment. Cysts located intraspinally have a tendency to rupture spontaneously. For this reason the high recurrence rate (30- 40%) is still a major problem in management.

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.

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.

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.

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.

[Primary sacral epidural hydatid cyst: a case report]. / 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.

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.

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.