The use of denosumab in giant cell tumors in the sacrum / O uso de denosumab em tumores de células gigantes no sacro / El uso de denosumab en el tumor de celulas gigantes en el sacro

ABSTRACT Giant Cell Tumor (GCT), a benign tumor with local aggression, corresponds to 5% of primary tumors. Fifteen percent of these are located in the sacrum. En bloc resection is an effective treatment, but when it cannot be performed, Denosumab may be indicated as an alternative treatment. The objectives of this work are: to justify the indication; determine the best dose and time of use; and recognize the need for post-treatment surgery. Methods A systematic search of clinical trials. Twenty-five articles were selected, ten of which met the inclusion criteria. The use of Denosumab is justified in advanced stages, with a dose of 120 mg administered subcutaneously, every 7 days in the first month and then maintained every 4 weeks, for 2.5 to 13 months. Adverse events are mild and can be observed in 84% of patients. With Denosumab, surgery may be less aggressive or even unnecessary. The bibliography justifies the indication of Denosumab in advanced stages of GCT, with a dose of 120 mg administered subcutaneously; there is no consensus as to the maintenance dose, which is a weekly dose in the first month and then every four weeks for 2.5 to 13 months. Complications are frequent but mild. Level of evidence III; Systematic review.

RESUMO O tumor de células gigantes (TCG), um tumor benigno com agressão local, corresponde a 5% dos tumores primários. Quinze por cento desses estão localizados no sacro. A ressecção em bloco é um tratamento eficaz, mas quando não pode ser realizada, o Denosumabe pode ser indicado como tratamento alternativo. Os objetivos desse estudo consistem em justificar a indicação; determinar a melhor dose e tempo de uso e reconhecer a necessidade de cirurgia pós-tratamento. Métodos Foi realizada uma busca sistemática de ensaios clínicos, sendo que foram selecionados 25 artigos, dos quais dez atenderam aos critérios de inclusão. O uso do Denosumabe é justificado em estágios avançados, com uma dose de 120 mg administrada por via subcutânea, a cada 7 dias no primeiro mês e, depois, mantida a cada 4 semanas, durante 2,5 a 13 meses. Os eventos adversos são leves e podem ser observados em 84% dos pacientes. Com o Denosumabe, a cirurgia pode ser menos agressiva ou nem necessária. A bibliografia justifica a indicação de Denosumabe em estágios avançados do TCG, com dose de 120 mg administrada por via subcutânea; não há consenso quanto à dose de manutenção, a qual é uma dose semanal no primeiro mês e depois a cada quatro semanas durante 2,5 a 13 meses. As complicações são frequentes, porém leves. Nível de evidência III; Revisão sistemática.

RESUMEN El tumor de células gigantes (TCG), un tumor benigno con agresión local, corresponde a 5% de los tumores primarios. Quince por ciento de éstos están localizados en el sacro. La resección en bloque es un tratamiento eficaz, pero cuando no puede ser realizada, el Denosumab puede ser indicado como tratamiento alternativo. Los objetivos de este estudio consisten en justificar la indicación, determinar la mejor dosis y tiempo de uso, y reconocer la necesidad de cirugía postratamiento. Métodos Fue realizada una búsqueda sistemática de ensayos clínicos, siendo que fueron seleccionados veinticinco artículos, de los cuales diez atendieron los criterios de inclusión. El uso de Denosumab está justificado en etapas avanzadas, con una dosis de 120 mg administrada por vía subcutánea, a cada 7 días en el primer mes y, después, mantenida a cada 4 semanas, durante 2,5 a 13 meses. Los eventos adversos son leves y pueden observarse en 84% de los pacientes. Con el Denosumab, la cirugía puede ser menos agresiva o ni necesaria. La bibliografía justifica la indicación de Denosumab en etapas avanzados de TCG, con dosis de 120 mg administrada por vía subcutánea; no hay consenso cuanto a la dosis de mantenimiento, la cual es una dosis semanal en el primer mes y después a cada cuatro semanas durante 2,5 a 13 meses. Las complicaciones son frecuentes, aunque leves. Nivel de evidencia III; Revisión Sistemática.

Therapeutic effect of Rhodiola grandiflora combined alprostadil on acute coronary syndrome and its in‐fluence on blood lipid levels／ / 心血管康复医学杂志

Objective :To study therapeutic effect of Rhodiola grandiflora combined alprostadil on acute coronary syn‐drome (ACS) and its influence on blood lipid levels .Methods : A total of 104 ACS patients ,who were treated in our hospital from Jul 2016 to Sep 2017 ,were selected ,randomly and equally divided into alprostadil group (received al‐prostadil injection based on routine treatment ) and combined treatment group (received Rhodiola grandiflora injec‐tion based on alprostadil group ) ,both groups were treated for two weeks .LVEDd ,LVEF ,levels of blood lipid :TC ,TG ,HDL‐C ,LDL‐C ,serum high sensitive C reactive protein (hsCRP ) ,interleukin 6 (IL‐6) and monocyte chemoattractant protein‐1 (MCP‐1) before and after treatment ,total effective rate and incidence of adverse reac‐tions were observed and compared between two groups .Results : After two‐week treatment ,total effective rate of combined treatment group was significantly higher than that of alprostadil group (94.23% vs .78. 85%) , P＝0.022. Compared with before treatment ,after two‐week treatment ,there were significant reductions in LVEDd , levels of TC ,TG ,LDL‐C ,serum hsCRP ,IL‐6 and MCP‐1 ,and significant rise in LVEF and HDL‐C level in two groups , P＜0.05 or ＜0. 01. Compared with alprostadil group after two‐week treatment ,there were significant re‐ductions in LVEDd [ (58.07 ± 6. 14) mm vs.(55.12 ± 5. 06) mm] ,levels of TC [ (5.63 ± 0.94) mmol／L vs.(4. 75 ± 0.81) mmol／L] , TG [ (2. 78 ± 0.54) mmol／L vs.(2. 16 ± 0.47) mmol／L] , LDL‐C [ (3. 28 ± 0.57) mmol／L vs.(2.56 ± 0. 42) mmol／L] ,serum hsCRP [ (6.27 ± 1. 14) mg／L vs .(5. 39 ± 0. 96) mg／L] , IL‐6 [ (7.85 ± 1. 47) ng／L vs .(6. 82 ± 1. 30) ng／L] and MCP‐1 [ (113.74 ± 19.62) ng／L vs.(94.36 ± 16.58) ng／L] ,and significant rise in LVEF [(45.74 ± 8.48)% vs.(50.78 ± 8.34)%] and HDL‐Clevel [(2.36 ± 0. 52) mmol／L vs.(2. 93 ± 0. 57) mmol／L] in combined treatment group , P＜0.01 all.During treatment ,there was no significant difference in inci‐dence rate of adverse reactions between two groups , P＝0. 539. Conclusion :Rhodiola grandiflora combined alpros‐tadil possesses significant therapeutic effect on ACS .It can significantly improve cardiac function ,regulate blood lipid metabolism and reduce inflammation with low incidence of adverse reactions ,which is worth extending .

Extradural lumbar nerve root cavernous hemangioma: case report and successful surgical resection / Hemangioma cavernoso extradural de raiz nervosa lombar: relato de caso e ressecção cirúrgica bem-sucedida

Extradural lumbar spinal canal cavernous hemangiomas (or cavernomas) are rare lesions that can induce intense back pain and neurological deficit. We present a case report of a patient with a pure radicular lombar extradural cavernoma resembling a benign neurological tumor in imaging exams and a successful surgical resection.

Os hemangiomas cavernosos do canal vertebral lombar extradural (ou cavernomas) são lesões raras que podem induzir dor intensa no dorso e déficit neurológico. Apresentamos um relato de caso de um paciente com um cavernoma extradural lombar radicular puro assemelhando-se a um tumor neurológico benigno em exames de imagem e uma ressecção cirúrgica bem-sucedida.

Effect of Rhodiola on the levels of inflammatory mediators and vascular endothelial function in rats with cerebral vasospasm after subarachnoid hemorrhage / 中国医师杂志

Objective To investigate the effect of Rhodiola on levels of inflammatory mediators and vascular endothelial function in rats with cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH).Methods Forty adult male SD rats were randomly divided into the sham operation group, model group, low-dose Rhodiola group, and high-dose Rhodiola group, with 10 rats in each group.Except for the sham operation group, rat models of CVS after SAH were established by cisterna magna twice method.1-5 d after modeling, the model group were treated with intraperitoneal injection of normal saline.The low-dose and high-dose Rhodiola groups were injected with 5mg/kg and 10mg/kg of Rhodiola respectively.5 days later, docking was performed and blood was collected to determine the levels of serum endothelin-1 (ET-1), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and cyclic guanosine monophosphate (cGMP).Then the rats were killed, and HE staining was performed to measure the diameter of basilar artery.The expression levels of basilar artery interleukin-6 (IL-6) mRNA, interleukin-1 β (IL-1 β) mRNA, vascular endothelial growth factor (VEGF) mRNA, endothelial nitric oxide synthase (eNOS), and inducible nitric oxide synthase (iNOS) were determined by real-time fluorescence quantitative polymerase chain reaction (RT-q-PCR).Results (1) The diameters of basilar arteries showed model group ＜ low-dose and high-dose groups ＜ the sham operation group (P ＜ 0.05).(2) The levels of ET-1, IL-6, TNF-α, IL-6 mR-NA, IL-1β mRNA and iNOS mRNA showed model group ＞ low-dose and high-dose Rhodiola groups ＞ the sham operation group while levels of cGMP, VEGF mRNA and eNOS mRNA showed model group ＜ low dose and high-dose Rhodiola groups ＜ the sham operation group (P ＜ 0.05).Conclusions Rhodiola can reduce the expressions of inflammatory reactions, improve the vascular endothelial function, and promote the expressions of vascular endothelial growth factor in rats with CVS after SAH.

Effect of sofren injection on acute lung injury in septic mice / 中华麻醉学杂志

Objective To evaluate the effect of sofren injection on acute lung injury (ALI) in septic mice.Methods Ninety-six pathogen-free made Kunming mice,aged 8-10 weeks,weighing 30-35 g,were divided into 4 groups (n =24 each) using a randon number table:sham operation group (group Sham),ALI group,vehicle group (group Vehicle) and sofren injection group (group Sofren).Sepsis was induced by cecal ligation and puncture.In Vehicle and Sofren groups,double distilled water and sofren injection 4 ml/kg were intraperitoneally injected,respectively,after the model was established,followed by repeated admninistration once every 12 h.At 12,24 and 48 h after operation,the animals were sacrificed and lungs were removed for mnicroscopic examination and for determination of wet to dry weight ratio (W/D ratio),malondialdehyde (MDA) content,superoxide dismutase (SOD) activity,and contents of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in lung tissues (by enzyme-linked immunosorbent assay).The lung injury score (LIS) was calculated after haematoxylin and eosin staining.Results Compared with group Sham,the LIS,W/D ratio and contents of MDA,TNF-α and IL-6 were significantly increased,and the SOD activity was decreased at each time point in ALI and Vehicle groups (P＜0.05).Compared with group ALI,the LIS,W/D ratio and contents of MDA,TNF-α and IL-6 were significantly decreased,and the SOD activity was increased at each time point in group Sofren (P＜0.05),and no significant change was found in each parameter mentioned above in group Vehicle (P＞0.05).Conclusion Sofren injection can attenuate ALI in septic mice.

The protective effects of Rhodiola rosea combined with vitamin E on the skeletalmuscle through hypoxia combined with exercise training in mice / 重庆医学

Objective To study the protective effects of vitamin E combined with Rhodiola rosea on the injury in mice skeletal muscle through hypoxia with exercise training and research the mechanism of action.Methods Forty ICR mice were randomly divided into control group and observation group,20 mice in each group.The control group was given Vitamin E (40 mg·kg-1·d-1),and the observation group was given Vitamin E (40 mg·kg-1·d-1)combined with Rhodiola rosea (20 g·kg-1·d-1);the rats in the two groups were treated with hypoxia (11.3%) for 4 weeks (5 ℃,15 m/min,60 min/d) after 15-day drug using.After the last training,all the mice were euthanized and then detected the gene of Bax and Bcl-2 mRNA through the RT-PCR in the skeletal muscle and the activity of GSH-PX,SOD,ROS,the concentration of MDA in the skeletal muscle.During the period (pretrain and 1,2,4 weeks) of hypoxia combined with exercise training,the CK,LDH in the serum were detected.Results The expression of CK and LDH in the observation group were lower than those of the control group (P<0.05).The activity of GSH-PX and SOD in the skeletal muscle of the observation group was significantly higher than that of the control group (P<0.05),while the ROS and MDA were lower than those of the control group(P<0.05);the expression of Bax mRNA and Bax/Bcl-2 of the observation group was significantly lower than that of the control group(P<0.05).While the expression of Bcl-2 mRNA was significantly higher than that of the control group(P<0.05).Conclusion Rhodiola rosea combined with Vitamin E can inhibit the expression of apoptotic genes by correcting the oxidation and hypoxia imbalance under hypoxia.

Analgesic effects of crude extracts and fractions of Omani frankincense obtained from traditional medicinal plant Boswellia sacra on animal models

Objective: To investigate the analgesic effect of Boswellia sacra (B. sacra), which could support the Omani traditional uses of frankincense for muscle, stomach, and arthritis pain. Methods: The crude extract, the essential oils and various sub-fractions of the crude methanol extract (each 300 mg/kg of the body weight of the animal) obtained from the resin of B. sacra were administered orally, and were evaluated for their analgesic activities by using two well known models of pain in mice, viz. acetic acid induced writhing test and formalin induced pain test in mice. Results: Of 13 samples, almost all of them were effective at an orally administered dose of 300 mg/kg of the body weight. The acetic acid induced writhes were inhibited in all the three phases with comparable values to the standard drug aspirin (300 mg/kg of body weight) with inhibition of 67.6% in phase I, 66.8% in phase II, and 37.9% in phase III. At the same time, all the tested samples were found effective in both the early and the late phases of formalin test. In formalin test, most of the tested samples showed more inhibitory effects as compared to the standard drug aspirin (300 mg/kg of body weight), which showed 36.2% and 29.6% inhibition in early and late phases respectively. Among the tested samples, the most significant inhibition was produced by Shabi frankincense oil (57.5% in early phase, and 55.6% in late phase). Interestingly, the extracts showed comparable percentage of inhibition to the oil and found in the following order: 60% chloroform. /n-hexane sub-fraction (55.3% in early phase, and 66.7% in late phase), and 70% chloroform. /n-hexane sub-fraction (59.6% in early phase, and 63.0% in late phase). Conclusions: The present study provided the scientific justification about the analgesic properties of the essential oils, extract, and various sub-fractions obtained from the resin of B. sacra, thus validating its use in traditional folk medicines and other products; and hence supporting the development in the analgesic properties of bioactive natural substances.

Analgesic effects of crude extracts and fractions of Omani frankincense obtained from traditional medicinal plant Boswellia sacra on animal models

OBJECTIVE@#To investigate the analgesic effect of Boswellia sacra (B. sacra), which could support the Omani traditional uses of frankincense for muscle, stomach, and arthritis pain.@*METHODS@#The crude extract, the essential oils and various sub-fractions of the crude methanol extract (each 300 mg/kg of the body weight of the animal) obtained from the resin of B. sacra were administered orally, and were evaluated for their analgesic activities by using two well known models of pain in mice, viz. acetic acid induced writhing test and formalin induced pain test in mice.@*RESULTS@#Of 13 samples, almost all of them were effective at an orally administered dose of 300 mg/kg of the body weight. The acetic acid induced writhes were inhibited in all the three phases with comparable values to the standard drug aspirin (300 mg/kg of body weight) with inhibition of 67.6% in phase I, 66.8% in phase II, and 37.9% in phase III. At the same time, all the tested samples were found effective in both the early and the late phases of formalin test. In formalin test, most of the tested samples showed more inhibitory effects as compared to the standard drug aspirin (300 mg/kg of body weight), which showed 36.2% and 29.6% inhibition in early and late phases respectively. Among the tested samples, the most significant inhibition was produced by Shabi frankincense oil (57.5% in early phase, and 55.6% in late phase). Interestingly, the extracts showed comparable percentage of inhibition to the oil and found in the following order: 60% chloroform/n-hexane sub-fraction (55.3% in early phase, and 66.7% in late phase), and 70% chloroform/n-hexane sub-fraction (59.6% in early phase, and 63.0% in late phase).@*CONCLUSIONS@#The present study provided the scientific justification about the analgesic properties of the essential oils, extract, and various sub-fractions obtained from the resin of B. sacra, thus validating its use in traditional folk medicines and other products; and hence supporting the development in the analgesic properties of bioactive natural substances.

Effect of Rhodioloside on PI3-K/AKT signaling pathway on cerebral ischemia-reperfusion injury in rats / 中国医师杂志

Objective To explore the mechanism of protective effect of Rhodioloside in cerebral ischemia-reperfusion rats and its relevance to phosphatidylinositol 3-kinases ( PI3-K)/protein serine-threonine kinases ( AKT) signaling pathway .Methods Forty eight Sprague-Dawley rats were randomly divided into four groups: sham-operation group , ischemia-reperfusion group , and Rhodiolo-side treatment groups (5 and 10 mg/kg).The model of right middle cerebral artery occlusion was established with thread ligation meth -od.The score of the neurological deficit was estimated 2 h followed by 24 h reperfusion.Histopathological changes were observed by hematoxylin-eosin(HE) staining.The infarct volume was measured with triphenyltetrazolium chloride (TTC) staining.Apoptotic cells were assessed with terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) method.The expressions of PI3-K and p-AKT were evaluated with immunohistochemistry .Results The score of the neurological deficit was decreased more ob-viously, the number of apoptotic were decreased more significantly , the expressions of PI3-K and p-AKT were increased more signifi-cantly in the Rhodioloside treatment groups (5 and 10 mg/kg) than in the ischemia-reperfusion group ( P <0.05).The score of the neurological deficit was decreased , the number of apoptotic was decreased , and the expressions of PI 3-K and p-AKT were increased in the Rhodioloside treatment group (10 mg/kg) than the Rhodioloside treatment group (5 mg/kg) ( P <0.05).Conclusions The protective mechanism of Rhodioloside therapy against cerebral ischemia r-eperfusion injury might be associated with activating the PI 3-K/AKT signaling pathway and then inhibiting neuronal apoptosis .

Agenesia sacra asociada a disrrafismo espinal e hidrocefalia / Sacra agenesia associated to spinal dysraphism and hydrocephaly

Introducción: la agenesia sacra es una malformación congénita rara que forma parte del síndrome de regresión caudal. Se caracteriza por un grupo de anomalías en las cuales la columna caudal está ausente. Esta enfermedad es la malformación más frecuente en los hijos de madres diabéticas, además se ha relacionado con otros factores predisponentes, como deficiencias de ácido fólico, de vitaminas, uso de insulina en el embarazo, e incluso, la hipoxia. Entre un 30-40 por ciento de pacientes con agenesia sacra completa, pueden tener asociado un mielomeningocele, y el desplazamiento de las raíces nerviosas empeora los trastornos neurológicos. En estos casos, la hidrocefalia, muchas veces también asociada a malformación Chiari tipo II, está ya presente al nacer. Caso clínico: se presenta el caso de un neonato con agenesia sacra asociada a disrrafismo espinal e hidrocefalia. La intervención quirúrgica fue precoz, se le colocó derivación ventrículo peritoneal y se realizó la reparación del defecto del tubo neural. La evolución posoperatoria fue favorable, aunque persistieron los déficits neurológicos preoperatorios. Conclusiones: no se hallaron factores predisponentes en este paciente y el análisis del cariotipo fue normal. Las anomalías óseas de miembros inferiores fueron las más llamativas, así como la presencia de hidrocefalia asociada a malformación Chiari tipo II y mielomeningocele. El tratamiento a estos casos requiere de un enfoque multidisciplinar, y la reparación quirúrgica del mielomeningocele debe ser precoz para conseguir una evolución favorable. Las formas graves pueden ocasionar una muerte temprana neonatal, en cambio, los niños que sobreviven, generalmente presentan inteligencia normal

Introduction: sacra agenesia is a rare congenital malformation as part of the caudal regression syndrome. It is characterized by a group of anomalies in which the caudal cord is absent. This disease is the most common malformation found in children from diabetic mothers but it has also been related to other predisposing factors such as folic acid deficiencies, vitamin deficiencies, use of insulin at pregnancy and even hypoxia. Thirty to forty percent of patients with complete sacra agenesia can also have myelomeningocele, and the displacement of nerve roots worsens the neurological disorders. In these cases, hydrocephaly, many times associated to Chiari malformation type II, is also present at birth. Clinical case: a neonate with sacra agenesia associated to spinal dysraphism and hydrocephaly. Surgical intervention was performed early, a peritoneal ventricular derivation was placed and the neural tube defect was repaired. The post-surgery evolution was favorable, but the preoperative neurological deficits persisted. Conclusions: there were no predisposing factors in this patient and the analysis of the cariotype was normal. The bone anomalies of the lower members were the most remarkable aspects as well as the hydrocephaly associated to Chiari malformation type II and myelomeningocele. The treatment of these cases requires multidisciplinary approach and surgical repair of the myelomeningocele at early phase to achieve favorable evolution. The most severe forms can cause early neonatal death; however, those surviving children generally present normal intelligence coefficient

Secuencia de displasia caudal: Estudio clínico y radiológico de un paciente / Caudal dysplasia sequence: Clinical and radiological study of a patient

La secuencia de displasia caudal (SDC), denominada también síndrome de regresión caudal y síndrome de agenesia sacra, es una malformación congénita poco frecuente, que incluye principalmente agenesia con extensión variable de cuerpos vertebrales distales lumbosacrococcígeos y/o sacrococcígeos. En este trabajo se presentan criterios diagnósticos por imagen, clasificación y estudio de un caso clínico.

Caudal dysplasia sequence (CDS), also called caudal regression syndrome and syndrome of sacral agenesis is a rare congenital malformation, which includes agenesis with variable extension of lumbo-sacral-coccygeal distal and sacrococcygeal vertebral bodies. In this article we review diagnostic criteria, classification and report a clinical case.

Síndrome de regresión caudal: caso clínico / Caudal regression syndrome: clinical case and update

Caudal regression is a rare congenital malformation which includes a wide spectrum of musculoskeletal abnormalities involving the lumbosacral spine, pelvis and lover limbs. It can be associated to visceral defects (gastrointestinal, genitourinary, cardiac or neurological) in various degrees. The etiology is not yet clear, but maternal diabetes, genetic predisposition, and vascular hypoperfusion are suspected. Objective: Describe a case of exceptional extension, including first year evolution. Clinical Case: A male newborn, term, was diagnosed before birth. Mother is a Type 2 diabetic. Physical exam and images confirm the diagnosis, show presence of 7 cervical vertebrae, 8 thoracic, agenesia of distal dorsal and lumbosacral spine. No spinal disraphia, medular conus at D2. Conclusion: The reported case shows that early diagnosis and multidisciplinary evaluation of the patient are essential elements to decrease complications and improve prognosis.

Antecedentes: El síndrome de regresión caudal es una malformación congénita poco frecuente, caracterizada por un amplio espectro de anormalidades musculoesqueléticas que comprometen columna lumbosacra, pelvis y extremidades inferiores. Se puede asociar a diversos defectos viscerales (gastrointestinales, genitourinarios, cardíacos y neurológicos) presentes en distintos grados según la severidad del caso. Su etiología aún no se encuentra bien dilucidada, pero se sospecha que la diabetes materna, la predisposición genética y la hipoperfusión vascular serían algunos de los factores involucrados en su patogénesis. Objetivo: Dar a conocer un caso de regresión caudal de extensión excepcional y describir su evolución durante el primer año de vida. Caso clínico: Se presenta el caso de un recién nacido de término, sexo masculino, hijo de madre diabética tipo 2, con diagnóstico antenatal de síndrome de regresión caudal. El examen físico y las imágenes confirman el diagnóstico y muestran la presencia de siete cuerpos vertebrales cervicales y sólo ocho torácicos, con agenesia de columna dorsal distal y lumbosacra, sin disrrafia espinal y cono medular en nivel de D2. Conclusión: El caso reportado demuestra que tanto el diagnóstico precoz como la evaluación multidisciplinaria del paciente, son pilares esenciales para disminuir el riesgo de complicaciones asociadas y mejorar su pronóstico.

Significance of sacral index in estimation of sex in sacra of cadavers in Punjab.

In the identification of sex in human skeletal remains, Sacrum is an important bone for identification of sex in human skeletal system. Since it is a component of axial skeleton and because of its contribution to the pelvic girdle and in turn to the functional differences in the region between the sexes, it has an applied importance in determining sex with the help of measurements carried upon it. Over the years different authors had carried various types of measurements on human sacra of different races and regions. A study for sexing of sacra was carried on 40 sacra (20 male & 20 female sacra) in Punjab. The method used was sacral index. The measuring instrument used was sliding vernier calliper. All the sacra taken were normal. The sacral index of sacra its mean and standard deviations were calculated. Then calculated range (mean ± 3S.D.) and demarking points (DP) of both the parameters and the percentage of bones in which sex could be identified by them was also calculated. The results were compared with the available literature. It was found that D.P of sacral index was very reliable in sexing of sacra.

Síndrome de Currarino: informe de un caso / Currarino’s syndrome: a case report

El síndrome de Currarino es una enfermedad hereditaria rara. La forma completa se caracteriza por la presencia de una malformación ano-rectal (generalmente estenosis), masa presacra y defectos óseos del sacro. El signo más importante es la presencia de estreñimiento desde el nacimiento. Se presenta un paciente de 13 meses de edad que consultó por estreñimiento crónico severo en quien se encontró la presencia de hemisacro y meningocele anterior, ambos hallazgos compatibles con una forma leve del síndrome de Currarino. Se realizó un manejo conservador y se inició polietilenglicol oral (PEG®), con una excelente respuesta al tratamiento. Se hace la presentación del caso junto con la revisión de la literatura actual con el fin de dar a conocer al personal médico la presencia del síndrome, enfatizar en puntos importantes que generen sospecha de su presencia y las diferentes opciones terapéuticas para su manejo.

The Currarino’s syndrome is a rare inherited disorder. The complete form is characterized by the presence of ano-rectal malformation (usually stenosis), presacral mass and bone defects of the sacrum. The most important symptom is the presence of constipation since birth. A 13 month old patient with chronic and severe constipation is presented. Among the studies the presence of hemisacrum and anterior meningocele were found, both findings consistent with a mild form of Currarino’s syndrome. A conservative management with polietilenglycol oral (PEG®), was initiated with an excellent response to treatment. The presentation of the case with a review of current literature is given to the medical staff in order to publicize the syndrome, as well as to emphasize key points that create suspicion of their presence and the different therapeutic options for its approach.

Síndrome de regresión caudal: caso clínico extremo y revisión de la literatura / Caudal regression syndrome: a severe case report and review of literature

Caudal regression syndrome (SRC) is a disruption of development of distal spinal segments, which affects in most cases, the development of lumbar vertebrae and sacrum. The exact etiology is still unknown; however, it has been related to pre and maternal diabetes, genetics factors and diminished vascular supply. At this time, we present an extreme case of SRC; 4 months old boy, his mother is diabetic, poorly controled, who presents SRC with spinal cord to T2.

El síndrome de regresión caudal (SRC), es una alteración del desarrollo de los segmentos espinales distales, que afecta en la mayoría de los casos el desarrollo del sacro y vértebras lumbares. La etiología exacta aun no esta precisada, sin embargo, se ha relacionado con la diabetes previa y gestacional, factores genéticos y la hipoperfusión vascular. En esta ocasión, se presenta el caso de regresión caudal extrema de un paciente masculino, de 4 meses de edad a la fecha, hijo de madre diabética, mal controlada en embarazo, que presenta SRC con presencia de médula espinal hasta T2.

Sexing of sacrum by sacral index and kimura's base-wing index.

A study for sexing of sacra was carried on 64 sacra (32 male & 32 female sacra) by two methods.One method used was sacral index and the other method was Kimura's base-wing index. The measuring instrument used was sliding vernier caliper. The method of sacral index showed high success rate as compared with Kimura's base-wing index method.