Sciatica has been classically described as pain in the back and hip with radiation in the leg along the distribution of the sciatic nerve, secondary to compression or irritation of the sciatic nerve. ...Spinal abnormality being the most common etiology, is one of the most common indications for MRI of the lumbosacral spine. Here we describe imaging findings secondary to a supralevator perianal abscess causing irritation of the sciatic nerve, which was diagnosed on MRI of the lumbosacral spine.
A 47-year-old male patient presented to the emergency department with severe acute pain in the right hip and right leg which was aggravated by limb movement. Clinically, a possibility of sciatica was suggested and MRI of the lumbosacral spine was ordered. The MRI did not reveal any abnormality in the lumbosacral spine; however, on STIR coronal images, a right perianal abscess with air pockets was seen. The perianal abscess was extending above the levator ani muscle with and was seen tracking along the sciatic nerve, explaining pain along the distribution of the sciatic nerve. The abscess was surgically drained, followed by an antibiotic course. The patient was symptomatically better post-surgery. Post-operative scan done 3 days later revealed significant resolution of the infra- and supralevator perianal abscess. The patient was discharged from hospital on post-operative day 3 on oral antibiotics for 7 days. On 15
post-operative day, the patient was clinically completely asymptomatic with good healing of the perianal surgical wound.
Extra-spinal causes are rare and most often overlooked in patients with sciatica. While assessing patients with sciatica, extra-spinal causes for the radiation of pain along the distribution of the sciatic nerve should always be looked for if abnormalities in the MRI of the lumbar spine are not found. Inclusion of STIR sequences in the imaging of the lumbosacral spine, more often than not, helps to identify the extra-spinal cause of sciatica when MRI of the lumbosacral spine does not reveal any abnormality.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Microdeletions of 2q23.1 disrupting MBD5 and loss of function mutations of MBD5 cause MBD5‐Associated Neurodevelopmental disorders (MAND). Nearly all reported patients have been isolated ...cases of de novo origin.
Methods
This study investigates three families with inherited MBD5 mutations from three different Regional Genetics Centres in the UK.
Results
Two of the parents in the study had MBD5 deletions in a mosaic form. The parent with an MBD5 deletion in an apparently nonmosaic form has a psychiatric disorder in the absence of developmental delay or dysmorphism.
Conclusions
Inherited forms of MBD5 deletions are rare, but do occur, especially in a mosaic form. The phenotypic spectrum of MAND may be wider than previously thought.
This report describes three families with inherited 2q23.1 microdeletions including a parent who has the deletion in an apparently nonmosaic form and has mental health issues in the absence of developmental delay or dysmorphic features. We also report two instances of parental mosaicism, which could be significant for counseling parents of an affected child with an apparent de novo deletion.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
BackgroundMicrodeletions of 2q23.1 disrupting MBD5 and loss of function mutations of MBD5 cause MBD5‐Associated Neurodevelopmental disorders (MAND). Nearly all reported patients have been isolated ...cases of de novo origin.MethodsThis study investigates three families with inherited MBD5 mutations from three different Regional Genetics Centres in the UK.ResultsTwo of the parents in the study had MBD5 deletions in a mosaic form. The parent with an MBD5 deletion in an apparently nonmosaic form has a psychiatric disorder in the absence of developmental delay or dysmorphism.ConclusionsInherited forms of MBD5 deletions are rare, but do occur, especially in a mosaic form. The phenotypic spectrum of MAND may be wider than previously thought.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
BACKGROUNDSciatica has been classically described as pain in the back and hip with radiation in the leg along the distribution of the sciatic nerve, secondary to compression or irritation of the ...sciatic nerve. Spinal abnormality being the most common etiology, is one of the most common indications for MRI of the lumbosacral spine. Here we describe imaging findings secondary to a supralevator perianal abscess causing irritation of the sciatic nerve, which was diagnosed on MRI of the lumbosacral spine. CASE REPORTA 47-year-old male patient presented to the emergency department with severe acute pain in the right hip and right leg which was aggravated by limb movement. Clinically, a possibility of sciatica was suggested and MRI of the lumbosacral spine was ordered. The MRI did not reveal any abnormality in the lumbosacral spine; however, on STIR coronal images, a right perianal abscess with air pockets was seen. The perianal abscess was extending above the levator ani muscle with and was seen tracking along the sciatic nerve, explaining pain along the distribution of the sciatic nerve. The abscess was surgically drained, followed by an antibiotic course. The patient was symptomatically better post-surgery. Post-operative scan done 3 days later revealed significant resolution of the infra- and supralevator perianal abscess. The patient was discharged from hospital on post-operative day 3 on oral antibiotics for 7 days. On 15th post-operative day, the patient was clinically completely asymptomatic with good healing of the perianal surgical wound. CONCLUSIONSExtra-spinal causes are rare and most often overlooked in patients with sciatica. While assessing patients with sciatica, extra-spinal causes for the radiation of pain along the distribution of the sciatic nerve should always be looked for if abnormalities in the MRI of the lumbar spine are not found. Inclusion of STIR sequences in the imaging of the lumbosacral spine, more often than not, helps to identify the extra-spinal cause of sciatica when MRI of the lumbosacral spine does not reveal any abnormality.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
BACKGROUND: The tension-free hernioplasty as introduced by Lichtenstein
has gained increasing acceptance during the last decade. This study
compared two methods of mesh fixation. MATERIAL AND ...METHODS: Fifty-four
patients undergoing sixty repairs were randomized into two groups. In
control group polypropylene mesh was secured with 2/0 polypropylene
sutures and skin closed with 2/0 polyamide black. In study group
polypropylene mesh was secured with skin staples and skin was closed
with staples from the same stapler. Duration of the surgery was
recorded. RESULTS: The operation was significantly shorter when
staples were used (median 42 min 30 s versus 54 min 30 s, P <
0.001). There was no significant difference in the incidence of
postoperative complications or pain. There were no recurrences in
either group in the follow up period (median 12 months). CONCLUSION:
This technique of mesh fixation is as effective as conventional
fixation with polypropylene sutures with an important added advantage;
significant reduction in the operative time.
The aim of study is to identify the barriers that affect the implementation of Industry 4.0, establish the relationship among the barriers using interpretive structural modelling (ISM), and identify ...the driving power and dependence of the identified barriers using MICMAC analysis. Industry 4.0, a different acronym for the fourth industrial revolution, is considered an important concept for the digitalisation of the manufacturing sector as it results in the efficient use of resources, reduced lead time, and improved product quality. A contextual relationship matrix was constructed based on questionnaire responses from industry and academia. Then, hierarchical relationship among the identified barriers were established using ISM method. Subsequently, driving power and dependence of the identified barriers were identified using MICMAC analysis. The analysed results helped determine the significance of the identified barriers and their relative importance, which will in turn help researchers and policymakers in the implementation of the Industry 4.0 concept. This study also suggests that the government should frame the policy to provide financial and technical support and subsidies for transforming conventional factories into smart factories, and proper training should be given to the workforce so that they can cope with the real-time needs of the industries.
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