Coccydynia in adult patients is not uncommon and is frequently neglected. Coccydynia is mostly associated with fall on buttocks. In long-standing cases, coccydynia can be debilitating. Rarely coccydynia can be due to more sinister causes and surgeons should be aware of all differential diagnosis. We present a case of an elderly female who presented with a complaint of pain over coccyx which was not subsiding with conventional treatment methods. Biopsy was done and a diagnosis of sclerosing epitheloid fibrosarcoma was made. We describe an unusual case of coccydynia secondary to this tumour with the histopathology finding and surgical management.

Study Design: Retrospective study of patients with lumbar canal stenosis (LCS) operated using endoscopic unilateral laminotomy with bilateral decompression (ULBD).Purpose: This study aimed to provide a detailed description of the technique of endoscopic decompression in LCS along with a description of the surgical anatomy and its advantages. We also discuss the clinical outcomes in patients operated using this technique.Overview of Literature: In 1999, the results with the use of microscopic ULBD were published. Microscopic/microendoscopic decompression using tubular retractor system showed good to excellent results in studies that compared such techniques with midline decompression. The first description of the use of endoscope in spine surgery was in 1988 when it was used for discectomy. With advancements and familiarity with the techniques, full endoscopic surgery has found application in LCS treatment.Methods: The clinical records of 953 patients who were operated between 1998 and 2008 were analyzed in 2018. Along with patient characteristics, information about return to daily activities, complication rates, and functional outcomes using Prolo score was assessed.Results: L4–L5 was the most common level for which surgery was performed. Two-level decompression was performed in 116 patients; 89.5% patients were able to return to their daily activities after 2 weeks. Functional outcomes as per the Prolo score were reported by patients as excellent, good, and poor in 89.85%, 1.59%, and 8.55%, respectively. Repeat surgery was required at same level in 16 patients and at a different level in 21 patients. Total 605 patients (63.49%) were symptom-free during the 70-month followup, while 344 complained of residual back pain, and four complained of persistent leg pain.Conclusions: ULBD using the Endospine system achieves adequate decompression in most cases and is a good alternative to open laminectomy, with the advantage of avoiding damage to the structural integrity of the spine and preserving soft tissue attachments.

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ObjectivesIn high‐BMI patients with and without fatty liver, we evaluate performance of a commercially available specially designed ultrasound probe (SDP) for scanning at depth. Greyscale and contrast‐enhanced ultrasound (CEUS) capability of SDP for parenchymal assessment and liver mass characterization, emphasizing HCC, is compared with standard curvilinear probes.MethodsThis retrospective study included 60 patients. Fifty‐five with measured BMI included 46/55 (84%) overweight or obese, and 9/55(16%) in the normal range with severe fatty liver. Fifty‐six patients with focal liver abnormality included 37 with a mass and 19 with post‐ablative treatment site. Masses included 23 confirmed malignancies, 15 HCC, 4 ICC, and 4 metastases. SDP followed suboptimal ultrasound using a standard probe. Images with varying fat content were compared for depth of penetration on greyscale and ability of CEUS to diagnose tumors.ResultsSDP showed statistically significant improvement P = <.05 in CEUS penetration for all degrees of fatty liver (mild, moderate, and severe). In malignant tumors, SDP improved detection of lesion washout in the portal venous/late phase (PVP/LP) at depth >10 cm, and in all malignant masses (P < .05).Fifteen confirmed deep HCC showed arterial phase hyperenhancement on standard probe in 10/15 (67%) and 15/15 (100%) on SDP. PVP/LP washout on standard probe was shown in 4/15 (26%) and on SDP, 14/15, (93%). Therefore, 93% of LR‐5 tumors were diagnosed with SDP. Removing necessity for biopsy.ConclusionsMetabolic syndrome and obesity challenge ultrasound, especially CEUS. SDP overcame limitations of standard probes for CEUS penetration especially in fatty liver. SDP was optimal for the liver mass characterization by detecting washout.

Abstract:Cysticercosis is an infection of pork tapeworm, Taenia Solium. It is difficult to diagnose an isolated intramuscular cysticercosis due to vague clinical symptoms. We report a case of 30 year old male presenting with a vague lump on the left shoulder. On imaging it was found out to be a case of isolated intramuscular cysticercosis. The diagnosis was further confirmed on fine needle aspiration and histopathology examination. This case report highlights the importance of considering cysticercosis as a differential to soft tissue swellings apart from being a rare entity.