UNASSIGNED: Low back pain is one of the most common reasons for loss of productivity. Herniated lumbar discs can often cause muscle weakness, reduced motor function, and change in walking capacity including foot drop and gait abnormalities like steppage gait.
UNASSIGNED: Here, we present the case report of a 52-year-old shopkeeper who had been suffering from low back pain for 5 years along with a steppage gait since childhood, which had grossly affected his business as well as his quality of life. The patient did not want a surgical procedure.
UNASSIGNED: Given these conditions, we opined that minimally invasive pain and spine intervention procedures like transforaminal epidural neuroplasty along with cooled radiofrequency ablation of medial branches can be effective in managing back pain as well as improving the quality of life.

METHODS: Retrospective literature review analysis OBJECTIVE: Analyze the risk factors, characteristics, outcome, and follow up of surgical management of disc herniation in children ≤15 years old (y.o) through a review of the literature.
BACKGROUND: Disc herniation is a rare disease in the pediatric population. While conservative treatment if very often tried, some cases require surgical treatment.
METHODS: A literature search was conducted using PubMed data base using the terms \'pediatric/children/adolescent disc herniation\' and \'surgical management\' as key words. Significant manuscripts i.e: case reports, case series, reviews were identified and analyzed. The exclusion criteria were: series and cases with patients >15 y.o, results non-individualizable and medical management.
RESULTS: 49 studies were identified, 28 were retained. 69 children <15 y.o were identified with a median age of 13 y.o (SD 1-15). The mean FU was 3.3 years. Trauma and repeated micro traumatism were identified as the main causes of disc herniation in this population. It is mostly a lumbar disease, with very anecdotic cases of thoracic or cervical herniation described. In the absence of neurological deficit, conservative treatment should be tried. Different types of surgery exist (open, endoscopic, tubular), with no difference in outcome or complications. The post-operative outcome was very satisfactory, with no neurological sequalae described with excellent recovery.
CONCLUSIONS: Pediatric disc herniation is often caused by precipitating factors such as trauma. In the absence of resolution with conservative treatment, surgical options yield favorable short term clinical outcomes with minimal complications and no neurological sequalae.

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Autolytic and putrefactive processes can cause considerable alterations to soft tissues and internal organs that may complicate forensic assessments. An overview was undertaken of the range of taphonomonic changes and processes that may result from postmortem putrefactive gas accumulation. The most commonly encountered phenomenon was purging of putrefactive fluids from the nose and mouth that was on occasion confused with bleeding from antemortem trauma. Much less common was putrefactive \'rigor mortis\' where the limbs extend due to the accumulation of soft tissue and subcutaneous gas. This may sometimes be associated with alteration of the position of a body suggesting that it had been deliberately moved. Distension and stretching of the skin and subcutaneous tissues may cause recently sutured surgical incisions to dehisce, raising the possibility of inflicted incised wounds. Raised intra-abdominal pressures may cause diaphragmatic herniation of small intestine and has been associated with so-called \'coffin birth\' where a fetus is expelled from the uterus after death due to pressure on the fundus. Gas accumulation on postmortem computed tomography examination may be confused with air embolism or the effects of trauma. All of these changes are the result of anaerobic bacterial action generating gases such as methane, carbon dioxide and hydrogen sulphide resulting in pressure gradients.

Corroborative evidence for discectomy in pediatric or adolescent patients remains scarce, with this single-arm meta-analysis investigating discectomy for lumbar disc herniation (LDH) within this population. PubMed, Embase (Elsevier), CiNAHL, Cochrane Library, Scopus, and Web of Science were searched. Eligible studies reported pediatric patients under 21 years of age with a diagnosis of LDH that was treated surgically with discectomy. This review was registered in PROSPERO (ID: CRD42023463358). Twenty-two studies met the eligibility criteria (n=1182). Visual analog scale (VAS) scores for back pain at baseline were 5.34 (95% CI: 4.48, 6.20, I2=98.9%). Postoperative VAS back pain scores after 12 months were 0.88 (95% CI: 0.57, 1.19, I2=95.6%). VAS scores for leg pain at baseline were 7.03 (95% CI: 6.63, 7.43, I2=93.5%). Postoperative VAS leg pain scores after 12 months were 1.02 (95% CI: 0.68, 1.36, I2=97.0%). Oswestry disability index (ODI) scores at baseline were 55.46 (95% CI: 43.69, 67.24, I2=99.9%). Postoperative ODI scores after 12 months were 7.82 (95% CI: 4.95, 10.69, I2=99.4%). VAS back, VAS leg and ODI scores demonstrated a minimum clinically important difference (MCID) at all postoperative points. Perioperative outcomes demonstrated operative time as 85.71 mins (95% CI: 73.96, 97.46, I2=99.4%) and hospital length of stay as 3.81 days (95% CI: 3.20, 4.41, I2=98.5%). The postoperative reoperation rate at the same level was 0.01 (95% CI: <0.00, 0.02, I2=0%). Discectomy appears safe and effective in pediatric and adolescent patients suffering from LDH. The findings here provide groundwork for future randomized control trials against conservative measures to elaborate on optimal management and elucidate long-term outcomes.

OBJECTIVE: To report a case of delayed death after initial successful treatment of severe bromethalin intoxication in a cat.
METHODS: A 2-year-old neutered male domestic shorthair cat presented as a referral for bromethalin toxicosis and progressive neurological decline. At the time of referral, the cat was nonambulatory tetraparetic with minimal motor function in all 4 limbs and exhibited a dull mentation. Within the first 4 hours of hospitalization, the cat\'s neurological status continued to rapidly decline, and osmotherapy, corticosteroids, and intralipids were administered. The treatment regimen also included levetiracetam, thiamine, cholestyramine, vitamin E, and gingko biloba. Six days after bromethalin ingestion, the cat displayed marked neurological improvement with near normal mentation and mild tetraparesis and was discharged. The cat continued to do well at home with improving neurological status and function. Nine days after discharge, the cat was presented dead on arrival. Postmortem examination revealed transforaminal brain herniation secondary to spongy degeneration of the white matter and increased intracranial pressure as the cause of death.
UNASSIGNED: To the authors\' knowledge, this is the first report of a cat that suffered delayed death despite initial neurological improvement after being treated for severe bromethalin toxicosis.

UNASSIGNED: Back pain in pregnancy is common, but pain from lumbar disk herniations in pregnancy is rare. This systematic review aims to comprehensively analyse literature on lumbar disk herniation in pregnancy, focusing on risk factors, incidence, clinical presentation, and management.
UNASSIGNED: We conducted a literature review using PubMed and Web of Science databases, including studies from January 1, 1950, to August 1, 2023. The Critical Appraisal Skills Programme (CASP) checklist for cohort studies and the Joanna Briggs Institute Critical Appraisal Checklist for case-control studies were utilised to assess risk of bias. The review protocol was not previously published.
UNASSIGNED: A total of 41 studies were reviewed, with 6 addressing incidence and risk factors and 35 focusing on clinical presentation and management. Symptomatic lumbar disk herniation during pregnancy was found to be uncommon, with no significant predisposition noted during pregnancy as per magnetic resonance imaging (MRI) findings. However, patients with MRI-detected herniations were more likely to report back pain. Non-surgical management resulted in higher rates of complete symptom resolution (69% vs. 50%) and lower rates of cesarean section (57% vs. 70%) compared to surgical management. Among surgically treated patients, microdiscectomy showed higher symptom resolution (59%) compared to laminectomy (17%) or a combined approach (33%).
UNASSIGNED: While pregnancy does not inherently increase the risk of herniated lumbar disks, the presence of a prolapsed disk can predispose to back pain during pregnancy. There is poor quality evidence that should be interpreted cautiously. Non-surgical management, in the absence of red-flag symptoms including bowel and bladder dysfunction may be trialled and yield comparatively better symptom resolution. Additionally, surgical management if necessitated has no clear link to pregnancy complications within the scope of this study.

UNASSIGNED: The aims of this study are to determine the incidence and more frequent localizations of orbital fat tissue herniation accompanying dehiscences in the medial orbital wall and to investigate the relationship between orbital fat tissue herniations and the anterior and posterior ethmoidal foramina.
UNASSIGNED: One thousand two hundred patients who had undergone computed tomography with a preliminary diagnosis of sinusitis and who had no previous facial, orbital, paranasal sinus surgeries or history of trauma were retrospectively analyzed. The localization of the ethmoidal foramina and orbital fat tissue herniations were marked. In patients with orbital fat tissue herniation, the relationship between the localization of orbital fat tissue herniation and the anterior and posterior ethmoidal foramina was investigated.
UNASSIGNED: The incidence of orbital adipose tissue herniation in our study was 7.9%. Of the 98 herniations on the bilateral medial orbital wall, 60 were in zone 3, and the most common herniation site was zone 3. A statistically significant difference was noted between the localization zone of the anterior ethmoidal foramen and the localization zones of orbital fat tissue herniations (Fisher\'s exact test, p < 0.001).
UNASSIGNED: Zone 3 is the weakest area of the medial orbital wall, and zone 3 is the most prone to herniation of fat tissue. The association of orbital fat tissue herniations with the anterior ethmoidal foramen is extremely common. Being cognizant of this finding may help a surgeon better estimate the anatomical view to be met before functional endoscopic sinus surgery as well as to minimize the risk of possible orbital complications, especially anterior ethmoidal artery injury.

UNASSIGNED: Minimally invasive esophagectomy has emerged as the established standard for treating esophageal cancer. The gastric graft is usually placed in the posterior mediastinum or the retrosternal tunnel for reconstruction. Hiatal hernia occurrence is more common in the posterior mediastinal reconstruction and is more frequently observed in laparoscopic compared to open approach. On the other hand, retrosternal hernia is a rare complication that deserves greater attention, considering the increasing popularity of retrosternal reconstruction in esophageal cancer treatment.
METHODS: We present the case of a 55-year-old male patient who underwent minimally invasive esophagectomy with retrosternal reconstruction using gastric conduit and cervical anastomosis. After four years, the patient experienced symptoms, including dyspnea and chest pain. CT scan revealed transverse colon herniation into the retrosternal tunnel.
UNASSIGNED: Our diagnosis was retrosternal herniation of the transverse colon. Although there was no sign of obstruction, the abundant colon in the retrosternal space caused mass effect symptoms. For that reason, we performed laparoscopic surgery to release the herniated organ and close the hernia hole. Postoperatively, the patient had a satisfactory recovery, and a follow-up CT scan confirmed the absence of any remaining herniated organs.
CONCLUSIONS: While hiatal hernia is a well-known complication in minimally invasive esophagectomy, retrosternal hernia is a lesser-known entity. Surgical intervention is necessary to alleviate symptoms caused by herniation or address complications such as strangulation. The occurrence of retrosternal hernia warrants further attention and research in the future.