Sacral reflex monitoring using bulbocavernosus reflex (BCR) and external urethral sphincter reflex (EUSR) is used to assess neural pathways responsible for bowel and bladder function during spine surgery. However, these techniques are generally considered limited in their ability to determine laterality due to bilateral afferent activation and shared sacral reflex circuitry. An 85-year-old male with progressive lower extremity weakness and worsening urinary incontinence underwent resection of a thoracic epidural tumor and separate sacral tumor involving the left S2 nerve root. BCR responses were recorded from the left and right external anal sphincter hemisphincters, and EUSR responses were recorded from the external urethral sphincter. Baseline recordings were stable. During manipulation of the thecal sac near the left S2 root, global sacral reflex attenuation occurred with complete loss of the left hemisphincter BCR response; release of retraction resulted in prompt bilateral recovery. Later, during targeted dissection adjacent to the left S2 nerve root, an isolated loss of the left hemisphincter BCR response occurred without changes in contralateral BCR or EUSR. Removal of the left S2 root retraction led to immediate return of the ipsilateral BCR response, though at a reduced amplitude. This case provides physiologic support that hemisphincter BCR recordings can reflect unilateral sacral nerve root dysfunction. A maneuver-dependent, reversible loss of the left hemisphincter BCR during S2 root retraction supports interpretation of hemisphincter changes as a marker of lateralized sacral reflex pathway dysfunction rather than global reflex suppression.

An 8-month-old intact male Labrador retriever dog from New Brunswick was referred to the Atlantic Veterinary College Small Animal Internal Medicine service (Prince Edward Island) for evaluation of marked hypercalcemia, polyuria-polydipsia, and urinary incontinence. Thoracic radiographs revealed a nonspecific, patchy-to-diffuse, interstitial-to-alveolar lung pattern, despite the absence of respiratory signs or abnormal lung auscultation. Fecal examination by Baermann analysis identified 1st-stage larvae of Angiostrongylus vasorum. Although A. vasorum has been documented in wild canid populations in parts of eastern Canada, this was the first confirmed case of an autochthonous infection in a companion animal in mainland Canada. The findings provide further evidence for the geographic expansion of A. vasorum within the Canadian Maritimes and contribute to a growing body of reports describing its emergence in North America. The dog's clinical presentation was atypical for angiostrongylosis, with no respiratory signs despite radiographic abnormalities, and hypercalcemia as a prominent clinical feature. These findings highlighted the variable and sometimes nonspecific nature of A. vasorum infection in dogs. Veterinarians practicing in eastern Canada should consider A. vasorum as a differential diagnosis in dogs with compatible clinical or imaging findings, even in the absence of respiratory signs or known endemicity. Routine Baermann fecal screening and prophylaxis with effective anthelmintics are recommended for dogs with increased risk of exposure to gastropod intermediate hosts. Key clinical message: Angiostrongylus vasorum is an emerging parasite in North America and can induce a variety of clinical signs in dogs. Veterinarians, specifically in the Canadian Maritimes, need to consider A. vasorum as a potential cause of respiratory signs, neurological signs, bleeding, and other clinical signs, and should recommend appropriate parasite prophylaxis in newly endemic areas.

PurposeTo determine the diagnostic accuracy of the defining characteristics for the Frail elderly syndrome (00257) diagnosis (NANDA-I 2021-2023 edition) in community-dwelling older adults.MethodsA cross-sectional study was conducted between February and May 2022, involving a sample of 148 older adults. Clinical validation was performed using latent class analysis, which was used to calculate accuracy, sensitivity, and specificity measures with their respective 95% confidence intervals for the defining characteristics. The likelihood ratio test (G2) was applied to assess the goodness of fit of the obtained models (p > 0.05). The study was approved by the Ethics Committee.FindingsA total of 17 defining characteristics were validated. Two latent class models were proposed, with Model 2 demonstrating superior fit and higher entropy. The nursing diagnosis achieved a prevalence of 50.7% in the sample. The most accurate defining characteristics were impaired physical mobility (00085) and impaired walking ability (00088), both with sensitivity and specificity values exceeding 85.9. Additional characteristics not originally included in the diagnosis were also identified and validated: insomnia (00095), impaired dentition (00048), urge urinary incontinence (00019), and dysfunctional family processes (00063).ConclusionThe nursing diagnosis Frail elderly syndrome (00257) was clinically validated among community-dwelling older adults based on a latent class model comprising 17 defining characteristics, all of which demonstrated accuracy, sensitivity, and specificity measures above 85%. Therefore, its assessment is recommended for routine use in Primary Health Care.Implications for nursing practiceThis study demonstrated the diagnostic efficacy for identifying vulnerable older adults within primary healthcare settings, enabling proactive and preventive care interventions for the population.

Aneurysmal bone cysts (ABC) are benign, vascular, osseous lesions accounting for 1% of all bony tumors. Giant cervicodorsal ABC are rare. Surgical excision is the treatment of choice. Incomplete excision has a high chance of recurrence. Giant lesions of the spinal column require staged surgeries and circumferential instrumentation to avoid instability. An 18-year-old male presenting with acute onset paraplegia and urinary incontinence with features of myelopathy. On evaluation, he was diagnosed with multi-level giant ABC of the cervico-dorsal spine. He underwent tumor excision and instrumentation via staged surgery. The postoperative course was uneventful. The patient was planned for adjuvant therapy but lost to follow up. He developed torrential bleeding from the tracheostomy site and expired. Management of giant ABC poses a challenge to the neurosurgeon. Multidisciplinary approach is mandatory for successful management of these patients. Surgical excision is the treatment of choice. Complete excision is achievable using staged excision.