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PubMed2003

Susceptibility to basal cell carcinoma is associated with high dermal mast cell prevalence in non-sun-exposed skin for an Australian populations.

In a Danish population, basal cell carcinoma (BCC) patients have a higher dermal mast cell prevalence in buttock skin than controls. This finding was supported by a functional link in mice between histamine-staining dermal mast cells and the extent of susceptibility to UV-B-induced systemic immunomodulation. It was important to confirm that this association was maintained in an Australian population with very different ancestry and sun exposure patterns. Australian BCC patients (n = 26) had significantly higher densities of mast cells in the dermis of buttock skin than control subjects (n = 25) (P = 0.0003, Mann-Whitney U-test). However, this correlation was lost at the sun-exposed site of the hand (P = 0.547, Mann-Whitney U-test). To further evaluate whether a relationship exists between dermal mast cell prevalence in sun-exposed skin and incidence of BCC in a larger study, biopsies of dorsal hand skin were obtained from an age-stratified random sample of 166 Queensland subjects, together with the 51 South Australian subjects, and dermal mast cell prevalence was quantified. Older subjects (over the median age of 42 years) had a greater incidence of BCC development (P = 0.0001, chi-square test) and significantly higher mast cell densities in hand skin (P = 0.0001, chi-square test) than younger subjects. However, mast cell density in sun-exposed hand skin was not significantly associated with BCC incidence. Finally, cellular expression of c-kit correlated with mast cell prevalence in non-sun-exposed skin, thereby implicating the stem cell factor-c-kit axis in the intrinsic mechanisms that regulate prevalence. These results show that high prevalence of dermal mast cells in buttock skin but not hand is associated with BCC development in an Australian population.

Adult↗
PubMed2001

Internal iliac artery embolization before endovascular repair of abdominal aortic aneurysms: frequency, efficacy, and clinical results.

OBJECTIVE: The aim of our study was to assess the frequency, efficacy, and incidence of adverse effects of internal iliac artery embolization. MATERIALS AND METHODS: Of 343 patients examined for stent-graft repair, 147 were suitable for endovascular treatment. Fifty-five patients underwent preprocedural embolization of the internal iliac artery either unilaterally (46 patients) or bilaterally (nine patients). Successful embolization was assessed angiographically and with helical CT follow-up examinations. Colonic ischemia was ruled out clinically or colonoscopically. Buttock claudication, and sexual dysfunction in men, were evaluated through a questionnaire. RESULTS: Embolization of the internal iliac artery increased by 16% the percentage of patients for whom endovascular repair was suitable. After successful embolization in all patients, routine CT follow-up examinations after a mean time of 16.7 months showed no evidence of endoleaks related to retrograde perfusion via embolized internal iliac arteries. Nevertheless, in all patients who had undergone embolization, a primary endoleak was detected in 43.4% at the first postoperative CT examination. None of our patients had evidence of colonic ischemia. Clinical follow-up data of 46 patients were available. Of these patients, mild to severe new onset buttock claudication was found in 13 (36.1%) of 36 patients with unilateral, and in eight (80%) of 10 patients with bilateral, internal iliac artery embolization (p = 0.03). Five (25%) of 20 men had an erectile dysfunction after the procedure. CONCLUSION: Embolization of the internal iliac artery is a safe and efficient procedure that increases the applicability for endovascular repair of aortoiliac aneurysms. However, buttock claudication and erectile dysfunction are a drawback in a substantial number of patients.

Aged↗
PubMedDate not supplied

Overnight interruption of wearing insulin pump: substitution dose and injection site of insulin.

Discontinuing wear of the insulin pump for short periods enhances the feasibility of continuous subcutaneous insulin infusion (CSII) therapy. Because insulin requirements differ during pump and injection therapy, we studied the optimal substitution dose and injection site in seven type I diabetic patients to compensate for the overnight (2100-0730 h) interruption of CSII. The missed basal continuous infusion dose was replaced by injecting intermediate-acting insulin subcutaneously in three different ways: 1.5 times the dose in the abdomen, twice the dose in the abdomen, and twice the dose in the buttock. During CSII, glycemia remained unchanged throughout the night. Both 1.5 times and twice the replacement doses injected in the abdomen resulted in an initial decline in blood glucose with hypoglycemia in two patients followed by a rebound rise. When the replacement dose of 1.5 times was used, blood glucose rose by 4.9 +/- 1.2 mM overnight (P less than .02). These changes after abdominal injection were associated with a rapid early absorption of injected insulin with hypoinsulinemia in the morning. With twice the replacement dose injected in the buttock, insulin absorption was slower, fluctuations in nocturnal glycemia were minor, and the blood glucose level at 0730 h was similar to that of the previous night. There was a significant inverse correlation between blood glucose and serum free-insulin levels in the early morning (r = - .60, P less than .01). In conclusion, a substitution dose of 1.5 times to twice the missed basal infusion rate injected in the buttock compensates for the overnight interruption of CSII without risk of major fluctuations in blood glucose levels or nocturnal hypoglycemia.

Abdomen↗
PubMed1989

[Regional ischemia/necrosis after surgery of lumbal aortic aneurysm].

Following operation for aneurysm of the abdominal aorta two patients developed buttock necrosis. One procedure was elective and one was an emergency procedure. Patient 1 in addition developed paralysis of the leg on the same side as the buttock necrosis, while patient 2 in addition developed colon ischemia. Both patients died from these complications. Buttock necrosis and paralysis are rare complications after operation for abdominal aortic aneurysm. Regional ischemia of the left colon is a more common complication. The case report illustrates the importance of the pelvic-femoral collaterals. In addition we emphasize the importance of maintaining or restoring hypogastric circulation in order to prevent these complications.

Aged↗
PubMedDate not supplied

Immunofluorescence in skin specimens from three different biopsy sites in patients with scleroderma.

Immunofluorescence (IF) data from three different biopsy sites (nailfold, forearm, buttock) were studied in 18 patients with scleroderma (SD, systemic sclerosis) and the results compared with those obtained from 10 normal controls (NC) and 7 patients with systemic lupus erythematosus (SLE). Immunoglobulin (Ig) deposits were detected by direct IF technique at the dermo-epidermal junction (DEJ) in 8/14 nailfolds, 6/15 forearms and in none of the buttock specimens of SD patients. Epidermal nuclear staining was present in 6/14 nailfolds, and in 6/15 forearms and buttocks. The most prominent finding was the observation of multiple Ig deposits in the cuticle of 9/14 patients with SD. NC group was negative in all sites for epidermal nuclear staining and the only DEJ deposit occurred in the forearm of one subject. In conclusion, this study demonstrates that Ig deposits in SD, both at the DEJ and in the epidermal nuclei, occur more often than previously reported and are especially frequent in the nailfold & cuticle area.

Adult↗
PubMed1993

Abusive scald burns in infants and children: a prospective study.

Between July 1, 1987 and June 30, 1990, 30 consecutive deliberately scalded children were studied prospectively. Purposes of the study were to characterize the scald-abused child and address the management problems specific to this group. Mean age was 22.5 months. Many had preburn growth retardation. Mean burn size was 18.1 per cent of the total body surface area and 37 per cent required a surgical procedure for their scald. All 30 children had burns on the buttocks. Four (13.3%) had other injuries. Eighty per cent of patients had at least one complication. In 30 per cent, diarrhea complicated nutrition support, wound, or autograft care. Four (13.3%) patients with a mean burn size of 32.3 per cent of the total body surface area, diarrhea, and burns involving the buttocks, perineum, and external genitalia died of burn wound sepsis; three of these had Gram-positive bacteremia (Staphylococcus aureus and enterococcus). Burn wounds exposed to the fecal stream (buttocks) should be examined carefully and frequently for signs of infection, particularly in those patients with diarrhea.

Burns↗
PubMed2000

Bilateral persistent complete sciatic artery.

A case with persistent sciatic artery (PSA) was found in a cadaver of a 65-year-old female during a medical gross anatomy course. The artery was bilateral and complete and provided the major blood supply to both lower extremities. The vessel arose from the internal iliac artery that was extremely large bilaterally. The sciatic artery passed out of the pelvis through the infrapiriform foramen and descended posterior to the sciatic nerve through the gluteal region. The sciatic nerve was considerably flattened out under the artery. Large articular branches arose from the part of the artery at the buttock just below the piriform muscle. The artery descended along the back of the thigh and was crossed obliquely posteriorly by the long head of the biceps femoris muscle. The sciatic artery continued as the popliteal artery located very superficially in the popliteal fossa. A companion vein, i.e., the sciatic vein, accompanied each artery. The right sciatic vein entered the pelvis posteriorly through the infrapiriform foramen, whereas the left perforated the quadriceps muscle from behind and joined the femoral vein anteriorly. There was a gracile superficial femoral artery bilaterally. The deep femoral arteries of both lower limbs were hypoplastic with slender circumflex branches. There were no macroscopic connections between the sciatic and the deep or superficial femoral arteries on either side. This anomaly should be kept in mind in the evaluation of patients with sciatic or buttock pain or palpable "pulsating" buttock mass. Persistent sciatic artery also could be a potential hazard during orthopedic manipulations, hip joint surgery, and renal transplant surgery.

Aged↗
PubMed1995

Spinal cord stimulation versus spinal infusion for low back and leg pain.

The relative roles of spinal cord stimulation and the spinal infusion of opioids in the treatment of chronic, non-cancer lower body pain remains unclear. This report contains a retrospective analysis of patients with chronic lower body, neuropathic pain and treated over a 5 year period. Unilateral leg and/or buttock pain was treated initially with spinal stimulation and bilateral leg or mainly low back pain was treated initially with spinal infusions. 26 patients received spinal stimulation. Pain relief was > or = 50% in 16 (62%) with increased activity levels. Stimulator coverage was most difficult or failed in patients with buttock pain. 16 patients received long-term spinal infusions. Pain relief was > or = 50% in 2 (13%) but 25-49% in another 8 (50%) with stable infusion doses and was best in patients requiring low-dose (< 1 mg/h morphine intrathecal) infusions in the trial period. The review indicates that spinal infusions may be best for bilateral or axial pain that has not responded to spinal stimulation. Clonidine appears to be an alternative in high-dose morphine patients. New diamond-shaped electrode and dual quadripolar arrays appear to be very helpful for back, buttock, and/or bilateral leg pain patterns.

Adult↗
PubMed2002

[Transient neurologic symptoms after spinal anesthesia with 4% hyperbaric mepivacaine].

This is a case report of transient neurologic symptoms (TNS) after spinal anesthesia with 4% hyperbaric mepivacaine,which have not been reported before. The patient was a 44-year-old man with a meniscus lesion who received spinal anesthesia with 80 mg 4% mepivacaine while undergoing knee arthroscopy. A L3-L4 mid-line approach was used with a 26-gauge Quincke needle and a 21-gauge introducer. The local anaesthetic was injected over approximately 30 s with the aperture of the Quincke needle in a cephalad direction. A transient pain syndrome was observed 4 h after spinal anesthesia, which included symmetric pain and/or dysesthesia in the buttocks and posterior thighs appearing 4 h after recovery from the spinal anesthesia and had a duration of 2 days. The patient stated that the pain radiated through the hips, buttocks, and posterior thighs and extended past the buttocks and lower legs. The pain was described as strong and aching,occasionally decreasing when walking around. It responded well to NSAID and resolved spontaneously within 3 days. No other neurologic symptoms or signs were noted.

Adult↗
PubMed1997

Magnification error of femoral geometry using fan beam densitometers.

Hip axis length (HAL) has been reported as an independent risk factor for hip fracture. DEXA machines using fan beam techniques have become increasingly available. Errors in calculated hip axis length may be expected because of different degrees of magnification by the fan beam. The magnitude of this error on measurement of hip geometry was studied, using an anthropomorphic femur phantom with both fan beam (Lunar Expert and Hologic QDR-2000) and pencil beam (Lunar DPXL) densitometers. The clinical relevance of these findings was also examined using patient measurements of buttock soft tissue thickness. Femoral neck axis length (FNAL), which correlates well with HAL, was used as a measurement of hip geometry. There was a linear increase or decrease of FNAL with increasing distance of the phantom above the scanning table, when measured with the Lunar Expert or Hologic QDR-2000, respectively. There was no significant difference in FNAL at different heights using the pencil beam densitometer. The maximal difference in buttock soft tissue thickness in 30 women studied was 8.7 cm. From the equations, derived from the phantom studies, this difference would result in an 8.2% (1.4 SD) increase, or an 11.4% (1.9 SD) decrease in FNAL in the largest woman as compared with the smallest woman when measured using the Lunar Expert or Hologic QDR-2000, respectively. We conclude that there may be unpredictable degrees of magnification of FNAL in vivo, caused by differences in buttock thickness, when measured using a fan beam densitometers. Until these problems are resolved. FNAL, or related parameters of femoral geometry, should be measured using pencil beam instruments.

Absorptiometry, Photon↗
PubMed1996

Sacrospinous colpopexy: management of postoperative pudendal nerve entrapment.

BACKGROUND: Sacrospinous colpopexy requires the placement of a suture through the sacrospinous ligament, under which lies the pudendal nerve. Entrapment of this nerve may result in perineal or buttock pain. This report analyzes a case of pudendal nerve entrapment and studies the management of the resultant neuropathy. CASE: A 62-year-old patient experienced a chronic pudendal neuropathy with perineal and buttock pain following a sacrospinous colpopexy. Removal of the suture, 2 years after it was originally placed, resulted in immediate relief of her pain. She has been asymptomatic for 1 year following surgery. CONCLUSION: Pudendal nerve entrapment should be considered in the differential diagnosis of perineal or buttock pain after sacrospinous colpopexy. Relief of pain can be achieved even 2 years after initial surgery.

Diagnosis, Differential↗
PubMedDate not supplied

Patient with metastatic adenocarcinoma imitating lumbar herniated nucleus pulposis.

OBJECTIVE: To highlight the utility of Cyriax's selective tissue-tensioning principles, specifically the "Sign of the Buttock," in identifying mechanical behavior of pain of pathologies not amenable to conservative treatment. CLINICAL FEATURES: A 41-year-old man was referred to the University of Pittsburgh Medical Center Spine Specialty Center with a diagnosis of L5-S1 herniated nucleus pulposis that was recalcitrant to treatment. The onset of symptoms had been 5 months before the patient's appointment at the Spine Center and 6 months after an apparent precipitating trauma. The patient had been followed up by his primary care physician, referred to urology, neurosurgery, and physical medicine and rehabilitation before being referred to the Spine Specialty Center. INTERVENTION AND OUTCOME: Clinical examination using Cyriax's Sign of the Buttock implicates the hip joint, while it helps to rule out the lumbar spine. Review of previous imaging studies failed to rule out hip pathology. Pelvis and hip magnetic resonance imaging led to suspicion of lytic lesions, and a diagnosis of metastatic adenocarcinoma was made via biopsy. CONCLUSION: We have found Cyriax's Sign of the Buttock to have diagnostic value in this case. When positive, this test may help identify serious extracapsular hip or pelvic pathology.

Adenocarcinoma↗
PubMed2005

Amplatzer Vascular Plug to occlude the internal iliac arteries in patients undergoing aortoiliac aneurysm repair.

PURPOSE: The purpose of this report is to evaluate the use of conventional coils and the Amplatzer Vascular Plug, a type of nitinol-based self-expanding device, to occlude the internal iliac artery in patients undergoing aortoiliac or common iliac aneurysm endograft repair, or both. METHODS: Between August and December 2004, in preparation for endograft repairs of aortoiliac or common iliac artery aneurysms, or both, at a community hospital system, five patients underwent the occlusion of the internal iliac artery with an Amplatzer Vascular Plug to prevent endoleak. During the preceding 12 months, the conventional coil embolization of the internal iliac artery was used for the same purpose in 10 patients. RESULTS: In five patients undergoing the Amplatzer Vascular Plug occlusion of the internal iliac artery, precise deployment at the origin of the artery was achieved. Complete and precise occlusion was confirmed angiographically, and only one device was used for each internal iliac artery. Two patients reported mild buttock claudication 2 weeks after occlusion, which resolved completely by 6 and 8 weeks, respectively. A type II endoleak from the inferior mesenteric artery developed in one patient. In the previous 10 patients, 11 internal iliac arteries were treated with conventional coils. Subsequent repeat coil embolization was required for three patients. The procedural complications in this second group included one case of coil embolization into the superficial femoral artery and one into the common iliac artery; both errant coils were retrieved successfully by endovascular techniques. An average of 7 +/- 3.4 (mode of 5) coils were used for each internal iliac artery. Three cases of buttock claudication occurred after the unilateral internal iliac artery occlusion in this group and did not resolve. No evidence of ischemic bowel, buttock necrosis, or sexual dysfunction was observed in either group. The estimated average cost to occlude one internal iliac artery was 375 dollars for Amplatzer Vascular Plugs and 3,500 dollars for conventional coils. CONCLUSIONS: The Amplatzer Vascular Plug allows for a cost-effective method to occlude the internal iliac artery in patients undergoing endograft repairs of aortoiliac aneurysms. The use of a single device with a precise placement at the origin of the artery minimizes cost and avoids ischemic complications.

Aged↗
PubMed2005

Effect of injection site on reactogenicity and immunogenicity of acellular and whole-cell pertussis component diphtheria-tetanus-pertussis vaccines in infants.

The effect of injection site on reactogenicity and specific immunogenicity was assessed in participants in a pertussis vaccine efficacy trial. The percent of DTwP and DTaP recipients with any reaction was slightly lower in subjects injected in the buttock compared with those injected in the thigh. This finding was most common in DTwP recipients. Geometric mean antibody values to pertactin, filamentous hemagglutinin and fimbriae (Bordetella pertussis antigens) were lower in DTaP vaccinees when buttock was utilized as the injection site. Our findings present evidence against the use of the buttock as the site of immunization for DTaP vaccines since the benefit with regards to reactogenicity is minimal and the immunologic response to an important antigen of B. pertussis, pertactin, is decreased.

Antibodies, Bacterial↗
PubMed2002

Intraoperative positioning during cesarean as a cause of sciatic neuropathy.

BACKGROUND: Sciatic nerve compression has been well documented as a cause of perioperative sciatic neuropathy but rarely during cesarean. CASE: A parturient complained of left foot drop after cesarean delivery for twins performed under spinal anesthesia. Intraoperatively, her right hip was raised with padding under the right buttock to tilt the pelvis approximately 30 degrees to the left. Postoperatively, the patient had weakness, sensory changes, and diminished reflexes in the left lower extremity. Electrodiagnostic studies supported a diagnosis of neurapraxia and partial denervation in the distribution of the sciatic nerve. By postpartum week 6, she had full recovery. CONCLUSION: Elevating the right buttock during cesarean can cause compression of the underlying structures of the left buttock and result in sciatic neuropathy. Decreasing the duration of time the patient is in the left lateral position may reduce the risk of this uncommon but debilitating complication.

Adult↗
PubMed2002

Misclassification due to body hair and seasonal variation on melanin density estimates for skin type using spectrophotometry.

Recent advances have enabled quite accurate estimations of cutaneous melanin density by spectrophotometry using reflectance of light at wavelengths 400 and 420 nm. Our purpose was to assess the effect of body hair and seasonal variation at the upper inner arm and buttock on measurements of melanin density. We estimated melanin density of 104 volunteers at 3-monthly intervals over 12 months both before and after shaving. Removing body hair at the upper inner arm had no effect, but substantially reduced melanin estimates at the buttock in men. Significant seasonal variation was only observed at the upper inner arm, with highest readings in summer-autumn. In case-control studies, misclassification due to body hair at the buttock and seasonal variation at the upper inner arm could affect the observed odds ratio substantially. However, both sources of error can be reduced by careful attention to key aspects of study design.

Adult↗
PubMed2002

Increased dermal mast cell prevalence and susceptibility to development of basal cell carcinoma in humans.

Exposure to ultraviolet B (UVB) radiation (280-320 nm) is the primary etiologic factor associated with the development of basal cell carcinoma (BCC). The outgrowth of these keratinocyte-derived skin lesions is enhanced by the ability of UVB to impair an immune response that would otherwise eliminate them. Studies in a range of inbred mouse strains as well as mast cell-depleted mice reconstituted with mast cell precursors support a functional link between histamine-staining dermal mast cells and the extent of susceptibility to UVB-induced systemic immunomodulation. Humans, like mouse strains, display variations in dermal mast cell prevalence. In a study of Danish and South Australian BCC patients and control subjects, one 4-mm punch biopsy of non-sun-exposed buttock skin was sampled from each participant. This skin site was investigated to avoid any changes in mast cell prevalence caused by sun exposure. Two sections (4 microm) per biopsy were immunohistochemically stained for detection of histamine-containing dermal mast cells. Computer-generated image analysis evaluated dermal mast cell prevalence in both sections by quantifying the total number of mast cells according to the total dermal area (expressed as mast cells per square millimeter). This technique enabled us to detect heterogeneity of dermal mast cell prevalence in buttock skin between individuals and provided evidence of an association between high dermal mast cell prevalence and BCC development in two diverse populations. We hypothesize that mast cells function in humans, as in mouse strains, by initiating immunosuppression following UV irradiation and, thereby, allowing a permissive environment for the development of BCC. Thus, a high dermal mast cell prevalence as demonstrable in buttock skin is a significant predisposing factor for development of BCC in humans.

Adult↗
PubMed2002

Internal iliac artery embolization with bilateral occlusion before endovascular aortoiliac aneurysm repair-clinical outcome of simultaneous and sequential intervention.

PURPOSE: To retrospectively evaluate the clinical outcome of patients after simultaneous or sequential internal iliac artery (IIA) embolization for bilateral IIA occlusion. MATERIALS AND METHODS: Sixteen patients (65-88 y; mean, 75.6 y; two women), 11 with aortobiiliac aneurysms, three with bilateral common iliac artery (CIA)/IIA aneurysms, and two with unilateral CIA/IIA aneurysms, underwent IIA occlusion before endovascular aortoiliac repair. Eight patients underwent simultaneous bilateral IIA embolization before endovascular aortic repair (EVAR). Eight patients had sequential bilateral IIA occlusion. The outcome was assessed by clinical follow-up. RESULTS: There were no severe ischemic complications such as buttock necrosis or acute bowel, bladder, or spinal cord ischemia. Early ischemic complications occurred in 25% (buttock/thigh claudication, n = 3, 18.8%; and sexual dysfunction, n = 1, 6.2%) and had an onset not later than 6 months after intervention: buttock claudication resolved (n = 2) or persisted after aggravation by inferior mesenteric artery embolization for type II endoleak (n = 1). Impotence in a fourth patient persisted. The ischemic complication rate after 6 months was 30% (three of 10) because of a fifth patient who developed ischemic colitis with aggravation of ischemic heart disease after 15 months. The mean follow-up duration was 19.7 months. Patients with simultaneous embolization had a lower complication rate than those with sequential embolization (one of eight [12.5%] vs four of eight [50%], respectively). CONCLUSIONS: IIA embolization for bilateral IIA occlusion can be performed with a complication rate comparable with results of previous studies of unilateral IIA embolization. Chronic buttock claudication may be aggravated by embolization of aortic side branches. Late complications can have an insidious course and be initiated by low-output cardiac failure. Bilateral IIA occlusion is recommended only in patients who are considered unfit for aortic surgery.

Aged↗