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PubMed2005

Clinical characteristics of pelvic fracture patients with gluteal necrosis resulting from transcatheter arterial embolization.

BACKGROUND: Transcatheter arterial embolization (TAE) can cause gluteal skin and muscle necrosis. However, the ultimate and typical signs of gluteal necrosis resulting from TAE have not yet thoroughly been investigated. METHODS: From January 1995 to December 2003, 165 pelvic fractures were managed with TAE to control retroperitoneal bleeding at our level 1 trauma center. From these, 12 patients suffered gluteal muscle and skin necrosis. We reviewed the medical records of these 12 patients for age, gender, fracture type, embolic sites, computed tomography (CT) findings, serum creatine kinase level, site of skin necrosis, time from injury to skin necrosis, treatment, and outcome. RESULTS: All 12 patients underwent TAE of the bilateral internal iliac arteries with gelatin sponge slurries. One patient suffered from an infection of the gluteal muscle from an open fracture site. Five patients presented with signs of gluteal soft tissue injuries on admission. Of these, four had skin abrasions and three revealed fluid or air collection under the gluteal skin on CT. The remaining six patients showed no evidence of soft tissue injuries on admission, and the lesions appeared between 2 days and 7 days after their admission. In these six patients, low-density areas (LDAs) of gluteal muscle with a clear border on the CT were observed following the appearance of skin lesion. The skin necrosis was located in the center of either or both buttocks, and signs of ischemia were clearly demarcated from the adjacent normal tissue. Four of 12 patients died from sepsis, three of whom suffered from uncontrollable gluteal infections that had been pointed out as LDAs on the CT. CONCLUSIONS: In every patient with gluteal necrosis associated with pelvic fracture following TAE, initial traumatic contusion cannot be ruled out as contributing to the development of the necrosis. However, for patients who undergo TAE of the bilateral internal iliac artery and who show clear-border LDAs on CT, skin necrosis centered on the buttock, and the delayed appearance of a skin lesion, careful attention must be given in the event of an arterial obstruction due to TAE.

Adolescent↗
PubMed2001

Psoas abscess and cellulitis of the right gluteal region resulting from carcinoma of the cecum.

Although retroperitoneal or psoas abscess is an unusual clinical problem, the insidious and occult characteristics of this abscess sometimes cause diagnostic delays, resulting in considerably high morbidity and mortality. In particular, psoas abscess caused by perforated colon carcinoma is uncommon. We report a case of psoas abscess caused by a carcinoma of the cecum. A 72-year-old Japanese woman was admitted to our hospital, with pain in the right groin and buttock. The pain had appeared 6 months before admission, and the symptoms had then been relieved by oral antibiotics. On March 25, 1999, inflammatory signs in the right buttock indicated localized cellulitis, and incision and drainage was performed at a local hospital. The patient was referred to our hospital on the same day. On admission to our hospital, computed tomography (CT) scan revealed a thick right-sided colonic wall and enlargement of the right ileopsoas muscle. Barium enema and colonofiberscopy revealed an ulcerated tumor occupying the entire circumference of the cecum. A retroperitoneal abscess and fistula had been formed by the retroperitoneal perforation of cecum carcinoma: surgical resection was performed after remission of the local inflammatory signs. Operative findings indicated that the cancerous lesion and its surrounding tissues were firmly attached to the right iliopsoas and major psoas muscle, and en-bloc resection, including adjacent muscular tissue, was performed. The fact that carcinoma of the colon could be a cause of psoas abscess and cellulitis in the gluteal region should be considered when an unexplained psoas abscess is diagnosed.

Adenocarcinoma↗
PubMed1983

The concentration of Mansonella ozzardi microfilariae in skin capillaries.

The densities of microfilariae of Mansonella ozzardi in different regions of the body of infected individuals were studied. The density in venous blood closely approximated to that found in finger capillaries, but was significantly lower than the densities in capillaries of the scapular region and buttocks. A possible explanation for this concentration of microfilariae is the lack of glomi in these two sites, which consequently have a lower flow of blood than areas where glomi occur and where microfilarial densities are lower. No relationship was found between blood and skin densities in the buttocks and scapular region, probably due to the inadequacy of the skin snip method used for the detection of this species of filaria. It was concluded that the most acceptable detection method for M. ozzardi remains the sampling of finger capillary blood. It could not be decided, due to the paucity of data, whether any relationship exists between skin microfilarial densities and the biting sites of the vectors.

Adolescent↗
PubMed1985

Long-dormant invasive mole associated with multiple malignancies.

A 65-year-old previously healthy housewife, gravida 3, para 3, was first diagnosed as Stage Ib carcinoma of the uterine cervix (poorly differentiated squamous cell carcinoma) and admitted. The external radiation of 5400 rad by telecobalt source was performed. No intracavitary radiation was added. After about 7 1/2 years the patient noticed a tumor of fist size on her buttocks, but she did not present in our clinic regularly. Because of enlarging tumor and general malaise she was readmitted a year later. On the fifth hospital day she died with ileus. Autopsy revealed osteosarcoma of buttocks in the radiation field, stomach cancer (tubular adenocarcinoma) with perforated peritonitis, and invasive mole of the uterine corpus. The patient's last pregnancy terminated as a full-term delivery at 26 years of age and she was 43 years at her menopause. The dormant period of invasive mole was 47 years after her last pregnancy, 30 years after her menopause, and at least 8 years after pelvic radiation.

Adenocarcinoma↗
PubMed1989

Interpreting children's labels for sex-related body parts of anatomically explicit dolls.

Sexually abused children are often said to use idiosyncratic terminology when referring to sexual body parts. Anatomic dolls are often used in sexual abuse investigations, especially of younger children, with both their behavioral and verbal responses used to draw conclusions about the likelihood of sexual abuse. However, there is little information available about the responses of nonabused children to these dolls. This study characterizes the terms nonreferred children use to label sexual body parts of anatomic dolls. The study involved 144 children ages 3 through 8 years who were asked for their names for specific body parts including anus, breast, buttock, penis, scrotum, and vagina. Responses for breast, buttock, and penis were more precise than for other body parts. More than half the respondents did not have labels for anus and scrotum. The "age" and "gender" of the dolls had little effect on the children's responses. Older children had more accurate terminology than younger children for sexually related body parts except for penis and anus. For the most part, the gender of the child or the interviewer had little influence on responses.

Anal Canal↗
PubMed1991

Piriformis syndrome: a rational approach to management.

Although rarely recognized, the piriformis syndrome appears to be a common cause of buttock and leg pain as a result of injury to the piriformis muscle. Four cases representing a broad spectrum of presentations are described here. The major findings include buttock tenderness extending from the sacrum to the greater trochanter and piriformis tenderness on rectal or pelvic examination. Symptoms are aggravated by prolonged hip flexion, adduction, and internal rotation, in the absence of low back or hip findings. Minor findings may include leg length discrepancy, weak hip abductors, and pain on resisted hip abduction in the sitting position. Myofascial involvement of related muscles and lumbar facet syndromes may occur concurrently. The diagnosis is primarily clinical as no investigations have proved definitive. The role of MRI of the piriformis muscle is assessed and other investigative tools are discussed. A rational management schema is demonstrated: (1) underlying biomechanical factors and associated conditions should be corrected; (2) the patient is instructed in a home program of prolonged piriformis muscle stretching which may be augmented in physical therapy by preceding ultrasound or Fluori-Methane (dichlorodifluoromethane and trichloromonofluoromethane spray); (3) a trial of up to three steroid injections is attempted; and (4) if all these measures fail, consideration should be given to surgical sciatic nerve exploration and piriformis release.

Adult↗
PubMed2006

Classification system for gluteal evaluation.

The buttock area has received much media attention in recent years, which has produced increased patient demand for buttock reshaping and augmentation. This phenomenon is reflected in statistics collected by the American Society for Aesthetic Plastic Surgery,which demonstrate a 533% increase in gluteal augmentation between 2002 and 2003. Increasing patient demand has necessitated a more structured approach to evaluation of gluteal anatomy and the development of surgical procedures to enhance its beauty. The proposed classification system for gluteal contouring focuses on evaluating and identifying the different frame types, the different gluteal muscle types, and the relationship between the muscle and the frame. Finally, a ptosis classification system is presented.

Buttocks↗
PubMed2006

Cutaneous angiolipoleiomyoma.

We describe a girl with cutaneous angiolipoleiomyoma on the buttock. The 16-year-old girl had a 2.5- x 1.5-cm subcutaneous tumor on the right buttock, which was slightly tender. The tumor appeared to be vascular and was, therefore, surgically excised. Histologically, the lesion was poorly circumscribed and was composed of differently sized blood vessels, smooth-muscle bundles, and mature adipose tissue. These histologic findings were consistent with those of angiomyolipoma, which commonly occurs in the kidney. Cutaneous angiomyolipoma, which is also known as cutaneous angiolipoleiomyoma, is a rare benign mesenchymal tumor. To our knowledge, only 16 cases have been reported in the English-language literature. In our report, we review the clinical features of 17 cases, including the current one. We point out the differences between the cutaneous and renal forms of angiomyolipoma, and conclude that the cutaneous lesion is distinct from a renal lesion in several aspects, including tuberous sclerosis complex association and immunoreactivity to both HMB-45 and MART-1.

Adolescent↗
PubMed2006

Assessment of mechanical conditions in sub-dermal tissues during sitting: a combined experimental-MRI and finite element approach.

A common but potentially severe malady afflicting permanent wheelchair users is pressure sores caused by elevated soft tissue strains and stresses over a critical prolonged period of time. Presently, there is paucity of information regarding deep soft tissue strains and stresses in the buttocks of humans during sitting. Strain and stress distributions in deep muscle and fat tissues were therefore calculated in six healthy subjects during sitting, in a double-donut Open-MR system, using a "reverse engineering" approach. Specifically, finite element (FE) models of the undeformed buttock were built for each subject using MR images taken at the coronal plane in a non-weight-bearing sitting posture. Using a second MR image taken from each subject during weight-bearing sitting we characterized the ischial tuberosity sagging toward the sitting surface in weight-bearing, and used these data as displacement boundary conditions for the FE models. These subject-specific FE analyses showed that maximal tissue strains and stresses occur in the gluteal muscles, not in fat or at the skin near the body-seat interface. Peak principal compressive strain and stress in the gluteus muscle were 74+/-7% and 32+/-9 kPa (mean+/-standard deviation), respectively. Peak principal compressive strain and stress in enveloping fat tissue were 46+/-7% and 18+/-4 kPa, respectively. Models were validated by comparing measured peak interface pressures under the ischial tuberosities (17+/-4 kPa) with those calculated by means of FE (18+/-3 kPa), for each subject. This is the first study to quantify sub-dermal tissue strain and stress distributions in sitting humans, in vivo. These data are essential for understanding the aetiology of pressure sores, particularly those that were recently termed "deep tissue injury" at the US National Pressure Ulcer Advisory Panel (NPUAP) 2005 Consensus Conference.

Adult↗
PubMed2004

Gluteal compartment syndrome following elective unilateral internal iliac artery embolization before endovascular abdominal aortic aneurysm repair.

During endovascular abdominal aortic aneurysm repair, aneurysmal involvement of the common or internal iliac arteries occasionally necessitates elective occlusion of one or both internal iliac arteries. Although elective internal iliac artery occlusion is often well tolerated, it can result in complications such as buttock claudication or rest pain, impotence, and colon ischemia. We report a case of gluteal compartment syndrome following elective unilateral internal iliac artery embolization prior to endovascular abdominal aortic aneurysm repair. On the first postoperative day, the patient developed sciatic nerve palsy, rhabdomyolysis, and renal failure, which promptly resolved after emergent operative exploration of his left buttock and debridement of all grossly necrotic muscle. This case emphasizes the point that, although elective internal iliac artery interruption is usually benign, it can have serious and unexpected complications that necessitate expeditious treatment for complete recovery.

Aged↗
PubMed2006

Concomitant unilateral internal iliac artery embolization and endovascular infrarenal aortic aneurysm repair.

INTRODUCTION: Endograft limb extension to the external iliac artery with embolization of an internal iliac artery (IIA) may be necessary in patients with abdominal aortic aneurysms (AAAs) extending to the common iliac artery to prevent endoleak during endovascular aortic aneurysm repair (EVAR). Coil embolization of the IIA can be performed at the same operative setting as EVAR or, alternatively, as a staged procedure. Most interventionalists favor the latter approach to avoid excessive contrast material and prolonged operative time. We investigated the clinical outcome of concomitant vs staged unilateral IIA embolization in the setting of EVAR. METHODS: Vascular surgeons at our institution treated 24 patients with infrarenal EVAR and unilateral coil embolization of the IIA from October 1, 2000 to June 30, 2005. All patients had normal renal function. The details of the operative procedure and perioperative complications were compared in patients undergoing concomitant vs staged procedures. Follow up was 1 to 40 months (average, 11 months). RESULTS: Among the 24, 16 underwent concomitant unilateral IIA embolization in the setting of EVAR and eight patients underwent the staged procedure. Average duration of operative time (298 vs 284 minutes), amount of intravenous contrast (215 mL vs 164 mL), and preoperative (1.12 vs 1.26 mg/dL), and postoperative (1.15 v. 1.31 mg/dl) creatinine levels were similar in the concomitant vs staged group, respectively (P > .05 for all factors). More sensitive markers of renal insufficiency such as creatinine clearance were not measured. In the concomitant group, 25% (4/16) of patients reported significant symptoms of buttock claudication ipsilateral to the embolized IIA, which resolved after a mean of 8.8 months (range, 1 to 15 months) vs no cases (0/8) in the staged group (P = .02048). One patient in the staged group developed ischemic colitis, which was treated conservatively. Coil embolizations that were performed as staged procedures were all done on an outpatient basis. All 24 patients were admitted the day of the EVAR and were discharged the next day, except one patient in the concomitant group was discharged the second day after the procedure, and one patient in the staged group was discharged 7 days after the procedure. CONCLUSION: Despite concern of prolonged operative time and the amount of contrast needed to perform concomitant IIA embolization and EVAR, our results showed that in patients with normal renal function, concomitant unilateral IIA embolization in the setting of EVAR was safe and effective and associated with shorter hospitalization compared with staged procedures. The disadvantage of a concomitant procedure is an increased likelihood of transient buttock claudication, but the small number of patients in this series prohibits definite conclusions about this complication. The concomitant procedure may be preferable for infirm patients with normal renal function who would be greatly inconvenienced by two procedures.

Aged↗
PubMed2006

Outcome after hypogastric artery bypass and embolization during endovascular aneurysm repair.

BACKGROUND: Multiple strategies have been devised to extend the applicability of endovascular aneurysm repair (EVAR) in patients with common iliac artery (CIA) aneurysms. This study was designed to examine outcome in patients undergoing EVAR with either hypogastric artery embolization or common iliac artery bifurcation advancement by hypogastric bypass. METHODS: A retrospective review of all patients undergoing EVAR since the inception of our program (1997-2006) was performed. Data were prospectively collected in an EVAR registry. Patients with large common iliac artery aneurysms (> or = 20 mm) and patent hypogastric arteries not amenable to a cuff or "bell bottom" technique were treated with coil embolization (EMBO) and/or hypogastric revascularization (BYPASS). The perioperative and mid-term outcomes were compared with the larger group of patients undergoing EVAR that did not require either treatment (CTRL). Bilateral common iliac artery aneurysms were treated with unilateral coil embolization and contralateral bypass. RESULTS: Common iliac artery aneurysms were present in 137 (31%) of the 444 patients undergoing EVAR, but only 57 (42%) of 137 required direct management. This included hypogastric artery embolization alone (EMBO) in 31 or hypogastric artery revascularization (BYPASS) in 26, with and without contralateral embolization (both revascularization/embolization in 46%). The procedure length (CTRL, 159 +/- 72 minutes; EMBO, 153 +/- 39 minutes; BYPASS, 283 +/- 75 minutes) and estimated blood loss (CTRL, 251 +/- 313 mL; EMBO, 233 +/- 158 mL; BYPASS, 400 +/- 287 mL) were significantly greater (P < .05) in the BYPASS group. The incidence of any postoperative complication (CTRL, 26%; EMBO, 68%; BYPASS, 54%), any ischemic complication (CTRL, 6%; EMBO, 55%; BYPASS, 27%), and new-onset buttock claudication (CTRL, 3%; EMBO, 39%; BYPASS, 27%) were all significantly greater in the BYPASS and EMBO group relative to the control (CTRL) group (n = 387). The incidence of new-onset buttock claudication ipsilateral to the hypogastric bypass was 4%; the balance of the new onset claudication in the BYPASS group was due to the contralateral embolization. The primary hypogastric artery bypass patency was 91 +/- 11% (SE) at 36 months by life-table analysis. CONCLUSIONS: Despite its increased complexity, hypogastric artery bypass is an excellent alternative to embolization in terms of patency and freedom from ischemic symptoms for patients with large common iliac artery aneurysms undergoing EVAR.

Aged↗
PubMed2005

Ventrogluteal area--a suitable site for intramuscular vaccination of infants and toddlers.

Buttock vaccination has lower reactogenicity and similar immunogenicity to the two other recommended paediatric vaccination sites (deltoid and anterolateral thigh). Safety concerns about buttock injection derived from injections with neurotoxic agents, like penicillin but not vaccines, have become entrenched. However, the ventrogluteal area is considered safe for intramuscular injection. This study outlines the development of the ventrogluteal area as a suitable site for intramuscular vaccination of infants and toddlers. Measurement was made in 642 children, aged 2-18 months and age-specific templates were prepared. These were used in an untrasonographic study of 57 children aged 2-18 months to determine the tissue composition of the ventrogluteal area compared with the recommended anterolateral thigh vaccination site. The ventrogluteal area was found to be clearly defined by the template and suitable for intramuscular injection. Subsequent vaccination studies with the area showed that it was:

Buttocks↗
PubMed2005

[Alternative site of implantation of pulse generator for spinal cord stimulation].

INTRODUCTION: Neurostimulation is now a well-accepted treatment for neuropathic pain. The system is composed of an electrode and a battery-powered stimulator generally implanted in the abdominal wall or subclavicular space according to the location of electrodes. One of the complaints of the patients is the discomfort due to the site and the volume of the battery, particularly with the largest model used for dual channel stimulation. To reduce the frequency of this discomfort we propose an alternative site of implantation of the generator. MATERIAL AND METHODS: From January 2001 to February 2002, 17 of our patients chose the buttock area for implantation of the generator. After introduction of the electrodes in the epidural space and tunnelisation has been made to buttock, a pocket is performed in the subcutaneous area to lodge the generator. RESULTS: Ninety-four percent of our patients were very satisfied with this alternative site. One of the 17 patients complained of pain when he was in a reclining position. Otherwise, this technique enable us to perform simultaneously the implantation of the electrodes and the generator facilitating the surgery.

Buttocks↗
PubMed1988

Multiple hairy pacinian neurofibromas (nerve-sheath myxomas).

Pacinian neurofibromas are unusual tumors with components that resemble Vater-Pacini corpuscles and are probably a variant of nerve-sheath myxoma. Lesions composed predominantly of these structures have occurred on or near the buttocks in three previously reported cases; however, all were solitary and congenital. Two of these patients, with lesions that closely resembled mature Vater-Pacini corpuscles, had underlying skeletal anomalies. Our patient had multiple hairy pacinian neurofibromas (nerve-sheath myxomas) on the buttocks that were not associated with radiographic evidence of and underlying skeletal anomaly. Skeletal anomalies may be associated with "sacrococcygeal paciniomas" but probably not with true pacinian neurofibromas.

Buttocks↗
PubMed1996

Persistent sciatic vein: diagnosis and treatment of a rare condition.

PURPOSE: Persistent sciatic vein (PSV) is a rare anomaly most often associated with Klippel-Trenaunay Syndrome (KTS). Magnetic resonance imaging (MRI) and extended use of phlebography have increased the frequency of diagnoses. To evaluate our experience, we reviewed patients in whom PSV was diagnosed at our institution. METHODS: MRIs and phlebograms of all patients with KTS seen since 1985 were reviewed, and patients with PSV were identified. RESULTS: Forty-one of 186 patients with KTS underwent MRI. PSV was diagnosed in 20 of the 41 (48.8%). In addition, one other patient without KTS had PSV. Thirteen patients (61.9%) were female. Patient age ranged from 5 to 71 years, with a median age of 22 years. PSVs were present in the entire thigh and buttock of eight patients (38.1%), the upper thigh and buttock of six patients (28.6%), and the lower thigh of seven patients (33.3%). Six patients (28.6%) had anorectal arteriovenous malformations with heavy bleeding. Five patients (23.8%) had pulmonary embolization. Two patients (9.5%) died. Amputation was required in one (4.8%). Nineteen patients (90.5%) underwent no specific surgery for PSV. Two patients (9.5%) underwent successful excision of PSVs. CONCLUSIONS: Excision of PSV appears to be rarely indicated. It may be indicated for localized symptoms in patients whose condition and anatomy permit. PSV may be a marker for patients with more extensive arteriovenous malformations and for those at high risk for rectal bleeding and pulmonary embolization. Prognosis is related to the associated vascular malformations. MRI and extended use of phlebography should increase the frequency of diagnoses. Treatment rationales should evolve.

Adolescent↗
PubMed2000

Internal iliac artery embolization in the stent-graft treatment of aortoiliac aneurysms: analysis of outcomes and complications.

PURPOSE: To analyze the complications of internal iliac artery (IIA) embolization in conjunction with stent-graft treatment of aortoiliac aneurysms. MATERIALS AND METHODS: Seventy-one patients with aortoiliac (n = 47) or iliac (n = 24) aneurysms were treated with endoluminal placement of stent-grafts. Thirty-two patients (31 men, one woman; mean age, 73 years; range, 56-88 years) had embolization or occlusion of one (n = 27) or both (n = 5) IIAs. Status of the IIAs and the collateral circulation was assessed by retrospective review of angiographic images. Follow-up consisted of a standardized patient questionnaire and review of radiologic and medical records. RESULTS: The mean follow-up time was 35 months (range, 5-64 months). Eleven of the 47 patients with abdominal aortic aneurysms (AAA) (23%) and 19 of the 24 patients with iliac aneurysms (79%) required IIA embolization. One patient with AAA and another with iliac aneurysm had unintentional occlusion of an IIA by extension of the stent-graft over their origins. A total of seven patients had bilateral occlusion of the IIAs after the procedure. Additionally, the inferior mesenteric arteries (IMAs) of two other patients with AAA were also embolized. In six patients, all three vessels were occluded after placement of the stent-grafts. Symptoms were reported in nine of the 20 (45%) patients with iliac aneurysms and in three of the 12 (25%) patients with AAA. Symptoms consisted of buttock claudication (nine of 32, 28%), new sexual dysfunction (two of 16, 12%), and transient urinary retention (3%). Seven of the claudicants had resolution of symptoms after a mean interval of 14 months (range, 1-36 months). There were no instances of bowel ischemia, neurologic sequelae, or buttock necrosis related to these procedures. CONCLUSION: Embolization of the IIA is associated with symptoms in a significant number of patients. While symptoms are transient in most patients, they can be problematic. Efforts should be made to preserve the pelvic circulation if possible.

Aged↗
PubMed1986

Hepatitis B vaccine in healthy hospital employees.

A low rate of seroconversion to hepatitis B vaccine is reported. This occurred in healthy hospital employees from two separate institutions. A total of 236 individuals were evaluated in this study and only 53% or 124 persons developed protective levels of antibody to hepatitis B surface antigen following a complete vaccine series. In one hospital, 30% of the vaccine recipients developed antibody but not to a protective level. Employees who received the entire series in the arm or in the arm and buttock (mixed) had a significantly greater number of responders than employees who received the entire series in the buttock (P less than .05). Recipients aged 50 to 59 years had a significantly lower response rate to the vaccine (P less than .05). There was no correlation with the vaccinee's sex or the timing of the second injection. Vaccine was noted to have frozen in one hospital and accounted for some loss of antigenicity. This failure to respond to the vaccine has necessitated the use of booster injections of vaccine and continued antibody monitoring.

Adult↗