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At least 667 records · Page 37Linked to original sources
PubMed2001

Unilateral and bilateral hypogastric artery interruption during aortoiliac aneurysm repair in 154 patients: a relatively innocuous procedure.

OBJECTIVE: Hypogastric artery (HA) occlusion during aortic aneurysm repair has been associated with considerable morbidity. We analyzed the consequences of interrupting one or both HAs in the standard surgical or endovascular treatment of aortoiliac aneurysms (AIAs). METHODS: From 1992 to 2000, 154 patients with abdominal aortic aneurysms (n = 66), iliac aneurysms (n = 28), or AIAs (n = 60) required interruption of one (n = 134) or both (n = 20) HAs as part of their endovascular (n = 107) or open repair (n = 47). Endovascular treatment was performed with a variety of industry- or surgeon-made grafts in combination with coil embolization of the HAs. The standard surgical techniques included oversewing or excluding the origins of the HAs and extending the prosthetic graft to the external iliac or femoral artery. RESULTS: There were no cases of buttock necrosis, ischemic colitis requiring laparotomy, or death when one or both HAs were interrupted. Persistent buttock claudication occurred after 16 (12%) of the unilateral and 2 (11%) of the bilateral HA interruptions. Impotence occurred in 7 (9%) of the unilateral and 2 (13%) of the bilateral HA interruptions. Minor neurologic deficits of the lower extremity were observed in 2 (1.5%) of the patients with unilateral HA interruption. CONCLUSIONS: Although HA flow should be preserved if possible, selective interruption of one or both HAs can usually be accomplished safely during endovascular and open repair of anatomically challenging AIAs. We believe other comorbid factors such as shock, distal embolization, or the failure to preserve collateral branches from the external iliac and femoral arteries may have contributed to the morbidity in other reports of HA interruption.

Aged↗
PubMed2001

Intentional internal iliac artery occlusion to facilitate endovascular repair of aortoiliac aneurysms.

PURPOSE: The safety of intentional occlusion of patent internal iliac arteries (IIAs) to facilitate the endovascular repair of aortoiliac artery aneurysms (abdominal aortic aneurysms [AAAs] and iliac aneurysms [IAs]) was evaluated. METHODS: We analyzed the techniques and clinical sequelae of selective occlusion of one or both IIAs in 103 patients and correlated these findings with the results of preoperative angiograms to identify vascular anatomy that may predict postoperative pelvic ischemia. To quantify the clinical presentation of pelvic ischemia, we developed these criteria: class 0, no symptoms; class I, nonlimiting claudication with exercise; class II, new onset impotence, with or without moderate to severe buttock pain, leading to physical limitation with exercise; class III, buttock rest pain, colonic ischemia, or both. IIA occlusion was achieved in 100% of the patients by means of either catheter-directed embolization or orificial coverage with a stent-graft. No patient in this study had angiographic evidence of significant visceral occlusive disease before the procedure. Sixty-four patients had isolated AAAs, 23 patients had AAAs and IAs, and 16 patients had isolated IAs. Ninety-two patients had one IIA selectively occluded, and 11 patients had both IIAs selectively occluded. RESULTS: After IIA occlusion, 12 patients were categorized in class I, 9 patients were categorized in class II, and 1 patient was categorized in class III, for a total of 22 patients (21%) with pelvic ischemia. Sixteen (17%) of 92 patients had unilateral IIA occlusions, and six (17%) of 11 patients had bilateral IIA occlusions. Five patients in class I improved and had no symptoms within 1 year, and one patient in class II was downgraded to class I because of improved symptoms. Two unique preoperative angiographic findings were identified in the remaining 16 patients (16%) with chronic pelvic claudication: (1) stenosis of the remaining IIA origin (> 70%) with nonopacification of more than three of the six IIA branches (63%); and (2) small caliber, diseased or absent medial and lateral femoral circumflex arteries ipsilateral to the side of the IIA occlusion (25%). One patient with class III ischemia died of cardiovascular collapse associated with colon infarction caused by either acute ischemia or particulate embolization. CONCLUSION: The incidence of pelvic ischemia after IIA occlusion is 20% immediately after endovascular aortoiliac aneurysm repair. A total of 25% of patients had no symptoms within 1 year. Two preoperative radiologic findings may help identify patients who are at risk for pelvic ischemia: stenosis of the patent IIA and disease deep femoral ascending branches ipsilateral to the occluded IIA. The risk of colon ischemia appears to be small after selective IIA occlusion to facilitate endovascular AAA repair.

Aged↗
PubMed1979

Treatment of iron deficiency in Nigerians with daily intramuscular Ferastral.

Treatment of severe iron deficiency with iron-poly(sorbitol-gluconic acid) complex (Ferastral) intramuscular 10 ml (iron 500 mg) on alternate days has been shown highly effective and well tolerated. In order to see whether the time of treatment could be shortened, 20 Nigerians with severe iron deficiency (mostly from hookworm infection) were treated with daily intramuscular Ferastral 10 ml until their calculated total requirement of iron was met. The total iron deficit was 877-2763 mg (mean 1875 mg). Supportive treatment included antimalarials, folic acid and anthelmintics. No patient complained of undue pain at injection sites or of any other undesirable side-effects. There was no evidence of hepatic or renal toxicity in any patient, including eight who were followed at intervals up to eight weeks from the start of treatment. The initial haemoglobin (Hb) level was 2.2-7.8 g/dl (mean 4.6 g/dl). Daily regeneration of Hb in the first 14 days was 0.12-0.49 g/dl (mean 0.30 g/dl), and haematological indices were generally normal by eight weeks. Recovery was slow or incomplete in six patients, all of whom had complications other than iron deficiency. Serum iron was measured in five patients, rose to around 8000 micrograms/dl on about day 4, and fell to physiological levels by day 14. The serum unsaturated iron binding capacity fell to nil in five out of six patients on around day 3, and reappeared between days 7 and 10. Five patients who had persistent blood loss from continued hookworm infestation received a further single dose of Ferastral (iron 1000 mg) 10 ml into each buttock after four weeks, and one patient after two weeks. This large dose was also acceptable to patients if given slowly; it was followed by an accelerated Hb regeneration, but no toxicity. Daily intramuscular Ferastral 10 ml until the calculated iron requirements are met (usually in less than five days) is recommended for the treatment of severe iron deficiency. Patients with continued blood loss or Hb less than 10 g/dl after four weeks without other cause of anaemia, may receive a boost of one intramuscular injection of Ferastral 20 ml (10 ml into each buttock).

Adolescent↗
PubMed2001

Clinical and laboratory signs of mitochondrial dysfunction secondary to nucleoside analogue antiretroviral therapy are reversible.

During 27 months treatment with 400 mg didanosine and 80 mg stavudine daily but no protease inhibitor therapy, a 50-y-old HIV-positive woman gradually lost 13 kg in weight, her arms, legs and buttocks decreased in volume and she experienced fatigue and polyneuropathy. Laboratory tests showed slight increases in plasma lactate and liver enzyme levels. Eighteen months after withdrawal of antiretroviral drug, the patient was free of fatigue and polyneuropathy and had regained 7 kg in weight as well as most of the volume of her arms, legs and buttocks.

Anti-HIV Agents↗
PubMed2005

Cellulite treatment using a novel combination radiofrequency, infrared light, and mechanical tissue manipulation device.

BACKGROUND: Most post-pubertal women exhibit cellulite, particularly in the thigh and buttock regions. The prevalence of cellulite has led to many attempts at treatment, including a variety of topical solutions, massage-based therapies, and surgical techniques--most with suboptimal clinical effects. The purpose of this controlled study was to evaluate a novel combination device involving radiofrequency, infrared light, and mechanical tissue manipulation for the treatment of cellulite. METHODS: Twenty adult women (ages 25-57 years) of various skin phototypes (I-V), and with moderate bilateral thigh and buttock cellulite, received eight biweekly treatments to a randomly selected side (the contralateral side serving as a non-treated control). A combined bipolar radiofrequency, infrared light, and mechanical suction-based massage device was applied at 20 watts RF, 20 watts IR (700-1500 nm) light, and 200 millibar vacuum (750 mmHg negative pressure). Patients were evaluated using standardized digital photography and circumferential leg measurements at baseline, prior to each treatment session, and at one, three, and six months after the final treatment. Clinical improvement scores of comparable photographs using a quartile grading scale (0 = or < 25%, 1 = 25%-50%, 2 = 51%-75%, 3 = or >75% improvement) were made independently by two masked medical assessors after the series of treatments. Final post-treatment body weight and patients' subjective evaluations were recorded. RESULTS: Ninety per cent (18/20) of patients noticed overall clinical improvement, and 17 of these 18 patients reported that they would pursue treatment of the contralateral thigh. Side effects were limited to transient erythema in most patients, and bruising was observed in 2/20 patients after the first couple of treatment sessions, but not as the treatment series progressed. Clinical improvement scores averaged 1.82 (corresponding to approximately 50% improvement) after the series of treatments. Circumferential thigh measurements were reduced by 0.8 cm on the treatment side. CONCLUSIONS: Cellulite can be significantly and safely reduced with the use of a noninvasive device that combines bipolar RF, infrared light, and mechanical massage. The effects of treatment appear to be prolonged, but maintenance treatments may be necessary to further enhance the clinical results achieved.

Adipose Tissue↗
PubMed1993

Air-fluidized beds and their ability to distribute interface pressures generated between the subject and the bed surface.

Pressures were measured under five anatomical sites prone to pressures sores for ten subjects, supine and sitting on two different air-fluidized beds. The beds were the Clinitron (trademark, SSI) and the Fluidair Plus (trademark, KCI Mediscus). Mean supine pressures were less than 4 kPa under four sites. The average supine buttock pressure was 2.65 kPa. This increased to 3.71 kPa upon sitting up, though pressures did not rise above the accepted capillary closing pressure, on either bed. Low interface pressures at these sites were due to good moulding between subject and bed. Heel pressures averaging 7.08 kPa, were a factor of 2.67 times greater than buttock pressure, and were higher than expected considering the depth the heels sunk to in both beds. This exceeded the accepted capillary closing pressure and was attributed to covering sheets preventing true floatation at the heels.

Adult↗
PubMed1985

Rapid sampling and long-term storage of subcutaneous adipose-tissue biopsies for determination of fatty acid composition.

The fatty acid composition of fat tissue is a valid indicator of the fatty acid composition of the diet over the preceding 1 to 3 yr. Here we describe a rapid method for sampling of buttock fat without anesthesia. On average, 35 mg can be obtained using a common blood-sampling system. Sampling of 40 subjects takes about 3 h. The procedure caused no more anxiety or discomfort than a routine venipuncture. Application in about 500 subjects has as yet yielded no infectious or other complications. With regard to the fatty acid composition of the biopsy, sampling site (left versus right buttock) was not found to be a source of error. The biopsies could be stored for periods up to 1.5 yr without changes in the fatty acid profile. With this method one can obtain biopsies from a large number of subjects and determine objectively the long-term fatty acid composition of their diet.

Adipose Tissue↗
PubMed1987

Differences in adipose tissue fatty acid composition between black and white men in New Orleans.

We report fatty acid composition in perirenal and buttock adipose tissue in 714 deceased black and white men aged 25-44 yr in New Orleans. Percent saturated fatty acids were higher (p less than 0.001) whereas percent monounsaturated fatty acids were lower (p less than 0.001) in perirenal than in buttock fat. Percent linoleic acid was similar in both races. We conclude that dietary intake of linoleic acid is similar in both races. The trend of decreasing linoleic acid with advancing age suggests that either intake of linoleic acid progressively decreases or its mobilization rate increasingly exceeds deposition rate or both. Percent palmitoleic acid (16:1) is lower (p less than 0.001) and that of stearic acid (18:0) is higher (p less than 0.001) in blacks than in whites. We believe no explanation can rest solely on differences in habitual dietary fat intake.

Adipose Tissue↗
PubMed1992

Equations for predicting stature in white and black elderly individuals.

In an anthropometric nutritional assessment, elderly individuals are frequently unable to assume the positions needed for many measurements. This is especially true for stature, which is affected by mobility and skeletal deformities, and as a result measurements may be unreliable and inaccurate. An alternative is to use a surrogate value of stature. We developed predictive equations using data from elderly subjects in Cycle I of the National Health Examination Survey (NHES). The developed equations were cross-validated using two separate independent and more contemporary samples of elderly White men and women. The possible predictor variables were knee height and buttocks-knee length in the men and knee height and age in the women. For both the men and the women, the majority of the variance in stature was accounted for by knee height. Selected equation models were cross-validated, and a single equation was recommended for each elderly group that included knee height rather than buttocks-knee length as predictor variables. This selection was based upon the performance of the equations, and also upon the practical ease of collecting the possible predictor variables. Included with the recommended equations are the RMSEs and the standard error for predicting stature for an individual (SEI). The successful application of the recommended equations with two recent sets of elderly persons indicates the current utility of the recommended equations in White elderly Americans.

Aged↗
PubMed1985

Direct immunofluorescence of normal skin in rheumatoid arthritis.

The clinical significance of previously described immunoglobulin and complement deposition in the superficial dermal vessel walls of patients with rheumatoid arthritis is unknown. In the present study, skin biopsies were obtained from the normal forearm and buttock of 48 unselected patients with rheumatoid arthritis and were examined by direct immunofluorescence (IF) for the presence of immunoglobulin (IgG,A,M) and complement (C3) in the vessel walls. Deposits of C3, IgM or IgG were detected in 10 patients. Five patients had deposits at the forearm sample alone, four patients had deposits at both biopsy sites, while one patient was positive at the buttock alone. Clinical features were similar in patients with and without vessel IF. However, patients with IF were significantly more seropositive with lower levels of complement and raised levels of serum IgA and IgM. There was also an increased level of circulating IgG immune complexes in these patients. Further analysis following exclusion of seronegative patients revealed similar results. This study suggests that the presence of vessel IF identifies a subgroup of patients who have evidence of more severe immunological disturbance.

Antibodies↗
PubMed1997

Bullous lesions in Kaposi's sarcoma: case report.

Bullous lesions have been only rarely described in Kaposi's sarcoma (KS), and their histopathologic features have never been described in detail. We report a case of bullous lesions of KS in an 82-year-old Italian woman. The patient had typical smooth pale reddish-grey slightly-raised KS plaques on the legs, present for at least 10 years. Several dull grayish-pink blisters (0.5 to 2 cm in diameter) affected both dorsa of her feet and ankles symmetrically. Two punch biopsies were taken, one from an infiltrated KS plaque on the right buttock and the other from a bullous lesion on the right foot. Histopathologically, the late KS plaque on the buttock showed typical features of KS, with an increased number of spindle cells arranged in short bundles and extravasation of erythrocytes. The bullous lesion on the foot showed a full-thickness vascular neoplasm involving the upper and lower dermis and the subcutaneous fat. The upper portion of the lesion contained many newly formed, highly-dilated blood vessels, touching the overlying epidermis and separated from it by a narrow band of collagen and endothelial cells; wide, empty spaces characterized the superficial dermis, in which preexisting venules and bands of collagen associated with non-atypical endothelial cells floated. All these findings would suggest a lymphangiomatous lesion, if the presence of specific diagnostic criteria of KS were not recognizable at a deeper level of the lesion. Various criteria actually suggest that the bullous lesion may be regarded as an epiphenomenon of a KS plaque lesion: (a) full-thickness involvement of the reticular dermis and, in this case, also of the subcutaneous fat; (b) dense and patchy lymphoplasmocytic infiltrate typical of plaque lesions and, much less frequently, of patch lesions; (c) presence of ectatic blood vessels, filled with plasma and erythrocytes (pseudoangiomatous findings), a nonpathognomonic but highly characteristic finding of the plaque lesion; and (d) as in the KS plaque lesions, in the bullous lesion as well the reticular dermis was characterized by an increased number of anastomosing bizarrely shaped vascular spaces lined by non-atypical endothelial cells. We hypothesize that the prevalence of lymphangiomatous differentiation in the upper dermis represents one of the many features of KS lesions. When present, it may correlate with the clinical feature of a blister.

Adipose Tissue↗
PubMed1998

Primary cutaneous Langerhans cell histiocytosis in an adult.

A 76-year-old man with Langerhans cell histiocytosis was admitted with an asymptomatic, dark red nodule on his left buttock. Histologic examination of the nodule showed a dense dermal infiltrate of histiocytic cells with bean-shaped nuclei; these cells reacted with antibodies to S-100 and CD1a. Ultrastructural analysis showed Birbeck granules in the cytoplasm of the histiocytic cells. Inguinal lymph node involvement subsequently developed in the patient and cutaneous nodules recurred three times in the inguinal area. Four years have passed since he first was admitted to our hospital with the cutaneous nodule on his buttock, and he is doing well without any intensive treatment except wide excision of the nodules and inguinal lymph nodes. We believe this case should be classified as one of "benign" primary cutaneous Langerhans cell histiocytosis based on the clinical course.

Aged↗
PubMed1998

Transient neurologic syndrome in one thousand forty-five patients after 3% lidocaine spinal anesthesia.

UNLABELLED: Recent reports have discussed the potential risk of transient radicular irritation (TRI) after spinal anesthesia with lidocaine. Because we have not encountered such neurologic sequelae with the high incidence reported, we prospectively examined the incidence of TRI after spinal anesthesia with lidocaine. One thousand forty-five adult patients (aged 47 +/- 15 yr) receiving spinal anesthesia with 3% hyperbaric lidocaine (1.0-1.5 mL) for anorectal surgery were consecutively studied. After the induction of spinal anesthesia, all patients were placed in the prone position for surgery. Patients were evaluated for neurologic symptoms in the buttocks, thighs, or lower extremities using a checklist to standardize data collection. Although there was no complaint of neurologic symptoms on Postoperative Day (POD) 1, four patients (0.4%) reported aching, hypesthesia, numbness, or dull pain of both lower extremities and buttocks by the morning of POD 3. In three patients, the symptoms resolved without any treatment by POD 5, whereas in one patient, numbness of the lower extremities lasted until POD 7. We conclude that a combination of lidocaine with surgical position or leg manipulation during surgery might be a major contributing factor in the development of transient neurologic syndrome. IMPLICATIONS: Recent studies have reported the potential risk of transient neurologic syndrome after lidocaine spinal anesthesia. The current study reports a low incidence of such sequelae in 1045 patients undergoing anorectal surgery during the prone position. Other factors, such as surgical position, may be important in the development of this syndrome.

Adult↗
PubMed1982

Traumatic lipomas/pseudolipomas.

The occurrence of lipomas following trauma is reported in three cases with a review of the literature including 36 additional cases. This condition is usually related to massive trauma in the hip, buttock, and thigh area that is most frequently secondary to a motor vehicle accident. It is most common in the female and may be attributed to the characteristic hip, buttock, thigh fat deposition of the female. The "tumor" usually follows heavy bruising and/or hematoma of the region and is clinically noticeable approximately 6 months thereafter. Initial treatment is preventive by drainage of the hematoma and compression of the site. Late treatment is surgical excision of the tumor.

Adult↗
PubMed1982

Subcapital fracture of neck of femur with complete posterior dislocation of the hip.

A rare case of a posterior fracture-dislocation of the hip joint with an ipsilateral subcapital fracture in a young woman is presented. The isolated femoral head was displaced in the subcutaneous area in the buttock. A possible explanatory mechanism of dual injury is that the posterior fracture-dislocation occurred first and then a lateral blow to the buttock caused the subcapital fracture. The missing fragment of the femoral head, in two parts, was located and replaced with a prosthesis before the hip was reduced. An extensive search in the literature failed to reveal a similar case.

Accidents, Traffic↗
PubMed1998

Results of suture of the sciatic nerve after missile injury.

OBJECTIVE: To evaluate functional recovery after suture of the sciatic nerve after missile injury. METHODS: We reviewed the outcome of 23 adults and four children who had the sciatic nerve sutured above the knee 3 to 14 weeks after missile injury and who were followed for 14 to 36 months. RESULTS: In adults, useful motor recovery was significantly better after suture of tibial (83%) than peroneal (39%) nerves, after suture of nerves at the thigh (71%) than at the buttock (31%) level, and after end-to-end anastomosis (74%) than grafting (39%). Useful sensory function was recovered in 78% of tibial nerves. Fifty-seven percent of adults walked wearing special shoes or pads. Significantly better recovery occurred in children, who all walked with normal footwear. CONCLUSION: We advocate exploration of the sciatic nerve at any level within 3 months if no spontaneous recovery occurs after a missile injury. We do not advocate exploration of the sciatic nerve at the buttock level if only peroneal function is lost except in children.

Activities of Daily Living↗
PubMedDate not supplied

Maternal discipline of children with Asperger Syndrome and nonverbal learning disorders.

PURPOSE: This study investigated how often mothers of children with Asperger Syndrome and nonverbal learning disorders reported using either psychological aggression (shouting, cursing, name calling) or corporal punishment (spanking, hitting) when disciplining their children, and also examined the correlates of these methods of discipline. DESIGN AND METHODS: A descriptive study of 41l mothers with children between ages 4 and 17 years. Mothers were recruited by placing an invitation on two national Web sites; one for parents of children with Asperger syndrome and one for parents of children with nonverbal learning disabilities. An anonymous, mailed survey was used and a 70% response rate was obtained. The Conflict Tactics Scale-Child Form was used to measure psychological aggression and corporal punishment. Univariate analyses were used to describe the child and maternal characteristics and maternal rates of discipline. The correlates of maternal discipline were measured using bivariate analyses. RESULTS: The overall reported use of any corporal punishment (slaps on the hand, arm, and leg; hitting on the buttocks with a belt or brush; spanking on the buttocks with a hand; pinching and shaking) during the past year was 58%. The yearly use of any psychological aggression (screaming and yelling, cursing, threatening to hit or spank, threatening to kick out or send away, calling the child "dumb" or "lazy") was 95%. Spanking declined with increasing age of the child and the mother. Mothers who used psychological aggression were more likely to use corporal punishment with their child. CLINICAL IMPLICATIONS: Informed nurses working with these populations can use the results of this study to help address the stresses felt by these mothers, and to teach alternative strategies of coping to mothers who are in danger of using psychological aggression and corporal punishment.

Adolescent↗
PubMed1977

Use of dermal-fat flaps in treating abdominal scars, in abdominoplasty, and in subtrochanteric lipectomy.

Triangular dermal-fat flaps can be used in the excision of adherent vertical scars in the lower abdomen to prevent a recurrence of the depressed adhesion. Also, several such flaps can be used on the upper margin of an abdominoplasty, and one on the lower edge (above the pubis), to equalize the thickness and the lengths of the two edges. This results in a better final appearance. Finally, the use of a single triangular dermal-fat flap on the lower margin when doing a lipectomy for "subtrochanterric lipodystrophy" (or a "plastic on buttock") gives the buttock a more normal shape--round in the medial two-thirds and almost flat in the lateral one-third.

Abdomen↗