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At least 721 records · Page 40Linked to original sources
PubMed2005

Persistence of lipoatrophy after a four-year long interruption of antiretroviral therapy for HIV1 infection: case report.

BACKGROUND: HIV-infected patients on long-term highly active antiretroviral therapy often present peculiar patterns of fat redistribution, referred to as lipodystrophy. In spite of recent investigations, it is not known whether and to what extent the main features of lipodystrophy--that is lipoatrophy of peripheral fat at face, limbs and buttocks, as well as fat accumulation at breasts, abdomen and the dorso-cervical region--can be reversible once clinically manifest. CASE PRESENTATION: A 35 year old Caucasian HIV infected female developed severe diffuse lipodystrophy while on highly active antiretroviral therapy. A remarkable increase of breast size, fat accumulation at waist, and a fat pad on her lumbar spine were paralleled by progressive and disfiguring lipoatrophy of face, limbs and buttocks. The patient decided to interrupt her therapy after 20 months, with a stably suppressed viremia and a CD4 lymphocyte count > 500/microL. She could carry on a safe treatment interruption for longer than 4 years. Most sites of fat accumulation switched to nearly normal appearance, whereas lipoatrophy was substantially unchanged at all affected sites. CONCLUSION: our observation provides pictorial evidence that lipoatrophy may not be reversible even under ideal circumstances. Therefore, strategies to prevent lipoatrophy should be considered when defining therapeutic regimens for HIV infected patients, especially those at high risk.

Adult↗
PubMed1997

Alternatively spliced transcripts of the aromatase cytochrome P450 (CYP19) gene in adipose tissue of women.

Estrogen biosynthesis in adipose tissue has assumed great significance in terms of a number of estrogen-related diseases. The biosynthesis of estrogens from C19 steroids is catalyzed by a specific form of cytochrome P450, namely aromatase cytochrome P450 (P450arom; the product of the CYP19 gene). The human CYP19 gene comprises nine coding exons, II-X, and its transcripts are expressed in the ovary, placenta, testes, adipose tissue, and brain. Tissue-specific expression of the CYP19 gene is determined at least in part by the use of tissue-specific promoters, which give rise to transcripts with unique 5'-noncoding termini. Thus, the distal promoter I.1 is responsible for expression uniquely in placenta. On the other hand, the proximal promoter II, which regulates expression via a cAMP-dependent signaling pathway, is responsible for expression in the gonads. Transcripts in breast adipose tissue contain 5'-termini corresponding to expression derived from promoters I.4, II, and I.3, with I.4-specific termini predominating. The latter are derived from promoter I.4, which contains a glucocorticoid response element and an interferon-gamma activation site element and is responsible for expression in the presence of glucocorticoids and members of the class I cytokine family. The object of the present study was to determine the distribution of these various transcripts in adipose tissue from abdomen, buttocks, and thighs of women, as this would provide important clues to the factors regulating aromatase expression in these sites. To achieve this, we employed competitive reverse transcription-PCR to amplify unique 5'-ends of each of the transcripts of the CYP19 gene that are expressed in adipose tissue as well as for the coding region to evaluate total CYP19 gene (P450arom) transcript levels. We observed that exon I.4-specific transcripts were predominantly present in adipose tissue samples obtained from women regardless of the tissue site or the age of the individual. In these tissues, promoter II- and exon I.3-specific transcripts were present in lower copy numbers. We also demonstrated that in these sites total or exon-specific P450arom transcripts levels increased in direct proportion to advancing age and that transcript levels were the highest in buttocks, followed by thighs, and lowest in the abdomen. These results suggest that in normal human adipose tissue, aromatase expression is mainly under local control by a number of cytokines via paracrine and autocrine mechanisms in the presence of systemic glucocorticoids.

Adipose Tissue↗
PubMed2001

Nocturnal application of transdermal estradiol patches produces levels of estradiol that mimic those seen at the onset of spontaneous puberty in girls.

The objective of pubertal induction in children with hypogonadism is to mimic spontaneous puberty in terms of physical and psychological development. In a clinical observation study, we induced puberty in 15 girls with hyper- or hypogonadotropic hypogonadism using low doses of transdermal estradiol patches attached only during the night and compared the estradiol concentrations obtained with those in healthy girls. Pubertal induction was started between the ages of 12.3 and 18.1 yr. A transdermal matrix patch of 17beta-estradiol (25 microg/24 h; Evorel, Janssen Pharmaceuticals-Cilag) was cut into pieces corresponding to 3.1, 4.2, or 6.2 microg/24 h initially and attached to the buttock. After 4-14 months, the dose was increased gradually. Serum 17beta-estradiol concentrations were measured every 2 h by RIA (detection limit, 6.0 pmol/L; 1.6 pg/mL). The results show that it is possible to mimic the spontaneous levels as well as the diurnal pattern of serum 17beta-estradiol in early puberty, by cutting a transdermal 17beta-estradiol matrix patch and attaching a part of it, corresponding to 0.08-0.12 microg estradiol/kg BW, to the buttock nocturnally. In most of the girls, breast development occurred within 3-6 months of the start of treatment.

Administration, Cutaneous↗
PubMed2003

Rhabdomyolysis of gluteal muscles leading to renal failure: a potentially fatal complication of surgery in the morbidly obese.

BACKGROUND: Rhabdomyolysis is a well-known cause of renal failure and is most commonly caused by ischemia/reperfusion or crush injury. We describe a new cause of this syndrome in a series of 6 patients who underwent necrosis of the gluteal muscles after bariatric surgery, 3 of whom eventually died of renal failure. METHODS: Potential etiologic factors were studied by comparing these patients with a consecutive series of 100 patients undergoing primary uncomplicated bariatric surgery during a 1-year period. Demographics, preoperative BMI, co-morbidities, duration of operation, and postoperative creatinine phosphokinase (CPK) levels. RESULTS: All patients presented with an area of buttock skin breakdown initially diagnosed as a simple decubitus ulcer. All had extensive myonecrosis of the medial gluteal muscles requiring extensive debridement. 5 of the 6 patients were male, with median BMI 67 compared with a median BMI 55 in the control group (P=0.0022). The patients were on the operating-room table for a median of 5.7 hours compared with 4.0 in the control group (P=0.01). 3 of the 6 developed renal failure requiring dialysis, which was fatal in all. One other patient developed a transient elevation of BUN and creatinine which did not require dialysis. Since recognition of this pattern, we now routinely perform serial CPK measurements. Median CPK rise in uncomplicated patients was to 1,200 mg/dl (SD 450-9,000), while CPK in affected patients ranged from 26,000 to 29,000 IU/l. We now routinely add additional buttock padding in very obese patients and institute aggressive hydration and mannitol diuresis if CPK rises above 5,000. No cases have occurred in the past 18 months in 220 patients. CONCLUSIONS: This is an important and potentially fatal complication of bariatric surgery. Very obese male patients with prolonged surgery are at risk of gluteal muscle necrosis with consequent renal failure, which we hypothesize is due to pressure by the operating-table leading to rhabdomyolysis and the creation of a compartment syndrome. Prevention may be aided by attention to intraoperative padding and positioning, and by limiting the duration of the operation.

Acute Kidney Injury↗
PubMed1998

Evaluation of wheelchair cushions by means of pressure distribution mapping.

We studied the seated buttock pressure distribution in six paraplegic patients by means of computerized pressure mapping. They were all male and their age ranged from 18 to 48 years old. Their level of paralysis varied from Th5 to L1. Five kinds of wheelchair cushions were studied: an air cushion, a contour cushion, a polyurethane foam cushion, a Cubicushion (which is made of polyurethane foams) and a silicone gel cushion. A tactile sensor consisting of 2064 matrices was used for measuring the buttock pressure distribution and the data was analyzed on a personal computer. Peak pressures measured for each cushion were as follows (in descending order): the Cubicushion, the polyurethane foam cushion, the contour cushion, the silicone gel cushion, and the air cushion. The areas of total contact measured for each cushion were as follows (in descending order): the air cushion, the silicone gel cushion, the polyurethane foam cushion, the contour cushion and the Cubicushion. Based on these findings, we conclude that the most advantageous cushion is the air cushion or the silicone gel cushion. Likewise, we conclude that the Cubicushion is not practical for pressure sore prevention.

Adolescent↗
PubMed1991

[Ultrasonic observation on distribution of subcutaneous fat in Japanese young adults with reference to sexual difference].

Utilizing an ultrasonic device (B-mode, 7.5MHz), the thickness of subcutaneous fat was measured at 54 different points in the bodies of 59 males (aged 20-25) and 66 females (aged 20-23). The results were as follows: 1. The females had significantly thicker subcutaneous fat than those of the males at every point measured. 2. The thick subcutaneous fats were observed at the abdomen, buttocks, and the anterior and medial parts of the thigh in the males, and at the breast, buttocks, abdomen, the posterior, medial, and anterior parts of the thigh, and the anterior, medial, and posterior parts of the upperarm in the females, respectively. 3. The subcutaneous fat of both sexes was more likely to be thicker in body parts closer to the trunk than the extremities. 4. The correlation coefficient between the percent body fat and the mean thickness of subcutaneous fat obtained from data was 0.91 for the males and 0.83 for the females.

Adipose Tissue↗
PubMed1998

Thermophysiological significance and the role of local clothing in ambient 10 degrees C environments.

In order to understand the role of clothing covering and uncovering the hands, feet, legs, thighs, buttocks and hypogastric region for human thermoregulation at an ambient temperature of 10 degrees C, two series of experiments were conducted on six healthy male subjects wearing three different kinds of clothing in Expt. 1 and four different kinds of clothing in Expt. 2. The three kinds of clothing used in Expt. 1 were, clothing A covering the whole body surface area except the head, clothing B covering the whole body surface area except the head and feet, and clothing C covering the whole body surface area except the head, hands and feet. The four kinds of clothing used in Expt. 2 were clothing C used in Expt. 1, clothing D covering the whole body surface area except the head, hands, feet and legs, clothing E covering the whole body surface area except the head, hands, feet, legs and thighs, and clothing F covering the whole body surface area except the head, hands, feet, legs, thighs, buttocks and hypogastric regions. The starting time of the experiment, the subject measurement variables and the garments used were all kept constant throughout the experiment. The subjects were instructed to enter a chamber at room-temperature and various sensors were attached. The subjects were then instructed to relax until a quasisteady temperature state was reached. The subjects were then moved into a chamber at 10 +/- 0.2 degrees C, 50 +/- 5% RH. for two hours. The main results can be summarized as follows: 1) The level of rectal temperatures of subjects wearing clothing C were maintained significantly better than the temperatures of subjects wearing clothing A and B who experienced a significant drop in temperature in the 10 degrees C chamber in Experiment 1. 2) In Experiment 2, the rectal temperatures of subjects wearing clothing E were maintained significantly better than subjects wearing clothing C, D, and F, who also experienced significant drops in temperature in the 10 degrees C chamber. These different behavior patterns of rectal temperatures were discussed in terms of the counter-current heat exchange system.

Adolescent↗
PubMed2001

Lower-limb vascularization in diabetic patients. Assessment by thallium-201 scanning coupled with exercise myocardial scintigraphy.

OBJECTIVE: To investigate, by thallium-201 scanning, circulation in the muscles of the lower limb (LL) in diabetic patients without clinical peripheral vascular disease but with a high cardiovascular risk profile. RESEARCH DESIGN AND METHODS: A total of 80 diabetic patients (76 patients with type 2 diabetes, mean age 57.3 years, duration of diabetes 13.0 +/- 7.5 years) with more than one additional cardiovascular risk factor but no claudication were investigated. After stress testing, 1.5 MBq/kg thallium-201 was administered to perform myocardial single-photon emission computed tomography followed by LL scanning. Muscle blood flow was considered abnormal if the asymmetry in thallium-201 uptake between the two buttocks and/or thighs and/or calves was > 10%. RESULTS: Muscle perfusion defects were found in 42% of the patients, mainly in the calves. These defects correlated with retinopathy (P = 0.042) and the HbA1c level (P = 0.044). In patients with defects in the buttock and/or thigh, the prevalence of nephropathy and retinopathy was higher than in those with isolated defects in the calf (P = 0.032 and 0.023, respectively). CONCLUSIONS: This study suggests that LL scanning coupled with myocardial scintigraphy is a convenient method of investigating peripheral muscle circulation. Proximal perfusion defects in patients without clinical arterial disease are associated with increased prevalence of retinopathy and nephropathy and, therefore, may be due to microvascular disease of LL muscle. Distal defects may indicate silent macrovascular disease of the LL.

Adult↗
PubMed1993

UV-related skin conditions and Langerhans' cell populations in human skin.

Chronic sun exposure and cumulative exposures to PUVA are associated with a risk of development of non-melanoma skin cancer. Acute UV irradiation reduces the number of epidermal antigen-presenting Langerhans' cells in the skin. Alterations in the Langerhans' cell population could be relevant to a disturbance in the cutaneous immune response in UV-exposed skin. Therefore the density of CDla+ and ATPase+ Langerhans' cells in epidermal sheets from the hand, buttock and in some cases face was examined in PUVA-treated patients (n = 8) and in patients with actinic keratosis (n = 13) or basal cell carcinoma (n = 16). The number of Langerhans' cells was significantly lower on the hand compared with that on the face and buttock (p < 0.05). There was no difference in Langerhans' cell distribution between the different diagnostic groups and controls, and there was no age-related change in Langerhans' cell density. These results indicate that patients who develop actinic keratosis or multiple basal cell carcinomas do not differ in Langerhans' cell density from healthy controls and that cumulative sunlight or PUVA exposure does not lead to a persistent reduction in Langerhans' cell numbers.

Aged↗
PubMed1998

Differential diagnosis of the hip vs. lumbar spine: five case reports.

With recent health care policy changes and the implementation of direct access in many states, physical therapists must be able to identify pathology that is beyond their scope of practice. The five case reports presented in this series required the differential diagnosis of hip vs. lumbar spine pathology. All of the cases required a referral from the physical therapist to either the patient's physician or a specialist because of abnormal screening test results. Each referral resulted in a new diagnosis of pathology that was beyond the scope of physical therapy. Cyriax's concepts of capsular and noncapsular patterns of joint restriction and the "Sign of the Buttock" proved useful in differentiating between hip and lumbar spine pathology in each patient. Our clinical experience indicates that utilizing the presence/absence of a capsular pattern and a "Sign of the Buttock" to screen out hip pathology in patients may be effective; however, further research is needed to support these claims.

Adult↗
PubMed1981

Thigh adductor contraction during transurethral resection of bladder tumours: evaluation of inactive electrode placement and obturator nerve topography.

Thigh adductor contraction occurred in 17 of 160 patients during transurethral resection of newly diagnosed bladder tumours. In 13 of the 17 patients contractions were abolished by changing the site of the inactive electrode from the buttocks to the thigh. The topographic relationship between the obturator nerve and the bladder wall studied radiographically and at autopsy showed that the distance between the bladder and the nerve considerably diminished with increasing bladder volume. Thus, when obturator nerve stimulation occurs during transurethral resection transposition of the inactive electrode from the buttocks to the thigh should be tried first to prevent further stimulation. Moreover, TUR at low bladder volume may reduce the frequency of obturator nerve stimulation.

Electrodes↗
PubMed1987

Metameric capillary hemangioma producing complete myelographic block in an infant. Case report.

A variety of lesions of ectodermal, mesodermal, (rarely) endodermal, or mixed-cell layer origin involve the region of the conus medullaris. Some of these abnormalities produce cord tethering and others, such as lipoma, frequently present as masses. In the present case, an infant was discovered to have a lesion most closely resembling a capillary hemangioma involving the skin of the midline and right buttock, the deep soft tissues of the right buttock, the dura, and the conus medullaris. The origin of this congenital spinal tumor from primitive mesoderm is proposed in light of its metameric pattern of distribution.

Aortography↗
PubMed2003

[Assessment of neonatal hyperbilirubinemia using a transcutaneous bilirubinometry].

PURPOSE: The purpose of the study is to investigate the relationship between total serum bilirubin(TSB) and transcutaneous bilirubinometry(TcB) in neonates with jaundice. METHOD: TcB from various sites(forehead, sternum, abdomen, buttock, hand, dorsalis-pedia) was measured using a JM-102 in a total of 102 neonate, 42 female and 60 male, with the mean 37.5 gestational week and the mean 2,903 gram of birth weight, as well as TSB from capillary punctures. RESULT: The mean bilirubin was 11.73 in serum, 20.55 on the forehead, 17.23 on the sternum, 16.19 on the abdomen, 18.22 on the buttock, 15.83 on the hand and 15.49 on the dorsalis-pedia. The relationship between TSB and TcBs were formulated by simple regression with 0.406 < r < 0.668(p <.000). A higher relationship was revealed between TSB and TCB at the forehead in infants of full-term, ABO incompatibility, and Hb greater than 16 mg/dl(r = 0.725, 0.790, and 0.717, retrospectively). Phototherapy altered the measurement of TcB per site. CONCLUSION: TcB on the forehead is a reliable, noninvasive and convenient measurement of TSB in normal infants(Institutions need to establish quantitative equations representing the specific relationship between TSB and TCB according to the hemodynamic problems of infants such as ABO incompatibility, or low Hb).

English Abstract↗
PubMed2001

Injection-induced sciatic nerve injury in Nigerian children.

OBJECTIVES: A retrospective study of all children with a diagnosis of sciatic nerve injury managed at the University College Hospital, Ibadan, Nigeria over a 12 year period was carried out in order to determine predisposing factors to the nerve injury and highlighting practical preventive measures. DESIGN: The necessary data was collected from the case files of children seen at the hospital with a diagnosis of sciatic nerve injury, from 1988 to 1999. RESULTS: There were 27 children aged five months to 12 years with a diagnosis of sciatic nerve injury. Twenty (74%) of the children were aged five years or less. While seven patients (26%) presented within two weeks of development of foot drop consequent on intramuscular (i.m.) injection given on the buttock, 20 patients (74%) presented much later. Fever was the most common complaint for which the injection had been given. The identity of the drugs given was not known in 10 patients. In the remaining 17 patients drugs administered were specified and included Chloroquine, Novalgin, Paraldehyde, Procaine penicillin, and Sulfadoxine-Pyrimethamine. Most of the patients had received the injections in privately owned medical facilities where staff with minimal training are often allowed to administer i.m. injections. CONCLUSION: It is suggested that the i.m. route for injection be strongly discouraged when a drug can be given by other routes. Only trained staff should be allowed to administer i.m. injections. Giving i.m. injections at sites other than the buttock maybe advantageous in children particularly those aged five years and below.

Child↗
PubMedDate not supplied

Comparison of three wheelchair cushions for effectiveness of pressure relief.

OBJECTIVE: Previous studies have suggested that no single wheelchair pressure-relieving cushion material was optimal for all persons with spinal cord injury (SCI). The purpose of this study was to compare the effectiveness of the short-term pressure-relieving ability of the three most commonly prescribed wheelchair cushions (Roho, Jay, Pindot) for a person with SCI. METHOD: The number of pressure sensors registering at the buttock-cushion interface during wheelchair sitting was measured by the Xsensor Pressure Mapping System after 5 min of sitting. An alternating treatments research design, with an initial baseline and a final treatment phase ending with the most effective cushion for relieving pressure, was used for the clinical evaluation. Measurements were compared using visual inspection and a Wilcoxon signed ranks test. RESULTS: Data analyses indicated that the number of pressure sensors that registered potential harmful levels of pressure at the buttock-cushion interface for the Roho cushion was significantly less than those of the Jay and Pindot cushions. CONCLUSION: The Roho cushion was more effective in relieving pressure at the seating surface than the Jay and Pindot cushions.

Adult↗
PubMed1994

Optimizing transperineal sonographic imaging of the cervix: the hip elevation technique.

Although transperineal ultrasonography is a valuable technique for imaging the cervix in pregnancy, transperineal imaging can be compromised when bowel gas obscures the external portion of the cervix. To determine if a hip elevation technique could improve visualization of a partially obscured cervix, transperineal scanning was performed with the hips and buttocks elevated on a thick cushion in 23 patients with suboptimal routine transperineal views. The "hips up" maneuver was tolerated by all patients and improved cervical visualization in 19 of 23 cases. We conclude that the simple maneuver of elevating the patient's hips and buttocks on a thick cushion is a useful adjunctive technique to improve transperineal imaging of the cervix when routine transperineal views are compromised by adjacent bowel gas.

Cervix Uteri↗
PubMed1999

Changes in body habitus and serum lipid abnormalities in HIV-positive women on highly active antiretroviral therapy (HAART).

Twenty-one women (propositi) who expressed serious concerns about changes in body habitus during highly active antiretroviral therapy (HAART) were evaluated by thorough physical examination, anthropometric measurements, and serum lipid and endocrine assays. The same evaluations were carried out in a comparison group of 21 women who received HAART but did not complain of changes in habitus. No significant demographic differences were found between the propositi and the comparison group, nor were there significant differences in CD4 count or plasma viral load (PVL) between the two groups. Lipid analyses were also performed on plasma obtained prior to HAART from 12 of the women. The frequency of changes reported by the 21 propositi were increase in abdominal size (90%), increase in breast size (71%), weight gain of >5 kg (43%), peripheral fat wasting (43%), buttock fat wasting (38%) and development of cervicodorsal fat pad (19%). A subset of patients in the comparison group experienced increase in abdominal size (29%) and weight gain >5 kg (19%), but none experienced clinically detectable peripheral or buttock fat wasting, increased breast size, or development of cervicodorsal fat pads. Mean waist circumference, waist-to-hip ratios (WHR), body fat, and body mass index (BMI) were above the desirable range for women in both propositi and the comparison group. Levels of total cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol associated with increased cardiovascular risk were found in 48%, 62%, 45%, and 33%. respectively, of the propositi, with similar findings in the comparison group. Fasting insulin levels were elevated in 4 propositi and 6 of the comparison group; mean insulin levels were within the normal range for both groups. In the comparison of lipids for the subset of patients before and after HAART therapy, HAART was associated with significant increases in total cholesterol, apolipoprotein B, and HDL cholesterol. Changes in body habitus caused by redistribution of fat occur commonly in women receiving HAART. Serum lipid abnormalities also are common during HAART and appear to be as frequent in women who do not experience clinically apparent body fat redistribution as in those who do. The observed changes in body fat distribution and in serum lipid levels are alterations that have been strongly correlated with increased risk for cardiovascular disease. Therefore, an understanding of the basis of these phenomena, and the risks with which they may be associated in this population, will be important for therapeutic decision making in women with HIV disease.

Adipose Tissue↗
PubMed1999

[A case of sacral chordoma presenting as urinary retention].

A 71-year-old man was referred to our hospital complaining of urinary retention. He noticed a small mass on his buttocks about one year ago. Computed tomographic (CT) scan and magnetic resonance imaging (MRI) showed a large mass of 10 cm in diameter located in the retrovesical space. The mass extended to the surface of his buttocks and contained many calcified deposits, and was accompanied with a sacral bone fracture. Transdermic biopsy revealed the presence of sacral chordoma. Chordoma is a rare tumor, arising from remnants of the notochord and is locally progressive. Both tumor resection and diverting colostomy were performed at another hospital. In that operation his spinal cord was protected down to the second sacral level. Unfortunately after the operation, the patient suffered total urinary incontinence. At 15 months after surgical treatment, the patient presented with lung and bone metastases, and at 2 years after his initial operation, he had local recurrence.

Aged↗