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PubMed1986

Current status of external counterpulsation.

This article traces the development of external counterpulsation from its beginnings to the present. Initially, counterpulsation was carried out by cannulating the femoral artery. The hemodynamic goals were to reduce the afterload of the left ventricle, and to raise or augment the diastolic pressure. This gave rise to the term "counterpulsation." The intra-aortic balloon is capable of producing these salutary effects because of its proximity to the outlet of the left ventricle. The same hemodynamic effects can be obtained by external counterpulsation. However, one must produce a negative pressure during cardiac systole, and ensure that this is applied to the lower extremities. The only clinical study in which this was done was in the treatment of patients in cardiogenic shock by Soroff and colleagues. The results of the clinical studies reviewed are all suggestive of benefits derived from external counterpulsation in a variety of clinical settings. These studies suggest the following avenues for improvement in the equipment used to carry out external counterpulsation: 1. Inclusion of the vascular bed of the buttocks to be subjected to the external pressures, as advocated by Zheng. 2. Inclusion of a negative pressure blanket, as advocated by Soroff. 3. Further investigation of graded-sequential external counterpulsation, using the buttocks and negative pressure. 4. Application of external counterpulsation earlier in cardiogenic shock and for at least 4 hours in acute myocardial infarction. Our evaluation is that this method has not been studied in a way that demonstrates its full potential. We feel that it is on the threshold of being shown to be useful in all of the clinical settings reviewed, and we hope that the necessary equipment will be created to allow investigators to establish its proper place in our therapeutic armamentarium.

Acute Disease↗

PubMed1988

[Progressive lymphangiokeratoma and angiosarcoma (Stewart-Treves syndrome) in congenital lymphedema].

Three unusual clinical and histopathological changes were found in a 59-year-old male patient with congenital lymphedema of the lower left leg. Firstly, a keratotic lymphangioma had developed in the course of only a few years and in the end involved the entire left leg up to the buttocks--far beyond the edematous area. Secondly, concealed beneath the lymphangiokeratoma, a solitary tumor almost the size of a table-tennis ball was found on the outer side of the lower left leg. Histopathologically, the tumor proved to be a malignant angiosarcoma, which had grown over a period of some months. It was characterized histopathologically by solid and angiomatous differentiation. Thirdly, the superficial and deep lymph vessels revealed remarkable atypia and papillary proliferations of endothelial cells. After amputation of the left leg at the thigh, with complete removal of the angiosarcoma, but leaving the pathologically altered vessels in the upper part of the left leg and the buttocks, no clinical signs of metastases of progression have been noted during the first year after operation.

Amputation, Surgical↗

PubMed1986

[Nonclostridial gas-producing phlegmone originating in the right thigh of a diabetic patient: report of a case with autopsy findings].

A 49-year-old male with a history of diabetes mellitus of a period of twenty years noticed pain and feverish sensation in both thighs and both inguinal regions: they were more severe in the right than in the left. There were redness and swelling of the skins of the scrotum and of the superomedial aspects of both thighs. He had no diabetic ulcer on the right foot or right leg. Examination revealed evidence of gas retention in the subcutaneous tissue of the right thigh. Incision confirmed the presence of pus, from which Escherichia coli and Bacteroides fragilis were cultured. His condition gradually deteriorated despite wide incision, debridement, irrigation, and intensive chemotherapy. He expired on the 26th hospital day. Autopsy showed phlegmone of the right loin, right buttock, right thigh, and upper half of the right leg. We presume that the skin of the superomedial aspect of the right thigh was first infected. Bacteria rapidly invaded into the subcutaneous tissue; they induced phlegmone with gas production. We conclude that phlegmone of the right thigh simultaneously spread both to the right loin and right buttock, and to the right leg.

Bacteroides Infections↗

PubMed1987

[A surgical case of aneurysm of the persistent sciatic artery].

Seventy two-year-old woman was admitted in September, 1985 to our hospital with complaints of painful mass in the right buttock and ischias. Aorto-peripheral arteriogram showed that enlarged right internal iliac and inferior gluteal arteries passed posteriorly to cross the right hip and down the posterior aspect of the femur to supply the popliteal artery. A saccular aneurysm was seen immediately posterior to the right femoral head. The femoral artery was small in size, but connecting to the popliteal artery. Delayed flow to the popliteal artery through the sciatic artery was noted in contrast to the femoral system. With Osborne's right buttock approach, the gluteus maximus muscle was divided in the direction of its fibers, exposing a 3.5 by 5 cm aneurysm which was located above, the sciatic nerve and adherent to it. The proximal sciatic artery and the trunk of the sciatic nerve passed beneath the piriformis muscle. The pressure of the dorsalis pedis artery decreased from 156/77 to 117/72 mmHg after ligation of the proximal sciatic artery. The aneurysm was dissected free from the sciatic nerve. Postoperatively she had no more gluteal discomfort, nor did she have any ischemic symptoms by walking.

Aged↗

PubMed1986

Sciatic artery aneurysms: report of three cases and review of the literature.

Sciatic artery aneurysms (SAAs) develop in a persistent sciatic artery, which is a congenital anomalous continuation of the internal iliac artery and may be the major blood supply to the lower extremity. SAAs may appear clinically with rupture, thrombosis, distal embolization, or compression of the sciatic nerve. We have reviewed our three cases and the literature to delineate those factors that permit correct preoperative diagnosis and appropriate surgical intervention. Our three patients (aged 54 to 82 years) appeared with severe ischemia that resulted in above-knee amputations. The literature reveals 21 patients ranging in age from 35 to 84 years (58% were women). Twenty of those patients had operations, one of which resulted in death, and five in above-knee amputations. Unexplained sciatic or buttock pain, or a palpable "pulsating" buttock mass, suggests an SAA. The diagnosis is confirmed by angiography. The recommended treatment is femoropopliteal bypass grafting followed by ligature or percutaneous endovascular thrombosis of the aneurysm. Early diagnosis and correct surgical therapy are the keys to successful management of SAA.

Aged↗

PubMedDate not supplied

[Veins and cellulitis].

There is no relation between what French women call "cellulitis" and the venous problems of genetic origin. It may be that cellulitis is the name given to those extra kilos, to mild obesity, to fatty deposits on the thighs and buttocks (sub-trochanteric and crural steatomeries: "jodhpurs"); the point is that cellulitis is apparent, either immediately or on pinching the skin, as an orange-peel pitting. This problem exteriorises the lobular structure of the surface fat. This derives from excessively large lobules, cutaneous relaxation, or excessive pressure on the walls separating the lobules into compartments. Slimming reduces the large areas of deposit at the base of the buttocks. Musculation of the thighs can improve their appearance. More people think they have cellulitis than are really afflicted with it; this is just one of the many deceptions associated with it.

Adipose Tissue↗

PubMed1979

Anthropometric data in middle-aged women. The population study of women in Göteborg 1968-1969.

Body weight, body height, skinfolds, circumferences and weight indices in a population sample of 1462 women in ages between 38 and 60 years are presented. Significant age differences were noted. High correlations (r) were found between body weight and triceps and subscapular skinfolds (0.62 and 0.72 respectively) and between body weight and arm, waist and buttock circumferences (0.75-0.88). Age differences were mostly noted between 46 and 50 years of age. After that age there was a comparatively greater increase of the waist circumference than of the buttock circumference, while triceps skinfold seemed to decrease after the age of 50 indicating an altered adipose tissue distribution from the extremities to the trunk with increasing age. When taking data from a previous study of body weight in the same population of women into consideration it seems that the age differences in body weight found in cross-sectional study like the present one may to a large extent depend on differences between different cohorts studied.

Adult↗

PubMed1981

Warfarin-induced skin necrosis: report of four cases.

Four cases of warfarin-induced skin necrosis are reported, and previous reports of this adverse drug reaction are summarized. A 53-year-old man experienced two episodes of skin necrosis on his left flank and buttock, following the initiation of warfarin therapy for acute thrombophlebitis and after a dose adjustment. The lesion formed multiple hemorrhagic bullae that ruptured, and an eschar formed that did not heal and eventually required skin grafting. Seven days after the initiation of warfarin therapy, an area of erythema surrounded by a halo was noted on the left thigh of a 79-year-old woman. Following the typical pattern, the erythematic area turned to a blue-black color and rapidly formed an eschar deep into the subcutaneous tissue that required debridement. A 70-year-old man was given a warfarin dose of 10 mg daily that was reduced to 2.5 mg daily. It was discontinued when bullous violaceous lesions were discovered on his lower left leg and foot. His prothrombin times never exceeded 20 seconds with a control of 10.6 seconds. A 37-year-old woman was admitted with an erythematous area on her right thigh that turned blue-black and subsequently formed an eschar. Her prothrombin time was 21 seconds with a control of 10.6 seconds. Of the 50 reports of warfarin-induced skin necrosis in the literature (including the four here), 74% of the cases involved women. The mean age of the patients was 54 years, and 60% of the lesions occurred on the thigh, breast, or buttock. Usually the onset of the lesion was noted on days 3--5 of warfarin therapy. Sixty percent of the patients were hypocoagulated. The etiology of warfarin-induced skin necrosis has not been definitively established. In the event of this unusual complication, warfarin therapy should be discontinued, vitamin K should be administered to reverse the effects of warfarin, and heparin should be used to provide anticoagulation.

Adult↗

PubMed1981

Aerobic and anaerobic bacteriology of cutaneous abscesses in children.

Specimens from 209 cutaneous abscesses in children were cultured for aerobic and anaerobic microorganisms. Of these, nine (4%) were sterile and 51 (24%) yielded pure cultures that were predominantly Staphylococcus aureus. The rest of the abscesses yielded growth of two or more aerobic and/or anaerobic organisms. The data were organized according to these anatomic locations: head, neck, trunk, finger, nailbed, hand, leg, buttocks, perirectal, and vulvovaginal areas. Aerobic bacteria only were present in 92 specimens (46%), anaerobes only were isolated in 52 (26%), and mixed aerobic and anaerobic bacteria were present in 56 abscesses (28%). A total of 467 isolates (270 anaerobes and 197 aerobes) were recovered, accounting for 2.3 isolates per specimen (1.3 anaerobes and 1.0 aerobes). The presence of more than one anaerobe per abscess was obtained from the vulvo-vaginal, buttocks, perirectal, finger, nailbed, and head areas. Aerobes were more prevalent in the neck, hand, leg, and trunk areas. The predominant aerobes recovered were: S aureus (89 isolates), alpha- and nonhemolytic streptococci (29), group A beta-hemolytic streptococci (16), Enterobacter (10), and Escherichia coli (8). The predominant anaerobes recovered were anaerobic Gram-positive cocci (79 isolates), Bacteroides sp (116, including 31 B melaninogenicus group and 29 B fragilis group), and Fusobacterium sp (39). Our findings indicate the polymicrobial nature and predominance of anaerobes in cutaneous abscesses in children in perirectal, head, finger, and nailbed areas.

Abscess↗

PubMed1995

Prevention of UVB-induced immunosuppression in humans by a high sun protection factor sunscreen.

BACKGROUND AND DESIGN: To date, studies of the effectiveness of sunscreens in preventing UVB-induced suppression of contact hypersensitivity in humans have not been published. Several studies in mice of the protection afforded by sunscreens from UVB-induced suppression of contact hypersensitivity and rejection of transplanted skin cancers have yielded dissimilar results, ranging from "no" to "complete" protection. We sought to determine whether the effect of preapplication of a sun protection factor (SPF) 29 sunscreen (containing octyl methoxycinnamate, oxybenzone, and octyl salicylate) could prevent local UVB-induced suppression of contact hypersensitivity to dinitrochlorobenzene (DNCB). Nineteen subjects received either three minimal erythema doses of UVB daily on three consecutive days (UVB group) or sunscreen followed by this same dose of UVB irradiation (sunscreen plus UVB group) to a 16-cm2 area of the buttock. One day after completion of irradiation, DNCB was applied to this buttock site, and 2 weeks later, forearm challenge with four different concentrations of DNCB was performed. A control group of 10 subjects underwent DNCB testing as above, but with no prior exposure to UVB (no-UVB group). RESULTS: The UVB group had a reduced response rate to all challenge doses of DNCB (3.125, 6.25, and 8.8 micrograms), except for the highest dose (12.5 micrograms) compared with the no-UVB control group (Fisher's Exact test, P < or = .008), and compared with the sunscreen plus UVB group (P < or = .02). The no-UVB and sunscreen plus UVB groups showed no significant differences in response rates to any of the doses of DNCB tested (P > or = .53). CONCLUSIONS: These results indicate that application of a sunscreen with over ninefold greater protection than that needed to prevent erythema prior to localized UVB radiation prevents localized UVB-induced suppression of contact hypersensitivity. Further studies are needed to determine whether sunscreens providing less protection, yet still preventing erythema, adequately prevent suppression of contact hypersensitivity, a possible surrogate marker for skin cancer tumor antigen recognition and rejection.

Adult↗

PubMed1995

Septic sacroiliitis.

The authors treated 31 patients with septic arthritis of the sacroiliac joint (14 patients with tuberculosis, 7 acute staphylococcal, 6 gonococcal, and 4 typhoid). The clinical presentation was vague and nonspecific, but most patients reported buttock pain, low back pain and difficulty walking. In 28 patients, the diagnosis was established after clinical examination, bone scans, hematologic investigations, and blood cultures. The diagnosis was established through arthrocentesis of the sacroiliac joint in 9 patients. In 3 patients, there was a delay in diagnosis. Twenty-nine patients improved on a conservative regimen of bed rest and antibiotics. Two patients required open drainage because of a large buttock abscess that was secondary to tuberculosis sarcoiliitis.

Adolescent↗

PubMed1994

Giant sacral cysts with neurogenic bladder.

Most sacral cysts are accidentally found on lumbar myelograms and are usually asymptomatic. We operated on two patients with giant sacral cysts from S3 nerve roots who complained of neurogenic bladder and perianal sensory disturbance as well as buttock pain. Morphology of these cysts and intraoperative electrophysiological findings of nerve conduction block showed two kinds of pathogenesis causing these neurological symptoms. One was attributed to conduction block of more caudal sacral nerves squeezed between these giant sacral cysts and the other was due to degeneration of nerve root fibers involved in the sacral cyst walls. Postoperatively, buttock pain and perianal hypesthesia were resolved, but the neurogenic bladder showed only partial recovery.

Adult↗

PubMed1994

[Persistent sciatic artery aneurysm. Case report].

Persistent sciatic artery is a rare vascular anomaly particularly interesting for possible complications as buttock aneurysm and ischemic or embolic. Authors describes a case of buttock aneurysm of persistent sciatic artery personally observed analyse its anatomic and clinical features, and lay stress on the importance of angiography as essential examination in order to an exact surgical treatment.

Aneurysm↗

PubMed1994

PUVA-treated psoriatic skin as a model for cutaneous wrinkling assessed by skin replicas.

Psoriatic patients may offer a useful model for PUVA-induced skin wrinkling. This study deals with the changes induced by PUVA therapy on the cutaneous microrelief of psoriatic patients assessed by surface replicas. A non-exposed body area (buttocks) was considered. The microrelief was evaluated by means of replicas analysed by an automatic image analyser. Three groups of patients were considered: 1) 10 psoriatic patients who had been undergoing PUVA treatment for the first time and who had received a total PUVA dose of 200 +/- 20 J/cm2; 2) 16 psoriatic patients in long-term PUVA treatment (> 1000 J/cm2); 3) 13 psoriatic controls whose buttocks had never been affected by psoriasis nor exposed to sunlight or PUVA. The results showed that the number and the entity of the cutaneous crests and furrows had been increased by PUVA therapy. In particular the skin pattern analysis showed significant statistical differences between the second and the third group, while no changes were evident between the first and third group (ANOVA and Tukey test for multiple comparisons). In conclusion, our findings indicate that long-term PUVA therapy causes marked changes in the cutaneous microrelief, that this phenomenon can be measured non-invasively and that the changes observed are dependent on the PUVA-dose energies received.

Adult↗

PubMed1993

Parasitological and clinical characterization of Simulium neavei-transmitted onchocerciasis in western Uganda.

In the forests of western Uganda onchocerciasis is transmitted by Simulium neavei s.s. Since little is known about the infection transmitted by this vector, a survey was made in 1991 with special regard to adult persons of 15 years and older in the 13 villages of the parish Kigoyera 40 km northeast of Fort Portal. 3268 (52%) of the 6271 registered inhabitants were examined clinically and parasitologically. The highest microfilaria (mf) densities were found on the buttocks, lower ones on the shoulders and the lowest on the ankles. In the parish the standardised prevalence of mf carriers was 62%. The crude prevalences of adult mf carriers ranged from 80% to 95% in the 13 villages. Densities of 100 mf/snip or more were found in 25% of male persons. The community microfilarial load (CMFL) in skin snips from the buttocks was 49 mf/snip, ranging from 22 to 93 in the 13 villages. The standardised prevalence of nodule carriers was 25% and the mean nodule load was 1.9 nodules per nodule carrier. Among 3420 nodules 90% were found on the pelvic girdle. The standardised prevalence of onchocercal dermatitis was 19%. The crude rates ranged within the age groups in males from 20% to 45% and in females from 16% to 41%. The standardised prevalence of persons presenting mf in the anterior chamber of the eye was 24% and the CMFL in the anterior chamber ranged between 1.2 and 3.3 mf/chamber in six villages. Standardised rates were 1.6% for sclerosing keratitis and 0.9% for reduced vision of 3/60 or less. These prevalences of eye lesions are comparable to those observed in West African forest areas. The CMFLs and the prevalences of mf and nodule carriers represent suitable criteria for community diagnosis of S. neavei-transmitted onchocerciasis in Uganda to guide ivermectin treatment, whereas the prevalence of "leopard skin" is not useful. Immigrants living less than five years in the endemic focus should be excluded from the assessment of mf carrier rates and those living there less than ten years from rapid assessment of nodule carrier rates.

Adolescent↗

PubMed1998

[A case of a lumbar spinal synovial cyst located on the midline].

We report a case of lumbar spinal synovial cyst located on the midline. A 72-year-old man was admitted to our hospital with the chief complaint of low back pain radiating to the left buttock and posterior thigh. An MR image revealed an extradural cystic lesion adjacent to the dorsal side of the dural sac at the L4-5 level. The cyst was remote from the facet joints and existed on the midline just in front of the L4 lamina. A CT scan showed a concave deformity of the ventral aspect of the L4 lamina because of compression by the cyst. The patient underwent L4 laminectomy and total removal of the cyst. The cyst was in contact with the anterior surface of the ligamentum flavum and it had no connection with the facet joint. In the histological examination, the cyst was multilobular and lined with synovial epithelium. Therefore the cyst was diagnosed as a synovial cyst. After the operation, the pain radiating to the buttock and thigh completely disappeared. Intraspinal synovial cysts are usually located in the lower lumbar spine and most of them are adjacent to the facet joint. The cysts that are located on the midline are very rare. We review previous reports and discuss clinical and pathological features of spinal synovial cysts.

Aged↗

PubMed1999

Intradermal tophi in gout: a case-control study.

OBJECTIVE: To describe the characteristics of intradermal tophi in patients with gout and search for factors associated with their development. METHODS: This is a case-control study of patients with gout: cases (Group A, n = 21) had intradermal (not subcutaneous) plaques of monosodium urate (MSU) crystals located in sites distant to articular or paraarticular structures, and controls (Group B, n = 42) had gout but no intradermal tophi. Both Group A and Group B were paired by sex, age (+/-5 years), and duration of the disease (+/-3 years). Analysis included serum and urinary uric acid levels at first visit, radiographic stage of gout, the presence of associated diseases, and previous therapy, specifically, chronic glucocorticoid and diuretic usage. RESULTS: Intradermal tophi were located in the legs, forearms, buttocks, thighs, arms, and abdominal wall. Patients in Group A had a greater number of nonintradermal tophi in common sites (11.9+/-12.5 vs. 4.2+/-7.9, mean +/- SD; p = 0.018), decreased glomerular filtration rate (46.74+/-25.11 vs. 70.87+/-30.18 ml/min; p = 0.042), advanced radiographic changes (57.2 vs. 7.1%; p = 0.0001), and longterm glucocorticoid self-medication (76 vs. 36%; p = 0.006). We found no differences in other associated diseases between groups. CONCLUSION: Intradermal tophi were commonly found in the legs and forearms, and less frequently in the buttocks, thighs, and abdominal wall of gouty patients, and were associated with longterm self-prescribed glucocorticoids and chronic renal failure. The occurrence of intradermal tophi in these patients appeared to correlate with advanced disease.

Adult↗

PubMed1986

Solitary Langerhans cell histiocytoma.

Biopsy of a solitary tumor of the buttock in a 3-month-old girl was diagnosed as a histiocytic proliferation suggestive of histiocytosis X. Electron microscopy showed Birbeck granules and dense myelinlike bodies within the cytoplasm of the tumor cells. An immunoperoxidase study, using a panel of monoclonal antibodies (OKT6, OKT4, and OKM1) and a polyclonal anti-S100 protein antibody, showed positive staining for OKT6 and OM1 and moderately positive staining for OKT4 and S100. After surgery to remove the tumor, visceral involvement could not be demonstrated during a 20-month follow-up.

Buttocks↗