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At least 865 records · Page 48Linked to original sources
PubMed1999

The QA pressure measurement system: an accuracy and reliability study.

OBJECTIVE: The main purpose of this study was to determine the accuracy and reliability of the Queen Alexandra Pressure Measurement System (QA PMS). Furthermore, we examined whether there were significant differences in measured pressures of the buttock area during sitting between normal subjects and spinal cord injured (SCI) patients. DESIGN: Accuracy (calibration) and reliability (test-retest) study. SETTING: The spinal cord unit of Tertiary Care Centre 'De Hoogstraat' in Utrecht, The Netherlands. PATIENTS: A convenience sample of 16 SCI patients and 15 normal subjects. MAIN OUTCOME MEASURES: The accuracy was determined by using the Standard Error of the Mean (SEM, in mmHg). The Technical Error of Measurement (TEM, in mmHg) was calculated as measure for differences between two paired measurements. The reliability was determined by using an Intraclass Correlation Coefficient (ICC). Significant differences in measured pressures between both groups (P<0.05) were determined by using an unpaired (two sample) t-test. RESULTS: Accuracy (calibration): mean SEM=0.30 (+/-0.1) mmHg, indicating a high level of accuracy. Differences between two paired measurements: mean TEM calibration= 1.87 (+/-0.76) mmHg; mean TEM normal subjects=4.76 (+/-1.78) mmHg; mean TEM SCI patients=6.34 (+/-2.19) mmHg. Reliability: mean ICC(3,1) calibration=0.85 (95% CI=0.74 0.95); mean ICC(2.1) normal subjects=0.92 (95% CI=0.90 0.94); mean ICC(2.1) SCI patients=0.90 (95% CI=0.88 0.92). The normal subjects had significantly higher mean pressures (P=0.028) than the SCI patients (mean pressures 31.0 vs 28.5 mmHg), whilst the SCI patients had significantly higher peak-pressures (P=0.0000) than the normal subjects (mean peak-pressures: 134.1 vs 75.7 mmHg). CONCLUSIONS: The QA Pressure Measurement System has sufficient accuracy and good reliability as a measurement procedure. There are significant differences between the measured pressures of both groups: the significantly higher peak pressures of the SCI patients seem to be the most important.

Buttocks↗
PubMed1997

Basal cell carcinomas of covered and unusual sites of the body.

BACKGROUND: The concept of unusual site for a basal cell carcinoma (BCC) has to be defined because there is much confusion about it. Basal cell carcinomas of covered areas of the body are sometimes considered as unusual because of their location. In this study an attempt is made to define what is an unusual site for a BCC according to experience and the problems encountered are briefly discussed. METHODS: A total of 1050 histologically-confirmed primary BCCs were studied. Age, sex and site of presentation were considered. RESULTS: Eighteen cases were recorded, localized on hand, axilla, areola or nipple, buttock perineal, and genital regions. CONCLUSIONS: Unusual location has been arbitrarily defined in the past according to the incidental percentage, to a mathematical index of density, to the literature reports. All these criteria suffer more or less from some discrepancy, but in our opinion all these should be considered for a definition. Our results, moreover, suggest that only the above described sites should be considered.

Adult↗
PubMed2001

Inflammatory linear verrucous epidermal naevi: a review of 23 cases.

Twenty-three patients diagnosed with inflammatory linear verrucous epidermal naevi (ILVEN) over a 13 year period are reviewed retrospectively. These ILVEN showed a predilection for the buttock and legs and were usually unilateral. Onset of the lesions was usually within the first 6 months of life and extension beyond the original margins occurred in 26% of cases. Sixteen of the 23 patients were male. Ten patients had ILVEN predominantly involving the left side, 12 were on the right side and, in one case, the side involved was not recorded.

Adolescent↗
PubMed2003

Truncal lesions do not exclude a diagnosis of Gianotti-Crosti syndrome.

A boy aged 2 years and 10 months had a pruritic eruption and low-grade fever for 1 week. Examination revealed discrete erythematous papules and papulovesicles on his buttocks and extensor surfaces of four limbs. Several papules were also present on his back. No lymphadenopathy and no hepatosplenomegaly were noted. Investigations failed to identify a single viral aetiology. Topical calamine lotion and a sedating oral antihistamine to be taken at night were prescribed. The truncal lesions subsided in 3 weeks. Complete remission of all lesions was seen after 6 weeks. Although most patients with Gianotti-Crosti syndrome only have the typical acrally distributed eruption, additional truncal lesions, if few in number, do not exclude the diagnosis.

Acrodermatitis↗
PubMed2003

The rhomboid flap for pilonidal disease.

INTRODUCTION: There have been many surgical techniques described for the treatment of pilonidal sinuses. Recurrent disease causes significant morbidity particularly with time from work. AIM: To assess the rhomboid flap's role in promoting one-stage primary healing in pilonidal disease and to evaluate the morbidity and recurrence. METHODS: Fifty-three patients were prospectively recruited of which 27 had previous multiple abscess formation requiring surgical drainage from their pilonidal disease, although none had acute disease at the time of surgery. By using the transposition flap, we were able to obliterate the natal cleft and therefore the rolling action of the buttocks between the cleft in these patients and thereby remove one of the factors involved in pilonidal disease. Hospital stay, healing time, wound infection, wound breakdown and recurrence were noted. RESULTS: There were 47 males and 6 females with a median age of 28 years (range 16-64 years). Median follow-up was 24 months (range 3-36 months). Post-operative morbidity involved superficial wound infection in 7 (13%) which settled with out-patient dressings. There were four recurrences (7%), two occurred between the flap and the anal canal, and the other two in the flap margin needing intervention. All the patients healed their wounds and the median healing time was 14 days. CONCLUSION: As this condition affects a predominantly young population causing significant time off from work, we feel that the Rhomboid Flap is useful for difficult cases in that it allows early return to full activity and does not necessitate prolonged postoperative care.

Adolescent↗
PubMed2003

Surgical treatment of chronic gluteal hidradenitis suppurativa: reused skin graft technique.

BACKGROUND: The treatment of chronic lesions in hidradenitis suppurativa (HS) remains a challenge for dermatologists. In most cases, wide surgical excision of the affected skin reduces the recurrence rate to a minimum. Split-thickness skin grafts have usually been applied to resurface large postoperative defects. OBJECTIVE. : The aim of this study is to introduce an alternative method of skin grafting, called "reused" or "recycled" skin graft, for the reconstruction of the large skin defect with chronic gluteal HS. METHODS: The study consisted of six patients (two females and four males) with gluteal HS. After a wide en bloc excision, the wound was immediately recovered with meshed-skin graft, made from the resected skin itself. Thus, the sacrifice of the skin donor is spared. The drum dermatome (Padgett-Hood) is suitable to take the split-skin graft from the resected skin of the affected buttock. The thickness of grafts was set between 12/1,000 and 20/1,000 inches, and all grafts were meshed with 1.5 times the expansion. The skin grafts were secured in place on the wound and a tie-over dressing was applied. RESULTS: Postoperative complications were usually minor ones, such as hematoma, discharge, and small areas of graft skin necrosis (less than 1 cm2), although one patient developed a 3 x 4 cm2 graft necrosis and wound infection. The follow-up period after surgery ranged from 8 to 36 months. No patient experienced any functional disabilities or recurrence during follow-up years. CONCLUSION: When the epidermal involvement remains mild to moderate, this reused skin graft technique is an alternative choice to resurface the surgical defect of gluteal HS. It is superior to the conventional procedure, which requires fresh skin donor site.

Adult↗
PubMedDate not supplied

Wegener granulomatosis in a child: cutaneous findings as the presenting signs.

Wegener granulomatosis (WG) is a systemic disease that is particularly unusual in children. A limited form has been described without renal involvement. We report a 14-year-old girl in whom the disease started with acneiform nodular and papular lesions on the forehead. Later necrotic ulcers developed on her forehead, arms, and buttocks. The cutaneous lesions were associated with upper and lower respiratory tract involvement, low-grade fever and arthralgias. Subsequently clinical and laboratory evaluations (increased ESR; leukocytosis and presence of serum IgG antibodies cANCA = 1:160), with chest roentgenograms revealing pulmonary densities and parenchymal infiltration, suggested the diagnosis of WG. The histologic findings of a cutaneous biopsy specimen were ulceration of the epidermis with diffuse neutrophilic inflammatory infiltrate and a late-stage small vessel vasculitis in the dermis. Histopathology of the nasal mucosa was characterized by a granulomatous process with a dense lymphohistiocytic infiltrate with few giant cells, a finding that confirmed the diagnosis of WG. No renal involvement was present. One month of cyclophosphamide (125 mg/day) and prednisone (70 mg/day) therapy markedly improved the patient's clinical condition. At present, 1 year later, she is free from any signs of the disease. According to the literature, the frequency of cutaneous lesions in WG ranges from 16% to 46%. They are the presenting sign only in 6% of patients. Cutaneous lesions are even more uncommon in children. In particular, an "acneiform" presentation is a rare finding in WG.

Adolescent↗
PubMedDate not supplied

Granuloma gluteale infantum: a case report.

Granuloma gluteale infantum is a benign disorder with the clinical appearance of "granulomatous" nodules involving the diaper area. It is an uncommon disorder considered a complication of primary irritant diaper dermatitis. A 6-month-old boy with reddish-purple oval nodules located on the right inguinal fold and right buttock diagnosed as granuloma gluteale infantum is presented. A contributing factor in our patient could be a primary irritant dermatitis or a preexisting candidial infection. The name granuloma gluteale infantum is a misnomer since no granulomas are found in these lesions.

Biopsy, Needle↗
PubMed2001

Magnetic resonance imaging findings in piriformis syndrome: a case report.

Piriformis syndrome (PS) is an unusual cause of sciatica that, because of the lack of strict diagnostic criteria, remains a controversial clinical entity. The diagnosis of PS is still primarily clinical because no diagnostic tests have proven to be definitive. We report the case of a 30-year-old woman, affected by a severe scoliosis, who developed a persistent buttock pain resembling that of PS. The clinical suspicion was confirmed by magnetic resonance imaging (MRI) of the pelvis, which showed an enlargement of the left piriformis muscle with an anterior isplacement of the sciatic nerve. The role of MRI in the diagnosis, clinical definition, and therapeutic approach to PS is discussed.

Adult↗
PubMed2002

Seat-interface pressures on various thicknesses of foam wheelchair cushions: a finite modeling approach.

OBJECTIVE: To investigate the effect of cushion thickness on subcutaneous pressures during seating by using a finite element modeling approach. DESIGN: Seat-interface pressure measurements were used in a computational model. SETTING: Biomechanics laboratory. PARTICIPANT: A single healthy man (weight, 70 kg). INTERVENTIONS: Subject sat upright either with or without cushions of various heights. Seat-interface pressures measured by using a sensor mat interfaced to a personal computer sampling at 15 Hz. MAIN OUTCOME MEASURES: Peak seat-interface pressure; finite-element software was used to model the buttock, ischial tuberosity, and seat cushion. Subcutaneous stresses were calculated from the model. RESULTS: The region of highest subcutaneous stress in the soft tissue was concentrated within 1 or 2 cm of the ischial tuberosity, with the maximum compressive stress inferior to the bottom surface of the ischial tuberosity. The maximum subcutaneous stress, maximum seat-interface pressure, and maximum subcutaneous shear stress each changed with cushion thickness. Subcutaneous pressures decreased with thicker cushions, but almost all of the reduction was obtained with an 8-cm cushion. The amount of subcutaneous shear stress increased slightly for thicker cushions. The maximum subcutaneous stress was greater than the maximum interface pressure but not by a constant factor. Instead, the former was consistently larger by 0.7 to 0.8 N/cm(2). CONCLUSIONS: Cushion use reduced the maximum subcutaneous stress inferior to the ischial tuberosity. However, increasing the cushion thickness beyond 8 cm was ineffective in further reducing subcutaneous stress. It was also found that seat-interface pressures were a good indicator of the subcutaneous stress reduction in seating.

Biomechanical Phenomena↗
PubMed2006

[Malignant eccrine poroma].

INTRODUCTION: Malignant eccrine poroma is a very rare tumour of the sweat glands with high malignancy and presenting with a polymorph clinical and histological picture. CASE REPORT: We describe the case of a 99-year-old patient with a malignant poroma on the buttock. Despite the large size of the tumour, no metastasis was found with standard examination techniques. Radical excision and defect closure with a Limberg flap was performed. RESULT: The healing course was uneventful and without complications. CONCLUSION: The malignant poroma is a tumour of high malignancy which can easily be misdiagnosed because of its different forms of presentation. Radical surgical therapy is the only known effective treatment.

Acrospiroma↗
PubMed2006

[Manifestation of Fabry disease in a heterozygous female patient. New perspectives using enzyme replacement therapy].

HISTORY AND ADMISSION FINDINGS: A 32-year-old woman with bilateral corneal opacities was at 9 years of age diagnosed to have reduced activity of the enzyme alpha-galactosidase A. She was admitted to our hospital because of skin lesions that had developed over the last 8 years. INVESTIGATIONS: The clinical features included angiokeratomas on the buttocks, hips, and periumbilical region, whorl-like corneal opacity (cornea verticillata), and mitral valve prolapse. Activity of alpha-galactosidase A was reduced to about a quarter of the normal value. Histological examination revealed lipid deposits within the endothelial cells of the skin. Molecular analysis of the alpha-galactosidase A gene revealed a point mutation at nucleotide-position 691 in exon 5 (p.Asp231Asn). TREATMENT AND COURSE: Enzyme replacement therapy with agalsidase alfa 0.2 mg/kg body-weight, infused over 40 min every other week, was initiated. So far no side effects due to the infusion therapy have been noted. The therapeutic success (reduction of lipid storage) cannot be assessed as yet. CONCLUSION: Fabry disease results from deficient activity of the enzyme alpha-galactosidase A. Affected (hemizygous) males often show the complete spectrum of symptoms and signs and have a deficient alpha-galactosidase A activity. Occasionally milder oligosymptomatic courses are observed, when residual enzyme activity is present. In contrast to previous belief, heterozygous females may be affected in the same manner as hemizygotes and may also have a significantly reduced enzyme activity.

Abdomen↗
PubMed1991

[Multilocular angiosarcoma with involvement of the heart].

A thyroid tumour, initially diagnosed as an anaplastic carcinoma of the thyroid, was removed in a 66-year-old woman. Further examination, other than ultrasonography of the abdomen (normal), were refused, 26 months later a painful swelling was noted in the right buttock: a fist-sized haematoma, without evidence of malignancy was removed at another hospital. Computed tomography revealed a cystic tumour in the left upper abdomen, about 8 x 11 cm, not clearly related to any organ. Echocardiography, performed because of atrial fibrillation, demonstrated a space-occupying lesion, 42 x 38 mm, in the left atrium with central necroses and originating broad-based from the interatrial septum and the aortic root. The retroperitoneal upper-abdominal tumour encircling the root of the aorta and a gluteal tumour in the area of the previous haematoma could not be completely removed. Histologically they and the previously removed (and again examined) thyroid tumour were angiosarcomas. Removal of the atrial tumour was not attempted. Six months later it had penetrated the entire atrial septum and grown into the right atrium. The patient had lost 25 kg and three months later died of respiratory failure. Autopsy was refused. The findings suggest a left-atrial angiosarcoma which may well have been the primary tumour site. In case of angiosarcomatous tumours echocardiography should be performed as a staging examination.

Aged↗
PubMed2002

Treatment of childhood mycosis fungoides with topical PUVA.

Mycosis fungoides is the most common type of cutaneous T-cell lymphoma, which is usually observed in mid to late adulthood. We report 5 cases of mycosis fungoides in children, all presenting as patch- and plaque-stage disease most commonly involving the buttocks. Histologic examination showed in every case the typical features of mycosis fungoides. In 4 of the 5 cases, the infiltrating lymphocytes were characterized by the T-cell phenotype CD3(+), CD4(+), CD8(+); and in 3 cases, a monoclonal rearrangement of the T-cell receptor gamma (TCR-gamma) gene was found. Three children received topical PUVA treatment, and the other two were treated with mid-potency topical corticosteroids, resulting in complete clinical remission. A management approach to mycosis fungoides with topical PUVA may be appropriate for children.

Buttocks↗
PubMed2001

Outcome after unilateral hypogastric artery occlusion during endovascular aneurysm repair.

PURPOSE: The purpose of this study was to determine the long-term functional outcome after unilateral hypogastric artery occlusion during endovascular stent graft repair of aortoiliac aneurysms. METHODS: During a 41-month period, 157 consecutive patients underwent elective endovascular stent graft repair of aortoiliac aneurysms with the Medtronic AneuRx device. Postoperative computed tomography scans were compared with preoperative scans to identify new hypogastric artery occlusions. Twenty-three (15%) patients had unilateral hypogastric occlusion, and there were no cases of bilateral occlusions. Telephone interviews about past and current levels of activity and symptoms were conducted, and pertinent medical records were reviewed. All 23 (100%) patients were available for the telephone interview. A disability score (DS) was quantitatively graded on a discrete scale ranging from 0 to 10 corresponding to "virtually bed-bound" to "greater-than-a-mile" exercise tolerance. Worsening or improvement of symptoms was expressed as a difference in DS between two time points (-, worsening/+, improving). RESULTS: Among the 23 patients, two groups were identified: 10 patients (43%) had planned and 13 patients (57%) had unplanned or inadvertent occlusions. The patients in the two groups did not differ significantly in the mean age (73.4 vs 73.7 years), sex (male:female, 9:1 vs 10:3), and duration of follow-up (15.6 vs 14.4 months). Nine (39%) of the 23 patients, five patients in the planned and four patients in the unplanned group, reported significant symptoms of hip and buttock claudication ipsilateral to their occluded hypogastric arteries. The mean decrement from baseline of these nine patients in their DS postoperatively was -3.3. The symptoms were universally noted on postoperative day 1. Although most patients improved (89%), one (11%) never got better. Among those whose symptoms improved, the mean time to improvement was 15 weeks, but with a plateau thereafter resulting in a net decrement of DS of -2.3 from baseline. Finally, when questioned whether they would undergo the procedure again, all 23 patients unanimously answered, "Yes." CONCLUSIONS: A significant number (39%) of patients who sustain hypogastric artery occlusion after endovascular aneurysm repair have symptoms. Although most patients with symptoms have some improvement, none return to their baseline level of activity. Despite this, all patients in retrospect would again choose endovascular repair over conventional open repair.

Aged↗
PubMed2002

Squamous cell carcinoma arising in a giant epidermal cyst: a case report.

Epidermal cysts are commonly encountered in surgical practice. Malignant degeneration of epidermal sebaceous cyst is uncommon. The authors report the case of a 38-year Filipino woman presenting with a voluminous sebaceous cyst of the left buttock. Ultrasonography and computer tomography were made preoperatively without any hint of eventual malignant degeneration. Marginal excision was performed with direct closure of the skin. The histological examination revealed epidermal sebaceous cyst with squamous cell carcinoma in situ, which is a quite rare, but well known complication occurring in sebaceous cysts.

Adult↗
PubMed2001

Factors affecting static seat cushion comfort.

To improve the understanding of factors affecting automobile seat cushion comfort in static conditions (i.e. without vibration), relationships between the static physical characteristics of a seat cushion and seat comfort have been investigated. The static seat comfort of four automobile cushions, with the same foam hardness but different foam compositions, was investigated using Scheffe's method of paired comparisons. The comfort judgements were correlated with sample stiffness, given by the gradient of a force-deflection curve at 490 N (= 50 kgf). Samples with lower stiffness were judged to be more comfortable than samples with greater stiffness. A similar comfort evaluation was conducted using five rectangular foam samples of the same composition but different foam hardness (and a wider range than in the first experiment). There was no linear relationship between the sample stiffness and seat comfort for these samples. Static seat cushion comfort seemed to be affected by two factors, a 'bottoming feeling' and a 'foam hardness feeling'. The bottoming feeling was reflected in the sample stiffness when loaded to 490 N, while the foam hardness feeling was reflected in foam characteristics at relatively low forces. The pressures underneath the buttocks of subjects were compared with the comfort judgements. The total pressure over a 4 cm x 4 cm area beneath the ischial bones was correlated with static seat comfort, even when the differences among samples were great; samples with less total pressure in this area were judged to be more comfortable than samples with greater total pressure. It is concluded that the pressure beneath the ischial bones may reflect both comfort factors: the bottoming feeling and the foam hardness feeling.

Adult↗
PubMed1999

Transient neurological symptoms after spinal anaesthesia with hyperbaric 5% lidocaine or general anaesthesia.

Transient neurotoxicity of concentrated local anaesthetics has been thought to be the main reason for transient neurological symptoms after spinal anaesthesia. Profound musculoligamental relaxation by high doses of local anaesthetics may contribute to the development of postoperative musculoskeletal pain. In order to evaluate the role of the loss of strength of the supportive structures of the spine in the development of transient neurological symptoms, 60 patients (ASA I-II) undergoing minor orthopaedic, varicose vein or inguinal hernia operations were allocated randomly to receive spinal anaesthesia with hyperbaric lidocaine 50 mg ml-1 (85-100 mg) or balanced general anaesthesia with neuromuscular block. Patients were interviewed 24 h later and after 1 week they returned a written questionnaire. Transient neurological symptoms, consisting of pain in the buttocks or pain radiating symmetrically to the lower extremities, occurred in eight patients (27%) receiving spinal anaesthesia and in one patient (3%) receiving general anaesthesia (P < 0.05). We conclude that a transient neurotoxic effect of hyperbaric lidocaine 50 mg ml-1 is probably the main reason for transient neurological symptoms after spinal anaesthesia but musculoligamental relaxation may contribute to the development of low back or leg pain after both anaesthetic techniques.

Adult↗