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A 41-year-old Japanese man with trichoadenoma on his buttock was described. Histological examination showed numerous horn cysts and some tumor islands consisting entirely of eosinophilic epithelial cells. A review of 24 reported cases of trichoadenoma revealed that most of them developed on the facial region (14 of 24 cases, 58%); the buttock (6 of 24, 25%) was the next most common site.
A 48-year-old male on cuprophane haemodialysis for 18 years, with a history of dialysis arthropathy and recurrent carpal tunnel syndrome developed macroglossia and bilateral buttock tumoral masses. The tongue and buttock masses were biopsied. Histology of both biopsies showed amyloid deposits of the beta 2-microglobulin (B2M) variety. Amyloidomas in the gluteal region and macroglossia have not been previously described in amyloid derived from B2M. These findings suggest that systemic B2M amyloidosis can have a similar tissue distribution to AL amyloidosis. This case also stresses the importance of inspection of the tongue, and palpation of the gluteal region for masses, in the assessment of patients with dialysis arthropathy.
BACKGROUND: We sought to identify whether transcutaneous oxygen tension (tcPo2) measurements could be used to noninvasively detect lesions in the arterial network supplying blood flow to the hypogastric circulation. METHODS AND RESULTS: A study was undertaken in vascular patients with suspected (PC, n=43) and not with suspected (NPC, n=34) proximal ischemia. TcPo2 was measured on both buttocks and with a chest reference electrode. Arteriography on the right or left side was positive for stenoses (> or =75%) or occlusion of one or more of the following arteries: the aorta, the common iliac arteries, or the internal iliac arteries. The arteriography was compared with the resting tcPo2 values (REST) and with the minimal value (MIN) and maximal change from rest normalized to eventual chest changes (DROP) recorded during or after a treadmill test. REST, MIN, and DROP were, respectively, as follows in positive versus negative arteriograms (mean+/-SD; in mm Hg): 80.2+/-10.9 versus 78.6+/-11.5 (P>0.05), 55.2+/-20.0 versus 69.9+/-15.8 (P<0.001), and -31.8+/-17.6 versus -9.5+/-6.4 (P<0.0001) in PC and 78.9+/-14.0 versus 80.5+/-14.3 (P>0.05), 64.4+/-21.0 versus 75.1+/-14.6 (P<0.02), and -24.1+/-13.5 versus -8.7+/-4.8 (P<0.0001) in NPC. In PC and NPC respectively, with a cutoff point of -16 and -15 mm Hg, DROP showed, respectively, 83%/82% and 79%/86% sensitivity/specificity in the diagnosis of positive arteriograms. CONCLUSIONS: Proximal ischemia is a frequent finding in vascular patients. TcPo2 measurement on the buttocks during exercise is a sensitive and specific indicator for lesions in the arterial tree toward the hypogastric circulation. Potentially it could objectively assess the response to endovascular or surgical approaches to iliac lesions.
OBJECTIVE: To describe a novel treatment for perianal excoriation in an infant receiving a promotility agent. CASE SUMMARY: A 2-month-old boy with reflux, and regurgitation was treated with cisapride. Shortly after cisapride therapy he developed a rash on his buttocks and anal irritation that progressed in severity despite the use of numerous topical products and extended diaper-free periods. A topical cholestyramine ointment compound was prepared and administered, resulting in complete resolution within 3 days. DISCUSSION: Cisapride can decrease the gastrointestinal transit time, which can lead to less time for bile acid reabsorption in the distal ileum. If high concentrations of bile acids are contained in the stool, they can irritate the anus and buttocks in a manner similar to the skin irritation experienced by patients with ostomies. Cholestyramine, a bile acid sequestrant, can irreversibly bind the bile when applied topically and bring relief to the patient. CONCLUSIONS: Topical cholestyramine ointment may be a safe and efficacious treatment option for perianal irritation due to bile acids.
During abdominal aortic surgery, dynamic changes occur in the pelvic circulation. Near-infrared spectroscopy (NIRS) was used in this study to evaluate arterial flow in the buttocks as a monitor of arterial flow in the pelvic area during abdominal aortic surgery. Twenty-two patients who underwent abdominal aortic aneurysmectomy comprised the study group. The NIRS probe was mounted on the left buttock during surgery, and the changes in oxy- and deoxy-hemoglobin (Hb) concentration were measured. In all cases Hb values reflected decreased arterial flow caused by aortic clamping and increased arterial flow after reconstruction of the distal arteries. The recovery pattern of the Hb values varied, but all recovered to the baseline value recorded before aortic clamping. None of the patients exhibited postoperative claudication of vessels supplying the gluteal muscles or colonic ischemia, and recovery time varied in accordance with the patient's arterial condition. This method is simple and enables individual evaluation of blood flow recovery from reconstructed arteries. This method allows approximate evaluation of the pelvic arterial flow of individual arteries, helps to predict postoperative claudication of the gluteal muscles, and offers additional information for evaluating colonic ischemia.
Suicidal stabbing to the back and buttocks is very unusual due to the limited accessibility of that region to the victim's hand. The following case report describes a 38-year-old man, known for depression and suicidal ideation, who was found deceased in his home after tearing his right internal iliac artery by stabbing himself through the buttock with a piece of glass from a broken beer bottle. The literature on suicidal stabbing, particularly focusing on the type of weapon and localisation of wounds, is reviewed.
In sports medicine, chronic hip, groin and buttock pain is a common diagnostic problem. Because of the complex anatomy of this region and the many potential neurological causes for pain, few sports clinicians have a detailed understanding of this problem. This paper discusses the clinical aspects of nerve entrapment syndromes related to sport and takes a regional approach in order to provide a diagnostic framework for the general sports physician. The various neurological syndromes are discussed and the surgical management elaborated in detail. For some specific conditions, such as the so-called 'piriformis syndrome', the pathophysiological understanding has changed since the early descriptions and now this particular diagnosis is often ascribed to almost any cause of buttock and/or hamstring symptoms. We discuss the nature of the origin of local symptoms and note that the often described symptoms are more likely due to compression of structures other then the sciatic nerve. Furthermore, the role of piriformis hypertrophy or anatomical nerve variations in the genesis of this syndrome must be questioned. We suggest renaming this the 'deep gluteal syndrome' to account for all of the observed phenomena. As sports medicine continues to develop a scientific basis, the role of nerve entrapments as the basis for chronic symptomatology is undergoing a new understanding and clinicians need to be aware of the diagnostic possibilities and be able to advise patients accordingly on the basis of scientific fact not anecdotal fiction.
A malignant solitary fibrous tumor arising in the right buttock associated with metastatic parietal pleural and intrapulmonary tumors and pleural effusion was found in a 59-year-old man. A chest computed tomogram revealed three tumors attached to the parietal pleura with rib destruction, and a tumor in the left lower lung field. Histologically, the tumors of the buttock and parietal pleura were characterized by proliferation of bundles of spindle-shaped or oval cells separated by wavy hyalinized collagen tissue with no expression of cytokeratin, S-100 protein, muscle actin or epithelial membrane antigen, but these cells weakly expressed CD34 and strongly expressed vimentin.
OBJECTIVE: This study was to compare skin viability of the free skin flap and the island skin flap in the pig. METHODS: The comparison was made between the 8 cm x 11 cm surgically denervated free skin flap and the pedicle island skin flap raised contralaterally on the buttock of 50 pigs. The free flap and the pedicle flap were subjected to 2 h of primary warm ischemia followed by 12 h of reperfusion and 0, 2, 4, 6, 10 h of secondary warm ischemia (n = 10). Skin viability was assessed 7 days after secondary ischemia. RESULTS: Pedicle skin flaps tolerated up to 10 h secondary ischemia without skin necrosis. However, incidences of flap failure (partial or total) in free flaps subjected to 0, 2, 4, 6, 10 h of secondary ischemia were 0, 10%, 50%, 80%, 100%, respectively. In a separate experiment, skin blood flow was studied in contralateral free skin flaps and pedicle island flaps (n = 20) subjected to 4 h of secondary ischemia. The skin reperfusion was very slow in 8 out of 20 free skin flaps at 1, 5 h after secondary is chemia, and the mean skin blood flow measured by 15 microns microspheres in these 8 free skin flaps was only 8% of their contralateral pedicle skin flaps. The mean skin blood flow in the remaining 12 free skin flaps was 76% of their contralateral pedicle skin flap. CONCLUSION: These observations were interpreted to indicate that buttock free skin flaps in the pig were less tolerant to secondary ischemia compared with their contralateral pedicle skin flaps subjected to the same ischemic protocol, and this reduced ischemic tolerance in free skin flaps was associated with compromised skin blood flow.
A sensor for in vivo biomechanical characterization of buttock soft tissue has been developed and evaluated. The sensor measures interface pressure, applied force, tilt, and rotation angle of the sensor head, and the thicknesses of multiple soft tissue layers. A composite ultrasonic transducer using a 1-3 ceramic-polymer structure was developed for the sensor. The sensor can identify subcutaneous soft tissue interfaces 5 to 65 mm below the skin surface with a 0.26-mm axial resolution, pressure over the range of 0 to 68 kPa, and force over the range of 0 to 3.6 kg. Our purpose for developing the sensor was to study the biomechanical characteristics of buttock soft tissues. Successful identification of distinguishing characteristics in persons with a susceptibility to pressure ulcers may result in the development of a risk assessment tool based on tissue characterization.
Intramuscular injections are regularly recommended for the administration of certain drugs in children. This article underlines the fact that buttock intramuscular injection risks injury to the sciatic nerve, which may lead to lower limb palsy, most often presenting as paralytic drop foot. This condition rarely results from direct traumatic lesion of the sciatic nerve, but usually from the caustic effect of the injected drug. It may occur in older children and adolescents, as well as in infants and younger children. Therefore, the buttocks should not be used as an intramuscular injection site in children whatever their age. In the case of sciatic nerve injury following intramuscular injection, extrafascicular neurolysis may prevent the occurrence of paralysis.
Hip and buttock pains in adults require careful evaluation to determine exactly what anatomical structure the patient is referring to when presenting with 'pain in the hip'. Pain in the posterior hip region and buttocks usually originates from dysfunction of the lumbosacral spine. Osteoarthritis of the hip is an important disorder that can refer pain to the anteromedial aspect of the knee.
The occurrence of asymptomatic genital excretion of herpes simplex virus in women with clinical buttock herpes was investigated. Inapparent genital viral infection was detected in 21.9% of the population. A history of buttock herpes should be considered when identifying high-risk pregnant women.
A rare case of carcinoma cuniculatum involving the buttock in a 56-year-old male is presented. This case is uncommon in that the tumor was largely subcutaneous, while the usual carcinoma cuniculatum is an exophytic growth. Although carcinoma cuniculatum has a wide clinical and histological spectrum, to our knowledge there has been only 1 case with similar histological features, located in a pilonidal sinus, and another case located on the buttock.
A 67-year-old woman with extramammary Paget's disease of the buttocks is reported. She manifested an eczematous skin lesion of both sides of the buttock and had an intradermal tumor of the right side. Resected specimens revealed widely spreading Paget's cells (15.5 X 15 cm), an intraepidermal adenocarcinoma (1 X 0.6 cm) in the eczematous epidermis, and an intradermal mucinous adenocarcinoma (3.3 X 2 X 2.5 cm). The intraepidermal adenocarcinoma was located just above the intradermal mucinous adenocarcinoma. From the histological localization of these lesions, and the electron microscopical findings of the Paget's cells and the intraepidermal adenocarcinoma, this case was thought to have started as an intraepidermal adenocarcinoma, which might have originated from the intraepidermal eccrine gland.
We report a clinical variety of recurrent genital herpes on the buttocks of seven women ranging in age from thirty-four to eighty-one years. The lesions had recurred for one to nine years and had produced a characteristic cicatricial rounded area within the S2 to S3 dermatomes on one buttock. Herpes disciformis is believed to be an anatomical variant of the common genital herpes infection. We have only noted it in middle-aged or older women with no history of genital herpes.
Results of a study of 15 patients with penetrating wounds of the buttock managed during a recent five year period suggest that penetrating trauma to the buttock is a distinct injury syndrome accompanied by serious intestinal, bladder or vascular damage. Following a complete history, physical examination and appropriate roentgenograms, most injuries can be anticipated, but proctoscopy and cystography should be performed upon all patients at risk. Intravenous pyelography, a poor test of bladder integrity, may be misleading and should by supplemented by additional techniques. If a retroperitoneal or intraperitoneal injury is suspected, preoperative antibiotic therapy, followed promptly by aggressive intraoperative management of all injuries, is recommended.
For patients susceptible to decubitus ulcers, wheelchair cushions and other body support surfaces must be prescribed with a view to providing a uniform distribution of buttock-cushion interface pressures. The capacity to distribute pressure uniformly at the support interface depends on the shape of the bony prominences, and the amount and mechanical compliance of the overlying soft tissue: an indication of this capability may be given by the indentation contour of the buttock-cushion interface. Using normal subjects, we devised a method for measuring this contour using ultrasonic dimension gauging techniques. Because the technique can describe the geometry of soft tissues deformed under load, it could make an important contribution to successful employment of analytical modeling to predict internal tissue stresses during sitting.