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PubMedDate not supplied

Inguinal paravascular (lumbar plexus) neurolytic block--description of a catheter technique: case report.

BACKGROUND AND OBJECTIVES: We provided care for a 47-year-old female with a history of lung carcinoma and bony metastases who sustained a pathologic fracture of the right acetabulum causing severe and uncontrolled pain in the right groin. Her pain was rated as 8-10 on a 10-point visual analog scale (VAS). Her terminal disease and poor surgical risk precluded therapeutic operative intervention. Consequently, a neurolytic block of the lumbar plexus was performed as a palliative measure. METHODS: A modified inguinal paravascular (lumbar plexus) block technique was used. A 17-gauge Tuohy needle was inserted in the groin area just lateral to femoral artery and 1 cm below the inguinal ligament. A guide wire was threaded through the needle and subsequently an angiogram catheter was introduced over the wire into the psoas muscle. Radiographic confirmation of the position was obtained, and the catheter was secured in place. A prognostic block using an infusion of 0.25% bupivacaine at 5 mL/h was initiated for the first 2 days. On the third day a neurolytic block with 6% phenol was performed. RESULTS: Marked pain relief was experienced by the patient (VAS: 0-1). Sensory block in the femoral, lateral femoral cutaneous, and obturator nerve distributions was elicited. Motor weakness in the femoral nerve was demonstrated. Narcotic use was markedly reduced, and the patient was discharged to home in a pain-free state. CONCLUSIONS: This case report supports the feasibility of placing a catheter via a modified anterior inguinal paravascular block technique and its subsequent use for both local anesthetic infusion and neurolytic block of the lumbar plexus.

Acetabulum↗
PubMed2007

Margin-free spondylectomy for extended malignant spine tumors: surgical technique and outcome of 13 cases.

STUDY DESIGN: Description of surgical technique and retrospective review of 13 cases. OBJECTIVES: To describe the surgical technique of margin-free spondylectomy and the outcome of 13 cases and to discuss the advantages and limitations of the procedure. SUMMARY OF BACKGROUND DATA: Recently, spondylectomy became a standard procedure by several pioneers. For extended malignant spine tumors involving pedicles or epidural space, however, performing an "en bloc" resection with a tumor-free margin remains a challenge. METHODS: Our procedure consists of a combined anterior and posterior procedure with one or two stages. In the anterior procedure, tumor vertebrae are covered by the pleura or psoas muscles as a barrier. The posterior procedure includes decompression through the intact posterior elements, coverage of the tumor with all possible soft tissue barriers, and en bloc extirpation by rotating the tumor vertebrae around the spinal cord. We performed this procedure in 13 cases: 3 chondrosarcoma, 3 giant cell tumor, 1 osteosarcoma, 1 chordoma, and 5 metastases. RESULTS: Neurologic status and pain improved in all cases except asymptomatic cases. There was no local recurrence, except in 2 cases (chondrosarcoma with extirpation of 5 vertebrae, chordoma with multiple previous surgeries). Two cases of chondrosarcoma were disease-free 14 years and 13 years after surgery, respectively. CONCLUSION: Although the best chance for a cure in extended malignant tumors of the spine is realized through wide resection, the procedure is not yet standardized. Margin-free spondylectomy is technically demanding, but the procedure can be used with a confidence as a more radical surgery for tumors extending to the epidural space and the unilateral pedicle. A key to success is the surgical technique, including a 360 degree dissection around the tumor vertebrae, instrumentation, and removal of the lesion with all possible soft tissues maintained intact to function as a barrier, like the dura mater.

Adolescent↗
PubMed2006

Femoral nerve palsy following mini-open extraperitoneal lumbar approach: report of three cases and cadaveric mechanical study.

Anterior extraperitoneal exposures to the lumbar spine are being increasingly used owing to the expanding use of novel technologies to treat degenerative disc disease. Lumbar plexus injuries are potential, albeit uncommon, complications of such exposures and can lead to significant perioperative morbidity. In this report, we present three patients with thoracolumbar fractures who sustained isolated femoral nerve palsies after a mini-open extraperitoneal approach to the midlumbar spine was undertaken to perform a partial corpectomy. To further understand the pathophysiology of this nerve injury, we conducted a cadaveric experiment to evaluate the effect of performing this approach and the effect of hip positioning on linear displacement of the femoral nerve. The displacement of the femoral nerve during the anterolateral extraperitoneal exposure through a 4- to 6-cm incision was equal to 6.6% of the full femoral nerve length. Relaxation of the femoral nerve was equal to 25% of the full nerve length when the hip was flexed to 90 degrees in neutral abduction-adduction. We conclude that the anterolateral extraperitoneal exposure of the midlumbar spine can potentially stretch the femoral nerve beyond its physiologic limits, particularly in trauma cases where exposure of the lateral vertebral body necessitates substantial retraction of the psoas muscle. The avoidance of self-retaining retractors for prolonged periods of time and the positioning of the hip in flexion may help to avoid such nerve injuries.

Adult↗
PubMed2005

Systemic pyoderma gangrenosum responding to infliximab and adalimumab.

Pyoderma gangrenosum (PG) is frequently associated with constitutional symptoms as part of a nonspecific inflammatory response. However, extracutaneous discrete aseptic neutrophilic infiltrates are extremely rare. We report a patient with idiopathic PG with splenic and psoas muscle involvement. His disease was extremely aggressive and was unresponsive to conventional immunosuppressive therapy. His cutaneous and extracutaneous PG cleared with infliximab and adalimumab.

Adalimumab↗
PubMed2005

The effect of partial unilateral ureteral obstruction release and allopurinol on the renal malondialdehyde and glutathione levels.

PURPOSE: The aim of the present study was to evaluate whether relief of partial unilateral ureteral obstruction (PUUO) with or without antioxidant drug affect renal tissue malonedialdehyde (MDA) and glutathion (GSH) levels. MATERIALS AND METHODS: A total of 25 rats were used in this PUUO study. Partial unilateral ureteral obstruction was created by the burial of the upper one-third of the left ureter in the psoas muscle. The rats were sacrificed on 28th day following PUUO. Relief of the obstruction was performed twenty minutes before sacrifice by cutting the proximal ureter in reperfusion group. 50 mg/kg intraperitoneal allopurinol was administered 20 minutes before relief of obstruction in the antioxidant group. Renal tissue MDA and GSH levels were measured in both kidneys. RESULTS: At the end of the study 5, 7 and 7 rats could only be interpreted in sham, reperfusion and antioxidant groups, respectively. While the mean left and right renal MDA and GSH levels were statistically different from each other in reperfusion group (P < 0.001), there were no significant differences in the sham (P > 0.05) and antioxidant (P > 0.05) group. Both the mean sham group left and right renal tissue MDA or GSH levels were significantly different from reperfusion group, but only the mean sham group left renal tissue MDA and right renal tissue GSH levels were not statistically different from antioxidant group (P < 0.05). The mean left or right renal MDA and GSH tissue levels of the antioxidant group were statistically different from reperfusion group (P < 0.05) except for the right renal tissue GSH level (P > 0.05). CONCLUSION: Partial unilateral ureteral obstruction leads to oxidative injury by relief of obstruction in both kidneys. The antioxidant allopurinol has a beneficial effect on renal MDA and GSH levels in both kidneys.

Allopurinol↗
PubMed1987

Effect of division of genitofemoral nerve on testicular descent in the rat.

The gubernaculum, which has an important role to play in testicular descent, is richly supplied by the genital branch of the genitofemoral nerve through its scrotal attachment. In neonatal rats the genitofemoral nerve overlying the psoas muscle was divided before inguinal descent would normally occur, and the effect of this procedure on subsequent testicular descent was observed. Denervation of the gubernaculum caused the testes to remain in the abdomen. The significance of this finding in the rat is that an intact genitofemoral nerve is an essential prerequisite for normal descent, perhaps by allowing the gubernaculum to evert.

Animals↗
PubMed1995

Fracture of polyurethane double pigtail stents: an in vivo retrospective and prospective fluoroscopic study.

OBJECTIVE: To study the behaviour of pigtail polyurethane ureteric stents during breathing and change in body habitus and thereby explain some side-effects of stenting, particularly spontaneous stent fracture. PATIENTS AND METHODS: The study comprised retrospective evaluation of records and radiographs of seven patients (five men and two women, mean age 41; SD 10.9 years) who were admitted with fractured polyurethane pigtail stents, and a prospective fluoroscopic study of the behaviour of 14 stents in 12 patients (11 men and one woman; mean age 40; SD 9.3 years) during breathing, spinal flexion, extension and rotation. RESULTS: Five of the seven pigtail stents fractured where the stent crossed the lateral edge of psoas muscle, 7-10 cm below the renal coil of the stent. The sixth stent was fractured at its lower third and the seventh fractured just proximal to the stent's bladder coil. The prospective study revealed a 20-80 degrees bend in the upper third of 11 of the 14 stents and a 35 degrees bend in the lower third of two stents. A 1-5 cm craniocaudal movement and a 0-2 cm vertical movement of the stents occurred during breathing and spinal flexion and extension. There were no changes in stent configuration during spinal lateral rotation or at the sacral promontary. The bend in the upper third of the ureter was profound in two stents whose vertical movement was restricted by other conditions. CONCLUSION: As the kidney-to-bladder distance shortens during inspiration and spinal flexion, the stent adapts by bending and/or moving. Fracture of the stent may be caused by repeated mechanical stress, particularly across the side-holes, and by diminution of its tensile strength by depolymerization during long indwelling times. Large polyurethane stents tended to bow, displacing the upper ureter anteriorly, while small, soft stents conformed to the anatomical course of the ureter, suggesting that they should be used after open or endoscopic surgery to the upper two-thirds of the ureter. Stress on the stent can be minimized by choosing the correct length, particularly where vertical stent movement is limited by other conditions.

Adult↗
PubMed1977

Affinity chromatography of myosin, heavy meromyosin, and heavy meromyosin subfragment one on F-actin columns stabilized by phalloidin.

A method of affinity chromatography based on the trapping of actin filaments within agarose gel beads is described. This method can be used for the purification of myosin and its active proteolytic subfragments, as well as for studies on the interaction between actin and these proteins. Actin columns stabilized by phalloidin bind myosin, heavy meromyosin (HMM), and heavy meromyosin subfragment 1 (HMM-S1) specifically and reversibly. The effect of pyrophosphate and KCl on the dissociation of actomyosin, acto-HMM, or acto-HMM-S1 complex is reported. We also describe the single-step purification of myosin from a crude rabbit psoas muscle extract.

Actins↗
PubMed1979

Computed tomography in the evaluation of post-nephrectomy patients.

Twenty-one CT examinations were performed in 19 patients who had undergone previous nephrectomy for renal carcinoma or retroperitoneal malignancy. Nine patients were free of disease and 10 had recurrence. Findings of recurrent disease included masses in the vacant renal fossa, inability to visualize the inferior vena cava or aorta, and ipsilateral psoas muscle thickening. Possible pitfalls in diagnosis are discussed.

Adolescent↗
PubMed1979

Evaluation of retroperitoneal hemorrhage by computed tomography before and after translumbar aortography.

Twenty patients were prospectively studied by computed tomography (CT) before and after undergoing translumbar aortography (TLA). Changes indicative of retroperitoneal bleeding were depicted by CT in all 20 patients despite the predominantly small size of the hematomas. CT scans obtained within two hours after TLA demonstrated: (a) thickening of the diaphragmatic crura, (b) enlargement of the left psoas muscle, and (c) obscuration of the aortic outline by soft-tissue density. Follow-up scans at 24 hours (10 patients) and one week (3 patients) revealed marked decrease in abnormalities, suggesting rapid resorption of the hematoma.

Aged↗
PubMed2004

Infected aortic aneurysms: imaging findings.

PURPOSE: To determine the imaging characteristics of infected aortic aneurysms. MATERIALS AND METHODS: Review of records of patients with surgical and/or microbiologic proof of infected aortic aneurysm obtained over a 25-year period revealed 31 aneurysms in 29 patients. This study included 21 men and eight women (mean age, 70 years). One radiologist reviewed 28 computed tomographic (CT) studies (22 patients underwent CT once and three patients underwent CT twice), 12 arteriograms (12 patients underwent arteriography once), eight nuclear medicine studies (six patients underwent nuclear medicine imaging once and one patient underwent nuclear medicine imaging twice), and three magnetic resonance (MR) studies (three patients underwent MR imaging once). Features evaluated included aneurysm size, shape, and location; branch involvement; aortic wall calcification; gas; radiotracer uptake on nuclear medicine studies; and periaortic and associated findings. The location of infected aortic aneurysms was compared with that of arteriosclerotic aneurysms. RESULTS: Aneurysms were located in the ascending aorta (n = 2, 6%), descending thoracic aorta (n = 7, 23%), thoracoabdominal aorta (n = 6, 19%), paravisceral aorta (n = 2, 6%), juxtarenal aorta (n = 3, 10%), infrarenal aorta (n = 10, 32%), and renal artery (n = 1, 3%). Two patients had two infected aortic aneurysms. CT revealed 25 saccular (93%) and two fusiform (7%) aneurysms with a mean diameter at initial discovery of 5.4 cm (range, 1-11 cm). Paraaortic soft-tissue mass, stranding, and/or fluid was present in 13 (48%) of 27 aneurysms, and early periaortic edema with rapid aneurysm progression and development was present in three (100%) patients with sequential studies. Other findings included adjacent vertebral body destruction with psoas muscle abscess (n = 1, 4%), kidney infarct (n = 1, 4%), absence of calcification in the aortic wall (n = 2, 7%), and periaortic gas (n = 2, 7%). Angiography showed 13 saccular aneurysms with lobulated contour in 10 (77%). Nuclear medicine imaging showed increased activity consistent with infection in six (86%) of seven aneurysms. MR imaging showed three saccular aneurysms. Adjacent abnormal vertebral body marrow signal intensity was seen in one (33%) of three patients. CONCLUSION: Saccular aneurysms (especially those with lobulated contour) with rapid expansion or development and adjacent mass, stranding, and/or fluid in an unusual location are highly suspicious for an infected aneurysm.

Adult↗
PubMed2006

Prostate cancer evaluated with ferumoxtran-10-enhanced T2*-weighted MR Imaging at 1.5 and 3.0 T: early experience.

PURPOSE: To prospectively evaluate the feasibility of ferumoxtran-10-enhanced magnetic resonance (MR) imaging at high magnetic field strength (3.0 T) and to compare image quality between 1.5- and 3.0-T MR imaging in terms of lymph node detection in patients with prostate cancer. MATERIALS AND METHODS: This study was institutional review board approved, and all patients gave written informed consent. Forty-eight consecutive patients aged 51-79 years (mean, 65.5 years) with prostate cancer were enrolled. T2*-weighted 1.5- and 3.0-T MR images of the pelvis were acquired in a sagittal plane parallel to the psoas muscle 24 hours after ferumoxtran-10 administration. A pelvic and body phased-array coil was used and yielded an in-plane resolution of 0.56 x 0.56 x 3.00 mm at 1.5 T and 0.50 x 0.50 x 2.50 mm at 3.0 T. All images were evaluated by three readers for total image quality, lymph node border delineation, muscle-fat contrast, and vessel-fat contrast. Statistical significance was calculated by using the Mann-Whitney U test. Subsequently, the general linear mixed model was used to estimate the contributions of three factors-patient, reader, and technique-to the variability of the imaging results. RESULTS: Significantly (P < .05) better muscle-fat contrast, vessel-fat contrast, lymph node border delineation, and total image quality were observed at 3.0-T MR imaging. The general linear mixed model revealed that the variability of all results could be attributed to the use of 3.0-T imaging. CONCLUSION: Ferumoxtran-10-enhanced MR imaging can be performed at high magnetic field strengths and result in improved image quality, which may lead to improved detection of small positive lymph nodes.

Aged↗
PubMed1983

Large posterior abdominal masses: computed tomographic localization.

Large posterior abdominal masses, particularly those in the right upper abdomen, may be difficult to localize correctly into the peritoneal or retroperitoneal compartments. The following signs were found to be reliable CT indicators of retroperitoneal location: obliteration of the perinephric fat outlining the psoas muscle; lateral displacement of the fat outlining the posterior right lobe of the liver; rotation of the intrahepatic portal veins to the left; anterior displacement of the inferior vena cava and renal veins; and anterior displacement of the ascending colon, descending duodenum, or pancreatic head.

Abdominal Neoplasms↗
PubMed1993

Automated biopsy devices: a blinded evaluation.

To evaluate 20 different automated biopsy devices with respect to the quality of tissue obtained for histopathologic analysis, a total of 1,470 18-gauge biopsy specimens were obtained from 10 fresh autopsy cases, including 30 liver, 20 kidney, 10 pancreas, and 10 psoas muscle biopsy specimens per device and per biopsy depth. There was no statistical difference in the performance of the long-throw Biopty, ASAP 18, 1.9-cm UltraCut, long-throw Monopty, and 2.5-cm ABS biopsy guns. All obtained a large amount of tissue with minimal fragmentation or crush artifact. Most of the short-throw biopsy guns (depth of biopsy < or = 1.1 cm) did not perform as well. Although the other guns performed adequately, less than optimal results were obtained with the Temno, Bio-Gun, Roth, Klear Kut, ABC, and Urocut biopsy guns. Most 18-gauge automated biopsy devices with a biopsy excursion of at least 2.0 cm provide a high-quality, diagnostically adequate specimen for histopathologic analysis.

Biopsy, Needle↗
PubMed1996

Anatomy of the retroperitoneum: observations of the distribution of pathologic fluid collections.

PURPOSE: To correlate anatomic dissections with clinical observations regarding anatomic distribution of retroperitoneal fluid, and to document the existence of planes that lie between classically described retroperitoneal spaces. MATERIALS AND METHODS: Latex was injected in varying amounts into the pancreatic tail in three fresh cadavers to simulate peripancreatic fluid collections. Spiral computed tomography (CT) was performed of the abdomen and pelvis after each latex injection. Two cadavers were subsequently frozen and sectioned in axial planes; limited dissections were performed on these specimens. One was embalmed and underwent extensive anatomic dissection. Five embalmed, unprepared cadavers were also dissected to confirm observations made in the three prepared cadavers. RESULTS: Latex injected into the tail of the pancreas entered a retromesenteric plane that was posterior to the anterior pararenal space and anterior to the anterior renal fascia. The plane continued superiorly, extending to the diaphragm near the esophageal hiatus; inferiorly, extending to the pelvis along the anterolateral surface of the psoas muscle; and laterally, posterior to the descending colon and its mesentery. The plane also communicated with a retrorenal plane lying between the posterior renal fascia and the posterior pararenal space. CONCLUSION: Embryologic development of the dorsal mesenteries suggests the existence of retromesenteric planes, and clinical observations further support their existence. These findings may explain the observed distribution of retroperitoneal fluid collections from diaphragm to pelvis.

Cadaver↗
PubMed1984

Myofibrillar end of the creatine phosphate energy shuttle.

Isometric contraction and relaxation of glycerinated rabbit psoas muscle fibers containing native creatine kinase (CK) and ATPase activities were studied. Energy for contraction and relaxation was provided either by ADP + creatine phosphate (CP) or ATP alone, and the effectiveness of these additions on rate and maximum force of contraction and relaxation were compared. In the presence of 250 microM ADP, physiological concentration of CP (10 mM) produced faster and stronger contraction and faster and more complete relaxation than equimolar or even higher concentrations of ATP. When contraction was initiated by addition of ADP to fibers preincubated with 10 mM CP, the apparent Km for ADP was 1.18 +/- 0.24 mM. If the fibers were preincubated with ADP and contraction initiated by addition of 10 mM CP, the apparent Km for ADP was more than an order of magnitude smaller (76.0 +/- 4 microM). The observed Km for ADP for contraction was about half the Km for CP in solution (151.5 microM). The apparent Km for CP for rate of contraction was 2.67 +/- .046 mM independent of sequence of addition of ADP. Since these experiments were done in the presence of P1,P5-diadenosine 5'-pentaphosphate, a powerful inhibitor of adenylate kinase, the role of this enzyme in the process was not significant. These observations support the idea of compartmentation of myofibrillar CK in close function with myosin ATPase as part of the phosphoryl creatine energy shuttle.

Adenosine Diphosphate↗
PubMed1990

Morphological and functional characterization of the endosarcomeric elastic filament.

The elastic filament was studied in chemically skinned fibers from rabbit psoas muscle by electron microscopy and resting tension measurements. Extraction of skinned fibers with 40 mM sodium pyrophosphate caused a selective removal of about two-thirds of the thick filaments and formed a gap between the remaining portion of the A band and the I band. Very thin filaments were seen in the gap and were decorated by anti-titin antibody. The resting tension of these fibers was comparable to that of unextracted control fibers. When the M band was completely extracted by a solution containing 0.6 M NaCl, the resting tension completely disappeared at sarcomere lengths from 2.8 to approximately 3.4 microns. These results suggest that the elastic force of short sarcomeres is endowed in the titin filaments and that these filaments are anchored to some structures of the Z and M lines. Other filaments were found in the gap between the two I bands of NaCl-extracted sarcomeres. These filaments differed from titin filaments by a larger diameter and the anchoring points. They may represent the sarcomeric structures responsible for the resting tension of extracted fibers stretched at sarcomere lengths longer than 3.4 microns.

Animals↗
PubMed1980

Chronic, nonocclusive, and maintenance-free central venous cannula in the rat.

To provide a means of taking repeated blood samples from conscious, stress-free rats, we devised a method to chronically cannulate the inferior vena cava. The rat was anesthetized with pentobarbital sodium plus methoxyflurane. The inferior vena cava was exposed through a midline abdominal incision. Silastic tubing (0.020 in. ID, 0.037 in. OD) was pushed through a tiny hole punctured in the wall of the vein; it remained in place without leaking due to the elasticity of the vessel wall. The cannula was advanced towards the heart until its tip lay at the level of the xiphisternum at which point blood could be aspirated. A series of silk (4-0) sutures to the psoas muscle and body wall held the cannula secure without compromising blood flow. The cannula ran subcutaneously to the back of the neck where it was ligated to the underside of the skin (prolene 4-0 suture), plugged with a short metal obturator, and exteriorized through a small stab wound. The cannula was filled with heparinized saline, but it was not necessary to regularly flush it through to maintain patency. Sepsis did not occur and animals autopsied several months after cannulation showed no tissue reaction around the cannula.

Animals↗