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PubMed2002

The anatomy of the iliolumbar vein. A cadaver study.

We carried out a cadaver study of 16 iliolumbar veins in order to define the surgical anatomy. Two variants were found; a single vein at a mean distance of 3.74 cm from the inferior vena cava (11 of 16) and two separate draining veins at a mean distance from the vena cava of 2.98 cm for the proximal and 6.24 cm for the distal stem (5 of 16). Consistently, the proximal vein tore on attempted medial retraction of the great vessels. The mean length of the vein was 1.6 cm and its mean width 1.07 cm. Three stems were shorter than 0.5 cm. Two or more tributaries usually drained the iliacus and psoas muscles, and the fifth lumbar vertebral body. The obturator nerve crossed all veins superficially at a mean of 2.76 cm lateral to the mouth. In four of these, this distance was less than 1.5 cm. Usually, the lumbosacral trunk crossed deep, at a mean distance of 2.5 cm lateral to the mouth, but in three veins, this distance was 1 cm or less. Our findings emphasise the need for proper dissection of the iliolumbar vein before ligature during exposure of the anterior lumbar spine.

Cadaver↗
PubMed2006

X-ray diffraction studies of the thick filament in permeabilized myocardium from rabbit.

Low angle x-ray diffraction patterns from relaxed permeabilized rabbit cardiac trabeculae and psoas muscle fibers were compared. Temperature was varied from 25 degrees C to 5 degrees C at 200 mM and 50 mM ionic strengths (mu), respectively. Effects of temperature and mu on the intensities of the myosin layer lines (MLL), the equatorial intensity ratio I(1,1)/I(1,0), and the spacing of the filament lattice are similar in both muscles. At 25 degrees C, particularly at mu = 50 mM, the x-ray patterns exhibited up to six orders of MLL and sharp meridional reflections, signifying that myosin heads (cross-bridges) are distributed in a well-ordered helical array. Decreasing temperature reduced MLL intensities but increased I(1,1)/I(1,0). Decreases in the MLL intensities indicate increasing disorder in the distribution of cross-bridges on the thick filaments surface. In the skeletal muscle, order/disorder is directly correlated with the hydrolysis equilibrium of ATP by myosin, [M.ADP.P(i)]/[M.ATP]. Similar effects of temperature on MLL and similar biochemical ATP hydrolysis pathway found in both types of muscles suggest that the order/disorder states of cardiac cross-bridges may well be correlated with the same biochemical and structural states. This implies that in relaxed cardiac muscle under physiological conditions, the unattached cross-bridges are largely in the M.ADP.P(i) state and with the lowering of the temperature, the equilibrium is increasingly in favor of [M.ATP] and [A.M.ATP]. There appear to be some differences in the diffraction patterns from the two muscles, however. Mainly, in the cardiac muscle, the MLL are weaker, the I(1,1)/I(1,0) ratio tends to be higher, and the lattice spacing D(10), larger. These differences are consistent with the idea that under a wide range of conditions, a greater fraction of cross-bridges is weakly bound to actin in the myocardium.

Actins↗
PubMed2006

Cooperative effects of rigor and cycling cross-bridges on calcium binding to troponin C.

The effects of rigor and cycling cross-bridges on distributions of calcium (Ca) bound within sarcomeres of rabbit psoas muscle fibers were compared using electron probe x-ray microanalysis. Calcium in the overlap region of rigor fibers, after correction for that bound to thick filaments, was significantly higher than in the I-band at all pCa levels tested between 6.9 and 4.8, but the difference was greatest at pCa 6.9. With addition of MgATP, differences were significant at high levels of activation (pCa 5.6 and 4.9); near and below the threshold for activation, Ca was the same in I-band and overlap regions. Comparison of Ca and mass profiles at the A-I junction showed elevation of Ca extending 55-110 nm (up to three regulatory units) into the I-band. Extraction of TnC-reduced I-band and overlap Ca in rigor fibers at pCa 5.6 to the same levels found in unextracted fibers at pCa 8.9, suggesting that variations reported here reflect changes in Ca bound to troponin C (TnC). Taken together, these observations provide evidence for near-neighbor cooperative effects of both rigor and cycling cross-bridges on Ca(2+) binding to TnC.

Animals↗
PubMed2005

Soft-tissue releases to treat spastic hip subluxation in children with cerebral palsy.

BACKGROUND: Spastic hip subluxation and dislocation are common problems in children with cerebral palsy. Soft-tissue releases have proved to be beneficial in the prevention of spastic hip dislocation. A protocol for treatment based on patient age, hip abduction, and hip migration percentage was established in 1988. The purpose of this study was to assess the outcome in sixty-five children treated according to this protocol and followed for a minimum of eight years. METHODS: The medical records and radiographs of sixty-five children, from an original series of seventy-four patients, who met the inclusion criteria were available for review. Forty-seven children had spastic quadriplegia and were unable to walk; eighteen children had spastic diplegia and were able to walk independently or with assistive devices. The mean age at the time of the surgery was 4.4 years. Open adductor tenotomy and psoas muscle recession or iliopsoas tenotomy were performed on 129 hips, which were followed for a mean of 10.8 years. The mean age at the time of follow-up was fifteen years. Hips were grouped according to the hip migration percentage preoperatively, at one year postoperatively, and at the time of final follow-up. The final outcome for the patient was defined according to the worse hip. An analysis was performed to identify potential factors influencing outcome. RESULTS: Thirty-two patients (49%) had a good result, eleven (17%) had a fair result, three (4%) had a poor result, and nineteen (30%) had a failure. The mean hip migration percentage was 34% preoperatively and 18% at the time of final follow-up. Nineteen patients required subsequent osseous reconstructive procedures, and eleven required repeat soft-tissue releases. The migration percentage at one year postoperatively was the most predictive of the final outcome (p = 0.001). Patients who had been able to walk preoperatively had a better long-term outcome (p = 0.01). Neither the preoperative hip migration percentage nor the age at surgery significantly affected the outcome. CONCLUSIONS: Soft-tissue release was effective for long-term prevention of hip dislocation in 67% (forty-three) of sixty-five children with spastic hip subluxation. Two preoperative factors that were related to a favorable outcome were a spastic diplegic pattern of involvement and the ability to walk. The hip migration percentage at one year postoperatively was a good predictor of final outcome.

Cerebral Palsy↗
PubMed1985

Accumulation of germanium in the tissues of a long-term user of germanium preparation died of acute renal failure.

Acute renal failure developed in a patient accompanied by systemic manifestations such as myopathy and skin rash. The patient, a middle aged house wife, had been taking 600 mg of germanium (Ge) preparation daily for 18 months as an elixir. The main component of the preparation was GeO2 and some organic compound was also present. Histological study of the kidney post mortem showed foamy cell transformation of glomerular epithelia, degeneration of tubular epithelia with red blood cell casts and urate crystals, and a mild proliferation of mesangial matrix. Analysis of the tissue content of Ge, prompted by her history, revealed an increased accumulation of the metal. As compared to a non-user died of liver cirrhosis, the concentration of the metal was higher particularly in the spleen (183X), thyroid gland (175X), psoas muscle (93X), jejunum (76X), and renal cortex (69X). So far, neither accumulation of Ge in humal tissue nor systemic toxicity of the Ge in human has been reported. The relevance of massive accumulation of Ge to the renal failure as well as to other systemic manifestations the patient presented remains to be clarified.

Acute Kidney Injury↗
PubMed1992

Rhabdomyolysis accompanying thyroid crisis: an autopsy case report.

Rhabdomyolysis is occasionally associated with metabolic disorders such as diabetic coma, severe electrolyte disturbances and myxedema coma. We describe rhabdomyolysis accompanying thyroid crisis. A 50-year-old man with Graves' disease developed rhabdomyolysis, congestive heart failure and hepatic failure during the course of thyroid crisis and then died of acute renal failure. Postmortem examination revealed rhabdomyolysis in the cardiac and psoas muscles, old myocardial infarction, hepatic centrilobular necrosis, renal cortical necrosis, and follicular hyperplasia in the thyroid. Circulatory collapse and dehydration under excessive hypermetabolic state presumably suppressed the source of energy and oxygen for muscle cells, leading to cellular damage.

Adrenal Cortex Hormones↗
PubMed1995

Somatostatinoma of the pancreas associated with von Hippel-Lindau disease.

A 39-year-old man was admitted because of lumbago, vomiting and massive gastrointestinal bleeding. Oliguria developed a few days later, which was followed by hyperkalemia and cardiac arrest. Autopsy disclosed multiple renal cell carcinomas with diffuse metastasis to the liver, adrenal gland, psoas muscle and vertebrae. In addition, a somatostatinoma was found in the pancreas. From these findings and past history of cerebellar hemangioblastoma and spinal hemangioma he was diagnosed to have von Hippel-Lindau disease. Von Hippel-Lindau disease with islet cell tumor is very rare and is reported here with a review of literature.

Adult↗
PubMed1979

Gray scale ultrasound: evaluation of iliopsoas hematomas in hemophiliacs.

Because of its insidious nature, intramuscular bleeding, in contrast to hemarthrosis, is missed or belatedly recognized in hemophiliacs. Sixteen patients with suspected iliopsoas bleeding were studied by gray scale ultrasonography. In 12 patients it was possible to confirm the diagnosis of iliopsoas hematoma because of enlargement and rounding of the psoas muscle.

Adolescent↗
PubMed1980

CT of acute pancreatitis: interim assessment.

a retrospective review of 102 ptients with the clinical diagnosis of acute pancreatitis undergoing computed tomographic (CT) evaluation during a 9 month period revealed 32 patients with abnormal CT scans. All 32 had enlargement of the pancreas. The extent of inflammatory process on these patients was examined. Twenty patients exhibited a phlegmonous mass extending into the region of the lesser sac. There was involvement of the left anterior pararenal space in 13 (the right in three and both in four). Eight patients demonstrated involvement of the posterior pararenal space, and in seven of these the inflammatory process extended down the psoas muscle into the pelvis. Five patients had involvement of the transverse mesocolon and small bowel mesentery. Eight patients developed a pseudocyst during the acute phase of the disease, 11 developed a pancreatic abscess, and two showed evidence of pancretic hemorrhage. This experience prompted a prospective study of the clinical course of acute pancreatitis relative to the extent of disease as recognized by CT.

Abscess↗
PubMed1983

Renal positional changes in spinal-cord-injured patients.

Spinal-cord injured patients can have urinary tract changes related to their conditions. Altered renal position and vertical axis have not previously been identified. The urograms of 55 paralyzed patients were reviewed and compared with normal controls. Statistically significant differences (p less than 0.001) were noted in the position of the kidneys with respect to the renal angle and distance of the lower poles to the midline. No significant difference was noted between patients who were paraplegic vs. those who were quadriplegic. The more medial and vertical positioning of the kidneys was believed to be due to the psoas muscle atrophy in the spinal-cord-injured patients.

Adolescent↗
PubMed1986

MRI of extracranial hematomas: preliminary observations.

Thirteen patients (16 examinations) with extracranial hematomas (four mediastinum, three pelvis, two calf, two psoas muscle, one liver, one abdominal wall) were examined with magnetic resonance imaging (MRI). With the exception of an acute hematoma (less than 48 hr), which did not have a distinctive MRI appearance, subacute and chronic hematomas (up to 10 months' duration) had areas of high signal intensity on both T1- (TR 500/TE 30) and T2- (TR 1500/TE 90) weighted pulse sequences. The hematomas in 10 of the patients were also evaluated by computed tomography (CT). The MRI findings complemented those seen on CT. Low-intensity parts of the hematoma on both T1- and T2-weighted images corresponded to areas of high attenuation on CT, whereas high-intensity zones correlated with regions of low attenuation. This observation was more apparent on the T1-weighted images. While older hematomas did not exhibit areas of hyperdensity that would allow a specific diagnosis on CT, MRI did demonstrate regions of high signal intensity indicative of hemorrhage.

Abdominal Muscles↗
PubMed1999

Acute osteoporotic vertebral collapse: open study on percutaneous injection of acrylic surgical cement in 20 patients.

OBJECTIVE: The aim of this study was to determine the efficacy of percutaneous vertebroplasty in treating painful spinal osteoporotic collapse. SUBJECTS AND METHODS: Twenty-three cases of vertebral collapse were evaluated with CT and MR imaging to determine osteoporotic origin and recent evolution. Percutaneous vertebroplasties were performed using CT guidance. The 20 patients included in the study (17 women, 3 men; 62-92 years old) had acute pain of less than 1 month's duration that hindered ambulation and required treatment with narcotic drugs. They underwent this procedure for analgesic purposes. The analogic visual scale of Huskisson was used for pain when scoring assessment. RESULTS: In 15 patients (75%), pain relief was complete within 24 hr after injection. Analgesic administration was stopped in 14 patients. Mild pain persisted in three (15%) of the remaining five patients. In one other patient (5%), crural pain was observed with cement leakage in the psoas muscle. In the fifth patient (5%), pain recurred after the patient was lifted. The pain was related to a new acute collapse of an adjacent vertebrae. CONCLUSION: Vertebroplasty for the treatment of osteoporotic vertebral collapse is a minimally invasive procedure that provides immediate pain relief and enables the patient to become quickly mobile.

Acrylic Resins↗
PubMed1988

Pressure and flow measurements in the partially obstructed ureter of the rat.

Hydronephrosis in man or experimental animals can be caused by an increased ureteral flow resistance. This condition can in the long run prove harmful to renal function. We compared two ways of measuring ureteral flow resistance in animals with and without a ureteral hindrance, the hindrance being induced by embedding the ureter in the psoas muscle. One needle connected via catheters to a pressure recording system and another connected to a pump system were introduced through the parenchyma into the renal pelvis. Experiments were carried out with two procedures: 1) infusion of 0.5 ml x min-1 of saline into the renal pelvis was performed while recording the pressure response; 2) a servocontrolled pump system was used which regulated the flow introduced into the renal pelvis to keep a preset pressure at a constant level. In the first group of experiments we did not establish a steady-state pressure despite 20-30 min of infusion. The result from the second series of experiments indicated that steady-state flow measurements could be achieved at the different pressure levels between zero and 30 mmHg. A good linear relationship between pressure and flow was found, even though a considerable hysteresis was observed. Furthermore, a reduced flow resistance down to a certain level at increased pressure was also recorded. As expected, the resistance to flow was significantly lower in the control than in the hydronephrotic animals. In order to investigate the diagnostic ability of the linear relationship between pressure and flow, prediction regions for one future animal were calculated. It seemed possible that determination of the whole pressure-flow relationship in the pressure range between zero and 30 mmHg will prove useful to determine the flow hindrance in hydronephrotic animals.

Animals↗
PubMed1992

Benign retroperitoneal schwannoma.

A rare case of benign retroperitoneal schwannoma in a 76-year-old man is reported. Ultrasound and computerized tomography disclosed two cystic retroperitoneal tumors sized 12 cm and 7 cm. The larger tumor was located anterior to psoas muscle and the smaller one was within the muscle. The larger tumor was excised via laparotomy. After 3.5 years follow-up the intramuscular tumor has remained unchanged and the patient has no symptoms.

Aged↗
PubMedDate not supplied

Anaplastic large-cell lymphoma (Ki-1 lymphoma) and diffuse large-cell immunoblastic lymphoma: two diagnostic problem cases.

Electron microscopy can be used to establish diagnoses in some otherwise difficult cases of neoplasia, but it is not generally regarded as important in the diagnosis of lymphoma. However, in some cases of anaplastic tumors not initially recognized as lymphomas, electron microscopy can prove quite valuable. Two cases are reported in which lymphoma was not suspected on the basis of the histologic findings, but was diagnosed by electron microscopy. Case 1 involved a 60-year-old woman who presented with a retroperitoneal mass that was located primarily in the body of the psoas muscle. Nuclear pockets were seen with electron microscopy. Ultimately she was diagnosed with anaplastic large-cell lymphoma (Ki-1 lymphoma). Case 2 involved a 43-year-old male with retroperitoneal lymphadenopathy, renal failure, polyclonal gammopathy, and a febrile illness. Signet-ring cells without junctions were identified with electron microscopy. Immunoperoxidase stains confirmed diffuse large-cell immunoblastic lymphoma.

Adult↗
PubMed1996

A modified technique of ultrasonic triplex scanning of the lower extremity arteries.

This study was undertaken to evaluate the utility of a modified technique of triplex scanning of the lower extremity arteries in 20 subjects without any clinical signs of arterial disease. The distal aorta and iliac arteries were examined with the subject in supine position and lying slightly on the opposite side. By moderate compression of the probe towards the psoas muscle and directing it over the iliac arteries with slight medial retraction of the abdomen, satisfactory visualization of the common and external arteries with 7.5 MHz high resolution imaging and a 5.6 MHz doppler probe were obtained in 56 of 80 segments (70%). In obese individuals it was necessary to use 5 MHz probe for satisfactory scanning of the aortic bifurcation and common iliac arteries. The distal superficial femoral, popliteal and tibioperoneal trunk segments were examined with the patient prone and the knee slightly flexed. Peak systolic, early diastolic reverse and late diastolic forward flow velocities were studied together with measurement of the arterial diemeters, which demonstrated wide variations. This study suggests that satisfactory scanning of the iliac and femoropopliteal arteries with the described technique can be achieved in the majority of subjects with a superficial high resolution probe. The combination of 7.5 MHz two-dimensional imaging with a 5.6 MHz pulsed wave Doppler probe offers optimal information of these arteries in nonobese individuals.

Adult↗
PubMed1999

Complications during anterior surgery of the lumbar spine: an anatomically based study and review.

Procedures involving anterior surgical decompression and fusion are being performed with increasing frequency for the treatment of a variety of pathological processes of the spine including trauma, deformity, infection, degenerative disease, failed-back syndrome, discogenic pain, metastases, and primary spinal neoplasms. Because these operations involve anatomy that is often unfamiliar to many neurological and orthopedic surgeons, a significant proportion of the associated complications are not related to the actual decompressive or fusion procedure but instead to the actual exposure itself. To understand the nature of these injuries, a detailed anatomical study and dissection was undertaken in six cadaveric specimens. Critical structures at risk in the abdomen and retroperitoneum were identified, and their anatomical relationships were categorized and photographed. These structures included the psoas muscle, kidneys, ureters, diaphragm and crura, esophageal hiatus, thoracic duct, greater splanchnic nerves, phrenic nerves, sympathetic chains, medial arcuate ligament, superior and inferior hypogastric plexus, segmental and radicular vertebral vessels, aorta, vena cava, median sacral artery, common iliac vessels, iliolumbar veins, lumbosacral plexus, and presacral hypogastric plexus. Based on these dissections and an extensive review of the literature, the authors provide a detailed anatomically based discussion of the complications associated with anterior lumbar surgery.

Journal Article↗
PubMed2005

Dorsolumbar junction spinal tuberculosis in an infant: case report.

The treatment of spinal tuberculosis is a challenging and controversial problem. The authors present the rare case of an 8-month-old infant with dorsolumbar junction tuberculosis. The child did not sit or stand and a hump was noted on his back. Radiological evaluations demonstrated destruction by a tuberculous abscess of the T-12 and L-1 vertebral bodies, extending into the psoas muscles and spinal canal. In addition to medical therapy, radical debridement and grafting were performed via an anterolateral approach. The follow-up period was 2 years. The difficulties in the management of spinal tuberculosis in infants are discussed.

Bone Transplantation↗