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PubMed1997

Free neurovascular transfer of latissimus dorsi muscle to the bladder. I. Experimental studies.

OBJECTIVES: Experimental studies were undertaken to investigate the practicability of a microneurovascular transfer of latissimus dorsi muscle to the bladder, and to look for possible techniques enhancing evacuation of a reservoir such as the bladder by striated muscle. MATERIALS AND METHODS: Twelve dogs were used for the studies. They were divided into 3 groups. Group I: Evacuation proficiency of a re-configured latissimus dorsi under tension was hydrodynamically tested after 6 months. Group II: Microneurovascular latissimus dorsi transposition anastomosing thoracodorsal vessels and nerve to circumflexa ilium profunda vessels and a lumbar plexus motor nerve, respectively, was performed to cover the bladder devoid of up to 50% of the detrusor muscle. Group III: Microneurovascular latissimus dorsi transposition was used to reconstruct the bladder after supratrigonal cystectomy. Urodynamic and radiographic in vivo studies were done after 6 and 9 months. RESULTS: Stimulation of the thoracodorsal nerve of geometrically reconfigurated non-transposed latissimus dorsi reservoirs after 6 months yielded average intraluminar pressures of 190 cm. H2O at maximum capacity, and 35 cm. H2O at a minimum capacity of 10 to 15 cc. Stimulation of latissimus dorsi transposed to the bladder resulted in a visible and measurable contraction of the transplanted muscle after 9 months. Mean bladder volumes in group II animals pre- and postoperatively were 267.5 and 270 cc, respectively. During cystography the bladder outline was smooth both during filling and voiding. Light and electron microscopic examination confirmed viable, re-innervated muscle. CONCLUSIONS: The "tension-torsion" reconfiguration produced intraluminal pressures which should enable stimulated striated muscle to evacuate bladder-like reservoirs successfully. Microneurovascular free transfer of latissimus dorsi muscle resulted in reinnervated, functional muscle in the pelvis. Augmentation cystoplasty using the latissimus dorsi in conjunction with a free omental flap for substitution of an accompanying mucosal defect was unsuccessful. The concept of microneurovascular transfer of latissimus dorsi muscle to the pelvis may be used for complicated fistula of the lower urinary tract, and may be a possible solution for the therapy resistent acontractile bladder.

Animals↗

PubMed1997

Aspergillus osteomyelitis after heart-lung transplantation.

Aspergillus osteomyelitis is a severe complication of invasive aspergillosis. Fewer than 15 cases have been observed after solid organ transplantation. We describe a case of Aspergillus osteomyelitis of the ilium after heart-lung transplantation with favorable outcome after medical treatment.

Acetabulum↗

PubMed1997

[The effect of prone position in spinal surgery on respiration and circulation].

The effects of position change on respiration and circulation of 42 patients during spinal operations were investigated in this study. The results showed that, if the patient was placed on the operation position following the administration of the anesthesia, the changes of respiration (f, VT, MV) and circulation (SBP, HR) were significant (P < 0.01, 0.05). On the contrary, if the patient was placed in the operation position and then started the anesthesia, the respiratory and circulatory changes were comparatively stable (P > 0.05). The authors concluded that: 1. for the cases undergoing spinal operations, it is advisable to place the patient in the operation position first and then start the anesthesia; 2. for the critical cases, a tolerable position should be adopted; 3. during the adjustment of the position of the patient, the clavicle and the ilium should be used as the fulcrum so as to avoid driect contact of the chest and abdoment with the operation table, thus to minimze interference on the respiratory and circulatory functions.

Adult↗

PubMed1976

Adverse effects of jejunoileal bypass on growth and development.

Ninety percent jejunoileal bypass was performed in 20 growing (100 gram) male Sprague-Dawley (SD) and 15 male, genetically obese, growing (125 gram) Zucker "fat rats" (FR). Twenty SD and 15 FR unoperated rats of similar age and weight served as controls. Animals were evaluated for weight gain or loss, complications, and survival. At death (4 months), caliper measurements of long bones, vertebral column, pelvis, and skull were obtained, and brain, liver, spleen, and kidneys were excised and weighed. Liver and gonadal histology were obtained. The "fat fat" was more fragile, with a 20 percent anastomotic leak rate and a 33 percent mortality rate. The mortality rate was 5 percent (SD) and zero in controls. Bypassed animals showed growth retardation with weight of SD rats 31 percent (p less than 0.05) and FR's 19 percent of controls (p less than 0.05). Organ weights (liver, spleen, kidneys) were similar, except for a smaller brain in bypassed rats [SD 1.06 +/- 0.08 to 1.83 +/- 0.08 Gm. control (p less than 0.05), FR 1.2 +/- 0.12 to 1.68 +/- 0.09 control (p less than 0.025)]. Skeletal development was retarded significantly in bypassed rats [vertebral column, 125.9 +/- 3.5 to 138.3 +/- 3.9 mm. in controls (p less than .025); ilium, 39.4 +/- 1.1 to 46.2 +/- 1.5 mm. in controls (p less than 0.05); skull circumference, 20.2 +/- 0.03 to 22.5 +/- 0.05 mm. in controls (p less than 0.025)]. No increase in fatty infiltration of liver was observed. Spermatogenesis was diminished 30 percent (p less than 0.05) in bypassed (SD) animals. The data document significant morbidity and mortality rates, growth retardation, and diminished spermatogenesis in bypassed "adolescent" rats. These results imply that jejunoileal bypass may affect intellectual, skeletal, and reproductive development adversely and question the advisability of these procedures in growing subjects.

Animals↗

PubMed1998

Prognostic factors for patients with sarcomas of the pelvic bones.

BACKGROUND: Treatment of malignant tumors of the pelvis represents one of the most difficult problems in musculoskeletal oncology. However, factors that influence the local and systemic control of the disease remain ill-defined. METHODS: One hundred and two patients with localized pelvic sarcomas who underwent a surgical excision of the tumors were analyzed. The tumor diagnosis was chondrosarcoma in 49 patients, osteosarcoma in 26 patients, Ewing's sarcoma in 20 patients, and other tumors in 7 patients. The tumor was located in the ilium in 65 patients, the pubis in 21 patients, the ischium in 8 patients, and the sacrum in 8 patients. Eighty-three patients underwent a limb-sparing surgery and 19 patients underwent hemipelvectomy. Prognostic factors for local recurrence, metastasis, and survival were analyzed. RESULTS: At last follow-up, 47 patients were disease free, 7 were alive with disease, and 48 had died. The 5-year survival rate was 55% (chondrosarcoma: 65%, osteosarcoma: 47%, and Ewing's sarcoma: 52%). Inadequate surgical margin emerged as the only independent adverse prognostic factor for local recurrence. For distant metastasis, surgical stage remained as an independent prognostic factor. Patients who underwent a hemipelvectomy and those who had an inadequate surgical margin had significantly poorer survivals. CONCLUSIONS: Pelvic sarcomas remain diseases with a poor prognosis. Independent prognostic factors are few; an adequate surgical margin is critical to prevent local recurrence, and the surgical stage is related to the risk of distant metastasis. Surgical margins and hemipelvectomy were predictors of survival, but the patients who underwent hemipelvectomy also tended to have the largest, most advanced tumors. Hemipelvectomy should be considered when there is sacral involvement.

Adolescent↗

PubMed1997

Functional evaluation of flail hip joint after periacetabular resection of the pelvis.

Five patients subjected to flail hip joint after resection of primary bone tumor of the pelvis involving acetabular region were examined with respect to function. When a thick portion of the supraacetabular pelvic neck was left in place, the operated legs functioned well regardless of whether the head of the femur was placed anterior or posterior to the iliac wing. In a patient who had only a thin portion of the iliac wing left in place and in those who underwent total excision of the ilium or hemiresection of the pelvis, the function of operated legs was poorer than with a thick portion of the supraacetabular pelvic neck left in place, but still more than 50% of leg function remained. Although flail hip joint results in a larger leg-length discrepancy than do other techniques, it enables favorable healing of the operative wound. Therefore, this method should be considered for women or sedentary patients with primary bone tumor of the pelvis involving acetabular region.

Acetabulum↗

PubMed1976

Morphology of untreated bilateral congenital dislocation of the hips in a seventy-four-year-old man.

Two untreated completely dislocated hips were examined pathologically in a 74-year-old male dissecting room cadaver. The femoral heads bilaterally were 9 cm above the acetabular fossae. They lay adjacent to each ilium with no secondary acetabulum formation. A thickened and markedly elongated fibrous capsule appeared to be the major structure that had checked further migration of the femoral heads during weight-bearing. The femoral heads, although slightly flattened medially and somewhat smaller in size than in the normal adult, showed no degenerative arthritis. Dysplastic acetabular fossae were filled with soft tissue. Bone-to-bone contact with secondary degenerative changes was present only where the femurs, at the level of the lesser trochanters, rubbed against the overhanging superior acetabular rims.

Acetabulum↗

PubMed1998

The quantitative anatomy of the superior gluteal artery and its location.

Twenty cadaveric posterior gluteal regions were dissected to quantitatively determine the location and dimensions of the superior gluteal artery and its branches on the posterior gluteal region. Two reference lines were defined: one (transverse) was drawn from the posterior inferior iliac spine (PIIS) across the ilium to the anterior superior iliac spine (ASIS), and another (vertical) was drawn orthogonal to the transverse line at a point 8 cm from the PIIS. Results showed that the average distances from the posterior superior iliac spine (PSIS) and PIIS to the superior gluteal artery origin at the sciatic notch were 60 mm and 42 mm, respectively. The deep superior branch traveled an average of 18 mm above the transverse line at the vertical line, and averaged 54 mm from the iliac crest at the same point. This same branch inserted in the medius an average of 29 mm from the ASIS, and 11 mm above the transverse line, while providing 4 to 7 perforators to the gluteus medius and 0 to 2 to the gluteus minimus. The deep inferior branch traveled an average of 23 mm below the transverse line along the vertical line and penetrated the minimus or medius 36 mm from the ASIS, while providing 3 to 8 perforators to the medius and 1 to 3 to the minimus. The average distance from the deep inferior branch to the superior edge of the acetabulum along the vertical line was 25 mm. These data may be helpful in preventing the injury of the superior gluteal artery during the posterior gluteal approach.

Arteries↗

PubMed1998

[Surgical management of malignant bone tumors in the child. Saint-Etienne Hospital experience, apropos of 17 cases].

From 1980 to 1997, seventeen children were treated for malignant bone tumors in the Department of Paediatric Surgery of the Saint-Etienne Hospital, with an average follow-up of 6 years and 3 months (2M-17Y). The histologic diagnoses were osteosarcomas (12 cases) and Ewing's sarcomas (5 cases). All children were treated surgically. For the 12 lower limb tumors, the techniques used were prosthetic replacement in 7 cases (associated with bone allograft in 3 cases), amputation in 3 cases and isolated bone allograft in 2 cases. The two ilium tumors were treated by resection and reconstruction with autologous bone graft. A single resection was performed for the shoulder-blade Ewing's tumors and a prosthesis for the 2 proximal humerus tumors. Six children died during follow-up. The authors stress that carcinologic resection is a priority before functional results. They insist on the mechanical failures of implants and on the difficulties of reoperations.

Adolescent↗

PubMed1998

Staining for histologic diagnosis of aluminum osteopathy--application of confocal laser scanning microscopy to observation for offminum in bones from aluminum-treated, subtotally nephrectomized rats.

To histologically detect excess aluminum (Al) taken up by bones in a rat model of renal failure prepared by 5/6-nephrectomy, non-decalcified bone tissue sections from specimens of the tibia, femur, rib and ilium were stained with a newly developed lumogallion reagent and examined for aluminum by confocal laser scanning microscopy. The assay revealed that Al contents in the tibia and femur of Al-treated rats tended to be a few-fold higher, compared to controls. With the lumogallion stain technique, Al in bones could be detected and identified at Al concentrations of > or = 9.0 micrograms/g in bone tissues. The reaction of the metal with lumogallion is specific and proved to be positive even at concentrations of excess Al so low as to be undetectable by conventional methods. The present observation disclosed that, unlike the generally accepted view, the Al was accumulated not in the calcification front but was distributed diffusely or as aggregates at high concentration in osteoid tissues. Z mode scans of the slides permitted steric delineation of the state of Al accumulation in bone tissues. The method described herein is considered a useful means for clinical diagnosis of aluminum osteopathy.

Aluminum↗

PubMed1998

Exposure of the hip by anterior osteotomy of the greater trochanter.

A new exposure for the direct lateral approach to the hip through the gluteus medius by anterior half osteotomy of the greater trochanter is described. The skin incision is made with the greater trochanter longitudinally at its midpoint and extends parallel to the shaft of the femur along its anterior border. The anterior two thirds of the tendinous gluteus medius muscle is divided. The incision continues to the middle of the greater trochanter and through the distal half of the vastus lateralis muscle. An anterior thin slice osteotomy of the greater trochanter is performed. The gluteus minimus is exposed and split in the line of its fibers or detached from the greater trochanter and the acetabular roof is exposed. In order to provide a wide exposure, a Charnley transverse retractor is used and a Calipers Dual Pin Retractor is inserted over the edge of acetabulum by elevating the soft tissues from the ilium. The Calipers Dual Pin Retractor is used to precisely position the prosthesis in an anatomic and functional position and eliminate leg length discrepancy.

Anthropometry↗

PubMed1998

The morphogenesis of the arteries of the pelvic extremity. A comparative study of mammals with special reference to the tree shrew Tupaia belangeri (Tupaiidae, Scandentia, Mammalia).

The ontogeny of the arteries of the pelvic extremity of Tupaia belangeri was investigated by light microscopy on the basis of serial sections of 30 embryos, dating from day 17 to day 42 post-copulation. In Tupaia, the gestational period takes approximately 43 days. Additionally, a 3-D reconstruction of the pelvic region and the right leg of a 22-day embryo was prepared. The arteries of an adult Tupaia were studied on the basis of a corrosion cast. The results were compared with the ontogeny of the arterial system of other mammals. In the 17-day embryo, the anlage of the pelvic extremity is penetrated by a capillary plexus. In the 18-day embryo, the a. ischiadica reaches the pelvic limb bud, representing the primary axial artery. On day 19, its r. perforans tarsi extends from the plantar to the dorsal aspect of the foot plate. The a. ischiadica is the main artery of the leg until the stage of the 22-day embryo. Afterwards, the peripheral arteries supplied by it are taken over by the a. iliaca externa and its extension, the a. femoralis. The a. iliaca externa springs from the a. iliaca communis in the 19-day embryo. From day 21 to day 22, the capillary plexus, which is nourished by the a. femoralis, closely approaches the a. ischiadica, and finally, a connecting branch joins the a. ischiadica. The a. ischiadica is then reduced to the a. glutea caudalis, and the aa. femoralis, poplitea profunda (at the cranial aspect of the m. popliteus), and interossea become the main arteries of the pelvic extremity. The a. poplitea superficialis, lying at the caudal aspect of the m. popliteus, and its continuation in the crural region, the a. peronea, develop until the 25-day embryo. The a. peronea gives rise to an r. perforans which penetrates the membrana interossea towards the dorsum of the foot. As a result of a shift of the origin of the a. iliaca externa in the proximal direction, the length of the a. iliaca communis gradually decreases until, on day 24, the a. iliaca externa springs directly from the lateral wall of the aorta. In the 20-day embryo, the a. iliaca externa gives rise to an a. circumflexa ilium profunda towards the lateral pelvic wall, and in 23-day embryos, to the a. profunda femoris. The main branches of the a. profunda femoris develop until day 24. At the same time, the aa. circumflexa femoris lateralis and nutricia ossis femoris arise from the a. femoralis. The a. saphena, which is already recognizable in the 23-day embryo, gives rise to the a. genus descendens, and as an a. plantaris medialis, to four aa. digitales plantares communes (I-IV) at the planta pedis. The development of the a. tibialis cranialis on day 25 takes place independently and without any topographic relation to the a. saphena, which functionally replaces the a. tibialis cranialis in some other mammals. In the 26-day embryo, the aa. peronea and tibialis cranialis extend to the dorsum of the foot where they continue as the aa. dorsales pedis profunda and superficialis. The fourth main artery of the lower leg, the a. caudalis femoris, which is first observed in the 20-day embryo, reaches the lateral aspect of the foot on day 24. Its r. calcaneus runs to the planta pedis. In 30-day embryos, the aa. digitales plantares propriae have differentiated. The corresponding dorsal arteries and the superficial plantar vascular are develop until day 35, so that all important arteries of the pelvic extremity, which are seen in the corrosion cast of the adult, are recognizable. Among the embryos and the adult Tupaia studied, individual variation is minimal. The developmental stage at which the arteries of the leg acquired a secondary vascular wall was ascertained. Only a vessel with a primary vascular wall can dissolve into a capillary plexus later on (e.g., a. interossea). In contrast, the course of an artery which has acquired a secondary vascular wall is determined, because modifications of the course of a vessel often need a capillary plexus as an intermediate st

Animals↗

PubMed1964