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PubMed2006

Mucinous adenocarcinoma associated with chronic anal fistula reconstructed by gracilis myocutaneous flaps.

Mucinous adenocarcinoma associated with chronic anal fistula is extremely rare, and such tumors have often reached an advanced stage at the time of presentation. Here we report a case of mucinous adenocarcinoma associated with chronic anal fistula that involved repair with gracilis myocutaneous flaps and review other reported cases. A 67-year-old man with an approximate 30-year history of an anal fistula was referred to our hospital due to enlargement of the perianal induration accompanied by mucinous secretion and pain. Physical examination of the perianal region revealed an ulcerated and discharging lesion on the buttocks. Histologic examination of a biopsy specimen of the ulcerated lesion revealed mucinous adenocarcinoma. An abdominoperineal resection was performed with resection of the ischiorectal fossa, coccyx, part of the gluteus maximus, and the obturator internus. The extensive defect was repaired with bilateral gracilis myocutaneous flaps. The patient did not experience a decrease in the strength of hip adduction and survived for 58 months without recurrence until he died of pneumonia. The repair using myocutaneous flaps was considered to contribute to a physically active life without recurrence.

Adenocarcinoma, Mucinous↗
PubMed2004

An unusual case of calciphylaxis.

BACKGROUND: Cutaneous calciphylaxis is a rare disorder that occurs most frequently in patients with end-stage renal disease (ESRD), those on hemodialysis, and renal transplant recipients. It is frequently associated with hyperparathyroidism and a markedly elevated calcium-phosphate product, and it carries a high mortality rate. The usual clinical presentation is of painful, stellate necrosis of the thighs or buttocks, often in the setting of livedo reticularis. Death usually results from septicemia. OBJECTIVE: This report documents an unusual case of recurrent, self-limiting calciphylaxis in the setting of a patient with ESRD and discusses the clinical and pathologic features of this potentially very fatal disorder. METHODS AND RESULTS: A 52-year-old woman presented with a greater than one-year history of relapsing and remitting, exquisitely painful, necrotic, numular plaques on the abdomen, breast, and arm. This patient had a markedly elevated calcium-phosphate product and parathyroid hormone level. The diagnosis of calciphylaxis was made by wedge biopsy of the most recent plaque, revealing calcification of medium-sized subcutaneous vessels and lobular capillaries with associated epidermal necrosis. CONCLUSIONS: This case demonstrates an unusual clinical variant of calciphylaxis that presented without the characteristic stellate necrosis or livedo reticularis that normally marks this condition and spontaneous resolution without incurring septicemia. Regardless of morphology, calciphylaxis should be considered in the differential diagnosis of painful, necrotic lesions occurring in the setting of ESRD.

Calciphylaxis↗
PubMed2004

The "winged" circular anal dilator in stapled hemorrhoidectomy.

Stapled hemorrhoidectomy is gaining popularity worldwide. One problem that is often encountered is difficulty with insertion of the circular anal dilator because of very protuberant and fatty buttocks and a narrow interischial tuberosity distance. We describe a modification of this device for easier introduction in such patients.

Anal Canal↗
PubMed2003

V-Y advancement flap for treatment of fistula-in-ano.

PURPOSE: The management of high fistula-in-ano presents a difficult surgical challenge. Laying open of high transsphincteric, intersphincteric, and suprasphincteric fistulas is associated with incontinence. Mucosal advancement flap can be technically difficult and is associated with ectropion and incontinence. We report a new technique for the treatment of fistulas, which may eliminate these problems. PATIENTS AND METHODS: Between 1997 and 2002, 18 patients (13 males), median age 46 (range, 25-64) years with high fistula-in-ano were treated. There were ten transsphincteric, four intersphincteric, and four suprasphincteric fistulas. In all patients, perianal sepsis was allowed to resolve completely with a drainage seton before definitive surgery. The surgical technique used involved core fistulectomy, curettage of any cavity, closure of the defect in the internal anal sphincter, and a V-Y advancement buttock flap to cover the internal opening, leaving the site of the external opening for drainage while preserving both internal and external sphincters. Outcome was assessed in terms of healing and continence. RESULTS: Most patients were discharged from the hospital within 48 hours. Median follow-up was 19 (range, 3-60) months. There were three patients who failed to heal. Of these, two underwent repeat surgery and healed. Two further patients had recurrent fistulas, both of whom continued with conservative treatment. Overall, 15 of 18 (83 percent) patients experienced healing of their fistula. Continence was preserved in all patients. CONCLUSION: This procedure is easy to perform, healing is rapid, and it appears to be effective in curing fistula-in-ano while preserving both external and internal anal sphincters.

Adult↗
PubMed2006

Expression of decorin and collagens I and III in different layers of human skin in vivo: a laser capture microdissection study.

Extracellular matrix (ECM) organization is a complex process that requires the coordinated efforts of many molecules. For the regulation of collagen fiber diameter, the proteoglycan decorin appears to be of major relevance. To investigate the role of decorin in the process of (photo-)aging in more detail, full-thickness punch biopsies were isolated from human buttock skin. Single exposure with two minimal erythemal doses of solar simulated irradiation caused down-regulation of decorin mRNA in young (n = 5) and old subjects (n = 5) after 24 h. Interestingly, decorin mRNA was elevated with age. To test the hypothesis that a decreased collagen-to-decorin-ratio impairs collagen structure we also investigated collagens I and III gene expression. Both were down-regulated with increasing age and after single UV-irradiation. As determined by laser capture microdissection-quantitative real time-Polymerase chain reaction (n = 11), decorin is mostly present in the reticular dermis while being absent from the papillary dermis. Minor expression was also observed in the epidermis. However, in contrast to full-thickness skin biopsies age-dependent changes in collagens I, III, and decorin expression could not be observed with this methodology indicating technical limitations. Together with our finding that collagens I and III mRNA are similarly expressed in the reticular and papillary dermis and are down-regulated by UV, our studies support the idea of a major role of decorin in ECM organization. Altered expression of decorin mRNA in the different dermal strata and a decrease in the collagen-to-decorin ratio inflicted by both age and ultraviolet irradiation possibly affect collagen bundle diameter and subsequently the mechanical properties of human skin.

Adult↗
PubMed2004

Henoch-Schönlein purpura.

Henoch-Schönlein purpura (HSP) is a multisystem immunoglobulin A-mediated vasculitis with a self-limited course affecting the skin, joints, gastrointestinal tract, and kidneys. HSP occurs most often in children between the ages of 3 and 10 years, and presents classically with a unique distribution of the rash to the lower extremities and the buttocks area. For this reason, a skin biopsy in children is rarely necessary for diagnosis. However, in the very young age children and adults, the rash is not classically distributed, and therefore a skin biopsy is often needed. Although there are currently no prospective controlled studies on the treatment of the different manifestations of HSP, there are several retrospectively designed studies and other physicians' personal experiences supporting the use of steroids in patients with severe gastrointestinal, severe renal, central nervous system, and testicular involvements. Severe renal and central nervous system disease may lead to life-threatening conditions, and immunosuppressive agents and plasmapheresis may be needed. The overall prognosis in HSP is excellent, but the long-term morbidity depends on the renal and neurologic involvement. One third to one half of these patients will have one or more recurrences of symptoms, usually within 6 weeks, but may occur as late as 3 to 7 years later.

Adult↗
PubMed2007

Sacral stress fracture in a marathon runner.

Athletically caused sacral stress fractures represent an uncommon reason for low back pain. The clinician must consider this possible diagnosis when evaluating patients with nonradicular low back or buttock pain. Women distance runners are more commonly afflicted. Athletically caused sacral stress fractures are most often unilateral. This case report presents an illustrative case of bilateral sacral stress fracture occurring in a male runner.

Adult↗
PubMed1993

Onchocerciasis in field workers at Baya Farm, Teppi Coffee Plantation Project, southwestern Ethiopia: prevalence and impact on productivity.

A survey of onchocerciasis in male field workers was conducted in Baya Farm, Teppi Coffee Plantation Project, southwestern Ethiopia, in order to determine the prevalence rate of onchocerciasis in that population and to measure the effect of the disease on work productivity. A total of 196 study subjects were examined both clinically and parasitologically. Parasitological diagnosis was based on bilateral skin biopsies from the calf, buttock, and scapula. It was found that the prevalence rate of onchocerciasis (82.7%) and the intensity of infection were very high. No study subject had any detectable visual impairment, and other chronic manifestations were few. Based on a twelve month retrospective review of labour cards, workers with onchocerciasis were significantly more likely to be absent from work due to illness and other reasons, and earned significantly less wages, than workers without onchocerciasis, thus suggesting that non-blinding onchocerciasis has a negative impact on work productivity.

Adult↗
PubMed1994

Prediction of stature from knee height for black and white adults and children with application to mobility-impaired or handicapped persons.

OBJECTIVE: No adequate methods exist for predicting stature to help assess the growth of handicapped (including mobility-impaired) children or to help in developing indexes of obesity or equations for estimating basal energy expenditure for adults. In this project, equations were developed to predict stature in white and black adults and children from nationally representative samples for application to mobility-impaired and handicapped persons. SAMPLES: Samples of healthy adults (n = 5,415) and children (n = 13,821) were selected from cycles I, II, and III of the National Health Examination Survey (NHES) conducted by the National Center for Health Statistics from 1960 to 1970. Balanced validation and cross-validation groups were created with regard to age, ethnic group, and sex. OUTCOME MEASURES: The NHES is the only national survey that contains body measurements biologically appropriate for predicting stature. These measurements include stature, sitting height, knee height, and buttocks to knee length. STATISTICAL ANALYSIS: Equations were computed from an all-possible-subsets of weighted regression procedure to select the predictor variables in the validation group based on the values of R2 and the root mean square error. RESULTS: Knee height predicted stature for white and black men, but the predictor variables for white and black women were knee height and age. For predicting stature in children 6 to 18 years of age, the predictor variable was knee height for all children. APPLICATIONS: The equations presented here were developed for use with mobility-impaired or handicapped persons, but the measurements were collected from ambulatory people by means of standard techniques. The use of recumbent anthropometric data from mobility-impaired or handicapped persons in the equations will expand the errors of prediction over those presented in this report. The standard error for a person is a guide to the range of probability within which a predicted value can occur.

Adolescent↗
PubMed1988

Tuberculosis of the sacroiliac joint: clinical features, outcome, and evaluation of closed needle biopsy in 11 consecutive cases.

Sacroiliac joint (SIJ) involvement has been reported in up to 9.7 percent of patients with skeletal tuberculosis. Lack of awareness of this now uncommon form of infection often leads to diagnostic delay and increased morbidity. Eleven consecutive cases of SIJ tuberculosis are reported; clinical and radiologic features, diagnosis, treatment, and outcome are discussed. Buttock pain was the presenting complaint in all patients. However, radicular pain in the lower back (seven patients) or lower limb (10 patients) was common and in one patient precipitated an unnecessary surgical intervention. SIJ tuberculosis is frequently an isolated phenomenon. Therefore, direct sampling of the SIJ is necessary to establish the diagnosis. The recently described technique of closed needle biopsy of the SIJ was employed in all 11 patients and established the diagnosis in nine of the 11.

Antitubercular Agents↗
PubMed1988

Hemorrhagic cystitis due to herpes simplex virus as a marker of disseminated herpes infection.

Herpetic cystitis has rarely been reported. Herein are described two immunocompromised female patients with genital or buttock herpetic lesions in whom hemorrhagic cystitis due to herpes simplex virus type 2 developed in the setting of disseminated herpetic infection. Both patients had indwelling Foley catheters. Urinary tract instrumentation may cause local or widespread dissemination of genital herpes in immunocompromised patients.

Aged↗
PubMed1991

Clinical implications of combined hypogastric and profunda femoral artery occlusion.

From 1983 to 1990, nine patients with combined hypogastric (HA) and profunda femoral arterial (PFA) occlusive disease presented with five nonhealing hip disarticulations, three nonhealing above-the-knee amputations, perineal necrosis in six patients, buttock necrosis in four patients, visceral ischemia in two patients, and lumbosacral spinal ischemia in one patient. Obviously some patients had more than one regional complication. Five patients died from complications of HA/PFA ischemia. Survivors included two patients who required a hemipelvectomy, one patient who required an axillary-to-hypogastric artery bypass graft for stump salvage, and one patient who survived despite lumbosacral paralysis and complete cystectomy. The 56% mortality and 100% morbidity emphasize the critical significance of combined hypogastric/profunda femoral artery circulatory compromise. Efforts should be made to preserve or re-establish the HA and/or PFA circulation whenever possible. A hemipelvectomy may be required to allow the wounds to finally heal. Furthermore, the certainty of an above-the-knee amputation healing is not present in these patients; therefore, a hemodynamic assessment of the healing potential of an above-the-knee amputation is required.

Aged↗
PubMed1978

The effects of vibration frequency and direction on the location of areas of discomfort caused by whole-body vibration.

Although much research has been devoted to the determination of equivalent comfort contours for human response to whole-body vibration little consideration has been given to the source of the feelings that give rise to such comfort contours. This paper shows that for vertical vibration there is a distinct difference in the locations of discomfort on the body at different frequencies and that the locations are not much affected by the vibration level. For horizontal motions, feelings of discomfort predominated in the lower abdomen and buttocks irrespective of vibration frequency or direction. A semantic scaling technique indicates the maximum sensitivity to vertical vibration acceleration in the 4 to 16 Hz range, but for both fore-and aft and lateral vibration there is a decrease in sensitivity with increasing frequency above 2Hz.

Journal Article↗
PubMed1994

Evaluation of the seating of Qantas flight deck crew.

In 1985 Qantas Airways (Australia) requested an ergonomics assessment of three pilots' seats so that one could be selected for fitting in all new aircraft as well replacement in existing aircraft. The Ipeco seat was chosen. In 1991, after all aircraft were fitted with the Ipeco seats, the company then requested a further evaluation of the seat to see if it was acceptable to the pilots and if there were any outstanding problems. A seat feature checklist plus a body chart discomfort rating scale was given to the total crew of 1030 pilots. The results from the 202 respondents indicated that although the pilots found the Ipeco seat an improvement on the Weber seat there were some modifications required. The main problems included insufficient adjustment range of the lumbar support area and the thigh supports, and infrequent replacement of the seat cushion. The body charts supported the checklist results in that the main areas of discomfort indicated were the buttocks and low back. Recommendations for improvements in design of the Ipeco seat, training in use and maintenance are presented. The method used in this study has application for field assessment of seating in a wide range of occupations, particularly bus drivers, truck drivers and train drivers, who spend long hours seated without being able to take breaks.

Journal Article↗
PubMed1986

Lower-limb influence on sitting balance while reaching forward.

To test the hypothesis that the lower limbs contribute to sitting balance when a person reaches forward, we measured the limits of forward reach in 20 healthy volunteers. While sitting on the buttocks alone (ischial support) or with the thighs also supported and with both feet on, one foot off, or both feet off the floor (in a balanced order), each subject reached as far forward as possible at table height at 0, 15, 30, and 45 degrees to the sagittal plane. With full thigh support the reaches at all angles were greatest with both feet on the floor, and decreased progressively with one foot off (when reaching toward the foot off the floor) and both feet off. Thigh support permitted significantly greater reach than ischial support at all angles with both feet off the ground, but not in other settings. These results have implications for seat design and when considering prostheses for patients unlikely to walk.

Adult↗
PubMed1987

Facial resurfacing in xeroderma pigmentosum: are we spoiling the ship for a ha'p'orth of tar?

A case of xeroderma pigmentosum (XP) is reported whose treatment included sub-total excision of facial skin and resurfacing in aesthetic units with grafts of relatively undamaged buttock skin. The principle of resurfacing is logical and supported by this and other reports which are reviewed. Though control was achieved in the grafted areas, tumours continued to develop in adjacent ungrafted skin. The importance of radical excision of exposed skin in severe cases of XP is emphasised.

Adult↗
PubMed1988

Changes in area and thickness of expanded and unexpanded axial pattern skin flaps in pigs.

The pig buttock flap model was used firstly, to compare changes in expanded axial skin flap area with control flaps prior to flap elevation and 3 or 4 months post-flap inset and, secondly, to compare the thickness of expanded and control flaps at elevation and for 3 to 6 months post-flap inset. Following 5 weeks' expansion and prior to elevation, the expanded tissue had gained a significant 63.3% mean increase in area compared with the control tissue (p less than 0.01). Immediately post elevation and inset, the expanded flaps were still significantly larger than the control flaps by a mean 29.8% (p less than 0.01) but had lost 56% of the original area gained. Little change in area occurred in the 3 months post-flap inset as the expanded flaps were still a mean 23.4% larger than the control (p less than 0.01). Dermal and cellular non-keratinised epidermal layers thickened markedly in expanded skin compared to control skin. Following elevation and inset of the flaps, both dermis and epidermis thickened in expanded and control flaps.

Animals↗
PubMed1988

Comparative viability of expanded and unexpanded axial pattern skin flaps in pigs.

A comparison of viable areas of axial pattern flaps post inset was made between expanded and non-expanded pig buttock island flaps. The deep circumflex iliac artery and vein supply approximately the proximal 14 x 10 cm area of this flap. Larger flaps were raised on expanded and control sides of eight pigs to determine if expansion increased the area of survival. In six of eight pigs whose initial tissue expansion did not create more than approximately a 50% increase in skin area, the expanded flaps had a statistically significant increase in viable skin area (proportionally) 10 days post inset than their control flaps (p less than 0.05). Two other pigs did not conform to this pattern. Their initial tissue expansion was greater than 50%, and the resulting area of flap viability was proportionally less in expanded flaps than the control flaps.

Animals↗