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PubMed1995

Restoration and analysis of standing-up in complete paraplegia utilizing functional electrical stimulation.

OBJECTIVE: Restoration of stand-up motion in patients with complete paraplegia utilizing multichannel functional electrical stimulation, and analysis of the restored motion. DESIGN: Nonrandomized control trial. SETTING: General community, a referral center, institutional practice, and ambulatory care: PATIENTS: Twelve volunteer samples were used for the collection of normal data. Two complete paraplegics received treatment for the restoration of stand-up motion. MAIN OUTCOME MEASURES: The electromyogram, joint angle, and floor reaction force were investigated during standing-up with arms crossed in front of the chest, and hands-assisted standing-up using parallel bars. The maximum knee joint torque during standing-up without hands-assists was calculated using a three-segment link model. Standing-up motion in complete paraplegics was restored, and then analyzed using the three-dimensional floor reaction force and the hip, knee, and ankle angles. RESULTS: Main muscles used to stand up were the quadriceps, tibialis anterior, and paraspinal muscles. Hands-assists reduced the muscle activity and the vertical floor reaction force. Peak muscle activity was less during hands-assisted standing-up, except for the rectus femoris and the iliopsoas muscle. The maximum knee joint torque during standing-up was 1.6Nm/kg for both knees. Two complete paraplegics were able to stand up smoothly from a wheelchair based on stimulation data obtained from normal subjects. The characteristic pattern during standing-up was knee flexion preceding extension. CONCLUSION: Stand-up motion was restored utilizing electromyogram data and knee joint torque data from normal subjects.

Adult↗
PubMedDate not supplied

Management of hip disorders in patients with cerebral palsy.

Hip disorders are common in patients with cerebral palsy and cover a wide clinical spectrum, from the hip at risk to subluxation, dislocation, and dislocation with degeneration and pain. Although the hip is normal at birth, a combination of muscle imbalance and bony deformity leads to progressive dysplasia. The spasticity or contracture usually involves the adductor and iliopsoas muscles; thus, the majority of hips subluxate in a posterosuperior direction. Many patients with untreated dislocations develop pain by early adulthood. Because physical examination alone is unreliable, an anteroposterior radiograph of the pelvis is required for diagnosis. Soft-tissue lengthening is recommended for children as soon as discernable hip subluxation (hip abduction <30 degrees, migration index >25%) is recognized. One-stage comprehensive hip reconstruction is effective treatment for children 4 years of age or older who have a migration index >60% but who have not yet developed advanced degenerative changes of the femoral head. Salvage options for the skeletally mature patient with a neglected hip are limited.

Adolescent↗
PubMed2005

Cold tuberculous abscess identified by FDG PET.

We report FDG PET of two cases of cold abscess due to Mycobacterium tuberculosis. Case 1 had colon cancer; FDG PET showed high FDG uptake in the colon lesion and low uptake in the inguinal lesion. The latter was a tuberculous cold abscess confirmed by CT/MRI and biopsy. Case 2 received radiotherapy for lung cancer and presented with suspected vertebral metastasis. Further studies revealed tuberculosis of the vertebra and a tuberculous cold abscess in the iliopsoas muscle. FDG PET showed moderate uptake in the third lumbar spine and low uptake in the abscess center of iliopsoas lesion. Both tuberculous cold abscesses showed moderate FDG uptake in the capsule and low uptake in the center. These features are unique compared with non-tuberculous abscess and typical tuberculosis lesions, which are characterized by high FDG uptake. Pathologically, tuberculous cold abscess is not accompanied by active inflammatory reaction. Our findings suggested that the FDG uptake by tuberculous lesion varies according to the grade of inflammatory activity. The new diagnostic features of tuberculous cold abscess may be useful in the evaluation of such lesions by FDG PET.

Abscess↗
PubMed1996

[Controversial rotation function of certain muscles in the hip joint].

The disputed rotating function of certain muscles in the hip joint. A device constructed for that study allows to determine the rotating function of the iliopsoas muscle as well as of the uniarticular adductor muscles of the thigh in every position of the hip joint by the method of threads. The iliac muscle rotates the thigh inward in every position of flexion/extension or abduction/adduction of the hip joint. The adductor magnus muscle always is a lateral rotator by those fibres which are inserted into the medical edge of the linea aspera, while the fibres attached to the adductor tubercle rotate the thigh inward. The psoas major, pectineus, adductor longus and adductor brevis muscles are able to rotate the thigh inward as well as outward. Their rotating function depends on the specific position of flexion/extension and abduction/adduction of the hip joint: Flexion and abduction intensify the lateral rotating function of these muscles, extension and adduction intensify the medial rotating function.

Aged↗
PubMed2004

Chronic groin pain in an amateur soccer player.

Chronic groin pain is common in soccer players because of the biomechanics of kicking causing recurrent stress to the abdominal muscles, groin flexors, and adductor muscles. Myositis ossificans in adductor muscles is a rare cause of chronic groin pain in soccer players. Only two cases have been reported and the iliopsoas muscle was involved in both. This case report emphasises the importance of direct radiography for diagnosis in chronic groin pain and is a reminder that the development of myositis ossificans in the adductor muscles may be a cause.

Adult↗
PubMed2006

Postmortem distribution of 3,4-methylenedioxy-N,N-dimethyl-amphetamine (MDDM or MDDA) in a fatal MDMA overdose.

In this manuscript, a newly identified compound, 3,4-methylenedioxy-N,N-dimethylamphetamine (MDDM or also called MDDA), was quantified. The substance was identified in the biological specimens of a 31-year-old man who died following a massive 3,4-methylenedioxymethamphetamine (MDMA) overdose. In addition, the postmortem distribution of the identified substance in various body fluids and tissues was evaluated. For MDDM quantitation, a formerly reported and validated liquid chromatography tandem mass spectrometry (LC-MS/MS) method was adapted. The following quantitative results of the MDDM quantitation were obtained: Femoral blood, aorta ascendens, and right atrial blood contained 2.5, 21.7, and 11.6 ng MDDM/ml, respectively. In left and right pleural fluid and pericardial fluid, concentrations of 47.0, 21.7, and 31.9 ng/ml, respectively, were found. MDDM levels in urine, bile, and stomach contents were 42.4, 1,101, and 1,113 ng/ml, respectively. MDDM concentrations in lungs, liver, kidney, and left cardiac muscle ranged from 12.8 to 39.8 ng/g, whereas these levels were below the limit of quantitation (< LOQ) in right cardiac and iliopsoas muscle. In conclusion, for the first time, MDDM was unambiguously identified in a fatal MDMA overdose. MDDM was probably present as a synthesis by-product or impurity in the MDMA tablets, which were taken in a huge amount by the victim, or MDDM was ingested separately and prior to the MDMA overdose. A third option, i.e., the eventual formation of MDDM as a result of postmortem methylation of MDMA by formaldehyde, produced by putrefaction processes or during storage under frozen conditions, is also discussed. The MDDM levels, substantiated in various body fluids and tissues, are in line with the distribution established for other amphetamine derivatives and confirm that peripheral blood sampling, such as that of femoral blood, remains the "golden standard".

Adult↗
PubMedDate not supplied

An autopsy case of Pena-Shokeir syndrome: severe retardation of skeletal muscle development compared with neuronal abnormalities.

An infant with multiple joint ankyloses, facial anomalies, and pulmonary hypoplasia, features similar to the phenotype of Pena-Shokeir syndrome, was examined at autopsy. Histological examination of the skeletal muscles revealed many small muscle fibers in a mixed, not group, distribution, although the structure of them was normally arranged. Histochemical assessment of adenosine triphosphatase (ATPase) activity of the iliopsoas muscle demonstrated the failure of the differentiation into type I fibers and the retardation of the skeletal muscle. At the same time, severe pulmonary hypoplasia, which was the likely cause for the retardation of the respiratory system, was found. In contrast to these numerous pathologic changes in the skeletal muscles, no significant abnormalities were observed in the central nervous system except for a somewhat immature external appearance; however, an examination of the spinal cord could not be carried out. Overall, this pattern of pathology suggests the possibility that developmental disorders of the mesenchyme are the primary contributors to the pathogenesis of Pena-Shokeir syndrome, while the immaturity of the central nervous system is involved to a lesser degree.

Abnormalities, Multiple↗
PubMed2001

Combined cardiomyopathy and skeletal myopathy: a variant with atrial fibrillation and ventricular tachycardia.

This article describes a family characterized by combined cardiomyopathy and nonspecific skeletal myopathy who present in the third to fifth decades with cardiac manifestations but earlier have evidence of subtle skeletal muscle dysfunction. They differ from previously defined syndromes and potentially represent a different genetic expression or mutation. Cardiomyopathy presents with atrial arrhythmias including AF and atrial flutter. Life-threatening ventricular tachyarrhythmias occur next with onset of ventricular dysfunction. Electrophysiological study revealed sustained monomorphic VT. Affected family members benefitted from an ICD and progression to congestive heart failure (CHF) occurred late. Skeletal myopathy continues with marked progressive muscle weakness and inability to ambulate without assistance. Genetic analysis is currently ongoing. Neurological evaluation in all three family members revealed nonspecific myopathy affecting the psoas and iliopsoas muscles. Atrophy and wasting of the facial and temporalis muscles were common. Skeletal muscle biopsy revealed myofiber atrophy consistent with myopathy.

Atrial Fibrillation↗
PubMed2002

Psoas abscess as a complication of pyogenic sacroiliitis: report of a case.

A psoas abscess is, either primary or secondary, a rare entity for a general surgeon. Images by ultrasonography and computed tomography (CT) can help a general surgeon to make an accurate diagnosis when encountering the patient complaining of unilateral lower abdominal deep pain with fever. A case of pyogenic abscess of the psoas muscle as a result of sacroiliitis in a 22-year-old man is reported herein. The abdominal CT and magnetic resonance imaging scans demonstrated a large multilocular abscess extending along the iliopsoas muscle, and erosion and a widening of the left sacroiliac joint. The abscess was drained with an open surgical approach and the patient responded well to antibiotic therapy. Aggressive surgical and medical treatment is necessary in patients with psoas abscess to prevent complications.

Adult↗
PubMed2002

Relationship between mechanical factors and incidence of low back pain.

STUDY DESIGN: A multifactorial cross-sectional nonexperimental design. OBJECTIVES: To collectively investigate the association among 17 mechanical factors and occurrence of low back pain (LBP). BACKGROUND: Several physical characteristics, based on assumptions, clinical findings, and scientific experiments, have been associated with the development of LBP Controversy exists regarding the degree of association between some of these physical characteristics and LBP. Information regarding the degree of association of each factor to LBP is needed for effective prevention and appropriate treatment strategies. METHODS AND MEASURES: A total of 600 subjects participated in this study. Subjects were categorized into 4 groups: asymptomatic men (n = 150, age [mean +/- SD] = 43 +/- 15 years), asymptomatic women (n = 150, age [mean +/- SD] = 43 +/- 13 years), men with LBP (n = 150, age [mean +/- SD] = 43 +/- 14 years), and women with LBP (n = 150, age [mean +/- SD] = 43 +/- 13 years). Seventeen physical characteristics were measured in each group and the relative association of each characteristic with LBP was assessed. RESULTS: Among all the factors tested, endurance of the back extensor muscles had the highest association with LBP Other factors such as the length of the back extensor muscles, and the strength of the hip flexor, hip adductor, and abdominal muscles also had a significant association with LBP. CONCLUSION: It appears that muscle endurance and weakness are associated with LBP and that structural factors such as the size of the lumbar lordosis, pelvic tilt, leg length discrepancy, and the length of abdominal, hamstring, and iliopsoas muscles are not associated with the occurrence of LBP.

Adult↗
PubMedDate not supplied

[Clinico-pathological analysis of vesiculotubular myopathy of adult onset].

The patient was a 50-year-old house wife. There were complicated consanguineous marriages in the family tree. Since 30 years of age, she had suffered from progressive limb muscle weakness, but without myalgia and myasthenia. At present, she was wheelchair-bound. Physical examinations showed obesity, congenital livedo racemosa, epicanthus palpebrae and left renal defect. Neurologically, facial, anterior cervical, and iliopsoas muscles were well preserved, but others were severely involved. Laboratory examinations revealed mildly elevated myogenic serum enzymes, and myogenic changes on needle EMG. In her muscle biopsy from the left rectus femoris muscle, there were no inflammatory changes, but marked variations of the fiber size as well as adipose tissue replacement were recognized. Strickingly, basophilic masses located in the center of the sarcoplasm were present in about 10% of the fibers. Histochemically, the masses were present in both type 1 and 2 fibers, and exhibited almost similar stained patterns to the tubular aggregates, but were dystrophin-, GRP78- and clathrin-positive. Under electron microscopy, the masses consisted of aggregates of the vesiculotubular structure, measuring approximately from 60 nm to more than 6 microns in diameter, which were continuous with T system/sarcoplasmic reticulum and were clearly segregated from myofilaments. This is a chronic progressive muscular disorder of adult onset with the peculiar pathological finding of vesiculotubular structure.

Age of Onset↗
PubMed2005

Bilateral iliopsoas hematomas complicating anticoagulant therapy.

An 85-year-old woman receiving anticoagulant therapy for transient ischemic attack suddenly developed bilateral femoral nerve palsy and severe pain in the bilateral groin and thighs. Her platelet count, prothrombin time and activated partial thromboplastin time were within the therapeutic range. Hematomas in the bilateral iliopsoas muscles were clearly detectable on CT scan. The right hematoma was larger than the left one and caused more severe femoral neuropathy, but improved gradually without surgical decompression. This case is reported here because bilateralism is exceptional, and iliopsoas hematoma should be suspected when a patient receiving anticoagulant therapy presents with pain in the groin or thigh.

Aged↗
PubMed1999

Descending projections from the nucleus retroambiguus to the iliopsoas motoneuronal cell groups in the female golden hamster: possible role in reproductive behavior.

In the cat, the nucleus retroambiguus (NRA) projects to expiratory motoneurons in the brainstem and spinal cord. Recently, it has been demonstrated that the NRA sends fibers to a specific set of motoneurons in the lumbosacral cord, which pathway is thought to play a crucial role in mating behavior. The question is whether such projections exist in the hamster, because the female of this species displays a very distinctive receptive behavior. In the hamster, lumbosacral cord injections of wheat germ agglutinin-horseradish peroxidase (WGA-HRP) combined with hemisection 1 or 2 segments rostral to injection sites in three of the five cases demonstrated retrogradely labeled neurons in the NRA at levels 1.0-2.25 mm caudal to the obex, contralateral to the injection sites. Injections of WGA-HRP into the NRA and adjoining reticular formation revealed that NRA fibers crossed the midline in the caudal medulla and descended in the contralateral lateral and ventrolateral funiculi to terminate bilaterally, but mainly contralaterally, in the motoneuronal cell groups of the abdominal wall and iliopsoas muscles. NRA projections to levels caudal to lumbar segment 5 were virtually absent. Electron microscopic examination revealed that, of the 162 labeled NRA terminal profiles found in the ultrathin sections, 144 (89%) made monosynaptic contacts with retrogradely labeled dendrites of iliopsoas motoneurons. These NRA terminals formed asymmetrical synapses and contained spherical vesicles indicative of an excitatory function. The results indicate that, in the hamster, direct contralateral NRA projections exist to iliopsoas motoneurons. A concept is discussed in which this pathway plays a crucial role in mating behavior.

Animals↗
PubMed2003

Ultrasound diagnosis of anterior iliopsoas impingement in total hip replacement.

Iliopsoas impingement syndrome, an infrequent complication of total hip replacement, has been rarely reported in the radiological literature. It follows chronic friction of the posterior aspect of the iliopsoas muscle and tendon against the acetabular cup, a piece of cement, or cup fixation screws. Clinical findings are non-specific and an imaging modality is required to diagnose the condition. Computed tomography (CT) is considered the gold standard imaging modality in evaluating iliopsoas impingement. We report a case of a patient in which the diagnosis was made by ultrasound and later confirmed by CT.

Aged↗
PubMed2003

Bone architecture and disc degeneration in the lumbar spine of mice lacking GDF-8 (myostatin).

GDF-8, also known as myostatin, is a member of the transforming growth factor-beta superfamily of secreted growth and differentiation factors that is expressed in vertebrate skeletal muscle. Myostatin functions as a negative regulator of skeletal muscle growth and myostatin null mice show a doubling of muscle mass compared to normal mice. We describe here morphology of the lumbar spine in myostatin knockout (Mstn(-/-)) mice using histological and densitometric techniques. The Mstn(-/-) mice examined in this study weigh approximately 10% more than controls (p<0.001) but the iliopsoas muscle is over 50% larger in the knockout mice than in wild-type mice (p<0.001). Peripheral quantitative computed tomography (pQCT) data from the fifth lumbar vertebra show that mice lacking myostatin have approximately 50% greater trabecular bone mineral density (p=0.001) and significantly greater cortical bone mineral content than normal mice. Toluidine blue staining of the intervertebral disc between L4-L5 reveals loss of proteoglycan staining in the hyaline end plates and inner annulus fibrosus of the knockout mice. Loss of cartilage staining in the caudal end plate of L4 is due to ossification of the end plate in the myostatin-deficient animals. Results from this study suggest that increased muscle mass in mice lacking myostatin is associated with increased bone mass as well as degenerative changes in the intervertebral disc.

Animals↗
PubMed2006

[Deep venous thrombosis caused by severe infection with group A streptococci].

A 38-year-old diabetic woman presented with a deep venous thrombosis of the right calf muscle two weeks after an infection of the pharynx. After one week of treatment with warfarin, she was readmitted in septic shock with a massive swelling of the leg. The thrombosis had progressed to the right iliac and femoral veins, and an abscess of the iliopsoas muscle caused by group A streptococci was detected. The treatment consisted of surgical drainage, intravenous penicillin and eventually hip joint exarticulation.

Adult↗
PubMed1996

Computer simulation of landing movement in downhill skiing: anterior cruciate ligament injuries.

Anterior cruciate ligament (ACL) injuries typically occur in high-speed downhill skiing during the landing phase following a jump. A direct dynamics simulation model was developed which allows investigation of possible ACL injury mechanisms without the need to use actual skiers in a potentially dangerous environment. The model included multibody dynamics, muscle dynamics and a model for ski-snow interaction. The model's ability to reproduce an actual landing movement was investigated by minimizing the differences between measured and stimulated landing movements as a function of constant muscle stimulation levels. The remaining difference was mainly due to noise in the measurements. A small balance disturbance was induced to simulate an injury condition. This disturbance caused the modeled skier to fall slightly backwards. A recovery attempt was made by maximal activation of the quadriceps and iliopsoas muscles. Peak resultant shear force at the knee joint in ACL direction was substantially higher in the injury simulation (1001 N) when compared to the simulated normal landing movement (589 N). Taking into account quadriceps contraction and orientation of the ACL with respect to tibial plateau, peak ACL force during the injury simulation was estimated to be 1350 N, which is within the range of failure loads for this ligament. The external forces were mainly (75%) responsible for this loading. The contribution of the fully activated quadriceps muscles was only 25%. It was concluded that the model could reproduce a typical landing movement and is therefore considered to be sufficiently realistic. Second, the simulation results suggest that external forces are the main cause for ACL injuries during landing movements in downhill skiing.

Anterior Cruciate Ligament Injuries↗
PubMed1976

Primary recognition and treatment of congenital dislocation of the hip.

The pathology associated with congenital dislocation of the hip has been reviewed. The pathophysiology as it affects the development of the hip under treatment makes a strong case for the avoidance of the "frog leg" position with fixed flexion and abduction of the hips in the plaster cast. It is apparent that tightness of the iliopsoas muscle and the underlying capsule makes that flexed abduction position necessary to hold the hip in position. The "frog leg" position is seriously implicated in the development of aseptic necrosis, not only of the dislocated hip but of the normal hip as well. The results seen in patients with surgical division of the iliopsoas tendon and capsular contracture, followed by leg immobilization in a functional position of extension at the hip accompanied by slight abduction and internal rotation, indicate the virtual elimination of the necessity for secondary reconstruction procedures on the hip at a later date. This appears to be the more conservative approach to treatment in children under age two. A period of one to three months in a splint that flexes and abducts the leg but permits changing positons may be tried before the obstruction is relieved. For children with lax capsule and iliopsoas, reduction may be possible by this route. For most the hip will be pressed in slightly improving the x-ray picture--but with the obstruction still before the femoral head. The seating of the femoral head must be exact. If it is not, imperfection in the development of the hip arises and may lead to later malfunction. Obstructions to perfect seating of the femoral head in the acetabulum must be overcome.

Age Factors↗