Sample records for buttocks

  1. Buttock Lift (United States)

    ... Rochester, Minn. July 29, 2013. Buttock lift About Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  2. Buttock Lifting with Polypropylene Strips. (United States)

    Ballivian Rico, José; Esteche, Atilio; Hanke, Carlos José Ramírez; Ribeiro, Ricardo Cavalcanti


    The purpose of this study was to evaluate the results of gluteal suspension with polypropylene strips. Ninety healthy female patients between the ages of 20 and 50 years (mean, 26 years), who wished to remodel their buttocks from December 2004 to February 2013 were studied retrospectively. All 90 patients were treated with 2 strips of polypropylene on each buttock using the following procedures: 27 (30 %) patients were suspended with polypropylene strips; 63 (70 %) patients were treated with tumescent liposuction in the sacral "V", lower back, supragluteal regions, and flanks to improve buttocks contour (aspirated volume of fat from 350 to 800 cc); 16 (18 %) patients underwent fat grafting in the subcutaneous and intramuscular layers (up to 300 cc in each buttock to increase volume); 5 (6 %) patients received implants to increase volume; and 4 (4.4 %) patients underwent removal and relocation of intramuscular gluteal implants to improve esthetics. Over an 8-year period, 90 female patients underwent gluteal suspension surgeries. Good esthetic results without complications were obtained in 75 of 90 (84 %) cases. Complications occurred in 15 of 90 (16.6 %) patients, including strip removal due to postoperative pain in 1 (1.1 %) patient, and seroma in both subgluteal sulci in 3 (3.3 %) patients. The results of this study performed in 90 patients over 8 years showed that the suspension with polypropylene strips performed as a single procedure or in combination with other cosmetic methods helps to enhance and lift ptosed gluteal and paragluteal areas. This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors

  3. Redefining the Ideal Buttocks: A Population Analysis. (United States)

    Wong, Wendy W; Motakef, Saba; Lin, Yi; Gupta, Subhas C


    The buttocks are a key element of female beauty, with aesthetic gluteoplasty becoming one of the fastest growing plastic surgery procedures. However, there remains no clear standard for the ideal buttocks. The authors performed a population analysis of the characteristics of the ideal buttocks to guide surgical planning. Images of buttocks were digitally altered to create buttocks of varying proportions on posterior and lateral views. Waist-to-hip ratios and varying vertical proportions were studied. Data were stratified and analyzed according to age range, gender, ethnicity, and nationality of the respondents. A total of 1146 responses were collected. Of 989 respondents who submitted their gluteal preferences, 482 respondents (48.7 percent) were women and 507 (51.3 percent) were men. Overall, the most attractive buttocks waist-to-hip ratio is 0.65 from the posterior view (44.2 percent of respondents). The next most attractive ratio was 0.60 (25 percent of respondents). Positioning of the lateral prominence at the inferior gluteal fold was rated by 26.3 percent of respondents as the most attractive. From the lateral view, the most attractive buttocks have a waist-to-hip ratio of 0.70 (29.8 percent of respondents), with the most prominent portion positioned at the midpoint of the buttocks (45.1 percent of respondents), which is a 50:50 vertical ratio. There were no significant differences in preferences between respondent ages, genders, or ethnicities. New ideal waist-to-hip ratios of 0.6 and 0.65 update the previous standards and indicate a more dramatic and "curvier" new ideal, signaling an important preference paradigm shift. The information derived from this study has the potential to guide gluteoplasty practices and techniques.

  4. Fibroid in the buttock: an unexpected diagnosis

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    Keogh, Ciaran F.; Gee, Richard; Munk, Peter L. [Department of Radiology, Vancouver Hospital and Health Sciences Center, 899 West 12th Ave, V5Z 1M9, Vancouver, BC (Canada); Torreggiani, William C. [Department of Radiology, Tallaght General Hospital, Tallaght, Co. Dublin (Ireland); O' Connell, John X. [Department of Pathology, Surrey Memorial Hospital, 13750 96th Avenue, V3V 1Z2, Surrey, BC (Canada)


    Uterine leiomyomas (fibroids) are very common lesions with well-described imaging features. We present an unusual case of a fibroid which presented in the buttock with atypical clinical and imaging features in a woman who had had a previous hysterectomy. Despite extensive imaging and biopsies, the diagnosis was not suspected until pathological evaluation of the resected mass. The differential diagnosis for such a lesion, and the imaging and pathological features of fibroids, including atypical and parasitic leiomyomas, are discussed. (orig.)

  5. Analytical review of 664 cases of penetrating buttock trauma (United States)


    A comprehensive review of data has not yet been provided as penetrating injury to the buttock is not a common condition accounting for 2-3% of all penetrating injuries. The aim of the study is to provide the as yet lacking analytical review of the literature on penetrating trauma to the buttock, with appraisal of characteristics, features, outcomes, and patterns of major injuries. Based on these results we will provide an algorithm. Using a set of terms we searched the databases Pub Med, EMBASE, Cochran, and CINAHL for articles published in English between 1970 and 2010. We analysed cumulative data from prospective and retrospective studies, and case reports. The literature search revealed 36 relevant articles containing data on 664 patients. There was no grade A evidence found. The injury population mostly consists of young males (95.4%) with a high proportion missile injury (75.9%). Bleeding was found to be the key problem which mostly occurs from internal injury and results in shock in 10%. Overall mortality is 2.9% with significant adverse impact of visceral or vascular injury and shock (P wounds, whilst vascular injury leads in stab wounds (P Wound infection, sepsis or multiorgan failure, small bowel fistula, ileus, rebleeding, focal neurologic deficit, and urinary tract infection were the most common complications. Sharp differences in injury pattern endorse an algorithm for differential therapy of penetrating buttock trauma. In conclusion, penetrating buttock trauma should be regarded as a life-threatening injury with impact beyond the pelvis until proven otherwise. PMID:21995834

  6. Intramuscular injections into the buttocks: Are they truly intramuscular?

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    Chan, V.O. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Colville, J. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Persaud, T. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Buckley, O. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Hamilton, S. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Torreggiani, W.C. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland)]. E-mail:


    Aim: To radiologically determine if intramuscular (IM) injections into the buttocks are truly intramuscular. Materials and methods: This was a prospective study conducted during a 6 month period beginning in October 2004. Fifty inpatients were recruited from a single tertiary referral hospital. Approval was obtained from the hospital research ethics committee and informed written consent was acquired from all participants. Prior to computerised tomography (CT), each patient received an IM injection of their prescribed medication along with 1 mL of air into the upper outer quadrant of the buttocks. CT images were subsequently analyzed by two radiologists to determine the position of the injected air bubble and to assess whether it was intramuscular or subcutaneous in position. Body mass index (BMI), distance to injection site, subcutaneous fat and muscle thickness were also measured. Results: Overall, only 32% (n = 16/50) of patients had intramuscular injections, with the majority of injections (68%, n = 34/50) being subcutaneous. When analysed by gender, 56% (n = 14/25) of males had intramuscular injections while in females, the efficacy rate was significantly lower at 8% (n = 2/25). Conclusion: The majority of assumed intramuscular injections are actually subcutaneous.

  7. Isolation of herpes simplex virus from the genital tract during symptomatic recurrence on the buttocks. (United States)

    Kerkering, Katrina; Gardella, Carolyn; Selke, Stacy; Krantz, Elizabeth; Corey, Lawrence; Wald, Anna


    To estimate the frequency of isolation of herpes simplex virus (HSV) from the genital tract when recurrent herpes lesions were present on the buttocks. Data were extracted from a prospectively observed cohort attending a research clinic for genital herpes infections between 1975 and 2001. All patients with a documented herpes lesion on the buttocks, upper thigh or gluteal cleft ("buttock recurrence") and concomitant viral cultures from genital sites including the perianal region were eligible. We reviewed records of 237 subjects, 151 women and 86 men, with a total of 572 buttock recurrences. Of the 1,592 days with genital culture information during a buttock recurrence, participants had concurrent genital lesions on 311 (20%, 95% confidence interval [CI] 14-27%) of these days. Overall, HSV was isolated from the genital region on 12% (95% CI 8-17%) of days during a buttock recurrence. In the absence of genital lesions, HSV was isolated from the genital area on 7% (95% CI 4%-11%) of days during a buttock recurrence and, among women, from the vulvar or cervical sites on 1% of days. Viral shedding of herpes simplex virus from the genital area is a relatively common occurrence during a buttock recurrence of genital herpes, even without concurrent genital lesions, reflecting perhaps reactivation from concomitant regions of the sacral neural ganglia. Patients with buttock herpes recurrences should be instructed about the risk of genital shedding during such recurrences. II-2.

  8. Parachordoma of the buttock: an immunohistochemical case study and review. (United States)

    Hirokawa, M; Manabe, T; Sugihara, K


    We report a case of parachordoma occurring in the buttock of a 43-year-old man, and review 20 cases of parachordoma reported in the English literature. The tumor in our case was grossly 3 cm in dimension, solid, lobulated and grayish-white in color. Microscopically, the tumor consisted of epithelioid and spindle cells, and fibromyxoid stroma. The epithelioid cells were immunohistochemically positive for vimentin, S-100 protein, neuron-specific enolase, keratin, carcinoembryonic antigen and epithelial membrane antigen, and negative for HMB45. These findings are similar to those for chordoma rather than extraskeletal myxoid chrondrosarcoma. Although the etiopathogenesis of parachordoma remains obscure, Schwann cells or some other neuron-related cell origin are suspected.

  9. Fat grafting of the buttocks and lower limbs. (United States)

    Pereira, L H; Radwanski, H N


    This article presents the senior author's experience in fat grafting for the treatment of contour deformities of the buttocks and lower limbs. This method has been termed liposculpture and consists in removal of adipose tissue by cannula and syringe and cleaning of the aspirated material with saline. All external contact is thus carefully avoided, preventing contamination. Fat grafting is done in multiple tunnels in a deep plane. Total of 140 patients were treated over the last 5 years and results were considered uniformly satisfactory. Fat absorption was estimated by clinical evaluation to be less than 20% volume. A low rate of complications (less than 3%) supports the authors' opinion that this is an efficient and safe procedure to correct or enhance contour deformities of the lower limbs.

  10. The spectrum of injuries in buttock stab wounds. (United States)

    Campion, T; Cross, S


    Buttock stab wounds are a surprisingly common and increasing source of presentations to emergency departments. These injuries can have a significant impact on quality of life, and there are a number of often subtle, but significant, injuries that the radiologist must be alert to when interpreting computed tomography examinations in these patients. In this review, we will examine briefly the sociological reasons for the increase in these injuries, discuss appropriate imaging techniques, and provide imaging examples of the clinically important injuries that may be encountered in this region. These injuries include rectal or colonic perforation; genito-urinary trauma, for example urethral injury; injury to the sciatic nerve; and a spectrum of vascular trauma including transection and pseudoaneurysm or arteriovenous fistula formation. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  11. Age-related ptosis of the buttock: an anthropometric gender-specific analysis. (United States)

    Hoenig, Johannes Franz; Swetje, Karin


    Buttock reshaping has received a lot of attention, although to date there are no anthropometric gender-specific datasets to show the aging of the gluteal region from infancy to old age to guide surgical planning of gender-specific buttock reshaping. To make surgical planning easier, we analyzed the characteristics of the aging buttock in 280 volunteers ranging in age from 15 to 85 years and classified the age characteristics of the gluteal region into gender-specific categories to establish a classification system that could guide surgical techniques needed to reshape and rejuvenate the buttock. Based on our measurements it was evident that males showed fewer signs of atrophy and less ptosis of their buttock with less reduction of the gluteal volume as they aged than did females. Based on the results, it is concluded that gender-specific surgical rejuvenation of the buttock area should include shortening of the gluteal crease, lifting the gluteal mass, adding volume, and smoothening of curvature to the lateral sides of the gluteal region. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

  12. Spiral lift: medial and lateral thigh lift with buttock lift and augmentation. (United States)

    Sozer, Sadri O; Agullo, Francisco J; Palladino, Humberto


    Patients with a pear- or guitar-shaped body contour deformity are not frequently encountered, but represent a surgical challenge. Traditionally, these patients have been treated with belt lipectomies, lower body lifts, medial thigh lifts, and liposculpture because liposuction alone often is insufficient. This article describes an alternative method for performing a medial, anterior, and lateral thigh lift with a buttock lift and autoprosthesis augmentation through a single spiral incision easily concealed by underwear. A retrospective study of patients treated for body contour deformities from January 2004 to June 2006 was conducted. The inclusion criteria for spiral lift were lipodystrophy and excess skin and subcutaneous tissue of the thighs, flanks, and buttocks without contour deformities of the abdomen. The incision extends from the inferior crease of the buttocks along the inguinal crease and continues just inferior to the anterior iliac spine, spiraling above the buttocks and meeting the contralateral incision at the sacrum. A dermal fat flap is rotated to function as an autologous buttock implant. Pre- and postoperative views, patient satisfaction, complications, and operative details are analyzed and described. Of the 253 consecutive patients treated for body contour deformities, 5 met the inclusion criteria for the spiral lift. All the patients were women ranging in age from 30 to 43 years. Comparison of pre- and postoperative views demonstrated improved contour and firmness of the thighs and gluteal region with easily concealed scars. The inferior gluteal sulcus became less evident, and the buttock mass was elevated and augmented with maximum projection at midlevel. Patient and surgeon satisfaction was high. One patient experienced delayed wound healing. Stability in the body contour repair was demonstrated at the 1-year follow-up assessment. A reliable, versatile, and effective technique is described. Applicability and experience with the procedure are

  13. Decoupled pelvis rotation in sitting: a passive motion technique that regulates buttock load associated with pressure ulcer development

    NARCIS (Netherlands)

    van Geffen, P.; Reenalda, Jasper; Veltink, Petrus H.; Koopman, Hubertus F.J.M.


    Wheelchair-users who cannot reposition themselves often suffer from pressure ulcers which are places of tissue breakdown in the buttock region under the sacrum and ischial tuberosities. Periodic pressure relief is needed to recover the buttock tissue from continuous deformation and impairment of

  14. The Effects of a Dynamic Tuberal Support on Ischial Buttock Load and Pattern of Blood Supply

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    van Geffen, P.; Koopman, Hubertus F.J.M.; Reenalda, Jasper; Veltink, Petrus H.

    Sitting acquired pressure ulcers are places of tissue breakdown that mainly occur under the ischial tuberosities (ITs). Successive durations of pressure relief help the buttock tissue recover from sustained deformation and blood-flow stagnation. A computer-aided simulator chair was developed with

  15. [Sigmoido-buttock fistula by diverticulitis: report of a rare complication]. (United States)

    Evaristo-Méndez, Gerardo; Sánchez-Hernández, Alma Teresa; Melo-Velázquez, Armando; Ventura-Sauceda, Félix Antonio; Sepúlveda-Castro, Rogelio Ricardo


    The complicated diverticulitis of the colon is characterized by its association with abscesses, bleeding, stenosis, perforation, obstruction or fistula. We report a case of spontaneous sigmoido-cutaneous fistula from diverticulitis to an unusual place in the gluteal region. A 59-year-old male patient presented an inflammatory wound in left buttock without response to the conservative medical treatment. The fistulography, colonoscopy, barium enema and computed tomography showed a sigmoido-cutaneous fistula to the left buttock from diverticulitis. The biopsy of the lesion ruled out malignancy. We performed an elective sigmoid resection with primary colorectal anastomosis, partial fistulectomy and injection of a fibrin sealant in the residual tract. The colon-cutaneous fistulas from diverticulitis are relatively rare. We report a spontaneous fistula with origin in a single diverticulum in the sigmoid colon and that drained through the piriform fossa of the pelvic floor to the skin of the left buttock. A high index of suspiscion is necessary to not confuse the colo-buttock fistula with local abscesses.

  16. "Universal" and ethnic ideals of beautiful buttocks are best obtained by autologous micro fat grafting and liposuction. (United States)

    Roberts, Thomas L; Weinfeld, Adam B; Bruner, Terrence W; Nguyen, Karl


    Recently there has been a dramatic increase in the number of patients seeking buttocks enhancement and in the degree of augmentation requested. To fulfill these requests,aesthetic plastic surgeons must understand the patient's personal requests and ethnic identity, as well as any universal ideal of proportions and contours that create the impression of beautiful buttocks. "Universally" perceived ideal buttocks are 1.4 times the circumference of the waist, which is consistent cross-culturally and throughout history. Beyond this are important ethnic differences in the image of perfect buttocks shape. The combination of autologous micro fat grafting and liposuction is the best and possibly only way to obtain various ideal shapes, and offers a lower incidence of complications compared with buttock implants.

  17. Inverted verrucous carcinoma of the buttock mimicking abscess and gossypiboma: MR and pathologic correlation

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    Hu, Bing; Gorbachova, Tetyana; Rodgers, Shuchi K. [Einstein Medical Center Philadelphia, Department of Radiology, Philadelphia, PA (United States); Belser, Paul [Einstein Medical Center Montgomery, Department of Pathology, East Norriton, PA (United States); Schiowitz, Robert [Einstein Medical Center Montgomery, Department of Surgery, East Norriton, PA (United States)


    Verrucous carcinoma (VC) is an uncommon, low-grade variant of squamous cell carcinoma. Its benign histologic appearance and indolent course may lead to a delayed diagnosis. We report a rare case of an inverted verrucous carcinoma of the buttock presenting as a slow-growing subcutaneous lesion with a draining sinus and no exophytic component, clinically mimicking abscess and gossypiboma, with magnetic resonance imaging (MRI) and pathologic correlation. Biopsy of the lesional base is mandatory for accurate diagnosis. An enhancement pattern with a convoluted undulating appearance in a subcutaneous lesion displayed on MRI should raise a consideration of inverted VC in the differential diagnosis. (orig.)

  18. Mammary type myofibroblastoma of the buttock: A case report and review of the literature

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    Park, Jong Min; Yi, Jae Hyuck [Dept.of Radiology, Kyungpook National University Hospital, College of Medicine, Kyungpook National University, Daegu (Korea, Republic of)


    Mammary-type myofibroblastoma is a very rare, benign mesenchymal tumor consisting of spindle-shaped cells along with thick hyalinized collagen bundles and an intralesional fat component; its histopathological features are identical to those of myofibroblastomas of the breast. It usually occurs along the embryonic milk-line; however, unusual cases occurring outside of the embryonic milk-line have also been reported. Although this tumor always shows clinically benign behavior, its variable histological composition can easily be confused with many other fibrous and lipomatous neoplasms. Unfortunately, its radiological findings are extremely rarely described in the literature. Here, we present a rare case of mammary-type myofibroblastoma in a 38-year-old woman who presented with a well-circumscribed solitary mass in the buttock, and discuss various radiologic imaging findings, such as plain radiography, ultrasonography, and magnetic resonance imaging results.

  19. Giant keloid of left buttock treated with post-excisional radiotherapy. (United States)

    Troiano, Michele; Simeone, Anna; Scaramuzzi, Gerardo; Parisi, Salvatore; Guglielmi, Giuseppe


    Keloids are defined as excessive scar tissue formation extending beyond the area of the original skin injury and occurring in predisposed individuals. While no single treatment has proven widely effective, several series report excellent outcomes for keloids with post-surgery radiation therapy as described in the literature. We present a patient with recurrent giant keloid of left buttock after several surgical removals, that at physical examination shows the size of 40×22×10 cm in the largest dimension. Patient underwent a surgical excision of gluteal lesion and postoperative radiotherapy using photons at 8 MV of linear accelerator: the total dose delivered was 22 Gy in 11 days, with a daily fraction of 2 Gy. No relapse was showed at 36 months post-therapy. Several methods seem unsatisfactory for preventing keloid recurrence. The combination of surgery and adjuvant radiotherapy seems an excellent strategy to prevent recurrent disease.

  20. Buttock and back pressure distribution tests on seats of mobile agricultural machinery. (United States)

    Hostens, I; Papajoannou, G; Spaepen, A; Ramon, H


    Multidisciplinary effort is usually required in the evaluation of comfort problems in the working environment of mobile agricultural machinery workers. Comfort can be partly assessed from the study of the pressure distribution of the human-seat interface. Four combine foam seats and a new air-based seat were compared with regards to static buttocks and back support pressures. Within and between subject variability and the issue of measurement repeatability were addressed. Significant differences were found in the maximum pressure profiles of the four seating systems with seats 2 and 3 performing better than seat I (seat 4 showed no significant difference when compared to the other seats). There is an almost linear relationship between mean pressure and body mass index. In all cases the air seating system performed better with regards to the static pressure gradients.

  1. Buttock Reshaping With Intramuscular Gluteal Augmentation in an Asian Ethnic Group: A Six-Year Experience With 130 Patients. (United States)

    Park, Tae Hwan; Whang, Kwi Whan


    Although the definition of what constitutes "beautiful buttocks" has been changing with time, the buttocks are generally perceived as an important element of sexual attraction and beauty in every culture. In Asian culture, "beautiful buttocks" are defined by an aggregate of the following 4 components: S-shaped curvature from the lower back to the buttocks, sufficient muscle volume, sufficient fat volume, and appropriate skin elasticity. The goal of our gluteal augmentation was therefore to restore the back curvature, provide sufficient hip volume (projection), and reposition the point of maximal gluteal projection to be higher than the pubic hair. The purpose of this study was to review the authors' 6-year (2008-2014) experience with intramuscular gluteal augmentation techniques using an oval-shaped smooth-surface silicon elastomer. After intergluteal fusiform incisions were made, we bluntly dissected the subcutaneous tissue deep down to the gluteus maximus muscle by using the xyz method introduced by Dr. Gonzalez. Most of the patients in this case series underwent additional procedures at the time of the gluteal augmentation, whereas 90% of patients underwent concomitant liposuction. The results were assessed objectively using serial photography and subjectively according to patients' assessment on a 5-score scale.The mean rating for patient satisfaction with the procedure was 4.6 of 5, whereas consensus ratings by 2 independent plastic surgeons showed a mean score of 4.2 of 5. The intramuscular gluteal augmentation technique using an oval-shaped smooth surface silicon elastomer resulted in excellent cosmetic outcomes and permitted successful reshaping of the buttocks.

  2. Management of adult patients with buttock and perineal burns: The Ross Tilley Burn Centre experience. (United States)

    Merchant, Nishant; Boudana, David; Willoughby, L; Lin, Jj; Rehou, Sarah; Shahrokhi, Shahriar; Jeschke, Marc G


    Perineal and buttock burns are challenging wounds to heal for several reasons because of the contamination risk and shear stress that is always present. Because of the nature of the wound bed, pathogens can have ready access to create systemic infections and complications. Prolonged healing times also delay the recovery for patients and add to their discomfort and psychological stress from the injury. The ideal treatment approach is not well defined, and the aims of this study were to conduct a literature review of current treatment suggestions and to look at our own patient population to determine how our center treated these challenging patients. This is a retrospective review of all patients treated between 2010 and 2013 at our center. Patients that received care for burns to the perineum or buttocks were evaluated. Mortalities within 24 hours of admission and transfers before completion of their care were excluded. All patients older than 18 years were included in the study. The primary outcome studied was a cause for graft revision. Secondary outcomes included benefits and risks of fecal management devices, risk of infection, and mortality. The literature review did not show consensus on how to best manage this patient population. Our results however demonstrated that patients treated with the fecal management device Flexi-seal (Convatec, Skillman, NJ) were at increased risk of developing an infection involving an enteric pathogen and requiring revision procedures. The patient population that was treated with this device was also older and had larger burns. The patients within this group that were treated initially with allograft required fewer revisions when compared with patients that received autograft in this group (23% vs. 34%, p > 0.05). After our data and the literature had been reviewed, the lack of evidence-based treatment protocols led us to create recommendations for burn surgeons with regard to the initial management of this complicated area

  3. Perforator Flaps after Excision of Large Epidermal Cysts in the Buttocks

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    Sang Wha Kim


    Full Text Available Background Epidermal cysts are commonly occurring masses usually less than 5 cm in diameter, but in predisposed patients, epidermal cysts can grow relatively large due to chronic infection. Methods From June 2002 to July 2010, 17 patients received 19 regional perforator-based island flaps to cover defects due to the excision of large epidermal cysts (diameter >5 cm in the buttocks. Eight patients had diabetes, and seven had rheumatoid arthritis. The pedicles were not fully isolated to prevent spasms or twisting. Results All the flaps survived completely, except for one case with partial necrosis of the flap, which necessitated another perforator-based island flap for coverage. There were two cases of wound dehiscence, which were re-closed after meticulous debridement. There were no recurrences of the masses during follow-up periods of 8.1 months (range, 6-12 months. Conclusions In patients with large epidermal cysts and underlying medical disorders, regional perforator-based island flaps can be the solution to coverage of the defects after excision.

  4. Acute calcific tendinitis of the gluteus medius: an uncommon source for back, buttock, and thigh pain. (United States)

    Paik, Nam Chull


    This study was conducted to describe the imaging features and clinical manifestations in acute calcific tendinitis (CaT) of the gluteus medius muscle (GMe). A retrospective analysis was conducted, aimed at six patients with acute calcific tendinitis of the gluteus medius muscle (CaT-GMe), who were seen between January 2011 and December 2012. Clinical presentations, radiologic data (radiography, CT, and MRI), and laboratory reports were all subject to review. All patients presented with pain and decreased range of motion (ROM) at the hip. Two of the six patients experienced pain in the anterolateral thigh and groin, with antalgic gait (anterior group). The other four complained of low back, buttock, and posterolateral thigh pain, accompanied by difficulty in standing and antalgic gait (posterior group). Edema within the GMe or effusion surrounding the muscle was regularly identified on MRIs. Calcific deposits were conspicuous in the gluteus medius tendon attachments to the lateral (anterior group) and superoposterior (posterior group) facets of the greater trochanter on radiography, CT, or MRI. Complete resolution of symptoms was uniformly achieved in 5-10 days with conservative management. Acute CaT-GMe should be considered in any patient suffering lateral hip pain (with either groin or low back pain) and ROM limitation. Images of the hip characteristically show edema of the gluteus medius and calcifications lateral or superior to the greater trochanter. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. A Case of Giant Squamous Cell Carcinoma of the Buttock Possibly Arose from Syringocystadenoma and Invaded to the Rectum

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    Megumi Nishioka


    Full Text Available We report a rare case of giant squamous cell carcinoma of the buttock infiltrated to the rectum. The tumor may have arisen from syringocystadenoma papilliferum. Since there was no sign of metastasis, radical operation including rectal amputation was performed after successful neoadjuvant therapies. Afterwards, the patient has been alive free from disease for 15 months with no lymph node and distant organ metastasis.

  6. The efficacy of capacitive radio-frequency diathermy in reducing buttock and posterior thigh cellulite measured through the cellulite severity scale. (United States)

    De La Casa Almeida, Maria; Suarez Serrano, Carmen; Medrano Sánchez, Ester Maria; Diaz Mohedo, Esther; Chamorro Moriana, Gema; Rebollo Salas, Manuel


    Cellulite, despite its high prevalence in women, has been subjected to very little research, while the majority has been carried out using unvalidated evaluation tools. To determine the efficacy of capacitive radio-frequency diathermy (CRFD) in reducing buttock and posterior thigh cellulite and to verify its relationship with the reduction of body weight. Design: Experimental clinical study consists of two parallel groups. Totally 54 lower limbs of 27 women (26.41 ± 6.16 years) were considered with each patient's two limbs being assigned one to each group via simple random distribution. First group received local application of CRFD (30 min) and the second received the same treatment followed by a supplementary whole-segment application of CRFD (20 min). Each limb received 20 sessions, twice a week. Cellulite Severity Scale dimensions score, weight and Body Mass Index (BMI) were taken for the evaluation of the study. A significance of p less than 0.01 was observed for all the variables in both groups, thereby demonstrating the effectiveness of both the treatments; no significant differences were observed between groups (p > 0.05). Monopolar static application of CRFD is effective in reducing buttock and posterior thigh cellulite. It appears that there is not necessarily any relationship between weight loss, decreased BMI and reduction in cellulite.

  7. Colocación de implantes glúteos y de cadera: una alternativa para mejorar el contorno en hipoplasia glúteo-trocantérea Placement of buttock and hip implants: an alternative for contour improvement in buttock and hips hypoplasia

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    L. Cárdenas-Camarena


    Full Text Available La mejoría del contorno glúteo y de caderas en un paciente varón que desea un contorno femenino es difícil de conseguir cuando no es posible disponer de una cantidad de grasa suficiente para inyectar y lograr una mejoría integral. Presentamos la técnica quirúrgica utilizada en un paciente transexual masculino que había tenido dos intentos fallidos de feminizar su contorno de glúteos y caderas. Utilizamos implantes ovales de silicona cohesiva, tanto para la región glútea como para las caderas, inyectando grasa en las áreas de transición entre los dos implantes. Con esta combinación obtuvimos un contorno femenino integral, eliminando por completo el aspecto masculino de la región glúteo-trocantérea. En conclusión, pensamos que la combinación empleada supone una opción novedosa y no descrita hasta el momento para el tratamiento de pacientes transexuales que buscan un contorno glúteo más femenino de forma integral, con resultados predecibles y muy gratificantes, que mejora las deficiencias que los pacientes masculinos tienen en esta zona en comparación con el contorno de los glúteos femeninos.Improvement of the gluteal and hip contour in patients seeking a more feminine shape is difficult to achieve, specially for those who don't have enough fat to transfer from other areas of the body. We describe the surgical technique used to improve hips and buttocks contour in a genetic male transsexual. This patient previously underrwent two unsuccessful surgeries to feminize his hip and buttock contour. Our successful approach involved the use of an oval-shaped cohesive silicone gel implants placed in both, the hip and buttock areas, along with fat injection in the areas between the two implants. A natural, feminine contour was achieved using the combination of buttock and hip implants with lipofilling using patient's own fat. These procedures completely eliminated the male contour previously noted in the gluteal trochanteric region

  8. Laser cellulite treatment and laser-assisted lipoplasty of the thighs and buttocks: Combined modalities for single stage contouring of the lower body. (United States)

    Petti, Christine; Stoneburner, Jacqueline; McLaughlin, Laura


    Cellulite and lipodystrophy are often found together, especially in areas of the buttocks and thighs, causing skin surface irregularities. Each of these conditions is currently treated independently as two separate surgical procedures. In our practice, we developed a novel combined approach for the simultaneous treatment of cellulite and lipodystrophy, as a single stage procedure in the same anatomic area. For the treatment of cellulite, we used the Nd:YAG laser at a wavelength of 1,440-nm, along with an innovative 1,000-micron directional side-firing fiber optic laser system. For the treatment of lipodystrophy, the Nd:YAG laser with a 1,440 nm wavelength, along with a fiber optic laser system was used. The objective of this study is to determine the efficacy and safety of a combined approach for the simultaneous treatment of cellulite and lipodystrophy. In 2012, 16 subjects with noticeable cellulite, Grade II and Grade III, accompanied by mild-to-moderate lipodystrophy of the lower body received single treatments of the Nd:YAG laser at a wavelength of 1,440-nm along with the 1,000-micron side-firing fiber optic laser system for simultaneous treatments of both cellulite and lipodystrophy. Patients were assessed at baseline and 3-6 months post-treatment by a modified Nurnberger-Muller scale utilized to quantify the cellulite severity. Additionally, patient satisfaction and a global aesthetic improvement scale were used to measure the improvement in lipodystrophy. Blinded reviewers identified the correct baseline photographs 97% of the time when presented with a set of photographs. The median modified Nurnberger-Muller scale score at baseline was 4.75 ± 1.2 and the average improvement was 2.0 ± 1.2. Global aesthetic improvement scores ranged from 1 to 3 with an average of 1.58 indicating a much-improved overall appearance. Satisfaction was high for both physicians and patients with scores corresponding to extremely satisfied/satisfied. Precise, effective

  9. A Pain in the Buttock

    Directory of Open Access Journals (Sweden)

    Zachary C. Landman


    Full Text Available Spondylolysis, a fracture of the pars interarticularis, is a common source back pain in children and adolescents. While the incidence is significantly higher in Asian and Inuit populations, it is never seen in nonambulatory children and is most commonly associated with athletic activities that involve extension or rotational deformity about the spine suggesting a functional component. Given that the associated pain is typically insidious in onset, lacks preceding trauma, and is accompanied by muscular spasm, prompt diagnosis requires a high index of suspicion, familiarity with provocative testing, and knowledge of the appropriate radiographic evaluation. Treatment requires cessation of athletic activity, bracing, and rest for a minimum of four to six weeks, or until symptomatic and radiographic resolution.

  10. SkIndia Quiz 25: A solitary nodule on the right buttock

    Directory of Open Access Journals (Sweden)

    Reza Yaghoobi


    Full Text Available Granuloma faciale (GF is a benign, chronic inflammatory disorder, characterized by reddish brown plaques with prominent follicular orifices and telangeictasia, usually occurring over the face. The condition often presents a problem in differential diagnosis. Herein we describe a case of GF with an unusual diascopic finding of an apple jelly appearance on diascopy.

  11. Asynchronous abdomino-parasacral resection of a giant pelvic lipoma protruding to the left buttock

    Directory of Open Access Journals (Sweden)

    Masanori Sato


    CONCLUSION: The asynchronous abdomino-parasacral approach with several turnings of the patient's body and plastic bag packing of the tumor were advantageous to manage en bloc resection of the giant pelvic lipoma presented in this case study.

  12. Sensitivity of the human back and buttocks: The missing link in comfort seat design. (United States)

    Vink, Peter; Lips, Daan


    The purpose of this study is to examine the differences in pressure sensitivity for areas of the human body in contact with the seat pan and backrest of a vehicle seat. These could provide a theoretical base for adapting the softness of the foam or the flexibility components used in seat design. Sensitivity was recorded at 32 points touching the seat pan and backrest by pushing a cylinder with a diameter of 20 mm into the seat until the participant reported that they were no longer comfortable. The force at which discomfort was reported was recorded using an advanced force gauge. The area of the body having contact with the front of the seat pan was more sensitive than the rest of those parts touching the seat pan. The area of the seat touching the shoulders was significantly more sensitive than the area in between the shoulders and lower down the back. Translating these findings directly into seat design should be done with care. Tests are still needed to confirm the assumed relationship between sensitivity and foam softness. Further information is also needed regarding the complete use of a seat, including analysis of vibrations while driving and comfort during ingress and egress. Copyright © 2016. Published by Elsevier Ltd.

  13. Biomechanics Analysis of Pressure Ulcer Using Damaged Interface Model between Bone and Muscle in the Human Buttock (United States)

    Slamet, Samuel Susanto; Takano, Naoki; Tanabe, Yoshiyuki; Hatano, Asako; Nagasao, Tomohisa

    This paper aims at building up a computational procedure to study the bio-mechanism of pressure ulcer using the finite element method. Pressure ulcer is a disease that occurs in the human body after 2 hours of continuous external force. In the very early stage of pressure ulcer, it is found that the tissues inside the body are damaged, even though skin surface looks normal. This study assumes that tension and/or shear strain will cause damage to loose fibril tissue between the bone and muscle and that propagation of damaged area will lead to fatal stage. Analysis was performed using the finite element method by modeling the damaged fibril tissue as a cutout. By varying the loading directions and watching both tensile and shear strains, the risk of fibril tissue damage and propagation of the damaged area is discussed, which may give new insight for the careful nursing for patients, particularly after surgical treatment. It was found that the pressure ulcer could reoccur for a surgical flap treatment. The bone cut and surgical flap surgery is not perfect to prevent the bone-muscle interfacial damage.

  14. Can physique and gluteal size predict penile length in adult ...

    African Journals Online (AJOL)

    tribe, there is a well-held belief that a man's penile size can be predicted from his physique and the size of his buttocks, with people of small physique and flat buttocks likely to have long penile lengths. Study design: A prospective study to test the scientific veracity of this traditional and apparently mythical belief. Stretched ...

  15. Can physique and gluteal size predict penile length in adult ...

    African Journals Online (AJOL)

    Background: In Nigeria, especially among the Igbo tribe, there is a well-held belief that a man's penile size can be predicted from his physique and the size of his buttocks, with people of small physique and flat buttocks likely to have long penile lengths. Study design: A prospective study to test the scientific veracity of this ...

  16. Phacomatosis pigmentopigmentalis: aberrant Mongolian spots and segmental café au lait macules. (United States)

    Wolf, Ronni; Wolf, Danny; Davidovici, Batya


    We report a case of an otherwise healthy male newborn, with segmental café au lait spots on his left buttocks and left thigh down to the medial knee, in a nevoid pattern, and an aberrant Mongolian spot on the ipsilateral cheek of the buttocks in a checkerboard pattern. We propose the name phacomatosis pigmentopigmentalis in analogy to phacomatosis pigmentovascularis, and phacomatosis pigmentokeratotica.

  17. Calfiness

    National Research Council Canada - National Science Library

    Jan Gondowicz


    .... In this ironic lecture a calf plays as important role as buttocks (stuck to the face) – it is a symbol of seductive youth and, to a considerable degree, of an unaware, but intuitive infantility...

  18. Vitiligo (United States)

    ... may consider surgical treatment of vitiligo. Avoid surgical treatment if one scars abnormally or sometimes have lost pigment after a ... buttocks are often used) is often left with scarring. The treated area responds almost 90% of the time, but ...

  19. Diagnosis of High Blood Pressure

    Medline Plus

    Full Text Available ... with this condition, such as coronary heart disease, stroke, or kidney disease. Signs, Symptoms, and Complications Because ... feet, and buttocks after walking or climbing stairs. Stroke : When the flow of oxygen-rich blood to ...

  20. Ischiogluteal bursitis: an uncommon type of bursitis

    Energy Technology Data Exchange (ETDEWEB)

    Van Mieghem, Isabelle M.; Boets, An; Sciot, Raf; Van Breuseghem, Iwan [Department of Radiology, University Hospitals, Catholic University Leuven, Leuven (Belgium)


    Ischiogluteal bursitis is a rare, infrequently recognized soft tissue mass of the buttock region. Of importance is the radiological differential diagnosis with other benign and malignant soft-tissue tumors. We describe the imaging findings of bursitis. (orig.)

  1. Strongyloides stercoralis-hyperinfectie bij een harttransplantatiepatiënt

    NARCIS (Netherlands)

    Aalfs, A.S.; Van Hattem, S.; Schuttelaar, M.L.A.


    A heart transplantation patient with asymptomatic reticular petechiae and purpura on thighs and buttocks is described. Gastrointestinal manifestations preceded the skin manifestations. The symptoms were caused by a Strongyloides stercoralis hyperinfection, transmitted to the patient via the donor

  2. The prevalence of skin scars in patients previously given ...

    African Journals Online (AJOL)


    SA), sees patients with various forms of chronic pain, most commonly back pain. Treating patients with low back pain often includes exposure of the patient's buttocks. Doctors in the clinic have occasionally noted disfiguring ...

  3. Sacroiliac joint pain - aftercare (United States)

    ... between the bones. Trauma from impact, such as landing hard on buttocks. History of pelvic fractures or ... take more than the amount recommended on the bottle or by your provider. If this is a ...

  4. Chemotherapy Improved Prognosis of Mesenchymal Chondrosarcoma with Rare Metastasis to the Pancreas

    National Research Council Canada - National Science Library

    Tsukamoto, Shinji; Honoki, Kanya; Kido, Akira; Fujii, Hiromasa; Enomoto, Yasunori; Ohbayashi, Chiho; Tanaka, Yasuhito


    .... The therapeutic effectiveness of chemotherapy remains uncertain. We report a 39-year-old man with extraskeletal mesenchymal chondrosarcoma of the buttock, who had metastases to the pancreas, bones, and lung...

  5. Chemotherapy improved prognosis of mesenchymal chondrosarcoma with rare metastasis to the pancreas

    National Research Council Canada - National Science Library

    Tsukamoto, Shinji; Honoki, Kanya; Kido, Akira; Fujii, Hiromasa; Enomoto, Yasunori; Ohbayashi, Chiho; Tanaka, Yasuhito


    .... The therapeutic effectiveness of chemotherapy remains uncertain. We report a 39-year-old man with extraskeletal mesenchymal chondrosarcoma of the buttock, who had metastases to the pancreas, bones, and lung...

  6. Diagnosis of High Blood Pressure

    Medline Plus

    Full Text Available ... breathing; feeling tired; and swelling in the ankles, feet, legs, abdomen, and veins in the neck. Peripheral ... cramping, numbness, aching, or heaviness in the legs, feet, and buttocks after walking or climbing stairs. Stroke : ...

  7. [Semiology for gluteal remodeling by lipofilling]. (United States)

    Ho Quoc, C; Mojallal, A


    Gluteal augmentation is a consultation request for many patients. The most common surgical techniques performed for gluteal augmentation employ gluteal implants. However, the results can be frustrating. Liposuction is one of the most common surgical procedures in aesthetic surgery. This surgical procedure can provide some complications. Fat grafting is an effective and predictable way to remodel the buttocks. To get better results, it's important to understand gluteal compartments with a descriptive study. The aim of this study is to describe gluteal semiology for buttocks remodeling with fat grafting. We have described gluteal semiology with our review of literature. We have analyzed fat compartments of gluteal region: volume, links between every compartments, connections with major gluteal muscle and with the skin. We have also analyzed shape and volume of the buttocks. We have described 11 aesthetic subunits, the volume and the shape of the buttocks, and the skin laxity. We did an important literature review to understand the most important gluteal zones to improve for patients' satisfaction. Our gluteal semiology description is very useful to understand liposuction/lipoinjection of gluteal areas. Fat grafting may be a reliable technique, simple and safe procedure. Surgery for correction of the buttocks may involve more than projection and volume. However, these must be in a balanced proportion with the rest of the body. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  8. A bipolar radiofrequency, infrared, vacuum and mechanical massage device for treatment of cellulite: a pilot study. (United States)

    Hexsel, Doris M; Siega, Carolina; Schilling-Souza, Juliana; Porto, Manoela D; Rodrigues, Ticiana C


    Cellulite has a complex and multifactorial etiology. Synergistic action on treating cellulite has gained support in the treatment of cellulite. This study evaluated safety and efficacy of a bipolar radiofrequency, infrared, vacuum and mechanical massage device for cellulite treatment and reduction of body measures. This was a pilot study, which assessed 9 subjects who presented body mass index from 18 to 25 Kg/Kg and at least grade 6 in the Cellulite Severity Scale (CSS). All subjects underwent a 12-session treatment of posterior thighs and buttocks. There was a significant reduction of the hip circumference (p = 0.001), however, no changes in thigh circumferences were observed (p = 0.4). CSS has improved specifically on both buttocks [p = 0.002 (left side) and p = 0.038 (right side)], and no changes were observed on thighs. The studied device demonstrated efficacy in the reduction of cellulite severity and body circumference measures in the buttocks.

  9. Fat transfer and fatal macroembolization. (United States)

    Astarita, Denis C; Scheinin, Lisa A; Sathyavagiswaran, Lakshmanan


    Fat embolism is usually associated with long bone fractures or other trauma. The diagnosis is usually clinical, and in most cases, emboli are not fatal and not usually seen on gross examination. At the Los Angeles County Coroner's Office, we autopsied the victim of fatal macroscopic fat embolization to the lungs. The patient died during buttock enhancement surgery when fat from liposuction was injected into her buttocks. Fat embolism from liposuction and fat injection is reportedly rare, and macroscopic embolization is rarer still. Varicose veins can occur in the area of the sciatic notch and are known to cause painful sciatica symptoms. We suggest them as a potential conduit for macroscopic fat to reach the lungs. Simple pre-operative questioning for sciatica symptoms and possible radiologic study to rule out sciatic varices seem prudent before undertaking buttock-enhancing surgery. Careful fat injection with pre-aspiration is always advised. © 2015 American Academy of Forensic Sciences.

  10. Sacral stress fractures in athletes. (United States)

    McFarland, E G; Giangarra, C


    Low back and buttock pain in runners can be a source of frustration for the athlete and a diagnostic dilemma for the physician. The authors reported on 3 cases of sacral stress fractures in women athletes, all of which initially presented as low back and/or buttock pain. Sacral stress fractures have been increasingly recognized as a potential cause of these symptoms, especially in young athletes. Because plain radiograph findings are typically normal, the diagnosis is best made with bone scintigraphy. Computed tomography is indicated if there is concern about neoplasm and to evaluate healing of the fracture. If treated with rest, most of these fractures heal and the athlete can return to previous sports activity. The treating physician should be suspicious of this injury among running athletes reporting sacral and buttock pain that does not respond to treatment.

  11. Can physique and gluteal size predict penile length in adult Nigerian men? (United States)

    Orakwe, J C; Ogbuagu, B O; Ebuh, G U


    In Nigeria, especially among the Igbo tribe, there is a well-held belief that a man's penile size can be predicted from his physique and the size of his buttocks, with people of small physique and flat buttocks likely to have long penile lengths. A prospective study to test the scientific veracity of this traditional and apparently mythical belief. Stretched penile length was measured in 115 men between the ages of 30-65 years and its correlation with the body-mass index and the circumference of the hip as measured around the most prominent points on their buttocks, was statistically determined. The mean age of the subjects was 42.30 years (SD = 9.67), with a median of 40 years and a range of 30-65 years. The mean penile length was 13.37 cm with a median of 13 cm and a range of 7.5-19.5 cm. The mean circumference of the body around the buttocks was 96.46 cm (SD = 10.91), median 98 cm, and range 73-122 cm. The body-mass index ranged 17.34-44.44, with the mean at 26.87 (SD = 5.86), and the median 25.53. Linear regression statistics showed no statistically significant correlation between stretched penile length and body-mass index, thus physique. There was a significant direct correlation between penile length and gluteal size. The supposed relationship between penile length and gluteal size may have a scientific basis, but contrary to belief, large buttocks is more predictive of longer penile length than small buttocks. Penile length has no relationship to physique.

  12. Obturator Internus and Obturator Externus Strain in a High School Quarterback. (United States)

    Khodaee, Morteza; Jones, Daniel; Spittler, Jack


    Buttock pain is a relatively common complaint among adolescent athletes and can have a very broad differential diagnosis. The authors present a previously unreported case of acute obturator internus and obturator externus strain in an adolescent male American football player. The diagnosis was made by MRI. The patient was treated with relative rest, physical therapy, and gradual return to physical activities as tolerated. Despite rarity of the hip external rotator muscles strains, it should be considered in the differential diagnosis of athletes with proximal posterior thigh and buttock pain.

  13. Nicolau Syndrome after Intramuscular Injection: 3 Cases

    Directory of Open Access Journals (Sweden)

    Seok-Kwun Kim


    Full Text Available Nicolau syndrome is a rare complication of intramuscular injection consisting of ischemic necrosis of skin, soft tissue, and muscular tissue that arises locoregionally. The characteristic pattern is pain around the injection site, developing into erythema, a livedoid dermatitis patch, and necrosis of the skin, subcutaneous fat, and muscle tissue. Three patients were injected with drugs (diclofenac sodium, ketoprofen, meperidine for pain relief. Three patients complained of pain, and a skin lesion was observed, after which necrosis developed on their buttocks. Each patient underwent debridement and coverage. The wound healed uneventfully. We report three cases of Nicolau syndrome in the buttocks following diclofenac intramuscular injection.

  14. A disappearing neonatal skin lesion.

    LENUS (Irish Health Repository)

    Hawkes, Colin Patrick


    A preterm baby girl was noted at birth to have a firm, raised, non-tender skin lesion located over her right hip. She developed three similar smaller lesions on her ear, buttock and right knee. All lesions had resolved by 2 months of age.

  15. Unusual Bones Articulating With the Pelvic Girdle

    African Journals Online (AJOL)

    Buttock pain is commonly traced to low back conditions. (1, 2). Few local conditions offer differential diagnosis in an otherwise healthy individual. These include gluteal abscess and sciatic entrapment neuropathy (1,2). Symp- tomatic accessory girdle bones have been described for the pectoral girdle but none for the pelvis ...

  16. Approach to lower back pain

    African Journals Online (AJOL)

    Alternating buttock pain. • Pain with associated early morning stiffness lasting >1 hour. • Pain not relieved by rest. • Pain improving with exercise or activity ... assessing gross bone density, disc and vertebral body height and alignment. These should include a view of the pelvis. The characteristic radiographic feature of IBP is ...

  17. Avulsion fractures of the pelvis

    African Journals Online (AJOL)

    ting or moving on the involved tuberosity.13. With physical examination, tenderness at the ischial tuberosity is found, but is often diffuse because the injured muscle lies deep beneath thick layers of adipose tissue and the belly of the gluteus maximus muscle.6 There may be some swelling of the buttocks. Lesser trochanter of ...

  18. Pressure Relief Behaviors and Weight Shifting Activities to Prevent Pressure Ulcers in Persons with SCI (United States)


    15. SUBJECT TERMS Pressure ulcer; spinal cord injury, wheelchair seating 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF...8 Inventions , patent applications, and/or licenses...relationship between activities that redistribute weight on the buttocks and the occurrence of pressure ulcers. 2. Keywords Wheelchair , wheelchair

  19. 75 FR 38066 - Airworthiness Directives; The Boeing Company Model 727, 727C, 727-100, 727-100C, 727-200, and 727... (United States)


    ... 0.75 inch to 11.8 inches in length at the buttock line 61, between water line (WL) 220 and WL 228. The cracks originated at the hydraulic line support brackets, which were installed in production after... receipt. FOR FURTHER INFORMATION CONTACT: Berhane Alazar, Aerospace Engineer, Airframe Branch, ANM-120S...

  20. H.R. Breukink and N.H. Casey*

    African Journals Online (AJOL)

    The possible upgrading of meat of mature does to an acceptable product through processing was investigated using chemical, physical and sensory evaluation techniques. Twelve goat does (six-tooth) were slaughtered and processed into vienna sausages and cured and smoked buttocks. These were compared with ...

  1. Multicentric extra-abdominal desmoid tumors arising in bilateral lower limbs

    Directory of Open Access Journals (Sweden)

    Nobuhiro Fukushima


    Full Text Available Extra-abdominal desmoid tumors preferentially affect the shoulders, arms, backs, buttocks, and thighs of young adults. Multicentric occurrence is rather rare but seems to be another distinctive feature of extra-abdominal desmoid tumors. In this article we report a rare case of multicentric extra-abdominal desmoid tumors arising in bilateral lower limbs.

  2. on eland (taurotragus oryx)

    African Journals Online (AJOL)

    viscera, kidneys, kidney fat, and heads including tongue and horns. The carcasses were split medially and the left side measured to obtain length of carcass and length and circumferences of buttock whereas surface area of the eye muscle (M. longissimus dorsi)was traced between the last thoracic and first lumbar vertebra.

  3. Incidence of dog bite injuries and clinical rabies in a tertiary health ...

    African Journals Online (AJOL)

    ... ratio of 4.8:1, lower limb/buttock injuries were significantly higher in children than adults, but the adults sustained significantly more severe (type III) injury. The majority of dog bite injuries were washed with soap and irrigated with water or saline and 87.7% of the victim of dog bite received postexposure anti-rabies vaccine.

  4. Radiographic Prevalence of Femoroacetabular Impingement in a Young Population with Hip Complaints Is High (United States)


    9 codes associated with hip complaints Diagnosis ICD-9 code Diagnosis ICD-9 code Hip, pelvic pain 719.45 Bursitis buttock, trochanter, hip 726.5...719.6 Nonallopathic lesions, not elsewhere classified 739.5 Other bursitis NOS 727.3 Sprain strain hip thigh NOS 843.9 Iliofemoral ligament sprain

  5. Obturator Internus and Obturator Externus Strain in a High School Quarterback


    Khodaee; Jones, Van; Spittler


    Introduction Buttock pain is a relatively common complaint among adolescent athletes and can have a very broad differential diagnosis. Case Presentation The authors present a previously unreported case of acute obturator internus and obturator externus strain in an adolescent male American football player. The diagnosis was made by MRI. The patient was treated with relative rest, physical therapy, and gradual return to physical ac...

  6. Recidiverende, jeukende en zich verplaatsende huidafwijkingen bij (voormalige) tropenreizigers: strongyloidiasis

    NARCIS (Netherlands)

    Buikhuisen, W. A.; Wetsteyn, J. C. F. M.; van Gool, T.; Kager, P. A.


    Two patients, a woman aged 24 and a man aged 86, had suffered from recurrent, itchy, linear, creeping skin lesions, notably on the thighs, buttocks and lower abdomen, for 9 months and more than 50 years, respectively. The woman had been in South America, and the man had worked on the Burma railway

  7. Penile gangrene due to calcific uremic arteriopathy | Bappa | Annals ...

    African Journals Online (AJOL)

    Calcific uremic arteriopathy (CUA) is a rare but potentially life-threatening complication of end-stage renal disease (ESRD) and secondary hyperparathyroidism. It typically presents with ischemic necrosis involving areas of adiposity in the body mainly the trunk, buttocks, or proximal extremity. Patients can also present with ...

  8. Cellulite: a review with a focus on subcision. (United States)

    Friedmann, Daniel P; Vick, Garrett Lane; Mishra, Vineet


    Cellulite is an alteration in skin topography most often found on the buttocks and posterolateral thighs of the majority of postpubertal females. This article aims to review the background, potential pathophysiology, and potential treatment options for cellulite, highlighting subcision as an ideal therapeutic option for this cosmetically distressing condition.

  9. Side-by-side comparison of areas with and without cellulite depressions using magnetic resonance imaging. (United States)

    Hexsel, Doris Maria; Abreu, Marcelo; Rodrigues, Ticiana C; Soirefmann, Mariana; do Prado, Débora Zechmeister; Gamboa, Maryelle Moreira Lima


    Cellulite is characterized by alterations in the relief of the skin surface. Magnetic resonance imaging (MRI) is recognized as a reliable technique for measuring adipose volume according to body site and for the visualization of the subcutaneous structures. To compare subcutaneous tissue in areas with and without cellulite on the buttocks of same subjects using a noninvasive technique. Thirty female patients with cellulite on the buttocks underwent MRI. An area with cellulite and another without cellulite on the contralateral buttock were selected. Two soft gelatin capsules of different sizes were used as skin markers to differentiate the areas with and without cellulite. Fibrous septa were visualized in 96.7% of the area with cellulite depressions; most of them were ramified (73.3%) and presented a high-intensity signal on T2 images (70%). All fibrous septa found in the examined areas were perpendicular to the skin surface. The average fibrous septa thickness was 2.18 +/- 0.89 in the area with cellulite and 0.27 +/- 0.64 in the area without cellulite. Results of the MRI analysis showed that cellulite depressions on the buttocks were significantly associated with the presence of underlying fibrous septa.

  10. Human Decompression Trial With 1.3 ATA Oxygen in Helium (United States)


    reported a "shooting pain" and paresthesia down his right buttock and leg during a right Babinski ; Babinski was downgoing bilaterally. Diver reported...found. A borderline Babinski was noted in his right foot, but it may have existed prior to the dive and was not considered by the Neurology staff to

  11. Successful surgical separation of conjoined twins: First experience ...

    African Journals Online (AJOL)

    Conjoined twins are identical or monozygotic twins whose bodies are joined in utero. Pygopagus or Iliopagus twins are a type of conjoined twins in which two bodies joined back to back at the buttocks. Surgical Separation of conjoined twins is extremely risk of death and life threatening. Female pygopagus twins of three ...


    African Journals Online (AJOL)


    Abstract. Background: Pyomyositis is a suppurative disease of skeletal Muscle and a well-known disease with ... loss of function of the limb or swelling of the affected ... adductors). 24 (38.7) calf muscles. 13 (21.0). Buttocks (glutei). 8 (12.9). Trunks anterior abdominal muscles. 4 (6.5) latissimus dorsi. 2 (3.2). Shoulder girdle.

  13. Lupus vulgaris of external nose. (United States)

    Bhandary, Satheesh Kumar; Ranganna, B Usha


    Lupus vulgaris is the commonest form of cutaneous tuberculosis which commonly involve trunk and buttocks. Lupus vulgaris affecting nose and face, are rarely reported in India. This study reports an unusual case of lupus vulgaris involving the external nose that showed dramatic outcome after six months of anti- tubercular treatment.

  14. Tailhook 91. Part 2. Events at the 35th Annual Tailhook Symposium (United States)


    ceremony. FlaoL anel The major event of the Tailhook 󈨟 symposium convened following the luncheon. The Flag Panel is one of the truly unique aspects of...member who laid on the floor, at least once, if not twice, holding money in his mouth and touching the stripper’s buttocks and vaginal area as she

  15. A Chronic Disseminated Dermatophytosis Due to Trichophyton violaceum

    NARCIS (Netherlands)

    Zhan, Ping; Li, Zhi-Hua; Geng, Chengfang; Jiang, Qing; Jin, Yun; Dolatabadi, S.; Liu, Weida; de Hoog, G Sybren

    A 48-year-old female had presented dandruff and breakable hair for more than 40 years, dry scaly erythema on bilateral palms and feet accompanying with nail destruction for 20 years, and scaling papules on the buttock for 5 years. Direct microscopic examination showed endothrix anthroconidia within

  16. Internal Oblique and Transversus Abdominis Muscle Fatigue Induced by Slumped Sitting Posture after 1 Hour of Sitting in Office Workers

    Directory of Open Access Journals (Sweden)

    Pooriput Waongenngarm


    Conclusion: Prolonged sitting led to increased body discomfort in the neck, shoulder, upper back, low back, and buttock. No sign of trunk muscle fatigue was detected over 1 hour of sitting in the upright and forward leaning postures. Prolonged slumped sitting may relate to IO/TrA muscle fatigue, which may compromise the stability of the spine, making it susceptible to injury.

  17. Factors associated with high cholesterol levels among adults in ...

    African Journals Online (AJOL)


    Finder Tape Measure. The tape measure was wrapped around the waist between the inferior margin of the last rib and the crest of the ilium directly over the skin or light clothing. Using the same tape measure, the hip circumference was measured at the maximum circumference over the buttocks and recorded in centimeters.

  18. The baboon syndrome

    DEFF Research Database (Denmark)

    Andersen, Klaus Ejner; Hjorth, N; Menné, T


    The catchword "baboon syndrome" is used to denote a characteristic distribution pattern of systemic allergic contact dermatitis. Diffuse erythema of the buttocks, upper inner surface of the thighs, and axillae are characteristic features. We describe 3 cases provoked by ampicillin, nickel...

  19. Herpangina (United States)

    ... Ulcers in the mouth and throat, and similar sores on the feet, hands, and buttocks The ulcers most often have a white to whitish-gray base and a red border. They may be very painful. In most cases, there are only a few sores.

  20. Case report

    African Journals Online (AJOL)



    Mar 24, 2016 ... muscle pain, with a slight fatigue and there was no personal or family history of connective tissue disease. Examination revealed a pink liliace periocular erythro edema of the face (Figure 1), pruritic papules on the dorsal hands, elbows and a purplish erythema of the buttocks (Figure 2), the external surface ...

  1. December 2005. 29 Use of Vaginal Speculums in Lower Rectal an

    African Journals Online (AJOL)



    Dec 2, 2005 ... dermatological problems (including pruritic changes), abscess, fistula, scar, and deformity. Pain upon spreading the buttocks may indicate the presence of ... East and Central African Journal of Surgery Volume 10 Number 2 – December 2005. 31. Fig. 3. The left lateral subcutaneous internal sphincterotomy.

  2. a note on condition indices for adult male impala, aepycero-s

    African Journals Online (AJOL)

    Citeria of condition are discused and defined. Thirty-eight condition indices taken from nine adult male impala were tested lor linear correlation with condition and total body fat. lndices derived from the complete disection of a buttock proved to be the most reliable, but as the kidney fat index was also reliable, and ...

  3. Effets d'une suppléance perceptive visuelle, auditive et tactile sur le contrôle des pressions fessières en position assise


    Chenu, Olivier; Cuisinier, Rémy; Pinsault, Nicolas; Demongeot, Jacques; Payan, Yohan; Vuillerme, Nicolas


    This article presents a study on different informative modalities of a percecptual supplementation device aiming at reducing overpressure at the buttock area. Visual, audio and tactile modalities are analysed and compared with a non-biofeedback session. In conclusion, modalities have a positive and equal effect, but they are not equally judged in term of comfort and disturbance with some other activities

  4. Mothers Knowledge and Home Management ofNappy Rash in Port ...

    African Journals Online (AJOL)



    Oct 10, 2006 ... Level of education significantly affected type of diaper used. (P=0.002). Baby's diaper was changed 3 ... skin rashes in the diaper area that are caused by various skin disorders and/or irritants[1,2]. It is the most ... surfaces in close contact with the diaper, including the buttocks, genitalia, lower abdomen, and ...

  5. Maximizing aesthetics in lateral-tension abdominoplasty and body lifts. (United States)

    Lockwood, Ted E


    The high-lateral-tension abdominoplasty addresses the practical and theoretic faults of standard abdominoplasty design. Key features include limited direct undermining, increased lateral skin resection with highest-tension wound closure along lateral limbs, two-layer superficial fascial system repair, and significant truncal liposuction when needed. The high-lateral-tension design limits the unfavorable features of standard abdominoplasty and produces balanced natural aesthetic contours. The high-lateral-tension abdominoplasty is the foundation for treatment of more generalized relaxation problems in the circumferential trunk and thighs. For more significant thigh laxity and buttock ptosis, the lateral-tension abdominoplasty is combined with the transverse thigh/buttock lift to produce the lower body lift #2.

  6. [Veins and cellulitis]. (United States)

    Vilain, R


    There is no relation between what French women call "cellulitis" and the venous problems of genetic origin. It may be that cellulitis is the name given to those extra kilos, to mild obesity, to fatty deposits on the thighs and buttocks (sub-trochanteric and crural steatomeries: "jodhpurs"); the point is that cellulitis is apparent, either immediately or on pinching the skin, as an orange-peel pitting. This problem exteriorises the lobular structure of the surface fat. This derives from excessively large lobules, cutaneous relaxation, or excessive pressure on the walls separating the lobules into compartments. Slimming reduces the large areas of deposit at the base of the buttocks. Musculation of the thighs can improve their appearance. More people think they have cellulitis than are really afflicted with it; this is just one of the many deceptions associated with it.

  7. Monte Carlo dose reconstruction in case of a radiological accident: application to the accident in Chile in December 2005; Reconstitution de dose par calcul Monte Carlo en cas d'accident radiologique: application a l'accident du Chili de decembre 2005

    Energy Technology Data Exchange (ETDEWEB)

    Huet, C.; Clairand, I.; Trompier, F.; Bottollier-Depois, J.F. [Institut de Radioprotection et de Surete Nucleaire (IRSN), Dir. de la Radioprotection de l' Homme, 92 - Fontenay aux Roses (France); Bey, E. [Hopital d' Instruction des Armees Percy, 92 - Clamart (France)


    Following a radiological accident caused by a gamma-graphy source in Chile in December 2005 involving one victim, I.R.S.N. was contacted to perform the dosimetric reconstruction of the accident using numerical simulation. Tools developed in the laboratory, associating anthropomorphic mathematic or voxel phantoms with the Monte Carlo calculation code m.c.n.p.x., were used in order to determine the dose distribution on the left buttock and absorbed doses to critical organs. The dosimetric mapping show that the absorbed at the skin surface is very high (1900 Gy) but drops rapidly at deep. At a depth of 5 cm, it is 20 Gy. Calculations performed with a mathematical phantom indicate that average doses to the critical organs are relatively low. Moreover, possible bone marrow sites for puncture are identified. Based on the dosimetric mapping, an excision measuring 5 cm in depth by 10 cm in diameter was performed on the left buttock of the victim. (authors)

  8. Skin reactions after photodynamic therapy are unaffected by 839 nm photobiomodulation therapy

    DEFF Research Database (Denmark)

    Bay, Christiane; Vissing, Anne-Cathrine; Thaysen-Petersen, Daniel


    BACKGROUND AND OBJECTIVE: Photodynamic therapy (PDT) is associated with erythema and edema. Photobiomodulation (PBM) therapy may stimulate the skin recovery process. We investigated the potential of PBM to reduce PDT-induced skin reactions. STUDY DESIGN AND METHODS: Healthy volunteers (n = 20) were...... randomized to receive left- or right side PBM (near-infrared 839/595 nm) or placebo-PBM (595 nm) on their buttocks. Corresponding test areas were exposed to standardized PDT reactions, using ablative fractional laser-assisted PDT (AFXL-PDT) with methyl-aminolevulinate (MAL) incubated for 30, 90, and 180...... minutes before red-light illumination. Each buttock received PBM and placebo-PBM for five consecutive days, starting one day before PDT interventions. Follow-up visits were performed 4 and 11 days after PDT. Outcome measure included blinded, observer-assessed skin reactions, substantiated by objectively...

  9. An interesting uncommon side effect of topical corticosteroids-hidradenitis suppurativa

    Directory of Open Access Journals (Sweden)

    Yugandar Inakanti


    Full Text Available There are many local and systemic side-effects of topical corticosteroids. To the best of our Knowledge, Hidradenitis Supportive (HS due to topical corticosteroids has not been reported previously. We report a 39-year old, male patient who started himself a topical corticosteroid Pander Plus cream because of itching, scaly lesions over groins and buttocks since 6 months. After 4 months of topical treatment, he developed pus discharging sinuses over both groins and buttocks. Based on patient history, clinical and laboratory findings and the exclusion of other diagnoses, HS points out the use of topical corticosteroids. The case well highlights this unusual condition and represents the first case reported in India to our best of the knowledge. Having performed thorough literature search I would like to discuss in this report the evidence for this relation and stress the importance of appropriate usage of topical corticosteroids.

  10. Recognizing and treating toilet-seat contact dermatitis in children. (United States)

    Litvinov, Ivan V; Sugathan, Paramoo; Cohen, Bernard A


    Toilet-seat contact dermatitis is a common condition around the world and is reemerging in the United States. It can be easily recognized and treated. However, few practitioners consider this diagnosis, which results in a delay in treatment and often exacerbation of the skin eruption. In the past, exposure to wooden toilet seats and associated varnish, lacquers, and paints led to the development of an allergic contact dermatitis on the buttocks and posterior thighs. In recent years, most public facilities have changed to plastic seats, resulting in a change in the clinical presentation of toilet-seat dermatitis. We present 5 cases of toilet-seat dermatitis in children from the United States and India and review the history, presentation, and clinical course of the disease. Our findings suggest that toilet-seat dermatitis is more common than previously recognized and should be considered in any child with a dermatitis that involves the buttocks and posterior thighs.

  11. Sacral Fatigue Fracture in an Amateur Soccer Player

    Directory of Open Access Journals (Sweden)

    Georgios Tzoanos


    Full Text Available Sacral fatigue fractures represent a frequently overlooked cause of low-back and buttock pain in athletes. A high index of clinical suspicion and MRI utilization can provide the accurate diagnosis. A 38-year-old male amateur, midfielder, soccer player presented to our department with aggravating right buttock pain during the previous month, following an increase in training intensity and frequency on an artificial turf field. A point of maximal tenderness was demonstrated over the area of the right sacroiliac joint. No radiographic abnormalities were observed. MRI of the pelvis revealed the presence of a stress fracture in the right sacral ala. The patient underwent conservative treatment and resumed playing soccer 12 weeks later, with no residual or recurrent clinical complaints. Apart from the recent change in training regimen, decreased shock absorption related to the physical properties of old generation artificial turf may have also been involved in this case.

  12. The measurement of constitutive and facultative skin pigmentation and estimation of sun exposure in Caucasians with basal cell carcinoma and cutaneous malignant melanoma

    DEFF Research Database (Denmark)

    Lock-Andersen, J; Drzewiecki, K T; Wulf, H C


    In two identical and simultaneously performed case-control studies of basal cell carcinoma (BCC) and cutaneous malignant melanoma (CMM) with age-matched, sex-matched and residence-matched controls, skin pigmentation was measured objectively by skin reflectance spectroscopy in 145 BCC patients...... and 174 matched controls and in 168 CMM patients and 176 matched controls. Measurements were performed at the forehead, the upper chest, the upper back, the lateral and medial aspects of the upper arm, and the buttocks. Self-estimation of sun exposure in childhood, in youth and in adulthood was performed...... by all subjects. There were no statistically significant differences in constitutive skin pigmentation at the buttocks between BCC patients and controls (P = 0.96) or between CMM patients and controls (P = 0.13). Facultative skin pigmentation in ultraviolet-exposed sites was not significantly different...

  13. Dedifferentiated parosteal osteosarcoma with well-differentiated metastases

    Energy Technology Data Exchange (ETDEWEB)

    Takeuchi, Katsuhito; Morii, Takeshi; Yabe, Hiroo; Morioka, Hideo; Toyama, Yoshiaki [Keio University, School of Medicine, Department of Orthopaedic Surgery, Shinjuku-ku, Tokyo (Japan); Mukai, Makio [Keio University, School of Medicine, Division of Diagnostic Pathology, Shinjuku-ku, Tokyo (Japan)


    Metastases of dedifferentiated sarcoma usually contain a dedifferentiated component. We report a rare case of dedifferentiated parosteal osteosarcoma (dd-POS) with well-differentiated multiple metastases in a 65-year-old woman with a painful firm mass on her thigh. Radiological examination revealed that the mass arose from the surface of her femur without medullary involvement. Multiple intramuscular metastases were detected in her lower leg on MR imaging. Small subcutaneous palpable masses were identified on her left lower leg, buttock, chest wall and head. An open biopsy and above-the-knee amputation were performed, and the mass on her femur was diagnosed as a dd-POS. However, histological examination on the subcutaneous lesions in her lower leg, buttock and head showed low-grade conventional POS without dedifferentiated components. To the best of our knowledge, this is the first report of a dd-POS with multiple metastases that do not contain any dedifferentiated components. (orig.)

  14. Assessment of Aeromedical Evacuation Transport Patient Outcomes With and Without Cabin Altitude Restriction (United States)


    patients. Near-infrared spectroscopy was used to monitor cerebral oxygenation at ground level and at altitude in 17 children . While no statistically...1 • Pressure ulcer (1) buttock – stage 1 Psychiatric • Unspecified schizophrenia/depressive disorder- anxiety – self-inflicted injury • Acute...and shortly after had no chest pain or difficulty breathing . n=0 D: Event Did Not Result in Patient Harm, But Increased Monitoring Required n

  15. Oleoma: rare complication of mesotherapy for cellulite. (United States)

    Ramos-e-Silva, Marcia; Pereira, Ana Libia Cardozo; Ramos-e-Silva, Stella; Piñeiro-Maceira, Juan


    Mesotherapy or intradermotherapy is used as a cosmetic procedure for many purposes, among them for cellulite. We report a case of oleoma on the thighs and buttocks that appeared two years after the injection of an unknown substance for improvement of cellulite. Lesions and associated pruritus resolved with colchicine, leaving depressed scars. Serious and peer-reviewed investigations must be performed to certify the efficacy and safety of this procedure. © 2012 The International Society of Dermatology.

  16. Within the Walls: An Analysis of Sexual Harassment and Sexual Coercion at Naval Consolidated Brig Miramar (United States)


    always 3. If an inmate tries a new hobby or art , the correctional officers will encourage him or her. never seldom often always 4...seldom often always 3. If a prisoner tries a new hobby or art , the correctional officers will encourage him or her. never seldom often always...down will touch our bodies. Some guards cup our breasts and even our buttocks. Better training and psychoanalysis of potential predators Keep males

  17. Physical Ability-Task Performance Models: Assessing the Risk of Omitted Variable Bias (United States)


    knuckle height. The box was attached to a dynamometer (model TCG-500, John Chatillon & Sons, New York, NY) that measured the maximal force exerted...of the lift, used unsafe lifting techniques, or paused for longer than 1 s during any portion of the lift. Dynamometer Measurements. A from buttocks. Arms were crossed over the chest, with the right hand grasping the left shoulder and the left hand grasping the right wrist . A

  18. Radiculopathy due to malignant melanoma in the sacrum with unknown primary site


    Kakutani, Kenichiro; Doita, Minoru; Nishida, Kotaro; Miyamoto, Hiroshi; Kurosaka, Masahiro


    Melanoma is an interesting tumor, showing the appearance of metastasis without any trace of its primary lesion. To report a very rare case of malignant melanoma in the sacrum with unknown primary origin. The authors present a case of a 52-year-old man who was admitted with increasing lower back, left buttock, and left lower extremity pain, and dysuria. Plain radiograph, computed tomography scan, and magnetic resonance imaging revealed a destructive lesion in the sacrum and left ilium, which i...

  19. MRI of hemangiopericytoma in the sacrum

    Energy Technology Data Exchange (ETDEWEB)

    Lian Yuwei [School of Medicine, Taipei Medical University, Taipei (Taiwan); Yao Minszu; Hsieh Shuchiang; Lao, Wilson T. [Department of Radiology, Taipei Medical University-Municipal Wan Fang Hospital, 111, Hsing-Long Road, Section 3, 116, Taipei (Taiwan); Fang Chialiang [Department of Pathology, School of Medicine, Taipei Medical University, Taipei (Taiwan); Chan, Wing P. [School of Medicine, Taipei Medical University, Taipei (Taiwan); Department of Radiology, Taipei Medical University-Municipal Wan Fang Hospital, 111, Hsing-Long Road, Section 3, 116, Taipei (Taiwan)


    Osseous hemangiopericytoma is rare. We present a case of a 30-year-old woman with low-back pain with radiation to the left buttock for 1 month. Magnetic resonance imaging (MRI) showed a tumor mass with areas of serpentine signal void pattern in the sacrum suggestive of a vascular tumor. Neither calcifications nor layered blood serum were noted. Histological diagnosis was compatible with osseous hemangiopericytoma. (orig.)

  20. L5 radiculopathy due to sacral stress fracture

    Energy Technology Data Exchange (ETDEWEB)

    Aylwin, Anthony; Saifuddin, Asif [Department of Diagnostic Imaging, Royal National Orthopaedic Hospital NHS Trust, HA7 4LP, Stanmore, Middlesex (United Kingdom); Tucker, Stuart [Department of Spinal Surgery, Royal National Orthopaedic Hospital NHS Trust, HA7 4LP, Stanmore, Middlesex (United Kingdom)


    We report the case of a 70-year-old man who presented with a history of left buttock pain with radiation into the left leg in an L5 distribution. MRI of the lumbar spine revealed a left sacral stress fracture with periosteal reaction involving the left L5 nerve root anterior to the sacral ala. With spontaneous healing of the fracture, the patient's symptoms resolved completely. (orig.)

  1. Injuries from Combat Explosions in Iraq: Injury Type, Location, and Severity (United States)


    column injury except for cervical vertebral column, trunk, back and buttocks, upper extremity unspecified, hip , upper leg and thigh, knee, other...the ICD-9 codes that describe trauma, and constructs a matrix using 12 natures of injury ( fractures , dislocations, sprains and strains, internal...versions were used in the analysis. The 11 of the 12 injury natures were collapsed into orthopaedic injuries ( fractures , dislocations, sprains and strains

  2. Post-surgical sacroiliac syndrome: a case study


    Diakow, Peter R.P.; Cassidy, J. David; DeKorompay, Victor L.


    Sacroiliac syndrome is characterized by buttock and lower limb pain that is associated with decreased mobility and tenderness of the sacroiliac joints. It can occur concomitantly with disorders of the lumbar spine and may go unrecognized until these other conditions are successfully treated. It may sometimes be associated with post-surgical immobilization of the spine and pelvis. A case is presented illustrating successful treatment by chiropractic manipulation.

  3. Cellulite: a review with a focus on subcision


    Friedmann DP; Vick GL; Mishra V


    Daniel P Friedmann,1 Garrett Lane Vick,2 Vineet Mishra3 1Westlake Dermatology Clinical Research Center, Westlake Dermatology & Cosmetic Surgery, Austin, 2Department of Medicine, 3Division of Dermatology and Cutaneous Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA Abstract: Cellulite is an alteration in skin topography most often found on the buttocks and posterolateral thighs of the majority of postpubertal females. This article aims to rev...

  4. An explorative study of non-invasive ultra-weak photon emission and the anti-oxidative influence of oral zinc sulphate in light-sensitive patients with erythropoietic protoporphyria

    DEFF Research Database (Denmark)

    Petersen, Anita Birgit; Philipsen, Peter Alshede; Wulf, Hans Christian


    from the buttock skin and dorsal hand before and after solar-simulated light (SUN) exposure. Blood samples were analysed routinely for plasma zinc, iron, ferritin, transferrin, haemoglobin, erythrocyte PPIX and Zn-PPIX. RESULTS: UPE in EPP patients resembled that seen in healthy individuals. Without...... correlation was found between plasma zinc concentration and the initial burst. CONCLUSION: Measurements of UPE can be used for monitoring UVA-induced oxidative processes in vivo in the skin of EPP patients....

  5. Chronic zosteriform cutaneous leishmaniasis


    Omidian M; Mapar M


    Cutaneous leishmanasis (CL) may present with unusual clinical variants such as acute paronychial, annular, palmoplantar, zosteriform, erysipeloid, and sporotrichoid. The zosteriform variant has rarely been reported. Unusual lesions may be morphologically attributed to an altered host response or owing to an atypical strain of parasites in these lesions. We report a patient with CL in a multidermatomal pattern on the back and buttock of a man in Khozestan province in the south of Iran. To our ...

  6. Attractiveness of the female body: Preference for the average or the supernormal?

    Directory of Open Access Journals (Sweden)

    Marković Slobodan


    Full Text Available The main purpose of the present study was to contrast the two hypotheses of female body attractiveness. The first is the “preference-for-the average” hypothesis: the most attractive female body is the one that represents the average body proportions for a given population. The second is the “preference-for-the supernormal” hypothesis: according to the so-called “peak shift effect”, the most attractive female body is more feminine than the average. We investigated the preference for three female body characteristics: waist to hip ratio (WHR, buttocks and breasts. There were 456 participants of both genders. Using a program for computer animation (DAZ 3D three sets of stimuli were generated (WHR, buttocks and breasts. Each set included six stimuli ranked from the lowest to the highest femininity level. Participants were asked to choose the stimulus within each set which they found most attractive (task 1 and average (task 2. One group of participants judged the body parts that were presented in the global context (whole body, while the other group judged the stimuli in the local context (isolated body parts only. Analyses have shown that the most attractive WHR, buttocks and breasts are more feminine (meaning smaller for WHR and larger for breasts and buttocks than average ones, for both genders and in both presentation contexts. The effect of gender was obtained only for the most attractive breasts: males prefer larger breasts than females. Finally, most attractive and average WHR and breasts were less feminine in the local than in the global context. These results support the preference-for the supernormal hypothesis: all analyses have shown that both male and female participants preferred female body parts which are more feminine than those judged average. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 179033

  7. Combat Injury Coding: A Review and Reconfiguration (United States)


    the clavicle, scapula, and pelvic girdle were grouped with the torso where they are anatomically located rather than in the upper and lower extremities...follows: 1. Head and neck: injuries to the head, face, and neck 2. Torso: injuries to the chest and abdomen, including the pel- vic girdle and...parasymphysis, or mandible avulsion) Open wound with loss of e10% muscle mass of trunk, buttocks, or pelvic girdle Amputation or crush hands, bilateral Open

  8. Characterizing the Size of the Encumbered Soldier (United States)


    Acromion, Buttock, Chest, Deltoid, Waist at Omphalion, Suprapatella, and First and Fifth Metatarsophalangeal protrusions) were palpated and/or two standing postures and one seated posture to obtain 3D whole body digital images for use in potential future modeling and simulation efforts...In addition, TPs were scanned in the Driver configuration using the Cyberware 3D head scanner to capture a digital image of their heads without any

  9. Perianal Ulcer in an Asian Man. (United States)

    Pillai, Nilanthy Sharon Anthony; Oh, Choon Chiat; Fung, Michelle Chan Mei; Wijaya, Limin


    A 79-year-old Chinese man presented with a 2-month history of pruritic, tender ulceration covering his perianal region. He was initially treated with oral amoxicillin/clavulanic acid and vancyclovir, with no improvement. His history included hypertension. On physical examination, there was a 1.5-cm solitary, pink shallow ulcer with a tender erythematous base on the right side of the buttock cleft (Figure 1).


    African Journals Online (AJOL)

    The percentage of total mass iif the hodv com- ponents of adult girlffe are given in Table 3. Ctr aass co nlp o s i t i{' ) tl. 'fhe available data from dressed carcasses of adult giraff'e can. for cornparative purposes, only be cliscused in terms of fcrur ma1or coil]ponents; these are buttock foreleg. neck and a component referred.

  11. People’s Republic of China Scientific Abstracts, Number 159 (United States)


    pelvis; left pelvis compound comminuted fracture , dislodgement of left femoral head from the acetabulum , right ischium and publis complete fracture ... fracture , left radius simple fracture ; upper back extensive skin defect, bilateral severe contusion compression of the buttock forming hematoma. With...anastomosis, blood vessel anastomosis and fixation of fractures were also carried out. 2. Infection and wasting stage (continuous for 1 month): On the 7th

  12. Back Pain in the U.S. Army Aviation Community (United States)


    region from the shoulder blades down to the lower region of the buttocks (consistent with definition provided in original survey version [Agius et 224 214 10 Shape of seat 166 157 9 Seat material 201 190 11 Duty on flight controls 201 192 9 Restraint/ shoulder harness 31 28 3 Quality of...too restrictive with combat load. Back rest has to be removed for space. 232. 19-exercise, weight lifting, driving 20-AH64 terrible lumbar

  13. Mechanical Diagnosis and Therapy approach to assessment and treatment of derangement of the sacro-iliac joint. (United States)

    Horton, Stuart John; Franz, Anja


    This case report describes the clinical reasoning and management of the sacroiliac joint, utilising the McKenzie Method of Mechanical Diagnosis and Therapy (MDT). A patient with a 2 year history of buttock and thigh pain demonstrates a directional preference for repeated anterior SIJ rotation. The MDT approach is discussed and is an ideal method for emphasising the patients involvement in managing their own back problem.

  14. Hand, foot, and mouth disease: identifying and managing an acute viral syndrome. (United States)

    Repass, Gregory L; Palmer, William C; Stancampiano, Fernando F


    Hand, foot, and mouth disease (HFMD) is a common, typically self-limited viral syndrome in children and adults. It is marked by fever, oral ulcers, and skin manifestations affecting the palms, soles, and buttocks, with symptoms usually lasting less than 1 week. Because it has the potential to reach epidemic levels in the United States, general practitioners need to be aware of it. Copyright© 2014 The Cleveland Clinic Foundation.

  15. Pressure sores prevention for paraplegic people: effects of visual, auditive and tactile supplementations on overpressures distribution in seated posture.


    Olivier Chenu; Yohan Payan; Hlavackova, P.; Jacques Demongeot; Francis Cannard; Bruno Diot; Nicolas Vuillerme


    International audience; This paper presents a study on the usage of different informative modalities as biofeedbacks of a perceptual supplementation device aiming at reducing overpressure at the buttock area. Visual, audio and lingual electrotactile modalities are analysed and compared with a non-biofeedback session. In conclusion, sensory modalities have a positive and equal effect, but they are not equally judged in terms of comfort and disturbance with some other activities.

  16. Pressure Sores Prevention for Paraplegic People: Effects of Visual, Auditory and Tactile Supplementations on Overpressures Distribution in Seated Posture

    Directory of Open Access Journals (Sweden)

    Olivier Chenu


    Full Text Available This paper presents a study on the usage of different informative modalities as biofeedbacks of a perceptual supplementation device aiming at reducing overpressure at the buttock area. Visual, audio and lingual electrotactile modalities are analysed and compared with a non-biofeedback session. In conclusion, sensory modalities have a positive and equal effect, but they are not equally judged in terms of comfort and disturbance with some other activities.

  17. An unusual burn caused by hot argy wormwood leaf water

    Directory of Open Access Journals (Sweden)

    Feng Guo


    Full Text Available An unusual burn case caused by hot wormwood leaf water was discussed. A 29-year-old woman sustained a 7% second-degree burn on both buttocks and left thigh. This case report highlights a rare cause of a chemical burn that may become more common with increasing use of this Chinese traditional medicine. The prevention measures of this burn injury were also presented.


    Directory of Open Access Journals (Sweden)

    Sabina Olaru


    Full Text Available The geometric method used in patterns design of different products categories, gives good results for garments manufacturing in industrial system, meaning type representative bodies. The quality of the results is due to the fact that in geometric method the completion of the basic patterns is achieved by prototype implementation followed by viewing the correspondence between the body and the garment, by dressing the human body or industrial mannequin. In the case that the garment, designed and manufactured for type representative bodies according to the standards is dressed by persons that do not fit the type bodies for whom the product was made, the fenomena called “draping defects” apprears. These unconcordances between wearer body and product obtained in industrial system is due to the conformational features of potential users such as: buttocks prominence and form, hips prominence and form, pelvis width and length, ratio between front and anterior-posterior diameters of the pelvis.Anthropometry researches have shown that for a standardized value of the hip perimeter the secondary dimensions of the area (posterior buttock arch, length from waist the buttock point, lower arch of torso may have different values. In this context, the paper aims to analyze the shape and size of the women’s pelvis and to develop the technical solutions to adapt the basic pattern for “trousers with adjusted silhouette” to concrete particularities of the body shape.

  19. Human body modeling method to simulate the biodynamic characteristics of spine in vivo with different sitting postures. (United States)

    Dong, Rui-Chun; Guo, Li-Xin


    The aim of this study is to model the computational model of seated whole human body including skeleton, muscle, viscera, ligament, intervertebral disc, and skin to predict effect of the factors (sitting postures, muscle and skin, buttocks, viscera, arms, gravity, and boundary conditions) on the biodynamic characteristics of spine. Two finite element models of seated whole body and a large number of finite element models of different ligamentous motion segments were developed and validated. Static, modal, and transient dynamic analyses were performed. The predicted vertical resonant frequency of seated body model was in the range of vertical natural frequency of 4 to 7 Hz. Muscle, buttocks, viscera, and the boundary conditions of buttocks have influence on the vertical resonant frequency of spine. Muscle played a very important role in biodynamic response of spine. Compared with the vertical posture, the posture of lean forward or backward led to an increase in stress on anterior or lateral posterior of lumbar intervertebral discs. This indicated that keeping correct posture could reduce the injury of vibration on lumbar intervertebral disc under whole-body vibration. The driving posture not only reduced the load of spine but also increased the resonant frequency of spine. Copyright © 2017 John Wiley & Sons, Ltd.

  20. Contouring of the gluteal region in women: enhancement and augmentation. (United States)

    Ali, Ahmed


    Techniques for improving the appearance of the gluteal region are important elements in body contouring. In all cultures and communities, this aspect of the physique holds a special place among the elements comprising the ideals of physical beauty. Recent studies described the aesthetics of the gluteal region in terms of shape, volume, and projection. Accumulation of fat at the supragluteal, lower paralumbar, infragluteal, and/or trochanteric areas often disturbs the natural shape of the buttocks. The problem is accentuated by the lack of lateral projection. This study was designed to find a method for contouring of the gluteal region. This method is based on the enhancement of the shape by liposculpture of the areas around the buttocks, and lipoinjection to achieve the volume and projection. Between July 2008 and December 2009, the study included 40 female patients complaining of disfigurement of the gluteal region. With 1 year follow-up period, 36 patients showed high satisfaction with the results. Pre- and postoperative perimeters of the gluteal regions showed good improvement in proportion and projection. The study concluded that liposuction of the areas around the buttocks could enhance the shape of the gluteal region. Lipoinjection could add a balanced shape, size, and projection. A pleasing gluteal appearance could be achieved by the combination of enhancement and augmentation.

  1. Gluteal Compartment Syndrome After Prolonged Immobilisation

    Directory of Open Access Journals (Sweden)

    H.L. Liu


    Full Text Available Muscles in the gluteal region are confined by distinct fascial attachments which can potentially result in compartment syndrome. A 74-year-old chronic drinker was admitted to the medical ward after being found drunk on the street. He noticed acute painful swelling of the right side of his buttock the following morning and recalled a slip and fall prior to his blackout. The whole right half of the buttock was tense with erythematous overlying skin. Examination revealed sciatic nerve palsy and myoglobinuria. Emergency fasciotomy and debridement were performed. Intra-operative pressure measurement confirmed a grossly elevated intra-compartmental pressure. Gluteal compartment syndrome is an extremely rare condition and has only been scantily documented previously in case reports. Early diagnosis is crucial but delay recognition is common from lack of knowledge of the condition and readily results in permanent sciatic nerve injury and acute renal shutdown from myoglobinuria. Awareness of the condition, early diagnosis and prompt exploration provide the only chance of avoiding these devastating consequences. Acute swelling diffusely affecting the whole or one side of the buttock, a history of trauma and prolonged local pressure impingement associated with pain out of proportion to the clinical signs should raise a suspicion of this rare condition.

  2. An integral topical gel for cellulite reduction: results from a double-blind, randomized, placebo-controlled evaluation of efficacy. (United States)

    Dupont, Eric; Journet, Michel; Oula, Marie-Laure; Gomez, Juan; Léveillé, Claude; Loing, Estelle; Bilodeau, Diane


    Cellulite is a serious cosmetic concern for most of the 90% of women affected by it. To assess the clinical efficacy of a complex integral anti-cellulite gel. This double-blind, randomized, placebo-controlled study involved 44 healthy women, aged 25-55 years. Subjects had a normal to slightly overweight body mass index and presented slight to moderate cellulite on their thighs, buttocks, and/or hips at baseline. Subjects were randomly assigned to either the treated or placebo group and accordingly applied the active product or placebo on their hips, stomach, buttocks, and thighs, twice daily for 3 months. Skin tonicity, orange-peel aspect, and stubborn cellulite were assessed at day 0, 28, 56, and 84. A self-evaluation questionnaire was completed by all volunteers. At the end of the study, an average of 81% of the subjects applying the active product presented improvement in their cellulite condition versus 32% for the placebo group (all descriptors and sites combined). At day 84, skin tonicity, orange-peel appearance, and stubborn cellulite were improved in a significant manner (Pcellulite was reduced on average by -19% for buttocks, -24% for hips, and -22% for thighs. Circumference measurements decreased in a significant manner (Pcellulite and reshape the silhouette.

  3. Microfocused Ultrasound with Visualization and Calcium Hydroxylapatite for Improving Skin Laxity and Cellulite Appearance. (United States)

    Casabona, Gabriela; Pereira, Gregório


    Age-associated skin laxity contributes to worsening of cellulite appearance. This study evaluated the effects of microfocused ultrasound with visualization (MFU-V; Ultherapy) in combination with diluted calcium hydroxylapatite (CaHA; Radiesse) on cellulite appearance and on neocollagenesis. Twenty women (18-55 years old) with skin laxity and moderate-to-severe cellulite on the buttocks and thighs were retrospectively enrolled. MFU-V was applied using 4 and 7 MHz transducers (25 lines/transducer/site) and immediately followed by subdermal CaHA injection (1 ml/buttock or thigh). Photographs at baseline and 90 days were assessed by 2 independent, blinded evaluators using a 5-item cellulite severity scale. One subject scheduled for thighplasty received treatment with 6 different CaHA dilutions (0.3 ml/5 cm 2 ) followed by MFU-V. Tissue specimens from each dilution site were examined under polarized light microscopy to assess neocollagenesis. Both evaluators reported statistically significant improvements compared with baseline for each item on the cellulite severity scale ( P cellulite on the buttocks and upper thighs.

  4. Effectiveness of carboxytherapy in the treatment of cellulite in healthy women: a pilot study. (United States)

    Pianez, Luana Ramalho; Custódio, Fernanda Silva; Guidi, Renata Michelini; de Freitas, Jauru Nunes; Sant'Ana, Estela


    Carbon dioxide therapy, better known as carboxytherapy, relates to percutaneous infusion of medical carbon dioxide with therapeutic approaches, and its use in the treatment of localized fat has demonstrated good results. Gynoid lipodystrophy, also known as cellulite, affects 80%-90% of women after puberty, especially in the buttocks and thighs. Its etiology is complex and involves multifactorial aspects. Its treatment and evaluation require the use of new technologies (more effective and low-cost approaches). The objective was to investigate the effectiveness of carboxytherapy in the treatment of cellulite in the areas of buttocks and posterior thigh. Ten women, 29±6.1 years, were selected and all of them received eight treatment sessions, with an interval of 7 days between sessions. Standardized digital photographs were used to assess the severity of cellulite, and panoramic images were collected by ultrasound diagnosis. The evaluations were performed before the first treatment (baseline) and 7 days after the last treatment session of carboxytherapy. After the treatment, there was a significant reduction (P=0.0025) of the cellulite from degree III to degree II, and this improvement had correlation with the improvement in the organization of the fibrous lines and the disposal of adipose tissue lines of the treated regions observed through the panoramic ultrasound images diagnosis. Carboxytherapy is an effective technique of treatment of cellulite in the buttocks region and posterior thighs of healthy women.

  5. The relationship between skin aging and steady state ultraweak photon emission as an indicator of skin oxidative stress in vivo. (United States)

    Gabe, Y; Osanai, O; Takema, Y


    Ultraweak photon emission (UPE) is one potential method to evaluate the oxidative status of the skin in vivo. However, little is known about how the daily oxidative stress of the skin is related to skin aging-related alterations in vivo. We characterized the steady state UPE and performed a skin survey. We evaluated the skin oxidative status by UPE, skin elasticity, epidermal thickness and skin color on the inner upper arm, the outer forearm, and the buttock of 70 Japanese volunteers. The steady state UPE at the three skin sites increased with age. Correlation analysis revealed that the steady state UPE only from the buttock was related to skin elasticity, which showed age-dependent changes. Moreover, analysis by age group indicated that b* values of the inner upper arm of subjects in their 20s were inversely correlated with UPE as occurred in buttock skin. In contrast, photoaged skin did not show a clear relationship with steady state UPE because the accumulation of sun-exposure might influence the sensitivity to oxidative stress. These results suggest that steady state UPE reflects not only intrinsic skin aging and cutaneous color but also the current oxidative status independent of skin aging. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. An epidemiological analysis of overuse injuries among recreational cyclists. (United States)

    Wilber, C A; Holland, G J; Madison, R E; Loy, S F


    Two-hundred and ninety-four male and 224 female randomly selected recreational cyclists responded to a mail questionnaire. Significant differences were observed between male and female cyclists' training characteristics. Overall, 85% of the cyclists reported one or more overuse injury, with 36% requiring medical treatment. The most common anatomical sites for overuse injury/complaints reported by the male and female cyclists combined were the neck (48.8%), followed by the knees (41.7%), groin/buttocks (36.1%), hands (31.1%), and back (30.3%). For the male cyclists, effect upon back and groin/buttocks overuse injuries/complaints were miles/week, lower number of gears, and less years of cycling. For female cyclists, training characteristics which had the most significant effect upon groin/buttocks overuse injury/complaints were more non-competitive events/year and less stretching before cycling. The odds of female cyclists developing neck and shoulder overuse injury/complaints were 1.5 and 2.0 times more, respectively than their male counterparts.

  7. Effectiveness of carboxytherapy in the treatment of cellulite in healthy women: a pilot study (United States)

    Pianez, Luana Ramalho; Custódio, Fernanda Silva; Guidi, Renata Michelini; de Freitas, Jauru Nunes; Sant’Ana, Estela


    Background Carbon dioxide therapy, better known as carboxytherapy, relates to percutaneous infusion of medical carbon dioxide with therapeutic approaches, and its use in the treatment of localized fat has demonstrated good results. Gynoid lipodystrophy, also known as cellulite, affects 80%–90% of women after puberty, especially in the buttocks and thighs. Its etiology is complex and involves multifactorial aspects. Its treatment and evaluation require the use of new technologies (more effective and low-cost approaches). The objective was to investigate the effectiveness of carboxytherapy in the treatment of cellulite in the areas of buttocks and posterior thigh. Patients and methods Ten women, 29±6.1 years, were selected and all of them received eight treatment sessions, with an interval of 7 days between sessions. Standardized digital photographs were used to assess the severity of cellulite, and panoramic images were collected by ultrasound diagnosis. The evaluations were performed before the first treatment (baseline) and 7 days after the last treatment session of carboxytherapy. Results After the treatment, there was a significant reduction (P=0.0025) of the cellulite from degree III to degree II, and this improvement had correlation with the improvement in the organization of the fibrous lines and the disposal of adipose tissue lines of the treated regions observed through the panoramic ultrasound images diagnosis. Conclusion Carboxytherapy is an effective technique of treatment of cellulite in the buttocks region and posterior thighs of healthy women. PMID:27578994

  8. An integral topical gel for cellulite reduction: results from a double-blind, randomized, placebo-controlled evaluation of efficacy

    Directory of Open Access Journals (Sweden)

    Dupont E


    Full Text Available Eric Dupont,1 Michel Journet,2 Marie-Laure Oula,3 Juan Gomez,1 Claude Léveillé,4 Estelle Loing,5 Diane Bilodeau6 1Immanence IDC Inc, Québec, QC, Canada; 2Clinique de Dermatologie St-Joseph, Montréal, QC, Canada; 3Evalulab Inc, Mont-Royal, QC, Canada; 4Clinique de Chirurgie Esthétique du Québec Métropolitain, Lévis, QC, Canada; 5Lucas Meyer Cosmetics, Québec, QC, Canada; 6CosmeConsult, Québec, QC, Canada Background: Cellulite is a serious cosmetic concern for most of the 90% of women affected by it. Objective: To assess the clinical efficacy of a complex integral anti-cellulite gel. Methods: This double-blind, randomized, placebo-controlled study involved 44 healthy women, aged 25–55 years. Subjects had a normal to slightly overweight body mass index and presented slight to moderate cellulite on their thighs, buttocks, and/or hips at baseline. Subjects were randomly assigned to either the treated or placebo group and accordingly applied the active product or placebo on their hips, stomach, buttocks, and thighs, twice daily for 3 months. Skin tonicity, orange-peel aspect, and stubborn cellulite were assessed at day 0, 28, 56, and 84. A self-evaluation questionnaire was completed by all volunteers. Results: At the end of the study, an average of 81% of the subjects applying the active product presented improvement in their cellulite condition versus 32% for the placebo group (all descriptors and sites combined. At day 84, skin tonicity, orange-peel appearance, and stubborn cellulite were improved in a significant manner (P<0.05 over placebo, on all studied areas. Skin tonicity improved on average by +41% for buttocks, +35% for hips, and +31% for thighs. Orange peel appearance was reduced on average by -25% for buttocks, -22% for hips, and -22% for thighs. Stubborn cellulite was reduced on average by -19% for buttocks, -24% for hips, and -22% for thighs. Circumference measurements decreased in a significant manner (P<0.05 over placebo

  9. Effects of altering cycling technique on gluteus medius syndrome. (United States)

    Green, B N; Johnson, C D; Maloney, A


    We discuss how altering the cycling technique of a cyclist receiving periodic chiropractic care helped in the management of gluteus medius syndrome. A 24-year-old male amateur cyclist had numbness and tingling localized to a small region on the superior portion of the right buttock. The area involved demonstrated paresthesia to light touch sensory evaluation. The cyclist had received chiropractic adjustments 2 days before the onset of the symptoms. One week earlier, the patient began riding a new bicycle with different gearing than his previous one. Manual-resisted muscle testing created soreness in the lumbosacral area and buttocks. Trigger points were identified in the right gluteus medius. Standing lumbar spine flexion was 70 degrees, limited by tight hamstrings. Because the patient was already receiving periodic chiropractic care, no passive therapy was used. Patient education regarding the difference in gear selection in bicycles of a higher quality was provided. He was instructed to train in lower gears than he had previously used and to maintain a cadence of 70 to 90 revolutions of the pedals per minute. After 2 days, the paresthesia on the right buttock resolved. The trigger points were only mildly tender with minimal residual soreness of the involved muscles. Management of gluteus medius syndrome by altering the cadence and gear development for a bicyclist is discussed. Either frank or cumulative injury to the gluteus medius muscle is the typical etiologic factor for this syndrome. Repetitive strain of the patient's gluteus medius muscle as a result of poor cycling technique appeared to be the cause here. Knowledge of bicycle fitting, training techniques, and bicycle mechanics appeared necessary to resolve the problem.

  10. Microfocused Ultrasound with Visualization and Calcium Hydroxylapatite for Improving Skin Laxity and Cellulite Appearance

    Directory of Open Access Journals (Sweden)

    Gabriela Casabona, MD


    Full Text Available Background:. Age-associated skin laxity contributes to worsening of cellulite appearance. This study evaluated the effects of microfocused ultrasound with visualization (MFU-V; Ultherapy in combination with diluted calcium hydroxylapatite (CaHA; Radiesse on cellulite appearance and on neocollagenesis. Methods:. Twenty women (18–55 years old with skin laxity and moderate-to-severe cellulite on the buttocks and thighs were retrospectively enrolled. MFU-V was applied using 4 and 7 MHz transducers (25 lines/transducer/site and immediately followed by subdermal CaHA injection (1 ml/buttock or thigh. Photographs at baseline and 90 days were assessed by 2 independent, blinded evaluators using a 5-item cellulite severity scale. One subject scheduled for thighplasty received treatment with 6 different CaHA dilutions (0.3 ml/5 cm2 followed by MFU-V. Tissue specimens from each dilution site were examined under polarized light microscopy to assess neocollagenesis. Results:. Both evaluators reported statistically significant improvements compared with baseline for each item on the cellulite severity scale (P < 0.001 with a 4.5-point improvement in mean overall score (P < 0.001 after a single MFU-V/CaHA treatment. At 90 days, histologic analysis showed peak neocollagenesis in samples treated with the 1:1 dilution, whether with CaHA alone or in combination with MFU-V. The highest conversion of collagen type III into collagen type I at month 3 occurred in samples injected with 1:1 and 1:0.6 CaHA dilutions without subsequent MFU-V treatment. Both procedures were well tolerated, and subject satisfaction was high. Conclusions:. Combination treatment with MFU-V and diluted CaHA is effective for improving skin laxity and the appearance of cellulite on the buttocks and upper thighs.

  11. Physiological and appearance characteristics of skin maceration in elderly women with incontinence. (United States)

    Ichikawa-Shigeta, Y; Sugama, J; Sanada, H; Nakatani, T; Konya, C; Nakagami, G; Minematsu, T; Yusuf, S; Supriadi; Mugita, Y


    To identify the physiological and appearance characteristics of skin maceration caused by urine and/or faeces and determine their suitability as risk indicators for incontinence-associated dermatitis. This cross-sectional, comparative study involved sixty-nine elderly women with urinary and/or faecal incontinence who provided informed consent to participate. Exclusion criteria included serious medical problems, acute illness and the presence of damaged skin on the buttocks. The physiological and appearance characteristics of macerated skin on the buttocks of the patients were examined. Stratum corneum and dermis hydration levels, transepidermal water loss and skin pH were used to assess skin condition. Skin morphology (sulcus cutis) was confirmed using images at x15 magnification. The erythema index and white index were used to evaluate colour in the macerated skin areas. Forty-four patients exhibited skin maceration. Stratum corneum and dermis hydration levels were significantly greater in the maceration group than in the non-maceration group, as were transepidermal water loss, skin pH and differences in sulcus cutis interval between the buttock of interest and the subumbilical region. Furthermore, differences in the erythema and white indices between these two regions were significantly higher and lower, respectively, in the maceration group than in the non-maceration group. To our knowledge, this is the first report to note that there are interesting changes not only in the epidermal layer but also in the dermis layer in patients with skin maceration. This finding confirmed that skin maceration caused by incontinence is a severe condition. Moreover, the erythema index was the best index for identifying skin maceration caused by incontinence, indicating that it can be used for precise and easy identification of the condition in clinical practice.

  12. Application of posterior pelvic tilt taping for the treatment of chronic low back pain with sacroiliac joint dysfunction and increased sacral horizontal angle. (United States)

    Lee, Jung-hoon; Yoo, Won-gyu


    Kinesio Taping (KT) is a therapeutic method used by physical therapists and athletic trainers in combination with other treatment techniques for various musculoskeletal and neuromuscular problems. However, no research has evaluated the effect of KT in patients with low back pain (LBP). The purpose of this case was to describe the application of posterior pelvic tilt taping (PPTT) with Kinesio tape as a treatment for chronic LBP and to reduce the anterior pelvic tilt angle. Case report. The patien was a 20-year-old female amateur swimmer with a Cobb's angle (L1-S1) of 68°, a sacral horizontal angle of 45°, and pain in both medial buttock areas and sacroiliac joints. We performed PPTT with Kinesio tape for 2 weeks (six times per week for an average of 9 h each time). The patient’s radiographs showed that the Cobb's angle (L1-S1) had decreased from 68° to 47° and that the sacral horizontal angle had decreased from 45° to 31°. Reductions in hypomobility or motion asymmetry, as assessed by the motion palpation test, and in pain, as measured by the pain-provocation tests, were observed. On palpation for both medial buttock areas in the prone position, the patient felt no pain. The patient experienced no pain or stiffness in the low back area while performing forward flexion in the standing position with knees fully extended when washing dishes in the sink. The case study demonstrated that PPTT intervention favourably affected the pelvic inclination and sacral horizontal angle, leading to beneficial effects on sacroiliac joint dysfunction (SIJD) and medial buttock pain. Additional research on the clinical effects of this taping procedure requires greater numbers of athletes with SIJD or LBP who have inappropriate anterior pelvic tilt angles and hyperlordosis.

  13. Gunshot wounds to the lower urinary tract: A single-institution experience (United States)

    Cinman, Nadya M.; McAninch, Jack W.; Porten, Sima P.; Myers, Jeremy B.; Blaschko, Sarah D.; Bagga, Herman S.; Breyer, Benjamin N.


    BACKGROUND This study aimed to analyze characteristics and outcomes of gunshot wounds to the lower urinary tract at our Level I trauma center. Our hypothesis is that gunshot wounds to the lower urinary tract have characteristic bullet trajectories, injury patterns, and associated injuries. METHODS Our prospective trauma database was composed of reviewed gunshot wounds to the lower urinary tract including the pelvic ureter, bladder, or urethra from 1989 through 2011. RESULTS We identified 50 patients (median age, 25 years; range, 3–53 years) with lower urinary tract injury. There was a mean of 2.3 bullets per patient (range, 1–8), with 26 patients injured from a single bullet. Urologic injury involving only the bladder occurred in 72% (36 of 50) of the patients. Ureteral injury was diagnosed in 20% (10 of 50) of the patients. Bullet trajectory was known in the majority of multiple bullet injuries and all cases involving a single bullet. All patients but one were managed operatively. During exploration, 90% (34 of 38) with transmural bladder injury had recognized bladder entry and exit wounds. Overall, 80% (40 of 50) had concurrent gastrointestinal injury. In patients with a single gunshot wound to the lower urinary tract, 58% (15 of 26) sustained concomitant intestinal injury, and 23% (6 of 26) sustained rectal injury. Of 20 posteroanterior gunshot wounds, 80% had buttock entry. All 10 single-bullet buttock-entry gunshot wounds injured the bladder. Isolated ureteral injury was associated with lower abdominal entry and anteroposterior trajectory. Urethral injury occurred in 4, with 75% upper-thigh entry. CONCLUSION Penetrating injuries to the lower urinary tract most commonly involve the bladder. During exploration for gunshot wounds to the bladder, two injury sites should be expected because failure to close may lead to complications. Gunshot wounds to the lower urinary tract often occur with concomitant bowel injury, with buttock entry. A multidisciplinary

  14. Advancing a smart air cushion system for preventing pressure ulcers using projection Moiré for large deformation measurements (United States)

    Cheng, Sheng-Lin; Tsai, Tsung-Heng; Lee, Carina Jean-Tien; Hsu, Yu-Hsiang; Lee, Chih-Kung


    A pressure ulcer is one of the most important concerns for wheelchair bound patients with spinal cord injuries. A pressure ulcer is a localized injury near the buttocks that bear ischial tuberosity oppression over a long period of time. Due to elevated compression to blood vessels, the surrounding tissues suffer from a lack of oxygen and nutrition. The ulcers eventually lead to skin damage followed by tissue necrosis. The current medical strategy is to minimize the occurrence of pressure ulcers by regularly helping patients change their posture. However, these methods do not always work effectively or well. As a solution to fundamentally prevent pressure ulcers, a smart air cushion system was developed to detect and control pressure actively. The air cushion works by automatically adjusting a patient's sitting posture to effectively relieve the buttock pressure. To analyze the correlation between the dynamic pressure profiles of an air cell with a patient's weight, a projection Moiré system was adopted to measure the deformation of an air cell and its associated stress distribution. Combining a full-field deformation imaging with air pressure measured within an air cell, the patient's weight and the stress distribution can be simultaneously obtained. By integrating a full-field optical metrology with a time varying pressure sensor output coupled with different active air control algorithms for various designs, we can tailor the ratio of the air cells. Our preliminary data suggests that this newly developed smart air cushion has the potential to selectively reduce localized compression on the tissues at the buttocks. Furthermore, it can take a patient's weight which is an additional benefit so that medical personnel can reference it to prescribe the correct drug dosages.



    Florina Paraschita


    Discopathy lumbar (DVL) is characterized by localized back pain in the lumbar region and radiating to the buttocks and along the leg, under certain nerve pathways. The purpose of this study was to find the best treatment for improving pronounced as back pain in lumbar-sacral and cervical region. In the study took part two women aged 42 to 55 years, with disease acquired due to requesting or incorrect posture, one being a former athlete, the other being an accountant and sitting a lot on the c...

  16. Granulocytic sarcoma: a rare cause of sciatica. (United States)

    Valsamis, Epaminondas Markos; Glover, Thomas Edward


    We describe a case report of a man aged 56 years with a 4-month history of right-sided sciatica-type pain with subclinical disc prolapse evident on MRI. Worsening pain together with the appearance of a tender mass in his right buttock prompted further imaging, which demonstrated an infiltrative mass engulfing the lumbosacral plexus. This was later shown to be a granulocytic sarcoma on biopsy. Intervertebral disc herniation can be an incidental finding and is not always the cause of sciatica. 2017 BMJ Publishing Group Ltd.

  17. Gianotti-Crosti Syndrome following immunization in an 18 months old child

    Directory of Open Access Journals (Sweden)

    Thirunavukkarasu Arun Babu


    Full Text Available Gianotti-Crosti syndrome (GCS is an uncommon dermatological condition characterized by distinct, self-limiting, symmetrical, erythematous, papulovesicular eruptions distributed mainly on the extremities, buttocks and face in young children. Although GCS is commonly attributed to viral infections, vaccinations too can rarely precipitate this condition. We report a rare case of GCS following diptheria, pertussis, and tetanus (DPT and oral polio immunisation in an 18-month-old child along with a review of similar vaccine-induced GCS cases reported in the literature.

  18. Knowledge goes pop : from conspiracy theory to gossip


    Birchall, Clare


    A voice on late night radio tells you that a fast food joint injects its food with drugs that make men impotent. A colleague asks if you think the FBI was in on 9/11. An alien abductee on the Internet claims extra-terrestrials have planted a microchip in her left buttock. 'Julia Roberts in Porn Scandal' shouts the front page of a gossip mag. A spiritual healer claims he can cure chronic fatigue syndrome with the energizing power of crystals . . . What do you believe? Knowledge Goes Pop examin...

  19. Mesotherapy and cutaneous Mycobacterium fortuitum infection. (United States)

    Difonzo, Elisa Margherita; Campanile, Grazia Lucia; Vanzi, Laura; Lotti, Lorena


    Cutaneous infections caused by Mycobacterium fortuitum usually are a complication of trauma or postsurgical wounds. A 41-year-old woman presented with numerous dusky red nodules, abscesses and sinuses on the right buttock and on the lateral surfaces of both thighs. The lesions developed at the injection sites of mesotherapy treatment. M. fortuitum was cultured from a biopsy specimen and purulent fluid drained from lesions. The lesions had cleared completely with ciprofloxacin 500 mg b.d. for 3 weeks, and then 250 mg b.d. for another 3 weeks. This case demonstrates the importance of suspecting mycobacterial etiology in patients with nodules and abscesses in the areas of mesotherapy treatment.

  20. Hutchinson-Gilford progeria syndrome

    Directory of Open Access Journals (Sweden)

    Zahoor Hussain Daraz


    Full Text Available Hutchinson-Gilford progeria syndrome (HGPS is a rare genetic disease in which symptoms of aging are manifested at an early age. In the present report, we describe a 9 months old female child presented with a history of progressive coarsening of skin, failure to thrive and irregular bumps over thighs, buttocks and lower limbs for the last 7½ months. In the course of time, she developed alopecia, hyperpigmented spots over the abdomen with thickening and a typical facial profile of HGPS including micrognathia, absent ear lobules, prominent eyes, loss of eyelashes, eyebrows and a bluish hue over the nose.

  1. A Huge Morel-Lavallée Lesion Treated Using a Quilting Suture Method: A Case Report and Review of the Literature. (United States)

    Seo, Bommie F; Kang, In Sook; Jeong, Yeon Jin; Moon, Suk Ho


    The Morel-Lavallée lesion is a collection of serous fluid that develops after closed degloving injuries and after surgical procedures particularly in the pelvis and abdomen. It is a persistent seroma and is usually resistant to conservative methods of treatment such as percutaneous drainage and compression. Various methods of curative treatment have been reported in the literature, such as application of fibrin sealant, doxycycline, or alcohol sclerodhesis. We present a case of a huge recurrent Morel-Lavallée lesion in the lower back and buttock region that was treated with quilting sutures, fibrin sealant, and compression, with a review of the literature. © The Author(s) 2014.

  2. Lumbal Spinalstenose

    DEFF Research Database (Denmark)

    Andresen, Andreas Kiilerich; Ernst, Carsten; Andersen, Mikkel Ø


    Lumbar spinal stenosis is the most common reason for spinal surgery in Denmark. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar...... spine. The condition is often exacerbated by standing, walking or lumbar extension and relieved by forward flexion. The options for non-surgical management include drugs and physiotherapy. Treatment outcomes seem to be better for surgical neural decompression than for non-operative treatment....

  3. Bacterial Aggregates Establish at the Edges of Acute Epidermal Wounds

    DEFF Research Database (Denmark)

    Bay, Lene; Kragh, Kasper N.; Eickhardt, Steffen R.


    : On the buttock of 26 healthy volunteers, 28 suction blisters were made and de-roofed. Four wounds were biopsied immediately after wounding, whereas the remaining 24 wounds were treated daily with sterile deionized water and covered with a moisture-retaining dressing. On day 4 post-wounding, swabs were obtained...... for culturing from the wounds and adjacent skin, and the wounds including adjacent skin were excised. Tissue sections were stained with peptide nucleic acid (PNA) fluorescence in situ hybridization (FISH) probes, counterstained by 4′,6-diamidino-2-phenylindole, and evaluated by confocal laser scanning...

  4. Cutaneous Metastatic Undifferentiated Pleomorphic Sarcoma from a Mediastinal Sarcoma. (United States)

    Jeong, Do Seon; Park, Dong Hwa; Kim, Chi Yeon


    Undifferentiated pleomorphic sarcoma, known as malignant fibrous histiocytoma, is a malignant neoplasm that arises in both soft tissue and bones. In 2002, the World Health Organization declassified malignant fibrous histocytoma as a formal diagnostic entity and renamed it 'undifferentiated pleomorphic sarcoma not otherwise specified.' It most commonly occurs in the lower extremities and rarely metastasizes cutaneously. We report a case of cutaneous metastatic undifferentiated pleomorphic sarcoma of the buttocks occurring in a 73-year-old man diagnosed with mediastinal sarcoma 4 years previously. He first noticed the mass approximately 2 months previously. Histological findings with immunomarkers led to a final diagnosis of cutaneous metastatic sarcoma from mediastinal undifferentiated pleomorphic sarcoma.

  5. [Gluteal compartment syndrome after total hip replacement. A presentation of two cases]. (United States)

    Villalba, J; Solernou, X


    Many postoperative complications have been described after a total hip arthroplasty, with early and acute, as well as late, complications being reported. Two cases of compartment syndrome of the buttock are described following a hybrid total hip arthroplasty (cemented stem and press-fit and screwed acetabulum) performed on 2 patients of 60 and 68 years old, both diagnosed and treated 24-48 hours after the surgery. Both cases had a primary prosthesis with no previous significant pathological findings. This condition is still rare, and few cases have been described at the medical literature. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

  6. Linear lichen planus in children - Case report* (United States)

    Horowitz, Marcia Raquel; Vidal, Marcela de Lima; Resende, Manuela Oliveira; Teixeira, Márcia Almeida Galvão; Cavalcanti, Silvana Maria de Morais; de Alencar, Eliane Ruth Barbosa


    Lichen planus is an uncommon disease in children, and only 2 to 3% of affected patients are under twenty years of age. This dermatosis may appear in several clinical forms, which vary according to the morphology and distribution of lesions. In less than 0.2% of all lichen planus cases, the lesions are distributed along the lines of Blaschko, and is a variant called linear lichen planus. This is a case report of a patient aged two years and eight months, who presented keratotic violaceous papules, affecting the abdomen, buttocks and right thigh, distributed along the lines of Blaschko. Histopathological examination confirmed a diagnosis of linear lichen planus. PMID:24346902

  7. Successful Treatment of Hemorrhagic Bullous Henoch-Schönlein Purpura with Oral Corticosteroid: A Case Report

    Directory of Open Access Journals (Sweden)

    Celebi Kocaoglu


    Full Text Available Henoch-Schönlein purpura (HSP is a vasculitis of small-sized blood vessels, resulting from immunoglobulin-A-mediated inflammation. It is the most common acute systemic vasculitis in childhood and mainly affects skin, gastrointestinal tract, joints, and kidneys. The characteristic rash of HSP consists of palpable purpuric lesions 2 to 10 mm in diameter concentrating in the buttocks and lower extremities. The occurrence of hemorrhagic bullae in children with HSP is rarely encountered. This report describes a 4.5-year-old female patient with HSP associated with hemorrhagic bullous lesions.

  8. A Nodular Type of Subcutaneous Sarcoidosis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Kyu Ho; Choi, Yun Sun; Kim, Byoung Suck; Joo, Jong Eun; Jung, Yoon Young; Cho, Young Kwon; An, Jin Kyung; Kim, Hyun Sook; Woo, Jung Joo [Eulji University Hospital, Daejeon (Korea, Republic of)


    Sarcoidosis is a granulomatous multisystemic disorder that rarely involves subcutaneous tissue. We describe the MR imaging findings of a subcutaneous sarcoidosis in a patient that presented with a nontender, palpable soft tissue mass on the left buttock, which was confirmed after surgical excision. The MR images showed the presence of a subcutaneous mass that breached the adjacent fascia with an irregular outline and homogeneous, slightly higher signal intensity than the surrounding muscle as seen on a T2-weighted image and with homogeneous enhancement after contrast injection. The lesion could not be differentiated from a sarcoma or a malignancy.

  9. Implications of different application sites on the bioavailability of a transdermal contraceptive patch containing ethinyl estradiol and gestodene: an open-label, randomized, crossover study. (United States)

    Höchel, Joachim; Schuett, Barbara; Ludwig, Matthias; Zurth, Christian


    A novel once-a-week contraceptive patch delivers the same systemic exposure seen with a combined oral contraceptive pill containing 0.02 mg ethinyl estradiol (EE) and 0.06 mg gestodene (GSD). This study evaluated the relative bioavailability of EE and GSD after application of this patch to three different sites. In this phase I, open-label, randomized, intra-individual comparison, crossover study, 43 women (aged 18 - 45 years) were randomized to one of six treatment sequences. Patches were applied to two test sites (buttocks and outer, upper arm) and one comparator site (lower abdomen). In each treatment period, four patches were worn for 7 days each, followed by a 7-day, patch-free interval. The primary objective was to investigate the relative bioavailability of transdermally administered EE and GSD between test and comparator sites using the primary variable area under the concentration- time curve (AUC(0-168)) during week 4 of each period. Of the 43 women who were randomized, 43 were included in the set for safety evaluation and 40 were included in the set for pharmacokinetic (PK) analysis. Three subjects were excluded from the PK analysis as they failed to complete the study. AUC(0-168) for EE and GSD were equal when the patch was applied to buttocks or abdomen (AUC(0-168) ratios: EE, 1.07 (94% confidence interval, CI: 0.994 - 1.16); GSD, 1.02 (94% CI: 0.946 - 1.10)). Relative bioavailabilities for EE and GSD were 31% and 24% higher, respectively, for arm vs. abdomen. AUC(0-168) 94% CI for the arm/abdomen ratio exceeded the pre-defined bioequivalence range of 80 - 125% (EE: 1.21 - 1.42; GSD: 1.15 - 1.34). Other PK parameters were correspondingly higher for arm vs. buttocks or abdomen. Patch adhesion and tolerability were good, with no relevant differences between sites. Differences in systemic EE/GSD exposure following patch application to the outer, upper arm vs. lower abdomen and buttocks are unlikely to be clinically relevant, and there were no relevant

  10. A case report of intramuscular myxoma in the paraspinal space

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Mi Jin; Cho, Woo Ho; Kim, Soung Hee [Sanggye Paik Hospitl, Inje University College of Medicine, Seoul (Korea, Republic of)


    Myxomas rare benign mesenchymal neoplasms composed of undifferentiated stellate cells in the myxoid stroma and can affect the heart, subcutaneous tissues, bone and skin. Myxomas arising from muscle tissue are called intramuscular myxomas, and account for 17% of all myxomas. Intramuscular myxomas are most commonly located in the large muscles of the thigh, shoulder, and buttocks. However, intramuscular myxomas of the head and neck region are rarely reported. In this study, we report a case of intramuscular myxoma arising from the paraspinal space of the head and neck region.

  11. Ischiogluteal bursitis mimicking soft-tissue metastasis from a renal cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Voelk, M.; Gmeinwieser, J.; Manke, C.; Strotzer, M. [Department of Radiology, University Hospital, Regensburg (Germany); Hanika, H. [Department of Urology, St. Josef Hospital, Regensburg (Germany)


    We report a case of ischiogluteal bursitis mimicking a soft-tissue metastasis from a renal cell carcinoma. A 66-year-old woman suffered from pain over the left buttock 6 months after she was operated on for renal cell carcinoma of the left kidney. CT of the abdomen and pelvis revealed a tumor-like lesion adjacent to the left os ischii, which was suspected to be a soft-tissue metastasis. Percutaneous biopsy revealed no evidence of malignancy, but the histopathological diagnosis of chronic bursitis. (orig.) With 2 figs., 8 refs.

  12. Topical retinoic acid changes the epidermal cell surface glycosylation pattern towards that of a mucosal epithelium

    DEFF Research Database (Denmark)

    Griffiths, C E; Dabelsteen, Erik; Voorhees, J J


    separate areas of buttock skin, with single applications of 0.1% RA, 2% SLS, or vehicle creams, followed by 4-day occlusion. Biopsies were assessed immunohistologically using highly specific monoclonal antibodies to cell surface carbohydrates (types 1, 2 and 3 chain structures), previously demonstrated...... for carbohydrate synthesis, are influenced by retinoids. Thus, we investigated whether epidermal cell surface glycosylation is altered in skin treated with topical RA, and contrasted it with changes induced by topical SLS. Skin biopsies were obtained from seven normal volunteers who had been treated, on three...

  13. Cellulite: a review with a focus on subcision

    Directory of Open Access Journals (Sweden)

    Friedmann DP


    Full Text Available Daniel P Friedmann,1 Garrett Lane Vick,2 Vineet Mishra3 1Westlake Dermatology Clinical Research Center, Westlake Dermatology & Cosmetic Surgery, Austin, 2Department of Medicine, 3Division of Dermatology and Cutaneous Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA Abstract: Cellulite is an alteration in skin topography most often found on the buttocks and posterolateral thighs of the majority of postpubertal females. This article aims to review the background, potential pathophysiology, and potential treatment options for cellulite, highlighting subcision as an ideal therapeutic option for this cosmetically distressing condition. Keywords: gynoid lipodystrophy, fibrous septae, radiofrequency, vacuum-assisted subscision

  14. Corneal arcus and xanthomas in homozygous familial hypercholesterolemia: First report from China

    Directory of Open Access Journals (Sweden)

    Xin Meng


    Full Text Available We report the case of a 12-year-old male who developed corneal arcus and multiple skin lesions with a 10-year history of xanthomas. The lesions appeared over his fingers, hands, elbows, knees, buttocks and feet. Laboratory studies showed a total serum cholesterol level of 752.1 mg/dL; a triglyceride level of 96.6 mg/dL; a low-density lipoprotein cholesterol level of 661.3 mg/dL. Findings were consistent with homozygous familial hypercholesterolemia. To our knowledge, this is the first such case to be reported from China.

  15. Synovis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome: A case of spine, pelvis, and anterior chest wall involvement, with overlooked plantar pustulosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Soo; Jeong, Soh Yong; Lee, Sujin; Baek, In Woon; Park, Jeongmi [Yeouido St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)


    Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is an inflammatory clinical condition with aseptic bone lesions and characteristic skin manifestations. A 63-year-old woman presented with vague musculoskeletal symptoms including chronic buttock pain. The clinical work-up revealed multiple spine and osteoarticular involvement. Multilevel bone marrow edema and cortical erosions involving the spine, asymmetric sacroiliitis, and osteosclerosis of the sternoclavicular joint were consistent with a diagnosis of SAPHO syndrome. Considering SAPHO syndrome in the differential diagnosis, subsequent skin inspection revealed plantar pustulosis. Despite the unique feature of accompanying skin and skeletal lesions, skin lesions could be overlooked if not suspected.

  16. Postpartum Sacral Stress Fracture: An Atypical Case Report


    Speziali, Andrea; Tei, Matteo Maria; Placella, Giacomo; Chillemi, Marco; Cerulli, Giuliano


    Sacral stress fractures are common in elderly people. However, sacral stress fracture should be always screened in the differential diagnoses of low back pain during the postpartum period. We present a case of sacral fracture in a thirty-six-year-old woman with low back pain and severe right buttock pain two days after cesarean section delivery of a 3.9 Kg baby. The diagnosis was confirmed by MRI and CT scan, while X-ray was unable to detect the fracture. Contribution of mechanical factors d...

  17. Chronic zosteriform cutaneous leishmaniasis

    Directory of Open Access Journals (Sweden)

    Omidian M


    Full Text Available Cutaneous leishmanasis (CL may present with unusual clinical variants such as acute paronychial, annular, palmoplantar, zosteriform, erysipeloid, and sporotrichoid. The zosteriform variant has rarely been reported. Unusual lesions may be morphologically attributed to an altered host response or owing to an atypical strain of parasites in these lesions. We report a patient with CL in a multidermatomal pattern on the back and buttock of a man in Khozestan province in the south of Iran. To our knowledge, this is the first reported case of multidermatomal zosteriform CL. It was resistant to conventional treatment but responded well to a combination of meglumine antimoniate, allopurinol, and cryotherapy.

  18. Annular Lupus Vulgaris Mimicking Tinea Cruris (United States)

    Heo, Young Soo; Shin, Won Woong; Kim, Yong Ju; Song, Hae Jun


    Cutaneous tuberculosis is an infrequent form of extrapulmonary tuberculosis. It is often clinically and histopathologically confused with various cutaneous disorders. A 36-year-old man attended our clinic with slowly progressive, asymptomatic, annular skin lesions on both the thighs and buttocks for 10 years. He consulted with many physicians and was improperly treated with an oral antifungal agent for several months under the diagnosis of tinea cruris, but no resolution of his condition was observed. A diagnosis of lupus vulgaris was made based on the histopathologic examination and the polymerase chain reaction assay. Anti-tuberculosis therapy was administered and the lesions started to regress. PMID:20548922

  19. Ulcerative lupus vulgaris over nose, leading to cosmetic deformity. (United States)

    Nair, Pragya A; Mehta, Malay J; Patel, Bhumi B


    Lupus vulgaris (LV), is a chronic and progressive form of secondary cutaneous tuberculosis. In India, it is commonly seen over buttocks, thighs, and legs whereas involvement of nose is quite rare. Ulcerative variant particularly over nose causes destruction of cartilage, leading to irreversible deformities and contracture. High-index of suspicion is required for early diagnosis and prevention of cosmetic deformity. A case of LV over nose in a young male with ulceration is reported who responded well to anti-tubercular therapy, but left with scarring of nose, which could have been prevented if adequate awareness regarding extra-pulmonary cases would have been practiced.

  20. Pancreatic panniculitis associated with acute pancreatitis and hemorrhagic pseudocysts: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Yong Suk; Kim, Mi Sung; Park, Chan Sub; Park, Ji Yeon; Park, Noh Hyuck [Kwandong Univ., Myongji Hospital, Goyang (Korea, Republic of)


    Pancreatic panniculitis is an inflammation and necrosis of fat at distant foci in patients with pancreatic disorders, most frequently, pancreatitis and pancreatic carcinoma. Clinically, pancreatic panniculitis is manifested by painless or painful subcutaneous nodules on the legs, buttocks, or trunk. The usual sites are the distal parts of the lower extremities. To the best of our knowledge, there have not been many reports for the radiologic findings of pancreatic panniculitis. In this article, we report a case of pancreatic panniculitis, including radiologic findings of CT and ultrasonography. The patient was presented with painful subcutaneous nodules on the trunk, and had underlying acute pancreatitis and hemorrhagic pseudocysts.

  1. Subcutaneous panniculitis-like T-cell lymphoma: MRI features and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Levine, Benjamin D.; Seeger, Leanne L.; Motamedi, Kambiz [UCLA-Santa Monica Medical Center and Orthopedic Hospital, Department of Radiological Sciences, Santa Monica, CA (United States); James, Aaron W. [UCLA-Santa Monica Medical Center and Orthopedic Hospital, Department of Pathology and Laboratory Medicine, Santa Monica, CA (United States)


    Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) represents a rare subclassification of peripheral T-cell lymphoma (PTCL). We present a case of a 21-year-old female who presented with a 1-month history of pain in the left buttock and hip, tender left inguinal lymph nodes, fevers, and night sweats. Percutaneous core needle biopsy was diagnostic for SPTCL with CD8+ cells positive for cytotoxic granules. Magnetic resonance imaging (MRI) features of SPTCL with a review of the literature are discussed. (orig.)

  2. Lipectomy of the ilio-lumbosacral region. (United States)

    Chamosa, Miguel


    In the past, several techniques for raising the gluteal mass have been described, all of which were based on dermolipectomies of major or minor extension. The main disadvantage of these dermolipectomies is the visible external scar. The author presents his technique for lipectomy of the ilio-lumbosacral region. It is proposed that multiplanar liposuction in this region lengthens the lumbar lordotic curve and results in upward traction on the buttocks, resulting in a more youthful contour of the region. The article describes a series of 98 patients with lipodystrophy of the ilio-lumbosacral area who underwent liposuction of the region and were highly satisfied with the results.

  3. Septic shock in pregnancy due to pyogenic sacroiliitis: a case report

    Directory of Open Access Journals (Sweden)

    Moros María Lapresta


    Full Text Available Abstract Introduction Lower back pain due to sacroiliac joint dysfunction is a common symptom during pregnancy. However, infection of the sacroiliac joint is rare, even more so if no predisposing factors are present. Case presentation After the onset of unspecific acute pain in the left buttock region, a 31-year-old pregnant woman developed septic shock due to pyogenic sacroiliitis. The medical and obstetric management, treatment applied and patient's experience are described. Conclusion The correct diagnosis and treatment of pyogenic sacroiliitis during pregnancy may avoid joint and bone destruction in addition to maternal and fetal complications.

  4. Sports and performing arts medicine: 3. Spine and neurologic injuries. (United States)

    Storm, Seneca A; Finnoff, Jonathan T; Willick, Stuart; Akau, Cedric K; Harrast, Mark A


    This self-directed learning module highlights select spine and neurological injuries in athletes and performing arts injuries. It is part of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Using a case vignette format, this article specifically focuses on sports-induced concussion, stingers and transient myelopathy, and buttock pain in athletes, and hand dystonia and hand numbness in musicians. The goal of this article is to facilitate the learner's ability to diagnose and treat spine and neurologic injuries in athletes and performing artists.

  5. Creeping eruption of the hand in an Iranian patient: Cutaneous larva migrans

    Directory of Open Access Journals (Sweden)

    Zabihollah Shahmoradi


    Full Text Available Cutaneous larva migrans (CLM, a serpiginous cutaneous eruption is the most commonly acquired tropical dermatosis. It is caused by infection with hookworm larvae in tropical and sub-tropical areas, and people who have a history of travel in these countries. The most frequent location of CLM is the distal lower extremities or buttocks. We describe a case of 57-year-old Iranian female patient with CLM of hand (unusual site without traveling to endemic countries that was successfully treated with oral albendazole. To the best of our knowledge, this is the first report of CLM in Iran.

  6. Non-traumatic myositis ossificans circumscripta: A diagnosis trap


    El Bardouni, Ahmed; Boufettal, Monsef; Zouaidia, Fouad; Kharmaz, Mohamed; Berrada, Mohamed S.; Mahassini, Najat; El Yaacoubi, Moradh


    Myositis ossificans circumscripta (MOC) is a benign condition of non-neoplastic heterotopic bone formation in the muscle or soft tissue. Trauma plays a role in the development of MOC, thus, non-traumatic MOC is very rare. Although MOC may occur anywhere in the body, the lesions are localized predominantly in the high-risk sites of injury, such as the thigh, buttock, and elbow. MOC can easily be mistaken for osteomyelitis or a malignant tumor, specifically osteosarcoma or soft-tissue sarcoma. ...

  7. The role of natural and UV-induced skin pigmentation on low-fluence IPL-induced side effects

    DEFF Research Database (Denmark)

    Thaysen-Petersen, Daniel; Lin, Jennifer Y; Nash, Jf


    disproportionately. The aim of this study was to evaluate the influence of constitutive and facultative skin pigmentation on low-fluence intense pulsed light (IPL)-induced adverse skin effects. STUDY DESIGN/MATERIALS AND METHODS: Twenty-one subjects with Fitzpatrick skin type II-IV were enrolled. Two buttock blocks...... were randomized to receive 0 or 8 solar simulated ultraviolet radiation (UVR) exposures of consecutively increasing Standard Erythema Doses (2-4 SED). Each block was subdivided into four sites, randomized to receive IPL of 0, 7, 8, or 10 J/cm(2) , once a week for 3 weeks. Biopsies were taken 16...

  8. Pregabalin for Opioid-Refractory Pain in a Patient with Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    Konstantinos A. Kontoangelos


    Full Text Available Background. Ankylosing spondylitis (AS is a systemic inflammatory disease with chronic back pain as the most common presenting symptom. We present a case of a male patient with AS reporting symptoms of severe low back pain, buttock pain, and limited spinal mobility. After chronic treatment with opioids, we administered pregabalin at a dose of 300 mg as an analgesic agent while opioids were discontinued. Findings. Pain symptoms improved progressively, and opioids were gradually discontinued without any withdrawal symptoms reported. Conclusions. Pregabalin is potentially useful in the management of pain in patients with AS while effectively managing the discontinuation of opioid treatment.

  9. A woman with juxta-articular nodules—An uncommon form of subcutaneous granuloma annulare

    Directory of Open Access Journals (Sweden)

    Lili Wang


    Full Text Available Granuloma annulare is a benign inflammatory dermatosis that is most common in children and young adults. The subcutaneous form of granuloma annulare, which occurs mainly on the extremities in children, is rare. Lesions usually occur as painless subcutaneous nodules without inflammation of the cutaneous surface; the most frequent sites are the legs, buttocks, and scalp. Nevertheless, we present a case of subcutaneous granuloma annulare confined to the dorsa of the hand joints and right knee in a 51-year-old woman.

  10. A newborn with neurocutaneous melanocytosis and Dandy-Walker malformation. (United States)

    De Cock, Jens; Snauwaert, Julie; Van Rompaey, Walter; Morren, Marie-Anne; Demaerel, Philippe


    Neurocutaneous melanocytosis is a rare congenital dysplasia of the neuroectodermal melanocyte precursor cells that leads to proliferation of melanin-producing cells in the skin and leptomeninges. We describe a newborn with a giant congenital melanocytic nevus on his back, buttocks, and thighs. His brain magnetic resonance imaging study revealed bilateral T1 hyperintense lesions in the cerebellum and in the amygdala, hydrocephalus, and a Blake's pouch cyst, consistent with neurocutaneous melanocytosis and Dandy-Walker malformation. Neurocutaneous melanocytosis has a wide clinical spectrum that includes hydrocephalus, epilepsy, cranial nerve palsy, increased intracranial pressure, and sensorimotor deficits. Copyright © 2014. Published by Elsevier Inc.

  11. Acne conglobata and Klinefelter's syndrome. (United States)

    Wollenberg, A; Wolff, H; Jansen, T; Schmid, M H; Röcken, M; Plewig, G


    Acne conglobata has been reported to be more common and more severe in XYY chromosomal aberration than in normal subjects. Whereas only exceptional cases have been observed in the more common XXY Klinefelter karyotype. We report a 17-year-old male with both Klinefelter's syndrome and acne conglobata, spreading from face to upper arms, trunk, buttocks and upper legs. The serum level of testosterone was normal, whereas luteinizing hormone and follicle-stimulating hormone were elevated. Skin lesions responded well to a combined therapeutic regimen including oral isotretinoin and prednisolone. An overview of severe acne in relation to chromosomal abnormalities is given and diagnostic and therapeutic options discussed.

  12. Acute respiratory distress syndrome and chemical burns after exposure to chlorine-containing bleach: a case report. (United States)

    Shin, Hong-Joon; Chang, Jin-Sun; Ahn, Seong; Kim, Tae-Ok; Park, Cheol-Kyu; Lim, Jung-Hwan; Oh, In-Jae; Kim, Yu-Il; Lim, Sung-Chul; Kim, Young-Chul; Kwon, Yong-Soo


    Chlorine-containing bleach can cause acute respiratory distress syndrome (ARDS) and chemical burns. However, simultaneous occurrence of the two conditions caused by this agent is very rare. We describe the case of a 74-year-old female who presented with shortness of breath and hemoptysis following accidental exposure to chlorine-containing bleach. She had second- to third-degree chemical burns on both buttocks and thighs, and received mechanical ventilation because of the development of ARDS. Mechanical ventilation was discontinued on day 6 of hospitalization because of the rapid improvement of hypoxemia, and the patient was transferred to another hospital for further management of the chemical burns on day 18.

  13. Cutaneous siderosis secondary to intramuscular iron dextran treated with 755 nm Q-switched alexandrite laser: A case report. (United States)

    Lloyd, Amanda A; Graves, Michael S; Ross, Edward V


    Cutaneous siderosis is accumulation of iron in the dermis and the subcutaneous tissue secondary to extravasation of an intramuscular or intravascular iron injection. It presents as varying shades of brown macules with no distinct contours. The hyperpigmentation is permanent without treatment. Q-switched lasers have been used effectively to treat lentigines and tattoos however, there is little data on the treatment of cutaneous siderosis with lasers. Our objective was to effectively treat cutaneous siderosis with a Q-switched alexandrite laser. A 50-year-old female had received nine injections of intramuscular iron dextran, one injection every 2 weeks alternating right buttock and left buttock over the course of 5 months. A couple of weeks after her 9th injection which was on the left, she noted brown hyperpigmentation in the injection area with the left worse than the right. She waited 3 months for the hyperpigmentation to self-resolve before presenting in our clinic. We utilized the Q-switched alexandrite laser to treat the patient with a test spot. One week later, there was nice partial clearance from the test spot so we commenced full treatment of the hyperpigmentation. There was significant improvement after the first treatment and she has been treated 4 times with continued improvement over the past 2 months. The Q-switched alexandrite laser is a useful tool in the treatment of cutaneous siderosis secondary to iron injection. © 2015 Wiley Periodicals, Inc.

  14. Sciatica-like symptoms and the sacroiliac joint: clinical features and differential diagnosis. (United States)

    Visser, L H; Nijssen, P G N; Tijssen, C C; van Middendorp, J J; Schieving, J


    To compare the clinical features of patients with sacroiliac joint (SIJ)-related sciatica-like symptoms to those with sciatica from nerve root compression and to investigate the necessity to perform radiological imaging in patients with sciatica-like symptoms derived from the SIJ. Patients with pain radiating below the buttocks with a duration of 4 weeks to 1 year were included. After physical and radiological examinations, a diagnosis of SI joint-related pain, pain due to disk herniation, or a combination of these two causes was made. Patients with SIJ-related leg pain (n = 77/186) were significantly more often female, had shorter statue, a shorter duration of symptoms, and had more often pain radiating to the groin and a history of a fall on the buttocks. Muscle weakness, corkscrew phenomenon, finger-floor distance ≥25 cm, lumbar scoliosis, positive Bragard or Kemp sign, and positive leg raising test were more often present when radiologic nerve root compression was present. Although these investigations may help, MRI of the spine is necessary to discriminate between the groups. Sciatica-like symptoms derived from the SIJ can clinically mimic a radiculopathy. We suggest to perform a thorough physical examination of the spine, SI joints, and hips with additional radiological tests to exclude other causes.

  15. Radiculopathy due to malignant melanoma in the sacrum with unknown primary site. (United States)

    Kakutani, Kenichiro; Doita, Minoru; Nishida, Kotaro; Miyamoto, Hiroshi; Kurosaka, Masahiro


    Melanoma is an interesting tumor, showing the appearance of metastasis without any trace of its primary lesion. To report a very rare case of malignant melanoma in the sacrum with unknown primary origin. The authors present a case of a 52-year-old man who was admitted with increasing lower back, left buttock, and left lower extremity pain, and dysuria. Plain radiograph, computed tomography scan, and magnetic resonance imaging revealed a destructive lesion in the sacrum and left ilium, which infiltrated the spinal canal and sacroiliac joint. The tumor cells were immunoreactive for HMB-45. The pathological diagnosis was malignant melanoma. No obvious primary malignant melanoma was detected on the skin surface, on the oral or anal mucosa, or in the fundus oculi. Following radiotherapy and chemotherapy, the severe buttock pain disappeared and the patient was able to walk without impediment. However the patient died nine months after initial diagnosis. Malignant melanoma in the sacrum with an unknown primary site, showing S1 radiculopathy is reported for the first time. The melanoma could have been a metastatic tumor of the sacrum, although the primary site was not detected. The incidence of primary melanoma is increasing faster than any other cancer. Thus treatment of patients with spinal metastasis of melanoma is an important challenge for orthopedic surgeons.

  16. Postpartum pyogenic sacroiliitis with methicillin-resistant Staphylococcus aureus in a healthy adult: A case report and review of the literature. (United States)

    Imagama, Takashi; Tokushige, Atsunori; Sakka, Akihito; Seki, Kazushige; Taguchi, Toshihiko


    Back and buttock pain during pregnancy and the postpartum period generally improves spontaneously and rarely causes problems. However, such pain is infrequently induced by pyogenic sacroiliitis. We herein present a 37-year-old female patient with no previous medical history who developed pyogenic sacroiliitis with severe right buttock pain 7 days after cesarean delivery. Arthrocentesis was performed, and a culture revealed the presence of methicillin-resistant Staphylococcus aureus (MRSA). After 6 weeks of treatment with intravenous antibiotics, her infection became quiescent. Eight cases of pyogenic sacroiliitis during the postpartum period and seven cases during pregnancy have been reported, but most of the causative pathogens were methicillin-sensitive Staphylococcus or Streptococcus species. This report describes the first case of postpartum pyogenic sacroiliitis caused by MRSA. The frequency of infection with MRSA has recently increased, and community-acquired MRSA, which affects even healthy young people, has also become a problem. Antibiotics for empirical therapy after a diagnosis of pyogenic sacroiliitis, including anti-MRSA antibiotics, should be carefully selected. Copyright © 2015. Published by Elsevier B.V.

  17. Pendulum Test: A Highly Accurate and Simple Physical Examination Maneuver to Identify Hip Pathology

    Directory of Open Access Journals (Sweden)

    Yasushi Oshima


    Full Text Available Background: Patients with hip pathology often complain of various symptoms, e.g. pain or discomfort of low back, lower extremity, hip, groin, thigh, buttock or knee. Physicians may be distracted by these complaints, and misdiagnose and mistreat hip pathology. To avoid this, the pendulum test, which is performed with a patient seated on the examination table and hips and knees are flexed at 90 degrees, while the examiner passively swings the patient's lower extremity in and out as a pendulum, has been employed for all patients with the complaint of low back, hip and knee. Objective: The efficacy and the accuracy of the pendulum test were evaluated. Patients and methods: Consecutive 40 patients, who had complained pain or discomfort of low back, lower extremity, hip, groin, thigh, buttock and knee were examined by the pendulum test. Results: Eighteen patients were positive for the pendulum test, and all of them correlated to the hip pathology. Conclusions: The pendulum test was confirmed to be easily performed and reliable in detecting the hip pathology. Therefore, this test is highly recommended for the differentiation of patients with low back, hip and knee complaints.

  18. Concurrent presentation of erythrodermic lichen planus and squamous cell carcinoma: Coincidence or malignant transformation?

    Directory of Open Access Journals (Sweden)

    Neema M Ali


    Full Text Available Lichen planus is a common papulosquamous disorder affecting about 1-2% of the population, neoplastic transformation of cutaneous lichen planus lesions occurs very rarely. A 40 year old female patient presented with a 1 year history of developing multiple, itchy, pigmented lesions over both lower legs which gradually spread to involve the whole body. A few tense bullae were seen on the extremities. An erythematous fleshy lesion was seen on the upper aspect of the left buttock. Skin biopsy from a plaque on the right forearm showed features suggestive of lichen planus. Skin biopsy of a bullae showed a sub epidermal bulla filled with a mixed inflammatory infiltrate. Direct immunofluorescence revealed no immunoreactants along the basement membrane zone. A diagnosis of erythrodermic lichen planus with bullous lichen planus was made. Biopsy of fleshy lesion of left buttock revealed a moderately differentiated squamous cell carcinoma. Erythrodermic lichen planus with bullous lesions and secondary squamous cell carcinoma; these occurences in a single patient is extremely rare and has not been previously reported to the best of our knowledge.

  19. Concurrent Presentation of Erythrodermic Lichen Planus and Squamous Cell Carcinoma: Coincidence or Malignant Transformation? (United States)

    Ali, Neema M; Bhat, Ramesh; Rao, Shwetha B


    Lichen planus is a common papulosquamous disorder affecting about 1-2% of the population, neoplastic transformation of cutaneous lichen planus lesions occurs very rarely. A 40 year old female patient presented with a 1 year history of developing multiple, itchy, pigmented lesions over both lower legs which gradually spread to involve the whole body. A few tense bullae were seen on the extremities. An erythematous fleshy lesion was seen on the upper aspect of the left buttock. Skin biopsy from a plaque on the right forearm showed features suggestive of lichen planus. Skin biopsy of a bullae showed a sub epidermal bulla filled with a mixed inflammatory infiltrate. Direct immunofluorescence revealed no immunoreactants along the basement membrane zone. A diagnosis of erythrodermic lichen planus with bullous lichen planus was made. Biopsy of fleshy lesion of left buttock revealed a moderately differentiated squamous cell carcinoma. Erythrodermic lichen planus with bullous lesions and secondary squamous cell carcinoma; these occurences in a single patient is extremely rare and has not been previously reported to the best of our knowledge.

  20. Classroom furniture and anthropometric characteristics of Iranian high school students: proposed dimensions based on anthropometric data. (United States)

    Dianat, Iman; Karimi, Mohammad Ali; Asl Hashemi, Ahmad; Bahrampour, Samira


    The study evaluated the potential mismatch between classroom furniture dimensions and anthropometric characteristics of 978 Iranian high school students (498 girls, 480 boys), aged 15-18 years. Nine anthropometric measurements (stature, sitting height, sitting shoulder height, popliteal height, hip breadth, elbow-seat height, buttock-popliteal length, buttock-knee length and thigh clearance) and five dimensions from the existing classroom furniture were measured and then compared together (using match criterion equations) to identify any potential mismatch between them. The results indicated a considerable mismatch between body dimensions of the students and the existing classroom furniture, with seat height (60.9%), seat width (54.7%) and desktop height (51.7%) being the furniture dimensions with a higher level of mismatch. The levels of mismatch varied between the high-school grade levels and between genders, indicating their special requirements and possible problems. The proposed dimensions of the classroom furniture more appropriate for the students were given. This additional information on students' anthropometry can be used by local furniture industries as a starting point for designing more appropriate furniture for school children, or used by schools to aid in furniture selection. Copyright © 2012 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  1. Persistence of lipoatrophy after a four-year long interruption of antiretroviral therapy for HIV1 infection: case report

    Directory of Open Access Journals (Sweden)

    Toro Giuseppe


    Full Text Available Abstract Background HIV-infected patients on long-term highly active antiretroviral therapy often present peculiar patterns of fat redistribution, referred to as lipodystrophy. In spite of recent investigations, it is not known whether and to what extent the main features of lipodystrophy – that is lipoatrophy of peripheral fat at face, limbs and buttocks, as well as fat accumulation at breasts, abdomen and the dorso-cervical region – can be reversible once clinically manifest. Case presentation A 35 year old Caucasian HIV infected female developed severe diffuse lipodystrophy while on highly active antiretroviral therapy. A remarkable increase of breast size, fat accumulation at waist, and a fat pad on her lumbar spine were paralleled by progressive and disfiguring lipoatrophy of face, limbs and buttocks. The patient decided to interrupt her therapy after 20 months, with a stably suppressed viremia and a CD4 lymphocyte count >500/μL. She could carry on a safe treatment interruption for longer than 4 years. Most sites of fat accumulation switched to nearly normal appearance, whereas lipoatrophy was substantially unchanged at all affected sites. Conclusion our observation provides pictorial evidence that lipoatrophy may not be reversible even under ideal circumstances. Therefore, strategies to prevent lipoatrophy should be considered when defining therapeutic regimens for HIV infected patients, especially those at high risk.

  2. [Furuncular myiasis caused by Dermatobia hominis. Fortuitous diagnosis on extemporaneous macroscopic analysis of an excised cutaneous nodule]. (United States)

    Hirsch, G; Jeandel, R; Biechler, M; Boivin, J-F; Hillion, B


    Furuncular myiasis is a parasitic disease caused by the development of human botfly larva in the skin. It affects people living in tropical countries and travelers returning from these countries and concerns a number of medical specialties. One form of treatment involves surgical extraction of the parasites. We report the case of a 47-year-old man returning from Guyana presenting two furuncle-like nodules of the skin on the right buttock and on the right shoulder blade. Extemporaneous intraoperative macroscopic examination of the buttock nodule resulted in diagnosis of myiasis caused by the human botfly, Dermatobia hominis. The diagnosis of furuncular myiasis is made primarily on clinical grounds and should be suspected on observation of an abscess in subjects returning from a tropical region. It is consequently rare to find D. hominis in biopsy specimens. In the present case, macroscopic examination showed an extremely rare image of the edge of the intact larva in a longitudinal cut, which to our knowledge has never been published to date. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  3. Rhabdomyolysis associated with single-dose intravenous esomeprazole administration: A case report. (United States)

    Jeon, Dae-Hong; Kim, Yire; Kim, Min Jeong; Cho, Hyun Seop; Bae, Eun Jin; Chang, Se-Ho; Park, Dong Jun


    Proton pump inhibitors are usually safe, although serious adverse effects can occur. We report the first case of rhabdomyolysis associated with single-dose intravenous esomeprozole administration. A 45-year-old Korean male visited our emergency room because of persistent lower chest discomfort that started 10 hours before. He had been diagnosed with diabetes and coronary heart disease, but discontinued oral hypoglycemic agents 1 month earlier. He continued to take medications for coronary heart disease. There was no abnormality on an electrocardiogram or in cardiac enzymes. Initial laboratory findings did not show abnormalities for muscle enzymes. Esomeprozole 40 mg was administrated intravenously for the control of his ambiguous chest discomfort. Then, 12 hours later, he complained of abrupt severe right buttock pain. An area of tender muscle swelling 8 cm in diameter was seen on his right buttock area. Creatine kinase and lactate dehydrogenase were elevated to 40,538 and 1326 U/L, respectively. A bone scan using 20 mCi of Tc-hydroxymethylene diphosphonate was compatible with rhabdomyolysis. His muscular symptoms, signs, and laboratory findings improved markedly with conservative management, including hydration and urine alkalinization. He is being followed in the outpatient department with no evidence of recurrence. We should keep in mind that single-dose intravenous administration of esomeprazole can induce rhabdomyolysis.

  4. Gluteal Compartment Syndrome Secondary to Pelvic Trauma

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    Fernando Diaz Dilernia


    Full Text Available Gluteal compartment syndrome (GCS is extremely rare when compared to compartment syndrome in other anatomical regions, such as the forearm or the lower leg. It usually occurs in drug users following prolonged immobilization due to loss of consciousness. Another possible cause is trauma, which is rare and has only few reports in the literature. Physical examination may show tense and swollen buttocks and severe pain caused by passive range of motion. We present the case of a 70-year-old man who developed GCS after prolonged anterior-posterior pelvis compression. The physical examination revealed swelling, scrotal hematoma, and left ankle extension weakness. An unstable pelvic ring injury was diagnosed and the patient was taken to surgery. Measurement of the intracompartmental pressure was measured in the operating room, thereby confirming the diagnosis. Emergent fasciotomy was performed to decompress the three affected compartments. Trauma surgeons must be aware of the possibility of gluteal compartment syndrome in patients who have an acute pelvic trauma with buttock swelling and excessive pain of the gluteal region. Any delay in diagnosis or treatment can be devastating, causing permanent disability, irreversible loss of gluteal muscles, sciatic nerve palsy, kidney failure, or even death.

  5. Longitudinal evaluation of manual lymphatic drainage for the treatment of gynoid lipodystrophy* (United States)

    Schonvvetter, Bianca; Soares, Juliana Laudicéia Marques; Bagatin, Ediléia


    BACKGROUND The gynoidlypodystrophy, known as cellulitis or cellulite, refers to a condition that gives the skin an undulating and uneven appearance, affecting 80-90% of women after puberty. OBJECTIVES to investigate the efficacy and safety of manual lymphatic drainage for cellulite management. METHODS this was an open, prospective, intervention study including 20 women aged from 20 to 40 years. Fourteen sessions of manual lymphatic drainage were performed once a week on lower limbs and buttocks. RESULTS Fifteen women completed the study. A significant improvement on quality of life was observed (p=0.018). A significant reduction (p=0.023), estimated at 0.3±0.8 cm, in hip circumference was found, but no difference was found in thighs circumference (p>0.05). A significant reduction elastic recuperation of skin on buttocks, which means skin elasticity worsening, was observed. All measures obtained by ultrasound images showed no changes (p>0.05). CONCLUSION manual lymphatic drainage was safe but not effective as an isolated approach for cellulite management. Further randomized, controlled or comparative studies about manual lymphatic drainage for cellulite control, as unique or combined therapeutic modality, are necessary. PMID:25184909

  6. Cellulite: poor correlation between instrumental methods and photograph evaluation for severity classification. (United States)

    Soares, J L M; Miot, H A; Sanudo, A; Bagatin, E


    Cellulite refers to skin relief alterations in women's thighs and buttocks, causing dissatisfaction and search for treatment. Its physiopathology is complex and not completely understood. Many therapeutic options have been reported with no scientific evidence about benefits. The majority of the studies are not controlled nor randomized; most efficacy endpoints are subjective, like not well-standardized photographs and investigator opinion. Objective measures could improve severity assessment. Our purpose was to correlate non-invasive instrumental measures and standardized clinical evaluation. Twenty six women presenting cellulite on buttocks, aged from 25 to 41, were evaluated by: body mass index; standardized photography analysis (10-point severity and 5-point photonumeric scales) by five dermatologists; cutometry and high-frequency ultrasonography (dermal density and dermis/hypodermis interface length). Quality of life impact was assessed. Correlations between clinical and instrumental parameters were performed. Good agreement among dermatologists and main investigator perceptions was detected. Positive correlations: body mass index and clinical scores; ultrasonographic measures. Negative correlation: cutometry and clinical scores. Quality of life score was correlated to dermal collagen density. Cellulite caused impact in quality of life. Poor correlation between objective measures and clinical evaluation was detected. Cellulite severity assessment is a challenge, and objective parameters should be optimized for clinical trials. © 2014 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

  7. Circumference reduction and cellulite treatment with a TriPollar radiofrequency device: a pilot study. (United States)

    Manuskiatti, W; Wachirakaphan, C; Lektrakul, N; Varothai, S


    A wide variety of treatments for circumference reduction and cellulite are available, but most procedures offer suboptimal clinical effect and/or delayed therapeutic outcome. Objective To determine the safety and efficacy of the TriPollar radiofrequency device for cellulite treatment and circumference reduction. Thirty-nine females with cellulite received eight weekly TriPollar treatments. Treatment areas included the abdomen, thighs, buttocks and arms. Subjects were evaluated using standardized photographs and measurements of body weight, circumference, subcutaneous thickness, and skin elasticity of the treatment sites at baseline, immediately after and 4 weeks after the final treatment. Physicians' evaluation of clinical improvement scores using a quartile grading scale was recorded. Thirty-seven patients (95%) completed the treatment protocol. There was significant circumference reduction of 3.5 and 1.7 cm at the abdomen (P = 0.002) and thigh (P = 0.002) regions, respectively. At 4 weeks after the last treatment, the average circumferential reductions of the abdomen and thighs were sustained. No significant circumferential reductions of the buttocks and arms at the last treatment visit compared to baseline were demonstrated (P = 0.138 and 0.152, respectively). Quartile grading scores correlating to approximately 50% improvement in cellulite appearance were noted. Tripollar radiofrequency provided beneficial effects on the reduction of abdomen and thigh circumference and cellulite appearance.

  8. Collagen cross-linking in sun-exposed and unexposed sites of aged human skin (United States)

    Yamauchi, M.; Prisayanh, P.; Haque, Z.; Woodley, D. T.


    A recently described nonreducible, acid-heat stable compound, histidinohydroxylysinonorleucine (HHL), is a collagen cross-link isolated from mature skin tissue. Its abundance is related to chronologic aging of skin. The present communication describes the quantity of HHL from aged human skin of the same individuals in sun-exposed (wrist) and unexposed (buttock) sites. Punch biopsies were obtained from these sites from nine people of age 60 or older. HHL contents (moles/mole of collagen) at these sites were for wrist 0.13 +/- 0.07 and for buttock 0.69 +/- 0.17 (mean +/- SD, p less than 0.001). In addition, it was found that acute irradiation of the cross-linked peptides with UVA (up to 250 J/cm2) and UVB (up to 1 J/cm2) had no effect on HHL structure. The same treatment significantly degraded another nonreducible, stable collagen cross-link, pyridinoline. The results suggest that chronic sunlight exposure may be associated with an impediment to normal maturation of human dermal collagen resulting in tenuous amount of HHL. Thus, the process of photoaging in dermal collagen is different from that of chronologic aging in human skin.

  9. Injury of the gluteal aponeurotic fascia and proximal iliotibial band: anatomy, pathologic conditions, and MR imaging. (United States)

    Huang, Brady K; Campos, Juliana C; Michael Peschka, Philippe Ghobrial; Pretterklieber, Michael L; Skaf, Abdalla Y; Chung, Christine B; Pathria, Mini N


    The fascia lata, or deep fascia of the thigh, is a complex anatomic structure that has not been emphasized as a potential source of pelvic and hip pain. This structure represents a broad continuum of fibrous tissue about the buttock, hip, and thigh that receives contributions from the posteriorly located aponeurotic fascia covering the gluteus medius muscle and from the more laterally located iliotibial band (ITB). At the pelvis and hip, the ITB consists of three layers that merge at the lower portion of the tensor fasciae latae muscle. The gluteal aponeurotic fascia and ITB merge at the buttock and hip before extending inferiorly to the Gerdy tubercle at the anterolateral tibia. Injuries to these anatomic structures are an underdiagnosed cause of pain and disability and may clinically mimic more common processes affecting the hip and proximal thigh. Categories of disease include overuse injuries, traumatic injuries, degenerative lesions, and inflammatory lesions. Familiarity with the anatomy and pathologic conditions of the fascia lata and its components is important in their recognition as a potential source of symptoms. This article illustrates the anatomy of this complex fascia through anatomic-pathologic correlation and describes the magnetic resonance imaging appearances of the pathologic conditions involving it.

  10. Silicone-Induced Granuloma after Injection for Cosmetic Purposes: A Rare Entity of Calcitriol-Mediated Hypercalcemia

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    Nidhi Agrawal


    Full Text Available Hypercalcemia is often a clue to the presence of unsuspected illness. We present an interesting case of an HIV-positive transgender female with a rare cause of silicone-induced granulomatous hypercalcemia. Although there have been a few case reports of silicone injections in dialysis patients causing hypercalcemia, this metabolic derangement secondary to silicone granulomas continues to be a unique entity with an unclear pathophysiology. We present a 45-year-old transgender HIV-positive female, with extensive silicone injections who presented with symptomatic hypercalcemia. Workup for malignancy and hyperparathyroidism was negative. 1,25-Dihydroxyvitamin D level and 24-hour urine calcium level were elevated. CT scan showed extensive high-density reticulonodular densities in the buttocks and gluteal muscle fascia extending upwards to the lumbar region, along with prominent external iliac and inguinal lymph nodes. Nuclear imaging showed diffuse heterogeneity and increased uptake in the buttocks, most consistent with granuloma calcifications, and an inguinal lymph node biopsy confirmed a foreign body giant cell reaction. The patient was started on prednisone and this resulted in decrease in serum and urinary calcium levels. Physicians should have a high index of suspicion for silicone-induced hypercalcemia considering the growing prevalence of body contour enhancement with injections, implants, and fillers using this material.

  11. Rhabdomyolysis associated with single-dose intravenous esomeprazole administration (United States)

    Jeon, Dae-Hong; Kim, Yire; Kim, Min Jeong; Cho, Hyun Seop; Bae, Eun Jin; Chang, Se-Ho; Park, Dong Jun


    Abstract Background: Proton pump inhibitors are usually safe, although serious adverse effects can occur. We report the first case of rhabdomyolysis associated with single-dose intravenous esomeprozole administration. Methods: A 45-year-old Korean male visited our emergency room because of persistent lower chest discomfort that started 10 hours before. He had been diagnosed with diabetes and coronary heart disease, but discontinued oral hypoglycemic agents 1 month earlier. He continued to take medications for coronary heart disease. There was no abnormality on an electrocardiogram or in cardiac enzymes. Initial laboratory findings did not show abnormalities for muscle enzymes. Esomeprozole 40 mg was administrated intravenously for the control of his ambiguous chest discomfort. Then, 12 hours later, he complained of abrupt severe right buttock pain. An area of tender muscle swelling 8 cm in diameter was seen on his right buttock area. Creatine kinase and lactate dehydrogenase were elevated to 40,538 and 1326 U/L, respectively. A bone scan using 20 mCi of 99mTc-hydroxymethylene diphosphonate was compatible with rhabdomyolysis. Results: His muscular symptoms, signs, and laboratory findings improved markedly with conservative management, including hydration and urine alkalinization. He is being followed in the outpatient department with no evidence of recurrence. Conclusion: We should keep in mind that single-dose intravenous administration of esomeprazole can induce rhabdomyolysis. PMID:27442680

  12. Confiabilidade intra e interexaminadores da fotogrametria na classificação do grau de lipodistrofia ginóide em mulheres assintomáticas Intra and inter-examiner reliability of photogrammetry in the classification of the degree of gynoid lypodystrophy in asymptomatic women

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    Ana Maria da Silva Mendonça


    photograph by two examiners on two one-year interval occasions; repeatability was assessed by a single examiner on two occasions one week apart. The Kappa index was applied. Results showed substantial correlation (κ=0.70 between examiners for cellulite degrees in upper buttock, and moderate correlation (κ=0.50 for cellulite degrees in lower buttock. As to repeatability, analyses showed excellent correlation (κ=0.81 for cellulitis degree in upper buttock and substantial correlation (κ=0.75 in lower buttock. The method proposed for classification of different gynoid lypodystrophy degrees by photogrammetry hence showed acceptable reliability intra and inter-examiner for the majority of evaluated regions, with the exception of the lower buttock.

  13. Sponyloarthritis features forecasting the presence of HLA-B27 or sacroiliitis on magnetic resonance imaging in patients with suspected axial spondyloarthritis: results from a cross-sectional study in the ESPeranza Cohort. (United States)

    Navarro-Compán, Victoria; de Miguel, Eugenio; van der Heijde, Désirée; Landewé, Robert; Almodóvar, Raquel; Montilla, Carlos; Beltrán, Emma; Zarco, Pedro


    Chronic back pain (CBP) is frequently the presenting symptom in patients with suspected axial spondyloarthritis (axSpA). Presence of sacroiliitis on magnetic-resonance-imaging (MRI) or HLA-B27 adds to diagnostic certainty. However, these costly tests cannot be applied in all patients with CBP. This study aims to investigate which SpA features increase the likelihood of a positive HLA-B27 or positive MRI of the sacroiliac-joints (MRI-SI) in patients with suspected axSpA. Data from 665 patients with CBP within the ESPeranza Programme were analysed. Diagnostic utility measures (LR+, LR-) for a positive MRI-SI or HLA-B27 were calculated for various definitions of inflammatory back pain (IBP), their separate items and for other SpA features. Pretest probabilityies of a positive result was 41% for MRI-SI and 40% for HLA-B27. For a positive MRI-SI result the most useful IBP characteristic was alternating buttock pain (LR + =2.6). Among the IBP-criteria, fulfillment of the 'ASAS criteria' (LR + =2.1) was most contributory. Interestingly, the addition of alternating buttock pain to the Calin/ASAS-IBP criteria (LR + =6.0 and 5.5, respectively) or the addition of awakening at second half of night to the Calin-IBP criteria (LR + =5.5) increased the pre-test probability of MRI-sacroiliitis from 41% to 79-80%. Dactylitis (LR + =4.1) and inflammatory bowel disease (IBD) (LR + =6.4) increased this probability to 73% and 81%, respectively. To forecast HLA-B27 positivity, awakening at the second half of the night, fulfillment of the ASAS-IBP definition and uveitis were the most useful, but only marginally predictive (LR + = 1.3, 1,6 and 2.6, respectively). If patients with suspected axial SpA have either (1) IBP according to Calin/ASAS definition plus alternating buttock pain, or (2) IBP according to Calin definition plus awakening at night, or (3) dactylitis or 4) IBD, the probability of finding a positive MRI-SI increases significantly.

  14. Effectiveness of carboxytherapy in the treatment of cellulite in healthy women: a pilot study

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    Pianez LR


    Full Text Available Luana Ramalho Pianez,1 Fernanda Silva Custódio,1 Renata Michelini Guidi,1-4 Jauru Nunes de Freitas,5-7 Estela Sant’Ana8-10 1Ibramed Center for Education and Advanced Training (CEFAI, Amparo, 2Santa Casa de Misericórdia Hospital, Porto Alegre, 3University of Campinas, Campinas, 4Ibramed Research and Development Department, Amparo, São Paulo, Brazil; 5Universitá Tor Vergata, Rome, Italy; 6Centro de Medicina Pesquisa e Ensino (CEMEPE, Belo Horizonte, 7Advanced Dermatology Studies Group (GDA, Rio de Janeiro, 8Federal University of São Carlos (UFSCAR, 9University of São Paulo (USP, São Carlos, 10Indústria Brasileira de Equipamentos Médicos (IBRAMED, Amparo, São Paulo, Brazil Background: Carbon dioxide therapy, better known as carboxytherapy, relates to percutaneous infusion of medical carbon dioxide with therapeutic approaches, and its use in the treatment of localized fat has demonstrated good results. Gynoid lipodystrophy, also known as cellulite, affects 80%–90% of women after puberty, especially in the buttocks and thighs. Its etiology is complex and involves multifactorial aspects. Its treatment and evaluation require the use of new technologies (more effective and low-cost approaches. The objective was to investigate the effectiveness of carboxytherapy in the treatment of cellulite in the areas of buttocks and posterior thigh.Patients and methods: Ten women, 29±6.1 years, were selected and all of them received eight treatment sessions, with an interval of 7 days between sessions. Standardized digital photographs were used to assess the severity of cellulite, and panoramic images were collected by ultrasound diagnosis. The evaluations were performed before the first treatment (baseline and 7 days after the last treatment session of carboxytherapy.Results: After the treatment, there was a significant reduction (P=0.0025 of the cellulite from degree III to degree II, and this improvement had correlation with the improvement in the

  15. Reduction in adipose tissue volume using a new high-power radiofrequency technology combined with infrared light and mechanical manipulation for body contouring. (United States)

    Adatto, Maurice A; Adatto-Neilson, Robyn M; Morren, Grietje


    A growing patient demand for a youthful skin appearance with a favorable body shape has led to the recent development of new noninvasive body contouring techniques. We have previously demonstrated that the combination of bipolar radiofrequency (RF) and optical energies with tissue manipulation is an efficient reshaping modality. Here, we investigated the efficacy and safety of a new high-power version of this combined technology, in terms of adipose tissue reduction and skin tightening. Thirty-five patients received one treatment per week over 6 weeks to their abdomen/flank, buttock, or thigh areas and were followed up to 3 months post completion of the treatment protocol. This new device has an increased power in the bipolar RF, as this parameter appears to be the most important energy modality for volume reduction. Patient circumferences were measured and comparisons of baseline and post treatment outcomes were made. Diagnostic ultrasound (US) measurements were performed in 12 patients to evaluate the reduction in adipose tissue volume, and a cutometer device was used to assess improvements in skin tightening. We observed a gradual decline in patient circumferences from baseline to post six treatments. The overall body shaping effect was accompanied with improvement in skin tightening and was clearly noticeable in the comparison of the before and after treatment clinical photographs. These findings correlated with measurements of adipose tissue volume and skin firmness/elasticity using diagnostic US and cutometer, respectively. The thickness of the fat layer showed on average a 29% reduction between baseline and the 1-month follow up. The average reduction in the circumference of the abdomen/flanks, buttocks, and thighs from baseline to the 3-month follow-up was 1.4, 0.5, and 1.2 cm, respectively, and 93% of study participants demonstrated a 1-60% change in fat layer thickness. Patients subjectively described comfort and satisfaction from treatment, and 97% of

  16. Obturator internus pyomyositis manifested as sciatica in a patient with subacute bacterial endocarditis: A rare case report. (United States)

    Hsu, Wei-Ching; Hsu, Jin-Yi; Chen, Michael Yu-Chih; Liang, Chung-Chao


    Pyomyositis is a pyogenic infection of the skeletal muscles causing myalgia and fever in patients. Hematogenous seeding engendered by persistent bacteremia and septic embolism is usually the underlying cause of the disease. Trauma, intravenous drug use, and immunodeficiency are the main predisposing factors.Obturator internus pyomyositis with sciatica has not previously been reported. We report a rare case of a patient with subacute bacterial endocarditis presenting with left buttock pain and sciatica.Computed tomography confirmed the diagnosis of obturator internus pyomyositis. The patient was discharged uneventfully after successful antibiotic treatment.The mortality rate of patients who have pyomyositis comorbid with another condition or disease is extremely high. Early diagnosis and aggressive management are imperative.

  17. Piriformis syndrome: a cause of nondiscogenic sciatica. (United States)

    Cass, Shane P


    Piriformis syndrome is a nondiscogenic cause of sciatica from compression of the sciatic nerve through or around the piriformis muscle. Patients typically have sciatica, buttocks pain, and worse pain with sitting. They usually have normal neurological examination results and negative straight leg raising test results. Flexion, adduction, and internal rotation of the hip, Freiberg sign, Pace sign, and direct palpation of the piriformis cause pain and may reproduce symptoms. Imaging and neurodiagnostic studies are typically normal and are used to rule out other etiologies for sciatica. Conservative treatment, including medication and physiotherapy, is usually helpful for the majority of patients. For recalcitrant cases, corticosteroid and botulinum toxin injections may be attempted. Ultrasound and other imaging modalities likely improve accuracy of injections. Piriformis tenotomy and decompression of the sciatic nerve can be done for those who do not respond.

  18. Squamous Cell Carcinoma and Multiple Bowen's Disease in a Patient with a History of Consumption of Traditional Chinese Herbal Balls

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    Joon Seok


    Full Text Available Arsenic has been classified as a class I human carcinogen, meaning that there is sufficient evidence of carcinogenicity to humans. Arsenic, however, remains a common contaminant in a number of traditional Chinese herbal balls. A 64-year-old man presented with an erythematous erosive patch on the left palm, multiple yellowish scaly patches on the right palm and an erythematous hyperkeratotic patch with bleeding on the left foot dorsum. He also had similar skin lesions on the back and buttock. He had a past medical history of chronic exposure to arsenic through consumption of traditional Chinese herbal balls. Skin biopsy revealed Bowen's disease on the left palm and squamous cell carcinoma on left foot dorsum. We report this case to emphasize that we should investigate patient's history thoroughly, including the use of Chinese herbal balls to find out arsenicism.

  19. Nontuberculous mycobacteria infection after mesotherapy: preliminary report of 15 cases. (United States)

    Sañudo, Alejandra; Vallejo, Fernando; Sierra, Martha; Hoyos, Juan G; Yepes, Sandra; Wolff, Juan Carlos; Correa, Luis A; Montealegre, Carlos; Navarro, Pilar; Bedoya, Elina; Sanclemente, Gloria


    Mesotherapy is an increasingly used technique which is currently causing several mycobacterial infections owing to contaminated substances being injected, and also to poor aseptic measures being held by nonprofessional practitioners. We collected 15 cases of nontuberculous mycobacteria (NTM) infection after mesotherapy in a 6-month period. All patients were female with ages ranging from 19 to 52 years; the main substances injected were procaine and lecithin, and the time between mesotherapy and the appearance of the lesions varied between 1 and 12 weeks. Clinical lesions were mostly nodules and abscesses, which were localized in the abdomen and buttocks in the majority of cases. The main patient complaint was local pain but some presented with systemic symptoms such as fever and malaise. Biopsies reported granulomatous chronic inflammation in the majority of cases. Skin cultures were positive for NTM and Mycobacterium chelonae. Mesotherapy not performed with quality controlled substances can be a predisposing factor for NTM infection.

  20. Aplasia cutis congenita with fetus papyraceus: report and review of the literature. (United States)

    Tempark, Therdpong; Shwayder, Tor A


    We report a case of a 2-week-old white female who presented with large stellate atrophic skin defects on bilateral thighs and knees at birth. The pregnancy was complicated by the death of monozygotic twin at the 16th week of gestation. This represents aplasia cutis congenita with fetus papyraceus. This rare condition is defined as the congenital skin defect and intrauterine death of fetus with or without a stillborn fetus pressed flat by the growing twin (fetus papyraceus) at delivery time. Aplasia cutis congenita coexisting with fetus papyraceus has a distinctive and reproducible distribution pattern of bilateral symmetrical truncal, buttock, and thigh lesions related to fetal death during the late first to early second trimester. There are at least 44 reported cases of this disorder in the English literature. We discuss our case and review the literature. © 2012 The International Society of Dermatology.

  1. Eye and hair colour, skin type and constitutive skin pigmentation as risk factors for basal cell carcinoma and cutaneous malignant melanoma. A Danish case-control study

    DEFF Research Database (Denmark)

    Lock-Andersen, J; Drzewiecki, K T; Wulf, H C


    To assess the importance of hair and eye colour, skin type and constitutive skin pigmentation as risk factors for basal cell carcinoma and cutaneous malignant melanoma in fair-skinned Caucasians, we conducted two identical case-control studies in Denmark. We studied 145 cases with basal cell...... the present hair colour and eye colour, and the constitutive skin pigmentation was measured objectively by skin reflectance of UV unexposed buttock skin. There were no differences between basal cell carcinoma cases and controls in hair colour or eye colour or constitutive skin pigmentation, but more cases...... were of skin type II than skin type IV; skin type 11 was a risk factor for basal cell carcinoma with an odds ratio (OR) of 2.3. For cutaneous malignant melanoma, more cases than controls were red-haired or blond and of skin type II, but there was no difference in constitutive skin pigmentation. Hair...

  2. Biostereometric analysis of body form - The second manned Skylab mission (United States)

    Whittle, M. W.; Herron, R. E.; Cuzzi, J. R.


    Results of biostereometric analyses of the body form of the Skylab 3 crew before and after flight. The Cartesian coordinates of numerous points on the body surface were derived by stereophotogrammetry, and mathematical analysis of the coordinate description allowed computation of the surface area and volume of the body, the volume of body segments, and the area and shape of cross sections. The weight loss in all three crew members was accompanied by a loss in volume distributed between the trunk and legs, with the legs showing the greatest proportional loss. The observed loss of volume apparently resulted from a combined loss of fluid in the abdomen and legs, of muscle in the legs and paraspinal region, and of fat in the abdomen and buttocks.

  3. Pyomyositis after vaginal delivery.

    LENUS (Irish Health Repository)

    Gaughan, Eve


    Pyomyositis is a purulent infection of skeletal muscle that arises from haematogenous spread, usually with abscess formation. It can develop after a transient bacteraemia of any cause. This type of infection has never been reported before in the literature after vaginal delivery. A 34-year-old woman had progressive severe pain in the left buttock and thigh and weakness in the left lower limb day 1 post spontaneous vaginal delivery. MRI showed severe oedema of the left gluteus, iliacus, piriformis and adductor muscles of the left thigh and a small fluid collection at the left hip joint. She was diagnosed with pyomyositis. She had fever of 37.9°C immediately postpartum and her risk factors for bacteraemia were a mild IV cannula-associated cellulitis and labour itself. She required prolonged treatment with antibiotics before significant clinical improvement was noted.

  4. Lower Limb Morel-Lavallée Lesion Treated With Short-Stretch Compression Bandaging. (United States)

    Costopoulos, Callista L; Sachs, Ira C; Graf, Kenneth W; Kauffman, Robin W; Mehta, Samir

    Morel-Lavallée lesions (MLLs) classically occur in the greater trochanteric region, lateral thigh, buttocks, and back. A high percentage of large MLLs require surgical intervention, which comes with an increased risk of skin necrosis and infection. We report a rare case of a large MLL that was successfully treated with compression. The lesion was created when the patient, a 66-year-old man, sustained a low-velocity crush injury. Extending from the medial distal thigh to the proximal medial calf, the MLL was nonoperatively treated with the short-stretch compression bandaging that is used in lymphedema management. The MLL resolved successfully and without complication or the need for surgical intervention.

  5. Morel-Lavallee lesion: case report of a rare extensive degloving soft tissue injury. (United States)

    Gummalla, Krishna Mohan; George, Mathew; Dutta, Rupak


    Morel-Lavallee syndrome (MLS) is a significant post-traumatic soft tissue injury in which the subcutaneous tissue is torn away from the underlying fascia (closed degloving), creating a cavity filled with hematoma and liquefied fat. It commonly occurs over the greater trochanter, but may also occur in the flank, buttocks and lumbodorsal regions. MLS is a rarely reported entity. The trauma surgeon and radiologist must be aware of this condition, as early diagnosis can lead to conservative management, while a delay can lead to surgical exploration. We report a case of extensive Morel-Lavallee lesion involving the left flank and thigh in a young adult. We discuss the magnetic resonance imaging findings and also describe the differential diagnoses and management options for MLS.

  6. Morel-Lavallee Lesions-Review of Pathophysiology, Clinical Findings, Imaging Findings and Management. (United States)

    Diviti, Sreelatha; Gupta, Nishant; Hooda, Kusum; Sharma, Komal; Lo, Lawrence


    Morel-Lavallee lesion is a post-traumatic soft tissue degloving injury. This is commonly associated with sports injury caused by a shearing force resulting in separation of the hypodermis from the deeper fascia. Most common at the greater trochanter, these injuries also occur at flank, buttock, lumbar spine, scapula and the knee. Separation of the tissue planes result in a complex serosanguinous fluid collection with areas of fat within it. The imaging appearance is variable and non specific, potentially mimicking simple soft tissue haematoma, superficial bursitis or necrotic soft tissue neoplasms. If not treated in the acute or early sub acute settings, these collections are at risk for superinfection, overlying tissue necrosis and continued expansion. In this review article, we discuss the clinical presentation, pathophysiology, imaging features and differential diagnostic considerations of Morel-Lavallee lesions. Role of imaging in guiding prompt and appropriate treatment has also been discussed.

  7. Primary atypical sacral meningioma- not always benign

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    Bhadra, A.K.; Casey, A.T.H.; Saifuddin, A.; Briggs, T.W. [Royal National Orthopaedic Hospital, Stanmore, London (United Kingdom)


    We present a case of an atypical recurrent meningioma of the sacrum with pulmonary metastasis in a 31-year-old man. He presented with deep-seated buttock pain and urinary hesitancy for 3 months. MRI revealed a lesion occupying the central and left side of the sacral canal at the S1-S2 level. Surgical excision of the lesion via a posterior approach was undertaken, and the patient became symptom-free post-operatively. Histology confirmed atypical meningioma. Eight months later he re-presented with similar symptoms, and MRI confirmed local recurrence. The patient underwent left hemisacrectomy. Six months later he again presented with low back pain and MRI confirmed a second local recurrence. A CT scan of the chest showed multiple lung metastases. The patient died of a severe chest infection 18 months later. (orig.)

  8. A Collation of United States Air Force Anthropometry (United States)


    rearmost surface of the right buttock to the forward surface of the kneecap (or tibial tuberosity ). USAF.MEN 23.83 1.10 21.3 22.0 23.8 25.7 26.6 n... breast bone (Substernale). USAFLY.MEN 48.72 1.99 44.1 45.5 48.7 52.0 53.5 n = 4000 123.75 5.06 112.1 115.6 123.7 132.2 135.9 S ASERNALE iHIGHT...the notch at the upper end of the breast bone). (Cont’d) 70 SOURCE X SD 1% 5% 50% 95% 99% N in in in in in in in cm cm cm cm cm cm cm USAF.MEN 56.42

  9. Acute Compartment Syndrome Which Causes Rhabdomyolysis by Carbon Monoxide Poisoning and Sciatic Nerve Injury Associated with It: A Case Report. (United States)

    Ji, Jung-Woo


    Rhabdomyolysis is most frequently caused by soft tissue injury with trauma to the extremities. Non-traumatic rhabdomyolysis may be caused by alcohol or drug abuse, infection, collagen disease, or intensive exercise, but incidence is low. In particular, rhabdomyolysis resulting from carbon monoxide poisoning is especially rare. If caught before death, carbon monoxide poisoning has been shown to cause severe muscle necrosis and severe muscle damage leading to acute renal failure. In cases of carbon-monoxide-induced rhabdomyolsis leading to acute compartment syndrome in the buttocks and sciatic nerve injury are rare. We have experience treating patients with acute compartment syndrome due to rhabdomyolysis following carbon monoxide poisoning. We report the characteristic features of muscle necrosis observed during a decompression operation and magnetic resonance imaging findings with a one-year follow-up in addition to a review of the literature.

  10. Penile herpes zoster: an unusual location for a common disease

    Directory of Open Access Journals (Sweden)

    Milan Bjekic

    Full Text Available Herpes zoster is a common dermatological condition which affects up to 20% of the population, most frequently involving the thoracic and facial dermatomes with sacral lesions occurring rarely and only a few reported cases of penile shingles. Case report: We report two cases of unusual penile clinical presentations of varicella zoster virus infection in immunocompetent men. The patients presented with grouped clusters of vesicles and erythema on the left side of penile shaft and posterior aspect of the left thigh and buttock, involving s2-s4 dermatomes. The lesions resolved quickly upon administration of oral antiviral therapy. Conclusion: Penile herpes zoster should not be overlooked in patients with unilateral vesicular rash.

  11. A Case of Lumbosacral Arachnoiditis Ossificans (United States)

    Kasai, Yuichi; Sudo, Takao; Sakakibara, Toshihiko; Akeda, Koji; Sudo, Akihiro


    The patient was a 13-year-old boy who complained of pain in both buttocks. Plain and reconstructive computed tomography (CT) images showed an ossified lesion within the dura mater at the L5–S2 levels, and arachnoiditis ossificans in the lumbosacral area was suspected. In the operative findings obtained after cutting the dura, a bone fragment 4.5 × 0.5 × 0.5 cm in size was observed in the center of the strongly adhesive nerve bundle of the cauda equina, which was removed en bloc. The postoperative clinical course of the patient was excellent. The case, along with a review of literature is presented. PMID:28663987

  12. Linkage and association scan for tanning ability in an isolated Mongolian population. (United States)

    Paik, Seung Hwan; Kim, Hyun-Jin; Lee, Seungbok; Im, Sun-Wha; Ju, Young Seok; Yeon, Je Ho; Jo, Seong Jin; Eun, Hee Chul; Seo, Jeong-Sun; Kim, Jong-Il; Kwon, Oh Sang


    Tanning ability is important, because it represents the ability of the skin to protect itself against ultraviolet (UV) radiation. Here, we sought to determine genetic regions associated with tanning ability. Skin pigmentation was measured at the outer forearm and buttock areas to represent facultative and constitutive skin color, respectively. In our study population consisting of isolated Mongolian subjects, with common histories of environmental UV exposure during their nomadic life, facultative skin color adjusted by constitutive skin color was used to indicate tanning ability. Through linkage analysis and family-based association tests of 345 Mongolian subjects, we identified 2 potential linkage regions regulating tanning ability on 5q35.3 and 12q13.2, having 6 and 7 significant single nucleotide polymorphisms (SNPs), respectively. Those significant SNPs were located in or adjacent to potential candidate genes related to tanning ability: GRM6, ATF1, WNT1, and SILV/Pmel17.

  13. Avoidable cancers in the Nordic countries. Radiation

    DEFF Research Database (Denmark)

    Winther, J F; Ulbak, Kaare; Dreyer, L


    Exposure to solar and ionizing radiation increases the risk for cancer in humans. Some 5% of solar radiation is within the ultraviolet spectrum and may cause both malignant melanoma and non-melanocytic skin cancer; the latter is regarded as a benign disease and is accordingly not included in our...... estimation of avoidable cancers. Under the assumption that the rate of occurrence of malignant melanoma of the buttocks of both men and women and of the scalp of women would apply to all parts of the body in people completely unexposed to solar radiation, it was estimated that approximately 95% of all...... malignant melanomas arising in the Nordic populations around the year 2000 will be due to exposure to natural ultraviolet radiation, equivalent to an annual number of about 4700 cases, with 2100 in men and 2600 in women, or some 4% of all cancers notified. Exposure to ionizing radiation in the Nordic...

  14. Superior gluteal nerve entrapment between two bellies of piriformis muscle

    Directory of Open Access Journals (Sweden)

    Yadav Y


    Full Text Available A double belly composition of piriformis muscle with superior gluteal nerve entrapment between the two muscle masses was detected. Piriformis muscle and its relation to sciatic nerve has been suggested as a cause of piriformis syndrome. Patients suffering from buttock pain are most often diagnosed as having piriformis syndrome, where anatomical variation of the piriformis is an important contributor. The present variation showed two distinct bellies of piriformis muscle. Interestingly the superior gluteal nerve was interposed between the two bellies. Such incidental findings on cadavers may help the clinicians to establish a rare yet important cause of piriformis syndrome. Furthermore, such observations are also relevant to the radiologists while interpreting MRI scans in cases of undiagnosed chronic gluteal pain.

  15. Primary extrahepatic hydatid cyst of the soft tissue: a case report

    Directory of Open Access Journals (Sweden)

    Guraya Salman


    Full Text Available Abstract Introduction Hydatid disease of the soft tissue is an exceedingly uncommon site to be affected by the tapeworm Echinococcus. The presentation is often vague and misleading. The diagnostic armamentarium has to be supplemented by a meticulously taken history and clinical examination. Case presentation The present case report describes a 33-year-old Saudi male with a painless swelling in the right buttock which turned out to be a primary hydatid disease of the soft tissue. The lump was successfully excised surgically and the patient had an uneventful discharge. Conclusion Surgical excision of the extrahepatic hydatid disease remains the mainstay of treatment; although medical treatment is available for the recurrent and disseminated disease.

  16. Hemothorax associated with Henoch–Schönlein purpura

    Directory of Open Access Journals (Sweden)

    Peng Hu


    Full Text Available Hemothorax is an extremely rare complication of Henoch–Schönlein purpura. In this report, we encountered a 9-year-old girl who suffered from nonthrombocytopenic purpura on her eyelids, buttocks, and lower limbs with hypertension, heme-positive stools, high serum immunoglobulin A, and low serum complement component 3. Her skin biopsy revealed leukocytoclastic vasculitis with immunoglobulin A deposition. In addition, physical examination showed dullness on percussion and quiet breath sounds on the left chest. Chest X-ray showed a large pleural effusion on the left hemithorax. Computed tomography of her thorax revealed massive left-sided hemothorax with mediastinal shift to the right side. Most critically, pleural fluid evacuated by the chest tube was bloody. The patient was diagnosed as having Henoch–Schönlein purpura in combination with hemothorax, and treated with pulse methylprednisolone followed by oral corticosteroids plus cyclophosphamide. Fortunately, we achieved excellent outcomes and the patient recovered gradually within a week.

  17. [Cellulite--the greatest skin problem in healthy people? An approach]. (United States)

    Pavicic, Tatjana; Borelli, Claudia; Korting, Hans Christian


    Cellulite or so called orange peel skin affects 80-90 % of all females. It is not considered as a pathological condition but as aesthetically disturbing dimpling of the skin seen most commonly on the thighs and buttocks. Despite its high prevalence, there have been only a few scientific investigations into the pathophysiology of cellulite reflected in the medical literature. A lack of knowledge regarding specific aetiopathogenetic factors and pathogenesis at large currently limits treatment options. The preferred hypotheses about the origin of cellulite include: gender specific dimorphic skin architecture, altered connective tissue septae, vascular changes and inflammatory processes. The most widely discussed management options include: attenuation of aggravating factors, physical procedures including laser therapy and application of topical incorporating actives. The latter approach has been evidence-based with respect to caffeine liposomal cream and retinol cream.

  18. Efficacy of a multifunctional plant complex in the treatment of the so-called 'cellulite': clinical and instrumental evaluation. (United States)

    Distante, F; Bacci, P A; Carrera, M


    'Cellulite' or more correctly oedemateous fibrosclerotic panniculopathy, or local lipodystrophy, is a common aesthetic problem for many women, visually characterized by the orange peel or dimpled look of the skin, mainly on the buttocks and thighs. The cause of cellulite is still a matter of debate. It is currently considered an endocrine-metabolic microcirculatory disorder that causes interstitial matrix alterations and structural changes in subcutaneous adipose tissue. The first step in cellulite treatment is stimulation of microcirculation and the removal of accumulated fluids and toxic elements. This can improve the interstitial matrix basal regulation, fibroblast activity and decrease interstitial oedema, with subsequent increase in lipolysis and a better oxygen and nutrition of the adipose tissue. In this paper are reported two trials aimed at evaluating clinically and instrumentally the effects of different orally administered multifunctional plant extracts-based formulations in the treatment of cellulite compared with a placebo.

  19. Fusarium soloni mycetoma

    Directory of Open Access Journals (Sweden)

    V J Katkar


    Full Text Available A young apparently healthy, non-diabetic, HIV non-reactive woman presented with a mycetoma-like lesion on right buttock. Discharge was scanty, and mycotic grains were not seen. Biopsy of sinus track was obtained for microscopy and culture. Microscopic examination revealed plenty of fungal hyphae in direct microscopic examination of grounded tissues in saline; KOH, Gram′s, and H and E-stained smears. All the three inoculated slants of Sabouraud′s media yielded heavy growth of Fusarium solani. Presence of numerous hyphal fragments in direct microscopy and heavy growth of F. solani in all three slants indicative of etiological role of fungus in the present case. It is probably a first report of F. soloni mycetoma from India.

  20. Paraplegic flexion contracture of hip joints: An unsolvable problem. (United States)

    Bhattacharyya, Sailendra


    Paraplegic flexion contracture of hip joints beyond 90° is a difficult condition to treat for any orthopedic surgeon. There is no fixed protocol of treatment described, by and large it is individualized. A 20 year old female presented with paraplegia for last 15 years due to irrecoverable spinal cord disease with complete sensory and motor loss of both lower extremities and was admitted with acute flexion contracture of both hip joints with trunk resting on thighs. She underwent bilateral proximal femoral resection. Both hip joints were straight immediately after surgery and patient could lie on her back. In a course of time, she started sitting on her buttocks, led a comfortable wheelchair life with a sitting balance. Proximal femoral resection is an effective method to treat long standing irrecoverable paraplegic acute flexion deformity of the hip joint.

  1. Presence of accessory penis, colonic duplication and several other congenital anomalies in a child: a very rare association. (United States)

    Chatterjee, Sayan; Mondal, Prabodh Chandra; Pandey, Shashi Bhushan; Achar, Arun


    An accessory penis is a very rare anomaly. Only five cases have been reported thus far to our knowledge. We present the case of a child aged 2 years and 10 months who had a penis-like structure (containing phallus and glans) attached to the right buttock. Associated anomalies were a non-communicating type of colonic duplication, a paramedian stenosed anal opening, a horse-shoe kidney, posterior urethral valves, scoliosis of the lumbo-sacral spine, polydactyly and equino-varus deformity of the right foot. As far as we can tell, this is the first report of an accessory penis associated with colonic duplication and other congenital anomalies. © The Author(s) 2014 Reprints and permissions:

  2. [Epidemiological analysis on 589 children with hand-foot-mouth disease from Xianju county of Zhejiang province]. (United States)

    Wang, Jianying; Zhu, Huoming; Chen, Yaqin; Zhang, Yijian


    To investigate the epidemiological characteristics of hand-foot-mouth disease. A total of 589 children from Xianju county, Zhejiang province with hand-foot-mouth disease in 2013 were recruited in the study and the diagnosis went through clinical and laboratory confirmation. Attributes that were analyzed included gender, age, month of occurrence, regional distribution and clinical presentation. The incidence rate of hand-foot-mouth disease in Xianju county for the year was 102.72/100 000, with 12 severe cases but no death. There were clearly more boys than girls, with a male to female ratio of 1.29 :1, which was statistically significant (χ(2) = 14.274, P hand, foot, mouth or buttocks. Most of hand-foot-mouth disease cases occur in younger children in areas with inadequate knowledge of hygiene, with seasonal variation.

  3. Calcifying Bursitis ischioglutealis: A Case report (United States)

    Schuh, Alexander; Narayan, Chirag Thonse; Schuh, Ralph; Hönle, Wolfgang


    Introduction: The ischiogluteal bursa is an inconstant anatomical finding located between the ischial tuberosity and the gluteus maximus. Ischiogluteal bursitis is a rare disorder. Case Report: We report the case of a 43-year-old female patient with bilateral calcifying ischiogluteal bursitis. The patient had no relevant medical history of systemic illness or major trauma to the buttock. After aspiration of both ischiogluteal bursitis which delievered calcareous deposits and instillation of a mixture of 1cc betamethasone (6 mg) and 4 cc of 1% lidocaine the patient was out of any complaints. Conclusion: Calcifying ischiogluteal bursitis is a rare entity but easily diagnosed on radiographs. Aspiration and local steroid instillation give good relief from symptoms. PMID:27298836

  4. Obturator internus pyomyositis manifested as sciatica in a patient with subacute bacterial endocarditis (United States)

    Hsu, Wei-Ching; Hsu, Jin-Yi; Chen, Michael Yu-Chih; Liang, Chung-Chao


    Abstract Pyomyositis is a pyogenic infection of the skeletal muscles causing myalgia and fever in patients. Hematogenous seeding engendered by persistent bacteremia and septic embolism is usually the underlying cause of the disease. Trauma, intravenous drug use, and immunodeficiency are the main predisposing factors. Obturator internus pyomyositis with sciatica has not previously been reported. We report a rare case of a patient with subacute bacterial endocarditis presenting with left buttock pain and sciatica. Computed tomography confirmed the diagnosis of obturator internus pyomyositis. The patient was discharged uneventfully after successful antibiotic treatment. The mortality rate of patients who have pyomyositis comorbid with another condition or disease is extremely high. Early diagnosis and aggressive management are imperative. PMID:27472717

  5. Transient Neurological Symptoms after Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    Zehra Hatipoglu


    Full Text Available Lidocaine has been used for more than 50 years for spinal anesthesia and has a remarkable safety record. In 1993, a new adverse effect, transient neurologic toxicity was described in patients recovering from spinal anesthesia with lidocaine. Transient neurological symptoms have been defined as pain in the lower extremities (buttocks, thighs and legs after an uncomplicated spinal anesthesia and after an initial full recovery during the immediate postoperative period (less than 24 h. The incidence of transient neurological symptoms reported in prospective, randomized trials varies from 4% to 37%. The etiology of transient neurological symptoms remains unkonwn. Despite the transient nature of this syndrome, it has proven to be difficult to treat effectively. Drug or some interventional therapy may be necessary. [Archives Medical Review Journal 2013; 22(1.000: 33-44

  6. Cutaneous in vivo metabolism of topical lidocaine formulation in human skin

    DEFF Research Database (Denmark)

    Rolsted, K; Benfeldt, E; Kissmeyer, A-M


    Little is known about the metabolising capacity of the human skin in relation to topically applied drugs and formulations. We chose lidocaine as a model compound since the metabolic pathways are well known from studies concerning hepatic metabolism following systemic drug administration. However......, the enzymes involved are also expressed in the skin. Hence, the aim of the current study was to investigate the extent of the cutaneous in vivo metabolism of topically applied lidocaine in human volunteers. A dose of 5 mg/cm(2) of Xylocaine(R) (5% lidocaine) ointment was applied onto the buttock skin...... of the volunteers. After 2 h, residual formulation was removed, and two 4-mm punch biopsies were taken from each volunteer. The quantity of lidocaine extracted from the skin samples (epidermis + dermis) was 109 +/- 43 ng/mm(2) skin. One metabolite (monoethylglycine xylidide, MEGX) was detected in skin from 7...

  7. Giant café-au-lait macule in neurofibromatosis 1: a type 2 segmental manifestation of neurofibromatosis 1? (United States)

    Yang, Chao-Chun; Happle, Rudolf; Chao, Sheau-Chiou; Yu-Yun Lee, Julia; Chen, WenChieh


    Type 2 segmental manifestation of autosomal dominant dermatoses refers to pronounced segmental lesions superimposed on the ordinary nonsegmental phenotype, indicating loss of heterozygosity occurring at an early stage of embryogenesis. We describe a 20-year-old Taiwanese woman with typical lesions of neurofibromatosis type 1 (NF1) in the form of characteristic café-au-lait spots, neurofibromas, axillary freckling and Lisch nodules. In addition, a giant garment-like or "bathing-trunk" café-au-lait macule involved the lower half of the trunk, the buttocks, and parts of the thighs, being superimposed on the ordinary smaller spots of NF1. This large café-au-lait macule may be best explained as an example of type 2 segmental NF1. A novel mutation (3009delG) in exon 23 was also identified in this patient, which has not yet been described in sporadic and familial NF1.

  8. A Rare Case of Quadratus Femoris Muscle Rupture After Yoga Exercises. (United States)

    Tzaveas, Alexandros; Anastasopoulos, Nikolaos; Paraskevas, George; Natsis, Konstantinos


    We present a case of a female patient with left groin pain after intense yoga exercises. The patient presented abnormal pattern of gait with no swelling over the groin, thigh, or buttock. Magnetic resonance imaging demonstrated a tear of the quadratus femoris muscle with an associated extensive hematoma formation. Patient was treated with a rehabilitation program consisting of nonsteroidal anti-inflammatory drugs and physiotherapy. At the follow-up control, the patient had improved her pain and flexibility of the hip, and gradually she returned to daily activities and yoga exercises. Such an entity is a rare cause of hip pain after exercise and should be kept in mind by the orthopedic surgeon, in cases of gluteal pain after intense physical activity. Moreover, such a condition should be included in the diagnostic algorithm of unknown origin hip pain.

  9. Acute lumbosacral plexopathy from gluteal compartment syndrome after drug abuse: a case report. (United States)

    Mitsiokapa, Evanthia A; Mavrogenis, Andreas F; Salacha, Andromachi; Tzanos, George


    Acute lumbosacral plexus injury from gluteal compartment syndrome is extremely rare. Physicians should be aware of this diagnosis when examining patients with altered mental status, prolonged immobilization, and gluteal muscle compression. This case report presents a patient with acute complete left lumbosacral plexus paralysis and acute renal failure after gluteal compartment syndrome secondary to prolonged immobilization from drug abuse. Clinical examination, imaging of the pelvis, renal function, creatine phosphokinase, and urine myoglobin were indicative of gluteal compartment syndrome and rhabdomyolysis. Electrodiagnostic studies showed complete limb paralysis. Medical treatment and rehabilitation was administered. Renal function recovered within the 1st week; function at the proximal muscles of the left lower limb improved within 6 months, with mild discomfort on sitting at the buttock, foot drop, and sensory deficits at the leg and dorsum of foot.

  10. An Anatomical Approach to Evaluating and Treating Cellulite. (United States)

    Christman, Mitalee P; Belkin, Daniel; Geronemus, Roy G; Brauer, Jeremy A


    Cellulite is the common rippling or dimpling of skin of the thighs and buttocks of women, formed from a confluence of skin laxity, tethering fibrous septa, and fat herniation. We describe an anatomical approach to evaluating the cellulite patient and selecting the best treatment from among available non-invasive, minimally invasive, and invasive therapies. It is crucial to consider the anatomy of the patient and the morphology of cellulite while choosing a treatment. Diffuse rippling represents increased adiposity and/or increased skin laxity which may stand to benefit from lipolytic and skin tightening modalities. Dimpling represents tethering by fibrous septa which may stand to improve from subcision by minimally invasive devices such as Cell na. Patients with both morphologies may be treated with a combination of treatments or Cellulaze. Careful evaluation of the patient can help identify the best therapeutic strategy. J Drugs Dermatol. 2017;16(1):58-61..

  11. Cosmeceuticals for cellulite. (United States)

    Hexsel, Doris; Soirefmann, Mariana


    Cellulite is characterized by alterations to the skin surface, presenting as dimpled or puckered skin of the buttocks and posterior and lateral thighs. It mainly affects women. Cellulite occurrence is believed to be due to structural, inflammatory, morphological and biochemical alterations of the subcutaneous tissue. However, its pathogenesis is not completely understood. Topical treatments for cellulite include many agents, such those that increase the microcirculation flow, agents that reduce lipogenesis and promote lipolysis, agents that restore the normal structure of dermis and subcutaneous tissue, and agents that scavenge free radicals or prevent their formation. There are many cosmetic and medical treatments for cellulite. However, there is little clinical evidence of an improvement in cellulite, and none have been shown to lead to its resolution. The successful treatment of cellulite will ultimately depend upon our understanding of the physiopathology of cellulite adipose tissue. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. Peripheral nerve field stimulation for pruritus relief in a patient with notalgia paraesthetica.

    LENUS (Irish Health Repository)

    Ricciardo, Bernadette


    This case study is presented to exemplify the application of peripheral nerve field stimulation in the treatment of recalcitrant notalgia paraesthetica. The patient was a 60-year-old woman with severe and disabling notalgia paraesthetica. The itch persisted despite the use of several medications - topical and oral. Following a successful trial of peripheral nerve field stimulation with a temporary electrode, two subcutaneous electrodes were inserted into the affected area with a battery implanted subcutaneously in her right buttock. The patient was reviewed at 5 months post implantation. She reported a greater than 85% improvement in her itch. She also reported a major improvement in her quality of life, with particular improvement in her ability to sleep through the night. This case illustrates the possible utilization of peripheral nerve field stimulation in the treatment of notalgia paraesthetica, which is a common yet poorly understood and treated condition. Replication and controlled studies are required to determine the general applicability of this approach.

  13. Nursery, gutter, or anatomy class? Obscene expression in consumer health. (United States)

    Smith, Catherine Arnott


    This paper presents results of a consumer health vocabulary study of text appearing on Web-based bulletin boards. Consumers used obscenities and euphemisms to refer to certain body parts, functions, and behaviors. The female genitalia are the body region most often described with an obscenity (29% of all instances); male genitalia, in contrast, were rendered as obscene only 3% of the time. Consumers responding on the bulletin boards appear genuinely to prefer euphemistic slang and baby talk (62%) over obscenities (24%) when referring to the buttocks. From an anatomical perspective, this large dataset reveals a consumer health vocabulary of euphemisms and outright obscenities coexisting with professional medical terminology. The evident preference for euphemisms and slang for some anatomical parts has important implications for the design of health information controlled vocabularies and translation systems, faced with a lay language more informal than expected.

  14. Systemic panca-associated vasculitis with central nervous involvement causing recurrent myelitis: case report

    Directory of Open Access Journals (Sweden)

    Bull Matthew D


    Full Text Available Abstract Background We report on the case of an established perinuclear antineutrophil cytoplasmic antibody (pANCA associated renal vasculitis being treated with prednisolone and rituximab, where the patient presented with leg weakness, urinary and faecal incontinence and buttock pain consistent with transverse myelitis. Case presentation The patient underwent MRI scanning showing patchy cord enhancement from T10 to the conus, which was suggestive of a cord malignancy. Prior to a cord biopsy, he was treated with steroids and a repeat MRI showed resolution of the original lesion with a new similar lesion from C7 to T3. Conclusions He made a marked recovery after further treatment with high dose steroids and plasma exchange.

  15. Extraskeletal Chondrosarcoma of Labium Majus

    Directory of Open Access Journals (Sweden)

    Arshad S. Khan


    Full Text Available Extraskeletal myxoid chondrosarcoma (ESMC is a rare tumor seen more often in men. It is seen to arise from soft tissue of lower extremity or buttocks. We report a case of soft tissue swelling of left labium majus in a 66-year-old female. Patient underwent wide excision with uneventful postoperative course. Histopathology of specimen confirmed it to be ESMC. Patient refused adjuvant therapy. Followup of 1 year has shown her to be disease- and symptom- free. Only two cases arising from vulva have been reported in literature . This is the third case and first from Indian subcontinent. A brief review of clinical features, diagnosis, treatment, and outcome of patients with extraskeletal chondrosarcoma is presented.

  16. Postpartum Sacral Stress Fracture: An Atypical Case Report

    Directory of Open Access Journals (Sweden)

    Andrea Speziali


    Full Text Available Sacral stress fractures are common in elderly people. However, sacral stress fracture should be always screened in the differential diagnoses of low back pain during the postpartum period. We present a case of sacral fracture in a thirty-six-year-old woman with low back pain and severe right buttock pain two days after cesarean section delivery of a 3.9 Kg baby. The diagnosis was confirmed by MRI and CT scan, while X-ray was unable to detect the fracture. Contribution of mechanical factors during the cesarean section is not a reasonable cause of sacral fracture. Pregnancy and lactation could be risk factors for sacral stress fracture even in atraumatic delivery such as cesarean section. Our patient had no risk factors for osteoporosis except for pregnancy and lactation. Transient or focal osteoporosis is challenging to assess and it cannot be ruled out even if serum test and mineral density are within the normal range.

  17. Insufficiency Fracture of the Superior and Inferior Pubic Rami in a Patient with Osteomalacia: Case Report

    Directory of Open Access Journals (Sweden)

    Barış Nacır


    Full Text Available Insufficiency fractures are subtype of stres fractures which occur when normal or physiological stresses are placed on weakened bone. These fractures occur in a variety of conditions in which the mineral content or the elasticity of bone is abnormal. The most common cause of insufficieny fracture is postmenopausal osteoporosis. The other important causes are senile osteoporosis, pelvic irradiation, corticosteroid treatment and rheumatoid arthritis. They also occured in vitamin D deficieny/osteomalacia. The diagnosis of pelvic insufficiency fracture due to osteomalacia should be suspected in a postmenopausal women presenting with severe groin and buttock pain and weakness.We presented here the clinical and radiological findings of superior and inferior pubic ramus insufficiency fracture in a patient with osteomalacia. (Osteoporoz Dünyasından 2010;16:44-8

  18. Low-grade fibromyxoid sarcoma, a deceptively benign tumor in a 5-year-old child. (United States)

    Menon, Seema; Krivanek, Michael; Cohen, Ralph


    Low-grade fibromyxoid sarcoma (LGFMS) is very uncommon in the pediatric population with only 20% of reported cases under the age of 18. The youngest reported case to date has been in a 4-year-old child. Lesions are usually slow growing and asymptomatic, and locations described in children have included paravertebral, thigh and intrathoracic. Although benign in appearance, these lesions can behave aggressively, with local recurrence and distant metastases primarily to lungs. These lesions can be resistant to the usual chemotherapy and radiotherapy with surgical resection being the treatment of choice. We report a case of a 5-year-old boy who presented with a mass in the left buttock.

  19. Elastofibroma of the gluteal region with a concomitant contralateral lesion: case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Cevolani, Luca; Casadei, R.; Donati, D. [Rizzoli Orthopaedic Institute, III Orthopaedic and Traumatology Clinic, Bologna (Italy); Vanel, D.; Gambarotti, M. [Rizzoli Orthopaedic Institute, Bone Tumor Center, Bologna (Italy)


    A 51-year-old man presented with elastofibroma (EF) of the gluteal region with a concomitant contralateral lesion. The patient presented with a slow growing mass of the proximal third of the right buttock and had swelling, discomfort in sitting, and right-hip pain during walking for 2 months. On MRI, a soft-tissue mass was noted between the gluteus maximus and the gluteus medius muscle. The mass showed similar signal intensity to the surrounding tissue on T1- and T2-weighted images and with linear hyperintense areas in its internal structure. At surgery, a soft, non-encapsulated, irregular, and rubber-like mass was found attached to the gluteus medius muscles. It was pathologically confirmed to be an EF. This unusual manifestation of an EF is discussed. (orig.)

  20. Sacral Stress Fracture in an Amateur Badminton Player

    Directory of Open Access Journals (Sweden)

    Yusuke Yuasa


    Full Text Available Sacral stress fractures are rare among athletes but have been reported most frequently in long distance runners. We report herein the first case of a sacral stress fracture in an amateur badminton player. A 16-year-old, left-handed adolescent girl, who had just started to play badminton 3 months previously, complained of acute left buttock pain when she received a shuttlecock. Magnetic resonance imaging revealed a linear lesion of the left sacrum with low signal intensity on T1- and high signal intensity on T2-weighted images, which was consistent with a stress fracture. Conservative treatment with rest relieved her symptoms. Her fracture was considered to have occurred due to repetition of an exercise that caused excessive vertical power.

  1. Free anterolateral thigh perforator flap for sacroiliac defect: First case report in pediatric population

    Directory of Open Access Journals (Sweden)

    Alejandro E. Ramirez


    Full Text Available Soft tissue defects of the sacroiliac area, usually can be covered by local flaps. However, for more complex defects, free flap transfers became necessary. We report a case of reconstruction with a free anterolateral thigh (ALT perforator flap for coverage of a sacroiliac bone exposure in a child. A six-years-old boy, suffered a car accident, resulting in pelvic and sacral fractures, as well as degloving injuries of the left thigh, buttocks, and trunk. The patient evolved with an unstable scar over the sacroiliac region with bone exposure. ALT free flap was performed. Left superior gluteal vessels were used as the recipient vessels. A stable coverage was achieved without complications. This is the first case reported of a free ALT perforator flap for sacroiliac coverage in the pediatric population. In cases of complex reconstruction in children, free perforator flap is a safe choice and should be considered in the algorithm of treatment.

  2. Lichen Planus Pemphigoides Presenting Preferentially Over Preexisting Scars: A Rare Instance of Isotopic Phenomenon (United States)

    Kumar, Piyush; Savant, Sushil S; Das, Anupam; Hassan, Shahid; Barman, Panchami Deb


    An 18-year-old girl presented with multiple itchy hyperpigmented papules and plaques, along with tense blisters over the lower limbs and buttocks for last 3 months. These papules, plaques, and bullae were mostly localized to preexisting scars. The histopathological findings from papule and bulla were consistent with lichen planus (LP) and bullous pemphigoid, respectively. Direct immunofluorescence (DIF) of perilesional skin around bulla showed linear deposition of IgG and C3. Considering clinical, histopathological and DIF findings, diagnosis of LP pemphigoides (LPP) was made. The preferential localization of LPP lesions over preexisting scars was a very interesting finding in our case an extremely rare instance of the isotopic phenomenon. PMID:26677275

  3. Pigmentary Markers in Danes – Associations with Quantitative Skin Colour, Nevi Count, Familial Atypical Multiple-Mole, and Melanoma Syndrome

    DEFF Research Database (Denmark)

    Johansen, Peter; Andersen, Jeppe Dyrberg; Madsen, Linnea Nørgård


    pigmentation measured on the buttock area. We hypothesize that the effect of MC1R variants on arm pigmentation is primarily reflecting the inability to tan when subjected to UVR. A gender specific effect on skin pigmentation was also observed, and it was found that the skin pigmentation of females on average......To investigate whether pigmentation genes involved in the melanogenic pathway (melanogenesis) contributed to melanoma predisposition, we compared pigmentary genetics with quantitative skin pigmentation measurements, the number of atypical nevi, the total nevus count, and the familial atypical...... variants (missense, NM_002386:c. 456C > A (p.TYR152*), or NM_002386:c.83_84insA (p.Asn29Glnfs*14) had significantly (ppigmentation of the upper-inner arm than those with none or one MC1R variant. We did not observe any significant association of the MC1R variants with constitutive...

  4. Increased dermal mast cell prevalence and susceptibility to development of basal cell carcinoma in humans

    DEFF Research Database (Denmark)

    Grimbaldeston, Michele A; Skov, Lone; Finlay-Jones, John J


    eliminate them. Studies in a range of inbred mouse strains as well as mast cell-depleted mice reconstituted with mast cell precursors support a functional link between histamine-staining dermal mast cells and the extent of susceptibility to UVB-induced systemic immunomodulation. Humans, like mouse strains......, display variations in dermal mast cell prevalence. In a study of Danish and South Australian BCC patients and control subjects, one 4-mm punch biopsy of non-sun-exposed buttock skin was sampled from each participant. This skin site was investigated to avoid any changes in mast cell prevalence caused...... by sun exposure. Two sections (4 microm) per biopsy were immunohistochemically stained for detection of histamine-containing dermal mast cells. Computer-generated image analysis evaluated dermal mast cell prevalence in both sections by quantifying the total number of mast cells according to the total...

  5. Blunt traumatic superior gluteal artery pseudoaneurysm presenting as gluteal hematoma without bony injury: A rare case report

    Directory of Open Access Journals (Sweden)

    Annu Babu


    Full Text Available Blunt traumatic injuries to the superior gluteal artery are rare in clinic. A majority of injuries present as aneurysms following penetrating trauma, fracture pelvis or posterior dislocation of the hip joint. We reported a rare case of superior gluteal artery pseudoaneurysm following blunt trauma presenting as large expanding right gluteal hematoma without any bony injury. The gluteal hematoma was suspected clinically, confirmed by ultrasound and the arterial injury was diagnosed by CT angiography that revealed a large right gluteal hematoma with a focal contrast leakage forming a pseudoaneurysm within the hematoma. Pseudoaneurysm arose from the superior gluteal branch of right internal iliac artery, which was successfully angioembolized. The patient was discharged on day 4 of hospitalization with resolving gluteal hematoma. This report highlighted the importance of considering an arterial injury following blunt trauma to the buttocks with subsequent painful swelling. Acknowledgment of this rare injury pattern was necessary to facilitate rapid diagnosis and appropriate treatment.

  6. Lymphangioma circumscriptum in the scrotum: a case report

    Directory of Open Access Journals (Sweden)

    Haroon Saroona


    Full Text Available Abstract Introduction Lymphangioma circumscriptum is a rare benign skin disorder involving hamartomatous lymphatic malformation of deep dermal and subcutaneous lymphatic channels. It is a therapeutic challenge for the dermatologist when it occurs at common sites such as axilla, shoulder, groin and buttocks and a diagnostic challenge for the surgeon when it occurs at rare sites such as the scrotum. Surgical treatment is the most commonly used method to treat scrotal lymphangioma circumscriptum but there are high rates of recurrence. Case presentation We report the case of a 30-year-old Pakistani man who presented with scrotal swelling which was clinically misinterpreted as an infectious disorder. Later on re-resection of deeper tissue was performed to prevent recurrence. He is still being followed-up on a regular basis. Conclusion Awareness of the occurrence of lymphangioma circumscriptum in the scrotum in adult men without prior disease is mandatory to avoid missing the diagnosis and to ensure proper treatment.

  7. Speak softly--and forget the stick. Corporal punishment and child physical abuse. (United States)

    Zolotor, Adam J; Theodore, Adrea D; Chang, Jen Jen; Berkoff, Molly C; Runyan, Desmond K


    Previous studies have shown an association between spanking and child physical abuse. However, the relationship between more frequent and severe corporal punishment and abuse remains unknown. The objective of this study was to examine the associations between reported spanking, spanking frequency, or spanking with an object and the odds of physical abuse in a representative sample of mothers from North and South Carolina. This study is a cross-sectional, anonymous telephone survey of adult mothers with children agedpunishment (spanking, spanking frequency, and spanking with an object) and an index of harsh physical punishment consistent with physical abuse (beating, burning, kicking, hitting with an object somewhere other than the buttocks, or shaking a child agedphysical abuse, the relationship between the reported hitting of a child with an object and reported abuse is much stronger. Reduction in this form of discipline through media, educational, and legislative efforts may reduce child physical abuse.

  8. Cutaneous manifestations in a patient with chronic lymphocytic leukemia involving the head, neck and distal extremities. (United States)

    Lu, Chongrong; Li, Li; Qiao, Qiaohua; Liu, Guozhen; Fang, Lizheng


    Chronic lymphocytic leukemia (CLL) infiltrating the skin is uncommon and can present in many different ways. The present study reports a case of CLL infiltrating multiple body areas. A 57-year-old male with a 10-year history of subclinical B-cell chronic lymphocytic leukemia (B-CLL) presented with skin hypertrophic changes of the ears, eyebrows, tip of the nose, toes and fingers. In addition, the patient had erythematous plaques on the buttocks. Histopathology revealed a lymphocytic infiltrate. The patient rejected the recommended chemotherapy and, following a three-year follow-up, remained alive with mildly aggravated symptoms. It has previously been reported that infiltrative CLL can involve the head and neck; however, involvement of multiple body areas, particularly toes and fingers is rare. This case highlights the importance of considering leukemia cutis in patients with underlying CLL who present with unusual clinical features.

  9. Ipsilateral café-au-lait macules, deafness, and pituitary microadenoma in a 35-year-old woman. (United States)

    Valdivieso, Rommel


    The association between ipsilateral café-au-lait macules, deafness, and pituitary adenoma has not been described previously. A 35-year-old woman affected since birth with two café-au-lait macules, one measuring 15 x 20 cm, with an irregular shape, covering almost all of the left buttock, and the other measuring 6 x 13 cm on the front side of the left thigh, is described. For as long as the patient can remember, she has been totally deaf in the left ear, diagnosed as 100% congenital sensorineural deafness. In addition, a left-side pituitary microadenoma was detected at the age of 31 years. She was also found to have a transitional lumbosacral vertebra, and multiple dermatofibromas and nevomelanocytic nevi. It is suggested that this association is not a coincidence, but is part of a neurocutaneous syndrome which has not been described previously.

  10. A case of agminated lentiginosis with multiple café-au-lait macules. (United States)

    Lee, J H; Kim, S E; Park, K; Son, S J; Song, K Y


    Agminated lentiginosis is an unusual pigmentary disorder, characterized by numerous lentigines grouped within an area of normal skin. The pigmented macules are often in a segmental distribution within a sharp demarcation at the midline. We encountered a 28-year-old woman with an unusual combination of multiple café-au-lait macules and diffuse numerous lentigines involving the right cheek and ipsilateral upper thorax with sharp demarcation at the midline. The multiple lentigines extended bilaterally over the back in a peppered distribution. There were 21 café-au-lait macules on both arms, and the trunk and buttocks; however, there were no Lisch nodules, neurofibromas, or any other clinical manifestations for neurofibromatosis. Histopathology of a macule revealed the features of lentigo.

  11. Clinical and morphological study of calf enlargement following S-1 radiculopathy

    Directory of Open Access Journals (Sweden)

    Osvaldo J. M. Nascimento


    Full Text Available Calf enlargement following sciatica is a rare condition. It is reported the case of a 28-year-old woman who complained of repeated episodes of lower back pain radiating into the left buttock and foot. One year after the beginning of her symptoms, she noticed enlargement of her left calf. X-ray studies disclosed L5-S1 disk degeneration. EMG showed muscle denervation with normal motor conduction velocity. Open biopsies of the gastrocnemius muscles were performed. The left gastrocnemius muscle showed hypertrophic type 2 fibers in comparison with the right gastrocnemius. Electron microscopy showed mildly increased number of mitochondria in these fibers. A satisfactory explanation for denervation hypertrophy has yet to be provided.

  12. CT findings of fibromatoses

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    Kim, Hak Nam; Choi, Yeon Hwa; Shin, Hyun Jun [Lee Rha Hospital, Chung Ju (Korea, Republic of)


    Fibromatoses constitute a group of benign fibroblastic soft tissue tumors with a tendency for local invasion and recurrence. CT provides excellent anatomic detail of soft tissue tumors and precise location, size, and extent of the tumors. The authors evaluated 7 CT scans of 6 pathologically proven aggressive fibromatoses during the last 4 years. Five lesions arose in the lower extremities: 4 in the buttocks and 1 in the thigh. One lesion arose in the upper back. The tumors were lobulated in contour and varied in size from 3.7 cm to 10.7 cm. Fibromatosis tumors were usually hypodense with muscle when no contrast medium was used and hyperdense with better delineation during infusion of the contrast medium. Three patients had recurrent disease after surgical removal. Fibromatosis may infiltrate the surrounding tissue beyond the margins, indicated on CT scans and by palpation at operation. Therefore the surgeon should plan a wide resection around the apparent limits of the fibromatosis.

  13. Urticarial vasculitis reveals unsuspected thyroiditis. (United States)

    Ferreira, Olga; Mota, Alberto; Baudrier, Teresa; Azevedo, Filomena


    A 38-year-old woman presented with erythematous, violaceous plaques with a serpiginous and unusual appearance located on the left shoulder, left thigh, and right buttock, evolving for 5 days, which eventually became generalized. A skin biopsy revealed leukocytoclastic vasculitis and a diagnosis of urticarial vasculitis was made. The complete blood count, biochemistry, complement levels, and other immunological test results were unremarkable. However, antithyroid antibody titers were increased. Despite having normal thyroid function tests and an absence of specific symptoms, the patient underwent a thyroid ultrasound, which revealed features of thyroiditis, and was subsequently referred to an endocrinologist. Several diseases can be associated with urticarial vasculitis, namely infections and autoimmune connective-tissue disorders such as systemic lupus erythematosus and Sjögren syndrome. Thyroiditis is an uncommon association.

  14. Two cases of burns caused by misuse of coagulation unit and monitoring. (United States)

    Rolly, G


    Two cases of severe burns with monitoring apparatus are described. In a female patient of 45 years, a severe third degree burn occurred by misuse of coagulation apparatus (inversion of the poles of an older Bovie apparatus), in the presence of a non-floating ECG monitoring device. A high intensity current was established from the coagulation unit, via the earth plate under the buttocks, to the indifferent electrode placed on the chest, where burns occurred. In an 8 month female baby, having laparotomy for a neuroblastoma, a third degree burn of 5 cm diameter occurred with a non-floating ECG monitor. A twin-wired disposable earth plate was placed just beneath the indifferent ECG electrode on the leg. A burning current was established between the Bovie coagulation unit and the monitor.

  15. Fatal Fat Embolism After Penis Enlargement by Autologous Fat Transfer: A Case Report and Review of the Literature. (United States)

    Zilg, Brita; Råsten-Almqvist, Petra


    Fat embolism is an incidental finding in cases of long bone fractures or other trauma, but it is also associated with liposuction and autologous fat transfer, a procedure where fat from liposuction is injected back into the same patient's face, breast, buttocks or penis. We here present a case of sudden death by fat embolism in a healthy young male, caused by a simple penis enlargement procedure, in which fat was injected into the penis shaft. We suggest that the risk of fat embolization might be higher when pretraumatized tissue is subjected to fat injection, like in this case, where a penis elongation was performed before the fat injection. © 2017 American Academy of Forensic Sciences.

  16. An exceptional case of cutaneous metastasis of squamous cell carcinoma of the lip

    Directory of Open Access Journals (Sweden)

    Vinita Trivedi


    Full Text Available Majority of head and neck cancers are squamous cell carcinomas. Distant metastases of squamous cell carcinoma of the head and neck (HNSCC occur at many sites, especially in the lung and bone. However, metastases to the skin are unusual and rare. Here, we report a case of a patient with squamous cell carcinoma of right side of the lower lip, who underwent radiotherapy after surgical excision of the tumor. One month post radiotherapy, multiple subcutaneous nodules appeared on his chest, abdomen, back, buttocks, and thighs. Pathological diagnosis of the excised subcutaneous nodule was suggestive of metastatic squamous cell carcinoma. To the best of our knowledge, this is the first report on multiple subcutaneous metastases of squamous cell carcinoma of the lip.

  17. Giant bathing trunk nevus in a child: Case report with review of literature

    Directory of Open Access Journals (Sweden)

    Sonia Jain


    Full Text Available Giant pigmented nevi are congenital melanocytic nevi that are of great cosmetic distress for the patient and cause an equal psychological stress to the parents. Here we report a case of a 4 year old female child who presented to us with a large black patch over her back extending upto upper half of her buttocks with multiple satellite lesions all over the body, since her birth. Their management is a challenge for the treating dermatologist owing to their large size and a propensity to recur. There have been reports of malignant change in upto 2% to 15% of the cases. However, there have been recent advances in the field with many new therapeutic modalities available.

  18. Aortoiliac occlusive disease presenting as sudden onset paraplegia. (United States)

    Lai, Chien-Hung; Wang, Cheng-Hsien; Wu, Shih-Yun; Shih, Hong-Mo


    Thromboembolism and atherosclerotic stenosis both can cause arterial occlusion. Aortoiliac occlusive disease involving bifurcation of the aortoiliac artery induces symptoms of ischemia such as claudication and pain of buttocks and thighs, decreased bilateral femoral pulses, and impotence. Here, we describe a 58-year-old woman with a past history of atrial fibrillation and lacuna stroke with minimal right side weakness. She presented to our emergency department with sudden onset bilateral pain in the legs and paraplegia. A comprehensive examination revealed paresthesia and decreasing bilateral distal pulses. Computed tomographic imaging showed filling defects over the low abdominal aorta just above the bifurcation of the common iliac artery and bilateral femoral arteries. Acute aortic embolic occlusion was suspected. Her symptoms were resolved after emergent thrombectomy for acute limb ischemia. Physicians need to be aware of aortoiliac embolic occlusive disease which may present as acute paraplegia. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Eccrine Syringofibroadenoma in Association With Acquired Epidermodysplasia Verruciformis. (United States)

    Tan, Timothy; Guitart, Joan; Liu, Luzheng Lisa; Brieva, Joaquin C; Amin, Sapna; Rani, Monica; Gerami, Pedram; Yazdan, Pedram


    A 75-year-old man with human immunodeficiency virus infection and numerous biopsy-proven warts for 10 years, refractory to cryosurgery, cimetidine, and topical imiquimod, presented with numerous pink to hypopigmented verrucous papules and plaques involving the face, trunk, buttocks, and groin. Laboratory evaluation revealed a CD4 T-cell count of 62 cells per microliter and human immunodeficiency virus viral load of ESFA). The patient was subsequently treated with acitretin and showed clinical improvement. ESFA is an uncommon benign adnexal tumor with unknown pathogenesis. Although its association with HPV has rarely been reported, ESFA in the setting of acquired epidermodysplasia verruciformis has not been described. The development of ESFA in this case may be the result of HPV-induced cellular transformation.

  20. [A case of conus medullaris infarction expanding to the vertebral bodies, major psoas and erector spinae muscles]. (United States)

    Konno, Takuya; Suwabe, Tatsuya; Kasahara, Sou; Umeda, Yoshitaka; Oyake, Mutsuo; Fujita, Nobuya


    A 77-year-old woman presented with conus medullaris and cauda equina syndrome following a sudden pain in the bilateral lower abdomen and right buttock. Lumbar magnetic resonance imaging (MRI) showed not only a conus medullaris lesion, but also several lesions in the vertebral bodies (L1, L2), right major psoas muscle, right multifidus muscle and bilateral erector spinae muscles. As these areas receive blood supply from each branch of the same segmental artery, we considered all of the lesions as infarctions that were a result of a single parent vessel occlusion. It is known that a vertebral body lesion can be accompanied by a spinal cord infarction, but in combination with infarction of a muscle has not been reported. This is the first report of a concomitant spinal cord and muscle infarction revealed by MRI. It is noteworthy that a spinal cord infarction could expand not only to neighboring vertebral bodies, but also to muscles.

  1. Randomized Comparison of the Therapeutic Effect of Acupuncture, Massage, and Tachibana-Style-Method on Stiff Shoulders by Measuring Muscle Firmness, VAS, Pulse, and Blood Pressure

    Directory of Open Access Journals (Sweden)

    Kazuhiro Tachibana


    Full Text Available To compare the therapeutic efficacy of acupuncture, massage, and Tachibana-Ryojutsu (one of Japanese traditional body balance therapy techniques (SEITAI, on stiff shoulders, the subjects’ muscle firmness, blood pressure, pulse, VAS, and body temperature were measured before and after the treatment. Forty-seven volunteer subjects gave written informed consent to participate in this study. The subjects were randomly divided into three groups to receive acupuncture, massage, or Tachibana-Ryojutsu. Each therapy lasted for 90 seconds. The acupuncture treatment was applied by a retaining-needle at GB-21, massage was conducted softly on the shoulders, and Tachibana-Ryojutsu treated only the muscles and joints from the legs to buttocks without touching the shoulders or backs. The study indicated that the muscle firmness and VAS of the Tachibana-Ryojutsu group decreased significantly in comparison with the acupuncture and massage groups after treatment.

  2. Effects of absorbent incontinence pads on pressure management mattresses. (United States)

    Fader, Mandy; Bain, Duncan; Cottenden, Alan


    The aim of this paper is to report a study to determine the effects of absorbent pads on the pressure-relieving properties of 'standard' and pressure management mattresses. Pressure ulcers and incontinence often co-exist. There is a strong association between poor mobility and continence problems and patients using pressure management products are therefore also likely to be using absorbent pads. An instrumented articulated anthropometric phantom with simulated soft body 'tissues' in the gluteal and sacral areas was used as the 'subject'. The phantom was raised and lowered on to three mattresses (standard foam, visco-elastic foam and surface-cut foam) in three states: naked, wearing a dry pad (Tena Super, SCA Hygiene AB) and wearing a wet pad. The pressure mapping device Xsensor was used to record the distribution of pressure over the sacral and ischial areas of the phantom. Peak pressure was used as the primary outcome variable and 10 repeats were made on each mattress under each condition. There were substantial and significant differences for all three mattresses in recorded peak pressures between the naked buttocks and the buttocks wearing a dry pad. There were no significant differences between measurements made using the dry vs. wet pad. Peak pressures frequently occurred over areas of pad folds. Additional testing showed that pads that were 'smoothed' by hand had significantly lower peak pressures than 'unsmoothed' pads. Absorbent pads have a substantial adverse effect on the pressure redistribution properties of mattresses. Pad folds appear to contribute to this effect, which can be ameliorated slightly by smoothing. Absorbent pad manufacturers should consider engineering pads that minimize disruption to pressure management. Further examination of continence and pressure management products is necessary to establish optimum combinations for nursing care.

  3. Systematic review of clinical applications of monitoring muscle tissue oxygenation with near-infrared spectroscopy in vascular disease. (United States)

    Boezeman, Reinout P E; Moll, Frans L; Ünlü, Çağdaş; de Vries, Jean-Paul P M


    The use of wavelengths of the near-infrared region by near-infrared spectroscopy (NIRS) has been studied for several applications in vascular disease. This systematic review aims to explore the clinical relevance of monitoring muscle tissue oxygenation in vascular disease with NIRS. A systematic search in PubMed, EMBASE, CINAHL and Cochrane databases was performed to identify clinical NIRS studies, published until April 2015, involving muscle tissue oxygenation in vascular disease. After screening 183 manuscripts, 38 studies (n=2010) were included. Studies concerned peripheral arterial disease (PAD) (twelve studies, n=848), compartment syndrome of lower extremities (seven studies, n=205), deep vein thrombosis (DVT) (six studies, n=429), buttock and lower extremity ischaemia in abdominal aortic aneurysm repair (six studies, n=139), free flap failure (five studies, n=354), and spinal cord ischaemia in thoracoabdominal aortic aneurysm repair (two studies, n=35). Nine studies compared NIRS with gold standards and provided cut-off values. Four studies regarding chronic compartment syndrome and DVT determined higher sensitivity (78%-97%) than specificity (56%-76%). Two studies regarding PAD and buttock claudication determined higher specificity (87%-95%) than sensitivity (33%-88%). Three studies regarding free flap failure determined sensitivity and specificity of 100%. We found sufficient evidence to use NIRS in clinical setting for assessment of chronic compartment syndrome of lower extremities, and as surveillance tool for detection of free flap failure. So far, clinical relevance of routine use of NIRS in other vascular applications is less clear. Cut-off values to discriminate are not yet unanimous and better validation has to be awaited for. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Chemotherapy-induced enterocutaneous fistula after perineal hernia repair using a biological mesh: a case report

    Directory of Open Access Journals (Sweden)

    Eriksen MH


    Full Text Available MH Eriksen, O Bulut Department of Surgical Gastroenterology, Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark Abstract: This is the first reported case of an enterocutaneous fistula as a late complication to reconstruction of the pelvic floor with a Permacol™ mesh after a perineal hernia. A 70-year-old man had a reconstruction of the pelvic floor with a biological mesh because of a perineal hernia after laparoscopic abdominoperineal resection. Nine months after the perineal hernia operation, the patient had multiple metastases in both lungs and liver. The patient underwent chemotherapy, including bevacizumab, irinotecan, calcium folinate, and fluorouracil. Six weeks into chemotherapy, the patient developed signs of sepsis and complained of pain from the right buttock. Ultrasound examination revealed an abscess, which was drained, guided by ultrasound. A computed tomography scan showed a subcutaneous abscess cavity located in the right buttock with communication to the small bowel. Operative findings confirmed a perineal fistula from the distal ileum to perineum. A resection of the small bowel with primary anastomosis was performed. The postoperative course was complicated by fluid and electrolyte disturbances, but the patient was stabilized and finally discharged to a hospice for terminal care after 28 days of hospital stay. It seems that hernia repairs with biological meshes have lower erosion and infection rates compared with synthetic meshes, and so far, evidence suggests that biological grafts are safe and effective in the treatment of pelvic floor reconstruction. There have been no reports of enteric fistulas after pelvic reconstruction with biological meshes. However, the development of intestinal fistulas after chemotherapy with bevacizumab has been described in the literature. Our case report supports this association between bevacizumab and fistula formation among rectal cancer patients, as symptoms of a

  5. Description of sensory preservation in children and adolescents with incomplete spinal cord injury. (United States)

    Betz, Randal R; Chafetz, Ross S; Vogel, Lawrence C; Samdani, Amer F; Mulcahey, Mary Jane


    This cross-sectional, multicenter cohort study describes patterns of preserved sensation in persons with American Spinal Injury Association (ASIA) Impairment Scale (AIS) B (sensory incomplete, or SI) and AIS C/D (motor incomplete, or MI). A total of 93 subjects with incomplete spinal injuries (58 with tetraplegia and 35 with paraplegia) were included for analysis. Sensation was based on the International Standards for Neurological Classification of SCI (ISNCSCI). In the 44 subjects with AIS B (SI), some light touch (LT) was present in 35% of dermatomes below the neurological level and pin prick (PP) in 8%. In contrast, in the 49 subjects with AIS C/D (MI), LT was present in 77% of dermatomes and PP in 27%. AIS C/D (MI) subjects with tetraplegia had more dermatomes with preserved sensation than those with paraplegia. When reviewing areas at highest risk for pressure sores, only 4 of 22 (19%) of subjects with AIS B (SI)/tetraplegia had any preserved LT or PP sensation in the periscapular region (dermatomes T1-T6). In the buttocks region (S3 and S4-S5), sensation was preserved in fewer than 50% of patients with either tetraplegia or paraplegia. (1) Sensory sparing below the neurologic injury was found to be surprisingly sparse in patients classified as AIS B (SI) (35% LT and 8% PP). Sparing was considerably better in patients who were AIS C/D (MI) (77% LT and 27% PP). (2) Preserved sensation in the periscapular region was very low in subjects with tetraplegia (19%) and was also low in the buttocks, with fewer than half of those classified as AIS B (SI) with either tetraplegia or paraplegia reporting sensation.

  6. Multiple hereditary exostoses and ischiofemoral impingement: a case-control study

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    Yoong, Philip; Mansour, Ramy; Teh, James L. [Nuffield Orthopaedic Centre, Department of Radiology, Oxford (United Kingdom)


    To assess whether there is a significant difference in the ischiofemoral space in patients with multiple hereditary exostoses affecting the proximal femora compared to normal patients. Ischiofemoral impingement is an increasingly recognized cause of hip and buttock pain. This causes narrowing of the ischiofemoral space resulting in an abnormal quadratus femoris muscle. We performed a retrospective search for individuals with MHE with proximal femoral involvement on pelvic MRI over a 7-year period (2006-2013). Suitable patients were age- and sex-matched with a control group. The minimum ischiofemoral space (MIFS) was recorded in each hip, as was the presence of edema and atrophy of quadratus femoris and concomitant hip osteoarthrosis. MRI features suggestive of ischiofemoral impingement were defined as MIFS less than 10 mm or an abnormal quadratus femoris muscle. Twenty-one hips in 11 individuals with MHE were included in the study. A total of 42 hips were analyzed. The mean age was 37 years (range, 13-72 years) and 55 % were male. There was a significant difference (p < 0.05) in the MIHS in individuals with MHE (mean, 10.7 mm, range, 0-21 mm) compared to a control group (mean, 18.1 mm, range, 10.5-26.5 mm). MRI features suggestive of ischiofemoral impingement were seen in 13/21 (62 %) hips in the MHE group and 0/21 (0 %) in the control group. The reduced ischiofemoral space and associated quadratus femoris abnormalities in patients with MHE involving the proximal femora may account for hip/buttock symptoms in the absence of significant degenerative change. (orig.)

  7. Pelvic morphology in ischiofemoral impingement

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    Bredella, Miriam A.; Azevedo, Debora C.; Oliveira, Adriana L.; Simeone, Frank J.; Chang, Connie Y.; Torriani, Martin [Massachusetts General Hospital, Department of Radiology, Musculoskeletal Imaging and Intervention, Boston, MA (United States); Stubbs, Allston J. [Wake Forest University School of Medicine, Department of Orthopedic Surgery, Division of Sports Medicine, Winston-Salem, NC (United States)


    To assess MRI measures to quantify pelvic morphology that may predispose to ischiofemoral impingement (IFI). We hypothesized that patients with IFI have a wider interischial distance and an increased femoral neck angle compared with normal controls. The study was IRB-approved and complied with HIPAA guidelines. IFI was diagnosed based on clinical findings (hip or buttock pain) and ipsilateral edema of the quadratus femoris muscle on MRI. Control subjects did not report isolated hip/buttock pain and underwent MRI for surveillance of neoplasms or to exclude pelvic fractures. Two MSK radiologists measured the ischiofemoral (IF) and quadratus femoris (QF) distance, the ischial angle as a measure of inter-ischial distance, and the femoral neck angle. The quadratus femoris muscle was evaluated for edema. Groups were compared using ANOVA. Multivariate standard least-squares regression modeling was used to control for age and gender. The study group comprised 84 patients with IFI (53 ± 16 years, 73 female, 11 male) and 51 controls (52 ± 16 years, 33 female, 18 male). Thirteen out of 84 patients (15 %) had bilateral IFI. Patients with IFI had decreased IF and QF distance (p < 0.0001), increased ischial angle (p = 0.004), and increased femoral neck angle (p = 0.02) compared with controls, independent of age and gender. Patients with IFI have increased ischial and femoral neck angles compared with controls. These anatomical variations in pelvic morphology may predispose to IFI. MRI is a useful method of not only assessing the osseous and soft-tissue abnormalities associated with IFI, but also of quantifying anatomical variations in pelvic morphology that can predispose to IFI. (orig.)

  8. People living with HIV on ART have accurate perception of lipodystrophy signs: a cross-sectional study. (United States)

    Alencastro, Paulo R; Barcellos, Nemora T; Wolff, Fernando H; Ikeda, Maria Letícia R; Schuelter-Trevisol, Fabiana; Brandão, Ajácio B M; Fuchs, Sandra C


    The prevalence of lipodystrophy ranges from 31 to 65%, depending on the criteria adopted for diagnosis. The usual methods applied in the diagnosis vary from self-perception, medical examination, skinfolds measurements, or even imaging assessment for confirmation of fat distribution changes. Although several methods have been developed, there is no gold standard for characterization of LA and LH, or mixed forms. This study aimed to compare self-reported signs of lipodystrophy with objective measures by skinfolds and circumferences, and to evaluate the prevalence of lipoatrophy (LA) and lipohypertrophy (LH) among subjects living with HIV/AIDS on ART. A cross-sectional study enrolled participants living with HIV/AIDS receiving ART, aged 18 years or older from an outpatient health care center, in Southern Brazil. Self-reported body fat enlargement in the abdomen, chest or breasts, and dorsocervical fat pad were used to determine LH, while LA was identified by self-reported fat wasting of the face, neck, legs, arms or buttocks. Measurements were obtained with a scientific caliper for infraorbital, buccal, and submandibular skinfolds, and using an inelastic tape to measure circumferences of waist, hip, neck, and arm. LH and LA were established by the presence of at least one self-reported sign. Comparisons of self-reported signs with objective measurements for men and women were carried out in 815 participants on ART, out of 1240 participants with HIV infection. Self-report of decreased facial fat and sunken cheeks was associated with lower infraorbital, buccal, and submandibular skinfolds. Participants who reported buffalo hump had, on average, greater neck circumference, as well as those who have increased waist circumference also reported abdominal enlargement, but no buttock wasting. Men were most commonly affected by lipoatrophy (73 vs. 53%; P lipodystrophy and lipoatrophy are prevalent, differ by gender, and are associated with objective measurements in people

  9. Intra- and inter-observer reliability of the application of the cellulite severity scale to a Spanish female population. (United States)

    De La Casa Almeida, M; Suarez Serrano, C; Jiménez Rejano, J J; Chillón Martínez, R; Medrano Sánchez, E M; Rebollo Roldán, J


    'Hexsel, dal'Forno and Hexsel Cellulite Severity Scale' (CSS) was developed to evaluate cellulite with an objective and easy to apply tool. Objective  Study CSS intra- and inter-observer reliability in a Spanish female population by evaluating patients' cellulite through photographs of their overall gluteofemoral zone as opposed to its creators who distinguished between buttocks and thigh. Cellulite Severity Scale was applied to 27 women, evaluating gluteofemoral cellulite, differentiating between left and right. Evaluations were made by three expert examiners each at three times with a 1-week separation. Variables were the five CSS dimensions (number of evident depressions; depth of depressions; morphological appearance of skin surface alterations; grade of laxity, flaccidity, or sagging skin; and the Nürnberger and Müller classification scale), and the overall CSS score. Cronbach's alpha, intra-class correlation and item total correlation were analysed. Cronbach's alpha values were 0.951 (right) and 0.944 (left). In the intra-observer reliability analysis, intra-class correlation coefficient ranged from 0.993 to 0.999 (P Cellulite Severity Scale has excellent reliability and internal consistency when used to evaluate cellulite on the buttocks and back of the thighs considered together. Nevertheless, the dimension grade of laxity, flaccidity or sagging skin does not contribute positively to the final consistency of the scale. This dimension needs to be analysed in greater depth in future studies. © 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.

  10. Correlation between lumbar lordosis angle and degree of gynoid lipodystrophy (cellulite) in asymptomatic women. (United States)

    Milani, Giovana Barbosa; Natal Filho, A'Dayr; Amado João, Sílvia Maria


    Gynoid lipodystrophy (cellulite) has been cited as a common dermatological alteration. It occurs mainly in adult women and tends to gather around the thighs and buttocks. Its presence and severity have been related to many factors, including biotype, age, sex, circulatory changes, and, as some authors have suggested, mechanical alterations such as lumbar hyperlordosis. To correlate the degree of cellulite with the angle of lumbar lordosis in asymptomatic women. Fifty volunteers were evaluated by digital photos, palpation, and thermograph. The degree of cellulite was classified on a scale of 1-4. Analyses were performed on the superior, inferior, right and left buttocks (SRB, IRB, SLB, ILB), and the superior right and left thighs (SRT, SLT). The volunteers underwent a lateral-view X-ray, and the angle of lumbar lordosis was measured using Cobb's method (inferior endplate of T12 and the superior endplate of S). The data were statistically analyzed using ANOVA and Spearman's correlation. A significance level of 5% was adopted. Volunteers had a mean age of 26.1+/-4.4 years and a mean body mass index of 20.7+/-1.9 kg/m(2). There was no significant difference in lumbar lordosis angle between those with cellulite classes 2 and 3 (p>or=0.297). There was also no correlation between lumbar lordosis angle and the degree of cellulite (p>or=0.085 and r>or=0.246). The analysis suggests that there is no correlation between the degree of cellulite and the angle of lumbar lordosis as measured using Cobb's method.

  11. Correlation between lumbar lordosis angle and degree of gynoid lipodystrophy (cellulite in asymptomatic women

    Directory of Open Access Journals (Sweden)

    Giovana Barbosa Milani


    Full Text Available INTRODUCTION: Gynoid lipodystrophy (cellulite has been cited as a common dermatological alteration. It occurs mainly in adult women and tends to gather around the thighs and buttocks. Its presence and severity have been related to many factors, including biotype, age, sex, circulatory changes, and, as some authors have suggested, mechanical alterations such as lumbar hyperlordosis. OBJECTIVE: To correlate the degree of cellulite with the angle of lumbar lordosis in asymptomatic women. METHODS: Fifty volunteers were evaluated by digital photos, palpation, and thermograph. The degree of cellulite was classified on a scale of 1-4. Analyses were performed on the superior, inferior, right and left buttocks (SRB, IRB, SLB, ILB, and the superior right and left thighs (SRT, SLT. The volunteers underwent a lateral-view X-ray, and the angle of lumbar lordosis was measured using Cobb's method (inferior endplate of T12 and the superior endplate of S. The data were statistically analyzed using ANOVA and Spearman's correlation. A significance level of 5% was adopted. RESULTS: Volunteers had a mean age of 26.1 ± 4.4 years and a mean body mass index of 20.7 ± 1.9 kg/m². There was no significant difference in lumbar lordosis angle between those with cellulite classes 2 and 3 (p > 0.297. There was also no correlation between lumbar lordosis angle and the degree of cellulite (p > 0.085 and r > 0.246. CONCLUSIONS: The analysis suggests that there is no correlation between the degree of cellulite and the angle of lumbar lordosis as measured using Cobb's method.

  12. A double-blind, placebo-controlled randomized trial evaluating the ability of low-level laser therapy to improve the appearance of cellulite. (United States)

    Jackson, Robert F; Roche, Gregory C; Shanks, Steven C


    Cellulite is present in 90% of post-adolescent women. Several technologies have been developed for treating cellulite; however, they all involve some degree of massage or mechanical manipulation. The purpose of this study was to assess the effectiveness of a low-level laser light device employing green 532 nm diodes as a stand-alone procedure without massage or mechanical manipulation for improving the appearance of cellulite in the thighs and buttocks. This double-blind study randomized subjects to undergo treatment with the LLLT device (N = 34) or sham treatment (N = 34). During a 2-week treatment phase, each subject received three weekly treatment sessions 2-3 days apart. During each session, the front and back of the hips, thighs, and waist were exposed for 15 minutes (30 minutes total). Nineteen subjects in the LLLT group achieved a decrease of one or more stages on the Nurnberger-Muller grading scale (55.88%) versus three subjects (8.82%) in the sham-treated group (P cellulite (P cellulite they received versus 25.8% of sham-treated subjects. There were no reports of adverse events. Low-level laser therapy using green 532 nm diodes is safe and effective for improving the appearance of cellulite in the thighs and buttocks. In contrast with other technologies, LLLT is effective as a stand-alone procedure without requiring massage or mechanical manipulation. Future studies will assess the long-term benefits of LLLT for the treatment of cellulite. Copyright © 2013 Wiley Periodicals, Inc.

  13. Long-wave infrared radiation reflected by compression stockings in the treatment of cellulite: a clinical double-blind, randomized and controlled study. (United States)

    Bagatin, E; Miot, H A; Soares, J L M; Sanudo, A; Afonso, J P J M; de Barros Junior, N; Talarico, S


    Cellulite refers to changes in skin relief on the thighs and buttocks of women, with a prevalence of 80-90%, causing dissatisfaction and search for treatment. Etiopathogenesis is multifactorial, as follows: herniation of the hypodermis towards the dermis, facilitated by perpendicular fibrous septa, changes in the dermal extracellular matrix, decreased adiponectin, genetic polymorphism, microcirculation alterations and inflammatory process. There are numerous therapeutic approaches, with little evidence of effectiveness. The long-wave infrared (LWIR) radiation interacts with water, improves microcirculation and stimulates metabolic processes. To date, the use of tissues with potential reflection of LWIR radiation has not been systematically investigated as adjuvant treatment for cellulite. To investigate the efficacy and safety of the treatment of cellulite through the use of compression stockings made with thread reflecting LWIR radiation. Clinical study of therapeutic intervention, controlled and double-blind, including 30 women, aging from 25 to 40 years, with cellulite of grades II and III on the thighs and buttocks who used compression stockings, "pantyhose" model, made with reflector thread of LWIR radiation, on only one randomized side. Women under other treatments for cellulite and with venous and/or blood insufficiencies were excluded. Evaluation of efficacy by clinical parameters, photographs, Dermatology Life Quality Index (DLQI), cutometry and high frequency ultrasonography and security by observation of adverse events and venous EcoDoppler recordings. DLQI scores showed significant reduction; the two-dimensional high-frequency ultrasonography showed an insignificant increase in dermal echogenicity as well as other efficacy parameters demonstrated no or slight improvement, with no differences between the sides exposed or not to LWIR; and there were no severe adverse events. Compression stockings, with or without thread reflector of LWIR, showed slight

  14. Reconstruction of gluteal deformities: a systematic review and experience of four cases. (United States)

    Tremp, Mathias; di Summa, Pietro Giovanni; Oranges, Carlo M; Schaefer, Dirk J; Kalbermatten, Daniel Felix


    The reconstruction of gluteal deformities remains a major challenge. The aim of this article is to provide a systematic review of the literature concerned, and to present a case series with representative defects from various zones. A review of the literature was performed using PubMed, EMBASE, and The Cochrane Library, in accordance with the PRISMA statement. Quality of evidence was rated according to GRADE. Patients with various buttock deformities were included and, depending on the defect, the reconstructive techniques applied consisted of lipoinjection, local fasciocutaneous flap, or pedicled gracilis muscle flap. Complications, patient's pain assessment, impairment in everyday-life activities, aesthetic outcome, objective assessment of sensitivity, and recurrence were considered. A total of 498 records were identified in the literature search. Of those, 12 studies met the PICOS (participants, interventions, comparators, outcomes, and study design) criteria. Overall, 41 patients were analysed, the evidence of which was of low quality. In this study, four patients (three female and one male) with a mean age of 44 ± 15 years were operated on between 2010-2014. The mean operation time was 83 ± 30 minutes. One patient required revision due to persistent seroma and recurrence, and one patient required neurolysis and gracilis denervation due to neuroma and scarring. After a mean follow-up of 40 ± 21 months, the results were functionally and cosmetically satisfactory. Reconstruction of buttock deformities using an integrated approach can lead to a long-lasting, functionally and aesthetically satisfactory result. However, evidence is limited due to the lack of good-quality studies.

  15. Effect of prolonged sitting on body-seat contact pressures among quay crane operators: A pilot study. (United States)

    Pau, Massimiliano; Leban, Bruno; Fadda, Paolo; Fancello, Gianfranco; Nussbaum, Maury A


    Quay crane operators are specialized in moving containers to and from vessels while adopting constrained sitting postures for prolonged periods (4-6 consecutive hours) in a very challenging environment. Thus, they are exposed to discomfort or pain that may result in deterioration of their performance with consequent reduction of operational safety levels. Such discomfort can be indirectly and partially assessed by measuring contact pressure at the body-seat interface. The aim of the study was to assess the feasibility, usefulness, and effectiveness of monitoring the variations in seat-body interface pressure during a regular work shift of 4 hours performed in a simulated environment. Eight professional operators performed a four-hour shift in a realistic control station set inside a quay crane simulator. Seat-body contact pressures were measured at 10 Hz using two pressure-sensitive mats placed on the seat pan and the backrest. Raw pressure data were processed to extract pressure vs. time curves related to the whole seat surface and, for the seat pan only, values associated with four anatomical regions (i.e. left and right thighs and buttocks). During the work shift, the mean backrest pressure was low and fairly constant. Seat pan pressure increased by 10%, rising from 7.4 (1.5) to 8.2 (2.3) kPa over the simulated shift. Detailed analysis of the four sub-regions revealed that as the trial progressed the mean contact pressure on buttocks decreased (-6% at the end of the trial) while thigh pressures increased (by 10 and 20% for right and left sides, respectively). Although further studies with larger samples are needed, long-term monitoring of the body-seat contact pressures of crane operators in a simulated environment appears to be a useful tool to identify specific postural strategies to reduce discomfort originated by prolonged sitting posture.

  16. First Case of 2 Synchronous Gluteal Arteries Aneurysms Treated by Endovascular Plug Embolization: Case Report and Literature Review. (United States)

    Esposito, Andrea; Menna, Danilo; Salcuni, Matteo; Di Leo, Ferdinando; Benedetto, Pietro; Trani, Antonio; Cappiello, Antonino Pierluigi


    Gluteal artery aneurysms (GAAs) are rare, accounting for less than 1% of all arterial aneurysms. Most of them are post-traumatic in nature and involve the superior gluteal artery (SGA), while injuries of the inferior gluteal artery (IGA) have been reported less frequently. We report an unusual case of a patient with double saccular GAA of unknown etiology, involving both the SGA and IGA, successfully treated by endovascular embolization. A 80-year-old man referred to our hospital complaining of the progressive onset of left buttock pain and swelling exacerbated by sitting position in the last 4 months. His past medical history was positive for hypertension, prostatic adenocarcinoma treated by brachytherapy, and endocarditis diagnosed about 30 years before and treated by cardiac surgical valve replacement; no history of trauma was reported. After ultrasonography was carried out, an enhanced computed tomography (CT) scan confirmed the presence of 2 large GAAs involving both the SGA and IGA, with maximum transverse diameter of 38 and 84 mm, respectively. The patient was referred for endovascular treatment after informed consent was provided. After sequential selective catheterization of SGA and IGA, 3 Amplatzer Plugs II (St. Jude Medical, Zaventem, Belgium) were deployed inside the aneurysms. Postoperative course was uneventful as buttock pain completely disappeared on the second postoperative day. The patient was discharged to home on the third postoperative day. One-month CT scan confirmed the complete thrombosis of the aneurysms without any endoleak. GAAs represent a rare pathology, and for that reason, the correct timing and choice of treatment are not clearly defined. Endovascular techniques are the first step in the approach to GAAs. In case of complex anatomy, GAAs embolization by the use of vascular plugs can be successfully performed. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Anthropometric evaluation and recommendation for primary schools classroom furniture design in Perlis (United States)

    Shan, Lim Shaiu; Jing, Ewe Hui; Effendi, M. S. M.; Rosli, Muhamad Farizuan


    This study was carried out with the objective to obtain the anthropometric data of primary school children from Year 1 to Year 6 and evaluate the children's anthropometry with the current dimensions of classroom furniture (i.e. chair and table). In addition, this study also proposed the design dimensions for the improvement in classroom furniture design with the consideration of children's anthropometric data. A total of 390 children selected from 13 primary schools in Perlis, Malaysia were participated in this study. There were 11 anthropometric measurements of children have been measured in this study, which include stature (St), popliteal height (PH), knee height (KH), thigh thickness (TT), buttock popliteal length (BPL), hip breadth (HB), sitting shoulder height (SSH), sitting elbow height (SEH), forearm-hand length (FHL), height of lumbar point (HLP) and buttock clearance (BC). Besides that, 7 dimensions relating to current classroom chair have been measured, such as seat height (SH), seat depth (SD), seat width (SW), upper edge of backrest (UEB), lower edge of backrest (LEB), S point (SP), overall chair height (OCH). Another 5 dimensions of the existing classroom table have been measured too, which involve table height (TH), table depth (TD), table width (TW), under table height (UH) and seat to table clearance (STC). All the measurements were performed by using metal measuring tape. The anthropometric data of the children were analyzed with the help of Microsoft Excel 2013. Several equations with associated with the anthropometric data and furniture dimensions have been applied in this research. The new design dimensions for classroom furniture that proposed in this paper which based on the collected anthropometric data can be referred as a guideline for classroom furniture design. The implementation of these data may help to create comfortability, safety, suitability and improve performance of children in the classroom.

  18. Effects of ambient conditions on the risk of pressure injuries in bedridden patients-multi-physics modelling of microclimate. (United States)

    Zeevi, Tal; Levy, Ayelet; Brauner, Neima; Gefen, Amit


    Scientific evidence regarding microclimate and its effects on the risk of pressure ulcers (PU) remains sparse. It is known that elevated skin temperatures and moisture may affect metabolic demand as well as the mechanical behaviour of the tissue. In this study, we incorporated these microclimate factors into a novel, 3-dimensional multi-physics coupled model of the human buttocks, which simultaneously determines the biothermal and biomechanical behaviours of the buttocks in supine lying on different support surfaces. We compared 3 simulated thermally controlled mattresses with 2 reference foam mattresses. A tissue damage score was numerically calculated in a relevant volume of the model, and the cooling effect of each 1°C decrease of tissue temperature was deduced. Damage scores of tissues were substantially lower for the non-foam mattresses compared with the foams. The percentage tissue volume at risk within the volume of interest was found to grow exponentially as the average tissue temperature increased. The resultant average sacral skin temperature was concluded to be a good predictor for an increased risk of PU/injuries. Each 1°C increase contributes approximately 14 times as much to the risk with respect to an increase of 1 mmHg of pressure. These findings highlight the advantages of using thermally controlled support surfaces as well as the need to further assess the potential damage that may be caused by uncontrolled microclimate conditions on inadequate support surfaces in at-risk patients. © 2017 Inc and John Wiley & Sons Ltd.

  19. Dermatological spectrum of hand, foot and mouth disease from classical to generalized exanthema. (United States)

    Hubiche, Thomas; Schuffenecker, Isabelle; Boralevi, Franck; Léauté-Labrèze, Christine; Bornebusch, Laure; Chiaverini, Christine; Phan, Alice; Maruani, Annabel; Miquel, Juliette; Lafon, Marie-Edith; Lina, Bruno; Del Giudice, Pascal


    Hand, foot and mouth disease (HFMD) is classically defined as a childhood fever accompanied by a rash with vesicles or erosions of the oral mucosa, hands, feet and sometimes the buttocks. Severe neurological complications are associated with enterovirus 71 outbreaks in Asia. Recently, it has been suggested that HFMD is related to coxsackie virus A6 (CV-A6) when there is an atypical rash. The objective of the study is to determine the dermatological pattern of HFMD and to identify the virus serotypes associated with a specific dermatological pattern. A prospective, cross-sectional study was conducted in 7 pediatric dermatology units in France from March 2010 to February 2012. All children with clinically suspected diagnosis of HFMD were included. Clinical data were collected and swabs from the nasopharynx and vesicles were taken for reverse transcription polymerase chain reaction and genotyping. Only children with confirmed HFMD--defined by clinical diagnosis of HFMD and positive enterovirus polymerase chain reaction results--were included for analysis. One hundred and four children consulted for suspected HFMD, including 89 (mean age: 25.7 months; sex ratio M/F 1.54) with confirmed HFMD. Seventy-eight (87.6%) had skin lesions on sites other than hand, feet and mouth. Thirty-seven (41.5%) had 5 or more anatomical sites involved (hand, feet and mouth, buttocks, legs, arms and trunk) considered as widespread exanthema. Widespread vesicular exanthema was observed with both CV-A6 and CV-A16. Peri-oral rash was associated with CV-A6 (P exanthema. Generalized and atypical exanthema were observed with both CV-A6 and CV-A16 infections. CV-A6 is associated with peri-oral rash.

  20. [Efficacy analysis of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures]. (United States)

    Li, F L; Jiang, C Y; Lu, Y; Zhu, Y M; Li, X


    To evaluate the clinical results of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures. From January 2013 to December 2014, 8 consecutive patients with postoperative deep infection after surgeries for proximal humeral fractures who were treated with two-stage reverse total shoulder arthroplasty were retrospectively reviewed after the final follow-up. There were 1 man and 7 women with a mean age of (58.5±6.4) years, of whom 3 left shoulders and 5 right shoulders were involved. There were 2 patients with periprosthetic infection after hemiarthroplasty for proximal humeral fractures, and 6 patients with humeral head necrosis as well as implant-associated infection after open reduction internal fixation for proximal humeral fractures with the locking plate. The diagnosis of postoperative deep infection was confirmed by either the preoperative cultures or the intraoperative biopsies during the first-stage surgery. At the first-stage surgery, all the patients underwent a thorough debridement, and then an antibiotic-impregnated bone cement spacer was placed after the removal of prosthesis or locking plate. During the second-stage surgery, the cement spacer was removed, and then a revision shoulder arthroplasty with the reverse shoulder prosthesis was performed in all the patients who were routinely followed up after the second-stage surgery. The visual analogue score (VAS), Constant score and University of California Los Angeles (UCLA) score were employed to evaluate the postoperative shoulder function. The mean follow-up time was (19.9±8.0) months (range 12 to 35 months). At the end of the follow-up, the median forward elevation [100° (60°, 140°) vs. 25° (0°, 90°), P=0.011], the median external rotation [15° (0°, 50°) vs. 5° (0°, 20°), P=0.048], and the median internal rotation [L4 (buttock, T12) vs. buttock (buttock, L3), P=0.041] were all significantly improved

  1. Prospective, multicenter study of endovascular repair of aortoiliac and iliac aneurysms using the Gore Iliac Branch Endoprosthesis. (United States)

    Schneider, Darren B; Matsumura, Jon S; Lee, Jason T; Peterson, Brian G; Chaer, Rabih A; Oderich, Gustavo S


    The GORE EXCLUDER Iliac Branch Endoprosthesis (IBE; W. L. Gore and Associates, Flagstaff, Ariz) is an iliac branch stent graft system designed to preserve internal iliac artery perfusion during endovascular repair of aortoiliac aneurysms (AIAs) and common iliac artery (CIA) aneurysms (CIAAs). We report the 6-month primary end point results of the IBE 12-04 United States pivotal trial for endovascular treatment of AIAs and CIAAs using the IBE device. The trial prospectively enrolled 63 patients with AIA or CIAA who underwent implantation of the IBE device at 28 centers in the United States from 2013 to 2015. All patients underwent placement of a single IBE device. Twenty-two patients (34.9%) with bilateral CIAs were enrolled after undergoing staged coil or plug embolization (21 of 22) or surgical revascularization (1 of 22) of the contralateral internal iliac artery. Follow-up at 30 days and 6 months included clinical assessment and computed tomography angiography evaluation as assessed by an independent core laboratory. The primary effectiveness end point was freedom from IBE limb occlusion and reintervention for type I or III endoleak and ≥60% stenosis at 6 months, and the secondary effectiveness end point was freedom from new onset of buttock claudication on the IBE side at 6 months. Mean CIA diameter on the IBE side was 41.0 ± 11.4 mm (range, 25.2-76.3 mm). There were no procedural deaths, and technical success, defined as successful deployment and patency of all IBE components and freedom from type I or III endoleak, was 95.2% (60 of 63). Data for 61 patients were available for primary and secondary effectiveness end point analysis. Internal iliac limb patency was 95.1% (58 of 61), and no new type I or III endoleaks or device migrations were observed at 6 months. The three patients with loss of internal iliac limb patency were asymptomatic, and freedom from new-onset buttock claudication on the IBE side was 100% at 6 months. New-onset buttock

  2. The impact of abnormal muscle tone from hemiplegia on reclining wheelchair positioning: a sliding and pressure evaluation. (United States)

    Huang, H C; Lin, Y S; Chen, J M; Yeh, C H; Chung, K C


    Little is known about the influence of existing muscle tone abnormality on the sitting posture of stroke patients in reclining wheelchairs. To investigate the impact of muscle tone abnormality from hemiplegia on the forward sliding and pressure of stroke patients while sitting in reclining wheelchairs. Experimental study. The Assistive Devices/Technology Center at the Rehabilitation Department of hospital. 14 able-bodied elders and nonambulatory elderly stroke patients with flaccid (N.=12) or spastic hemiplegia (N.=13) participated in this study. Of the 12 patients with flaccid hemiplegia, 8 suffered from left-sided hemiplegia and 4 from right-sided hemiplegia. Of the 13 patients with spastic hemiplegia, 6 suffered from left-sided hemiplegia and 7 from right-sided hemiplegia. We performed 3 reclining cycles in wheelchairs with conventional seats and V-shaped seats for each participant. The sliding along the backrest (BS) plane and the seat (SS) plane, mean sitting pressure (MP), and sacral peak pressure (SPP) of the participants were recorded. The Kruskal-Wallis test was used to compare the difference in BS, SS, MP, and SPP between able-bodied elders and stroke patients. The BS, SS, and SPP during repetitive reclining were generally greatest in flaccid hemiplegic participants, followed by spastic hemiplegic participants, and finally by able-bodied participants. There was no significant difference in MP among three subject groups on both conventional seats and V-shaped seats in most comparisons. Able-bodied participants' buttocks tended to slide forward on conventional seats but backward on V-shaped seats, whereas hemiplegic participants' buttocks slid forward on both seat types. Stroke patients with flaccid hemiplegia are the most vulnerable to sacral sitting and higher sacral pressure in reclining wheelchairs, followed by patients with spastic hemiplegia. There is a difference in the displacement pattern between participants with normal muscle tone and those with

  3. Psychometric Assessment of the Japanese Version of the Zurich Claudication Questionnaire (ZCQ: Reliability and Validity.

    Directory of Open Access Journals (Sweden)

    Nobuhiro Hara

    Full Text Available The Zurich Claudication Questionnaire (ZCQ is a self-administered measure to evaluate symptom severity, physical function, and surgery satisfaction in lumbar spinal stenosis (LSS. The purpose of this study is to assess the psychometric properties of the Japanese ZCQ in LSS patients.LSS patients who are scheduled to undergo surgery were recruited from 12 facilities. Responses to several questionnaires, including the Japanese ZCQ; the visual analogue scale (VAS to evaluate the degree of pain in the buttocks/legs, numbness in the buttocks/legs, and low back pain; the Oswestry Disability Index (ODI; and the SF-36v2, were collected before surgery and again 3 months after surgery (the post-surgery ZCQ was administered twice for test-retest reliability. For reliability, test-retest reliability was evaluated using the intra-class coefficient (ICC and internal consistency was evaluated using Cronbach's alpha coefficient. Concurrent validity was assessed using Spearman's correlation coefficients between the Japanese ZCQ and other questionnaires. Effect size (ES and standard response mean were calculated for responsiveness. All analyses were performed individually for the Japanese ZCQ symptom, function, and satisfaction domains.Data from 180 LSS patients were used in this analysis. The ICCs were 0.81, 0.89, and 0.88 and Cronbach's alpha coefficients were 0.78, 0.84, and 0.92 for the Japanese ZCQ symptom, function, and satisfaction domains, respectively. Regarding the concurrent validity, strong correlations (±0.5 were demonstrated between the Japanese ZCQ domains and the VAS leg pain, ODI, and SF-36v2 physical functioning or bodily pain, whereas correlations were approximately 0.3 in scales measuring other symptoms that are less related to symptom, function, or satisfaction domains. ESs showed high values for the ZCQ symptom and function domains (-1.73 for both.These psychometric assessments demonstrate that the Japanese ZCQ is a psychometrically reliable

  4. A wireless lingual feedback device to reduce overpressures in seated posture: a feasibility study. (United States)

    Chenu, Olivier; Vuillerme, Nicolas; Demongeot, Jacques; Payan, Yohan


    Pressure sores are localized injuries to the skin and underlying tissues and are mainly resulting from overpressure. Paraplegic peoples are particularly subjects to pressure sores because of long-time seated postures and sensory deprivation at the lower limbs. Here we report outcomes of a feasibility trial involving a biofeedback system aimed at reducing buttock overpressure whilst an individual is seated. The system consists of (1) pressure sensors, (2) a laptop coupling sensors and actuator (3) a wireless Tongue Display Unit (TDU) consisting of a circuit embedded in a dental retainer with electrodes put in contact with the tongue. The principle consists in (1) detecting overpressures in people who are seated over long periods of time, (2) estimating a postural change that could reduce these overpressures and (3) communicating this change through directional information transmitted by the TDU.Twenty-four healthy subjects voluntarily participated in this study. Twelve healthy subjects initially formed the experimental group (EG) and were seated on a chair with the wireless TDU inside their mouth. They were asked to follow TDU orders that were randomly spread throughout the session. They were evaluated during two experimental sessions during which 20 electro-stimulations were sent. Twelve other subjects, added retrospectively, formed the control group (CG). These subjects participated in one session of the same experiment without any biofeedback.Three dependent variables were computed: (1) the ability of subjects to reach target posture (EG versus CG), (2) high pressure reductions after a biofeedback (EG versus CG) and (3) the level of these reductions relative to their initial values (EG only). Results show (1) that EG reached target postures in 90.2% of the trials, against 5,3% in the CG, (2) a significant reduction in overpressures in the EG compared to the CG and (3), for the EG, that the higher the initial pressures were, the more they were decreased. The

  5. Psychometric Assessment of the Japanese Version of the Zurich Claudication Questionnaire (ZCQ): Reliability and Validity. (United States)

    Hara, Nobuhiro; Matsudaira, Ko; Masuda, Kazuhiro; Tohnosu, Juichi; Takeshita, Katsushi; Kobayashi, Atsuki; Murakami, Motoaki; Kawamura, Naohiro; Yamakawa, Kiyohumi; Terayama, Sei; Ogihara, Satoshi; Shiono, Hiroo; Morii, Jiro; Hayakawa, Keiji; Kato, So; Nakamura, Kozo; Oka, Hiroyuki; Sawada, Takayuki; Inuzuka, Kyoko; Kikuchi, Norimasa


    The Zurich Claudication Questionnaire (ZCQ) is a self-administered measure to evaluate symptom severity, physical function, and surgery satisfaction in lumbar spinal stenosis (LSS). The purpose of this study is to assess the psychometric properties of the Japanese ZCQ in LSS patients. LSS patients who are scheduled to undergo surgery were recruited from 12 facilities. Responses to several questionnaires, including the Japanese ZCQ; the visual analogue scale (VAS) to evaluate the degree of pain in the buttocks/legs, numbness in the buttocks/legs, and low back pain; the Oswestry Disability Index (ODI); and the SF-36v2, were collected before surgery and again 3 months after surgery (the post-surgery ZCQ was administered twice for test-retest reliability). For reliability, test-retest reliability was evaluated using the intra-class coefficient (ICC) and internal consistency was evaluated using Cronbach's alpha coefficient. Concurrent validity was assessed using Spearman's correlation coefficients between the Japanese ZCQ and other questionnaires. Effect size (ES) and standard response mean were calculated for responsiveness. All analyses were performed individually for the Japanese ZCQ symptom, function, and satisfaction domains. Data from 180 LSS patients were used in this analysis. The ICCs were 0.81, 0.89, and 0.88 and Cronbach's alpha coefficients were 0.78, 0.84, and 0.92 for the Japanese ZCQ symptom, function, and satisfaction domains, respectively. Regarding the concurrent validity, strong correlations (±0.5) were demonstrated between the Japanese ZCQ domains and the VAS leg pain, ODI, and SF-36v2 physical functioning or bodily pain, whereas correlations were approximately 0.3 in scales measuring other symptoms that are less related to symptom, function, or satisfaction domains. ESs showed high values for the ZCQ symptom and function domains (-1.73 for both). These psychometric assessments demonstrate that the Japanese ZCQ is a psychometrically reliable and


    McGovern, Ryan P; Kivlan, Benjamin R; Martin, RobRoy L


    Stretching of the deep rotators of the hip is commonly employed in patients with lumbosacral, sacroiliac, posterior hip, and buttock pain. There is limited research demonstrating the effectiveness of common stretching techniques on the short external rotators of the hip. The objective of this study was to evaluate length change during stretching of the superior and inferior fibers of the piriformis, superior gemellus, obturator internus, and inferior gemellus. Repeated-measures laboratory controlled cadaveric study. Seventeen hip joints from nine embalmed cadavers (5 male; 4 female) with an age between 49-96 years were skeletonized. Polypropylene strings were attached from the origin to insertion sites of the short external rotators. The change of length (mm) noted by excursion of the strings was used as a proxy for change in muscle length, when the hip was moved from the anatomical position to four specific stretch positions: 1) 45 ° internal rotation from hip neutral flexion/extension, 2) 45 ° external rotation from 90 ° hip and knee flexion, 3) 30 ° adduction from 90 ° of hip and knee flexion, and 4) 30 ° of adduction with the hip and knee flexed so the lateral malleolus contacted the lateral femoral epicondyle of the contralateral limb , were recorded. There was a significant effect on string displacement by stretch position, F (15,166) = 14.67, p obturator internus and inferior gemellus had the largest string displacement with 45 ° internal rotation from neutral flexion/extension. While all stretch positions caused a significant string displacement indicating length changes of the deep rotators of the hip, the three stretch positions that caused the greatest change were: 1) 30 ° adduction from 90 ° of hip and knee flexion, 2) 45 ° internal rotation from neutral flexion/extension, and 3) 45 ° external rotation with 90 ° hip and knee flexion. This study has clinical implications for the effectiveness of specific stretching

  7. Use of an absorbent dressing specifically for fecal incontinence. (United States)

    Bliss, Donna Z; Savik, Kay


    Use of an absorbent product is a self-care strategy for managing fecal incontinence that protects against visible soiling. The purpose of this study was to examine use of a small surgical dressing that can be placed between the buttocks to absorb leaked feces. Cross-sectional survey. A survey was mailed to 75 randomly selected community-living people in 25 states and the District of Columbia, who ordered the dressing more than once within the past year. Thirty-six people (age = 55 +/- 16 years mean +/- SD), 57% men and 94% white responded. A 48-question survey that included questions asked about demographics and general health, emotional states (eg, anxiety and depression), bowel pattern and incontinence, quality of life, and use of an anorectal dressing was developed for this study. The survey also contained 2 tools, the Fecal Incontinence Severity Index and the Fecal Incontinence Quality of Life instrument. The Fecal Incontinence Severity Index is a tool that enables valid assessment of fecal incontinence severity using patient recall of symptoms of frequency and type of bowel leakage. The Fecal Incontinence Quality of Life instrument results in a valid and reliable evaluation of fecal incontinence-specific quality of life using 4 domains of lifestyle, coping/behavior, depression/self-perception, and embarrassment. The fecal incontinence severity score was 28 +/- 14 (mean +/- SD); 79% leaked loose/liquid feces, 50% leaked daily, and leaked feces remained between the buttocks in 64%; 21% also leaked urine. Eighty-five percent experienced incontinence-associated dermatitis. Of those who used the dressing, 50% were men. The anorectal dressing was preferred to a pad by 92%, prevented soiling in 88%, and its ability to stay in place was rated very good or good by 76%. Eighty percent of respondents rated the dressing's comfort very good or good; 85% rated its overall effectiveness very good or good. Use of the dressing lessened anxiety about fecal soiling in 81% and

  8. Treatment of relapse in herpes simplex on labial and facial areas and of primary herpes simplex on genital areas and "area pudenda" with low-power He-Ne laser or Acyclovir administered orally (United States)

    Velez-Gonzalez, Mariano; Urrea-Arbelaez, Alejandro; Nicolas, M.; Serra-Baldrich, E.; Perez, J. L.; Pavesi, M.; Camarasa, J. M.; Trelles, Mario A.


    Sixty patients (greater than 16 yrs old) suffering primary or relapse genital herpes simplex viruses (HSV) and relapse labial HSV were appointed for this study. Three or more relapses were experienced per year. Patients (under treatment) were divided into two groups (distribution areas), corresponding to either labial herpes or genital herpes. These groups were sub-divided into 3 groups. The total number of labial or facial HSV patients was 36 (10 in group 1, 12 in group 2, 14 in group 3) and 24 for genital, buttocks, or 'area pudenda' HSV patients (6 in group 1, 8 in group 2, 10 in group 3). The design was a randomized, double- blind study. The setting was hospital and outpatient. The patients diagnosed as having the HVS disease were sent to the dermatology department and were assigned to a group at random. Treatment was begun as follows: During the treatment signs and symptoms were assessed and after the treatment, the relapses were also assessed (biochemical and hematological tests before and after the treatment) and the diagnosis of the HSV type I and II. The statistical evaluation of the results was performed and carried out with the SPSS and BMDP program. The relapses of the herpes infection in the lips and the face were significantly reduced (p less than 0.026) in patients treated with laser He-Ne and laser He-Ne plus Acyclovir. The interim between the relapses also increased significantly (p less than 0.005) in relation with the group treated with Acyclovir. The duration of the herpetic eruptions was clearly reduced in all locations in patients treated with laser He-Ne plus Acyclovir. No differences were noted between patients treated with laser He-Ne only or Acyclovir only. Therefore it is probable that therapeutic synergism took place. In relation with this, laser He-Ne shows the same therapeutic efficacy as Acyclovir taken orally. The association of Acyclovir and laser Ne-Ne could be an alternative method for the treatment of HSV in the face. The number

  9. Baboon syndrome and toxic erythema of chemotherapy: Fold (intertriginous) dermatoses. (United States)

    Wolf, Ronni; Tüzün, Yalçın


    Three decades ago, researchers described an eruption with a very characteristic distribution pattern that was confined to the buttocks and the intertriginous and flexor areas. They gave this reaction pattern one of the most unforgettable names in dermatology, baboon syndrome (BS), due to the characteristic, bright-red, well-demarcated eruption predominantly on the buttocks and genital area, reminiscent of the red bottom of a baboon. The authors described three cases provoked by ampicillin, nickel, and mercury. They were convinced that BS represented a special form of hematogenous or systemic contact-type dermatitis, but several important papers that appeared during the past decade disagreed and suggested that BS should be distinguished from hematogenous or systemic contact-type dermatitis. A new acronym, SDRIFE (symmetrical drug-related intertriginous and flexoral exanthema), was proposed along with five diagnostic criteria: (1) exposure to a systemically administered drug at the time of first or repeated doses (contact allergens excluded), (2) sharply demarcated erythema of the gluteal/perianal area and/or V-shaped erythema of the inguinal/perigenital area, (3) involvement of at least one other intertriginous/flexural fold, (4) symmetry of affected areas, and (5) absence of systemic symptoms and signs. Although there are merits to the arguments in favor of SDRIFE, many of us still prefer to use the wittier name baboon syndrome, and even more authors use both terms. We confess that we find it difficult to relinquish the term BS, which has served us so well for years; however, recognition, familiarity, and knowledge of the characteristics of this form of drug eruption must supersede sentimental attachment to a certain nomenclature and so, however reluctantly, we must embrace change. Another intertriginous drug eruption is the one induced by chemotherapy. Toxic erythema of chemotherapy (TEC) is a useful clinical term that recently has been introduced to describe this


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    Full Text Available BACKGROUND Hypertensive disorder of pregnancy is the foremost cause of maternal deaths in developed countries and the third most common cause of death in developing countries. Eclampsia alone accounts for 50,000 maternal deaths worldwide, annually. Collaborative trial in 1995 conclusively proved that Magnesium Sulphate is the preferred treatment for eclamptic fits. Commonly used regimens are the IM MgSO4 regimen popularized by Pritchard and, the IV MgSO4 regimen popularized by Zuspan. The present study was done with an aim to compare IM Magnesium Sulphate regimen with IV Magnesium Sulphate regimen with regard to prevention of recurrence of seizure and maternal and fetal outcome. MATERIAL AND METHODS After institutional ethical committee approval and obtaining informed consent from patients, 100 patients presenting with eclamptic fits reporting to our centre were included in the study and were randomly allocated to one of the following groups. Group I. M.: Received a loading dose of 4 gm IV MgSO4 over 5-10 minutes +5 gm MgSO4 deep intramuscular injection in each buttock and a maintenance dose of 5 gm MgSO4 deep intramuscular injection in alternate buttock every 4 hourly. Group I.V.: Received MgSO4 4gm slow IV over 5-10 minutes as loading dose and 1 gm MgSO4 per hour as continuous intravenous maintenance infusion. RESULTS Both the treatment regimens were comparable with regard to recurrence of convulsions. 3 (6% patients in Group IM and 2 (4% patients in Group IV developed convulsions after initiation of treatment, p value 0.646. Incidence of loss of knee jerk was significantly higher in Group IM as compared to group IV; 7 (14% in Group IM versus 1 (2% in Group IV, p value 0.027. Incidence of other parameters of toxicity were comparable between the groups. Maternal and fetal outcome were poor in both the groups but were comparable and no significant differences were observed between the groups. CONCLUSION Both IM and IV regimen are equally

  11. Lipodystrophic syndrome in children and adolescents infected with the human immunodeficiency virus

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    Crésio Alves

    Full Text Available The introduction of highly active antiretroviral therapy (HAART for the treatment of acquired immunodeficiency syndrome (AIDS has resulted in greater survival of patients infected with the human immunodeficiency virus (HIV. However, the use of these drugs has been associated with lipodystrophic syndrome (LS, which is characterized by metabolic alterations (dyslipidemia, insulin resistance, diabetes, and lactic acidosis and abnormal corporal fat distribution. Clinically, LS may manifest as three different forms: lipohipertrophy (accumulation of fat in the central part of the body, lipoatrophy (loss of fat in the extremities, face and buttocks and mixed (lipohipertrophy + lipoatrophy. Although its physiopathology has not been elucidated, some mechanisms have been described, including leptin and adiponectin deficiency, mitochondrial dysfunction and use of antiretroviral drugs. The type, dose and duration of the antiretroviral treatment, as well as age and puberty are the main risk factors. LS is also associated with increased incidence of cardiovascular illnesses, atherosclerosis and diabetes mellitus. Treatment includes physical activity, cautious restriction of caloric intake, changes in antiretroviral therapy, and use of insulin-sensitizing and lipid-lowering agents. Follow up must be periodic, consisting of measurement of body fat distribution, evaluation of the lipid profile and insulin resistance.

  12. Lipodystrophic syndrome in children and adolescents infected with the human immunodeficiency virus. (United States)

    Alves, Crésio; Oliveira, Ana Cláudia; Brites, Carlos


    The introduction of highly active antiretroviral therapy (HAART) for the treatment of acquired immunodeficiency syndrome (AIDS) has resulted in greater survival of patients infected with the human immunodeficiency virus (HIV). However, the use of these drugs has been associated with lipodystrophic syndrome (LS), which is characterized by metabolic alterations (dyslipidemia, insulin resistance, diabetes, and lactic acidosis) and abnormal corporal fat distribution. Clinically, LS may manifest as three different forms: lipohipertrophy (accumulation of fat in the central part of the body), lipoatrophy (loss of fat in the extremities, face and buttocks) and mixed (lipohipertrophy + lipoatrophy). Although its physiopathology has not been elucidated, some mechanisms have been described, including leptin and adiponectin deficiency, mitochondrial dysfunction and use of antiretroviral drugs. The type, dose and duration of the antiretroviral treatment, as well as age and puberty are the main risk factors. LS is also associated with increased incidence of cardiovascular illnesses, atherosclerosis and diabetes mellitus. Treatment includes physical activity, cautious restriction of caloric intake, changes in antiretroviral therapy, and use of insulin-sensitizing and lipid-lowering agents. Follow up must be periodic, consisting of measurement of body fat distribution, evaluation of the lipid profile and insulin resistance.

  13. Calfiness

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    Jan Gondowicz


    Full Text Available In Ferdydurke Witold Gombrowicz presented the secret of interpersonal relations by using anatomical metaphors. In this ironic lecture a calf plays as important role as buttocks (stuck to the face – it is a symbol of seductive youth and, to a considerable degree, of an unaware, but intuitive infantility. This topic is covered in the novel as part of an episode about a fascinating teenage girl Zuta, who is one of most demonic characters in the 20th-century prose. This paper draws attention to the ambiguity of the self-emancipating strategy that Gombrowicz’s hero uses when he discovers this notion and in order to fight against it. A calf, which represents the temptation of modern, sterile and totalitarian sex appeal, refers – as a spiritual, form-shaping power – to the lack of self-confidence that contemporary people conceal, also from themselves. And that is the hidden origin – as Gombrowicz implies – of mass culture’s erotic blackmail.

  14. Female waist-to-hip ratio, body mass index and sexual attractiveness in China

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    B.J. DIXSON, Baoguo LI, A.F. DIXSON


    Full Text Available Men and women at Northwest University (n = 751, Xi’an, China were asked to judge the attractiveness of photographs of female patients who had undergone micrograft surgery to reduce their waist-to-hip ratios (WHR. Micrograft surgery involves harvesting adipose tissue from the waist and reshaping the buttocks to produce a low WHR and an ‘hourglass’ female figure. This gynoid distribution of female body fat has been shown to correlate with measures of fertility and health. Significantly larger numbers of subjects, of both sexes, chose post-operative photographs, with lower WHRs, as more attractive than pre-operative photographs of the same women. Some patients had gained, and some had lost weight, post-operatively, with resultant changes in body mass index (BMI. However, these changes in BMI were not related to judgments of attractiveness. These results show that the hourglass female figure is rated as attractive in China, and that WHR, rather than BMI, plays a crucial role in such attractiveness judgments [Current Zoology 56 (2: 175–181, 2010].

  15. Pseudoaneurysm Accompanied by Crowe Type IV Developmental Dysplasia of the Hip: A Case Report

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    Hirotake Yo


    Full Text Available We report the case of a 72-year-old woman whose pseudoaneurysm was difficult to diagnose and treat. The patient had a history of congenital dislocated hip and was undergoing anticoagulation therapy with warfarin due to the mitral valve replacement. Her chief complaint was pain and enlargement of the left buttock, and the laboratory tests revealed severe anemia. However, her elderly depression confused her chief complaint, and she was transferred to a psychiatric hospital. Two months after the onset of the symptoms, she was finally diagnosed with a pseudoaneurysm by contrast-enhanced CT and angiography. IDC coils were used for embolization. A plain CT showed hemostasis as well as a reduced hematoma at 2 months after the embolization. The possible contributing factors for the pseudoaneurysm included bleeding due to warfarin combined with an intramuscular hematoma accompanied by Crowe type IV developmental dysplasia of the hip that led to an arterial rupture by impingement between pelvis and femoral head. Since the warfarin treatment could not be halted due to the valve replacement, embolization was chosen for her treatment, and the treatment outcome was favorable.

  16. Bullous impetigo and pregnancy: Case report and review of blistering conditions in pregnancy. (United States)

    Cohen, Philip R


     Bullous impetigo results from Staphylococcus aureus (S. aureus) release of exfoliative toxins type A and type B thatresults in flaccid, easily ruptured, bullae in the upper layers of the epidermis.  Physiologic, gestation-associated, and incidental skin changes can occur in pregnancy.  Blisters in pregnant women can occur secondary to either common skin disorders orspecific dermatoses of pregnancy.  To describe a pregnant woman with bullous impetigo and review bullous conditions in pregnant women.  PubMed was used to search the following terms, separately and in combination:  blister, blistering, bullous, gestationis, herpes, herpetiformis, impetigo, pemphigoid, pregnancy, pregnant, psoriasis, pustular, virus. All papers were reviewed and relevant manuscripts, along with their reference citations, were evaluated.  Flaccid, easily rupturing, pustules, which developed into superficial annular erosions with peripheral scale and central healing appeared in a woman of 7-weeks gestation and allergy to penicillin on her lower abdomen, suprapubic region, perineum, buttocks, and proximal legs.  A bacterial culture subsequently isolated methicillin-susceptible S. aureus.  All of the lesions resolved after treatment with clindamycin.  Bullous impetigo should be considered in the differential diagnosis of common skin diseases presenting as blistersin pregnant women.

  17. Staphylococcal scalded skin syndrome in a premature newborn caused by methicillin-resistant Staphylococcus aureus: case report

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    Andreas Hörner

    Full Text Available CONTEXT: Staphylococcal scalded skin syndrome is an exfoliative skin disease. Reports of this syndrome in newborns caused by methicillin-resistant Staphylococcus aureus are rare but, when present, rapid diagnosis and treatment is required in order to decrease morbidity and mortality. CASE REPORT: A premature newly born girl weighing 1,520 g, born with a gestational age of 29 weeks and 4 days, developed staphylococcal scalded skin syndrome on the fifth day of life. Cultures on blood samples collected on the first and fourth days were negative, but Pseudomonas aeruginosa and Enterococcus sp. (vancomycin-sensitive developed in blood cultures performed on the day of death (seventh day, and Pseudomonas aeruginosa and Serratia marcescens were identified in cultures on nasopharyngeal, buttock and abdominal secretions. In addition to these two Gram-negative bacilli, methicillin-resistant Staphylococcus aureus was isolated in a culture on the umbilical stump (seventh day. The diagnosis of staphylococcal scalded skin syndrome was based on clinical criteria.

  18. CT-guided injection of botulinic toxin for percutaneous therapy of piriformis muscle syndrome with preliminary MRI results about denervative process

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    Fanucci, E.; Masala, S.; Sodani, G.; Varrucciu, V.; Romagnoli, A.; Squillaci, E.; Simonetti, G. [Dept. of Radiology, Univ. of Rome (Italy)


    Piriformis muscle syndrome (PMS) is a cause of sciatica, leg or buttock pain and disability. The pain is usually increased by muscular contraction, palpation or prolonged sitting. The aim of our paper was to evaluate the feasibility of CT-guided percutaneous botulinic toxin (BTX) injection for the purpose of PMS treatment. Thirty patients suffering from PMS, suspected with clinical and electrophysiological criteria, after imaging examinations excluding other causes of sciatic pain, resulted positive at the lidocaine test and were treated by intramuscular injection of BTX type A under CT guidance. The follow-up (12 months) was performed with clinical examination in all cases and with MR 3 months after the procedure in 9 patients to evaluate the denervative process entity of the treated muscle. In 26 cases relief of symptoms was obtained after 5-7 days. In 4 patients an insufficient relief of pain justified a second percutaneous treatment which was clinically successful. No complications or side effects were recorded after BTX injection. The MR examination showed a signal intensity change of the treated muscle in 7 patients due to the denervative process of PM, whereas in the remaining 2 cases only an atrophy of the treated muscle was detected. Larger series are necessary to confirm these MRI preliminary results. The CT-guided BTX injection in the PMS is an emergent and feasible technique that obtains an excellent local therapeutic effect without risk of imprecise inoculation. (orig.)

  19. Sciatica and claudication caused by ganglion cyst. (United States)

    Yang, Guang; Wen, Xiaoyu; Gong, Yubao; Yang, Chen


    Case report. We report a rare case that a ganglion cyst compressed the sciatic nerve and caused sciatica and claudication in a 51-year-old male. Sciatica and claudication commonly occurs in spinal stenosis. To our knowledge, only 4 cases have been reported on sciatica resulting from posterior ganglion cyst of hip. A 51-year-old male had a 2-month history of radiating pain on his right leg. He could only walk 20 to 30 m before stopping and standing to rest for 1 to 3 minutes. Interestingly, he was able to walk longer distances (about 200 m) when walking slowly in small steps, without any rest. He had been treated as a case of lumbar disc herniation, but conservative treatment was ineffective. On buttock examination, a round, hard, and fixative mass was palpated at the exit of the sciatic nerve. MR imaging of hip revealed a multilocular cystic mass located on the posterior aspect of the superior gemellus and obturator internus, compressing the sciatic nerve. On operation, we found that the cyst extended to the superior gemellus and the obturator internus, positioned right at the outlet of the sciatic nerve. At 18 months of follow-up, the patient continued to be symptom free. He returned to comprehensive physical activity with no limitations. For an extraspinal source, a direct compression on the sciatic nerve also resulted in sciatica and claudication. A meticulous physical examination is very important for the differential diagnosis of extraspinal sciatica from spinal sciatica.

  20. Comparing cost per use of 3M Cavilon No Sting Barrier Film with zinc oxide oil in incontinent patients. (United States)

    Baatenburg de Jong, H; Admiraal, H


    This study compares the total cost of treatment, skin-condition management and prevention of skin breakdown of perianal/buttock skin in incontinent patients receiving 3M Cavilon No Sting Barrier Film (Cavilon NSBF) and zinc oxide oil. This single-centre open-label prospective randomised study involved 40 patients with at least moderate skin damage resulting from incontinence. Patients were randomised to receive either zinc oxide oil or Cavilon NSBF and were treated for 14 days. The study products and other treatment-related products used were recorded, as was the time needed to cleanse the application site and apply the product. Use of both products resulted in an improvement in skin condition after 14 days, but this was significantly better with Cavilon NSBF than zinc oxide oil. Cavilon NSBF was more cost-effective as fewer applications were required, less time was spent applying the skin barrier product and faster healing rates were achieved. The cost-effectiveness ratio per treatment group showed an improvement of one point in the total score of the skin-assessment scale costs: 28.36 Euro for Cavilon NSBF versus 98.06 Euro for zinc oxide oil. Both products resulted in an improvement in skin condition after 14 days, but Cavilon NSBF was found to be more cost-effective. This study was supported by an educational grant from 3M.

  1. Aplasia cutis congenita: report of 22 cases. (United States)

    Mesrati, Hela; Amouri, Meriem; Chaaben, Hend; Masmoudi, Abdelrahmen; Boudaya, Sonia; Turki, Hamida


    Aplasia cutis congenita (ACC) is a rare malformation characterized by absent or scarred areas of skin at birth. Although most commonly found on the scalp, ACC can also involve other locations. Its etiology and pathogenesis remain unclear. To describe the epidemiologic, clinical, therapeutic, and evolutionary aspects of ACC through a hospital series. We conducted a retrospective study from 1995 to 2012 and reported all cases of ACC. We enrolled 22 cases (14 girls and eight boys) of ACC during 18 years. The mean age at diagnosis was 5.7 years. Sixteen ACC involved the scalp, five the trunk, and one the left buttock. ACC was oval-shaped in 20 cases, triangular in one case, and linear in one case. The mean size was 4 cm. ACC was associated with bone defects in two cases, various malformations in eight (37.1%), and with syndromic malformation in three (Adams-Olivier syndrome: two cases; Goltz syndrome: one case). Conservative treatment consisting of wound dressing with vaseline was indicated in six cases. Bone reconstruction was performed in two cases. Regular follow-up and no treatment was recommended in 14 cases. Our study emphasizes the frequent association of ACC with malformations (37.1%) and bone defects (9%). © 2015 The International Society of Dermatology.

  2. Ultrasound-Guided Injection of Botulinum Toxin Type A for Piriformis Muscle Syndrome: A Case Report and Review of the Literature

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    Andrea Santamato


    Full Text Available Piriformis muscle syndrome (PMS is caused by prolonged or excessive contraction of the piriformis muscle associated with pain in the buttocks, hips, and lower limbs because of the close proximity to the sciatic nerve. Botulinum toxin type A (BoNT-A reduces muscle hypertonia as well as muscle contracture and pain inhibiting substance P release and other inflammatory factors. BoNT-A injection technique is important considering the difficult access of the needle for deep location, the small size of the muscle, and the proximity to neurovascular structures. Ultrasound guidance is easy to use and painless and several studies describe its use during BoNT-A administration in PMS. In the present review article, we briefly updated current knowledge regarding the BoNT therapy of PMS, describing also a case report in which this syndrome was treated with an ultrasound-guided injection of incobotulinumtoxin A. Pain reduction with an increase of hip articular range of motion in this patient with PMS confirmed the effectiveness of BoNT-A injection for the management of this syndrome.

  3. Colgajo póstero-medial de muslo (adductor: a propósito de un caso Postero-medial thigh flap (adductor flap: case report

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    L. Gómez-Escolar Larrañaga


    Full Text Available En pacientes con úlceras masivas o confluentes en la región glútea, puede ser necesaria la amputación de la extremidad inferior y la reconstrucción mediante colgajos totales de muslo para la cobertura del defecto. Esta técnica es muy agresiva y además de las evidentes secuelas físicas que crea puede generar importantes trastornos psíquicos para el paciente. Presentamos el caso de una paciente con una gran úlcera por decúbito en la región isquio-trocantéreosacra en la que se empleó el colgajo Adductor como alternativa a la amputación de la extremidad inferior.Amputation of the lower extremity and total thigh flaps may be necessary for coverage in patients with massive multiple or confluent sores in the buttock region. This is an aggressive technique with important physical and psychological consequences for the patient. The Adductor flap was used as an alternative of the amputation in a patient with a big ischial-trocantericsacral pressure sore.

  4. Epidemiology and screening of intentional burns in children in a Dutch burn centre. (United States)

    Bousema, Sara; Stas, Helene G; van de Merwe, Marjolijn H; Oen, Irma M M H; Baartmans, Martin G A; van Baar, Margriet E


    International estimates of the incidence of non-accidental burns (NAB) in children admitted to burn centres vary from 1% to 25%. Hardly any data about Dutch figures exist. The aim of this study was to evaluate the incidence, treatment and outcome of burns due to suspected child abuse in paediatric burns. We described the process of care and outcome, including the accuracy of the SPUTOVAMO screening tool and examined child, burn and treatment characteristics related to suspicions of child abuse or neglect. A retrospective study was conducted in children aged 0-17 years with a primary admission after burn injuries to the burn centre Rotterdam in the period 2009-2013. Data on patient, injury and treatment characteristics were collected, using the Dutch Burn Repository R3. In addition, medical records were reviewed. In 498 paediatric admissions, suspected child abuse or neglect was present in 43 children (9%). 442 screening questionnaires (89%) were completed. In 52 out of 442 questionnaires (12%) the completed SPUTOVAMO had one or more positive signs. Significant independent predictors for suspected child abuse were burns in the genital area or buttocks (OR=3.29; CI: 143-7.55) and a low socio-economic status (OR=2.52; 95%CI: 1.30-4.90). The incidence of suspected child abuse indicating generation of additional support in our population is comparable to studies with a similar design in other countries. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  5. Flow visualisation of downhill skiers using the lattice Boltzmann method (United States)

    Asai, Takeshi; Hong, Sungchan; Ijuin, Koichi


    In downhill alpine skiing, skiers often exceed speeds of 120 km h-1, with air resistance substantially affecting the overall race times. To date, studies on air resistance in alpine skiing have used wind tunnels and actual skiers to examine the relationship between the gliding posture and magnitude of drag and for the design of skiing equipment. However, these studies have not revealed the flow velocity distribution and vortex structure around the skier. In the present study, computational fluid dynamics are employed with the lattice Boltzmann method to derive the relationship between total drag and the flow velocity around a downhill skier in the full-tuck position. Furthermore, the flow around the downhill skier is visualised, and its vortex structure is examined. The results show that the total drag force in the downhill skier model is 27.0 N at a flow velocity of 15 m s-1, increasing to 185.8 N at 40 m s-1. From analysis of the drag distribution and the flow profile, the head, upper arms, lower legs, and thighs (including buttocks) are identified as the major sources of drag on a downhill skier. Based on these results, the design of suits and equipment for reducing the drag from each location should be the focus of research and development in ski equipment. This paper describes a pilot study that introduces undergraduate students of physics or engineering into this research field. The results of this study are easy to understand for undergraduate students.

  6. Student's Body Dimensions in Relation to Classroom Furniture

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    Samira Baharampour


    Full Text Available Background: This study was carried out to investigate the fit between university student's anthropometry and classroom furniture dimensions. Method: In this cross-sectional and descriptive-analyzing study conducted in 2012, a total of 194 students (aged 18 through 30 years, were recruited randomly from Tabriz University of Medical Science community. The body size of each student was assessed using anthropometric measurements including shoulder height, elbow height, popliteal height, buttock-popliteal length, hip breadth and distance between elbows. Combinational equations defined the acceptable furniture dimensions according to anthropometry and match percentages were computed, according to either the existing situations assuming that they could use the most appropriate of the sizes available. Results: Desk and seat height were higher than the accepted limits for most students (92.5% and 98.4%, respectively, while seat depth was appropriate for only 84.6% of students. The data indicate a mismatch between the students’ bodily dimensions and the classroom furniture available to them. The chairs are too high and too deep and desks are also too high for the pupils. This situation may have negative effects on the sitting posture of the students especially when reading and writing. Conclusion: High mismatch percentages were found between furniture and students' anthropometry. The results confirm that furniture for university students should be selected and designed busied on their anthropometric dimensions.

  7. Serous degeneration of bone marrow mimics spinal tumor. (United States)

    Sung, Chih-Wei; Hsieh, Kevin Li-Chun; Lin, Yun-Ho; Lin, Chun-Yi; Lee, Chian-Her; Tsuang, Yang-Hwei; Kuo, Yi-Jie


    To present a rare case of serous degeneration of bone marrow which resembles primary spinal tumor or bony metastasis to spine. Serous degeneration of bone marrow or gelatinous marrow transformation is a rare disease characterized by focal marrow hypoplasia, fat atrophy, and accumulation of extracellular mucopolysaccharides abundant in hyaluronic acid. Few literature was reviewed and few clinical case was presented. Two cases of serous marrow transformation were reported. In the first case, a 29-year-old man suffered from severe left buttock pain. Bone metastasis was impressed in radiology examinations. Percutaneous endoscopic lumbar discectomy was performed along with bone biopsy. In the second case, a 49-year-old man presented lower back pain with radiation to bilateral lower legs. Magnetic resonance imaging revealed a water-like signal lesion in sacrum. Serous marrow transformation was confirmed pathologically in both cases. To the best of our knowledge, a case of serous degeneration of bone marrow resembling malignancy has not been reported in the literature. In this report, two cases demonstrate serous transformation of bone marrow mimics spinal tumor.

  8. [Insufficiency fracture of the sacrum after hormonal therapy and radiotherapy for prostate cancer: A case in which 99mTc-MDP bone scintigraphy was useful for differential diagnosis]. (United States)

    Yokokawa, Tokuzou; Shirai, Tatsuo; Ogata, Hitoshi; Furui, Shigeru


    A case in which radiotherapy was requested for bone metastases from prostate carcinoma after hormonal and radiation therapy and diagnosed as insufficiency fracture of the sacrum on bone scan was reported. A 78-year-old man underwent endocrine therapy with luteinizing hormone releasing hormone agonists and radical radiotherapy toward pelvis for prostate cancer. The onset of buttock pain started from the nine-month after the beginning of radiotherapy, and was diagnosed as sacrum metastasis by MRI, and radiotherapy was requested again for pain control. However, on bone scan, butterfly-like changed accumulation was noted, therefore sacrum insufficiency fracture was suspected. Addition of CT inspection and reconfirmation of MRI were performed, and bone metastases became negative, and serial observation was performed of the painkilling effect after that. No tumor marker rise was seen after five months without sigh of new bone metastases and the final diagnosis became insufficient fracture. In order to avoid unnecessary treatment, we think that the view of bone scintigram for diagnosis of sacrum insufficient fracture should be known.

  9. Bacteremic skin and soft tissue infection caused by Prevotella loescheii. (United States)

    Mehmood, Mansoor; Jaffar, Nabil A; Nazim, Muhammad; Khasawneh, Faisal A


    Anaerobes are a major component of gut flora. They play an important role in the pathogenesis of infections resulting from breaches in mucus membranes. Because of the difficulties in cultivating and identifying it, their role continues to be undermined. The purpose of this paper is to report a case of Prevotella loescheii bacteremic skin and soft tissue infection and review the literature. A 42-year-old Caucasian man was admitted for an elective bariatric surgery. A lengthy intensive care unit stay and buttocks decubitus ulcers complicated his post-operative course. After being transferred to a long-term care facility, the decubitus ulcer became secondarily infected with multiple bacteria including P. loescheii; an anaerobe that grew in blood and wound cultures. The patient was treated successfully with aggressive surgical debridement, antibiotics and subsequent wound care. P. loescheii colonizes the gut and plays an important role in periodontal infections. In rare occasions and under suitable circumstances, it can infect skin and soft tissues as well as joints. Given the difficulties in isolating anaerobes in the microbiology lab, considering this bacterium alongside other anaerobes in infections of devitalized tissue is indicated even if cultures were reported negative.

  10. Evaluation of the seating of Qantas flight deck crew. (United States)

    Lusted, M; Healey, S; Mandryk, J A


    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.

  11. Dermoscopy of shagreen patch: A first report

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    Shivanand Gundalli


    Full Text Available The name is derived from French phrase peau chagrinee which is usually found on lower back, buttock and thigh. The major manifestations of Tuberous sclerosis include skin lesions in more than 95%, mental retardation in approximately 50%, autism, seizures in approximately 85%. The incidence at birth is estimated to be 1 in 5800. We report case of shagreen patch in a 27 year female which is present since birth. However there is no history of seizures or consanginous marriage in our case. Associated features are naevus comedonicus and naevus collagenosis, facial angiofibroma. Shagreen patch are present in mandibular area of face. Although, diagnosis is easy, it can be mistaken for inflammatory verrucous epidermal nevus, plaques of other inflammatory skin conditions. Diagnosis is usually on clinical background. Sometimes biopsy is necessary to confirm the diagnosis. Dermoscopy, a non-invasive, in vivo technique for the microscopic examination of pigmented skin lesions, has the potential to improve the diagnostic accuracy. Dermoscopy of Shagreen patch showed reddish-brown strands with white dots giving a cobblestone appearance It can be utilized as a diagnostic aide in the diagnosis of Shagreen patch. Authors evaluated the dermoscopic patterns of Shagreen patch and hence, it is useful in diagnosis.

  12. Liquid silicone used for esthetic purposes as a potentiator for occurrence of post-radiotherapy genital lymphedema: case report

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    Raíssa Quaiatti Antonelli

    Full Text Available ABSTRACT CONTEXT: Lymphedema consists of extracellular fluid retention caused by lymphatic obstruction. In chronic forms, fat and fibrous tissue accumulation is observed. Genital lymphedema is a rare condition in developed countries and may have primary or acquired etiology. It generally leads to urinary, sexual and social impairment. Clinical treatment usually has low effectiveness, and surgical resection is frequently indicated. CASE REPORT: We report a case of a male-to-female transgender patient who was referred for treatment of chronic genital lymphedema. She had a history of pelvic radiotherapy to treat anal cancer and of liquid silicone injections to the buttock and thigh regions for esthetic purposes. Radiological examinations showed signs both of tissue infiltration by liquid silicone and of granulomas, lymphadenopathy and lymphedema. Surgical treatment was performed on the area affected, in which lymphedematous tissue was excised from the scrotum while preserving the penis and testicles, with satisfactory results. Histopathological examination showed alterations compatible with tissue infiltration by exogenous material, along with chronic lymphedema. CONCLUSION: Genital lymphedema may be caused by an association of lesions due to liquid silicone injections and radiotherapy in the pelvic region. Cancer treatment decisions for patients who previously underwent liquid silicone injection should take this information into account, since it may represent a risk factor for radiotherapy complications.

  13. [Questions by adolescents about dieting]. (United States)

    Bloch, A


    In recent years there has been increasing concern and involvement of Israeli adolescents with dieting. An increase in the incidence of obesity has been emphasized by the mass media. This has been marked by an increase in the number of questions on dieting sent anonymously by 12 to 14 year-olds to a column in a popular youth magazine about adolescent sexuality. These letters include requests for diets to prevent obesity in general and fatness of certain parts of the body in particular, such as the thighs or buttocks; questions as to side-effects of diets already started, particularly amenorrhea; and questions about the onset of bulimia and anorexia nervosa, expressing fear of the consequences. This study gives examples of the questions and the answers, and indicates the professions of those to whom the applicants were referred for further diagnosis and treatment. Newer techniques of health education with regard to adolescent dieting are urgently needed so that the health staff can promote insight and indicate the need for treatment at as early a stage as possible. The use of mass media in a suitable manner is critical, given the increase in diet-advertising.

  14. Postpartum Vaginal Blood Loss following Two Different Methods of Cervical Ripening

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    Okon Asuquo Okon


    Full Text Available Eighty women undergoing induction of labor at the University of Calabar Teaching Hospital were recruited and randomly allocated into two treatment groups (40 each, to receive either serial 50 µg doses of misoprostol or intracervical Foley catheter. Vaginal blood loss was collected and measured using an under buttocks plastic collection bag and by perineal pad weighing up to 6 hours postpartum. There were no significant differences between the two groups with respect to sociodemographic and obstetric characteristics. Comparison of blood loss in vaginal deliveries between the two groups revealed that subjects in the misoprostol group had significantly higher blood loss than subjects in the Foley catheter group (488 ± 222 versus 326 ± 106, p<0.05. In both groups, there was strong and statistically significant positive correlation between postpartum blood loss and induction delivery interval (r=0.75, p<0.0001; r=0.77, p<0.0001. There were no significant differences in maternal outcomes. In view of this, further study is required to ascertain if lower doses of misoprostol for induction of labor may result in lesser blood loss. This trial is registered with ISRCTN14479515.

  15. Estimating body fat in African American and white adolescent girls: a comparison of skinfold-thickness equations with a 4-compartment criterion model. (United States)

    Wong, W W; Stuff, J E; Butte, N F; Smith, E O; Ellis, K J


    Although skinfold-thickness equations are widely used to estimate body fat, their accuracy in a biracial population of female adolescents has not been established. We undertook this study to determine the agreement between 8 widely used skinfold-thickness equations and a 4-compartment criterion model in predicting the percentage body fat of 72 white and 40 African American girls aged 13.0 +/- 1.9 y. The biceps, triceps, suprailiac, subscapular, thigh, calf, and abdominal skinfold thicknesses of the subjects were measured with skinfold calipers and the buttocks circumference with a metal tape. The percentage fat mass (%FM) predicted by using each skinfold-thickness equation was compared with the criterion value calculated by the 4-compartment model on the basis of measurements of body density, body water, and bone mineral content. When the racial groups were analyzed separately, the Bland-Altman analysis indicated that the quadratic equations agreed most closely with the 4-compartment model's measurement of %FM. Agreement of the other equations varied with body fatness. The quadratic equation of Slaughter et al is recommended for population studies in female adolescents because of its accuracy and simplicity. However, an individual %FM can be over- or underestimated by approximately 10% when this skinfold-thickness equation is used.

  16. Ovarian metastasis of malignant melanoma: The first pediatric case

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    Yuko Araki


    Full Text Available We report a case of an 8-year-old girl with metastasis of malignant melanoma (MM to the ovary. She was initially diagnosed with cutaneous MM on the left buttock for which she underwent wide local excision, left inguinal/pelvic lymph node dissection, and subcutaneous injection of interferon beta. In spite of the treatment, she developed dissemination of MM to the liver, the bone, and the right ovary. All the lesions responded well to systemic chemotherapy (intravenous dacarbazine, except for the right ovarian tumor. She underwent an elective right salpingo-oophorectomy to avoid torsion or rupture of the tumor. However, she developed metastases to the contralateral ovary with peritoneal dissemination in 4 months. She received home palliative care and died at home 14 months after the last surgery. Ovarian metastasis of MM is a rare form of dissemination, and only 15 adult cases have ever been reported. Our patient is the first pediatric case. Since there is no standard of surgical indication for metastatic MM to the ovary, palliative resection can be an option for improving quality of life of a patient with this rare condition.

  17. "A shine on the nose": sexual metaphors in surrealism. (United States)

    Taylor, Sue


    This essay explores a curious phenomenon in the work of several European surrealist artists, notably Hans Bellmer and René Magritte, from the late 1920s through the 1950s: In images of the body, a penis may appear in place of a nose; breasts, testicles, or buttocks stand in for the eyes of a face, a vaginal opening for the nostrils, an anus for the mouth. Alternatively, disembodied arms and legs or an elongated neck take on a phallic character, or the entire body becomes an erect penis. Aside from the shock value of these disconcerting substitutions, for which the Surrealists surely strove, what are we to make of them? Psychoanalytic accounts of fetishism point to castration anxiety as one explanatory factor in the creation of such metaphors-Freud's paradigmatic fetishist cathected a "shine on the nose" in place of the missing phallus, as described in the analyst's now-classic essay of 1927. Moreover, the aggression underlying an artist's disfiguring a face by adding genitalia is discussed in light of a general theory of caricature formulated by another contemporary of the Surrealists, Ernst Kris ("The Psychology of Caricature," 1936.) In light of a postwar social reality that included wounded bodies and widespread devastation, Surrealism can be said to reflect the experience of actual disfigurement and death. Additionally, however, biographical information on individual artists suggest possible intrapsychic sources for the hostility behind these sexualized representations.

  18. The time of onset and duration of 5-methoxypsoralen photochemoprotection from UVR-induced DNA damage in human skin

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    Chadwick, C.A.; Potten, C.S. (Christie Hospital (NHS) Trust, Manchester (United Kingdom). Paterson Inst. for Cancer Research); Cohen, A.J. (Toxicology Advisory Services, Sutton (United Kingdom)); Young, A.R. (St. Thomas' Hospital, London (United Kingdom). St. John' s Inst. of Dermatology)


    Sites of previously unexposed buttock skin of eight human volunteers (skin type II) were treated daily for 3, 5, 8, or 10 days with suberythemogenic doses of solar-simulated radiation (SSR) in the presence of a UVB sunscreen containing 5-methoxypsoralen (5-MOP) at 30 p.p.m., or daily for 10 days with SSR + the same sunscreen without 5-MOP. One week after cessation of treatment, these sites, together with a control unexposed site, were challenged with 2 minimal erythema doses (2 MED) of SSR. Biopsy samples were taken within 15 min of the challenge dose, and were incubated for 1 h in tritiated thymidine. UV-induced DNA damage was measured indirectly by unscheduled DNA synthesis (UDS), and directly using a monoclonal antibody to thymine dimers, and automated image analysis. The level of pigmentation was assessed in sections in a semiquantitative fashion with Masson-Fontana staining, and the number of layers in the stratum corneum was used to assess changes in epidermal thickness. Using the UDS and dimer measurements, the level of photochemoprotection afforded by 5-MOP was determined from the reduction in the level of DNA damage observed. The photochemoprotection was expressed as a ratio of the 5-MOP-treated sites compared with the sites that did not receive 5-MOP treatment. (Author).

  19. School furniture match to students' anthropometry in the Gaza Strip. (United States)

    Agha, Salah R


    This study aimed at comparing primary school students' anthropometry to the dimensions of school furniture and determining whether the furniture used matches the students' anthropometry. A sample of 600 male students, whose ages were between 6 and 11 years, from five primary schools in the Gaza Strip governorates participated in the study. Several students' body dimensions were measured. The dimensions measured included elbow-seat height, shoulder height, knee height, popliteal height and buttock-popliteal length. Measurements of the dimensions of the classroom furniture indicated that there was a considerable mismatch between the students' body dimensions and the classroom furniture. The mismatches in seat height, seat depth and desk height occurred for 99% of the students, while the mismatch for the back rest height was only 35%. Two design specifications were proposed in order to decrease the mismatch percentage based on the data obtained. The two proposed designs showed a considerable improvement in the match percentages as compared to the existing design. STATEMENT OF RELEVANCE: Having identified mismatches between the dimensions of the school furniture used in primary schools in the Gaza Strip, two new design specifications are proposed and shown to improve match with the students' anthropometric dimensions. The findings of the study are also an important addition to local knowledge on school children's anthropometry.

  20. Acute compartment syndrome. (United States)

    Via, Alessio Giai; Oliva, Francesco; Spoliti, Marco; Maffulli, Nicola


    acute compartment syndrome (ACS) is one of the few true emergencies in orthopedics and traumatology. It is a painful condition caused by the increase interstitial pressure (intracompart-mental pressure - ICP) within a closed osteofascial compartment which impair local circulation. It occurs most often in the legs, but it can affects also the arms, hands, feet, and buttocks. It usually develops after a severe injury such as fractures or crush injury, but it can also occurs after a relatively minor injury and it may be iatrogenic. Uncommon causes of ACS have been also described, that suggest surgeons to pay great attention to this serious complication. Diagnosing ACS is difficult in clinical practice, even among expert surgeons. Currently, the diagnosis is made on the basis of physical examination and repeated ICP measures. ICP higher than 30 mmHg of diastolic blood pressure is significant of compartment syndrome. Once diagnosis is made, fasciotomy to release the affected compartment should be performed as early as possible because delayed decompression would lead to irreversible ischemic damage to muscles and peripheral nerves. acute compartment syndrome is a surgical emergency. There is still little consensus among authors about diagnosis and treatment of these serious condition, in particular about the ICP at which fasciotomy is absolutely indicated and the timing of wound closure. New investigations are needed in order to improve diagnosis and treatment of ACS.

  1. MRI-guided cryoablation of the posterior femoral cutaneous nerve for the treatment of neuropathy-mediated sitting pain

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    Joshi, Dharmdev H.; Thawait, Gaurav K.; Fritz, Jan [Johns Hopkins University School of Medicine, Section of Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Del Grande, Filippo [Johns Hopkins University School of Medicine, Section of Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Ospedale Regionale di Lugano, Servizio di Radiologia, Lugano, Ticino (Switzerland)


    Neuropathy of the posterior femoral cutaneous nerve may manifest as pain and paresthesia in the skin over the inferior buttocks, posterior thigh, and popliteal region. Current treatment options include physical and oral pain therapy, perineural injections, and surgical neurectomy. Perineural steroid injections may provide short-term pain relief; however, to our knowledge, there is currently no minimally invasive denervation procedure for sustained pain relief that could serve as an alternative to surgical neurectomy. Percutaneous cryoablation of nerves is a minimally invasive technique that induces a sustained nerve conduction block through temporary freezing of the neural layers. It can result in long-lasting pain relief, but has not been described for the treatment of neuropathy-mediated PFCN pain. We report a technique of MR-guided cryoablation of the posterior femoral cutaneous nerve resulting in successful treatment of PFCN-mediated sitting pain. Cryoablation of the posterior femoral cutaneous nerve seems a promising, minimally invasive treatment option that deserves further investigation. (orig.)

  2. Trunnion Corrosion and Early Failure in Monolithic Metal-on-Polyethylene TMZF Femoral Components: A Case Series

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    Peter Walker


    Full Text Available We describe four patients who were treated with primary total hip arthroplasty (THA at two tertiary academic Australian teaching hospitals that experienced premature failure of head-neck trunnions through dissociation of the head-neck taper junction. This retrospective case series have similar clinical presentations and macroscopic pathology with severe head-neck taper junction loss of material, corrosion and early catastrophic failure. It is proposed that the accelerated wear is related to use of varus offset neck in a proprietary beta titanium alloy (Ti-12Mo-6Zr-2Fe  or TMZFÒ Stryker Osteonics, Mahwah NJ, USA TMZF femoral stem, longer head-neck combination in a relatively active, older, male patient population. In this limited case series presentation was on average 80 months (range 53-92 following index procedure. In three of the four patients, a prodromal period of groin or buttock pain was reported for between 1 week and 2 months prior to acute presentation. Significant metallosis and local tissue damage including gluteal muscle insufficiency was evident. Each stem revised was well fixed. An extended trochanteric osteotomy was required in two of the four cases for stem extraction. We recommend caution and further evaluation on the relationship between TMZF metal alloy and its longevity in higher demand patients with high neck offset, varus stem geometry and large CoCr bearing heads.

  3. Mycetoma in children in Sudan. (United States)

    Fahal, A H; Sabaa, A H Abu


    We report on 722 children with confirmed mycetoma seen at the Mycetoma Research Centre, Khartoum, Sudan during May 1991 to March 2009. There were 531 males (73.5%) and 191 females (26.5%) with an age range of 4-17 years (mean 13.7+/-2.9 years); most were students. The majority of patients were from Central and Western Sudan. The disease duration ranged between 6 months and 14 years (mean 2.27+/-2.12 years). Most of the patients had eumycetoma (79.1%). The clinical course was typical in the majority of the patients. Family history of mycetoma was reported in 15% of patients. The foot was affected most, followed by knee, hand, head and neck, chest wall and buttocks. In the foot, the metatarsal bones and calcaneum were affected most. Cytological and ultrasonic examinations of the lesions and histological examination of the surgical biopsies were the cornerstone in the diagnosis of mycetoma. Combined medical treatment and surgical excision was the standard treatment. Disease recurrence after surgical excision was reported in 17.9% of patients. The morbidity rate in this study was high, and it had led to high school dropout and many socioeconomic impacts on patients, families and community. Children with mycetoma need psychological support to identify and to treat their psychosocial problems. Copyright 2009 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

  4. Infiltrative intramuscular myxoma of the cervical spine: a case report. (United States)

    Manoharan, Sakthivel Rajan Rajaram; Shaw, Andrew B; Arnold, Christina A; Farhadi, H Francis


    Myxomas are benign tumors of mesenchymal cell origin that usually present as solitary lesions. They are infrequently associated with fibrous dysplasia, as in McCune-Albright or Mazabraud syndrome. Myxomas can develop in a variety of locations, although the most frequent sites are the thigh, buttocks, shoulder, and upper arm. Intramuscular myxomas (IMs) refer to lesions that occur within muscle compartments. They have been infrequently reported in the neck musculature. To date, only five cases have been reported within the posterior neck muscles without associated intraspinal extension. To our knowledge, this is the first case of an IM presenting with extension into the spinal canal. We report a case of posterior cervical IM with intraspinal extension presenting in a 63-year-old woman as a palpable mass. Complete intralesional resection of the tumor was achieved by standard midline posterior approach. Meticulous resection of the entire capsule was achieved and all margins were confirmed to be free of neoplasm. A diagnosis of myxoma was provided on pathologic evaluation. Follow-up at 1.5 years confirmed maintained complete resolution of the preoperative symptoms, with no evidence of local recurrence on imaging. Intramuscular myxomas should be included in the differential diagnosis of cervical paraspinal tumors. Furthermore, we suggest that masses involving the axial muscles should be closely monitored and the patient counseled regarding potential neurologic sequelae. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Movement strategies during car transfers in individuals with tetraplegia: a preliminary study. (United States)

    Kataoka, M; Yasuda, T; Kataoka, T; Ueda, E; Yonetsu, R; Okuda, K


    Three-dimensional kinematic analysis of car transfer (CT) movement in four adult males with C6 tetraplegia. The aim of the present study was to assess the normal transfer technique movement from a wheelchair to a car (that is, CT) in subjects with tetraplegia. A better understanding of CT movement is invaluable knowledge for spinal cord injury rehabilitation. This type of knowledge will improve rehabilitation programs so that patients with tetraplegia will have greater societal participation. School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan. Four adult males with C6 tetraplegia, an impairment grade of A according to the American Spinal Injury Association guidelines, took part in the study. The subjects used their own wheelchair and car in our assessments of their CT movement technique. Movements were assessed using a three-dimensional video analysis system with six digital video cameras. CT data, which included lateral displacement of the head and buttocks, and angular displacement of neck flexion and trunk forward inclination, were collected and correlation coefficients were calculated. All four subjects demonstrated negative correlations in lateral displacements greater than 0.70. As for correlation coefficients of angular displacement, two subjects demonstrated negative correlations (r = -0.98 and r = -0.77) and one subject demonstrated a positive correlation (r = 0.75). The neck flexion and trunk forward inclination strategy was different among the four subjects. Each subject with C6 tetraplegia demonstrated different strategies during CT movement.

  6. Minor rheumatology: Nonsystemic rheumatic disease of juxta-articular soft tissues of the pelvis and lower extremity: Diagnosis and treatment. Part 3

    Directory of Open Access Journals (Sweden)

    A. E. Karateev


    Full Text Available Pain associated with rheumatic diseases of juxta-articular soft tissues (RDJAST of the pelvis and lower extremity is a frequent reason for seeking advice from general practitioners and rheumatologists. However, the true cause of painful sensations is often overlooked by a physician and the patient is long and frequently treated unsuccessfully for lumbago, coxarthrosis, or gonarthrosis.The complexities of topical diagnosis are largely associated with the fact that instrumental methods virtually always determine these or those degenerative changes in the lumbar spine and hip joint (HJ, which formally supports the presence of nonspecific low back pain and coxarthrosis. Differential diagnosis can be made between these conditions if their clinical features are considered, by discriminating symptoms, such as pains in the back or buttock, and those located predominantly in the hip and groin area.The most known forms of RDJAST of the pelvis and HJ may include trochanteritis, hip abductor and adductor syndromes, iliopectineal bursitis, and ischial tuberosity bursitis.This review briefly describes the major forms of RDJAST of the mentioned area, their clinical manifestations, and topical diagnostic techniques. It also considers main therapeutic approaches: the administration of nonsteroidal antiinflammatory drugs, local injections of glucocorticoids and plateletrich plasma, and physiotherapy.

  7. Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release (United States)

    Carro, Luis Perez; Hernando, Moises Fernandez; Cerezal, Luis; Navarro, Ivan Saenz; Fernandez, Ana Alfonso; Castillo, Alexander Ortiz


    Summary Background Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic sciatic nerve entrapment in the subgluteal space. Multiple pathologies have been incorporated in this all-included “piriformis syndrome”, a term that has nothing to do with the presence of fibrous bands, obturator internus/gemellus syndrome, quadratus femoris/ischiofemoral pathology, hamstring conditions, gluteal disorders and orthopedic causes. Methods This article describes the subgluteal space anatomy, reviews known and new etiologies of DGS, and assesses the role of the radiologist and orthopaedic surgeons in the diagnosis, treatment and postoperative evaluation of sciatic nerve entrapments. Conclusion DGS is an under-recognized and multifactorial pathology. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification. The whole sciatic nerve trajectory in the deep gluteal space can be addressed by an endoscopic surgical technique. Endoscopic decompression of the sciatic nerve appears useful in improving function and diminishing hip pain in sciatic nerve entrapments, but requires significant experience and familiarity with the gross and endoscopic anatomy. Level of evidence IV. PMID:28066745

  8. Exposure to thin-ideal media affect most, but not all, women: Results from the Perceived Effects of Media Exposure Scale and open-ended responses. (United States)

    Frederick, David A; Daniels, Elizabeth A; Bates, Morgan E; Tylka, Tracy L


    Findings conflict as to whether thin-ideal media affect women's body satisfaction. Meta-analyses of experimental studies reveal small or null effects, but many women endorse appearance-related media pressure in surveys. Using a novel approach, two samples of women (Ns=656, 770) were exposed to bikini models, fashion models, or control conditions and reported the effects of the images their body image. Many women reported the fashion/bikini models made them feel worse about their stomachs (57%, 64%), weight (50%, 56%), waist (50%, 56%), overall appearance (50%, 56%), muscle tone (46%, 52%), legs (45%, 48%), thighs (40%, 49%), buttocks (40%, 43%), and hips (40%, 46%). In contrast, few women (1-6%) reported negative effects of control images. In open-ended responses, approximately one-third of women explicitly described negative media effects on their body image. Findings revealed that many women perceive negative effects of thin-ideal media in the immediate aftermath of exposures in experimental settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Dermatophytosis caused by Trichophyton raubitschekii. Report of the first case in São Paulo, Brazil Dermatofitose por Trichophyton raubitschekii. Registro do primeiro caso em São Paulo, Brasil

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    Carlos da Silva LACAZ


    Full Text Available The authors report the first case of dermatophytosis caused by Trichophyton raubitschekii in a patient from the State of São Paulo with Tinea corporis lesions localized on the buttocks. Culture on Sabouraud-agar with cycloheximide permitted the isolation and identification of the fungus, and the diagnosis was confirmed by Dr. Lynne Sigler, University of Alberta, Canada. Systemic treatment with fluconazole, 150 mg/week for 4 weeks, in combination with topical treatment with isoconazole initially yielded favorable results, with recurrence of the lesions after the medication was discontinued. This is the fifth case of this dermatophytosis published in the Brazilian medical literature.Os Autores registram o primeiro caso de dermatofitose por Trichophyton raubitschekii em paciente do Estado de São Paulo, com lesões de Tinea corporis localizada nas nádegas. O cultivo em ágar-Sabouraud com cicloheximida permitiu o isolamento e identificação do fungo, cujo diagnóstico foi confirmado pela Drª Lynne Sigler, da Universidade de Alberta, Canadá. O tratamento sistêmico com fluconazol, 150mg/semana por 4 semanas, associado ao tratamento tópico com isoconazol ofereceu inicialmente resultados favoráveis, com recidiva das lesões, após suspensão do medicamento. Trata-se do quinto caso publicado na literatura médica nacional.

  10. Púrpura de Henoch-Schönlein com acometimento incomum de face Unusual face involvement in Henoch-Schönlein purpura

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    Carolina Bassoli de Azevedo


    Full Text Available A Púrpura de Henoch-Shönlein é uma vasculite de causa idiopática, que se caracteriza pelo depósito predominante de IgA na parede dos pequenos vasos, envolvendo tipicamente pele, intestino, articulações e glomérulo renal. O acometimento cutâneo ocorre principalmente em membros inferiores e região glútea, sendo raramente encontrado em face e membros superiores. Relatamos o caso de uma paciente do sexo feminino, com seis anos de idade, que apresentava lesões púrpuricas em região auricular, periorbital, malar, mentoniana e membros superiores, além de artralgia e volvo intestinal. Após tratamento cirúrgico e pulsoterapia com glicocorticoide, houve regressão dos sintomas, sem maiores complicações.Henoch-Schönlein Purpura is an idiopathic vasculitis characterized by deposits of immunoglobulin, mainly IgA, on the walls of small vessels, typically involving the skin, gut, joints, and renal glomeruli. Cutaneous involvement affects specially the lower limbs and buttocks, and it is seldom found on the face and upper limbs. We report the case of a 6-year old girl with purpuric lesions over the auricular, periorbital, malar, and mentonian regions and the upper limbs, arthralgia, and intestinal torsion. After surgical treatment and pulse therapy with glucocorticoids, her symptoms subsided without further complications.

  11. Directory of Open Access Journals (Sweden)

    Bianca de Mello Guaraldi


    Full Text Available Progressive symmetrical erythrokeratodermia is a rare autosomal dominant genodermatosis with variable penetrance described by Darier in 1911. It is characterized by erythematous and keratotic plaques, sharply defined and symmetrically distributed along the extremities, buttocks and, more rarely, on the face. We report a case of a 55-year-old patient with lesions on the dorsum of the hands, interphalangeal pads, wrists, groin and back feet. This case demonstrates a rare and late diagnosis, clinical profusion and presence of familiar involvement.Eritroqueratodermia simétrica progressiva é uma genodermatose rara de herança autossômica dominante, com penetrância variável, descrita por Darier em 1911. E caracterizada por placas eritematosas e queratósicas, bem delimitadas, simetricamente distribuídas ao longo das extremidades, nádegas e mais raramente face. Os autores relatam o caso de uma paciente de 55 anos apresentando lesões no dorso das mãos, coxins interfalangeanos, punhos, região inguinal e dorso dos pés. O caso demonstra raridade, diagnóstico tardio, exuberância clínica e acometimento familial.

  12. Skeletal Muscle Metastasis as an Initial Presentation of Follicular Thyroid Carcinoma: A Case Report and a Review of the Literature

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    Mutahir A. Tunio


    Full Text Available Introduction. Follicular thyroid carcinoma (FTC frequently metastasizes to the lungs and bones. However, metastasis to the skeletal muscles is an extremely rare manifestation of FTC. To date, only seven cases of FTC have been reported in the literature. Skeletal muscle metastases from FTC usually remain asymptomatic or manifest as swelling and are associated with dismal prognosis. Case Presentation. A 45-year-old Saudi woman presented with right buttock swelling since 8 months. Physical examination revealed right gluteal mass of size  cm and right thyroid lobe nodule. The rest of examination was unremarkable. Magnetic resonance imaging (MRI showed  cm lobulated mass arising from the gluteus medius muscle, and tru-cut biopsy confirmed the metastatic papillary carcinoma of thyroid origin. The patient subsequently underwent palliative radiotherapy followed by total thyroidectomy and radioactive iodine ablation. At the time of publication, the patient was alive with partial response in gluteal mass. Conclusion. Skeletal muscles metastases are a rare manifestation of FTC, and searching for the primary focus in a patient with skeletal muscle metastasis, thyroid cancer should be considered as differential diagnosis.

  13. A surgeon's nightmare: pyoderma gangrenosum with pathergy effect mimicking necrotising fasciitis. (United States)

    Slocum, Amanda Mun Yee


    A 53-year-old woman was admitted for vulval swelling and fever. She was initially diagnosed with vulval cellulitis and given parenteral antibiotics. Within 1 week, she developed necrotic-looking skin lesions extending from her vulva to her buttock. Emergency surgical debridement with diversion colostomy was performed in view of suspected necrotising fasciitis. Shortly after the surgery, she developed necrotic-looking skin lesions at the peripheral venous cannula insertion site, central line insertion site, and around her surgical wounds and stoma. A second surgical debridement was performed and shortly afterwards, similar skin lesions appeared around her surgical wounds. Her clinical progression was suggestive of pyoderma gangrenosum with pathergy effect. Hence, she was started on topical steroid, systemic steroid and immunosuppressant. The skin lesions responded well to medical therapy. Further systemic workup for conditions associated with this disease revealed findings suspicious for myelodysplastic syndrome. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Intramuscular hematoma with motor weakness after trigger point injection (United States)

    Kim, Sang Gyun; Shim, Kwang Seok; Lee, Dong Won; Kim, Eun ju; Lee, Sang-Gon; Lee, Ji-Hyang; An, Ji hyun


    Abstract Rationale: Although trigger point injection is known as an easy and low-risk procedure, it is contraindicated to patients with hemorrhagic disorders or who regularly take anticoagulants/antiplatelets. However, taking clopidogrel is not a defined contraindication to this low-risk procedure. Patient concerns: The chief complaint of a 76-year old woman regularly taking clopidogrel was low back and left buttock pain which prolonged for several years. Diagnoses: The patient was diagnosed with L4-5 and L5-S1 spinal stenosis at the orthopedics department and was referred for lumbar spinal epidural steroid injection. Intervention: She was treated with trigger point injection. Outcomes: Three hours after the injection, she complained motor weakness and pain in the injection area. A hematoma on left gluteus medium muscle was detected with ultrasonography and ultrasound-guided needle aspiration was accomplished to relieve the symptom. Lessons: Trigger point injection for patients taking clopidogrel should be done with a caution to prevent such complication. PMID:28953648

  15. Lower limb movement variability in patients with peripheral arterial disease. (United States)

    Crowther, Robert G; Spinks, Warwick L; Leicht, Anthony S; Quigley, Frank; Golledge, Jonathan


    Peripheral arterial disease is a chronic obstructive disease of the arteries of the lower limb caused by atherosclerosis. The resultant decrease in blood flow can result in symptoms of pain in the lower limb on exercise known as intermittent claudication. Exercise induced pain is experienced in the calves, thigh or buttocks restricting activities of daily living and thus reducing quality of life. This study investigated lower limb movement variability in individuals with peripheral arterial disease-intermittent claudication (n=28) compared to individuals without peripheral arterial disease-intermittent claudication (control, n=25). A further aim was to examine the efficacy of various techniques used to describe single joint movement variability. All participants underwent two-dimensional angular kinematics analysis of the lower limb during normal walking. Single joint movement variability was measured using linear (spanning set and coefficient of variation) techniques. Between group differences were examined by one-way ANOVA. The peripheral arterial disease-intermittent claudication participants displayed significantly higher levels of lower limb movement variability in all joints when assessed using the coefficient of variation technique. There were no significant between group differences using the spanning set technique. Individuals with peripheral arterial disease-intermittent claudication have higher levels of lower limb movement variability and reduced walking speed compared to healthy age and mass matched controls. This variability may be an adaptation to the gradual onset of ischaemic pain in this population.

  16. Lumbosacral Plexus Injury and Brachial Plexus Injury Following Prolonged Compression

    Directory of Open Access Journals (Sweden)

    Chung-Lan Kao


    Full Text Available We report the case of a 36-year-old woman who developed right upper and lower limb paralysis with sensory deficit after sedative drug overdose with prolonged immobilization. Due to the initial motor and sensory deficit pattern, brachial plexus injury or C8/T1 radiculopathy was suspected. Subsequent nerve conduction study/electromyography proved the lesion level to be brachial plexus. Painful swelling of the right buttock was suggestive of gluteal compartment syndrome. Elevation of serum creatine phosphokinase and urinary occult blood indicated rhabdomyolysis. The patient received medical treatment and rehabilitation; 2 years after the injury, her right upper and lower limb function had recovered nearly completely. As it is easy to develop complications such as muscle atrophy and joint contracture during the paralytic period of brachial plexopathy and lumbosacral plexopathy, early intervention with rehabilitation is necessary to ensure that the future limb function of the patient can be recovered. Our patient had suspected gluteal compartment syndrome that developed after prolonged compression, with the complication of concomitant lumbosacral plexus injury and brachial plexus injury, which is rarely reported in the literature. A satisfactory outcome was achieved with nonsurgical management.

  17. A validated photonumeric cellulite severity scale. (United States)

    Hexsel, D M; Dal'forno, T; Hexsel, C L


    With recent advances in the treatment of cellulite and localized fat, a comprehensive objective method of measuring cellulite can be potentially useful, especially since important morphological aspects of cellulite are not part of the current classification. Objective To develop and to validate a new photonumeric cellulite severity. Based on standardized photographs of 55 patients with cellulite, five key morphological aspects of cellulite were identified. A new photonumeric severity scale was developed and validated. The five key morphological features of cellulite were identified and included the number of depressions, depth of depressions, clinical appearance of evident raised lesions, and presence of flaccidity and the grade of cellulite. Each item was graded from 0 to 3, allowing final classification of cellulite as mild, moderate, and severe. Results for validation of the scale are statistically significant (P 0.7; correlation item-total > 0.7, with the exception of the right buttock; intraclass correlation coefficients 0.881-0.922; Cronbach's alpha 0.851-0.989 and factor analysis 68-76%. The proposed photonumeric scale is a consistent, comprehensive, reliable, and reproducible tool for the standardized and objective assessment of the severity of cellulite. Conflicts of interest The authors hereby affirm that neither the manuscript nor any part of it has been published or is being considered for publication elsewhere.

  18. Quantitative & qualitative evaluation of the efficacy of a 1440 nm Nd:YAG laser with novel bi-directional optical fiber in the treatment of cellulite as measured by 3-dimensional surface imaging. (United States)

    Katz, Bruce


    Cellulite gives the skin surface an orange peel or mattress-like appearance thought to be caused by expansion of subcutaneous fat, fibrotic septae and, dermal laxity and atrophy. To evaluate the safety and efficacy of a single cellulite treatment using an Nd:YAG 1440-nm laser delivered with a special fiber delivery system and temperature control. Women with cellulite on their thighs and buttocks were enrolled in a prospective Institutional Review Board-approved study. Subjects were 15 healthy females of all Fitzpatrick Skin types with cellulite (grades II-III). A single treatment was performed with an average of seven 5 x 5 cm squares treated per leg. Evaluations with 2D and 3D imaging, patient and blinded evaluator scales as well as skin histology were performed at baseline, 3 and 6 months post treatment. In the 2D photographs, blinded evaluators were able to identify treated photographs versus baseline in 90% of cases and the number of sites with improvement in contour irregularities was 94%. With 3D imaging, the average decrease in skin depressions (dimples) was 49% at 6 months and 66% of patients showed improvement in overall skin contour at 6 months follow-up. Patient and physician satisfaction scores were high and no adverse events were reported. The Nd:YAG 1440 nm laser with a special fiber delivery system produced significant improvement in cellulite with one treatment after 6 months of follow up. There were no adverse events.

  19. Cellulite treatment: evidence and ethics, brief history, and emphasis on current practices including liposuction (United States)

    de Riese, Cornelia


    According to Taber's Cyclopedic Medical Dictionary "cellulite" is defined as: "a non-technical term for subcutaneous deposits of fat, especially in the buttocks, legs, and thighs." These deposits result in puckered, dimply skin and they are a cause for major aesthetic concerns in affected patients. The etiology of this condition is still unclear. Female predilection is witnessed in clinical practice as it is reported in the literature. It remains a subject for further studies whether it is a structural problem of connective tissue or as suggested probably related to hormonal causes. Magnetic resonance imaging may provide some answers to these questions. Not knowing what is causing this nuisance makes it almost impossible to treat. No wonder that there is little scientific validation to support any of the many treatments that are advertised on the Internet or in women's magazines. This review focuses on mechanical and microinvasive interventions that claim to alleviate "cellulite": lipoplasty, liposcultpure, liposuction, subcision, and laser. Among the parameters analyzed are the proposed modes of action of these techniques as well as adverse events and complications that may occur. Of special interest will be the evidence that backs these procedures. Extracting reliable data is hampered by methodical problems with the design of most of the published trials. In essence, at this time there is no "cure" for cellulite. Safe treatment recommendations are related to healthy life style choices that include toning exercises, dietary changes, and weight loss.

  20. A comparative study of the anatomy of adipose tissue in areas with and without raised lesions of cellulite using magnetic resonance imaging. (United States)

    Hexsel, Doris; Siega, Carolina; Schilling-Souza, Juliana; Porto, Manoela Donida; Rodrigues, Ticiana Costa


    Cellulite is considered a noninflammatory phenomenon characterized by alterations to the skin surface, with depressed and raised lesions. Few studies have evaluated subcutaneous fat in patients with cellulite, and there is no information about the anatomy of raised lesions. Sixty women with raised cellulite lesions were evaluated using magnetic resonance imaging (MRI). Cellulite grade was evaluated using the Cellulite Severity Scale (CSS). Raised cellulite lesions were marked and compared with control areas on the opposite side of the body (buttocks, abdomen, and upper thighs). Mean age was 39.3 ± 11.0 years and average body mass index (BMI) was 25.4 ± 4.1 kg/m(2) . There were no differences between the raised lesions and the control areas in the anatomy of the fat lobes and their size. CSS scores were higher in older patients and in those with higher BMI. Patients with higher BMI had more fat lobes. The anatomy of subcutaneous fat was similar in raised and control areas for shape, size, and thickness. Higher CSS scores were found in older patients and those with higher BMI. © 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

  1. Cellulite: advances in treatment: facts and controversies. (United States)

    Emanuele, Enzo


    Cellulite is traditionally considered a highly prevalent aesthetic condition in women. From a clinical standpoint, it is characterized by a cottage-cheese-like appearance of the skin, which can be most commonly found in certain areas of the body (eg, thighs, buttocks, and legs). Although cellulite is generally asymptomatic, the more severe stages can be accompanied by the appearance of painful nodules and increased local temperature, which are suggestive of an inflammatory reaction occurring in the dermis and in the underlying subcutaneous adipose tissue. Whether cellulite is a real disease or only a disturbing aesthetic issue is still a matter of controversy. This debate notwithstanding, it seems clear from market trends that there is considerable commercial interest in developing effective strategies aimed at reducing the cottage-cheese-like appearance of cellulite areas. Quite disturbingly, the majority of treatment attempts to date have been conducted in an empirical manner and without the application of rigorous scientific methodology. This is likely due--at least in part--to the lack of major, evidence-based pathophysiological insights into the nature of this condition. More stringent regulatory control is needed over commercial products aiming at improving the appearance of cellulite. © 2013 Elsevier Inc. All rights reserved.

  2. Efficacy of multipolar radiofrequency with pulsed magnetic field therapy for the treatment of abdominal cellulite. (United States)

    Wanitphakdeedecha, Rungsima; Sathaworawong, Angkana; Manuskiatti, Woraphong; Sadick, Neil S


    Cellulite is a metabolic condition, predominately seen in females, that affects the subcutaneous tissue of the posterolateral thighs, buttocks, pelvic region, and abdomen. It is characterized by skin dimpling and lumpiness resembling an orange peel. Despite the wide range of treatment options for patients with cellulite, there is a paucity of empirical data supporting their efficacy. The objective of this study was to evaluate the efficacy of a new-generation multipolar radiofrequency (RF) device for the treatment of cellulite. A multipolar RF device with pulsed magnetic fields was used to treat abdominal cellulite. Twenty-five healthy adult females with stage II or stage III abdominal cellulite underwent 8 weekly treatments. Assessments were performed at baseline and at weeks 1, 4, and 12 following the final treatment. Reduction in subcutaneous thickness in the axial and sagittal plane of the abdomen was observed at 1 week following treatment initiation. Results from self-reported questionnaires revealed a significantly high level of patient satisfaction (60%). Assessments by a blinded investigator at one, four, and twelve weeks after the final treatment demonstrated a significant improvement in cellulite appearance. No adverse effects were reported and the treatment was well tolerated. This study demonstrates the safety, efficacy, and subject satisfaction of multipolar RF with pulsed magnetic field therapy in the treatment of abdominal cellulite.

  3. Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system. (United States)

    Trelles, Mario A; van der Lugt, Claudia; Mordon, Serge; Ribé, Adriana; Al-Zarouni, Marwan


    Cellulite is a disorder of the subcutaneous fat layer and the overlying superficial skin. Recently, radiofrequency (RF) has been proposed as an effective treatment of cellulite; however, the mechanism through which the absorbed electrical energy acts on the tissue is still not fully clear. This study reports on the histological findings from biopsies taken immediately after a single RF treatment session, on cellulite located in the buttocks, with a novel technology called automatic multi-frequency and low impedance (AMFLI) RF. Tissue samples were stained with either haematoxylin and eosin (H&E), so that we could study the morphological findings, or with oil red O, to enable us to identify lipid deposits. The histological findings observed in biopsies taken after a single RF treatment showed changes in shape, size, and lipid content, as well as in cytoplasmic and nuclear morphology. After RF treatment adipocytes were more polyhedric, with irregular, degenerated membranes, with less or no lipid content and apoptotic changes. We postulate that RF treatment on cellulite produces a decrease in lipid content of cells as well as changes in the adipocyte membrane which will lead to cell rupture and the death and extrusion of lipid content out of the cell. Further studies are needed to characterise the nature of the extra-cellular lipid material that we have demonstrated with the oil red O stain in our biopsies.

  4. [Cellulite]. (United States)

    Proebstle, T M


    Cellulite is a condition affecting the dermal and subdermal compartment and developing on thighs and buttocks of almost every woman. Macroscopically, cellulite is characterized by dimpling, visible either spontaneously or after provoking maneuvers. While published concepts on the pathophysiology of cellulite are in parts inconclusive or contradictory, there are at least some recent studies describing or confirming structural and anatomic changes on dermal and subdermal tissues: (1) A gender specific dimorphism with subdermal septae oriented orthogonally towards the skin surface as well as protrusion of fat tissue into the dermis. (2) These intradermal fat protrusions additionally correlate with the presence of cellulite. (3) There is also a correlation between the thickness of the subdermal fat layer and the presence of cellulite. (4) Cellulite also correlates with focal hypertrophic subcutaneous septae and a reduced density of septae in general. Treatment of cellulite aims at (1) the reduction of the subcutaneous fat layer, (2) increase in dermal thickness and elasticity and (3) dissection of hypertrophic connective tissue septae, responsible for the most pronounced dermal indentions. A variety of treatment options have evolved ranging from topical retinol to interstitial laser.

  5. Calibrated delivery drape versus indirect gravimetric technique for the measurement of blood loss after delivery: a randomized trial. (United States)

    Ambardekar, Shubha; Shochet, Tara; Bracken, Hillary; Coyaji, Kurus; Winikoff, Beverly


    Trials of interventions for PPH prevention and treatment rely on different measurement methods for the quantification of blood loss and identification of PPH. This study's objective was to compare measures of blood loss obtained from two different measurement protocols frequently used in studies. Nine hundred women presenting for vaginal delivery were randomized to a direct method (a calibrated delivery drape) or an indirect method (a shallow bedpan placed below the buttocks and weighing the collected blood and blood-soaked gauze/pads). Blood loss was measured from immediately after delivery for at least one hour or until active bleeding stopped. Significantly greater mean blood loss was recorded by the direct than by the indirect measurement technique (253.9 mL and 195.3 mL, respectively; difference = 58.6 mL (95% CI: 31-86); p 500 mL (8.7% vs. 4.7%, p = 0.02). The study suggests a real and significant difference in blood loss measurement between these methods. Research using blood loss measurement as an endpoint needs to be interpreted taking measurement technique into consideration. This study has been registered at as NCT01885845.

  6. Clinical case of the late diagnosis of neurolipomatosis (Dercum’s disease

    Directory of Open Access Journals (Sweden)

    N. A. Shnayder


    Full Text Available Dercum’s disease (Dercum’s syndrome, neurolipomatosis is a rare and inadequately studied chronic disease that is characterized by subcutaneous fatty deposits in different parts of the trunk and accompanied by compression-ischemic neuropathy of the cutaneous branches of peripheral nerves with pain syndrome, pathological fatigue, and obesity. The most common site of subcutaneous deposits is the upper extremities, elbows, anterior abdominal wall, buttocks, thighs, and knees. However, Dercum’s disease is systemic and can be manifested by a wide range of symptoms and it frequently recurs, including after surgical removal of lipomas. The paper presents a case of the late diagnosis of neurolipomatosis in a 23-year-old male. It considers the etiology, pathogenesis, and diagnosis of the disease and current approaches to its treatment. A better understanding of the characteristic clinical syndrome of painful lipomatosis will assist in the early diagnosis of the disease and in the prevention of inadequate therapy cases.

  7. MR imaging of benign fatty tumors in children: report of four cases and review of the literature

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    Ha, T.V. (Dept. of Radiology, Univ. of Massachusetts Medical Center, Worcester, MA (United States)); Kleinman, P.K. (Dept. of Radiology, Univ. of Massachusetts Medical Center, Worcester, MA (United States)); Fraire, A. (Dept. of Pathology, Univ. of Massachusetts Medical Center, Worcester, MA (United States)); Spevak, M.R. (Dept. of Radiology, Univ. of Massachusetts Medical Center, Worcester, MA (United States)); Nimkin, K. (Dept. of Radiology, Univ. of Massachusetts Medical Center, Worcester, MA (United States)); Cohen, I.T. (Dept. of Pediatric Surgery, Univ. of Massachusetts Medical Center, Worcester, MA (United States)); Hirsh, M. (Dept. of Pediatric Surgery, Univ. of Massachusetts Medical Center, Worcester, MA (United States)); Walton, R. (Dept. of Plastic Surgery, Univ. of Massachusetts Medical Center, Worcester, MA (United States))


    This study correlates the magnetic resonance imaging characteristics with the pathologic findings in rare benign fatty soft tissue tumors in four children. A review of the literature is presented. Two cases of infiltrating lipoma displayed bright signal on both T1- and T2-weighted images, similar to that observed in subcutaneous fat. Histological study revealed extensive muscle infiltration by mature fat, with some areas of total fatty replacement. The case of facial lipomatosis revealed an extensive process of fatty invasion of adjacent soft tissue and osseous deformity by mass effect of the tumor. This lesion was bright on T1- and T2-weighted images. Histopathologic examination showed widespread invasion of squamous mucosa and skeletal muscle. The single case of lipoblastoma involved the presacral region and right buttock. This lesion, although bright on both T1 and T2 weighting, was relatively hypointense to subcutaneous fat on T1. Microscopic examination revealed a well-encapsulated fatty mass made up of cells ranging from lipoblasts to mature lipocytes. In childhood, when fatty lesions are almost always benign, a morphologic characterization by magnetic resonance may be sufficient basis on which to make critical therapeutic judgements. (orig.)

  8. Fine-needle aspiration cytology of postirradiation sarcomas, including angiosarcoma, with immunocytochemical confirmation

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    Silverman, J.F.; Lannin, D.L.; Larkin, E.W.; Feldman, P.; Frable, W.J. (East Carolina Univ. School of Medicine, Greenville, NC (USA))


    Postirradiation sarcomas are an unusual but well-recognized late effect of cancer therapy. In this article, a fine-needle aspiration (FNA) series of four cases is presented. There were three female patients and one male patient, with an age range of 28-55 yr (mean, 41). Two of the patients were irradiated for uterine cervical carcinoma while the other two received irradiation for malignant lymphoma. The time interval to the development of the postirradiation sarcoma ranged from 10 to greater than 20 yr. There were a postirradiation synovial sarcoma of the buttock region, malignant fibrous histiocytoma of the bone (femur), and rhabdomyosarcoma and angiosarcoma of the retroperitoneum. A spectrum of cytologic findings was encountered, reflecting the specific types of sarcomas. Immunocytochemical studies performed on the aspirated material from the angiosarcoma demonstrated the utility of immunoperoxidase stains for ULEX europaeus agglutinin-1 (UEA-1) and, to a lesser degree, factor VIII-related antigen antibody, confirming the vascular nature of this malignancy. The FNA findings from all four cases demonstrated cytologic features that allowed recognition of this unusual complication of irradiation treatment. This article confirms the utility of FNA cytology in following patients with previous malignancies and differentiating a postirradiation sarcoma from recurrent carcinoma.

  9. Incontinence-associated dermatitis in the critically ill patient: an intensive care perspective. (United States)

    Coyer, Fiona; Campbell, Jill


    Incontinence-associated dermatitis is a skin disorder evident as a complication of incontinence. It is characterized by perineal, buttock and groin erythema and skin breakdown. Incontinence-associated dermatitis is a ubiquitous, nosocomial condition commonly present in critically ill patients in the intensive care unit. Critically ill patients, by the nature of their critical illness and therapies used to treat their presenting condition, are commonly predisposed to faecal incontinence and are consequently at high risk of developing incontinence-associated dermatitis. However, this condition is under-explored and under-reported in the intensive care literature. The aim of this paper is to provide a review of the literature relating to incontinence-associated dermatitis from the critically ill patients in the intensive care setting. There is a paucity of literature addressing this condition in the intensive care context, with only 11 studies identified. This paper will provide an overview of the definitions, prevalence and incidence of incontinence-associated dermatitis. Furthermore, an exposition of incontinence-associated dermatitis from the critically ill patient and intensive care nursing perspectives will be presented through a review of the skin barrier function, clinical presentation, risk factors, clinical assessment and severity categorization, prevention and management of incontinence-associated dermatitis. It is imperative that critical care nurses have an appreciation of incontinence-associated dermatitis as a common, yet preventable condition, and are equipped with knowledge to appropriately prevent and manage this common complication. © 2017 British Association of Critical Care Nurses.

  10. Age-induced and photoinduced changes in gene expression profiles in facial skin of Caucasian females across 6 decades of age. (United States)

    Kimball, Alexa B; Alora-Palli, Maria B; Tamura, Makio; Mullins, Lisa A; Soh, Chieko; Binder, Robert L; Houston, Neil A; Conley, Emily D; Tung, Joyce Y; Annunziata, Nikki E; Bascom, Charles C; Isfort, Robert J; Jarrold, Bradley B; Kainkaryam, Raghu; Rocchetta, Heather L; Swift, Dionne D; Tiesman, Jay P; Toyama, Kazumi; Xu, Jun; Yan, Xianghong; Osborne, Rosemarie


    Intrinsic and extrinsic factors, including ultraviolet irradiation, lead to visible signs of skin aging. We evaluated molecular changes occurring in photoexposed and photoprotected skin of white women 20 to 74 years of age, some of whom appeared substantially younger than their chronologic age. Histologic and transcriptomics profiling were conducted on skin biopsy samples of photoexposed (face and dorsal forearm) or photoprotected (buttocks) body sites from 158 women. 23andMe genotyping determined genetic ancestry. Gene expression and ontologic analysis revealed progressive changes from the 20s to the 70s in pathways related to oxidative stress, energy metabolism, senescence, and epidermal barrier; these changes were accelerated in the 60s and 70s. The gene expression patterns from the subset of women who were younger-appearing were similar to those in women who were actually younger. Broader application of these findings (eg, across races and Fitzpatrick skin types) will require further studies. This study demonstrates a wide range of molecular processes in skin affected by aging, providing relevant targets for improving the condition of aging skin at different life stages and defining a molecular pattern of epidermal gene expression in women who appear younger than their chronologic age. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  11. Rehabilitation of proximal hamstring tendinopathy utilizing eccentric training, lumbopelvic stabilization, and trigger point dry needling: 2 case reports. (United States)

    Jayaseelan, Dhinu J; Moats, Nick; Ricardo, Christopher R


    Case report. Proximal hamstring tendinopathy is a relatively uncommon overuse injury seen in runners. In contrast to the significant amount of literature guiding the evaluation and treatment of hamstring strains, there is little literature about the physical therapy management of proximal hamstring tendinopathy, other than the general recommendations to increase strength and flexibility. Two runners were treated in physical therapy for proximal hamstring tendinopathy. Each presented with buttock pain with running and sitting, as well as tenderness to palpation at the ischial tuberosity. Each patient was prescribed a specific exercise program focusing on eccentric loading of the hamstrings and lumbopelvic stabilization exercises. Trigger point dry needling was also used with both runners to facilitate improved joint motion and to decrease pain. Both patients were treated in 8 to 9 visits over 8 to 10 weeks. Clinically significant improvements were seen in pain, tenderness, and function in each case. Each patient returned to running and sitting without symptoms. Proximal hamstring tendinopathy can be difficult to treat. In these 2 runners, eccentric loading of the hamstrings, lumbopelvic stabilization exercises, and trigger point dry needling provided short- and long-term pain reduction and functional benefits. Further research is needed to determine the effectiveness of this cluster of interventions for this condition. Therapy, level 4.

  12. Pyoderma Gangrenosum: A Rare Cause of Cutaneous Ulceration and One Easily Misdiagnosed

    Directory of Open Access Journals (Sweden)

    Wedad Abdelrahman


    Full Text Available Pyoderma gangrenosum (PG is a rare inflammatory neutrophilic dermatosis often misdiagnosed. It is uncommon in infants and children accounting for 4% of cases. A one-year-old male in paediatric ICU ventilated for bronchopneumonia was referred with ulcerated areas on his neck and axilla corresponding to sites of recent removal of central and arterial lines. Examination revealed areas of deep ulceration with violaceous undermined borders in keeping with PG. This was supported by a skin biopsy showing a neutrophilic infiltrate in the deeper dermis. Topical clobetasol propionate was commenced and a dramatic improvement within 24 hours noted. Blood results showed a leucocytosis of 29.7; a differential WCC showed toxic granulation in neutrophils with myeloid left shift; immunoglobulins showed elevated IgG 23 and IgA 4.86. The elevated WCC made us consider a leukaemic trigger; however, they settled with treatment of the underlying infection. PG in children is more likely to have an atypical distribution involving the head and neck (26.6% or buttocks (15%. An interesting feature in this case is the presence of pathergy, a term used to describe the induction or exacerbation of PG at sites of iatrogenic or incidental trauma. It is seen in 31% of patients with PG.

  13. Giant inframuscular lipoma disclosed 14 years after a blunt trauma: A case report

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    Nigri Giuseppe


    Full Text Available Abstract Introduction Lipoma is the most frequent benign tumor of the soft tissue. This lesion is often asymptomatic except in cases of enormous masses compressing nervous-vascular structures. Although the diagnosis is mostly clinical, imaging tools are useful to confirm the adipose nature of the lesion and to define its anatomic border. Sometimes, lipomas may be the result of a previous trauma, such as in this patient. Case presentation A 45-year-old man presented at our institution with a giant hard firm mass in the upper external quadrant of the right buttock disclosed after a weight loss diet. Subsequent magnetic resonance imaging showed a giant adipose mass developed beneath the large gluteal muscle and among the fibers of the medium and small gluteal muscles. When questioned on his medical history, the patient reported a blunt trauma of the lower back 14 years earlier. He underwent surgery and histological examination confirmed a giant lipoma. Conclusion Lipomas might result from a previous trauma. It is hypothesized that the trigger mechanism is activated by cytokine and growth factors released after the trauma. We herein present an exceptional case of a giant post-traumatic lipoma which caused a painful compression on the right sciatic nerve.

  14. Gluteal muscle contracture: diagnosis and management options (United States)

    Rai, Saroj; Meng, Chunqing; Wang, Xiaohong; Chaudhary, Nabin; Jin, Shengyang; Yang, Shuhua; Wang, Hong


    Gluteal muscle contracture (GMC), a debilitating disease, exists all over the globe but it is much more prevalent in China. Patients typically present with abduction and external rotation of the hip and are unable to bring both the knees together while squatting. Multiple etiologies have been postulated, the commonest being repeated intramuscular injection into the buttocks. The disease is diagnosed primarily by clinical features but radiological features are necessary for the exclusion of other pathological conditions. Non-operative treatment with physiotherapy can be tried before surgery is considered but it usually fails. Different surgical techniques have been described and claimed to have a better outcome of one over another but controversy still exists. Based on published literatures, the clinical outcome is exceptionally good in all established methods of surgery. However, endoscopic surgery is superior to conventional open surgery in terms of cosmetic outcome with fewer complications. Nevertheless, its use has been limited by lack of adequate knowledge, instrumentations, and some inherent limitations. Above all, post-operative rehabilitation plays a key role in better outcome, which however should be started gradually. PMID:28059055

  15. [Etiological analysis and significance of anterior knee pain induced by gluteal muscles contracture]. (United States)

    Zhao, Gang; Liu, Yu-jie; Wang, Jun-liang; Qi, Wei; Qu, Feng; Yuan, Bang-tuo; Wang, Jiang-tao; Shen, Xue-zhen; Liu, Yang; Zhu, Juan-li


    To explore causes of gluteal muscle contracture induced anterior knee pain and curative effect of arthroscopic release. From March 2002 to August 2013,36 patients with gluteal muscle contracture induced anterior knee pain were treated, including 15 males, 21 females, aged from 9 to 40 years old with an average (18.7±7.2) years old; the courses of diseases ranged from 4 to 30 years. The clinical manifestations involved limited to symmelia, positive Ober sign, buttocks touch contracture belts, knee and patella slide to lateral when doing squat activities. All patients were performed gluteal muscle contracture release under arthroscopic. Postoperative complications were observed, Kujala scoring before and after operation was used for compare curative effect. All patients were followed up with an average of 29 months. The incision were healed well, and no complications were occurred. Postoperative Kujala score were improved more than preoperative. Gluteal muscle contracture release could alleviate hypertension of lateral patella, and palys an important role in preventing patellofemoral arthritis.

  16. A case of multiple metastatic malignant melanoma with the largest lesion in the ileum and no skin lesion

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    Shuji Suzuki


    Full Text Available We report the case of a 72-year-old woman with malignant melanoma and multiple metastases; the largest tumor was in the ileum. The patient experienced general fatigue and bloody feces for 1 month before consulting a nearby clinic. Blood tests revealed anemia, and fecal occult blood was positive, but no abnormalities were detected using gastrointestinal endoscopy and colonoscopy or the skin of the entire body. Computed tomography images of the chest, abdomen, and pelvic region, and positron emission tomography–computed tomography images of the entire body revealed multiple nodules in the ileum, left mammary gland, left thyroid, right inguinal lymph node, and on the fascia of the right thoracic area and right buttocks. The tumor in the left mammary gland was excised and immunohistochemical analysis revealed that the excised tissue was positive for HMB45, melan-A, and MITF, but negative for S-100 protein. Diagnosed with melanoma with multiple metastases, the patient underwent four cycles of dacarbazine, nimustine hydrochloride, and vincristine (DAV plus interferon beta chemotherapy and one cycle of dacarbazine, nimustine hydrochloride, cisplatin, and tamoxifen (DAC-Tam chemotherapy. Two series of embolizations of the artery feeding the ileum tumors, as well as a series of plasma and red blood cell transfusions, were performed for ileum tumor hemorrhage. The patient was hospitalized eight times, for a total of 204 days during the 1-year survival period before her death from respiratory failure.

  17. Incidence of dog bite injuries and clinical rabies in a tertiary health care institution: a 10-year retrospective study. (United States)

    Abubakar, S A; Bakari, A G


    It is widely recognized that rabies is grossly under-reported even though it is a notifiable disease and a lack of accurate figures has rendered rabies a low public health and veterinary priority. This study aimed at determining the incidence of dog bite injuries and clinical rabies in a tertiary health care centre. Case records of patients managed at the accident and emergency unit of Ahmadu Bello University Teaching Hospital, Zaria, between June 2000 and May 2010 with diagnosis of dog bite and rabies were retrieved. Relevant clinical data were extracted using a structured questionnaire designed for the study. Eighty-one persons out of 24,683 consultations in the accident and emergency unit presented with dog bite injuries with two clinical cases of human rabies. Mean age of victims of dog bite injuries was 21.1 ± 14.3 years and the majority (55.6%) were children. Males were more affected than females with a male:female ratio of 4.8:1, lower limb/buttock injuries were significantly higher in children than adults, but the adults sustained significantly more severe (type III) injury. The majority of dog bite injuries were washed with soap and irrigated with water or saline and 87.7% of the victim of dog bite received postexposure anti-rabies vaccine. Hospital incidence of dog bite injuries was low, but the use of postexposure prophylaxis was high.

  18. Animal Bites in Borujerd: An Overview of Animal Bites in Iran

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    Sabouri Ghannad


    Full Text Available Background Rabies has been reported as the most important endemic zoonotic disease in Iran and still remains as a major public health problem. Objectives The main objective of the current research was to study the epidemiology of animal bites in Borujerd County in Iran and to compare its prevalence to other parts of Iran from April 2006 to September 2011. Patients and Methods The data were recorded in questionnaires and analyzed by SPSS version 16. Chi-square test was performed to evaluate the relationship among variables and P value was set as 0.05. Results Dog bites were the most common (69.8%, followed by cat (17.2%, fox and wolf (1.4%, sheep and cow (2.8%, monkey and donkey (5%, mouse and squirrel (2.2% and other animals (1.6%. Leg was the most common bite site forming 46.6% of cases, followed by hands (41.8%, buttocks (4.6%, head (4% and body (2.9%. Most of the subjects belonged to the age group < 10 (175.2 per 100000 populations. The injury location was associated significantly with sex and the residential status. Conclusions This study strongly highlights a high priority goal for health authorities to develop educational programs, recommended for the general population to inform them about the benefits of continuing the medication. Vaccination of domestic dogs and also eradication of stray ones, in addition to educational programs should be prioritized by health authorities.

  19. Polyclonality of Trichophyton rubrum Isolates in aDermatophytosis Patient with Multiple Lesions. (United States)

    Takeda, Kiminobu; Mochizuki, Hirokazu; Izumi, Katsuhiko; Sakata, Yuichi; Ushigami, Tsuyoshi; Nishibu, Akiko; Anzawa, Kazushi; Mochizuki, Takashi


    We cultured 15 isolates of Trichophyton rubrum and one isolate of Trichophyton mentagrophytes from an 82-year-old male tinea patient with multiple lesions. To determine whether feet lesions were the source of dermatophytes of other tinea lesions, we extracted total cellular DNA from the T. rubrum isolates(13 from feet, two from right waist and buttock). PCR targeting the non-transcribed spacer(NTS)region of ribosomal RNA gene was performed. Molecular polymorphisms were detected by length variation of amplicons.Four molecular types were found among the 15 isolates. The predominant type, which we previously named Type III, comprised seven isolates cultured from both feet and from left waist and buttock. This was followed by Type VI, five isolates; Type V, two isolates; and Type IV, one isolate. Apart from type III, which was cultured from both feet, isolates were cultured from one foot only. The patient was successfully treated for all types with a six-month course of oral terbinafine and topical luliconazole. The molecular typing supported the notion that tinea pedis was the source of tinea corporis in the patient.

  20. Evaluation of the efficacy of a topical cosmetic slimming product combining tetrahydroxypropyl ethylenediamine, caffeine, carnitine, forskolin and retinol, In vitro, ex vivo and in vivo studies. (United States)

    Roure, R; Oddos, T; Rossi, A; Vial, F; Bertin, C


    Three studies were performed to investigate the mechanism of action and evaluate the efficacy of a topical cosmetic slimming product combining tetrahydroxypropyl ethylenediamine, caffeine, carnitine, forskolin and retinol. The Ex vivo study on skin explants showed that caffeine and forskolin both stimulated glycerol release and demonstrates for the first time that retinol and carnitine in combination synergistically stimulated keratinocyte proliferation, which leads to an increase epidermal thickness. The double-blind, randomized, placebo-controlled clinical study associating circumference measurements on five selected parts of the body, cutaneous hydration measurements as well as blinded expert grading of skin aspect was conducted on 78 women who applied the product or placebo twice daily for 12 consecutive weeks. After 4 weeks of twice-daily application of the product, significant reductions in circumference of abdomen, hips-buttocks and waist were already observed. Improvements concerned all the measured body parts after 12 weeks. Orange peel and stubborn cellulite decreased significantly from 4 weeks of treatment and tonicity improved from 8 weeks, demonstrating that the product improved skin aspect. At the end of the study, eight parameters of the thirteen evaluated were significantly improved in the active group and compared with placebo. © 2011 Johnson and Johnson consumer France. ICS © 2011 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

  1. Risk factors associated with sacral stress fractures: a systematic review (United States)

    Yoder, Kristi; Bartsokas, Jenna; Averell, Kristina; McBride, Erin; Long, Christine; Cook, Chad


    Objectives: The objective of this study was to examine and identify risk factors associated with the development of sacral stress fractures in order to improve diagnosis in clinical practice. Methods: Electronic search strategies in PubMed, CINAHL, Scopus, and SPORTDiscus were combined with a hand search to identify articles for inclusion. Studies were considered if they described patient cases in which imaging confirmed diagnosis of a sacral stress fracture, and the diagnosis included whether the fracture was a sacral insufficiency or sacral fatigue stress fracture. Results: In those that developed sacral insufficiency fractures, the risk factors that were most prevalent included osteoporosis, pelvic radiation therapy, rheumatoid arthritis, long-term corticosteroid therapy, and postmenopausal, each with a prevalence of 100%. Risk factors with 100% prevalence in those diagnosed with sacral fatigue fractures included recent increase in training intensity and deficient diet. Discussion: A pattern of signs and symptoms are consistent among subjects with sacral stress fractures. Patients being unsuccessfully treated for low-back and buttock pain who fit the risk factor profiles for sacral stress fractures should be referred to a physician for further diagnostic workup. PMID:26109829

  2. Do body build and composition influence striae distensae occurrence and visibility in women? (United States)

    Kasielska-Trojan, Anna; Antoszewski, Bogusław


    Striae have been reported to be one of the most common skin changes and a commonly encountered esthetic problem. To analyze risk factors of striae not associated with pregnancy and verify if body build and composition influence striae distensae (SD) occurrence and visibility. Eighty female students (40 with striae (the mean age 23.9 years, SD 2.05 years) and 40 without these lesions (24.7 years, SD 6.2 years)) were included in the study. The subjects were asked to fill out a questionnaire including questions concerning risk factors of SD. Body build and composition were examined using Tanita SC-331S Body Composition Analyzer. Women without striae more often reported a history of intended weight loss (P build and composition parameters indicated BMI as risk factor of SD (P = .021; OR =1.155, 95% CI 1.006; 1.325). History of contraceptives intake and a family history of striae are risk factors of SD occurrence, while weight loss can reduce the risk of these lesions. BMI appeared to be the risk factor of striae visibility, especially in abdomen, but not on the buttocks. Further clinical researches are needed to examine the pathophysiology of this condition and to inform patients about the possibility to reduce the risk of striae occurrence. © 2017 Wiley Periodicals, Inc.

  3. Neuroarthropathy of the hip following spinal cord injury

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    Bibek Banskota


    Full Text Available We present the case of a 33-year-old male who sustained a burst fracture D12 vertebrae with spinal cord injury (ASIA impairment scale A and a right mid-diaphysial femoral shaft fracture around 1.5 years back. The patient reported 1.5 years later with a swelling over the right buttock. Arthrotomy revealed serous fluid and fragmented bone debris. The biopsy showed a normal bony architecture with no evidence of infection and malignant cells. Hence, a diagnosis of Charcot′s hip was made. Charcot′s neuroarthropathy of the feet is a well-recognized entity in the setting of insensate feet resulting from causes such as diabetes or spina bifida. Although Charcot′s disease of the hips has been described, it is uncommon in association with spinal cord injury, syphilis and even with the use of epidural injection. The present case highlights the fact that neuroarthropathy of the hip can occur in isolation in the setting of a spinal cord injury, and this can lead to considerable morbidity.

  4. A Case of 72 Diabetic Woman with Zoster Paresis

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    E. Sajadi


    Full Text Available Introduction: VZV is an exclusively human pathogen. The primary infection typically occurs during childhood and causes varicella. As with other members of the herpes viruses’ family, VZV is noninfectious in its latent form but can reactivate at a later time to form intact virions in the involved sensory neurons. These virions then migrate to the skin through axons, spread from cell to cell, and penetrate the epidermis.Case Report: In this case a 72 years old woman with history of diabetes mellitus and hypertension is reported hospitalized because of urinary retention, weakness and parestesia in the right leg, complicated with vesiculoulcerative lesions in sacral area with distribution to the right buttock and vagina. L.P was done to confirm inflammatory radicopathy that showed aseptic meningitis and therapy started with acyclovir and prednisolone. Patient got well and discharged from the hospital.Conclusion: Motor weakness in noncranial nerve is one of the zoster complications known as zoster paresis. Weakness begins suddenly 2-3 weeks after rash and progresses to extremities. In this case 3 weeks after rash, nerve complications were observed. We recommend to do paresthesia examination of skin for eruption in all patients presented with paresis.

  5. Non-invasive measurement of reepithelialization and microvascularity of suction-blister wounds with benchmarking to histology

    DEFF Research Database (Denmark)

    Larsen, Heidi Fhaer; Ahlström, Malin Glindvad; Gjerdrum, Lise Mette Rahbek


    blister (10 mm) was induced on each buttock in 30 healthy volunteers (15 females:15 males) and de-roofed on day 0. The wounds were randomized to daily treatment with 1.4% zinc sulfate shower gel (n = 20), placebo (n = 20) or control (n = 20). Digital photography coupled with planimetry, transepidermal...... groups but increased more with the placebo than with the zinc shower gel (p = 0.003) or the control treatment (p = 0.002) and correlated (rS = 0.313, p = 0.015) with the inflammatory response on day 4, as determined by histology. Coagulase-negative staphylococci were more common in wounds compared...... with skin (p = 0.002) and was reduced (p = 0.030) with zinc sulfate treatment. Planimetric analysis of digital wound images was not biased (p = 0.234) compared with histology, and TEWL measurements showed no correlation (rS = 0.052, p = 0.691) with epithelialization. Neoepidermal formation, determined...

  6. [Bacterial dermohypodermitis: a retrospective single-center study of 244 cases in Guinea]. (United States)

    Cisse, M; Keïta, M; Toure, A; Camara, A; Machet, L; Lorette, G


    Dermo-hypodermal bacterial infections (erysipelas, cellulitis and necrotizing fasciitis) are frequent and may be life-threatening. A retrospective study of a period of 4 years and 6 months (1 June 1999 to 31 December 2003) was carried out at the Donka University Hospital centre (Conakry-Guinea) in order to analyze the epidemiological, clinical and therapeutic characteristics of bacterial dermohypodermitis in a hospital environment. Two hundred and forty-four patients (188 women and 56 men) were hospitalized for bacterial dermohypodermitis. Mean age was 38 years. The site of dermohypodermitis comprised the entire lower limbs in 4 cases (2%), legs and feet in 200 cases (82%), thighs in 12 cases (4%), buttocks in 4 cases (2%) and upper limbs in 24 cases (10%). A previous history of dermohypodermitis, chronic alcoholism, use of non-steroidal anti inflammatory drugs, obesity and lymphoedema was identified. Necrotizing bacterial dermohypodermitis and necrotizing fasciitis were the main complications and were seen in 31 patients. These conditions were generally associated with use of non-steroidal anti inflammatory drugs (90% vs. 25%) (OR=27, CI 95=8-94), delayed initiation of suitable treatment and use of traditional medicine. Our study shows female predominance of bacterial dermohypodermitis. This is explained by cutaneous atrophy in women resulting from use of depigmenting drugs that facilitate skin breaks, thus allowing ingress of bacteria. NSAID intake, while frequent in our series, was far higher in the fasciitis group, suggesting a potentially aggravating role of these drugs.

  7. "You're naked, you're vulnerable": Sexual well-being and body image of women with lower limb lymphedema. (United States)

    Winch, Caleb J; Sherman, Kerry A; Smith, Katriona M; Koelmeyer, Louise A; Mackie, Helen; Boyages, John


    Lower-limb lymphedema is an incurable illness manifesting as visible swelling enlarging the leg(s) and/or feet, buttocks, and genitals. This study used semi-structured interviews and thematic analysis to explore sexual well-being among women with primary (congenital) lymphedema (n=11) or secondary lymphedema associated with gynecological cancer (n=8). Five themes (subthemes) summarized women's responses, with Attractiveness and Confidence (Publicly Unattractive, Privately Unconfident, Lymphedema or Aging?) describing women's central concern. These body image-related concerns accounted for sexual well-being in association with Partner Support (Availability of Support, Languages of Support, Fears About Support) and the degree of Functional Interruptions (Lymphedema in Context, Enduring Impacts, Overcoming Interruptions). Successful Lymphedema Coping (Control, Acceptance) and self-perceived ability to fulfill a valued Sexual Role also affected sexual well-being. Few differences between women with primary versus secondary lymphedema were evident. Lymphedema clinicians should screen for sexual concerns and have referral options available. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Primary tumor sites in relation to ultraviolet radiation exposure and skin visibility correlate with survival in cutaneous melanoma. (United States)

    Gordon, Daniela; Hansson, Johan; Eloranta, Sandra; Gordon, Max; Gillgren, Peter; Smedby, Karin E


    The prognostic value of detailed anatomic site and ultraviolet radiation (UVR) exposure patterns has not been fully determined in cutaneous melanoma. Thus, we reviewed medical records for detailed site in a population-based retrospective Swedish patient cohort diagnosed with primary invasive melanoma 1976-2003 (n = 5,973). We followed the patients from date of diagnosis until death, emigration or December 31st 2013, and evaluated melanoma-specific survival by subsite in a multivariable regression model adjusting for established prognostic factors. We found that melanoma on chronic UVR exposure sites (face, dorsum of hands; adjusted HR 0.6; CI 0.4-0.7) and moderately intermittent UVR sites (lateral arms, lower legs, dorsum of feet; HR 0.7; CI 0.6-0.8) were associated with a favorable prognosis compared with highly intermittent sites (chest, back, neck, shoulders and thighs). Further, melanoma on poorly visible skin sites upon self-examination (scalp, retroauricular area, back, posterior upper arms and thighs, buttocks, pubic area; HR 1.3; CI 1.1-1.5) had a worse prognosis than those on easily visible sites (face, chest, abdomen, anterior upper arms and thighs, lower arms and legs, dorsum of hands and feet, palms). In conclusion, highly intermittent UVR exposure sites and poor skin visibility presumably correlate with reduced melanoma survival, independent of established tumor characteristics. A limitation of the study was the lack of information on actual individual UVR exposure. © 2017 UICC.

  9. Optimal External Wrench Distribution During a Multi-Contact Sit-to-Stand Task. (United States)

    Bonnet, Vincent; Azevedo-Coste, Christine; Robert, Thomas; Fraisse, Philippe; Venture, Gentiane


    This paper aims at developing and evaluating a new practical method for the real-time estimate of joint torques and external wrenches during multi-contact sit-to-stand (STS) task using kinematics data only. The proposed method allows also identifying subject specific body inertial segment parameters that are required to perform inverse dynamics. The identification phase is performed using simple and repeatable motions. Thanks to an accurately identified model the estimate of the total external wrench can be used as an input to solve an under-determined multi-contact problem. It is solved using a constrained quadratic optimization process minimizing a hybrid human-like energetic criterion. The weights of this hybrid cost function are adjusted and a sensitivity analysis is performed in order to reproduce robustly human external wrench distribution. The results showed that the proposed method could successfully estimate the external wrenches under buttocks, feet, and hands during STS tasks (RMS error lower than 20 N and 6 N.m). The simplicity and generalization abilities of the proposed method allow paving the way of future diagnosis solutions and rehabilitation applications, including in-home use.

  10. Skin injuries identified in cattle and water buffaloes at livestock markets in Bangladesh. (United States)

    Alam, M R; Gregory, N G; Jabbar, M A; Uddin, M S; Kibria, A S M G; Silva-Fletcher, A


    Skin injuries were assessed in 560 imported and local cattle and water buffaloes at two livestock markets in Bangladesh. The body of each animal was divided into 11 anatomical regions, and abrasions, lacerations, penetrations, ulcerations, bleeding, swelling, hyperkeratosis and scars were recorded for each region. Among the 560 animals studied, 501 were found to have at least one injury. The prevalence of skin injuries was 89 per cent, with 84 per cent of the cattle and 99 per cent of the water buffaloes having obvious skin injuries. The most common types of injury were abrasions that were found in 73 per cent of the animals, followed by scars (50 per cent), and lacerations (41 per cent). Buffaloes had more abrasions (95 per cent), lacerations (57 per cent), swelling (15 per cent) and hyperkeratosis (32 per cent) compared with cattle, whereas scars (60 per cent) were more common in cattle (Ptypes of injuries were present but in different proportions. The buttock region had a higher proportion of abrasions (36 per cent) followed by the hip, hindlimb and back regions. Penetration, ulceration, bleeding and swelling were present at lower frequencies in all regions. Causes for these injuries included rubbing against the inside wall of vehicles used for transportation and stock-handler abuse (59 per cent and 13 per cent, respectively). Buffaloes sustained more transport injuries than cattle, and the number of injuries was higher in imported than local animals.

  11. Ichthyosiform sarcoidosis: report of three cases from Japan and literature review. (United States)

    Miura, Takako; Kato, Yasunobu; Yamamoto, Toshiyuki


    Cutaneous lesions of sarcoidosis present with various manifestations including specific and non-specific cutaneous lesions. Ichthyosiform sarcoidosis is a rare form of cutaneous sarcoidosis, presenting with asymptomatic, adherent, polygonal scales, mainly appearing on the lower limbs.  Ichthyosiform sarcoidosis has a predilection for dark-skinned races, and cases affecting Japanese patients have rarely been reported in English literature.  We herein describe three Japanese cases of ichthyosiform sarcoidosis on the lower limbs. All of the patients were female, with an age range of 57-69 years old.  Histologically, sarcoidal granulomas were located in the mid- to lower dermis.  All cases had scar sarcoidosis on the knees.  Furthermore, Case 1 presented with papular sarcoidosis on the back, and Case 3 presented with subcutaneous nodules on the buttock as well as erythema nodosum-like lesions on the lower legs.  All patients had lung sarcoidosis, but ocular sarcoidosis was seen in only Case 2. Case 3 showed Heerfordt syndrome with facial nerve paralysis. Histological features showed that the granular layers were scarcely detected in the overlying epidermis; however, filaggrin expression was not decreased.  Sarcoidal granulomas accumulated around the sweat glands in one case, whereas those features were not detected in the other two cases. In conclusion, ichthyosiform cutaneous sarcoidosis may be overlooked or misdiagnosed as xerotic dry skin which is frequently found in elderly people, and ichthyosiform cutaneous lesions may be more prevalent than previously estimated.

  12. Acute compartment syndrome (United States)

    Via, Alessio Giai; Oliva, Francesco; Spoliti, Marco; Maffulli, Nicola


    Summary Background: acute compartment syndrome (ACS) is one of the few true emergencies in orthopedics and traumatology. It is a painful condition caused by the increase interstitial pressure (intracompart-mental pressure – ICP) within a closed osteofascial compartment which impair local circulation. It occurs most often in the legs, but it can affects also the arms, hands, feet, and buttocks. It usually develops after a severe injury such as fractures or crush injury, but it can also occurs after a relatively minor injury and it may be iatrogenic. Uncommon causes of ACS have been also described, that suggest surgeons to pay great attention to this serious complication. Diagnosing ACS is difficult in clinical practice, even among expert surgeons. Currently, the diagnosis is made on the basis of physical examination and repeated ICP measures. ICP higher than 30 mmHg of diastolic blood pressure is significant of compartment syndrome. Once diagnosis is made, fasciotomy to release the affected compartment should be performed as early as possible because delayed decompression would lead to irreversible ischemic damage to muscles and peripheral nerves. Conclusion: acute compartment syndrome is a surgical emergency. There is still little consensus among authors about diagnosis and treatment of these serious condition, in particular about the ICP at which fasciotomy is absolutely indicated and the timing of wound closure. New investigations are needed in order to improve diagnosis and treatment of ACS. PMID:25878982

  13. Finite element modelling of human-seat interactions: vertical in-line and fore-and-aft cross-axis apparent mass when sitting on a rigid seat without backrest and exposed to vertical vibration. (United States)

    Liu, Chi; Qiu, Yi; Griffin, Michael J


    Biodynamic models representing distributed human-seat interactions can assist seat design. This study sought to develop a finite element (FE) model representing the soft tissues of the body supported by seating and the vertical in-line apparent mass and the fore-and-aft cross-axis apparent mass of the seated human body during vertical vibration excitation. The model was developed with rigid parts representing the torso segments, skeletal structures (pelvis and femurs) and deformable parts representing the soft tissues of the buttocks and the thighs. The model had three vibration modes at frequencies less than 15 Hz and provided reasonable vertical in-line apparent mass and fore-and-aft cross-axis apparent mass. The model can be developed to represent dynamic interactions between the body and a seat over a seat surface (e.g. dynamic pressure distributions and variations in seat transmissibility over the seat surface). The three-dimensional FE model of the human body represents the in-line apparent mass and cross-axis apparent mass measured on a seat. With deformable soft tissues it can assist seat design by representing dynamic human-seat interactions, such as pressure distributions and variations in seat transmissibility over a seat surface.

  14. Paraqueratose granular: relato de seis casos em crianças Granular parakeratosis: a report of six cases in children

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    Susana Giraldi


    Full Text Available A paraqueratose granular é alteração da queratinização, primeiramente descrita em adultos, caracterizada por pápulas e placas hiperqueratósicas nas áreas intertriginosas. Os autores descrevem seis casos de paraqueratose granular em crianças. Um paciente apresentava lesões nas regiões glúteas, dois em ambas as axilas e região cervical (apresentações inéditas na literatura. Três pacientes apresentavam lesões em pregas inguinais. Realizam também revisão da literatura e discutem a possível etiologia dessa rara dermatose.Granular parakeratosis is an alteration of keratinization that was first described in adults. It is characterized by hiperkeratotic plaques and papules in intertriginous areas. The authors describe six cases of granular parakeratosis in children. One patient had lesions on the buttocks; two children presented papules in both axillae and cervical region (presentations never described before in the literature. The remaining three patients presented with lesions in the inguinal folds. Review of the literature and discussion on the pathogenesis of this rare dermatosis are presented.

  15. Musculoskeletal Manifestations in Inflammatory Bowel Disease

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    Giovanni Fornaciari


    Full Text Available Muscoloskeletal manifestations are the most common extraintestinal complications of inflammatory bowel disease. Wide ranges in prevalence have been reported, depending on the criteria used to define spondylarthropathy. In 1991, the European Spondylarthropathy Study Group developed classification criteria that included previously neglected cases of undifferentiated spondylarthropathies, which had been ignored in most of the oldest epidemiological studies on inflammatory bowel disease. The spectrum of muscoloskeletal manifestations in inflammatory bowel disease patients includes all of the clinical features of spondylarthropathies: peripheral arthritis, inflammatory spinal pain, dactylitis, enthesitis (Achilles tendinitis and plantar fasciitis, buttock pain and anterior chest wall pain. Radiological evidence of sacroiliitis is common but not obligatory. The articular manifestations begin either concomitantly or subsequent to the bowel disease; however, the onset of spinal disease often precedes the diagnosis of inflammatory bowel disease. The prevalence of the different muscoloskeletal manifestations is similar in ulcerative colitis and Crohn's disease. Symptoms usually disappear after proctocolectomy. The pathogenetic mechanisms that produce the muscoloskeletal manifestations in inflammatory bowel disease are unclear. Several arguments favour an important role of the intestinal mucosa in the development of spondylarthropathy. The natural history is characterized by periods of flares and remission; therefore, the efficacy of treatment is difficult to establish. Most patients respond to rest, physical therapy and nonsteroidal anti-inflammatory drugs, but these drugs may activate bowel disease. Sulphasalazine may be recommended in some patients. There is no indication for the systemic use of steroids.

  16. Lumbopelvic dysfunction and stress urinary incontinence: a case report applying rehabilitative ultrasound imaging. (United States)

    Painter, Elizabeth E; Ogle, Melissa D; Teyhen, Deydre S


    Case report. It has been suggested that altered neuromuscular control of the transversus abdominis and pelvic floor muscles may contribute to sacroiliac joint (SIJ) region pain and stress urinary incontinence. There are limited examples describing the evaluation and management of individuals with both SIJ region pain and stress urinary incontinence in the literature. This case report describes a patient with both conditions and details the integration of rehabilitative ultrasound imaging (RUSI) during physical therapy evaluation. 6 A 35-year-old female soldier presented with a 6-week history of left buttock pain and 4-year history of stress urinary incontinence during activities that involved running, jumping, and fast walking. RUSI was used to supplement the physical assessment process, revealing altered motor control strategies of the transversus abdominis and pelvic floor muscles, and as a form of biofeedback during the rehabilitation process. After completing a rehabilitation program that incorporated principles of lumbar stabilization and pelvic floor muscle re-education, this patient was able to complete all physical activities in basic combat training without SIJ region pain or urinary leakage. This case demonstrates the importance of considering pelvic floor muscle dysfunction and training in a patient with primary complaints of SIJ region pain. It also highlights the potential role of RUSI as both an evaluation and biofeedback tool for the deep abdominal and pelvic floor muscles.

  17. Familial disseminated cutaneous glomuvenous malformation: Treatment with polidocanol sclerotherapy

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    Aditi Jha


    Full Text Available Glomuvenous malformations (GVMs present as asymptomatic multiple pink-to-blue nodules or plaques. Disseminated lesions are rare, representing 10% of all the cases. Familial cases are caused by mutations in the glomulin gene. A young male presented with multiple bluish-to-dusky red-coloured nodules 10-15 in numbers over the trunk, limbs and buttocks since 12 years of age. They ranged in size from 1 to 3 cm, partially to non-compressible and tender on palpation. There was no history of any systemic complaint. His sister and mother had similar lesions but in a limited distribution. Biopsy showed multiple ectatic dilated vascular channels lined by multiple layers of glomus cells consistent with the diagnosis of GVM. The biopsy of the lesions from the mother and sister also showed similar features. Mutation analysis for glomulin gene could not be done because of the unavailability of the facility at our setting. He underwent sclerotherapy with 3% polidocanol every 2 weeks, and there was significant improvement in the lesions after six sessions of sclerotherapy. The patient is under follow-up and there is no recurrence of the lesions over treated sites after 6 months.

  18. Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3-4 fixation. (United States)

    Kwon, Yoon-Kwang; Jang, Ju-Hee; Lee, Choon-Dae; Lee, Sang-Ho


    Many studies attest to the excellent results achieved using anterior lumbar interbody fusion (ALIF) for degenerative spondylolisthesis. The purpose of this report is to document a rare instance of L-4 vertebral body fracture following use of a stand-alone interbody fusion device for L3-4 ALIF. The patient, a 55-year-old man, had suffered intractable pain of the back, right buttock, and left leg for several weeks. Initial radiographs showed Grade I degenerative spondylolisthesis, with instability in the sagittal plane (upon 15° rotation) and stenosis of central and both lateral recesses at the L3-4 level. Anterior lumbar interbody fusion of the affected vertebrae was subsequently conducted using a stand-alone cage/plate system. Postoperatively, the severity of spondylolisthesis diminished, with resolution of symptoms. However, the patient returned 2 months later with both leg weakness and back pain. Plain radiographs and CT indicated device failure due to anterior fracture of the L-4 vertebral body, and the spondylolisthesis had recurred. At this point, bilateral facetectomies were performed, with reduction/fixation of L3-4 by pedicle screws. Again, degenerative spondylolisthesis improved postsurgically and symptoms eased, with eventual healing of the vertebral body fracture. This report documents a rare instance of L-4 vertebral body fracture following use of a stand-alone device for ALIF at L3-4, likely as a consequence of angular instability in degenerative spondylolisthesis. Under such conditions, additional pedicle screw fixation is advised.

  19. Superior Cluneal Nerve Entrapment Neuropathy and Gluteus Medius Muscle Pain: Their Effect on Very Old Patients with Low Back Pain. (United States)

    Kokubo, Rinko; Kim, Kyongsong; Isu, Toyohiko; Morimoto, Daijiro; Iwamoto, Naotaka; Kobayashi, Shiro; Morita, Akio


    In the very elderly, their general condition and poor compliance with drug regimens can render the treatment of low back pain (LBP) difficult. We report the effectiveness of a less-invasive treatment for intractable LBP from superior cluneal nerve entrapment neuropathy (SCN-EN) and gluteus medius muscle (GMeM) pain. Between April 2013 and March 2015, we treated 17 consecutive elders with LBP, buttock pain, and leg pain. They were 4 men and 13 women ranging in age from 85 to 91 years (mean 86.6 years). We carefully ascertained that their symptoms were attributable to SCN-EN and GMeM pain. The median follow-up period was 21.5 ± 12.2 months (range 2-35 months). SCN-EN was diagnosed in 15 patients (28 sites) and GMeM pain in 14 (27 sites). In 5 patients, we obtained symptom control by local block (Numerical Rating Scale for LBP: declined from 7.8 to 0.8 [P pain postoperatively, they subsequently underwent peroneal nerve neurolysis and surgery for tarsal tunnel syndrome. These treatments resulted in significantly symptom abatement (Numerical Rating Scale: from 8.2 to 1.7, Roland-Morris Disability Questionnaire score: from 12.8 to 8.6; P pain, and leg pain due to SCN-EN or GMeM pain can be treated successfully by peripheral block and less-invasive surgery under local anesthesia. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Ultrasonography and computed tomography for diagnosis and follow-up of pelvic rhabdomyosarcomas in children

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    Geoffray, A.; Couanet, D.; Montagne, J.P.; Leclere, J.; Flamant, F.


    The authors report 18 cases of pelvic rhabdomyosarcomas in children examined at presentation and followed on US and CT. There were 11 boys, 7 girls; tumor location was bladder, prostate or uterus in 12, perineum in 4, buttock in 2. US is good to define tumoral extension within the bladder CT is better to delineate the extension outside the bladder and regional spread to iliac nodes. CT is the only useful examination for perineal tumors. During chemotherapy US can be frequently repeated to appreciate tumoral regression and to give measurement of the mass. Preoperative CT should be performed when tumoral regression seems sufficient to permit complete tumoral excision without pelvic exanteration. Correlation between US and CT and surgical findings proved to be good. US and CT are also very useful in the follow-up when the child has finished treatment as it can demonstrate a local recurrence before clinical symptoms appear. However, post-surgical and post-radiation changes may be difficult to recognize. These aspects are discussed.

  1. Necrotizing fasciitis : plain radiographic and CT findings

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    Lee, Chang Dae; Park, Jeong Hee; Jeon, Hae Jeong; Lim, Jong Nam; Heo, Tae Haeng; Park, Dong Rib [Konkuk Univ. College of Medicine, Seoul (Korea, Republic of)


    To evaluate the plain radiographic and CT findings of the necrotizing fasciitis. We retrospectively reviewed the radiologic findings of 4 cases with necrotizing fasciitis. Three cases were proven pathologically. We evaluated pattern and extent of the gas shadows in plain films. CT findings were analysed, with emphasis on : (a) gas pattern, (b) extent, (c) location and involved site, (d) associated focal abscess, and (e) swelling of the adjacent muscles. On plain radiographs, four cases showed streaky or mottled gas densities in the pelvis, three cases in the perineum, one case in the abdomen, and two cases in the thigh. On CT images, gas pattern was mottled and streaky appearance with swelling of the adjacent muscles. Gas shadows located in the extraperitoneal space in four cases, fascial layer in four cases, and subcutaneous layer in four cases. There were gas shadows in pelvic wall, perineum, abdominal wall, buttock, thigh, and scrotum. Focal low density lesion suggestive of focal abscess was not visualized. Plain radiography is useful for early diagnosis of the necrotizing fasciitis and CT is very useful for detection of precise location and extent of the disease. CT is also useful for differentiation of necrotizing fasciitis from focal abscess and cellulitis.

  2. Symptomatic sacroiliac joint disease and radiographic evidence of femoroacetabular impingement. (United States)

    Morgan, Patrick M; Anderson, Anthony W; Swiontkowski, Marc F


    Symptomatic sacroiliac (SI) joint disease is poorly understood. The literature provides no clear aetiology for SI joint pathology, making evaluation and diagnosis challenging. We hypothesised that patients with documented sacroiliac pain might provide insight into the aetiology of these symptoms. Specifically, we questioned whether SI joint symptoms might be associated with abnormal hip radiographs. We reviewed the pelvic and hip radiographs of a prospectively collected cohort of 30 consecutive patients with SI joint pathology. This database included 33 hips from 30 patients. Radiographic analysis included measurements of the lateral centre edge angle, Tönnis angle, and the triangular index, of the ipsilateral hip. Evidence for retrotorsion of the hemipelvis was recorded. Hips were graded on the Tönnis grading system for hip arthrosis. In this cohort 14/33 (42%) of hips had evidence of significant osteoarthrosis indicated by Tönnis grade 2 or greater and 15/33 (45%) displayed subchondral cyst formation around the hip or head neck junction. In assessing acetabular anatomy, 21% (7/33) had retroversion, 12% (4/33) had a lateral centre edge angle >40° with 3% (1/33) >45°. Tönnis angle was arthrosis. The clinician should maintain FAI in the differential diagnosis when investigating patients with buttock pain.

  3. Nutcracker syndrome: A rare cause of left flank pain that can also manifest as unexplained pelvic pain. (United States)

    Berthelot, Jean-Marie; Douane, Frédéric; Maugars, Yves; Frampas, Eric


    Nutcracker syndrome (NCS) is symptomatic unilateral renal venous hypertension due to compression of the left renal vein between the superior mesenteric artery and aorta (anterior NCS) or between the aorta and spine (posterior NCS). The left ovarian or spermatic vein empties into the left renal vein and is an additional site of venostasis in about half the cases of NCS. The presenting symptom of NCS in about half the cases is atypical left flank pain suggesting a disorder of the lower ribs or thoracolumbar spinal junction, particularly as the pain worsens with standing and increased lumbar lordosis. NCS may be suggested by any combination of the following manifestations: hematuria, which is often only microscopic; orthostatic proteinuria; varicocele and infertility; dyspareunia and other gynecological symptoms; varicose veins in the pelvis, buttocks, or upper thighs; orthostatic hypotension and fatigue; and abdominal pain. Narrowing of the left renal vein on imaging studies is required but far from sufficient to establish the diagnosis. Several converging clinical findings and a marked pressure gradient between the left renal vein and inferior vena cava must be present also. Urological procedures and vascular surgery are being superseded by endovascular stenting with or without simultaneous treatment of the acquired gonadal vein insufficiency by embolization. Copyright © 2016 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  4. Chediak-Higashi: a case report

    Directory of Open Access Journals (Sweden)

    A Paymard


    Full Text Available Background & aim: Chédiak–Higashi syndrome, a rare autosomal recessive disorder characterized by immune deficiency, bleeding diathesis, recurrent bacterial infections, albinism dynamic and progressive neurological disorder, as well as major organs such as the liver and spleen lymphocytic infiltration is determined. The aim of this study was to report a case of a rare manifestation of the disease. Case Report: The case-study in the present report was a 4-month-old female that two months after vaccination had intermittent fever associated with fever, weakness, which lasted more than a week. After blood tests, ultrasound and examination of blood cells, Chédiak–Higashi syndrome diagnosis was made. In terms of blood cells, pancytopenia, platelets and fresh frozen plasma were administered to the patient to prevent bleeding. After Buttock infections, the patient was suffering from septicemia and septic shock followed by a lack of response to resuscitation and cardiopulmonary arrest and then died. Conclusion: In this patient all Chediak Higashi syndrome, including long fever, loss of appetite, frequent infections, albinism variable and multiple neurological deficit was seen. Chdyak Higashi syndrome is treatable with early diagnosis and bone marrow transplantation.

  5. Arctic climate threat - methane from thawing permafrost; Klimazeitbombe Permafrost

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    Walter Anthony, Katey [Alaska Univ., Fairbanks, AK (United States). Water and Environmental Research Center


    Arctic permafrost is already thawing, creating lakes that emit methane. The heat-trapping gas could dramatically accelerate global warming. How big is the threat? What can be done? Touchdown on the gravel runway at Cherskii in remote northeastern Siberia sent the steel toe of a rubber boot into my buttocks. The shoe had sprung free from gear stuffed between me and my three colleagues packed into a tiny prop plane. This was the last leg of my research teams five-day journey from the University of Alaska Fairbanks across Russia to the Northeast Science Station in the land of a million lakes, which we were revisiting as part of our ongoing efforts to monitor a stirring giant that could greatly speed up global warming. These expeditions help us to understand how much of the perennially frozen ground, known as permafrost, in Siberia and across the Arctic is thawing, or close to thawing, and how much methane the process could generate. The question grips us and many scientists and policy makers because methane is a potent greenhouse gas, packing 25 times more heating power, molecule for molecule, than carbon dioxide. (orig.)

  6. Magnetic resonance-guided focused ultrasound surgery using an enhanced sonication technique in a pig muscle model

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    Kopelman, Doron [Department of Surgery B, ' HaEmek' Medical Center, Afula, and Technion, Israel Institute of Technology, Haifa (Israel)]. E-mail:; Inbar, Yael [Department of Diagnostic Imaging and Focused Ultrasound Treatment Center, Sheba Medical Center, Tel-Hashomer (Israel); Hanannel, Arik [InSightec Ltd., Haifa (Israel); Freundlich, David [InSightec Ltd., Haifa (Israel); Vitek, Shuki [InSightec Ltd., Haifa (Israel); Schmidt, Rita [InSightec Ltd., Haifa (Israel); Sokolov, Amit [InSightec Ltd., Haifa (Israel); Hatoum, Ossama A. [Department of Surgery B, ' HaEmek' Medical Center, Afula, and the Technion, Israel Institute of Technology, Haifa (Israel); Rabinovici, Jaron [Department of Gynecology and Obstetrics, Sheba Medical Center, Tel-Aviv University, Tel-Hashomer (Israel)


    The purpose of this study: To evaluate the safety and efficacy of an enhanced magnetic resonance-guided focused ultrasound (MRgFUS) emission protocol that results in more extensive treatment by increasing the volume of each focal ablation using the same energy. Materials and methods: Six pigs were treated with an MRgFUS system combined with real-time MR, for imaging and temperature mapping, with 102 'enhanced' and 97 'regular' focal ablations performed on both buttock muscles. Real-time imaging, temperature mapping, and acoustic reflected spectrum data enabled immediate evaluation of the results. MR contrast-enhanced images and pathology examinations were used for confirmation. Results: The location of the ablated volume by 'enhanced' sonication is predictable, with a maximum possible shift of 6 mm toward, and 3 mm away, from the transducer. The ablated volume after enhanced sonication was, on average, 1.8 times larger than after a regular sonication of the same energy. Pathology results showed the same thermally induced damage patterns in the enhanced sonications and the regular sonications. Conclusion: Accelerated MRgFUS with enhanced sonication is a safe, controllable, and more effective tissue ablative modality than standard sonication. This new technology may significantly reduce the length of tumor ablation procedures. (Isn't the new technology you're talking about MRgFUS? If so, you don't need to repeat it at the end of this sentence.)

  7. Genital Herpes: A Review. (United States)

    Groves, Mary Jo


    Genital herpes is a common sexually transmitted disease, affecting more than 400 million persons worldwide. It is caused by herpes simplex virus (HSV) and characterized by lifelong infection and periodic reactivation. A visible outbreak consists of single or clustered vesicles on the genitalia, perineum, buttocks, upper thighs, or perianal areas that ulcerate before resolving. Symptoms of primary infection may include malaise, fever, or localized adenopathy. Subsequent outbreaks, caused by reactivation of latent virus, are usually milder. Asymptomatic shedding of transmissible virus is common. Although HSV-1 and HSV-2 are indistinguishable visually, they exhibit differences in behavior that may affect management. Patients with HSV-2 have a higher risk of acquiring human immunodeficiency virus (HIV) infection. Polymerase chain reaction assay is the preferred method of confirming HSV infection in patients with active lesions. Treatment of primary and subsequent outbreaks with nucleoside analogues is well tolerated and reduces duration, severity, and frequency of recurrences. In patients with HSV who are HIV-negative, treatment reduces transmission of HSV to uninfected partners. During pregnancy, antiviral prophylaxis with acyclovir is recommended from 36 weeks of gestation until delivery in women with a history of genital herpes. Elective cesarean delivery should be performed in laboring patients with active lesions to reduce the risk of neonatal herpes.

  8. Capillary-lymphatic malformation, kaposiform hemangioendothelioma and delayed Kasabach-Merritt phenomenon. (United States)

    del Pozo, Jesús; López-Gutiérrez, Juan Carlos; Gómez-Tellado, Manuel; Nistal, Manuel; Soler, Rafaela; Sacristán, Felipe; Tovar, J A


    According to International Society for the Study of Vascular Anomalies classification, vascular anomalies are mainly divided into two groups: vascular tumors and vascular malformations. Nevertheless, a small group of patients present clinical and/or histopathologic overlapping features. We report a case of a 4-month-old boy that presented a vascular lesion on his right buttock with involvement of abdominal wall muscles, abdominal cavity and drainage to primitive iliac by a tortuous drainage vein. Surgery was performed and histopathology demonstrated a combined vascular malformation. Six months later he developed a thrombocytopenia and repeat magnetic resonance imaging revealed a new solid mass involving the majority of the abdominal cavity. At 18 months of age the patient developed a Kasabach-Merrit phenomenon and treatment with vincristine, interferon and then acetyl-salicilic acid and dypiridamol was started. No response in platelet counts was obtained and one more surgery was perfomed. On this occasion a histopathologic study revealed vascular malformation areas intermingled with areas of kaposiform hemangioendothelioma. This patient demonstrates the Kasabach-Merritt phenomenon with kaposiform hemangioendothelioma arising within a pre-existing combined vascular malformation. © 2010 Wiley Periodicals, Inc.

  9. Early diagnosis of congenital vascular malformation as a condition to rapid prevention of complications – case study

    Directory of Open Access Journals (Sweden)

    Dominika Jaguś


    Full Text Available Klippel–Trénaunay syndrome is a rare congenital condition characterised by a triad of symptoms: capillary-lymphatic-venous malformations, varicose veins and venous malformations as well as soft tissue and skeletal hypertrophy of the affected limb. In this article, we present a case of a 5-year-old boy with extensive vascular malformations of the lower limbs and the buttock region. In this case, manifestation of all three symptoms was gradual. At the age of 4 years, the patient was admitted to the Department of Imaging Diagnostics for further diagnosis, where the triad characteristic for Klippel–Trénaunay syndrome and popliteal vein agenesis were diagnosed. Currently, a multidisciplinary team takes care of the boy in the Children’s Memorial Health Institute. Early and accurate diagnosis allows for rapid prevention of complications associated with Klippel–Trénaunay syndrome and enables patient-tailored treatment.

  10. Association of microcephaly and cafe-au-lait spots in a patient with ring chromosome 12 syndrome. (United States)

    Zen, P R G; Pinto, L L C; Graziadio, C; Pereira, V B; Paskulin, G A


    We describe a patient who was evaluated because of delayed development. The patient had microcephaly and cafe-au-lait spots and the facial features included upward slanting of the palpebral fissures, short nasal bridge and a highly arched palate. In addition the external ears had bilateral over folded helices, there was clinodactyly of the fourth and fifth fingers and multiple cafe-au-lait spots on the back, buttocks and thighs. Chromosomal analysis of peripheral blood showed 46,XY,-r(12)(p13.3q24.33)[73]/45,XY,-12[8]/47,XY,r(12)(p13.3q24.33),+r(12)(p13.3q24.33)[2]. This is the eighth case of a patient with a ring chromosome 12 to be reported so far. The similarity of our patient to those previously described suggests that the ring chromosome 12 syndrome can be delineated as a distinct entity with characteristic clinical features.

  11. TexiCare: an innovative embedded device for pressure ulcer prevention. Preliminary results with a paraplegic volunteer. (United States)

    Chenu, Olivier; Vuillerme, Nicolas; Bucki, Marek; Diot, Bruno; Cannard, Francis; Payan, Yohan


    This paper introduces the recently developed TexiCare device that aims at preventing pressure ulcers for people with spinal cord injury. This embedded device is aimed to be mounted on the user wheelchair. Its sensor is 100% textile and allows the measurement of pressures at the interface between the cushion and the buttocks. It is comfortable, washable and low cost. It is connected to a cigarette-box sized unit that (i) measures the pressures in real time, (ii) estimates the risk for internal over-strains, and (iii) alerts the wheelchair user whenever necessary. The alert method has been defined as a result of a utility/usability/acceptability study conducted with representative end users. It is based on a tactile-visual feedback (via a watch or a smartphone for example): the tactile modality is used to discreetly alarm the person while the visual modality conveys an informative message. In order to evaluate the usability of the TexiCare device, a paraplegic volunteer equipped his wheelchair at home during a six months period. Interestingly, the first results revealed bad habits such as an inadequate posture when watching TV, rare relief maneuvers, and the occurrence of abnormal high pressures. Copyright © 2013 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  12. The life cycle of bruises in older adults. (United States)

    Mosqueda, Laura; Burnight, Kerry; Liao, Solomon


    To summarize the occurrence, progression, and resolution of accidentally acquired bruises in a sample of adults aged 65 and older. The systematic documentation of accidentally occurring bruises in older adults could provide a foundation for comparison when considering suspicious bruising in older adults. Between April 2002 and August 2003, a convenience sample of 101 seniors was examined daily at home (up to 6 weeks) to document the occurrence, progression, and resolution of accidental bruises that occurred during the observation period. Three community-based settings and two skilled nursing facilities in Orange County, California. One hundred one adults aged 65 and older (mean age=83). Age, sex, ethnicity, functional status, handedness, medical conditions, medications, cognitive status, depression, history of falls, bruise size, bruise location, initial bruise color, color change over time. Nearly 90% of the bruises were on the extremities. There were no bruises on the neck, ears, genitalia, buttocks, or soles of the feet. Subjects were more likely to know the cause of the bruise if the bruise was on the trunk. Contrary to the common perception that yellow coloration indicates an older bruise, 16 bruises were predominately yellow within the first 24 hours after onset. People on medications known to affect coagulation pathways and those with compromised function were more likely to have multiple bruises. Accidental bruises occur in a predictable location pattern in older adults. One cannot reliably predict the age of a bruise by its color.

  13. Online Female Escort Advertisements

    Directory of Open Access Journals (Sweden)

    James D. Griffith


    Full Text Available Female escorts represent an occupational group that charges a fee for sex, which can be regarded as an extreme form of short-term mating. The present study examined if the fees charged by escorts are related to traits typically associated with female short-term mate value. A total of 2,925 advertisements for female escorts offering sexual services in the United States were examined, as a customized software program was used to download all the advertisements from an online escort directory. The advertisement content was coded, and relationships between advertised physical characteristics and the hourly rate charged by female escorts were examined. The analyses showed that higher fees were associated with female escorts who advertised a waist-to-hip ratio near 0.7, lower weight and body mass index, younger age, and photographic displays of breast and buttocks nudity. The findings provide evidence that evolutionarily relevant traits associated with female short-term mate value are systematically related to fees charged for sexual services.

  14. Radiculopathy due to microfibrillar collagen hemostat mimicking recurrence of disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Doita, M.; Nishida, K.; Kurosaka, M. [Kobe University Graduate School of Medicine, Department of Orthopedic Surgery, Kobe (Japan)


    Microfibrillar collagen hemostat (Avitene) is an absorbable topical hemostatic agent prepared from purified bovine corium collagen. A 65-year-old woman presented with left buttock and lower extremity radicular pain. The patient underwent a disc excision in which Avitene was used to control venous bleeding from the epidural space. Leg pain decreased postoperatively, but she developed radicular pain when she started walking 3 days after the operation. Magnetic resonance imaging (MRI) performed post-operatively showed there was a mass lesion located between the dural sac and L5 nerve root. The lesion exhibited high signal intensity on T1-weighted images and higher signal intensity at the rim of the mass on T2-weighted images. A second operation performed 10 days later revealed that the nerve root was adherent to an extradural granulomatous mass associated with Avitene. Macroscopically, the resected mass was found to be composed mainly of microfibrillar collagen hemostat materials. Hemostat agents may produce a clinically symptomatic, radiologically apparent mass lesion. When considering a mass lesion arising after spine surgery, the differential diagnosis should include foreign body granuloma along with recurrent disc herniation and peridural scar formation. (orig.)

  15. Fractionated laser resurfacing corrects the inappropriate UVB response in geriatric skin. (United States)

    Spandau, Dan F; Lewis, Davina A; Somani, Ally-Khan; Travers, Jeffrey B


    Non-melanoma skin cancer is a disease primarily afflicting geriatric patients as evidenced by the fact that 80% of all non-melanoma skin cancers are diagnosed in patients over the age of 60 years. As such, geriatric skin responds to cancer-inducing UVB irradiation in a manner that allows the establishment of tumor cells. Currently, the only effective treatment for non-melanoma skin cancer is the removal of the tumors after they appear, indicating the need for a more cost-effective prophylactic therapy. Geriatric volunteers were treated with fractionated laser resurfacing therapy on either sun-protected (upper buttocks) or chronically sun-exposed (dorsal forearm) skin. Fractionated laser resurfacing therapy was shown to decrease the occurrence of senescent fibroblasts in geriatric dermis, increase the dermal expression of IGF-1, and correct the inappropriate UVB response observed in untreated geriatric skin. These responses to fractionated laser resurfacing were equal to the effects seen previously using the more aggressive wounding following dermabrasion. Furthermore, fractionated laser resurfacing was equally effective in both sun-protected and sun-exposed skin. The ability of fractionated laser resurfacing treatment to protect against the occurrence of UVB-damaged proliferating keratinocytes indicates the potential of fractionated laser resurfacing to reduce or prevent aging-associated non-melanoma skin cancer.

  16. Tarlov Cyst Causing Sacral Insufficiency Fracture. (United States)

    Puffer, Ross C; Gates, Marcus J; Copeland, William; Krauss, William E; Fogelson, Jeremy


    Tarlov cysts, also known as perineural cysts, have been described as meningeal dilations of the spinal nerve root sheath between the peri- and endoneurium at the dorsal root ganglion. Most often they are found in the sacrum involving the nerve roots. Normally asymptomatic, they have been reported to present with radiculopathy, paresthesias, and even urinary or bowel dysfunction. Sacral insufficiency has not been a well-documented presentation. The patient is a 38-year-old female who started to develop left low back pain and buttock pain that rapidly progressed into severe pain with some radiation down the posterior aspect of her left leg. There was no recent history of spine or pelvic trauma. These symptoms prompted her initial emergency department evaluation, and imaging demonstrated a large Tarlov cyst with an associated sacral insufficiency fracture. She was noted to have a normal neurological examination notable only for an antalgic gait. She was taken to surgery via a posterior approach and the cyst was identified eccentric to the left. The cyst was fenestrated and the nerve roots identified. Given her large area of bone erosion and insufficiency fractures, fixation of the sacroiliac joints was deemed necessary. Fusion was extended to the L5 vertebral body to buttress the fixation. She tolerated the procedure well and was discharged from the hospital on postoperative day 3. Tarlov cysts of the sacrum can lead to significant bone erosion and subsequent insufficiency fractures, requiring fenestration and in some cases, complex sacropelvic fixation.

  17. Surgical excision of symptomatic sacral perineurial Tarlov cyst: case series and review of the literature. (United States)

    Elsawaf, Ahmed; Awad, Tariq Elamam; Fesal, Salem S


    Symptomatic sacral perineural cysts are extremely rare. The aim of this retrospective study is to investigate the outcome of 15 consecutive patients treated by microsurgical resection of the cyst and to review the literature. The authors retrospectively reviewed their clinical data archive from 2002 to 2014. Fifteen patients who were operated on due to symptomatic sacral perineural cysts were enrolled in the study. Patients' symptoms, radiographs, intra-operative findings, and clinical results were evaluated. All 15 patients underwent microsurgical excision of the cyst. The literature on this topic available in PubMed was also reviewed. There were 5 men and 10 women included in the study, with a mean age of 31 years (range 7-60 years). Preoperative symptoms include low back pain, coccydynia, buttock pain, perianal pain and radicular pain. All of the patients underwent surgical resection. The mean follow-up was 54 months (range 3-160 months). All the patients experienced complete or substantial resolution of the preoperative local and radicular pain after surgery. Cyst excision is an effective and safe technique for symptomatic sacral perineural (Tarlov) cysts. Careful patient selection is vital to the management and treatment of this difficult and controversial pathology.

  18. Imaging of hibernomas: A retrospective study on twelve cases

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    Papathanassiou Zafiria G


    Full Text Available Abstract Background To analyze the imaging features of hibernomas on computed tomography (CT and magnetic resonance (MRI. Methods Twelve hibernomas were retrospectively assessed with CT and MR imaging and compared to the histology of the specimen Results Nine females and three males with a mean age of 30 years were included. Ten tumors occurred in the thigh and two affected the subcutis of the periscapular and buttock regions. On eight CT scans, seven (87,5% lesions were homogeneous and mildly to moderately hyperdense compared to subcutaneous fat while one lesion was heterogeneous with mixed hypo and hyperattenuating areas. On six T1W images, five (83,3% lesions appeared homogeneous and hypointense relative to subcutaneous fat and one was heterogeneous. Incomplete fat suppression was depicted in all cases. All lesions displayed marked enhancement. Large intratumoral vessels were depicted in three of the 12 (25% cases. Septations were depicted on four of the eight unenhanced CT and on all six MRI examinations. Conclusions Hibernoma usually appears hypodense and hypointense relative to subcutaneous fat on pre-contrast CT and MR T1W with variable enhancement patterns and incomplete fat suppression on STIR or fat-saturated sequences. These characteristics relate directly to the presence of brown fat. However, atypical findings such as heterogeneous patterns of mixed fatty and non fatty components on unenhanced CT and MR T1W can be also encountered. Absence of large intratumoral vessels should not exclude hibernomas from the differential diagnosis of regional lipomatous tumors.

  19. Central nervous system manifestation and CT findings of Fabry's disease. Case report

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    Toyonaga, Kazutaka; Nishihira, Takeo (Okinawa Central Hospital (Japan))


    A case of Fabry's disease with central nervous system dysfunction is reported. This 27-year-old man had recurrent episodes of pains in the extremities when he was a child. Spontaneous clinical remission occured around puberty. He had been well until age 22 when he experienced transient weakness of the left arm. The following year he developed transient blindness of the right eye. Then, he developed weakness in the extremities, dysphagia, dysarthria, and was brought to the hospital in unconscious state. Several members of his family are affected with the same disease presenting leg pains, kidney disease and angiokeratoma. Physical examination disclosed an optic atrophy, pseudobulbar palsy with spastic weakness in the all extremities and multiple angiokeratoma in the flank, buttocks and thighs. Abnormal laboratory findings included leukocytosis, increased ESR and strongly positive CRP. Biopsy of the skin disclosed dilated capilaries with numerous vacuoles in the cytoplasm of the epithelial cells. Thin-layer chromatography of the urine sediment showed a marked increase in ceramide trihexoside. Leukocyte alphagalactosidase level was abnormally low. CT scan showed diffuse cerebral atrophy and multiple low density areas in the thalamus, ventral pons and centrum semiovale. The CT findings and possible mechanism of the response to predonisolone were also discussed.

  20. Gluteal Compartment Syndrome following an Iliac Bone Marrow Aspiration

    Directory of Open Access Journals (Sweden)

    Edmundo Berumen-Nafarrate


    Full Text Available The compartment syndrome is a condition characterized by a raised hydraulic pressure within a closed and non expandable anatomical space. It leads to a vascular insufficiency that becomes critical once the vascular flow cannot return the fluids back to the venous system. This causes a potential irreversible damage of the contents of the compartment, especially within the muscle tissues. Gluteal compartment syndrome (GCS secondary to hematomas is seldom reported. Here we present a case of a 51-year-old patient with history of a non-Hodgkin lymphoma who underwent a bone marrow aspiration from the posterior iliac crest that had excessive bleeding at the puncture zone. The patient complained of increasing pain, tenderness, and buttock swelling. Intraoperative pressure validation of the gluteal compartment was performed, and a GCS was diagnosed. The patient was treated with a gluteal region fasciotomy. The patient recovered from pain and swelling and was discharged shortly after from the hospital. We believe clotting and hematologic disorders are a primary risk factor in patients who require bone marrow aspirations or biopsies. It is important to improve awareness of GCS in order to achieve early diagnosis, avoid complications, and have a better prognosis.

  1. [Acute and overuse injuries in elite paracycling - an epidemiological study]. (United States)

    Kromer, P; Röcker, K; Sommer, A; Baur, H; Konstantinidis, L; Gollhofer, A; Südkamp, N P; Hirschmüller, A


    Although paracycling is a growing discipline in high level competitive sports as well as in posttraumatic rehabilitation, epidemiological data of resulting injuries is still missing. Therefore, 19 athletes of the German national paracycling team were asked about their injuries during the 2008 season using a standardized questionnaire. Overall, 18 (94.7 %) of 19 athletes reported overuse injuries; most commonly localized at the back (83.3 %), neck/shoulder (77.8 %), knee (50 %), groin/buttock (50 %) and hands/wrists (38.9 %). Altogether, 18 accidents were registered, corresponding to an injury rate of 0,95 acute injuries per athlete per year (0,07 / 1000 km). The most common acute injuries were abrasions (69.2 %) and contusions (61.5 %), whereas fractures were stated only twice (11.8 %). The anatomical distribution of overuse injuries in disabled cyclists confirms the results of studies in able-bodied cycling, although the incidences in low-back pain and neck/shoulder pain is clearly higher in disabled cycling, as well as the rate of traumatic injuries. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Differences from gender about the impact of Eating Behaviour Disorder on personality factors of students at secondary level

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    Full Text Available This paper tries to know the obsession for the thinness or incessant search of the thinness, as essential characteristic of eating Disorders, verify if significant differences exist according to the sex, to analyze the trend of students to have thoughts or to give them heavy meals –or gluttonies– uncontrollable, and verify the degree of dissatisfaction with the general form of their body or with the parts of the same one that more worried those who suffer eating Disorders (stomach, hips, thighs, buttocks, etc. For it, we have used an eclectic methodology. The samples of students who have done the test EPQ-J is 700. The students analyzed in the sample show lacks in some areas at the personal level that they exhibit to suffer an eating Disorders. There would be necessary to underline that, with regard to the «emocionalidad», 7.73% of the men and 9.63% of the women prove to be anxious, worried, with fast changes of humor, frequently depressed, they sleep badly, etc., obtaining their representation, at the age of 13. There has been verified that, 12.26% of the males and 6.85% of the women are unsatisfied with their own body.

  3. Body image in obese children: Effects produced by physical exercise program

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    E. Romero


    Full Text Available Body image self-perception in obese children is important since it can encourage behaviors leading to social isolation and cause an increase in food intake. The objective of this study was to determine the changes produced in the level of body image satisfaction and the variation in anthropometric indicators of young children in the State of Sonora, Mexico after participating in a program of 40 sessions of physical exercise with an average caloric expenditure of 267 Kcal per session. 119 children were enrolled in the program; they were between the ages of 8 and 11 with a body mass index (BMI of 26.59 ± 4.2 (kg/m2. They were evaluated before and after the physical activity intervention by means of a Body Image Satisfaction (BIS Test. The results with significant changes (p ≤ 0.05 between the pre-test and post-test are in weight and height. There are also significant changes observed in self-image in 15 parts of evaluated body segments, mainly in the abdomen, chest, thighs, buttocks, waist, and hips in all children from the experimental group. The results conclude that physical exercise, in spite of not producing significant changes in BMI, can positively modify body image perception.

  4. [On Liu qin xi (six animal frolics) in Huai nan zi (Discourses of Master Huainanzi)]. (United States)

    Sun, Xiaozhong


    The six styles of the art of Daoyin recorded in Liu An's Huai nan zi (Discourses of Master Huainanzi) of the Western Han Dynasty was called the Liu qin xi which was simplified from the complicated ancient Daoyin art of bionic practice imitating the movements of six kinds of animal. Among them, the "xiong jing"imitates the erecting walking style of a bear so as to strengthen the waist and lower extremities; the "niao shen"follows the spreading of wings of a bird so as to extend the arms and legs, to train the shoulders and extremities; the "fu yu"imitates the movements of swimming and moving head of a wild duck so as to train the head and neck; the "yuan jue"imitates the jumping of a monkey among the tree branches so as to train the legs and waist; the "chi shi"imitates the streching neck movements of an eagle so as to strengthen the neck and improvement of vision; while the "hu gu"imitates the movement of turning head of a tiger so as to train one's nape and the buttock.

  5. Multidisciplinary Management of a Giant Plexiform Neurofibroma by Double Sequential Preoperative Embolization and Surgical Resection

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    Roberto Vélez


    Full Text Available Plexiform neurofibromas are benign tumors originating from subcutaneous or visceral peripheral nerves, which are usually associated with neurofibromatosis type 1. Giant neurofibromas are very difficult to manage surgically as they are extensively infiltrative and highly vascularized. These types of lesions require complex preoperative and postoperative management strategies. This case report describes a 22-year-old female with a giant plexiform neurofibroma of the lower back and buttock who underwent pre-operative embolization and intraoperative use of a linear cutting stapler system to assist with haemostasis during the surgical resection. Minimal blood transfusion was required and the patient made a good recovery. This case describes how a multidisciplinary management of these large and challenging lesions is technically feasible and appears to be beneficial in reducing perioperative blood loss and morbidity. Giant neurofibroma is a poorly defined term used to describe a neurofibroma that has grown to a significant but undefined size. Through a literature review, we propose that the term “giant neurofibroma” be used for referring to those neurofibromas weighing 20% or more of the patient's total corporal weight.

  6. Measurement of intraperitoneal volume by segmental bioimpedance analysis during peritoneal dialysis. (United States)

    Zhu, Fansan; Hoenich, Nicholas A; Kaysen, George; Ronco, Claudio; Schneditz, Daniel; Murphy, Lola; Santacroce, Sally; Pangilinan, Amy; Gotch, Frank; Levin, Nathan W


    Currently, ultrafiltration during peritoneal dialysis is determined from direct measurement of weight differences between the initial filling and final draining volumes. A new technique based on segmental bioimpedance analysis (SBIA) has been developed to accurately measure intraperitoneal volume continuously during peritoneal dialysis. Twenty-two peritoneal dialysis patients were studied in a supine position during peritoneal dialysis consisting of 4 tidal exchanges (TPD). For bioimpedance measurements, 4 electrodes were placed, 1 on each hand and foot, to inject an alternating current. Sensing electrodes were placed on the lower ribs and the buttocks on both sides of the body. Calibration of the SBIA method was performed by first filling a known volume of dialysate to establish the relationship between change in resistance and a known fluid volume in the peritoneal cavity. The increase of fluid volume in the peritoneal cavity during dwell time was considered to be equal to net ultrafiltration volume occurring during this period. These measurements were compared with those obtained by the difference in weight between the total filling and draining volumes. The change in intraperitoneal volumes measured by differences in weight (0.39 +/- 0.29 L) did not differ significantly from those established from SBIA (0.41 +/- 0.31 L). Bland-Altman analysis yielded limits of agreement of 0.12 L. The SBIA technique provides a continuous noninvasive approach to the measurement of changes in intraperitoneal fluid volume.

  7. Two Cases of Lower Body Contouring with

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    Hyun Ho Han


    Full Text Available Massive weight loss results in skin excess, leading to an unsatisfying body contour. Variousthigh lift procedures can correct flabby skin in the lower leg. We present a lower bodycontouring technique with a report on two patients. The procedure is determined by the bodycontour of the patient. As the skin excess in the thigh area tended to appear mostly on themedial side, a vertical medial thigh lift was considered. Moreover, for patients with a pear/guitar-shaped body contour, we added the spiral thigh lift for skin excess in the buttocks andthe lateral thigh area. The extent of tissue to excise was determined by pinching the patientin a standing position. The inferior skin flap was fixed to non-movable tissue, which was helpfulfor lifting the tissue and preventing the widening of the scar. After the operation, a drain waskept for 3 to 4 days. A compressive garment was used after removing the drain. There wereno complications. The patients were discharged 6 to 8 days after the operation. In conclusion,skin excess, especially in the lower body, can be corrected by a thigh lift combining severalprocedures, varying from person to person.

  8. Two Cases of Lower Body Contouring with a Spiral and Vertical Medial Thigh Lift

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    Sang Wha Kim


    Full Text Available Massive weight loss results in skin excess, leading to an unsatisfying body contour. Various thigh lift procedures can correct flabby skin in the lower leg. We present a lower body contouring technique with a report on two patients. The procedure is determined by the body contour of the patient. As the skin excess in the thigh area tended to appear mostly on the medial side, a vertical medial thigh lift was considered. Moreover, for patients with a pear/guitar-shaped body contour, we added the spiral thigh lift for skin excess in the buttocks and the lateral thigh area. The extent of tissue to excise was determined by pinching the patient in a standing position. The inferior skin flap was fixed to non-movable tissue, which was helpful for lifting the tissue and preventing the widening of the scar. After the operation, a drain was kept for 3 to 4 days. A compressive garment was used after removing the drain. There were no complications. The patients were discharged 6 to 8 days after the operation. In conclusion, skin excess, especially in the lower body, can be corrected by a thigh lift combining several procedures, varying from person to person.

  9. Two cases of lower body contouring with a spiral and vertical medial thigh lift. (United States)

    Kim, Sang Wha; Han, Hyun Ho; Seo, Je Won; Lee, Jung Ho; Oh, Deuk Young; Ahn, Sang Tae; Rhie, Jong Won


    Massive weight loss results in skin excess, leading to an unsatisfying body contour. Various thigh lift procedures can correct flabby skin in the lower leg. We present a lower body contouring technique with a report on two patients. The procedure is determined by the body contour of the patient. As the skin excess in the thigh area tended to appear mostly on the medial side, a vertical medial thigh lift was considered. Moreover, for patients with a pear/guitar-shaped body contour, we added the spiral thigh lift for skin excess in the buttocks and the lateral thigh area. The extent of tissue to excise was determined by pinching the patient in a standing position. The inferior skin flap was fixed to non-movable tissue, which was helpful for lifting the tissue and preventing the widening of the scar. After the operation, a drain was kept for 3 to 4 days. A compressive garment was used after removing the drain. There were no complications. The patients were discharged 6 to 8 days after the operation. In conclusion, skin excess, especially in the lower body, can be corrected by a thigh lift combining several procedures, varying from person to person.

  10. Match between school furniture dimensions and children's anthropometry in Isfahan schools

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    Z. Asaad


    Full Text Available Background and aims   the main part of students' time is spent at school. Recent studies have  released that lack of match between students' anthropometry size and dimensions of existing  furniture is a risk factor in creating discomfort and muscle- skeletal disorders (such as backache and neck pain, reducing concentration, increasing fatigue, restless and eyestrain in youths and students.   Methods   In this study 982 students, 493 male (50.2% and 489 female (49.8% ranging 7 - 12 years old, were selected. In addition to age, sex, weight and height, six dimensions of anthropometric measures including: shoulder height, elbow rest height, knee height, popliteal height, buttock-popliteal length and hip breadth by anthropometry, caliper and adjustable seat height, goniometry, tape and scale, were taken into account.   Results   This study explains that there is a significant difference between the minimum and  maximum acceptable and available dimensions of furniture (p<0.001. The Height of desk in old  design is higher than acceptable height for many students (in the order of size in 100, 95.4, and 74.3 percent. The seat depth in this design is shorter for the majority of students (in the order of size in 92.1, 92 and 97.9 percent of studied students.   Conclusion   In designing suitable furniture for students, considering available anthropometry differences in age and sex is essential.  

  11. Progressive coxa valga after childhood excision of the hip abductor muscles. (United States)

    Brien, E W; Lane, J M; Healey, J


    To our knowledge, progressive coxa valga, femoral anteversion, and hip subluxation after surgical resection of soft tissue tumors of the gluteal muscles have not been described. The importance of this paper is to document proximal femoral deformity and hip subluxation in children after tumor resection of the hip abductor muscles, to provide guidelines for diagnosis and management of this problem, and to avoid late complications of progressive joint incongruity. Late deformity was seen in two cases after limb salvage surgery for a soft tissue buttock tumor. In both cases, the gluteus medius and minimus muscles were completely resected and the tensor fascia lata and gluteus maximus were partially resected. The ages of the patients at initial treatment were 4 months old and 5 years old, and both patients were followed for a minimum of 4 years. Valgus deformity was seen as early as 15 months. One patient has had a varus osteotomy to correct severe coxa valga and hip subluxation; the other patient with moderate deformity is being followed clinically and radiographically.

  12. Berneese periacetabular osteotomy for residual hip dysplasia in adults--a case report and review of literature. (United States)

    Kashif, Izhar; Umer, Masood; Haroon, Rashid


    Pelvic osteotomy for acetabular dysplasia has been introduced to improve acetabular coverage of the femoral head and reduce the risk of secondary osteoarthrosis. Several surgical methods for acetabular reorientation have been proposed for this purpose by reorientation of the acetabulum single, double, triple, spherical and periacetabular osteotomies. We report our first experience with periacetabulur berneese osteotomy described by Prof. R. Ganz and now the procedure of choice in appropriately selected patients. Fifteen years old boy who presented with complaints of fall and pain in the right gluteal region for 5 days duration that increased with walking. Examination revealed an antalgic gait. Rest of his examination was normal except mild tenderness in the right buttock area. His plain X-rays revealed an incidental finding of dysplastic left hip with deficient lateral coverage, deformed femoral head, coxa magna and mild coxa valga. In addition he had focal arthritic changes over the superolateral acetabulam with sclerosis and cyst formation. His anterior center-edge angle was 24 degrees with an acetabular index of 44 degrees. He had grade II arthritic changes according to the Tonnis classification of osteoarthritis. A periacetabulur ganz osteotomy was performed. Correction was confirmed with intraoperative X-rays. His post operative course was smooth and he was allowed full weight bearing at 8 weeks when X-rays showed satisfactory healing of osteotomy.

  13. Sexting by High School Students. (United States)

    Strassberg, Donald S; Cann, Deanna; Velarde, Valerie


    In the last 8 years, several studies have documented that many adolescents acknowledge having exchanged sexually explicit cell phone pictures of themselves, a behavior termed sexting. Differences across studies in how sexting was defined, recruitment strategies, and cohort have resulted in sometimes significant differences in as basic a metric as what percentage of adolescents have sent, received, or forwarded such sexts. The psychosocial and even legal risks associated with sexting by minors are significantly serious that accurate estimates of its prevalence, including over time, are important to ascertain. In the present study, students (N = 656) from a single private high school were surveyed regarding their participation in sexting. Students at this same school were similarly surveyed four years earlier. In this second survey, reported rates of sending (males 15.8%; females 13.6%) and receiving (males 40.5%; females 30.6%) sexually explicit cell phone pictures (revealing genitals or buttocks of either sex or female breasts) were generally similar to those reported at the same school 4 years earlier. Rates of forwarding sexts (males 12.2%; females 7.6%) were much lower than those previously acknowledged at this school. Correlates of sexting in this study were similar to those reported previously. Overall, our findings suggest that sexting by adolescents (with the exception of forwarding) remains a fairly common behavior, despite its risks.

  14. [Experimental evaluation of pure traditional Chinese medical mouth rinse on skin and mucosa stimulation and bacteriostatic-bactericidal effect]. (United States)

    Ma, Mu-zhi; Liu, Zhao-jun; Lu, Jia-tong; Chen, Gong-pei; Yu, Fei; Zheng, Yuan-na


    To observe the stimulating effect of pure traditional Chinese medical mouth rinse (PTCMMR) on skin and mucosa and to evaluate the efficacy of PTCMMR on inhibiting and killing oral common bacteria. PTCMMR and normal saline (NS) were separately dripped onto 14 five-month rabbits' left and right eyes for 7 days, and were smeared on the left and right side of buttocks, abdomens, back of 10 seven-month guinea pigs (after hair removal) once a day for comparison between the two sides. Five animals were sacrificed after 3 and 7 days of smearing to make pathological sections. Bacterium suspension with Staphylococcus aureus, Escherichia coli, Candida albicans, Pseudomonas aeruginosa and Streptococcus B were dropped to nutrient solution containing different concentrations of PTCMMR or compound Borax solution to observe the growth situation of bacteria. Inhibition zone diameters were measured after 18h of incubation within 37 degrees centigrade incubator. The data was statistically analyzed using SPSS 17.0 software package. There was no obvious change such as redness, dermatitis between rabbits' left eye conjunctiva and the control group. The bacteriostatic and bactericidal effect of anaerobe and aerobe with dropping of PTCMMR was stronger than that of control group. PTCMMR has no stimulation to skin and mucosa, while it has strong efficacy to inhibit and kill oral common bacteria.

  15. Detailed analysis of allergic cutaneous reactions to spinal cord stimulator devices. (United States)

    Chaudhry, Zeshan Ahmed; Najib, Umer; Bajwa, Zahid H; Jacobs, W Carl; Sheikh, Javed; Simopoulos, Thomas T


    The use of spinal cord stimulation (SCS) devices to treat chronic, refractory neuropathic pain continues to expand in application. While device-related complications have been well described, inflammatory reactions to the components of these devices remain underreported. In contrast, hypersensitivity reactions associated with other implanted therapies, such as endovascular and cardiac rhythm devices, have been detailed. The purpose of this case series is to describe the clinical presentation and course of inflammatory reactions as well as the histology of these reactions. All patients required removal of the entire device after developing inflammatory reactions over a time course of 1-3 months. Two patients developed a foreign body reaction in the lead insertion wound as well as at the implantable pulse generator site, with histology positive for giant cells. One patient developed an inflammatory dermatitis on the flank and abdomen that resolved with topical hydrocortisone. "In vivo" testing with a lead extension fragment placed in the buttock resulted in a negative reaction followed by successful reimplantation of an SCS device. Inflammatory reactions to SCS devices can manifest as contact dermatitis, granuloma formation, or foreign body reactions with giant cell formation. Tissue diagnosis is essential, and is helpful to differentiate an inflammatory reaction from infection. The role of skin patch testing for 96 hours may not be suited to detect inflammatory giant cell reactions that manifest several weeks post implantation.

  16. Cauda equina syndrome presentation of sacral insufficiency fractures

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    Muthukumar, T.; Butt, S.H.; Cassar-Pullicino, V.N.; McCall, I.W. [The Robert Jones and Agnes Hunt Orthopaedic Hospital, Department of Radiology, Oswestry, Shropshire (United Kingdom)


    Sacral insufficiency fractures are a well recognised cause for low back, buttock and groin pain in the elderly. However, over a 4 year period, four patients have presented with symptoms of cauda equina syndrome, who were found on investigation to have acute sacral insufficiency fracture without any other aetiological spinal abnormality. Four patients who presented to the spinal surgeons of our institution with symptoms of cauda equina syndrome were referred for spinal MR. Sagittal and axial T1 and T2 weighted turbo spin echo sequences of the lower thoracic and lumbar spine were performed on all patients. Subsequent studies included MR of the sacrum supplemented where appropriate by CT and technetium MDP bone scintigraphy. No evidence of a compressive lesion of the lower thoracic or lumbar spine was present in any of the four patients. Dedicated MR examination of the sacrum in these patients revealed unilateral acute insufficiency fractures involving zone 1 from S1 to S3 extending from the sacro-iliac joint to the lateral margin of the sacral foramen. There was no evidence of compression of the sacral nerve roots. The possible mechanism for the symptomatic presentation is discussed. Sacral insufficiency fractures should be excluded in elderly or osteoporotic patients presenting with cauda equina syndrome who have no evidence of compression in the thoraco-lumbar MR studies. (orig.)

  17. Hand, foot and mouth disease (HFMD): emerging epidemiology and the need for a vaccine strategy. (United States)

    Aswathyraj, S; Arunkumar, G; Alidjinou, E K; Hober, D


    Hand, foot, and mouth disease (HFMD) is a contagious viral disease and mainly affects infants and young children. The main manifestations are fever, vesicular rashes on hand, feet and buttocks and ulcers in the oral mucosa. Usually, HFMD is self-limiting, but a small proportion of children may experience severe complications such as meningitis, encephalitis, acute flaccid paralysis and neurorespiratory syndrome. Historically, outbreaks of HFMD were mainly caused by two enteroviruses: the coxsackievirus A16 (CV-A16) and the enterovirus 71 (EV-A71). In the recent years, coxsackievirus A6 and coxsackievirus A10 have been widely associated with both sporadic cases and outbreaks of HFMD worldwide, particularly in India, South East Asia and Europe with an increased frequency of neurological complications as well as mortality. Currently, there is no pharmacological intervention or vaccine available for HFMD. A formalin-inactivated EV-A71 vaccine has completed clinical trial in several Asian countries. However, this vaccine cannot protect against other major emerging etiologies of HFMD such as CV-A16, CV-A6 and CV-A10. Therefore, the development of a globally representative multivalent HFMD vaccine could be the best strategy.

  18. Primary rhabdomyosarcoma of the sacrum: a case report and review of the literature

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    Hakozaki, Michiyuki [Fukushima Medical University School of Medicine, Department of Orthopaedic Surgery, Fukushima (Japan); Fukushima Medical University School of Medicine, First Department of Pathology, Fukushima (Japan); Hojo, Hiroshi; Kuze, Tetsuo; Abe, Masafumi [Fukushima Medical University School of Medicine, First Department of Pathology, Fukushima (Japan); Tajino, Takahiro; Yamada, Hitoshi; Kikuchi, Shinichi [Fukushima Medical University School of Medicine, Department of Orthopaedic Surgery, Fukushima (Japan); Kikuta, Atsushi [Fukushima Medical University School of Medicine, Department of Pediatrics, Fukushima (Japan); Qualman, Stephen J. [Ohio Children' s Hospital and Ohio State University School of Medicine, Department of Laboratory Medicine and IRSG Pathology Center, Columbus, OH (United States)


    We describe herein a rare case of primary rhabdomyosarcoma (RMS) occurring in the sacrum. A 16-year-old woman presented with a 2-month history of pain in bilateral buttocks and posterior thighs. Computed tomography showed a primary tumor with bone destruction in the 2nd sacral vertebra and invasion to the 1st to 3rd vertebrae and retroperitoneal space. Histological examination of the tumor showed proliferation of spindle-shaped cells intermingled with rhabdomyoblasts in a fascicular and storiform growth pattern. Tumor cells showed immunoreactivity for vimentin, desmin, muscle-specific actin, sarcomeric actin, {alpha}-smooth muscle actin and CD99, and partial immunoreactivity for myoD1, myf-4, myogenin and myoglobin. Reverse transcription polymerase chain reaction demonstrated expression of myoD1. On the basis of the aforementioned findings, a poorly differentiated spindle cell variant of embryonal RMS was diagnosed. The patient underwent combined therapy with chemotherapy and radiotherapy, but died 17 months after incisional biopsy. The present case is instructive in differential diagnosis of primary bone tumors, and the possibility of skeletal RMS needs to be considered. (orig.)

  19. Primary cutaneous smoldering adult T-cell leukemia/ lymphoma. (United States)

    Gittler, Julia; Martires, Kathryn; Terushkin, Vitaly; Brinster, Nooshin; Ramsay, David


    HTLV-1 is a virus that is endemic in southwesternJapan and the Caribbean and has been implicatedin the development of ATLL. ATLL, which is anuncommon malignant condition of peripheralT-lymphocytes, is characterized by four clinicalsubtypes, which include acute, lymphomatous,chronic, and smoldering types, that are based onLDH levels, calcium levels, and extent of organinvolvement. We present a 52-year- old woman withpruritic patches with scale on the buttocks and withtender, hyperpigmented macules and papules oftwo-years duration. Histopathologic examinationwas suggestive of mycosis fungoides, laboratoryresults showed HTLV-I and II, and the patient wasdiagnosed with primary cutaneous ATLL. We reviewthe literature on HTLV-1 and ATLL and specifically theprognosis of cutaneous ATLL. The literature suggeststhat a diagnosis of ATLL should be considered amongpatients of Caribbean origin or other endemicareas with skin lesions that suggest a cutaneousT-cell lymphoma, with clinicopathologic features ofmycosis fungoides. Differentiation between ATLLand cutaneous T-cell lymphoma is imperative as theyhave different prognoses and treatment approaches.

  20. Dynamics of seated computer work before and after prolonged constrained sitting. (United States)

    Madeleine, Pascal


    This laboratory study investigated seated computer work before and after prolonged constrained sitting. Discomfort ratings and kinetic and kinematics data were recorded in nine healthy males performing computer work for 5 min before and after 96 min of sitting. The displacement of the center of pressure (CoP) in anterior-posterior and medial-lateral directions and lumbar curvature (LC) were calculated. The root mean square, standard deviation, and sample entropy values were computed from the CoPs and LC signals to assess the magnitude, amount of variability, and regularity of sitting dynamics, respectively. The discomfort increased for the buttocks (p = .02).The standard deviation and sample entropy values of the CoPs and LC signals, respectively, increased (p .15) after prolonged constrained sitting compared with before. This present study showed that during seated computer work, prolonged constrained sitting affected the amount of variability and the regularity of sitting postural control, whereas the magnitude was not affected. The importance of the dynamics of sitting control may challenge the idea of a static and ideal seated posture at work.

  1. Histopathological findings in pregnancy associated cutaneous hyperpigmentation. (United States)

    Fernandez-Flores, Angel; Barja, Juan M; Vilas-Sueiro, Alejandro; Alija, Antonio


    Hyperpigmentation in pregnancy is a common phenomenon, experienced to some degree by up to 90% of pregnant women. It mainly involves sun-exposed areas, but it can extend to non-exposed zones. Cases with extensive hyperpigmentation are rarely reported. In this paper, we describe the case of a 30-year-old phototype V woman in her 37th week of pregnancy, who presented with brownish hyperpigmentation of the skin in extensive areas, including both axillae, the abdomen and the lowest part of the back. In the abdomen, there was a reinforcement of the hyperpigmentation through the linea nigra and the umbilicus. The hyperpigmentation affected the buttocks as well and involved the intertriginous area between them. Histopathologic analysis showed a hyperpigmented basal layer of the epidermis with no melanocytic atypia or melanocytic nests. Histochemical staining for iron did not show any deposits. Immunohistochemical studies for HMB-45, Melan A and SOX10 demonstrated an increased number of melanocytes. There was hyperpigmentation of basal layer keratinocytes. We also performed immunohistochemical stains for estrogen and progesterone receptors, which were both negative. The patient was examined 3 months after delivery, evidencing a significant clearing of the lesions. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. First case of symmetric drug-related intertriginous and flexural exanthema (sdrife) due to rivastigmine? (United States)

    Allain-Veyrac, Gwenaëlle; Lebreton, Anne; Collonnier, Catherine; Jolliet, Pascale


    The term 'baboon syndrome' was introduced in 1984 to describe a special form of systemic, contact-type dermatitis that occurs after ingestion or systemic absorption of a contact allergen in individuals previously sensitized by topical exposure to the same allergen in the same areas. Its clinical picture presents as an erythema of the buttocks and upper inner thighs resembling the red bottom of baboons. This reaction was originally observed with mercury, nickel, and ampicillin. In 2004, some authors proposed the acronym SDRIFE standing for 'symmetric drug-related intertriginous and flexural exanthema' specifically for cases elicited by systemically administered drugs. Since 1984, about 100 cases have been reported in the literature; for most of the concerned drugs, previous skin sensitization or possible cross-sensitization has not been shown. We report the first case of SDRIFE due to rivastigmine, with the exception of an erythematous maculopapular eruption due to rivastigmine that was previously reported. Rivastigmine is a reversible and noncompetitive acetylcholinesterase inhibitor used for the treatment of Alzheimer disease. SDRIFE is an important condition to keep in mind in order to avoid a misdiagnosis when dealing with other exanthematous disorders and to prevent re-exposure to the responsible allergen in the future.

  3. Body dissatisfaction and mirror exposure: evidence for a dissociation between self-report and physiological responses in highly body-dissatisfied women.

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    Fátima Servián-Franco

    Full Text Available Weight and shape concerns are widespread in the general population. Mirror exposure has been used to reduce body dissatisfaction but little is known about the mechanisms which underlie this therapeutic technique. The present study examined emotional, cognitive, and psychophysiological responses, in women with high and low levels of body dissatisfaction, exposed to their own bodies in a mirror.Forty-two university-attending women (21 high body-dissatisfied (HBD and 21 low body-dissatisfied (LBD, were confronted with their own body during four 5-min trials in which participants were instructed to focus their attention on different parts of their body under standardized conditions. Emotional and cognitive measures were taken after each exposure trial. Heart rate (HR and skin conductance (SC were recorded continuously.HBD women experienced more negative emotions and cognitions following body exposure compared to LBD women but, conversely, showed a reduced physiological reaction in terms of HR and SC. In both groups greater physiological responses were observed looking at the thighs, buttocks, and abdomen. Extent of negative emotions and cognitions were positively associated with HR and/or SC in LBD women but no associations were observed in HBD women.The dissociation between self-report and psychophysiological measures in HBD women supports the existence of a passive-behavioral inhibited coping style in HBD women and suggests deficiencies in the generation of physiological correlates of emotion related to body dissatisfaction.

  4. Intervertebral disc degeneration: evidence for two distinct phenotypes. (United States)

    Adams, Michael A; Dolan, Patricia


    We review the evidence that there are two types of disc degeneration. 'Endplate-driven' disc degeneration involves endplate defects and inwards collapse of the annulus, has a high heritability, mostly affects discs in the upper lumbar and thoracic spine, often starts to develop before age 30 years, usually leads to moderate back pain, and is associated with compressive injuries such as a fall on the buttocks. 'Annulus-driven' disc degeneration involves a radial fissure and/or a disc prolapse, has a low heritability, mostly affects discs in the lower lumbar spine, develops progressively after age 30 years, usually leads to severe back pain and sciatica, and is associated with repetitive bending and lifting. The structural defects which initiate the two processes both act to decompress the disc nucleus, making it less likely that the other defect could occur subsequently, and in this sense the two disc degeneration phenotypes can be viewed as distinct. © 2012 The Authors. Journal of Anatomy © 2012 Anatomical Society.

  5. Cutaneous chemical burns in children - a comparative study. (United States)

    Hardwicke, Joseph; Bechar, Janak; Bella, Husam; Moiemen, Naiem


    Exposure to chemicals is an unusual causation of cutaneous burns in children. The aim of this study is to look at childhood chemical burns and compare this to adult chemical burns from the same population. A total of 2054 patients were referred to the pediatric burns unit during the study period. This included 24 cutaneous chemical burns, equating to an incidence of 1.1%. Over half of the injuries occurred in the domestic setting. The mean total body surface area (TBSA) affected was 1.9%. When compared to a cohort of adult patients from the same population with cutaneous chemical burns, the TBSA affected was identical (1.9%) but distribution favored the buttock and perineum in children, rather than the distal lower limb in adults. Children presented earlier, had lower rates of surgical intervention and had a shorter length of stay in hospital (p Chemical burns in children are rare, but are becoming more common in our region. It is important to be aware of the characteristic distribution, etiology and need to identify children at risk of child protection issues. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  6. Mazabraud's Syndrome Coexisting with a Uterine Tumor Resembling an Ovarian Sex Cord Tumor (UTROSCT): a Case Report

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    Calisir, Cuneyt; Inan, Ulukan; Yavas, Ulas Savas; Isiksoy, Serap; Kaya, Tamer [Eskisehir Osmangazi University, Eskiseh (Korea, Republic of)


    Intramuscular myxoma is a relatively uncommon benign soft tissue tumor. Its association with fibrous dysplasia of bone represents a rare syndrome described by Mazabraud and Girard in 1957. The relationship between fibrous dysplasia and myxoma remains unclear. A common histogenesis has been proposed for both lesions. Wirth et al. has suggested a basic metabolic error of both tissues during the initial growth period, restricted to the region of bone involvement. Myxomas may appear at any age, but have a predilection for older individuals, occurring most commonly during the sixth and seventh decades of life. They are often located in the large muscles of the thigh, shoulder and buttocks. The majority of intramuscular myxomas are solitary. Cross-sectional techniques are essential in the preoperative planning of excision of soft tissue tumors. The ability to evaluate soft tissue myxomas is best accomplished with MR imaging. Myxomas typically demonstrate the following MR features: very sharply defined contour and homogeneous signal intensity. In particular, the lesions are significantly low in signal intensity on T1-weighted images and high in signal intensity on T2-weighted images. In the patient of this case, the MR appearance was in agreement with previously reported cases.

  7. Porocarcinoma in situ showing follicular differentiation: A case report

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    Chia-Lan Ou


    Full Text Available Poroid neoplasm is a skin appendage tumor that has both benign and malignant counterparts. It has traditionally been regarded as of eccrine origin and has four types: intraepidermal poroma (hidroacanthoma simplex, poroma, dermal duct tumor, and poroid hidradenoma. Here we describe the case of a 64-year-old woman who had a verrucous, erythematous to brownish tumor on her left buttock for many years. Histopathology revealed an intra-epidermal poroid tumor with both benign and malignant parts. The benign part had intra-epidermal nests of poroid cells, which were smaller, monomorphic and sharply marginated from adjacent keratinocytes. The malignant part showed similar cell types, but had a higher nuclear/cytoplasmic ratio, pleomorphism, and prominent mitoses. Ductal structures were noted in neoplastic cells and an epithelial membrane antigen stain was strongly positive. Interestingly, peripheral palisading and primitive follicular germ formation were also observed in the neoplasm, which suggests follicular differentiation. We made a final diagnosis of porocarcinoma in situ with follicular differentiation, which may support the folliculosebaceous–apocrine unit theory, but a tumor with such a combination has not been described before.

  8. Bifurcated-bifurcated aneurysm repair is a novel technique to repair infrarenal aortic aneurysms in the setting of iliac aneurysms. (United States)

    Shin, Susanna Hewon; Starnes, Benjamin Ware


    Up to 40% of abdominal aortic aneurysms (AAAs) have coexistent iliac artery aneurysms (IAAs). In the past, successful endovascular repair required internal iliac artery (IIA) embolization, which can lead to pelvic or buttock ischemia. This study describes a technique that uses a readily available solution with a minimally altered off-the-shelf bifurcated graft in the IAA to maintain IIA perfusion. From August 2009 to May 2015, 14 patients with AAAs and coexisting IAAs underwent repair with a bifurcated-bifurcated approach. A 22-mm or 24-mm bifurcated main body device was used in the IAA with extension of the "contralateral" limb into the IIA. Intraoperative details including operative time, fluoroscopy time, and contrast agent use were recorded. Outcome measures assessed were operative technical success and a composite outcome measure of IIA patency, freedom from reintervention, and clinically significant endoleak at 1 year. Fourteen patients underwent bifurcated-bifurcated repair during the study period. Technical success was achieved in 93% of patients, with successful treatment of the AAA and IAA and preservation of flow to at least one IIA. The procedure was performed with a completely percutaneous bilateral femoral approach in 92% of patients. Three patients had a type II endoleak on initial follow-up imaging, but none were clinically significant. There were no cases of bowel ischemia or erectile dysfunction. One patient had buttock claudication ipsilateral to IIA coil embolization (contralateral to bifurcated iliac repair and preserved IIA) that resolved by 6-month follow-up. Two patients required reinterventions. One patient presented to his first follow-up visit on postoperative day 25 with thrombosis of the right external iliac limb ipsilateral to the bifurcated iliac repair, which was successfully treated with thrombectomy and stenting of the limb. This same patient presented at 83 months with growth of the preserved IIA to 3.9 cm and underwent coil

  9. Real-time finite element monitoring of sub-dermal tissue stresses in individuals with spinal cord injury: toward prevention of pressure ulcers. (United States)

    Linder-Ganz, Eran; Yarnitzky, Gilad; Yizhar, Ziva; Siev-Ner, Itzhak; Gefen, Amit


    Patients with a spinal cord injury (SCI) are susceptible to deep tissue injury (DTI), a necrosis in excessively deformed muscle tissue overlying bony prominences, which, in wheelchair users, typically occurs in the gluteus muscles under the ischial tuberosities. Recently, we developed a generic real-time, subject-specific finite element (FE) modeling method to provide monitoring of mechanical conditions in deep tissues deformed between bony prominences and external surfaces. We previously employed this method to study internal tissue loads in plantar tissues of the foot [Yarnitzky, G., Z. Yizhar, and A. Gefen. J. Biomech. 39:2673-2689, 2006] and in muscle flaps of residual limbs in patients who underwent transtibial amputation (Portnoy, S., G. Yarnitzky, Z. Yizhar, A. Kristal, U. Oppenheim, I. Siev-Ner, and A. Gefen. Ann. Biomed. Eng. 35:120-135, 2007). The goal of the present study was to adapt the method to study the time-dependent mechanical stresses in glutei of patients with SCI during wheelchair sitting, continuously in real-time, and to compare the trends of internal tissue load data with those of controls. Prior to human studies, the real-time FE model-adapted to study the buttocks during sitting-was validated by comparing its predictions to data from a physical phantom of a buttocks and to non-real-time, commercial FE software. Next, real-time, subject-specific, FE models were built for six participating subjects (3 patients with SCI, 3 controls) based on their individual anatomies from MRI scans. Subjects were asked to sit normally in a wheelchair, on a ROHO cushion, and to watch a 90 min movie. Continuous interface pressure measurements from a pressure mat were used as subject-specific boundary conditions for real-time FE analyses of deep muscle stresses. Highest peaks of compression, shear and von Mises stresses throughout the trial period, and averages of peaks of these stresses were recorded over the trial for each individual. These parameters

  10. The incidence of transient neurologic syndrome after spinal anesthesia with lidocaine or bupivacaine: The effects of needle type and surgical position: brief report

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    Etezadi F


    Full Text Available "nBurning Transient Neurologic Syndrome (TNS which was first described by Schneider et al in 1993, is defined as a transient pain and dysesthesia in waist, buttocks and the lower limbs after spinal anesthesia.1,2 The incidence of TNS after spinal anesthesia with lidocaine is reported to be as high as 10-40%.3,4 This prospective study was designed to determine the incidence of TNS with two different types of drugs, lidocaine and bupivacaine, in lithotomy or supine positions as the primary outcomes and to determine the association between two different types of needles and surgical positions with the occurrence of TNS as the secondary outcome."nThe present study was conducted on 250 patients (ASA I-II, aged 18-60 years old, who were candidates for surgery in supine or lithotomy positions. According to the needle type (Sprotte or Quincke and the local anesthetic (lidocaine or bupivacaine all patients were randomly divided into four groups. After establishing standard monitoring, spinal anesthesia was performed in all sitting patients by attending anesthesiologists at L2-L3 or L3-L4 levels. The patients were placed in supine or lithotomy position, in regards to the surgical procedure. During the first three postoperative days, patients were observed for post spinal anesthesia complications, especially TNS. Any sensation of pain, dysesthesia, paresthesia or hyperalgesia in the low back area, buttocks, the anterior or posterior thigh, knees, either foot or both feet were recorded. Moreover, duration of pain, its radiation and its relation to sleep and the patients' position were all carefully considered. Ultimately, the patients' response to opioid (pethidine for analgesia was determined."nThe incidence of TNS was higher when spinal anesthesia was induced with lidocaine (68% vs. 22%, P=0.003. TNS developed in 85% of the patients in lidocaine group and 58% in bupivacaine group after surgery in lithotomy position (P=0.002. In 77 patients pain

  11. Body shape preference and body satisfaction in Taiwanese college students. (United States)

    Shih, Ming-Ying; Kubo, Chiharu


    This study examined differences in measures of perception of body shape and body satisfaction among 25 male and 165 female undergraduates. The students completed a body image questionnaire, comprised of four parts: (1) anthropometric data; (2) figure rating scale; (3) cognitive attitude toward body size; and (4) satisfaction with body characteristics. This study found that male ratings of the Ideal figure, the figure of how they currently thought they looked, and the figure of how they felt most of time were almost identical, as were the figure of what they thought most attractive to women and the figure of how they thought others saw them. On the contrary, female ratings of the Ideal figure were significantly thinner than their perception of their current figure, the figure as others saw them, and the figure they felt most of time. Furthermore, the female figure that women rated as most attractive to males was thinner than the figure that males actually preferred. On the other hand, male judgments of the male figure most attractive to females were heavier than female ratings of the same. Both males and females erred in estimating what the opposite sex would find attractive. Males overestimated and females underestimated the body size attractive to the other sex. Although over half of the male and female subjects reported their body size as 'In-between', more males wanted to gain weight and more females wanted to lose weight to present their Ideal body shape. Furthermore, males were biased toward being satisfied with their body and females were biased toward being dissatisfied with their body. Additionally, the number of females satisfied with hands and dissatisfied with upper thighs and buttocks was higher than that of males.

  12. The prevalence of radiographic sacroiliitis in patients affected by inflammatory bowel disease with inflammatory low back pain

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    A. Lo Nigro


    Full Text Available Inflammatory bowel diseases (IBD, are Crohn’s disease (CD or ulcerative colitis (UC, are frequently complicated by joint complaints with prevalence that varies between 10 and 28 %. The IBD related arthropathy may be expressed as peripheral arthritis or axial one frequently indistinguishable from the classical ankylosing spondylitis (AS. According to ESSG criteria for spondyloarthropathy, the presence of synovitis or the inflammatory back pain (IBP in IBD patients is diagnostic for spondyloarthropathy, but for diagnosis of as also radiological criteria must be fulfilled. There are few studies regarding the radiological prevalence of sacroiliitis in patients with IBD. We examined, by plain film radiograms of pelvis, 100 sacroiliac joints (SJ of 50 IBD patients with IBP. The New York (1984 SJ radiological score with gradation from 0 to 4 was applied. Total sacroiliac score (SJS was summarized between left and right side (from 0 to 8. Fourteen patients fulfilled New York modified criteria for AS and 8 patients had unilateral 2nd grade sacroiliitis. Only 4 of 14 AS patients (28% were HLA B27 positive. Thirty patients had localized IBP, 10 extended to buttock and 4 extended to sacrum. Sixteen patients had sciatica-like extension of back pain. A difference in SJS between left and right side were observed only in CD patients (1,3± 0,8 e 0,8± 0,9 respectively; p<0,05, but not in UC (1,5± 1,2 vs 1,5± 1,3; p=ns nor in total IBD patients (1,4± 1 vs 1,2± 1,2; p=ns. Total SJS was higher in UC respect CD, but not significantly (2,9± 2,3 vs 2,1± 1,5; p=ns. Our data confirm the importance of these symptoms in patients with IBD, who need to be carefully investigated also for these aspects.

  13. Surya Namaskar (Sun Salutation: A Path to Good Health

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    Amit Vaibhav


    Full Text Available Surya Namaskar (Sun Salutation is an ancient and sacred yogic technique of India for expressing gratitude to the Sun. Surya Namaskar is a set of 12 Asanas (postures, It is done preferably in the morning while facing the rising sun. There are numerous health benefits of Surya Namaskar for different system of the body specially musculoskeletal, cardiovascular, gastrointestinal, nervous system, respiratory and endocrinal. The heart, liver, intestine, stomach, chest, throat, legs and backbone are main benefited organs. By practicing Surya Namaskar each and every cell of body get revitalize and regenerated, therefore it is highly recommended by all yoga experts for healthy routine life. The regular practice of Surya Namaskar improves blood circulation throughout the body, maintains health and makes the body disease-free. Regular practice of Surya Namaskar gives strength, flexibility and vitality to the body. Sun Salutation asanas help to burn extra body fat on belly, buttocks and back by modulating endocrinal system. It also helps to regulate menstrual cycles among women and also facilitate an easy childbirth. Apart from these benefits of Surya Namaskar also help to keep the mind stress free, calm and illuminated. Thus, a regular practice of Surya Namaskar is highly recommended to keep the body and mind healthy. Though the Surya Namaskar steps are very scientific and practical science ancient time but still it needs advance modern scientific justification to spread it globally, keeping this thing into the mind the present review has been framed to revalidate sacred steps of Surya Namaskar on the basis of available evidence based studies.

  14. Workstation Related Anthropometric and Body Composition Parameters of Indian Women of Different Geographical Regions

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    Inderjeet Singh


    Full Text Available Background: Anthropometry plays an important role in industrial design, clothing design, ergonomics and architecture where statistical data about the distribution of body dimensions in the population are used to optimize products. Changes in lifestyles, nutrition, and ethnic composition of populations lead to changes in the distribution of body dimensions (e.g. the obesity epidemic, and require regular updating of anthropometric data collections. Aim and Objectives: This study analyzed the variation in anthropometric dimensions and body composition parameters of working women employees of different geographical zones. Material and Methods: The study was undertaken on nine hundred forty (940 women employees of Defence Research and Development Organization (DRDO working in seventeen different laboratories and belonged to different states of India. The age range of studied women was between 20-60 years. Fourteen body dimensions namely stature, popliteal height, knee height, buttock to popliteal length, hip breadth, waist breadth, shoulder breadth, forearm length, arm length, eye height (sitting, sitting shoulder height, hand length, hand breadth and elbow width were measured in cm using Martin anthropometers and Martin's sliding caliper. Body composition parameters like weight, percentage body fat, fat mass and fat free mass were recorded. Results: All anthropometric parameters were found significantly different (p<0.001. Body composition variables of women were also found significantly different in all three zones but fat free mass was not significantly different. Conclusion:It can be concluded that diet, environmental conditions and living style of different regions can influence the anthropometry and body composition of the individuals, however the influence of ethnic, genetic and hereditary factor are not controlled in this study.

  15. Pondering Parotid Masses

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    Mark A Miller


    Full Text Available A49-year-old, human immunodeficiency virus (HIV- infected, Haitian-born woman presented with a left facial mass that she had noticed for the previous eight weeks. She was known to have been HIV-seropositive for the previous 11 years and had been on multiple antiretroviral therapies. Her past medical history was also significant for hypertension, disseminated varicella zoster virus and recurrent oral and buttock Herpes simplex episodes. She was taking the following medications at the time of her presentation with the facial mass: stavudine, lamivudine, didanosine, nelfinavir mesylate, famciclovir, hydrochlorothiazide and cotrimoxazole. She had no complaints of fever, chills, sweats, weight loss or anorexia. She denied any pain, redness or warmth at the site of the facial swelling. Her most recent CD4 lymphocyte count was 336 cells/µL, with an HIV viral load of log102.6 copies/mL. Physical examination revealed a 4 cm fluid-filled mass in the left parotid gland. There was no detectable induration, redness, warmth or tenderness, and no associated adenopathy. The rest of the examination was unremarkable. An aspirate of the mass was performed under sterile conditions and yielded 30 mL of turbid, yellow liquid. A Gram stain revealed no neutrophils, scant mononuclear cells and no visible organisms. An acid-fast stain was negative as well. Routine, mycobacterial and fungal cultures showed no growth. Cytological analysis showed scant reactive lymphocytes and no malignant cells. The patient was not given therapy and was observed for another two months. The fluid reaccumulated in the left parotid gland, and the patient?s only complaint concerned the unsightly appearance of the mass. The lesion was again aspirated for 30 mL of fluid and this time, the fluid had a turbid, brown appearance. All laboratory results were identical to the results from the first aspirate. What is your diagnosis, and how would you treat this patient?

  16. Abrupt Intralesional Color Change on Dermoscopy as a New Indicator of Early Superficial Spreading Melanoma in a Japanese Woman

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    Anna Sadayasu


    Full Text Available Diagnosis of superficial spreading melanoma in the early stage is often difficult, even with dermoscopy. We report the case of a 37-year-old Japanese woman with superficial spreading melanoma in her left buttock. The lesion developed 20 years before becoming visible and gradually enlarged over the past few years without any symptoms. Physical examination showed a well-demarcated dark-brown macule 10 mm in diameter. Dermoscopy demonstrated a central dark area with a blue-grey structureless area, a milky-red area with irregular blue-grey dots or globules suggestive of regression structures, and multifocal black pigmentation with whitish scaly areas. An abrupt intralesional change in color from a central dark area to a peripheral light-brown area was also seen. The peripheral area showed an atypical pigment network with an obscure mesh and holes. Histopathologic examination of the lesion showed acanthosis with melanocytic proliferation and nuclear atypia, a band-like lymphocytic infiltrate, melanophages and a few nests of melanocytes just beneath the epidermis. The epidermal melanocytes were positive for S-100, Melan-A and HMB-45, but the dermal nests of melanocytes were negative for HMB-45 and positive for S-100 and Melan-A. A diagnosis of superficial spreading melanoma with a tumor thickness of 0.4 mm (pT1aN0M0, stage 1A was established based on the clinical, dermoscopic and histopathologic findings. This case suggests that dermoscopy is useful in the diagnosis of this condition. An abrupt intralesional change of color might be a new indicator of early superficial spreading melanoma.

  17. The Retrograde Transvenous Push-Through Method: A Novel Treatment of Peripheral Arteriovenous Malformations with Dominant Venous Outflow

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    Wohlgemuth, Walter A., E-mail:; Müller-Wille, René, E-mail:; Teusch, Veronika I., E-mail: [University Medical Center Regensburg, Department of Radiology (Germany); Dudeck, Oliver, E-mail: [University of Magdeburg, Department of Radiology and Nuclear Medicine (Germany); Cahill, Anne M., E-mail: [Perelman School of Medicine of the University of Pennsylvania, Division of Interventional Radiology, Department of Radiology, Children’s Hospital of Philadelphia (United States); Alomari, Ahmad I., E-mail: [Boston Children’s Hospital and Harvard Medical School, Division of Vascular and Interventional Radiology (United States); Uller, Wibke, E-mail: [University Medical Center Regensburg, Department of Radiology (Germany)


    PurposeTo evaluate the efficacy and safety of a novel retrograde transvenous embolization technique of peripheral arteriovenous malformations (AVMs) using Onyx.Materials and MethodsWe conducted a retrospective analysis of all patients who underwent transvenous retrograde Onyx embolization of peripheral AVMs with dominant venous outflow over a 29-month period. The embolization is aimed at retrograde filling of the nidus after building a solid plug in the dominant venous outflow (push-through). Classification, clinical signs, technical aspects, clinical and technical success rates, and complications were recorded. Short-term outcome was assessed.Results11 Symptomatic patients (8 female; mean age 31.4 years) were treated at our Vascular Anomalies Center with this method between January 2012 and May 2014. The AVMs were located on the upper extremity (n = 3), pelvis (n = 2), buttock (n = 2), and lower extremity (n = 4). Retrograde embolization was successfully carried out after preparatory transarterial-flow reduction in eight cases (73 %) and venous-flow reduction with Amplatzer Vascular Plugs in four cases (36 %). Complete devascularization (n = 10; 91 %) or 95 % devascularization (n = 1; 9 %) led to complete resolution (n = 8; 73 %) or improvement of clinical symptoms (n = 3; 27 %). One minor complication occurred (pain and swelling). During a mean follow-up time of 8 months, one clinically asymptomatic recurrence of AVM was detected.ConclusionInitial results suggest that retrograde transvenous Onyx embolization of peripheral AVMs with dominant venous outflow is a safe and effective novel technique with a low complication rate.

  18. Analysis of Muscle Contraction on Pottery Manufacturing Process Using Electromyography (EMG) (United States)

    Soewardi, Hartomo; Azka Rahmayani, Amalia


    One of the most common problems in pottery manufacturing process is musculoskeletal disorders on workers. This disorder was caused by uncomfortable posture where the workers sit on the floor with one leg was folded and another was twisted for long duration. Back, waist, buttock, and right knee frequently experience the disorders. The objective of this research is to investigate the muscle contraction at such body part of workers in manufacturing process of pottery. Electromyography is used to investigate the muscle contraction based on the median frequency signal. Focus measurements is conducted on four muscles types. They are lower interscapular muscle on the right and left side, dorsal lumbar muscle, and lateral hamstring muscle. Statistical analysis is conducted to test differences of muscle contraction between female and male. The result of this research showed that the muscle which reached the highest contraction is dorsal lumbar muscle with the average of median frequency is 51,84 Hz. Then followed by lower interscapular muscle on the left side with the average of median frequency is 31,30 hz, lower interscapular muscle on the right side average of median frequency is 31,24 Hz, and lateral hamstring muscle average of median frequency is 21,77 Hz. Based on the statistic analysis result, there were no differences between male and female on left and right lower interscapular muscle and dorsal lumbar muscle but there were differences on lateral hamstring muscle with the significance level is 5%. Besides that, there were differences for all combination muscle types with the level of significance is 5%.

  19. How long-distance truck drivers and villagers in rural southeastern Tanzania think about heterosexual anal sex: a qualitative study. (United States)

    Mtenga, S; Shamba, D; Wamoyi, J; Kakoko, D; Haafkens, J; Mongi, A; Kapiga, S; Geubbels, E


    To explore ideas of truck drivers and villagers from rural Tanzania about heterosexual anal sex (HAS) and the associated health risks. Qualitative study using 8 in-depth interviews (IDIs) and 2 focus group discussions (FGDs) with truck drivers and 16 IDIs and 4 FGDs with villagers from the Morogoro region. Study participants included 24 women and 46 men. Data analysis was performed thematically employing standard qualitative techniques. Reasons why men would practice HAS included sexual pleasure, the belief that anal sex is safer than vaginal sex, alternative sexual practice, exploration and proof of masculinity. Reasons why women would practice HAS included financial need, retaining a partner, alternative for sex during menses, pregnancy prevention and beauty enhancement because HAS is believed to 'fatten the female buttocks'. Most participants believed that condoms are not needed during HAS. This was linked to the ideas that infections only 'reside in wet places' (vagina) and that the anus is not 'conducive' for condom use; condoms reduce 'dryness' and 'friction' (pleasure) and may 'get stuck inside'. The study participants reported practices and ideas about HAS that put them at risk for HIV and sexually transmitted infections. Greater attention to education about HAS is urgently needed in Tanzania, where this sexual practice is still regarded as a taboo. This study offers useful information that could be included in sex education programmes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  20. Lumbar extension exercises in conjunction with mechanical traction for the management of a patient with a lumbar herniated disc. (United States)

    Gagne, Allison R; Hasson, Scott M


    Low back pain resulting from lumbar disc herniation is a common reason for referral for physical therapy. There is no evidence to support the management of lumbar disc herniation and derangement using mechanical traction combined with lumbar extension exercises. Therefore, the purpose of this case report was to describe and discuss the use of mechanical traction in conjunction with lumbar extension exercises for a patient with a lumbar herniated disc. The patient was a 49-year-old male referred to physical therapy with a medical diagnosis of a lumbar herniated disc at L5-S1 with compression of the L5 nerve root confirmed by MRI. The patient's chief complaint was pain over the left lumbosacral and central lumbar region with radiating pain into the left buttock accompanied by numbness and tingling in the left lower leg and foot. The patient was seen for a total of 14 visits. The first 5 days (2 weeks) of therapy consisted of lumbar extension exercises. For the following nine visits (over a 3-week period), mechanical traction was added as an adjunct to the extension exercises. Outcome measures included the Oswestry Disability Questionnaire, Back Pain Function Scale (BPFS), and the Numeric Pain Rating Scale (NPRS). Results from initial evaluation to discharge (Oswestry: 36% to 0%; BPFS: 33/60 to 57/60; NPRS: 7/10 to 0/10) demonstrated that the patient no longer experienced low back pain and improved in terms of functional status and pain-related disability. The patient no longer complained of numbness and tingling in the left lower extremity and the goals for the patient had been attained. The data from this case report suggests lumbar extension exercises in conjunction with mechanical traction facilitated the patient's improvement in pain and return to prior level of function.

  1. Craniometric analysis for estimation of stature in Nepalese population--A study on an autopsy sample. (United States)

    Shrestha, Rijen; Shrestha, Pramod Kumar; Wasti, Harihar; Kadel, Tulsi; Kanchan, Tanuj; Krishan, Kewal


    Establishing the identity of the deceased becomes essential when highly decomposed bodies, mutilated body parts or skeletal remains are recovered from mass fatality sites. In these situations, estimation of stature along with other parameters such as age, sex and race/ethnicity becomes important to establish the biological profile of the deceased. Following the Maoist insurgency in Nepal, there have been numerous discoveries of unidentified human remains in mass graves or otherwise. No systemic studies and anthropological data on the Nepalese population however, is available posing problems in anthropologic evaluation of the remains. The sample of the present study consisted of 200 autopsied cases (148 males and 52 female adult cadavers). During the autopsy, the scalp was reflected after giving a coronal incision extending from one mastoid to the other exposing the cranium in each case. Maximum cranial length (MCL), maximum cranial breadth (MCB), bi-zygomatic breadth (BZB), minimum frontal breadth (MFB) and length of parietal chord (PC) were then measured. Stature was measured as the length of the body from head to heel in centimeters with the heel, buttocks, back of the shoulders and the head in contact with the autopsy table. Linear and stepwise multiple regression models were derived for estimation of stature from cranial measurements. Univariate, bivariate and multivariate regression models show statistically significant correlation between stature and the cranial measurements. The present study opines that the stature estimation from cranial dimensions using multivariate linear regression models is more accurate than those of the univariate and bivariate regression models. This study presents a rare data from Nepalese population that show typical Asian features and thus, is significant from anthropologic and genetic point of view. The study observations further contribute a baseline data bank for forensic pathologists and specialists. Copyright © 2014

  2. Accidental death due to complete autoerotic asphyxia associated with transvestic fetishism and anal self-stimulation - case report. (United States)

    Atanasijević, Tatjana; Jovanović, Aleksandar A; Nikolić, Slobodan; Popović, Vesna; Jasović-Gasić, Miroslava


    A case is reported of a 36-year-old male, found dead in his locked room, lying on a bed, dressed in his mother's clothes, with a plastic bag over his head, hands tied and with a barrel wooden cork in his rectum. Two pornographic magazines were found on a chair near the bed, so that the deceased could see them well. Asphyxia was controlled with a complex apparatus which consisted of two elastic luggage rack straps, the first surrounding his waist, perineum, and buttocks, and the second the back of his body, and neck. According to the psychological autopsy based on a structured interview (SCID-I, SCID-II) with his father, the deceased was single, unemployed and with a part college education. He had grown up in a poor family with a reserved father and dominant mother, and was indicative of fulfilling DSM-IV diagnostic criteria for alcohol dependence, paraphilia involving hypoxyphilia with transvestic fetishism and anal masturbation and a borderline personality disorder. There was no evidence of previous psychiatric treatment. The Circumstances subscale of Beck's Suicidal Intent Scale (SIS-CS) pointed at the lack of final acts (thoughts or plans) in anticipation of death, and absence of a suicide note or overt communication of suicidal intent before death. Integration of the crime scene data with those of the forensic medicine and psychological autopsy enabled identification of the event as an accidental death, caused by neck strangulation, suffocation by a plastic bag, and vagal stimulation due to a foreign body in the rectum.

  3. Clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus in pregnancy. (United States)

    Laibl, Vanessa R; Sheffield, Jeanne S; Roberts, Scott; McIntire, Donald D; Trevino, Sylvia; Wendel, George D


    The objective of this study was to review the presentation and management of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) in pregnant women. This was a chart review of pregnant patients who were diagnosed with MRSA between January 1, 2000, and July 30, 2004. Data collected included demographic characteristics, clinical presentation, culture results, and pathogen susceptibilities. Patients' pregnancy outcomes were compared with the general obstetric population during the study period. Fifty-seven charts were available for review. There were 2 cases in 2000, 4 in 2001, 11 in 2002, 23 in 2003, and 17 through July of 2004. Comorbid conditions included human immunodeficiency virus and acquired immunodeficiency syndrome (13%), asthma (11%), and diabetes (9%). Diagnostic culture was most commonly obtained in the second trimester (46%); however 18% of cases occurred in the postpartum period. Skin and soft tissue infections accounted for 96% of cases. The most common site for a lesion was the extremities (44%), followed by the buttocks (25%), and breast (mastitis) (23%). Fifty-eight percent of patients had recurrent episodes. Sixty-three percent of patients required inpatient treatment. All MRSA isolates were sensitive to trimethoprim-sulfamethoxazole, vancomycin, and rifampin. Other antibiotics to which the isolates were susceptible included gentamicin (98%) and levofloxacin (84%). In comparison with the general obstetric population, patients with MRSA were more likely to be multiparous and to have had a cesarean delivery. Community-acquired MRSA is an emerging problem in our obstetric population. Most commonly, it presents as a skin or soft tissue infection that involves multiple sites. Recurrent skin abscesses during pregnancy should raise prompt investigation for MRSA. II-3.

  4. The Usefulness of Bone Scan in Electric Burns

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    Kim, Tae Hyung; So, Yong Seon; Kweon, Ki Hyeon; Han, Sang Woong; Kim, Seok Hwan; Kim, Jong Soon; Han, Seung Soo [Hanil Hospital, Seoul (Korea, Republic of)


    Bone scan is known to be an effective tool for observing the state of soft tissues and bones of electric burn patients. It is also used for observing the progress of patients after debridement or skin graft as well as determining to amputate specific body parts. To evaluate bone scan's role in electric burn, we analyzed bone scan 37 patients with electric burn. Among the 37 patients, 8 of 37 were injured in low voltage and 29 of them in high voltage. 27 patients received the electrical input through the hand, 6 through the scalp, 2 through the shoulder, 1 through the left chest wall and 1 through the left inguinal area. Among 29 patients received high voltage, 22 patients had the electrical output through the foot, 3 through the hand, 2 through the shoulder, 1 through the buttock and 1 through the left chest wall. Bone scans revealed cellulitis in 37 patients with 47 sites, osteomyelitis in 15 patients with 15 sites and bone defects in 4 patients with 4 sites. In 4 patients with skin graft or skin flap, follow up bone scan showed improvements of bony uptake in preoperatively bony defect area and all of them were healed without complication There were 2 cases in which uptake increased in the myocardium, 1 in the liver and 6 in the kidney, however, scrum calcium level, EKG, cardiac enzyme, liver and renal function tests were normal. In conclusion, bone scans are helpful in the assessment of injury sites after electrical insult and in differential diagnosis of cellulitis and osteomyelitis. It is also useful tool of assessment after skin graft or skin flap, however, it should be further evaluated about internal organ damage.

  5. A modified Delphi survey on the signs and symptoms of low back pain: indicators for an interventional management approach. (United States)

    Cid, José; De La Calle, José L; López, Esther; Del Pozo, Cristina; Perucho, Alfredo; Acedo, María Soledad; Bedmar, Dolores; Benito, Javier; De Andrés, Javier; Díaz, Susana; García, Juan Antonio; Gómez-Caro, Leticia; Gracia, Adolfo; Hernández, José María; Insausti, Joaquín; Madariaga, María; Moñino, Pedro; Ruiz, Manuel; Uriarte, Estrella; Vidal, Alfonso


    Low back pain (LBP) symptoms and signs are nonspecific. If required, diagnostic blocks may find the source of pain, but indicators of suspect diagnosis must be defined to identify anatomical targets. To reach a consensus from an expert panel on the indicators for the most common causes of LBP. A 3-round (2 telematic and 1 face-to-face) modified Delphi survey with a questionnaire on 78 evidence-based indicators of 7 LBP etiologies was completed by 23 experts. 98.7% of the questionnaire was consensuated. The most accepted indicators were for zygapophysial joint pain, painful ipsilateral paravertebral palpation, worsening with trunk extension, paravertebral musculature spasm on the affected articulation, and referred pain above the knee, without radicular pattern. For sacroiliac joint pain, unilateral pain when seating, with at least 3 described provoking tests: Approximation; gapping; Patrick's; Gaenslen's; thigh thrust; Fortin finger; and Gillet's tests. For discogenic pain, midline pain that may be provoked by pressure on the spinal processes at the affected level; for quadratus lumborum muscle, painful palpation on both the L1 level paravertebral region, referred to iliac crest, and the iliac crest, referred to greater trochanter. For iliopsoas muscle, pain elicited by thigh flexion, referred to buttock, inguinal region, and anterior thigh. For pyramidal muscle, pain while sitting on the affected side and positive Freiberg's test. For radicular pain, paresthesias and positive Lassègue's test at 60°. Seventy-seven diagnostic suspect indicators of LBP conditions were consensuated. These may facilitate conservative or interventional pain management decision-making. © 2013 World Institute of Pain.

  6. The invention of an iliosacral screw fixation guide and its preliminary clinical application. (United States)

    Pan, Wei-bo; Liang, Jun-bo; Wang, Bin; Chen, Guo-fu; Hong, Hua-xing; Li, Qian-yun; Chen, Hai-xiao


    To introduce an iliosacral screw fixation guide and evaluate its efficacy in fixation of sacroiliac joint fracture-dislocations. Between January 2011 and May 2011, eight patients (five men, three women) with sacroiliac joint fracture-dislocation underwent percutaneous iliosacral screw fixation with the assistance of this minimally invasive guide and under CT guidance. The patients, aged from 26 to 56 years (mean 32 years), had vertically unstable pelvic fractures. Before surgery, six patients who had displacement of >2 cm in their sacroiliac joints underwent skeletal traction on the femoral condyle. The inserted sites were marked out on the affected side of their buttocks after the best screw trajectory had been determined under CT control. The gear that controls the direction of the minimally invasive guide was adjusted according to the inserting angle determined by CT scans. A K-wire was inserted into the sacroiliac joint along the pilot sleeve of the guide, and a hollow screw (diameter 7.3 mm) was implanted into the sacroiliac joint along the K-wire. All eight operations were successful on the first attempt. The operations lasted from 10 to 20 minutes (mean 14 minutes). Immediate CT scans confirmed that all the screws had been placed in the desired positions, none had penetrated the bones and the configuration of the sacroiliac joints had been satisfactorily restored and firmly fixed. No patient experienced numbness or radiating pain in the lower limbs during surgery. There were no postoperative vascular or neurological complications. The minimally invasive guide can eliminate discrepancies resulting from the surgeon's own sensory input when inserting screws under the guidance of CT, making percutaneous iliosacral screw fixation more accurate, safe and simple. © 2012 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.

  7. A clinical study of 125 patients with phrynoderma

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    S Ragunatha


    Full Text Available Background: Phrynoderma is a type of follicular hyperkeratosis. Various nutritional deficiency disorders have been implicated in the etiology of phrynoderma. Aim: To determine clinical features of phrynoderma and its association with nutritional deficiency signs. Materials and Methods: A cross-sectional descriptive study of 125 consecutive patients with phrynoderma attending the outpatient department (OPD of dermatology was conducted in a tertiary care hospital. In all patients, a detailed history was taken and cutaneous examination findings such as distribution, sites of involvement, morphology of the lesions, and signs of nutritional deficiencies were noted. Results: The proportion of patients with phrynoderma attending the OPD was 0.51%. There were 79 males and 46 females. Age of the patients was in the range of 3-26 years with a mean of 10 ΁ 4.3 years. The lesions were asymptomatic in 114 (91.2% patients. The distribution of lesions was bilateral and symmetrical in 89 (71.2% patients. The disease was localized (elbows, knees, extensor extremities, and/or buttocks in 106 (84.8% patients. The site of onset was elbows in 106 (84.8% patients. The lesions were discrete, keratotic, follicular, pigmented or skin colored, acuminate papules in all patients. Signs of vitamin A and vitamin B-complex deficiency were present in 3.2% and 9.6% patients, respectively. Epidermal hyperkeratosis, follicular hyperkeratosis, and follicular plugging were present in the entire biopsy specimen. Conclusion: Phrynoderma is a disorder with distinctive clinical features and can be considered as a multifactorial disease involving multiple nutrients, local factors like pressure and friction, and environmental factors in the setting of increased nutritional demand.

  8. Paraneoplastic Pemphigus and Autoimmune Blistering Diseases Associated with Neoplasm: Characteristics, Diagnosis, Associated Neoplasms, Proposed Pathogenesis, Treatment. (United States)

    Kartan, Saritha; Shi, Vivian Y; Clark, Ashley K; Chan, Lawrence S


    Autoimmune paraneoplastic and neoplasm-associated skin syndromes are characterized by autoimmune-mediated cutaneous lesions in the presence of a neoplasm. The identification of these syndromes provides information about the underlying tumor, systemic symptoms, and debilitating complications. The recognition of these syndromes is particularly helpful in cases of skin lesions presenting as the first sign of the malignancy, and the underlying malignancy can be treated in a timely manner. Autoimmune paraneoplastic and neoplasm-associated bullous skin syndromes are characterized by blister formation due to an autoimmune response to components of the epidermis or basement membrane in the context of a neoplasm. The clinical manifestations, histopathology and immunopathology findings, target antigens, associated neoplasm, current diagnostic criteria, current understanding of pathogenesis, and treatment options for a selection of four diseases are reviewed. Paraneoplastic pemphigus manifests with clinically distinct painful mucosal erosions and polymorphic cutaneous lesions, and is often associated with lymphoproliferative neoplasm. In contrast, bullous pemphigoid associated with neoplasm presents with large tense subepidermal bullae of the skin, and mild mucosal involvement, but without unique clinical features. Mucous membrane pemphigoid associated with neoplasm is a disorder of chronic subepithelial blisters that evolve into erosions and ulcerations that heal with scarring, and involves stratified squamous mucosal surfaces. Linear IgA dermatosis associated with neoplasm is characterized by annularly grouped pruritic papules, vesicles, and bullae along the extensor surfaces of elbows, knees, and buttocks. Physicians should be aware that these autoimmune paraneoplastic and neoplasm-associated syndromes can manifest distinct or similar clinical features as compared with the non-neoplastic counterparts.

  9. Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space. (United States)

    Hernando, Moisés Fernández; Cerezal, Luis; Pérez-Carro, Luis; Abascal, Faustino; Canga, Ana


    Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic sciatic nerve entrapment in the subgluteal space. Multiple pathologies have been incorporated in this all-included "piriformis syndrome," a term that has nothing to do with the presence of fibrous bands, obturator internus/gemellus syndrome, quadratus femoris/ischiofemoral pathology, hamstring conditions, gluteal disorders and orthopedic causes. The concept of fibrous bands playing a role in causing symptoms related to sciatic nerve mobility and entrapment represents a radical change in the current diagnosis of and therapeutic approach to DGS. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification. A broad spectrum of known pathologies may be located nonspecifically in the subgluteal space and can therefore also trigger DGS. These can be classified as traumatic, iatrogenic, inflammatory/infectious, vascular, gynecologic and tumors/pseudo-tumors. Because of the ever-increasing use of advanced magnetic resonance neurography (MRN) techniques and the excellent outcomes of the new endoscopic treatment, radiologists must be aware of the anatomy and pathologic conditions of this space. MR imaging is the diagnostic procedure of choice for assessing DGS and may substantially influence the management of these patients. The infiltration test not only has a high diagnostic but also a therapeutic value. This article describes the subgluteal space anatomy, reviews known and new etiologies of DGS, and assesses the role of the radiologist in the diagnosis, treatment and postoperative evaluation of sciatic nerve entrapments, with emphasis on MR imaging and endoscopic correlation.

  10. Head injury mechanisms in FIS World Cup alpine and freestyle skiers and snowboarders. (United States)

    Steenstrup, Sophie Elspeth; Bakken, Arnhild; Bere, Tone; Patton, Declan Alexander; Bahr, Roald


    Head injuries represent a concern in skiing and snowboarding, with traumatic brain injuries being the most common cause of death. To describe the mechanisms of head and face injuries among World Cup alpine and freestyle skiers and snowboarders. We performed a qualitative analysis of videos obtained of head and face injuries reported through the International Ski Federation Injury Surveillance System during 10 World Cup seasons (2006-2016). We analysed 57 head impact injury videos (alpine n=29, snowboard n=13, freestyle n=15), first independently and subsequently in a consensus meeting. During the crash sequence, most athletes (84%) impacted the snow with the skis or board first, followed by the upper or lower extremities, buttocks/pelvis, back and, finally, the head. Alpine skiers had sideways (45%) and backwards pitching falls (35%), with impacts to the rear (38%) and side (35%) of the helmet. Freestyle skiers and snowboarders had backwards pitching falls (snowboard 77%, freestyle 53%), mainly with impacts to the rear of the helmet (snowboard 69%, freestyle 40%). There were three helmet ejections among alpine skiers (10% of cases), and 41% of alpine skiing injuries occurred due to inappropriate gate contact prior to falling. Athletes had one (47%) or two (28%) head impacts, and the first impact was the most severe (71%). Head impacts were mainly on snow (83%) on a downward slope (63%). This study has identified several characteristics of the mechanisms of head injuries, which may be addressed to reduce risk. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. A phase-contrast microscopy-based method for modeling the mechanical behavior of mesenchymal stem cells. (United States)

    Saeed, Mayssam; Sharabani-Yosef, Orna; Weihs, Daphne; Gefen, Amit


    We present three-dimensional (3D) finite element (FE) models of single, mesenchymal stem cells (MSCs), generated from images obtained by optical phase-contrast microscopy and used to quantify the structural responses of the studied cells to externally applied mechanical loads. Mechanical loading has been shown to affect cell morphology and structure, phenotype, motility and other biological functions. Cells experience mechanical loads naturally, yet under prolonged or sizable loading, damage and cell death may occur, which motivates research regarding the structural behavior of loaded cells. For example, near the weight-bearing boney prominences of the buttocks of immobile persons, tissues may become highly loaded, eventually leading to massive cell death that manifests as pressure ulcers. Cell-specific computational models have previously been developed by our group, allowing simulations of cell deformations under compressive or stretching loads. These models were obtained by reconstructing specific cell structures from series of 2D fluorescence, confocal image-slices, requiring cell-specific fluorescent-staining protocols and costly (confocal) microscopy equipment. Alternative modeling approaches represent cells simply as half-spheres or half-ellipsoids (i.e. idealized geometries), which neglects the curvature details of the cell surfaces associated with changes in concentrations of strains and stresses. Thus, we introduce here for the first time an optical image-based FE modeling, where loads are simulated on reconstructed 3D geometrical cell models from a single 2D, phase-contrast image. Our novel modeling method eliminates the need for confocal imaging and fluorescent staining preparations (both expensive), and makes cell-specific FE modeling affordable and accessible to the biomechanics community. We demonstrate the utility of this cost-effective modeling method by performing simulations of compression of MSCs embedded in a gel.

  12. Chiropractic management of patients with bilateral congenital hip dislocation with chronic low back and leg pain. (United States)

    Diez, Francisco


    To discuss conservative methods for treating patients with chronic low back and leg pain associated with the biomechanical and postural alterations related to bilateral congenital hip dislocation. This report describes the cases of 2 adult female subjects with bilateral congenital hip dislocation without acetabula formation who suffered from chronic low back and leg pain managed conservatively by chiropractic methods. The first subject is a 45-year-old woman with a 9-month history of right buttock pain and radiating right leg pain and paresthesia down to the first 2 toes, with a diagnosis of a herniated L4 intervertebral disk. The second subject is a 53-year-old woman who complained of chronic intermittent low back pain and constant unremitting pain on her right leg for the last 3 years. Chiropractic manipulation utilizing Logan Basic apex and double notch contacts, as well as sacroiliac manipulation on a drop table with a sacrum contact and with a posterior to anterior and superior to inferior (PA-SI) rocking thrust, together with a spinal stabilization exercise program, were used on these 2 patients. Both patients had significant clinical improvement, with reduction on the Visual Analogue Scale (VAS) of 67% and 84%, Oswestry Disability Index improvement of 73% and 81%, and an improvement on the Harris hip score of 71% and 44%, respectively. A conservative management approach, including specific chiropractic manipulation and a spinal stabilization exercise program, can help manage the treatment of adult patients with chronic low back and leg pain related to bilateral congenital dislocation of the hips.

  13. Childhood bruising distribution observed from eight mechanisms of unintentional injury. (United States)

    Hibberd, Owen; Nuttall, Diane; Watson, Rhiannon E; Watkins, William J; Kemp, Alison Mary; Maguire, Sabine


    To inform the assessment of described mechanisms of bruising in children. Prospective cross-sectional study. The emergency department, and children in the local community. Children aged 0-13 years with bruises from unintentional injuries. bleeding disorder, medication affecting coagulation or child protection concerns. Injury incidents were categorised into one of eight causal mechanisms (fall fromhitting an object during fall, stairs or impact, crush, sports or motor vehicle collision). Location, number and mechanism of bruising for each injury mechanism. 372 children had 559 injury incidents, resulting in 693 bruises; 85.2% of children were walking independently, with impact injuries and fall from standing height (including hitting an object) being the predominant mechanisms. A single bruise was observed in 81.7% of all incidents. Stair falls resulted in ≥3 bruises only with falls involving ≥10 steps (6/16). Bruising was rarely observed on the buttocks, upper arm, back of legs or feet. No bruises were seen in this dataset on ears, neck or genitalia. Petechial bruising was only noted in 1/293 unintentional incidents, involving a high-impact injury in a school-aged child. These findings have the potential to aid an assessment of the plausibility of the explanation given for a child with bruising. Certain bruise distributions were rarely observed, namely multiple bruises from a single mechanism, petechiae and bruising to the ears, neck or genitalia. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Clinical characteristics and outcomes of pediatric germ cell tumors in Ali-Asghar Children’s Hospital; 1990-2004

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    Ansari Sh


    Full Text Available Background: Germ cell tumor (GCT account for approximately 2-3% of all malignancies in childhood. About 20% of patients with GCT are still resistant to therapy. Methods: This study was undertaken on 57 patients with Germ cell tumor who were admitted to Ali Asghar Children’s Hospital during 1990-2004. Through this study, information about sex, age type of pathology, clinical sign, treatment and survival (5-year period was gathered in order to have better treatment and follow up. This study was carried out as across-sectional survey and the obtained data was analyzed via Spss 10 soft ware. Results: The findings showed that the mean age of patients was 4/9 ± 0/1 (1mo -14y, male 54%, female 46%, male/female, ratio=1/1. Site of tumor: saccrococcygeal 57/8 %( 33, gonadal 42% (24. Pathological type is yolk sac 61/4% (35, dysgerminoma 12/2% (7, malignant teratoma 14% (8, embryonal carcinoma 10/5% (6. The most common clinical sign were buttock mass 31/5% (18, abdominal pain 10/5% (6, abdominal mass 17/5%(10, testicular mass 28% (16. All of the patients were treated with chemotherapy (bleomycine, vinblastin, cisplatinum mean of duration follow up were 48/4 months. In all of patients 31/5% (18 of the cases were alive and 70% (40 of patients were relapse and 15/7% (9 no information, 52/6% (30 of cases were expired. Five years survival of patients was 62%. Conclusion: The analysis of the patients treated shows that extragonadal location of primary tumor (specially sacrococcygeal, level of AFP above 10 ng/ml in patients ,6 or more months of age and metastatic disease were the most unfavorable factors for overall survival.

  15. Initial results of the management of aortoiliac aneurysms with GORE® Excluder® Iliac Branched Endoprosthesis. (United States)

    Schönhofer, S; Mansour, R; Ghotbi, R


    We prospectively observed the outcomes of all patients (N.=15) with an aortoiliac and a common iliac artery aneurysm who were electively treated with the GORE® Excluder® Iliac Branched Endoprosthesis (IBE) with regard to clinical, anatomical and radiological results. We evaluated operative mortality, aneurysm rupture rate and aneurysm related mortality as well as conversion to open surgery, incidence of endoleak, rate of aneurysm migration, aneurysm enlargement, graft patency, reintervention rate and the clinical outcome. Postoperative follow-up included a computed tomography angiography (CTA) before discharge, clinical evaluation and Duplex ultrasound or CTA 3 weeks after the intervention and Duplex ultrasound every 3 months afterwards. Mean patient age was 79 years (range 61-83 years); f/m: 1/2; mean follow-up was 9 months; 80% of the patients presented 2 or more major comorbidities and 1/3 were considered to be not eligible for open repair. Mean hospitalization time was 5 days. Technical success rate was 93.3% (intent-to-treat basis). Mortality within 30 days was 0%; there were no ruptures; type II endoleak directly after the procedure occurred in 20%, dropping to 13.3% after 3 months. We defined the initial technical success in absence of type I endoleaks. The initial technical success rate was 100%. No IBE occlusion or type Ia, Ib or III endoleak was observed during the postoperative follow-up (mean follow-up: 9 months). All of the internal iliac side branches remained patent. Reintervention rate, buttock claudication rate and pelvic complication rate were 0%. The GORE® IBE provides a new and safe alternative for the management of complete endovascular repair of an extensive aortoiliac or common iliac aneurysm while maintaining pelvic blood flow in iliac branched devices. Due to the lower complexity if compared to previous endovascular or hybrid methods, it should be performed in every anatomically suitable case.

  16. Experience with the GORE EXCLUDER iliac branch endoprosthesis for common iliac artery aneurysms. (United States)

    van Sterkenburg, Steven M M; Heyligers, Jan M M; van Bladel, Mathijs; Verhagen, Hence J; Eefting, Daniël; van Sambeek, Marc R; Zeebregts, Clark J; Reijnen, Michel M P J


    In this study, we analyzed the procedural success and early outcome of endovascular treatment of a multicenter cohort of patients with common iliac artery (CIA) aneurysms treated with the new GORE EXCLUDER (W. L. Gore & Associates, Flagstaff, Ariz) iliac branch endoprosthesis (IBE). A retrospective cohort analysis was performed in 13 sites in The Netherlands. Anatomic, demographic, procedural, and follow-up data were assessed from hospital records. From November 2013 to December 2014, 51 CIA aneurysms were treated with an IBE in 46 patients. The median diameter of the treated aneurysm was 40.5 (range, 25.0-90.0) mm. The mean procedural time was 198 ± 56 minutes. All but one implantation were successful; two type Ib endoleaks were noticed, resulting in a procedural success rate of 93.5%. The two type Ib endoleaks spontaneously disappeared at 30 days. There was no 30-day mortality. Ipsilateral buttock claudication was present in only two cases at 30 days and disappeared during follow-up. The incidence of reported erectile dysfunction was low and severe ischemic complications were absent. After a mean follow-up of 6 months, data on 17 treated aneurysms were available. Two showed a stable diameter, whereas 15 showed a mean decrease of 3.9 ± 2.2 mm (P < .001). Reinterventions were performed in two patients (7.1%). The 6-month primary patency of the internal component of the IBE device was 94%. The use of the GORE EXCLUDER IBE device for CIA aneurysms is related to high procedural success, high patency rates, and low reintervention rates at short-term follow-up. Prospective data with longer follow-up are awaited to establish the role of the device in the treatment algorithm of CIA aneurysms. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  17. Skin cancer prevention in annual performance of total skin examination, photoprotection counseling, and patient instruction of self-skin examination. (United States)

    Yiannias, James A; Laman, Susan D; Stevens, Ryan; Rkein, Ali M; Nelson, Evan; Noble, Brie N


    Prevention of skin cancer includes early diagnosis and photoprotection, such as by physician-performed total skin examination (TSE) and patient-performed self-skin examination (SSE). Hypothesizing that 90% of our patients receive an annual TSE, photoprotection counseling, and SSE instruction, we assessed the extent to which this was documented in patients' records. We also sought to identify differences in documentation of TSE, photoprotection counseling, and instruction on SSE with or without use of a dictation template prompting documentation. Retrospective review of a random sample of 400 patients in an outpatient dermatology practice of a tertiary care academic medical center for any dermatology appointment between May 1 and July 31, 2007. Exclusion criteria included refusal to undergo TSE, lack of access to skin (e.g., wheelchair-bound or in cast), or inappropriate visit type (e.g., for acne, psoriasis, or lupus). Of 400 randomly selected patients, 313 met inclusion criteria. The dictation template was used in 133; of these, 89% (119/133) had documentation in their clinical note of a TSE (exclusive of the buttocks or groin area), and 98% (130/133) had documentation of instruction on sun protection and SSE. Without use of the dictation template, these percentages dropped to 78% (140/180) and 20% (36/180), respectively. Physicians using a dictation template were more likely to document having conducted a TSE and instructed patients on photoprotection and SSE. A dictation template aids documentation of annual TSE and patient education efforts on photoprotection and SSE. © 2013 The International Society of Dermatology.

  18. Mismatch between classroom furniture and anthropometric measures in Chilean schools. (United States)

    Castellucci, H I; Arezes, P M; Viviani, C A


    Children spend about five hours per day sitting down while doing their school work. Considering this as well as the potential inadequate use of school furniture, it is likely that some anatomical-functional changes and problems in the learning process may occur. The aim of this study was to compare furniture sizes within three different schools with the anthropometric characteristics of Chilean students in the Valparaíso region, in order to evaluate the potential mismatch between them. The sample consisted of 195 volunteer students (94 male, 101 female) of the 8th grade, ranging from 12.5 to 14.5 years of age from 3 different schools. Regarding the methodology, 6 anthropometric measures (Stature, Popliteal height, Buttock-popliteal length, Elbow height while sitting, Hip width, Thigh thickness and Subscapular height) were gathered, as well as 8 dimensions from the school furniture. For the evaluation of classroom furniture a match criterion equation was defined. After considering the existing classroom furniture dimensions in each match criterion equation, the anthropometric characteristics of the considered population were compared in order to determine the mismatch between them. Results indicated that seat height, which should be considered as the starting point for the design of classroom furniture, was appropriate for students' popliteal height in only 14% of the 2 out of the 3 schools, and 28% in the third. Seat to desk height was too high and mismatched 99% of the students in one school and 100% in the others. Therefore, it was possible to conclude that the classroom's furniture was inadequate in almost all the analyzed cases and subjects. It is possible that the high mismatch percentage found between furniture and students' anthropometry can be associated to the fact that the acquisition and selection of the furniture was made without any ergonomic concern or criteria. Copyright 2009 Elsevier Ltd. All rights reserved.

  19. Screening of Inflammatory Bowel Disease and Spondyloarthritis for Referring Patients Between Rheumatology and Gastroenterology. (United States)

    Sanz Sanz, Jesús; Juanola Roura, Xavier; Seoane-Mato, Daniel; Montoro, Miguel; Gomollón, Fernando


    To define clinical screening criteria for spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) and vice versa, which can be used as a reference for referring them to the rheumatology or gastroenterology service. Systematic literature review and a two-round Delphi method. The scientific committee and the expert panel were comprised of 2 rheumatologists and 2 gastroenterologists, and 7 rheumatologists and 7 gastroenterologists, respectively. The scientific committee defined the initial version of the criteria, taking into account sensitivity, specificity, standardization and ease of application. Afterwards, members of the expert panel assessed each item in a two-round Delphi survey. Items that met agreement in the first or second round were included in the final version of the criteria. Positive screening for SpA if at least one of the following is present: onset of chronic low back pain before 45 years of age; inflammatory low back pain or alternating buttock pain; HLA-B27 positivity; sacroiliitis on imaging; arthritis; heel enthesitis; dactylitis. Positive screening for IBD in the presence of one of the major criteria or at least two minor criteria. Major: rectal bleeding; chronic diarrhea with organic characteristics; perianal disease. Minor: chronic abdominal pain; iron deficiency anemia or iron deficiency; extraintestinal manifestations; fever or low grade fever, of unknown origin and duration >1week; unexplained weight loss; family history of IBD. Screening criteria for IBD in patients with SpA, and vice versa, have been developed. These criteria will be useful for early detection of both diseases. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  20. Seronegative polyarthritis as severe systemic disease. (United States)

    Rozin, A P; Hasin, T; Toledano, K; Guralnik, L; Balbir-Gurman, A


    Severe extra-articular disease is associated with high levels of rheumatoid factor (RF ) in patients with seropositive rheumatoid arthritis (RA ) and a poor prognosis. It is said that patients with seronegative rheumatoid arthritis have a more benign course and less destructive disease. We observed several patients with seronegative non-rheumatoid polyarthritis, with aggressive extra-articular systemic disease. Review of seronegative systemic polyarthritis with clinical presentation of typical cases. Medline search for systemic manifestations of seronegative polyarthritis. 1. A 56-year-old woman was admitted to the cardiac intensive care unit with stabbing presternal chest pain aggravated by breathing and progressive dyspnoea, which gradually developed over a period of two weeks with one episode of fever at 38.0 degrees C. She had suffered chronic pain in her buttocks for three years with polyarthralgia and evanescent palmar-plantar rash. Imaging showed bilateral sacroiliitis (HLA B27 negative) and a large pericardial effusion. Extra-articular manifestations of SAPHO syndrome were proposed and she was successfully treated with combined therapy: pulse methylprednisolone, azathioprine, colchicine and prednisone. 2. A 47-year-old woman with psoriatic arthropathy developed high fever with leucocytosis and thrombocytosis and lung infiltrates during exacerbation of her joint disease . She was treated with pulse methylprednisolone followed by corticosteroid tapering, anti-TNF (infliximab) and methotrexate with complete resolution. 3. A 19-year-old man with inflammatory bowel disease developed acute pericarditis with response to 6-mercaptopurine, salazopyrine and prednisone. We discuss a range of seronegative arthritis diseases with possible systemic manifestations including the main procedures for early diagnosis. Infection, malignancy, hypersensitivity, granulomatous disease and other collagen diseases such as systemic lupus erythematosus should be excluded, but

  1. [Differentiation between moisture lesions and pressure ulcers using photographs in a critical area]. (United States)

    Valls-Matarín, Josefa; Del Cotillo-Fuente, Mercedes; Pujol-Vila, María; Ribal-Prior, Rosa; Sandalinas-Mulero, Inmaculada


    To identify difficulties for nurses in differentiating between moisture lesions and pressure ulcers, proper classification of pressure ulcers to assess the adequate classification of the Grupo Nacional para el Estudio y Asesoramiento de Úlceras por Presión y Heridas Crónicas (GNEAUPP) and the degree of agreement in the correct assessment by type and category of injury. Cross-sectional study in a critical area during 2014. All nurses who agreed to participate were included. They performed a questionnaire with 14 photographs validated by experts of moisture lesions or pressure ulcers in the sacral area and buttocks, with 6 possible answers: Pressure ulcer category I, II, III, IV, moisture lesions and unknown. Demographics and knowledge of the classification system of the pressure ulcers were collected according to GNEAUPP. It involved 98% of the population (n=56); 98.2% knew the classification system of the GNEAUPP; 35.2% of moisture lesions were considered as pressure ulcers, most of them as a category II (18.9%). The 14.8% of the pressure ulcers photographs were identified as moisture lesions and 16.1% were classified in another category. The agreement between nurses earned a global Kappa index of .38 (95% CI: .29-.57). There are difficulties differentiating between pressure ulcers and moisture lesions, especially within initial categories. Nurses have the perception they know the pressure ulcers classification, but they do not classify them correctly. The degree of concordance in the diagnosis of skin lesions was low. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  2. Mycetoma in Iran: Causative Agents and Geographic Distribution (United States)

    Bassiri-Jahromi, Shahindokht


    Background: Mycetoma is a chronic granulomatous disease caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). It usually involves the subcutaneous tissue after a traumatic inoculation of the causative organism. We reviewed retrospectively 13 patients with mycetoma. Materials and Methods: This study reports the etiologic agents and distribution of mycetoma in 35 cases from 1994 to2009 in Iran. The diagnostic of mycetoma were confirmed by histopathology and direct preparation, culture techniques, and histopathology of granules and surgical biopsies, radiological examination of the affected site. Results: Mycetoma was identified in 35 patients of 168 suspected patients (20.8%). They occurred in 22 male and 13 females. Their ages ranged from 14 to 80 years. The duration of the disease ranged from two months to 38 years. Sixteen patients had eumycetoma, and 19 patients had actinomycetoma, one of them had mix infections by eumycetoma and actinomycetoma. The majority of the patients were from central and states in south and north of Iran. The feet were most affected site (65.7%) of the cases, followed by hands (25.7%), face (2.8%), and trunk (2.8%), and buttock (2.8%). Most patients (68.5%) were more than 40 year-old. The male to female ratio was 5:3. The disease was abundant among housewife in urban and farmer in rural area of Iran. The most common prevalent mycetoma agents in this study were Actinomyces sp. There was a history of risk factors in 28.6% of patients in this study. Conclusion: Mycetoma occasionally occurs particularly in the South, Central, and North of Iran, and seen most often in persons, who live in hot, humid climates. If there are risk factors for invasive fungal infections traumatic inoculation with any fungus may result in rapid local spread and systemic disease, often with fatal outcome. PMID:25284877

  3. Mycetoma in Iran: Causative agents and geographic distribution

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    Shahindokht Bassiri-Jahromi


    Full Text Available Background: Mycetoma is a chronic granulomatous disease caused by true fungi (eumycetoma or filamentous bacteria (actinomycetoma. It usually involves the subcutaneous tissue after a traumatic inoculation of the causative organism. We reviewed retrospectively 13 patients with mycetoma. Materials and Methods: This study reports the etiologic agents and distribution of mycetoma in 35 cases from 1994 to2009 in Iran. The diagnostic of mycetoma were confirmed by histopathology and direct preparation, culture techniques, and histopathology of granules and surgical biopsies, radiological examination of the affected site. Results: Mycetoma was identified in 35 patients of 168 suspected patients (20.8%. They occurred in 22 male and 13 females. Their ages ranged from 14 to 80 years. The duration of the disease ranged from two months to 38 years. Sixteen patients had eumycetoma, and 19 patients had actinomycetoma, one of them had mix infections by eumycetoma and actinomycetoma. The majority of the patients were from central and states in south and north of Iran. The feet were most affected site (65.7% of the cases, followed by hands (25.7%, face (2.8%, and trunk (2.8%, and buttock (2.8%. Most patients (68.5% were more than 40 year-old. The male to female ratio was 5:3. The disease was abundant among housewife in urban and farmer in rural area of Iran. The most common prevalent mycetoma agents in this study were Actinomyces sp. There was a history of risk factors in 28.6% of patients in this study. Conclusion: Mycetoma occasionally occurs particularly in the South, Central, and North of Iran, and seen most often in persons, who live in hot, humid climates. If there are risk factors for invasive fungal infections traumatic inoculation with any fungus may result in rapid local spread and systemic disease, often with fatal outcome.

  4. Correction of lumbosacral hyperlordosis in achondroplasia. (United States)

    Park, Hui-Wan; Kim, Hak-Sun; Hahn, Soo-Bong; Yang, Kyu-Hyun; Choi, Chong-Hyuk; Park, Jin-Oh; Jung, Sung-Hoon


    Anterior bulging of the abdomen and posterior protrusion of the buttocks are externally visible deformities reflecting lumbosacral hyperlordosis. Imbalance in pelvic femoral muscles may account for this posture. Despite the clinical significance of hyperlordosis, its surgical treatment has not been well-described. In the current preliminary study, the authors compare two techniques used at the authors' institution for lower limb lengthening, one of which affects the correction of lumbosacral hyperlordosis. Ten patients had bilateral lower extremity lengthening procedures. Seven patients had bilateral tibial lengthening and three patients had combined femoral and tibial lengthening. Ring external fixators were used. Correction of hyperlordosis was assessed by comparing four radiographs with measurements in the sagittal plane obtained preoperatively with those at the latest followup. In the femoral lengthening group, the average preoperative lumbar lordosis angle was 18 degrees, the lumbosacral joint angle was 12 degrees, the sacral inclination angle was 58.3 degrees, and the sacrohorizontal angle was 31 degrees. The mean changes at the latest followup were: lumbar lordosis angle (+1 degree), lumbosacral joint angle (+0.3 degrees), sacral inclination angle (-19 degrees), and sacrohorizontal angle (-15 degrees). In the tibia lengthening group, all parameters were relatively unaltered at the last followup compared with their preoperative levels. Tibial lengthening had no effect on lumbosacral hyperlordosis. However, femoral lengthening resulted in an improved apparent lumbosacral hyperlordosis, although the lumbar lordosis angle was not changed significantly. The change in sacrum tilting provides a likely explanation for the improvement in cosmetic hyperlordosis observed in patients who have had femoral lengthening.

  5. Virological investigation of hand, foot, and mouth disease in a tertiary care center in South India

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    Pavithra M Vijayaraghavan


    Full Text Available Context: Hand, foot, and mouth disease (HFMD remains a common problem in India, yet its etiology is largely unknown as diagnosis is based on clinical characteristics. There are very few laboratory-based molecular studies on HFMD outbreaks. Aim: The aim of this study was to characterize HFMD-related isolates by molecular techniques. Settings and Design: Between 2005 and 2008, during two documented HFMD outbreaks, 30 suspected HFMD cases presented at the Outpatient Unit of the Department of Dermatology, Christian Medical College (CMC, Vellore. Seventy-eight clinical specimens (swabs from throat, mouth, rectum, anus, buttocks, tongue, forearm, sole, and foot were received from these patients at the Department of Clinical Virology, CMC, for routine diagnosis of hand, foot, and mouth disease. Materials and Methods: Samples from these patients were cultured in Vero and rhabdomyosarcoma (RD cell lines. Isolates producing enterovirus-like cytopathogenic effect (CPE in cell culture were identified by a nested reverse transcription-based polymerase chain reaction (RT-PCR and sequenced. The nucleotide sequences were analyzed using the BioEdit sequence program. Homology searches were performed using the Basic Local Alignment Search Tool (BLAST algorithm. Statistical Analysis used: The statistical analysis was performed using Epi Info version 6.04b and Microsoft Excel 2002 (Microsoft Office XP. Results: Of the 30 suspected HFMD cases, only 17 (57% were laboratory confirmed and Coxsackievirus A16 (CVA16 was identified as the etiological agent in all these cases. Conclusions: Coxsackievirus A16 (CVA16 was identified as the virus that caused the HFMD outbreaks in Vellore between 2005 and 2008. Early confirmation of HFMD helps to initiate control measures to interrupt virus transmission. In the laboratory, classical diagnostic methods, culture and serological tests are being replaced by molecular techniques. Routine surveillance systems will help understand the

  6. Characterization of severe hand, foot, and mouth disease in Shenzhen, China, 2009-2013. (United States)

    Huang, Yun; Zhou, Yuanping; Lu, Hong; Yang, Hong; Feng, Qianjin; Dai, Yingchun; Chen, Long; Yu, Shouyi; Yao, Xiangjie; Zhang, Hailong; Jiang, Ming; Wang, Yujie; Han, Ning; Hu, Guifang; He, Yaqing


    Hand, foot, and mouth disease (HFMD) is caused by human enteroviruses, especially by enterovirus 71 (EV71) and coxsackievirus A16 (CA16). Patients infected with different enteroviruses show varied clinical symptoms. The aim of this study was to determine whether the etiological spectrum of mild and severe HFMD changed, and the association between pathogens and clinical features. From 2009 to 2013, a total of 2,299 stool or rectal specimens were collected with corresponding patient data. A dynamic view of the etiological spectrum of mild and severe HFMD in Shenzhen city of China was provided. EV71 accounted for the majority proportion of severe HFMD cases and fatalities during 2009-2013. CA16 and EV71 were gradually replaced by coxsackievirus A6 (CA6) as the most common serotype for mild HFMD since 2010. Myoclonic jerk and vomiting were the most frequent severe symptoms. Nervous system complications, including aseptic encephalitis and aseptic meningitis were observed mainly in patients infected by EV71. Among EV71, CA16, CA6, and CA10 infection, fever and pharyngalgia were more likely to develop, vesicles on the hand, foot, elbow, knee and buttock were less likely to develop in patients infected with CA10. Vesicles on the mouth more frequently occurred in the patients with CA6, but less in the patient with EV71. Associations between diverse enterovirus serotypes and various clinical features were discovered in the present study, which may offer further insight into early detection, diagnosis and treatment of HFMD. © 2015 Wiley Periodicals, Inc.

  7. Ultrasonographic evaluation of lschial bursitis

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    Kim, Sung Moon; Shin, Myung Jin; Kim, Kyung Sook; Chang, Jae Suck; Lee, Soo Ho [Asan Medical Center, Ulsan Univ. College of Medicine, Seoul (Korea, Republic of); Ahn, Joong Mo [Samsung Medical Center, Sungkyunkwan Univ. College of Medicine, Seoul (Korea, Republic of); Cho, Kil Ho [Yeungnam Univ. College of Medicine, Kyongsan (Korea, Republic of)


    The objective of this study was to evaluate the findings of ultrasonography (US) in patients with ischial bursitis. Our study included 27 patients (mean age 62 years) who underwent US for a painful mass or tenderness in the buttock area. In six of these 27, serous fluid was obtained by needle aspiration, and in five cases, bursal excision permitted histologic confirmation. The other sixteen patients were followed up for one or two months with only NSAID medication; all showed some improvement or remission of symptoms. Using a 5-10 MHz linear array probe, US examination was performed while the patient was lying face down. US images were analyzed with regard to location and size of the lesions, thickness of cyst wall, the presence of internal septa or mural nodules, echogenicity of the cyst wall, fluid content, internal septa, compressibility by a probe, and Doppler signals within the cyst wall. In all 27 patients, ischial bursitis was located superficially to ischial tuberosity. Lesion size(maximum diameter) was 1.5-7(mean 3.8)cm, and the cyst wall was 0.2-0.8cm thick. Internal septa and mural nodules were seen in 12 cases (44%) and 13 cases (48%), respectively. The cyst wall was identifiable in 21 cases (78%), appearing as a single layer with low echogenicity (n=10) or with high echogenicity (n=1); it also appeared as two (n=6) or three (n=4) layers of different echogenicities. When internal septa were present, fluid within the cyst was low echoic in 59% of cases, high echoic in 30%, and of mixed echogenicity (so-called compartmentalization) in 15%. In all cases, the cyst became deformed, when compressed by a probe. In all patients who underwent doppler examination, some vascularity was found within the cyst wall. US helped to detect ischial bursitis; US findings were thin-walled cystic lesion located superficially to ischial tuberosity, with or without internal septa and mural nodules, and easy compressibility.

  8. Site-dependent differences in both prelamin A and adipogenic genes in subcutaneous adipose tissue of patients with type 2 familial partial lipodystrophy. (United States)

    Araújo-Vilar, D; Lattanzi, G; González-Méndez, B; Costa-Freitas, A T; Prieto, D; Columbaro, M; Mattioli, E; Victoria, B; Martínez-Sánchez, N; Ramazanova, A; Fraga, M; Beiras, A; Forteza, J; Domínguez-Gerpe, L; Calvo, C; Lado-Abeal, J


    Type 2 familial partial lipodystrophy (FPLD2) is characterised by loss of fat in the limbs and buttocks and results from mutations in the LMNA gene. To evaluate the role of several genes involved in adipogenesis in order to better understand the underlying mechanisms of regional loss of subcutaneous adipose tissue (scAT) in patients with FPLD2. In total, 7 patients with FPLD2 and 10 healthy control participants were studied. A minimal model was used to calculate the insulin sensitivity (IS). scAT was obtained from abdomen and thigh by biopsy. Relative gene expression was quantified by real-time reverse transcription PCR in a thermal cycler. Prelamin A western blot analysis was carried out on scAT and prelamin A nuclear localisation was determined using immunofluorescence. Adipocyte nuclei were examined by electron microscopy. Patients with FPLD2 were found to have significantly lower IS. The expression of LMNA was similar in both groups. The expression of PPARG2, RB1, CCND3 and LPL in thigh but not in abdomen scAT was significantly reduced (67%, 25%, 38% and 66% respectively) in patients with FPLD2. Significantly higher levels of prelamin A were found in peripheral scAT of patients with FPLD2. Defects in the peripheral heterochromatin and a nuclear fibrous dense lamina were present in the adipocytes of patients with FPLD2. In FPLD2 participants, prelamin A accumulation in peripheral scAT is associated with a reduced expression of several genes involved in adipogenesis, which could perturb the balance between proliferation and differentiation in adipocytes, leading to less efficient tissue regeneration.

  9. Compartment syndromes

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    Aly Saber


    Full Text Available Body compartments bound by fascia and limited by bony backgrounds are found in the extremities, buttocks, abdomen and thoracic cavity; conditions that cause intracompartmental swelling and hypertension can lead to ischemia and limb loss. Although compartment syndromes are described in all body regions from head to toe, the etiology, diagnosis, treatment, and prevention are best characterized for three key body regions: the first is extremity, the second is abdominal, and the third is thoracic compartment syndromes. Thoracic compartment syndrome usually occurs as a result of pathological accumulation of air, fluid or blood in the mediastinum and has traditionally been described in trauma. As the intracranial contents are confined within a rigid bony cage, any increase in volume within this compartment as a result of brain oedema or an expanding traumatic intracranial haematoma, leads to a reciprocal decrease in the volume of cerebrospinal fluid and intracranial venous blood volume. Limb compartment syndromes may present either in acute or chronic clinical forms. Intra-abdominal pressure can be measured by direct or indirect methods. While the direct methods are quite accurate, they are impractical and not feasible for routine practice. Indirect measurement is done through inferior vena cava, gastric, rectal and urinary bladder. Indirect measurement through urinary bladder is the simplest and is considered the method of choice for intra-abdominal pressure measurement. The management of patients with intra-abdominal hypertension is based on four important principles: the first is related to the specific procedures aiming at lowering intra-abdominal pressure and the consequences of intra-abdominal hypertension and abdominal compartment syndrome; the second is for general support and medical management of the critically ill patient; while the third is surgical decompression and the fourth is optimization after surgical decompression.

  10. Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space

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    Hernando, Moises Fernandez; Cerezal, Luis; Perez-Carro, Luis; Abascal, Faustino; Canga, Ana [Diagnostico Medico Cantabria (DMC), Department of Radiology, Santander, Cantabria (Spain); Valdecilla University Hospital, Orthopedic Surgery Department Clinica Mompia (L.P.C.), Santander, Cantabria (Spain); Valdecilla University Hospital, Department of Radiology, Santander, Cantabria (Spain)


    Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic sciatic nerve entrapment in the subgluteal space. Multiple pathologies have been incorporated in this all-included ''piriformis syndrome,'' a term that has nothing to do with the presence of fibrous bands, obturator internus/gemellus syndrome, quadratus femoris/ischiofemoral pathology, hamstring conditions, gluteal disorders and orthopedic causes. The concept of fibrous bands playing a role in causing symptoms related to sciatic nerve mobility and entrapment represents a radical change in the current diagnosis of and therapeutic approach to DGS. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification. A broad spectrum of known pathologies may be located nonspecifically in the subgluteal space and can therefore also trigger DGS. These can be classified as traumatic, iatrogenic, inflammatory/infectious, vascular, gynecologic and tumors/pseudo-tumors. Because of the ever-increasing use of advanced magnetic resonance neurography (MRN) techniques and the excellent outcomes of the new endoscopic treatment, radiologists must be aware of the anatomy and pathologic conditions of this space. MR imaging is the diagnostic procedure of choice for assessing DGS and may substantially influence the management of these patients. The infiltration test not only has a high diagnostic but also a therapeutic value. This article describes the subgluteal space anatomy, reviews known and new etiologies of DGS, and assesses the role of the radiologist in the diagnosis, treatment and postoperative evaluation of sciatic nerve entrapments, with emphasis on MR imaging and endoscopic correlation. (orig.)

  11. "Eczema coxsackium" and unusual cutaneous findings in an enterovirus outbreak. (United States)

    Mathes, Erin F; Oza, Vikash; Frieden, Ilona J; Cordoro, Kelly M; Yagi, Shigeo; Howard, Renee; Kristal, Leonard; Ginocchio, Christine C; Schaffer, Julie; Maguiness, Sheilagh; Bayliss, Susan; Lara-Corrales, Irene; Garcia-Romero, Maria Teresa; Kelly, Dan; Salas, Maria; Oberste, M Steven; Nix, W Allan; Glaser, Carol; Antaya, Richard


    To characterize the atypical cutaneous presentations in the coxsackievirus A6 (CVA6)-associated North American enterovirus outbreak of 2011-2012. We performed a retrospective case series of pediatric patients who presented with atypical cases of hand, foot, and mouth disease (HFMD) from July 2011 to June 2012 at 7 academic pediatric dermatology centers. Patients were included if they tested positive for CVA6 or if they met clinical criteria for atypical HFMD (an enanthem or exanthem characteristic of HFMD with unusual morphology or extent of cutaneous findings). We collected demographic, epidemiologic, and clinical data including history of skin conditions, morphology and extent of exanthem, systemic symptoms, and diagnostic test results. Eighty patients were included in this study (median age 1.5 years, range 4 months-16 years). Seventeen patients were CVA6-positive, and 63 met clinical inclusion criteria. Ninety-nine percent of patients exhibited a vesiculobullous and erosive eruption; 61% of patients had rash involving >10% body surface area. The exanthem had a perioral, extremity, and truncal distribution in addition to involving classic HFMD areas such as palms, soles, and buttocks. In 55% of patients, the eruption was accentuated in areas of eczematous dermatitis, termed "eczema coxsackium." Other morphologies included Gianotti-Crosti-like (37%), petechial/purpuric (17%) eruptions, and delayed onychomadesis and palm and sole desquamation. There were no patients with serious systemic complications. The CVA6-associated enterovirus outbreak was responsible for an exanthem potentially more widespread, severe, and varied than classic HFMD that could be confused with bullous impetigo, eczema herpeticum, vasculitis, and primary immunobullous disease.

  12. Effects of William training on lumbosacral muscles function, lumbar curve and pain. (United States)

    Fatemi, Rouholah; Javid, Marziyeh; Najafabadi, Ebrahim Moslehi


    There are many types of treatments and recommendations for restoring back deformities depending on doctors' knowledge and opinions. The purpose of the exercises is to reduce pain and to ensure stability of the lower trunk by toning the abdominal muscles, buttocks and hamstrings. Given the duration of flares and relapses rate, it is important to apply an efficient and lasting treatment. To evaluate the effects of 8 weeks of William's training on flexibility of lumbosacral muscles and lumbar angle in females with Hyperlordosis. Forty female students with lumbar lordosis more than normal degrees (Hyperlordotic) that were randomly divided into exercise and control groups were selected as the study sample. The lumbar lordosis was measured using a flexible ruler, flexibility of hamstring muscles was measured with the active knee extension test, the hip flexor muscles strength was measured using Thomas test, the lumbar muscles flexibility measures by Schober test, abdominal muscles strength measured by Sit-Up test and back pain was measured using McGill's Visual Analogue Scales (VAS) questionnaire. Data were compared before and post-test using independent and paired t-testes. Results showed that 8 weeks of William's exercise led to significant decreases in lumbar angle and back pain, increases in flexibility of hamstring muscles, hip flexor muscles flexibility, lumbar extensor muscles flexibility and abdominal muscles strength. The findings show that William's corrective training can be considered as a useful and valid method for restoring and refining back deformities like as accentuated back-arc and became wreaked muscles' performance in lumbar areas.


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    Samo K. Fokter


    Full Text Available Background. Degenerative lumbar spinal stenosis (DLSS is a common cause of low back and leg pain in the elderly. Conservative treatment seldom results in sustained improvement.Methods. Fifty-six patients (33 women, 23 men older than 50 years (mean 67 years, range 51 to 82 years and with no prior low back surgery were treated from 1993 to 1999 for clinical and radiologic evidence of DLSS. The goal of this study was to describe the results of decompressive laminectomy with or without fusion in terms of reoperation, severity of back pain, leg pain and patient satisfaction. Answers to Swiss spinal stenosis questionnaires completed before surgery and one to five years afterwards were evaluated. Seven patients (12.5% with degenerative spondylolisthesis, scoliosis and/or more radical facetectomies received fusion.Results. Of the 56 patients in the original cohort, two were deceased and two had undergone reoperation by follow-up. Forty-eight patients answered questionnaires. Average duration of follow-up was 2.5 years. More than 70 percent of the respondents had no or only mild back or buttock pain at follow-up and more than 60 percent were able to walk more than 500 m. Added fusion reduced the incidence of low back pain and pain frequency, and increased walking distance (ANOVA.Conclusions. Eighty-one percent of patients were satisfied with the results of surgery and 87.5% would choose to have the operation again if they had the choice. Decompressive laminectomy for DLSS yields best results if instrumented fusion is included in the procedure.

  14. Symptoms dermatologists should look for in daily practice to improve detection of psoriatic arthritis in psoriasis patients: an expert group consensus. (United States)

    Villani, A P; Rouzaud, M; Sevrain, M; Barnetche, T; Paul, C; Richard, M-A; Beylot-Barry, M; Misery, L; Joly, P; Aractingi, S; Aubin, F; Le Maître, M; Cantagrel, A; Ortonne, J-P; Jullien, D


    Up to 29% of patients with psoriasis seen by dermatologists have undiagnosed psoriatic arthritis (PsA). As early detection of PsA may be associated with improved joint and skin outcomes, it is essential for dermatologists to improve their ability to diagnose PsA. Skin and nail features of psoriasis associated with PsA are well known to dermatologists but they may feel less confortable assessing other symptoms and they rarely use PsA screening questionnaires. To develop a limited list of clinical signs and symptoms that a dermatologist should be looking for in a psoriasis patient in addition to specific skin features and nail involvement, to improve PsA detection. A systematic search was performed in Pubmed, Cochrane and Embase databases to identify clinical key symptoms associated with PsA. It yielded 27 studies in which we extracted a list of clinical signs and symptoms observed in PsA and submitted it to a panel of dermatology experts through a DELPHI selection process. The experts had to determine which minimal set of signs and symptoms dermatologists should look for in daily practice to improve detection of PsA in patients with psoriasis. The four items that received a score higher than 90% in the DELPHI process were finally selected. Those items were as follows: peripheral inflammatory pain (100%), axial inflammatory pain (95.3%), dactylitis (93%), buttock and sciatic pain (90.7%). The remaining items: distal interphalangeal joints (DIPs) involvement (83.7%), Talalgia (79.1%), swollen Achille's tendon (41.9%), costo-chondral involvement (32.6%), uveitis (7%), mouth ulcerations (2.3%), were not retained. We propose a set of four items to screen psoriasis patients for psoriatic arthritis for routine clinical use by dermatologists. © 2014 European Academy of Dermatology and Venereology.

  15. The effect of human-mattress interface's temperature on perceived thermal comfort. (United States)

    Califano, R; Naddeo, A; Vink, P


    In recent years, methods that allow for an objective evaluation of perceived comfort, in terms of postural, physiological, cognitive and environmental comfort, have received a great deal of attention from researchers. This paper focuses on one of the factors that influences physiological comfort perception: the temperature difference between users and the objects with which they interact. The first aim is to create a measuring system that does not affect the perceived comfort during the temperatures' acquisition. The main aim is to evaluate how the temperature at the human-mattress interface can affect the level of perceived comfort. A foam mattress has been used for testing in order to take into account the entire back part of the human body. The temperature at the interface was registered by fourteen 100 Ohm Platinum RTDs (Resistance Temperature Detectors) placed on the mattress under the trunk, the shoulders, the buttocks, the legs, the thighs, the arms and the forearms of the test subject. 29 subjects participated in a comfort test in a humidity controlled environment. The test protocol involved: dress-code, anthropometric-based positioning on mattress, environment temperature measuring and an acclimatization time before the test. At the end of each test, each of the test subject's thermal sensations and the level of comfort perception were evaluated using the ASHRAE (American Society of Heating, Refrigerating and Air-Conditioning Engineers) scale. The data analyses concerned, in the first instance, correlations between the temperature at the interface and comfort levels of the different parts of the body. Then the same analyses were performed independently of the body parts being considered. The results demonstrated that there was no strong correlation among the studied variables and that the total increase of temperature at interface is associated with a reduction in comfort. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Clinical results and second-look arthroscopic findings after treatment with adipose-derived stem cells for knee osteoarthritis. (United States)

    Koh, Yong-Gon; Choi, Yun-Jin; Kwon, Sae-Kwang; Kim, Yong-Sang; Yeo, Jee-Eun


    In the present study, the clinical outcomes and second-look arthroscopic findings of intra-articular injection of stem cells with arthroscopic lavage for treatment of elderly patients with knee osteoarthritis (OA) were evaluated. Stem cell injections combined with arthroscopic lavage were administered to 30 elderly patients (≥65 years) with knee OA. Subcutaneous adipose tissue was harvested from both buttocks by liposuction. After stromal vascular fractions were isolated, a mean of 4.04 × 10(6) stem cells (9.7 % of 4.16 × 10(7) stromal vascular fraction cells) were prepared and injected in the selected knees of patients after arthroscopic lavage. Outcome measures included the Knee Injury and Osteoarthritis Outcome Scores, visual analog scale, and Lysholm score at preoperative and 3-, 12-, and 2-year follow-up visits. Sixteen patients underwent second-look arthroscopy. Almost all patients showed significant improvement in all clinical outcomes at the final follow-up examination. All clinical results significantly improved at 2-year follow-up compared to 12-month follow-up (P 65 years, only five patients demonstrated worsening of Kellgren-Lawrence grade. On second-look arthroscopy, 87.5 % of elderly patients (14/16) improved or maintained cartilage status at least 2 years postoperatively. Moreover, none of the patients underwent total knee arthroplasty during this 2-year period. Adipose-derived stem cell therapy for elderly patients with knee OA was effective in cartilage healing, reducing pain, and improving function. Therefore, adipose-derived stem cell treatment appears to be a good option for OA treatment in elderly patients. Therapeutic case series study, Level IV.

  17. Cellulite: a new treatment approach combining subdermal Nd: YAG laser lipolysis and autologous fat transplantation. (United States)

    Goldman, Alberto; Gotkin, Robert H; Sarnoff, Deborah S; Prati, Clarissa; Rossato, Flávia


    Cellulite is an alteration of the topography of the skin that occurs in body areas where fat deposition seems to be under the influence of estrogen: mainly the hips, buttocks, thighs, and abdomen. The presence of cellulite is a significant source of patient dissatisfaction. There is currently no cure or consistently effective treatment for cellulite. The authors sought to show that the subdermal application of the neodymium-doped yttrium aluminium garnet (Nd:YAG) laser combined with autologous fat transplantation is a safe and effective treatment for cellulite. From January 2003 to December 2006, 52 female patients with Curri grade III to IV cellulite were treated with subdermal 1064-nm Nd:YAG laser lipolysis combined with autologous fat transplantation. Patient assessment was collected for data analysis. After the treatment, tissue samples were obtained in some subjects in order to ascertain the histologic effects of the laser treatment. This treatment resulted in significant clinical improvement in cellulite. The adverse effects were mild and temporary, and the postoperative period was well tolerated. A majority of patients (84.6%) rated the results of treatment as either good or excellent. The treatment of severe cases of cellulite (Curri grades III and IV) by a combination of 1064-nm Nd:YAG laser lipolysis and autologous fat transplantation proved to be both safe and effective. In addition, subdermal laser lipolysis has the advantage of inducing neocollagenesis and stimulating postoperative skin tightening. This represents a new treatment option for the ubiquitous cellulite disorder. Although this treatment has shown promising results in this pilot study, further studies are necessary in order to draw final conclusions.

  18. Histopathological evaluation of caffeine-loaded solid lipid nanoparticles in efficient treatment of cellulite. (United States)

    Hamishehkar, Hamed; Shokri, Javad; Fallahi, Shahoo; Jahangiri, Azin; Ghanbarzadeh, Saeed; Kouhsoltani, Maryam


    Cellulite refers to dimpled appearance of the skin, usually located in the thighs and buttocks regions of most adult women. The aim of this study was to formulate topically used caffeine-loaded solid lipid nanoparticle (SLN) for the treatment of cellulite. SLNs were prepared by hot homogenization technique using Precirol® as lipid phase. The physical characterization and stability studies of SLNs as well as in vitro skin permeation and histological studies in rat skin were conducted. The mean particle size, encapsulation efficiency and loading efficiency percentages for optimized SLN formulation were 94 nm, 86 and 28%, respectively. In vitro drug release demonstrated that caffeine-loaded SLN incorporated into carbopol made hydrogel (caffeine-SLN-hydrogel) exhibited a sustained drug release compared to the caffeine hydrogel over 24 h. Caffeine-loaded SLNs showed a good stability during 12 months of storage at room temperature. The DSC and XRD results showed that caffeine was dispersed in SLN in an amorphous state. In vitro permeation studies illustrated higher drug accumulation in the skin with caffeine-SLN-hydrogel compared to caffeine hydrogel. The flux value of caffeine through rat skin in caffeine-SLN-hydrogel was 3.3 times less than caffeine hydrogel, representing lower systemic absorption. In contrast with caffeine hydrogel, the histological studies showed the complete lysis of adipocytes by administration of caffeine-SLN-hydrogel in the deeper skin layers. Results of this study indicated that SLNs are promising carrier for improvement of caffeine efficiency in the treatment of cellulite following topical application on the skin.

  19. In vitro and in vivo efficacy of sulfo-carrabiose, a sugar-based cosmetic ingredient with anti-cellulite properties. (United States)

    Vogelgesang, B; Bonnet, I; Godard, N; Sohm, B; Perrier, E


    Most of adult women exhibit cellulite on the hips, buttock and thighs. Although extracellular matrix and lymphatic system disorders can increase its appearance, cellulite basically results from an excessive fat storage in the adipose tissue which exerts considerable pressure on the surrounding skin tissue and creates a dimpled irregular appearance. Caffeine, the most widely used anti-cellulite ingredient, favours fat break-down by inhibiting the phosphodiesterase enzyme and encouraging a high intracellular level of cAMP. A series of studies has shown that spermine and spermidine, two ubiquitous polyamines, encouraged fat storage and slowed fat break-down in the adipose tissue. Besides, it was shown that heparan sulfate glycosaminoglycans had a strong affinity for polyamines. To design a new cosmetic ingredient with anti-cellulite properties, we used molecular modelling to screen several ingredients with a structure similar to that of heparan sulfate glycosaminoglycans. This way, we identified sulfo-carrabiose as a potent molecule for trapping spermine and spermidine. These virtual results were first confirmed in tubo where sulfo-carrabiose was shown to dose-dependently inactivate spermine and spermidine. In vitro, adipocytes cultured with sulfo-carrabiose exhibited a significant reduction of lipogenesis and a significant increase of lipolysis. When sulfo-carrabiose was incorporated in a cosmetic formula, significant improvements were observed in thigh circumference, with better results than those obtained with caffeine after 28 days of use. Furthermore, a combination of caffeine and sulfo-carrabiose led to results significantly better than those obtained with caffeine alone. As measured by fringe projection, thigh volume was also significantly reduced after sulfo-carrabiose treatment. Finally, the appearance of cellulite assessed by clinical evaluation was also significantly reduced within 28 days. © 2010 BASF Beauty Care Solutions. ICS © 2010 Society of Cosmetic

  20. Reliability of texture analysis using co-occurrence matrices (glcm) on photographic image in the assessment of cellulite in a Spanish population. (United States)

    de la Casa Almeida, M; Suárez Serrano, C; Jiménez Rejano, J J; Ríos Díaz, J; Benitez Lugo, M L; Rebollo Roldán, J R


    Despite the existence of diverse instruments to assess cellulite, its high prevalence and the continuous advances in its treatment makes the development of new, more objective methods for evaluation necessary. To study intraobserver validity and reliability (test-retest) of textural analysis using co-occurrence matrices on photographic images in the evaluation of cellulite in a Spanish population and its possible relationship to the degree of cellulite. Twenty-seven women were selected for this reliability study (mean age 26.41 SD = 6.16). Digital photographs were taken under standardized conditions in contraction and relaxation of the femoral gluteus region. The areas of interest of the photographs were selected at two different times a month apart. Textural parameters studied were energy (ASM), entropy, contrast, Homogeneity (IDM) and textural correlation. Reliability was analysed by the intraclass correlation coefficient (ICC). Differences between laterality and between contraction and relaxation were performed by analysis of variance for repeated measurements. Correlation between Cellulite Severity Scale (CSS) and the textural parameters by means of the Pearson correlation coefficient was studied. CSS was re-coded to a binary variable, performing a differentiate analysis for each laterality with this variable and the textural parameters. In the intraobserver reliability analysis ICC was high (≥0.80) in seven parameters and excellent (≥0.90) in 35 parameters. In general, CSS and textural parameters showed more cellulite severity in right areas than in left ones. Correlation coefficients showed a moderate correlation between textural parameters and CSS score. The multivariate discriminant model obtained with textural parameters classified a high percentage of images (96% right side and 82% left side). Textural analysis used to assess cellulite on the backs of thighs and buttocks proved to be an instrument that has excellent reliability, moderate correlation

  1. A single center, randomized, comparative, prospective clinical study to determine the efficacy of the VelaSmooth system versus the Triactive system for the treatment of cellulite. (United States)

    Nootheti, Pavan K; Magpantay, Angela; Yosowitz, Gail; Calderon, Steve; Goldman, Mitchel P


    One area of cosmetic concern for women of all races is the unsightly appearance of cellulite in the buttocks area and lower extremities. Two modern technological advances claim to improve cellulite and provide reproducible results, TriActive and VelaSmooth. The TriActive laser is intended to reduce the appearance of cellulite through the combination of low-energy diode laser, contact cooling, suction, and massage. The VelaSmooth is based on a combination of two different ranges of electromagnetic energy: infrared light and radio frequency (RF) combined with mechanical manipulation of the skin. This single center study was designed to evaluate the efficacy of the VelaSmooth versus TriActive in the reduction of the appearance of cellulite. Twenty female patients were treated twice a week for 6 weeks with the randomization of TriActive on one side and VelaSmooth on the other side. Patients were evaluated with photographs and circumferential thigh measurements before treatment and after the final treatment. Although there was improvement in the reduction of cellulite for each device individually, there was no significant difference between VelaSmooth or TriActive devices in the following categories: reduction of thigh circumference, photographic evaluation, and perceived change in before and after photographic grading. There was a statistically significant increase in the incidence of post-treatment bruising with the VelaSmooth compared to TriActive. In conclusion, both the TriActive and VelaSmooth provide improvement of cellulite. When comparing differences in efficacy, the average mean percent change calculated was roughly the same for both treatments and showed no statistical difference. (c) 2006 Wiley-Liss, Inc.

  2. Adiponectin expression in subcutaneous adipose tissue is reduced in women with cellulite. (United States)

    Emanuele, Enzo; Minoretti, Piercarlo; Altabas, Karmela; Gaeta, Elio; Altabas, Velimir


    Cellulite, which appears as orange peel-type or cottage cheese-like dimpling of the skin on the thighs and buttocks, is a complex, multifactorial, cosmetic disorder of the subcutaneous fat layer and the overlying superficial skin. Adiponectin is an adipocyte-derived hormone mainly produced by subcutaneous fat that shows important protective anti-inflammatory and vasodilatory effects. We hypothesized that adiponectin expressed in the subcutaneous adipose tissue (SAT) might play a role in the pathogenesis of cellulite. We reasoned that a reduction in the expression of adiponectin - a humoral vasodilator - in the SAT of cellulite areas might contribute to the altered microcirculation frequently found in these regions. A total of 15 lean (body mass index [BMI] cellulite and 15 age- and BMI-matched women without cellulite participated in this study. Real-time reverse transcription polymerase chain reaction (RT-PCR) was used to assess adiponectin gene expression. Plasma adiponectin levels were measured using a commercial enzyme immunoassay kit. Adiponectin mRNA expression in the SAT of the gluteal region was significantly lower in areas with cellulite compared with those without (12.6 ± 3.1 AU versus 16.6 ± 4.1 AU; P=0.006). However, plasma adiponectin levels did not differ between women with (20.3 ± 7.3 μg/ml) and without (19.3 ± 6.1 μg/ml) cellulite (P=0.69). Adiponectin expression is significantly reduced in the SAT in areas affected by cellulite. Our findings provide novel insights into the nature of cellulite and may give clues to the treatment of this cosmetic issue. © 2011 The International Society of Dermatology.

  3. Quantitative model of cellulite: three-dimensional skin surface topography, biophysical characterization, and relationship to human perception. (United States)

    Smalls, Lola K; Lee, Caroline Y; Whitestone, Jennifer; Kitzmiller, W John; Wickett, R Randall; Visscher, Marty O


    Gynoid lipodystrophy (cellulite) is the irregular, dimpled skin surface of the thighs, abdomen, and buttocks in 85% of post-adolescent women. The distinctive surface morphology is believed to result when subcutaneous adipose tissue protrudes into the lower reticular dermis, thereby creating irregularities at the surface. The biomechanical properties of epidermal and dermal tissue may also influence severity. Cellulite-affected thigh sites were measured in 51 females with varying degrees of cellulite, in 11 non-cellulite controls, and in 10 male controls. A non-contact high-resolution three-dimensional laser surface scanner was used to quantify the skin surface morphology and determine specific roughness values. The scans were evaluated by experts and naive judges (n=62). Body composition was evaluated via dual-energy x-ray absorptiometry; dermal thickness and the dermal-subcutaneous junction were evaluated via high-resolution 3D ultrasound and surface photography under compression. Biomechanical properties were also measured. The roughness parameters Svm (mean depth of the lowest valleys) and Sdr (ratio between the roughness surface area and the area of the xy plane) were highly correlated to the expert image grades and, therefore, designated as the quantitative measures of cellulite severity. The strength of the correlations among naive grades, expert grades, and roughness values confirmed that the data quantitatively evaluate the human perception of cellulite. Cellulite severity was correlated to BMI, thigh circumference, percent thigh fat, architecture of the dermal-subcutaneous border (ultrasound surface area, red-band SD from compressed images), compliance, and stiffness (negative correlation). Cellulite severity was predicted by the percent fat and the area of the dermal-subcutaneous border. The biomechanical properties did not significantly contribute to the prediction. Comparison of the parameters for females and males further suggest that percent thigh fat

  4. Short- and Long-Term Quality of Life and Bowel Function in Patients With MRI-Defined, High-Risk, Locally Advanced Rectal Cancer Treated With an Intensified Neoadjuvant Strategy in the Randomized Phase 2 EXPERT-C Trial

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    Sclafani, Francesco; Peckitt, Clare [The Royal Marsden NHS Foundation Trust, London (United Kingdom); Cunningham, David, E-mail: [The Royal Marsden NHS Foundation Trust, London (United Kingdom); Tait, Diana [The Royal Marsden NHS Foundation Trust, London (United Kingdom); Giralt, Jordi [Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Department of Medical Oncology, Barcelona (Spain); Glimelius, Bengt [University of Uppsala, Uppsala (Sweden); Keränen, Susana Roselló [Biomedical Research Institute INCLIVA, Department of Hematology and Medical Oncology, University of Valencia (Spain); Bateman, Andrew [Southampton General Hospital, Cancer Sciences Unit, University of Southampton (United Kingdom); Hickish, Tamas [Poole Hospital NHS Foundation Trust, Department of Medical Oncology, Bournemouth University (United Kingdom); Tabernero, Josep [Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Department of Medical Oncology, Barcelona (Spain); Thomas, Janet; Brown, Gina; Oates, Jacqueline; Chau, Ian [The Royal Marsden NHS Foundation Trust, London (United Kingdom)


    Objective: Intensified preoperative treatments have been increasingly investigated in locally advanced rectal cancer (LARC), but limited data are available for the impact of these regimens on quality of life (QoL) and bowel function (BF). We assessed these outcome measures in EXPERT-C, a randomized phase 2 trial of neoadjuvant capecitabine combined with oxaliplatin (CAPOX), followed by chemoradiation therapy (CRT), total mesorectal excision, and adjuvant CAPOX with or without cetuximab in magnetic resonance imaging-defined, high-risk LARC. Methods and Materials: QoL was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR29 questionnaires. Bowel incontinence was assessed using the modified Fecal Incontinence Severity Index questionnaire. Results: Compared to baseline, QoL scores during preoperative treatment were better for symptoms associated with the primary tumor in the rectum (blood and mucus in stool, constipation, diarrhea, stool frequency, buttock pain) but worse for global health status, role functioning, and symptoms related to the specific safety profile of each treatment modality. During follow-up, improved emotional functioning and lessened anxiety and insomnia were observed, but deterioration of body image, increased urinary incontinence, less sexual interest (men), and increased impotence and dyspareunia were observed. Cetuximab was associated with a deterioration of global health status during neoadjuvant chemotherapy but did not have any long-term detrimental effect. An improvement in bowel continence was observed after preoperative treatment and 3 years after sphincter-sparing surgery. Conclusions: Intensifying neoadjuvant treatment by administering induction systemic chemotherapy before chemoradiation therapy improves tumor-related symptoms and does not appear to have a significantly detrimental effect on QoL and BF, in both the short and the long term.

  5. Pigmentary Markers in Danes--Associations with Quantitative Skin Colour, Nevi Count, Familial Atypical Multiple-Mole, and Melanoma Syndrome.

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    Peter Johansen

    Full Text Available To investigate whether pigmentation genes involved in the melanogenic pathway (melanogenesis contributed to melanoma predisposition, we compared pigmentary genetics with quantitative skin pigmentation measurements, the number of atypical nevi, the total nevus count, and the familial atypical multiple mole and melanoma (FAMMM syndrome. We typed 32 pigmentary SNP markers and sequenced MC1R in 246 healthy individuals and 116 individuals attending periodic control for malignant melanoma development, 50 of which were diagnosed with FAMMM. It was observed that individuals with any two grouped MC1R variants (missense, NM_002386:c. 456C > A (p.TYR152*, or NM_002386:c.83_84insA (p.Asn29Glnfs*14 had significantly (p<0.001 lighter skin pigmentation of the upper-inner arm than those with none or one MC1R variant. We did not observe any significant association of the MC1R variants with constitutive pigmentation measured on the buttock area. We hypothesize that the effect of MC1R variants on arm pigmentation is primarily reflecting the inability to tan when subjected to UVR. A gender specific effect on skin pigmentation was also observed, and it was found that the skin pigmentation of females on average were darker than that of males (p<0.01. We conclude that MC1R variants are associated with quantitative skin colour in a lightly pigmented Danish population. We did not observe any association between any pigmentary marker and the FAMMM syndrome. We suggest that the genetics of FAMMM is not related to the genetics of the pigmentary pathway.

  6. Babinski, histologist and anatomo-pathologist. (United States)

    Poirier, J


    Joseph Babinski (1857-1932), a French neurologist of Polish origin, médecin des hôpitaux de Paris, is well known for the discovery of the Sign (the toes phenomenon) which bears his name. Beyond the Sign, his semiological work in the field of neurology is also important (particularly cutaneous and osteo-tendinous reflexes, cerebellar and vestibular semiology, hysteria and pithiatism) as well as his role in the birth of the French neurosurgery. On the contrary, the implication of Babinski in pathological anatomy and histology is usually unrecognized. However, in the beginning of his career, Babinski worked as an Interne in the clinical departments of Victor Cornil (1837-1908), professor of pathological anatomy and president of the Société d'Anatomie de Paris, Alfred Vulpian (1826-1887), past professor of pathological anatomy and then professor of experimental physiology, and in the laboratory of Louis Ranvier (1835-1922), professor of general anatomy at the Collège de France. Babinski beacame préparateur at the chair of pathological anatomy, member then treasurer of the Société Anatomique, member of the Société de Biologie. He reported on several clinico-pathological observations of general pathology (liver cirrhosis, cancer of the kidney, cancer of a buttock, squamous epithelioma, tuberculosis, multiple cysts of the liver and the kidneys, bowel occlusion), of neuropathology (embolic brain softenings, hydatic cysts of the brain, multiple sclerosis, spinal cord combined sclerosis, tabetic arthropathies, adiposo-genital syndrome due to a pituitary tumor) and of human neuro-muscular histology (neuro-muscular spindles, muscular histology after nerve sectioning, diphtheria paralysis, peripheral neuritis).

  7. Chiropractic and rehabilitation management of a patient with extraforaminal entrapment of L4 nerve with balance problem. (United States)

    Alagha, Babak


    Disc herniation is one of the most common causes of low back pain with radicular pain. Among various types of disc herniation, the extraforaminal disc herniation is a rare cause of lumbar radiculopathy. The aim of presenting this case study is to demonstrate the benefits of Chiropractic care including spine and extremity manipulation and rehabilitation in the treatment of a rare case of extraforaminal L4 nerve entrapment causing severe L4 radiculopathy and chronic mild low back pain (LBP). The aim of presenting this case study is to demonstrate the benefits of Chiropractic care including spine and extremity manipulation and rehabilitation in treatment of rare case of extraforaminal L4 nerve entrapment which caused severe L4 radiculopathy and chronic mild low back pain (LBP). A 45-year old female patient arrived at the clinic with chronic mild low back pain and right buttock pain, all of which had presented for two years' duration. During the preceding month, the radicular pain initiated in medium to high intensity, radiating to her right leg following the L4 dermatomal pattern with a periodic tingling sensation in her right foot. A neuro exam demonstrated a proprioception deficit in her right leg. A Romberg test was positive. The patient was treated by low amplitude high velocity spinal and extremity manipulation for 10 consecutive sessions (2 weeks), followed by rehabilitation and exercise therapy including advanced myofascial release therapy for an additional 12 sessions (4 weeks). After treatment, the patient reported a significant improvement in her low back pain and radiculopathy. In addition, she achieved some improvement in balance. It seems that Chiropractic care and rehabilitation therapy may be a safe and effective modality in treatment of an L4 radiculopathy in a patient with an extraforaminal L4 nerve entrapment. Although it is rare, an L4 extraforaminal disc herniation should be considered as a possible cause of symptoms in patients with chronic mild

  8. Prevention of Fat Embolism in Fat Injection for Gluteal Augmentation, Anatomic Study in Fresh Cadavers. (United States)

    Ramos-Gallardo, Guillermo; Orozco-Rentería, David; Medina-Zamora, Pablo; Mota-Fonseca, Eduardo; García-Benavides, Leonel; Cuenca-Pardo, Jesus; Contreras-Bulnes, Livia; Ambriz-Plasencia, Ana Rosa; Curiel-Beltran, Jesus Aaron


    Liposuction is a popular surgical procedure. As in any surgery, there are risks and complications, especially when combined with fat injection. Case reports of fat embolism have described a possible explanation as the puncture and tear of gluteal vessels during the procedure, especially when a deep injection is planned. A total of 10 dissections were performed in five fresh cadavers. Each buttocks was divided into four quadrants. We focused on the location where the gluteal vessels enter the muscle and the diameter of the vessels. Colorant at two different angles was injected (30° and 45°). We evaluated the relation of the colorant with the main vessels. We found two perforators per quadrant. The thickness of the gluteal muscle was 2.84 ± 1.54 cm. The area under the muscle where the superior gluteal vessels traverse the muscle was located 6.4 ± 1.54 cm from the intergluteal crease and 5.8 ± 1.13 cm from the superior border of the muscle. The inferior gluteal vessels were located 8.3 ± 1.39 cm from the intergluteal crease and 10 ± 2.24 cm from the superior border of the muscle. When we compared the fat injected at a 30° angle, the colorant stayed in the muscle. Using a 45° angle, the colorant was in contact with the superior gluteal artery and the sciatic nerve. No puncture or tear was observed in the vessels or the nerve. The location where the vessels come in contact with the muscle, which can be considered for fat injection, were located in quadrants 1 and 3. A 30° angle allows for an injection into the muscle without passing into deeper structures, unlike a 45° injection angle.

  9. Risk factors for hand, foot, and mouth disease and herpangina and the preventive effect of hand-washing. (United States)

    Ruan, Feng; Yang, Tao; Ma, Huilai; Jin, Yan; Song, Shili; Fontaine, Robert E; Zhu, Bao-Ping


    Hygiene and social distancing are recommended control measures for hand, foot, and mouth disease (HFMD) and herpangina. However, empirical data to support this recommendation are limited. During an outbreak of HFMD and herpangina due to infection by the human enterovirus 71, we defined a case as a vesicular papular rash on the hands, feet, buttocks, or oral mucosa and onset from April 30 to June 26, 2008. We selected 176 HFMD and herpangina case-children and a stratified random sample of 201 asymptomatic control-children; frequency matched according to residency status. We administered a questionnaire to the parents about their children's exposures and hygienic behaviors. Risk factors for HFMD and herpangina included playing with neighborhood children (odds ratio [OR]: 11 [95% confidence interval (CI): 6.2-17]), visiting an outpatient clinic for another reason ≤ 1 week before onset (OR: 20 [95% CI: 5.0-88]), and community exposures to crowded places (OR: 7.3 [95% CI: 4.1-13]). By using a score summarizing responses to 4 hand-washing questions, we found that 50% of the case-children and 2.5% of control-children had a poor score of 1 to 3, whereas 12% of the case-children and 78% of control-children had a good score of ≥ 7 (OR: 0.00069 [95% CI: 0.0022-0.022]) after we adjusted for residency, age, and community exposures by using logistic regression. Hand-washing by preschool-aged children and their caregivers had a significant protective effect against community-acquired HFMD and herpangina from the human enterovirus 71 infection.

  10. Mycetoma in the Sudan: an update from the Mycetoma Research Centre, University of Khartoum, Sudan. (United States)

    Fahal, Ahmed; Mahgoub, El Sheikh; El Hassan, Ahmed M; Abdel-Rahman, Manar Elsheikh


    This communication reports on the Mycetoma Research Centre of the University of Khartoum, Sudan experience on 6,792 patients seen during the period 1991-2014.The patients were predominately young (64% under 30 years old) males (76%). The majority (68%) were from the Sudan mycetoma belt and 28% were students. Madurella mycetomatis eumycetoma was the most common type (70%). In 66% of the patients the duration of the disease was less than five years, and 81% gave a history of sinuses discharging mostly black grains (78%). History of trauma at the mycetoma site was reported in 20%. Local pain was reported in 27% of the patients, and only 12% had a family history of mycetoma. The study showed that 57% of the patients had previous surgical excisions and recurrence, and only 4% received previous medical treatment for mycetoma. Other concomitant medical diseases were reported in 4% of the patients. The foot (76%) and hand (8%) were the most commonly affected sites. Less frequently affected sites were the leg and knee (7%), thigh (2%), buttock (2%) and arm and forearm (1%). Rare sites included the chest wall, head and neck, back, abdominal wall, perineum, oral cavity, tongue and eye. Multiple sites mycetoma was recorded in 135 (2%) of cases. At presentation, 37% of patients had massive lesions, 79% had sinuses, 8% had local hyper-hydrosis at the mycetoma lesion, 11% had regional lymphadenopathy, while 6% had dilated tortuous veins proximal to the mycetoma lesions. The diagnosis of mycetoma was established by combined imaging techniques and cytological, histopathological, serological tests and grain culture. Patients with actinomycetoma received a combination of antimicrobial agents, while eumycetoma patients received antifungal agents combined with various surgical excisions. Surgical excisions in the form of wide local excision, debridement or amputation were done in 807 patients, and of them 248 patients (30.7%) had postoperative recurrence. Different types of amputations

  11. Prevalence of Body Dysmorphic Disorder and its Association With Body Features in Female Medical Students. (United States)

    Shaffi Ahamed, Shaik; Enani, Jawaher; Alfaraidi, Lama; Sannari, Lujain; Algain, Rihaf; Alsawah, Zainah; Al Hazmi, Ali


    Body dysmorphic disorder (BDD) is a distressing psychiatric disorder. So far there have not been any studies on BDD in Saudi Arabia. The aim of this study was to determine the prevalence of body dysmorphic disorder in female medical students and to investigate whether there is an association between BDD and body features of concern, social anxiety and symptoms of BDD. A cross sectional study was carried out on female medical students of the college of medicine, King Saud University, Riyadh, Saudi Arabia during January to April, 2015. Data were collected using the body image disturbance questionnaire, Body dysmorphic disorder symptomatology and social interaction anxiety scale. Descriptive statistics, bivariate and multivariate analysis were used to analyze the results. Out of 365 students who filled out the questionnaire, 4.4% (95% confidence intervals (CI): 2.54% to 7.04%) were positive for BDD with skin (75%) and fat (68.8%) as the most frequent body features of concern. Ten features (skin, fat, chest, hips, buttocks, arms, legs, lips, fingers, and shoulders) out of twenty-six were significantly associated with BDD. Arms and chest were independently associated with BDD. The odds of presence of body concern related to "arms" was 4.3 (95% C.I: 1.5, 12.1) times more in BDD subjects than non-BDD subjects, while concern about "chest" was 3.8 (1.3, 10.9) times more when compared to non-BDD subjects. No statistically significant association was observed between BDD and social anxiety (P = 0.13). This was the first study conducted in Kingdom of Saudi Arabia (KSA) on female medical students, which quantified the prevalence of BDD and identified the body features associated with it. Body dysmorphic disorder is prevalent in female medical students but it is relatively rare and an unnoticed disorder.

  12. Gender similarities and differences in 200 individuals with body dysmorphic disorder⋆ (United States)

    Phillips, Katharine A.; Menard, William; Fay, Christina


    Background Gender is a critically important moderator of psychopathology. However, gender similarities and differences in body dysmorphic disorder (BDD) have received scant investigation. In this study, we examined gender similarities and differences in the broadest sample in which this topic has been examined. Methods Two hundred subjects with BDD recruited from diverse sources were assessed with a variety of standard measures. Results There were more similarities than differences between men and women, but many gender differences were found. The men were significantly older and more likely to be single and living alone. Men were more likely to obsess about their genitals, body build, and thinning hair/balding; excessively lift weights; and have a substance use disorder. In contrast, women were more likely to obsess about their skin, stomach, weight, breasts/chest, buttocks, thighs, legs, hips, toes, and excessive body/facial hair, and they were excessively concerned with more body areas. Women also performed more repetitive and safety behaviors, and were more likely to camouflage and use certain camouflaging techniques, check mirrors, change their clothes, pick their skin, and have an eating disorder. Women also had earlier onset of subclinical BDD symptoms and more severe BDD as assessed by the Body Dysmorphic Disorder Examination. However, men had more severe BDD as assessed by the Psychiatric Status Rating Scale for Body Dysmorphic Disorder, and they had poorer Global Assessment of Functioning Scale scores, were less likely to be working because of psychopathology, and were more likely to be receiving disability, including disability for BDD. Conclusions The clinical features of BDD in men and women have many similarities but also some interesting and important differences. These findings have implications for the detection and treatment of BDD. PMID:16490564

  13. Prevalence of Malignant Soft Tissue Tumors inExtremities: An Epidemiological Study in Syria

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    Habib Reshadi


    Full Text Available Background:   Although the majority of soft tissue masses are benign, it is important to consider malignancy in differential diagnoses. Because most soft tissue sarcomas present as a painless mass, clinicians must watch for signs suggestive of malignancy, including large size, rapid growth, and site deep into the deep fascia.The purpose of this study was to determine the relative prevalence according to sex and age, site of tumor, skeletal distribution, and treatment (surgery, chemotherapy and radiotherapy before and after surgery, and ascertain the relative frequency of these tumors in specific anatomic sites and age groups based on pathological studies. Methods: A total of 308 patients, with a musculoskeletal tumor were evaluated retrospectively. All of the patients enrolled into this study were referred to the Beirouni Hospital of Damascus University with a proven diagnosis of alignant soft tissue tumors from the beginning of January 2008 until the end of 2010. The prevalence of the malignant soft tissue tumors in these patients was analyzed. For purposes of analysis, all lesions were placed in 1 of 9 categories: hand and wrist, forearm, humorous (arm, proximal limb girdle (axilla and shoulder, foot and ankle, thigh, hip and buttocks region, trunk, and other lesions. Age and sex also were recorded. Results: Malignant tumors consisted of seven diagnostic categories: malignant fibrous histiocytoma (23%, liposarcoma (22%, rhabdomyosarcoma (9%, leiomyosarcoma (8%, malignant schwannoma (5%, dermatofibrosarcoma protuberans (5%, synovial sarcoma (10%, fibrosarcoma (13%, extraskeletal chondrosarcoma (1%, and extraskeletal Ewing sarcoma (4%. Conclusions: Despite the multitude of pathologic possibilities, most malignant soft-tissue tumors are classified into a small number of diagnoses. These may be further defined when the site of the lesion and the age of the patient are considered. Knowledge of tumor prevalence will assist radiologists in

  14. Prevalence of Malignant Soft Tissue Tumors inExtremities: An Epidemiological Study in Syria

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    Habib Reshadi


    Full Text Available Background:   Although the majority of soft tissue masses are benign, it is important to consider malignancy in differential diagnoses. Because most soft tissue sarcomas present as a painless mass, clinicians must watch for signs suggestive of malignancy, including large size, rapid growth, and site deep into the deep fascia.The purpose of this study was to determine the relative prevalence according to sex and age, site of tumor, skeletal distribution, and treatment (surgery, chemotherapy and radiotherapy before and after surgery, and ascertain the relative frequency of these tumors in specific anatomic sites and age groups based on pathological studies. Methods: A total of 308 patients, with a musculoskeletal tumor were evaluated retrospectively. All of the patients enrolled into this study were referred to the Beirouni Hospital of Damascus University with a proven diagnosis of alignant soft tissue tumors from the beginning of January 2008 until the end of 2010. The prevalence of the malignant soft tissue tumors in these patients was analyzed. For purposes of analysis, all lesions were placed in 1 of 9 categories: hand and wrist, forearm, humorous (arm, proximal limb girdle (axilla and shoulder, foot and ankle, thigh, hip and buttocks region, trunk, and other lesions. Age and sex also were recorded. Results: Malignant tumors consisted of seven diagnostic categories: malignant fibrous histiocytoma (23%, liposarcoma (22%, rhabdomyosarcoma (9%, leiomyosarcoma (8%, malignant schwannoma (5%, dermatofibrosarcoma protuberans (5%, synovial sarcoma (10%, fibrosarcoma (13%, extraskeletal chondrosarcoma (1%, and extraskeletal Ewing sarcoma (4%. Conclusions: Despite the multitude of pathologic possibilities, most malignant soft-tissue tumors are classified into a small number of diagnoses. These may be further defined when the site of the lesion and the age of the patient are considered. Knowledge of tumor prevalence will assist radiologists in

  15. Early excision and grafting, an alternative approach to the surgical management of large body surface area levamisole-adulterated cocaine induced skin necrosis. (United States)

    Miner, Jason; Gruber, Paul; Perry, Travis L


    Levamisole-adulterated cocaine as a cause of retiform purpura progressing to full-thickness skin necrosis was first documented in 2003 and currently comprises over 200 reported cases. Whereas, its presentation, pathophysiology, and diagnostic workup have been reasonably well-defined, only one publication has significantly detailed its surgical management. For this reason there exists a relative absence of data in comparison to its reported incidence to suggest a preferred treatment strategy. In the case mentioned, treatment emphasized delayed surgical intervention while awaiting lesion demarcation and the monitoring of autoantibodies. At our institution we offer an alternative approach and present the case of a 34 year old female who presented with 49% TBSA, levamisole-induced skin necrosis managed with early surgical excision and skin grafting. The patient presented three days following cocaine exposure with painful, purpura involving the ears, nose, buttocks, and bilateral lower extremities which quickly progressed to areas of full-thickness necrosis. Lab analysis demonstrated elevated p-ANCA and c-ANCA, as well as leukopenia, decreased C4 complement, and urinalysis positive for levamisole, corroborating the diagnosis. Contrasting the most thoroughly documented case in which the patient underwent first surgical excision on hospital day 36 and underwent 18 total excisions, our patient underwent first excision on hospital day 10 and received only one primary excision prior to definitive autografting. To our knowledge, this is the largest surface area surgically treated that did not result in surgical amputation or autoamputation of limbs or appendages, respectively. We contend that early excision and grafting provides optimal surgical management of this syndrome while avoiding the morbidity seen with delayed intervention. Published by Elsevier Ltd.

  16. A 29-Year-Old Male with Borderline Lepromatous Leprosy

    Directory of Open Access Journals (Sweden)

    Lubna Khondker


    Full Text Available Leprosy (Hansen’s disease is a chronic granulomatous infectious disease that primarily affects the peripheral nerves, skin, upper respiratory tract mucosa, eyes and certain other tissues. It is diagnosable and curable if recognized early and treated adequately. A twenty nine-year-old male from Jessore, Bangladesh reported in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh with the complaints of multiple erythematous, large, raised and circumscribed lesions with loss of sensations on different parts of the body, especially distal portions of all four limbs for last eight months. Subsequently he developed ulcers on the anesthetic fingers due to smoking and few ulcerative lesions on both feet. Skin examination revealed multiple erythematous, large nodular lesions on both sides of the cheek and forehead, multiple erythematous, indurated, large plaques with raised margin and central clearing on the trunk, waist and all four limbs, few satellite lesions around the large plaques on the trunk, few hypopigmented patches and plaques on buttock and lower limbs, multiple painless ulcers on dorsal surface of fingers of both hands, both lateral malleoluses and right sole. On examination of peripheral nerves, left great auricular nerve, both ulnar nerves and both common peroneal nerves were moderately enlarged and tender. Slit skin smear for AFB (modified Z-N stain was done and revealed that there were large number of acid and alcohol-fast bacilli arranged in straight and curved parallel bundles with globular masses (cigar-bundle appearance, morphologically resembling Mycobacterium leprae. Skin biopsy for histopathological examination revealed extensive infiltration of macrophages in the dermis, separated from epidermis by narrow grenz zone, with destruction of skin adnexa. Few foci of poorly defined granuloma in dermis were also noted. The patient was managed with rifampicin, clofazimine, dapsone, prednisolone and omeprazole.

  17. [Bacterial dermohypodermitis and necrotizing fascitis: 104-case series from Togo]. (United States)

    Saka, B; Kombaté, K; Mouhari-Toure, A; Akakpo, S; Boukari, T; Pitché, P; Tchangaï-Walla, K


    The purpose of this retrospective study was to obtain data on the epidemiology, clinical features, and outcome of bacterial dermohypodermitis (BDH) observed in a hospital setting hospital in Lomé, Togo. Cases of BDH treated in dermatology and internal medicine of the Lomé university hospital center from January 1999 to December 2009 were reviewed. A total of 104 patients were hospitalized for BDH during the study period. Mean patient age was 42.9 +/- 16.1 years and sex ratio (M/F) was 0.89. Infection by HIV was detected in 10 of 37 patients in whom serology was performed. The site of erysipelas was located on the legs and feet in 93 cases (89.4%), entire lower limb in 4 (3.9%), upper limbs in 4 (3.9%), thighs in 2 (1.9%), and buttock in 1 (0.9%). The main local and systemic risk factors were existence of an entry site in 89 cases, use of depigmenting drugs in 11, HIV infection in 10, previous history of erysipelas in 9 cases, and lymphoedema in 8. First-line treatment used penicillin G in 90 cases. Seven patients presented necrotizing fasciitis. Necrotizing fasciitis was associated with HIV infection in 2 cases, use of non-steroidal anti-inflammatory drugs (NSAID) in 2, and use of depigmenting drugs in one. Two deaths were recorded in the necrotizing fasciitis group including one HIV-infected patient. Recurrence was observed in 8 patients and secondary complications such as lower limb elephantiasis occurred in 7 patients.

  18. "Fitspiration" on Social Media: A Content Analysis of Gendered Images. (United States)

    Carrotte, Elise Rose; Prichard, Ivanka; Lim, Megan Su Cheng


    "Fitspiration" (also known as "fitspo") aims to inspire individuals to exercise and be healthy, but emerging research indicates exposure can negatively impact female body image. Fitspiration is frequently accessed on social media; however, it is currently unclear the degree to which messages about body image and exercise differ by gender of the subject. The aim of our study was to conduct a content analysis to identify the characteristics of fitspiration content posted across social media and whether this differs according to subject gender. Content tagged with #fitspo across Instagram, Facebook, Twitter, and Tumblr was extracted over a composite 30-minute period. All posts were analyzed by 2 independent coders according to a codebook. Of the 415/476 (87.2%) relevant posts extracted, most posts were on Instagram (360/415, 86.8%). Most posts (308/415, 74.2%) related thematically to exercise, and 81/415 (19.6%) related thematically to food. In total, 151 (36.4%) posts depicted only female subjects and 114/415 (27.5%) depicted only male subjects. Female subjects were typically thin but toned; male subjects were often muscular or hypermuscular. Within the images, female subjects were significantly more likely to be aged under 25 years (P<.001) than the male subjects, to have their full body visible (P=.001), and to have their buttocks emphasized (P<.001). Male subjects were more likely to have their face visible in the post (P=.005) than the female subjects. Female subjects were more likely to be sexualized than the male subjects (P=.002). Female #fitspo subjects typically adhered to the thin or athletic ideal, and male subjects typically adhered to the muscular ideal. Future research and interventional efforts should consider the potential objectifying messages in fitspiration, as it relates to both female and male body image.

  19. Treatment of postoperative sciatic nerve palsy after total hip arthroplasty for postoperative acetabular fracture: A case report

    Directory of Open Access Journals (Sweden)

    Akio Kanda


    Full Text Available Acetabular fracture is usually treated with osteosynthesis. However, in the case of an intra-articular fracture, osteosynthesis can result in arthropathy of the hip joint and poor long-term results, hence, total hip arthroplasty is required. However, in total hip arthroplasty for postoperative acetabular fracture, sciatic nerve palsy tends to develop more commonly than after primary total hip arthroplasty. This is a case report of a 57-year-old Japanese male who had internal skeletal fixation for a left acetabular fracture that had occurred 2 years earlier. One year later, he developed coxarthrosis and severe pain of the hip joint and total hip arthroplasty was performed. After the second surgery, he experienced pain along the distribution of the sciatic nerve and weakness of the muscles innervated by the peroneal nerve, indicating sciatic nerve palsy. We performed a third operation, and divided adhesions around the sciatic nerve. Postoperatively, the anterior hip joint pain and the buttocks pain when the hip was flexed were improved. Abduction of the fifth toe was also improved. However, the footdrop and sensory disturbance were not improved. A year after the third operation, sensory disturbance was slightly improved but the footdrop was not improved. We believe the sciatic nerve palsy developed when we dislocated the hip joint as the sciatic nerve was excessively extended as the hip joint flexed and internally rotated. Sciatic nerve adhesion can occur easily in total hip replacement for postoperative acetabular fracture; hence, adhesiotomy should be conducted before performing hip dislocation to prevent injury caused by nerve tension. The patient agreed that the details of this case could be submitted for publication. The work has been reported in line with the CARE criteria and cite.

  20. The biomechanics of gravity-dependent traction of the lumbar spine. (United States)

    Janke, A W; Kerkow, T A; Griffiths, H J; Sparrow, E M; Iaizzo, P A


    This study evaluated the biomechanical responses evoked by the use of a gravity-dependent, self-operated traction device. These responses were determined by radiographs and were correlated with the body weight of the patient who was supported by a seat strap. To examine the biomechanical effectiveness of the LTX 3000 Lumbar Rehabilitation System. The LTX 3000 Lumbar Rehabilitation System (Spinal Designs International, Minneapolis, MN) was used to administer the lumbar fraction. No previous study has been conducted on this device. For each of the 14 healthy male patients (age range, 19-69 years), lumbar lengthening, alterations in spinal curvature, and thoracic spine movement were assessed using radiographs taken: 1) before traction; 2) at 2, 10, and 15 minutes after the onset of traction; and 3) 2 minutes after traction was completed. Strain on the buttocks-supporting seat strap was recorded continuously during study sessions. The entire patient pool displayed an average maximal lumbar lengthening of 6.39 +/- 4.21 mm. The amount of lumbar lengthening was influenced by the degree of thoracic immobilization and by the amount of prior LTX 3000 (Spinal Designs International) use. Significant curvature reduction was observed during and after traction for the entire patient pool. Strain measurements correlated well with the measured response in the radiographs. Proper use of the LTX 3000 (Spinal Designs International) induces significant lumbar lengthening and curvature reduction in healthy patients. Measurements of body weight supported by the seat strap could help determine if thoracic immobilization has been achieved and if the patient is responding to the lumbar unloading.