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At least 181 records · Page 10Linked to original sources

PubMed1998

Femoral nerve lesion in total hip replacement: an experimental study.

A total of 20 hip joints of 10 non-fixed corpses were examined within 48 h of death to measure the pressure below the inguinal ligament simulating the surgical conditions during total hip arthroplasty. The purpose of this study was to assess the influence of various leg positions and insertion techniques of retractors during the surgical procedure for total hip replacement in order to detect supposed causes for indirect pressure injuries of the femoral nerve. The obtained results verified no increase of pressure in the inguinal canal which could explain an indirect injury of the femoral nerve. If the retractor is inserted correctly at the anterior acetabular rim, the pressure in the lacuna musculorum can even be reduced, and furthermore, the femoral nerve is protected by the iliopsoas muscle. Femoral nerve lesions which have been published so far can only be explained by an incorrect use of instruments or implants (e.g., screws, cement, acetabular cup) or an extreme postoperative leg length discrepancy.

Arthroplasty, Replacement, Hip↗

PubMed2003

Infection-associated hemophagocytic syndrome in a diabetic patient undergoing chronic hemodialysis.

Hemophagocytic syndrome (HPS) is an uncommon but severe illness associated with a variety of infections, malignant tumors, and autoimmune diseases. We report a case of infection-associated HPS in a patient receiving chronic hemodialysis. Peptostreptococcus-induced sepsis and abscess formation in the left iliopsoas muscle led to the onset of infection-associated HPS in this patient. The patient had diabetes mellitus and end-stage renal disease, and it is likely that immunological dysfunctions from these disorders played a part in the onset of both severe bacterial infections and HPS.

Aged↗

PubMed1995

Supernumerary ovary with an endometrioma and osseous metaplasia: a case report.

A 32-year-old-woman with a history of endometriosis and chronic pelvic pain had left-sided pain and ultrasonographic documentation of a left pelvic complex cyst approximately 5 cm in diameter. Laparotomy revealed a left retroperitoneal cystic mass adjacent to the iliopsoas muscle and overlying the major pelvic vessels. The mass was dissected and excised. Histopathologic study revealed endometrioma and osseous metaplasia in a supernumerary ovary.

Adult↗

PubMed1991

Rapidly progressive squamous cell carcinoma of the cervix coexisting with human immunodeficiency virus infection: clinical opinion.

The acquired immune deficiency syndrome (AIDS) has been characterized by aggressive malignancies and infections with unusual presentations. There is a well-documented association between cervical dysplasia and the development of cervical carcinoma, and more recent evidence of an association between cervical dysplasia and HIV infection. The course of coexistent HIV infection and cervical cancer has not been well described. We report a patient with HIV infection and a stage IIIB squamous cell carcinoma of the cervix who, despite adequate treatment, had rapid disease progression as well as metastasis to an unusual iliopsoas muscle site in association with an abscess. As HIV becomes more prevalent in the female population, an increased frequency of rapidly progressive cervical carcinoma may be forthcoming. Improved life expectancy of HIV-infected patients due to modern medication is anticipated, causing a cervical neoplasm to have a more prominent effect on prognosis. Close surveillance with frequent Pap smears and colposcopies as well as aggressive management of cervical dysplasia and carcinoma in HIV-infected patients is suggested as is thorough patient counseling.

Acquired Immunodeficiency Syndrome↗

PubMed1990

Improved method for quantification of tissue PMN accumulation measured by myeloperoxidase activity.

Myeloperoxidase (MPO) was used as a marker enzyme for measuring polymorphonuclear leukocyte (PMN) accumulation in tissue samples. The MPO recovery from kidney, liver, myocardium, skeletal muscle (iliopsoas), and skin was measured, and a variation of 5%-100% was found, depending on the tissue analyzed. The recovery could be improved to 100% in all tissues by incubation of the tissue samples at 60 degrees C for 2 hr. This improved method was used to measure PMN accumulation in rabbit myocardium after regional ischemia and reperfusion. The MPO activity increased fivefold in the occluded area as compared with intact myocardium. Treatment with IB4, a monoclonal antibody recognizing the leukocyte adhesion molecule Mac-1, decreased the MPO activity in the occluded area almost to the level in intact myocardium.

Acute-Phase Reaction↗

PubMed2006

Retroperitoneal false aneurysm presenting as anterior thigh pain and weakness: a case report.

This case highlights the importance of considering retroperitoneal pathology in the differential diagnosis of anterior thigh pain and weakness. We describe a woman in her mid seventies with a history of a left total hip arthroplasty and lumbar decompression who presented with left anterior thigh pain and left lower-extremity weakness. A computed tomography scan of the retroperitoneum revealed a mass along the left iliopsoas muscle. An arteriogram revealed a large false aneurysm that communicated with the left common femoral artery. Surgery to resect the aneurysm revealed exposed parts of the hip replacement that may have contributed to the formation of the aneurysm. We concluded that imaging of the retroperitoneum should be considered in any patient presenting with anterior thigh pain and weakness.

Aged↗

PubMed1998

Detection of SYT-SSX fusion transcripts in synovial sarcoma by reverse transcription-polymerase chain reaction using archival paraffin-embedded tissues.

The reciprocal translocation t(X;18)(p11;q11) is known to be highly characteristic of synovial sarcoma, and its consequence, an SYT-SSX fusion gene, is expected to be a diagnostic molecular marker. In this study, we conducted a reverse transcription-polymerase chain reaction-based assay to detect the SYT-SSX fusion gene transcripts using archival formalin-fixed, paraffin-embedded tumor specimens from a series of 32 synovial sarcoma cases including 6 tumors found in unusual anatomical sites. The SYT-SSX fusion transcripts could be detected in 30 of 32 paraffin-embedded specimens (94%). A subsequent sequence analysis using the polymerase chain reaction products confirmed that the detected messages were derived from either the SYT-SSX1 (22 cases) or SYT-SSX2 (8 cases) fusion gene. Of 23 SYT-SSX-positive monophasic tumors, 16 tumors had an SYT-SSX1 fusion transcript. Fusion transcripts were detectable in all the 7 biphasic tumors analysed, one of which had an SYT-SSX2 fusion transcript. All of the six tumors at unusual locations (lung; 3, metastasis to the abdominal cavity from a tumor of retroperitoneal origin; 1, sacral region; 1, iliopsoas muscle; 1) contained detectable messages. Our results indicate that this molecular assay can be applied to archival formalin-fixed, paraffin-embedded tumor tissues as a feasible and reliable molecular technique for the diagnosis of synovial sarcoma.

Adolescent↗

PubMed1996

Clinical use of percutaneous intramuscular electrodes for functional electrical stimulation.

OBJECTIVE: To evaluate the clinical use of the percutaneous intramuscular electrode in functional electrical stimulation (FES). DESIGN: Randomized and controlled study. SETTING: A referral center and institutional practice providing outpatient care. PATIENTS: Seventeen patients (12 men, 5 women) who had implanted percutaneous intramuscular electrodes for more than 1 year were examined. The average follow-up time after implantation of electrodes was 2.2 years (range, 1yr to 4yr 10mo). Overall, there were 327 electrodes (83 upper extremities and 244 lower extremities). INTERVENTION: The indwelling electrode was composed of helically coiled Teflon-coated rope stranded from 19 hard drawn wires of SUS 316L stainless steel (SES 114). MAIN OUTCOME MEASURES: The rates of breakage, movement, and infection, and the number of electrodes that needed reimplantation were evaluated. RESULTS: Only one electrode broke (0.3%) in the iliopsoas muscle at 12 weeks after implantation. Eight electrodes (2.4%) were removed because of loss of sufficient contraction force caused by movement of the electrodes. Movements occurred at 9 weeks in 6 electrodes and at 5 months in two. The failure rate of electrodes in the lower extremities was 3.7%. No failures occurred in the upper extremities. Ten electrodes (3.1%) required reimplantation. Although ten superficial infections (3.1%) were seen around the site of electrode insertion, no removals of electrode were needed. All electrodes in one patient were removed, however, because of generalized methicillin-resistant Staphylococcus aureus infection complicated with renal disease. Electrodes were reimplanted after improvement of the infection. CONCLUSIONS: The ultrafine percutaneous intramuscular electrode was considered practical for long-term FES use.

Adult↗

PubMed1989

Ovarian conservation at hysterectomy: a potential diagnostic pitfall.

Three patients who were evaluated by computed tomography (CT) for possible recurrent tumour of the cervix are described. Two had proven carcinoma and the third had non-Hodgkin's lymphoma of the cervix. In each, soft tissue masses in the iliac fossa, close to the iliopsoas muscles, were demonstrated. The position, shape, symmetry and, in one patient, the presence of surgical clips led to the correct diagnosis that these soft tissue masses were normal ovaries which had been moved out of the true pelvis at the time of hysterectomy. Such ovarian conservation creates a potential cause of error as the ovaries can then simulate enlarged nodal masses.

Adenocarcinoma↗

PubMed2002

Quantification of human mitochondrial DNA in a real time PCR.

Recently, a moderately priced machine for real-time quantitative PCR has become available, the Perkin Elmer 5700. The rapid and quantitative assay of mitochondrial DNA (mtDNA) copy number is potentially useful in a variety of molecular, evolutionary and forensic fields. Using this new tool, we have evaluated the precision and reliability of the real time PCR to quantify undeleted mitochondrial genome copy number, and to determine the frequency of an age-associated deletion of 4977 base pairs in length, in 42 human iliopsoas muscle DNA samples from persons of known age. We have evaluated the accuracy with which age can be predicted, knowing only the frequency of this common 4977 bp deletion, and derived a statistical formula which describes the confidence with which the 4977 bp frequency predicts age. The results indicate that the mutation frequency could be used to distinguish between tissue from young and old individuals. However in this data set, while there was considerable agreement of 4977 bp frequency among replicates from the same individual sample, there was substantial diversity of mean mutation frequency between individuals of the same or similar ages. The simplest interpretation of these results is that there are biological modifiers of 4977 bp frequency that are age-independent, which are potentially interesting but may limit the usefulness of this deletion frequency alone as a "molecular forensic clock."

Autopsy↗

PubMedDate not supplied

Puncturing the pulseless femoral artery: a simple technique that uses palpation of anatomic landmarks.

PURPOSE: The authors report a simple technique in which palpation of anatomic landmarks is used to localize the pulseless common femoral artery. MATERIALS AND METHODS: A finger is placed immediately lateral to the pubic tubercle and inferior to the inguinal ligament to palpate the point allowing the most posterior depression. Anatomically, this depression lies between the iliopsoas muscle laterally and the pectineus muscle medially. The femoral vein lies in the floor of this depression, and 1.5 cm lateral to the depression lies the femoral artery. RESULTS: This anatomic relationship and its usefulness for locating the common femoral artery were verified by puncture and dissection of nine cadaveric groins and successful puncture of 19 pulseless arteries of 17 patients. CONCLUSION: The described technique was found to be quick, simple, and reliable and is now the authors' method of choice for puncturing the pulseless femoral artery.

Angiography↗

PubMed2000

Early report: comparison of breath-hold MR excretory urography, Doppler ultrasound and isotope renography in evaluation of symptomatic hydronephrosis in pregnancy.

AIM: To compare assessment by MR excretory urography (MREU), Doppler ultrasound and isotope renography of women with symptomatic hydronephrosis in pregnancy and to define its cause. MATERIALS AND METHODS: Eleven women at 19-34 weeks of gestation were studied prospectively with gadolinium-enhanced breath-hold gradient echo MREU and transabdominal Doppler ultrasound compared with a 'gold standard' of isotope renography employing frusemide challenge. All studies were performed within 24 h, were reported independently in a blinded fashion and employed clearly defined criteria. Obstetric and infant outcomes were obtained. RESULTS: There were no adverse reactions to gadolinium administration in pregnancy and no adverse obstetric or infant outcomes. Three of the 11 women were unable to tolerate the complete MREU protocol. Ultrasound indices could not be used to predict ureteric obstruction as shown by isotope renography. MREU agreed with renographic findings in five of the six cases with obstruction and in two without obstruction. MREU directly demonstrated hydronephrosis to result from extrinsic compression of the ureter between the gravid uterus and iliopsoas muscle. CONCLUSION: MR excretory urography is a promising technique which affords equivalent functional and additional anatomical information to isotope renography. It is more accurate than Doppler ultrasound in the assessment of ureteric obstruction in pregnancy.Spencer, J. A. (2000). Clinical Radiology55, 446-453.

Contrast Media↗

PubMed2005

[Comparison of radiation dose and image quality of Siremobil-IsoC(3D) with a 16-slice spiral CT for diagnosis and intervention in the human pelvic bone].

PURPOSE: To compare the image quality of 16-slice computed tomography with the image quality of Siremobil-IsoC (3D) of the pelvic region and to measure simultaneously the radiation dose before and after implantation of a sacroiliac screw (SI-screw) MATERIALS AND METHODS: The pelvic region of 8 human cadavers was examined in the Siremobil-IsoC (3D) at five different levels. We used a standard protocol for the 16-slice CT of the complete pelvic region before and after insertion of a pelvic screw, followed by stepwise reduction of the tube current to find the tube current that equalizes the image quality of both modalities. We controlled the image quality by judging important structures such as neuroforamen, nerves, sacroiliacal joint space, intervertebral space, osteophytes, iliopsoas muscle, acetabular surface, fovea centralis, hip joint and os pubis. The image quality was judged by three radiologists and three trauma surgeons using a ranking from 1 to 5. The dose was measured with an endorectally placed NOMEX Dosimeter, to obtain the gonadal dose. RESULTS: The medium score for all viewers of the Siremobil-IsoC (3D) examinations was between 3 and 4.3. The medium score for all CT-examinations with a tube current of 250 mA was between 1.3 and 2.2. The reduction of tube current down to 80 mA hardly influenced the marks for the analyzed structures. Under 80 mA, bony structures, even after implantation of a SI-screw, were still marked as good, but soft tissue differentiation was getting worse. For the examination of the pelvis, the average dose-length product for the IsoC (3D) was 41.2 mGy x cm. The medium dose-length product for CT was 389 mGy x cm for 250 mA, 125 mGy x cm for 80 mA and 82 mGy x cm for 60 mA. CONCLUSION: The Siremobil-IsoC (3D) is sufficient for therapeutic intraoperative purpose, but the image quality is not sufficient for diagnostic purpose. The higher dose-length product of a CT examination is justifiable because of a better overview, shorter examination time and qualitative superiority. An advantage of the Siremobil-IsoC (3D) is the intraoperative availability with acceptable 3D image quality compared to conventional fluoroscopy.

Bone Screws↗

PubMed2004

[Pregnancy-associated femoral nerve affection].

BACKGROUND: Common neuropathies during pregnancy are carpal tunnel syndrome or peripheral facial paralysis. However, there is little information about femoral nerve affection during pregnancy. CASE REPORT: We report on a female at 30 weeks of gestation, complaining of pain in hips and thighs and gait difficulty. Pregnancy was normally developed. Neurological examination showed a bilateral weakness in both quadriceps and iliopsoas muscles combined with soreness in hips and thighs, without deficits of sensibility. Laboratory findings and results of a lumbar punction were normal. Pelvic ultrasound and an MRI scan of the spine and pelvis showed no mass or disc prolaps. Neuromyographic evaluation bilaterally revealed acute signs of denervation of the muscles innervated by femoral nerve. Caesarean section was performed at 32 gestational weeks, as pain was unbearable and refractory to treatment with even opiates. Post partum, pain relieved immediately, and after weeks of physiotherapy, complete remission was achieved. CONCLUSION: This unusual manifestation of a neuropathy in pregnancy could be due to pressure on the femoral nerve. The patients' anxiety can be eliminated, as the described cases in literature show an excellent prognosis. However, the severity of symptoms can lead us to necessity of premature delivery.

Female↗

PubMed1991

[Femoral nerve lesion in heparin therapy].

Two case reports on femoral nerve lesion due to hematoma in the iliopsoas muscle or as the case may be in the iliacus muscles on both sides are presented with review of the literature. Synopsis of the reported cases--certainly a minority of anticoagulant therapy complications nevertheless increasingly mentioned in the literature--suggests that there might be a higher risk of bleeding for women within the first week of so-called high-dose heparin therapy. Coagulation studies do not contribute essentially in preventing retroperitoneal haematoma since they are within therapeutic limits in many cases. So clinical observation is crucial in the diagnosis of this complication of heparin therapy, which might occur more frequently under concomitant administration of acetacylic acid. Early surgical decompression of the femoral nerve seems to provide better results seen on follow-up than conservative treatment, especially in patients with rapid onset of severe limb weakness.

Blood Coagulation Tests↗

PubMedDate not supplied

[Pathomorphologic development of the dysplastic hip joint].

On the basis of findings published in the literature, morphologic changes seen among the author's patients were classified as anthropologic and teratologic dislocations. The anthropologic dislocations were sub-classified into four groups, identified as dysplasia, subluxation, severe subluxation and luxation. Their anatomic peculiarities were described and illustrated. One observation which appears important, and which has already been reported by other authors, is that the limbus is not an infolded free joint border; also, that even in cases of severe luxation the femoral head often does not go beyond the acetabular labrum, which is displaced far upward. A number of special features appear to be of major importance for therapy. Mechanically, a severe subluxation behaves in the same manner as a subluxation. No reduction maneuver is needed to reposition the joint. On plain radiographs, subluxation are often mistaken for luxations. In dislocated hips the tendon of the iliopsoas muscle lies between the anterior portion of the acetabulum and the femoral head. When the extremity is extended, the psoas tendon is an obstacle to reduction. The real articular obstacle to reduction is not the limbus (primary limbus) but the primary joint cavity, which is too narrow. The limbus is only an obstacle on the way to the primary acetabulum.

Acetabulum↗

PubMed2003

Disseminated infection due to Scedosporium apiospermum in a patient with acute myelogenous leukemia.

A 62-year-old man diagnosed with acute myelogenous leukemia which had developed from myelodysplastic syndrome received cytarabine and idarubicine as an induction therapy. The patient developed pneumonia and bacterial sepsis during profound neutropenia. Fever and sepsis improved by using many anti-bacterials and anti-fungals but he became febrile again and complained of severe lumbar pain. 67Ga scintigram showed abnormal uptake in the lumbar vertebra and left sternoclavicular joint, suggesting a diagnosis of discitis and osteomyelitis in the lumbar vertebra and sternoclavicular arthritis. We biopsied the site several times but culture of the biopsy specimen could not isolate any pathogens, and high fever persisted for about 10 months despite administration of various anti-bacterials and anti-fungals. Finally we inserted a catheter into the abscess at the iliopsoas muscle and Scedosporium apiospermum was isolated in the bloody pus obtained from the catheter. Itraconazole and amphotericin B were restarted, and the high fever and lumbar pain improved rapidly. The findings of S. apiospermum infection in this patient emphasizes the importance of being aware of this pathogen in patients with hematologic malignancy during the neutropenic phase.

Amphotericin B↗

PubMed2002

Distribution study of 3,4-methylenedioxymethamphetamine and 3,4-methylenedioxyamphetamine in a fatal overdose.

In this study, regional tissue distributions of the amphetamine analogue 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") and its metabolite 3,4-methylenedioxyamphetamine (MDA) in a fatal overdose are presented. Quantitation of MDMA and MDA levels occurred in blood samples taken centrally (right and left heart and main adjacent great vessels) and peripherally (subclavian and femoral blood). In addition, MDMA and MDA concentrations were determined in cardiac and iliopsoas muscle, both lungs, liver, both kidneys, spleen, the four brain lobes, cerebellum and brainstem, and adipose tissue. Finally, MDMA and MDA levels were determined in serum, vitreous humor, urine, and bile. For all samples, a fully validated high-pressure liquid chromatography procedure with fluorescence detection was used. The found substances were also identified with liquid chromatography-tandem mass spectrometry. Our data confirm that blood sampling from an isolated peripheral vein is recommended for MDMA and MDA. In addition, the vitreous humor MDMA level indicates that this fluid can be an interesting alternative when a suitable blood sample is missing. Considering the substantial differences in concentrations in blood samples taken from various sites in the body and the high levels in some tissues (e.g., in liver), we concluded that the influence of postmortem redistribution should be taken into account in the interpretation of toxicological data when an appropriate peripheral sample cannot be obtained or when blood samples are not available because of putrefaction.

3,4-Methylenedioxyamphetamine↗