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9 cases with variant of the form of the trochanter minor (double apex) are reported. A double insertion or a changed action of the iliopsoas muscle is discussed.
A series of 5 patients diagnosed with a meaningful influence of ultrasound has been presented. In 2 cases the changes within iliopsoas muscle were found, sacral anterior meningocele, neoplastic infiltration of the great retro-perineal vessels from the fourth lumbar vertebral body metastasis and neurofibromatosis of cervical spinal canal were diagnosed in the remaining cases.
Haemophilia A and B are congenital bleeding disorders caused by a deficiency of factor VIII:C or IX:C in plasma. An early diagnosis is crucial to reduce the risk of permanent handicaps. A case of a 14 year-old boy is described. He was admitted to hospital with haematuria at the age of 12, but remained undiagnosed for another two years, when he was readmitted with an iliopsoas muscle bleeding affecting the femoral nerve. Laboratory findings showed a severe haemophilia A. The symptoms leading to the diagnosis and the differences between the various degrees of haemophilia are discussed. Retrospectively, the patient could have been diagnosed earlier if one had accounted for the more rare manifestations. In haemophilia bleeding time, platelet count, fibrinogen and factor II, VII and X are all normal. Only APTT is prolonged and should lead to further tests including factor VIII:C and IX:C.
SUMMARY OF BACKGROUND DATA: Compression neuropathy of the femoral nerve has been reported as an uncommon complication of bleeding into the iliopsoas muscle. OBJECTIVE: The authors detected anatomic reasons of direct injury to the femoral nerve at the lower lumbar level. METHODS: Keeping the hip in extension during the course of carrying out anterior fusion on a previously failed posterior fusion was considered another causative factor of femoral nerve injury. Anatomical dissection confirmed the likelihood of this injury being produced in this situation. RESULTS: Femoral nerve traction and compression can occur after prolonged compression of the nerve within the psoas muscle stretched between an immobile lower lumbar spine and the lesser trochanter when the hip is kept in extension. In the patients described no other reasons for direct or indirect injury were identified. CONCLUSION: Although uncommon, the complication should be kept in mind. It can be avoided by intraoperative hip flexion.
A 65-year-old woman being treated under the diagnosis of pneumonia was subjected to further evaluation for right back tenderness. Chest radiography revealed a granular, net-like shadow in the right lower lung field, and right pleural thickening with pleural fluid retention. Ultrasonography demonstrated a cystic mass of uniformly low echo density, corresponding to the site of tenderness. This lesion was located on the right renal dorsal, right iliopsoas muscle ventral side. Based on CT findings of internal water density and marginal enhancement, the lesion was diagnosed as an abscess. With the suspicion of right tuberculous pyothorax with retroperitoneal gravitation abscess, puncture was attempted. The diagnosis was confirmed by the presence of Mycobacterium tuberculosis in the specimen. Antituberculosis chemotherapy was initiated, with drainage for symptom relief and lesion range definition. The abscess cavity communicated with the right pleural cavity via s stalk. The stalk path was confirmed by CT, and surgical curettage was performed. Tuberculous pyothorax with retroperitoneal gravitation abscess is rare and is not discussed in standard textbooks. In large series of cases it is not mentioned. In this patient we assumed that retroperitoneal gravitation abscess occurred as a result of the advanced state of tuberculous pyothorax.
In conclusion, a functional orthosis may be used to effectively treat most, but not all, abnormalities of the lower extremity that cause abnormal function of the foot. Abnormalities that are resistant to treatment with functional orthoses are compensated talipes equinus, excessive verticality of the oblique axis of the midtarsal joint, forefoot adductus that exceeds 15 degrees of adductus, Charcot's disease, congenital shortage of the iliopsoas muscle, and certain neurologic diseases that exhibit transient muscle spasm or paralysis, resulting in abnormal forces acting upon the foot that vary with time. Unfortunately, laboratories that claim to fabricate functional orthoses may turn out products that vary from nondescript arch supports to orthoses that only partially control function of the foot. The author hopes the practitioner who reads this article will be better able to evaluate whether his or her laboratory is providing his or her patient with a functional orthosis when one is ordered.
A 54-year-old woman was hospitalized because of paraparesis, sensory disturbance of the lower extremities, and dysuria. Laboratory data included an erythrocyte sedimentation rate (ESR) of 16 mm/h and lactate dehydrogenase (LDH) level of 459 IU/l. Myelogram showed an enlarged spinal cord at the L1 level, and spinal MRI revealed a high signal area on T2-weighted images. Spinal cord biopsy by thoraco-lumbar laminectomy showed thickening of the pia mater and neovascularization, but no malignant cells. Immediately after the operation, the patient displayed progressive mental deterioration. Cranial MRI showed widespread high signal areas in the cerebral white matter on T2-weighted images which resembled those of leukoencephalopathy. Steroid therapy was tried but was ineffective. Ten months after the onset of symptoms, a brief period of regression of both clinical symptoms and MRI appearances occurred following the administration of Inosiplex, subsequent progressive deterioration led to death 14 months after the onset of symptoms. LDH, C-reactive protein (CRP), and cerebrospinal fluid (CSF) protein were all elevated during the deterioration of her general status. Postmortem examination revealed a large tumor mass of the left adrenal gland which extended to the Th12, L1, and L2 vertebrae and remarkable brain edema. Microscopic mononuclear tumor cells were widespread but confined to the lumens of small vessels of the brain, spinal cord, spinal root and right adrenal gland, almost as if they were occluded. Cerebral white matter presented widespread multiple small infarcts and extensive myelin thinning. In addition to the left adrenal gland, interstitial invasions of tumor cells were discovered in the kidneys, iliopsoas muscles, oviducts, myocardium, lymph nodes, and thyroid gland.(ABSTRACT TRUNCATED AT 250 WORDS)
Lumbar plexus block via the inguinal approach is indicated for analgesia following knee surgery. The technique consists in an injection of the anaesthetic solution through a catheter placed into the space limited by the fascia of the iliopsoas muscle. In this area are the different nervous roots which constitute the plexus. A good technique and a good knowledge of the anatomy of this region are necessary for a successful block and for the safety of the patient.
A male patient with severe aplastic anemia was admitted for bone marrow transplantation. While waiting for a donor, high doses of methylprednisolone, anabolic steroid and granulocyte colony stimulating factor were given without response. Deferoxamine was administered for prophylaxis of hemochromatosis because of high level of ferritin. Acute right lower abdominal pain and pyrexia developed. A diagnosis of acute appendicitis was made and appendectomy was performed. The histopathological examination of the resected appendix revealed necrotizing hemorrhagic appendicitis with numerous hyphae of Mucorales. Though anti-fungal agent (amphotericin B) administration was continued, he subsequently developed ileo-cecal abscess and eventually died due to myoglobinuric nephropathy caused by extensive necrosis of the iliopsoas muscle. Autopsy revealed dissemination of hyphae of Mucorales in lungs, kidneys, large vessels and muscle of the bilateral lower limbs. Systemic vascular invasion and embolization of fungal hyphae were also observed. However, culture of exudate sampled from ileocecum yielded no Mucorales. It was emphasized that antemortem diagnosis and effective anti-fungal treatments are essential for the management of intestinal mucormycosis. The relation ship between mucormyocosis and deferoxamine was also discussed.
Extrapulmonary tuberculosis at times appears to be an unusual presentation of the disease. Its incidence has not decreased, though a slow decline in pulmonary tuberculosis has been observed over the past decades around the world. The diagnosis of extrapulmonary tuberculosis is still rather difficult today. Tuberculosis of the bones and joints, which constitutes a smaller part of extrapulmonary tuberculosis, is relatively rare in documented cases and can yield variable clinical manifestations. This study describes a young male patient who developed a rare condition of tuberculous arthritis of the right sacroiliac joint, with an abscess formation over the anterior aspect of the right iliac fossa and iliopsoas muscle. The diagnosis was made by roentgenographic examinations and proved by microscopic confirmation of the presence tuberculous bacilli in drainage from the involved foci. Antituberculosis therapy was begun thereafter. Symptoms improved and the patient was regularly followed up at the Outpatient Department. It is suggested that in patients with prolonged fever and possible Mycobacterium tuberculosis infections, repeated roentgenographic and microbiological examinations are mandatory.
A one-stage, combined operative procedure for reduction of congenitally dislocated hips in older children consists of shortening of the femur; open reduction by an inferior approach to the joint; reconstruction of the acetabular roof; correction of anteversion of both the femoral neck and the neck-shaft angle; anterior transposition of the iliopsoas muscle. On 60 hips operated in children, ages 5 to 15 with a follow-up period, ranging from 5 to 9 years, the results were found to be excellent in 3 per cent, good in 60 per cent, fair in 30 per cent, and poor in 7 per cent. The procedure is indicated in children up to the time of early puberty. The primary indication is high bilateral dislocation. In unilateral dislocations some residual leg-length discrepancy frequently occurs. This procedure should be done only by orthopedic surgeons who have special training and experience in the treatment of congenital dislocation of the hip.
A man, 73 years old, who developed acute biliary tract infection complicated with retroperitoneal abscess formation in iliopsoas region was reported. The magnetic resonance imaging was especially effective to delineate the lesion, extending from the subhepatic down to the iliopsoas muscle. The echo-guided fine needle aspiration technique was successful to make the lesion subside.
Adiponectin (ApN), an adipocytokine expressed in adipocytes with antidiabetic and antiatherogenic actions, has been detected in cord blood, suggesting a putative role in intrauterine fetal development. The aim of this study was to confirm the presence of ApN in the fetal circulation and directly investigate ApN expression in fetal tissues. The study showed high ApN levels in umbilical venous blood from fetuses [n = 44; 31.2 +/- 14.1 (sd) mg/liter in umbilical vs. 8.4 +/- 4.0 in maternal circulation (P < 0.0001)] that positively correlated with gestational age. By using RT-PCR, Western blotting, and immunohistochemistry, ApN was detected in several fetal tissues at mid- and late gestation (from 14 to 36 wk) but not in the placenta. ApN was expressed in tissues of mesodermic origin, i.e. brown and white adipocytes, skeletal muscle fibers of diaphragm and iliopsoas, smooth muscle cells of small intestine and arterial walls, perineurium and renal capsule, and tissues of ectodermal origin, i.e. epidermis and ocular lens. The distribution of ApN expression in nonadipose tissues showed a general decline during the progression of gestation. The unexpected pattern of ApN expression in the human fetus may account for the high ApN levels in cord blood and predicts novel roles for ApN during fetal development.
Muscle tightness is often considered to be a predisposing factor in muscle injuries. The purpose of this study was to assess the muscle flexibility of the hamstrings, rectus femoris, iliopsoas, gastrocnemius, and soleus muscles in long distance runners. Range of motion measurements of five movements, including hip flexion with knee extended, hip extension with knee flexed, hip extension with knee extended, ankle dorsiflexion with knee extended, and ankle dorsiflexion with knee flexed, were evaluated to determine muscle tightness. Twenty runners and 20 nonrunners volunteered for the study. Each group consisted of 10 males and 10 females. The observed means were compared between runners and nonrunners, males and females, plus the dominant and nondominant leg using a three-way analysis of variance. The runners were found to have tighter hamstrings (p < .05), and soleus (p < .05) muscles than nonrunners. There was no significant difference in rectus femoris and iliopsoas muscle tightness in runners compared with nonrunners. In addition, the males had tighter hamstring muscles than the females in both runners and nonrunners (p < .05). The hamstring muscles of the dominant leg were tighter than the hamstrings of the nondominant leg in all subjects (p < .05). In conclusion, long distance runners appear to have posterior muscle tightness in the lower extremity.
The purpose of this study was to characterize biomechanically three different crouch walking patterns, artificially induced in eight neurologically intact subjects and to compare them to selected cases of pathological crouch walking. The subjects were equipped with a lightweight mechanical exoskeleton with artificial muscles that acted in parallel with hamstrings and iliopsoas muscles. They walked at a speed of approximately 1m/s along the walkway under four experimental conditions: normal walking (NW), hamstrings contracture emulation (HAM), iliopsoas contracture emulation (IPS) and emulation of both hamstrings and iliopsoas contractures (IPSHAM). Reflective markers and force platform data were collected and ankle, knee and hip-joint angles, moments and powers were calculated. HAM and IPSHAM shifted ankle-angle rotation profiles into dorsiflexion during midstance compared to IPS and NW where ankle-angle trajectories were similar. HAM, IPS and IPSHAM shifted the knee angle of rotation profiles into flexion during stance, compared to NW. IPS and IPSHAM shifted hip angle of rotation profiles toward pronounced flexion while HAM shifted hip angle of rotation profile toward extension, compared to NW. HAM and IPSHAM significantly increased ankle moment during midstance, compared to IPS and NW where ankle moment profiles were similar. All experimental conditions exhibited similar behavior in the knee-moment profiles during midstance while IPS and IPSHAM knee-moment profiles exhibited significantly higher knee-extension moment during terminal stance and pre-swing. In the hip joint all experimental conditions exhibited similar shape of hip moment profiles throughout the gait cycle. HAM and IPS kinematic and kinetic patterns were qualitatively compared to two selected clinical cases, showing considerable similarity. This implies that distinct differences in kinematics and kinetics between HAM, IPS and IPSHAM may be clinically relevant in helping determine the relative contribution of hamstrings and iliopsoas muscles contractures to particular crouch walking.
The nucleus retroambiguus (NRA) is a group of premotor neurons at the transition between brainstem and spinal cord. It projects to certain motoneuronal cell groups, among which is a distinct set of motoneurons in the lumbar enlargement innervating muscles including iliopsoas, adductor longus, and hamstrings. To find out whether these NRA-motoneuronal projections are monosynaptic, injections of wheat germ-agglutinin horseradish peroxidase (WGA-HRP) into the NRA were combined with injections of cholera toxin subunit b (CTb) into the hamstring muscles. Electron microscopical examination revealed that the NRA terminal profiles make monosynaptic contacts with dendrites of motoneurons innervating these muscles. The NRA terminal profiles formed asymmetrical synapses, and contained spherical and a few dense core vesicles. These findings provide evidence of monosynaptic NRA-hindlimb motoneuronal projections which are likely to be excitatory.
In recent years a number of mitochondrial DNA (mtDNA) deletions have been detected in various tissues from individuals over 20 years of age. It has been postulated that these deletions are associated with natural aging. In order to determine whether a correlation exists between age and the amount of deleted 4977 bp mtDNA, we used two PCR reactions to study total DNA (nuclear and mitochondrial DNA) extracted from skeletal muscle (m. iliopsoas) obtained at autopsy from 93 individuals representing a wide age spectrum (range: 3 months-97 years). The primer pair L15/H15 was used to amplify a 533 bp fragment of intact mtDNA to determine the percentage of total DNA. A second PCR with the primer pair L35/H35 was then employed to amplify a 667 bp fragment of the deleted mtDNA. The amount of template DNA necessary to amplify the specific fragments of deleted mtDNA was found to decrease with age. Whereas no 4977 bp deletion could be detected in subjects under 20 years of age even with 1000 ng of total DNA, in individuals aged 21 to 30 years 1000 ng total DNA were sufficient. Only 1 ng total DNA was needed in all individuals over 70. Our results show that the 4977 bp deletion can be a useful marker of natural aging in human subjects.