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PubMed2002

Proximal femur reconstruction by an allograft prosthesis composite.

Twenty-seven patients who had resection of the proximal femur for bone tumors and reconstruction with an allograft prosthesis composite are reported. In most of the patients, the prosthesis was a long-stem revision type, cemented in the allograft and uncemented in the femoral shaft. The abductor muscles and iliopsoas were sutured to the corresponding tendons on the allograft. Implant-related complications and functional results were evaluated and are reported. Twenty-two patients achieved a minimum followup of 36 months (range, 36-126 months; average, 58 months). The implant was removed in two patients (one for infection, one for intraoperative fracture of the allograft). One patient experienced nonunion, whereas in the remaining 24 patients, the allograft eventually united to the host bone. A frequent late complication (17 patients) was fracture of the greater trochanter of the allograft. In the whole series, only four new operations were done for implant-related complications. In 22 patients who could be evaluated, the functional evaluation according to the Musculoskeletal Tumor Society System was excellent in 16 (73%) patients, good in four (18%), and fair in two (9%). These results compare favorably with those of megaprostheses for tumor resection of the proximal femur, where a Trendelenburg gait almost always is present.

Adolescent↗
PubMed2005

Energy cost and muscular activity required for leg swing during walking.

To investigate the metabolic cost and muscular actions required for the initiation and propagation of leg swing, we applied a novel combination of external forces to subjects walking on a treadmill. We applied a forward pulling force at each foot to assist leg swing, a constant forward pulling force at the waist to provide center of mass propulsion, and a combination of these foot and waist forces to evaluate leg swing. When the metabolic cost and muscle actions were at a minimum, the condition was considered optimal. We reasoned that the difference in energy consumption between the optimal combined waist and foot force trial and the optimal waist force-only trial would reflect the metabolic cost of initiating and propagating leg swing during normal walking. We also reasoned that a lower muscle activity with these assisting forces would indicate which muscles are normally responsible for initiating and propagating leg swing. With a propulsive force at the waist of 10% body weight (BW), the net metabolic cost of walking decreased to 58% of normal walking. With the optimal combination, a propulsive force at the waist of 10% BW plus a pulling force at the feet of 3% BW the net metabolic cost of walking further decreased to 48% of normal walking. With the same combination, the muscle activity of the iliopsoas and rectus femoris muscles during the swing phase was 27 and 60% lower, respectively, but the activity of the medial gastrocnemius and soleus before swing did not change. Thus our data indicate that approximately 10% of the net metabolic cost of walking is required to initiate and propagate leg swing. Additionally, the hip flexor muscles contribute to the initiation and propagation leg swing.

Electromyography↗
PubMedDate not supplied

[Native and contrast radiographic examination of the urinary tract].

INTRODUCTION: Plain x-rays and contrast urography are important for diagnosing urinary tract diseases. The first plain film of the urinary tract was made in 1896, and the first tests using contrasts started in 1904. Excretory urography has been used since 1930. PLAIN FILM OF THE URINARY TRACT: Plain films of the urinary tract are used in the kidney area, the area of the ureter and urinary bladder. They also show structures (lumbar and sacral spine and pelvis), muscles (m. iliopsoas) as well as calculi. EXCRETORY UROGRAPHY: X-ray visualization of the urinary tract with contrast substances is intravenous urography. It is used for diagnosing diseases of the upper urinary system with symptoms such as: pain, colic, hydronephrosis, as well as acute cortical infections, urinary bladder tumors, etc. RETROGRADE UROGRAPHY: Retrograde urography is a procedure recommended when either the pyelocalyx system or the ureter are not seen unilaterally or bilaterally. CYSTOGRAPHY AND URETHROCYSTOGRAPHY: Cystography is used to visualize the bladder. It is recommended in case of intravesical obstruction. Urethrocystography is a technique for investigation of the anterior and prostatic urethra as well as the neck of the urinary bladder.

Contrast Media↗
PubMedDate not supplied

Reconstructive surgery in the myelomeningocele hip.

In 17 myelomeningocele patients with subluxating or dislocated hips, 31 posterolateral iliopsoas were treated by transfers, as described by Sharrard, in addition to complimentary procedures to balance muscle power and center the hip joint. Surgical goals are to stablize the hips within the acetabulum and prevent the occurrence of severe fixed flexion and adduction contractures of the hip and secondary lumbar lordosis. Surgery is performed at about 1 year of age with bilateral adductor transfer to the ischium, followed in 2 weeks by the posterolateral transfer of the iliopsoas muscle, first on one hip and 2 weeks later following with the other hip. Adductor transfer to the ischium reduces the adductor and secondary flexor power of the adductor longus and anterior fibers of the adductor brevis. After transfer it provides some extensor power. The range of abduction is increased. The transferred iliopsoas muscle has a better mechanical advantage in its new function as an abductor and extensor, and the hips were better centered radiographically than the cases with iliopsoas transfer alone. Fewer bony procedures were required to center the hips when the iliopsoas transfer was performed in children before the age of 1 1/2 years.

Braces↗
PubMed1995

[A 21-year-old man with distal dominant progressive muscle atrophy].

We report a 21-year-old man with distal dominant progressive muscle atrophy. The patient was apparently well until 17 years of age when he noted a decrease in exercise tolerance. One year later, he noted difficulty in arising his heels when the walked. He was admitted to our service for the work up in June 10, 1992. On admission, the patient was rather slender in the body build up; otherwise general physical examination was unremarkable. Upon neurologic examination, mental status and higher cerebral functions were normal. In the cranial nerves, the sternocleidomastoid muscles were atrophic bilaterally; other cranial nerves appeared intact. His gait was unstable and he showed steppage gait; walking on toes and heels were impossible. Distal dominant muscle atrophy was noted in both upper and lower extremities. Muscle strength in the deltoid, biceps brachii and triceps brachii was normal. In the lower extremities, both tibialis anterior and triceps surae muscles were weak (3/5). The iliopsoas and quadriceps femoris muscles were normal, however, the adductor muscles of the thigh showed marked weakness (2/5). Myotonia was absent. Deep reflexes were decreased; sensation was intact. Routine blood tests were unremarkable; CK was 96 IU/l, lactate 6.9 mg/dl, and pyruvate 0.61 mg/dl. After an ischemic forearm exercise test, blood lactate level rose to 22.5mg/dl (base line 11.2), and blood ammonia to 88.3 micrograms/dl (base line 71.2). EMG showed myogenic changes and myotonic discharges. A diagnostic biopsy was performed. The patient was discussed in a neurologic CPC, and the chief discussant arrived at the conclusion that the patient had type III glycogen storage disease. The differential diagnosis included rimmed vacuole type myopathy, Miyoshi type distal muscular dystrophy, Welander type muscular dystrophy, adult type acid-maltase deficiency, and lysosomal glycogen storage disease with normal acid maltase. However, characteristic clinical presentation of initial weakness in the triceps surae muscle associated with atrophy of the sternocleidomastoid muscle confirmed best of the clinical characteristics of type III glycogen storage disease; the only finding which did not fit with its diagnosis was elevation of the blood lactate level after the ischemic exercise test. The muscle biopsy specimen showed marked vacuole formation; approximately 20 to 30% of the vacuoles were rimmed vacuoles, however, the majority was not rimmed. PAS staining on an epon-embedded specimen revealed marked accumulation of PAS-positive materials in those vacuoles as well as in the interfascular space. The non-rimmed vacuoles were not positively stained in the acid-phosphatase staining, which exclude the diagnosis of acid maltase deficiency. No mitochondrial abnormalities were found.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

Computed tomographic features of suspected traumatic injury to the iliopsoas and pelvic limb musculature of a dog.

Computed-tomographic (CT) findings in a dog with acute suspected traumatic injury to the iliopsoas and neighboring pelvic musculature include enlargement of the affected muscles, multifocal intramuscular hypoattenuating areas, and nonuniform contrast enhancement of injured musculature. The CT features are postulated to be the result of intramuscular edema and inflammation, and correspond well to previously described ultrasonographic findings in dogs. Because of the close anatomic association between the femoral nerve and iliopsoas muscle, dogs with suspected iliopsoas injuries should be carefully evaluated for evidence of femoral nerve dysfunction. CT imaging may provide useful information regarding the nature and extent of iliopsoas muscular damage, as well as concurrent injuries in the actuely traumatized patient.

Animals↗
PubMed1994

CT of the iliopsoas compartment: value in differentiating tumor, abscess, and hematoma.

OBJECTIVE: The iliopsoas compartment is an extraperitoneal space defined by the iliopsoas fascia; its major components include the iliacus, psoas major, and psoas minor muscles. Distinction of neoplastic, inflammatory, and hemorrhagic conditions of the iliopsoas compartment is often difficult, whether based on clinical evaluation or CT findings. The purpose of this study was to determine specific CT features that might help differentiate these three abnormalities. MATERIALS AND METHODS: We retrospectively reviewed CT scans of 44 patients who had abnormalities of the iliopsoas compartment (15 neoplasms, 21 abscesses, and eight hematomas). Final diagnoses were established by surgical biopsy (n = 14), percutaneous biopsy (n = 18), or clinical evidence (n = 12). Diagnoses were correlated with 11 CT features to determine findings that could be used to differentiate the three abnormalities. These included enlargement of the iliopsoas muscles; extent, margination, and attenuation of the lesion; presence of gas, calcification, bone destruction, fat infiltration, and fascial disruption; and associated fluid or adenopathy. The radiologist who interpreted the scans had no knowledge of the clinical findings. RESULTS: The most reliable CT features for each condition were as follows: irregular margins, 67% sensitive, 52% specific, and 57% accurate for neoplasms; low attenuation, 100% sensitive, 43% specific, and 70% accurate for abscesses; and diffuse involvement of the entire muscle, 88% sensitive, 78% specific, and 80% accurate for hematomas. Combinations of individual CT features did not improve the ability to differentiate the three conditions. CONCLUSION: Our results show that the efficacy of CT, when scans are interpreted without knowledge of the clinical history, is poor for differentiating iliopsoas neoplasms, abscesses, and hematomas.

Adolescent↗
PubMed1976

Prenatal changes of lactate dehydrogenase isoenzyme patterns and activity in bovine tissues.

Isoenzyme patterns, total lactate dehydrogenase (LDH, E.C. 1.1.1.27) activity and H and M subunit activity were determined in the tissues of Czech Spotted bovine foetuses. Total LDH activity rose in the skeletal muscles throughout the whole of the prenatal period. In the viscera it usually attained the maximum at a foetal length of 66.7 cm. Differences in the isoenzyme patterns of the various organs of an 8.1-cm foetus were relatively small (41.9--66.1% H subunits). In the heart and kidneys, in which LDH1 and LDH2 markedly predominate in adulthood, the isoenzyme pattern resembled the adult one at a length of only 13.3 cm, but in the liver, spleen and lungs not until 66.7 cm. The proportion of H subunits also rose in the part of the gastrointestinal tract where secretory and resorptive activity predominate (the abomasum, the small and the large intestine). Conversely, it fell in organs concerned mainly with the mechanical processing of food (the rumen, reticulum and omasum). The proportion of M subunits rose in all the skeletal muscles up to a foetal length of 66.7 cm. Later on, differentiation into muscles in which M subunits predominated (the longissimus dorsi and the triceps brachii), into muscles with approximately the same proportion of H and M subunits (the iliopsoas) and to muscles with a preponderance of H subunits (the masseter and the muscular part of the diaphragm) occurred.

Animals↗
PubMed1979

[Spasm of the adductor muscles, pre-dislocations and dislocations of the hip joints in children and adolescents with cerebral palsy. Clinical observations on aetiology, pathogenesis, therapy and rehabilitation. Part II. The importance of the iliopsoas tendon, its tenotomy, of the coxa valga antetorta, and correction through osteotomy turning the hip into varus (author's transl)].

The following factors besides spasm and contraction of the adductor muscles contribute to the occurrence of dislocations of the hip in spastic paralysis: Spasm and contraction of the iliopsoas muscle and enhanced valgus position and antetorsion. The author holds the opinion that in case of malformation of the proximal end of the femur, it is not only the indirect action of the spastic musculature via the proximal femur-epiphyseal cartilage which is responsible for this phenomen in accordance with the law on functional adaption through longitudinal growth (Pauwels), but also the direct traction of the iliopsoas tendon. A clue in this direction is the often very pronounced elongation or enlargement of the trochanter minor. The author demonstrates the pathogenetic importance of iliopsoas contracture and malpositioning of the neck of the femur by means of analyses of the course in two patients. The following principles of treatment are postulated for spastic dislocation of the hip: Elimination of the pathogenetic factors through myotenotomy of the adductor muscles and complete resection of the obturator nerve, with observation of strict aftertreatment criteria, tenotomy of the iliopsoas, repositioning and osteotomy with turning into varus. Osteotomy without previous elimination of the pathogenetically acting muscular forces does not appear useful. Likewise, permanent re-positioning by means of muscle-relaxing operation cannot be sufficiently safe-guarded without additional osteotomy once the dislocation has taken place. In twelve patients with spastic dislocation of the hip, treated in accordance with these guidelines (two without osteotomy) aged 6 6/12 and 19 5/12 years, a roentgenologically good result was obtained in half of the cases, whereas the functional result was satisfactory not only with these patients but also with part of the other patients. If surgical treatment is instituted early enough, and if the experiences described here are taken into consideration, it is to be expected that the results will be even more satisfactory. The corset supporting the seated patient, developed by us, has been found very useful during the aftertreatment stage. A definite stand is taken against the therapeutic nihilism which leaves treatment of spastic dislocations to physiotherapy. It is also pointed out that indication for treatment is not represented only by the target of learning how to walk, but also by providing an overall improvement of the life situation of the patient, by either enabling him, or improving his ability, to sit or by "merely" improving the care of the perineum.

Adolescent↗
PubMedDate not supplied

Muscular amyloidoma presenting as inguinal masses in multiple myeloma.

We report a case with protruding inguinal masses for 6 months, in whom muscular amyloidoma was not suspected before muscle biopsy. On pelvic magnetic resonance imaging (MRI), round masses showing peripheral rim enhancement with gadolinium were observed in iliopsoas and iliacus muscles of both inguinal areas. The same lesions were also observed in gluteus muscles. The biopsy showed Congo red positive materials in a dense fibrous background. Serum and urine electrophoresis showed Bence Jones protein, lambda type. In bone marrow section, myeloma cells were found. Peripheral blood stem cell transplantation (PBSCT) following four cycles of VAD (vincristine, adriamycin, dexamethasone) chemotherapy was performed and the result was satisfactory. Amyloidoma lesions decreased in size and number on the following MRI.

Abdominal Wall↗
PubMed1999

[Giant psoas abscess with aggressive extension: report of a case].

We report a case of giant psoas abscess with aggressive extension outside the muscles of the iliopsoas component. A 57-year-old man was admitted to our hospital, presenting with right flank pain and severe general malaise. He had been diabetic, but no treatment had been performed for diabetes. Leukocytosis, positive CRP and hyperglycemia were noted, but he was nearly afebrile on admission. Computerized tomography revealed a large multilocular mass in the right retroperitoneal space involving the ipsilateral psoas muscle. The diagnosis was not apparent until the 12th hospital day, when moderate grade fever was noted and brownish purulent fluid was obtained by percutaneous puncture of the mass. Staphylococcus aureus was isolated on culture. Antibiotic chemotherapy was started, and ultrasound-guided percutaneous drainage was then performed under the diagnosis of psoas abscess. At that time, the abscess was aggressively extending from the iliopsoas component into the pelvic floor, involving the rectus muscle, the gluteal muscles and formation of subucutaneous lesions. At 46 days after drainage, surgical resection of the abscess with removal of the adjucent tissue was performed because of persistent discharge of pus and multiple residual lesions. The postoperative course was uneventful, and there has been no recurrence. Many cases of psoas abscess have been reported in the Japanese literature. Prompt drainage, either percutaneously or surgically are required. Surgical resection of the abscess, with not only opening the cavity but also removal of the adjacent tissue, may be recommended in some cases, especially those diffuse or multilocular lesions.

Anti-Bacterial Agents↗
PubMed1995

Femoral varus derotational osteotomy in cerebral palsy.

The records concerning 64 hips in 36 cerebral palsy patients treated with varus derotational osteotomy (VDO) alone (2 hips), VDO with muscle releases (adductors, iliopsoas, hamstrings; 46 hips), and VDO, soft-tissue release, and innominate bone osteotomy (16 hips) were reviewed. There were 23 quadriplegic and 13 diplegic patients. Average age at surgery was 7 years. Average follow-up period was 3.8 years. All hips that had VDO, soft-tissue release, and innominate osteotomy were stable at follow-up. Nine hips of the 44 treated with VDO and muscle release alone dislocated, and required second osteotomies.

Adolescent↗
PubMed1995

The role of the psoas and iliacus muscles for stability and movement of the lumbar spine, pelvis and hip.

The activation patterns of the psoas and iliacus muscles were investigated in 7 healthy adult subjects (4 men and 3 women) during a variety of motor tasks in standing, sitting and lying. Myoelectric activity was recorded simultaneously from the 2 muscles using thin wire electrodes inserted under guidance of high-resolution ultrasound. In general, both muscles were coactivated, albeit to different relative levels, particularly when hip flexor torque was required. Selective activation of the iliacus could, however, be seen to stabilize the pelvis in contralateral hip extension during standing. Psoas was found to be selectively involved in sitting with a straight back and in contralateral loading situations requiring stabilization of the spine in the frontal plane. During training exercises from a supine position, such as sit-ups, the contribution of the psoas and iliacus muscles could be varied by changing the range of motion as well as the position and support for the legs. Thus, the 2 anatomically different muscles of the iliopsoas complex were shown to have individual and task-specific activation patterns depending on the particular demands for stability and movement at the lumbar spine, pelvis and hip.

Adult↗
PubMed1997

Vastus-Psoas release for acetabular exposure in revision hip surgery.

A technique is presented for wide exposure of the acetabulum for revision total hip arthroplasty surgery in the presence of a solidly fixed, modular, or monoblock femoral component without the need for trochanteric osteotomy. The technique involves release of the proximal portion of the vastus lateralis, vastus intermedius, and vastus medialis muscles and the iliopsoas tendon form the femur and placement of the femoral head/neck posterior to the acetabulum. The exposure afforded by this release usually precludes the need for trochanteric osteotomy and/or removal of a well-fixed femoral component in revision surgery that is being done for isolated loosening of acetabular components, thereby decreasing operative time, morbidity, and the risks of complication of trochanteric osteotomy.

Acetabulum↗
PubMed2001

[Skeletal muscle pathology of chronic graft versus host disease accompanied with myositis, affecting predominantly respiratory and distal muscles, and hemosiderosis].

We report the muscle pathology in a 43-year-old woman who died of chronic graft versus host disease (GVHD) complicated by myositis and systemic transfusional hemosiderosis, after an allogeneic bone marrow transplantation and a donor leukocyte transfusion for acute myelogenous leukemia. Despite cyclosporin A treatment, fatal ventilatory failure progressed while she was still ambulant. Autopsy revealed the presence of chronic GVHD mildly involving the liver, skin, pericardium, pancreas, and salivary glands, in addition to skeletal muscles. Myopathic changes with mild inflammation and prominent iron deposition were found in the tibialis anterior muscle and, to a lesser degree, in the diaphragm and the intercostal muscle. There were iron deposits in both macrophages and sarcoplasm in the tibialis anterior. The iliopsoas and pectoralis major muscles showed prominent type 2 fiber atrophy; inflammation and iron deposition were minimal in the iliopsoas, but none in the pectoralis. Although we ascribed respiratory failure largely to GVHD myositis, weakness of the lower leg appeared to be aggravated by iron deposition superimposing the underlying GVHD myositis.

Adult↗
PubMed2005

Soft-tissue releases to treat spastic hip subluxation in children with cerebral palsy.

BACKGROUND: Spastic hip subluxation and dislocation are common problems in children with cerebral palsy. Soft-tissue releases have proved to be beneficial in the prevention of spastic hip dislocation. A protocol for treatment based on patient age, hip abduction, and hip migration percentage was established in 1988. The purpose of this study was to assess the outcome in sixty-five children treated according to this protocol and followed for a minimum of eight years. METHODS: The medical records and radiographs of sixty-five children, from an original series of seventy-four patients, who met the inclusion criteria were available for review. Forty-seven children had spastic quadriplegia and were unable to walk; eighteen children had spastic diplegia and were able to walk independently or with assistive devices. The mean age at the time of the surgery was 4.4 years. Open adductor tenotomy and psoas muscle recession or iliopsoas tenotomy were performed on 129 hips, which were followed for a mean of 10.8 years. The mean age at the time of follow-up was fifteen years. Hips were grouped according to the hip migration percentage preoperatively, at one year postoperatively, and at the time of final follow-up. The final outcome for the patient was defined according to the worse hip. An analysis was performed to identify potential factors influencing outcome. RESULTS: Thirty-two patients (49%) had a good result, eleven (17%) had a fair result, three (4%) had a poor result, and nineteen (30%) had a failure. The mean hip migration percentage was 34% preoperatively and 18% at the time of final follow-up. Nineteen patients required subsequent osseous reconstructive procedures, and eleven required repeat soft-tissue releases. The migration percentage at one year postoperatively was the most predictive of the final outcome (p = 0.001). Patients who had been able to walk preoperatively had a better long-term outcome (p = 0.01). Neither the preoperative hip migration percentage nor the age at surgery significantly affected the outcome. CONCLUSIONS: Soft-tissue release was effective for long-term prevention of hip dislocation in 67% (forty-three) of sixty-five children with spastic hip subluxation. Two preoperative factors that were related to a favorable outcome were a spastic diplegic pattern of involvement and the ability to walk. The hip migration percentage at one year postoperatively was a good predictor of final outcome.

Cerebral Palsy↗
PubMed1996

The clinical spectrum of limb girdle muscular dystrophy. A survey in The Netherlands.

A cross-sectional study was performed in the Netherlands to define the clinical characteristics of the various subtypes within the broad and heterogeneous entity of limb girdle muscular dystrophy (LGMD). An attempt was made to include all known cases of LGMD in the Netherlands. Out of the reported 200 patients, 105 who fulfilled strictly defined criteria were included. Forty-nine patients, mostly suffering from dystrophinopathies and facioscapulohumeral muscular dystrophy, appeared to be misdiagnosed. Thirty-four cases were sporadic, 42 patients came from autosomal recessive and 29 from autosomal dominant families. The estimated prevalence of LGMD in the Netherlands was at least 8.1 x 10(-6). The clinical features of the autosomal recessive and sporadic cases were indistinguishable from those of the autosomal dominant patients, although calf hypertrophy was seen more frequently, and the course of the disease was more severe in autosomal recessive and sporadic cases. The pectoralis, iliopsoas and gluteal muscles, hip adductors and hamstrings were the most affected muscles. Distal muscle involvement occurred late in the course of the disease. Facial weakness was a rare phenomenon. The severity of the clinical picture was correlated with a deteriorating lung function. All autosomal dominantly inherited cases showed a mild course, although in two families life-expectancy was reduced because of concomitant cardiac involvement.

Adolescent↗