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PubMed1997

Ilio-psoas abscess in a neonate.

A full-term, small-for-gestational-age, neonate was born 4 days after rupture of the membranes. On the 5th day of life, she developed sepsis due to Klebsiella pneumoniae. On the 18th day of life, the right hip was noted swollen with limited range of motion, but it was painless on passive movements. Ultrasonography revealed abscess of the right ilio-psoas muscle with normal appearance of the right hip joint. Surgical incision and drainage and antibiotic administration resulted in a gradual full recovery. Ultrasonography can confirm the diagnosis of this exceptional clinical entity in neonates, which is difficult to differentiate from septic arthritis of the hip.

Bacteremia↗

PubMed2006

A rare psoas hernia: endoscopic diagnosis and management.

Of the various traumatic injuries associated with blunt abdominal trauma, traumatic hernias form a rare and small group. We present a case report of a hernia in the psoas muscle in a 26-year-old lady diagnosed during extraperitoneal repair for inguinal hernia. The hernia was managed laparoscopically by reduction of contents and mesh placement over the defect. This is the first such case reported in the literature till date.

Adult↗

PubMed2002

[Acute groin pain and femoral nerve deficit in a warfarin treated patient].

Warfarin is frequently used as an anticoagulant. The most common and serious complication is bleeding. We present a 43-year-old warfarinized patient who was admitted with unilateral groin pain and a neurological deficit of the lumbar nerve root L1-4. A CT scan showed a haematoma in and behind the ilio-psoas muscle extending to below the inguinal ligament, due to a warfarin induced coagulation deficit (INR 7.0) which was reversed on admission with vitamin K. There is no conclusive evidence in the literature supporting either conservative or surgical treatment modalities. Our patient was successfully treated conservatively.

Acute Disease↗

PubMed1998

Rate of phosphate release after photoliberation of adenosine 5'-triphosphate in slow and fast skeletal muscle fibers.

Inorganic phosphate (Pi) release was determined by means of a fluorescent Pi-probe in single permeabilized rabbit soleus and psoas muscle fibers. Measurements of Pi release followed photoliberation of approximately 1.5 mM ATP by flash photolysis of NPE-caged ATP in the absence and presence of Ca2+ at 15 degrees C. In the absence of Ca2+, Pi release occurred with a slow rate of 11 +/- 3 microM . s-1 (n = 3) in soleus fibers and 23 +/- 1 microM . s-1 (n = 10) in psoas fibers. At saturating Ca2+ concentrations (pCa 4.5), photoliberation of ATP was followed by rapid force development. The initial rate of Pi release was 0.57 +/- 0.05 mM . s-1 in soleus (n = 13) and 4.7 +/- 0.2 mM . s-1 in psoas (n = 23), corresponding to a rate of Pi release per myosin head of 3.8 s-1 in soleus and 31.5 s-1 in psoas. Pi release declined at a rate of 0.48 s-1 in soleus and of 5.2 s-1 in psoas. Pi release in soleus was slightly faster in the presence of an ATP regenerating system but slower when 0.5 mM ADP was added. The reduction in the rate of Pi release results from an initial redistribution of cross-bridges over different states and a subsequent ADP-sensitive slowing of cross-bridge detachment.

Adenosine Diphosphate↗

PubMed1993

Malignant tumour of the psoas: another cause of meralgia paraesthetica.

Contrasting the more benign causes known for meralgia paraesthetica we report a case due to a malignant tumour of the psoas muscle. We discuss the use of sensory nerve conduction study and somatosensory evoked potentials of the lateral femoral cutaneous nerve as well as needle EMG and diagnostic nerve block to detect the site of the lesion along its course. This appears of major importance, as causes located above the inguinal ligament can bear a more serious prognosis than the ones below.

Action Potentials↗

PubMed2001

Retroperitoneal hematoma associated with femoral neuropathy: a complication under antiplatelets therapy.

We report a case of retroperitoneal hematoma presenting as femoral nerve pulsy on antiplatelet therapy. The patient, a 78-year-old man who had undergone antiplatelet treatment using ticlopidine, was admitted to our hospital with complaints of sudden-onset low abdominal and back pain. Computed tomography showed an iso-density mass in the right retroperitoneum within the psoas muscle. We made a diagnosis of retroperitoneal hematoma compressing the femoral nerve and performed an operation to remove the hematoma in order to decompress the femoral neuropathy. Postoperatively, the patient rapidly recovered from the femoral neuropathy. In the particular case in which no antagonist against the ticlopidine is available, surgical decompression could produce a good outcome.

Aged↗

PubMed1993

One-year psoas training can prevent lumbar bone loss in postmenopausal women: a randomized controlled trial.

On the premise that bone response to exercise is locally controlled, we conducted a randomized trial to evaluate the effects of a 1-year training of psoas muscles (treatment group: TG) versus a 1-year training of deltoid muscles (control group: CG) on the lumbar trabecular bone mineral density (TBMD). TBMD was measured with computed tomography scan. Seventy-eight subjects were included and 67 completed the study. Intention to treat analysis revealed no significant change in TBMD from 0 to 12 months. Data analysis in the 67 remaining women, including both assiduous and nonassiduous subjects, revealed greater bone loss in CG than in TG although the difference was not significant. Similar analysis in a subgroup of subjects who performed the exercises assiduously (TG: n = 23, CG: n = 26) showed that the mean bone loss of all four vertebrae from 0 to 12 months was significantly greater in the CG (-8.87 +/- 12.75 mg/cm3, mean +/- SD) than in the TG (0.14 +/- 11.21 mg/cm3, mean +/- SD, P = 0.01). These results suggest that continuous 1-year psoas training can prevent lumbar bone loss in postmenopausal women and support the hypothesis of local action of physical activity.

Bone Density↗

PubMedDate not supplied

Technique for iliopsoas ultrasound-guided active electromyography-directed botulinum a toxin injection in cerebral palsy.

Symptomatic hip flexion deformity secondary to iliopsoas spasticity may interfere with gait, impair sitting balance, or contribute to hip subluxation or dislocation. A nonsurgical, minimally invasive technique to ameliorate iliopsoas spasticity is presented. The technique uses intramuscular injections of botulinum A toxin to provide selective neuromuscular blockade of the iliacus or psoas muscles or both. Because of the anatomic location of the target muscles, this technique uses ultrasound guidance for needle placement. Active electromyographic stimulation is used to verify the needle position adjacent to active myoneural interfaces. The authors' experience to date includes the treatment of 28 patients (53 hips). Use of this technique has resulted in improved hip range of motion. No intraoperative or postoperative adverse events or complications have been observed.

Botulinum Toxins, Type A↗

PubMedDate not supplied

Sonography of postpartum ovarian vein thrombophlebitis.

PURPOSE: We report the gray-scale, color, and power Doppler findings in 3 cases of postpartum ovarian vein thrombophlebitis (PPOVT), an uncommon but potentially lethal disorder. METHODS: A retrospective review of medical records revealed 3 patients with PPOVT who had pelvic sonography performed during the disease course. RESULTS: The sonographic findings of PPOVT included a tubular, hypoechoic mass identified anterior to the psoas muscle in all cases. Perivenous phlegmon formation resulted in hydronephrosis and obstructive periureteritis in 1 case. Inferior vena cava involvement was detected in 2 cases. Decreases in the sizes of the thrombus and the phlegmon were seen on post-treatment studies. CONCLUSIONS: The long course of the thrombosed ovarian vein and the presence of inferior vena cava thrombus are sonographic signs helpful in distinguishing PPOVT from other inflammatory conditions. Sonography cannot be proposed as a primary tool in the diagnosis of PPOVT because it successfully diagnosed only 1 of our 3 cases. However, sonography may be useful in monitoring the response to anticoagulant therapy.

Adolescent↗

PubMed1995

Evaluation of freeze substitution in rabbit skeletal muscle. Comparison of electron microscopy to X-ray diffraction.

Rabbit psoas muscle fibres, relaxed and in rigor, have been freeze substituted for electron microscopy. Fourier transforms and average density maps of micrographs of transverse sections have been obtained and compared to X-ray diffraction data. The Fourier amplitudes from rigor and relaxed muscle are comparable to equatorial data from X-ray diffraction of muscle if there is more disorder in the electron micrographs which can be described by a 'temperature' factor. The phases of reflections out to the 3,2 have been determined; those reflections at the same radius and therefore not separable in the X-ray patterns, such as the 2,1 and the 1,2, are separated in the transforms of sections through the A band. In transforms from both rigor and relaxed muscle they have the same phase. In rigor muscle they have different amplitudes. All the phases are positive or negative showing that the lattice is centrosymmetric at the resolution obtained. The phases obtained generally support those suggested by model building studies using X-ray diffraction data. In rigor muscle, areas where the cross-bridges are regularly attached are clearly seen in thin transverse sections. A handedness to this structure is indicated by a lack of mirror symmetry, in both the Fourier transform of thick sections, and in the averaged density map. This correlates well with the arrangement where the myosin head is bound as in the acto-S1 structure but only to actin monomers within a limited azimuthal range.

Animals↗

PubMed1987

Possible cooperativity in crossbridge detachment in muscle fibers having magnesium pyrophosphate at the active site.

When rabbit psoas muscle fibers bathed in solutions containing the ATP analogue magnesium pyrophosphate (MgPPi) are first stretched rapidly and then held isometric, a force is generated during the stretch which decays during the subsequent isometric period (Schoenberg, M., and E. Eisenberg. 1985. Biophys. J. 48:863-871). Previously we showed that the force decay is due to crossbridge heads detaching and reattaching in positions of lesser strain, the rate of decay of force reflecting the crossbridge detachment rate constants. Since the crossbridge detachment rate constants with MgPPi bound to the active site are so much faster than without analogue bound, at subsaturating concentrations of analogue, if the heads act independently and nucleotide association and dissociation is rapid, the rate of force decay should simply be proportional to the number of heads with bound analogue. That is, the analogue concentration dependence of the rate of force decay should have the same form as the Michaelis-Menten equation. Here we report that the concentration dependence of the rate of force decay is not described by the Michaelis equation, but is instead sigmoidal. This suggests possible cooperativity in the detachment of the crossbridge heads, the amount of cooperativity being described by an interaction coefficient of approximately 2. One idea put forward to explain the data is that both of the heads of a crossbridge may need to bind analogue before the crossbridge can relax a substantial fraction of the tension it supports.

Adenosine Triphosphate↗

PubMed1969

Coordinated development of the sarcoplasmic reticulum and T system during postnatal differentiation of rat skeletal muscle.

An electron microscope study has been carried out on rat psoas muscle, during the early postnatal stages of development. Among the several subcellular components, the sarcotubular system undergoes the most striking modifications during this period. In muscle fibers of the newborn rat, junctional contacts between the T system and the SR are sparse and are, mostly, longitudinally or obliquely oriented. The T tubules do not penetrate deeply into the muscle cell, as indicated by the predominantly peripheral location of the triads and the persistence, at these stages of development, of a highly branched subsarcolemmal system of tubules. Diadic associations of junctional SR elements with the plasma membrane are also occasionally observed. The early SR elaborations incompletely delineate the myofibrils, at both the A- and I-band level. Longitudinal sections show irregularly oriented SR tubules, running continuously over successive sarcomeres. Flattened junctional cisterns filled with granular material are sparse and laterally interconnected, at circumscribed sites, with the SR tubules. Between 1 and 2 wk postpartum, transversal triadic contacts are extensively established, at the A-I band level, and the SR network differentiates into two portions in register with the A and I band, respectively. At 10-15 days after birth, the SR provides a transversely continuous double sheet around the myofibrils at the I-band level, whereas it forms a single discontinuous layer at the A-band level. The relationship that these morphological modifications of the sarcotubular system may bear to previously described biochemical and physiological changes of rat muscle fibers after birth is discussed.

Animals↗

PubMed1974

Differences in the charge distribution of glycerol-extracted muscle fibers in rigor, relaxation, and contraction.

Glycerol-extracted rabbit psoas muscle fibers were impaled with KCl-filled glass microelectrodes. For fibers at rest-length, the potentials were significantly more negative in solutions producing relaxation than in solutions producing either rigor or contraction; further the potentials in the latter two cases were not significantly different. For stretched fibers, with no overlap between thick and thin filaments, the potentials did not differ in the rigor, the relaxation, or the contraction solutions. The potentials measured from fibers in rigor did not vary significantly with the sarcomere length. For relaxed fibers, however, the potential magnitude decreased with increasing sarcomere length. The difference between the potentials measured for rigor and relaxed fibers exhibited a nonlinear relationship with sarcomere length. The potentials from calcium-insensitive fibers were less negative in both the rigor and the relaxation solutions than those from normal fibers. When calcium-insensitive fibers had been incubated in Hasselbach and Schneider's solution plus MgCl(2) or Guba-Straub's solution plus MgATP the potentials recorded upon impalement were similar in the rigor and the relaxation solution to those obtained from normal fibers in the relaxed state. It is concluded that the increase in the negative potential as the glycerinated fiber goes from rigor to relaxation may be due to an alteration in the conformation of the contractile proteins in the relaxed state.

Animals↗

PubMed1991

Effect of osmotic compression on the force-velocity properties of glycerinated rabbit skeletal muscle cells.

The force-velocity relations of single glycerinated rabbit psoas muscle fibers at 5 degrees C were studied at maximum and half-maximum activation in the presence of 0 (control) and 39-145 g/liter dextran T-70. Resting fiber diameter decreased progressively to approximately 70% of the nondextran control as the dextran concentration was increased. Isometric force at full activation increased to a maximum of 136% of control at 111 g/liter dextran and then fell to 80% of control in 145 g/liter dextran. Maximum velocity, which fell to 49% of the control value in the highest concentration of dextran, was nearly constant at approximately 65% control over the range of 58-111 g/liter dextran. Relative maximum power, which gives an estimate of changes in intermediate velocity, was not significantly reduced by dextran concentrations up to 76 g/liter, but then fell progressively to 62% of control in the highest concentration of dextran. At half-maximum activation, maximum velocity and relative maximum power were not significantly different from the values at full activation. The results obtained at partial activation indicate that the decline of velocity seen in the presence of dextran is not due to a passive internal load and that the dextran does not cause a viscous resistance to shortening. The increased velocity in the absence of dextran can be explained by the reduced ability of cross-bridges to resist shortening, as proposed by Goldman (1987. Biophys. J. 51:57).

Animals↗

PubMed2002

The elementary force generation process probed by temperature and length perturbations in muscle fibres from the rabbit.

Single chemically permeabilized fibres from rabbit psoas muscle were activated maximally at 5-6 degrees C and then exposed to a rapid temperature increase ('T-jump') up to 37 degrees C by passing a high-voltage pulse (40 kHz AC, 0.15 ms duration) through the fibre length. Fibre cooling after the T-jump was compensated by applying a warming (40 kHz AC, 200 ms) pulse. Tension and changes in sarcomere length induced by the T-jumps and by fast length step perturbations of the fibres were monitored. In some experiments sarcomere length feedback control was used. After T-jumps tension increased from approximately 55 kN m(-2) at 5-6 degrees C to approximately 270 kN m(-2) at 36-37 degrees C, while stiffness rose by approximately 15 %, suggesting that at a higher temperature the myosin head generates more force. The temperature-tension relation became less steep at temperatures above 25 degrees C, but was not saturated even at near-physiological temperature. Comparison of tension transients induced by the T-jump and length steps showed that they are different. The T-jump transients were several times slower than fast partial tension recovery following length steps at low and high temperature (phase 2). The kinetics of the tension rise after the T-jumps was independent of the preceding length changes. When the length steps were applied during the tension rise induced by the T-jump, the observed complex tension transient was simply the sum of two separate responses to the mechanical and temperature perturbations. This demonstrates the absence of interaction between these processes. The data suggest that tension transients induced by the T-jumps and length steps are caused by different processes in myosin cross-bridges.

Animals↗

PubMed1994

Retroperitoneal plexiform neurofibromas: CT findings.

OBJECTIVE: CT findings in retroperitoneal plexiform neurofibromas have been described previously only in a few case reports. This study was performed to characterize the CT features in a larger group of patients with this benign neoplasm and to delineate those findings that suggest the presence of concurrent malignant tumors of the nerve sheath. MATERIALS AND METHODS: From a review of CT scans showing retroperitoneal masses in 25 patients with neurofibromatosis type 1, we identified 16 patients whose clinical and CT features suggested the diagnosis of plexiform neurofibromas. The diagnosis was confirmed by biopsy of the mass in three patients. In the remaining 13 patients, the diagnosis was supported by long-term follow-up in eight and by biopsy confirmation of either a neurofibroma or a plexiform neurofibroma elsewhere in the body in the other five patients. Concurrent retroperitoneal malignant tumors of the nerve sheath were confirmed by biopsy in five patients. RESULTS: CT showed bilateral, remarkably symmetric masses extending along the medial and posterior aspects of the psoas muscles in 15 of the 16 patients. Parapsoas masses tended to be long and cylindrical. In addition to parapsoas masses, eight patients had bilateral, symmetric masses extending along the anterior aspect of the sacrum in a sheetlike fashion. Masses were identified in the region of the celiac axis and the origin of the superior mesenteric artery in four patients. Only one patient had an isolated celiac/superior mesenteric artery mass without associated parapsoas or presacral masses. Retroperitoneal masses were of homogeneous, low attenuation when compared with adjacent muscle on CT images of 14 patients. Two patients had an unusual swirling and serpiginous pattern of increased attenuation superimposed on a low-attenuation background. Asymmetry in size and attenuation was due to malignant nerve sheath tumors in five patients. CONCLUSION: Retroperitoneal plexiform neurofibromas have a characteristic appearance on CT scans. They are typically bilateral, symmetric, low-attenuation masses in a parapsoas or presacral location. Asymmetry in size and attenuation of a larger mass suggests the possibility of a malignant tumor of the nerve sheath. Recognition of the CT features of a retroperitoneal plexiform neurofibroma can obviate the expense, pain, and risk of an unnecessary biopsy. Conversely, detection of findings suggestive of malignant tumor can lead to appropriate recommendation of biopsy.

Adult↗

PubMedDate not supplied

Misplacement of a psoas compartment catheter in the subarachnoid space.

BACKGROUND AND OBJECTIVES: This case report describes an unusual cause of misplacement of an indwelling catheter in the subarachnoid space after primary psoas compartment block in a patient undergoing total knee arthroplasty. CASE REPORT: A 67-year-old woman presenting for total knee joint replacement received a combination of continuous psoas compartment block and sciatic nerve block. Neurostimulation and additional ultrasound guidance were used for identification of the lumbar plexus. After elicitation of a quadriceps motor response, a negative aspiration test, and an uneventful test dose, 20 mL ropivacaine 0.375% and 20 mL mepivacaine 1% were injected. Despite difficult ultrasound conditions because of intestinal air, local anesthetic spread was observed paravertebrally at the medial border of the psoas muscle as usual. A catheter was then advanced 7 cm through the insulated directional puncture needle. An additional sciatic nerve block was performed by using Labat's approach. Ten minutes after injection unilateral sensory block was noted and surgery was started. After uneventful surgery, bilateral sensory block to the T4 level and complete motor block in both lower limbs was detected. A second aspiration test was negative, and an epidural block was suspected. For verification of the catheter tip location, a computed tomography scan with contrast dye was performed revealing catheter placement in the subarachnoid space. The catheter was removed and showed a kink about 7 cm from the tip. After regression of the neuraxial block, lumbar plexus block persisted for another 2 hours. CONCLUSION: An additional test dose via the catheter is recommended if the indwelling catheter is inserted after injection of the local anesthetics through the puncture needle. If epidural anesthesia occurs, an x-ray of the catheter is advisable because negative aspiration via catheter does not rule out subarachnoid catheter location.

Arthroplasty, Replacement, Knee↗

PubMed2002

Anatomic landmarks and time management during retroperitoneoscopic radical nephrectomy.

BACKGROUND AND PURPOSE: Retroperitoneoscopy has not been widely considered the preferred approach to laparoscopic radical nephrectomy for cancer, in part because the retroperitoneal anatomic landmarks have not been well defined. The aim of this study is to provide prospective, objective data on retroperitoneoscopic radical nephrectomy with regard to anatomic landmarks and time management of the sequential operative steps. MATERIALS AND METHODS: A uniform database was devised to record predetermined intraoperative parameters prospectively in 18 consecutive retroperitoneoscopic radical nephrectomies. RESULTS: A three- or four-port technique was employed to perform 10 left and 8 right retroperitoneoscopic radical nephrectomies. Initial balloon dilation was routinely performed outside of and posterior to Gerota's fascia. The anatomic landmarks visible immediately on initial insertion of the laparoscope were: psoas muscle in 18 cases (100%), Gerota's fascia in 18 (100%), peritoneal reflection in 15 (83%), ureter and/or gonadal vein in 11 (61%), and renal artery pulsations in 10 (56%). Aortic pulsations were seen in 9 of 10 left (90%) and the inferior vena cava in 2 of 8 right (25%) radical nephrectomies. The mean surgical time was 203 +/- 52.9 minutes (range 105-290 minutes). The sequential operative steps and their individual time breakdowns were: port placement 12 +/- 3.9 minutes, hilar dissection 63 +/- 29.1 minutes, adrenal mobilization 49 +/- 12.1 minutes, specimen mobilization 19 +/- 20.8 minutes, and specimen entrapment and exit 23 +/- 18.2 minutes. When the initial balloon dilation resulted in visibility of four or more anatomic landmarks, the hilar dissection time was significantly shorter (P < 0.001). CONCLUSIONS: Proper development of the retroperitoneal space and identification of adequate anatomic landmarks is important during retroperitoneoscopy. This timed analysis of the sequential operative steps of retroperitoneoscopic radical nephrectomy has served as an important self-assessment tool for us in improving our surgical technique. As a result, our surgical time for retroperitoneoscopic radical nephrectomy has decreased from the earlier 4- to 5-hour range to the current 2- to 3-hour range.

Aged↗