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PubMed2004

Paradiscal extraforaminal technique for lumbar sympathetic block: report of a proposed new technique utilizing a cadaver study.

Knowledge of the relationship of the lumbar sympathetic chain to the vertebral bodies is needed to perform sympathetic block and sympatholysis. This information should be correlated with fluoroscopy to determine the best method to perform this technique clinically. Twenty cadavers were dissected to demonstrate the lumbar sympathetic chain. In five cadavers, a 17 G Hustead needle was introduced inferior to the transverse process in the concavity of the body of L2 vertebra utilizing an extraforaminal (paraforaminal) approach and images were obtained in both the anteroposterior and lateral views. Needles were placed by utilizing either the loss of resistance technique (just piercing the psoas muscle) or by placing the needle posterior to the anterior border of the vertebral body. The cadavers were then dissected to demonstrate needle position in relationship to the lumbar sympathetic chain. Each lumbar sympathetic chain was located on the anterolateral aspect of the vertebral body at the medial attachment of psoas major to the vertebral body. When needles were inserted using the loss of resistance technique, dissection revealed needle tips considerably anterior to the ganglia and missing it. When the needle was placed just on the anterior border of the vertebral body, the tip was close to the sympathetic chain. In all of the dissections, lumbar segmental vessels were found in the concavity of the vertebral body ventrodorsally and closely related to the sympathetic chain. The chain varies in both size and location of the ganglia. In the majority of cases, lumbar ganglia were 3 in number. We believe the extraforaminal technique of lumbar sympathetic block is superior to the paramedian approach considering that there should be a reduced chance of passing through viscera and a lower incidence of genitofemoral neuralgia. However, with the extraforaminal technique, two important possible complications need to be highlighted. Chances of injury to the segmental lumbar vessels and the anterior ramus are present. Therefore, the extraforaminal technique needs to be modified. We advocate the extraforaminal paradiscal technique for lumbar sympathetic block. The initial target point for entry should be the lateralmost tip of the transverse process. Advancement of the needle should be extraforaminal with minimal chance of injury to the nerve or the anterior ramus. Final target point should be paradiscal. The needle tip should be positioned just posterior to the anterior border of the vertebral body. Loss of resistance technique should not be utilized and is potentially dangerous. Use of at least two needles is advisable (L2 and L3 vertebral body). Care should be taken to avoid the lumbar vessels. A transdiscal technique recently advocated may also avoid some of the complications with the paramedian technique, but chances of discitis, nerve root injury, accelerated disc degeneration, disc herniation and rupture of the anterior annulus have to be considered when using this technique.

Journal Article↗

PubMed2005

Giant abdominal wall abscess dissecting into thorax as a complication of ESWL.

Abscess as a complication of extracorporeal shock wave lithotripsy is a rare condition. We present the computed tomography findings of an abdominal wall abscess that occurred after extracorporeal shock wave lithotripsy for which prophylactic antibiotics had not been given. The abscess destroyed the posterior abdominal wall muscles and dissected into the thorax. The muscles were thickened and showed enhancement. A parenchymal defect in the right kidney adjacent to a caliceal stone, with strands extending from this defective region to the abscess, was observed, and was thought to be the result of parenchymal destruction caused by the shock waves. Other parts of the kidney and psoas muscle were normal. Microbiologic examination revealed Escherichia coli.

Abdominal Abscess↗

PubMed1994

General peritonitis induced by rectal examination: an unusual complication of primary psoas abscess.

Primary psoas abscess is a relatively rare disease with highest incidence in children and adolescents. It usually presents with fever, abdominal pain and limp. Limping tends to incriminate musculoskeletal problems below the pelvis, but movement of the hip involves the psoas muscle which is mostly retroperitoneal and intimately related to pelvic and intraperitoneal organs. Although the current tendency is to use abdominal sonography, rectal examination is still a valuable step in clinical examination, and may help to assess a pelvic mass or abscess. The following case report describes the elusive nature of psoas abscess and a rare occurrence of abscess rupture and peritonitis, immediately after rectal examination.

Child, Preschool↗

PubMed1998

Steady-state fluorescence polarization studies of the orientation of myosin regulatory light chains in single skeletal muscle fibers using pure isomers of iodoacetamidotetramethylrhodamine.

The regulatory light chain (RLC) from chicken gizzard myosin was covalently modified on cysteine 108 with either the 5- or 6-isomer of iodoacetamidotetramethylrhodamine (IATR). Labeled RLCs were purified by fast protein liquid chromatography and characterized by reverse-phase high-performance liquid chromatography (HPLC), tryptic digestion, and electrospray mass spectrometry. Labeled RLCs were exchanged into the native myosin heads of single skinned fibers from rabbit psoas muscle, and the ATR dipole orientations were determined by fluorescence polarization. The 5- and 6-ATR dipoles had distinct orientations, and model orientational distributions suggest that they are more than 20 degrees apart in rigor. In the rigor-to-relaxed transition (sarcomere length 2.4 microm, 10 degrees C), the 5-ATR dipole became more perpendicular to the fiber axis, but the 6-ATR dipole became more parallel. This orientation change was absent at sarcomere length 4.0 microm, where overlap between myosin and actin filaments is abolished. When the temperature of relaxed fibers was raised to 30 degrees C, the 6-ATR dipoles became more parallel to the fiber axis and less ordered; when ionic strength was lowered from 160 mM to 20 mM (5 degrees C), the 6-ATR dipoles became more perpendicular to the fiber axis and more ordered. In active contraction (10 degrees C), the orientational distribution of the probe dipoles was similar but not identical to that in relaxation, and was not a linear combination of the orientational distributions in relaxation and rigor.

Animals↗

PubMed2002

[Tubercular abscess of the psoas without associated spinal involvement. A case report].

INTRODUCTION: Tuberculous psoas abscess outside of locoregional causes is uncommon and can cause a problem of differential diagnosis. EXEGESIS: We report a case of unilateral tuberculous abscess of the psoas which first clinical and radiological features presented like a retroperitoneal tumor. Exploration laparotomy discovered a bulky abscess of the left psoas muscle. Bacteriologic and histologic evaluation confirmed the tuberculous origin. Radiological study of the spine did not show any signs of spondylodiscitis. Under antituberculosis treatment a crural collection occurred and a surgical drainage was performed. Five years later, there was a recurrence of a crural collection which responded well to antituberculosis treatment. CONCLUSION: Tuberculous psoas abscess is usually secondary to spinal involvement, more uncommonly to digestive, urologic or genital tuberculosis. Primary abscess was rarely described and the pathogenesis remains unclear. Psoas contamination is supposed to be hematogenous or lymphatic in origin. Ultrasonography and computed tomography (CT) transformed the diagnosis and the therapeutic approach by percutaneous puncture and drainage.

Adult↗

PubMed1966

A melting point for the birefringent component of muscle.

The A filament of the striated muscle sarcomere is an ordered aggregate of one or a few species of proteins. Ordering of these filaments into a parallel array is the basis of birefringence in the A region, and loss of birefringence is therefore a measure of decreased order. Heating caused a large decrease in the birefringence of glycerinated rabbit psoas muscle fibers over a narrow temperature range ( approximately 3 degrees C) and a large decrease in both the birefringence and optical density of the A region of Drosophila melanogaster fibrils. These changes were interpreted as a loss of A filament structure and were used to define a transition temperature (T(tr)) as a measure of the stability of the A region. Since the transition temperature was sensitive to pH, ionic strength, and urea, solvent conditions which often affect protein structure, it is an experimentally useful indicator for factors affecting the structure of the A filament. Fibers from glycerinated frog muscle were less stable over a wide pH range than fibers from glycerinated rabbit muscle, a fact which demonstrates a species difference in structure. Glycerinated rabbit fibrils heated to 70 degrees C shortened to about 40% of their initial length. The extent of shortening was not correlated with the loss of birefringence, and phase-contrast microscopy showed that this shortening occurred in the I region as well as in the A region. This response may be useful for studying the I filament and actin in much the same way that the decrease in birefringence was used for studying the A filament and myosin. The observations presented show that some properties of muscle proteins can be studied essentially in situ without the necessity of first dispersing the structure in solutions of high or low ionic strength.

Animals↗

PubMed1986

Effects of partial extraction of troponin complex upon the tension-pCa relation in rabbit skeletal muscle. Further evidence that tension development involves cooperative effects within the thin filament.

Partial extraction of troponin C (TnC) decreases the Ca2+ sensitivity of tension development in mammalian skinned muscle fibers (Moss, R. L., G. G. Giulian, and M. L. Greaser. 1985. Journal of General Physiology. 86:585), which suggests that Ca2+-activated tension development involves molecular cooperativity within the thin filament. This idea has been investigated further in the present study, in which Ca2+-insensitive activation of skinned fibers from rabbit psoas muscles was achieved by removing a small proportion of total troponin (Tn) complexes. Ca2+-activated isometric tension was measured at pCa values (i.e., -log[Ca2+]) between 6.7 and 4.5: (a) in control fiber segments, (b) in the same fibers after partial removal of Tn, and (c) after recombination of Tn. Tn removal was accomplished using contaminant protease activity found in preparations of LC2 from rabbit soleus muscle, and was quantitated using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and scanning densitometry. Partial Tn removal resulted in the development of a Ca2+-insensitive active tension, which varied in amount depending on the duration of the extraction, and concomitant decreases in maximal Ca2+-activated tensions. In addition, the tension-pCa relation was shifted to higher pCa values by as much as 0.3 pCa unit after Tn extraction. Readdition of Tn to the fiber segments resulted in the reduction of tension in the relaxing solution to control values and in the return of the tension-pCa relation to its original position. Thus, continuous Ca2+-insensitive activation of randomly spaced functional groups increased the Ca2+ sensitivity of tension development in the remaining functional groups along the thin filament. In addition, the variation in Ca2+-insensitive active tension as a function of Tn content after extraction suggests that only one-third to one-half of the functional groups within a thin filament need to be activated for complete disinhibition of that filament to be achieved.

Animals↗

PubMed2004

Use of botulinum toxin in pediatric spasticity (cerebral palsy).

Local injection of botulinum toxin (BT) is a well-established treatment option for spastic movement disorders in children. BT blocks the release of acetylcholine from the axon terminal into the synaptic cleft of the motor endplate resulting in paresis of the injected musculature. Such localised, temporary chemodenervation of affected muscles can lead to functional gains and may improve the child's daily routine and rehabilitative care. We summarise state-of-the-art treatment of spasticity in children with BT type A, addressing critical issues and introducing recent advances, such as sonography-guided injection of BT and the distal injection of the psoas muscle without the need for general anaesthesia. First-hand experience with BT type B in children is presented.

Botulinum Toxins↗

PubMed1998

Orientation changes of fluorescent probes at five sites on the myosin regulatory light chain during contraction of single skeletal muscle fibres.

Changes in the orientation of the myosin regulatory light chain (RLC) in single muscle fibres were measured using polarised fluorescence from acetamidotetramethylrhodamine (ATR). Mutants of chicken skeletal RLC containing single cysteine residues at positions 2, 73, 94, 126 and 155 were labelled with either the 5 or 6-isomer of iodo-ATR, giving ten different probes. The labelled RLCs were exchanged into demembranated fibres from rabbit psoas muscle without significant effect on active force generation. Fluorescence polarisation measurements showed that nine out of the ten probe dipoles were more perpendicular to the fibre axis in the absence of ATP (in rigor) than in either relaxation or active contraction. The orientational distribution of the RLC region of the myosin head in active contraction is closer to the relaxed than to the rigor orientation, and is not equivalent to a linear combination of the relaxed and rigor orientations. Rapid length steps were applied to the fibres to synchronise the motions of myosin heads attached to actin. In active contraction the fluorescence polarisation changed both during the step, indicating elastic distortion of the RLC region of the myosin head, and during the subsequent rapid force recovery that is thought to signal the working stroke. The peak change in fluorescence polarisation produced by an active release of 5 nm per half sarcomere indicates an axial tilt of less than 5 degrees for all ten probes, if all the myosin heads in the fibre respond to the length step. This tilting was towards the rigor orientation for all ten probes, and could be explained by 14% of the heads moving to the rigor orientation. An active stretch tilted the heads away from the rigor conformation by a similar extent.

Animals↗

PubMed1990

Stimulation of the phosphorylation of uridine in skeletal muscle by insulin and vanadate.

The action of insulin and sodium vanadate on the phosphorylation of uridine by skeletal muscle was studied in vitro. Insulin significantly increased the incorporation of 3H-uridine into uracil nucleotides by pieces of rat diaphragm incubated for 15 min in a phosphate-buffered medium. This action of the hormone was exceptionally consistent when MgATP was added to the incubation medium. In experiments in which pieces of psoas muscle were incubated in TRIS buffer in the presence and absence of insulin, the hormone caused a significant activation of uridine kinase measured in cytosolic extracts of the incubated tissue. In experiments with rat diaphragm similar to those with insulin, the vanadate ion caused a significant increase in phosphorylation of uridine. The results of these experiments provide preliminary support for the proposal that uracil nucleotide metabolism is regulated by insulin and that insulin activates uridine kinase, the limiting enzyme in the synthesis of uracil nucleotides from uridine by the salvage pathway.

Animals↗

PubMed1991

Substitution of cardiac troponin C into rabbit muscle does not alter the length dependence of Ca2+ sensitivity of tension.

1. The isometric length-tension relationship for cardiac muscle is generally steeper than for skeletal muscle in the physiological range of sarcomere lengths. Recent studies suggest that cardiac troponin C (cTnC) may have intrinsic properties that confer greater length-dependent changes in Ca2+ sensitivity of tension than for skeletal troponin C (sTnC). We tested this hypothesis by characterizing tension-pCa (pCa is -log[Ca2+]) relationships in rabbit skinned psoas muscle fibres at mean sarcomere lengths of 2.32 and 1.87 microns both before and after partial replacement of endogenous sTnC with cTnC. 2. In untreated control fibres, the mid-point (pCa50) of the tension-pCa relationship shifted to lower pCa by 0.15 +/- 0.02 pCa units, i.e. became less sensitive to Ca2+, when sarcomere length was reduced, and the relationship became steeper. 3. Partial extraction of endogenous sTnC and reconstitution with cTnC resulted in no change in the length-dependent shift of pCa50 when reconstitution with cTnC was more than 95% complete; however, when reconstitution was less than 95% complete, there were significant increases in the length-dependent shift in pCa50. 4. An increase in the length-dependent shift of pCa50 was also observed in fibres from which sTnC was partially extracted, but no cTnC was subsequently re-added. 5. We conclude that differences in type of TnC alone are not sufficient to explain differences between skeletal and cardiac muscles in the length dependence of Ca2+ sensitivity of tension.

Animals↗

PubMed1997

Orientation of cross-bridges in skeletal muscle measured with a hydrophobic probe.

Cis-parinaric acid (PA) binds to a hydrophobic pocket formed between the heavy chain of myosin subfragment-1 (S1) and the 41-residue N-terminal of essential light chain 1 (A1). The binding is strong (Ka = 5.6 x 10(7) M-1) and rigid (polarization = 0.334). PA does not bind to myofibrils in which A1 has been extracted or replaced with alkali light chain 2 (A2). As in the case of S1 labeled with other probes, polarization of fluorescence of S1-PA added to myofibrils depended on fractional saturation of actin filament with S1, i.e., on whether the filaments were fully or partially saturated with myosin heads. Because fluorescence quantum yield of PA is enhanced manyfold upon binding, and because PA binds weakly to myofibrillar structures other then A1, the dye is a convenient probe of cross-bridge orientation in native muscle fibers. The polarization of a fiber irrigated with PA was equal to the polarization of S1-PA added to fibers at nonsaturating concentration. Cross-linking of S1 added to fibers at nonsaturating concentration showed that each S1 bound to two actin monomers of a thin filament. These results suggest that in rigor rabbit psoas muscle fiber each myosin cross-bridge binds to two actins.

Animals↗

PubMed1981

Immunological and biochemical properties of transverse tubule membranes isolated from rabbit skeletal muscle.

A new method for isolating transverse tubule membranes from rabbit skeletal muscle has been developed. This procedure has the advantage of being mild, fast, and producing with good yields a purified membrane fraction. The transverse tubule membranes are purified by a discontinuous sucrose density centrifugation after loading contaminating light sarcoplasmic reticulum vesicles with calcium phosphate in the presence of ATP. Immunofluorescence staining of cryostat sections of rabbit psoas muscle with purified goat antibodies directed against the purified membranes shows that the reacting antigens are distributed at the boundary of the A and I bands of the myofibrils where transverse tubules are localized in mammalian muscle. The purified antibodies showed no cross-reactivity with sarcoplasmic reticulum, nor did they show any fluorescence staining of the muscle plasma membrane, indicating that the isolated membranes indeed originate from the transverse tubules. The transverse tubule fraction has a characteristic protein composition distinguishable from that of sarcoplasmic reticulum, a much higher cholesterol content than that of the crude microsomes, plasma membrane, and sarcoplasmic reticulum, and a phospholipid content about twice as high as that of sarcoplasmic reticulum and plasma membrane. The purified transverse tubule membrane has a distinct phospholipid composition with high contents of sphingomyelin and phosphatidylserine. A Mg2+-activated ATPase characteristic of the transverse tubule fraction undergoes a 20-30-fold increase in specific activity during purification. The levels of Ca2+-ATPase activity present in the purified transverse tubule fraction remain comparable to those of sarcoplasmic reticulum even after extensive removal of the latter.

Adenosine Triphosphatases↗

PubMed1979

Psoas transfer for the treatment of congenital dislocation of the hip.

Since 1965, anterolateral transfer of the psoas muscle has been employed by us as a routine surgical treatment for congenital dislocation of the hip joint. The transfer was carried out in association with open reduction in those patients in whom an intracapsular obstruction was evident, but corrective measures for acetabular dysplasia or cervicocapital deformity of the femur were not performed in this series. We treated 87 hip joints with this procedure from 1965 to 1973. In 38 hip joints, both open reduction and the psoas transfer were followed up for an average of 8 years. Thirteen hip joints with open reduction alone were included as controls. Position of the femoral head and development of the acetabulum and proximal end of the femur were assessed on X-rays, mainly after Severin's criteria. Redislocation was not encountered. Fifty percent of the hip joints with open reduction and the psoas transfer were classed as grade I or II. This figure is higher than that of controls, to which 23% were classed as grade I or II. Better concentricity of the head was achieved as determined by the CE angle (Wiberg). Development of acetabulum occurred when the transfer had been carried out in children under 1 year of age and was less likely in the older children. The detorsional effect of the psoas transfer remained questionable since detorsion in the transferred group did not exceed that of the controls.

Anthropometry↗

PubMed2001

Role of ubiquitin-proteasome-dependent proteolytic process in degradation of muscle protein from diabetic rabbits.

The activity of ATP, ubiquitin (Ub)-dependent proteases partially purified from skeletal muscle (psoas) from alloxan diabetic rabbits was determined at different periods of insulin deficiency. Two days after alloxan injection, no change was observed in the activity of ATP, Ub-dependent proteases, but this activity increased 3 and 5 days after diabetes induction, attaining 181% of control values on the 5th day. However, after this early rise, the activity of muscle ATP, Ub-dependent proteases decreased, returning to values that did not differ significantly from controls 7 and 10 days after alloxan injection. After 15 days, the activity of these proteases was 57% lower than in muscle from control rabbits. Both the initial increase and the subsequent fall in the activity of the enzymes were prevented by insulin treatment of alloxan diabetic rabbits. The data suggest that Ub-proteasome-dependent proteolysis have an important role in the control of muscle protein degradation and may be regulated by insulin.

Animals↗

PubMed1985

The effects of partial extraction of TnC upon the tension-pCa relationship in rabbit skinned skeletal muscle fibers.

The activation of contraction in vertebrate skeletal muscle involves the binding of Ca2+ to low-affinity binding sites on the troponin C (TnC) subunit of the regulatory protein troponin. The present study is an investigation of possible cooperative interactions between adjacent functional groups, composed of seven actin monomers, one tropomyosin, and one troponin, along the same thin filament. Single skinned fibers were obtained from rabbit psoas muscles and were then placed in an experimental chamber containing relaxing solution maintained at 15 degrees C. Isometric tension was measured in solutions containing maximally and submaximally activating levels of free Ca2+ (a) in control fiber segments, (b) in the same segments after partial extraction of TnC, and finally (c) after recombination of TnC into the segments. The extraction was done at 11-13 degrees C in 20 mM Tris, 5 mM EDTA, pH 7.85 or 8.3, a procedure derived from that of Cox et al. (1981. Biochem. J. 195:205). Extraction of TnC was quantitated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of the control and experimental samples. Partial extraction of TnC resulted in reductions in tension during maximal Ca activation and in a shift of the relative tension-pCa (i.e., -log[Ca2+]) relationship to lower pCa's. The readdition of TnC to the extracted fiber segments resulted in a recovery of tension to near-control levels and in the return of the tension-pCa relation to its original position. On the basis of these findings, we conclude that the sensitivity to Ca2+ of a functional group within the thin filament may vary depending upon the state of activation of immediately adjacent groups.

Animals↗

PubMed1984

Psoas disease causing a characteristic change in the ultrasonographic appearance of the psoas compartment.

Twenty patients with ultrasonographic evidence of disease involving the psoas compartment were analysed retrospectively. The abnormality found was a mass lesion in the psoas muscle with increased or decreased echogenicity and a characteristic loss of the normal appearance of striated homogeneous bundles. Those examined included eight patients with abscesses, six with hematomas and six with tumor infiltration. All the abscesses were echopoor and showed absence of the normal appearance of the muscle. Such findings are non-specific because of the similar appearance of non-organized hematomas or lymphomatous infiltration. Organized hematomas and primary retroperitoneal tumors were echogenic but with loss of the normal appearance. Ultrasound guided needle aspiration is sometimes necessary to complete the diagnosis and may be a definitive strategy. We recommend ultrasonography for use in detecting psoas disease when appropriate clinical signs are present.

Abscess↗

PubMed1981

Nuclear magnetic resonance transverse relaxation in muscle water.

The origin of the nonexponentiality of proton spin echoes of skeletal muscle has been carefully examined. It is shown that the slowly decaying part of the proton spin echoes is not due to extracellular water. First, for muscle from mice with in vivo deuteration, the deuteron spin echoes were also nonexponential, but the slowly decaying part had a larger weighing factor. Second, for glycerinated muscle in which cell membranes were disrupted, the proton spin echoes were similar to those in intact muscle. Third, the nonexponentiality of the proton spin echoes in intact muscle increased when postmortem rigor set in. Finally, when the lifetimes of extracellular water and intracellular water were taken into account in the exchange, it was found that the two types of water would not give two resolvable exponentials with the observed decay constants. It is suggested that the unusually short T2's and the nonexponential character of the spin echoes of proton and deuteron in muscle water are mainly due to hydrogen exchange between water and functional groups in the protein filaments. These groups have large dipolar or quadrupolar splittings, and undergo hydrogen exchange with water at intermediate rates. The exchange processes and their effects on the spin echoes are pH-dependent. The dependence of transverse relaxation of pH was observed in glycerinated rabbit psoas muscle fibers.

Animals↗