[Giant polymorphous hamartomas of the superficial soft parts of the trunk].
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Abdominal Muscles↗
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Evaluation of the flexion relaxation phenomenon of the trunk muscles in sitting.
STUDY DESIGN: A normative, single-group study was conducted. OBJECTIVE: To investigate the flexion relaxation phenomenon in the thoraco-lumbopelvic muscles among a pain-free population when moving from an upright to a slump sitting posture. SUMMARY OF BACKGROUND DATA: The presence of the flexion relaxation phenomenon (FRP) of the back muscles is well documented at end-range spinal flexion when standing. This phenomenon is commonly found disrupted in low back subjects. However, whether FRP occurs in sitting remains controversial. METHODS: The sample consisted of 24 healthy pain-free adults. Surface electromyography was used to measure activity in the superficial lumbar multifidus (SLM), the thoracic erector spinae (TES), and the transverse fibers of the internal oblique (IO) muscles while subjects moved from an erect to a slump sitting posture. An electromagnetic motion-tracking device simultaneously measured thoracolumbar kinematics during this task. RESULTS: There was a significant decrease in both the SLM and the IO activity when moving from an erect to a slump sitting posture (P = 0.001 and P = 0.004, respectively), indicating the presence of FRP. TES activity was highly variable. While 13 subjects exhibited an increase in activity (P = 0.001), 11 demonstrated a decrease in activity (P = 0.001), indicating the presence of FRP. FRP occurred in the mid-range of spinal flexion for the SLM, IO and TES when present. CONCLUSION: The findings show that the SLM and the IO are facilitated in neutral lordotic sitting postures and exhibit FRP at mid range flexion while moving from upright sitting to slump sitting. These findings show that FRP in sitting differs from that in standing. Variable motor patterns (activation or FRP) of the TES were observed. These findings suggest that sustaining mid to end-range flexed sitting spinal postures result in relaxation of the spinal stabilizing muscles.
Adult↗
[Transplants from the shoulder-back region].
BACKGROUND: In spacious or multilayered tissue losses and cases of multiple locations of defects, a large amount of tissue with different components such as skin, fatty tissue, and muscle is required for proper reconstruction. A donor area which can meet these demands is the shoulder-back region with the subscapular vessel, which arises from the axillary artery. PATIENTS AND METHODS: We report our clinical experience with 12 patients in whom we reconstructed defects with transplants from this region. RESULTS: Our anatomic investigation and measurements provided proof of a constant anatomy of the vessels with a length of the vascular pedicle and a vascular diameter suitable for microvascular anastomosis. Based on our clinical experience, the scapular, parascapular, and latissmus dorsi muscle transplants are very suitable for the reconstruction of very large superficial defects or for the augmentation of multilayered defects of the upper aerodigestive tract. CONCLUSIONS: A main advantage of the transplants from the shoulder and back region is the possibility of combining several transplants with a wide variety of tissue combinations with one vascular pedicle for a single-step reconstruction of multiple defects of the oral cavity and the pharynx.
Anastomosis, Surgical↗
Trunk muscle fatigue during a back extension task in standing.
There is some evidence that the fatiguing characteristics during isometric back extension tasks may assist in identifying differences between individuals with and without low back pain (LBP). During these tasks, especially in standing, other abdominal trunk muscles are also active. The abdominal trunk muscles acting across multiple segments of the lumbar spine function in isolation or in synergy to create flexion torques. It is suggested that co-activation patterns of the trunk muscles are able to control the axis of rotation of the extension torque and also provide multi-segmental stability of the spine. The purpose of this study was to examine the fatigue responses in 4 asymptomatic individuals to a sustained isometric extension task of the trunk muscles evaluating the shifts in the median frequency of the electromyographic (EMG) signal. This study suggests that in asymptomatic subjects, the more superficial abdominal muscles (External Oblique and Rectus Abdominis) increased in activity as the test progressed. There was large inter-individual variation in both amplitude and median frequency changes. Rectus abdominis and the back extensors demonstrated characteristics of fatigue during the task. Studies to test for any characteristic trends in whether specific trunk muscles fatigue in standing is a feature in chronic LBP, invites a formal investigation.
Abdominal Muscles↗
Bilateral persistent complete sciatic artery.
A case with persistent sciatic artery (PSA) was found in a cadaver of a 65-year-old female during a medical gross anatomy course. The artery was bilateral and complete and provided the major blood supply to both lower extremities. The vessel arose from the internal iliac artery that was extremely large bilaterally. The sciatic artery passed out of the pelvis through the infrapiriform foramen and descended posterior to the sciatic nerve through the gluteal region. The sciatic nerve was considerably flattened out under the artery. Large articular branches arose from the part of the artery at the buttock just below the piriform muscle. The artery descended along the back of the thigh and was crossed obliquely posteriorly by the long head of the biceps femoris muscle. The sciatic artery continued as the popliteal artery located very superficially in the popliteal fossa. A companion vein, i.e., the sciatic vein, accompanied each artery. The right sciatic vein entered the pelvis posteriorly through the infrapiriform foramen, whereas the left perforated the quadriceps muscle from behind and joined the femoral vein anteriorly. There was a gracile superficial femoral artery bilaterally. The deep femoral arteries of both lower limbs were hypoplastic with slender circumflex branches. There were no macroscopic connections between the sciatic and the deep or superficial femoral arteries on either side. This anomaly should be kept in mind in the evaluation of patients with sciatic or buttock pain or palpable "pulsating" buttock mass. Persistent sciatic artery also could be a potential hazard during orthopedic manipulations, hip joint surgery, and renal transplant surgery.
Aged↗
Consequences for the teenagers after anogenital sexual contacts.
Necessity of research of teenagers after violent actions of sexual character is connected basically with anogenital sexual contacts. Survey of victims by the medicolegal (forensics medicines) expert assumes knowledge of illnesses like anorectal complex, causing anorectal dysfunctions (perianal itch, proctalgia, a crack of anal tract, encopresis). All specified diseases concerned with anorectal rings can be idiopatic (without the established reason) and secondary (locks, violent actions of sexual character, medical manipulations, traumas). On suspicion of anal penetration in children, survey should be carried out after obligatory conversation with the psychologist and with special feeling of a step, taking into account age factors and diseases of mental sphere. Such survey demands a certain algorithm of inspection, whose basic stages consist of the following: (1) Survey of anal areas will be carried out after preliminary conversation and examinations of other sites of a body in knee-elbow position. Whenever possible, the expert should be on floor with surveyed. (2) Hands of the expert should be warm so as not to provoke a pressure of muscles in the anus. (3) The anal reflex is checked by an easy touch, without painful variant, to a superficial part anal apertures (external sphincter is tunicae reduced, back pass is involved). (4) Children, as a rule, do not keep sphincter, a strong-willed pressure and therefore, reduction of a reflex is accompanied by reduction of force as a result of reduction of sphincter and its tone.
Adolescent↗
Histochemical changes of rat skeletal muscles induced by cold acclimation.
After cold acclimation of rats the augmentation of succinic dehydrogenase activity in the fast-twitch oxidative glycolytic (FOG) and the slow-twitch oxidative (SO) fibers was observed in entire regions of the soleus, the extensor digitorum longus, the plantaris, the longissimus and the gastrocnemius muscles. Furthermore, a tendency to increased proportion of the FOG and the SO fibers was observed more prominently in superficial regions than in deep regions of a large muscle such as the gastrocnemius muscle.
Adaptation, Physiological↗
Effects of dehydration on thermoregulatory responses of horses during low-intensity exercise.
Effects of dehydration on thermoregulatory and metabolic responses were studied in six horses during 40 min of exercise eliciting approximately 40% of maximal O2 consumption and for 30 min after exercise. Horses were exercised while euhydrated (C), 4 h after administration of furosemide (FDH; 1.0 mg/kg i.v.) to induce isotonic dehydration, and after 30 h without water (DDH) to induce hypertonic dehydration. Cardiac output was significantly lower in FDH (144.1 +/- 8.0 l/min) and in DDH (156.6 +/- 6.9 l/min) than in C (173.1 +/- 6.2 l/min) after 30 min of exercise. When DDH, FDH, and C values were compared, dehydration resulted in higher temperatures in the middle gluteal muscle (41.9 +/- 0.3, 41.1 +/- 0.2, and 40.6 +/- 0.2 degrees C, respectively) and pulmonary artery (40.8 +/- 0.3, 40.1 +/- 0.2, and 39.7 +/- 0.2 degrees C, respectively). Temperatures in the superficial thoracic vein and subcutaneous sites on the neck and back and peak sweating rates on the neck and back were not significantly different in DDH and C. In view of higher core temperatures during exercise after dehydration and decrease in cardiac output without concomitant increases in peripheral temperatures or reduced sweating rates, we conclude that the impairment of thermoregulation was primarily due to decreased transfer of heat from core to periphery.
Animals↗
A reappraisal of the anatomy of the levator ani muscle in man.
A study of the attachments of the musculotendinous fibres of the levator ani muscle shows that it is made of two portions: a thick anterior portion which is mostly fleshy and a thin posterior portion which is mostly aponeurotic. The anterior portion consists of two layers: a superficial perineal layer and a deep pelvic layer. Both layers have a common origin from the back of the body of the pubic bone and the anterior part of the tendinous arch. In addition both layers make a U-shaped loop around the recto-anal junction. The posterior fibres of the deep pelvic layer received nerve supply only from the third and fourth sacral nerves. The rest of the muscle was supplied from the sacral nerves as well as the perineal branches of the pudendal nerve. The role of the anterior fibres in reinforcing the sphincters of the anal canal and fixation of the pelvic viscera is stressed. The close anatomical relation between the posterior portion of the muscle and the obturator internus suggests that the latter may play a role in supporting the weak posterior portion of the levator ani, especially during straining positions associated with lateral rotation at both hips.
Adult↗
A reliable approach to the closure of large acquired midline defects of the back.
A systematic regionalized approach for the reconstruction of acquired thoracic and lumbar midline defects of the back is described. Twenty-three patients with wounds resulting from pressure necrosis, radiation injury, and postoperative wound infection and dehiscence were successfully reconstructed. The latissimus dorsi, trapezius, gluteus maximus, and paraspinous muscles are utilized individually or in combination as advancement, rotation, island, unipedicle, turnover, or bipedicle flaps. All flaps are designed so that their vascular pedicles are out of the field of injury. After thorough debridement, large, deep wounds are closed with two layers of muscle, while smaller, more superficial wounds are reconstructed with one layer. The trapezius muscle is utilized in the high thoracic area for the deep wound layer, while the paraspinous muscle is used for this layer in the thoracic and lumbar regions. Superficial layer and small wounds in the high thoracic area are reconstructed with either latissimus dorsi or trapezius muscle. Corresponding wounds in the thoracic and lumbar areas are closed with latissimus dorsi muscle alone or in combination with gluteus maximus muscle. The rationale for systematic regionalized reconstruction of acquired midline back wounds is described.
Adult↗
The applied anatomy of the thoracolumbar fascia.
The thoracolumbar fascia was studied by dissection in ten adult human cadavers. The posterior layer of this fascia was found to consist of two laminae. The superficial lamina is formed by the aponeurosis of latissimus dorsi. The deep lamina consists of bands of fibers passing caudolaterally from the midline. Both laminae form a retinaculum over the back muscles, and the deep lamina constitutes a series of accessory posterior ligaments that anchor the L2 to L5 spinous processes to the ilium and resist flexion of the lumbar spine. The function of these ligaments is enhanced by the contraction of the back muscles and the action of certain, restricted portions of the abdominal muscles.
Adult↗
Diverging intramuscular activity patterns in back and abdominal muscles during trunk rotation.
STUDY DESIGN: An intramuscular electromyographic study was performed on trunk rotations during sitting and standing. OBJECTIVE: The aim was to provide new information on activation levels for deep trunk muscles in various unresisted and resisted trunk rotations. SUMMARY AND BACKGROUND DATA: Frequent daily trunk twisting and decreased maximal strength during trunk rotation have been associated with low back pain or sciatic pain. However, the involvement of deep trunk muscles during different trunk rotations is relatively unknown. METHODS: Ten healthy subjects participated. Fine-wire electrodes were inserted, under ultrasound guidance, into psoas, quadratus lumborum, the superficial medial lumbar erector spinae (ES-s, multifidus) and its deep lateral portion (ES-d, iliocostalis), iliacus, rectus abdominis, obliquus externus, and obliquus internus. RESULTS: The highest involvement for all muscles was observed on the ipsilateral side, in maximal trunk twists with shoulder resistance, except obliquus externus, which showed a dominant contralateral side, and rectus abdominis, which was little activated in all rotations. In contrast, maximal trunk twist without shoulder resistance, i.e., freely performed, resulted generally in lower levels for all muscles involved and in a shift of side dominance for the lumbar muscles quadratus lumborum, psoas, and ES-s. CONCLUSIONS: During trunk rotations the activity patterns for various trunk muscles could drastically change, and even be the opposite, between the two body sides, within the same type of task, depending on several factors such as initial position, effort level, sitting or standing, and external shoulder resistance.
Abdomen↗
The fibrocartilage skeleton and related structures of the ventral pouch of balaenopterid whales.
The mandibular symphysis of rorqual whales, whales of the genera Megaptera and Balaenoptera, is characterized by a Y-shaped fibrocartilage structure that lies in the substance of the muscular ventral pouch of these animals. The stem of the structure joins with the symphysis and is usually indicated externally by an unfurrowed median strip of blubber that has been called the "cutwater" by earlier writers. The arms of the Y pass back and are superficially indicated in all rorqual whales as a ridge running parallel to the rami of the mandibles. This fibrocartilage skeleton of the pouch is most closely related to the mylohyoid muscle. The function of the fibrocartilage Y is probably linked with the jaw mechanics of these whales, but its precise function is otherwise not known.
Animals↗
Paraspinal muscle fibrosis: a specific pathological component in ankylosing spondylitis.
The histological appearance of percutaneous superficial paraspinal muscle biopsy specimens from eight patients with ankylosing spondylitis was compared with that of biopsy specimens from 13 control patients with similar degrees of disability and spinal immobility due to severe, chronic mechanical back pain. In both groups marked type II muscle fibre atrophy was shown. Additionally, in patients with ankylosing spondylitis there were obvious increases in perifibre connective tissue in association with central migration of cell nuclei but without evidence of inflammation. Qualitative electromyography failed to show denervation changes in either group. Paraspinal muscle fibrosis, occurring over and above atrophic changes due to disuse, seems to be a specific pathological component of ankylosing spondylitis which may be of particular importance in early disease as it may contribute towards back stiffness and weakness.
Adult↗
[Chronic stress-related compartment syndrome of the forearm].
The chronic anterior compartment syndrome of the forearm is a rare pathology (3 cases have been already published), and of new knowledge. Three new cases on 2 patients (one on both sides) are described here. The authors describe recent advances about physiopathology, exploration and surgical treatment. It is due to strenuous activity using flexor muscles of the forearm without any release period (here motor cyclist competition). The symptom was pain at the anterior forearm similar to cramp. The most important for diagnosis was to measure the pressure after activity. The threshold level read after activity was up to 30 mm of Hg, with a very slow coming back to normal value. The isotopic scanner with hydroxyl methylene di-phosphonate (HMDP), after activity, showed a delay of arrival of the tracer and a stasis. RMI seems to give abnormal modification of the signal. The only treatment was surgical and an open fasciotomy of superficial and deep fascia must be done, with opening of the muscle's perimysium. The patients became painfree and resumed their sport after surgical treatment.
Adult↗
Effect of different upright sitting postures on spinal-pelvic curvature and trunk muscle activation in a pain-free population.
STUDY DESIGN: A normative within-subjects single-group study. OBJECTIVE: To compare spinal-pelvic curvature and trunk muscle activation in 2 upright sitting postures ("thoracic" and "lumbo-pelvic") and slump sitting in a pain-free population. SUMMARY OF BACKGROUND DATA: Clinical observations suggest that both upright and slump sitting postures can exacerbate low back pain. Little research has investigated the effects of different upright sitting postures on trunk muscle activation. METHODS: Spinal-pelvic curvature and surface electromyography of 6 trunk muscles were measured bilaterally in 2 upright (thoracic and lumbo-pelvic) sitting postures and slump sitting in 22 subjects. RESULTS: Thoracic, compared to lumbo-pelvic, upright sitting showed significantly greater thoracic extension (P < 0.001), with significantly less lumbar extension (P < 0.001) and anterior pelvic tilt (P = 0.03). Furthermore, there was significantly less superficial lumbar multifidus (P < 0.001) and internal oblique (P = 0.03) activity, with significantly higher thoracic erector spinae (P < 0.001) and external oblique (P = 0.04) activity in thoracic upright sitting. There was no significant difference in superficial lumbar multifidus activity between thoracic upright and slump sitting. CONCLUSIONS: Different upright sitting postures resulted in altered trunk muscle activation. Thoracic when compared to lumbo-pelvic upright sitting involved less coactivation of the local spinal muscles, with greater coactivation of the global muscles. These results highlight the importance of postural training specificity when the aim is to activate the lumbo-pelvic stabilizing muscles in subjects with back pain.
Adult↗
[Latissimus dorsi free flap with "Y" anastomoses. Technical variant and use in leg reconstruction].
The authors report a new technique for harvesting and anastomosis of the latissimus dorsi free flap. The latissimus dorsi free flap is elevated with the subscapular and circumflex scapular vessels forming a "Y" pedicle. The recipient artery is sectioned and the arterial tree of the flap is anastomosed to the recipient vessel by two end-to-end anastomoses. This technique is particularly useful in leg reconstructive surgery when only one vessel remains: it simplifies transfer (end-to-end anastomosis), anastomoses are easier because more superficial.
Adult↗
Distal symmetrical polyneuropathy in a dog.
A 1.3-year-old Great Dane dog had a chronic progressive neurologic disease clinically expressed as a distal symmetrical polyneuropathy characterized by weakness and bilateral atrophy of bulbar and distal appendicular musculature. Qualitative and quantitative studies showed neurogenic atrophy of muscles below the elbow and stifle. There was Wallerian-type degeneration, Schwann cell proliferation and cell bands of Büngner, and marked depletion of medium (5 to 8 microns) to large (9 to 15 microns) diameter myelinated fibers in the distal parts of appendicular and laryngeal nerves. Sensory (saphenous and superficial radial) and autonomic (sympathetic and dorsal vagal trunk) nerves were affected to a lesser degree. A distribution of distal axonal degeneration suggested a dying back process. The disease differed from classical dying back disorders by absence of axonal degeneration in selected pathways of the central nervous system.
Animals↗