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PubMed2004

Basic fibroblast growth factor expression following surgical delay of rat transverse rectus abdominis myocutaneous flaps.

Partial transverse rectus abdominis myocutaneous (TRAM) flap loss in breast reconstruction can be a devastating complication for both patient and surgeon. Surgical delay of the TRAM flap has been shown to improve flap viability and has been advocated in "high-risk" patients seeking autogenous breast reconstruction. Despite extensive clinical evidence of the effectiveness of surgical delay of TRAM flaps, the mechanisms by which the delay phenomenon occurs remain poorly understood. To examine whether angiogenic growth factors such as basic fibroblast growth factor (bFGF) may play a role in the delay phenomenon, the authors studied the expression of bFGF in rat TRAM flaps subjected to surgical delay. Thirty-five female Sprague-Dawley rats were randomly assigned to one of four TRAM flap groups: no delay (n = 6), 7-day delay (n = 12), 14-day delay (n = 10), or 21-day delay (n = 7). Surgical delay consisted of incising skin around the perimeter of the planned 2.5 x 5.0-cm TRAM flap followed by ablation of both superior epigastric arteries and the left inferior epigastric artery, thus preserving the right inferior epigastric artery (the nondominant blood supply to the rectus abdominis muscle of the rat). TRAM flaps were then elevated after 7, 14, and 21 days of delay by raising zones II, III, and IV off the abdominal wall fascia. Once hemostasis was assured, the flaps were sutured back in place. All flaps were designed with the upper border of the flap 1 cm below the xiphoid tip. Three days after the TRAM procedure, postfluorescein planimetry was used to determine percent area viability of both superficial and deep portions of TRAM flaps. All rats were euthanized and full-thickness TRAM specimens were taken from zones I, II, III, and IV for enzyme-linked immunoabsorbent assay analysis of bFGF levels. Statistical testing was done by t test (percent viability) and two-way analysis of variance (bFGF levels). All delayed flaps had significantly higher bFGF levels when compared with all nondelayed control flaps (p < 0.05). The bFGF levels were not different in the rats that received TRAM flaps 7, 14, or 21 days after delay surgery. There was also no significant difference in bFGF levels among zones I through IV. Control rats had more peripheral zone necrosis compared with all delayed TRAM rats. All delayed flaps had a significantly higher area of flap viability superficially than nondelayed control flaps (p < 0.05). There was no difference in deep flap viability. Surgical delay of rat TRAM flaps is associated with improved flap viability and significantly elevated levels of bFGF over nondelayed TRAM flaps at postoperative day 3 after TRAM surgery. The increases in bFGF noted at this time point suggests that bFGF may play a role in the improved TRAM flap viability observed after delay surgery. Further investigation is needed to evaluate the role bFGF may play in the delay phenomenon.

Angiogenesis Inducing Agents↗

PubMed1998

Dendritic fibromyxolipoma: clinicopathologic study of a distinctive benign soft tissue lesion that may be mistaken for a sarcoma.

Twelve cases are described of a distinctive benign soft tissue lesion that may be mistaken for a sarcoma. The tumors occurred in 11 men and a woman aged 33 to 81 years (mean, 64 years), and measured from 2 to 11 cm in greatest diameter (mean, 6 cm). They were grossly described as soft, well-circumscribed, yellow-gray, with a mucoid cut surface. All cases were superficially located in the subcutis or muscular fascia of the head and neck region or the chest and back. Histologically, the tumors were characterized by a proliferation of spindle or stellate fibroblastic cells variably admixed with mature adipose tissue embedded in an abundant myxoid and collagenized stroma. The spindle and stellate fibroblastic cells were characterized by slender dendritic prolongations of their cytoplasm, which appeared to extend for short distances along connective tissue planes. Electron microscopy in two cases confirmed the dendritic nature of the fibroblastic cells, which showed elongated cytoplasmic processes lacking external lamina and displaying foci of pinocytotic activity. Immunohistochemical studies in 11 cases showed strong positivity of the spindle cells with vimentin, CD34 and bcl-2, and negative staining for smooth muscle actin, muscle-specific actin (HHF35), desmin, S-100 protein, keratin, and EMA. Because of their prominent myxoid stroma and relatively large size, some of these tumors were initially misinterpreted as low-grade sarcomas. Clinical follow-up in five cases, however, showed that the patients were alive and well without evidence of recurrence between 5 and 13 years (mean follow-up, 8 years) after simple local excision. The present cases appear to represent a distinctive form of benign soft tissue neoplasm that should be distinguished from myxoid liposarcoma and other benign and malignant myxoid tumors of superficial soft tissues.

Adult↗

PubMed1983

Designing the latissimus dorsi free flap for knee coverage.

Several techniques have been described for coverage of the exposed knee joint using local soft tissue and muscle. Occasionally, because of multiple previous procedures or the extent of the defect, local tissue is inadequate. In these situations the latissimus dorsi free flap is useful. The most acceptable recipient vessels comprise the superficial femoral system, but they are at a significant distance from the knee. This distance is bridged by designing the flap as a paddle with a narrow strip of proximal muscle in continuity with the thoracodorsal vessels. Placing the skin island eccentrically allows the muscle to be folded on itself and packed into the bony defect.

Adult↗

PubMed1991

Study on the subclavian artery and its branches in Japanese adults.

We examined the entire array of branches and the state of ramification of each branch of 144 subclavian arteries (Su) in 72 Japanese adults, and obtained the following findings. (1) The incidence of Type I -A(1) was 13.2%, the highest among the entire Su ramification. This was followed by Type I -B(1) at 9.0%, then Type I -A(2) at 6.9%, indicating considerable variation in the morphology of Su ramification. (2) Ontogenetic factors were implicated because of the existence of cases in which Su traversed the scalenus anterior muscle anteriorly (Type III: 0.7%), or was transfixed (0.7%). (3) Type 1-c was the form of thyrocervical trunk (Ttc) observed with the highest incidence of 31.3%. In addition, we propose that Types a-j (that were formed from a common trunk consisting only of the ascending cervical artery and inferior thyroid artery, and those in which another branch was included in this common trunk: 88.9%) be called Ttc. (4) The most common type of transverse cervical artery (Tc), which is formed from a common trunk consisting of superficial and deep branches, was found to be Type 1-a that branches from the first part of Ttc. It was observed with the highest incidence of 61.8%. Some of the superficial branches to the upper portion of the trapezius muscle that were independent and branched from Ttc (Types e, f: 2.8%), we called upper superficial branches. (5) The most frequently observed type of suprascapular artery (Ss) was Type b (38.2%), followed by Type a (25.7%), which branches independently from Su. We concluded that the sites at which Tc and Ss originate are the positions at which they traverse the brachial plexus (superior, transfixed to the plexus). (6) In cases in which the supreme intercostal artery (Is) and the deep cervical artery (Cp) were separate, (Types d-i excluding Type g: 31.9%), Is branched from a more proximal position than Cp.

Aged↗

PubMed1983

Normal human skin echogram.

Sector B-mode echograms of the stratum corneum from the top of pemphigus foliaceus bulla, 15/1,000 inch split-thickness skin graft including the epidermis and superficial dermis, and the whole skin with subcutaneous fat were compared with histologic sections. The corneo-epidermal and epidermo-dermal interfaces were not delineated either by 5, 10 or 15 MHz transducer. The subcutaneous fat exhibited an almost echolucent zone with weak echoes from the fibrous trabeculae or large blood vessels. Regional differences of in vivo normal skin echograms were studied on the forehead, abdomen, back, upper arm, thigh, lower leg and heel. The presence or absence of the cutaneous muscles, fascia or bone was clearly demonstrated. For the standard echogram of the skin, a 10 MHz transducer was considered appropriate, though the detailed echograms were obtained mostly in the deep dermal and subcutaneous structures.

Adipose Tissue↗

PubMed2003

Anterior subfascial transposition of the ulnar nerve.

After anterior subfascial transposition, the ulnar nerve lies superficial to the flexor-pronator muscle group but deep to its fascia. Eight patients with cubital tunnel syndrome were treated with this method and reviewed retrospectively. The average age at the time of operation was 52 years. All patients had severe cubital tunnel syndrome based on Dellon's classification. The average follow-up period was 2 years and 9 months. Post-operative outcome assessment was based on the modified Bishop rating system. Six patients had excellent and two had good outcomes. All were back at work by the 5th post-operative week. There were no complications or recurrence of symptoms. Anterior subfascial transposition of the ulnar nerve is an effective method of surgical treatment for patients with severe cubital tunnel syndrome.

Adult↗

PubMed1995

Posterior interbody arthrodesis with a fibular strut graft in spondylolisthesis.

We reviewed the results of posterior interbody arthrodesis of the fifth lumbar and first sacral vertebrae with the use of a fibular strut graft in nine patients who had had a grade-III, IV, or V spondylolisthesis. The average age of the patients at the time of the operation was twenty-seven years (range, seventeen to thirty-two years). The average duration of the symptoms preoperatively was three years (range, nine months to eleven years), and the average duration of follow-up was three years (range, two to five years). The most common preoperative symptom was back pain, which was rated an average of 8.3 points (7, 8, or 9 points) on a visual-analog scale of 1 to 10 points. The average angle of the slip was 45 degrees (range, 15 to 70 degrees). Four of the slips were grade III, four were grade IV, and one was grade V. Postoperatively, the average pain score was 1.4 points (1, 2, or 3 points). This improvement was significant (p < 0.05, Student t test). All nine patients had roentgenographic evidence of osseous fusion at the one-year follow-up examination. Complications included a dural tear in one patient, a superficial wound infection in two patients, temporary weakness of the evertors of the foot in six patients, and transient decreased sensation along the dorsum of the foot of the donor leg in two patients.

Adult↗

PubMed2000

Comparative study of Mm. Multifidi in lumbar and thoracic spine.

Imbalance of Mm. Multifidi may play a role in spinal disorders such as scoliosis in the thoracic spine, and lumbar disc herniation and lower back pain in the lumbar spine. Even though changes in these muscles are related to the etiology of these disorders, their anatomy is still poorly understood, especially in the upper regions of the spine. With the aim of gaining a better understanding of the anatomy of Mm. Multifidi in the lumbar and thoracic spine, 12 fresh and two embalmed cadavers were dissected. Our results indicate that Mm. Multifidi present differences in lumbar and thoracic spines concerning their deepness, fibre trajectory, muscle length, muscle mass and tendinous tissue. In the lumbar spine Mm. Multifidi are a superficial, thick and fleshy mass, and their fibres are more vertical in relation to the spinous processes. In the thoracic spine Mm. Multifidi are deeper, thinner, and their fibres are more tendinous and oblique than in the lumbar spine. These differences have implications on Mm. Multifidi architecture and consequently for their function in these two regions of the spine.

Biomechanical Phenomena↗

PubMedDate not supplied

Use of botulinum toxin in the treatment of chronic myofascial pain.

BACKGROUND: Myofascial pain syndrome (MPS) is defined as acute or chronic pain with sensory or motor autonomic symptoms, referred from active myofascial triggering points with associated dysfunction. Previous studies have suggested the usefulness of botulinum toxin A (BTX-A) in the treatment of MPS since it is capable of controlling muscular spasms, as well as other alternative mechanisms of action. OBJECTIVES: To analyze the efficacy of BTX-A treatment and its effect on daily life activities assessing pain reduction using a visual analogue scale (VAS); degree of improvement in physical impairment and disability scoring in the Oswestry low back pain questionnaire; and psychologic status using the Hospital Anxiety and Depression Scale (HAD), in patients suffering from MPS. METHOD: An open-label interventional prospective trial was conducted in 77 patients diagnosed of refractory MPS (defined as the presence of muscle spasm with pain on mobilization or stretching, plus the existence of trigger points with associated referred pain), resistant to both conservative management and to physical therapy. The BTX-A dosages for the different muscles were chosen according to a standardized protocol. Electromyographic guidance was used to localize the motor end plate prior to injection in superficial muscles; while fluoroscopic guidance was employed to evidence intramyofascial spread of the contrast solution within deep muscles. The assessment of treatment efficacy was based on a pain VAS applied before enrollment, at 15, 30, and 90 days and upon completion of the study; the Lattinen test to establish a relationship between pain intensity and its corresponding impact on daily living; and the HAD scale to assess psychologic stress, performed both before treatment and at the end of the study; and the Oswestry Questionnaire was used to evaluate patients' ability to carry out daily life activities according to their degree of physical impairment and disability scores. RESULTS: The global analysis revealed a positive correlation between the VAS score prior to treatment and the scoring at 15, 30, and 90 days. This correlation was maintained when analyzing independently for superficial or deep muscles. The correlation coefficients for HAD scores and the Lattinen test values showed a significant association between pre- and post-treatment findings. No adverse events were recorded for 83.1% of the cases. CONCLUSIONS: The results of this study are consistent with other studies showing the efficacy of BTX-A for treating pain in MPS. The evaluation of the psychologic dimension of this disorder and its associated disability can provide valuable information for the adequate management of these patients and for assessing treatment outcome.

Adult↗

PubMed1994

The significance of calf muscle pump function in venous ulceration.

PURPOSE: Patients with clinically evident chronic venous insufficiency were evaluated to relate the degree of insufficiency and calf muscle pump dysfunction to venous ulceration. METHODS: Sixty-nine limbs in 55 patients with chronic venous insufficiency by Society for Vascular Surgery/International Society for Cardiovascular Surgery Classification were compared in three groups: classes 1 and 2 with no history of ulceration (19 limbs); class 3 with healed ulceration (20 limbs); and class 3 with active ulcers (30 limbs). Air plethysmography measurements of outflow fraction, venous volume, venous filling time, venous filling index, ejection fraction, ejection volume, residual volume fraction, and residual volume were made. In 62 of the 69 limbs, color-flow duplex ultrasonography was used to determine the pattern of reflux. RESULTS: The outflow fraction was normal in 84%, 75%, and 77% of nonulcerated, healed, and ulcerated limbs. The venous filling index was abnormal in most limbs (nonulcerated 95%, healed 90%, ulcerated 98%) but not significantly different among groups. Differences in calf muscle pump function were significant. Ulcerated limbs had significantly poorer ejection fractions (p = 0.0002) and greater residual volume fractions (p = 0.0006) than nonulcerated or healed limbs. By ultrasonography, deep and superficial vein incompetence was present in most limbs and was not statistically different among groups. Although venous insufficiency was not measurably different among groups, limbs with active venous ulcers had significantly poorer calf muscle pump function than those with healed ulcers or with no history of ulceration. CONCLUSION: Venous insufficiency is necessary but not sufficient to cause ulceration, and a deficiency of the calf muscle pump is significant to the severity of venous ulceration.

Adult↗

PubMed2001

Iontophoretic delivery of calcium for experimental hydrofluoric acid burns.

OBJECTIVE: To examine the efficacy of iontophoretic delivery of calcium to experimental hydrofluoric acid burns. DESIGN: Prospective, controlled study. SETTING: Institutional laboratory. SUBJECTS: Male nude rats. INTERVENTIONS: For the in vitro experiment, a full-thickness skin from the back was set in a vertical flow-through diffusion cell. Calcium chloride was applied to the donor chamber, and transdermal transport of calcium was examined with or without a voltage gradient of 1.5 V. Either intact skin or skin whose stratum corneum was stripped with adhesive tapes was used. For the in vivo experiment, hydrofluoric acid burns were induced by dispensing 50% hydrofluoric acid (50 microL) on the backs of the nude rats, who were under pentobarbital anesthesia. Rats were divided into four groups (n = 5 for each group): control group (burned but not treated); topical group (treated with calcium gluconate jelly); infiltration group (intradermal and subcutaneous injection of calcium gluconate); and iontophoresis group (treated with iontophoresis of calcium chloride at 1.5 V). Burn areas were measured and pathologic findings were classified microscopically into five stages at 1 wk: stage 1, epidermal burn; stage 2, superficial dermal burn; stage 3, deep dermal burn; stage 4, full-thickness burn; and stage 5, burn affecting the skeletal muscle. MEASUREMENTS AND MAIN RESULTS: In the in vitro experiment, calcium concentrations increased significantly only in stripped skins with a 1.5-V gradient. In the in vitro experiment, burn areas were reduced significantly in the iontophoresis group compared with the other three groups. Pathologic findings were significantly improved in the iontophoresis group compared with the control group. This efficacy of iontophoresis was observed when it was initiated within 30 mins after hydrofluoric acid burn. CONCLUSIONS: These results show that transdermal transport of calcium was enhanced in stripped skins by iontophoresis and that iontophoresis was more efficacious than topical or infiltration therapy for experimental hydrofluoric acid burns. Iontophoretic delivery of calcium seems to be easier than intra-arterial infusion and may be effective for the lesions where intra-arterial infusion is difficult.

Administration, Topical↗

PubMed1982

Reference values for intramuscular pressure in the lower leg in man.

Intramuscular pressures in the anterior tibial and superficial posterior compartments of the lower leg were measured by the wick catheter technique in 34 healthy individuals (17 males and 17 females, mean age 42 years). The pressures were measured at rest, during and after exercise and during venous and arterial occlusion. The pressure was 1.1 (range 0.3-3.0) kPa in the anterior tibial and 0.5 (range 0.0-2.0) kPa in the superficial posterior compartment at rest. During exercise the intramuscular pressures rose to 3.5 (range 1.0-8.0) kPa and 0.9 (range 0.1-2.8) kPa respectively. The anterior tibial compartment pressures were lower in females than in males at exercise and lower in older than in younger persons at rest. After exercise the pressures were back to the pre-exercise levels within 5 min. Venous occlusion caused an increase in the pressure which was more marked in the anterior tibial compartment than in the superficial posterior compartment. Arterial occlusion did not cause any dramatic changes in intramuscular pressures, but there was a slight elevation during the period of reactive hyperaemia.

Adult↗

PubMed1988

[Studies on the tendinous compartments of the extensor muscles on the back of the human hand and their tendon sheaths. I].

In 47 dissected right and left hands of adults of both sexes, kept in a moist condition, significant practical-clinical investigations of the transitional zone between forearm and hand were undertaken. In particular it was sought to determine the characteristic sizes of the extensor retinaculum, the osteofibrous tunnels, the insertion tendons of the hand and finger extensor muscles, and their tendon sheaths. Together with the palmar carpal ligament, the 2 to 3 cm wide extensor retinaculum annularly surrounds the whole circumference of the carpus. It extends obliquely from radial-proximal to ulnar-distal and conducts the extensor tendons over the carpal articulations. According to recent studies, it is divided into a superficial and a deep fibrous layer. From the undermost surface, vertical and oblique septa run to the plane of the forearm and carpal bones. They separate the fibrous portion of the 6 tendinous compartments of the dorsum manus. In 8.5% of cases, an accessory and completely independent tunnel of the extensor pollicis brevis muscle exists in the material investigated, and in 2.2% of cases, there is an additional tunnel for the extensor carpi radialis muscle. Hence, one occasionally finds 8 separate osteofibrous gliding compartments for the extensor muscles in the dorsal hand region. The longest tunnel belongs, as a rule, to the extensor digiti minimi muscle, whilst the widest pertains to the extensor digitorum muscle. Within the tunnel and also proximal and distal to it, the extensor tendons are surrounded by synovial sheaths. Because of its wide encroachment on the dorsum of the hand, the insertion tendon of the extensor digiti minimi muscle possesses the longest tendon sheath, measuring 68.8 mm. The next longest sheath, that of the extensor pollicis longus muscle, which measures 56.2 mm, begins further proximal to the gap of the radiocarpal articulation. In 12.8% of cases, there are divided sheaths of the abductor pollicis longus and of the extensor pollicis brevis muscle. The tendon sheath of both extensor carpi radiales muscles is frequently divided into 2 compartments which, in 2/3 of cases, communicate. The compartment of the extensor carpi radialis brevis muscle, in 91.5% of cases, shares a window-like opening with the roof of the synovial vagina of the extensor pollicis longus muscle. The tendon sheath of the long extensor muscles of the fingers originates 5 mm proximal to the forearm border of the extensor retinaculum and has a communal recess. The IVth tendon sheath opens distally and splays out in a glove-like manner to some distal recesses.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1992

Predicting return to work for lower back pain patients receiving worker's compensation.

The results of a prospective study of 134 patients with lower back pain suggest that nonorganic factors are better predictors of return to work than organic findings. Patients who returned to work had fewer job, personal, or family related problems. There were no significant differences between patients who returned to work and those who did not when comparing myelograms, computed tomographic scans, or roentgenographs. The only significant difference in physical organic findings was for muscle atrophy. Patients who did not return to work had a statistically higher incidence rate of muscle atrophy. Length of time off from work was significantly related to outcome, but when patients were categorized according to time off the job, different factors predicted failure to return for patients off work for less than 6 months and patients off for more than 6 months. For patients off for less than 6 months, important predictors were a high Oswestry score, history of leg pain, family relocation, short tenure on the job, verbal magnification of pain, reports of moderate to severe pain on superficial palpation, and positive reaction to a "sham" sciatic tension test. None of these was a significant predictor for the group off for more than 6 months. For the group off work for more than 6 months, previous injuries, and stability of family living arrangements were among the significant predictors not significant for the group off less than 6 months. Using 21 factors selected from a larger group of 92 factors, three statistically significant (P less than or equal to 0.001) predictive measures were developed. These measures predicted return to work for the total sample, and for the two subgroups (off more than, or less than 6 months) more accurately than did the total set of 92 factors.

Back Pain↗

PubMed1999

Attachments of the posterior layer of lumbar fascia.

STUDY DESIGN: Superficial and deep laminae of the posterior layer of lumbar fascia were dissected. The lumbar portion was measured for evidence of segmental thickenings. Superior attachments were dissected, documented, and photographed. OBJECTIVES: To verify the existence of posterior accessory ligaments and establish the superior attachments and fiber angles of the posterior layer of lumbar fascia. SUMMARY OF BACKGROUND DATA: There have been two small dissection studies on the posterior layer. Their findings are conflicting in several areas of clinical significance. Thickenings in the lumbar region were described in one study, but have not been verified. The superior attachments of the posterior layer have not been formally documented. METHODS: Study 1: In 21 embalmed cadavers, the lumbar region of the posterior layer was dissected. The lumbar spinous processes and adjacent fascia were marked. The fascia was removed and examined, and its thickness measured with a manual micrometer. Results were statistically analyzed. Study 2: Superior attachments of the posterior layer in 20 cadavers were dissected and photographed. Capacity to transmit tension was estimated and documented photographically, and fiber angles measured in situ. RESULTS: Study 1: There was no evidence of macroscopic segmental thickening in the posterior layer. Study 2: The superficial lamina was continuous superiorly with the rhomboids, and the deep lamina with the tendons of splenius cervices and capitis. These previously undocumented attachments were of variable thickness and fibrosity, and capable of transmitting tension. CONCLUSIONS: Both superficial and deep laminae of the posterior layer are more extensive superiorly than previously thought. This may have implications for certain tests used in assessment and management of low back pain such as the slump and "nonorganic" tests. The thickness of the superior attachments is variable. Their capacity for load bearing is yet to be quantified.

Aged↗

PubMed2006

Sclerosing dermatofibrosarcoma protuberans (DFSP): an unusual variant with focus on the histopathologic differential diagnosis.

A 59-year-old man presented with a 10-cm x 8-cm tumoral plaque with a superficial nodule in the interscapular region of the back (Fig. 1). The lesion had been growing for 25 years. As a cystic lesion was suspected, the superficial nodule was biopsied. The histopathologic diagnosis was low-grade sarcoma with sclerosis. Two months after the initial biopsy, the lesion was completely excised, reaching the muscular fascia, with a 2-cm margin and with a free graft. Formalin-fixed paraffin-embedded samples were submitted to histologic and immunohistochemical study (4-microm paraffin sections); frozen tissue was submitted to electron microscopy. For histopathology, sections were stained with hematoxylin and eosin. Immunohistochemistry was performed following standard avidin-biotin immunoperoxidase procedures with primary antibodies for vimentin, CD34, smooth muscle-specific actin, bcl-2, S-100, desmin, myoglobin, factor VIII, p53 (all from DAKO, Copenhagen, Denmark), HHF-35 (Enzo Diagnostics, Farmingdale NY), cytokeratin (AE1/AE3) (Biogenex, San Ramon, CA), and factor XIIIa (Calbiochem Novabiochem Corporation, La Jolla, CA). At low magnification, the histologic study of the initial tumoral nodule revealed a poorly circumscribed mesenchymal proliferation, with fibroblastic-like neoplastic cells arranged in a fascicular and storiform pattern, admixed with extensive areas of sclerosis. At higher magnification, tumoral cells were spindle-shaped with hyperchromatic nuclei and scant cytoplasm. In some areas, sclerosis was so evident that a keloid-like pattern was seen (Fig. 2a). The surgical specimen showed a fibroblastic neoplastic proliferation infiltrating the dermis and hypodermis. In the dermis, cells were arranged in a storiform pattern, whereas in the hypodermis there was a honeycomb or lace-like pattern (Fig. 2b). There were also cellular areas alternating with sclerotic areas, with transitional zones in between, in both the dermis and hypodermis. The immunohistochemical study of the initial tumoral nodule and the surgical specimen showed that tumoral cells expressed vimentin, CD34 (Fig. 3), bcl-2, HHF-35, and smooth muscle actin. Neoplastic cells failed to show positivity with desmin, myoglobin, factor XIIIa, factor VIII, S-100, cytokeratin (AE1/AE3), and p53. An ultrastructural study revealed spindle cells having an irregular contour with a well-developed granular reticulum endoplasmic (REG) system in their cytoplasm, as well as some Golgi complexes and mitochondria. Also visible was the presence of many actin filaments and some myosin condensations (Fig. 4), characteristics of a fibroblastic cell with myofibroblastic differentiation. The final histopathologic diagnosis of the surgical specimen was sclerosing dermatofibrosarcoma protuberans. Two years after surgery, the patient is alive and well.

Biopsy, Needle↗

PubMed2006

Lumbopelvic kinematics and trunk muscle activity during sitting on stable and unstable surfaces.

STUDY DESIGN: A single-group comparative study. OBJECTIVES: To compare lumbopelvic kinematics and muscle activation patterns while sitting on stable and unstable surfaces. BACKGROUND: Unstable surfaces are commonly used during the rehabilitation of certain low back pain disorders. The benefits postulated are increased muscle activity and facilitation of sustainable midrange positions via neuromuscular control. The use of unstable sitting devices in the workplace is controversial, as the postulated increase in muscle activity is thought to lead to a muscle fatigue/pain response. However, little evidence exists for or against the ability of these devices to alleviate or prevent spinal pain. METHODS AND MEASURES: This study included 26 healthy adults (14 male, 12 female). Fastrak 3-dimensional motion analysis detected lumbar curvature, pelvic tilt, and postural sway during sitting on a stable and unstable surface over 5-minute periods. Surface electromyography was used to measure activity in the superficial lumbar multifidus, transverse fibers of internal oblique, and iliocostalis lumborum pars thoracis. RESULTS: Spinal postures were similar for sitting on a stable and unstable surface. Significant increases in postural sway were detected (P = .013) in 3 dimensions of movement during sitting on an unstable surface. Gender differences were noted. No EMG amplitude or variance differences were detected between seating conditions. CONCLUSIONS: Preliminary data show that sitting on unstable surfaces induces greater spinal motion, but does not significantly alter the lumbosacral posture nor the amount of activity in the superficial trunk muscles under investigation.

Adult↗

PubMed1982

[Localization of C. ovis in experimentally infected lambs].

Studied were the distribution of Cysticercus ovis in cadavers of lambs experimentally infected with various amounts of Taenia ovis ova, the ratio between superficially localized cysticerci and those found deep in the individual groups of muscles and organs, and the ratio between alive and dead cysticerci. The tests were carried out with thirteen lambs treated as follows: 2 animals were infected with 1000 T. ovis ova each; 3 were infected with 4000 ova each; 4--with 7000 ova each; and 4--with 30 000 ova each. No strictly defined predilection for the localization of Cysticercus ovis was established in the body of the experimentally infected lambs. In compliance with the parasite burden in the individual organs and muscle groups per unit of mass these ranked in the following descending order: heart, diaphragm, fore and hind limbs, masticatory muscles, neck and back muscles, tongue, and abdominal and intercostal muscles. Experimentally, highest was the percent of viable cysticerci in the muscles of the fore and hind limbs and in the muscles of the neck.

Animals↗