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152 records · Page 9Linked to original sources

PubMed1999

Long-term results of dorsal penile vein ligation for symptomatic treatment of erectile dysfunction.

About 20% of patients with erectile dysfunction do not react to intracavernous pharmacological treatment (SKAT) because of a cavernous leak. The first attempt to treat venous insufficiency goes back as far as the beginning of the century. Ligature and resection of the superficial and deep veins of the penis (DPVL) were performed in 122 patients (nonresponders to SKAT with a maintenance flow of less than 40 ml min-1). Twenty-four patients suffered from primary dysfunction and 98 from secondary dysfunction. The average age of the patients was 49 years, and the average duration of the preoperative erectile dysfunction 4.4 years. Postoperative follow-up was carried out for 70 months. In 98% of the patients, cavernosography revealed a dorsal leak. Twenty-six per cent had ectopic veins, 38% a leakage through the crural veins and 24% a glandular or spongiosal shunt. After the 70-month follow-up, only 14% of the 122 patients were able to achieve an adequate spontaneous erection and 19% also responded to SKAT. Depending upon the time elapsed since the operation, the rate of spontaneous reaction was reduced. It was found that younger patients with a short history of erectile dysfunction, no arterial cofactor, a maintenance flow of less than 100 ml min-1 and a severe dorsal leakage from a DPVL were the most likely to benefit from this procedure. Since degeneration of smooth muscle cells of the cavernosa is in most patients the cause of the venous leakage, penis vein surgery is to be regarded as symptomatic treatment.

Adult↗

PubMed1994

Epithelioid leiomyosarcoma of the skin and subcutaneous tissue. Clinicopathologic, immunohistochemical, and ultrastructural study of five cases.

This report describes five cases of an unusual variant of malignant smooth-muscle neoplasm involving the skin and subcutaneous tissue characterized by a proliferation of predominantly round to oval epithelioid cells with abundant eosinophilic cytoplasm. Of the five patients, four were men, one a woman; ages ranged from 69 to 85 years (mean, 76.4). The size of the lesions varied from 1.2 to 2.5 cm; two were located in the scalp, two in the face, and one in the back of the neck. Immunohistochemical evaluation of the tumor cells showed immunoreactivity for actin and vimentin in all cases and negative labeling for desmin, S-100 protein, keratin, epithelial membrane antigen, HMB-45, factor VIII, and alpha-1-antichymotrypsin. Ultrastructural examination showed features of smooth muscle differentiation, that is, focal plasmalemmal densities, basement membrane material, and cytoplasmic filaments with focal condensations. All patients were treated by surgical excision and two also with post-operative radiotherapy. Two cases recurred after 1 year, requiring wide excision. A second recurrence from one of these cases showed the emergence of a highly anaplastic, pleomorphic spindle cell sarcoma; the patient died of unrelated causes, with evidence of persistent disease, after 2 years. In the remainder of cases, the patients were alive and well with no evidence of recurrence or metastasis from 2 to 6 years. Because of the unusual morphologic features of this variant of smooth-muscle tumor it may be confused with a variety of primary and metastatic neoplasms of the skin, including malignant melanoma, epithelioid sarcoma, and metastatic carcinoma. Epithelioid leiomyosarcoma should be recognized as a distinct morphologic variant of primary cutaneous smooth muscle neoplasm and should be considered in the differential diagnosis of epithelioid neoplasms in dermal and superficial soft tissue locations.

Actins↗

PubMed1999

The saphenous venous compartments.

The relationships between the connective framework of the lower extremity hypodermis and the saphenous veins was studied by dissection, stereomicroscopy, ultrasonography and histology in 64 lower limbs. A fibroelastic lamina was evidenced in the hypodermis of the medial aspect of the thigh and leg and in the back face of the leg. This lamina, together with the underlying muscular fascia, fixed the boundaries of two compartments occupied by the saphenous veins and nerves. The adventitia of the saphenous veins was connected to the compartment walls by thick connective strands. The saphenous veins ran deeply in the hypodermis, closely ensheathed by a fibroelastic sleeve. As a consequence, they could no longer be considered as a truly superficial vein. This term seems to be appropriate only for their tributaries, which ran in a more superficial plane just below the dermis. The role of the saphenous vessels in blood return from the lower limbs may be greater than classically accepted. In fact, due to their close fascial ensheathing and adventitial anchoring, muscular contractions may enhance blood flow within these vessels as occurs in the intermuscular veins. Finally, dilative pathology of the saphenous vein may be resisted by the membranous lamina as a sort of a fibroelastic shield.

Adult↗

PubMed2003

[Anatomy of latissimus dorsi and its clinical application].

OBJECTIVE: To investigate the feasibility of segmentation of latissimus dorsi on the basis of anatomy and electrophysiology. METHODS: Ten cadaveric latissimus dorsi was dissected according to the blood supply, nerve innervation. Electromyelogram (EMG) of latissimus dorsi of 13 healthy persons was recorded with superficial electrode plate in the motion of shoulder joint. The results of record were managed with statistic methods. Ten patients(including reconstruction of breast and repair of scar on elbow joint and on chest wall) were treated with the lateral inferior myocutaneous island flap. RESULTS: According to the medial and lateral vasculonervous branches, latissimus dorsi can be divided into the medial superior and lateral inferior segments. The clinical application of the segment achieved good results in reconstructing breast and in repairing scars on elbow and on chest wall. CONCLUSION: Latissimus dorsi can be divided into two segments and applied separately. The lateral inferior segment is more useful in shoulder motion.

Adult↗

PubMed1997

An ultrastructural study of calcitonin gene-related peptide-immunoreactive nerve fibers innervating the rat posterior longitudinal ligament. A morphologic basis for their possible efferent actions.

STUDY DESIGN: The present study investigated ultrastructural characteristics of calcitonin gene-related peptide-immunoreactive nerve fibers in the posterior longitudinal ligament of the rat lumbar spine. OBJECTIVES: To provide a morphologic basis for assessment of the afferent and, in particular, efferent functions of calcitonin gene-related peptide immunoreactive nerves in the posterior longitudinal ligament and their eventual role in degenerative spondylarthropathies and low back pain. SUMMARY OF BACKGROUND DATA: Previous studies using light-microscopic localization of sensory neuronal markers such as calcitonin gene-related peptide have reported the presence of sensory fibers in the supporting structures of the vertebral column. Meanwhile, accumulating research data have suggested efferent properties for calcitonin gene-related peptide, i.e., a trophic action that alters the intrinsic properties of target cells not through transient action of synaptic transmission, but through long-lasting signal transmission by the secreted neuropeptides. To verify such trophic, paracrine actions of the calcitonin gene-related peptide-containing fibers in the posterior longitudinal ligament, however, ultrastructural details of the terminals and their spatial relationship to their eventual target structures have to be elucidated. METHODS: Rat posterior longitudinal ligaments were stained immunohistochemically for calcitonin gene-related peptide. Light-microscopic analysis of the semithin sections facilitated subsequent electron microscopy of specific sites of the posterior longitudinal ligament to determine ultrastructural details and nerve fiber-target relationships. RESULTS: The rat lumbar posterior longitudinal ligament was found to be innervated by two distinctive calcitonin gene-related peptide immunoreactive nerve networks. In immunoelectronmicroscopy, the fibers of the deep network had numerous free nerve endings, whereas those of the superficial network showed spatial associations with other non-calcitonin gene-related peptide immunoreactive components of the network. In both systems, naked axons not covered by the Schwann cells made close spatial contact with smooth muscle cells: of blood vessels and resident posterior longitudinal ligament fibroblasts. CONCLUSIONS: The ultrastructural characteristics of the innervation of the rat posterior longitudinal ligament would be compatible not only with a nociceptive function, but also with neuromodulatory, vasoregulatory, and trophic functions, as has already been established in some visceral organs.

Animals↗

PubMed1980

Our experiences with the free latissimus dorsi myocutaneous flap.

We have used 9 free latissimus dorsi myocutaneous flaps. All but 1 survived completely. This one showed superficial necrosis at the flap margin. Our operative techniques and experiences are reported here, with some of our results. A relatively large flap can be nourished by only one vascular pedicle, the subcapsular-thoracodorsal vessels. Though three are many vascular variations in the axillary region, the subscapular-thoracodorsal vessels are easily identifiable in our experience, and their diameters are always large enough for microvascular anastomosis. The bulk of this flap is one of its important features. Care must be taken in the design of the flap so that it fits exactly, and it should also be remembered that the volume of the flap will decrease greatly later on. The flap is remarkably simple, safe, and reliable. We believe it will be the method of choice in many microsurgical cases.

Adolescent↗

PubMed1998

Analysis of rapid stopping during human walking.

The mechanisms involved in rapidly terminating human gait were studied. Subjects were asked to walk at a comfortable speed and to stop walking as soon as they felt an electrical stimulus to the superficial peroneal nerve. This simulated hitting an obstacle with the top of the foot. Stimuli were presented repeatedly at random during a 20-min period of walking. Electromyograms and joint angular movements of the right leg and forces under both feet were recorded. The step cycle was divided into 16 parts, and the responses to stimuli in each part were analyzed separately. Subjects generally stopped with the right foot in front of the left or vice-versa, depending on when the stimulus was applied in the step cycle. There was also a transition region in which subjects would rise up on their toes and either back down or take one more quick, short forward step. Three different mechanisms were used to produce a stop. 1) An extension synergy in the swing leg was initiated just before this leg hit the ground to brake the forward momentum of the body. 2) The push-off phase of the stance leg was inhibited to reduce the forward thrust and maintain the stance leg on the ground behind the body. 3) If these mechanisms were insufficient, the body rose up onto the toes of the extended forward leg and thereby converted more kinetic energy to potential energy. A decision to take an additional step depends on whether the momentum of the body is sufficient to carry the center of mass in front of its support on the forward leg. If so, an additional step is taken. Despite the complexity of the decisions that must be made, changes in electromyographic activity are seen throughout the legs and trunk in 150-200 ms.

Adult↗

PubMed2006

Surgical technique and anatomic study of latissimus dorsi and teres major transfers.

BACKGROUND: Combined latissimus dorsi and teres major musculotendinous transfer has been described for the treatment of massive rotator cuff deficits. The procedure is technically complex because of the proximity of the radial nerve, the axillary nerve and its posterior branches, and the neurovascular bundles to the muscles. The purpose of the present cadaveric study was to examine surgically relevant relationships for latissimus dorsi and teres major tendon transfers. METHODS: Twelve cadaveric shoulder girdles were dissected, and the latissimus dorsi, the teres major, and the posterior cord of the brachial plexus and its branches were identified. The relationships between the tendons and local neurologic structures were measured during various steps of the latissimus dorsi/teres major transfer procedure. The effect of humeral rotation on the exposure of the latissimus dorsi and teres major tendons through the posterior approach was quantified, and relevant surgical landmarks were described. RESULTS: The radial nerve passed directly anterior to the tendons at an average of 2.9 cm medial to the superior aspect and 2.3 cm medial to the inferior aspect of the humeral insertions. From the posterior axillary approach, maximal internal rotation facilitated exposure for tenotomy by delivering the tendon insertions on the humerus into the surgical field. During axial mobilization of the musculotendinous units, the neurovascular pedicles to the latissimus dorsi and teres major were identified at an average of 13.1 and 7.4 cm axial to the humeral insertions, respectively. The posterior branch of the axillary nerve was noted to cross superficially over the transferred tendons as they were tunneled under the posterior deltoid. CONCLUSIONS: Multiple steps of the combined latissimus dorsi and teres major musculotendinous transfer place local neurologic structures at risk. These steps include tendon release, musculotendinous axial mobilization, and tendon tunneling in the plane between the infraspinatus-teres minor and the posterior deltoid. We have quantified and described the relationship of the axillary and radial nerves to the tendons during tenotomy, the distance from the tendons' insertions to their neurovascular bundle that must be identified during axial mobilization, and the course of the posterior branch of the axillary nerve in relation to the tunneled path of the tendons. CLINICAL RELEVANCE: The present study provides important anatomic findings for the safe mobilization and transfer of the latissimus dorsi and teres major tendons during the surgical treatment of irreparable rotator cuff tears.

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