Reliability of sonography in the assessment of lumbar stabilizer muscles size in healthy subjects and patients with scoliosis.

OBJECTIVE: The purpose of the present study was to compare the reliability of sonography in the evaluation of abdominal and multifidus muscles size between healthy subjects and patients with scoliosis. METHODS: In this study, 20 healthy males and 20 male patients with scoliosis (20-50 years old) were recruited. Multifidus and abdominal muscles (transversus abdominis, internal and external oblique) size were assessed by sonography. Three images were recorded; the first and second images were taken on the same day with an hour interval to evaluate within-day reliability, and the third image was taken one-week later to assess between-day reliability. RESULTS: Intraclass correlation coefficient (ICC = 0.82-0.91) demonstrated high within-day reliability of sonography in the assessment of abdominal muscle thickness in both groups. In addition, high between-day reliability was observed for these muscles in both healthy and patient groups (ICC = 0.80-0.89). Within-day and also between-day reliability of multifidus muscle were shown to be high in the healthy group (ICC = 0.81-0.88) and the patient group (ICC = 0.78-0.85). Overall, within-day reliability was higher than between-day reliability and also the reliability of sonography in healthy subjects was greater than of those suffering from scoliosis. CONCLUSIONS: According to the results, sonography was shown to be a highly reliable imaging technique for assessment of abdominal and multifidus muscle size in healthy males and those suffering from scoliosis.

A Comparison of the Abdominal and Lumbar Multifidus Muscle Size in Patients With Lumbar Spondylolisthesis and Healthy Patients at Rest and During Contraction Using Ultrasonography.

OBJECTIVE: Using ultrasonography, this study investigated the abdominal and lumbar multifidus muscle size in patients with lumbar spondylolisthesis compared with healthy patients at rest and during contraction. METHODS: This research was a nonexperimental, analytic case-control study. Ultrasound imaging was used to assess the thickness of the abdominal and lumbar multifidus muscles in 25 healthy patients and 25 patients with spondylolisthesis. For the purpose of this study, both men and women, aged 30 to 70 years, were recruited from physiotherapy clinics affiliated with the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Measurements were taken at rest and during contraction. RESULTS: There was a significant difference in abdominal and lumbar multifidus muscle size between the healthy and spondylolisthesic groups, both at rest and contraction (P < .05 in all instances). No significant difference was found between the right and left for all measurements (P > .05). CONCLUSION: Patients with spondylolisthesis had smaller stabilizer muscle thickness at rest and during contraction compared with the healthy group.

Psoas/iliacus muscle invasion from mucinous appendiceal neoplasm. Radiologic appearance and outcome of treatment in 3 patients.

BACKGROUND: Mucinous appendiceal neoplasms have a pattern of metastases that is different from the other gastrointestinal cancers. The first site for cancer dissemination is the peritoneal space surrounding the primary tumor and this is followed by increasingly extensive peritoneal spread. Invasion of the psoas and iliacus muscle is an unusual phenomenon. METHOD: From a prospective database of appendiceal mucinous neoplasms treated by cytoreductive surgery (CRS) and perioperative hyperthermic chemotherapy (HIPEC), patients with psoas muscle invasion were reviewed. Their clinical features and treatments were tabulated. RESULTS: Three patients with ages 33, 60, and 63 were identified. Two patients had disease progression into the psoas muscle 33 and 95 months after CRS plus HIPEC. One had dissecting mucinous tumor into psoas, iliacus and quadratus lumborum muscle at the time of diagnosis of the appendiceal mucinous neoplasm. All three survived at least five years from their initial treatment. CONCLUSION: Despite the fact that mucinous tumor invasion was outside the peritoneal cavity, long term benefit from psoas muscle resection with a mucinous appendiceal neoplasm is possible and resection possibly with HIPEC should be considered.

4D intravital microscopy uncovers critical strain differences for the roles of PECAM and CD99 in leukocyte diapedesis.

Leukocyte transendothelial migration (TEM) is an essential component of the inflammatory response. In vitro studies with human cells have demonstrated that platelet/endothelial cell adhesion molecule (PECAM) functions upstream of CD99 during TEM; however, results in vivo with mice have been apparently contradictory. In this study we use four-dimensional (4D) intravital microscopy to demonstrate that the site and order of function of PECAM and CD99 in vivo are dependent on the strain of mice. In FVB/n mice, PECAM functions upstream of CD99, as in human cells in vitro, and blocking antibodies against either molecule arrest neutrophils before they traverse the endothelium. However, in C57BL/6 mice, PECAM and CD99 appear to function at a different step, as the same antibodies arrest leukocyte migration through the endothelial basement membrane. These results are the first direct comparison of PECAM and CD99 function in different murine strains as well as the first demonstration of the sequential function of PECAM and CD99 in vivo.

[Abdominal wall abscess as the presenting sign in carcinoma of the colon: report of 4 cases]. / Abcès pariétal abdominal révélateur de néoplasie colique: présentation de 4 cas.

PURPOSE: We report four cases of unusual presentation of colonic cancer revealed by an abscess of the abdominal wall. MATERIALS AND METHODS: Our study included 3 men and 1 women ranging in age from 33 to 66 years presenting with abdominal wall abscess (in the left anterior abdominal wall in 2 patients and in the quadratus lumborum muscle in the other 2 patients). Our cases were listed from the departments of radiology and abdominal surgery of Sahloul hospital from 1995 through 2000. Ultrasonography (US) and computed tomography (CT) were performed in all cases; barium enema in three. RESULTS: US and CT revealed segmental colonic wall thickening (left colon in three patients and right colon in one patient). The diagnosis of colonic cancer was reached by colonoscopy with biopsy in all 4 cases. All of our patients underwent surgical treatment. CONCLUSION: In this era of newer diagnostic imaging modalities, US and CT must frequently be used in the evaluation of patients with abdominal wall abscess, to depict intra-abdominal infection and especially malignant lesion causing abdominal wall abscess.

The abdominal wall: an overlooked source of pain.

When abdominal pain is chronic and unremitting, with minimal or no relationship to eating or bowel function but often a relationship to posture (i.e., lying, sitting, standing), the abdominal wall should be suspected as the source of pain. Frequently, a localized, tender trigger point can be identified, although the pain may radiate over a diffuse area of the abdomen. If tenderness is unchanged or increased when abdominal muscles are tensed (positive Carnett's sign), the abdominal wall is the likely origin of pain. Most commonly, abdominal wall pain is related to cutaneous nerve root irritation or myofascial irritation. The pain can also result from structural conditions, such as localized endometriosis or rectus sheath hematoma, or from incisional or other abdominal wall hernias. If hernia or structural disease is excluded, injection of a local anesthetic with or without a corticosteroid into the pain trigger point can be diagnostic and therapeutic.

Restoration of abdominal wall integrity as a salvage procedure in difficult recurrent abdominal wall hernias using a method of wide myofascial release.

The management of primary and recurrent giant incisional hernias remains a complex and frustrating challenge even with multiple alloplastic and autogenous closure options. The purpose of this study was to develop a reconstructive technique of restoring abdominal wall integrity to a subcategory of patients, who have failed initial hernia therapy, by performing superior and lateral myofascial release. Over a 1.5-year period, 10 patients with previously unsuccessful treatment of abdominal wall hernias, using either primary repair or placement of synthetic material, were studied. The patients had either recurrence of the hernia or complications such as infections requiring removal of synthetic material. The hernias were not able to be treated with standard primary closure techniques or synthetic material. The average defect size was 19 x 9 cm. Each patient underwent wide lysis of bowel adhesions releasing the posterior abdominal wall fascia to the posterior axillary line, subcutaneous release of the anterior abdominal wall fascia to a similar level, and complete removal of any synthetic material (if present). The abdominal domain was reestablished by releasing the laterally retracted abdominal wall. The amount of available abdominal wall tissue was increased by wide release of the cephalic abdominal wall fascia overlying the costal margin and the external oblique fascia and muscle laterally. If needed, partial thickness of the internal oblique muscle and its anterior fascia were also released laterally to perform a tension-free primary closure of the defect. All repairs were closed with satisfactory functional and aesthetic results. All alloplastic material was removed. Fascial release was limited so as to close only the hernia defect without tension. No significant release of the rectus sheath and muscle was needed. Good, dynamic muscle function was noted postoperatively. All repairs have remained intact, and no further abdominal wall hernias have been noted on follow-up.

Use of injectable potassium chloride for euthanasia of American lobsters (Homarus americanus).

Potassium chloride (KCl: 330 mg/ml) was assessed as an euthanasia agent in American lobsters (Homarus americanus). Two groups of 10 lobsters (408.2 to 849.9 g) were maintained at 11.9 to 12.1 degrees C ('warm') and 1.5 to 2.5 degrees C ('cold') to evaluate the possible effect of ambient temperature on response to KCl. Death was defined as time of cardiac arrest, as viewed and measured by use of ultrasound. The KCl solution was injected (100 mg of KCl/100 g of body weight) at the base of the second walking leg to flood the hemolymph sinus containing the ventral nerve cord with potassium. Disruption of this 'central nervous system' was immediate, followed by cardiac arrest within 60 to 90 seconds. Group median ( +/- SD) baseline heart rate was 42 +/- 14 'warm' and 36 +/- 5 'cold' beats per minute. Time until cardiac arrest ranged from 35 to 90 (57 +/- 18) seconds in the 'warm' group and from 40 to 132 (53 +/- 34) seconds in the 'cold' group. There was no significant difference between group medians for either parameter. Histologic lesions were limited to mild to moderate acute degeneration, characterized by cell swelling, loss of contraction bands, and occasional mild cytoplasmic vacuolation of skeletal muscle at the injection site. Injectable KCl solution was an effective, reliable method for euthanasia of H. americanus.

Early effects of exogenous arginine after the implantation of prosthetic material into the rat abdominal wall.

We have investigated the effects of high arginine (Arg) levels (7.5 mg/100 g body weight per hour) on the early integration of biocompatible mesh grafts into the rat abdominal wall. Studies were performed over implantation intervals of 6, 12, 24 or 48 hours (n=12, each). Arginine and related compounds were quantified in plasma, wound fluids and multiple tissues. Plasma nitric oxide (NO) production was studied. Strips were taken from the polypropylene fiber-host tissue interfaces (PTIs) for optical microscopic analysis and for immunohistochemical analysis using rat-specific antibodies against type I and type III collagens. Exogenous Arg was metabolized at the peripheral tissues but reliably reached the wound space. High amounts of Arg and ornithine (Orn) were detected in the specimens considered. No changes on citrulline (Ctr) or NO concentrations were observed, overall suggesting that, during the period studied, the arginase pathway predominated. The acute scarring response differed significantly in the two placements considered. The P-SS interface evidenced more extensive new tissue growth than the P-DS interface. Forty-eight hours after mesh implantation cellular infiltration, fibroblast proliferation, and mesh-surrounding angiogenesis were higher in the arginine-treated rats. Type III collagen staining was related to arginine treatment, being higher (++) in the study group. In conclusion, and independently of the site of mesh placement, supplemental Arg seemed to favorably affect early local collagen deposition. This could be potentially helpful to ameliorate the integration of biomaterials into the tissues and, consequently, to allow for the design of more selective therapeutic strategies to prevent hernia recurrence rates.

Anti-inflammatory activity of the alkaloid bukittinggine from Sapium baccatum.

The anti-inflammatory and related activities of bukittinggine were evaluated in comparison with reference drugs. The results obtained revealed that bukittinggine exhibited a significant inhibitory effect in carrageenin-induced hind paw edema and adjuvant-induced arthritis in rats. Its anti-inflammatory activity in both test models was comparable to that of acetylsalicylic acid. Bukittinggine also showed an inhibitory effect on the late proliferative phase of the inflammatory process in cotton pellet-induced granuloma formation in rats. In carrageenin-induced rat pleurisy, bukittinggine exhibited marked inhibitory activity on exudative formation, accumulation of leukocytes and on PGE2-like activity in the exudate. Furthermore bukittinggine could significantly reduce fever in yeast-induced hyperthermic rats and possessed analgesic activity comparable to that of acetylsalicylic acid when tested in acetic acid-induced writhing response in mice. However, bukittinggine exhibited only a weak effect in the tail-flick test when compared with morphine. It is likely that bukittinggine possesses a mechanism of anti-inflammatory, analgesic and antipyretic action similar to that of acetylsalicylic acid.

Comparison of tissue effects with sculptured fiberoptic cables and other Nd:YAG laser and argon laser treatments.

The use of a fiber optic cable in contact with tissue results in a complex thermal interaction between the cable and the tissue. The effect of the laser-tissue interaction was investigated using sculptured quartz fiber optic cables, sapphire contact rods, and bare fiber optic cables attached to the Nd:YAG laser. The laser-tissue effects of the Nd:YAG and argon lasers were compared. Examination of treated animals showed there to be a significant difference between immediate and 48-hour thermal effects. The sculptured fibers created significantly less tissue damage than the sapphire contact tips, the 0.6-mm bare fiber, or the argon laser with a 0.3-mm bare fiber either with or without contact. All Nd:YAG laser contact treatments were less damaging than the argon laser treatments.

Electrostimulation of healing abdominal incisional hernias by low frequency, bipolar, symmetrical rectangular pulses. An experimental study.

A total of 107 male Wistar rats had abdominal hernias repaired (3 weeks after they had been artificially induced) by a two layer closure of the abdominal wall--the Mayo technique. The wounds of 56 rats were subjected to constant stimulation by an electric flow field. An implanted stimulation unit provided a low frequency (0.87 Hz), bipolar, symmetrical rectangular pulsed current (+/- 25 microA). A control group were given units that did not transmit current. In 39 of the 51 animals in the control group the muscle margins of the abdominal scars separated by between 1 and 5 mm. The scars of the electrostimulated animals were distinguished histologically by early formation of fibroblasts and deposition of collagen and the rapid maturation and longitudinal alignment of the collagen fibres. 46 of 56 of these scars were not separated. This technique may have a clinical application as adjuvant treatment for relapses of incisional hernias.

Myonecrosis following deep pelvic hyperthermia.

A case report is presented in which severe myonecrosis of the inferior anterior abdominal wall followed treatment of a recurrent pelvic tumour with an annular phased array (AA) deep heating device. This unusual complication has not been observed at this institution in 107 patients previously treated with deep pelvic or abdominal hyperthermia, who had undergone a total of 368 hyperthermia sessions. The injury was confirmed radiographically and histopathologically, and was associated with serum enzymatic elevations characteristic of muscular injury. The implications for clinical trials employing the AA or similar devices are discussed.