Magnetic Resonance Imaging Evaluation of Changes in Gluteal Muscles After Treatments With the High-Intensity Focused Electromagnetic Procedure.

BACKGROUND: High-intensity focused electromagnetic (HIFEM) field procedure induces changes in the gluteal muscles and improves the aesthetic appearance of the buttocks. OBJECTIVE: This study aims to objectively assess the hypertrophic response of the gluteal muscles after HIFEM treatments. MATERIALS AND METHODS: Seven subjects (40.00 ± 6.68 years) received 4, 30-minute HIFEM treatments of the buttocks. Magnetic resonance imaging of the pelvic region was obtained at baseline, 1-month, and 3-month follow-up to reconstruct 3D volumes of musculusgluteus maximus, medius, and minimus. Volumetric changes were calculated and statistically analyzed. Standardized photographs, weight measurements, patient satisfaction, treatment comfort, and adverse events were also documented. RESULTS: Volumetric analysis revealed a significant increase (p = .001) in the size of the examined muscles at 1-month (+10.81 ± 1.60%) and 3-month (+13.23 ± 0.91%) follow-up. A more profound hypertrophic effect was seen in the upper buttock region. This translated into a visible buttock lifting, also captured by patient photography. Gluteal adipose tissue was insignificantly affected. Patients were satisfied, and they found the treatments comfortable. No adverse events were observed. CONCLUSION: Simultaneous enhancement of gluteal muscles was documented. This represents the first objective evaluation of the HIFEM-induced structural changes in the gluteal muscles and physiologic documentation of the aesthetic improvement previously reported by other authors.

Myofascial Trigger Points Therapy Modifies Thermal Map of Gluteal Region.

BACKGROUND: Thermal imaging may be effectively used in musculoskeletal system diagnostics and therapy evaluation; thus, it may be successfully applied in myofascial trigger points assessment. OBJECTIVE: Investigation of thermal pattern changes after myofascial trigger points progressive compression therapy in healthy males and females. METHODS: The study included 30 healthy people (15 females and 15 males) with age range 19-34 years (mean age: 23.1 ± 4.21). Thermograms of myofascial trigger points were taken pre- and posttherapy and consecutively in the 15th and 30th minutes. Pain reproducible by palpation intensity was assessed with numeric rating scale. RESULTS: Progressive compression therapy leads to myofascial trigger points temperature (p=0.02) and surface (p=0.02) and surface (p=0.02) and surface (p=0.02) and surface (. CONCLUSIONS: The study indicates that myofascial trigger points reaction to applied therapy spreads in time and space and depends on participants' sex.

Intramuscular hematoma with motor weakness after trigger point injection: A case report.

RATIONALE: Although trigger point injection is known as an easy and low-risk procedure, it is contraindicated to patients with hemorrhagic disorders or who regularly take anticoagulants/antiplatelets. However, taking clopidogrel is not a defined contraindication to this low-risk procedure. PATIENT CONCERNS: The chief complaint of a 76-year old woman regularly taking clopidogrel was low back and left buttock pain which prolonged for several years. DIAGNOSES: The patient was diagnosed with L4-5 and L5-S1 spinal stenosis at the orthopedics department and was referred for lumbar spinal epidural steroid injection. INTERVENTION: She was treated with trigger point injection. OUTCOMES: Three hours after the injection, she complained motor weakness and pain in the injection area. A hematoma on left gluteus medium muscle was detected with ultrasonography and ultrasound-guided needle aspiration was accomplished to relieve the symptom. LESSONS: Trigger point injection for patients taking clopidogrel should be done with a caution to prevent such complication.

An unexpected cause of severe and refractory PTH-independent hypercalcemia: case report and literature review.

Hypercalcemia is a common condition in the internal medicine practice. Sometimes its cause is not readily apparent, so extensive investigation is appropriate. Here we report an unexpected cause for hypercalcemia in an elderly woman. The case of an 82-years old woman with PTH-independent hypercalcemia, lymphocytosis, normal serum 1,25 (OH)vitamin D levels, and low serum PTHrp levels, is described. Medical history and complementary investigation were unremarkable, except for increased metabolic activity in the glutei regions, as measured by whole body 18F-FDG PET-CT. Reviewing her medical history, her sister recalled that she had been submitted to intramuscular methylmethacrylate injections, for cosmetic purposes, five years before presentation, which was confirmed by muscle biopsy. Low calcium intake, parenteral bisphosphonates, calcitonin, and glucocorticoids were used to control serum calcium levels. Methylmethacrylate injections, used cosmetically, are a new cause for hypercalcemia, even after many years. Hypercalcemia was probably due to calcitriol overproduction in foreign body granulomas. Persistent reactive lymphocytosis could be a clue for this inflammatory cause of hypercalcemia.

[Treatment of lumbar disc herniation combine with buttock tender node with Pizhen].

OBJECTIVE: To observe the therapeutic effects of Pizhen in treating lumbar disc herniation combined with buttock tender node. METHODS: From August 2009 to February 2010,83 patients (29 males and 54 females) with lumbar disc herniation combined with buttock tender node were randomly divided into the Pizhen group and acupuncture group. Pizhen group were treated with Pizhen manipulation, inserting needle by vertical prick with quacking inserting and quick withdrawing the needle, no rotating and the depth was through the surface of fascia, two times as a course of treatment; acupuncture group were treated with acupuncture, inserting Ashi-point, retaining the needle 20 min, ten times as a course of treatment. VAS scoring at the end of treatment and B ultrasonic image at 3d after treatment was carried out to observe the therapeutic effects. RESULTS: B ultrasonic image of buttock tender node showed inflammation reaction or ellipse. The width of the inflammation reaction decreased after treatment, but there has no statistical significance (P=0.635). There was no significant difference between two groups (P=0.813). CONCLUSION: Pizhen manipulation is better than acupuncture. B ultrasonic image gives morphological performance of buttock tender node, the content is inflammatory infiltrates. B ultrasound has certainly significance in diagnosing, treating and evaluating the clinical effect of Pizhen manipulation on treating buttock tender node.

Piriformis syndrome: a simple technique for US-guided infiltration of the perisciatic nerve. Preliminary results.

The piriformis syndrome is an uncommon cause of sciatica, buttock or thigh pain. Because of the deep location of the muscle and sciatic nerve, infiltration has traditionally been guided by electromyography, fluoroscopy, computed tomography or magnetic resonance imaging. The aim of the present study is to describe a simple technique for ultrasound (US)-guided perisciatic infiltration of corticosteroids and anaesthetic using the inferior gluteal artery as a landmark. This technique was used satisfactorily in ten patients. Although the series in the study is limited, the procedure for US-guided infiltration of the perisciatic nerve is a quick, simple, economical and effective technique and can be considered an alternative in the percutaneous treatment of the piriformis syndrome.

Computed tomography in the evaluation of the gluteal region.

The role of computed tomography (CT) in the evaluation of the gluteal region was assessed. Six cases of gluteal masses were studied preoperatively by CT; several were also studied with conventional radiographic methods, including barium enema, cystogram, and intravenous urogram. Our case material included an epithelioid sarcoma, Ewing's sarcoma, endodermal sinus tumor, cystic hygroma, neurofibromatosis, and a normal variant. The conventional radiologic studies were normal or demonstrated nonspecific soft tissue density mass effect. By comparison, CT, with its cross-sectional imaging capability, provided unique diagnostic information. CT depicted the presence and origin of a mass, provided tissue characterization, and showed the extent of the lesion, often demonstrating the gluteal mass as an extension of an intrapelvic lesion. CT was valuable in monitoring tumor response to therapy, detecting recurrences, and excluding normal variants as the cause for a gluteal mass. The information provided by CT was important in treatment planning.