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1.
Ann R Coll Surg Engl ; 103(3): e91-e93, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645276
2.
J Equine Vet Sci ; 98: 103363, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33663728

RESUMO

Back pain is a common condition in horses, yet despite this, quantitative assessments of the efficacy of treatment are scarce. Mechanical nociceptive thresholds (MNTs) and acoustic myography (AMG) recordings were obtained, both preinterventionand postintervention, from the left and right epaxial muscles in eight healthy general riding horses (mean age 17 ± 6 yrs). Using an algometer, MNT readings were taken at each of the 6 preselected points along the thoracolumbar M. longissimus and M. gluteus medius region. AMG recordings of the M. longissimus and M. gluteus medius were taken while walking, trotting, and cantering on a left or right hand 20m circle on a longe, on a waxed sand surface in an indoor arena. Horses were then treated using a class 1 laser. Therapy was applied for 1 minute at 1000 Hz to the same preselected points from which MNT measurements had previously been taken. Measurements were subsequently taken 1 hour and 24 hours post-treatment for MNT reading, and only 24 hours after for AMG measurements. No significant effect of treatment was noted for the MNTs. The AMG results were analyzed in terms of their temporal summation (T-score), where statistically significant improvements in the T-scores for M. longissimus and M. gluteus medius were noted for the different gaits. It is concluded that cold laser therapy has a positive effect on horse muscles that reveals a change in their firing frequency that is commensurate with changes seen with analgesia in subjects experiencing pain.


Assuntos
Marcha , Nociceptividade , Animais , Dor nas Costas/veterinária , Nádegas , Cavalos , Músculos
3.
Artigo em Inglês | MEDLINE | ID: mdl-33562743

RESUMO

BACKGROUND: Abdominal and lumbo-pelvic stability alterations may be the origin of lower limb injuries, such as adductor pathology in soccer players. Imbalance can be caused by both intrinsic and extrinsic factors. METHODS: In this randomized controlled trial over 8 weeks, 25 female footballers were randomly allocated to an experimental group (isometric abdominal training and gluteus medius-specific training) or a control group (isometric abdominal training). Evaluations were performed at baseline, at the end of the intervention and after a 4-week follow-up period. The exercise protocol in common for both groups included three exercises: Plank, Lateral plank and Bird dog. Specific exercises for the gluteus medius were: Pelvic drop and Stabilization of the gluteus medius in knee valgus. Outcome measures were lumbar-pelvic stability and adductor strength. RESULTS: After the intervention, there was an increase in lumbo-pelvic stability in both groups, being greater in the control group than in the experimental group (mean differences [MD]: 4.84 vs. MD: 9.58; p < 0.01) with differences in the analysis of repeated measures (p < 0.001), but not in group interaction (p = 0.26). Changes were found in adductor strength in the experimental group (MD: -2.48; p < 0.001 in the left adductor; MD: -1.48; p < 0.01 in right adductor) and control group (MD: -1.68; p < 0.001 in the left adductor; MD: -2.05; p < 0.001 in the right adductor) after the intervention, with differences in the analysis of repeated measures in left (p < 0.001) and right (p < 0.001) adductor strength. CONCLUSIONS: An abdominal and gluteal training protocol shows no advantage over a protocol of abdominal training alone for lumbo-pelvic stability and adductor strength, while improvements in both variables are maintained at four weeks follow-up.


Assuntos
Futebol , Animais , Nádegas , Cães , Terapia por Exercício , Feminino , Humanos , Músculo Esquelético , Coxa da Perna
4.
Oper Orthop Traumatol ; 33(1): 36-45, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33475789

RESUMO

OBJECTIVE: Transgluteal approach for anatomical reduction of femoral neck fractures (extra-intraarticular) in children under preservation of the blood supply of the femoral head. INDICATIONS: Femoral neck fractures AO 31-M/2.1 I­III; 31-M/3.1 I­III; 31-M/3.2 I­III. CONTRAINDICATIONS: None. SURGICAL TECHNIQUE: Preparation of a muscular flap including the proximal insertion of the vastus lateralis muscle and approximately one third of the gluteus medius muscle. Elevation of the gluteus minimus muscle from the hip capsule without completely detaching it from its insertion. Exposure of the anterolateral hip capsule and capsulotomy followed by controlled reduction of the fracture fragments without compromising the retinacular vessels. POSTOPERATIVE MANAGEMENT: Touch-down weightbearing for 4-6 weeks (age dependent). To protect the healing of the abductors, active abduction or passive adduction prohibited for 4-6 weeks. Consolidation radiographs 4-6 weeks postoperatively. RESULTS: Excellent results in 29 patients subsequently treated in the last 10 years by the transgluteal approach. No cases of avascular necrosis of the femoral head by this procedure.


Assuntos
Fraturas do Colo Femoral , Nádegas , Criança , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/cirurgia , Cabeça do Fêmur , Fixação Interna de Fraturas , Humanos , Radiografia , Resultado do Tratamento
5.
Am Fam Physician ; 103(2): 81-89, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33448767

RESUMO

Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. Hip pain is usually located anteriorly, laterally, or posteriorly. Anterior hip pain includes referred pain from intra-abdominal or intrapelvic causes; extra-articular etiologies, such as hip flexor injuries; and intra-articular etiologies. Intra-articular pain is often caused by a labral tear or femoroacetabular impingement in younger adults or osteoarthritis in older adults. Lateral hip pain is most commonly caused by greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction. Posterior hip pain includes referred pain such as lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, and hamstring tendinopathy. In addition to the history and physical examination, radiography, ultrasonography, or magnetic resonance imaging may be needed for a definitive diagnosis. Radiography of the hip and pelvis should be the initial imaging test. Ultrasound-guided anesthetic injections can aid in the diagnosis of an intra-articular cause of pain. Because femoroacetabular impingement, labral tears, and gluteus medius tendon tears typically have good surgical outcomes, advanced imaging and/or early referral may improve patient outcomes.


Assuntos
Lesões do Quadril/diagnóstico , Doenças Musculoesqueléticas/diagnóstico , Dor/etiologia , Adulto , Nádegas , Diagnóstico Diferencial , Medicina de Família e Comunidade/métodos , Feminino , Quadril , Articulação do Quadril , Humanos , Masculino , Dor/diagnóstico
6.
J Pediatr Orthop ; 41(3): e240-e245, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33481480

RESUMO

BACKGROUND: Gluteal fibrosis (GF) is a fibrotic infiltration of the gluteal muscles resulting in functionally limiting contracture of the hips and is associated with injections of medications into the gluteal muscles. It has been reported in numerous countries throughout the world. This study assesses the 5-year postoperative range of motion (ROM) and functional outcomes for Ugandan children who underwent surgical release of GF. METHODS: A retrospective cohort study of children who underwent release of GF in 2013 at Kumi Hospital in Eastern Uganda. Functional outcomes, hip ROM, and scar satisfaction data were collected for all patients residing within 40 km of the hospital. RESULTS: One hundred eighteen children ages 4 to 16 at the time of surgery were treated with surgical release of GF in 2013 at Kumi Hospital. Of those 118, 89 were included in this study (79.5%). The remaining 29 were lost to follow-up or lived outside the study's radius. Detailed preoperative ROM and functional data were available for 53 of the 89 patients. In comparison with preoperative assessment, all patients postoperatively reported ability to run normally (P<0.001), sit upright in a chair (P<0.001), sit while eating (P<0.001), and attend the entire day of school (P<0.001). Passive hip flexion (P<0.001) improved when compared with preoperative measurements. In all, 85.2% (n=75) of patients reported satisfaction with scar appearance as "ok," "good," or "excellent" 29.2% (n=26) of patients reported back or hip complaints. CONCLUSIONS: Overall, the 5-year postoperative outcomes suggest that surgical release of GF improves ROM and functional quality of life with sustained effect. LEVEL OF EVIDENCE: Level IV-case series.


Assuntos
Nádegas/cirurgia , Contratura/cirurgia , Procedimentos Ortopédicos/estatística & dados numéricos , Adolescente , Nádegas/patologia , Criança , Feminino , Fibrose , Seguimentos , Humanos , Masculino , Procedimentos Ortopédicos/métodos , Período Pós-Operatório , Qualidade de Vida , Amplitude de Movimento Articular , Estudos Retrospectivos
7.
BMJ Case Rep ; 14(1)2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472803

RESUMO

Granulicatella adiacens, which occurs as part of the oral microflora, is an uncommon cause of infection. However, it can cause serious bloodstream infections including infective endocarditis. Although oral bacteria, most commonly the Fusobacterium spp, can cause internal jugular vein (IJV) thrombophlebitis, there are no reported cases of IJV thrombosis caused by G. adiacens Here we report a patient with septic IJV thrombosis with G. adiacens bacteraemia. A middle-aged man presented to our hospital with fever and altered mental status. Blood cultures were positive for G. adiacens, and pan-scan CT with contrast showed left IJV thrombosis, pulmonary embolism and abscesses in the gluteal muscles. The patient was successfully treated with antibiotics. When confronted with G. adiacens bacteraemia in patients with poor oral hygiene, it is necessary to be cautious of the fact that this organism can cause IJV thrombophlebitis.


Assuntos
Abscesso/diagnóstico por imagem , Carnobacteriaceae , Infecções por Bactérias Gram-Positivas/diagnóstico , Veias Jugulares , Embolia Pulmonar/diagnóstico por imagem , Tromboflebite/diagnóstico por imagem , Abscesso/terapia , Antibacterianos/uso terapêutico , Hemocultura , Nádegas , Drenagem , Duração da Terapia , Inibidores do Fator Xa/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , Piridinas/uso terapêutico , Tiazóis/uso terapêutico , Tromboflebite/tratamento farmacológico , Tomografia Computadorizada por Raios X
8.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462021

RESUMO

We present two unusual presentations of extrapulmonary tuberculosis (EPTB) and more specifically intra-abdominal tuberculosis (TB). These cases were initially suspicious for ovarian cancer, presenting with non-specific symptoms, ultrasound-confirmed ascites and elevated cancer antigen 125 tumour marker (CA 125). However, in both cases chest imaging demonstrated enlarged mediastinal nodes amenable to endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which confirmed the diagnosis of TB. Both cases were successfully treated with quadruple TB therapy.


Assuntos
Dor Abdominal/etiologia , Antígeno Ca-125/sangue , Tuberculose/diagnóstico , Adolescente , Biomarcadores/sangue , Nádegas , Feminino , Humanos , Pessoa de Meia-Idade , Tuberculose/sangue , Tuberculose/complicações
9.
J Strength Cond Res ; 35(1): 16-24, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33332802

RESUMO

ABSTRACT: Williams, MJ, Gibson, N, Sorbie, GG, Ugbolue, UC, Brouner, J, and Easton, C. Activation of the gluteus maximus during performance of the back squat, split squat, and barbell hip thrust and the relationship with maximal sprinting. J Strength Cond Res 35(1): 16-24, 2021-The purpose of this research was to compare muscle activation of the gluteus maximus and ground reaction force between the barbell hip thrust, back squat, and split squat and to determine the relationship between these outcomes and vertical and horizontal forces during maximal sprinting. Twelve, male, team sport athletes (age, 25.0 ± 4.0 years; stature, 184.1 ± 6.0 cm; body mass, 82.2 ± 7.9 kg) performed separate movements of the 3 strength exercises at a load equivalent to their individual 3 repetition maximum. The ground reaction force was measured using force plates and the electromyography (EMG) activity of the upper and lower gluteus maximus and was recorded in each leg and expressed as percentage of the maximum voluntary isometric contraction (MVIC). Subjects then completed a single sprint on a nonmotorized treadmill for the assessment of maximal velocity and horizontal and vertical forces. Although ground reaction force was lower, peak EMG activity in the gluteus maximus was higher in the hip thrust than in the back squat (p = 0.024; 95% confidence interval [CI] = 4-56% MVIC) and split squat (p = 0.016; 95% CI = 6-58% MVIC). Peak sprint velocity correlated with both anterior-posterior horizontal force (r = 0.72) and peak ground reaction force during the barbell hip thrust (r = 0.69) but no other variables. The increased activation of gluteus maximus during the barbell hip thrust and the relationship with maximal running speed suggests that this movement may be optimal for training this muscle group in comparison to the back squat and split squat.


Assuntos
Contração Isométrica , Músculo Esquelético , Adulto , Nádegas , Eletromiografia , Humanos , Masculino , Coxa da Perna , Adulto Jovem
10.
Phys Ther Sport ; 48: 43-53, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33360409

RESUMO

OBJECTIVE: To evaluate the reporting of eligibility criteria and baseline participant characteristics in randomised controlled trials investigating the effects of exercise interventions in tendinopathy. METHODS: Randomised controlled trials investigating the effects of exercise therapy compared to a non-exercising intervention in upper and lower limb tendinopathy were included. Data extraction was categorised into the following domains: participant demographics, tendinopathy descriptors, general health, participant recruitment and eligibility criteria. RESULTS: The review included the following tendinopathies: Achilles (n = 9), gluteal (n = 2), lateral elbow tendinopathy (n = 15), patellar (n = 3) plantar (n = 3), and rotator cuff (n = 13). Age, sex, duration of symptoms and symptom severity were commonly reported across the review, while prior history of tendinopathy was poorly reported (6/45). Variables such as physical activity level (17/45), sleep (0/45), psychological factors (2/45), medication at baseline (8/45), co morbid health complaints (10/45) and sociodemographic factors (11/45) were poorly reported across the included studies. Substantial variation existed between studies in the specific eligibility criteria used. CONCLUSION: The findings of this systematic review demonstrate that participant characteristics are poorly reported in exercise trials in tendinopathy. To improve effectiveness of exercise interventions in tendinopathy, improved reporting of participant characteristics may allow better comparisons and targeted interventions for specific subgroups.


Assuntos
Terapia por Exercício/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Tendinopatia/terapia , Tendão do Calcâneo/patologia , Nádegas/patologia , Cotovelo/patologia , Definição da Elegibilidade , Exercício Físico , Humanos , Extremidade Inferior/patologia , Patela/patologia , Seleção de Pacientes , Manguito Rotador/patologia , Resultado do Tratamento
11.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(12): 1177-1181, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33353273

RESUMO

Objective: To investigate the safety and feasibility of transgluteal percutaneous drainage using double catheterization cannula in the treatment of deep pelvic abscess. Methods: A retrospective analysis of the clinical data of patients who underwent transgluteal percutaneous drainage using double catheterization cannula with deep pelvic abscesses admitted to the Jinling Hospital from May 2017 to September 2020 was conducted. Seven patients were enrolled, including 5 males and 2 females, who aged 26-74 (median 53.0) years old, and all of them had digestive fistula. One male patient was punctured again due to the tube falling off, and a total of 7 patients underwent 8 times of transgluteal percutaneous drainage, all under the guidance of CT. The puncture and drainage steps of the double catheterization cannula group are as follows: (1) Locate the puncture point under CT in the lateral position; (2) Place the trocar into the abscess cavity; (3) Confirm that the trocar is located in the abscess cavity under CT; (4) Pull out the inner core and insert into the double catheterization cannula through the operating hole; (5) Confirmthat the double catheterization cannula is located in the abscess cavity under CT; (6) The double catheterization cannula is properly fixed to prevent it from falling off. The white blood cells, C-reactive protein (CRP), procalcitonin, and interleukin-6 (IL-6) of all patients before the drainage and 1 days, 3 days, and 5 days after the drainage were collected, as well as the bacterial culture results of the drainage fluid. The changes of various infection biomarkers before and after the drainage were compared. Results: All 7 patients were cured. No complications such as hemorrhage and severe pain were observed. The average time with drainage tube was 60.8 (18-126) days. Five patients finally underwent gastrointestinal reconstruction surgery due to gastrointestinal fistula. The median serum interleukin-6 of patients before drainage, 1 day, 3 days and 5 days after drainage were 181.6 (113.0, 405.4) µg/L, 122.2 (55.8, 226.0) µg/L, 59.2 (29.0,203.5) µg/L and 64.1 (30.0,88.4) µg/L, respectively.The level of serum interleukin-6 at 3 days and 5 days after drainage was significantly lower than before drainage (F=3.586, P=0.026). Although the white blood cell count, C-reactive protein, and procalcitonin decreased gradually after drainage compared with before drainage, the difference was not statistically significant (all P>0.05). Conclusion: Transgluteal percutaneous drainage with double catheterization cannula is simple and effective, and can be used for the treatment of deep pelvic abscess.


Assuntos
Abscesso , Fístula do Sistema Digestório/complicações , Drenagem/métodos , Infecção Pélvica/cirurgia , Abscesso/etiologia , Abscesso/cirurgia , Adulto , Idoso , Nádegas/cirurgia , Cateterismo/métodos , Fístula do Sistema Digestório/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecção Pélvica/etiologia , Pelve/cirurgia , Estudos Retrospectivos , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
12.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318271

RESUMO

Sarcomas are a rare and fatal treatment complication following radiotherapy. Radiation-induced sarcomas (RISs) presenting as a gluteal abscess is a rarity, accounting for its varied presentation. We present a case of a middle-aged woman, post-chemo-radiation for carcinoma cervix 5 years ago, who presented with gluteal abscess. Achieving haemostasis post incision and drainage under anaesthesia was a challenge. On further evaluation, she was diagnosed with radiation-induced gluteal soft tissue sarcoma. Haemostasis was achieved after radiation following failed attempts of surgical and radiological interventions. She is currently planned for chemotherapy. Cancer survivors have an increased risk of developing a second malignancy following radiation treatment. RISs are highly aggressive, exhibit a varied clinical presentation and pose a challenge in early diagnosis; thus, have a poor outcome. RISs pose a diagnostic challenge; any dubious lesion in the previously irradiated field should raise suspicion and prompt aggressive management.


Assuntos
Nádegas , Neoplasias Induzidas por Radiação/diagnóstico , Segunda Neoplasia Primária/diagnóstico , Sarcoma/diagnóstico , Abscesso/diagnóstico , Angiografia Digital , Doenças do Ânus/diagnóstico , Biópsia , Nádegas/diagnóstico por imagem , Nádegas/patologia , Carcinoma de Células Escamosas/radioterapia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Feminino , Hemorragia/etiologia , Hemorragia/terapia , Técnicas Hemostáticas , Humanos , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/complicações , Neoplasias Induzidas por Radiação/patologia , Segunda Neoplasia Primária/complicações , Segunda Neoplasia Primária/patologia , Sarcoma/complicações , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Tomografia Computadorizada por Raios X , Neoplasias do Colo do Útero/radioterapia
13.
Pan Afr Med J ; 37: 48, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33209175

RESUMO

In the COVID-19's crisis, elective surgery and non-emergent cases were postponed; all other procedures have to be minimized. A 17-year male patient with severe crush and degloving injury over the thigh, gluteal, sacral, and perineum areas was admitted to our Department on the 16th of March 2020. The patient presented soft tissue skin and muscle loss. A double Latissimus Dorsi and Anterolateral Thigh free flaps were indicated. However, due to the particular circumstance of the COVID-19 crisis, we applied domestic negative wound therapy (NPWT) using gauzes and wall suction. We obtained suitable granulation tissue after 17 consecutive days with this treatment. The raw area was then covered with an expanded split-thickness skin graft. The wound healed at 95%, and the patient was discharged on 25th of April 2020. He was followed up in an outpatient setting with wound care and physiotherapy. This case showed that in a limited-resource setting, with available wall suction, the domestic NPWT is a versatile tool to promote granulation tissue.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Lesões por Esmagamento/cirurgia , Desenluvamentos Cutâneos/cirurgia , Tratamento de Ferimentos com Pressão Negativa/métodos , Pneumonia Viral/epidemiologia , Retalhos Cirúrgicos/transplante , Acidentes de Trânsito , Adolescente , Bandagens , Nádegas/lesões , Desbridamento , Humanos , Masculino , Músculo Esquelético/lesões , Pandemias , Períneo/lesões , Coxa da Perna/lesões , Cicatrização , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/microbiologia
14.
Artigo em Russo | MEDLINE | ID: mdl-33095534

RESUMO

OBJECTIVE: Sciatic nerve injury in the deep gluteal space is a major clinical problem due to microsurgical manipulations in this region are limited in scope. We offer new endoscopic approach to the sciatic nerve in the deep gluteal space which allows to perform microsurgical manipulations, neurophysiological mapping and electrode installation for the chronic nerve stimulation. MATERIAL AND METHOD: 3 patients with sciatic neuropathy have been operated. Before the operation they suffered from neuropathic pain in the the posterior thigh and calf, reaching 7-8 points on the visual analog scale (VAS). Paresis of triceps surae and biceps femur also was occurred. We performed endoscopic approach to the deep gluteal space through a small incision under the gluteal fold. Microsurgical external and internal decompression of sciatic nerve was performed under the endoscopic control. Next, intra-trunk nerve mapping was performed to visualize sensory fibers. Cylindrical electrodes for chronic neurostimulation were directly placed on the sensory fibers of sciatic nerve. RESULTS: Pain relief was obtained in all cases after activating the simulator, the patient noted a 50% reduction in pain. Muscle straight restoration was observed in all cases 2-3 months later. The clinical effect was stable in the follow up (6 months). CONCLUSION: This technique, combining minimal invasiveness and intraoperative neurophysiological control, makes it possible to optimally position the electrode, both to achieve positive analgesic effect and for potential restoration of nerve function.


Assuntos
Neuralgia , Neuropatia Ciática , Nádegas , Endoscopia , Humanos , Neuralgia/etiologia , Neuralgia/terapia , Nervo Isquiático , Neuropatia Ciática/etiologia , Neuropatia Ciática/cirurgia
15.
Plast Reconstr Surg ; 146(4): 778-781, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32969999

RESUMO

Mortality after gluteal augmentation with fat transfer techniques is extremely high. Placement of fat subcutaneously versus in the gluteal musculature, or both, is considerably debated. The purpose of this study was to radiographically show the anatomical difference in live subjects in different procedural positions: the flexed or "jackknife" versus prone position. A total of 10 women underwent computed tomographic scanning of the pelvis with venous phase run-off in both the jackknife and prone positions. A computed tomography-specialized radiologist then reviewed images and measured distances from the inferior and superior gluteal veins to the skin and muscle. Three-dimensional imaging and analysis were also performed. Measurements were significantly shorter with respect to distance from skin to muscle, skin to vessel, and vessel to muscle observed from inferior and superior gluteal veins in the jackknife versus the prone position. Three-dimensional modeling showed a significant reduction in the volume and inferior and superior gluteal vein diameters when in the jackknife position. When placed in the jackknife position for gluteal augmentation with fat transfer, extreme caution should be taken with the injecting cannula, as the underlying muscle is only 2 to 3 cm deep. Three-dimensional analysis showed narrowed and reduced volume of gluteal vasculature when in the jackknife position; this is a possible indication of torsion or stretch on the vessel around the pelvic rim that could cause vein avulsion injury from the pressurized fat within the piriform space.


Assuntos
Nádegas/irrigação sanguínea , Nádegas/diagnóstico por imagem , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/diagnóstico por imagem , Posicionamento do Paciente/métodos , Tomografia Computadorizada por Raios X , Adulto , Nádegas/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Músculo Esquelético/cirurgia , Decúbito Ventral , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos , Adulto Jovem
16.
Dermatol Online J ; 26(6)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32815698

RESUMO

Porokeratosis ptychotropica (PP) is a rare variant of porokeratosis characterized by pruritic, scaly papules and plaques localized to the perianal and gluteal cleft regions. Clinically, PP resembles other common disorders, resulting in frequent misdiagnosis. The diagnosis of PP often takes several years to make, therefore many reported cases in the literature described the late stages of PP. We report a case of PP diagnosed at an early stage. By presenting our patient, we aim to raise further awareness of PP to avoid a delay in diagnosis, thus preventing long term complications of this rare entity.


Assuntos
Poroceratose/diagnóstico , Pele/patologia , Nádegas , Erros de Diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Poroceratose/patologia
17.
Plast Reconstr Surg ; 146(2): 284-293, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740577

RESUMO

BACKGROUND: Gluteal prominence is a unique characteristic that is widely acknowledged in female contouring but ignored in the male population. This study focuses on male gluteal aesthetics based on a muscular anatomical approach. METHODS: A retrospective review of gluteal contouring in men from January of 2012 to September of 2019 was conducted. Male body sculpting surgery in the gluteal area was performed in most cases. Patients were included according to preoperative assessment and the American Heart Association risk analysis. The gluteal area was divided into four main anatomical contouring zones and classified according to the procedure type. The follow-up period of 3 months to 6 years was included with photographs and medical assessment data. A nonstandardized satisfaction survey was performed postoperatively. RESULTS: The analysis included data from 374 consecutive gluteal dynamic definition liposculptures performed in men (mean age, 38.2 years; range, 20 to 66 years). Patients were treated according to the authors' new classification of deformities. Fat extraction, liposhifting, and fat grafting were performed on a regular basis to enhance and define the gluteal area. A satisfaction index of 92.5 percent was reported. Minor complications were reported: seroma, 0.2 percent; prolonged bruising, 1.3 percent; and swelling, 1.8 percent. No necrosis, burns, or infections were reported. CONCLUSIONS: Men have been increasingly requesting improvement and definition of the buttocks, and our novel algorithm allows for a reliable method in this regard. The high satisfaction index supports the natural and athletic results accomplished with our new approach.


Assuntos
Tecido Adiposo/transplante , Contorno Corporal/métodos , Nádegas/anatomia & histologia , Estética , Lipectomia/métodos , Adulto , Idoso , Contorno Corporal/efeitos adversos , Nádegas/diagnóstico por imagem , Seguimentos , Humanos , Lipectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Adulto Jovem
18.
Plast Reconstr Surg ; 146(3): 276e-282e, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32842100

RESUMO

BACKGROUND: The deep inferior epigastric artery perforator (DIEP) flap is the gold standard in autologous breast reconstruction. When the abdomen is not available, alternative donor sites can be found at the buttock, the lumbar region, or the thighs. These flaps are referred to as second-choice flaps. This study compares the superior gluteal artery perforator (SGAP) flap and the lumbar artery perforator (LAP) flap to the DIEP flap using patient-reported outcomes. METHODS: A retrospective study was performed reviewing the records of 417 women who underwent a free flap breast reconstruction with either a DIEP, an LAP, or an SGAP flap, between 2006 and 2018. Patients were asked to fill out the BREAST-Q questionnaire, and patient-reported outcomes were analyzed and correlated to the demographic information. RESULTS: The response rate was 54.5 percent, with 50 LAP, 153 DIEP, and 25 SGAP flap patients participating. When questioned about their satisfaction with breasts and satisfaction with outcome, all three procedures were rated similarly high. When comparing the physical well-being of the donor site and appearance of the donor site, LAP flap patients reported significantly lower scores than DIEP and SGAP flap patients. CONCLUSIONS: Patients who undergo LAP or SGAP flap breast reconstruction seem similarly satisfied with the appearance and outcome of their free flap breast reconstruction compared with DIEP flap patients. The donor-site morbidity and its impact on the patient's well-being in SGAP and LAP flap patients have been underestimated. Despite more donor-site discomfort, the LAP and SGAP flaps are feasible alternatives whenever the DIEP flap is not possible.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Medidas de Resultados Relatados pelo Paciente , Retalho Perfurante/irrigação sanguínea , Adulto , Artérias , Nádegas/irrigação sanguínea , Nádegas/cirurgia , Artérias Epigástricas , Feminino , Humanos , Região Lombossacral/irrigação sanguínea , Região Lombossacral/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos
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