Background Percutaneous coronary intervention(PCI)is a widely utilized revascularization technique for coronary artery disease(CAD).While clinical and biomarker-based prognostic tools are standard for predicting outco...Background Percutaneous coronary intervention(PCI)is a widely utilized revascularization technique for coronary artery disease(CAD).While clinical and biomarker-based prognostic tools are standard for predicting outcomes,there is growing interest in sarcopenia as a marker of frailty and its potential role in long-term prognosis.The prognostic value of the psoas muscle index(PMI),a sarcopenia metric,remains underexplored in PCI populations regarding long term survival.Methods This single-center retrospective cohort study evaluated 177 patients undergoing PCI from 2015 to 2019.PMI was calculated from computed tomography(CT)imaging at the L3 vertebral level using the formula:(left psoas area+right psoas area)/height2 and expressed in cm^(2)/m^(2).Sarcopenia was defined as the lowest sex-specific PMI quartile.Primary outcomes included 5-year all-cause mortality and 3-point major adverse cardiovascular events(MACE:non-fatal myocardial infarction,ischemic stroke,and cardiac death).Binary linear regression and Cox proportional hazards models were utilized to determine associations between PMI and outcomes Results Sarcopenic patients exhibited significantly higher 5-year all-cause mortality compared to non-sarcopenic counterparts(64.4%vs.35.6%,P<0.001),while no significant difference was observed in 3-point MACE incidence(55.6%vs.51.4%,P=0.520).Sarcopenia was independently associated with all-cause mortality on binary logistic regression(OR=3.49;95%CI:1.69–7.19;P=0.0007),but not MACE(OR=1.00;95%CI:0.50–1.98;P=0.99).In a multivariable Cox regression model,sarcopenia was associated with increased hazard of mortality(HR=1.60;95%CI:0.96–2.66;P=0.071),though this did not reach statistical significance.Kaplan-Meier analysis demonstrated significantly reduced survival among sarcopenic patients(χ^(2)=6.13,P=0.0133).Conclusions PMI is a significant independent predictor of 5-year all-cause mortality in PCI patients,underscoring the prognostic importance of assessing skeletal muscle mass in this population.展开更多
Psoas muscle metastasis, though rare, is the commonest site of skeletal muscle involvement in cervical carcinoma. The appropriate clinical management of this condition, particularly of the pain related to malignant ps...Psoas muscle metastasis, though rare, is the commonest site of skeletal muscle involvement in cervical carcinoma. The appropriate clinical management of this condition, particularly of the pain related to malignant psoas syndrome, is still evolving and the diagnostic features on conventional morphological imaging modalities are often non specific, with the differential diagnosis lying between sarcoma, hematoma, and abscess. In this report, a comparison of various morphofunctional imaging modalities was made. Fluorodeoxyglucosepositron emission tomography(FDG-PET)/computed tomography(CT) was the first to suspect disease involvement of the psoas muscle, demonstrating intense FDG uptake(compared with the contralateral muscle), while ultrasound showed heterogeneous echotexture, and magnetic resonance imaging(MRI) showed subtle altered signal intensity in the right psoas muscle. Both anatomical imaging modalities and non contrast CT of the PET-CT examination demonstrated a bulky psoas muscle, without any focal abnormality. On diffusionweighted imaging of MRI(DWI-MRI), restricted diffusion of the involved muscle was an important observation. The psoas muscle metastatic involvement was proven histopathologically. Thus, enhanced glucose metabolism and restricted diffusion in the newer noninvasive molecular imaging modalities(e.g., PET/CT and DWI-MRI) could serve as valuable adjunctive parameters in diagnosing this entity in the absence of a focal abnormality in the anatomical modalities. In the treatment response monitoring scenario, FDG-PET/CT demonstrated near complete resolution following administration of 3 cycles of systemic chemotherapy and local external radiotherapy.展开更多
Although acute appendicitis is a common disease, retroperitoneal abscesses are rarely observed. Here, we report a case consisting of a psoas abscess and cutaneous fistula caused by appendicitis. The patient was a 56-y...Although acute appendicitis is a common disease, retroperitoneal abscesses are rarely observed. Here, we report a case consisting of a psoas abscess and cutaneous fistula caused by appendicitis. The patient was a 56-year-old male who was introduced to our institution due to an intractable right psoas abscess. Imaging tests had been performed over the previous 3 years; however, clinicians could not find the origin of the abscess and failed to resolve the problem. A successful operation was performed via a laparoscopic approach, and 17 mo have passed without recurrence. The advantage of laparoscopic surgery is well understood in cases of appendicitis with abscesses. However, the indication for laparoscopic approach is not clear for retroperitoneal abscesses. From our experience, we can conclude that appendicitis with retroperitonealabscesses can be managed and treated using a laparoscopic approach.展开更多
BACKGROUND Patients with end-stage liver disease usually have varying degrees of malnutrition,and severe malnutrition may affect the prognosis of patients after liver transplantation(LT).However,there is no recommende...BACKGROUND Patients with end-stage liver disease usually have varying degrees of malnutrition,and severe malnutrition may affect the prognosis of patients after liver transplantation(LT).However,there is no recommended standard for the nutrition assessment of patients waiting for LT,and it is unknown whether malnutrition has an impact on the occurrence of postoperative complications.AIM The study aim was to investigate the value of the controlling nutritional status(CONUT)score and psoas muscle thickness per height(PMTH)in predicting prognosis in LT.METHODS We retrospectively analyzed the clinical data of 313 patients who underwent classic orthotopic LT from January 2016 to December 2018 in Tianjin First Central Hospital affiliated with Tianjin Medical University.The CONUT score is derived from the preoperative serum albumin and total cholesterol levels,and total lymphocyte count.Patients were divided into low(≤4),medium(5–8),and high(9–12)CONUT score groups perioperative characteristics,Clavien-Dindo grade III/IV/V postoperative complications,graft loss and infection,and cumulative postoperative survival in the three groups were compared 3 mo after LT.PMTH was calculated as the ratio of the transverse thickness of the psoas muscle in the umbilical plane to the height of the patient.The cutoff values of receiver operating characteristic curves were determined separately for men and women.The values were 14.1 cm/m2 for women and 17.9 cm/m2 for men.The patients were then divided into low and high PMTH groups by the cutoff values.The comparison of data between the two groups was the same as above.RESULTS Patients with medium and high CONUT scores had lower preoperative serum hemoglobin,more intraoperative red blood cell(RBC)transfusions,longer postoperative intensive care unit stay and hospital stays,higher 7 and 14 preoperative-day serum bilirubin levels,and a higher incidence of postoperative grade III/IV complications and infections than patients with low CONUT scores.Differences in the 3-mo cumulative survival among the three groups were not significant.Patients with a low PMTH had higher preoperative serum urea nitrogen,more intraoperative packed RBC and frozen plasma transfusions,longer times to postoperative ventilator extubation,higher incidence of total postoperative complications,and a lower 3-mo cumulative survival than those with a high PMTH.CONCLUSION A CONUT score≥5 and a low PMTH were both associated with poor prognosis in LT.The CONUT score had no predictive value for short-term patient survival after LT,but the PMTH was predictive of short-term patient survival after LT.展开更多
Use of the da Vinci■surgical robotic system has expanded to numerous upper and lower urinary tract procedures.We describe our surgical technique and perioperative outcome of robotic distal ureterectomy with psoas hit...Use of the da Vinci■surgical robotic system has expanded to numerous upper and lower urinary tract procedures.We describe our surgical technique and perioperative outcome of robotic distal ureterectomy with psoas hitch and ureteroneocystostomy for distal ureteral pathologies.Eight patients with a median age of 69.5 years old underwent robotic distal ureterectomy with psoas hitch and ureteroneocystostomy between April 2009 and August 2014.The entirety of all cases was performed robotically by a single surgeon at a tertiary academic medical center.Median operative time was 285 min(range:210-360 min),estimated blood loss was 50 mL(range:50-75 mL)and median length of hospital stay was 2.5 days(range:1-6 days).There was one post-operative complication,a readmission for dehydration(Clavien Ⅰ).It suggests that robotic distal ureterectomy with psoas hitch and ureteroneocystostomy is a safe and effective minimally invasive alternative for patients with distal ureteral pathology.展开更多
Lumbar sympathetic block is an analgesic procedure frequently performed in chronic pain clinics for ischemic lower limb pain from peripheral arterial disease. Although the lumbar sympathetic ganglia are anatomically n...Lumbar sympathetic block is an analgesic procedure frequently performed in chronic pain clinics for ischemic lower limb pain from peripheral arterial disease. Although the lumbar sympathetic ganglia are anatomically near major vascular and neural structures, complications such as severe hemorrhage is rarely reported. Aspirin/extended release dipyridamole (Aggrenox) is indicated for secondary stroke prevention. Stroke is frequently a co-morbid condition in patients with peripheral vascular disease. Interventional pain physicians frequently face the difficulty of deciding whether to continue or stop antithrombotic medications in the periprocedural period because of the devastating consequences of both hemorrhagic and thrombotic complications. Due to a paucity of data, no guidelines have been specifically written for interventional procedures for chronic pain. To aid future decision making, we present a case report of psoas hematoma developed after lumbar sympathetic block in a patient with end stage renal failure and hepatic dysfunction who had limb-threatening ischemia. The patient was treated with Aggrenox until three days before the procedure.展开更多
Psoas muscle is a rare location for hydatid disease. Here we present a case of infected hydatid cyst left psoas muscle presenting as left flank pain, fever, local flank tenderness, and raised blood counts. Preoperativ...Psoas muscle is a rare location for hydatid disease. Here we present a case of infected hydatid cyst left psoas muscle presenting as left flank pain, fever, local flank tenderness, and raised blood counts. Preoperative diagnoses was made by Ultrasonography (USG) and Computed Tomography (CT) abdomen, although serology for hydatid disease was negative.展开更多
Hydatid cyst of the psoas is rare even in countries endemic to hydatidosis. We hereby report a case of hydatid cyst of the psoas in a 69 years old patient with a history of hypertension and had received left nephrecto...Hydatid cyst of the psoas is rare even in countries endemic to hydatidosis. We hereby report a case of hydatid cyst of the psoas in a 69 years old patient with a history of hypertension and had received left nephrectomy due to a renal abscess 2 years prior to his admission.展开更多
<div style="text-align:justify;"> <span style="font-family:Verdana;">Tuberculous sacroiliitis secondary to a psoas abscess is rare, only a few sporadic cases were reported in the litera...<div style="text-align:justify;"> <span style="font-family:Verdana;">Tuberculous sacroiliitis secondary to a psoas abscess is rare, only a few sporadic cases were reported in the literature. Tuberculous sacroiliitis is rare, usually unilateral, its symptomatology is misleading, its diagnosis is often delayed or even confused with damage to the hip or lumbosacral hinge, most often related to difficulties exploration of the sacroiliac joint. We report the case of a 66-year-old diabetic patient with low back pain, unilateral right with inflammatory appearance, insidious installation, evolving for about 8 months. The diagnosis of tuberculous sacroiliitis was made after biopsy of the sacroiliac joint. CT and MRI are necessary for lesion diagnosis. Tuberculosis treatment was started and the abscess was surgically drained. The aim of this work was to describe the diagnostic pathway of a patient with tuberculous sacroiliitis in a tropical environment. Conclusion: Tuberculous sacroiliitis, secondary to an abscess of the psoas muscle is an unusual cause of hip pain and is likely to be overlooked due to its atypical presentation.</span> </div>展开更多
OBJECTIVE： It is unknown whether the psoas major muscle, thought to be a key muscle for treatment of lower back pain, can be punctured at Shenshu（BL23）.METHODS： Twelve dissected specimens were used for studying th...OBJECTIVE： It is unknown whether the psoas major muscle, thought to be a key muscle for treatment of lower back pain, can be punctured at Shenshu（BL23）.METHODS： Twelve dissected specimens were used for studying the needling pathway of BL23 by perpendicularly inserting the depth-measuring blade of a vernier caliper at BL23. Dimensions of psoas muscle were measured. Correlation studies were conducted. In addition, our samples were grouped by gender and underlying medical conditions for analysis.RESULTS： Half（50%） of the needle insertions successfully punctured psoas muscle. The mean depth of needle insertion to puncture psoas muscle（D_（min）） in the group with short-term underlying medical conditions was 38.0 mm（interquartile range 29.0–51.8 mm）, approximately 6 mm deeper than 32.0（29.3–42.5） mm in the group with long-term health problems（P = 0.041）. The cross-sectional area（CSA） of psoas muscle in the former group was on average approximately 1.5 times that of the latter group（P = 0.04）. When the data were analysed by gender, the thickness of psoas muscle in the male group was 19.0（6.5–24.0） mm compared to 19.5（5.8–34.8） mm in the female group（P = 0.02）. The age in the female group（P = 0.04） and the body length of the total group（P = 0.04） negatively correlated to D_（min）.CONCLUSION： Needle insertion at BL23 might be able to puncture psoas muscle. Differences in the CSA of psoas muscle and D_（min） were observed in groups with short-term and long-term underlying medical conditions.展开更多
Magnetic resonance elastography (MRE) can visualize the shear wave propagation of in vivo tissues, which can be mapped into viscoelastic properties. No study has measured the biomechanical properties of the PM muscle ...Magnetic resonance elastography (MRE) can visualize the shear wave propagation of in vivo tissues, which can be mapped into viscoelastic properties. No study has measured the biomechanical properties of the PM muscle in vivo using MRE. In this study, we evaluated stiffness values calculated by local frequency estimate (LFE) and algebraic inversion of differential equation (AIDE) in PM-MRE. The PM muscles of 17 healthy male volunteers were scanned in supine position by MRE. The Laplacian-based estimate (LBE) phase wrapped image data were filtered by gaussian-bandpass filter (GBF), and by both directional and GBF. LFE (MREWave) and AIDE wave inversion methods were used to calculate the respective elastograms. The wave interferences were removed by directional filtering, and smooth wave fields were obtained. The stiffness values calculated by LFE of non-DF images were 1.39 ± 0.25 kPa and 1.33 ± 0.22 kPa for right and left PM respectively, whereas for DF images, they were 1.26 ± 0.20 kPa for right PM and 1.18 ± 0.28 kPa for left PM. The stiffness values calculated by AIDE of non-DF images were 0.78 ± 0.10 kPa and 0.78 ± 0.13 kPa for right and left PM respectively, whereas for DF images, they were 0.73 ± 0.12 kPa for right PM and 0.74 ± 0.11 kPa for left PM. There was no statistically significant difference in mean values of stiffness with/without applying directional filter whereas there was a statistically significant difference in mean values of stiffness between LFE and AIDE. Both LFE and AIDE could be used for psoas major MR Elastography.展开更多
The primary abscess of the psoas of the child is a rare affection, the pathogenesis of which is still unexplained. The positive diagnosis of this condition is difficult and relies mainly on medical imaging. We report ...The primary abscess of the psoas of the child is a rare affection, the pathogenesis of which is still unexplained. The positive diagnosis of this condition is difficult and relies mainly on medical imaging. We report a case of primary psoas abscess in an immunocompetent child, whose diagnosis was facilitated by the provision of abdominal radiography without preparation and abdominal ultrasound. The evolution was favorable thanks to the combination of antibiotic therapy and surgery.展开更多
Aims:Although the skeletal muscle index at the third lumbar vertebra(L3-SMI)is commonly utilized for the diagnosis of sarcopenia,the psoas muscle index at L3(L3-PMI)may serve as a reliable alternative indicator.This s...Aims:Although the skeletal muscle index at the third lumbar vertebra(L3-SMI)is commonly utilized for the diagnosis of sarcopenia,the psoas muscle index at L3(L3-PMI)may serve as a reliable alternative indicator.This study aims to investigate the application of the PMI in patients who have undergone transjugular intrahepatic portosystemic shunt(TIPS).Methods:This study included a cohort of 406 patients with cirrhosis who underwent TIPS between February 2016 and July 2022 across three medical centers in China.Clinical and imaging data,specifically L3-SMI and L3-PMI,were collected for these patients.The prognosis of the patients was assessed through re-examinations and telephone follow-ups,which extended up to 5 years.The diagnostic thresholds for sarcopenia,as defined by L3-PMI and L3-SMI,were established at 6.36 or 42.00 cm^(2)/m^(2) for males and 3.92 or 38.00 cm^(2)/m^(2) for females,respectively.Cox proportional hazards and Kaplan–Meier(K-M)analyses were employed to evaluate patient survival.Results:The findings indicated that both L3-PMI and L3-SMI before TIPS were independent risk factors for mortality.The results of the paired t-test demonstrated a significant increase in L3-PMI 1 month post-TIPS(5.11±1.81 vs.5.71±1.90 cm^(2)/m^(2) ,p<0.001),whereas L3-SMI did not exhibit a significant increase until 6 months post-TIPS(45.45±9.41 vs.48.59±10.38 cm^(2)/m^(2) ,p<0.001).Among these patients,191(47.0%)and 159(39.2%)were diagnosed with sarcopenia according to the L3-PMI and L3-SMI models,respectively.Patients identified as sarcopenic by both indicators demonstrated a significantly lower survival rate(L3-SMI model:hazard ratio[HR],1.913;95%confidence interval[CI],1.094–3.410;log-rank p=0.020;L3-PMI model:HR,1.867;95%CI,1.059–3.290;log-rank p=0.030).In sarcopenic patients,the reversal of sarcopenia associated with improved survival occurred 1 month after TIPS in the L3-PMI model(HR,2.675;95%CI,1.245–5.735;log-rank p=0.012),while a similar effect was not observed until 6 months post-TIPS in the L3-SMI model(HR,3.342;95%CI,1.477–7.560;logrank p=0.004).Conclusions:L3-PMI and L3-SMI demonstrate comparable efficacy in diagnosing cirrhosis-related sarcopenia.Furthermore,L3-PMI has the capacity to identify improvements in sarcopenia as early as 1 month following TIPS,thereby providing earlier insights into patient survival outcomes.展开更多
文摘Background Percutaneous coronary intervention(PCI)is a widely utilized revascularization technique for coronary artery disease(CAD).While clinical and biomarker-based prognostic tools are standard for predicting outcomes,there is growing interest in sarcopenia as a marker of frailty and its potential role in long-term prognosis.The prognostic value of the psoas muscle index(PMI),a sarcopenia metric,remains underexplored in PCI populations regarding long term survival.Methods This single-center retrospective cohort study evaluated 177 patients undergoing PCI from 2015 to 2019.PMI was calculated from computed tomography(CT)imaging at the L3 vertebral level using the formula:(left psoas area+right psoas area)/height2 and expressed in cm^(2)/m^(2).Sarcopenia was defined as the lowest sex-specific PMI quartile.Primary outcomes included 5-year all-cause mortality and 3-point major adverse cardiovascular events(MACE:non-fatal myocardial infarction,ischemic stroke,and cardiac death).Binary linear regression and Cox proportional hazards models were utilized to determine associations between PMI and outcomes Results Sarcopenic patients exhibited significantly higher 5-year all-cause mortality compared to non-sarcopenic counterparts(64.4%vs.35.6%,P<0.001),while no significant difference was observed in 3-point MACE incidence(55.6%vs.51.4%,P=0.520).Sarcopenia was independently associated with all-cause mortality on binary logistic regression(OR=3.49;95%CI:1.69–7.19;P=0.0007),but not MACE(OR=1.00;95%CI:0.50–1.98;P=0.99).In a multivariable Cox regression model,sarcopenia was associated with increased hazard of mortality(HR=1.60;95%CI:0.96–2.66;P=0.071),though this did not reach statistical significance.Kaplan-Meier analysis demonstrated significantly reduced survival among sarcopenic patients(χ^(2)=6.13,P=0.0133).Conclusions PMI is a significant independent predictor of 5-year all-cause mortality in PCI patients,underscoring the prognostic importance of assessing skeletal muscle mass in this population.
文摘Psoas muscle metastasis, though rare, is the commonest site of skeletal muscle involvement in cervical carcinoma. The appropriate clinical management of this condition, particularly of the pain related to malignant psoas syndrome, is still evolving and the diagnostic features on conventional morphological imaging modalities are often non specific, with the differential diagnosis lying between sarcoma, hematoma, and abscess. In this report, a comparison of various morphofunctional imaging modalities was made. Fluorodeoxyglucosepositron emission tomography(FDG-PET)/computed tomography(CT) was the first to suspect disease involvement of the psoas muscle, demonstrating intense FDG uptake(compared with the contralateral muscle), while ultrasound showed heterogeneous echotexture, and magnetic resonance imaging(MRI) showed subtle altered signal intensity in the right psoas muscle. Both anatomical imaging modalities and non contrast CT of the PET-CT examination demonstrated a bulky psoas muscle, without any focal abnormality. On diffusionweighted imaging of MRI(DWI-MRI), restricted diffusion of the involved muscle was an important observation. The psoas muscle metastatic involvement was proven histopathologically. Thus, enhanced glucose metabolism and restricted diffusion in the newer noninvasive molecular imaging modalities(e.g., PET/CT and DWI-MRI) could serve as valuable adjunctive parameters in diagnosing this entity in the absence of a focal abnormality in the anatomical modalities. In the treatment response monitoring scenario, FDG-PET/CT demonstrated near complete resolution following administration of 3 cycles of systemic chemotherapy and local external radiotherapy.
文摘Although acute appendicitis is a common disease, retroperitoneal abscesses are rarely observed. Here, we report a case consisting of a psoas abscess and cutaneous fistula caused by appendicitis. The patient was a 56-year-old male who was introduced to our institution due to an intractable right psoas abscess. Imaging tests had been performed over the previous 3 years; however, clinicians could not find the origin of the abscess and failed to resolve the problem. A successful operation was performed via a laparoscopic approach, and 17 mo have passed without recurrence. The advantage of laparoscopic surgery is well understood in cases of appendicitis with abscesses. However, the indication for laparoscopic approach is not clear for retroperitoneal abscesses. From our experience, we can conclude that appendicitis with retroperitonealabscesses can be managed and treated using a laparoscopic approach.
基金Nation Natural Science Foundation of China(General Program),No.81870444Natural Science Foundation of Tianjin,No.17JCQNJC12800.
文摘BACKGROUND Patients with end-stage liver disease usually have varying degrees of malnutrition,and severe malnutrition may affect the prognosis of patients after liver transplantation(LT).However,there is no recommended standard for the nutrition assessment of patients waiting for LT,and it is unknown whether malnutrition has an impact on the occurrence of postoperative complications.AIM The study aim was to investigate the value of the controlling nutritional status(CONUT)score and psoas muscle thickness per height(PMTH)in predicting prognosis in LT.METHODS We retrospectively analyzed the clinical data of 313 patients who underwent classic orthotopic LT from January 2016 to December 2018 in Tianjin First Central Hospital affiliated with Tianjin Medical University.The CONUT score is derived from the preoperative serum albumin and total cholesterol levels,and total lymphocyte count.Patients were divided into low(≤4),medium(5–8),and high(9–12)CONUT score groups perioperative characteristics,Clavien-Dindo grade III/IV/V postoperative complications,graft loss and infection,and cumulative postoperative survival in the three groups were compared 3 mo after LT.PMTH was calculated as the ratio of the transverse thickness of the psoas muscle in the umbilical plane to the height of the patient.The cutoff values of receiver operating characteristic curves were determined separately for men and women.The values were 14.1 cm/m2 for women and 17.9 cm/m2 for men.The patients were then divided into low and high PMTH groups by the cutoff values.The comparison of data between the two groups was the same as above.RESULTS Patients with medium and high CONUT scores had lower preoperative serum hemoglobin,more intraoperative red blood cell(RBC)transfusions,longer postoperative intensive care unit stay and hospital stays,higher 7 and 14 preoperative-day serum bilirubin levels,and a higher incidence of postoperative grade III/IV complications and infections than patients with low CONUT scores.Differences in the 3-mo cumulative survival among the three groups were not significant.Patients with a low PMTH had higher preoperative serum urea nitrogen,more intraoperative packed RBC and frozen plasma transfusions,longer times to postoperative ventilator extubation,higher incidence of total postoperative complications,and a lower 3-mo cumulative survival than those with a high PMTH.CONCLUSION A CONUT score≥5 and a low PMTH were both associated with poor prognosis in LT.The CONUT score had no predictive value for short-term patient survival after LT,but the PMTH was predictive of short-term patient survival after LT.
文摘Use of the da Vinci■surgical robotic system has expanded to numerous upper and lower urinary tract procedures.We describe our surgical technique and perioperative outcome of robotic distal ureterectomy with psoas hitch and ureteroneocystostomy for distal ureteral pathologies.Eight patients with a median age of 69.5 years old underwent robotic distal ureterectomy with psoas hitch and ureteroneocystostomy between April 2009 and August 2014.The entirety of all cases was performed robotically by a single surgeon at a tertiary academic medical center.Median operative time was 285 min(range:210-360 min),estimated blood loss was 50 mL(range:50-75 mL)and median length of hospital stay was 2.5 days(range:1-6 days).There was one post-operative complication,a readmission for dehydration(Clavien Ⅰ).It suggests that robotic distal ureterectomy with psoas hitch and ureteroneocystostomy is a safe and effective minimally invasive alternative for patients with distal ureteral pathology.
文摘Lumbar sympathetic block is an analgesic procedure frequently performed in chronic pain clinics for ischemic lower limb pain from peripheral arterial disease. Although the lumbar sympathetic ganglia are anatomically near major vascular and neural structures, complications such as severe hemorrhage is rarely reported. Aspirin/extended release dipyridamole (Aggrenox) is indicated for secondary stroke prevention. Stroke is frequently a co-morbid condition in patients with peripheral vascular disease. Interventional pain physicians frequently face the difficulty of deciding whether to continue or stop antithrombotic medications in the periprocedural period because of the devastating consequences of both hemorrhagic and thrombotic complications. Due to a paucity of data, no guidelines have been specifically written for interventional procedures for chronic pain. To aid future decision making, we present a case report of psoas hematoma developed after lumbar sympathetic block in a patient with end stage renal failure and hepatic dysfunction who had limb-threatening ischemia. The patient was treated with Aggrenox until three days before the procedure.
文摘Psoas muscle is a rare location for hydatid disease. Here we present a case of infected hydatid cyst left psoas muscle presenting as left flank pain, fever, local flank tenderness, and raised blood counts. Preoperative diagnoses was made by Ultrasonography (USG) and Computed Tomography (CT) abdomen, although serology for hydatid disease was negative.
文摘Hydatid cyst of the psoas is rare even in countries endemic to hydatidosis. We hereby report a case of hydatid cyst of the psoas in a 69 years old patient with a history of hypertension and had received left nephrectomy due to a renal abscess 2 years prior to his admission.
文摘<div style="text-align:justify;"> <span style="font-family:Verdana;">Tuberculous sacroiliitis secondary to a psoas abscess is rare, only a few sporadic cases were reported in the literature. Tuberculous sacroiliitis is rare, usually unilateral, its symptomatology is misleading, its diagnosis is often delayed or even confused with damage to the hip or lumbosacral hinge, most often related to difficulties exploration of the sacroiliac joint. We report the case of a 66-year-old diabetic patient with low back pain, unilateral right with inflammatory appearance, insidious installation, evolving for about 8 months. The diagnosis of tuberculous sacroiliitis was made after biopsy of the sacroiliac joint. CT and MRI are necessary for lesion diagnosis. Tuberculosis treatment was started and the abscess was surgically drained. The aim of this work was to describe the diagnostic pathway of a patient with tuberculous sacroiliitis in a tropical environment. Conclusion: Tuberculous sacroiliitis, secondary to an abscess of the psoas muscle is an unusual cause of hip pain and is likely to be overlooked due to its atypical presentation.</span> </div>
文摘OBJECTIVE： It is unknown whether the psoas major muscle, thought to be a key muscle for treatment of lower back pain, can be punctured at Shenshu（BL23）.METHODS： Twelve dissected specimens were used for studying the needling pathway of BL23 by perpendicularly inserting the depth-measuring blade of a vernier caliper at BL23. Dimensions of psoas muscle were measured. Correlation studies were conducted. In addition, our samples were grouped by gender and underlying medical conditions for analysis.RESULTS： Half（50%） of the needle insertions successfully punctured psoas muscle. The mean depth of needle insertion to puncture psoas muscle（D_（min）） in the group with short-term underlying medical conditions was 38.0 mm（interquartile range 29.0–51.8 mm）, approximately 6 mm deeper than 32.0（29.3–42.5） mm in the group with long-term health problems（P = 0.041）. The cross-sectional area（CSA） of psoas muscle in the former group was on average approximately 1.5 times that of the latter group（P = 0.04）. When the data were analysed by gender, the thickness of psoas muscle in the male group was 19.0（6.5–24.0） mm compared to 19.5（5.8–34.8） mm in the female group（P = 0.02）. The age in the female group（P = 0.04） and the body length of the total group（P = 0.04） negatively correlated to D_（min）.CONCLUSION： Needle insertion at BL23 might be able to puncture psoas muscle. Differences in the CSA of psoas muscle and D_（min） were observed in groups with short-term and long-term underlying medical conditions.
文摘Magnetic resonance elastography (MRE) can visualize the shear wave propagation of in vivo tissues, which can be mapped into viscoelastic properties. No study has measured the biomechanical properties of the PM muscle in vivo using MRE. In this study, we evaluated stiffness values calculated by local frequency estimate (LFE) and algebraic inversion of differential equation (AIDE) in PM-MRE. The PM muscles of 17 healthy male volunteers were scanned in supine position by MRE. The Laplacian-based estimate (LBE) phase wrapped image data were filtered by gaussian-bandpass filter (GBF), and by both directional and GBF. LFE (MREWave) and AIDE wave inversion methods were used to calculate the respective elastograms. The wave interferences were removed by directional filtering, and smooth wave fields were obtained. The stiffness values calculated by LFE of non-DF images were 1.39 ± 0.25 kPa and 1.33 ± 0.22 kPa for right and left PM respectively, whereas for DF images, they were 1.26 ± 0.20 kPa for right PM and 1.18 ± 0.28 kPa for left PM. The stiffness values calculated by AIDE of non-DF images were 0.78 ± 0.10 kPa and 0.78 ± 0.13 kPa for right and left PM respectively, whereas for DF images, they were 0.73 ± 0.12 kPa for right PM and 0.74 ± 0.11 kPa for left PM. There was no statistically significant difference in mean values of stiffness with/without applying directional filter whereas there was a statistically significant difference in mean values of stiffness between LFE and AIDE. Both LFE and AIDE could be used for psoas major MR Elastography.
文摘The primary abscess of the psoas of the child is a rare affection, the pathogenesis of which is still unexplained. The positive diagnosis of this condition is difficult and relies mainly on medical imaging. We report a case of primary psoas abscess in an immunocompetent child, whose diagnosis was facilitated by the provision of abdominal radiography without preparation and abdominal ultrasound. The evolution was favorable thanks to the combination of antibiotic therapy and surgery.
文摘目的:探讨行斜外侧腰椎椎体间融合术(oblique lumbar interbody fusion,OLIF)联合侧入路螺钉内固定术(anterolateral screw fixation,AF)治疗的患者术前腰大肌形态特征与术后发生一过性神经肌肉损伤之间的相关性。方法:回顾性分析2018年6月~2023年4月在我院行经左侧入路L4/5单节段OLIF联合AF治疗的腰椎管狭窄症(lumbar spinal stenosis,LSS)患者的临床资料。将术后出现术侧下肢一过性腰丛神经、腰大肌损伤的22例患者纳入A组,匹配35例未出现相关损伤症状的患者作为对照,纳入B组。收集两组患者性别、年龄和体质指数(body mass index,BMI)、病程、美国麻醉医师协会(American Society of Anesthesiologists,ASA)评分等一般资料和手术相关信息,并于术前L4/5椎间隙中点轴位MRI图像上测量腰大肌形态学参数,包括面积、长轴、宽轴以及腰大肌横截面最高点(a点)、腰大肌横截面最宽点(b点)的Moro分区位置,观察左侧椎体侧缘与腰大肌内侧间隙(cd间隙)是否存在。采用回归分析探讨术前腰大肌形态特征与术后发生一过性神经肌肉损伤的关系。结果:两组患者性别、年龄、BMI、病程和ASA评分均无统计学差异,具有可比性(P>0.05)。两组均顺利完成手术,手术时间、术中出血量和住院时间均无统计学差异(P>0.05)。A组患者共报告72例次腰大肌、腰丛神经损伤相关症状,其中大腿前外侧感觉异常16例(22.2%),大腿内侧感觉异常14例(19.4%),腹股沟区感觉异常11例(15.3%),髋关节内收异常12例(16.7%),膝关节伸展异常10例(13.9%),髋关节屈曲异常9例(12.5%)。两组患者腰大肌面积、长轴、宽轴及a点分布无统计学差异;A组cd间隙消失率和b点位于MoroⅠ区的比例分别为27.3%和36.4%;B组分别54.3%和2.8%,A组显著性高于B组(P<0.05)。回归分析结果显示cd间隙消失(OR=0.177,95%CI 0.037~0.852)与b点分布于MoroⅠ、Ⅱ区是术后发生一过性神经肌肉损伤并发症的独立危险因素。结论:术前腰大肌形态特征与L4/5节段OLIF联合AF术后发生一过性神经肌肉损伤相关;腰大肌横截面最宽点位于MoroⅠ、Ⅱ区和椎体侧缘和腰大肌内侧间隙(cd间隙)消失是其发生的危险因素。
基金the approval of Ethics Committees of Union Hospital Tongji Medical College,Huazhong University of Science and Technology(No.2022-S207)The First Affiliated Hospital of Soochow University(No.2022412)The First Hospital of Shanxi Medical University(No.2022KK094).
文摘Aims:Although the skeletal muscle index at the third lumbar vertebra(L3-SMI)is commonly utilized for the diagnosis of sarcopenia,the psoas muscle index at L3(L3-PMI)may serve as a reliable alternative indicator.This study aims to investigate the application of the PMI in patients who have undergone transjugular intrahepatic portosystemic shunt(TIPS).Methods:This study included a cohort of 406 patients with cirrhosis who underwent TIPS between February 2016 and July 2022 across three medical centers in China.Clinical and imaging data,specifically L3-SMI and L3-PMI,were collected for these patients.The prognosis of the patients was assessed through re-examinations and telephone follow-ups,which extended up to 5 years.The diagnostic thresholds for sarcopenia,as defined by L3-PMI and L3-SMI,were established at 6.36 or 42.00 cm^(2)/m^(2) for males and 3.92 or 38.00 cm^(2)/m^(2) for females,respectively.Cox proportional hazards and Kaplan–Meier(K-M)analyses were employed to evaluate patient survival.Results:The findings indicated that both L3-PMI and L3-SMI before TIPS were independent risk factors for mortality.The results of the paired t-test demonstrated a significant increase in L3-PMI 1 month post-TIPS(5.11±1.81 vs.5.71±1.90 cm^(2)/m^(2) ,p<0.001),whereas L3-SMI did not exhibit a significant increase until 6 months post-TIPS(45.45±9.41 vs.48.59±10.38 cm^(2)/m^(2) ,p<0.001).Among these patients,191(47.0%)and 159(39.2%)were diagnosed with sarcopenia according to the L3-PMI and L3-SMI models,respectively.Patients identified as sarcopenic by both indicators demonstrated a significantly lower survival rate(L3-SMI model:hazard ratio[HR],1.913;95%confidence interval[CI],1.094–3.410;log-rank p=0.020;L3-PMI model:HR,1.867;95%CI,1.059–3.290;log-rank p=0.030).In sarcopenic patients,the reversal of sarcopenia associated with improved survival occurred 1 month after TIPS in the L3-PMI model(HR,2.675;95%CI,1.245–5.735;log-rank p=0.012),while a similar effect was not observed until 6 months post-TIPS in the L3-SMI model(HR,3.342;95%CI,1.477–7.560;logrank p=0.004).Conclusions:L3-PMI and L3-SMI demonstrate comparable efficacy in diagnosing cirrhosis-related sarcopenia.Furthermore,L3-PMI has the capacity to identify improvements in sarcopenia as early as 1 month following TIPS,thereby providing earlier insights into patient survival outcomes.
