Anterosuperior Iliac Spine Research Articles

Retroperitoneal laparoscopic nephrectomy in children.

We report our experience with retroperitoneal laparoscopic nephrectomy and nephroureterectomy in children, and describe our surgical technique. Five and 15 children 9 months to 17 years old underwent nephrectomy with cystoscopy plus intravesical ureteral stump fulguration for ureteral ablation and nephrectomy only, respectively. Surgical indications were unilateral multicystic dysplastic kidney in 8 cases (parental preference for surgery), a refluxing, chronic pyelonephritic kidney in 5, renal vascular hypertension in 2, and hydronephrosis and chronic pyelonephritis in 5, including 3 in whom a nephrostomy tube was placed percutaneously before laparoscopic nephrectomy. Access was obtained by a 10 mm. incision made posterior to the anterosuperior iliac spine with dissection into the retroperitoneal space and trochar placement. Two and sometimes 3 additional 5 mm. ports were placed retroperitoneally. Average operative time was 1 hour 42 minutes. The most recent cases were performed in less than 1 hour and in 3 nephrectomy only required 30 minutes. All but 1 procedure were completed laparoscopically. One case was converted to open surgery secondary to obscured visibility due to bleeding. Blood loss in all cases was less than 30 cc (average 5 to 10). A total of 13 children were discharged home immediately postoperatively. Five children underwent concomitant procedures, including contralateral ureteroneocystotomy in 4, circumcision in 1 and cystoscopic fulguration of the ureteral stump in 5. Those who underwent ureteral reimplantation were hospitalized for 48 hours. One patient remained hospitalized for 3 days due to fever of unknown origin and 2 were admitted to the hospital for 23-hour observation. All children returned to full activity within 1 week of surgery. Analgesia consisted of 1 dose of ketorolac, bupivacaine injections at the incisional sites at the completion of the procedure, and acetaminophen postoperatively. As confirmed by parent questionnaire, patient satisfaction was excellent.

Import Catheter in Erectile Dysfunction

Purpose We propose an alternative technique for intracavernous self-injection of sodium nitroprusside for erectile dysfunction by inserting a Medtronic ImPort * * Medtronic PS Medical/IPI, Minneapolis, Minnesota. catheter with a valved tip. Materials and Methods A silicone catheter was implanted in 3 patients with psychogenic impotence. The reservoir, which is used for vasoactive agent injection, was implanted laterally to the anterosuperior iliac spine and the distal tip of the catheter was inserted into the corpora cavernosa via a subcutaneous tunnel. The injection technique was taught to the patient and the initial injection was performed 1 week later. Results All patients and partners were satisfied with the technique and quality of erections at a mean followup of 14 months. There were no major local complications due to catheter implantation and no systemic complications due to sodium nitroprusside injection. Conclusions An alternative technique for intracavernous pharmacotherapy of inserting an ImPort catheter prevented the complications of intracavernous injections in patients with erectile dysfunction.

Bone Graft Harvest Site As a Determinant of Iliac Crest Strength

Bone graft harvest site fracture can occur after removal of bone from the anterior iliac crest. No biomechanically proven guidelines for safe removal of bone exist. Cadaveric hemipelves were tested in a materials testing system machine, with the harvest site occurring 15-mm posterior to the anterosuperior iliac spine in 8 specimens and 30-mm posterior in 7 specimens. These pelves were then tested to failure by simulating avulsion fractures caused by the forces of the flexors of the hip. Average force at failure was 783 N (standard deviation, +/- 333 N) in the 15-mm group and 1917 N (standard deviation, +/- 735) in the 30-mm group. This study provides objective data which demonstrate that harvest 30 mm posterior to the anterosuperior iliac spine weakens the iliac crest less than harvest 15 mm posterior to the anterosuperior iliac crest. To minimize the possibility of iliac crest fracture after bone graft harvest, bone should be removed at least 30 mm from the anterior superior iliac spine.

Femoral instrumentation using the anterosuperior iliac spine as a landmark in total knee arthroplasty: An anatomic study

Twenty-six adult cadavers were utilized in an anatomic study desig to measure intramedullary femoral alignment in relation to the anterosuperior iliac spine. Fifty femurs were measured to determine the reliability of the anterosuperior iliac spine as an accurate landmark for distal femoral resection in total knee arthroplasty (TKA). A precision machined stainless steel Ushaped parallel alignment guide was fabricated and inserted into the femoral canals of intact adult cadavers. The guide's relationship to the anterosuperior iliac spine was measured and recorded. All hips were maintained in neutral alignment. Independent variables recorded included gender, knee alignment, and side of lower extremity. The range for medial deviation was 1–28 mm for the right femur and 2–25 mm for the left femur (average, 8.5 mm). The range for lateral deviation was 3–14 mm for the right femur and 2–17 mm for the left femur (average, 10.3 mm). There was no statistical correlation between the independent variables of side measured, gender, and measured offset at the anterosuperior illac spine. Based on this highly variable patterof alignment, utilizing simulated intraoperative technique, use of the anterosuperior iliac spine does not provide a landmark accurate enough to repeatedly produce a distal femoral resection within 2°–3° of ideal. Use of the anterosuperior iliac spine may lead to less than ideal femoral resection and malpositioning of total knee components

Ilioinguinal nerve entrapment: a little-known cause of iliac fossa pain.

The ilioinguinal nerve entrapment syndrome is an abdominal muscular pain syndrome, characterized by the clinical triad of muscular type iliac fossa pain with a characteristic radiation pattern, an altered sensory perception in the ilioinguinal nerve cutaneous innervation area, and a well-circumscribed trigger point medial and below the anterosuperior iliac spine. Relief of pain by infiltration of a local anaesthetic confirms the diagnosis. This report describes retrospectively the clinical picture of ilioinguinal nerve entrapment in 32 mainly non-surgical patients. In 14 cases a definite diagnosis was established and in 18 patients the diagnosis was considered probable. The mean delay in diagnosis was 12.8 months. Better knowledge of this syndrome may avoid invasive investigations and be cost saving.

Muscular plastic for aesthetic conformation of abdominal girdle.

Two techniques of waist reduction which utilize the external oblique abdominis muscle are described. The first method superimposes the external oblique abdominis muscle, and involves making an incision in the muscle inside the anterosuperior iliac spine, continuing obliquely upward toward the midaxillar line, lifting the flap by its deep side. The technique is completed by crossing and superimposing each muscle lamina over the other. The second method creates a muscle belt by lifting the external oblique abdominis muscle and an aponeurotic muscle flap from the area deep to the superoanterior iliac spine as an upper pedicle. The remaining ends, separated from the muscle, are approximated to each other and sutured. The aponeurotic muscle flaps are carried forward to be crossed and superimposed in the midline under the umbilicus as a belt.

Development of right inguinal hernia after appendectomy

The incidence of right inguinal hernia is significantly greater in patients who have undergone appendectomy than in the general population. The most likely cause of such hernias is injury to the segmental nerve supply to the inguinal musculature. The choice of incision at appendectomy may therefore be important, and the surgeon should avoid injury to the nerve branches and important structures in the inguinal region, especially below the horizontal line extending from the anterosuperior iliac spine to the rectus muscle.

Electromyographic Study of Transplanted Muscles about the Knee in Poliomyelitic Patients

An electromyographic study is presented of twenty-one patients with paralysis of the lower extremity due to poliomyelitis on whom thirty-nine muscle transplantations for quadriceps insufficiency were performed. Electromyograms and gait movies were filmed simultaneously on the same movie film by specially designed apparatus. The phasic activity of each muscle studied was plotted on polar coordinate graph paper, for both the patients with poliomyelitis and for six normal control subjects. Numerous phase conversions were evident in both the transplanted and non-transplanted muscles in the patients with poliomyelitis. Extension of the phasic activity of the gluteus maximus through most of the stance phase and conversion of hamstring activity from swing to stance phase were observed in non-transplanted muscles. Ten of fourteen hamstring transplants achieved stance-phase activity roughly comparable to that of the normal quadriceps femoris. Two of eleven sartorius transplants and four of the twelve tensor transplants achieved stance-phase activity. It was noted that the tensor and sartorius transplants frequently functioned while both the hip and knee were flexing. A preliminary report is made of sartorius and tensor transplants that were converted to one-joint muscles by detachment of their proximal ends from the anterosuperior iliac spine with reattachment in the region of the greater trochanter. Some of the factors that may have bearing on phase conversion are discussed.