Ileopsoas Muscle Research Articles

DOP118 Correlation between psoasic index and diaphragmatic index ultrasound in the evaluation of sarcopenia in a cohort of patients with inflammatory bowel disease: a study in a tertiary referral center

Abstract Background Sarcopenia is prevalent in patients with inflammatory bowel disease(IBD) and impacts surgical and therapeutic outcomes; thus, effective diagnostic tools are needed to assess muscle mass and function in IBD population.The ileo-psoas muscle(IP) muscle has already been used in the literature for the assessment of sarcopenia, however, as it is a deep muscle and it needs experienced operators for a proper measurement. Therefore, diaphragm muscle (DM) more superficial and easily assessed, was examined to check its correlation with IP. The aim of this work was to evaluated the correlation of positivity SARC-F score with ultrasound (US) measure of the IP and DM. Methods A total of 57 IBD patients with significant suspected sarcopenia with SARC-F score positive ≥4, were enrolled. IP and DM US were detected in the enrolled patients. The transverse diameter of the IP was evaluated. Moreover, we calculated the US psoas/height ratio as the average of the psoas diameter divided by the patient's height (mm/m). For DM, diameters during expiration and during inspiration were assessed, then diaphragmatic expansion was calculated. We calculated the diaphragm/height ratio (mm/m) as well. The correlation between IP and DM ratio was researched by using the Pearson correlation test. Age and sex were taken into consideration as confounders in a linear regression model, using the psoas/height ratio and these confounders as independent variables and the diaphragm index as dependent variable. Results The mean of the three US IP measured diameters was 28.40 mm, the psoas/height ratio was 16,62 mm/m. The mean maximum inspiration DM diameter was 20.4 mm (± 5 mm), the mean minimum expiration MD diameter was 10.7 mm (± 3,5 mm). The mean difference between the two diameters was 9.7 mm (± 3,4 mm). The diaphragm/height ratio was 0.59 mm/m (±0.21 mm/m). A significant correlation was identified between IP and DM ratio, with a Pearson coefficient r = 0.3568 (p-value <0.05). A consistent association was found between the two indices, with diaphragm/height ratio increasing linearly with the psoas/height ratio (OR: 0.018; p-value: 0.008). Multivariate analysis showed that age and sex were not significantly associated with the diaphragm/height ratio (p-value >0.05). Conclusion The findings of this study emphasize the potential of muscle US as a reliable diagnostic tool for assessing sarcopenia in IBD patients.IP US is confirmed to correlate with sarcopenia.DM can be used more easily and correlates with IP.This research could take a significant implications for disease management in IBD patients.

The role of CT-assessed sarcopenia and visceral adipose tissue in predicting long-term survival in patients undergoing elective endovascular infrarenal aortic repair.

To evaluate if ileo-psoas muscle size and visceral adipose tissue (VAT) can predict long-term survival after endovascular aneurysm repair (EVAR). Patients who underwent EVAR between 2004 and 2012 in a single centre were included. Total psoas muscle area (TPA), abdominal VAT area, subcutaneous adipose tissue (SAT), and total adipose tissue were measured on the preoperative CT. Primary endpoint was all-cause mortality. Values are presented as median and interquartile range or absolute number and percentage. Cox regression analyses were performed to assess the associations with mortality. Two hundred and eighty-four patients could be included in the study. During a median follow-up of 8 (4-11) years, 223 (79.9%) patients died. Age (P ≤ .001), cardiovascular (P = .041), cerebrovascular (P = .009), renal diseases (P = .002), and chronic obstructive pulmonary disease (P ≤ .001) were independently associated with mortality. TPA was associated with mortality in a univariate (P = .040), but not in a multivariate regression model (P = .764). No significant association was found between mortality and TPA index (P = .103) or any of the adiposity measurements with the exception of SAT (P = .040). However, SAT area loss in a multivariate analysis (P = .875). Assessment of core muscle size and VAT did not contribute to improving the prediction of long-term survival after EVAR. The finding of this study contradicts the previously claimed utility of core muscle size and VAT in predicting long-term survival after EVAR.

A fatal case of paediatric post-traumatic pyomyositis.

A 6-year-old girl was brought to the emergency department with a history of an accidental fall a few days earlier. She presented with a fever, cough and constipation. Sars-CoV-2 infection being suspected, she was transferred to a paediatric facility for Covid-positive patients. During the diagnostic process, the clinical picture suddenly deteriorated with the development of bradycardia, tachypnea and altered sensorium. Despite cardiopulmonary resuscitation attempts, the child died about 16 hours after admission to the emergency department. A judicial forensic autopsy was performed that concluded that her death was due to multiple acute pulmonary, cardiac and renal infarctions secondary to septic thromboembolism in the course of post-traumatic bacterial necrotizing pyomyositis of the right ileo-psoas muscle.

Pyomyositis: case series of 14 patients to study the significance of early diagnosis and management

Introduction Pyomyositis denotes primary pyogenic infection of skeletal muscle. It is predominantly a disease of tropical countries. It usually involves the largest muscle groups around the pelvic girdle and lower extremities. Primary reasons for delay in diagnosis are its low incidence and vague presentation [7]. This delay can result in complications such as extension into and destruction of an adjacent joint, sepsis and, even death. Our study is aimed to highlight the extent and sequence of treatment protocol required for good management of these patients. Methods We retrospectively analyzed our experience with a series of 14 pediatric patients with primary pyomyositis who were treated and followed up. There were five girls and nine boys. All 14 patients underwent plain radiographs, USG and MRI of the affected area followed by surgical drainage and a course of antibiotics. Patients were followed up with weekly CRP. Results Six out of 14 (42.9 %) patients had a history of mild trauma. Ileopsoas muscle was involved in 4 patients, 3 cases in which the gluteals or quadriceps were involved, 2 cases with obturator muscle involvement and 2 cases in which adductors were the infection site. All 14 patients were treated surgically. Conclusion Our study shows that early diagnosis, complete drainage of the purulent material and the use of appropriate antibiotic therapy are the key determinants of successful treatment that lead to complete resolution in the majority of cases.

Primary Angiosarcoma of the Kidney: Case Report and Comprehensive Literature Review.

PurposeAngiosarcoma (AS) is an aggressive malignant tumour of endothelial origin, most frequently compelling the skin. The kidney is a rare site of primary occurrence of AS with a quite challenging diagnosis and poor prognosis, mainly due to its raw metastasising power. We described our first case of AS treatment. A comprehensive literature review in this field is also carried out.Patients and methodsWe report the case of a 56-years-old man with radiological appearance of an 11 cm poor vascularised left renal mass. The pre-operative imaging ruled out distant metastases and inferior vena cava thrombosis. Thus, after radioembolization, we performed a transperitoneal open radical nephrectomy with regional lymphadenectomy with the removal of the middle portion of the ileo-psoas muscle, followed by two lines of adjuvant chemotherapy. We analysed all the papers concerning primary kidney AS until December 2018.ResultsEstimated intraoperative blood loss was 200 mL with an operative time of 100 minutes. No postoperative complications were recorded, with the patient discharge in the 8th postoperative day. The pathological assessment showed a pT3a N0, M0 tumour compatible with AS of the kidney. An immune-histochemical study showed a vascular positive for CD31, CD34, Fli-1 with a Ki-67/Mib 1 of 50%. One month after surgery the patient began adjuvant chemotherapy with gemcitabine. After 45 days from surgery, a Computed Tomography scan showed lung and liver metastases with disease relapse in the left kidney lodge. The response to the first-line treatment was excellent, unlike the second-line, encountering a chemo-refractory disease. The cancer-specific survival was of 15 months. We included 66 cases in our review.ConclusionThis is the first case of treatment of kidney AS performed at our Institute. Our findings added new information about the unclear biology and progression of this subset of tumours, demonstrating an abysmal prognosis.

A Rare Metastasis of Lung Carsinoma Detected with PET/CT

Case 1: A 61-year-old male case presented with cough and swelling of thigh. He had a history of smoking at 30 packets/year. Chest X-ray and tomography showed 5 cm spicule contour mass in the right lower lobe of the lung. Positron Emission Tomography (PET) detected two malignant appearance; on the right lung SUVmax value:12,7 and SUVmax: 5 on the subcutaneous nodule of the right medial thigh (Figure 1A). Tumor infiltration was detected in the right lower lobe bronchus on the fiberoptic bronchoscopy and the biopsy result was reported as squamous cell carcinoma. Subcutaneous lesion biopsy was performed with histopathological finding of squamous cell lung carcinoma metastasis. The case was considered inoperable. He was treated with concomitant chemo-radiotherapy and without any problem of the case in the 10th month of follow-up period. Case 2: A 59-year-old female case presented with dyspnea, hoarseness, weight loss and swelling of right arm. She had a history of smoking at 25 packets/year. Chest X-ray and tomography showed 3 cm central mass in the right upper lobe of the lung and 4 cm soft tissue mass in the hypopharynx. Positron Emission Tomography (PET) detected three malignant appearance; on the right upper lobe of lung SUVmax value:7.3,on the hypopharynx soft tissue mass SUVmax value:22.8 and on the subcutaneous nodule of the right medial arm SUVmax: 17.8 (Figure 1B). Subcutaneous lesion biopsy was performed with histopathological finding of lung carcinoma metastasis. The case was considered inoperable. First tracheostomy opened to protect the airway and nasogastric tube fitted for feding. She was treated with chemotherapy and without any problem of the case in the 3th month of follow-up period. Metastasis to skin-subcutaneous tissue is rarely detected in lung cancer. The detection of these metastases and the treatment approach are difficult and this is an important factor that alters survival. Autopsy series have detected subcutaneous metastases in 0.75-9% of patients who died from metastatic lung carcinoma [1,2]. A retrospective study in 2012 indicated that 2.8% of 2130 patients with advanced non-small cell lung cancer (NSCLC) showed cutaneous metastases as an initial presentation [3]. The most common histologic type of carcinoma of the lung that metastasizes to skin-subcutaneous tissue is adenocarcinoma followed by squamous cell, small-cell and large-cell carcinoma [4]. In very rare cases, soft tissue metastasis may occur at the same time or before the primary cancer has been detected. The most frequently reported locations of subcutaneous metastases include the back, chest wall, abdomen, thigh muscles, ileopsoas muscle and paraspinous muscles. The metastases often may occur by a hematogenous route or via lymphatics [2,4]. Despite the combination of radiotherapy and chemotherapy, patients with lung cancer with cutaneous metastases have a poor prognosis; median survival of patients with lung cancer metastases is 3–6 months [5]. Histopathologic sampling should be performed and all lung cancer should be considered to be metastasis in skin-subcutaneous tissue lesions detected in the case of suspicion. Local subcutaneous biopsy to be performed makes it possible to reach definite histopathologic diagnosis and to carry out genetic studies thanks to large biopsies to be taken.

Spondylodiscitis: a rare complication following percutaneous nephrostomy.

Spondylodiscitis is an inflammation of the intervertebral disc and the adjacent vertebral bodies. The spondylodiscitis can not only be a complication of medical interventions such as an operation near spinal column but also urogenital and vascular interventions and intravenous catheter use. A 71-year-old man was admitted to our emergency department with fever and severe abdominal pain. Antibiotic therapy had been performed with intravenous administration of 2 g of ceftriaxone and the patient underwent the placement of a percutaneous nephrostomy according to Seldinger technique. After 1 week, the patient experienced a severe pain at the lumbar tract of the vertebral column associated with a moderate abdominal pain and septic fever. A magnetic resonance imaging (MRI) of the lumbar spine showed widespread impregnation of the upper portion of L3 and the lower portion of L2 compressing the spinal roots as well as the ileopsoas muscle such as a spondylodiscitis. Liquor culture showed an increase of liquor immunoglobulin G, total liquor protein and was positive for Extended-spectrum beta-lactamases (ESBL) - producing Escherichia coli. After the antibiotic therapy, the spondylodiscitis resolves without important sequelae. In the present case report, we describe a very rare complication of percutaneous nephrostomy tube placement, despite of the prophylactic antibiotic therapy according to the most recent guidelines. Predisposing factors to spondylodiscitis include the very young and elderly, the immunosuppressed, diabetic individuals and a general debilitating disease such as renal failure. This case suggests the importance of remembering spondylodiscitis when septic fever and back pain occurs following the placement of a percutaneous nephrostomy in a septic patient.

Endovascular Treatment of a Symptomatic Thoracoabdominal Aortic Aneurysm by Chimney and Periscope Techniques for Total Visceral and Renal Artery Revascularization

Conventional endovascular therapy of thoracoabdominal aortic aneurysm with involving visceral and renal arteries is limited by the absence of a landing zone for the aortic endograft. Solutions have been proposed to overcome the problem of no landing zone; however, most of them are not feasible in urgent and high-risk patients. We describe a case that was successfully treated by total endovascular technique with a two-by-two chimney-and-periscope approach in a patient with acute symptomatic type IV thoracoabdominal aortic aneurysm with supra-anastomotic aneurysm formation involving the renal and visceral arteries and a pseduaneurismatic sac localized in the left ileopsoas muscle.

Bilateral Ileopsoas Muscle Hematoma and Hemorrhage Secondary to a Coughing Attack in a Patient with Hemophilia A: A Case Report

Hemophilia A is an X-linked recessive disease characterized by defective or dysfunctional deficiency of factor VIII in the circulation. The incidence of factor VIII deficiency is lower than the incidence of vWD but it is the most common hereditary factor deficiency among the others. The prevalence of factor VII deficiency is approximately 1/10,000 in liveborn babies. There are three clinical types defined as light, medium and severe. In patients with severe clinical type hemarthrosis and other bleeding, which require factor replacement, may occur from birth. In these patients hemorrhage may occur spontaneously or secondary to trauma. However, severe muscle hemorrhage either spontaneous or secondary to minor trauma is rarely seen. In this report we present a 46 year old male patient with hemophilia A who applied to the emergency service because of abdominal pain following a coughing attack and a swelling on the left side. We detected hemorrhage and hematoma in bilateral iliopsoas muscle which developed due to a previous coughing attack.

Ureteral leakage after radiofrequency ablation in a renal tumor: Repair with rendezvous technique

Radiofrequency ablation (RFA) is a safe and minimally invasive procedure for the local treatment of solid renal tumors in selected patients, but sometimes complications can occur. Nontarget ureteral thermal injury is a known risk of the procedure. Herein, we report a case of a patient who underwent a simultaneous treatment of surgical sigma resection and percutaneous RFA of the inferior pole renal lesion and who developed a proximal ureteric lesion secondary to thermal injury, with urinary leakage and an abscess formation of ileo psoas muscle. This report describes a successful management of the interventional radiologist team with a rendezvous procedure of these complications after RFA procedure.

Surface properties and implantation site affect the capsular fibrotic overgrowth

Transplantation of encapsulated pancreatic islets is a promising approach for the treatment of type 1 diabetes. Large-scale application of this technique, however, is hampered by insufficient biocompatibility of the capsules. In this study, we have evaluated the biocompatibility of a new synthetic material with six different chemical groups on their surface (amino, carboxy-sulfate, carboxylate, hydroxylate, sulfate, and PMMA) used for the fabrication of the microcapsules. Eight Lewis rats were inoculated with a suspension of empty capsules made for each candidate material in the retroperitoneal ileopsoas muscle and renal subcapsular space. Four weeks later kidney and muscle containing the capsules were explanted, paraffin embedded, sectioned and stained with Sirius Red and Masson's Trichrome for histological analysis. The amount of fibrosis was also ultrastructurally evaluated with scanning electron microscopy. The samples were then subjected to digitalized quantitative analysis using specific software to determine the degree of fibrotic overgrowth. The quantification of collagen deposition, calculated in proximity of the microcapsules, was expressed as a percentage of the total area and can be considered a good index for the biocompatibility, an essential prerequisite for functional pancreatic islet transplantation. The results show that subcapsular renal space is the best implantation site and the positive surface charge induces a more intense collagen synthesis.

Late bacterial granuloma at an intrathecal drug delivery catheter

In the case reported, neurological complaints were pain and dysaesthesiae in the lower back and thigh, as well as paresis of the ileopsoas muscle. MRI of the lumbar spine showed an intradural-extramedullary mass at the level of L1 homogeneously enhancing with gadolinium. This mass was situated at the tip of an intrathecal catheter implanted 11 years before for a morphine trial infusion as therapy for phantom pain after amputation of the right arm. Now, removal of the catheter was performed. Cultures of lumbar CSF and the catheter tip demonstrated coagulase negative staphylococcus. Antibiotic medication with cephalosporines was given for 6 weeks. After removal of the catheter, the patient was free of pain and he progressively regained full neurological function. Although most catheter-associated granulomas reported so far were sterile in nature, bacterial infection should still be considered even years after catheter placement.

Peripheral Primitive Neuroectodermal Tumor (PPNET) of Pelvic Origin: Report of a Case Arising from an Unusual Location

We report a rare case of a peripheral primitive neuroectodermal tumor (PPNET) originating from the left ileopsoas muscle in an adult patient with neoplastic thrombosis of the left external iliac vein, the common femoral vein and the left popliteal vein. We performed a median laparotomy with an oblique left inguinal incision to remove the neoplasm, which consisted of a large mass surrounding the iliac-psoas muscles, extending from the transverse apophysis of the spinal column to Scarpa's triangle, and passing through the lacuna musculorum. Histopathological examination revealed a primitive neuroectodermal tumor (PNET) with focal areas of necrosis, hemorrhage and vascular invasion. Immunophenotyping was positive for CD99, NSE, and focally for CK. Ultrastructural examination of the neoplastic cells showed often multiple nuclei with dense chromatin and very large nucleoli. The patient was discharged ten days after the operation. Adjuvant treatment consisted of radiotherapy at a dose of 2000 cGy in five fractions followed by six cycles of chemotherapy. The venous thrombosis was treated by anticoagulant therapy and recanalization of the occluded veins was obtained after two months of therapy. An MRI scan, carried out 12 months later, showed a local relapse, which was treated with chemotherapy and arterial chemoembolization.

ABSCESS OF THE ILIOPSOAS MUSCLE ASSOCIATED EXTRENAL FISTULA OF THE RECTUM CAUSED BY RADIATION PROCTITIS-A CASE REPORT-

This paper deals with a case of abscess of the iliopsoas muscle an intractable external fistula of the rectum caused by adiation proctitis. In a 68-year-old man. There were previous histories of undergoing an A-C bypass operetion for coronary stricture 10 years before; and undergoing aportial resection of the bladder with radiation therapy for urinary bladder cancer, flowed by colostomy for hemorrage and stricture of the rectumu for rdiation froctitis 2 year before admission. In April, 1997 when he had been treated at outpatient clinic, exudmation of pusfrom the sacurred that was diagnosed external fistula of the rectum on a fistulography and he was continuously treated on an ambulant basis. On november 17, 1997, the patient had a temprature 38.7°C, the while blood cell count increased to 35×104/ml, inflammation reactiom increased, and unconsiouzsness appeared. An emergency CT revealed retention of fluid in the retroperitoneum covering from the fistulation through the iliopsoas musucle to peivis. An abscess of the ileopsoas muscle was diagnosed. It was detrmined that any operations under general anesthesiawere impossible due to poor general condition, and an emergency incision drainage was perfomed under local anesthesia. There after, the patient developed MRSA septicemia which demanded redrainage and stric general management, but he was successfully freed from the management. Although the intractable fistula in persistently present, he was discharged after a resection of sequestrum and is followed on an ambulant basis.

A CASE OF GIANT INTRAMUSCULAR ANGIOMA OF THE RETROPERITONEUM

A 19-year-old man was seen at the hospital because of a left lower abdominal tumor. The tumor was infant's head in size and unmovable. Abdominal CT and angiography revealed a retroperitoneal tumor with plenty of blood flow. A possibility of malignant tumor was suspected and operation was carried out. Histopathological examination resulted in that the tumor was an intramuscular angioma arising in the retroperitoneal iliopsoas muscle, without malignant findings. Intramuscular angiomas are benign tumors and commonly found in the skeletal muscles of the extremities. The tumor in this case, however, arised in the left ileopsoas muscle and grew in the retroperitonum. The intramuscular angioma of the retroperitoneum is rare, but when we encounter a tumor with plenty of blood flow, this this type of tumor should be entertained as a probable diagnosis. In terms of this point, this paper also presents the methods of diagnosis, laparotomy findings, and some device for excision procedure.

Effects of clonidine-induced hypotension and dopamine-induced hypertension on blood flows in prostatic adenocarcinoma (Dunning R3327) and normal tissues.

In the present study it was investigated whether hypertension induced by dopamine or hypotension induced by clonidine could influence the relative blood distribution in a s.c. transplanted prostatic adenocarcinoma in relation to blood flow in normal tissues in rats. The blood flow was measured by using a radioactive microspheres technique. A bolus injection of 5 micrograms clonidine caused a decrease in the systemic blood pressure with 15-45 mm Hg, and blood flow to the central parts of the tumor, decreased with more than 50%. In the prostate, testes and ileo-psoas muscle a similar reaction was seen. During an infusion of 95-120 micrograms/kg/min dopamine, the blood pressure increased with 15-30 mm Hg, but the blood flow to the tumor was unchanged. However, in the testes and kidneys a decreased blood flow was observed. Moreover, mean blood flow to the central parts of the tumor decreased with increase in tumor size. The results further indicated that hyper- or hypotension or concomitantly given vasoactive drugs with the specific cancer treatment can have unwarranted effects on the distribution of cytotoxic drugs and oxygenation of the tumor.

ABSCESS OF THE APPENDICITIS DUE TO AN ARTIFICIAL TOOTH -REPORT OF A CASE-

An artificial tooth swallowed in error caused appendiceal abscess 2 years later. This case is described with reference to the literature. A 47-year-old man was presented with lumbago and fever, as well as right lower abdominal pain, which had been disregarded. Physical examination revealed knock pain over the right lumber region, tenderness and peritoneal signs in the right lower quadrant. The body temperature was 38.2°C with a leukocyte count of 12500. Microscopic hematuria was not recognized. Abdominal radiography revealed a radiopaque foreign body, 10×8 mm in size, in the right lower quadrant. Enhanced CT disclosed a uniform low density area in the right ileopsoas muscle with a high density spot in the retroperitoneal cavity. An emergency operation was performed under a diagnosis of appendiceal abscess due to a foreign body. An appendix showing inflammatory swollen was extensively adhesive to the retroperitoneum and ileopsoas muscle.There was an egg-sized abscess in the ileopsoas muscle. Appendectomy was completed with drains left in the peritoneal cavity and abscess. The excised appendix contained the artificial tooth which had been swallowed 2 years before. This experience suggested the importance of a careful study on anamnesis and abdominal plain films for diagnosing appendicitis due to foreign bodies before operation.

Ileo-psoas muscle metastasis from pulmonary carcinoma

Metastatic disease to muscle is rare and may be misdiagnosed when it is the presenting symptom, particularly in the absence of a known primary tumor. Skeletal muscle metastasis as a mode of presentation of primary lung cancer is an unusual phenomenon. Here, we report a case of ileo-psoas muscle metastasis from lung cancer as the initial clinical manifestation in a 58 year-old male with a personal history of heavy smoking. Excisional biopsy of the mass in the ileo-psoas muscle revealed metastatic adenocarcinoma. Computed tomography scan of the chest for a primary search was done and found to be pulmonary carcinoma. DOI: http://dx.doi.org/10.3126/jpn.v2i3.6033 JPN 2012; 2(3): 251-253