Arteriovenous malformation: An unusual cause of rectus sheath hematoma, following laparoscopic cholecystectomy

Rectus sheath hematoma (RSH) is an accumulation of blood in the rectus abdominis muscle sheath, secondary to several conditions which may cause the epigastric vessel rupture or muscular tear, but mostly affecting patients undergoing anticoagulation therapy.We present a rare case of a 67-year-old woman who underwent laparoscopic cholecystectomy and developed RSH on the 12th postoperative day. The patient was under anticoagulation therapy with acenocoumarole due to mitral valve replacement. The bleeding source was an arteriovenous malformation (AVM) rupture as indicated by the angiogram images and it was embolized succefully. The patient was discharged seven days later.     

Isolated avulsion of the biceps femoris insertion-injury patterns and treatment options: a case report and literature review

Isolated avulsion of the biceps femoris tendon is a relatively rare condition. We report a case of a 43 year-old soccer player with a rupture of the biceps femoris tendon which occurred in a hyperextension of the knee. Based on this case, we discuss the literature referring to injury pattern and treatment.     

Measurement of compartment pressure of the rectus sheath during intra-abdominal hypertension in rats

Objective To investigate whether the compartment pressure of the rectus sheath (CPRS) reflects the intra-abdominal pressure (IAP) under various conditions of intra-abdominal hypertension (IAH).Design and setting Prospective experimental study with in vivo pressure measurements at the Institute for Clinical and Experimental Surgery, University of Saarland.Animals Sprague-Dawley rats.Interventions Stepwise increase and decrease in IAP with continuous measurement of the correspondent CPRS.Measurements and results Physiological IAP (2 mmHg) and CPRS (6 mmHg) showed a statistically significant difference. Stepwise elevation in IAP was associated with a simultaneous increase in CPRS. Accordingly, stepwise decompression of IAP resulted in a stepwise decrease in CPRS. Under both conditions Bland-Altman analysis comparing IAP to correspondent CPRS showed a very good agreement for IAP at or above 12 mmHg. In addition, closure of the overlaying subcutaneous tissue and skin did not affect CPRS or its correlation with IAP.Conclusions CPRS accurately reflects IAP for IAP of 12 mmHg or higher. Thus CPRS measurements may represent a novel approach for diagnosis and monitoring of IAH.Electronic supplementary material Supplementary material is available in the online version of this article at and is accessible for authorized users.     

Roles played by histamine in strenuous or prolonged masseter muscle activity in mice

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青壮年股骨颈骨折外科手术治疗的方法研究

目的探讨两种手术方法治疗青壮年股骨颈骨折的效果。方法 84例青壮年股骨颈骨折患者分为两组,每组42例,A组采用切开复位空心螺钉加压内固定联合股方肌骨瓣移植治疗,B组采用闭合复位空心螺钉加压内固定治疗,比较两组骨折愈合时间和髋关节功能恢复情况。结果所有患者成功随访24～50个月,A组骨折愈合时间优于B组（t=4.0844,P〈0.05）,髋关节功能优于B组（χ2=4.9411,P〈0.05）。结论空心螺钉加压内固定联合股方肌骨瓣移植治疗青壮年股骨颈骨折,操作简单,创伤小,疗效确切,是理想的治疗方法。     

Expression of heat shock protein 72 in rat quadriceps muscles following anterior cruciate ligament resection

 This study investigated the expression of heat shock protein 72 (HSP 72) in quadriceps femoris muscle following anterior cruciate ligament (ACL) resection and running training in rats. A group of 15 Wistar strain male rats (10 weeks old) were divided into three groups: sham-operated (S), ACL resection (A), and running training following ACL resection (R). In the A and R groups, the ACL of the right knee was resected using microsurgical techniques. Rats in the R group were subjected to running training for 9 weeks on a motor-driven treadmill for rodents 1 week after ACL resection. At 10 weeks after ACL resection, glycerinated single fibers were prepared from vastus lateralis (VL), vastus medialis (VM), rectus femoris (RF), and semimembranosus (SM) muscles. To determine the levels of HSP72 (HSP-inducible) in each muscle, we used the Western blotting technique. HSP72 expression in VL and VM increased following ACL resection (P < 0.05) but not in RF or SM. Exercise training caused an elevation in HSP72 expression in VL and VM. There were no significant changes in HSP72 expression in RF or SM following exercise training. These results suggest that some stress would be generated by ACL resection in VM and VL and might cause atrophy in VM and VL. Received: July 29, 2002 / Accepted: October 18, 2002 Acknowledgments. We especially thank Professor H. Aoki of the Department of Orthopaedic Surgery at St. Marianna University School of Medicine for his encouragement and many valuable comments. We also thank Vice President T. Yoshioka of Aomori University of Health and Welfare for his valuable criticism and advice. This study was supported in part by a Grant-in-Aid for Encouragement of Young Scientists (B) from The Ministry of Education, Culture, Sports, Science and Technology (MEXT) to K.G. Offpring requests to: R. Okuyama     

针刀、电针和圆利针对膝骨关节炎模型兔股直肌Bcl-2、Bax、Caspase-3蛋白表达的影响

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Novel High-Quality Sonographic Methods to Diagnose Muscle Wasting in Long-Stay Critically Ill Patients: Shear Wave Elastography,Superb Microvascular Imaging and Contrast-Enhanced Ultrasound

Novel ultrasound (US) methods are required to assess qualitative changes in the quadriceps rectus femoris (QRF) muscle when evaluating mechanically ventilated, long-stay ICU patients with suspected neuromuscular acquired weakness (ICUAW). Our aim was to analyze novel US muscle assessment methods in these patients versus healthy controls by carrying out a prospective observational study. Shear wave elastography (SWE) showed, with a receiver operating characteristic (ROC) curve of 0.972 (95% confidence interval (CI) = 0.916–1.000), that patients increased muscle stiffness associated with muscle fibrosis when diagnosed with ICUAW. We also performed, for the first time, superb microvascular imaging (SMI), which is an innovative US technique designed for imaging microvascularization unseen with color Doppler US, and observed that 53.8% of cases had significantly lower QRF muscle microvascular angiogenic activity than controls (p < 0.001). Finally, we used contrast-enhanced ultrasound (CEUS) to analyze maximum and minimum QRF muscle perfusion and obtained a ROC curve of 0.8, but when used as markers for SMI, their diagnostic capacity increased to 0.988 (CI = 0.965–1) and 0.932 (CI = 0.858–1), respectively. These findings show, for the first time, that these novel sonographic muscle methods should be used for their diagnostic capacity when assessing sarcopenic processes associated with this group of critically ill patients.     

Use of MMG Signals for the Control of Powered Orthotic Devices: Development of a Rectus Femoris Measurement Protocol

ABSTRACT

A test protocol is defined for the purpose of measuring rectus femoris mechanomyographic (MMG) signals. The protocol is specified in terms of the following: measurement equipment, signal processing requirements, human postural requirements, test rig, sensor placement, sensor dermal fixation, and test procedure. Preliminary tests of the statistical nature of rectus femoris MMG signals were performed, and Gaussianity was evaluated by means of a two-sided Kolmogorov-Smirnov test. For all 100 MMG data sets obtained from the testing of two volunteers, the null hypothesis of Gaussianity was rejected at the 1%, 5%, and 10%?significance levels. Most skewness values were found to be greater than 0.0, while all kurtosis values were found to be greater than 3.0. A statistical convergence analysis also performed on the same 100 MMG data sets suggested that 25 MMG acquisitions should prove sufficient to statistically characterize rectus femoris MMG. This conclusion is supported by the qualitative characteristics of the mean rectus femoris MMG power spectral densities obtained using 25 averages.     

Muscle thickness and echo-intensity changes of the quadriceps femoris muscle during a strength training program

IntroductionUltrasound (US) has an important role in musculoskeletal (MSK) evaluation, allowing the study of muscle morphology and function. Muscle thickness (MT) and muscle echo-intensity (EI) are two important parameters that may quantify muscle structural adaptations to a variety of stimuli. The aim was to explore the potential of quantitative US imaging for assessing the adaptations and responses of the muscle tissue to increased contractile activity using B-mode US. This study was centred on the quadriceps femoris muscle contractile activity on MT and EI.Methods and materialsTwenty-eight young male adults participated in the study, divided in a control group and two training groups performing concentric or eccentric strength training, respectively. The effect of a 15-week strength program was studied on MT and EI in several regions of the heads of the quadriceps femoris using B-mode US. All images acquisitions and measurements were done by the same experience sonographer.ResultsStrength training resulted in an increase of MT at all muscles and sites (p < 0.05), except the VM. Strength training failed in changing EI in most of the quadriceps femoris, except in the VI and some regions of the VL. No statistically significant differences were observed in our quantitative US parameters between concentric and eccentric training (p > 0.05).ConclusionThese results emphasise the value of MT as a quantifiable muscle US method for evaluating muscle adaptation to exercise training. However, the inconsistency of the EI values indicates that more studies are needed to develop it as an accurate diagnostic tool.