OBJECTIVE: The extreme lateral supracerebellar infratentorial (ELSI) approach has the potential to access several distinct anatomical regions that are otherwise difficult to reach. We have illustrated the surgical anatomy through cadaveric dissections and provided an extensive review of the literature to highlight the versatility of this approach, its limits, and comparisons with alternative approaches. METHODS: The surgical anatomy of the ELSI has been described using 1 adult-injected cadaveric head. Formalized noninjected brain specimens were also dissected to describe the brain parenchymal anatomy of the region. An extensive review of the literature was performed according to each targeted anatomical region. Illustrative cases are also presented. RESULTS: The ELSI approach allows for wide exposure of the middle and posterolateral incisural spaces with direct access to centrally located intra-axial structures such as the splenium, pulvinar, brainstem, and mesial temporal lobe. In addition, for skull base extra-axial tumors such as petroclival meningiomas, the ELSI approach represents a rapid and adequate method of access without the use of extensive skull base approaches. CONCLUSIONS: The ELSI approach represents one of the most versatile approaches with respect to its ability to address several anatomical regions centered at the posterior and middle incisural spaces. For intra-axial pathologies, the approach allows for access to the central core of the brain with several advantages compared with alternate approaches that frequently involve significant brain retraction and cortical incisions. In specific cases of skull base lesions, the ELSI approach is an elegant alternative to traditionally used skull base approaches, thereby avoiding approach-related morbidity.
- MeSH
- disekce MeSH
- dura mater anatomie a histologie MeSH
- hluboké zádové svaly anatomie a histologie chirurgie MeSH
- lidé MeSH
- mozeček anatomie a histologie MeSH
- mozkový kmen anatomie a histologie chirurgie MeSH
- mrtvola MeSH
- neurochirurgické výkony metody MeSH
- pulvinar anatomie a histologie chirurgie MeSH
- skalní kost anatomie a histologie chirurgie MeSH
- spánkový lalok anatomie a histologie chirurgie MeSH
- thalamus anatomie a histologie chirurgie MeSH
- zadní jáma lební anatomie a histologie chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- MeSH
- bolesti hlavy * diagnóza etiologie rehabilitace MeSH
- diferenciální diagnóza MeSH
- faryngální svaly MeSH
- hluboké zádové svaly MeSH
- krční svaly MeSH
- lidé MeSH
- muskuloskeletální manipulace metody MeSH
- okulomotorické svaly MeSH
- os hyoideum MeSH
- palpace metody MeSH
- spoušťové body * MeSH
- syndromy myofasciální bolesti diagnóza etiologie rehabilitace MeSH
- Check Tag
- lidé MeSH
Bolesti dolní části zad (low back pain; LBP) jsou mimořádně častým a závažným zdravotním problémem. Paraspinální svaly hrají důležitou funkci při pohybech trupu, přispívají k udržení postury a stability páteře. U pacientů s chronickými LBP dochází ke strukturálním i funkčním změnám paraspinálních svalů. Makroskopické změny lze vyšetřit na CT a zejména na MR, mikroskopické změny pomocí svalové biopsie. V dostupné literatuře existují důkazy, že atrofie paraspinálních svalů a zvýšení podílu tukové tkáně uvnitř paraspinálních svalů jsou významně asociovány s nespecifickými LBP, a to zejména s chronickými bolestmi. Z diferenciálně diagnostického hlediska je nutné změny v paraspinálních svalech asociované s LBP odlišit od postižení paraspinálních svalů u pacientů s axiálními myopatiemi, které jsou však vzácné. Cílem tohoto sdělení je upozornit na strukturální i funkční změny paraspinálních svalů u pacientů s chronickými nespecifickými LBP. Je uveden diagnostický postup při chronických LBP spojených s degenerací paraspinálních svalů k vyloučení přítomnosti axiální myopatie.
Low back pain (LBP) is a frequent and major health problem. Paraspinal muscles play an important role in trunk movements, helping to maintain posture and spinal stability. Changes of paraspinal muscle morphology and function are described in patients with chronic LBP. Macroscopic changes can be evaluated by CT and especially by MRI, while microscopic changes are assed by muscle biopsy. There is evidence available in literature stating that atrophy of paraspinal muscles and increased fat deposits in the paraspinal muscles are significantly associated with non-specific LBP, especially with chronic LBP. From a ferential diagnostic point of view, changes in paraspinal muscles associated with LBP must be distinguished from paraspinal muscle involvement in patients with axial myopathies, but these are rare. The aim of this paper is to highlight the structural and functional changes of paraspinal muscles in patients with chronic non-specific LBP. A diagnostic algorithm for chronic LBP associated with degeneration of paraspinal muscles to exclude the presence of axial myopathy is presented.
- Klíčová slova
- axiální myopatie, tuková infiltrace,
- MeSH
- hluboké zádové svaly * diagnostické zobrazování patologie MeSH
- lidé MeSH
- lumbalgie * komplikace patologie MeSH
- magnetická rezonanční tomografie metody MeSH
- nemoci svalů diagnóza patologie rehabilitace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Cíl: Zjištění možné souvislosti mezi bolestí dolní části zad a asymetrií plochy průřezu páteřního musculus multifidus pomocí UZ měření u fyzicky aktivních a neaktivních dospívajících chlapců. Soubor a metody: Celkem bylo zkoumáno 45 dospívajících chlapců - 28 chlapců bylo fyzicky aktivních a 17 fyzicky neaktivních. Byly u nich zaznamenány výška, hmotnost, přítomnost bolesti zad a ultrazvukem byla změřena plocha průřezu páteřního musculus multifidus. Výsledky byly uvedeny jako střední hodnota, směrodatná odchylka a procentuální změna výsledků. Rozdíl mezi dvěma vzorky byl vypočítán pomocí dvouvýběrového Studentova t-testu (hladina významnosti činila p < 0,05). Výsledky: Z výsledků vyplývá, že velikost musculus multifidus byla větší ve skupině s fyzickou neaktivitou (4,86 ± 1,91 cm2) než ve skupině s fyzickou aktivitou (4,06 ± 1,42 cm2). Byla zjištěna nevýznamná asymetrie vyjádřená jako procento plochy průřezu páteřního musculus multifidus u fyzicky aktivních i fyzicky neaktivních chlapců s bolestí zad: 17,7 (14,1-21,0) %, resp. 10,9 (3,3-18,5) %, a také bez bolesti zad: 6,9 (6,6-7,4) %, resp. 7,5 (6,9-8,0) %, avšak významná asymetrie vyjádřená jako procento plochy průřezu páteřního musculus multifidus byla zjištěna mezi chlapci s bolestí zad i a chlapci bez bolesti zad jak ve skupině fyzicky aktivních (p < 0,05), tak ve skupině fyzicky neaktivních (p < 0,05). Závěr: Tato pilotní studie ukázala, že může existovat souvislost mezi bolestí zad a asymetrií plochy průřezu musculus multifidus. Pro potvrzení těchto výsledků jsou nutné další studie.
Aim: To determine the possible relationship between low back pain (LBP) and asymmetry of the cross-sectional area of the multifidus spinal muscle as measured by US in physically active and inactive adolescent boys. Materials and methods: In total, 45 adolescent boys were examined - 28 boys were physically active and 17 physically inactive. Height, weight, occurrence of back pain were recorded, and the spinal multifidus cross-sectional area was measured by US. The results were listed as mean, standard deviation, and percentage change of results. The difference between two samples was deducted using a two-tailed Student t-test (the level of significance was p < 0.05). Results: The results showed that the multifidus muscle size was larger in the physically inactive group (4.86 ± 1.91 cm2) than the physically active group (4.06 ± 1.42 cm2). The non-significant asymmetry expressed as a percentage of the cross-sectional area of the multifidus spinal muscle was found between boys who were physically active and physically inactive with back pain: 17.7 (14.1-21.0)% and 10.9 (3.3-18.5)%, resp.; and also without back pain: 6.9 (6.6-7.4)% and 7.5 (6.9-8.0)%, resp.; but the significant asymmetry expressed as a percentage of the cross-sectional area of the multifidus spinal muscle was found between boys with back pain and boys without back pain in both the physically active (p < 0.05) and physically (p < 0.05) inactive groups. Conclusion: The pilot study showed that there might be a relationship between back pain and asymmetry of the cross-sectional area of the multifidus spinal muscle. Further studies are needed to confirm these results.
OBJECTIVES: Sarcopenia is associated with a poor prognosis in the ICU. The purpose of this study was to describe a simple sarcopenia index using routinely available renal biomarkers and evaluate its association with muscle mass and patient outcomes. DESIGN: A retrospective cohort study. SETTING: A tertiary-care medical center. PATIENTS: High-risk adult ICU patients from October 2008 to December 2010. INTERVENTIONS: The gold standard for muscle mass was quantified with the paraspinal muscle surface area at the L4 vertebrae in the subset of individuals with an abdominal CT scan. Using Pearson's correlation coefficient, serum creatinine-to-serum cystatin C ratio was found to be the best performer in the estimation of muscle mass. The relationship between sarcopenia index and hospital and 90-day mortality, and the length of mechanical ventilation was evaluated. MEASUREMENTS AND MAIN RESULTS: Out of 226 enrolled patients, 123 (54%) were female, and 198 (87%) were white. Median (interquartile range) age, body mass index, and body surface area were 68 (57-77) years, 28 (24-34) kg/m, and 1.9 (1.7-2.2) m, respectively. The mean (± SD) Acute Physiology and Chronic Health Evaluation III was 70 (± 22). ICU, hospital, and 90-day mortality rates were 5%, 12%, and 20%, respectively. The correlation (r) between sarcopenia index and muscle mass was 0.62 and coefficient of determination (r) was 0.27 (p < 0.0001). After adjustment for Acute Physiology and Chronic Health Evaluation III, body surface area, and age, sarcopenia index was independently predictive of both hospital (p = 0.001) and 90-day mortality (p < 0.0001). Among the 131 patients on mechanical ventilator, the duration of mechanical ventilation was significantly lower on those with higher sarcopenia index (-1 d for each 10 unit of sarcopenia index [95% CI, -1.4 to -0.2; p = 0.006]). CONCLUSIONS: The sarcopenia index is a fair measure for muscle mass estimation among ICU patients and can modestly predict hospital and 90-day mortality among patients who do not have acute kidney injury at the time of measurement.
- MeSH
- biologické markery krev MeSH
- cystatin C krev MeSH
- hluboké zádové svaly diagnostické zobrazování MeSH
- hodnoty glomerulární filtrace MeSH
- jednotky intenzivní péče MeSH
- kohortové studie MeSH
- kreatinin krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- mortalita v nemocnicích * MeSH
- počítačová rentgenová tomografie MeSH
- retrospektivní studie MeSH
- sarkopenie diagnóza MeSH
- senioři MeSH
- umělé dýchání statistika a číselné údaje MeSH
- věkové faktory MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The pathogenesis of adolescent idiopathic scoliosis (AIS), including the associated local changes in deep paravertebral muscles, is poorly understood. The asymmetric expression of several molecules involved in the melatonin signaling pathway, including melatonin receptors 1A/1B (MTNR1A/MTNR1B), estrogen receptor 2 (ESR2) and calmodulin (CALM1), has previously been suggested to be associated with AIS. However, this hypothesis is based on single studies in which the data were obtained by different methodological approaches. Therefore, to evaluate the symmetry of the mRNA expression levels of these molecules, 18 patients with AIS and 10 non‑scoliotic controls were enrolled in the present study. Muscle biopsy samples from deep paraspinal muscles (from the convexity and concavity of the scoliotic curve in patients with AIS, or from the left and right sides in controls) were obtained during spinal surgery. For each sample, the relative mRNA expression levels of MTNR1A, MTNR1B, CALM1 and ESR2 were analyzed by reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR) and were quantified according to the quantification cycle method. The results indicated that the mRNA expression levels of none of the investigated molecules were significantly different between samples obtained from the convex and concave side of the scoliotic curve in patients with AIS. In addition, no difference in expression was detected between the patients with AIS and the controls. With regards to MTNR1A and MTNR1B, their expression was very weak in paravertebral muscles, and in the majority of cases their expression could not be detected by repeated RT‑qPCR analysis. Therefore, these data do not support the previously suggested role of the asymmetric expression of molecules involved in the melatonin signaling pathway in deep paravertebral muscles in the pathogenesis of AIS.
- MeSH
- beta receptor estrogenů genetika MeSH
- dítě MeSH
- dospělí MeSH
- exprese genu MeSH
- genetická predispozice k nemoci MeSH
- hluboké zádové svaly metabolismus MeSH
- kalmodulin genetika MeSH
- lidé středního věku MeSH
- lidé MeSH
- messenger RNA MeSH
- mladiství MeSH
- mladý dospělý MeSH
- receptor melatoninový MT1 genetika MeSH
- receptor melatoninový MT2 genetika MeSH
- skolióza etiologie metabolismus patologie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: The pathogenesis of adolescent idiopathic scoliosis (AIS) remains poorly understood. To date, potentially involved local changes in the deep paraspinal muscles still remain unknown. METHODS: Needle electromyography (EMG) and muscle biopsy of paraspinal muscles at convexity and concavity of the AIS main thoracic curve were performed in 25 subjects. In this group, EMG was performed in 16 AIS subjects (12 females, 12-27 years), muscle biopsy in 18 AIS subjects (15 females, 11-31 years) compared to 10 non-scoliotic controls (6 females, 12-55 years). Samples of muscle tissue were removed during corrective surgery and were examined histologically, enzyme histochemically and immunohistochemically. Both methods of EMG and muscle biopsy were performed in 9 subjects (7 women, 12-27 years). RESULTS: Right curve convexity was found in 24 AIS subjects. Amplitudes of motor unit action potentials (MUPs) were significantly increased on the AIS curve convexity versus concavity. Turns, duration and phases of MUPs were without any significant changes. In all 18 subjects, the histological examination revealed muscle fiber redistribution with numerical predominance of type I on the curve convexity which strongly correlated with the progression of the Cobb angle. CONCLUSION: Our findings demonstrate significant changes of muscle fiber redistribution in the paraspinal muscles of AIS with increased proportion of type I on the convexity corresponding to a significantly higher amplitude of MUPs on the same side. A possible explanation of this alteration is a secondary adaptation due to chronic high load demand.
- MeSH
- dítě MeSH
- dospělí MeSH
- elektromyografie MeSH
- hluboké zádové svaly * patologie patofyziologie MeSH
- kosterní svalová vlákna patologie fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- progrese nemoci MeSH
- skolióza * patologie patofyziologie MeSH
- studie případů a kontrol MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
