Getting Powerful Shapely Glutes
An operation on the medial side of the thigh is one of the most unsatisfactory operations an aesthetic plastic surgeon can perform. The patient's expectations of the procedure are usually too great and he she is then disappointed by the result. The patient should therefore be given an extremely detailed explanation prior to the thigh and buttock lift. The indication should be considered carefully and if the patient expects too much, they should preferably be turned away. The extent of the resection should be defined carefully the day before the operation. If the skin on the inner side of the thigh is loose, the buttock region is usually also loose, so these operations can be combined well. The incision line in the buttock area should not extend beyond the lateral buttock fold, as otherwise there may be residual aesthetically displeasing scars, which often disturb patients more than hanging skin. With extremely slack skin in the area of the medial thigh, vertical tightening extending...
The gluteus maximus muscle is one of the largest muscles in the body. Its principle actions are to extend the thigh and assist in its lateral rotation, steady the thigh and assist in raising the trunk from the flexed position. It has a dual blood supply from the superior and inferior gluteal vessels. The inferior gluteal artery and posterior cutaneous nerve of the thigh supply the inferior portion of gluteus maximus and the skin of the posterior thigh. Excision of the lower aspect of the gluteus maximus results in no functional deficit the donor site can be closed primarily and the muscle is sufficiently bulky to fill the cavity 16 . Baird et al. reported a series of 16 patients in which the inferior gluteal myocutaneous flap was employed to close large perineal wounds 33 , all but one patient achieved complete healing of the perineal wound. In addition, Gottlieb and Jejurikar 18 prefer the inferior gluteus maximus muscle. To facilitate exposure, dissection and elevation of the...
Shallow perineal defects may be closed utilising single or bilateral gluteus maximus V-Y flaps. The origins of the gluteal muscles are detached from their attachment to the sacrum, advanced medially and secured to each other in the midline. A V-shaped incision is made in the posterior lateral buttock skin down to the gluteal muscle. The musculocutaneous unit is advanced medially and a midline closure is performed without tension. The donor site is closed as a V-Y plasty 18 . Hurst et al. 19 utilised this flap in 4 of 12 patients (12.4 of 97 patients submitted to proctectomy for Crohn's disease) achieving primary closure.
The other standard procedures are clear and can be easily and safely learned following good basic surgical training. Similar basic surgical rules apply to brachioplasty, abdominoplasty, and thigh lift and buttock lifts. In principle, these procedures entail cleanly lifting a cutaneous fatty flap from the fascia and tightening the skin appropriately, using a large cutaneous resection and positioning the incisions in such a way that they are preferably not visible. The surgeon's talent is estimating the correct cutaneous resection, so that not too much and not too little is removed, and accurate surgical planning of the incisions so that they will preferably be in a non-visible area. The intracutaneous suturing technique with Monocryl, a suture which is not removed, is now standard and provides the best results. In certain cases, the skin may also be adapted with overcast cutaneous suturing with thin nylon, following subcutaneous, tension-free skin closure. When these continuous sutures...
Seronegative spondyloarthropathies may be the most common causes of chronic inflammatory monarthritis. Important clinical clues include the presence of low-back or buttock pains with morning stiffness reflecting spinal involvement or inflammation of the sacroiliac joints extraarticular features, such as pitting of the nails or a scaling skin rash (psoriasis) characteristic skin lesions, such as keratoderma blennorrhagicum or circinate balanitis, associated with urethritis and conjunctivitis (Reiter's disease) a history consistent with inflammatory bowel disease (ulcerative colitis or Crohn's disease) or a history of uveitis.
Usually associated with antecedent skin infection or trauma, NF is rapid in onset with the sequential development of erythema, extensive edema, and severe, unremitting pain, often despite antibiotic therapy. Hemorrhagic bul-lous lesions, skin necrosis, and crepitus associated with gas in soft tissues also may develop. Systemic toxicity manifest by fever, hypotension, tachycardia, delirium, and multiple organ dysfunction is characteristic of severe cases. Anesthesia localizes at the infection site because of associated nerve necrosis. The legs and other extremities are the most common locations for NF, although any site can be involved, including the perineum, trunk, head and neck, and buttocks 45,46 .
ASPS has also collected data on breast augmentation and reconstruction along with other plastic surgery procedures with national telephone surveys conducted by TeleNation, a service of MarketFacts, Inc. Each week TeleNation completes two national telephone surveys, including the Cosmetic Surgery Telephone Survey 40 . The survey consists of a minimum of 1000 interviews with adults 18 or older (500 males and 500 females) in the contiguous USA. TeleNation interviews are conducted over a 3 day period in the MarketFacts National Telephone Center. The Cosmetic Surgery Telephone Survey contains information on demographics (age, gender, household income, marital status, location of residence, education), view of cosmetic surgery (approve of cosmetic surgery for myself and others approve of cosmetic surgery for others but not myself undecided and disapprove of cosmetic surgery), views of cosmetic surgery compared with 10 years ago (same attitude toward cosmetic surgery now as 10 years ago more...
Henoch-Schonlein purpura occurs primarily in children and young adults following an upper respiratory tract infection. Purpuric lesions develop over the extensor surfaces and buttocks. Edema of the lower legs is common edema of the hands, scalp, and periorbital areas occurs in young children. Arthritis, abdominal pain, gastrointestinal bleeding, and renal involvement presenting as proteinuria and hematuria are other features. Serum complement levels are usually normal. Immunofluorescent staining of skin biopsy specimens of early lesions reveals mainly immunoglobulin A and complement deposition in the walls of affected vessels.
Local swelling, warmth, and tenderness are usually present. Tenderness may be palpated along the course of the tendon. On deep structures, such as the supraspinatus or gluteus medius tendons, deep-point tenderness in a specific and reproducible location may be elicited.
When giving these drugs orally, the nurse encourages the patient to drink a full glass of water with the drug. When barbiturates are administered intramuscularly, the nurse gives the drug in the gluteus maximus, vastus lat-eralis, or other areas where there is little risk of encountering a nerve trunk or major artery. Injection near or into peripheral nerves results in permanent nerve damage. When giving oral paraldehyde, the nurse mixes the drug with cold orange or tomato juice to eliminate some of the pungent taste. When paraldehyde is ordered for rectal administration, the nurse dissolves the dose of the drug (usually 10-20 mL) in one to two parts of oil or isotonic sodium chloride and gives it as a retention enema.
The classic presentation occurs in a young man between 15 and 40 years old who experiences the insidious onset of intermittent or persistent low back pain and stiffness that is often worse in the morning hours and after prolonged rest. The pain is typically relieved by physical activity. It is usually centered in the lumbosacral spine but may also be present in the buttocks and hips and occasionally radiate into the thighs.
Injury to the musculature of the hip is covered elsewhere but briefly, the glu-teus maximus, given its location, is prone to contusion injury, and muscle strains are uncommon in comparison to hamstring and quadriceps injury. In-sertional tendon injuries of the gluteus medius and minimus on the greater tro-chanter are often overlooked and more recently recognized as a source of pain that mimics trochanteric bursitis 78-80 . Calcific tendonitis tendinosis may also be a source of lateral hip pain and has been associated with ''trochanteric bursitis'' and has been mistaken for malignancy in some cases because of inflammatory changes and adjacent bone changes 81,82 .
Remind person to tighten buttocks and squeeze abdomen while rolling over. Assist as needed. Remind person to tighten buttocks and squeeze abdomen while rolling over. 4. Push with arms and let legs hang over side of the bed until feet are flat on floor. Tighten buttocks and squeeze abdomen. 5. Sit and balance yourself. Relax buttocks and abdomen.
May be elevated in combination with a gluteal muscle flap based on the same pedicle. The pedicle of the gluteal thigh flap, the descending branch of the inferior gluteal artery can be separated from beneath the gluteal muscle and dissected to its take-off from the inferior gluteal artery as it emerges from underneath the piriformis muscle, allowing independent placement of the muscle in the cavity and the skin paddle on the surface 18 . This technique allows two separate tissue transfers in a single flap procedure and is well suited for patients that require a wider pelvic dissection in addition to an extensive resection of the perineal skin 19 .
This technique was described by Taylor et al. in 1983 35 . It is an excellent method for closing a large perineal defect. Based on the inferior epigastric artery and vein, it may be passed into the pelvis to close the pelvic floor and fill the dead space. It is best employed pro-phylactically in high risk patients at the time of proc-tectomy when potential perineal wound problems are anticipated 17 , or at the time of abdominoperineal excision for a large neoplasm 34 when extensive perineal excision is needed in Crohn's disease 36 , or, finally, when the combined approach is used to excise a large perineal sinus in Crohn's disease or after radiotherapy 16 . As a delayed or secondary procedure, the advantages of this flap must be weighed against the potential difficulties and morbidity of having to reenter the lower abdomen and mobilise the bowel to provide space to pass this flap into the pelvis, which is often severely fibrotic. Moreover, in very large pelvic wounds, the bulk of a...
The external type of snapping hip is the most common, and is caused by catching of either the posterior iliotibial band (ITB) or the anterior aspect of the gluteus maximus muscle as it moves over the greater trochanter during flexion and extension of the hip joint 16 . An external snapping hip is typically a clinical diagnosis, so imaging is seldom needed.
The vast majority of stenotic (Fig. 19) and occlusive diseases of the aorta in the western world result from atherosclerosis. Occlusion of the abdominal aorta can be acute or chronic. Abrupt occlusion of the aortic bifurcation is rare. It is characterized by the sudden onset of pain, pallor, paralysis, and coldness in the legs. Usually a filling defect-meniscus on MIP projections indicates embo-lus. Urgent embolectomy is indicated and can usually be performed transfemorally. Chronic occlusion of the aortic bifurcation (Leriche's syndrome) is usually due to arteriosclerosis, is most frequently seen in the elderly, especially males with a history of smoking and manifests as intermittent claudication in the legs and buttocks and erectile impotence (Fig. 20). Leriche syndrome typically re-
At the end of the fourth week, when the embryo has approximately 28 somites, the main external features are the somites and pharyngeal arches (Fig. 5.20). The age of the embryo is therefore usually expressed in somites (Table 5.2). Because counting somites becomes difficult during the second month of development, the age of the embryo is then indicated as the crown-rump length (CRL) and expressed in millimeters (Table 5.3). CRL is the measurement from the vertex of the skull to the midpoint between the apices of the buttocks.
Isolated angiitis of the central nervous systen is a recently recognized vasculitic disorder primarily involving the
The classic triad is palpable purpura with a normal platelet count, colicky abdominal pain, and arthritis. Palpable purpura occurs in 100 of patients but is the presenting symptom in only half. Dependent areas are usually involved, and involvement of the buttocks is common. Arthritis is transient and usually involves the knees and ankles there are no permanent sequelae. Up to one-third of patients may experience hemoptysis and half have occult gastrointestinal bleeding, but serious hemorrhage is rare. Ten percent to fifty percent have renal involvement, ranging from transient isolated microscopic hematuria to rapidly progressive glomerulonephritis. HSP and immunoglobulin A (IgA) nephropathy are similar, but the latter is confined to the kidney, whereas the former is a systemic disease.
Old World species are generally larger than New World species, and there is considerable sexual dimorphism. Most have bare buttock pads, which may be brightly colored. Their tails are seldom fully prehensile, and may be significantly reduced in size. Almost all are active during the day, with excellent vision, hearing, and sense of smell. They communicate almost entirely by sight and sound, displaying a wide range of calls. Many display a range of facial expressions, used for communication with their own species as well as with other species nearby. Most are fully arboreal, but baboons are ground feeders, and macaques live both on the ground and in the trees.
The patterns of pain referral from the SI joint are variable and are thus difficult to distinguish from other causes of low back pain.2,14-16 Presenting symptoms and signs include lower lumbar pain, buttock pain, groin pain, lower abdominal pain, pain radiating to the leg or foot, and focal pain and tenderness over the joint.1,2,14,15,17,18 The complex pain referral patterns are explained by the innervation of the joint. The SI joint and the sacroiliac ligaments contain myelinated and un-myelinated axons that are thought to conduct proprioception and pain sensation from mechanoreceptors and free nerve endings in the joint.19-21 The anterior aspect of the sacroiliac joint likely derives the majority of its innervation from the dorsal rami of the L1-S2 roots but may also be innervated by the obturator nerve, superior gluteal nerve, and lumbosacral trunk.13,22-24 The posterior aspect of the joint is innervated by the dorsal rami of L4-S4, with major contributions from S1 and S2.19,22-24...
Reduced LH pulse amplitude may be explained by decreased gonadotropin-releas-ing hormone (GnRH) production or by reduced pituitary responsiveness to GnRH. A leading hypothesis is that reduced LH pulse amplitude in obesity results from increased estrogen production, because estradiol suppresses the pituitary LH response to GnRH stimulation in males (33). Testosterone is converted to estradiol by aromatase P450, the product of the CYP19 gene (34). Aromatase is expressed in Leydig cells where it is upregulated by LH hCG (35) however, most of the estrogen in men is from aromatase in adipose and skin stromal cells, with a lesser contribution from aortic smooth muscle cells, kidney, skeletal cells, and the brain. The promoter sequences of the P450 aromatase genes are tissue specific because of differential splicing, but the translated protein is the same in all tissues. The conversion of androstenedione to estrone was more than 10-fold greater in the upper thigh, buttock, and flank than in...
Proper establishment of the exaggerated lithotomy position is critical in establishing optimal perineal exposure and obviating positioning-related morbidity. The desirable flat perineum lying parallel to the floor can be achieved by elevating the buttocks or by marked flexion of the thighs. This requires avoiding pressure on the legs and the shoulders by using proper padding and careful placement of supports. The arms should be kept as close to the body as possible. In many instances, this can be accomplished by simply taping the hands (properly padded) to the knees.
Atmospheric) results in little distention of arteries because of their low compliance, but results in considerable distention of veins because of their high compliance. In fact, approximately 550 mL of blood is needed to fill the stretched veins of the legs and feet when an average person stands up. Filling of the veins of the buttocks and pelvis also increases, but to a lesser extent, because the increase in transmural pressure is less.
Hot-tub folliculitis is a special form of Gram-negative folliculitis caused by Pseudomonas. It occurs within 6 h to 3 d after exposure to poorly maintained hot tubs. The trunk, buttocks, legs, and arms are sites of predilection. Mild constitutional symptoms, including fever and malaise, may accompany the cutaneous findings. Hot-tub folliculitis, which is generally a benign, self-limited condition, can progress to a serious illness in an immunocompromised host. A furuncle is a deeper, more aggressive infection of a hair follicle or a cutaneous gland. These lesions range in size from 5 mm to 3 cm diameter and occur most commonly on hairy areas exposed to friction, trauma, or macerations (i.e., buttocks, face, neck, axillae, groin, thighs, upper back). Patients present with a painful, often fluctuant swelling. Pruritus, local tenderness, and erythema are often associated. As pus forms in the center of the lesion, the overlying skin becomes thin, the lesion becomes elevated, pain...
Delamination, or micro-fractures of collagen fibrils leading to mechanical distortion of the annular lamellae and sensitization of nociceptors with release of substance P. In fact, provocative discography triggers substance P release (11). As a result of stimulation of the dorsal root ganglion or direct chemical irritation of the nerve roots, the patient may experience referred pain to the buttocks and legs (39). Patients may present with one of three general types of disc pathologies. The first is the classic leg pain disc caused by disc herniation with nuclear migration through an annular tear and sciatica due to true dural tension. The internally disrupted disc with annular pathology, which produces back pain and variable amounts of buttock and leg pain but no true radiculopathy, causes the back pain disc. The mixed pattern of painful disc disease presents with features of both pathologies caused by small, contained disc herniations and central herniations.
Splitting of the fascia lata, division of the fibers of the tensor fasciae latae muscle and detachment of the gluteus medius with a cautery knife c. The greater trochanter and the insertion of the gluteus minimus are shown, the latter is divided between two stay sutures to exposes the joint capsule d. Insertion of the retractors 1. caudal, 2. cranial to the neck, 3. at the anterior acetabular rim. The joint capsule is open in an inverted T-shaped fashion to expose the fracture a. Skin incision b. Splitting of the fascia lata, division of the fibers of the tensor fasciae latae muscle and detachment of the gluteus medius with a cautery knife c. The greater trochanter and the insertion of the gluteus minimus are shown, the latter is divided between two stay sutures to exposes the joint capsule d. Insertion of the retractors 1. caudal, 2. cranial to the neck, 3. at the anterior acetabular rim. The joint capsule is open in an inverted T-shaped fashion to expose the...
To place sling under patient, stand in front of patient, lean patient forward on knees, place sling behind patient and bring leg flaps alongside patient's thighs. Tuck back edge of commode opening under patient's buttocks. Lean patient back. Grasp snap hook bar in one hand, and reaching under patient's leg, grasp D ring in other and pull until front edge of sling is just behind knees. Repeat on other side. Attach snap hook on each side of D ring on other side. (Can also criss-cross flaps under one leg and over the other, or support each leg independently by connecting snap hook and D ring on the same side together.)
Liposuction of the abdominal hip region is the most frequently requested procedure, particularly by men. Only individual zones should ever be treated with liposuction, i.e., abdomen hips or outer and inner thighs and buttock region (saddle area), as first the amount of tumescence that can be injected is limited (maximum 61) and second the procedure would be too stressful for the patient. As the navel region is particularly sensitive, a lot of tumescence must be used here. Liposuction of both hips or the upper and lower abdomen is carried out in a fan shape with the patient frequently changing position. Liposuction should be carried out carefully in the upper abdominal area, and a thin layer of fat should be left below the skin, as otherwise dimples will form and there can be loose skin.
Henoch-Schonlein purpura is nonthrombocytopenic vascular purpura. The pur-puric eruption differs considerably from that due to thrombocytopenia in that lesions are maculopapular, initially resembling urticaria because of edema and perivascular infiltration and later becoming erythematous, with central areas of hemorrhage that finally fade to brown because of denaturation of the extravasated hemoglobin. The rash appears on the buttocks and on the extensor surfaces of the arms and lower legs. Accompanying the rash are joint or gastrointestinal symptoms, localized areas of edema, and renal damage. Initial hematuria occurs in about one third of patients. The platelet count, bleeding time, and tests for hemostasis are normal. A positive tourniquet test is found in 25 of patients. Treatment is symptomatic. When severe abdominal pain is present, steroid therapy is beneficial.
Hepatitis B vaccine is traditionally administered intramuscularly, using a needle of 1.0 to 1.5 inches in length and 20- to 25-gauge in caliber. The preferred injection site is the deltoid muscle in adults and anterolateral thigh muscle in infants. Among 194 health care workers who received intramuscular buttock injections of hepatitis B vaccination, only 58 subsequently developed detectable anti-HBs titers 36 . This finding was verified by a prospective randomized trial where health care workers who received immunization in the arm achieved higher seroconversion rate of 93 and GMT of 1454 mlU mL, as compared with those who were injected in the buttock. Among those who received buttock injection, the seroconversion rate (83 versus 72 ) and the GMT (387 mlU mL versus 85 mlU mL) were higher with the use of 2-inch needles versus 1-inch needles 37 . Buttock injection makes intramuscular delivery of the vaccine difficult and should be avoided.
Verrall and colleagues 21 also compared the clinical finding of posterior thigh injury with MRI findings of hamstring strain. Again, not all clinically suspected hamstring injuries had findings on MR for muscle strain. Of the 83 patients imaged, 68 (82 ) had typical hyperintense signal on fluid-sensitive images as interpreted by a musculoskeletal radiologist, compatible muscle strain, whereas 12 (14 ) had no signal change at all. The remaining three patients had MR evidence of muscle injury outside of the hamstring muscle complex (lower gluteus maximus, vastus lateralis, and adductor magnus). Those with MRI-detectable signal changes had more pain (5 10 versus 2 10), were
Tighten buttocks and squeeze abdomen throughout. 3. Bring legs onto bed while tightening buttocks and squeezing abdomen. Slide into side lying position with knees bent. Helper assist as needed. Remind person to squeeze buttocks and tighten abdomen when beginning to roll. 5. Tighten buttocks and abdomen. Let legs slide into flattened position.
Laparoscopic surgery has become very popular for the treatment of severe obesity. Obesity can be distributed in either an android fashion, primarily within the abdominal area or centrally as seen primarily in male patients, or in a gynoid manner, in the hips and buttocks, peripherally as seen primarily in female patients. Many of our severely obese female patients have both peripheral and central obesity. We have found that central obesity is associated with a significant increase in intra-abdominal pressure and this pressure is as high or higher than the pressure seen in patients with an acute abdominal compartment syndrome (Fig. 5.1). Data support the finding that this increase in intra-abdominal pressure is associated with a number of obesity related co-morbidity problems leading to the development of a chronic abdominal compartment syndrome . These co-morbidities include obesity hypoventilation syndrome with its high cardiac filling pressures, gastroesophageal reflux disease,...
Streptomycin is usually administered daily as a single IM injection. The preferred site is the upper outer quadrant of the buttock or the midlateral thigh. The deltoid area is used only if the area is well developed. In patients 60 years of age or older, the dosage is reduced because of the risk of increased toxicity.
The hypophyseal hormones, all proteins encoded by genes, have a major impact upon metabolism and development in mammals. This is especially true for the sexual-cycle hypophyseal hormones FSH and LH. In females, puberty begins with the first menstrual cycle. Each menstrual cycle is the female body's way of preparing for a possible pregnancy. At the beginning of the cycle, the hypophysis produces high concentrations of FSH, which stimulates the ovarian follicle to develop and produce estrogen, a steroid hormone that increases body fat in regions such as the buttocks and breasts. Simultaneously, increased LH production matures the egg in the ovarian follicle and stimulates progesterone production. Progesterone causes the endometrium (the lining of the uterus) to increase its blood vessel content and thickness for receiving and maintaining a fertilized egg and for the subsequent long gestation period (nine months in humans). If the egg is fertilized by sperm, it will adhere to the...
Adequate debridement of the perineal wound with surgical removal of all devitalised and infected tissue is of great importance. Unfortunately, the presence of multiple tracks or abscess on the buttocks or surrounding perineal skin often interferes with the above-mentioned local procedures. It is usually advisable to examine all fistulae under anaesthesia in order to define its exact position, dilate any strictures present and collect some samples for histology and cultures 16 . A daily irrigation of the cavity with
If for some reason quinine cannot be administered by infusion, quinine dihydrochloride can be given in the same dosages by IM injection in the anterior thigh (notin the buttock). The dose of quinine should be divided between two sites - half the dose in each anterior thigh. If possible, for IM use, quinine should be diluted in normal saline to a concentration of 60-100 mg salt ml.
Gestational period Six to seven months Life span In the wild, baboons older than fifteen years are rare, but in captivity adults may live to twenty-five or thirty years Special anatomy Reproductive females display a sexual swelling in the perineal region and around the buttocks that, at the time of ovulation, may contain several liters of fluid and turn bright red adult males have extremely long canines which they use to threaten rivals, display their fighting ability to receptive females, or inflict wounds
Spasticity tends to occur most frequently in a specific group of muscles that are responsible for maintaining upright posture. These muscles are called antigravity or postural muscles. They include the muscles of the calf (gastrocnemius), thigh (quadriceps), buttock (gluteus maximus), groin (adductor), and occasionally the back (erector spinae).
Visual signals are often found among social mammals. These have been most observed in primates. Chimpanzee and bonobo females show a spectacular pink swelling of their genitals during estrus, which recurs every five weeks if pregnancy does not occur. Certain monkeys develop an estrus flush on their faces as well as their buttocks.
Decubiti most commonly occur on the buttocks and other areas that are in constant contact with the surface of a bed or wheelchair. A person with decreased skin sensation does not perceive the discomfort that normally would indicate that he or she has been in one position for too long. Pressure sores frequently appear quietly, with little or no pain, and continue to enlarge, resulting in large holes in the skin that gradually expand into the underlying muscle. Additional factors that may contribute to this process include inadequate nutrition, dependency on certain medications, stool or urine incontinence, and a lack of education regarding prevention.
The typical presentation is of insidious low back pain radiating into the buttocks with early morning stiffness the buttock pain is often alternating unlike that due, for example, to disc disease. The symptoms are normally worse with inactivity and improve with exercise. Diagnosis is often delayed because back pain is so common in the population. Enthesitis, such as Achilles tendonitis, is frequently present. Table 2.8 shows the Modified New York criteria used in diagnosis. Apart from imaging, laboratory tests are usually unhelpful but ESR and CRP are raised in 30-35 of patients.
Gas in the tissues is not diagnostic of gas gangrene, as gas is also seen in necrotizing fasciitis, anaerobic cellulitis and infected vascular gangrene, or from an open wound. The diagnosis is principally clinical. There is a history of a deep wound, usually of the buttock or thigh, less than 3 days previously. Local pain and swelling are severe, with a serosanguineous discharge. The patient is apprehensive and fearful of dying. Initially there is no pyrexia, but the patient is tachycardic. The production of gas is rarely abundant, but the systemic toxaemia leads to haemolysis, renal and hepatic failure.
The eroticization of feelings of humiliation is a familiar example of the conflation of very different affect systems, which, as I have noted, is a uniquely human attribute. The conflation of feelings of humiliation and erotic excitement can be illustrated by the narrative structure of certain fantasies. These accounts also illustrate the importance of unconscious intentionality as a director of the corporeal imagination. The conflation of erotic feelings and humiliation is evident in fantasies of being beaten.5 I have no way of estimating the prevalence of fantasies of being beaten, but the writer Daphne Merkin, in a New Yorker article (1996), described her life-long preoccupation with fantasies of being beaten on the buttocks. Fantasies of being beaten, controlled, and humiliated may, for some, be necessary to achieve orgasm. A humiliating fantasy of this sort may take
If the loss of elasticity and slackness of the skin is confined to the upper third of the thigh, the operation may be carried out in a half-moon shaped skin fat resection in this area (a). The scar is then located in the groin and runs into the buttock crease. There is no scar on the inner side of the thigh. This is the operation that is wanted most frequently and is also presented in detail in the video. If there is also pronounced wrinkling of skin on the buttock, then a skin fat resection must be carried out here as well. The scar then will be in the buttock crease and runs forwards into the inguinal region. The resection lines are drawn before the operation with the patient in a standing position. It must be kept in mind here that the incision line in the area of the inguinal fold should be relatively high (two fingerwidths in the cranial direction) since the scars always descend slightly over time and then could be visible in the upper leg area. The incision in the groin, which...
If intravenous infusion is not possible, chloroquine and quinine may be given by intramuscular injection into the anterior thigh (not into the buttock, where absorption is slow and uncertain and the sciatic nerve is at risk). Chloroquine - but not quinine - may also be given by subcutaneous injection.
Stomach, buttocks, thighs, or other areas. Briefly, in this procedure, an incision is made in the skin, a cannula (tube) is inserted, and the fat is suctioned out. Other procedures commonly performed by plastic surgeons include facelifts, breast augmentation (or reduction), rhinoplasty (reshaping the nose), hair transplants, hand surgery, skin grafts for burn survivors and repair of cleft palate (both usually done in a hospital setting), breast reconstruction associated with cancer surgery, and other disfiguring malformations of the face and head. The top three cosmetic procedures in the United States are liposuction, breast augmentation, and eyelid lifts.
Either as a result of therapy or as a manifestation of the underlying rheumatic disease, skin integrity may be compromised in these patients. In addition to the delayed wound healing and a propensity to infection that may result from chronic corticosteroid and immunosuppressive therapy, an even greater problem in the postoperative period is the potential for the development of decubitus ulceration (particularly heels and buttocks).
Folliculitis refers to a circumscribed superficial pustular infection of the hair follicle. These pruritic lesions, which are up to 5 mm in diameter, often present as small red papules with a central area of purulence that may rupture and drain. Systemic signs and symptoms are rare. Lesions typically are located on the head, back, buttocks, and extremities. The most common organism isolated is S aureus. A condition known as hot tub folliculitis is attributable to hot tub or whirlpool water contaminated with Pseudomonas aeruginosa-, the ear canal, the breast area, and other skin locations covered by a swim suit are commonly involved. A condition known as eosinophilic pustular folliculitis should be considered in the differential diagnosis of chronic excoriated-appearing follicular infections in HIV-infected patients who have a peripheral eosinophilia and CD4 count of less than 250 mm3 6,7 . In normal hosts, folliculitis usually resolves spontaneously without systemic treatment, and the...
The donor site can be usually sutured straightforwardly. To facilitate donor site closure, the flap should be designed to be less than 12 cm in width. It may be extended to within 8 cm from the popliteal fossa. In a series of 19 patients with 21 buttock and perineal wounds closed in a single stage, Hurtwitz et al. demonstrated the reliability, versatility and low morbidity of the gluteal thigh flap 18, 32 . It provides excellent soft tissue bulk and usually little to no functional deficit is noted postoperatively 19 . Many authors consider it to be the gold standard for the chronic, deep midline perineal defect, while others feel that de-epithelialised fasciocutaneous flaps have a limited capability in filling completely dead spaces, especially in complex sinuses 18 .
Jet injectors can deliver vaccines or drugs subcutaneously, intramuscularly, or intra-dermally. Some injectors employ high pressure and low volume stream of fluid, and others utilize small particles accelerated to a high velocity 12 . Most jet injectors are indicated for insulin administration. The recommended injection sites for the use of jet injectors include arms, legs, abdomen, hips and buttocks.
The patient is placed in the prone position and wide sterile preparation of the soft tissues over the sacrum and buttocks is performed. If C-arm fluoroscopy is to be used in imaging the joint, the x-ray beam is angled medial to lateral and is rotated until the anterior and posterior projections of the inferior third of the joint are superimposed on each other (Figure 13.4). For fixed fluoroscopy, the patient is positioned in the prone oblique position to align the x-ray beam with the inferior third of the joint. If two joint planes are seen, the more medial one should be targeted, since it most likely represents the posterior aspect of the joint. Sections measuring 3 to 5 mm are obtained for cross-sectional imaging guidance. The inferior third of the joint is identified,
Partial tear of the gluteus minimus. Longitudinal sonographic image of the hip shows a partial tear of the gluteus minimus (arrow) as it inserts onto the greater trochanter. Fig. 2. Partial tear of the gluteus minimus. Longitudinal sonographic image of the hip shows a partial tear of the gluteus minimus (arrow) as it inserts onto the greater trochanter.
Gluteal biopsy Biopsies are usually taken from the upper outer quadrant of the buttock under local anesthetic. A minor operations set with scalpel, blunt-nosed forceps, and two artery forceps is required. After sterilization of the appropriate area, the skin is anesthetised with approx 5 mL of 1 lignocaine (without epinephrine). An oval incision approx 1.5 x 0.5 cm is made and fat adherent to the skin is excised to a depth of approx 1.5 cm. It is usually possible to excise a cone of fat (with the skin at the apex) 2-3 cm in diameter without causing excessive bleeding. It may be necessary to place a deep absorbable suture to achieve hemostasis. The skin is closed with interrupted or subcuticular sutures. Alternative sources of tissue include the edge of an abdominal incision being performed for some other reason, and omental fat. In these cases it is important to avoid diathermy.
Bullous impetigo, a disease of mainly infants and young children, may appear purulent and, when the blister is removed, the area resembles scalded skin. Flaccid, transparent bullae develop most commonly on skin of the face, buttocks, trunk, perineum, and extremities. These skin lesions may have associated adenopathy, leukocytosis, and pruritus with no or minimal systemic symptoms or signs. Lesions are associated with little or no pain or surrounding erythema.
Either because of a short limb, a deformed or stiff joint or weak muscles. The effect of muscle weakness will depend on the site and degree of muscle pathology. Unilateral abductor muscle weakness at the hip produces the Trendelenburg gail (p. 282). Bilateral weakness of gluteal muscles causes a waddling gait. If the gait is bizarre or seems greatly exaggerated in comparison with other objective findings, psychological causes should be considered. However, in adolescents disc problems may also present with a bizarre gait.
Approximately half a century after Charcot described ischemic pain in the lower extremities, Dejerine in 1911 described a syndrome he called intermittent claudication of the spinal cord (72-74). This neurogenic intermittent claudication is known as pseudoclaudication. In 1954, Verbiest reported in detail symptoms caused by the developmental narrowing of the lumbar vertebral canal (72). Later, a number of cases of neurospinal compression were reported (73-75). Pseudoclaudication or neurogenic claudication is bilateral or unilateral and consists of discomfort or pain in the buttocks, thighs, legs, and calves precipitated by walking uphill, on a straight level, or worse by walking downhill. Standing can also cause symptoms in neurogenic claudication. The discomfort or weakness or frank pain is relieved by sitting or by lying down (76). Bending forward or adopting a flexed position can alleviate the symptoms of neurogenic claudication (75). Leaning against a wall or bending forward can...
More or less rapidly within hours or days. The clinical presentation can include swelling, tenderness, induration at palpation, asymmetry of the buttocks, redness, superficial cellulitis, or even gangrenous skin. Inguinal lymph nodes may be enlarged. Systemic symptoms such as fever, chills, malaise, and tachycardia occur more frequently with high or deep abscesses than with more superficial ones. Only a careful rectal examination reveals the development of a high anorectal abscess.
This increase in pressure due to gravity influences the effective circulating blood volume in several ways. First, the increased hydrostatic pressure that occurs in the legs (as well as the buttocks and pelvic area) when a person is quietly standing pushes outward on the highly distensible vein walls, causing marked distension. The result is pooling of blood in the veins that is, much of the blood emerging from the capillaries simply goes into expanding the veins rather than returning to the heart. Simultaneously, the increase in capillary pressure caused by the gravitational force produces increased filtration of fluid out of the capillaries into the interstitial space. This accounts for the fact that our feet swell during prolonged standing. The combined effects of venous pooling and increased capillary filtration reduce the effective circulating blood volume very similarly to the effects caused by a mild hemorrhage. This explains why a person may sometimes feel faint upon standing...
With the cxccption of the congenitally dislocated hip, the major presenting symptom of hip disease is usually pain. Pain is usually felt in the groin, but may be reported in the thigh or knee or, less frequently, the buttock. The pain is usually worse oil activity, and limits walking. There is often troublesome pain at night, which prevents sleep or awakens the patient when turning over during sleep. Some degree of stiffness is common and results in limitation of flexion which may be sufficient to prevent the patient putting on socks or shoes, or cutting the toenails. There may also be difficulty getting in and out of the bath or sitting on a low seat.
Symptoms most commonly include groin, hip, buttock, or thigh pain 7984 . These fractures most commonly occur in long distance female runners 81-85 . Severe groin pain may make running impossible. Standing on the leg of the affected side may elicit the pain or be impossible. Deep palpation
In 1998, Saifuddin et al. retrospectively reviewed 99 lumbar discogram reports in which 260 discs were injected and 179 were abnormal. They found that pain experienced in the buttock, hip, groin, or lower limb can arise from the posterior annulus without direct involvement of the nerve root (47).
During and immediately after preg nancy, laxity of the pelvis may occur causing instability in the pelvic girdle. This may allow a small amount of movement to be detected. This diagnosis is usually clear from the symptoms and the clinical context. Pain arising from the sacroiliac joints may radiate into the buttocks and posterior thighs, but unlike sciatica, rarely extends below the knee. Local palpation over the sacroiliac joints is often unhelpful and may give rise to false positive and false negative results. Stressing the pelvis may produce buttock pain if these joints are inflamed.
Sacral stress fractures may present as low back or buttock pain, mimicking disk disease, sciatica, or sacroiliac joint pathology. These fractures more commonly affect the female runner there are reports of adolescent female runners who had low back pain subsequently being diagnosed with sacral stress fractures
Coalitions short-term alliances designed to gain access to a contested resource, often by fighting matrilines several generations of adult females all related by common descent from one foundress (female ancestor) sexual swelling an estrogen-induced water retention that causes reddening and swelling in the perineal region and around the buttocks
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