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Maedica Sep 2023Angiosarcoma is a rare type of soft tissue cancer with several clinical presentations and a poor prognosis. We present a case of a 75-year-old man who was admitted due...
Angiosarcoma is a rare type of soft tissue cancer with several clinical presentations and a poor prognosis. We present a case of a 75-year-old man who was admitted due to anemia and fatigue. The patient had undergone an endovascular repair (EVAR) of a 9 cm infrarenal aneurysm of the abdominal aorta two months ago. A computed tomography (CT) scan of the abdomen on admission indicated a Type-II endoleak and a large hematoma of the left psoas muscle with multiple sites of intramuscular extravasation. Osseous metastases were found at the head of the left femoral head and at the iliac bones. A CT guided biopsy of the femoral head revealed an angiosarcoma of unknown primary site a few days after the patient had died from intra-alveolar hemorrhage caused by lung metastases.
PubMed: 38023756
DOI: 10.26574/maedica.2023.18.3.519 -
Frontiers in Oncology 2023The objective of this study is to investigate whether the evaluation of postoperative outcomes or overall survival in patients who undergo surgery for esophageal cancer...
OBJECTIVES
The objective of this study is to investigate whether the evaluation of postoperative outcomes or overall survival in patients who undergo surgery for esophageal cancer can be achieved by assessing sarcopenia using psoas muscle mass index and peak expiratory flow.
METHODS
This retrospective study analyzed the clinical data of 356 elderly patients (≥ 65 years) who had undergone radical surgery for esophageal cancer. Muscle mass and muscle strength were assessed by psoas muscle mass index (bilateral psoas area/height) and peak expiratory flow, using preoperative computed tomography and spirometry, respectively. Sarcopenia is defined as a condition where both the psoas muscle mass index and peak expiratory flow fall below their gender-specific cutoff values. Survival and postoperative complications were compared between patients with and without sarcopenia.
RESULTS
Out of the 356 elderly individuals diagnosed with esophageal cancer, 84 patients (23.6%) were found to have sarcopenia. The group with sarcopenia showed a notably higher occurrence of postoperative pneumonia (29.8% vs 16.9%, P < 0.001) and anastomotic leak (9.5% vs 3.7%, P < 0.05) compared to those without sarcopenia. Additionally, a multivariate analysis concluded that sarcopenia independently acted as a risk factor for postoperative pneumonia, possessing an odds ratio of 1.90 (P < 0.05). The survival rate after 3 years for individuals with sarcopenia was considerably lower than those without sarcopenia (57.8% vs 70.2%, P < 0.05). Sarcopenia was identified as an unfavorable prognostic factor for overall survival, with a hazard ratio of 1.51 (P < 0.05).
CONCLUSIONS
Preoperative sarcopenia diagnosed by psoas muscle mass index and peak expiratory flow is associated with reduced overall survival and adverse postoperative outcomes among elderly individuals suffering from esophageal cancer.
PubMed: 38090498
DOI: 10.3389/fonc.2023.1303877 -
Journal of Spine Surgery (Hong Kong) Sep 2023Lateral access lumbar interbody fusion is an increasingly popular procedure that allows for anterior column support through discectomy, endplate preparation, and... (Review)
Review
BACKGROUND AND OBJECTIVE
Lateral access lumbar interbody fusion is an increasingly popular procedure that allows for anterior column support through discectomy, endplate preparation, and interbody insertion. This procedure was initially described and performed with the patient in the lateral decubitus position. This would typically be followed by repositioning the patient to the prone position for pedicle screw fixation. Increasingly common is the lateral access lumbar interbody fusion in the prone position. This narrative review seeks to summarize the available literature on advantages, disadvantages, and unique features of the prone position lateral access lumbar interbody fusion.
METHODS
We performed a narrative review of articles published up to 01 November 2022 through a PubMed search. The search terms "prone lateral spine surgery" and "lateral approach spine surgery" AND "prone position" were used. Articles not available in English were excluded. The search result abstracts were independently reviewed by 2 authors and 28 full text articles were reviewed. Both reviewing authors were orthopedic surgery chief residents.
KEY CONTENT AND FINDINGS
There are several unique advantages as well as disadvantages to the prone position lateral interbody fusion. Some advantages include ease of placing pedicle screws, simultaneous posterior and lateral access, greater ease in achieving segmental lumbar lordosis, and a relatively safer positioning of the psoas muscle, lumbar plexus, and abdominal structures. Disadvantages include more difficulties with exposure and retraction, as well as visualization, positioning and ergonomics of surgery.
CONCLUSIONS
Prone position lateral interbody fusion is an increasingly prevalent and useful surgical technique with several advantages and disadvantages when compared to lateral interbody fusion in the lateral decubitus position. There are several surgical indications and goals for which prone lateral interbody fusion may provide significant benefit when compared to other interbody fusion techniques.
PubMed: 37841787
DOI: 10.21037/jss-23-34 -
Journal of Critical Care Medicine... Oct 2023Since its debut, as reported by the first published studies, COVID-19 has been linked to life-threatening conditions that needed vital assistance and admission to the...
BACKGROUND
Since its debut, as reported by the first published studies, COVID-19 has been linked to life-threatening conditions that needed vital assistance and admission to the intensive care unit. Skeletal muscle is a core element in an organism's health due to its ability to keep energy balance and homeostasis. Many patients with prolonged hospitalization are characterized by a greater probability prone to critical illness myopathy or intensive care unit-acquired weakness.
OBJECTIVE
The main aim of this study was to assess the skeletal muscle in a COVID-19 cohort of critically ill patients by measuring the psoas area and density.
MATERIAL AND METHODS
This is a retrospective study that included critically ill adult patients, COVID-19 positive, mechanically ventilated, with an ICU stay of over 24 hours, and who had 2 CT scans eligible for psoas muscle evaluation. In these patients, correlations between different severity scores and psoas CT scans were sought, along with correlations with the outcome of the patients.
RESULTS
Twenty-two patients met the inclusion criteria. No statistically significant differences were noticed regarding the psoas analysis by two blinded radiologists. Significant correlations were found between LOS in the hospital and in ICU with psoas area and Hounsfield Units for the first CT scan performed. With reference to AUC-ROC and outcome, it is underlined that AUC-ROC is close to 0.5 values, for both the psoas area and HU, indicating that the model had no class separation capacity.
CONCLUSION
The study suggested that over a short period, the psoas muscle area, and the psoas HU decline, for both the left and the right sight, in adult COVID-19 patients in ICU conditions, yet not statistically significant. Although more than two-thirds of the patients had a negative outcome, it was not possible to demonstrate an association between the SARS-COV2 infection and psoas muscle impairment. These findings highlight the need for further larger investigations.
PubMed: 37969882
DOI: 10.2478/jccm-2023-0026 -
European Spine Journal : Official... Sep 2023This study aimed to investigate the changes of the posterior paraspinal muscles (PPM) and psoas muscle in patients with low back pain (LBP) over time.
PURPOSE
This study aimed to investigate the changes of the posterior paraspinal muscles (PPM) and psoas muscle in patients with low back pain (LBP) over time.
METHODS
Patients with LBP who had a repeat lumbar MRI with a minimum of 3-years apart at a tertiary referral center were analyzed. MRI-based quantitative assessments of the PPM and the psoas muscle were conducted for the baseline and follow-up MRI. The cross sectional area (CSA), the functional cross sectional area (fCSA) and the fat area (FAT) were calculated using a dedicated software program. The fatty infiltration (FI,%) of the regions of interest was calculated. Differences between the 1st and 2nd MRI were calculated for all assessed muscular parameters.
RESULTS
A total of 353 patients (54.4%female) with a median age of 60.1 years and BMI of 25.8 kg/m at baseline were analyzed. The mean time between the 1st and 2nd MRI was 3.6 years. The fCSA declined in both sexes significantly from the 1st to the 2nd MRI, whereas the FAT increased. In line with this result, the FI increased in both males (29.9%) and females (19.4%). Females had a higher FI and FI than males in both MRIs. In females, no significant changes were found for the psoas muscle. The CSA and fCSA in males were significantly smaller in the 2nd MRI. With increasing age, a significant trend in a decrease in ∆FI was observed for both sexes.
CONCLUSION
The study revealed significant quantitatively muscular changes in males and females, especially in the posterior paraspinal muscles in only three years' time.
Topics: Male; Humans; Female; Middle Aged; Low Back Pain; Longitudinal Studies; Psoas Muscles; Lumbar Vertebrae; Lumbosacral Region; Paraspinal Muscles; Magnetic Resonance Imaging
PubMed: 37378708
DOI: 10.1007/s00586-023-07814-1 -
Nutrients Sep 2023This study aimed to determine the proportion of patients with sarcopenia diagnosed by MRI and compare these results to bioelectrical impedance analysis (BIA).
BACKGROUND
This study aimed to determine the proportion of patients with sarcopenia diagnosed by MRI and compare these results to bioelectrical impedance analysis (BIA).
METHODS
Children with newly diagnosed Crohn's disease (CD) who had MRI enterography (MRE) and BIA and had at least 12 months of follow-up were included. Total psoas muscle area (TPMA) and total paravertebral muscle (TPVM) were measured and compared to subjects' lean mass and the lean mass body index (LMBI) was assessed by BIA.
RESULTS
30 newly diagnosed children with CD were included (mean age 14.2 years, 53% male). Sarcopenia was found in 13 (43%) children; mean TPMA was 15.2 (1.1 SD) cm and TPVM 30.95 (1.7 SD) cm. A highly positive correlation was shown for lean mass assessed by BIA and TPMA (0.706, < 0.001) and TPVM (0.75, < 0.001). Sarcopenia was more prevalent in boys (77% vs. 24%, = 0.004), patients with the perianal disease (69% vs. 29%, = 0.03), and children with sarcopenia were likely to receive anti-TNF (77% vs. 41%, = 0.05). During the follow-up period, 16 (53%) children experienced a relapse. TPMA (HR 0.99, = 0.018) and TPVM (HR 0.99, = 0.031) values were statistically significant risk factors for relapse.
CONCLUSION
A high proportion of patients with CD have sarcopenia at the time of the diagnosis. There is a good correlation between muscle mass assessed by MRI and BIA. Because MRI is performed in a great proportion of newly diagnosed CD patients it can also be used to assess the presence of sarcopenia.
Topics: Humans; Child; Male; Adolescent; Female; Sarcopenia; Crohn Disease; Tumor Necrosis Factor Inhibitors; Muscles; Magnetic Resonance Imaging
PubMed: 37686870
DOI: 10.3390/nu15173838 -
Journal of Clinical Medicine Jul 2023Sarcopenia is a syndrome characteristic in elderly patients and is also associated with a significant proportion of chronic disorders such as inflammatory bowel disease... (Review)
Review
BACKGROUND
Sarcopenia is a syndrome characteristic in elderly patients and is also associated with a significant proportion of chronic disorders such as inflammatory bowel disease (IBD). In this case, it can lead to a worse prognosis of the disease and a decreased quality of life.
STUDY AIM
This study aims to identify the best ways to diagnose sarcopenia in patients with IBD, establish its impact on the course of the disease, and find preventive methods to counteract the effects of sarcopenia in the outcome of patients with IBD and, therefore, minimize disabilities and increase the health-related quality of life (HRQoL).
MATERIAL AND METHODS
A systematic review with the Prospero registration number CRD42023398886 was performed in PubMed and Web of Science databases, evaluating all original articles published in the last 10 years (clinical trials and randomized control trials) that describe sarcopenia and IBD in the human adult population.
RESULTS
From the 16 articles that were included, 5 articles defined sarcopenia by the skeletal muscle index (SMI) and reported data regarding its correlation with body composition: BMI; visceral fat (VF); subcutaneous fat (SC); and VF/SC index. Other articles evaluated the link between sarcopenia and the total psoas muscle area, thigh circumference, calf circumference, subjective global assessment, hand grip strength, and appendicular SMI, alongside inflammatory markers such as IL-6 and C-reactive protein, level of disability, malnutrition, frailty, resistance training alone and in combination with whey protein, and infliximab treatment.
DISCUSSIONS AND CONCLUSIONS
There is a great heterogeneity regarding the assessment criteria and methods used to diagnose sarcopenia due to the variability of population characteristics, both anthropometric and socio-cultural, alongside the high variability in the cut-offs. Therefore, any method which identifies sarcopenia in IBD patients, thus enabling intervention, may provide good results for patient quality of life and outcomes.
PubMed: 37510827
DOI: 10.3390/jcm12144713 -
Weak correlation between total psoas muscle area and sarcopenia index for children with brain tumor.Nutrition in Clinical Practice :... Aug 2023The aim of this study is to determine whether the sarcopenia index (SI) is a viable measure of muscle mass in pediatric patients with brain tumors.
OBJECTIVE
The aim of this study is to determine whether the sarcopenia index (SI) is a viable measure of muscle mass in pediatric patients with brain tumors.
METHODS
Retrospectively enrolled patients (1-16 years) who had serum creatinine (Cr) and cystatin C (CysC) levels evaluated within 28 days of an abdomen magnetic resonance imaging scan for the lumbar vertebrae 3-4 total psoas muscle area (tPMA) were studied. Variables were compared using their z scores calculated from age- and sex-dependent reference. We hypothesized that a low SI indicated less skeletal muscle, and therefore potentially indicated sarcopenia.
RESULTS
The SI z score had no correlation with tPMA z score (r = 0.004). Both Cr and CysC levels were positively correlated with tPMA in z scores (r = 0.249 and 0.320). tPMA strongly correlated with body mass index in z scores (r = 0.582). The z scores of tPMA, Cr and CysC decreased with elevated World Health Organization grades of tumor, but the z scores of SI showed no significant dependence on WHO grades.
CONCLUSION
The correlation of SI to muscle mass is very weak in our sample of pediatric patients with brain tumor. Its viability as biomarker for sarcopenia needs more study.
Topics: Humans; Child; Sarcopenia; Psoas Muscles; Retrospective Studies; Biomarkers; Brain Neoplasms
PubMed: 37087682
DOI: 10.1002/ncp.10996