Complicaciones perianales causadas por agentes modeladores inyectados en glúteos / Perianal complications caused by gluteal injection of modeling agents

En este reporte presentamos tres pacientes en quienes ocurrieron condiciones inflamatorias perianales tardías, luego de la administración de sustancias modeladoras no identificadas en los glúteos. El diagnóstico inicial y supuesto no fue correcto, ya que no se investigó durante la evaluación preliminar el antecedente de la administración de elementos modeladores. Recomendamos que los pacientes con patologías inflamatorias del ano, sobre todo aquellos cuyo curso es extraño, se les pregunte acerca de la administración de agentes modeladores en los glúteos. Esta práctica puede contribuir a la eficacia del diagnóstico de manifestaciones perianales caracterizadas por flogosis, que se presentan de forma inusual. (AU)

In this report we present three patients in which late perianal inflammatory conditions occurred after administration of unidentified modeling agents to the buttocks. The initial diagnosis was not correct because of the administration of modeling agents was not investigated during the initial eval-uation. We recommend inquiring patients with inflammatory pathologies of the anus, especially those whose course is unusual, about the adminis-tration of modeling agents to the buttocks. This approach can contribute to the efficiency of the diagnosis of perianal complaints characterized by inflammation, but rare in its appearance. (AU)

Efeitos de um protocolo de exercícios preventivos sobre fatores de risco para lesões em militares / Effects of a protocol of preventive exercises on risk factors for military injury

Objetivo: analisar os efeitos de um programa de prevenção de lesão sobre a função muscular do quadril, a amplitude de movimento (ADM) de dorsiflexão do tornozelo e o controle postural em militares. Metodologia: foram incluídos no estudo nove militares (30,56±8,33 anos), que foram avaliados pré e pós intervenção por meio dos seguintes instrumentos: a) Avaliação funcional do quadril através dos testes funcionais para o músculo glúteo máximo e glúteo médio; b) Avaliação da ADM de dorsiflexão do tornozelo, por meio do teste de Lunge realizado com uma fita métrica; c) Avaliação do equilíbrio, por meio da Posturografia Dinâmica Computadorizada (sistema EquiTest® NeuroCom), incluindo os testes de organização sensorial (TOS), que é dividido em seis condições e o índice geral do equilíbrio (composite). Os militares foram submetidos a um programa de prevenção de lesão durante 10 semanas, aplicado 2 vezes semanais com duração de aproximadamente 50 minutos. O programa foi constituído de exercícios em 4 categorias, incluindo aquecimento / corrida, fortalecimento muscular, equilíbrio e alongamento. Resultados: houve melhorias significativas sobre a função muscular de glúteo médio não-dominante (p=0,01), a ADM de dorsiflexão do tornozelo dominante (p=0,02) e sobre o controle postural, através do aumento da condição V dos TOS (p=0,04), valor de composite (p=0,02) e do sistema vestibular (p=0,03). Conclusão: O programa de exercícios proposto melhorou os parâmetros de função muscular glútea, mobilidade de tornozelo e controle postural em militares.

Objective: to analyze the effects of an injury prevention program on hip muscle function, range of motion (ADM) of ankle dorsiflexion and postural control in the military. Methodology: nine military personnel (30.56 ± 8.33 years) were included in the study, who were evaluated before and after intervention through the following instruments: a) Functional assessment of the hip ­ through functional tests for the gluteus maximus and gluteus medius muscles; b) Evaluation of the ADM of ankle dorsiflexion ­ by means of the Lunge test performed with a tape measure; c) Evaluation of balance ­ through Computational Dynamic Posturography (EquiTest® NeuroCom system), including sensory organization tests (TOS), which is divided into six conditions and the general equilibrium index (composite). The military underwent an injury prevention program for 10 weeks, applied twice weekly with a duration of approximately 50 minutes. The program consisted of exercises in 4 categories, including warm up / running, muscle strengthening, balance and stretching. Results: there were significant improvements in non-dominant gluteus medial muscle function (p = 0.01), dominant ankle dorsiflexion ROM (p = 0.02) and postural control, through an increase in the TOS V condition (p = 0.04), composite value (p = 0.02) and vestibular system (p = 0.03). Conclusion: a exercises program improved of gluteal muscle function, ankle mobility and postural control in the military.

A case of high-temperature steel bar penetration injury from scrotum to buttocks / 中华烧伤杂志

On November 17, 2013, the Second Affiliated Hospital of Kunming Medical University admitted a 23-year-old male patient with a high-temperature steel bar penetration injury from scrotum to buttocks who was transferred from another hospital. Expanded debridement, suture, and drainage of the perineum, right thigh, and right hip were performed as soon as possible after admission. A sputum suction tube was used as the guide mark for expanded debridement during the operation to ensure the accuracy of the direction and scope of expanded debridement. The incision was treated with vacuum sealing drainage (VSD) and full drainage. On the 20th day after the operation (the 25th day after admission), the unhealed wound was transplanted with split-thickness skin graft from the right thigh, and the drainage of the operation area and dressing change were strengthened. On the 53rd day after injury, the patient was discharged after complete wound healing. This case suggests that VSD after early debridement is an effective means to treat high-temperature steel bar penetration injuries.

Avaliação da eficácia da carboxiterapia na melhora da sensibilidade tátil, da satisfação corporal e do aspecto de estrias albas na região glútea em mulheres: um ensaio clínico randomizado / Evaluation of the effectiveness of carboxitherapy in improving tactile sensitivity, body satisfaction and appearance of stretch marks in the gluteus region in women: a randomized clinical trial

Introdução: Estrias são lesões dérmicas lineares que acometem ambos os sexos, sendo duas vezes mais comuns em mulheres. Objetivos: Investigar se a carboxiterapia é eficaz para melhorar a sensibilidade tátil, a satisfação corporal e o aspecto de estrias albas localizadas na região glútea de mulheres. Métodos: 38 mulheres hígidas com estrias albas bilateralmente na região glútea participaram do estudo. A aplicação da carboxiterapia foi realizada em um glúteo e porção superior da coxa através da introdução da agulha hipodérmica paralelamente as estrias. Foram realizadas doze sessões com duração média de 20 minutos cada, com intervalo de sete dias. A eficácia da intervenção foi avaliada através de registros fotográficos, avaliação da dor, avaliação da sensibilidade tátil, e autoavaliação de satisfação pós-tratamento. Resultados: Não houve diferença estatisticamente significativa entre o grupo experimental e o grupo controle no que diz respeito à avaliação dos registros fotográficos. Houve redução significativa entre a dor e melhora da sensibilidade nas voluntárias. Também houve diferença significativa da satisfação com a aparência do próprio glúteo antes e após o tratamento. Conclusão: A carboxiterapia foi eficaz em melhorar a sensibilidade tátil e a satisfação com o corpo de mulheres hígidas com estrias albas na região glútea. (AU)

Introduction: Stretch marks are linear lesions that affect both sexes, being twice as common in women. Objectives: To investigate whether carboxytherapy is effective in improving tactile sensitivity, body satisfaction and the appearance of stretch marks located in the gluteal region of women. Methods: Thirty-eight healthy women with bilateral stretch marks in the gluteal region participated in the study. Carboxitherapy was applied to a gluteus and upper thigh by introducing the hypodermic needle in parallel as stretch marks. Twelve sessions were held with an average duration of 20 minutes each, with an interval of seven days. The assessment of the intervention was assessed through photographic records, pain assessment, assessment of tactile sensitivity and automatic assessment of satisfaction after treatment. Results: There was no statistically significant difference between the experimental group and the control group regarding the evaluation of photographic records. We observed a significant reduction between pain and improved sensitivity in the volunteers, and a significant difference in satisfaction with his appearance before and after treatment. Conclusion: Carboxytherapy was effective in improving tactile sensitivity and body satisfaction in healthy women with stretch marks in the gluteal region. (AU)

Anatomic landmarks for a safe arthroscopic approach to the deep gluteal space: a cadaveric study / Hitos anatómicos para un abordaje artroscópico seguro del espacio glúteo profundo: un estudio cadavérico

SUMMARY: To determine the morphometric landmarks and anatomical variants relevant to the arthroscopic approach to the deep gluteal space. Twenty deep gluteal spaces from cadaveric specimens were dissected. The anatomical variants of the sciatic nerve (SN) were determined according to the Beaton and Anson classification. A morphometric study of the distances in the subgluteal space was carried out to define the anatomical references to achieve a safe arthroscopic approach for piriformis syndrome [GT-SN=Distance from greater trochanter (GT) to SN emergence; GT-IT=Distance from GT to ischial tuberosity (IT); GT-IGA=distance from GT to inferior gluteal artery (IGA) emergence; IT-SN=distance from IT to SN emergence; IT-IGA=distance from IT to IGA]. The SN showed the most frequent anatomical pattern with an undivided nerve coming out of the pelvis below the piriformis muscle (Beaton type A) in 16 specimens (80 %). The common peroneal nerve emergence in the subgluteal space through the piriformis muscle (PM) with the tibial nerve being located at the lower margin of the piriformis muscle (Beaton type B) was observed in 4 specimens (20 %). The morphometric measurements of the surgical area of study were: GT-SN=7.23 cm (±8.3); GT-IT=8.56 cm (±0.1); GT-IGA=8.46 cm (±0.97); IT-SN=5.28 cm (±0.73), IT- IGA=5.47 cm (±0.74). When planning surgery for the deep gluteal syndrome in adult patients, the fact that the emergence of the SN in the subgluteal space is approximately 7 cm from the greater trochanter and 5 cm from the ischial tuberosity must be considered.

RESUMEN: El objetivo del estudio fue determinar referentes morfométricos y variantes anatómicas relevantes en el abordaje artroscópico del espació subglúteo. Se disecaron veinte regiones glúteas procedentes de cadáver. Las variaciones anatómicas del nervio ciático (SN) se determinaron de acuerdo con la clasificación de Beaton y Anson. Se llevó a cabo un estudio morfométrico de distancias en el espacio subglúteo, con objeto de determinar referencias que permitan un abordaje artroscópico seguro del sindrome piriforme [GT-SN= distancia trocánter mayor (GT) a la emergencia del nervio ciático (SN); GT-IT= distancia GT a la tuberosidad isquiática (IT); GT-IGA= distancia GT a la emergen- cia de la arteria glútea inferior (IGA); IT-SN= distancia IT a la emergencia del SN; IT-IGA= distancia IT a la IGA]. El patrón más frecuente del SN fue su emergencia no dividida por el margen inferior del músculo piriforme (tipo A Beaton) en 16 especímenes (80 %). La salida del nervio fibular común a través del músculo piriforme (PM) con el nervio tibial localizado en el margen inferior del PM (tipo B Beaton) se observó en 4 especímenes (20 %). Las medidas en el área quirúrgica de estudio fueron: GT-SN= 7,23 cm ± 8,3; GT-IT= 8,56 cm ± 0,1; GT-IGA= 8,46 cm ± 0,97; IT-SN= 5,28 cm ± 0,73 IT-IGA= 5,47 cm ± 0,74. En la cirugía del síndrome glúteo profundo en adultos, debe considerarse que la sa- lida del SN hacia el espacio subglúteo tiene lugar aproximadamente a 7 cm del GT y a 5 cm de la IT.

Quemadura con cloroformiato de etilo en ocasión de la respuesta a una emergencia química. A propósito de un caso / Burning by Ethyl chloroformate in response to a chemical emergency. A case report

Resumen Se describe un caso de quemadura causada por cloroformiato de etilo en ocasión de la respuesta a un incidente que requirió el trasvase del producto desde contenedores defectuosos a otros seguros. La investigación del evento puso en evidenciala necesidad de mantener un protocolo de registro de materiales que ingresan a la zona caliente, que debe ser tenido en cuentaal momento del retiro de los mismos, procediendo a su correcta descontaminación bajo la fiscalización del oficial de seguridad.

Abstract A burn by Ethyl chloroformate in occasion of response to a chemical emergency which required to transfer products from defective containers to safe containers is described. The investigation of the event highlighted the need to maintain aprotocol for the registration of materials to be entered in the hot zone, which must be considered al the moment of remove andproceeding to the proper decontamination under the supervision of the security officer.

Hallazgos quirúrgicos en pacientes con alogenosis iatrogénica / Surgical findings in patients with iatrogenic allogenosis

INTRODUCCION: los biopolímeros son macromoléculas cuyo uso como sustancias de relleno con fines estéticos ha ido en aumento en los últimos años. Esto ha generado un incremento de complicaciones por alogenosis iatrogénica de difícil tratamiento. OBJETIVO: describir los hallazgos intraoperatorios en las pacientes con alogenosis iatrogénica intervenidas quirúrgicamente en el Departamento de Cirugía Plástica del Hospital Hermanos Ameijeiras. METODO: se realizó un estudio descriptivo, prospectivo, longitudinal y monocéntrico con 15 pacientes femeninas que recibieron tratamiento quirúrgico para extracción de sustancias modelantes desde enero 2017 a diciembre 2019. RESULTADOS: el rango de edad predominante fue entre los 19 y 29 años con un 66.6% y entre los 30 y 40 años de edad con un 33.3%. El procedimiento quirúrgico fue realizado bajo anestesia general en el 33.3% de las pacientes; de ellos el 20% fue en la región mamaria, 40% glúteos y 40% genitales y pubis. Se empleó anestesia local en el 66.6%, distribuidas en 20% en la región frontal y glabelar, 30% en los párpados y 50% en los labios. El 100% mostró hallazgos intraoperatorios similares. CONCLUSIONES: independientemente del producto inyectado, la región anatómica y la expresión clínica de la enfermedad, los hallazgos transoperatorios son los mismos. Tanto en las zonas más inyectadas que fueron la región glútea, genital y púbica como en la de menor frecuencia que correspondió a las zonas frontales y glabelar, la extracción del producto resultó en múltiples nódulos en forma de perlas de pequeño tamaño y cavernas.

INTRODUCTION: biopolymers are macromolecules whose use as fillers for aesthetic purposes has been increasing in recent years. This has generated an increase in complications due to iatrogenic alogenosis that is difficult to treat. OBJECTIVE: to describe the intraoperative findings in patients with iatrogenic alogenosis who underwent surgery at the Department of Plastic Surgery of the Hermanos Ameijeiras Hospital. METHODS: a descriptive, prospective, longitudinal, single-center study was conducted with 15 female patients who received surgical treatment for removal of modeling substances from January 2017 to December 2019. RESULTS: the predominant age range was between 19 and 29 years old with 66.6% and between 30 and 40 years old with 33.3%. The surgical procedure was performed under general anesthesia in 33.3% of the patients; of them 20% were in the breast region, 40% buttocks and 40% genitalia and pubis. Local anesthesia was used in 66.6%, distributed in 20% in the frontal and glabellar region, 30% in the eyelids and 50% in the lips. 100% showed similar intraoperative findings. CONCLUSIONS: regardless of the product injected, the anatomic region and the clinical expression of the disease, the transoperative findings are the same. Both in the most injected areas which were the gluteal, genital and pubic region and in the less frequently injected areas which corresponded to the frontal and glabellar areas, the extraction of the product resulted in multiple nodules in the form of small pearls and caverns.

The absence of piriformis muscle, combined muscular fusion, and neurovascular variation in the gluteal region

The gluteal region contains important neurovascular and muscular structures with diverse clinical and surgical implications. This paper aims to describe and discuss the clinical importance of a unique variation involving not only the piriformis, gluteus medius, gluteus minimus, obturator internus, and superior gemellus muscles, but also the superior gluteal neurovascular bundle, and sciatic nerve. A routine dissection of a right hemipelvis and its gluteal region of a male cadaver fixed in 10% formalin was performed. During dissection, it was observed a rare presentation of the absence of the piriformis muscle, associated with a tendon fusion between gluteus and obturator internus, and a fusion between gluteus minimus and superior gemellus muscles, along with an unusual topography with the sciatic nerve, which passed through these group of fused muscles. This rare variation stands out with clinical manifestations that are not fully established. Knowing this anatomy is essential to avoid surgical iatrogeny.

Recommendation of the best site based on the distribution pattern of extramuscular and intramusular nerves for gluteal muscle injection / Recomendación del mejor sitio para la inyección del músculo glúteo basado en el patrón de distribución de los nervios extramusculares e intramusculares

To reveal the extra- and intramuscular nerve distribution patterns of the gluteus maximus, medius, and minimus, and to provide guidance for gluteal muscle injection in order to avoid nerve injury. Ten adult and 10 child cadavers were used. The superior and inferior gluteal nerves innervating the gluteus maximus, medius, and minimus were dissected, exposed, and sutured in-situ on the muscle. The three gluteal muscles were removed, and the distribution patterns of the intramuscular nerves were revealed by modified Sihler's nerve staining. The nerve distribution pattern was returned to the corresponding position in the body, and the patterns in the four quadrants of the buttock were analyzed. There were 3-12 extramuscular nerve branches of the gluteus maximus, medius, and minimus. After entering the muscle, these nerve branches arborized and anastomosed to form an arc-shaped, nerve-dense zone. The nerve distribution was most dense in the inferomedial region of the superolateral quadrant and the inferolateral region of the superomedial quadrant of the buttocks. The nerve distribution was relatively dense in the inferolateral region of the superolateral quadrant, and the medial region of the inferomedial quadrant. An arc-shaped, nerve-sparse zone in the superolateral and superomedial quadrants near the lower iliac crest accounted for about two-fifths of the two quadrants' limits. The arc-shaped, nerve-sparse zone in the superolateral quadrant is the preferred injection site, and the superomedial quadrant near the lower iliac crest is also recommended as a gluteal intramuscular injection region, free from nerve injury.

El objetivo de este trabajo fue revelar los patrones de distribución nerviosa extramusculat e intramuscular de los músculos glúteo máximo, medio y mínimo y proporcionar orientación para la inyección en la región glútea con el propósito de evitar lesiones nerviosas. Se utilizaron diez cadáveres adultos y diez niños. Los nervios glúteos superior e inferior que inervan a los músculos glúteo máximo, medio y mínimo fueron disecados, expuestos y suturados in situ en el músculo. Se extirparon los tres músculos glúteos y se revelaron los patrones de distribución de los nervios intramusculares mediante la tinción nerviosa de Sihler modificada. El patrón de distribución nerviosa se devolvió a la posición correspondiente en el cuerpo y se analizaron los patrones en los cuatro cuadrantes de la región glútea. Se encontraron 3 a 12 ramos nerviosos extramusculares de los músculos glúteo máximo, medio y mínimo. Después de ingresar al músculo, estas ramas nerviosas se arborizaron y anastomizaron para formar una zona densamente nerviosa en forma de arco. La distribución nerviosa fue de mayor densidad en la región inferomedial del cuadrante superolateral y en la región inferolateral del cuadrante superomedial de la región glútea. La distribución nerviosa era relativamente densa en la región inferolateral del cuadrante superolateral y en la región medial del cuadrante inferomedial. Una zona en forma de arco en los cuadrantes superolateral y superomedial y con escasa inervación, cerca de la cresta ilíaca representaba una parte de los límites de los dos cuadrantes. La zona de poca inervación en forma de arco en el cuadrante superolateral es el sitio de inyección preferido, y el cuadrante superomedial próximo a la cresta ilíaca también se recomienda como una región de inyección intramuscular glútea, libre de lesión nerviosa.

Reporte de caso: origen del músculo piriforme a través de dos cabezas en forma de bíceps, propicia división del nervio isquiático en nervio fibular común y nervio tibial / Case report: origin of the piriformis muscle through two heads in the form of biceps, favorable division of the sciatic nerve in the common fibular nerve and tibial nerve

El músculo piriforme es un músculo pelvitrocantérico que recibe su nombre debido a su forma de pera, cuyo origen es de varios fascículos que se encuentran entre los forámenes anteriores del sacro, correspondiente a las segunda, tercera y cuarta vértebra. Estos fascículos se funden constituyendo un músculo aplanado, que se inserta en el trocánter mayor del fémur. Presenta una relación bien conocida con el nervio isquiático, el cual comúnmente emerge hacia la región glútea por el margen inferior de este músculo, sin embargo a través del tiempo, autores han descrito variaciones del paso de este nervio que podrían asociarse a alguna patología de compresión del nervio isquiático. En una disección rutinaria de dos individuos formolizados, uno femenino y otro masculino de la región glútea, encontramos que el músculo piriforme se originaba a través de dos cabezas, cada una con su propia fascia que se unían en un vientre común, en forma de bíceps y a través de un tendón cilíndrico se insertaban en la parte medial del trocánter mayor del fémur. El nervio isquiático se encontraba dividido, el nervio fibular común emergía a la región glútea a través de las cabezas, en tanto el nervio tibial por el margen inferior del músculo piriforme. Es importante comunicar las variaciones anatómicas para complementar el conocimiento de las mismas, las que pueden explicar ciertos trastornos físicos y dolorosos como el denominado síndrome del músculo piriforme.

The piriform muscle is a pelvitrochanteric muscle that gets its name due to its pear shape, whose origin are several fascicles located between the anterior foramina of the sacrum, corresponding to the second, third and fourth vertebrae. These fascicles are fused forming a flattened muscle, which is inserted into the greater trochanter of the femur. It has a well-known relationship with the sciatic nerve, which commonly emerges towards the gluteal region through the lower margin of this muscle, however over time, authors have described variations in the course of this nerve that could be associated with some compression pathology of the sciatic nerve. In a routine dissection of two formalized individuals, one female and one male, we found that the piriformis muscle originated through two heads, each with its own fascia that joined in a bicep-shaped common belly. Through a cylindrical tendon it is inserted into the medial part of the greater trochanter of the femur. The sciatic nerve was divided, the common fibular nerve emerged to the gluteal region through the heads, while in the tibial nerve divided through the inferior margin of the piriformis muscle. It is important to report on the anatomical variations to complement knowledge of these variations, which may explain certain physical and painful disorders such as the socalled piriformis muscle syndrome.

Nódulo doloroso en glúteo. A propósito de un caso / Painful nodule in the buttock. About a case...

Se presenta el caso clínico de un paciente con calcinosis cutis distrófica en glúteo, una pa- tología infrecuente e infra-diagnosticada por la falta de sospecha clínica. Es de vital importancia que a quienes presenten calcificaciones cutáneas se les realice una detallada anamnesis y un estudio analítico con función renal, metabolismo del calcio y fósforo y autoinmunidad para descartar la existencia de una patología subyacente como las enfermedades autoinmunes o renales..(AU)

We present the clinical case of a patient with calcinosis dystrophic skin on the buttock, an infre- quent and infradiagnosed pathology due to the lack of clinical suspicion. It is very important that those patients with skin calcifications have a detalied anamnesis and analytical study with renal function, calcium and phosphrus metabolism and autoinmmunity to rule out the existence of un- derlying pathology such an autoimmune or renal diseases..(AU)

Height of elevated fetal buttock for prediction of successful external cephalic version

14 cm, and HOB >7.8 cm were 10.80 (95% confidence interval [CI], 1.57–74.94), 5.26 (95% CI, 1.06–26.19), and 10.50 (95% CI, 1.03–107.12), respectively. Areas under the curve (AUCs) for AFI, HOB, and parity were 0.66 (95% CI, 0.54–0.78), 0.74 (95% CI, 0.64–0.85), and 0.69 (95% CI, 0.62–0.76), respectively. HOB had the largest AUC, but there were no significant differences among the AUCs of other factors. The cut-off value of HOB was 6 cm.CONCLUSION: This study showed that the AUC of HOB was greater than that of parity and AFI, although it was not statistically significant. As HOB is a noninvasive and comprehensive marker to predict successful ECV, consideration of HOB would be helpful before conducting ECV. Further studies are needed.

Comparative study of different clinical approaches for gluteal muscle syndrome with silver needle / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy of silver needle lumbar and sacral spine approach in treating gluteal muscle syndrome.@*METHODS@#Eighty-seven patients with gluteal muscle syndrome treated with silver needles in the Department of Rehabilitation Medicine of our hospital from September 2017 to September 2019 were selected. Except for symptoms of waist and hip pain and discomfort, all selected patients were examined by CT or MRI to confirm pathological imaging changes such as inflammatory exudation of the gluteal muscle. The 87 patients with gluteal muscle syndrome were divided into 2 groups according to the digital table method, and 42 patients in the lumbosacral approach group, including 19 males and 23 females, aged (50.70±12.45) years old, and disease duration of (1.63±1.27) years;45 cases in the buttock approach group, including 20 males and 25 females, aged (52.80±12.18) years old, with a course of disease of (1.78±1.22) years. The lumbosacral approach group was treated with spinal L to S bilateral articular process joints and L transverse process acupuncture needles, and the buttock approach group was treated with the gluteus medulla wing starting point and femoral trochanter stop. The VAS scores, soft tissue tenderness thresholds, and hip abductor muscle strength of the affected group were measured before and 4 weeks after treatment in the two groups. The clinical efficacy was also evaluated 4 weeks after treatment.@*RESULTS@#After 4 weeks, the VAS score of the lumbosacral approach group was 1.26±0.70, and the buttock approach group was 1.18±0.74, which were significantly lower than those before treatment, but there was no statistical difference between the groups (>0.05). The soft tissue tenderness threshold and ipsilateral hip abductor muscle strength were (5.51±0.70) kg and (10.34±2.19) kg in the lumbosacral approach group, and (4.78±1.05) kg, (9.33±1.42) kg in the buttock approach group. The results in the lumbosacral approach group was better than those in the buttock approach group(<0.05). The clinical efficacy of the lumbosacral approach group:16 cases got an excellent result, 20 good, 5 fair and 1 poor;in the buttock approach group, 13 excellent, 17 good, 12 fair and 3 poor. The clinical efficacy between the two groups had statistical difference (<0.05).@*CONCLUSION@#In the treatment of gluteus medius syndrome with silver needle, lumbosacral approach and buttock approach can effectively relieve the pain. Compared with the improvement of soft tissue tenderness threshold and hip abductor muscle strength, the upper lumbosacral approach is more prominent, and the overall clinical effect is more significant.

Carcinoma de células de Merkel de región glútea. Reporte de un caso / Merkel cell carcinoma of the gluteal region. Report of a case / Carcinoma de células de Merkel de região glútea. Relato de caso

Resumen: Introducción: el carcinoma de células de Merkel es un tumor primario maligno de piel que afecta fundamentalmente regiones expuestas a las radiaciones solares. Pocos casos han sido comunicados en una región no expuesta al factor de riesgo mencionado, como es la glútea. El objetivo de este trabajo es comunicar un caso clínico de carcinoma de células de Merkel de región glútea. Caso clínico: paciente de 63 años, sexo masculino, que consultó por tumoración de 2 cm de diámetro en región glútea derecha, de rápido crecimiento, que se operó de coordinación con anestesia, realizándose su resección completa. El resultado del estudio anatomopatológico informó carcinoma de células de Merkel. No se evidenció diseminación a distancia, por lo que de acuerdo con la clasificación TNM se determinó como estadio I. Se completó el tratamiento con radioterapia local. Actualmente el paciente sigue en seguimiento y asintomático. Discusión: los carcinomas de células de Merkel son tumores altamente agresivos. Además de la radiación solar como factor de riesgo, se mencionan la inmunodeficiencia y un nuevo poliomavirus, el poliomavirus de células de Merkel. Se presentan como tumoraciones de color violáceo y rápido crecimiento, y es frecuente el compromiso ganglionar sincrónico o metacrónico. La resección quirúrgica con márgenes suficientes y vaciamiento ganglionar, en caso de haber compromiso o estudio de ganglio centinela en caso de no haberlo, es lo indicado. El pronóstico depende del estadio y se ha reportado hasta 30% de recidiva a dos años.

Summary: Introduction: Merkel cell carcinoma is a malign primary tumour that mainly affects regions that are exposed to solar radiation. Few cases have been reported in a region that is not exposed to the above mentioned risk factor, as the gluteal regions. The study aims to communicate the clinical case of a Merkel cell carcinoma of the gluteal region. Clinical case: 63-year-old male patient who consulted for a tumour with a 2cm diameter in the right gluteal region, rapidly growing, being completely resected in a cordinaterd surgery under anesthesia. Pathology study revealed that it was Merkel cell carcinoma. No distance dissemination was seen, and thus as per the TNM staging system it was classified as stage I. Therapy was completed with local radiotherapy, It is currently under follow up and asymptomatic. Discussion: Merkel cell carcinoma are highly aggressive tumours. Apart from solar radiation as a risk factor, it is worth mentioning immunodeficiency and a new polyomavirus, the Merkel cell polyomavirus. This condition can be seen as purple, rapidly growing tumours and they frequently involve synchronic or metachronic lymph node compromise. Surgical resection with sufficient margins and lymph node emptying, in the event of lymph node compromise or sentinel node biopsy is recommended. Prognosis depends on the stage and a 30% relapse has been reported after 2 years.

Resumo: Introdução: o carcinoma de células de Merkel é um tumor primário maligno de pele que afeta fundamentalmente regiões expostas às radiações solares. São poucos os casos relatados em uma região não exposta a esse fator de risco, como é a glútea. O objetivo desta comunicação é apresentar o caso clínico de um carcinoma de células de Merkel de região glútea. Caso clínico: paciente de 63 anos, sexo masculino que consultou por tumoração de 2 cm de diâmetro, na região glútea direita, com rápido crescimento que foi ressecada completamente em uma cirurgia eletiva com anestesia. O laudo anatomopatológico foi: carcinoma de células de Merkel. Não se evidenciou disseminação a distância por isso foi classificado como estádio I de acordo com a classificação TNM. O tratamento foi completado com radioterapia local. Atualmente em seguimento e assintomático. Discussão: os carcinomas de células de Merkel são tumores altamente agressivos. Além da radiação solar, a imunodeficiência e um novo poliomavirus, o poliomavirus de células de Merkel, são mencionados como fator de risco. Apresentam-se como tumorações de cor violácea e crescimento rápido e frequentemente se observa compromisso ganglionar sincrônico ou metacrônico. A ressecção cirúrgica com margens suficientes e esvaziamento ganglionar, quando há compromisso ou estudo de gânglio sentinela quando não há, é a conduta indicada. O prognóstico depende do estádio e há registros de até 30% de recidiva a 2 anos.