Umbilical rotation: a new technique for the cutaneous fixation of continent catheterizable vesicostomies.

PURPOSE: For cutaneous fixation of the continent catheterizable vesicostomy we present a new technique, in which the umbilicus is rotated caudally by 180° and the catheterizable channel is sutured to the umbilical cone. This procedure reduces the distance between the stoma entrance and the bladder. MATERIALS AND METHODS: Between 2001 and 2008, 67 patients underwent construction of a continent catheterizable vesicostomy. In 82% (n = 55), this was an appendicovesicostomy according to the Mitrofanoff principle. For 21 of these patients, later in the series (2005 onwards), the procedure involved rotation of the umbilicus. We evaluated cosmetic outcome and channel-related complication rates and compared the results between the two groups, with and without umbilical rotation. RESULTS: The overall complication rate was 22.4% (n = 15); stoma stenosis occurred in eight cases. In the majority of cases with complications, endoscopic treatment was sufficient. The complication rate was significantly lower in the group with umbilical rotation compared to the other group (14.3% vs 26.1%, P < 0.02). CONCLUSIONS: Umbilical rotation always enables cutaneous implantation of the vesicostomy in the umbilical pit and is a safe and straightforward procedure.

Simultaneous measurement of intramuscular pressure and surface electromyography of the multifidus muscle.

The anatomic proof of a spinal compartment and the clinical symptoms of compartment syndrome in patients with chronic back pain are inconsistent with the rarely met measuring criteria of intramuscular pressure (IMP). Previous studies assume a dependence of the IMP on spinal alignment (degree of lumbar spine flexion) and the degree of muscle activation. The significance of these disturbance variables in the interpretation of IMP could explain the above discrepancy. This study therefore investigates the influence of both a 30% increase in trunk flexion and alterations in muscle contraction from 100% to 60%. Sixteen healthy subjects participated in the study. The IMP and mean rectified amplitude of the multifidus surface EMG signal were determined at rest and 0 degrees and approximately 30 degrees of lumbar spine flexion, and they were compared. Subsequently, both parameters were measured during both 100% and 60% maximal voluntary contraction (MVC) of the muscle and then correlated. During rest and 0 degrees flexion, the median IMP was 9.3 mmHg (range 0.0-22.5) while the median mean rectified amplitude (MRA) of the EMG signal was 1.98 microV (range 1.32-7.38). In 30 degrees flexion, the median IMP went up to 24.3 mmHg (range 1.4-97.3) with hardly any increase in the median MRA of 2.32 microV (range 1.20-9.72). Under 60% MVC, the median IMP rose to 186.6 mmHg (range 15.4-375.4) and the median MRA to 21.02 microV (range 4.63-43.63). During 100% MVC, the median MRA increased to 34.38 microV (range 12.99-102.54) while the median IMP rose to 273.4 mmHg (range 90.4-395.1). Spearman's rank correlation coefficient for the IMP and MRA quotients of the 100/60% MVC values was r= -0.21. To sum up, it can be said that IMP was subject to great interindividual variation in all the experiments. This parameter is highly dependent on spinal alignment and muscular activity. Further studies are needed so that the IMP can be interpreted properly when diagnosing a chronic compartment of the erector spinae muscles.