Contralateral Thigh Research Articles

MR Lymphography of Lymphatic Vessels in Lower Extremity with Gynecologic Oncology-Related Lymphedema

ObjectiveTo characterize lymphatic vessel morphology in lower extremity lymphedema using MR lymphography at 3T.Study DesignForty females with lower extremity lymphedema secondary to gynecologic carcinoma treatment underwent MR lymphography (MRL) at 3T. Lymphatic vessel morphology in normal and affected limbs was compared.ResultsThe median diameter of the lymphatic vessels in swollen calf and thigh were significantly larger than that in the contralateral calf and thigh, respectively (p<0.05). The median number of lymphatic vessels visualized in normal calf was less than that in the lymphedematous calf (p<0.01), while no significant difference was found between the normal thigh and swollen thigh. Lymphatic vessel number in the affected calf was significantly greater than that in affected thigh and the mean diameter of affected calf was also significantly wider than that of affected thigh (p<0.01). Mean diameter of lymphatic vessels in the affected calf was significantly different between stage I and stage III (p<0.05), but not significantly different between stages I and II, and between stages II and III (p>0.05). The median number of lymphatic vessels for affected calf showed significant difference between stage I and stage III, and between stage II and stage III (p<0.05), but no significant difference between stage I and stage II (p>0.05). There was no significant difference in mean diameter or median number of lymphatic vessels in the affected thigh found between different stages (p>0.05).ConclusionThere are significant differences in the number or diameter of lymphatic vessels between normal and affected limbs and there are significant differences for affected calf between early and late stages of lymphedema; therefore, MR lymphography can be helpful in diagnosis or clinical staging for lower extremity with gynecologic oncology-related lymphedema.

Simultaneous reconstruction of head and neck defects following tumor resection and trismus release with a single anterolateral thigh donor site utilizing a lateral approach to flap harvest

An anterolateral thigh (ALT) flap has gradually become the workhorse flap of reconstructions at different anatomical locations because of its reliability and versatility. In this study, we introduced the concepts: one is the ALT flap harvest from a lateral approach and the other is the reconstruction of extensive head and neck defects with a single ALT donor site. A lateral approach ALT flap was harvested in 13 patients who had buccal cancer and/or tumors of the lower lip combined with buccal trismus. Three types of ALT flaps (type I: two skin paddles, one pedicle; type II: two skin paddles, two pedicles; type III: one skin paddle, one pedicle) were used in one-stage reconstructions of these extensive head and neck defects. In our series, there were four type I, five type II, and four type III flaps. All flaps survived and no major postoperative complication occurred. Four of the 13 donor sites were repaired with a split-thickness skin graft harvested from the contralateral thigh. The immediate interincisor distance increase was 21.4 and 16.5 mm at 1-year follow-up. Different types of ALT flap from a single donor site can be designed by means of a lateral approach; and the satisfactory results of reconstruction for extensive head and neck defects following the tumor resection and trismus release can be achieved.

Estimulação elétrica de alta voltagem em nervo ciático de ratos: estudo pelo IFC

ObjectiveTo analyze the efficiency of high voltage pulsed current (HVPC) with early application in three different sites, in the regeneration of the sciatic nerve in rats submitted to crush injury, the sciatic functional index (SFI) was used to assess the functional recovery.MethodsAfter crushing of the nerve, 57 animals were submitted to cathodal HVPC at frequency of 50Hz and voltage of 100V, 20 minutes per day, 5 days per week. The rats were divided into five groups: control group; ganglion group; ganglion + muscle group; muscle group; and sham group. The SFI was determined weekly for seven weeks, from the preoperative period to the 6th postoperative week.ResultsCompared with the control group, the results showed a significantly better performance of group 2 for the first 3 weeks; group 3 showed significantly better performance in the third week; and group 4 showed a significantly negative performance during the 4th and 6th weeks.ConclusionEarly application of HVPC had a positive effect in the treatment of the spinal cord region and the sciatic nerve root ganglion with a dispersive electrode on the contralateral lumbar region or on the gastrocnemius. However, HVPC had a negative effect in the treatment with an active electrode on the gastrocnemius and a dispersive electrode on the contralateral thigh. Level of evidence II, Prospective comparative study.

Contralateral Deep Venous Thrombosis After Hip Arthroscopy

Since the 1980s, hip arthroscopy has become an accepted treatment modality for a variety of hip conditions. It is generally considered a low-risk procedure with a low rate of complications. The risk of developing a deep venous thrombosis (DVT) or venous thromboembolism following these procedures is also thought to be low, and most patients undergoing these procedures receive no pharmacologic prophylaxis postoperatively. This article presents a case of a 33-year-old woman with a history of oral contraceptive use who presented 13 days after a routine hip arthroscopy with pain and swelling in the contralateral thigh. Ultrasonography revealed acute DVTs in the left common femoral, superficial femoral, and popliteal veins. She was admitted to the hospital and treated accordingly. A workup for thrombophilic disorders was negative. We believe that her history of oral contraceptive use, the use of axial traction, and asymmetric forces about the pelvis during the procedure contributed to this postoperative complication. Although this complication is rare and the use of pharmacologic prophylaxis is not common, physicians must be aware of this potential complication following hip arthroscopy.

Critical assessment of the anterolateral thigh flap donor site

The free anterolateral thigh flap (ALT) is now used as a 'workhorse flap'. The donor site morbidity is thought to be minimal, although most evidence derives from questionnaire-based studies rather than rigorous objective clinical assessment. In particular, robust quantitative data on thigh sensibility and quadriceps function is lacking. The aim of this study was to provide a comprehensive clinical assessment of donor site morbidity. We performed a prospective study of consecutive free ALT perforator flaps performed at Salisbury Foundation Trust between March 2008 and April 2010. The donor site was assessed at six months including a questionnaire (symptoms, function), scar analysis (Vancouver Scar Scale, VSS), and evaluation of quadriceps power and lateral thigh sensibility (compared with the contralateral unoperated thigh). One hundred ALT flaps were performed on 97 patients (mean age 46.8 years). The donor site was closed directly in 88 cases and using a split skin graft in 12 cases. At follow-up (n=68), tingling was the most common reported symptom (59%), whereas pain, itching and muscle herniation were reported infrequently. Donor site scars were mostly flat, pale and soft but widened. Pathological scarring was rare. Sensibility was reduced in donor thighs (p<0.001) and correlated with flap width but peak quadriceps contraction was similar between donor and unoperated thighs. There was a high throughput and diverse application of ALT flap reconstructions during the study period. Reduced sensibility was common around the scar but rarely troublesome. Quadriceps function was not affected even when dissection of intramuscular perforators was required. The ALT is a versatile flap that can deliver a large skin paddle with minimal impact on thigh function.

Targeting Apoptosis for Optical Imaging of Infection

Infection is ubiquitous and a major cause of morbidity and mortality. The most reliable method for localizing infection requires radiolabeling autologous white blood cells ex vivo. A compound that can be injected directly into a patient and can selectively image infectious foci will eliminate the drawbacks. The resolution of infection is associated with neutrophil apoptosis and necrosis presenting phosphatidylserine (PS) on the neutrophil outer leaflet. Targeting PS with intravenous administration of a PS-specific, near-infrared (NIR) fluorophore will permit localization of infectious foci by optical imaging. Bacterial infection and sterile inflammation were induced in separate groups (n = 5) of mice. PS was targeted with a NIR fluorophore, PSVue(®)794 (2.7 pmol). Imaging was performed (ex = 730 nm, em = 830 nm) using Kodak Multispectral FX-Pro system. The contralateral normal thigh served as an individualized control. Confocal microscopy of normal and apoptotic neutrophils and bacteria confirmed PS specificity. Lesions, with a 10-s image acquisition, were unequivocally visible at 5 min post-injection. At 3 h post-injection, the lesion to background intensity ratios in the foci of infection (6.6 ± 0.2) were greater than those in inflammation (3.2 ± 0.5). Image fusions confirmed anatomical locations of the lesions. Confocal microscopy determined the fluorophore specificity for PS. Targeting PS presented on the outer leaflet of apoptotic or necrotic neutrophils as well as gram-positive microorganism with PS-specific NIR fluorophore provides a sensitive means of imaging infection. Literature indicates that NIR fluorophores can be detected 7-14 cm deep in tissue. This observation together with the excellent results and the continued development of versatile imaging devices could make optical imaging a simple, specific, and rapid modality for imaging infection.

A Prospective Study of Preoperative Computed Tomographic Angiography for Head and Neck Reconstruction with Anterolateral Thigh Flaps

During anterolateral thigh flap harvest, inadequate perforators may necessitate modification of the flap design, exploration of the contralateral thigh, or additional flap harvest. Computed tomographic angiography may facilitate perforator mapping and optimize flap design. The authors performed this pilot study to determine the predictive power of computed tomographic angiography in anterolateral thigh flap planning and execution. : Sixteen consecutive computed tomographic angiography-mapped anterolateral thigh flaps for head and neck reconstruction were studied. Perforator location, origin, caliber, and course were compared between computed tomographic angiography and intraoperative findings. The relationship of patient characteristics, imaging studies, and intraoperative factors to flap design and surgical outcomes was analyzed. : Among the 16 anterolateral thigh flaps, 40 of 54 perforators identified intraoperatively were visible on computed tomographic angiography, resulting in 74 percent sensitivity. Intraoperative perforator location averaged 0.35 cm from the computed tomographic angiography-predicted location. The overall ability of computed tomographic angiography to predict perforator size was 67.5 percent. Its overall accuracy in predicting whether a perforator took a septocutaneous or intramuscular course before perforating the deep fascia was 77.5 percent. Preoperative angiography resulted in surgeons modifying the operative plan in 37 percent of cases and 57 percent of double-island flap cases. All flaps were elevated successfully and survived. : Computed tomographic angiography identified larger perforators better than smaller ones and proximal perforators better than distal ones. It accurately predicted the location and origin of visible perforators and less accurately predicted the size and course of visible perforators. Most importantly, the information it provided influenced surgeons to modify their reconstructive strategy, resulting in a higher level of recipient-site specificity.

Reduction in thigh circumference and improvement in the appearance of cellulite with dual-wavelength, low-level laser energy and massage

Objectives: This study evaluated the efficacy and safety of a low-level, dual-wavelength laser energy and massage device for improving the appearance of cellulite and reducing thigh circumference. Methods: Subjects (n = 83) with mild to moderate cellulite enrolled in this IRB-approved, open-label, multicenter study. Their right or left thighs received eight treatments with a low-level, dual-wavelength laser and massage device. The untreated contralateral thigh served as a control. Circumferences of the upper, middle, and lower thighs (treated and untreated) were measured before the fifth and eighth treatments and 1 month after the final treatment. Results: Reduction in thigh circumference of the treated areas exceeded those of the control areas for the upper, middle, and lower thigh in most subjects. The maximum reduction (−0.82 cm) occurred in the upper thigh at 1 month. The mean reduction of the upper, middle, and lower thigh circumferences was −0.64 cm for the treated thighs compared to −0.20 cm for untreated thighs. The difference was significant (p < 0.0001). Fifty-nine (71.1%) treatment thighs lost circumference compared to 44 (53.0%) control thighs. Resolution of adverse effects including erythema, swelling, and increased urination was seen within 30 minutes after treatment. All were resolved without sequelae and within the expected duration. Conclusion: The low-level, dual-wavelength laser energy and massage device safely improves the appearance of cellulite while reducing thigh circumference.

Talar Callosity in Children—What, Who, Why?

Figure 2. The foot with the larger callosity is the one drawn closer to the body in cross-legged sitting. T he talar callosity is a relatively uncommon ankle lump in children. Although asymptomatic and entirely ‘‘benign,’’ it is a major cause of parental concern. Clinically, the talar callosity refers to an area of hyperkeratotic skin on the anterolateral aspect of the ankle. Talar callosities are typically 2.0 to 2.5 cm in diameter, may be unilateral or bilateral, and are usually a shade darker than the surrounding skin (Figure 1). They can be associatedwith smaller callosities over the ipsilateral lateral malleolus, fifth metatarsal base or head, or other bony prominence in the foot. For 5 years, 26 children at our institution had talar callosities. There were 17 boys (65.4%) and 9 girls (34.6%) between 3 and 8 years of age (mean age, 5.3 years). All 26 children had generalized ligament laxity and a preference for cross-legged sitting without shoes. Sixteen children (61.5%) had bilateral callosities. The 10 children (38.5%) with unilateral involvement consistently sat cross-legged so that the ankle with the callosity (Figure 2) was the one drawn closer to the body and bore the additional weight of the contralateral thigh. It was also the side on which there was greater hindfoot equinovarus and forefoot adductus and supination, thrusting the anterolateral aspect of the talar head into prominence. This position of the foot in a crosslegged sitting position can be readily simulated with passive manipulation; in our experience, this simple demonstration greatly facilitates parents’ understanding of the condition. The families of 19 children were satisfied with simple reassurance on the basis of clinical evaluation. At the

Endovascular Stent Treatment for Symptomatic Benign Iliofemoral Venous Occlusive Disease: Long-Term Results 1987–2009

Venous stenting has been shown to effectively treat iliofemoral venous obstruction with good short- and mid-term results. The aim of this study was to investigate long-term clinical outcome and stent patency. Twenty patients were treated with venous stenting for benign disease at our institution between 1987 and 2005. Fifteen of 20 patients (15 female, mean age at time of stent implantation 38 years [range 18–66]) returned for a clinical visit, a plain X-ray of the stent, and a Duplex ultrasound. Four patients were lost to follow-up, and one patient died 277 months after stent placement although a good clinical result was documented 267 months after stent placement. Mean follow-up after stent placement was 167.8 months (13.9 years) (range 71 (6 years) to 267 months [22 years]). No patient needed an additional venous intervention after stent implantation. No significant difference between the circumference of the thigh on the stented side (mean 55.1 cm [range 47.0–70.0]) compared with the contralateral thigh (mean 54.9 cm [range 47.0–70.0]) (p = 0.684) was seen. There was a nonsignificant trend toward higher flow velocities within the stent (mean 30.8 cm/s [range 10.0–48.0]) and the corresponding vein segment on the contralateral side (mean 25.2 cm/s [range 12.0–47.0]) (p = 0.065). Stent integrity was confirmed in 14 of 15 cases. Only one stent showed a fracture, as documented on x-ray, without any impairment of flow. Venous stenting using Wallstents showed excellent long-term clinical outcome and primary patency rate.

Histology of an undisplaced femoral fatigue fracture in association with bisphosphonate treatment

A 57-year-old woman stumbled over her carpet, almost fell, and tried to sit down on the floor, when she heard a crack and sustained a transverse diaphyseal fracture of her left femur. The fracture had been preceded by thigh pain for a couple of months, but this was thought to be caused by spinal stenosis, for which she had been operated twice. She had been diagnosed with seronegative rheumatoid arthritis 10 years before the fracture and had initially undergone different pharmacologcal treatments, all of which except cortisone had been terminated. The diagnosis was repeatedly doubted, but cortisone gave symptomatic relief and was therefore continued at 5 mg/day with intermittent high-dose treatment (25 mg/day) during exacerbations. Apart from prednisolone, no anti-rheumatic drugs had been given during the previous 6 years. The patient had been given alendronate (70 mg/week) in 2001, followed by risedronate (35 mg/week) from 2002 until the fracture in 2009. The patient had also been taking 20–40 mg omeprazol a day since 2000. The fracture had a typical fatigue fracture appearance (Neviaser et al. 2008), and was operated on with intramedullary nailing. Because of a history of pain on weight bearing also in her contralateral thigh, new radiographs were taken and showed a non-displaced stress fracture of the subtrochanteric region (Figure 1). This fracture was also treated with intramedullary nailing. Figure 1. Right femur. Arrow indicates undisplaced fatigue fracture. Surgery (second operation) After the nail had been inserted, the non-displaced fracture was exposed. It could be seen as a dark line the size of a hair on the bone surface, surrounded by a barely visible protrusion of the bone. A 12 × 15-mm specimen including the fracture was excised, with the patient's informed consent. The procedure was approved by the Regional Ethics Committee. Both fractures healed uneventfully and mineralized callus was seen at the biopsy site after 5 months.

Management of subtrochanteric femur fractures with internal fixation and recombinant human bone morphogenetic protein-7 in a patient with osteopetrosis: a case report

IntroductionOsteopetrosis is a group of conditions characterized by defects in the osteoclastic function of the bone resulting in defective bone resorption. Clinically, the condition is characterized by a dense, sclerotic, deformed bone which, despite an increased density observable by radiography, often results in an increased propensity to fracture and delayed union.Case PresentationWe report the case of a 27-year-old Asian man presenting with bilateral subtrochanteric femur fractures. He had a displaced right subtrochanteric femur fracture after a low-energy fall, which was treated surgically. The second fracture that our patient endured was diagnosed as a stress fracture ten weeks later when he complained of pain in the contralateral left thigh. By that time, the right-sided fracture exhibited no radiographic evidence of healing, and when the left-sided stress fracture was being treated surgically, bone grafting with recombinant human bone morphogenetic protein-7 was also performed on the right side.ConclusionWhile there are no data supporting the use of bone morphogenic proteins in the management of delayed healing in patients with osteopetrosis, no other reliable osteoinductive grafting options are available to treat this condition. Both fractures in our patient healed, but based on the serial radiographic assessment it is uncertain to what degree the recombinant human bone morphogenetic protein-7 may have contributed to the successful outcome. It may have also contributed to the formation of heterotopic bone around the fracture site. Further investigation of the effectiveness and indications of bone morphogenic protein use for the management of delayed fracture healing in patients with osteopetrosis is warranted.

Reconstruction of Extensive Groin Defects with Contralateral Anterolateral Thigh–Vastus Lateralis Muscle Flaps

Reconstruction of Extensive Groin Defects with Contralateral Anterolateral Thigh–Vastus Lateralis Muscle Flaps

Comparison of the tolerability of recombinant human hyaluronidase + normal saline and recombinant human hyaluronidase + lactated ringer's solution administered subcutaneously: A phase IV, double-blind, randomized pilot study in healthy volunteers

Background: Recombinant human hyaluronidase (rHuPH20) (150 U) is approved by the US Food and Drug Administration to facilitate subcutaneous fluid administration in adults and children. Objective: This Phase IV, double-blind, randomized pilot study was designed to compare the tolerability, flow rate, and safety profile of subcutaneous infusions of normal saline (NS) and lactated Ringer's (LR) solutions following subcutaneous administration of rHuPH20. Methods: Healthy volunteers received 1 mL rHuPH20 (150 U) in each thigh, followed by simultaneous gravity-driven subcutaneous infusions of 500 mL of LR solution into 1 thigh and NS solution into the contralateral thigh. Subjects rated infusion-site discomfort in each thigh using a 100-mm (0 = no pain to 100 = most severe pain) visual analog scale (VAS) at baseline (ie, after catheter placement/ rHuPH20 injection and just prior to the start of the infusions) and at the following times: after infusion of 250 mL, after infusion of 500 mL (end of infusion), and when thigh circumference returned to within 5% of baseline. Adverse events (AEs) were recorded throughout the study. The primary tolerability end point was the maximal increase from baseline in infusion-site discomfort on the VAS. Secondary end points included infusion flow rate, change in thigh circumference, subject preference for leftversus right-thigh infusion, and safety profile measures. Results: Fifteen subjects (14 women, 1 man; mean age, 41 years [range, 20–60 years]) were included in the study. Mean (SD) maximal increase from baseline VAS pain score was significantly greater with NS solution than with LR solution (20.0 [19.4] vs 9.4 [18.3] mm, respectively; P = 0.005). Mean infusion flow rate was not significantly different between the NS and LR solutions (384.1 [118.1] vs 395.8 [132.8] mL/h). No significant differences between solutions were observed in mean maximal change in thigh circumference (5.2% [1.6%] vs 5.3% [1.5%]). All subjects expressed global preference for LR infusion over NS infusion. All subjects experienced ≥1 AE; the majority of AEs were mild, localized infusion-site reactions. Of all AEs (regardless of their relationship to study drug or procedure), 81% were mild injectionsite reactions that were similar in nature for the NS and LR solutions. Although the types of mild local AEs were similar for the 2 infusions, they were numerically more common with NS infusions (15 subjects [100%]) than with LR infusions (9 subjects [60%]). For the NS and LR solutions, the most frequent infusion-site AEs were pain (67% vs 40%, respectively), erythema (47% vs 13%), and irritation (27% vs 20%). Conclusions: This small pilot study found that the mean maximal increase from baseline in self-assessed pain VAS scores was statistically significantly higher with NS solution than LR solution. In addition, all subjects preferred LR solution to NS solution, and the incidence of some infusion-site AEs was numerically greater with NS solution. Although the VAS score indicated a statistically significant difference in tolerability favoring LR, the modest changes from baseline suggest both solutions were generally well tolerated and support the use of both NS and LR, as appropriate, for rHuPH20-facilitated subcutaneous isotonic fluid infusion in healthy adults. These results need to be confirmed in larger, controlled clinical studies.

Imaging Vascular Endothelial Growth Factor (VEGF) Receptors in Turpentine-Induced Sterile Thigh Abscesses with Radiolabeled Single-Chain VEGF

Angiogenesis plays a central role in the pathogenesis of chronic inflammatory disorders. Vascular endothelial growth factor (VEGF) and its receptors are the most important regulators of angiogenesis. We wished to determine whether labeled forms of single-chain VEGF (scVEGF) could be used to image VEGF receptors in a well-characterized model of sterile soft-tissue inflammation induced by intramuscular injection of turpentine. Anesthetized adult male Swiss-Webster mice received a 20-microL intramuscular injection of turpentine into the right thigh. At 4, 7, or 10 d later, groups of 3-5 mice were injected via the tail vein with 50 microg of either scVEGF that had been site specifically labeled with Cy5.5 (scVEGF/Cy) or inactivated scVEGF/Cy (inVEGF/Cy) and then examined by fluorescence imaging. At 3, 4, 6, 7, 9, 10, or 12 d, additional groups of 3-5 mice were injected via the tail vein with 74-111 MBq of (99m)Tc-scVEGF (or (99m)Tc-inVEGF) and then examined by SPECT imaging. On days 3 through 10, both forms of scVEGF (scVEGF/Cy and (99m)Tc-scVEGF) showed significantly higher uptake (P < 0.05) in the right (abscessed) thigh than in the contralateral thigh (and higher uptake than the inactivated tracer). Peak uptake occurred on day 7 (3.67 +/- 1.79 [ratio of uptake in abscessed thigh to uptake in normal thigh, mean +/- SD] and 0.72 +/- 0.01 for scVEGF/Cy and inVEGF/Cy, respectively, and 3.49 +/- 1.22 and 1.04 +/- 0.41 for (99m)Tc-scVEGF and (99m)Tc-inVEGF, respectively) and slowly decreased thereafter. Autoradiography revealed peak tracer uptake in the thick irregular angiogenic rim of the abscess cavity on day 9 (5.83 x 10(-7) +/- 9.22 x 10(-8) and 5.85 x 10(-8) +/- 5.95 x 10(-8) percentage injected dose per pixel for (99m)Tc-scVEGF and (99m)Tc-inVEGF, respectively); in comparison, a thin circumscribed rim of uptake was seen with (99m)Tc-inVEGF. Immunostaining revealed that VEGFR-2 (VEGF receptor) colocalized with CD31 (endothelial cell marker) at all time points in the abscess rim, whereas F4/80 (macrophage) immunostaining reached a maximum at day 7 and decreased by day 10. The uptake of scVEGF in turpentine-induced abscesses was specific and directly related to VEGFR-2 expression in the neovasculature of the angiogenic rim. Peak tracer uptake coincided with maximum macrophage infiltration, suggesting that scVEGF imaging may be useful for the detection, localization, and monitoring of chronic inflammation in bone, joints, or soft tissues.

Posterior compartment of the lower leg reconstruction with free functional rectus femoris transfer after sarcoma resection

A 72-year-old man with the third recurrence of a low-grade liposarcoma of the right lower leg came to our attention seeking limb-salvage surgery. The tumour was removed en bloc with all the superficial posterior compartment of the leg. Appropriate foot flexion was restored by means of a free-functional rectus femoris musculocutaneous flap harvested from the ipsilateral thigh. The patient was kept on a postoperative splint for 6 weeks. Three months after the operation, clinical and elecromyographic signs of reinnervation were observed. The patient was able to walk, run and climb stairs and no donor-site morbidity was observed. Thigh extension was rated M4, comparable to the contralateral thigh. Foot flexion, without any postoperative exercise, was rated M3 with a 30 degrees excursion. To the best of our knowledge, this is the first report of reconstruction of the posterior compartment of the leg r with a free functional rectus femoris flap. We believe this muscle could be the ideal option for such reconstruction.

True hematogenous metastases of melanoma on contralateral skin graft donor site: a case report

The incidence of cutaneous melanoma, the most lethal form of skin cancer, is increasing all over the world. Malignant melanoma spreads through hematogenous, lymphagenous path, or by iatrogenic implantations. In this report, we present an unusual case in which a patient experienced the development of melanoma within the split-thickness skin graft donor site on the contralateral lower extremity. Metastases of malignant melanoma occurred in the donor site of the graft, 8 weeks after primary tumor excision, ipsilateral axillary dissection, and reconstruction with a split-thickness skin graft harvested from the contralateral upper thigh. As eight melanoma nodules were seen in donor area, we strongly suspect that spreading of melanoma occurred via a true hematogenous pathway in this case.

Force Per Active Area and Muscle Injury during Electrically Stimulated Contractions

Multiple mechanical factors have been implicated in the initiation of exercise-induced muscle injury. Although high absolute force levels are associated with greater injury, the importance of high force per active area independent of absolute force remains to be determined, especially in humans. This study sought to examine the role of specific force in muscle injury when peak eccentric force and total eccentric force were matched between two exercise bouts. Ten subjects (six men, four women) performed 80 electrically stimulated (EMS) eccentric contractions of the right and left quadriceps femoris (QF) through a 90 degree arc at approximately 45 degrees x s(-1). Specific force was manipulated by applying 25-Hz EMS to one thigh and 100-Hz EMS to the contralateral thigh, whereas force production was matched by lowering the EMS amplitude during the 100-Hz bout. T2 magnetic resonance images of the QF were collected before and 3 d after the eccentric exercise bouts. Injury was assessed via changes in isometric force and ratings of soreness in the QF over the course of 28 d after exercise and by determining changes in T2 relaxation time and muscle volume 3 d after exercise. The 100-Hz EMS induced a greater force loss (P < 0. 05), soreness (P < 0.05), change in muscle volume (P = 0.03), and volume of muscle demonstrating an increase in T2 (P = 0.005) compared with 25-Hz EMS. Our findings suggest that in humans, high specific force potentially plays an important role in the initiation of exercise-induced muscle injury.

Local Inflammatory and Metabolic Response in the Knee Synovium After Arthroscopy or Arthroscopic Anterior Cruciate Ligament Reconstruction

The aim of this study was to study local synovial metabolism and inflammation after arthroscopy and arthroscopic anterior cruciate ligament (ACL) reconstruction. Microdialysis in the synovial membrane was performed during 4 hours postoperatively in 20 patients undergoing a minor arthroscopy procedure (e.g., meniscus surgery and 10 patients undergoing ACL reconstruction with a quadruple hamstring graft). Contralateral thigh adipose tissue served as a reference. Lactate, glucose, glycerol, and prostaglandin E(2) (PGE(2)) were monitored. The ACL group received intra-articular morphine preoperatively, and a cooling and compression device was applied postoperatively according to local clinical routines. The synovial lactate levels and the consumption of synovial glucose was increased postoperatively in the arthroscopy group compared to the reference adipose tissue. There were no significant differences regarding synovial levels of glycerol, lactate, or glucose compared to the reference tissue in the ACL group. PGE(2) levels were significantly lower in the ACL group compared to the arthroscopy group. A major arthroscopic surgical procedure (ACL reconstruction) did not increase the local synovial metabolism or induce a detectable inflammatory response compared to a minor arthroscopic surgical procedure (e.g., meniscal surgery) in our clinical setting. Intra-articular injection of morphine and or the use of a combined cooling and compression device in the ACL group showed a modulation of the response in tissue chemistry as measured by synovial microdialysis. Level III, therapeutic case-control study.

An imaging analysis of 99mTc-UBI (29–41) uptake in S. aureus infected thighs of rabbits on ciprofloxacin treatment

The uptake of (99m)Tc-UBI (29-41) was evaluated at sites of bacterial infections in rabbits before and after treatment with ciprofloxacin. Staphylococcus aureus susceptible to ciprofloxacin was used to induce a focal infection in each rabbit of group 1 (G1), group 2 (G2), and group 3 (G3) with 2 x 10(4), 2 x 10(6), and 2 x 10(8) colony forming units (CFU), respectively. After 24 h, images of infected thighs (target: T) and contralateral thighs (nontarget: NT) were acquired. Animals then received ciprofloxacin intramuscularly for 5 days followed by imaging on the third and fifth days. The control group 4 (G4) was imaged at days 1, 3, and 5 under the same acquisition parameters. Group 5 (G5) was employed to study biodistribution of the peptide. Increases in (T/NT) ratios in G1, G2, and G3 were observed from 5 min onwards with maximum values at 60 min. G3 revealed the highest accumulation of the peptide. Growth of the same strain of S. aureus on blood agar medium was visualized after fine needle aspiration. After ciprofloxacin treatment, the images for G1-G3 resulted in significantly decreased (P < 0.05) T/NT values on the third and fifth days that correlated with reduction in number of viable bacteria. No significant difference (P < 0.05) in left to right thigh ratios in the control group (G4) was observed. Biodistribution of the peptide showed rapid removal of tracer from circulation through the kidneys. ( 99m ) Tc-UBI (29-41) accumulation directly correlates with the number of viable bacteria. This infection localization agent can be utilized for monitoring efficacy and duration of antibiotic treatment.