Lower Extremities Of Women Research Articles

[Translated article] Changes in the Location of Cutaneous Melanoma Over the Past 30 Years. A Retrospective Observational Study

BackgroundThe location of cutaneous melanoma is associated with photoexposure. ObjectivesTo retrospectively analyze changes in the location of cutaneous melanoma over the past 30 years. Patients and methodsAll patients treated at our hospital for cutaneous melanoma from 1988 through 2017 were prospectively collected. Data obtained in cases diagnosed from 1988 through June 2006 were compared to those diagnosed from July 2006 through 2017. ResultsA total of 1,937 patients (876 men and 1061 women; median age, 57 years; interquartile range 27) were diagnosed with primary cutaneous melanoma. The location of melanoma was head and neck (470 cases), trunk (745 cases), upper limbs (239 cases), and lower limbs (483 cases). From July 2006 through 2017 we detected an increase in the incidence of head and neck melanomas (19.9% vs 28.6%, p <0.001). A drop in the incidence of melanomas located in the lower extremities was also seen in women (39.8% vs 30.4%, p <0.001), and in the trunk men (57.5% vs 47.3%, p=0.003). In the multivariate analyses, only the decrease in melanomas located in lower extremities in women remained significant. ConclusionThe increased incidence of head and neck melanomas in both sexes and the decrease in trunk melanomas in men can be attributed to the aging of our population. The reduction in the incidence of melanomas in the lower extremities in women could be associated with changes in photoexposure patterns. Analyzing the factors possibly associated with these changes would contribute to better understanding the pathogenesis of cutaneous melanoma for prevention purposes.

Cambios en la localización del melanoma cutáneo en los últimos 30 años. Estudio observacional retrospectivo

BackgroundThe location of cutaneous melanoma is associated with photoexposure. ObjectivesTo retrospectively analyze changes in the location of cutaneous melanoma over the past 30 years. Patients and methodsAll patients treated at our hospital for cutaneous melanoma from 1988 through 2017 were prospectively collected. Data obtained in cases diagnosed from 1988 through June 2006 were compared to those diagnosed from July 2006 through 2017. ResultsA total of 1,937 patients (876 men and 1061 women; median age, 57 years; interquartile range 27) were diagnosed with primary cutaneous melanoma. The location of melanoma was head and neck (470 cases), trunk (745 cases), upper limbs (239 cases), and lower limbs (483 cases). From July 2006 through 2017 we detected an increase in the incidence of head and neck melanomas (19.9% vs 28.6%, p <0.001). A drop in the incidence of melanomas located in the lower extremities was also seen in women (39.8% vs 30.4%, p <0.001), and in the trunk men (57.5% vs 47.3%, p=0.003). In the multivariate analyses, only the decrease in melanomas located in lower extremities in women remained significant. ConclusionThe increased incidence of head and neck melanomas in both sexes and the decrease in trunk melanomas in men can be attributed to the aging of our population. The reduction in the incidence of melanomas in the lower extremities in women could be associated with changes in photoexposure patterns. Analyzing the factors possibly associated with these changes would contribute to better understanding the pathogenesis of cutaneous melanoma for prevention purposes.

Biomechanical Analysis of the Knee Joint during Jump Landing of Genu Valgum Women

The purpose of this study was to identify the analysis of kinematics and kinetic of jump landing on lower extremities in women with valgus knees. To this study, 24 adult women without musculoskeletal diseases were selected as participants. They were separated into a normal group (12 women with quadriceps angles (Q angles) of lower than 20 degrees) and a valgus group (12 women with Q angles of greater than 20 degrees). The study analysis variables were the joint angle and the moment by event, and the center of pressure and the ground reaction force during jump landing. Eight motion capture cameras and two ground reaction force measuring devices were employed to measure and analyze these variables. In the study, Cortex 5.0 was used as a motion analysis program and SPSS 25.0 for Windows was used for data processing. In addition, the independent samples t-test was employed to analyze kinematics and kinetics differences between the valgus and normal groups during jump landing. The statistical significance level was set at p<0.05. According to the study results, in terms of the kinematic factors during jump landing, no statistically significant differences were identified in the knee joints. But, in terms of the knee joint moment of kinematic factors during jump landing, the valgus group showed a significant, larger extension and valgus moment than the normal group. A comprehensive review of the study findings suggests that knee extension and valgus moment increases tibial internal rotation in women with valgus, which results in valgus deformity and the following abnormal movements during jump landing.

Unusually large leiomyoma of buccal mucosa – Clinical case report

Leiomyomas are benign smooth muscle tumors, which occur most commonly, in the uterine myometrium, gastrointestinal tract, skin, and lower extremities of women. Only 1% of leiomyomas occur in the head-and-neck region. A thorough differential diagnosis is required before undertaking surgical excision of a lesion as it mimics fibromas, lipomas, and sometimes, leiomyosarcomas. We report a case of a 40-year-old male with an unusually large leiomyoma on the right buccal mucosa, which was present for 4 years. A complete surgical excision of the lesion was done. There was no recurrence of the lesion seen anywhere in the oral cavity.

Studying Changes of the Effective Radius in Blood Vessels after Exposure of Lower Extremities to Periodical Mechanical Vibrations.

Background:Previous studies demonstrated a health improving effect in patients underwent an automatic vibratory massage taking 10 minutes. One of reasons that may explain a healing effect of the automatic massage is a stimulated increase in both blood circulation through vascular system and effective size of blood vessels. Objective: This paper aims to quantify a contribution of the automatic mechanical massage of lower extremities into the observed reduction in arterial blood pressure and explain this effect.Material and Methods: In our experimental study, the lower extremities of male and female patients were exposed to low frequency (12 Hz) mechanical vibrations for 10 minutes and the change in systolic and diastolic arterial blood pressures before and after this procedure was measuredResults: The experiments showed there is a reduction in systolic and diastolic arterial blood pressures after vibrational massage. There were corresponding 3.5±1.8 mmHg and 3.1±1.6 mm Hg arterial blood pressure reductions among men and 5.5±3.2 mm Hg and 2.2±1.2 mm Hg reductions among women.Conclusion: We explained this effect by increasing effective radius of blood vessels. Based on the Hagen-Poiseuille equation, we made estimates for the relative change in the effective radius of blood vessels. They gave the 0.7% and 1.3% increases in the effective radius of blood vessels in lower extremities in men during systole and diastole, respectively, and the corresponding 1.1% and 0.6% increases in the effective radius of blood vessels of lower extremities in women during the same periods.

Multinucleate cell angiohistiocytoma: Case report and literature review

Multinucleate cell angiohistiocytoma is a rare, vascular, fibrohistiocytic proliferation that has a benign but progressive course. The clinical presentation is that of grouped red-purple papules and nodules characteristically located on the lower extremities in women. The histopathology shows a proliferation of narrow vessels within thickened collagen bundles associated with multinucleate giant cells. These lesions are probably reactive in nature, and several mechanisms of pathogenesis, including hormonal, have been proposed. Different modalities, including intense pulsed light and pulsed-dye laser, have been used for treatment of these lesions. We report a case of a 74-year-old Caucasian woman with long-standing multinucleate angiohistiocytoma on her bilateral thighs that eluded diagnosis for several years. Upon biopsy and histopathological analysis, the diagnosis was made. Treatment options were entertained, although ultimately not pursued by the patient. We report this case to increase clinical awareness of this rare disease and to contribute to the ongoing literature aimed to further characterize this condition.

Abdominal fat distribution differently affects muscle strength of the upper and lower extremities in women.

In obese subjects, reduced muscle mass and strength are associated with impaired functional and metabolic capacity. We therefore investigated the association between abdominal fat distribution, fat mass index and maximum muscle strength of upper and lower extremities in obese patients. One hundred and fifty five outpatients with a body mass index (BMI)⩾30 kg/m2 (105 women; 45.1±14.6 years; BMI 43.5±8.2 kg/m2) were included in the study. Grip and knee extension strength were measured with dynamometers. Using bioelectric impedance analysis, fat-free mass and fat mass indices (FFMI, FMI) were calculated. The influence of age, weight, FFMI, FMI and waist-to-hip ratio (WHR) on grip and knee extension strength was investigated in a risk factor-adjusted regression analysis. BMI did not correlate with hand grip or knee extension strength. The regression model confirmed a positive effect of higher weight on strength parameters; however, increased FMI was shown to have a negative effect on strength in both sexes (women, knee: β: -1.495, confidence interval (CI): -2.075 to -0.0914, P<0.0001; women, hand: β: -0.714, CI: -1.156 to -0.273, P=0.002; men, hand: β:-1.448, CI: -2.618 to -0.278, P=0.016). Although increased WHR positively influenced knee extension strength (β: 24.286, CI: 0.728-47.844, P<0.043), it did not affect grip strength in women. This association was not seen in men. Body fat distribution rather than BMI alone needs to be considered when evaluating strength parameters in obesity. As the relationship between obesity and strength of the upper versus lower extremities differs, grip strength cannot be considered an indicator of whole body strength in obese individuals.

Temperature changes in selected areas of body surface induced by systemic cryostimulation.

The aim of this study was to assess the distribution and dynamics of temperature changes on the surface of selected body parts after systemic cryostimulation. The changes that occurred as a reaction to the 1st, 5th, and 10th session of a series of 10 sessions were also analyzed. The study group consisted of 24 students (12 women and 12 men, ∼21 yr of age) from the University School of Physical Education in Krakow. They were treated in a cryogenic chamber at the Rehabilitation Center in Krakow once daily for 10 d. The mean temperature in the chamber was -130°C ± 10°C and the session duration was 3 min. Thermovisual examination of temperature distribution in the selected parts of the upper and lower extremities was conducted before and immediately after a session on the 1(st) (S1), 5(th) (S2), and 10(th) (S3) day of treatment. All thermograms were digitally recorded using a Flir Therma CAM TM Sc500 camera. On the 5th day of treatment, the examined group demonstrated the smallest mean temperature changes (4.57°C-17.31°C for the anterior part of the upper extremities in men and the posterior part of the lower extremities in women, respectively) before and after cryostimulation. The most significant temperature changes were observed in the group of women (6.80°C-20.08°C for the posterior parts of the upper extremities on S2 and the lower extremities on S3, respectively). There is an important difference in response to cryogenic temperature between men and women in a series.

Primary cutaneous perivascular epithelioid cell tumor: A clinicopathological and molecular reappraisal

Perivascular epithelioid cell tumor (PEComa) is a rare neoplasm of uncertain histogenesis with a mixed myomelanocytic immunophenotype, rarely arising in the skin (primary cutaneous PEComa [pcPEComa]). We analyzed the clinicopathological features of 8 pcPEComas, assayed for DNA copy number changes and for initiating mutations common in melanocytic neoplasms. pcPEComas were evaluated using immunohistochemistry, comparative genomic hybridization, and DNA sequencing. pcPEComas were erythematous nodules, mostly in the lower extremities of women (5/8), composed of large pale-staining epithelioid cells. The patient's age range was 26 to 67 (mean 46) years. The percentages of tumors staining positively were as follows: micro-ophthalmia-associated transcription factor, NKI/C3, bcl-1, E-cadherin, and cathepsin K (100%); HMB-45, 4E-binding protein 1, and CD68 (88%); smooth muscle actin and muscle-specific actin (40%); S100 (38%); calponin (20%); desmin (13%); and melan-A, SOX10, and keratin (0%). No chromosomal copy number changes or initiating mutations were identified. Small sample size is a limitation. pcPEComas have a different molecular signature than extracutaneous tumors and are unrelated to tuberous sclerosis. However, the common expression of 4E-binding protein 1 points to a role of the mTOR pathway in their pathogenesis. Because pcPEComas are diagnostically challenging, we propose that micro-ophthalmia-associated transcription factor, NKIC3, smooth muscle actin, desmin, bcl-1, cathepsin K, and 4E-binding protein 1 can be used when evaluating a possible pcPEComa.

Epidemiología del melanoma en una población multicultural mediterránea

BackgroundThe Hospital Costa del Sol, with a catchment population of 380,000 registered inhabitants, logged an average of 48 new melanoma cases per year, of which 30% occurred in foreigners. ObjectiveTo analyze the clinical and epidemiological features of melanoma in the Hospital Costa del Sol and the trend in the diagnosis of melanoma in the last 10 years. Material and methodsWe performed a retrospective analysis of malignant melanomas diagnosed at the Hospital Costa del Sol from 2002 to 2011. ResultsWe reviewed 411 patients (481 melanomas); 50.6% were women. The mean age was 57.33 years. There was a predominance of phototypes ii and iii (57.6%, 26.1%) and recreational sun exposure (73.1%). A total of 69.2% of the patients were Spanish and 30.8% were foreigners. The most commonly affected location was the trunk followed by the head and neck in men and the lower extremities in women. The most frequent histopathological type was superficial spreading melanoma. Twenty-six patients (6.3%) developed multiple melanomas and 22.3% had an associated non-melanoma skin cancer. The hospital incidence rate was 17.5 cases/100,000 population/year. Analysis of the trend showed an increase in the number of in situ and thin (less than 1mm) melanomas. ConclusionThe incidence of melanoma is increasing in our area, mainly due to thin melanomas. Our patients also had a high risk of developing a second melanoma or other types of non-melanoma skin cancer.

Mass of individual muscles in the lower extremities of women with the hypermobility type of Ehlers‐Danlos syndrome: comment on the article by Rombaut et al

Mass of individual muscles in the lower extremities of women with the hypermobility type of Ehlers‐Danlos syndrome: comment on the article by Rombaut et al

Isokinetic Strength of Lower Extremities in Women with Chronic Inversion Ankle Sprain

Isokinetic Strength of Lower Extremities in Women with Chronic Inversion Ankle Sprain

De novo intraepidermal epithelioid melanocytic dysplasia: a review of 263 cases

De novo intraepidermal epithelioid melanocytic dysplasia (DNIEMD) is a newly characterized lesion that is associated with a personal and/or family history of malignant melanoma (MM) and/or dysplastic nevi (DN). However, the biological significance is still uncertain and the persons predisposed to this lesion have not been adequately described. Clinicopathologic data of 258 patients, from 263 biopsies diagnosed with DNIEMD, was obtained. A brief voluntary questionnaire was used to obtain demographic, risk factor and disease history. There is an 82% (n=263) predominance of women with DNIEMDs. For men and women, the distributions of these lesions occur on the lower extremities (71%), the upper extremities (24%) and trunk (5%). Thirty-one percent of the 258 patients responded to the questionnaires. 48% of the 60 respondents had green or blue eyes. 26% of 62 respondents had a history of non-melanoma skin cancer (NMSC). Combined data revealed that 68% of 134 patients had a history of DN. As well, 24% of 89 patients had personal histories of melanoma, while 24% of 72 patients had a family history of melanoma. Most of these DNIEMD lesions are found on the lower extremities of women and men, and they have an increased association with MM, DN and NMSC.

Dermatofibroma gigante: descripción de un caso y revisión de la literatura

Dermatofibroma is a very frequent lesion that usually appears as a slowly growing nodule in the dermis, and preferentially involves the lower extremities of women. Several clinical variants have been described. Giant dermatofibroma has been defined as a rare variant of dermatofibroma measuring more than 5 cm that presents typical histological features and a benign biological behavior. We report the case of a 52-year-old man that presented a giant dermatofibroma with a diameter of 6 cm in the right shoulder and we review the few cases of this variant that have been described in the literature.

Giant Dermatofibroma: Case Report and Review of the Literature

Dermatofibroma is a very frequent lesion that usually appears as a slowly growing nodule in the dermis, and preferentially involves the lower extremities of women. Several clinical variants have been described. Giant dermatofibroma has been defined as a rare variant of dermatofibroma measuring more than 5 cm that presents typical histological features and a benign biological behavior. We report the case of a 52-year-old man that presented a giant dermatofibroma with a diameter of 6 cm in the right shoulder and we review the few cases of this variant that have been described in the literature.

Exercise in waist‐high warm water decreases pain and improves health‐related quality of life and strength in the lower extremities in women with fibromyalgia

To evaluate the short- and long-term efficacy of exercise therapy in a warm, waist-high pool in women with fibromyalgia. Thirty-four women (mean +/- SD tender points 17 +/- 1) were randomly assigned to either an exercise group (n = 17) to perform 3 weekly sessions of training including aerobic, proprioceptive, and strengthening exercises during 12 weeks, or to a control group (n = 17). Maximal unilateral isokinetic strength was measured in the knee extensors and flexors in concentric and eccentric actions at 60 degrees /second and 210 degrees /second, and in the shoulder abductors and adductors in concentric contractions. Health-related quality of life (HRQOL) was assessed using the EQ-5D questionnaire; pain was assessed on a visual analog scale. All were measured at baseline, posttreatment, and after 6 months. The strength of the knee extensors in concentric actions increased by 20% in both limbs after the training period, and these improvements were maintained after the de-training period in the exercise group. The strength of other muscle actions measured did not change. HRQOL improved by 93% (P = 0.007) and pain was reduced by 29% (P = 0.012) in the exercise group during the training, but pain returned close to the pretraining level during the subsequent de-training. However, there were no changes in the control group during the entire period. The therapy relieved pain and improved HRQOL and muscle strength in the lower limbs at low velocity in patients with initial low muscle strength and high number of tender points. Most of these improvements were maintained long term.

Anatomic Distribution of Cutaneous Melanomas and Painful Sunburns in Adults

Background: Data show that intermittent painful sunburns are an important causative factor for cutaneous malignant melanoma. Objective: This study was undertaken to determine whether the differences in the anatomic distribution of melanomas in men, compared to women, could be accounted for by the distribution of sunburns and whether the high incidence of melanomas on the lower extremities of women is associated with the distribution of sunburns. Methods: One hundred and fifty nonmelanoma patients, men and women aged 20 to 60 years, recalled having painful sunburns within the previous 6 months. The locations of the sunburns were indicated on body surface diagrams. The locations of 1168 melanomas as recorded in the NYU-Melanoma Cooperative Group data base were plotted on anatomic diagrams. The anatomic distribution of melanomas and of sunburns for men and women were compared. Results: There was no statistically significant difference in the distribution of sunburns on any anatomic location in men as compared to women. However, there was a disproportionately high number of melanomas on the backs of men and on the legs of women. In both men and women, there was a significant difference between the anatomic distribution of painful sunburns and melanomas. Conclusion: Since the anatomic distribution of painful sunburns is similar in men and women, whereas the anatomic distribution of melanomas differ, it would appear that factors in addition to sunburns in adults account for the differences in the anatomic distribution of melanomas in men and women.

The relationship between skin cancers, solar radiation and ozone depletion.

During the period 1957-1984 the annual age-adjusted incidence rate of cutaneous malignant melanoma (CMM) increased by 350% for men and 440% for women in Norway. The annual exposure to carcinogenic sunlight in Norway, calculated by use of measured ozone levels, showed no increasing trend during the same period. Thus, ozone depletion is not a cause of the increasing trend of the incidence rates of skin cancers. The incidence rates of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) increase with decreasing latitude in Norway. The same is true for CMM in Norway, Sweden, and Finland. Our data were used to estimate the implications of a future ozone depletion for the incidence rates of skin cancer: a 10% ozone depletion was found to give rise to a 16-18% increase in the incidence rate of SCC (men and women), a 19% increase in the incidence rate of CMM for men and a 32% increase in the incidence rate of CMM for women. The difference between the numbers for men and women is almost significant and may be related to a different intermittent exposure pattern to sunlight of the two sexes. The increasing trend in the incidence rates of CMM is strongest for the trunk and lower extremities of women, followed by that for the trunk of men. The increasing incidence rates of skin cancers as well as the changing pattern of incidence on different parts of the body is most likely due to changing habits of sun exposure. Comparisons of relative densities of CMM, SCC, LMM and SCC falling per unit area of skin at different parts of the body indicate that sun exposure is the main cause of these cancer forms although other unknown factors may play significant roles as well. For the population as a whole sun exposure during vacations to sunny countries has so far been of minor importance in skin cancer induction.

Edward Wyer's Observations on the Lymphatic Distention of the Lower Extremities of Women While in the Puerperal State

Edward Wyer's Observations on the Lymphatic Distention of the Lower Extremities of Women While in the Puerperal State