Lower Thigh Research Articles

神奈川県における牛無鉤嚢虫症の集団発生

Seventy-one female beef cattle aged 2 to 3 years, from a stock farm in Kanagawa Prefecture were examined between July 1993 and March 1994, and 59 (83.1%) were found to be densely infected with Cysticercus bovis. Worm bladders 1×1 to 11.5mm in size, in the muscles and organs were light gray to light brown in color. Parasitized sites were: heart (67/71; 94%), masseter (54/69; 78%), diaphragm (58/70; 83%), tongue (29/69; 42%), lung (28/69; 41%), liver (21/69; 30%), tail (19/69; 28%), and digestive tract (6/28; 21%). Among dressed carcasses, the incidence was highest in the shoulder (92%), followed by the thigh (82%), flank (74%), neck (69%), thoratic part (72%), lower thigh (54%), and rump (46%).

Precision of the one- versus two-handed method of skinfold measurement in the obese.

Skinfolds at five anatomic sites were measured on 47 subjects in a study of gallbladder disease in Starr County, Texas, by two methods, one and two handed. A comparison was made of the two methods as to bias and precision. There were statistically significant but biologically unimportant differences (on the order of 1-2 mm) at four of the five sites. At three of these, the two-handed method gave larger values (lower thigh, triceps, and subscapular), and at the other site (medial calf) this method produced smaller values on average. Measurement precision was improved using the two-handed method at three of the five sites, significantly so for the triceps skinfold. Measuring skinfolds with two hands improves the precision of measurement for some skinfold sites in obese individuals. It does not introduce important and systematic biases across skinfold sites. Adoption of this technique should be used when circumstances outweigh the cost of involving an extra observer in the measurement of skinfold thickness, such as when precision is very important and when subjects are obese. © 1995 Wiley-Liss, Inc.

Multiple Cutaneous Ulcers of the Legs

REPORT OF A CASE A 70-year-old woman presented with cutaneous ulcerations of the lower extremities of 3 years' duration. The first ulcer occurred at a site where she had sustained a small puncture wound on her right ankle after striking it on her dishwasher. Initially, redness and tenderness developed around the site. Eventually the skin broke open and formed a nonhealing ulcer. Subsequently, other ulcers developed on both lower legs that were usually painful and were sometimes associated with red nodules. They eventually involved the lower legs, ankles, feet, and thighs. A few of the ulcers finally healed with large, deep scars, but most failed to heal over many months. There was never any association with fevers, chills, sweats, or other systemic symptoms. The patient stated that her general health had been good, except for the development of asthma approximately 15 years before the onset of her cutaneous ulcers. Her

Techniques of Sclerotherapy: A Method to Distend Leg Veins with the Patient in a Horizontal Position Prior to Needle Insertion

Objective: To demonstrate the efficacy of the use of a large contoured thigh cuff to distend varicose veins, with the patient in a horizontal position, prior to needle insertion for sclerotherapy. Design: Prospective study in varicose vein patients treated by injection-compression sclerotherapy. Setting: Outpatient Surgery Clinic, University of California San Diego, La Jolla, California. Patients: Patients presenting with varicose veins on the lower thigh and below. Interventions: Patients underwent injection-compression sclerotherapy. Needles insertion was done with the patient in a horizontal position after veins were distended using a large contoured thigh cuff. Main outcome measures: Successful vein distension and needle insertion. Results: Ninety-five percent of patients had adequate vein distension for needle insertion. Conclusion: Vein distension, prior to needle insertion for sclerotherapy can be achieved by using a large contoured thigh cuff.

Current Perspective on Lyme Borreliosis

SELECTED CASE A 29-year-old woman presented with knee and elbow pain of 12 days' duration. Twelve weeks earlier in mid-June she had been working in a craft center at a camp on the Chesapeake Bay, Md, but spent much recreational time biking through wooded and open coastland. She recalled scratching a slightly pruritic area on her See also p 1364. lower thigh in early July. Several days later she noticed a circular area of intense redness, approximately 8 cm in diameter, which she attributed to irritation from scratching. Over the next 10 days, the rash grew considerably larger, showing a red outer border more visible than the center. The rash then disappeared gradually. In late July, she felt unusually hot and fatigued, experienced headache and intermittent nausea for 5 days, and had difficulty sleeping and concentrating both at work and while biking. For about 36 hours she had mild pain

Measurements of potential differences in human subjects induced by motion in a superconducting magnetic field.

We have attempted to measure the electromotive forces (emfs) induced in human beings moving at a constant speed in a highly dense magnetic field. Experiments were initially conducted on a set of models, and then directly on human subjects. The models consisted of single circular loops of Tygon tubing (I.D., 0.635 cm; O.D., 0.9525 cm) filled with normal saline solution, with circumferences of 20, 40, 60, 80, and 100 cm. The models were connected to an amplifier via silver/silver-chloride electrodes. Each saline loop was mounted on a movable platform, with the plane of the loop perpendicular to the platform's axis; the platform was enabled to move at known constant speeds into and out of the bore of a 1.89-T magnet. The human subjects were then substituted for the saline loops, with the long axis parallel to the direction of motion, and with standard EKG electrodes placed at 180 degrees successively on the ankle, calf, lower thigh, upper thigh, chest, and head. In all cases, for human subjects and models, the peak induced voltage was directly proportional to the speed of movement and the square of the circumference of the bounded cross-sectional areas. Thus, for the saline loops, the correlation coefficient between induced voltage and circumference was .998, and for human subjects, .947. Under the loose assumption that for equal circumferences the bounded areas in human subjects were equal to those in the circular loops, the induced emfs in human subjects were consistently about 13% greater than those in the loops. At a mean speed of 1.18 m/s, the chest had a peak induced voltage of 260 mV, while the voltage at the ankle had a peak of 19.8 mV. The experimental data were used to estimate the corresponding induced-current density at the pericardium, 17 mA/m2. We conclude for a human subject moving at constant speed along the body's long axis into a magnetic field that Faraday's law is closely followed for various cross-sections of the body. Further, in those cases in which the magnetic field and its gradient are not well-established, one can use saline-filled loops to estimate approximate values of voltages induced in human subjects.

Nerve conduction studies in experimental non‐freezing cold injury: I. Local nerve cooling

In rabbits, the tibial nerve was exposed in the lower thigh under general anesthesia and cooled in a metal trough at 1 to 2 degrees C or 5 degrees C for 2, 3, or 4 hours. Nerve conduction studies showed local failure of conduction at the site of cooling which persisted after rewarming, and which was followed by distal degeneration of affected fibers. No persistent conduction block was seen. Changes in maximal velocity indicated that the fastest-conducting motor and afferent axons had been preferentially affected. Histological findings in nerves examined at different intervals after cooling confirmed the physiological evidence of primary axonal damage, affecting particularly large diameter fibers. Paranodal demyelination was inconspicuous and restricted to regions just proximal to sites of axonal degeneration. No segmental demyelination was seen. These results clarify previous uncertainties as to the time-course and distribution of nerve damage after local cooling at temperatures just above freezing point.

Influence of Adipose Tissue Distribution on the Biological Activity of Androgensa

To establish whether the conversion of androstenedione (A) to estrogens and 5 alpha-reduced metabolites in human adipose tissue was determined by the site of origin of the tissue, studies were carried out on adipose stromal cells from different body sites. Adipose tissue was obtained from the breast, omentum, abdomen, lower thigh, upper thigh, buttock, and flank from patients undergoing liposuction for cosmetic reasons or at surgery. Stromal cells were isolated after incubation of the adipose tissue with collagenase and were grown in culture using alpha-minimal essential medium (MEM) + 15% fetal calf serum. Studies of A metabolism were carried out when the cells were between days 4 and 12 in culture. After an 8-hour incubation with (3H)-A as substrate, estrone (E1), testosterone (T), 5 alpha-androstanedione (5 alpha-A-dione), androsterone (AND), and dihydrotestosterone (DHT) were isolated using thin layer and paper chromatography. The conversion per 1 x 10(6) cells of A of E1 was more than 10-fold greater in the upper thigh, buttock, and flank than in the breast, lower thigh, abdomen, or omentum (0.13-3.0 vs 0.01-0.09%). The formation of 5 alpha-reduced androgens varied from 0.86-10% and was similar in tissue from different body sites. Cortisol (10(-7) M) stimulated E1 formation 3- to 10-fold in cells from all sites, whereas 5 alpha-reductase activity was either unchanged or increased moderately (up to twofold). In cells from the abdomen, omentum, and lower thigh, the formation of 5 alpha-reduced androgens was more than 10-fold greater than the formation of E1. In cells from the upper thigh, buttock, and flank, E1 formation was comparable to 5 alpha-reduced androgen formation. These studies show marked differences in the relative conversion of A to estrogens and 5 alpha-reduced androgens in adipose stromal cells depending on their site of origin, and they suggest that the distribution of body fat may be a major factor in determining the biologic effects of secreted androgens.

Discriminant analysis of the physiques of schoolboy rugby players, hurlers and non-team members.

The subjects were 31 successful schoolboy rugby players and 25 successful schoolboy hurlers; 34 non-team members acted as controls. Thirty-one anthropometric measurements were taken on each subject: height, weight, sitting height, five skeletal lengths, six skeletal diameters, 13 muscle circumferences and four skinfolds. The non-players were significantly smaller than both the rugby players and the hurlers in weight, biacromial diameter, bideltoid, neck, chest, flexed arm, upper and lower thigh and calf circumferences. The non-players were significantly smaller than the rugby players in arm length, femur diameter and waist, hip and relaxed arm circumferences. The non-players were significantly smaller than the hurlers in femur length, biiliac and ankle diameters. There were no statistically significant differences between the rugby players and hurlers. Discriminant analysis produced a function containing terms for height, weight, fat free weight, humerus diameter and neck, bideltoid, forearm and calf circumferences which correctly assigned 83 (92%) of the subjects to 'player' and 'non-player' categories. When the function was applied to the 15 members of the rugby team of a different school, 14 were placed in the 'player' category and one subject was given a borderline classification. It is concluded that there were differences in physique between the team members and non-members and that the techniques used in the study were effective in quantifying them.

Lipo-Suction Surgery of the Knees

Ideal aesthetic proportions of the lower limb call for a tapering thigh leading obliquely inward toward the knee. A very small medial and anterior convexity at the knee forms the transition to lower leg. Although frequently ignored in anatomy texts, significant fat deposits are often present in the lower thigh above and medial to the knee, especially in females. Current fashion, calling for skirts with hemlines above the knee, heightens concern among wearers about the appearance of the knees. Fat in this area is ideally suited to removal by lipo-suction surgery. This article will review the anatomy of the region with recommendations for a technique of lipo-suction surgery that combines the ability for adequate removal, safety, and the distinct advantage of avoiding all visible scars. The technique, in essence, calls for removal of the fat by the use of a long #10 cannula introduced through incisions in the groin and/or the top of the crease between the buttocks overlying the upper coccyx.

TWO CASES OF ABDOMINAL ANGINA OCCURRING 7 YEARS AND 32 YEARS AFTER AMPUTATION OF LOWER EXTREMITIES IN BUERGER'S DISEASE

Buerger's disease is a vascular occlusive disease affecting mainly the extremities of younger people. It, however, rarely affects the arteries of the abdominal organs such as the celiac and mesenterium.Two patients suffering from Buerger's disease were admitted to our hospital with symptoms of abdominal angina. They had undergone amputation of the right lower thigh and lumbar sympathectomy.In angiography, occlusion was found at CA, SMA and IMA.One patient was treated with aorto-SMA bypass and the other with aorto-SMA bypass and aroto-lineal bypass.Pathologically, one had atherosclerosis and the other a mixed type of Buerger's disease and sclerosis.Postoperatively, they have been doing well and are free from abdominal pain.

Treatment of Persistent Lymphocele Following Saphenous Vein Harvesting: A Case Report

A case of lymphocele in the lower thigh, following removal of the saphenous vein, is presented. The pathophysiology and surgical treatment are described. Lymphatic complications after removal of saphenous veins are uncommon. Most of these consist of a temporary leak or subcutaneous collection of lymph. Persistent collection of lymph in the thigh may require an operation. Such a case, successfully treated by an operation, is described. The value of lymphan giogram, both in diagnosis and as an aid in the operation, is discussed.

Squamous Cell Carcinoma in Chronic Osteomyelitis

Malignant change at the site of a chronic osteomyelitis, a rare condition, is reported in a 45-year-old man, along with a review of the literature. This patient with a 30-year history of chronic osteomyelitis of the right femur and an intermittently discharging sinus had a large abscess in the lower thigh. The abscess was drained, and an ulcer developed at the mouth of the sinus tract. Soon afterward, he sustained a pathologic fracture through the lower femur. Biopsy specimens of the ulcer showed a well-differentiated squamous carcinoma. An amputation was performed at the level of the proximal 10 cm of the femur. The patient remains well 18 months later with no clinical or radiologic evidence of metastases. Changes in character of a previously innocuous osteomyelitis sinus tract should arouse suspicion of neoplastic transformation. Biopsy of various depths of the sinus tract, including the bone marrow, is essential. Early amputation for squamous cell carcinoma is indicated and offers a good prognosis.

しつじん帯損傷と“Ｐｒｏｐｒｉｏｃｅｐｔｉｖｅ”（固有受容器）訓練

Many reports about knee rehabilitation have focused mainly on muscle exercise and range of motion. However, little attention has heed given to neuromuscular coordination. Neuromuscular system provides functional stability of the knee joint.Proprioceptive exercise (neuromuscular coordination) has been given to patients with knee ligament injuries as conservative treatment or postoperative exercise. KINCOM isokinetic exercise apparatus has been used to evaluate the effect of the proprioceptive exercise. The patient was positioned on the table with the knee flexed at a 90 degree angle and instructed to move the upper portion of the lower thigh of affected side backward as quickly as possible when the arm of the apparatus moves suddenly slightly forward which is felt on the lower part of the leg. Three patients were evaluated by this method and it was observed that their reactive speed increased as the exercise progressed. Proprioceptive exercise provides protection to the knee from reinjury and stabilization to the knee more dynamically.

Noninvasive techniques in the assessment of lower-extremity arterial occlusive disease. The advantages of proximal and distal thigh cuffs.

We studied 209 limbs angiographically and noninvasively to determine whether measurements of upper-thigh (UT) and lower-thigh (LT) segmental pressures (four-cuff technique), combined with segmental pulse-volume recordings (PVRs), offered any advantage over the standard single-thigh cuff (three-cuff technique) and PVR in the diagnosis of aortoiliac (AI) and superficial femoral artery (SFA) occlusive disease. Angiographic stenosis of 50% or greater and occlusions were considered to be hemodynamically significant lesions in this study. In the absence of SFA disease, sensitivity to AI disease was high (96%) and not significantly different using three- or four-cuff measurements. However, in the presence of SFA-segment disease, four-cuff measurements, both with and without PVR, were significantly more sensitive to AI disease (100%) and more specific for a normal AI segment (76%) than the three-cuff, PVR technique. Plethysmography alone was most sensitive to SFA disease (90%), even in the presence of AI disease, and sensitivity was not improved by additional segmental pressure measurements. The four-cuff system enhances the physician's ability to diagnose AI disease in the presence of SFA lesions, while PVR is most useful in detecting SFA lesions in the presence of AI disease.

The physique of sportsmen

A range of anthropometric measurements was taken on 116 sportsmen who were successfully involved in a variety of sports. The measurements included 11 skeletal lengths, 4 bone widths, 14 trunk and limb circumferences, and 15 skinfold thicknesses. The greatest inter-subject variability occurred in the skinfold measurements. The variability of limb bone lengths and muscle circumferences was generally high, particularly in the case of lower thigh circumference and leg bone lengths. The variability of trunk length and biacromial diameter was low. Alpha factor analysis produced seven factors as follows (the percentage of the total variance explained is in parenthesis): 1) circumferences and bone widths (32%), 2) skeletal lengths, particularly of limb bones (17%), 3) skinfolds on the trunk (10%), 4) leg and triceps skinfolds (8%), 5) muscle size specific to the legs (6%), 6) trunk length (5%), and 7) pelvic depth (4%). These seven factors were stable across other factoring solutions. Canonical factor analysis produced five additional factors corresponding to proximal limb-bone lengths, distal limb-bone lengths, hip width, shoulder width, and a further skinfold factor. Step-wise multiple regression analysis of factor scores indicated that 83% of the variance could be accounted for by six anthropometric measurements and 95% by a total of twelve measurements.

Retroperitoneal synovial sarcoma. A report of four cases.

Synovial sarcoma most commonly affects the extremities, especially the lower thigh and knee region; other primary sites, in contrast, have been only infrequently reported. Therefore, we undertook this study of four synovial sarcomas arising in the retroperitoneum. This group, whose ages ranged from 17-57 years (mean, 36 years), comprised three males and one female. The nonspecific clinical presentations consisted of pain and/or a mass; diverse preoperative radiographic procedures merely served to reinforce the impression of a retroperitoneal mass. Histologically, all four examples revealed a typical biphasic pattern. Two cases showed a predominant spindle cell component; two others disclosed a more even distribution of the spindle-cell and epithelioid-cell elements, one of these containing, in addition, broad areas of stromal calcification. Follow-up data, obtained for two patients, indicated that both died as a direct result of peritoneal sarcomatosis. The differential diagnosis of selected spindle-cell and biphasic neoplasms known to arise in the retroperitoneum will be discussed.

Contribution à l’étude de la vascularisation du muscle tenseur du fascia lata

The tensor fascia lata is a short flat muscle arising from the anterior superior iliac spine and inserting into the fascia lata at mid thigh. It is supplied by three arterial pedicles of unequal importance, branching from the external iliac, gluteal and deep femoral arteries. The 'dominant' blood supply is carried by the lateral circumflex femoral artery which comes from the deep femoral and enters the muscle, approximately 8.8 cm beneath the anterior superior iliac spine. This vessel varies in size from 2 to 3.5 mm; it is 8 cm long but can be lengthened by ligating the branch for the vastus lateralis. On the deep sheath of the iliotibial tract it gives off three branches which supply each third of the fleshy body. The upper branch runs vertically to the iliac insertion of the muscle but not so far as the iliac crest and provides no cutaneous twig. On the contrary, the mid branch runs transversally through the muscle and sends perforating vessels to the skin overlying the fascia lata 6--7 cm below the anterior superior iliac spine. The descending branch runs parallel to the muscular fibers of the muscle and supplies the skin of the lateral lower thigh down to 8 cm above the knee. So the pedicle supports an area of the skin which is double the length (22 cm) and triple the width (9.5 cm) of the fleshy body. The tensor fascia lata including the two layers of the iliotibial tract but excluding its upper insertion, together with the skin of the lateral aspect of the thigh can be safely used as a myocutaneous flap for covering defects of the trochanteric, ischial and sacral areas.

Arteriomegaly of Persistent Sciatic Arteries

Angiographic findings are described in a patient with enlarged persistent sciatic arteries and a ruptured sciatic artery aneurysm. The left persistent sciatic artery was patent and dilated to a width of 10 cm throughout its length. It had ruptured in the lower thigh. The common iliac, internal iliac, and both sciatic arteries were dilated and tortuous, with generally smooth outlines. Some patchy calcification in the arterial wall was noted. Arterial flow was extremely slow in the dilated arteries, requiring very delayed films to show the right sciatic artery as far as its bifurcation at the knee.

Anthropometric determination of body volume, body density and segmental volume in adult Indian women.

Body density, total body volume, leg volume and arm volume of 65 young Indian women 20-25 years were measured experimentally. In addition, a series of 61 anthropometric measurements were also taken on each subject. Correlations of leg volume with total body volume and body density were 0.91 and -0.73 respectively and of arm volume with total body volume and body density were 0.84 and -0.66 respectively. Hip girth alone showed a very high positive correlation (r = 0.94) with body volume and on selective stepwise multiple regression analysis, a combination of even four anthropometric measurements, namely, hip girth, lower thigh girth, ankle girth and shoulder diameter gave an extremely high positive multiple correlation coefficient (R = 0.98) with body volume. Selective stepwise multiple linear regression analysis was conducted also to estimate leg volume, arm volume and body density and stepwise regression equations up to 4th step for estimating each parameter are given.