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PubMed2003

Comparison of arteriovenous grafts in the thigh and upper extremities in hemodialysis patients.

Placement of a thigh graft is an option in hemodialysis patients who have exhausted all upper extremity sites for permanent vascular access. The outcome of thigh grafts has been reported only in retrospective studies. The outcomes of 409 grafts placed at a single institution during a 3.5-yr period were evaluated prospectively, including 63 thigh grafts (15% of the total). Information was recorded on surgical complications, dates of radiologic and surgical interventions, and date of graft failure. The technical failure rate was approximately twice as high for thigh grafts, as compared with upper extremity grafts (12.7 versus 5.8%; P = 0.046). Intervention-free survival was similar for thigh and upper extremity grafts (median, 3.9 versus 3.5 mo; P = 0.55). Thrombosis-free survival was also comparable for thigh and upper extremity grafts (median, 5.7 versus 5.5 mo; P = 0.94). Cumulative survival (time to permanent failure) was similar for thigh and upper extremity grafts (median, 14.8 versus 20.8 mo; P = 0.62). When technical failures were excluded, the median cumulative survival was 27.6 mo for thigh grafts and 22.5 mo for upper extremity grafts (P = 0.72). The frequency of angioplasty (0.28 versus 0.57 per year), thrombectomy (1.58 versus 0.94 per year), surgical revision (0.28 versus 0.18 per year), and total intervention rate (2.15 versus 1.70 per year) was similar between thigh and upper extremity grafts. Access loss as a result of infection tended to be higher for thigh grafts than for upper extremity grafts (11.1 versus 5.2%; P = 0.07). In conclusion, placement of thigh grafts should be considered a viable option among hemodialysis patients who have exhausted all options for a permanent vascular access in both upper extremities.

Aged↗
PubMed1994

Pharmacokinetics and metabolic effects of growth hormone injected subcutaneously in growth hormone deficient patients: thigh versus abdomen.

OBJECTIVE: The absorption of insulin following subcutaneous (s.c.) injection is faster in the abdomen than the thigh. We therefore studied the effect of changing the site of injection on the absorption and metabolic effects of human growth hormone. DESIGN AND MEASUREMENTS: In a cross-over study human GH (Norditropin) was injected s.c. in the thigh or abdomen in random order. Ultrasonography of the thigh and abdomen was performed in order to evaluate the thickness of the s.c. tissue. After each treatment period (4 weeks), serum profiles of GH, IGF-I, IGF binding proteins 1 and 3 (IGFBP-1 and IGFBP-3), glucose, insulin, non-esterified fatty acids (NEFA), glycerol, 3-hydroxybutyrate, alanine, lactate and glucagon were measured for 37 hours after GH injection (3 IU/m2 at 1900 hour). PATIENTS: Nine GH deficient patients (five males, four females). RESULTS: The mean (+/- SEM) thickness of the s.c. tissue (mm) was higher on the abdominal site (9.35 +/- 1.38 (thigh), and 22.61 +/- 2.19 (abdomen), P < 0.001). Mean (+/- SEM) integrated levels (area under the curves (AUC) divided by time) of GH (mU/l) were identical: 5.54 +/- 0.70 (thigh) versus 5.48 +/- 0.64 (abdomen) (P = 0.91). AUC (mU/l) for the initial 6 hours were, however, significantly different (14.10 +/- 3.76 (thigh) and 19.02 +/- 3.18 (abdomen), P = 0.02). Maximal serum concentration (Cmax) (mU/l) 23.18 +/- 3.86 (thigh) and 29.66 +/- 4.78 (abdomen) (P = 0.19) was achieved faster (Tmax) following injection in the abdomen. Tmax (hours) was 5.89 +/- 0.41 (thigh) and 4.26 +/- 0.49 (abdomen) (P < 0.002). Mean IGF-I levels (microgram/l) were unaffected by GH injection sites (355 +/- 60 (thigh) and 365 +/- 63 (abdomen), P = 0.61). Mean IGFBP-3 levels (microgram/l) were significantly different (2100 +/- 143 (thigh), and 2350 +/- 176 (abdomen), P = 0.05). Mean levels of IGFBP-1, insulin, glucose, lipid intermediates, metabolites and glucagon were not significantly different. CONCLUSIONS: Human GH was absorbed faster when injected s.c. in the abdomen as compared with the thigh, despite the thicker s.c. tissue on the abdomen. Apart from higher IGFBP-3 levels after s.c. injections in the abdomen, similar metabolic effects of GH were obtained with the two injection sites.

Abdomen↗
PubMed1986

Computed axial tomographic scanning of the thigh: an alternative method of nutritional assessment in pediatrics.

In this study we compared the findings of computed axial tomographic (CT) scanning of the thigh with the findings of arm anthropometry and urinary creatinine determinations to assess nutrition in children with inflammatory bowel disease receiving total parenteral nutrition. All 14 children received our standard solution for total parenteral nutrition as well as prednisone and sulfasalazine (Azulfidine) therapy. All patients were assessed by arm anthropometry, 24-hour urine collections for creatinine clearance, and CT scanning of the thigh during total parenteral nutrition. Arm muscle and fat area were estimated by anthropometry, and those in the thigh were estimated by CT scanning. Our results show the total muscle area from the CT scan can predict muscle mass calculated from the urinary creatinine excretion rates. In addition, there is a close correlation between the thigh muscle area as measured by CT scanning and the muscle area calculated from urinary creatinine excretion rates. In addition, the comparison of thigh muscle area and thigh fat area to the midarm muscle area and midarm fat area, respectively, showed that the thigh is a better predictor of muscle than fat in the midarm. We conclude that the total thigh muscle area is a better predictor of muscle mass as compared to the midarm muscle area. In addition, the CT scan cut at the level of the thigh in children and adolescents with inflammatory bowel disease can provide valuable information about the thigh compartment and analyses of different cross-sectional areas of the thigh.

Adolescent↗
PubMed1989

Number and anatomical distribution of incompetent thigh perforating veins.

Although incompetent thigh perforating veins are considered to be a common cause of recurrence of varicose veins after high saphenous ligation, the number and distribution of such incompetent veins have not been reported. The aim of the study was to determine the number and anatomical distribution of incompetent thigh perforating veins. Sixty-five limbs in 48 patients with varicose veins who were found to have incompetent thigh perforating veins on ascending deep to superficial venography were studied. In 80 per cent of patients one incompetent thigh perforating vein was found and in 20 per cent more than one was found. Concomitant incompetent calf perforating veins were found in 92 per cent of the limbs studied. The incompetent thigh perforating veins were found to occur anywhere in the thigh, from the upper edge of the patella to a few centimetres below the saphenofemoral junction. The majority (71 per cent) were found in the middle third of the thigh. All incompetent thigh perforating veins were communicating with the long saphenous vein, including those in five patients with incomplete stripping. The surgeon should be aware of incompetent thigh perforating veins which may be multiple and occur at any site on the medial aspect of the thigh.

Adult↗
PubMed1998

Evaluation of the thigh muscles after knee exercise on a Cybex II.

We investigated the degree of local heat and swelling of the thigh muscles produced by exercise. Eleven university athletes aged from 19 to 23 years old performed isokinetic exercise of the right knee on a Cybex II. Then serial determination of thigh circumference and thigh temperature (up to 120 min after exercise) as well as serial magnetic resonance (MR) imaging (up to 60 min after exercise) was performed on both thighs. The circumference of the right thigh peaked at 5.6 +/- 2.1 min after exercise and returned to normal at 38.6 +/- 9.2 min. The temperature of the right thigh peaked at 14.2 +/- 5.7 min after exercise and was not normalized after 120 min except in two subjects. T2-weighted MR images showed a marked increase in the signal intensity of the right knee flexor and extensor muscles. The signal intensity peaked immediately after exercise and subsequently decreased gradually but did not return to normal after 60 min in some muscles. Changes in the thigh circumference were closely correlated with changes in the MR findings. The changes in the thigh muscles after knee exercise could be demonstrated using MR imaging, thigh circumference, and thigh temperature data. These parameters may provide indicators for managing muscle fatigue and recovery.

Adult↗
PubMed2001

Sensory disturbance of the thigh after renal transplantation.

PURPOSE: Although sensory disturbance of the anterior and/or lateral thigh often develops after renal transplantation, this complication is overlooked because of the minor degree of disability. We evaluated the rate of sensory disturbance of the thigh after renal transplantation. MATERIALS AND METHODS: We examined neurological deficits of the thigh on the operated side in 61 patients who underwent renal transplantation, including 48 using the internal and 13 using the external iliac artery. RESULTS: We noted sensory disturbance in 23 of the 61 cases, including 20 of the 48 in which the internal iliac artery was used. One patient had complete femoral nerve palsy involving motor weakness. Sensory disturbance was in the anterior thigh in 15 patients, in the lateral thigh in 3, and on the anterior and lateral thigh in 2. Postoperatively there was sensory disturbance of the thigh in 3 of the 13 patients in whom the external iliac artery was used. Sensory disturbance persists in all 3 cases at the time of this report, including in the anterior thigh in 1, and in the anterior and lateral thigh in 2. CONCLUSIONS: The rate of sensory disturbance of the thigh after renal transplantation is high. Therefore, we should inform patients of the possibility of sensory disturbance before renal transplantation surgery is performed.

Femoral Nerve↗
PubMed2002

Pharmacodynamics of the new fluoroquinolone gatifloxacin in murine thigh and lung infection models.

Gatifloxacin is a new 8-methoxy fluoroquinolone with enhanced activity against gram-positive cocci. We used the neutropenic murine thigh infection model to characterize the time course of antimicrobial activity of gatifloxacin and determine which pharmacokinetic (PK)-pharmacodynamic (PD) parameter best correlated with efficacy. The thighs of mice were infected with 10(6.5) to 10(7.4) CFU of strains of Staphylococcus aureus, Streptococcus pneumoniae, or Escherichia coli, and the mice were then treated for 24 h with 0.29 to 600 mg of gatifloxacin per kg of body weight per day, with the dose fractionated for dosing every 3, 6, 12, and 24 h. Levels in serum were measured by microbiologic assay. In vivo postantibiotic effects (PAEs) were calculated from serial values of the log(10) numbers of CFU per thigh 2 to 4 h after the administration of doses of 8 and 32 mg/kg. Nonlinear regression analysis was used to determine which PK-PD parameter best correlated with the numbers of CFU per thigh at 24 h. Pharmacokinetic studies revealed peak/dose values of 0.23 to 0.32, area under the concentration-time curve (AUC)/dose values of 0.47 to 0.62, and half-lives of 0.6 to 1.1 h. Gatifloxacin produced in vivo PAEs of 0.2 to 3.1 h for S. pneumoniae and 0.4 to 2.3 h for S. aureus. The 24-h AUC/MIC was the PK-PD parameter that best correlated with efficacy (R(2) = 90 to 94% for the three organisms, whereas R(2) = 70 to 81% for peak level/MIC and R(2) = 48 to 73% for the time that the concentration in serum was greater than the MIC). There was some reduced activity when dosing every 24 h was used due to the short half-life of gatifloxacin in mice. In subsequent studies we used the neutropenic and nonneutropenic murine thigh and lung infection models to determine if the magnitude of the AUC/MIC needed for the efficacy of gatifloxacin varied among pathogens (including resistant strains) and infection sites. The mice were infected with 10(6.5) to 10(7.4) CFU of four isolates of S. aureus (one methicillin resistant) per thigh, nine isolates of S. pneumoniae (two penicillin intermediate, four penicillin resistant, and two ciprofloxacin resistant) per thigh, four isolates of the family Enterobacteriaceae per thigh, a single isolate of Pseudomonas aeruginosa per thigh, and 10(8.3) CFU of Klebsiella pneumoniae per lung. The mice were then treated for 24 h with 0.29 to 600 mg of gatifloxacin per kg every 6 or 12 h. A sigmoid dose-response model was used to estimate the dose (in milligrams per kilogram per 24 h) required to achieve a net bacteriostatic effect over 24 h. MICs ranged from 0.015 to 8 microg/ml. The 24-h AUC/MICs for each static dose (1.7 to 592) varied from 16 to 72. Mean +/- standard deviation 24-h AUC/MICs for isolates of the family Enterobacteriaceae, S. pneumoniae, and S. aureus were 41 +/- 21, 52 +/- 20, and 36 +/- 9, respectively. Methicillin, penicillin, or ciprofloxacin resistance did not alter the magnitude of the AUC/MIC required for efficacy. The 24-h AUC/MICs required to achieve bacteriostatic effects against K. pneumoniae were quite similar in the thigh and lung (70 versus 56 in neutropenic mice and 32 versus 43 in nonneutropenic mice, respectively). The magnitude of the 24-h AUC/MIC of gatifloxacin required for efficacy against multiple pathogens varied only fourfold and was not significantly altered by drug resistance or site of infection.

Animals↗
PubMed1982

Influence of thigh blood flow upon the arterial pressure gradient over the collateral arteries in patients with occlusion of the superficial femoral artery.

The effect of circulatory arrest of the calf and foot and head-up tilt upon pressure gradient over the thigh and distribution of muscle blood flow in the thigh was studied in 14 patients with occlusion of the superficial femoral artery. In the supine position circulatory arrest just below the knee initially reduced the directly measured mean arterial pressure gradient over the thigh by about 30% indicating that a similar proportion of total leg blood flow supplied the calf and foot. Local muscle blood flow was measured by the local 133Xe washout technique proximally and distally in the thigh muscle. Total leg blood flow was measured by an indicator dilution technique. During 10 min of circulatory arrest of the calf and foot local muscle blood flow in the thigh increased by approximately 35% proximally and distally. Total leg blood flow remained unchanged and the pressure gradient was reduced by about 10% as compared with that before tourniquet. During head-up tilt local muscle blood flow in the thigh decreased by about 30% proximally and distally. Total leg blood flow also decreased by about 30%. Circulatory arrest below the knee did not alter this response. These findings indicate that blood flow change uniformly in the thigh during head-up tilt and during tourniquet on the calf. Furthermore blood flow to the calf appears only to account for 30% of the arterial pressure drop over the collateral arteries in the thigh, indicating that thigh blood flow is of major importance for the pressure gradient over the collateral arteries.

Aged↗
PubMed2000

Adaptations to a 7-day head-down bed rest with thigh cuffs.

PURPOSE: Thigh cuffs were two elastic strips fixed at the upper part of each thigh, which limits the shift of fluid from the legs into the cardio-thoracic region. The purpose of this study was to examine the effects of thigh cuffs on hormonal and plasma volume responses and orthostatic tolerance during a 7-day head-down bed rest (HDBR). METHODS: Orthostatic tolerance, plasma volume, total body water, blood volume-regulating hormones, and hydro-electrolyte responses were measured in eight healthy men (age range, 25-40 yr), using thigh cuffs 10 h daily during 7 d of -6 degrees HDBR. RESULTS: Thigh cuffs worn during HDBR attenuated the decrease in plasma volume observed after HDBR (thigh cuffs: -5.85 +/- 0.95% vs control: -9.09 +/- 0.82%, P < or = 0.05). During this experiment, there was no significant change in total body water. Thus, the hypovolemia did not result from a loss of water but from a fluid shift from the blood compartment into the interstitial and/or intracellular compartment. Hormonal responses during HDBR and stand test were not modified by the thigh cuffs. Thigh cuffs had no significant effect on the clinical symptoms of orthostatic intolerance after HDBR. CONCLUSIONS: Thigh cuffs worn during HDBR blunted the decrease in plasma volume but did not reduce orthostatic intolerance; thus, they are not a completely effective countermeasure. Furthermore, hypovolemia seems to be necessary but not sufficient to induce orthostatic intolerance after HDBR.

Adult↗
PubMed1991

Absorption of NPH (isophane) insulin in resting diabetic patients: evidence for subcutaneous injection in the thigh as the preferred site.

The absorption kinetics of NPH (isophane) insulin injected subcutaneously into the abdominal wall and subcutaneously (SC) and intramuscularly (IM) into the thigh was studied in 11 Type 1 diabetic patients. The thickness of the subcutaneous adipose tissue layer was measured by ultrasound. NPH (isophane) insulin injected IM into the thigh was absorbed faster than NPH insulin injected SC into the thigh (T50%, IM 8.0 +/- 0.6 h and SC 10.3 +/- 0.7 h, p less than 0.05). No difference in T50% values was found for injection into the abdominal wall (9.7 +/- 1.2h) compared with the thigh. The mean absorption rate from 1.5 to 13.5 h after injection was higher after injection IM into the thigh (6.4 +/- 0.3% of initial dose injected absorbed per h) than after SC injection into the thigh (5.2 +/- 0.3% h-1) and SC into the abdominal wall (5.1 +/- 0.3% h-1) (p less than 0.01). The most constant absorption rate was obtained after SC injection into the thigh (within-study day CV of the mean absorption rate 19.9 +/- 3.2% vs 34.4 +/- 3.2% after IM injection into the thigh and 27.1 +/- 4.9% after SC injection into the abdominal wall (p less than 0.02]. The study provides further evidence that the subcutaneous tissue of the thigh is the preferred injection site for NPH insulin.

Absorption↗
PubMed1999

Clinical outcomes of untreated symptomatic patients with negative findings on sonography of the thigh for deep vein thrombosis: our experience and a review of the literature.

OBJECTIVE: Our objective was to determine whether immediate venography or other additional imaging is necessary in symptomatic patients who have negative findings on sonography of the thigh for deep vein thrombosis (DVT). MATERIALS AND METHODS: We retrospectively evaluated the clinical outcomes of 146 patients with physical signs or symptoms consistent with DVT in whom sonography of the thigh was negative for DVT. We combined our results with those of three prospective studies that evaluated symptomatic patients with suspected DVT in whom sonography of the thigh had negative findings. Propagated DVT (from calf to thigh) and pulmonary emboli were considered adverse outcomes. RESULTS: Only one pulmonary embolus (0.7%) occurred in our patient population. However, one (7.7%) of 13 patients who underwent second examinations because of persistent symptoms developed thigh DVT. Review of the literature found four (0.2%) of 1797 patients subsequently developed pulmonary emboli after undergoing sonography of the thigh that was initially interpreted as having negative findings. Fifteen (12.5%) of 120 patients who underwent second sonographic examinations developed DVT of the thigh. No deaths from pulmonary emboli occurred in patients in our study or patients in the studies published in the medical literature. CONCLUSION: Immediate venography or other additional imaging is not necessary in symptomatic patients in whom sonography of the thigh is negative for DVT, given the exceedingly low risk of a pulmonary embolus. Follow-up sonography is indicated in persistently symptomatic patients to detect propagation of calf DVT into the thigh.

False Negative Reactions↗
PubMed1997

Thigh muscle size and strength after anterior cruciate ligament reconstruction and rehabilitation.

It is the hypothesis of the senior author (GAA) that high circumference measurements are not an accurate reflection of thigh muscle cross-sectional area or muscle strength after standard rehabilitation following anterior cruciate ligament reconstruction. Likewise, normal quadriceps femoris strength is not achieved in these patients despite aggressive rehabilitation. The purpose of our study was to quantify thigh muscle size and strength and correlate thigh circumference, muscle cross-sectional area by magnetic resonance imaging (MRI), and isokinetic strength in our patients. Thirty-three patients with anterior cruciate ligament repair utilizing autografts of iliotibial band (N = 28), semitendinosus autograft (N = 3), and bone-patellar tendon-bone autograft (N = 2) were retrospectively evaluated 48.7 +/- 6.91 months after surgery. We compared involved operated extremities with uninjured, uninvolved contralateral extremities, measuring thigh circumference, isokinetic peak torque, and cross-sectional area by MRI. We found a significant 1.8% decrease in thigh circumference, a 10% decrease in average quadriceps torque, and a 8.6% decrease in quadriceps cross-sectional area by MRI in the involved extremities compared with the uninvolved extremities. A positive correlation between MRI cross-sectional area, quadriceps, and hamstring peak torque was recorded in involved and uninvolved extremities. A positive correlation between thigh circumference, quadriceps, and hamstring peak torque was found in uninvolved extremities but not in operated extremities. The authors concluded that thigh circumference underestimates atrophy and is not correlated with cross-sectional thigh muscle area by MRI or strength in operated extremities. Persistent quadriceps weakness and decreased cross-sectional area at 49 months postsurgery and rehabilitation continue to challenge our efforts. The pathophysiology of the decrease in thigh muscle size and quadriceps femoris strength is discussed.

Adolescent↗
PubMed1990

The lateral transverse thigh free flap: an alternative for autogenous-tissue breast reconstruction.

The lateral transverse thigh free flap is a horizontal variant of the more commonly known vertical tensor fasciae latae myocutaneous free flap. Fresh cadaver injections of the lateral circumflex femoral artery indicated simultaneous perfusion of the upper lateral thigh tissues and the standard tensor fasciae latae territory extending down the lateral thigh. These experimental data strongly indicated that the clinical application would be successful. The flap is composed mostly of fat from the prominence of the upper lateral thigh ("saddlebags") based on a small plug of underlying tensor fasciae latae muscle. The amount of skin that can be included with this flap is limited in a vertical dimension to about 6 to 8 cm but is determined by the ability to close the defect. We have performed 17 flaps in 11 patients with up to 18 months of follow-up. Ten were delayed and 7 were immediate reconstructions. The chest and hip dissections are performed simultaneously by two microsurgeons. There has been one flap loss due to arterial disruption on day 3. An early problem was seroma formation in the donor site, which has been improved in the later patients by closing the dead space with sutures. The lateral transverse thigh free flap has the following advantages over other methods of autogenous-tissue breast reconstruction: (1) longer, more peripherally placed vessels, (2) easier flap dissection and no need to turn the patient during the procedure, (3) decreased postoperative morbidity and more rapid recovery, (4) reduction of an area of excess fat in those patients in whom the hips are more prominent than the abdomen, (5) greater intrinsic internal projection of the flap, and (6) excellent vascularity. The disadvantages of the flap are (1) microsurgery is required, (2) the amount of skin available is not as great as that with the gluteal or transverse rectus abdominis musculocutaneous (TRAM) flap, (3) the scar on the upper lateral thigh is probably more visible than on the buttock or the abdomen, and (4) a balancing procedure on the opposite hip is usually necessary in unilateral cases. Our current indications for the lateral transverse thigh free flap are (1) the transverse rectus abdominis musculocutaneous flap is unavailable, (2) for a particular breast size, the thigh fat proportions are greater than the abdominal proportions, or (3) the patient prefers this option to the transverse rectus abdominis musculocutaneous or gluteus flap. Results and complications with the lateral transverse thigh free flap will be presented along with pertinent comparisons with the other choices for autogenous-tissue breast reconstruction.

Adult↗
PubMed1980

Computerized tomographic determination of human thigh components. The effects of immobilization in plaster and subsequent physical training.

Thigh components were estimated by computerized tomography (CT) as well as by anthropometry in two healthy male soccer players (23--29 years), who for 5 weeks had one knee immobilized in a plaster of Paris. The investigations were performed on both thighs just after removal of the cast and after 5 weeks physical training of the inactivated quadriceps muscle. The different components were easily identified on a transverse scan through the middle of the thigh. The quadriceps muscle was 26% smaller after removal of the cast in the inactivated leg as compared with the contralateral leg; no differences were observed in the remaining thigh components. After rehabilitation a specific increase (22%) in the hypotrofic quadriceps muscle was observed, whereas no changes were disclosed in the remaining thigh components. The quadriceps muscle averaged 52% of the lean component in the uninjured thigh, and the subcutaneous part of the total cross-sectional area averaged 15%. The changes in the anthropometrically determined thigh components paralleled those observed by the CT scanning procedure. It is concluded that the loss in the lean thigh volume during immobilization in plaster cast is exclusively due to waste of the quadriceps muscle. CT scanning comprises a new valid tool to study changes in thigh components.

Adult↗
PubMed1997

Three-dimensional ultrasound-assessed fetal thigh volumetry in predicting birth weight.

OBJECTIVE: To compare the accuracy of three-dimensional ultrasound-assessed fetal thigh volumetry in predicting birth weight with that of other commonly used formulas composed of biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL) by two-dimensional ultrasound. METHODS: We assessed the thigh volume of 100 fetuses using three-dimensional ultrasound. Meanwhile, their BPD, AC, and FL were measured by two-dimensional ultrasound. All infants were delivered within 48 hours after the ultrasound examinations. From polynomial regression analysis, we generated a best-fit formula for the thigh volume to predict birth weight. The accuracy of this thigh-volume formula was compared with those of three formulas commonly used in the United States. In addition, another group of 50 fetuses was measured for prospective validation. RESULTS: The high volume assessed by three-dimensional ultrasound was highly correlated with birth weight (r = 0.89, n = 100, P < .0001). The best-fit formula for thigh volume to predict birth weight was linear, and it was superior to the other commonly used two-dimensional formulas in predicting birth weight. The predicting error (0 g), percent error (0.7%), absolute error (176.1 g), and absolute percent error (5.8%) of the thigh-volume formula were all smaller than those of the other formulas (n = 100, all P < .05). In addition, the thigh-volume formula predicted birth weight more accurately than the other two-dimensional formulas in the prospective-validation group. The three-dimensional formula had smaller mean values of predicting error (38.6 g), percent error (1.5%), absolute error (160.0 g), and absolute percent error (5.1%) than the two-dimensional formulas (n = 50, all P < or = .001), as well as the smallest variances of the above errors (178.1 g, 5.6%, 84.3 g, and 2.9%, respectively). CONCLUSION: The three-dimensional ultrasound-assessed thigh volume has better accuracy in predicting birth weight than the commonly used formulas by two-dimensional ultrasound, and it may improve fetal weight prediction in clinical practice. However, a large-scale prospective validation study may be needed to confirm our conclusions.

Adult↗
PubMed2000

No effect of venoconstrictive thigh cuffs on orthostatic hypotension induced by head-down bed rest.

Orthostatic intolerance (OI) is the most serious symptom of cardiovascular deconditioning induced by head-down bed rest or weightlessness. Wearing venoconstrictive thigh cuffs is an empirical countermeasure used by Russian cosmonauts to limit the shift of fluid from the lower part of the body to the cardio-cephalic region. Our aim was to determine whether or not thigh cuffs help to prevent orthostatic hypotension induced by head-down bed rest. We studied the effect of thigh cuffs on eight healthy men. The cuffs were worn during the day for 7 days of head-down bed rest. We measured: orthostatic tolerance (stand tests and lower body negative pressure tests), plasma volume (Evans blue dilution), autonomic influences (plasma noradrenaline) and baroreflex sensitivity (spontaneous baroreflex slope). Thigh cuffs limited the loss of plasma volume (thigh cuffs: -201 +/- 37 mL vs. control: -345 +/- 42 mL, P < 0.05), the degree of tachycardia and reduction in the spontaneous baroreflex sensitivity induced by head-down bed rest. However, the impact of thigh cuffs was not sufficient to prevent OI (thigh cuffs: 7.0 min of standing time vs. control: 7.1 min). Decrease in absolute plasma volume and in baroreflex sensitivity are known to be important factors in the aetiology of OI induced by head-down bed rest. However, dealing with these factors, using thigh cuffs for example, is not sufficient to prevent OI. Other factors such as venous compliance, microcirculatory changes, peripheral arterial vasoconstriction and vestibular afferents must also be considered.

Adult↗
PubMed1999

[Can 3D volumetric analysis of the fetal upper arm and thigh improve conventional 2D weight estimates?].

AIM: To determine the usefulness of three-dimensional ultrasound volumetry of fetal thigh and upper arm in predicting weight at delivery. METHOD: Inclusion criteria to our prospective study were single-ton pregnancies with a planned or expected delivery within 96 hours of enrollment. In 74 patients (formula-finding group) standard fetal biometry, followed by measurement of thigh and upper arm volumes by three-dimensional ultrasound, was performed. Subsequently, our new 3D-formulas were tested in a prospective validation group of 52 patients. RESULTS: Both upper arm and thigh volumes correlated well with birth weight (r2 = 0.95, respectively, p < 0.0001). The best result, however, was achieved by a combination of standard 2D-measurements with the volumetric data of upper arm and thigh (r2 = 0.98, p < 0.0001). With use of polynomial regression analysis we obtained two best-fit formulas: BIRTH WEIGHT: -263.8 +13.7269 x Arm Volume +7.16575 x Thigh Volume +148.2 x ATD. Birth weight: -1288.7 +51.9502 x Arm Volume -0.252 x Arm Volume 2 -2.1766 x Thigh Volume +0.0321 x Thigh Volume 2 +36.2509 x GA -0.7526 x GA2 +654.3 x BIP -36.6136 x BIP2 -381.8 x ATD +24.0927 x ATD2. CONCLUSION: Three-dimensional volumetry of the fetal thigh and upper arm may improve prediction of birth weight. Further larger studies are needed to validate our results.

Arm↗
PubMedDate not supplied

[Evaluating rehabilitation progress by measuring thigh circumference].

QUESTION: Thigh girth measurements have been widely used to quantify rehabilitation progress following knee surgery, but the correlation between thigh girth and other functional measures has not been investigated. This study intended to investigate whether such a correlation exists. METHODS: 15 women with bilateral osteoarthrosis of the knee participated in this study. Isokinetic knee extensor strength, thigh girth and body mass were measured immediately before, then at six weeks and six months following cementless total knee arthroplasty. RESULTS: The involved side showed clear pre-operative isokinetic knee extensor strength deficits, and slight reductions in thigh girth. Post-operatively, mean strength deficits were reduced, whereas differences in mean thigh girth became lager. Although thigh girth changes correlated well with body mass, they did not correlate with knee extensor strength. CONCLUSION: Changes in thigh girth are mainly due to changes in body mass. Thigh girth measurement is of no use for the quantification of the rehabilitation progress in total knee arthroplasty.

Aged↗