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[The role of perforated veins of the inside thigh in varicose recurrence].

The hunterian and juxtahunterian perforators, which communicate with the deep system on the inner thigh, either with the trunk of the long saphenous vein, single or bifurcated, or with one or several separate trunks, correspond to three schematic anatomical types. They play a major part in the post-surgical relapse of varicose veins, as the author's statistics show. Indeed, out of 157 post-surgical varicose relapses, clinical examination and phlebography have proved that perforator incontinency on the inner thigh contributes to the process in 40 p. cent of the cases, with the exception of 10 p. cent of the cases; normally it is associated with a redeveloped long sapheno-femoral junction, as well as with incontinence of the short sapheno-femoral junction which also relapses eventually. In approximately two out of three cases, sclerosant treatment is enough, but when these perforators are very large they must be operated, following minute examination using a good phlebographical technique.

Humans↗

The relationship between tourniquet pressure and underlying soft-tissue pressure in the thigh.

UNLABELLED: Soft-tissue pressures in specimens of the lower extremities of cadavera, obtained following hip disarticulation, were measured directly beneath a pneumatic thigh tourniquet to establish the relationship between the tourniquet pressure and underlying soft-tissue pressure. It was found that the tissue pressure was consistently lower than the tourniquet pressure and that the percentage of tourniquet pressure reflected in the underlying tissue varied inversely with the circumference of the thigh. It was also found that the pressure decreased with increasing depth of the soft tissue. CLINICAL RELEVANCE: the use of a pneumatic tourniquet is potentially associated with injury to underlying muscles, vessels, and nerves if excessive pressure occurs beneath the tourniquet. In order to minimize the risk of soft-tissue injury, the lowest tourniquet pressure that maintains a bloodless field should be used. A nomogram based on data generated in this experiment is provided as a guide to determining appropriate tourniquet pressures.

Anthropometry↗

[New viewpoint on the interpretation of rheograms of the extremities. III. Rheograms of the thigh].

Under some new points of view which were discussed in the former reports rheographical examinations of the thigh were performed. The results of examinations of 215 healthy test persons of male and female sex at the age of 15--75 years are reported and compared with the results of 52 angiological patients. The relative pulse volume, the angle of increase, the angle of the peak and the height of the peak were used as separation parameters. In contrast to the lower leg and to the foot in which the angular sum of the after-waves had proved as sharpest separation parameter for the angular sum of the after-waves of the rheogram of the thigh a profound age-dependent was found which much restricts the use for the routine work.

Adolescent↗

Gunshot wounds to the thigh. Evaluation of vascular and subclinical vascular injuries.

A retrospective review of 173 patient charts, angiograms, surgical reports, and plain radiographs were performed for all patients admitted with gunshot wounds to the thigh from May 1988 to January 1991 at Martin Luther King, Jr. Hospital. A zonal classification of gunshot wounds to the thigh was created and defined to determine if a zonal classification was predictive of a positive angiogram. Associations and relationships of patients with vascular injury are presented.

Adult↗

Voluminous solitary non-Hodgkin extraganglionary lymphoma of thigh.

The case of a 36-year-old woman is presented. She had a voluminous tumour inside the 1/3 average part of the right thigh at 12 cm from the inguinal region. Apart from some local pains, she had a normal haematological formula, normal spleen, liver and lymph nodes. As the tumour of 5.5 x 5 x 4.5 cm was well incapsulated between the sartorius muscle and the great adductor tendon it was easily extirpated and presented a whitish-light yellow section. The histological cellular aspect was pleiomorphic with round, ovalar cells; some were big and clear cells of centroblast-type with several mitoses and giant multinucleated cells and collagenic bundles in between. The nodular Hodgkin sclerosis is not confirmed immunohistochemically because of the negative reaction for antigen Kil (CD30) so that the diagnosis was lymphoma with lymphoma with big B cells by CD20 reaction. We also found positive T cells at CD43 that might be reactive lymphocytes. The tumour ranks a rare malignant lymphoma and for the first time, an extraganglionar lymphoma in thigh was found. We have not met such a location in the literature.

Adult↗

Lateral thigh flap.

The lateral thigh flap is a fasciocutaneous flap from the lower limb that can be a versatile and reliable alternative in the reconstruction of specific head and neck defects. This article discusses the anatomy, clinical applications, advantages, and disadvantages of the lateral thigh flap.

Esophagus↗

[Vesico-cutaneous fistula of the thigh as a late manifestation].

Vesico-cutaneous fistulas rarely occur in the urinary tract (1.7% of all urinary fistulas). Trauma, neoplasias, inflammation and iatrogenic pathologies are among the principal causes. The external mouth of the fistula is usually found in the hypogastric area, scrotum, perineum and rarely elsewhere. This report describes the case of a 48 year old woman who, after severe trauma suffered bladder laceration, treated only with cystorraphy. Sepsis and gangrene followed involving the pubic area and the right thigh, associated with acute renal and adrenal gland cortex failure. After emergency treatment, the patient was discharged with an indwelling catheter. Ten months later she was referred to our urology clinic because of a suspected bladder-vaginal fistula. The indwelling catheter was removed and the bladder resumed functioning well. Six months later the external mouth of the fistula appeared on the right inner thigh. NMR confirmed the diagnosis of a vesico-cutaneous fistula. Surgery resolved the abnormality.

Cutaneous Fistula↗

Anteromedial thigh: a source for phallic reconstruction.

The anteromedial thigh region is a fruitful site to create different types of fasciocutaneous flaps and compound flaps because of its versatile fasciocutaneous vascularization. On the other hand, phallic reconstruction is still a challenge. We used a proximally based, fasciosubcutaneous pedicle anteromedial thigh fasciocutaneous flap to reconstruct a penis for an electrical burn patient, including the gracilis muscle into the flap for additional bulk. This flap has the potential for sensory reinnervation, its application is easy with regard to a microvascular operation and it presents a remarkable option in phallic reconstruction.

Adult↗

Free anterolateral thigh flaps for reconstruction of head and neck defects.

The anterolateral thigh flap is a septocutaneous artery flap based on the septocutaneous or muscle perforators of the lateral circumflex femoral system. Little has been reported about the variations in its vascular anatomy and its application for head and neck reconstruction. We report 22 cases in which this flap was used for the reconstruction of head and neck defects. Based on our clinical and cadevaric experiences, the derivation of the vascular pedicle of this flap has four variations by which the septocutaneous perforators are derived from the descending branch of the lateral circumflex femoral system and/or from the transverse branch of that system, or for which there are no septocutaneous perforators but there are muscle perforators originating from the lateral circumflex femoral system. Clinically, the vascular variations and the locations of perforators of this system can be determined preoperatively with stereoangiograms or simple angiograms and Doppler audiometry. The anterolateral thigh fasciocutaneous flap is suitable for reconstruction of defects in an oral floor with tongue and esophageal deficits, scalp defects with dural defects, and for large full thickness defects of the lip. The advantages of this flap are safe elevation, a long and wide vascular pedicle, skin that is generally thin, and good pliability. Even if the skin is thick, a thinner flap can be created by sacrificing a large amount of fatty tissue. Furthermore, the skin territory is very wide and long. The donor defect can often be closed directly with its scar being less noticeable. The disadvantage of this flap is that the anatomy of the pedicle vessels has irregular derivation from the main vessels. This can be overcome, however, by employing preoperative stereoangiograms.

Adult↗

Fever, leukocytosis, and referred thigh pain.

The patient, a 43-year-old man with insulin-dependent diabetes mellitus, presented four days after sustaining a dog bite on his right hand, complaining of excruciating, intermittent, right thigh pain. He was febrile (temperature, 38.3 degrees C [101 degrees F]) and had a leukocyte count of 27.8 x 10(9) per liter (27,800 per mm3). On physical examination, he had a 2-cm open wound with minimal purulent drainage on the fourth digit of his right hand. He had some limited range of motion of the right hip and focal muscular tenderness in the medial thigh, but no other infectious or neurologic findings. A radiographic evaluation included chest, lumbar, right femur, and pelvic films and a computed tomographic (CT) scan of the abdomen; all were normal. In addition, a nuclear medicine scan showed no signs of infection. A CT scan and a magnetic resonance image (MRI) of the pelvis were done (Figures 1 and 2).

Adult↗

[Capillary and cavernous hemangioma disclosed by painful amyotrophy of the thigh].

We report the case of an intramuscular cavernous and capillary hemangioma of the thigh revealed by pains evolving for 2 years and by an amyotrophy. After 21 months of investigation, the surgical excision and the histological examination only established the dia Thigh MRI. T1-weighted axial and sagittal sections with gadolinium infusion.

Adult↗

Case report: MR appearance of hemangiopericytoma of the thigh.

We report a case of hemangiopericytoma in the thigh of a 42-year-old woman. CT examination depicted a peripherally enhanced, multicystic mass without calcification. On T1-weighted images of MRI, the mass showed slightly high signal intensity relative to muscle, with the exception of the lower pole, which showed high signal intensity. On T2*-weighted images, the mass showed high signal intensity and cystic appearance. The lower pole showed low signal intensity on T2*-weighted images and was thought to be intratumoral hemorrhage. Low signal intensity structures on both T1- and T2*-weighted images were observed within and around the mass. They were thought to be dilated vessels, although this was not confirmed at surgery. Hemangiopericytoma should be considered in the differential diagnosis of a tumor in the thigh when MR images show the mass with slightly high signal intensity on T1-weighted images, intratumoral hemorrhage, and flow voids within or adjacent to the tumor.

Adult↗

Vasa vasorum of superficial collecting lymphatics of human thigh.

Collecting lymphatics were obtained from human thigh fat for light microscopy and tridimensional reconstruction at time of operation for varicose veins. No patient had lymphedema and routine sections showed no inflammation or notable pathologic alteration of the surrounding soft tissue. Abundant vasa vasorum was observed around the musculature of superficial collecting lymphatics of human thigh. Within intervalvular portions of the lymphatic collectors where the muscle coat was thicker and more compact, the vasa vasorum penetrated between smooth muscle cells and was in contact with the endothelium. In valvular portions of the collecting lymphatics where the muscle layer was thinner and more fragmented, there were fewer vasa vasorum. Tri-dimensional reconstructions of the collecting lymphatic wall showed two communicating plexi of vasa vasorum--one outside and the other inside the muscle layer. Arteries and veins of similar size did not have such an abundant vasa vasorum. The explanation for this difference may relate to the fact that a relatively low oxygen and nutrient content of lymph is insufficient to nourish the collecting lymphatic. Moreover, diffusion of nutrients from the external plexus is likely also impeded by the thickness and density of the muscle layer. The vasa vasorum deep in the muscular layer and in the subendothelial space probably sustain adequate nutrition and oxygenation to the collecting lymphatic.

Adipose Tissue↗

Calcific tendinitis in the posterior proximal thigh as a self-limited condition: pathogenic role of inflammatory responses.

OBJECTIVE: Calcific tendinitis occurs rarely in the posterior proximal thigh. We investigated whether it is self-limited and how the natural course of the disease progresses. METHODS: We treated 6 patients with no surgical intervention, and analyzed laboratory and radiological findings in the followup period of more than one year (average followup, 2.5 yrs). RESULTS: Although tendinitis was severe, rapid relief was observed within 2 weeks (average 5 days). Radiological features including extraskeletal calcifications did not change within 2 weeks, and then improved by 6 weeks. Four of 6 cases showed abnormal laboratory variables. All elevated white blood cell counts and C-reactive protein levels improved within one week with clinical resolution. In comparison with time course of the symptoms, changes in the radiological findings over time appeared not to be parallel with the clinical course, but laboratory progression appeared to correspond well with clinical resolution. CONCLUSION: Inflammatory responses to hydroxyapatite crystals may play a role in the pathogenesis of symptoms of calcific tendinitis in the posterior proximal thigh, most of which are self-limited.

Adult↗

[Scleroderma-like patch on the thigh in infants after vitamin K injection at birth: six observations].

INTRODUCTION: Texier's disease or pseudosclerodermatous reaction after intramuscular injection of vitamin K1 is well known in adults although only 1 report of a case in a newborn was found in the literature. We report 6 cases. CASE REPORTS: Six infants (4 boys, 2 girls) developed "peau d'orange" skin lesions after the age of 6 months which was localized in the lower third of the medial aspect of the thigh. Initial rapid locoregional extension was followed by stabilization and then regression. In all 6 cases, histology showed lesions of the fascia and/or the deep hypoderma associated with variable mononuclear inflammatory infiltration and hyalin fibrosis. When performed, immunological studies (complement fixation, search for autoantibodies) were always negative or normal. No visceral involvement was found. DISCUSSION: A pseudosclerodermatous lesion of the lower third of the thigh occurred in 6 infants at the site of an intramuscular injection of vitamin K1 administered at birth. The history, clinical manifestations, histology and outcome of these cases are compatible with the diagnosis of Texier's disease. We discuss the role of the solvent in the Roche vitamin K1 injection. The pathogenesis of this side effect remains unknown. CONCLUSION: Texier's disease in infants after injection of vitamin K1 at birth is a stereotypic dermatosis. Diagnosis is based on history and clinical presentation. The causal effect of injectable vitamin K1 should be entertained whenever pseudosclerodermatous lesions are observed in a young child.

Antifibrinolytic Agents↗

[Multiple hydatid cysts of the thigh: the role of magnetic resonance imaging].

Hydatid cysts of the thigh are uncommon in our country despite a high frequency of hydatic disease which is estimated to affect 5.33% of the general population. Diagnosis is usually made late in the clinical course. Ultrasonography, CT scan and magnetic resonance imaging are the most helpful diagnostic tools. We report a case of a 76-year-old female smoker who had undergone surgery for a hydatic cyst of the right lung at the age of 56 years. In June 1997, the patient was admitted for decompensation of chronic obstructive lung disease. Physical examination revealed a 6 cm painless mass in the right thigh which had developed progressively over the last year. Ultrasonography showed multiple hydatic cysts. Magnetic resonance imaging confirmed the diagnosis, showing interconnected multivesicular cystic formations. Medical treatment was given due to respiratory failure and patient refusal of a surgical procedure.

Aged↗

The total thigh and rectus abdominis myocutaneous flap for closure of extensive hemipelvectomy defects.

Hemipelvectomy is a lifesaving procedure when used appropriately and yields a 35%, five-year survival in the cancer patient. However, the standard posterior flap for closure is not always available. Two flaps, the thigh flap and the rectus abdominis myocutaneous flap, are described in which any soft tissue defect resulting from hemipelvectomy can be safely closed primarily when the posterior flap is not available. The total rectus abdominis flap is previously undescribed and unique in its application. These techniques significantly contribute to the surgeon's armamentarium for decreasing morbidity and mortality and resectability of unusual pelvic and thigh tumors.

Abdominal Muscles↗

Effects of 0.4 T rotating magnetic field exposure on density, strength, calcium and metabolism of rat thigh bones.

The current study investigated the effects of 0.4 T rotary non-uniform magnetic field (RMF) exposure on bone density in ovariectomized (OVX) rats. Results showed that many bone indexes are significantly elevated after RMF exposure compared to the control OVX group and confirmed mechanistic evidence that strong magnetic field (MF) exposure could effectively increase bone density and might be used to treat osteoporosis. Synergy of daily RMF exposure (30 min a day for 30 days using an 8 Hz rotary 0.4 T MF) with calcium supplement tended to increase the indexes of thigh bone density, energy absorption, maximum load, maximum flexibility, and elastic deformation as compared to those of untreated OVX control group. Results also revealed that the indexes of alkaline phosphatase (ALP), serum phosphate, and serum calcium were higher in rats exposed to RMF with calcium than in the untreated OVX control group. Changes in bone mineral density (BMD) and bone mineral content (BMC) were observed in rats for three months including the first month RMF exposure. Bone density in rats exposed each day for 60 min increased during 1-month exposure and continued to increase during the post-exposure period. Furthermore, bone density and calcium content in rats exposed for 90 min daily decreased initially in the exposure month; however, ratio of increase was well above the control values by the end of the post-exposure period suggesting possible window and delayed effects. The study indicated that RMF exposure to both male and OVX female rats for 120 min a day over 15 day period should effectively promote increase of bone calcium contents (BCC) and bone-specific alkaline phosphatase (BAP) in rats thigh bone as well as a corresponding decrease in deoxypyridinoline crosslinks (DPD).

Alkaline Phosphatase↗