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Contributions of regional adipose tissue depots to plasma lipoprotein concentrations in overweight men and women: possible protective effects of thigh fat.

Anthropometry and dual-photon absorptiometry (DPA) were used to examine associations of regional adiposity with plasma lipid, lipoprotein, and lipoprotein subfraction mass concentrations in moderately overweight men and women. Among 130 women, waist to thigh girth ratio (WTR) correlated with triglycerides (TG) (r = .33, P less than .0001) and negatively with high-density lipoprotein (HDL)-cholesterol (HDL-C) (r = -.37, P less than .0001) concentration, as expected. While WTR did not correlate with low-density lipoprotein (LDL)-cholesterol (LDL-C) it correlated positively with the mass subfraction of small (Sfo, 0 to 7) LDL (r = .38, P less than .0001), and negatively with large (Sfo, 7 to 12) LDL (r = -.31, P less than .01). Among 133 men, similar though weaker relationships were found. Thigh girth correlated positively with HDL and HDL2-C and mass, and with LDL particle size among women. Multivariate analysis suggests that association of WTR with lipoprotein values known to carry risk of coronary heart disease (CHD) are due at least as much to effects of thigh girth as to deleterious effects of waist girth. Estimates of fat weight in thigh and abdominal regions by DPA support thigh fat as contributing to these effects of thigh girth. Thigh fat may contribute to lipoprotein profiles that predict lower risk of cardiovascular disease.

Absorptiometry, Photon↗

Thigh pain in primary total hip arthroplasty: the effects of elastic moduli.

Thigh pain after uncemented total hip arthroplasty (THA) remains a controversial topic. Our objective was to assess the effect of material composition in the development of thigh pain after primary THA. A cohort of 241 primary THAs was followed for a minimum of 2 years. All patients received identically shaped tapered cementless femoral components; the first half received a Cr-Co-Mo implant and the other half an identical implant made of Ti-6Al-4V. There were no statistically significant preoperative differences in the 2 component groups except that the percentage of blacks in the Cr-Co-Mo group was larger than in the Ti-6Al-4V group (26% vs. 14%; P <.05). The overall 1- and 2-year incidence of thigh pain was 9.5% and 8.7%, respectively. Implant composition was unrelated to reported thigh pain 1 and 2 years postoperatively. However, patients receiving larger versus smaller stems irrespective of material composition were more likely to report thigh pain at year 1 (relative risk = 4.68; 95% confidence interval = 1.41, 15.50). Thigh pain reported at year 2 was also higher in patients with larger versus smaller implants; however, this difference was not statistically significant (RR = 1.73; 95% CI = 0.68, 4.43). Material composition of this tapered stem design is unrelated to the incidence of thigh pain.

Adolescent↗

Clinical effects of thigh cuffs during a 7-day 6 degrees head-down bed rest.

Thigh cuffs are used by Russian cosmonauts to limit the fluid shift induced by space flight. A ground simulation using the head-down bed rest (HDBR) model was performed to assess the effects of thigh cuffs on clinical tolerance and orthostatic adaptation. 8 male healthy volunteers (32.4 +/- 1.9 years) participated twice in a 7-day HDBR--one time with thigh cuffs (worn daily from 9 am to 7 pm) (TC) and one time without (WTC). Orthostatic tolerance was assessed by a 10 minute stand test and by a LBNP test (5 min at -15, -30, -45 mmHg) before (BDC-1) and at the end of the HDBR period (R+1). Plasma volume was measured before and at the end of HDBR by the Evans blue dye dilution technique. Thigh cuffs limits headache due to fluid shift, as well as the loss in plasma volume (TC: -5.85 +/- 0.95%; WTC: -9.09 +/- 0.82%, p<0.05). The mean duration of the stand test (R+1) did not differ in the two group (TC 7.1 +/- 1.3 min; WTC 7.0 +/- 1.0 min). The increase in HR and decrease in diastolic blood pressure were slightly but significantly larger without thigh cuffs. Duration of the LBNP tests did not differ with thigh cuffs. Thigh cuffs limit the symptoms due to fluid shift and the loss in plasma volume. They partly reduced the increase in HR during orthostatic stress but had no effect on duration of orthostatic stress tests.

Adult↗

Associations of hip and thigh circumferences independent of waist circumference with the incidence of type 2 diabetes: the Hoorn Study.

BACKGROUND: The higher risk of type 2 diabetes in persons with a high waist-to-hip ratio (WHR) or waist-to-thigh ratio (WTR) has mostly been attributed to increased visceral fat accumulation. However, smaller hip or thigh circumference may also explain the predictive value of the WHR or WTR for type 2 diabetes. OBJECTIVE: This study considered prospectively the association of hip and thigh circumferences, independent of waist circumference, with the incidence of type 2 diabetes. DESIGN: The Hoorn Study is a population-based cohort study of diabetes. A total of 1357 men and women aged 50-75 y and nondiabetic at baseline participated in the 6-y follow-up examination. Glucose tolerance was assessed by use of a 75-g oral-glucose-tolerance test. Baseline anthropometric measurements included body mass index (BMI) and waist, hip, and thigh circumferences. RESULTS: Logistic regression analyses showed that a 1-SD larger hip circumference gave an odds ratio (OR) for developing diabetes of 0.55 (95% CI: 0.36, 0.85) in men and 0.63 (0.42, 0.94) in women, after adjustment for age, BMI, and waist circumference. The adjusted ORs for a 1-SD larger thigh circumference were 0.79 (0.53, 1.19) in men and 0.64 (0.46, 0.93) in women. In contrast with hip and thigh circumferences, waist circumference was positively associated with the incidence of type 2 diabetes in these models (ORs ranging from 1.60 to 2.66). CONCLUSION: Large hip and thigh circumferences are associated with a lower risk of type 2 diabetes, independently of BMI, age, and waist circumference, whereas a larger waist circumference is associated with a higher risk.

Abdomen↗

Fatty acid content in chicken thigh and breast as affected by dietary polyunsaturation level.

One hundred ninety-two female broiler chickens were randomly distributed into 16 experimental treatments as a result of the combination of 4 levels of dietary polyunsaturated fatty acids (PUFA) (15, 34, 45, and 61 g/kg) and 4 levels of supplementation with alphatocopheryl acetate (alpha-TA) (0, 100, 200, and 400 mg/kg), to determine the modification of the amount and type of fatty acids (FA) deposited in raw and cooked chicken tissues. At 44 d, quantified FA of thighs and breasts were not affected by dietary supplementation with alpha-TA. Total FA content of breast was less than 15% of the total FA content of thigh. However, increasing the PUFA content of the diet by 46 g, from 15 to 61 g/kg, decreased total FA of thigh 17%, but did not affect FA content in breast meat. Monounsaturated fatty acid (MUFA) and saturated fatty acid (SFA) content of thigh (y) decreased linearly as the inclusion of dietary PUFA (x) increased (MUFA: y = 89.34 - 0.92x, R2 = 0.70; SFA: y = 53.81 - 0.43x, R2 = 0.57), whereas the relationship between PUFA content of feed (x) and thighs (y) was exponential (y = 92.03 92.03e(-00155x), R2 = 0.75). A similar response was observed in breast, with less variation and more incorporation of PUFA than thigh. Cooking of thigh meat led to a reduction in total FA content that affected SFA, MUFA, and PUFA in a similar proportion.

Animals↗

Patient-perceived outcomes in thigh pain after primary arthroplasty of the hip.

UNLABELLED: Thigh pain after arthroplasty first was identified in the joint replacement literature in 1988; little information has been published about the functional status of patients who develop this complication. Eleven patients who reported thigh pain at 2 years after cementless primary total hip arthroplasty were matched with patients who did not report thigh pain on the following characteristics: age, gender, diagnosis, bone type, and surgical procedure (ie, unilateral or bilateral). Preoperative WOMAC function scores were different in these two groups (53.5 versus 39.7). There were no differences in SF-36 and Quality of Well Being scores in the two patient groups. There were also no differences in the WOMAC, SF-36, and Quality of Well Being scores at the 2-year followup. However, item analysis of the WOMAC indicated that patients with thigh pain were more likely to report at least some functional deficit relative to patients without thigh pain at the 2-year followup. Thigh pain does not seem to affect 2-year postoperative quality of life severely in patients who have had cementless hip arthroplasties with a tapered stem design. Selected functional activities will be impacted by the presence of thigh pain. LEVEL OF EVIDENCE: Prognostic study, Level III (case-control study). See the Guidelines for Authors for a complete description of levels of evidence.

Activities of Daily Living↗

Flash x-ray observations of cavitation in cadaver thighs caused by high-velocity bullets.

BACKGROUND: The purpose of this study was to record flash x-ray images of cavitation in human cadaver thighs caused by the passage of high-velocity bullets. The images are an initial step for understanding the cavitation process in human tissue and for implementing a better definition of extensive tissue injury. METHODS: Bullets were fired through the mid-thighs of 13 cadaver legs. The bullets were of two calibers, 7.62-mm full metal jacket boat tail with strike velocities in the range of 794 m/s to 880 m/s (10 thighs) and 5.70 mm full metal jacket with velocities in the range of 973 m/s to 992 m/s (3 thighs). Short duration (35 ns) x-ray images were recorded at various selected times after the bullets passed near the femurs. This study was carried out at the Armed Forces Institute of Pathology under approved human subject protocols. RESULTS: The cavity sizes and shapes were observed for the two types of bullets and at a number of times during the expansion and collapse of the cavities. As the bullets passed through the thighs, narrow cavities behind the bullets were observed. At later times, large expanded cavities were observed that encompassed the entire mid-thigh region. The observed cavities are at variance with those which were reported previously in gelatin tissue simulants. CONCLUSION: Flash x-ray radiography is an effective technique for the observation of internal cavitation in cadaver thighs caused by high-velocity bullets. These observations suggest that gelatin is not a proven simulant for human cadaver tissue in the study of cavitation subsequent to high-velocity missile impact.

Cadaver↗

Knee extension and flexion torque as a function of thigh asymmetry.

Although tape measurement of thigh girth is a common component of a clinical knee examination, the implications of thigh girth asymmetry are not well understood. The purpose of this study was to examine the relationship between thigh girth asymmetry and torque asymmetry for extension and flexion of the knee. Thirty subjects with thigh girth asymmetry of at least 2 cm, measured at a site 15 cm proximal to the superior pole of the patella, were studied. Subjects were measured for girth at 10 sites along each thigh. Knee flexion and extension torque production were also tested on a Cybex II isokinetic dynamometer. Girth asymmetry was determined by the difference in measurements between the subjects' smaller and larger thighs. Percent girth asymmetries varied by site, with the greatest average girth asymmetry (asymmetry = 5.94%) at 16 cm proximal to the superior patellar pole. Percent peak torque asymmetries were computed from the differences between subjects' stronger vs. weaker thighs. Correlations and regressions of both extension and flexion torque asymmetries upon girth asymmetry sites showed higher associations and less error for more proximal measurements. Fair to moderate correlation coefficients (r = .37-.42, p < .05) were statistically significant for extension torque asymmetry compared with girth asymmetry at sites 12, 14, 16, and 20 cm proximal to the patella and for flexion torque asymmetry only at the 14-cm site. Although girth and torque asymmetries were found to be somewhat related, percent girth asymmetry provided only a limited prediction of percent peak torque asymmetry.

Adolescent↗

Stump length as related to atrophy and strength of the thigh muscles in trans-tibial amputees.

Stump length and the thigh muscles strength of the amputated limb are among the major factors influencing outcome of prosthetic rehabilitation of trans-tibial amputees. In the present study the authors evaluated and compared the strength of quadriceps and hamstrings muscles of both limbs in trans-tibial amputees, as measured by means of an electrical dynamometer. The obtained results showed that the thigh muscles of the sound limbs are significantly stronger than those of the amputated limbs (p < 0.01). The results obtained for amputees with shorter stumps were compared with those with longer stumps. In the group of amputees (n = 9) with a stump shorter than 15.1 cm, values of peak torque (in isokinetic contraction) and maximal average torque (in isometric contraction) were significantly (p < 0.5) weaker when compared to those (n = 9) with a stump longer than 15.1 cm. The results obtained for amputees with a higher rate of thigh muscle atrophy were compared to those with lesser atrophy. In the group of amputees where muscle atrophy was accompanied by decrease in thigh girth of over 5.9 cm, muscles strength did not significantly decrease (p < 0.5) as compared to amputees where thigh girth decrease was less than 5.9 cm. It is concluded that atrophy of the thigh muscles of trans-tibial amputees is accompanied with a significant decrease in strength. In amputees with a short stump, the short lever action provided by the stump interferes with the ability of the thigh muscles to control the prosthesis efficiently during daily activities such as standing and walking.

Activities of Daily Living↗

[Distribution of the lateral cutaneous nerve of the thigh in the area of intramuscular injection].

UNLABELLED: The technique of intramuscular injection (IM) into the antero-lateral region of the thigh is widely used. Nevertheless, despite this area being indicated as the second best location for this practice, the technique is still observed to be very painful for both adult and child patients. OBJECTIVE: To study the localization, distribution and course of the lateral cutaneous nerve of the thigh, and its topographic relationship with the area recommended for the practice of intramuscular injection, relating these characteristics to the pain resulting from such procedures. METHOD: By means of exposing the antero-lateral region by classical dissection, the lateral cutaneous nerve of the thigh was identified and isolated in 20 fixed adult male cadavers, giving emphasis to the viewing of its nerve rami across the iliotibial tract. RESULTS: In 100% of the cases, the lateral cutaneous nerve emerged medially in relation to the upper anterior iliac spine. After this, it issued three wide-caliber rami in 70% of the specimens and only two in the remaining 30%. In the upper third and in the upper portion of the middle third of the thigh, a network of numerous small nerve rami was observed, enveloped in a variable quantity of adipose tissue. However, in the lower portion of the middle third of the thigh and in the lower third, no significant nerve rami were seen. CONCLUSION: Based on our data, we recommend whenever possible that the distal half of the region displayed by the classical technique be utilized as the location of choice for the practice of intramuscular injection into the antero-lateral region of the thigh. This is because this region is less innervated by the lateral cutaneous nerve of the thigh, which will cause less pain in this area during such procedures, thereby affording greater comfort to the patient.

Adult↗

Thigh compartment syndrome in a football athlete: a case report and review of the literature.

Although contusions of the thigh are common in all sports, a compartment syndrome from closed blunt trauma without a femur fracture is rare. Thigh compartment syndrome is unusual due to increased compliance of the thigh to accommodate increased expansion from hematoma or third space fluid. Compartment syndrome of the thigh is characterized by unrelenting pain, swelling, and limited knee range of motion. A single case of a thigh compartment syndrome caused by a direct blow to the anterior aspect of the thigh from a football helmet during kickoff occurred. Immediate thigh fasciotomy was performed. Early diagnosis with appropriate emergency treatment can avoid serious and permanent complications.

Adolescent↗

Thigh bleeding time as a valid indicator of hemostatic competency during surgical treatment of patients with advanced renal disease.

We compared the usefulness of the modified Ivy bleeding time performed in the forearm (arm bleeding time) with that performed in the thigh (thigh bleeding time) as an indicator of hemostatic competence during surgical treatment in 16 patients with chronic renal failure. In 22 normal adults, the arm bleeding time (mean plus or minus standard deviation, 6.6 +/- 1.4 minutes) was significantly longer than the value in the thigh (mean plus or minus standard deviation, 4.1 +/- 1.3 minutes) (p less than 0.001), and there was no correlation between arm and thigh bleeding time. Preoperatively, the arm bleeding time in patients with renal disease was markedly prolonged (greater than 20 minutes) in 15 patients and slightly prolonged in one patient. There was no abnormal perioperative bleeding in 13 patients whose preoperative thigh bleeding time was seven minutes or less. Prolonged and excessive perioperative bleeding was observed in three patients whose thigh bleeding time was 8.0, 9.5 and 26.5 minutes. These findings suggest that thigh bleeding time is a better indicator of competence of primary hemostasis during the operation than the arm bleeding time in patients with advanced renal failure.

Adult↗

Acute compartment syndrome of the thigh. A spectrum of injury.

Twenty-one compartment syndromes of the thigh in seventeen patients were identified for retrospective review. Ten of the compartment syndromes were associated with an ipsilateral femoral fracture; five of these femoral fractures were open. In five patients, the syndrome followed femoral intramedullary stabilization. The remaining eleven syndromes followed blunt trauma to the thigh, prolonged compression by body weight, or vascular injury. The patients who were awake and alert at the time of the examination complained of intense pain in the thigh, and they had neuromuscular deficits. For the patients who could not cooperate with a subjective physical examination because they were under general anesthesia or because of associated injuries, the measurement of compartment pressure assumed a more important diagnostic role. All of the patients had tense swelling of the involved thigh. The predisposing risk factors for the development of compartment syndromes of the thigh, which are common in the multiply injured population, include: systemic hypotension, a history of external compression of the thigh, the use of military antishock trousers, coagulopathy, vascular injury, and trauma to the thigh, with or without a fracture of the femur. In approximately one-half of these patients, a crush syndrome developed, with myoglobinuria, renal failure, and collapse of multiple organ systems. Eight patients (47 per cent) died as a result of multiple injuries. Of the nine patients (ten compartment syndromes) who survived, infection developed at the site of the fasciotomy in six. Follow-up examination revealed marked morbidity, including sensory deficit and motor weakness of the lower extremity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

[Evaluation of 99mTc-HM-PAO thigh accumulation in patients with cerebro-vascular disease].

99mTc-HM-PAO cerebral SPECT and whole body scintigraphy (WBS) were performed in 5 patients without cerebro-vascular disease (CVD) (Group 1), 31 patients with CVD but not hemiparesis (Group 2) and 18 patients with CVD and hemiparesis (Group 3). Four ROIs were drawn manually around the whole body (WB), brain (Br), right and left thigh (Th). We calculated some ratios: the total counts in the brain over the total counts in the whole body (Br/WB), the total counts in the thigh over the total counts in the whole body (Th/WB) and the mean counts in the thigh over the mean counts in the brain (Th/Br). The Br/WB was 6.9 +/- 1.8%, rt-Th/WB was 4.9 +/- 2.1%, lt-Th/WB was 5.1 +/- 1.3% and Th/Br was 0.46 +/- 0.17 in group 1. Whole body scintigraphies in group 1 revealed clear and similar images between right and left thigh. The Br/WB was 6.7 +/- 1.4%, Th/WB of paretic side was 4.6 +/- 1.0%, Th/WB of non-paretic side was 5.8 +/- 1.2% and Th/Br was 0.47 +/- 0.18 in group 3. The Th/WB in non paretic side was significantly higher than that in paretic side (p < 0.01). The thigh images in group 3 revealed clearly different between paretic and non-paretic thigh. In conclusion we could acquire the clear thigh images with 99mTc-HM-PAO. It was possible that we evaluated not only cerebral perfusion but also muscle atrophy and/or perfusion in patients with CVD using 99mTC-HM-PAO.

Adult↗

Effect of calf-thigh intermittent pneumatic compression device after total hip arthroplasty: comparative analysis with plantar compression on the effectiveness of reducing thrombogenesis and leg swelling.

The purpose of this study was to evaluate the efficacy of two intermittent pneumatic compression devices as prophylaxis against intravascular coagulation and leg swelling following total hip arthroplasty. We studied 121 patients by assessing thrombogenesis using the D-dimer level before and after total hip arthroplasty. In addition, the patients' postoperative swelling was evaluated by measuring the thigh and lower leg circumference. Altogether, 58 patients were assigned to the calf-thigh pneumatic compression group, and the other 63 were assigned to the plantar compression group; the two pneumatic compression devices were compared to evaluate which was more effective for reducing thrombogenesis. At 7 days postoperatively, the mean D-dimer levels of the calf-thigh compression group and the plantar compression group were 8.86 and 9.26 microg/ml, respectively. There was no significant difference ( P = 0.697) between the two groups. However, the increased ratio of the circumference of the thigh, which was compared after arthroplasty, averaged 1.22% in the calf-thigh compression group and 3.19% in the plantar compression group, which was significantly different ( P << 0.01). Calf-thigh pneumatic compression was found to be more effective than plantar compression for reducing thigh swelling during the early postoperative stage.

Adult↗

Thermal transitions of natural actomyosin from poultry breast and thigh tissues.

Natural actomyosin was isolated from broiler breast and thigh tissues, characterized by sodium dodecylsulfate-polyacrylamide gel electrophoresis (SDS-PAGE), and examined for thermal transitions (Tm) during heat-induced aggregation. Electrophoresis showed some variation in the quantity of each subunit protein present between the tissue actomyosins and, with Amido Black staining, yielded actin to myosin molar ratios of 5.71 and 6.33 for breast and thigh natural actomyosins, respectively. The heat-induced initiation of protein to protein interactions occurred at 30 to 31 C for actomyosin of breast tissue and at 42 to 44 C for actomyosin of thigh tissue. Two distinct thermal transitions were found for each actomyosin. Derivative curves from the plot of differential change in optical density or absorbance (A) as a function of temperature (T) (dA/dT) between 28 C and 70 C showed Tm1 at 49.2 C and Tm2 at 60.2 C for breast actomyosin with corresponding values of Tm at 52.6 C and 57.9 C for thigh actomyosin. The interval between Tm1 and Tm2 (delta Tm) for thigh actomyosin (5.3 C) was less than that of breast actomyosin (11.0 C). This result suggests that less thermal energy is required for aggregation of actomyosin from thigh tissue. The differences in thermal characteristics between the two actomyosins may be related to differences observed in heat-processed products prepared from breast and thigh tissues.

Actomyosin↗

Gluteal thigh flap used as a fascio-cutaneous free flap.

The gluteal thigh flap is a myofascio-cutaneous flap receiving its blood supply from a descending branch of the inferior gluteal artery. The gluteal thigh flap was first described by Hurwitz in 1980; since then numerous articles have reported on the successful use of this flap, as a transposition or a pedicled island flap, to cover wounds in the sacrogluteal and perineal regions. In contrast to its widespread use as a pedicled flap, employment of the gluteal thigh flap as a free flap is almost unreported in the literature, despite its extremely low donor morbidity and numerous articles on successful (other) free flap reconstructions based on the (same) inferior gluteal artery (e.g., in breast reconstruction). In this article we report on the successful use of the gluteal thigh flap as a purely fascio-cutaneous free flap in limb reconstruction. The literature on the microvascular anatomy of the gluteal thigh flap is reviewed in detail, and a precise description is given of the preoperative measures and surgical manoeuvres required to increase the reliability of this free flap. From the anatomical data and the problems encountered in this case, it should be concluded that, despite the many advantages of this flap and an ultimately successful outcome, the gluteal thigh flap is not a first choice flap for microvascular transfer.

Adolescent↗

Distribution of myofiber types in the hip and thigh musculature of sheep.

The composition of muscles by myofiber type is associated with their locomotory or postural functions. In the present study the composition of the hip and thigh musculature of sheep by myofiber types and the differences in their distribution were examined. Myofibers were classified into type I, IIA, and IIB myofibers by differences in myosin ATPase and NADH tetrazolium reductase (NADH-TR) activity. The vastus intermedius muscle consisted only of type I myofibers, which exhibit weak alkali-stable myosin ATPase and strong NADH-TR activity. The gluteus accessorius and profundus muscles had more than 50% type I myofibers. The other muscles had less than 50% type I myofibers as a whole. Type I myofibers were concentrated in the deep portions of the gluteus and quadriceps femoris muscles, which extend the hip and stifle joints, and of the pectineus muscle. They were scattered evenly in the caudally situated locomotory muscles in the thigh. Type IIA myofibers, characterized by strong alkali-stable myosin ATPase and NADH-TR activity, showed little difference in distribution in the hip and thigh muscles. Type IIB myofibers, characterized by strong alkali-stable myosin ATPase and weak NADH-TR activity, were distributed more in the cranial, caudolateral, and caudomedial portions than in the middle portions of the thigh. The distribution of type IIB myofibers is suited to powerful flexion and extension of the thigh and leg. In the hip and thigh musculature, it appears that type I myofibers are effectively distributed to maintain a standing posture without diminishing the propulsive force of the hindlimb.

Adenosine Triphosphatases↗