SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A recurrent abscess of the thigh, associated with a broad ligament abscess, presented in a postmenopausal woman with cirrhosis of the liver. This unusual complication has not been reported before. The risk of serious morbidity and mortality from the combination of these two coexisting lesions is obvious, and gynecologists and surgeons should be prepared for early surgical intervention.
Findings for focal accumulation of 123I-15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid ([123I]BMIPP) in a patient with liposarcoma of the thigh are presented. Iodine-123-BMIPP accumulated heterogeneously in the liposarcoma. The region with marked accumulation of [123I]BMIPP was diagnosed as mixoid liposarcoma. The region with little accumulation of [123I]BMIPP was diagnosed as well-differentiated liposarcoma. Differences in the accumulation of [123I]BMIPP may reflect differences in fatty acid metabolism between histopathological types of liposarcoma.
In the light of previous studies, the authors conducted an anatomical study on 21 cadaveric dissections with injection in order to define the characteristics of the distally based fasciocutaneous flap of the posterior surface of the thigh, described for the first time in 1988 by Maruyama. This leaf-shaped flap extends from the popliteal region to the gluteal sulcus. It possesses an axial arterial network derived from the popliteal artery, reinforced by the perforating arteries derived from the vessel or the profunda femoris artery. The venous return is ensured by venae comitantes and the communicating saphenous vein. The flap raising technique is described. From 1991 to 1994, 3 patients were operated in order to cover a defect of the knee (1 case) and amputation stumps (2 cases). The postoperative course was uneventful and the results were considered to be stable and of excellent quality with a follow-up of 2 to 4 years.
We describe a patient with insulin-dependent diabetes without vascular complications in whom scleredema was confined to the thighs. Electron microscopy demonstrated heterogeneity in both the size and density of the collagen fibrils and the presence of filamentous material between them.
Sarcomas of the soft tissue constitute a fairly rare group of neoplasms localized mainly at the level of the extremities. Apart from clinical and semeiotic investigations, diagnosis is based on imaging techniques. Among these (ultrasound, CT, NMR and angiography), all of which are helpful in diagnosis, NMR seems to provide the most complete data and sensitivity and specificity. In fact, it has greater specificity than ultrasound or CT as regards identification of any infiltration of the muscle or deep interstitial tissues and can also contribute information on the nature of the sarcoma, as it provides high definition of the structural composition of the tissues. Angiography remains important as a preoperative guide to the surgical approach. Surgery is the treatment of choice, although in recent years it has been integrated with radio or chemotherapy. Thanks to the progress in treatment constituted by combination treatments there has been a dramatic reduction in the need for amputations, compartmental excision and disinsertion of muscle groups. We report the case of a patient with fibrosarcoma of the thigh and discuss the various imaging techniques and different approaches to the treatment of these neoplasms.
We report a case of actinomycosis presenting with both a thigh abscess and a pulmonary lesion. Diagnosis was obtained by biopsy of this abscess, showing sulfur granules and further identification of Actinomyces israelii together with Actinobacillus actinomycetemcomitans in culture. Furthermore. Actinomyces israelii was isolated from bronchial secretions.
Over one hundred and twenty free anterolateral thigh flaps have been performed since 1988, of which ten were operated as free anteromedial flaps because the nutrient vessels emerged from the medial intermuscular space formed by the sartorius, the rectus femoris and vastus medialis muscles. Clinical study indicated that there were three types of nutrient cutaneous arteries in the space: type 1, the medial branch of the descending branch of the lateral circumflex femoral artery in 6 cases; type 2, the superficial femoris artery in 2 cases; and type 3, the branch of the femoris artery in 2 cases. The name of the flap, the operation technique and the compensative characteristics of the arteries are discussed.
A man aged 70 during a hospital stay over a period of a few weeks developed increasing pain and swelling of the left thigh. Despite extensive diagnostic imaging and surgical drainage, initially no diagnosis could be established. After more than 3 months the tumour proved to be caused by leakage of urine from the pelvis to the soft tissues of the leg. Unfamiliarity of the clinicians with such an extension of an urinoma contributed to the considerable diagnostic delay. Introduction of a bladder catheter stopped the flow of urine to the leg and reduced the leg circumference.
An otherwise healthy woman aged 28 had symmetrical band-shaped dents on both thighs. She worked as a secretary; several female colleagues showed identical lesions. An investigation showed that the arrangement of the office equipment combined with sharp-edged desk tops caused these abnormalities. The diagnosis made read 'semicircular lipoatrophy caused by repetitive leaning against a desk'. This is probably a common problem, although it rarely leads to consultation of a dermatologist.
A swelling in the distal thigh may be caused by a tumour of bone or soft tissues, an aneurysm or an inflammation. Signs of inflammation may render interpretation more difficult. Four males aged 60, 48, 15 and 81 years had had a swelling in the popliteal space or above the knee, in some cases with pain. Supplementary examinations, especially MRI scanning and arteriography did not always result in a diagnosis. The diagnosis could be made, however, during operation: an empyemic thrombosed popliteal artery aneurysm, a liposarcoma, pyomyositis and suture dehiscence of a plastic prosthesis of the popliteal artery. After treatment, consisting of or started during the operation, uneventful recovery occurred.
Only 2 cases of lymphangioma of traumatic origin have been previously reported, and in both it was a matter of repeated microtraumas. This is a report of a circumscribed lymphangioma in a 22-year-old man after a severe direct trauma of the thigh. Five months after the trauma a painless, slowly growing mass appeared in this area. Histologically, the removed mass appeared to be a combination of cavernous and cystic lymphangioma. The development of this lesion, which must be considered a hamartoma, may possibly be attributable to a traumatic hematoma and to subsequent reactive fibrosis which may have blocked the lymph drainage possibly from a sequestrated portion of the primitive lymphatic anlage.
The common injuries and disorders that affect the hip joint, pelvis, and thigh and its surrounding tissues are discussed in this chapter. The clinician's challenge is to determine the severity of the injury and select the correct treatment and rehabilitation. Careful observation, diagnostic tests, and a thorough medical history aids this selection. The characteristics of several sports injuries are highlighted with the essential components of effective treatment and physical rehabilitation.
BACKGROUND: We examined speech and swallowing outcomes and complications in patients with anterolateral thigh (ALT) flap reconstruction of cervical esophageal defects. METHODS: We retrospectively reviewed 29 patients treated with laryngopharyngectomy and ALT flap reconstruction at The University of Texas M. D. Anderson Cancer Center from March 2002 to July 2004. We compared complication rates, nutritional intake, number of tracheoesophageal punctures (TEPs), speech fluency and use, operative defects, and radiotherapy effects. RESULTS: Twenty-two patients had circumferential defects, and seven had partial defects. Twenty-four patients had radiotherapy. Eleven patients underwent TEP. Higher complication rates in patients after TEP compared with those without TEP were not statistically significant (p = .268). Ninety percent of patients with TEP spoke fluently. Ninety percent of all patients returned to oral alimentation without significant effect from TEP (p = 1.00), complications (p = 1.00), radiation therapy (p = 1.00), or surgical defect (p = .56). CONCLUSIONS: The ALT flap successfully reconstructs laryngopharyngeal defects with excellent speech and swallowing results.
The efficiency of MRI-guided focused ultrasound (FUS) hyperthermia with continuous sonication was investigated for the treatment of VX2 carcinoma implanted in rabbit thigh muscle. Six rabbits were treated with a single session of FUS when the tumor diameter exceeded 2 cm (10-21 days after implant). The FUS treatment method was based on a spiral trajectory of the focal point that allows continuous sonication under automatic, real-time MR guidance. The total heating time was approximately 1000 sec. Efficacy of treatment was evaluated twice a week based on clinical (weight) and MRI data. Treated animals were sacrificed 5 weeks after the heating procedure and histological analysis was performed. Tumor regression was observed in each treated animal. Complete ablation of tumor, with confirmation by histological analysis, was obtained in five of six treated cases. Tumor regrowth occurred in one animal. Thermal injury was limited to the targeted region in three cases, but ablation also reached some healthy muscle around the tumor in the other three cases. A good correlation was found between postmortem histological analysis and premortem MRI data. Efficacy of MR-controlled hyperthermia using FUS heating with spiral trajectories was demonstrated for successful local control of intramuscular VX2 tumor.
Similarities between the muscle synergies associated with the flexion reflex and locomotion in reduced preparations have suggested that spinal circuits subserving these two motor tasks might share common interneurons. To test this hypothesis in functionally complex muscles, we studied the interaction between low-threshold cutaneous afferents and the locomotor central pattern generator (CPG) during treadmill locomotion in awake, intact cats. Electrical stimuli were delivered via implanted nerve cuff electrodes at all phases of locomotion, and EMGs were recorded from fourteen intramuscular subregions in eight bifunctional thigh muscles (adductor femoris, biceps femoris, caudofemoralis, gracilis, semimembranosus, semitendinosus, tensor fasciae latae, and tenuissimus). In addition, the EMG patterns recorded during locomotion were compared with those recorded during two other centrally driven rhythmical behaviors, scratching and paw shaking, to determine whether the functional relationships among these intramuscular subregions were fixed or task dependent. Four of the five broad, bifunctional muscles studied (biceps femoris, gracilis, semimembranosus, and tensor fasciae latae) had functional subunits that could be differentially activated in one or more of the three movements studied; adductor femoris was consistently uniformly activated despite its distributed skeletal attachments. The pattern of recruitment of the intramuscular functional subunits was movement-specific. The locomotor CPG and cutaneous reflex pathways both similarly subdivided some bifunctional muscles, but not others, into intramuscular subregions. The results of the present study confirm that some combinations of muscle subregions and cutaneous nerves constitute simple reciprocal categories of flexors and extensors, as described originally by Sherrington (1910). "Typical" low threshold excitatory or inhibitory reflex responses were produced in muscles or muscle subregions that were recruited as "net" flexors of extensors, respectively. However, muscles with complex activation patterns during walking often had very individualized, complex reflex responses during locomotion that did not conform to the background locomotion synergies. All of the reflex responses observed were mediated by low threshold cutaneous afferents. These data indicate that there are multiple, low threshold, excitatory and inhibitory cutaneous reflex pathways that have highly specialized connections with flexor and extensor muscles and even their intramuscular subregions. It is also clear that the premotoneuronal circuits mediating these cutaneous reflex effects are not necessarily synonymous with those of the locomotor CPG. These two systems do interact powerfully, however, suggesting some convergence. The nature of the convergence between the CPG and the many independent subsets of spinal interneurons mediating cutaneous reflexes is specialized and muscle subregion-specific.
Although in vivo magnetic resonance imaging (MRI) is rapidly becoming a recognised tool in experimental pharmacological research, at the best of our knowledge, scarce application in the field of antibacterial drug research has been reported so far. In this last field, animal models of bacterial infections are used to test the efficacy of novel compounds. In this paper we have explored the potential usefulness of MRI in monitoring the chronological evolution of experimental bacterial infections and the effect of different therapeutic treatments. A murine model of thigh infection induced by Staphylococcus aureus has been used and the efficacy of vancomycin and imipenem/cilastatin has been tested. Three groups of infected animals were studied by microbiology, histology and MRI methods. The results obtained show that in vivo MRI data are highly consistent with microbiological and histological data, allowing, similarly to these commonly used techniques, the efficacy of different antibacterial treatments to be quantified. Our findings suggest that MRI could be used to assess the efficacy of new chemical entities in antibacterial pharmacological research. The advantages of MRI, as a non invasive technique, in comparison with commonly used microbiological and histological methods are discussed.
We report the case of a 30-year-old female patient, who had suffered a grade III open femur fracture in a motor vehicle accident 14 weeks prior to being transferred to the trauma department of the University Hospital in Bonn. Upon admission to our unit, posttraumatic osteitis, an unstable fracture following compression plating, and a soft tissue defect of the anterolateral distal thigh were discovered. Following removal of the hardware and stabilization of the fracture with external fixation, the infection was brought under control. Because the patient refused the time-consuming segmental transport utilizing the callus distraction technique, local muscle transfer and shortening of the femur were carried out. The most lateral of the hamstring muscles, the biceps femoris, was used as a distally based muscle flap utilizing a delay technique. With the help of a reversed biceps femoris flap, the soft tissue defect was closed, the infection subsided and the fracture healed. The surgical technique is outlined.
We reviewed 145 consecutive patients who had total hip replacements using uncemented CLS Spotorno femoral stems which achieve primary fixation with bony ingrowth which occurs later mainly in the metaphyseal region. The mean age was 54.9 years and average follow up 7.8 years. The Merle d'Aubigne and Harris hip scores were used for evaluation, together with plain radiographs. Current medium term follow up showed a survival rate of 96.7% and a good functional score in more than 90%. Special attention was paid to postoperative thigh pain which occurred in only one patient. These results are encouraging, but a follow up of more than 10 years is required before comparable results to cemented stems can be claimed.