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At least 1,351 records · Page 75Linked to original sources
PubMed1980

[Pulmonary embolism in leg and pelvic vein thrombosis. Results of a prospective study - diagnosis, frequency, nuclearmedical and clinical appearance (author's transl)].

In a prospective study 169 patients with clinically suspected leg/pelvic-vein thrombosis were tested by 131 I fibrinogen uptake-test and radionuclide venography for confirmation of this diagnosis and also by a nuclearmedical lung investigation. In all cases of an abnormal perfusion scan a supplementary ventilation scan was performed. The perfusion scan has a sensitivity for pulmonary embolism of near 1.0 but its specificity is only 0.57. An additional ventilation study (133 Xenon, 81m Krypton) improves the specificity to 0.95. A mismatch of regional ventilation and perfusion is the nuclearmedical substrate of pulmonary embolism. The diagnosis of thrombosis was confirmed in 105 of 169 cases (62%). Thrombosis was located in the lower legs in 56%, in the thigh veins in 23% and in the external iliac veins in 21%. From 105 patients with leg/pelvic-vein thrombosis 60 (57.1%) had pulmonary emboli, from 64 patients with negative tests concerning thrombosis only 3 (4.7%) (p < 0.001). Pulmonary emboli were present in 46% when thrombosis was located in the lower legs, in 67% when thigh veins and in 77% when pelvic veins were involved. The average frequency of 57% emboli found in patients with leg and pelvic vein thrombosis agrees with data from pathologic-anatomical studies. An analysis of these patients with embolism showed that 70% of them were over 70 years old, that 52% of the emboli originated from thigh and pelvis and 43% from the lower leg and that 59% had no clinical signs of embolism. 80.4% of the patients had multiple perfusion defects (up to 9) which correlated in size with the severity of the clinical symptoms and which were about equally distributed in both lungs. Larger perfusion defects occure more frequently with thromboses of the thigh and pelvis than in thromboses of the lower leg. According to the chest x-ray pulmonary emboli were suspected to only 6 of 26 patients with clinical evidence of embolism (23%).

Adult↗
PubMed1995

Simulated microgravity increases cutaneous blood flow in the head and leg of humans.

BACKGROUND: The cutaneous microcirculation vasodilates during acute 6 degrees head-down tilt (HDT, simulated microgravity) relative to upright conditions, more in the lower body than in the upper body. HYPOTHESIS: We expected that relative magnitudes of and differences between upper and lower body cutaneous blood flow elevation would be sustained during initial acclimation to simulated microgravity. METHODS: We measured cutaneous microvascular blood flow with laser-Doppler flowmetry at the leg (over the distal tibia) and cheek (over the zygomatic arch) of eight healthy men before, during, and after 24 h of HDT. Results were calculated as a percentage of baseline value (100% measured during pre-tilt upright sitting). RESULTS: Cutaneous blood flow in the cheek increased significantly to 165 +/- 37% (mean +/- SE, p < 0.05) at 9-12 h HDT, then returned to near baseline values by 24 h HDT (114 +/- 29%, NSD), despite increased local arterial pressure. Microvascular flow in the leg remained significantly elevated above baseline throughout 24 h HDT (427 +/- 85% at 3 h HDT and 215 +/- 142% at 24 h HDT, p < 0.05). During the 6-h upright sitting recovery period, cheek and leg blood flow levels returned to near pre-tilt baseline values. CONCLUSIONS: Because hydrostatic effects of HDT increase local arterial pressure at the carotid sinus, baroreflex-mediated withdrawal of sympathetic tone probably contributed to increased microvascular flows at the head and leg during HDT. In the leg, baroreflex effects combined with minimal stimulation of local veno-arteriolar and myogenic autoregulatory vasoconstriction to elicit relatively larger and more sustained increases in cutaneous flow during HDT. In the cheek, delayed myogenic vasoconstriction and/or humoral effects apparently compensated for flow elevation by 24 h of HDT. Therefore, localized vascular adaptations to gravity probably explain differences in acclimation of lower and upper body blood flow to HDT and actual microgravity.

Adult↗
PubMed1995

A model for change in delivering community leg ulcer care.

Leg ulcer care has largely been provided by community nursing staff in the UK. However, the treatment of leg ulcers has been accompanied by high cost and poor healing rates. As part of an initiative in a single district of the UK, six community leg ulcer clinics were established and a system of audits implemented to monitor their progress over two years. Improvements were demonstrated in the success of the patient referral system, correct assessment of patients with significant arterial leg disease, effective use of dressings, follow-up to prevent ulcer recurrence, improved nursing education in leg ulcer care, vastly improved healing rates during the first twelve weeks of treatment compared to patients in a pre-study audit, reduced pain and increase in the ability of patients to perform activities inside and outside the home, and a cost reduction from an estimated $680,000 per annum to $250,000 in the study district. The model of care implemented in these community clinics can be adapted to other communities. Priority must be given to auditing outcomes and changes to ensure that the most effective care is delivered in each community.

Aftercare↗
PubMed1995

[Contralateral replantation after bilateral traumatic lower leg amputation. Case report with 6 year follow-up].

A 66-year-old patient attempted suicide by jumping in front of a train. The lower extremities were amputated at different levels. On the right side, there was a complete amputation within the distal third of the lower leg. Proximal to the amputation site, there was an extensive soft-tissue and bone defect. On the left side, there was a crush injury of the tarsal and mid-tarsal bones. The left lower leg showed only few injuries. An ipsilateral (anatomical) replantation was not possible. In order to save one lower extremity, we decided to carry out a cross-over (contralateral) replantation of the right foot to the left lower leg. After a follow-up of six years, the patient is able to walk well with her prosthesis on the right side and the right foot hooked up to the left lower leg. Functionally, this treatment (cross-over replantation-one-side prosthesis of the lower leg) is much better than the prosthesis on both extremities, as the result has shown. Also from a psychological point of view, it seems to be better for the patient to preserve one extremity even with a cross-over replanted foot.

Aged↗
PubMed1994

Treatment of post-phlebitic syndrome and venous leg ulcers with flunarizine.

The effect of flunarizine in the treatment of post-phlebitic syndrome (PPS) and venous leg ulcers was studied in 42 patients in a double-blind, placebo-controlled trial over a period of 3 months. During the first month the dose of flunarizine or the matching placebo was 1 capsule of 5 mg twice-daily, and during the following 2 months 1 capsule of 5 mg once-daily. Most of the subjective symptoms such as heaviness in the legs, pain, paraesthesia, cramps at night, and swelling of the ankles considerably improved during treatment with flunarizine and were slightly improved in the placebo group. The ulcer surface area decreased after 3 months' treatment with flunarizine by 68.3% (p < 0.001), and after treatment with placebo by 20.5% (p > 0.05). In 15 patients treated with flunarizine and 1 with placebo the ulcers vanished completely. An improvement in the photoplethysmographic record of the lower legs in the flunarizine group was observed, as shown by increase in the index recovery time, while there were no significant changes in the placebo group. The results show that the favorable effect of flunarizine in the treatment of PPS and venous leg ulcers might be due largely to an improvement in subcutaneous circulation of the lower legs. Flunarizine may be an important adjunct to the conservative management of the complications caused by chronic venous insufficiency.

Adult↗
PubMed1994

Correlation between neurological leg deficits and reaction time of upper limbs among low-back pain patients.

The purpose of the study was to examine how neurological deficits of the leg, i.e. sensory deficit, deficient reflexes and muscular weakness, correlate with reaction times of upper limbs in a group with chronic low-back pain. Thirty-two patients were studied. Three sets of measurements of simple reaction time and choice reaction time of upper limbs were conducted at one-week intervals. Neurological deficits of the leg were recorded by a physician and the subjects answered a questionnaire about the severity of their low-back symptoms (Oswestry's index). We also defined a neurological index which reflected the total sum of the three types of leg deficits experienced by each of the subjects. Sensory deficit of the leg and the neurological index correlated strongly with slower reaction times of upper limbs, while the other two neurological deficits did not reach a level of significance. Sensory deficits of the leg seem to be an indicator of much greater motor disability than has been thought so far. The motor disability not only appears distally from the lumbar radicular damage caused for example by an intervertebral herniation, it also seems to relate to psychomotor reaction more generally, even on upper limbs.

Adult↗
PubMed1994

Effect of 20 days bed rest upon peripheral capillary filtration rate, venous compliance and blood flow in arms and legs.

Capillary filtration rate, venous compliance and blood flow in arms and legs were measured during bed rest by strain gauge plethysmography using a liquid metal alloy in silastic tubes. Furthermore orthostatic tolerance to lower body suction was recorded. Six young healthy males and three young healthy females participated in the 20 days bed rest study. Neither arm nor leg blood flow was changed by bed rest. Arm blood flow varied between 2.18 +/- 0.30 and 3.03 +/- 0.35 vol%.min-1 and leg blood flow between 1.42 +/- 0.12 and 1.76 +/- 0.40 vol%.min-1. The capillary filtration rate tended to decrease in the arms from 0.27 +/- 0.07 vol%.min-1 at day 0 to 0.17 +/- 0.03 vol%.min-1 at day 3 and a tendency to an increase in filtration rate in the legs from 0.16 +/- 0.06 at day 0 to 0.56 +/- 0.21 vol%.min-1 at day 3 but both of these changes had recovered from day 10 on. There was a steady state in venous compliance of the forearm between 1.31 +/- 0.20 and 1.50 +/- 1.13 vol% during the first two weeks of the bed rest period but the values tended to increase to 1.75 +/- 0.16 and 1.89 +/- 0.22 vol% at days 16 and 19, respectively, while leg venous compliance showed a transient tendency to increase at day 3 (from 0.83 +/- 0.08 at day 0 to 1.30 +/- 0.32 vol% at day 3) to attain control values from day 5. Orthostatic intolerance measured during lower body suction decreased in the present subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Patency of the plantar arch as a prognostic indicator in patients with critical leg ischaemia; a retrospective study.

OBJECTIVE: To find out if patency of the plantar arch on the preoperative angiogram was an accurate indicator of prognosis of vascular intervention, of leg salvage and of survival in patients with critical ischaemia of the leg. DESIGN: Retrospective study. SETTING: University Hospital. SUBJECTS: 302 patients who underwent femoral angiography for critical ischaemia of the leg in 1985-1986. INTERVENTIONS: Examination of aortofemoral angiograms and scoring of the radiological changes according to a suggested scoring system. MAIN OUTCOME MEASURES: Correlation of scores with outcome. RESULTS: Patients with patent plantar arches had a significantly higher cumulative patency after vascular intervention (logrank chi 2 4.2, p < 0.05), leg salvage (logrank chi 2 11.9, p < 0.01) and significantly longer survival (logrank chi 2 7.8 p < 0.01) than patients with partly or completely occluded plantar arches. CONCLUSION: It is important to see the plantar arch on the preoperative angiogram. The scoring system is valuable in predicting patency after vascular intervention, leg salvage and survival.

Adult↗
PubMed1994

Leg temperature and heat content in humans during immersion hypothermia and rewarming.

Core temperature afterdrop following cold water immersion has previously been shown to be greater during treadmill exercise than shivering (J. Appl. Physiol. 1987; 63:2375-9). To test the hypothesis that this results from increased transfer of heat from the core to exercising muscles, we quantified the changes in leg temperature and heat content during cooling and exercise/shivering protocols. Upper and lower leg muscle temperatures were measured at multiple depths in five thin healthy male subjects immersed in 8 degrees C water until core temperatures reached 32.8-34.9 degrees C. In these thin subjects there was a significant but small difference between exercise and shivering afterdrop (approximately 0.2 degrees C), and total leg heat content was unchanged during this period with both protocols. Subsequent heat gain was similar in both treatments but, in the lower leg, was greater during exercise than shivering, suggesting that shivering is less effective than exercise in increasing lower leg heat content.

Adult↗
PubMed1993

Use of the Ilizarov technique after a free microvascular muscle flap transplantation in massive trauma of the lower leg.

The use of microvascular flaps has become routine in treating compound tibial fractures with extensive soft-tissue loss. Vascularized bone grafts, or shortening of the leg and later elongation with the Ilizarov technique, have been advocated if the injury involves major bone loss. The authors treated four of these massive injuries by debridement and external fixation with the leg at its normal length. Acute free flap reconstructions (four latissimus dorsi, and one case added with a vascularized iliac crest graft) were performed. Tibial corticotomy was later made above or below the defect (varying from 2.5 to 7 cm) and the bone was corrected with slow (0.5-0.75 mm/day) segmental distraction. This was combined with elongation of the leg in two cases. The consolidation time after corticotomy ranged from nine to 12 weeks. The healing time of the fracture after the initial injury was 12, 14, 22, and 36 months, respectively. In massive injury of the lower leg, maintain the initial length of the leg, and perform early free muscle flap reconstruction and segmental bone distraction under the free flap.

Adult↗
PubMed1993

Peak oxygen deficit during one- and two-legged cycling in men and women.

The objectives of this study were to determine the relationships of estimated active muscle mass and gender to anaerobic capacity, as measured by the peak oxygen deficit, and to compare these relationships with those for peak oxygen uptake (VO2peak). Fat-free leg volumes (FFLV), and one- and two-legged cycling peak oxygen deficit and VO2peak were determined in young, physically active men (N = 11) and women (N = 9). For men and women, mean (+/- SD) peak oxygen deficit for one-legged cycling (2.27 +/- 0.30 and 1.18 +/- 0.18 l) was 52% of that for two-legged cycling (4.40 +/- 0.62 and 2.25 +/- 0.28 l). For all subjects and both modes of exercise, there was a strong linear relation between peak oxygen deficit (1) and estimated active muscle mass (FFLV) (r = 0.94). This relation was the same in one- and two-legged cycling, but was different for men and women. For a given FFLV, the peak oxygen deficit was significantly higher (P < 0.05) in men than women by an average of 0.44 l. The relation of peak oxygen deficit to FFLV was significantly stronger than the relation of VO2peak to FFLV (r = 0.80). We conclude: (a) that the peak oxygen deficit is strongly related to the estimated active muscle mass during cycling; (b) that for a given estimated active muscle mass (FFLV), the peak oxygen deficit is higher in men than women; and (c) that the peak oxygen deficit is more strongly related than VO2peak to the estimated quantity of active muscle.

Adult↗
PubMed1995

[Leg ulcer and Klinefelter syndrome].

We report a case of 47 years old patient who was admitted to hospital because of bilateral leg ulcers for 6 years. Chromosome analysis revealed XXY karyotype, confirming the clinical diagnosis of Klinefelter's syndrome. Testosterone level was low and Plasminogen Activator Inhibitor (PAI-1) was elevated. The patient was given androgen therapy which resulted in a normalization of the PAI-1 activity. The frequency of leg ulcers in patients with Klinefelter syndrome is between 6 and 12% according to studies. Different causes would explain the tendency towards leg ulcers in Klinefelter's syndrome: conjunctive tissues abnormalities were revealed in some studies. A higher frequency of venous insufficiency is reported in patients with Klinefelter's syndrome, either due to the particular morphology (obesity, taller size) or due to an androgen deficiency. A few arterial dysplasias cases of arteries's legs were described in patients with leg ulcers and Klinefelter syndrome. Haemostasis disorders presented in this case and normalized after androgen therapy will contribute to the physiopathologic discussion.

Adult↗
PubMed1995

[Psychophysiologic insomnia and periodic leg movements in sleep syndrome].

In 31 patients with psychophysiological insomnia, the relationship between periodic leg movements and sleep was studied. Patients with frequent periodic leg movements estimated their sleep latency to be longer than did patients with few or without leg movements. There were no other significant differences regarding sleep structure and subjective sleep quality between both groups. It appears likely that frequent periodic leg movements in patients with psychophysiological insomnia (not suffering from a restless legs syndrome) can be considered an accidental finding rather than an important factor involved in the pathogenesis of the disorder.

Arousal↗
PubMed1996

[Leg length inequality after childhood femoral fractures--permanent or temporary phenomenon?].

Leg length inequality is the most common complication reported after femoral shaft fractures in childhood. Most authors agree that significant overgrowth occurs in the first two years after injury and will not be further corrected. We reviewed 221 patients (166 boys, 44 girls) with a fracture of the femoral shaft. The mean age at the time of fracture was 6.5 years (range 11 months to 12 years); 123 patients were treated conservatively, 96 by skin traction, 11 by skeletal traction, and 16 by immediate cast bracing. In 98 patients the fracture was stabilized by osteosynthesis. In 5 fractures located in the distal third of the femur we used crossed Kirschner wires. Fifty-nine patients were treated by intramedullary nailing, without problems regarding trochanteric apophyseal arrest or alteration in the collum angle. Thirty-four patients were treated by plate fixation, this being associated with high rates (9%) of implant-breakage. A total of 127 patients were interviewed and examined; they were skeletally mature at the time of reexamination. A leg-length discrepancy was found in 45 patients. Shortening from 10 to 30 mm (mean 14.3 mm) occurred in 7 patients; 38 patients had lengthening from 10 to 25 mm (mean 14.1 mm). Overgrowth significantly depended on the age at trauma (4-9 years; P = 0.04), number of repositions (2 or more; P = 0.0005) and degree of axial deviation (> 10 degrees; P = 0.04). Delayed surgical treatment (> 48 h; P = 0.0035), especially plate fixation (P = 0.0003) induced overgrowth as well. Forty-six patients had previously been reevaluated 12 years before (1981). In 12 patients 13 years or older at the time of the first review, no change in leg-length difference occurred. At the first review 34 patients were younger than 13 years. Eight of them had no leg-length discrepancy. In 16 patients the growth rate of the affected femur decreased, so that leg-length discrepancy diminished after the 2-year period posttraumatically in a range from 5 to 15 mm. Overgrowth of the femur continued in 7 cases ranging from 5 to 10 mm. No change occurred in 3 patients. Thus, there is a further change in length inequality more than 2 years post-traumatically.

Adolescent↗
PubMed1996

[Acute aortic dissection with leg ischemia].

From January of 1987 to July of 1994, 83 patients with acute aortic dissection were treated at our institution. Of these, 7 patients (8%) sustained acute leg ischemia. Angiography showed that one patient had arterial occlusion at the abdominal aorta, three had occlusion at the right common iliac artery, and one had severe right common iliac artery stenosis. Four patients with acute type A dissection underwent emergency replacement of the aortic arch and/or ascending aorta. Three of them were discharged, but one patient died due to renal failure and multiple organ failure. In three patients with acute type B dissection, one with aortic rupture was successfully treated by replacement of the descending thoracic aorta; of the other two who received bypass operations for leg ischemia, one died due to myonephropathic metabolic syndrome and sepsis which were caused by a delay in surgery. In conclusion, emergency thoracic aortic repair should be performed in acute type A dissection with leg ischemia, whereas bypass operation for ischemic leg should be considered in patients of acute type B dissection with leg ischemia when they are not complicated with rupture or visceral ischemia.

Acute Disease↗
PubMed1995

Peak and submaximal physiologic responses following electrical stimulation leg cycle ergometer training.

Eight males with spinal cord injury (SCI) participated in an exercise training program using neuromuscular electrical stimulation (NMES) leg cycle ergometry. Each subject completed a minimum of 24 (mean +/- SD = 38.1 +/- 17.2) 30-minute training sessions over a 19-week period. The initial work rate (WR) of 0 watts (W) of unloaded cycling was increased when appropriate with subjects exercising at 11.4 +/- 3.7 W (range = 6.1 W-18.3 W) at the end of the training program. Randomized block repeated measures ANOVA was used to compare pretraining and posttraining peak physiologic responses during graded NMES leg cycle tests and subpeak physiologic responses during 10 minutes of NMES leg cycle exercise at an absolute WR (0 W). A significant (P < or = 0.05) increase was observed for peak VO2; (+10%, 1.29 +/- 0.30 to 1.42 +/- 0.39 1.min-1). No other statistically significant differences were noted for any other peak variable (VCO2, VO2 ml.kg-1 min-1, VE, WR, HR, RER) pre- to posttraining. During submaximal NMES leg cycle testing, a significant decrease was noted for RER (-9.2%, 1.19 +/- 0.14 to 1.08 +/- 0.09). No other submaximal variable (VO2 1.min-1, ml.kg-1.min-1, VCO2, HR, VE) showed significant changes as a result of the training. Although the improvement in peak VO2 was not as dramatic as those reported in previous studies, it appears that NMES leg cycle training performed two times per week can significantly enhance cardiorespiratory fitness.

Adult↗
PubMed1995

H-reflex and F-wave potentials in leg and arm muscles.

The systematic analyses of secondary muscle potentials of H-reflex and F-wave type were done in multicentric study. The examinations were carried out in healthy volunteers with 9 muscles analysed on the legs and 9 on the lower arms and hands. The H-reflex potential was found regularly in thigh muscles (vastus medialis 100%, biceps femoris 97%, semitendinosus 93%). Less frequently but still with high incidence it appeared in posterior lower leg muscles (soleus 93%, caput mediale gastrocnemii 73%). In anterior tibial muscle and extensor digitorum brevis it did not appear at all. Only exceptionally it was found in short peroneal muscle (3%) and occasionally, only on proximal nerve stimulation, in flexor hallucis brevis. The similar distribution pattern was found in lower arm and hand muscles with analysis on both sides. In flexor digitorum superficialis (73-70%) and flexor carpi radialis (73-57%) the percentage of H-potential muscles was the highest, in flexor carpi ulnaris (47-40%) lesser but still remarkable. Brachioradialis (37-30%) and extensor digitorum communis (27-27%) percentage decreased further. The even more distal, pronator quadratus (21-20%) and abuctor digiti minimi (17-17%) presented as muscles with low incidence of H-reflex positivity. In extensor indicis proprius (3%) the lowest H-potential incidence was found and in opponens pollicis no H-potential at all. F-waves if evaluated as "F-frequency" follow the similar distribution pattern. The lowest "F-frequency" was found on the legs in anterior tibial, short peroneal and extensor digitorum brevis muscles. In the last one more than one half of stimuli failed to evoke the F-potential. Those are the muscles in which H-potentials almost never appeared. The highest "F-frequency" was recorded in thigh, posterior lower leg muscle and flexor hallucis brevis. Some of the examinees displayed in almost all examined muscles H-potential (6 of 30), the others (9 of 30) had it in neither one or in a single muscle. It looks like as if a kind of H-reflex or F-wave individuals exist. If the H- or F-potentials distribution pattern got projected on the homunculus in quadrupedal position the following idea appears. The thigh muscles, the plantar flexors of the feet and hand and finger flexors are first of all tonic muscles mostly involved in standing or holding. The extensors of the foot/toes, respectively of hand/fingers interrupt phasically the sustained action of standing by lifting the foot/hand from the ground. The muscles with mostly tonic function produce much H-reflexes, transitional forms or at least F-wave with high "F-frequency". Is that a kind of phylogenetical remnants, better developed in the motorically less differentiated legs? Have the H-reflex muscles if compared with F-wave muscles different motor units structure? Have they different motoneurons, with different liability to produce recurrent discharges?

Adolescent↗
PubMed1996

Primary cutaneous large B-cell lymphomas of the legs. A distinct type of cutaneous B-cell lymphoma with an intermediate prognosis. Dutch Cutaneous Lymphoma Working Group.

BACKGROUND AND DESIGN: Primary cutaneous follicular center cell lymphomas represent a distinct type of cutaneous B-cell lymphoma, clinically characterized by localized skin lesions on the head or trunk and an excellent prognosis. Histologically similar lymphomas may occur on the legs. The clinical behavior of this group is still undefined, and controversy exists whether these lymphomas should be classified as follicular center cell lymphoma or B-immunoblastic lymphoma. We reviewed the clinical, histologic, and follow-up data of 18 patients with primary cutaneous large B-cell lymphoma of the legs. RESULTS: Primary cutaneous large B-cell lymphoma of the legs generally occurred in elderly patients (median age at diagnosis, 76 years), in particular women (male-female ratio, 7:2), and preferentially affected the lower legs (14 of 18 patients). Radiotherapy and/or systemic polychemotherapy resulted in complete remissions in 16 of 17 patients. Follow-up data demonstrated estimated 2- and 5-year survival rates of 77% and 58%, respectively. Histologic evaluation showed diffuse dermal infiltrates with variable proportions of centroblasts (large noncleaved cells), large centrocytes (large cleaved cells), and B immunoblasts. Seventeen of 18 patients were diagnosed as having primary cutaneous follicular center cell lymphoma; only 1 patient, whose histologic examination showed more than 30% immunoblasts, was diagnosed as having B-immunoblastic lymphoma. CONCLUSIONS: Primary cutaneous large B-cell lymphoma of the legs is a distinct clinicopathologic entity that mainly affects elderly patients and has an intermediate prognosis. Although most cases have a follicular center cell origin, primary cutaneous large B-cell lymphoma is proposed as the most appropriate term for this type of cutaneous lymphoma.

Aged↗