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Image digitizing has facilitated body shape evaluation gained entry in ergonomics industry, in fashion and in health. Objective: to validate the 3D image digitizer (TC 2 -18) to determine body dimensions in a fast and reliable manner. Methods: 285 adults of both sexes were studied to measure anthropometrics, plethysmography, and digitized body shape. Results: Digitizer obtained measurements highly correlated with those obtained through anthropometrics and plethysmography (R 2 ≥ 0.75). However, the TC 2 -18 gave lower values in total body volume when compared with plethysmography (CI 95%, −3.9 to −3.5 L). In contrast, the TC 2 -18 yielded higher values in mesosternal (CI 95%, 8.8–9.6 cm), neck (CI 95%, 2.6–3.0 cm), gluteus maximus (CI 95%, 3.1–3.7 cm), relaxed arm (CI 95%, 2.9–3.3 cm), and minimal waist (CI 95%, 3.1–3.7 cm) circumferences; as well as similar data for the upper thigh, calf and forearm circumference. Conclusion: TC 2 -18 3D digitizer yielded valid and reliable measures when adult persons are evaluated. Found differences occur due to movement during digitizing and by difference inherent to the used devices.

The aim of this study was to assess the effect of varying the maximum resting period between consecutive ambulatory bouts in community-based outcomes. Ambulation was assessed in 97 community-dwelling older adults (mean (SD) age 69.2 (7.7) years) using an accelerometer (activPAL™) worn on the upper thigh for 7 consecutive days. The volume, pattern and variability of ambulation were calculated over a range of maximum resting periods (1–30 s). Outcomes with a maximum resting period from 1 to 6 s did not vary due to device functionality. Non-linear regression (power law, r2 > 0.99) showed that increasing the maximum resting period from 6 to 30 s resulted in changes in volume (increased duration spent walking, and decreased number of bouts), variability (S2 increased) and pattern (α decreased), and a linear relationship with an increase in average bout length. With a MRP of 6s, 6% of the cohort achieved the public health guidelines of 150 min of ambulation/week accumulated in bouts ≥10 min, which increased to 40% using a maximum resting period of 30 s. Modifying the maximum resting period impacts on volume, pattern and variability measures of community based ambulation, and attainment of public health guidelines. This highlights the need for standardised algorithms to aid interpretation and explicit reporting of the maximum resting period to aid comparison between studies.

With technological advances in magnetic resonance angiography (MRA), spatial resolution of 1-mm perforating vessels can reliably be visualized and accurately located in reference to patients' anatomic landmarks without exposing patients to ionizing radiation or iodinated contrast, resulting in optimal perforator selection, improved flap design, and increased surgical efficiency. As their experience with MRA in breast reconstruction has increased, the authors have made changes to their MRA protocol that allow imaging of the vasculature in multiple donor sites (buttock, abdomen, and upper thigh) in one study. This article provides details of this experience with multiple donor site contrast-enhanced MRA.

Correspondence: Dr. Suresh Kumar, C-5/109, First Floor, Sector 11, Rohini, Delhi – 110085. Ph: +91-11-27571916, +91-9312998847. E-mail: suresh.kumar1956@rediffmail.com On examination On the right side there was a large residual flabby mass extending from the trochanter to the lower mid part of the thigh. There were marks of old bruises over lateral aspect of upper thigh and over the trochanteric region (Figure 2). On the left side, the flabby mass extended from the trochanter to the level of the upper pole of patella. There were healed scar mark on lateral aspect of mid thigh and healed bruise marks on posterior aspect of upper thigh and upper part of the mid thigh (Figure 3). Radiograph of the pelvis showed united fracture of superior and inferior pubic rami on left side. Ultrasound examination showed collection beneath subcutaneous plane extending along the whole length of both the thighs. A surgical intervention was performed under spinal anesthesia. A curved lateral incision was given and adventitious bursa was found extending down on deep fascia from the trochanter Battered buttock syndrome–traumatic lipomata

To determine the variability of patient positioning during three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer treated with no immobilization or one of four immunobilization devices, and to determine the effects of patient body habitus and pelvic circumference on patient movement with each individual inmobilization technique.To see whether our immobilization techniques have improved day-to-day patient movement, a retrospective analysis was carried out. A total of 62 patients treated at one facility on a single machine with 3D-CRT via a four-field box technique (anterior-posterior and opposed laterals) in the supine position with either no immobilization or one of four immobilization devices. Five groups of patients were compared: (a) group 1-no immobilization; (b) group 2-alpha cradle from the waist to upper thigh; (c) group 3-alpha cradle from waist to below the knees; (d) group 4-styrofoam leg immobilizer (below knees); and (e) group 5-aquaplast cast encompassing the entire abdomen and pelvis to midthigh with alpha cradle immobilization to their lower legs and feet. Prior to starting radiotherapy, portal films of all four treatment fields were obtained 1 day before treatment. Subsequently, portal films were then obtained at least once a week. Portal films were compared with the simulation films and appropriate changes were made and verified on the next day prior to treatment. A deviation of greater than 0.5 cm or greater was considered to be clincally significant in our analysis. We studied the difference among the types of immobilization and no immobilization by looking at the frequency of movements (overall, and on each of the three axes) that a patient had during the course of his treatment. Using a logistic regression model, the probability of overall and individual directional movement for each group was obtained. In addition, the effects of patient body habitus and pelvic circumference on movement were analyzed.The maximum deviation was 2 cm and the median deviation was 1.2 cm. For each patient, the probability of movement ranged from 0 to 76%, with a mean of 39%. There was no significant difference seen in overall movement with any of the immobilzation devices compared to no immobilization, but there was less vertical (9 vs. 18%; p = 0.03) and AP (6 vs. 15%; p = 0.14) movement with the aquaplast than any other group. However, when examining the lateral direction, the aquaplast had significantly more movement (32 vs. 9%; p0.001). When accounting for body habitus and pelvic circumference, no immobilization device was effective in reducing movement in obese patients or in patients with pelvic circumference greater than 105 cm. The aquaplast group had a significantly increased amount of lateral movement with obesity (42 vs. 23%; p0.05), and with pelvic circumference105 cm (33 vs. 29%; p0.05).There was no significant reduction in overall patient movement noted with any of the immobilization devices compared to no immobilization. The aquaplast group had reduced vertical and AP movement of greater than 0.5 cm. There was significantly more lateral movement with aquaplast appreciated in obese patients or patients with pelvic circumferences greater than 105 cm. The aquaplast immobilization appears to be useful in reducing movement in two very clinicaly important dimensions (AP and vertical). Despite our findings, other immobilization may still be useful especially in the treatment of nonobese patients. It is clear that the optimal immobilization technique and patient positioning are yet to be determined.

Grease gun trauma often involves subcutaneous injection of the grease because of the high pressures required for its industrial application. The case is presented of a man who developed a pneumonitis shortly after sustaining a grease gun injury, with injection of grease into his upper thigh associated with significant vascular damage. Pneumonitis has not previously been reported with this type of injury, and is likely to represent a systemic reaction to the local inflammatory response. Management of these injuries should incorporate early debridement with anticipation of underlying vascular trauma, and also an awareness of the potential systemic complications.

Osteoid osteoma is one of the commonest benign bone tumour and can occur in any bone. Most commonly it is unilocular and multifocal occurrence is very rare. A 14-year-old male is described who presented with 1 year history of pain in the upper thigh. Two foci of osteoid osteoma in the proximal femur were diagnosed on CT scan. The resection ‘en-bloc’ of both tumour was undertaken and histological examination confirmed the diagnosis. There has been no evidence of recurrence at 36 months after resection. To our knowledge, this is the first reported case of discrete synchronous multifocal osteoid osteoma of the proximal femur.

Thirty-two cases are described of a relatively rare form of benign connective tissue proliferation characterized by ectopic fatty tissue in the dermis. The lesions usually appear as large, solitary, slow-growing, pedunculated to dome-shaped, skin-colored nodules or plaques showing predilection for the buttock and upper thigh. Other areas involved include the back, shoulder, knee, neck, and ear. Twenty patients were women and 12 were men, 19 to 78 years of age (mean, 46.9 years). The size of the lesions ranged from 4 to 69 mm (mean, 49 mm). Histologically, the lesions were characterized by the presence of mature adipose tissue infiltrating around the periadnexal adventitial dermis and between adnexal structures and admixing with dense stromal collagen. Marked deposition of mucopolysaccarides was noted in the majority of the lesions. Clinical follow-up in all 32 patients showed no evidence of recurrence. Because of their distinctive clinicopathologic features, we prefer to designate these lesions as solitary, pedunculated lipofibroma. In addition, seven of the patients had diabetes mellitus, suggesting a possible relation between the two conditions.

Meralgia paresthetica may be associated with diabetes, trauma, infection, and use of self-retaining retractors. Our patient experienced left upper thigh paresthesia after undergoing laparoscopic myomectomy with extensive dissection of the left retroperitoneal space. Neurologic evaluation confirmed meralgia paresthetica. The patient was observed for 4 months, by which time the neuropathy resolved spontaneously.

Controversy continues to surround the use of patch angioplasty after carotid endarterectomy. Vein patch rupture is considered to be an uncommon occurrence with an incidence of 0.4-4% 1-3 related to the use of long saphenous vein harvested from the ankle. A recent publication has suggested this can be avoided by using long saphenous vein from the upper thigh. However this case confirms that there is still a risk of rupture even when vein patches are taken from the upper thigh long saphenous vein.

Accurate knowledge of the hemodynamics of the common femoral artery is a critical part of both the preoperative evaluation of patients with peripheral vascular disease and the postoperative follow-up examination. Interrogation of the iliofemoral system with determinations of palpable pulse status, Doppler analog waveforms, and upper thigh pressure ratios has yielded an overall sensitivity of 91 percent and a specificity of 85 percent in the detection of inflow stenosis. This degree of accuracy (89 percent) allows practical surgical decisions to be based on the results of these noninvasive studies.

T HERE can be no doubt that the deveIopment of the diagnosis and treatment of anorecta1 diseases have Iagged considerabIy behind that of other branches of surgery. FaIse modesty on the part of both patient and physician with respect to confidences concerning, and manipuIations about, the Iower intestina1 tract has been one factor tending to retard the natura1 growth of the science of proctoIogy; but perhaps a mdre important factor has been the reIative diffIcuIty of making adequate examinations of the anus and rectum on account of the natura1 inaccessibility of the area invoIved. constructed examining table. In the inverted position the patient’s Iegs and thighs are horizonta1 and on a IeveI with the examiner’s waist; the trunk, neck and head are dependent and make with the thighs an angIe onIy sIightIy greater than go”. The knee-chest position is more easiIy assume< by the patient than the inverted position, and is onIy sIightIy Iess satisfactory for the examiner. The Iateral position, best modified to the typica Sims’ position, is somewhat more comfortabIe from the point of view of the patient, but very much Iess satisfactory than the other positions for the purposes of the examiner. If that branch of surgery under discussion is to deveIop satisfactoriIy in the future, it wiI1 do so onIy as a resuIt of the concerted effort of a11 surgeons to be as thorough in their proctoIogica1 examinations as they are in their other physica examinations. Inspection and paIpation are the onIy two methods of physica examination which are of vaIue in the diagnosis of proctoIogica1 diseases, and it therefore becomes incumbent upon the examiner to pIace the patient in as favorable a physica position as possibIe for examination, in order that the most may be made of the two senses upon which he must depend for a diagnosis. The Sims’ position is achieved as foIIows : the patient is made to Iie on the Ieft side with the Iegs flexed upon the thighs and the thighs upon the abdomen; the dependent shouIder and arm are puIIed backward so that the patient Iies on the side of the face and partIy on the anterior as we11 as the IateraI waI1 of the chest; the upper thigh is flexed to a somewhat greater extent than the Iower so as to aIIow the knee of the former to touch the bed or tabIe upon which the patient is being examined.

The development of elastic fibers within the fibrous stroma of basal cell epithelioma has previously been reported (1). Because these cases only included material from sun-exposed regions, the influence of actinic exposure on elastic fibers could not be eliminated. It was therefore thought necessary to review a series of basal cell epitheliomas from areas not exposed to actinic irradiation and observe the elastic fibers. periphery of solid epithelial nestsf (Figure 1A). In the two other cases, the thin elastic fibers were found lying in a brush-like arrangement at the periphery of the epithelial nests within the stroma (Figure IB). DISCUSSION The study of elastic fibers in cases of superficial basal cell epithelioma from sun-protected areas was TABLE Elastic fibers in superficial basal cell epithelioma-sun protected areas Case Number Age and Sex Duration of Tumor Anatomical Location Pattern of Elastic Fibers within the Tumor 1 70 F-W 1 year Upper Chest Sheaths of elastic fibers surrounding tumor nests 2 64 F-W 20 years Upper Thigh Sheath like 3 42 F-W 1 month Upper Back Sheath like 4 50 F-W 4 years Breast Sheath like 5 40 F-W 6 months Lower Back Sheath like 6 40 F-W 4 years Posterior Leg Sheath like 7 70 M-W 10 years Midback Sheath like 8 35 M-W 1 year Upper Thigh Brush like pattern of elastic fibers 9 60 F-W Unknown Posterior Hip Brush like MATERIALS AND OBSERVATIONS One hundred cases of superficial basal cell epitheliomas on unexposed areas were reviewed. Sections were stained with acid orcein and Giemsa. The series included 43 men and 57 women with the average age of 55 years. Newly-formed elastic fibers were found in nine cases. The clinical data on these nine cases are given in the Table. The newly-formed elastic fibers in the fibrous stroma of basal cell epithelioma are much thinner than those of the surrounding normal corium. They are found in two different patterns. In seven cases, the thin orceinophilic fibers formed sheaths at the done mainly to supplement the previous work. In the present study no evidence of solar elastosis was present in the skin at the periphery of the tumor. Formation of elastic sheaths surrounding the epithelial nests in basal cell epithelioma resembles those seen at the periphery of normal hair follicles. This resemblance may be explained if one considers basal cell epithelioma as a monstrous attempt in adnexogenesis in post-embryonal incompetent skin (2, 3). Solar exposure seems to play no definite role in the formation of elastic fibers. Newly-formed elastic fibers were seen in nine of the hundred cases of superficial basal cell epithelioma on non-solar-exposed areas. The pattern f A similar pattern was seen in the previous study of basal cell epithelioma from sun-exposed areas.