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A 20 months old Nigerian girl who had rectal prolapse was subjected to sitting on a hot ‘sitz’- like bath as a home management of the prolapse. Gluteal, perineal and upper thigh burns and sepsis; also, febrile convulsion and spontaneous passage of 5 ascaris worms were the sequellae.

True Profunda femoris artery aneurysm is extremely rare. Its lateral and deeper location in upper thigh causes delayed indentification making surgical management difficult. Mainstay management technique is surgical with excellent long term outcomes. We report our experience of a 18 cm giant profunda femoris true aneurysm management and review the literature.

WOS: 000410743200014, Soft tissue injury due to orthopedic hardware migration is an uncommon complication. However particularly patients who have routine physical therapy sessions for extremity contractures are at risk for vascular injury in the setting of migrated screws. Ultrasound is an efficient modality to evaluate migrated screws and adjacent soft tissue structures. As a consequence of repetitive trauma a migrated screw would eventually result in injury. Herein a case of upper thigh hematoma due to screw migration in a patient with hip osteotomy is reported.

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

Multiple clustered dermatofibroma (MCD) is a rare tumour which usually appears during the first and second decades of life. We report a man in whom the MCD was congenital, although during the first few years of his second decade it extended to involve a broad zone on the left hip, gluteal region and upper thigh.

Electrobioimpedance volumetric assessment is based on the principle of delivering a constant, nondetectable alternating current to a tissue segment. A potential difference measured between the electrodes is converted to impedance. Since impedance changes with variations in blood flow, penile volumetric change is measured noninvasively. We applied this procedure to the development of a new device to evaluate erectile activity nocturnally, and we report our findings in men with no history of erectile dysfunction.Our study group comprised 10 men with a mean age of 44 years who had no history of erectile dysfunction. The NEVA device consists of a small recording device attached to the upper thigh, and 3 small adhesive electrode pads placed over the hip and on the penile base and glans, respectively. Each subject used the NEVA device for 2 nights.Overall 20 nights of electrobioimpedance volumetric assessment were recorded. Tumescence monitoring revealed 3 to 6 erections per night per subject (mean 3.45) lasting 10 to 50 minutes (mean 17). As determined from the impedance measurements, mean volume change was 14.4 ml. with a 213% mean volume change over baseline.The new NEVA device is small, comfortable to wear and easy to use. It determines the number and duration of erectile events and percentage increase of blood volume changes during these events in normal men in a noninvasive manner. Future directions of study include a comparison to men with erectile dysfunction and analysis of the dynamic information of the NEVA data.

Ophthalmoplegia is an unusual finding in diffuse large B cell lymphoma. This report describes the case of a 72-year old male patient who presented with ophthalmoplegia but no gross neurological manifestations and an isolated mass in the left upper thigh. His ophthalmoplegia improved from his first cycle of systemic and intrathecal chemotherapy, his thigh mass effusion spontaneously resolved, and his laboratory tests also showed improvement. The patient remained well, though weak, for several months with no other neurological signs. He subsequently died from clinically diagnosed pulmonary embolism.

A new equation to estimate muscle mass in males was developed using parameters common to the 1981 Canada Fitness Survey and the male cadaver data of Martin et al. (1990b). The cadavers (N = 12) were randomly divided into two groups. The equation was developed on cadaver Group A and then validated on Group B. Once the equation with the most suitable variables was validated on Group B, it was redeveloped on combined data from Groups A and B. The final equation is as follows: muscle mass (gm) = Ht (0.031MUThG2 + 0.064CCG2 + 0.089CAG2) −3.006; adjusted R2 = .96, SEE = 1,488 gm, F = 87.5, p = .0001. Variables (in cm) were Ht, height; MUThG, modified upper thigh girth; CCG, corrected calf girth; and CAG, corrected arm girth. The predictive ability of this equation was comparable to the original equation of Martin et al. (1990b) and can be a valuable tool for muscle mass estimation of male subjects in the 1981 Canada Fitness Survey. Key words: equation, estimation, body composition, body fat, fat free mass, lean body mass, Canada Fitness Survey

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.

He says, “You’re the doctor, Dr. B.“ I hate him for giving up. But I’ve given him the script. He has pain which doesn’t let him rest—in his right testicle, for 30 years. He is Mr. Dabney. A big black guy. A recovered alcoholic. “What should I do, doc?” he asks. He wants them to take the testicle off. Maybe the nerve, too, since another doctor told him that’s where the pain is. I have told him over and over again that chopping off his ball won’t make his pain go away. In my head I call it his ball. To him I call it his testicle. And then, maybe I think we should take his testicle off. To show him it wouldn’t work. That the pain would be worse. Then I’d be right. But I’d have to up his dose. This is the fix I’m always in: I think the pain is real. And the pain is in his head. Both things are true. The only thing that’s made headway is medicine: different kinds of sedating pills that do no more than take the edge off. We spring from one pill to the other and then back again. Maybe someone can give him another medicine, a nerve block. Has he ever had an injection for pain? Last time, we had talked about seeing the pain doctors—is he still interested in that? “You’re the doctor,” he says. “Whatever you say.” I gave him the opiates right at the beginning of the visit to spare us both the suspense. Scripts on a blue background that look like foreign currency. We’re both in Opiate Land now, our relationship forever threatened by mistrust and dependence. We’re rolling around in a big painful opiate ball. “Any New Year’s plans?” I ask. “I’m hanging out with my lady friend,” he says. “We’ve been together for thirty-four years.” I let him go on. “I was in an alcoholic ward. She was visiting her brother. I don’t know what I looked like then. She looked good. I don’t know why she started talking to me. I asked for her number.” “And you’ve been together since then?” I asked. “She was married when we got together,” he said, “and I knew that. She always came to me for thirty-four years. He’s not around anymore. He died. So I asked her, now that he’s not around, maybe I can come to you?” I have another patient with chronic pain scheduled right after him. I have decided to cut her off; she kept missing visits. Though it may sound harsh, I have to be honest: I don’t like her and I’ll be happy she’s gone. The lawyers took their time approving my letter, and she rescheduled before I terminated her. I have to see her today for the last time. “I got something for Christmas,” he says. “She’s a little dog. I call her Queenie. The girl from across the street gave her to me. “ “What kind of dog?” “A cocker spaniel. She knows how to go to the bathroom by herself. I thought I had to make her go outside, but the girl who gave her to me said she could do it all by herself. I waited, two, three hours, the dog went by herself in a little box.” “Are you walking the dog?” I ask. “Physical activity might decrease your pain.” . And then we could decrease your opiate dose. And then we could decrease your opiate dose.“Sure I walk the dog,” he says. “And she makes me feel very happy.” I say, “I’m glad to hear that.” “So I asked my lady friend if I could come to her,” he goes on. “She said no. So I know she’s seeing other people too.” I tick off the lab boxes in my head: syphilis test, HIV, urine Chlamydia. “Are you using protection?” “Most of the time.” “Do you feel like this is working for you?” “It’s all fine with me. It was a very good Christmas. I really love this Queenie.” I start giving him the speech: he has to see the pain specialists or I can’t give him the opiates. I need to see the note from the pain specialists in the computer—or else I will banish him from Opiate Land. He nods. “Whatever you say. You’re the doctor. I’ll do whatever you ask.” I watch him get up, find his cane, and head for the door. “It’s this pain, doc,” he says. “I wish there were some way to make it go away.” “Little by little,” I say, cursing the truth in this—maybe we can make it better little by little—and also the lie (he’s had it for thirty years!). The testicle pain also affects his groin and upper thigh. He hobbles down the hall. I sit down and dictate into my phone. In my pocket, the letter for the next patient is folded up like a secret message, and the little speech I have composed to her is lying in the pit of my stomach.

A 55-year-old female presented with 19-month duration of asymptomatic ulcerated nodules in the upper thigh and groin (Fig. 42.1). She was otherwise healthy, with no fever, no fatigue and no systemic symptoms.

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.

Background. Large differences in uptake between tumors, even for the same size, frequently observed in clinical and experimental radioimmunotherapy (RAIT), make monitoring of uptake in individual tumors imperative in comparing protocols. 90 Y, widely-used for RAIT, emits no gamma radiation and absorption of the beta particle in tissue makes its detection unsuitable for in vivo monitoring. We tested whether bremsstrahlung radiation, produced when betas are decelerated by nuclei, could be used to monitor tumor uptake. Methods. Subcutaneous human LS174T colon carcinoma tumors were grown in the upper thigh of nude mice and labeled antibody injected intracardially

A 44-year-old man was involved in a motorcycle crash. His left lower extremity was impacted between the motorcycle and a car. He suffered left-sided rib fractures, capsular injury to his left fifth proximal interphalangeal joint and had a large haematoma in the medial aspect of the left thigh. Ultrasound of the left thigh was performed 1 week after the accident (Figure 1). The subsequent clinical course was characterised by a persistent fluid collection in the medial aspect of the left thigh that was painful and bothersome. Further evaluation with MRI of the left thigh was performed 2 months after the time of injury (​(​FigureFigure 2, 3 and 4). Laboratory findings revealed a normal coagulation panel. Figure 1 Longitudinal greyscale ultrasound image of the left upper thigh shows a subcutaneous fluid collection containing avascular fat lobules (arrow). Figure 2 T1 weighted axial MRI of the left upper thigh shows a subcutaneous fluid collection containing globular hyperintense fat lobules (arrows) and hypointense capsule. Figure 3 Short tau inversion-recovery (STIR) coronal MRI of the left upper thigh confirms the subcutaneous location of the fluid collection. Note the typical ovoid margins and hypointense capsule. Figure 4 T2 weighted axial MRI of the left upper thigh shows a subcutaneous fluid collection containing multiple fluid–fluid levels. What are the characteristics of the fluid collection on ultrasound? What observations can you make from the MRI? What is your diagnosis?

A previously healthy 15-month-old boy presented with a papular, erythematous rash that had developed over the previous 5 weeks. The papules were arranged in a thin vertical line that extended along the inner side of his right leg from his foot to his upper thigh ([Figure 1][1]). The patient had no

The evaluation of malnutrition by the use of anthropometry poses considerable problems if any meaningful information is to be acquired, particularly on individual children. It is possible to formulate reference values (17), for height and weight taking age into account, or perhaps as a simple ratio but there may be little relation between the assessment of malnutrition by this means and functional impairment. It is suggested in this paper that anthropometry in this context should include length or stature, weight, skinfold thicknesses (triceps, subscapular and suprailiac) and circumferences (head, upper arm, upper thigh). The reference values to be used in the assessment of malnutrition are not very satisfactory, and there are objections to the simple use of the NCHS (9) data. It would be more desirable to use values obtained on "well-fed" indigenous populations, although these hardly exist at the present time. Well-controlled surveys are urgently needed on length or stature, weight, skinfolds, and circumferences of appropriate populations if anthropometric evaluation of malnutrition is to be anything other than a crude assessment. At a more complex level, the relationship of these anthropometric variables to various functional tests also needs investigation.

For pt.I see ibid., vol.35, no.7, p.847-67 (1990). Analytic solutions to the time-dependent multiregion bioheat equation are evaluated numerically for cartesian and spherical models. Principle and alternate branch contributions to the solutions are examined. The calculations include a parametric investigation and analyses of temperature behaviour in idealised upper thigh and tumour models.

Publisher Summary Telangiectasias or angioectasias are small dilated-blood vessels near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter. They can develop anywhere on the body, but are commonly seen on the face around the nose, cheeks, and chin. They can also develop on the legs, specifically on the upper thigh, below the knee joint, and around the ankles. High-pressure reflux through failed valves is at the root of nearly all telangiectatic webs, although there are some exceptions due to A–V malformations or shunts. The first treatment session is usually limited to a small number of sites in order to observe the patient for any allergic reactions, and the ability to tolerate the burning or cramping of a hypertonic solution, to judge the effectiveness of a particular concentration and class of sclerosing agent, and to observe the ability to comply with compression. Concentrations of sclerosants used for telangiectasias are less than those used for reticular veins. Typically, the solutions are not foamed. When sclerosing solutions are injected into telangiectasia, blood is usually flushed out of the vessel ahead of the solution, thus the sclerosant is usually not diluted at all. When based upon a correct diagnosis and an appropriate treatment plan, sclerotherapy is a highly effective method of treatment for telangiectasias.

(Received on 23 March 2014: Accepted after revision on 30 May 2014) On examination, child was febrile (101 F) with no skin sepsis and stable vital parameters. There was a palpable non mobile lump in left iliac fossa. Left thigh was swollen diffusely up to mid-thigh with no definite mass. Ultrasound scan (USS) revealed left iliopsoas abscess (IPA) with inconclusive extent. Magnetic resonance imaging (MRI) and computed tomography (CT) scans revealed a multiloculated abscess extending into upper thigh (Figure 1).

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.

Purpose: This study aimed to investigate how the cross-sectional areas (CSA) of the quadriceps femoris (QF)3, hamstrings (Ham), and psoas major (PM) in junior sprinters are related to mean running velocity (MV100m) calculated from official records of 100-m races. Methods: In 44 sprinters (22 boys and 22 girls) aged 14-17 yr, cross-sectional images were taken at the upper thigh and midthigh and midway between the fourth and fifth lumbar vertebrae using magnetic resonance imaging. CSA of the three muscles located in both sides were analyzed. For each muscle, the mean values of the CSA of the right and left sides were calculated and used for regression analyses of the relationships between CSA variables and MV100m. Results: Stepwise multiple-regression analyses produced prediction equations of MV100m with independent variables of QF CSA at the midthigh and PM-to-QF CSA ratio at the upper thigh for boys (R2 = 0.38) and PM-to-QF CSA ratio at the midthigh for girls (R2 = 0.33). In the regression model for boys, QF CSA at the midthigh had a negative regression coefficient. Conclusion: For junior sprinters of both genders, the higher development of PM relative to QF, rather than absolute muscle size, is a factor in achieving a better performance in 100-m race performance.

The kicking action predominantly used in Australian Rules football is considered to be responsible for many lower limb injuries. The aim of this study was to describe a non-invasive method of identifying the thigh muscles involved in kicking an Australian Rules football, using MRI. Both upper thighs of 10 recreational footballers were examined using a 1.5-T General Electric MRI scanner before and immediately after carrying out a set kicking exercise protocol. The signal intensity (SI) changes in 14 individual muscles were investigated using a standardized region of interest to determine the levels of muscle activity. Significant SI changes were observed in several muscles of the kicking and stance legs among all participants. In the kicking leg, the greatest SI changes were observed in the adductor longus and tensor fascia latae muscles (49.38% (+/-8.95) and 45.47% (+/-7.91), respectively; P < 0.05), whereas in the stance leg, the muscles displaying the highest changes were the semitendinosus and tensor fascia latae muscles (46.48% (+/-9.97) and 33.68% (+/-8.36), respectively; P < 0.05). This study has shown that MRI can be useful for observing the activity of individual muscles in the upper thigh during the kicking motion. This non-invasive approach provides a detailed analysis of anatomy and emphasizes the muscles at high risk of injury.

Introduction: Pressure relief done by a spinal cord injured patient is of utmost importance in order to prevent pressure sore formation. Some pressure-relieving techniques are described in previous literature, but their effectivity has not yet been deter- mined on different wheelchair cushions. Null Hypothesis (H0): The null hypothesis (H0) stated for thi study is that there is no difference in the effectivity of forward leaning and forward leaning towards the left as pressure relieving techniques for quadriplegic wheelchair users over the differen wheelchair cushions. Design: An analytical experimental study design using a convenient sample group of ten complete lesion quadriplegics (C6 to T1) was performed at the Physiotherapy Department, University of Pretoria. Method: Interface pressure (in mmHg) over the ischial tuberosities and upper thigh areas was measured using the Talley Oxford Pressure Monitor MKII with a 12-way matrix cell system. Results and Conclusion: The Friedman test for associated observations indicated statistically that the leaning diagonally forward pressure relieving technique is more effective for all three wheelchair cushions used in this study.

Although primarily considered as a versatile free-flap donor site, the anterolateral thigh can also be a source of a local muscle perforator flap. This attribute has previously been rarely considered for lower limb coverage. This small series of 3 additional cases demonstrates the usefulness of a proximal pedicled anterolateral thigh flap for medial and lateral thigh wounds. This flap can also be part of a combined flap, in particular when transferred with the vastus lateralis muscle as a local chimeric flap. The peninsular version of the anterolateral thigh local flap avoids venous congestion and is very reliable. The orthograde pedicled anterolateral thigh muscle perforator flap should be considered as another useful alternative for any upper thigh wound if a flap is essential.

Objective: To highlight the various morphological smear pattern in cases of subcutaneous Cryptococcus infection in healthy adults. Method: Cryptococcus is an opportunist fungus and primary infection is acquired through respiratory tract. Dissemination by blood stream results in systemic infection. Ten to 15% of systemic infection present as cutaneous lesions. Between December 2002 and April 2004 three healthy adults presented to us consecutively with subcutaneous swelling. Results: We diagnosed these cases on FNAC as Cryptococcus. In all the three patients there was no history of local penetrating injury and any signs or symptoms of systemic disease. They were two male and one female, immuno competent and were negative for HIV 1 & 2 tested by ELISA. The sites were right abdominal flank, occipital and left anterior upper thigh. Aspirated materials were oily fibro fatty tissue and necrotic purulent materials. Cryptococcus numbers varied in all the smears so also their size and capsule thickness. Background smear morphology and tissue reaction were also different. It could be gelatinous, granulomatous, and cellulitic response or mixed responses and this can be picked up on cytological smears. Cultures were confirmatory in all the three cases. These lesions were resolved with antifungal treatment. Conclusion: Our brief article highlights the morphological spectrum on FNAC smears and diagnostic problems faced in these uncommon circumstances where the aspirates were purulent and the yeasts were small, few and thin walled. In the acute inflammatory smear with occasional giant cells and/or granulomas special stains like PAS or Mucicarmine are necessary to look for budding yeast of Cryptococcus with thin neck.

Between 1811 and 2003, the mean height of 17-year-old Estonian boys increased 18.4 cm (0.97 cm per decade). The increase was 5.2 cm (0.7 cm per decade) between 1811 and 1886, 12.3 cm (2.2 cm per decade) between 1922 and 1978, and 0.5 cm per decade between 1978 and 2003. Between 1922 and 2003, mean height increased 8.2% and mean weight increased 27.2%. Between 1956 and 2003, biacromial (shoulder) breadth increased more than bicristal (hip) breadth; relative chest depth diminished; chest circumference and upper thigh circumference both increased. A multidimensional body structure model is constructed from 1998 to 2003 data.

✓ The authors present an unusual case of sciatic nerve entrapment due to a World War II shrapnel injury to the left thigh suffered during the battle of Anzio in 1943. The patient presented for evaluation of left lower-extremity pain in the sciatic nerve distribution. Magnetic resonance imaging of the lumbosacral spine revealed a disc bulge at L5—S1 that would not explain severe sciatica. A positive Tinel sign was present in the posterior aspect of the upper thigh at the site of a scar resulting from a World War II shrapnel injury. The patient underwent exploratory external neurolysis of the area, and the sciatic nerve was released from fibrous adhesive entrapment. The patient improved dramatically following surgery. During a 3-year follow-up period, no recurrence of symptoms was noted.

A 20-year-old male was impaled through the chest, abdomen, and right upper thigh by three 1.5 cm (0.59 in) diameter rods, each 2 m (6.56 ft) in length. The first rod entered below his right nipple, the second through the right hypochondrium, and the third through the right upper thigh. He was transported to the hospital with the rods in situ. This paper provides insight as to how these unusual injuries were managed in a limited-resource environment. Even in a developing country, the challenges posed by multiple impalement injuries can be managed successfully by rapid prehospital transfer, along with an adequate and coordinated hospital team effort.

Drew Payne Community Staff Nurse, Whittington Health, London made from fabric, has no hard edges that might press into the skin. However, if the loop is secured too tightly it can press down on the catheter and occlude it; if the catheter is pulled very sharply the loop can break open. The hook catheter-securing device is a hinged plastic fixing device that forms an arch over the catheter and is clicked into place with a locking mechanism. Some of the devices hold the catheter tube in place; others fix over the catheter valve and the end of the catheter together. This device is not easily released; they are often opened by pressing a small catch or button. As they are made from plastic they often have hard edges, and the device does not lie flat, standing proud of the catheter which could be a source of pressure if a patient lies on it for any length of time. Both types of device are held in place by either straps or adhesive pads, though adhesive pads are becoming more common. Straps work the same way as the straps that hold catheter bags to a patient’s leg. They fit around the abdomen or upper thigh, though the upper thigh is now more commonly used. If used correctly, they can be just as secure as fixing a catheter bag to the leg. However, if fixed too tightly they can almost act like a tourniquet around the thigh; if fixed too loosely they can fall off. Adhesive pads stick the device directly to the patient’s skin, either to the abdomen or the top of the thigh. They hold the device very securely and move with the movement of the patient’s body. Like any adhesive, they can potentially irritate the skin and patients can become allergic to them.

A 26-year-old female patient presented with multiple, smooth, round to oval, well-defined, and skin-colored nodules, without central punctum, over both axillae since past 5 years. Few nodules were observed on chest, right upper arm, and left upper thigh. No other ectodermal abnormalities were observed in the patient. There was no family history of similar lesions. A clinical diagnosis of multiple neurofibromas was made, and largest of the lesion was excised. Histopathological examination showed features of steatocystoma multiplex. Steatocystoma multiplex is an extremely rare cystic disorder of pilosebaceous units. Although previously regarded as an inherited autosomal dominant disorder, sporadic cases have been reported.

A 70‐year old woman attended the dermatology clinic with a tick attached to her upper thigh (Figure 1). The tick was safely and accurately removed and the patient was investigated for Lyme disease,...

The inguinofemoral region is a crossroads of numerous vascular, nervous and muscular structures. As even the most astute clinician can have difficulty in correctly diagnosing the cause of complaints or a mass in the groin and thigh region, radiological investigation is frequently warranted. For the radiologist involved, knowledge of the anatomy and specific pathology of the groin is essential. This paper deals with the imaging characteristics of the various diseases in the inguinofemoral triangle. Furthermore, this article provides an overview of the role of the various imaging modalities in the evaluation of disease in the groin and upper thigh. A sound working knowledge of groin anatomy and pathology is mandatory. The various imaging modalities used should be considered complementary.

An 80-year-old man had symptoms of urinary retention. Biopsy of the prostate revealed B cell lymphoma. To evaluate the extent of the disease, an F-18 FDG study was performed with positron emission tomography/computed tomography (CT). One hour after intravenous administration of 18.5 mCi F-18 FDG, imaging was carried out from the skull base to the upper thigh. An area of moderately increased activity was noted within the prostate bed. A noncontrast CT, for attenuation correction and anatomic localization, revealed maintenance of fat planes around the prostate, indicating disease localized to that organ. Hence, a B cell lymphoma had been localized to the prostate.

Purpose: Uncertainties from the use of lung blocks during total body irradiation (TBI) are present due to the process of block cutting and block mounting required for treatment. We investigated the use of volumetric modulated arc therapy (VMAT) to improve clinical TBI practice. Methods: Two pediatric patients (Pat‐1, Pat‐2) and one adult patient (Pat‐3) had CT scans from head to upper thigh. The treatment targets (12Gy) included bony structures (all patients) and lymph nodes+spleen (LNS) (Pat‐1, Pat‐3). Three plans were generated in Pinnacle for each patient: TBI plans with AP/PA fields at 380cm SAD with and without lung blocks and a VMAT plan at 100 SAD with 3–4 couch positions. Target coverage V12Gy and dose to lung V6Gy were compared among three plans for each patient. Treatment times as well as doses to other critical structures were also compared for different techniques. Results: for AP/PA plans, lung blocks reduced lung V6Gy to 28.7%, 6.3% and 24.9% for these three patients from 100% (without block), however, target V12Gy decreased to 72.5%, 68.6%, and 88.7% from 84.9%, 86.3%, 95.5% (without block), respectively. VMAT plan achieved 44.3%, 53.7% and 71.5% for lung V6Gy with excellent target coverage of 91.7%, 96.2% and 95.3%. While lung blocks only be used 3/8 treatments for AP/PA TBI, VMAT plan lung mean doses were 21–35% lower than AP/PA+block technique. Meanwhile, average mean dose to the brain, heart, kidneys and liver was also reduced 40%, 43.7%, 41.1% and 40.6% using VMAT plans. VMAT planning was more challenging when targets include LNS and/or for large patients (shoulder>40cm, Pat‐3). Setup and beam‐on time for VMAT were comparable to or less than AP/PA technique for Pat‐1, Pat‐2, but were much longer for Pat‐3. Conclusion: VMAT plans have potential to reduce uncertainties for treating small‐medium sized patients who need lung blocks in TBI treatments.

Chondroid syringoma, or mixed tumor of skin, is a relatively rare, usually benign sweat gland tumor, most often seen in the head-and-neck region. Rare malignant examples have been reported, commonly involving the extremities. We report here a case radiologically mimicking a malignant neoplasm, but histologically-proven benign subcutaneous chondroid syringoma, arising in the anterior aspect of the upper thigh of a 59-year-old male.

When a large tumour involves the buttock and anterolateral upper thigh, modifications to the classical hemipelvectomy may be required for its removal. Herein, we report the use of a medial myocutaneous flap for coverage of soft tissue defects produced by such procedures.

Wound areas on the upper thigh following split thickness skin grafts can be standardized. They are, therefore, suitable as wound models for comparative investigations into the kinetics of epithelialization using various wound therapeutic agents. In a prospective clinical study, the epithelialization time in two split thickness graft donor sites was examined in an intraindividual comparison on 16 patients. Zinc oxide and potassium/calcium chloride hydrogel were used as the comparative substances. The results confirm the suitability of the study design for the testing of efficacy of topical wound therapeutic agents. The model can be standardized, is practical, and does not require additional stress to the patient.

A limited clinical trial on split-thickness skin graft donor sites was conducted in 15 consecutive patients to assess the action of MEBO compared with the conventional Sofra-Tulle (Roussel Laboratories Ltd., Uxbridge, UK) split-thickness skin graft donor site dressing used in our service. All patients included in the study were white, with Fitzpatrick skin types II and III (age range, 5–65 years). The same patient as well as the same donor site was used to study MEBO and the control (Sofra-Tulle). Donor sites other than the upper thigh were excluded from the study. Patients requiring thicker skin grafts than the previously set thickness for the study were also excluded.

Summary We present the case of a 44-year-old patient with a primary leiomyosarcoma of the right upper thigh, who developed a second mesenchymal lesion at the same thigh, diagnosed as an extra-abdominal desmoid tumor, some months after surgical treatment of his leiomyosarcoma. Clinically, histomorphologically, DNA cytometrically, immunohisto- chemically and radiologically the different histogenetic origin of the two lesions could be proven. The patient died 17 months after his first tumor diagnosis of lung metastases of his leiomyosarcoma.

Tunica vaginalis hydrocele (TVH) is a relatively common entity. The procedure of testicular reposition in a subcutaneous pouch following severe scrotal avulsion injury is also a standard line of care. Though, the occurrence of TVH in such a reposited testis is extremely rare clinical presentation. We herein report a case of 55-year male patient who presented with swelling over medial aspect of left upper thigh which was diagnosed as TVH of reposited testis on detailed assessment. The patient was managed on the usual lines of management protocols of TVH with successful outcome.

A 34-year-old white female with a 5-cm malignant schwannoma of the upper thigh underwent complete removal of the tumor by fresh-tissue Mohs surgical excision. The patient refused postoperative radiotherapy, and is without signs of recurrence 5 years after surgery. Mohs surgical excision in the treatment of malignant schwannoma has not to our knowledge been reported previously.

Lipoma is a common benign soft tissue tumor. It may arise in any location, but most frequently it is located on the trunk, chest, upper thigh, upper arm, and shoulder. Reports of a lipoma in the foot exist, but the occurrence of the tumor in this location is very rare. Lipomas of the toe have only been reported in children, some imitating or having associated gigantism. We present a benign lipoma occurring on the plantar aspect of the second toe in an adult.

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.