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Summary: A 16-year-old male presented with a 2-year history of a 5 x 5 cm dermatofibrosarcoma protuberans (DFSP) on the medial aspect of his right lower leg. Wide local excision (WLE) with a 2cm margin was performed and a free anterolateral thigh (ALT) flap was used to reconstruct the defect. This technique satisfactorily reconstructed a large defect in an adolescent with minimal donor site morbidity, as the donor site was closed primarily, and a functionally and aesthetically acceptable outcome. There was no evidence of tumour recurrence at 6 months follow-up.

The defeat of the Varoliyev bridge represents in many respects a little-studied area, both in clinical and diagnostic terms, which is why, in my opinion, the following case deserves attention, on which we will focus at the present moment.

Background Erythema induratum of Bazin (EIB) is a rare cutaneous manifestation of tuberculosis (TB) that frequently occurs in middle-aged women. The clinical manifestations of EIB can mimic various skin diseases, easily leading to misdiagnosis or underdiagnosis. We report a case of a 16-year-old Chinese girl who initially presented with EIB and was subsequently diagnosed with cavitary TB. Case presentation The patient is a 16-year-old Chinese girl who presented with clusters of erythematous subcutaneous nodules on the posterior part of her right lower leg matching the clinical manifestations of EIB but was otherwise asymptomatic. The patient was subsequently diagnosed with cavitary TB on the basis of a positive result from a T-SPOT.TB test and the observation of cavitary lung lesions in chest computed tomography scanning. A good clinical response was observed in the patient after the initial phase of a standard 6-month antibiotic regimen. Conclusions Adolescents infected with Mycobacterium tuberculosis frequently present atypical symptoms. Cutaneous manifestations of tuberculosis in adolescents can be considered good clinical indicators to predict the underlying disease. Strong clinical suspicion is required for a prompt diagnosis in adolescents with EIB.

A 51-year-old female with right knee posterior mass for 10 months with numbness of the right lower leg and swelling and pain for 5 months.

The human ankle joint and plantar flexor muscle–tendon unit play an important role in endurance running. It has been assumed that muscle and tendon interactions and their biomechanical behaviours depend on their morphological and architectural characteristics. We aimed to study how plantar flexor muscle characteristics influence marathon running performance and to determine whether there is any difference in the role of the soleus and gastrocnemii. The right lower leg of ten male distance runners was scanned with magnetic resonance imagining. The cross-sectional areas of the Achilles tendon, soleus, and lateral and medial gastrocnemius were measured, and the muscle volumes were calculated. Additional ultrasound scanning was used to estimate the fascicle length of each muscle to calculate the physiological cross-sectional area. Correlations were found between marathon running performance and soleus volume (r = 0.55, p = 0.048), soleus cross-sectional area (r = 0.57, p = 0.04), soleus physiological cross-sectional area (PCSA-IAAF r = 0.77, p p p = 0.03). None of the gastrocnemius characteristics were associated with marathon performance. We concluded that a larger soleus muscle with a thicker Achilles tendon is associated with better marathon performance. Based on these results, it can be concluded the morphological characteristics of the lower leg muscle–tendon unit correlate with running performance.

Semiconductor is still one of the major contributors in terms of Singapore's GDP. Wafer sort or probe is one of semiconductor test methodology. In spite of the growth and success in wafer sort industry, same with other, Work-related Musculoskeletal Disorder (WRMSD) problem is yet being experience among workers. Even though, processes are highly automated, some manual handling by workers is still existed in the process. Data was collected from 21 male participants via disseminating a survey using Google forms. The survey is consisting of participant demographic data together with Cornell Musculoskeletal Discomfort Questionnaires (CMDQ). CMDQ is used to calculate the musculoskeletal discomfort. In addition to CMDQ, workers posture analysis was also evaluated using Rapid Upper Limb Assessment (RULA) and Rapid Entire Body Assessment (REBA). The intention of this research was to identify the type of work-related musculoskeletal disorders experience by workers in semiconductor industry in Singapore. Four activities were identified that required prolonged standing among workers. These are 1) Attending to machine 2) Inspection through microscope 3) Inspection through naked eye and 4) Carrying and packing. To provide an analysis of summary of factors collected from data gathering descriptive measures were used. The RULA and REBA result to medium risk that postulates the need of further evaluation for proper ergonomics interventions to minimize risk of WRMSD. CMDQ results pointed to 4 body parts that exhibit discomfort, these are neck, lower back, left lower leg and right lower leg. Age and Hour are the most common factors that correlate the discomfort experienced by the workers. The discomfort from these body parts can be reduce by break period between standing and sitting, walking around, wear comfortable and supportive shoes, replacing hard floor with rubber, hamstring and calf stretching.

The goal of this study was to evaluate the reproducibility and repeatability of tissue sodium concentration (TSC) measurements using 23 Na MRI in skeletal muscle tissue. 23 Na MRI was performed at 3 T on the right lower leg of eight healthy volunteers (aged 28 ± 4 years). The examinations were repeated at the same site after ~ 22 weeks to assess the variability over a medium-term period. Additionally, they were scanned at a second site shortly before or shortly after the first visit (within 3 weeks) to evaluate the inter-site reproducibility. Moreover, we analysed the effect of B0 correction on the variability. Coefficients of variations (CVs) from mean TSC values as well as Bland-Altman plots were used to assess intra-site repeatability and inter-site reproducibility. In phantom measurements, the B0 correction improved the quantitative accuracy. We observed differences of up to 4.9 mmol/L between the first and second visit and a difference of up to 3.7 mmol/L between the two different sites. The CV for the medium-term repeatability was 15% and the reproducibility CV was 9%. The Bland-Altman plots indicated high agreement between the visits in all muscle regions. The systematic bias of -0.68 mmol/L between site X and Y (P = 0.03) was slightly reduced to -0.64 mmol/L after B0 correction (P = 0.04). This work shows that TSC measurements in healthy skeletal muscle tissue can be performed with good repeatability and reproducibility, which is of importance for future longitudinal or multicentre studies.

A 58-year-old female with no significant past medical history presented with complain of skin pigment changes at various parts of the body for the past several months. She reported some associated itching at these sites.

Sclerotic fibromas of the skin (SFSs) have a very characteristic histology but the clinical signs are non-specific. Consequently, it is extremely difficult to make a diagnosis of SFS on the basis of the clinical findings only. We report here two cases of SFS arising on the right scapular region and the right lower leg, respectively. Both cases were clinically similar to keloids. Skin surgeons should remember that SFSs are an important differential diagnosis from keloids.

We report a case of a patient presenting with fever, right lower leg swelling, and pain who was found to have a fluid collection between muscle planes noted on point-of-care ultrasound. Point-of-care ultrasound raised the clinician's concern for deep musculoskeletal infection, leading to prompt initiation of antibiotics and magnetic resonance imaging.

A man in his 50s presented with a two week history of a large ecchymosis on his left ankle and foot, and a two month history of petechial rash on his lower limbs (fig 1 and fig 2). He had no history of recent trauma, fevers, night sweats, weight loss, or upper respiratory symptoms, and did not report any bleeding from other sites. His diet largely consisted of ready meals and he had not consumed fresh fruit or vegetables for more than a year. Fig 1 Large ecchymosis over patient’s left ankle and foot, with hyperkeratosis of skin overlying dorsal and lateral aspects of the foot. Multiple perifollicular haemorrhages on medial aspect of patient’s right lower leg Fig 2 Perifollicular haemorrhages surrounding prominent hyperkeratotic follicles with multiple corkscrew hairs on patient’s right lower leg (black arrows) He said that he had not used alcohol or injected drugs in the past six …

The study assesses the effects of a six-week plyometric training program (PT) on muscle stiffness in the dominant and non-dominant leg in male collegiate volleyball players. The study group comprised 16 volleyball players who had played collegiate volleyball for at least four years. For six consecutive weeks, twice a week, the players undertook a plyometric program of 60-min training sessions, each preceded with a specialist warm-up. The analysis of the anterior muscles of the right and the left lower leg revealed a significant increase in stiffness in the muscles of the right leg and the left leg. No significant differences were found between the anterior muscles of the left lower leg and the right lower leg in particular weeks of the training program. The analysis of the posterior lower leg muscles revealed no significant differences, either in the consecutive weekly training microcycles or between the left leg and the right leg. The measurement of muscle tone and biomechanical properties of muscles can be used as a fast and direct assessment of plyometric training-related muscle fatigue. A similar level of muscle stiffness in both lower legs (symmetry) is a reflection of the appropriate selection of plyometric training loads.

From the increase in the number of rehabilitation patients, precise and detailed records of rehabilitation have become difficult due to the busyness of physical therapists. This creates difficulty for quantitative analysis of rehabilitation. Therefore, we are constructing a system that automatically records rehabilitation using activity recognition techniques with wearable sensors. The system can offer the dual prospect of decreasing a practitioners’ load and enabling quantitative analysis of rehabilitation. In general, a large number of wearable sensors are demanded to be placed on each part of a patient’s body for accurate activity recognition. However, managing a larger number of wearable sensors incurs significant time and effort of therapists and patients to apply them and adds to a patients’ discomfort, consequently it significantly decreases practicality. Therefore, we investigate the suitable number and positions of wearable sensors for activity recognition for rehabilitation. Experiments were carried out with 16 healthy subjects wearing seven wearable inertial measurement units (IMUs). The subjects performed 10 different rehabilitation activities chosen by a qualified physical therapist as typical ones used in real rehabilitation therapy. The activities were recognized while reducing the number of sensors with all combinations of sensor placements using six classification algorithms. Then, the accuracy on each setting was examined. As a result, 0.833 of F-measure value was obtained when using three sensors on the waist, right thigh, and right lower leg.

Venous Ulcer is a very common disease encountered in surgical practice. There are many modality of treatment in contemporary science, yet it takes very long time for healing of the ulcer. Objective - This is a single case study depicting the effect of Virechana Karma along with internal medications in a case of chronic venous ulcer. Materials and Methods - In this study a male patient of 52 years presenting with a non healing ulcer on the right lower leg was diagnosed as venous ulcer. He was treated with Virechana Karma and internal medications along with Kashaya Parisheka to the ulcer. Result - After discharge, follow up of patient was done. Complete healing of wound was noted in 45 days. The changes in wound healing were documented during the stay in the hospital and during follow up. Conclusion - After Virechana a significant reduction in many of symptoms was noted. This treatment protocol has shown encouraging results in terms of early healing of the ulcer with low cost of the treatment when compared to conventional treatment methods.

Somatosensory reflex epilepsy is induced by repetitive cutaneous contact of a circumscribed body area with a tight time-lock between somatosensory stimulation and seizure. We describe the case of a 27-year-old man with seizures induced by repetitive tapping on the sole of the right foot. Simultaneous video-EEG monitoring and surface electromyography was performed during a seizure triggered by repetitive tapping on the right sole aspect using a hammer. Stimulation produced a tingling sensation on the right sole that extended to the right lower leg. This was followed by motor Jacksonian march of the right leg. [Published with video sequence on www.epilepticdisorders.com].

Sparganosis, an infection due to the plerocercoid of Spirometra erinacei, are found worldwide but the majority of cases occur in East Asia including Korea. This report is on a recurred case of sparganosis in the subcutaneous tissue of the right lower leg 1 year after a surgical removal of a worm from a similar region. At admission, ultrasonography (USG) of the lesion strongly suggested sparganosis, and a worm was successfully removed which turned out to be a sparganum with scolex. Since sparganum has a variable life span, and may develop into a life-threatening severe case, a patient once diagnosed as sparganosis should be properly followed-up for a certain period of time. Although imaging modalities were useful for the diagnosis of sparganosis as seen in this case, serological test such as ELISA should also be accompanied so as to support the preoperative diagnosis.

Cavernous angiomas are common in the upper body and viscera but saphenous vein cavernous angiomas have not been previously described in the literature. We present a case of a rare congenital vascular malformation of the lower extremity masquerading as an aneurysm in a 4-year-old girl who presented with an asymptomatic right lower leg mass. Ultrasound was concerning for saphenous venous aneurysm and MRI was confirmatory. Operative exploration identified a vascular mass without evidence of an aneurysm; cavernous angioma was confirmed on pathologic examination. Although infantile vascular lesions are common, imaging diagnosis of venous aneurysm – an unusual asymptomatic clinical entity – should raise concerns about possible rare entities or diagnostic alternatives.

A 63-year-old woman presents to the medical receiving unit with a 2-month history of violaceous haemorrhagic nodules on her right lower leg on the background of 10-year history of chronic lymphoedema ([figure 1][1]). She had a complex medical history including previous deep venous thrombosis (DVT)

Klippel-Trenaunay-Weber syndrome (KTWS) is a rare congenital disorder. The incidence of KTWS is 3-5/100000 live birth. It is characterized by port-wine stain, varicose veins, and bony and soft tissue hypertrophy affecting a limb. Most of the cases were diagnosed after the childhood when the clinical picture became clear and complete. Our neonate was diagnosed just after birth; the right lower leg was hypertrophied with port-wine stained. Early diagnosis and multidisciplinary approach will improve the outcome and decrease the morbidity.

While cutaneous metastases are already extremely rare in primary metastatic prostatic adenocarcinoma, cutaneous manifestations in recurrent prostate cancer have rarely been described prior to this report. Here we present the case report of a 93-year-old male who underwent radical prostatectomy but eventually suffered from a previously undescribed recurrence of prostatic adenocarcinoma with distant cutaneous metastases to proximal right lower leg.

The purpose of the present study was to examine test-retest reliability and minimal detectable change (MDC) values for Achilles tendon (AT) length determined using panoramic ultrasound (US) imaging. Seventeen men (age = 21.0 ± 2.3 y) visited the laboratory on two separate days, where AT length was examined along the mid-longitudinal axis of the right lower leg with a portable B-mode panoramic US device. These measures were found to have acceptable reliability with intra-class correlation coefficient (ICC) and standard error of measurement (SEM) values of 0.954 and 4.43 mm (SEM% of the mean = 2.37%), respectively. In addition, the MDC for the panoramic US assessment of AT length was 12.27 mm (MDC% of the mean = 6.57%). These findings suggest that panoramic US imaging is a reliable technique for detection of clinically relevant changes in AT length and may therefore be a practical and time-efficient clinical tool for future studies examining AT length in vivo.

It has been observed that a patient’s “normal” moles resemble each other clinically. This concept also applies to dermoscopic observations, as shown by our previous demonstration that an individual’s nevi tend to have one to three predominant overall dermoscopic patterns [1]. A recent study investigated and compared the dermoscopic patterns of multiple primary melanomas (MPMs) in a large series of patients [2]. The authors showed that MPMs of elderly patients with sun-damaged skin were often dermoscopically similar in pigment network and regression structures. This observation is intriguing because it suggests that a rule valid for the nevi of an individual (all nevi have a similar dermoscopic pattern, typical or otherwise), may also be valid for melanomas: i.e., in a given individual, melanomas in similar anatomical sites have similar dermoscopic patterns [3]. However, the authors mainly assessed thin melanomas and admitted this as a limitation of their study: “Thin and superficial spreading melanomas were predominant in our study population.” In the last five years we had the opportunity of observing five patients over 70 years of age with multiple melanomas (multifocal), thicker than 2 mm, located in photo-damaged areas (Figure 1–4) (Table 1). We evaluated the dermoscopic images of these pigmented skin lesions retrospectively. The images were taken using a photo camera equipped with a polarized contact dermoscope (DermLite® Photo 3Gen, San Juan Capistrano, CA, US). All images were analyzed by an expert dermoscopist (P.R.). Lesions were evaluated for eight dermoscopic features, as reported in Table 1. Figure 1. (a) Clinical appearance of two similar synchronous melanomas occurring on the back of a 77-year-old man; (b & c) Dermoscopic images of the melanomas: Breslow thickness 3.1 mm (b) and 2.2 mm (c). The lesions had the same dermoscopic features: atypical ... Figure 4. Three similar melanomas occurring two on the back (a, b) and one on the right lower leg (c) of a 78-year-old man; (a, b, c) Dermoscopic images of the melanomas: Breslow thickness 3.0 mm (a), 2.2 mm (b) and 2.4 mm (c). The lesions had the same dermoscopic ... TABLE 1. Dermographic data of the patients [Copyright: ©2014 Feci et al.] As suggested by Moscarella et al. [2], similar appearance was defined as the same dermoscopically detected features with similar scores and/or with a difference in only one minor feature (a feature present in less than 10% of the lesion). Different appearance was defined as different dermoscopically detected features with different scores in all melanomas of a given patient. Features in a given lesion were quantified as present in 50% of the lesion. Five patients (3 males) with a total of 12 melanomas were collected from the databases of three skin clinics. Age ranged from 70 to 84 years (mean 76.6 years). Three patients (60%) had two, and two patients (40%) had three primary melanomas. Mean Breslow thickness was 2.8 mm. As reported in Table 2, in all our cases, the melanomas of a given patient shared very similar dermoscopic features and scores (Table 2) (Fig 1 a, b, c). We classified patients as having melanomas with similar or different dermoscopic features on the basis of lesion scores. In particular, 4/5 patients (80%) showed melanomas that were dermoscopically similar, and 1/5 (20%) had melanomas that were dermoscopically different. TABLE 2. Evaluation and scores of the dermoscopic features [Copyright: ©2014 Feci et al.] In line with the experience described in Moscarella et al., our results suggest that the principles valid for nevi of a given individual (all nevi have similar dermoscopic pattern, typical or otherwise) might also be valid for thick and thin melanomas [3]. However, thick melanomas may tend to be similar by nature. Although our case series is too small for any statistical analysis, our preliminary results seem to corroborate the results of Moscarella and colleagues.

The aim of this study is to examine dominant hand usage and detect the injury regions in racket sports. A total of 98 athletes, of which 37 (37.8%) are female, 61 (62.2%) are male, studying at 11 different universities and attending competitions with schools teams with an average age of 21.11±1.66, height of 1.71±0.08 cm, weight of 64.92±10.85 kg, and BMI of 22.00±2.41(kg/m2) have participated in the study. When it comes to the distribution of the athletes by branches, the sample consists of 22 table tennis players, 24 badminton players, 25 tennis players and 27 squash players. The "Edinburgh Inventory Hand Preference Survey" was used as a data collection tool to determine the hand preferences of the athletes. In the determination of sports injuries suffered by athletes, the Cornell Musculoskeletal Discomfort Questionnaire was administered. There are significant differences between the lefty and righty athletes in terms of injuries in the left shoulder, left wrist and right lower leg regions when the injury regions in racket sports are compared by hand preferences (p

The article describes a case of late diagnostics of tertiary syphilis affecting the musculoskeletal system in a patient who was under long-term supervision with a district general practitioner and who was diagnosed with thrombophlebitis. The diagnosis was verified only after the autotomy of the right lower leg

Metastatic Crohn's disease is a very rare skin manifestation of Crohn's disease. Its time of occurrence and severity do not necessarily correlate with the intestinal disease. The main characteristic is that the granulomatous skin changes occur at sites distant from the bowel. We report the case of a 65-year-old woman with metastatic Crohn's disease on her right lower leg without clinical intestinal signs at the time of diagnosis. The inflammatory pustulating skin lesions resolved after systemic and topical treatment with corticosteroids. After reducing immunosuppressive therapy, fistulating lesions reappeared on the lower legs and at the mons pubis. Coloscopy now, more than five years after the onset of the first skin lesions, showed an intestinal Crohn's disease. Metastatic Crohn's disease and its differential diagnoses with granulomatous reaction pattern are discussed in this manuscript.

The advent of microsurgery has allowed the replantation of traumatically amputated limbs. Replantation of a severed limb to the contralateral stump in bilateral traumatic amputation, however, is rarer, and criticisms include a prolonged hospital stay and complications. A 54-year-old man was caught in a paper-pulping machine and suffered bilateral lower limb amputation rendering his left lower leg unsalvageable. The right lower leg, after debridement however, was suitable for replantation to the left stump. This replantation was performed successfully. The patient was rehabilitated with a contralateral prosthesis and ambulates with a walking stick. At 11-year follow-up the patient has a preference for his replanted leg in contrast to his contralateral prosthesis and has suffered no long-term complications. In addition, from a psychological perspective, he has experienced restoration of perceived body length with the cross-leg replantation.

The day-to-day reliability of lower leg volume is poorly documented. This investigation determined the day-to-day reliability of lower leg volume (soleus and gastrocnemius) measured using water displacement. Thirty young adults (15 men and 15 women) had their right lower leg volume measured by water displacement on five separate occasions. The participants performed normal activities of daily living and were measured at the same time of day after being seated for 30 min. The results revealed a high day-to-day reliability for lower leg volume. The mean percentage change in lower leg volume across days compared to day 1 ranged between 0 and 0.37%. The mean within subjects coefficient of variation in lower leg volume was 0.72% and the coefficient of variation for the entire sample across days ranged from 5.66 to 6.32%. A two way mixed model intraclass correlation (30 subjects x 5 days) showed that the lower leg volume measurement was highly reliable (ICC = 0.972). Foot and total lower leg volumes showed similarly high reliability. Water displacement offers a cost effective and reliable solution for the measurement of lower leg edema across days.

The effect of liniment applied by massage or stick on skin and calf blood flow was studied in 12 subjects. The blood flow was recorded with laser Doppler flowmetry with skin probe and strain gauge plethysmography. A massage liniment used to lower the friction that is not supposed to have any therapeutic effect (Frisco) was massaged into the right lower leg for 10 min and the registration was performed for 60 min. Then the liniment studied, Tiger Balm was massaged into the left lower leg and another registration was carried out. This procedure was performed a second time and the liniments were applied with a stick and wiped off after 10 min. Liniments with massage resulted in an increase in both skin and calf blood flow. The effect was greater and longer lasting when using Tiger Balm. When the liniments were applied with a stick, a decrease in skin and calf blood flow was noted when using Frisco. Tiger Balm caused a slight increase in the skin blood flow but had no influence on the calf blood flow.

Stewart-Bluefarb syndrome (SBS) is a subtype of pseudo-Kaposi sarcoma (PKS), which is associated with congenital arteriovenous malformation. It is a rare syndrome, characterized by cutaneous lesions with onset in the second decade of life. We report a case of SBS in a 33-year-old man presenting with a 15-year history of unilateral, reddish-brown, raised lesions on his right lower leg and the dorsum of his foot. Diagnosis of PKS was confirmed by histopathology and radiology. We report the clinical features, aetiopathogenesis, differential diagnosis and treatment of this rare condition.

OBJECTIVE: . Cuff algometry is used for the psychophysical assessment of deep-tissue pain sensitivity. The cuff pressure homogeneity may affect the pain sensitivity assessment and potentially be improved by alternative cuff designs optimizing the pressure distribution. The aim of this study was to investigate the relationship between pain sensitivity, inflation pressure, and distribution of interface pressure between the skin and cuff during stimulation with a conventional air tourniquet and a novel tourniquet including a water tube interfacing the air cuff with the skin.METHODS: . Air and water cuff stimulations were applied separately on the right lower leg of 12 subjects until the tolerance pain threshold. The inflation pressure was controlled and recorded by a computer-control program, while the interface pressure distribution was measured by a flexible pressure sensor mat located between the cuff and skin.RESULTS: . The mean interface pressure across the entire stimulation surface was not significantly different from inflating pressure during air-cuff algometry. For the water cuff there was a significant reduction in the mean interface pressure compared with the inflating pressure at both the detection and tolerance pain levels (P < 0.002). The interface pressure distribution of the water cuff around the limb was significantly more homogeneous compared with the air cuff (P < 0.03). This homogeneity showed a significant correlation with pain sensitivity (P < 0.008).CONCLUSION: . Cuff systems with a liquid medium optimize the homogeneity of the interface pressure distribution. However, the deviation of the interface pressure from the inflating pressure is crucial as it counteracts the effects of pressure homogeneity on pain sensitivity in water-cuff algometry.

A 70-year-old male presented with a painful, itchy rash. The rash began with an itchy sensation which then transformed into blisters that were easily breakable. The patient is a long term resident at a local nursing home. The patient was also allergic to Zocor and Fluvastatin.

This pilot study was aimed to elucidate the growing role of non-dermatophytic filamentous moulds in the cutaneous lesions of laborers who worked in agriculture field in the villages of Bharauch, Gujarat ,India. Eighteen patients (13 males and 5 females, aged 21 to 46 years) with various skin problems presented to the outpatient department (OPD) of Welfare Hospital and Research Center, and Shashwat Skin Clinic, Bharauch, India were examined for the non-dermatophytic filamentous fungi by using standard mycological techniques. All the specimens were treated in 10 % potassium hydroxide solution of direct microscopy; and cultural isolation was done onto Sabouraud medium with chloramphenicol. The detailed identification of fungal isolates was carried out in “ Narayan” stain. The treatment of patient was attempted with oral administration of itraconazole. Aspergillus terreus was identified in the cutaneous lesion of 1 of the 18 patients both by direct microscopy as well as by cultural isolation. The cinnamon-brown coloured colonies of A. terreus grew in pure culture from the biopsied tissue on Sabouraud dextrose agar with chloramphenicol. In “Narayan” stain, conidial heads of A. terreus were found compact, biseriate, and densely columnar. The patient had received trauma on the skin of right lower leg by wooden splinter while working in the field. The oral administration of itraconazole for 12 weeks showed good clinical response. The demonstration of A. terreus in the skin lesion by direct microscopy and cultural isolation, and good response to antifungal drugs clearly indicated that our patient was suffering with cutaneous mycosis. The patient with chronic cutaneous lesion, history of the skin trauma, and occupational exposure to the soil should be investigated for cutaneous mycosis. The immediate attention to traumatic injury to the skin is highly imperative to prevent the further complications. This seems to be first report of primary cutaneous mycosis due to A. terreus in an immunocompetent patient from this part of India.

Penetrating extremity injuries can result in the development of arteriovenous fistulas (AVFs), whereby normal blood flow through the capillary bed is bypassed. Late complications of untreated AVFs include proximal arterial dilatation, venous congestion, congestive heart failure, and distal ischemia. We report the case of a 57-year-old man who was referred to us for treatment of a traumatic AVF with multiple sequelae, 34 years after he sustained a shrapnel injury to his right lower leg. We performed successful endovascular repair of this AVF with the patient under spinal anesthesia. Computed tomographic angiography (CTA) done 1 month and 6 months later confirmed AVF exclusion. Patients may present with sequelae of traumatic AVFs many years after their initial injury. Endovascular repair of AVFs offers several advantages over conventional repair and can be performed successfully even in the presence of complex anatomic abnormalities.

We present a case of osteoid osteoma with a history of mild pain, local swelling and point tenderness on the right lower leg. The diagnosis of osteoid osteoma was difficult due to the atypical clinical history and misleading radiological and bone scan findings. When it is difficult to differentiate an osteoid osteoma from osteomyelitis using CT, MRI or bone scan; HIG scintigraphy can be used to exclude an infection.

We report a case of a 39-year-old woman with a recurrent aneurysmal fibrous histiocytoma of the right lower leg. Cytogenetic analysis of the tumor specimen disclosed a 46,XX,t(12;19)(p12;q13) karyotype. Multicolor fluorescence in situ hybridization (M-FISH), followed by conventional FISH analysis, confirmed the reciprocal translocation as the sole cytogenetic anomaly, and allowed for the positioning of chromosomes 12 and 19 breakpoints proximal to the BCL3 gene and between ETV6 and PIK3C2G gene loci, respectively. Our case highlights the importance of distinguishing this recurrent but benign lesion from similarly appearing malignant skin tumors. Cytogenetic analysis may contribute to the diagnosis of this uncommon but distinctive clinicopathological entity.

Schwannoma is one of the most common neurogenic tumor, and is usually found solitary on a single peripheral nerve. We report three rare cases of multiple schwannoma experienced. [Case 1] 51-year-oldfemale, found with multiple soft tissue tumors, histologically diagnosed as schwannoma. Lumbar MRI showed multiple nodular tumor on the cauda equina, suspected to be neurogenic. [Case 2] 24-year-old female. soft tissue tumors of the right lower leg and foot were extracted, and diagnosed as schwannoma. During follow-up, the patient was found with another soft tissue tumor on the right thigh. MRI was taken, and the tumor was suspected to be neurogenic. [Summary] it is not uncommon to find multiple schwannoma on a single peripheral nerve. In this paper, we report three cases of multiple schwannoma found on two or more peripheral nerves and on the cauda equina.

In this case report a patient is presented with an extensive ulcerous cutaneous leiomyosarcoma which developed at the front of the right lower leg within a few months. This ulceration initially appeared as a venous ulceration and, accordingly an outpatient therapy was initiated. When the patient was admitted to the hospital metastases were already present. Ulcerous malignant skin tumours of the lower legs may clinically imitate a venous ulceration and therefore may not be diagnosed in appropriate time. In our patient case history, clinical morphology as well as missing signs of chronic venous insufficiency led to the definite diagnosis by histopathological examination.

An elliptical cylinder model developed by Jensen (1978) has been a widely accepted method for determining human segment inertial parameters. The goal of the present study was to evaluate the accuracy of the segment volume calculation step of this model. Three possible sources of error were examined: between-sex differences in body shape, image ratio, and human inconsistencies in digitizing. Volume estimates for the right lower arm + right hand, right lower leg + right foot, and whole body on 20 young men and women were calculated from digitized images at a ratio of 1:10 and 1:5 of the actual size (measured) and compared to values measured using an underwater displacement technique (criterion). Results showed no differences between the sexes on the accuracy of estimating the three volumes at either image ratio. Combining both sexes, the error in calculating segment volumes with an image-to-actual-size ratio of 1:10 were significantly larger, p < 0.05, than at a ratio of 1:5 for both the lower arm + hand (4.28 ± 2.92% vs. –0.43 ± 2.49%) and the whole body (4.80 ± 2.49% vs. 2.01 ± 2.17%). There was no significant change in mean for the lower leg + foot when the image was increased from 1:10 to 1:5 (–0.12 ± 3.92% vs. –0.81 ± 3.01%, respectively). Although not statistically significant, p > 0.05, a greater magnification seemed to have also reduced the influence of human inconsistencies, which was found to be a primary source of error. When the image-to-actual-size ratio is high (i.e., 1:5) and precaution is taken during digitization, the elliptical cylinder model provides accurate estimates of segment volumes of the whole body and extremities.

Cases of deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) related to the isolated risk factor of uterine myoma are very rare. In a setting of emergency department (ED), it is unlikely that uterine myoma would be suspected as the primary cause of symptoms in a patient with thromboembolism. We presented a 44-year-old woman who visited the ED for DVT presenting with right lower leg swelling with an underlying cause of a huge uterine myoma. Various aetiologies, including obstetric and gynaecological causes (especially uterine myoma), should be considered in female patients visiting the ED with suspected DVT or PTE.

A magnetic resonance imaging (MRI) technique for the assessment of contractile and noncontractile components of human skeletal muscle is described, and the inter-rater and intra-rater test-retest reliability for repeated measurements from the same MR image are examined. Twenty cross-sectional MR images from the right lower leg were obtained from 30 healthy young men and women (mean age 24.1 years, SD 3.3). The anatomical cross-sectional area (aCSA; cm2), the cross-sectional area of noncontractile components (Noncon; cm2), the contractile cross-sectional area (cCSA = aCSA minus Noncon; cm2), and the relative amount of Noncon (%), of the ankle dorsiflexor muscle compartment were determined for each slice using a computer-based image analysis system. Reliability for repeated measurements of the slice with the largest aCSA for the 30 subjects was analyzed by two raters on two different occasions. Inter-rater reliability on both occasions, assessed by the intraclass correlation coefficient (ICC), was excellent for cCSA (ICC3.1 = 0.99) and Noncon (ICC(3.1)0.82). Intra-rater (between occasions) reliability was excellent for the two raters for measurements of cCSA (ICC1.1 = 0.99) and Noncon (ICC1.10.94). Bland and Altman analyses did not identify any clinically relevant bias in the measurements. Method errors were acceptable: within subjects coefficients of variation (CV) was less than 1.8% for cCSA and less than 16.3% for Noncon. It is concluded that repeated measurements of contractile and noncontractile components of the ankle dorsiflexor muscle compartment, obtained from the same MR image, are highly reliable.

A 40-year-old gentleman presented with a 7-day history of a painful ulcer over the lateral aspect of his right lower leg. He was an intravenous drug user for the last 15 years and on a methadone programme for the previous 12 months. He admitted to the practice of “skin popping” (injecting drugs subcutaneously) over his right leg as he had exhausted all of the venous access sites. The ulcer had been present for the last 2 years and he did not seek any medical attention as this area was used as a “shooters patch” to inject illicit drugs. Clinical examination revealed a 22 15 cm ulcer over the lateral aspect of his right lower leg with a central area of necrosis approximating 12 8 cm (Fig. 1). The base of the ulcer extended down to the fibula. Radiographic examination

Most sporting compression stockings possess a graduated pressure profile. However, it remains unclear whether the graduated pressure profile is an essential feature for reducing the development of muscle fatigue. This study sought to examine the effect of the pressure profile of compression stockings on the degree of muscle fatigue of lower leg muscles induced by submaximal running exercise. 15 male subjects performed 30-min treadmill running in 1 control and 4 compression stocking conditions with the following profiles; 1) graduated low pressure, 2) graduated high pressure, 3) uniform pressure distribution, and 4) localized pressure just over the gastrocnemius muscle belly. Before and immediately after the exercise, T2-weighted magnetic resonance images of the right lower leg were obtained without testing garments. T2 values of the triceps surae and tibialis anterior were calculated from the images. T2 was significantly increased after the running in all conditions. The magnitude of T2 increase was significantly greater in the control than in other 3 conditions except for the one with graduated low pressure, whereas there were no significant differences among the latter 3 conditions. The findings suggest that a graduated pressure profile is not an essential feature of compression stockings for reducing the development of muscle fatigue during submaximal running exercise.