Humans ; Leg/pathology* ; Skin Neoplasms/pathology* ; Lymphoma, Large B-Cell, Diffuse/pathology*

Objective: To evaluate the associations of sarcopenia, handgrip strength and calf circumference with cognitive impairment among Chinese older adults. Methods: Totally 2,525 older adults were recruited from the Healthy Aging and Biomarkers Cohort Study. Cognitive impairment was assessed by the Chinese Mini-Mental State Examination. Handgrip strength was calculated from the means of the right and left hand values. Calf circumference was measured at the site of maximum circumference of the non-dominant leg. The formula developed by Ishii was used to define sarcopenia. Multiple logistic regression was performed to evaluate the associations of sarcopenia, handgrip strength, and calf circumference with cognitive impairment. Results: The prevalence of cognitive impairment was 34.36%. The adjusted odds ratio ( Conclusion Sarcopenia, identified by low handgrip strength and low calf circumference, was positively associated with cognitive impairment.
Aged ; Aged, 80 and over ; China/epidemiology* ; Cognitive Dysfunction/etiology* ; Female ; Hand Strength ; Humans ; Leg/anatomy & histology* ; Logistic Models ; Male ; Sarcopenia/pathology*

Lymphedema, a chronic disease that lowers patients' quality of life, is categorized as primary or secondary. Secondary lymphedema can be improved by treating the underlying cause. However, in many cases, efforts are not made to identify the primary cause of lymphedema and treatment is targeted at the edema itself, resulting in misdiagnosis. Here, we describe the case of a 61-year-old man with right leg edema of unknown cause that had persisted for 3 years. Intestinal tuberculosis was confirmed during a re-evaluation of the cause, and his symptoms improved after anti-tuberculous treatment. This improvement was assessed qualitatively by indocyanine green lymphography before and after treatment, as well as by observation of the clinical symptoms. Lower extremity lymphedema caused by intestinal tuberculosis is extremely rare, and this case reveals the importance of continuing to identify the causes of resistant pathologies.
Chronic Disease ; Diagnostic Errors ; Edema ; Humans ; Indocyanine Green ; Leg ; Lower Extremity ; Lymphedema ; Lymphography ; Middle Aged ; Pathology ; Quality of Life ; Tuberculosis

PURPOSE: The aim of this study was to analyze anatomical popliteal artery entrapment syndrome (PAES) and to individualize the treatment of this condition according to the anatomical status of the artery and the adjacent structure. METHODS: A total of 35 anatomical PAES legs in 23 consecutive patients treated within the Asan Medical Center, Seoul, Korea between 1995 and 2011 were analyzed retrospectively. Anatomical PAES was diagnosed by MRI and/or CT scans of the knee joint, and CT or conventional transfemoral arteriography of the lower extremities. RESULTS: We noted a type II gastrocnemius medial head (GNM) anomaly, a type III GNM anomaly, or an aberrant plantaris muscle in 51.4%, 20%, and 28.6% of PAES legs, respectively. In assessments of the arterial lesions, popliteal or tibial artery occlusion was noted in 19 of 26 symptomatic PAES legs. For cases without popliteal artery lesions, myotomy of the anatomically deranged muscle was performed in 5 of 7 symptomatic and 4 of 9 asymptomatic PAES legs. For occluded popliteal arteries, we performed ten direct repairs of the pathological popliteal artery and 4 femoro-below the knee popliteal bypass surgeries. As a result of the arterial Surgery, 9 direct procedures with myotomy yielded a patent artery, while 3 graft failures were noted in the bypass group. The median follow-up period was 84 months (range, 12–206 months). CONCLUSION: We recommend that treatment of PAES should be individualized based on pathology, symptoms, and various imaging studies.
Angiography ; Arteries ; Chungcheongnam-do ; Follow-Up Studies ; Head ; Humans ; Knee ; Knee Joint ; Korea ; Leg ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle, Skeletal ; Pathology ; Popliteal Artery* ; Retrospective Studies ; Seoul ; Tibial Arteries ; Tomography, X-Ray Computed ; Transplants

INTRODUCTIONThe pattern of venous reflux in Thai patients with chronic venous insufficiency (CVI) was studied in correlation with clinical manifestations.

METHODSUltrasonography findings and clinical data were prospectively collected and retrospectively reviewed.

RESULTSCVI was found in 104 legs of 79 patients (mean age 59.8 ± 12.5 years; C4: 24.1%, C5: 8.9%, C6: 67.1%). 6.7% of the legs had a history of deep vein thrombosis (DVT). The prevalence of superficial vein reflux (SVR), deep vein reflux (DVR), and combined SVR and DVR in 90 legs without previous venous surgery was 82.2%, 63.3% and 57.8%, respectively. In legs with SVR, the prevalence of great saphenous vein reflux (GSVR), small saphenous vein reflux (SSVR), and combined GSVR and SSVR was 91.9%, 33.8% and 25.7%, respectively. 77.0% of SVR involved the calf segment. For medial ulceration, 79.6% had GSVR and 35.2% had SSVR. For lateral ulceration, 46.7% had SSVR and 33.3% had isolated GSVR. Pulsatile venous signal was found in 3.3% of legs. In 17 legs with ulceration after previous surgical treatment, calf vein reflux (residual calf great saphenous vein or small saphenous vein) was found in 13 (76.5%) legs.

CONCLUSIONCalf vein reflux plays an important role in CVI and in patients with recurrent ulceration after previous superficial venous surgery. Although GSVR was present in most patients with CVI in the legs, SSVR may present in one-third of patients, especially those with lateral ulceration. The high prevalence of DVR in the absence of DVT and the presence of a pulsatile venous signal in some patients highlight the incomplete understanding of CVI aetiology.

Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Chronic Disease ; Female ; Humans ; Leg ; blood supply ; pathology ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Saphenous Vein ; diagnostic imaging ; Severity of Illness Index ; Thailand ; Ultrasonography ; Vascular Surgical Procedures ; Venous Insufficiency ; diagnostic imaging ; Venous Thrombosis ; diagnostic imaging

OBJECTIVE: To evaluate the diagnostic value of computed tomography-myelography (CTM) compared to that of magnetic resonance imaging (MRI) in patients with lumbar radiculopathy. METHODS: The study included 91 patients presenting with radicular leg pain caused by herniated nucleus pulposus or lateral recess stenosis in the lumbar spine. The degree of nerve root compression on MRI and CTM was classified into four grades. The results of each imaging modality as assessed by two different observers were compared. Visual analog scale score for pain and electromyography result were the clinical parameters used to evaluate the relationships between clinical features and nerve root compression grades on both MRI and CTM. These relationships were quantified by calculating the receiver-operating characteristic curves, and the degree of relationship was compared between MRI and CTM. RESULTS: McNemar's test revealed that the two diagnostic modalities did not show diagnostic concurrence (p<0.0001). Electromyography results did not correlate with grades on either MRI or CTM. The visual analog pain scale score results were correlated better with changes of the grades on CTM than those on MRI (p=0.0007). CONCLUSION: The present study demonstrates that CTM could better define the pathology of degenerative lumbar spine diseases with radiculopathy than MRI. CTM can be considered as a useful confirmative diagnostic tool when the exact cause of radicular pain in a patient with lumbar radiculopathy cannot be identified by using MRI. However, the invasiveness and potential complications of CTM are still considered to be pending questions to settle.
Constriction, Pathologic ; Electromyography ; Humans ; Leg ; Magnetic Resonance Imaging* ; Myelography ; Pain Measurement ; Pathology ; Radiculopathy* ; Spine ; Visual Analog Scale

STUDY DESIGN: Histopathological analyses were performed in ligamentum flavum (LF) hypertrophy patients with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH). PURPOSE: The aim of the present study was to evaluate histopathological changes in LF patients with LSS and LDH. OVERVIEW OF LITERATURE: LSS is the most common spinal disorder in elderly patients. This condition causes lower back and leg pain and paresis, and occurs as a result of degenerative changes in the lumbar spine, including bulging of the intervertebral discs, bony proliferation of the facet joints, and LF thickening; among these, LF thickening is considered a major contributor to the development of LSS. METHODS: A total of 71 patients operated with the surgical indications of LSS and LDH were included. LF samples were obtained from 31 patients who underwent decompressive laminectomy for symptomatic degenerative LSS (stenotic group) and from 40 patients who underwent lumbar discectomy for LDH (discectomy group). LF materials were examined histopathologically, and other specimens were examined for collagen content, elastic fiber number and array, and presence of calcification. RESULTS: The stenotic and discectomy groups did not differ with regard to mean collagen concentration or mean elastic fiber number (p=0.430 and p=0.457, respectively). Mean elastic fiber alignment was 2.36±0.99 in the stenotic group and 1.38±0.54 in the discectomy group (p<0.001). Mean calcification was 0.39±0.50 in the stenotic group, whereas calcification was not detected (0.00±0.00) in the discectomy group; a statistically significant difference was detected (p<0.001) between groups. CONCLUSIONS: LF hypertrophy in spinal stenosis may occur as a result of elastic fiber misalignment along with the development of calcification over time. Further studies determining the pathogenesis of LSS are needed.
Aged ; Collagen ; Diskectomy ; Elastic Tissue ; Humans ; Hypertrophy ; Intervertebral Disc ; Laminectomy ; Leg ; Ligamentum Flavum* ; Paresis ; Pathology ; Spinal Stenosis* ; Spine ; Zygapophyseal Joint

STUDY DESIGN: Fifty patients surgically treated for tethered cord syndrome (TCS) were retrospectively studied at Liaquat National Hospital, Karachi from 2010 until 2014. PURPOSE: To assess the common presentations of TCS in our part of the world and the surgical outcome of the different presentations. OVERVIEW OF LITERATURE: TCS is a stretch-induced functional disorder of the spinal cord with its caudal part anchored by an inelastic structure, which results in characteristic symptoms and signs. Due to the variety of lesions and clinical presentations and the absence of high-quality clinical outcome data, the decision regarding treatment is difficult. METHODS: Fifty consecutive patients with TCS were reviewed retrospectively with a follow-up period of 12–48 months. The majority of the patients were 0-15 years of age with the mean age of 4 years. The presenting complaints and the associated pathologies were documented, and the patients were assessed using the new Karachi TCS severity scale for clinical assessment. RESULTS: Eighty five percent of the patients with thickened filum terminale improved. Sixty six percent of the patients with diastematomyelia, 60% with lipoma and only 46% with myelomeningocele showed clinical improvement postoperatively. Sixty two percent of the patients who presented with paraperesis improved following surgery while 37% remained stable and only one patient deteriorated. Back and leg pain improved in 93% of patients and 50% of patients with urinary impairment improved. CONCLUSIONS: Outcome of patients with TCS varies according to pathology and severity of symptoms. Diastematomyelia and thickened filum had the best outcome. The Karachi TCS severity scale is a valid tool for future studies.
Cauda Equina ; Follow-Up Studies ; Humans ; Leg ; Lipoma ; Meningomyelocele ; Neural Tube Defects* ; Pathology ; Retrospective Studies ; Spinal Cord ; Spine

Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4-5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method.
Adult ; Decompression ; Diagnosis, Differential ; Electrocoagulation ; Humans ; Leg ; Methods ; Pathology ; Postoperative Period ; Radiculopathy ; Varicose Veins*

In this study, we describe our diagnosis and treatment of two patients who presented with femoral vessel compression caused by a cystic lesion in the groin. One case was diagnosed as adventitial cystic disease (ACD) of the common femoral artery resulting in leg claudication and the other was diagnosed as a ganglion cyst (GC) causing femoral vein compression and unilateral leg swelling. The operative findings differed between these two cases with respect to the dissection of the cyst and femoral vessel, but the postoperative histological examination results were similar. The pathogenesis of ACD and GC is not fully understood, and further investigation is needed to delineate the exact pathology of these uncommon conditions.
Adventitia ; Diagnosis ; Femoral Artery ; Femoral Vein ; Ganglion Cysts ; Groin* ; Hip ; Humans ; Leg ; Pathology