Association between walking ability and trunk and lower-limb muscle atrophy in institutionalized elderly women: a longitudinal pilot study.

BACKGROUND: The aim of this study was to investigate the association between walking ability and muscle atrophy in the trunk and lower limbs. METHODS: Subjects in this longitudinal study were 21 elderly women who resided in nursing homes. The thicknesses of the following trunk and lower-limb muscles were measured using B-mode ultrasound: rectus abdominis, external oblique, internal oblique, transversus abdominis, erector spinae, lumbar multifidus, psoas major, gluteus maximus, gluteus medius, gluteus minimus, rectus femoris, vastus lateralis, vastus intermedius, biceps femoris, gastrocnemius, soleus, and tibialis anterior. Maximum walking speed was used to represent walking ability. Maximum walking speed and muscle thickness were assessed before and after a 12-month period. RESULTS: Of the 17 measured muscles of the trunk and lower limbs, age-related muscle atrophy in elderly women was greatest in the erector spinae, rectus femoris, vastus lateralis, vastus intermedius, and tibialis anterior muscles. Correlation coefficient analyses showed that only the rate of thinning of the vastus lateralis was significantly associated with the rate of decline in maximum walking speed (r = 0.518, p < 0.05). CONCLUSIONS: This longitudinal study suggests that reduced walking ability may be associated with muscle atrophy in the trunk and lower limbs, especially in the vastus lateralis muscle, among frail elderly women.

Daytime physical activity patterns and physical fitness in institutionalized elderly women: an exploratory study.

This study investigated the relationship between daytime physical activity patterns and physical fitness in elderly women. The subjects comprised 19 elderly women who resided in a nursing home. Time spent lying, sitting, standing and walking and the number of steps taken during the daytime from 10:00 to 16:00 were measured to determine physical activity patterns. Physical fitness measures included muscle strength, balance, flexibility and physical performance. The elderly women spent 18.3% of their daytime walking, 7.31% in a standing position, 56.9% sitting and 17.4% lying down. Our results showed that the time spent in walking or standing positions was significantly associated with balance and physical performance such as walking speed, while the time spent in a sitting position was inversely associated with muscle strength, balance and physical performance. The results of this study suggest that the time the elderly spend on weight-bearing activities and in sedentary behavior are associated with physical fitness.

Hilar cholangiocarcinoma associated with sarcoid reaction in the regional lymph nodes.

A 74-year-old woman was admitted to our hospital with a 2-week history of jaundice. Percutaneous transhepatic cholangioscopy revealed a nodular tumor originating in the upper part of the common hepatic duct, which was invading the confluence of the right and left hepatic ducts. Microscopic examination of biopsy specimens revealed adenocarcinoma. Abdominal ultrasonography and computed tomography demonstrated multiple enlarged lymph nodes around the extrahepatic bile duct and the common hepatic artery. Laparotomy revealed lymph node enlargement in the hepatoduodenal ligament, behind the pancreatic head, and along the common hepatic and left gastric arteries. Extended left hepatic lobectomy, caudate lobectomy, and resection of extrahepatic bile duct with extended lymph node dissection were performed. The histology of permanent specimen revealed no tumor metastasis but a sarcoid reaction in the lymph nodes. The patient is in good health 21 months after the operation, without any evidence of recurrence. This is the first successfully resected case of hilar cholangiocarcinoma associated with sarcoid reaction in the regional lymph nodes.