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PubMed1972

Effects of prefrontal lesions on left leg-right leg differentiation in dogs.

Twenty five animals trained in the left leg-right leg differentiation were given orbital, proreal or medial precruciate lesions. Pure cortical ablations did not affect the task whereas these deep lesions involving the bundle of fibers inside the prefrontal region caused severe deficit. The medial lesions (superficial and deep) produced disinhibition of the intertrial reactions. The nature of the deficit in the differentiation and the relation between this deficit and the disinhibition is discussed.

Animals↗
PubMed2003

Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome.

BACKGROUND: There is a need for an easily administered instrument which can be applied to all patients with restless legs syndrome (RLS) to measure disease severity for clinical assessment, research, or therapeutic trials. The pathophysiology of RLS is not clear and no objective measure so far devised can apply to all patients or accurately reflect severity. Moreover, RLS is primarily a subjective disorder. Therefore, a subjective scale is at present the optimal instrument to meet this need. METHODS: Twenty centers from six countries participated in an initial reliability and validation study of a rating scale for the severity of RLS designed by the International RLS study group (IRLSSG). A ten-question scale was developed on the basis of repeated expert evaluation of potential items. This scale, the IRLSSG rating scale (IRLS), was administered to 196 RLS patients, most on some medication, and 209 control subjects. RESULTS: The IRLS was found to have high levels of internal consistency, inter-examiner reliability, test-retest reliability over a 2-4 week period, and convergent validity. It also demonstrated criterion validity when tested against the current criterion of a clinical global impression and readily discriminated patient from control groups. The scale was dominated by a single severity factor that explained at least 59% of the pooled item variance. CONCLUSIONS: This scale meets performance criteria for a brief, patient completed instrument that can be used to assess RLS severity for purposes of clinical assessment, research, or therapeutic trials. It supports a finding that RLS is a relatively uniform disorder in which the severity of the basic symptoms is strongly related to their impact on the patient's life. In future studies, the IRLS should be tested against objective measures of RLS severity and its sensitivity should be studied as RLS severity is systematically manipulated by therapeutic interventions.

Adult↗
PubMed1995

Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group.

A large International Restless Legs Syndrome (RLS) Study Group has been formed. As its first task, the group has taken upon itself the role of defining the clinical features of the RLS. As minimal criteria for diagnosis, the group proposes the following four features: (a) desire to move the extremities, often associated with paresthesias/dysesthesias; (b) motor restlessness; (c) worsening of symptoms at rest with at least temporary relief by activity, and (d) worsening of symptoms in the evening or night. Other features commonly seen in RLS include sleep disturbance, periodic limb movements in sleep and similar involuntary movements while awake, a normal neurological examination in the idiopathic form, a tendency for the symptoms to be worse in middle to older age, and, in some cases, a family history suggestive of an autosomal dominant mode of inheritance.

Age of Onset↗
PubMed2002

Effect of prior heavy arm and leg exercise on VO2 kinetics during heavy leg exercise.

The aim of the present study was to examine the effect of prior exercise at a remote site on the VO(2) kinetics during subsequent heavy cycle exercise using a model that allowed us to discriminate between the VO(2) fast and slow component responses. Ten male subjects completed a constant-load exercise of 6 min cycling at 90% of the VO(2)peak in three conditions: without prior exercise (LE-C), after heavy cycling exercise (6 min at 90% of the VO(2)peak) (LE-L) and after heavy arm-cranking exercise (6 min at 90% of the arm VO(2)peak) (LE-A). Subjects performed four repetitions of each exercise protocol, separated by at least 1 day. VO(2) was measured on a breath-by-breath basis and VO(2) kinetics were determined with a biexponential model. There were no significant differences in the VO(2) fast component parameters between LE-C, LE-L and LE-A. However, the VO(2) slow component amplitude was significantly reduced in LE-L and LE-A compared to LE-C, but the reduction was less pronounced in LE-A [the value of the VO(2) slow exponential term at the end of exercise, A(2)', was 657 (SD 200) ml x min(-1) in LE-C versus 384 (SD 136) ml x min(-1) in LE-L and 551 (SD 169) m x min(-1) in LE-A; P<0.05]. The results of this study demonstrate that prior heavy arm exercise alters VO(2) kinetics during cycling exercise by reducing the VO(2)slow component amplitude, though this reduction is smaller than the reduction observed following prior heavy leg exercise. These data indicate that the primary factor causing changes in the VO(2) kinetics is probably located in the involved muscle.

Adaptation, Physiological↗
PubMed2005

Effects of rest-duration, time-of-day and their interaction on periodic leg movements while awake in restless legs syndrome.

BACKGROUND AND PURPOSE: The diagnostic criteria for restless legs syndrome (RLS) indicate that both time-of-day and rest effects induce or aggravate symptoms. Periodic limb movements while awake (PLMW) provide an objective motor sign of RLS that can be measured during an awake suggested immobilization test (SIT). This study uses the SIT at different times of the day and analyzes time-of-day and duration-of-rest effects and their interaction on the PLMW. PATIENTS AND METHODS: Twenty-eight RLS patients who were not on medications had SIT tests at 10 pm, 8 am and 4 pm on two consecutive days. PLMW for each 20-min period were analyzed for time-of-day and rest effects and their interaction. PLMW increase from the first to last 20-min SIT period assessed the rest-effects. RESULTS: Significant effects were found for rest, time-of-day and rest-time-of-day interaction. The rest-effect increased most from morning to afternoon while total PLMW increased more from afternoon to night. Males compared to females had significantly more PLMW and a larger rest-effect change with time-of-day. CONCLUSIONS: Rest and time-of-day effects and their interaction all increase RLS symptoms. PLMW increase with rest may provide a sensitive measure of symptom severity.

Age Factors↗
PubMed1999

Clinical outcome and its predictors in 1560 patients with critical leg ischaemia. Chronic Critical Leg Ischaemia Group.

OBJECTIVE: to assess the predictivity of clinical variables in patients with chronic critical leg ischaemia (CLI). Design observational prospective cohort study. METHODS: the i.c.a.i. (ischemia critica degli arti inferiori) trial database was used to assess the impact of patients' history, cardiovascular risk, manifestations of the disease and specific invasive and pharmacological interventions on mortality, amputation rate and persistence of CLI. RESULTS: of 1560 patients, 298 died within one year; at six months 187 were amputees and 746 still suffered from CLI. Prior major vascular events doubled the risk of dying within one year. Previous revascularisation was associated with a lower mortality, but also with a higher probability of amputation. Among cardiovascular risk factors, only diabetes affected prognosis, in terms of increased mortality and lower probability of recovery from CLI. Patients with tissue loss had a higher amputation rate and less probability of recovery. Ankle pressure was predictive of mortality and amputation only when unmeasurable. Patients requiring revascularisation had better chances of recovering from CLI, but not of longer-term survival or limb salvage compared to those in whom surgery was deemed unnecessary. Antiplatelet drugs caused resolution of CLI and decreased the amputation rate by about 1/3, while the advantage of the test treatment (alprostadil-alpha-cyclodextrine) was confined to CLI resolution only. CONCLUSIONS: this study documents the high mortality and heterogeneity of patients with CLI. It provides stratification criteria for reliably estimating the achievable benefit in routine practice and for clinical trials.

Aged↗
PubMed1981

Relationships between leg muscle fiber type distribution and leg exercise performance.

The object of the present experiments was to study the impact of muscle fiber type composition on "aerobic" and "anaerobic" performance capacities. Muscle fiber type composition was determined on biopsies from the m. vastus lateralis of 29 healthy males, consisting of sedentary subjects, physical education students, and short- and long-distance runners. The subjects performed: (a) a 30-s all-out ride on a cycle ergometer; b) a short-term (60 s), isokinetic, one-leg exercise test, (c) a 40-m sprint run; d) a 300 m run; and (e) a 2000-m run. Correlations between muscle fiber composition, expressed as % fast twitch (FT) fibers on one hand, and peak power, maximal peak torque, power decrease, and peak torque decrease in the laboratory tests were significant (P less than O.001) for the trained subjects but not for the sedentaries. Average speed during the 40-m sprint and the 2000-m run was positively (P less than 0.001) and negatively (P less than 0.001) related, respectively, to % FT in the trained subjects whereas no such correlations were present for sedentaries. It is suggested that fiber type composition in trained males is one factor contributing to ability to perform short-term as well as endurance exercise. This statement may not be true for the general population.

Adolescent↗
PubMed1999

The influence of non-paretic leg movement on muscle action in the paretic leg of hemiplegic patients.

The aim of this investigation was to study the effect of non-involved-side exercise on the involved (paretic) leg-muscle of patients with stroke. Each of the ten adults studied attempted to perform, while seated, a predetermined sequence of the following actions : (1) a voluntary knee extension on the involved side; (2) a maximal, isometric knee-flexion on the non-involved side; (3) a maximal, isometric knee-flexion on the non-involved side with counter-resistance (in front of the ankle joint) on the involved side. The root-mean-square voltage was measured across the rectus femoris, the medial hamstring, the tibialis anterior, and the medial gastrocnemius muscles (on the involved side) with surface electrodes. The root-mean-square voltages of the involved-side rectus femoris and the tibialis anterior muscles were found to increase substantially during non-involved-side knee flexion relative to that detected for voluntary knee extension on the involved side. The voltage of the rectus femoris muscle increased substantially also when counter-resistance was present. There was no similar substantial increase of muscular activity, in the medial hamstring and medial gastrocnemius, induced by contralateral isometric knee-flexion. This study suggests that, among patients with severe hemiplegia, isometric knee flexion in the non-involved side may be useful for facilitating the paretic rectus femoris and tibialis anterior muscular activities.

Aged↗
PubMed1998

Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study.

Periodic limb movements during sleep (PLMS), with or without symptoms of a restless legs syndrome (RLS), may cause sleep disturbances. The pharmacologic treatments of choice are dopaminergic drugs. Their use, however, may be limited due to tolerance development or rebound phenomena. Anecdotal observations have shown that oral magnesium therapy may ameliorate symptoms in patients with moderate RLS. We report on an open clinical and polysomnographic study in 10 patients (mean age 57 +/- 9 years; 6 men, 4 women) suffering from insomnia related to PLMS (n = 4) or mild-to-moderate RLS (n = 6). Magnesium was administered orally at a dose of 12.4 mmol in the evening over a period of 4-6 weeks. Following magnesium treatment, PLMS associated with arousals (PLMS-A) decreased significantly (17 +/- 7 vs 7 +/- 7 events per hour of total sleep time, p < 0.05). PLMS without arousal were also moderately reduced (PLMS per hour of total sleep time 33 +/- 16 vs 21 +/- 23, p = 0.07). Sleep efficiency improved from 75 +/- 12% to 85 +/- 8% (p < 0.01). In the group of patients estimating their sleep and/or symptoms of RLS as improved after therapy (n = 7), the effects of magnesium on PLMS and PLMS-A were even more pronounced. Our study indicates that magnesium treatment may be a useful alternative therapy in patients with mild or moderate RLS-or PLMS-related insomnia. Further investigations regarding the role of magnesium in the pathophysiology of RLS and placebo-controlled studies need to be performed.

Aged↗
PubMed2003

The prevalence of restless legs syndrome among pregnant women in Japan and the relationship between restless legs syndrome and sleep problems.

STUDY OBJECTIVES: To clarify the prevalence of restless legs syndrome (RLS) in pregnant women living in Japan and to analyze the relationship between sleep problems and RLS, in order to discuss ways for pregnant women to obtain comfortable sleep and to improve the health of both the mother and child. DESIGN: A cross-sectional questionnaire survey. SETTING: 500 clinical institutions with maternity services were randomly sampled from a list of organizations identified in a survey by the Japan Association of Obstetricians and Gynecologists. Of these 500 institutions, 260 participated in the survey. PARTICIPANTS: 16,528 pregnant women living in Japan. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: In this survey of pregnant women, the prevalence of RLS was found to be 19.9%. An analysis was conducted on the relationship between RLS and other factors such as subjective evaluation of sleep, difficulty initiating sleep, difficulty maintaining sleep, early morning awaking, and excessive daytime sleepiness. The result of this analysis suggested that women with these sleep-related problems were more likely to have RLS than those without. In addition, RLS was more prevalent in the later stages of pregnancy. CONCLUSION: In the pregnant women in our survey, the prevalence of RLS was found to be 19.9%, which is higher than the prevalence of RLS that has been found in the general public in a previous study. This suggests that RLS-related sleep problems may be an important public health issue among pregnant women in Japan. This finding may have implications for attempts to improve sleep hygiene in this group.

Adult↗
PubMed1983

Radiating leg pain and positive straight leg raising in spondylolysis in children.

Three children presented with low back pain radiating to the leg and with spasm of the hamstring and paravertebral muscles. Since the pain could not be ascribed to trauma, it was necessary to exclude the presence of infection or tumors. All the signs--localization of the pain, tenderness on one side of the back, X-ray film findings of unilateral or bilateral spondylolysis, and localized positive bone scan--pointed to spondylolysis as the cause of pain. All three children exhibited symptoms resembling those found in the facet syndrome described by Mooney and Robertson.

Adolescent↗
PubMed1987

Flucloxacillin in chronic leg ulcers. Penetration of flucloxacillin into chronic leg ulcer exudate and the effect on the bacteria.

The penetration of flucloxacillin into ulcer exudate was investigated in six patients with chronic leg ulcers. The flucloxacillin dosage used was 1 g orally three times daily for three days, and the serum and exudate concentrations were measured repeatedly during a 10 h-period following the first and the seventh dose. All the ulcers were contaminated with (S. aureus) Staphylococcus aureus either in pure culture (three ulcers) or in culture mixed with Gram-negative bacteria (three ulcers). Bacterial counting in the ulcers was performed twice before and twice during the antibiotic treatment. The flucloxacillin concentrations measured in the ulcer exudate were found to be lower than the corresponding serum concentrations. However, the exudate concentrations were found to be above the minimum inhibitory concentration (MIC) for the contaminating S. aureus during an average of 7 h after each dose, and the number of S. aureus during the treatment period was reduced to less than 0.01% of the initial number. The Gram-negative bacteria were not susceptible to flucloxacillin. The number of these bacteria decreased before flucloxacillin treatment but increased again during treatment, probably owing to the changed conditions in the ulcers following the marked decrease in the number of S. aureus.

Aged↗
PubMed1984

[A study on torsion of the lower leg in osteoarthritis of the knee. Measurement of leg torsion by computerized tomography].

UNLABELLED: Lower leg torsion was measured by computerized tomography (CT-scan) in the knees with osteoarthritis. MATERIALS AND METHODS: Experimental studies; Using the Toshiba CT/TCT-60A, the degree of torsion in five dried tibias were measured in three positions of varus, 0 degrees, 10 degrees and 20 degrees; and in two positions of flexion 0 degrees and 20 degrees. Clinical studies; The degree of tibial torsion was measured by CT-scan in 68 adult patients (85 knees) and compared with the torsion in 13 controls (24 tibias). The correlation between tibial torsion and osteoporosity was investigated by measuring CT-density of the third lumbar vertebra. RESULTS: No statistically significant difference was found among the results of measurement obtained in five dried tibias placed in three positions of varus and in two positions of flexion. These results indicate that measurement of torsion using CT-scan is not influenced by the position when varus and flexion deformity are less than 20 degrees. Osteoarthritic knees were divided into five radiographic stages. There were significant differences between the lateral tibial torsions for each stage. The lateral tibial torsion was 23.5 degrees in normal adults, 14.1 degrees in stage II, 11.9 degrees in stage III, 7.5 degrees in stage IV and V, for an average of 11.3 degrees. The rate of decrease in lateral tibial torsion was 59.6% in the proximal tibia, 4.2% in the tibial shaft and 36.2% in the distal tibia. The decreases of lateral tibial torsion were correlated with decrease of CT-density of the third lumbar vertebra. CONCLUSION: It is apparent from this study that there is a correlation between decreasing lateral tibial torsion with the radiographic stage of osteoarthritis of the knee and general osteoporosity.

Adult↗
PubMed1984

[The anterior tibial artery and vascularization of the muscles of the anterior compartment of the leg. Application to the anterior compartment syndrome of the leg].

The arterial vascularisation of the anterior loge of the leg is supply by the anterior tibial artery. Three muscles are contained in an inextensible space. Each of this muscles received an arterial supply proportional to his volume. The fragility to ischemy of the extensor hallucis longus is not explained by insufficiency of this arterial branches.

Angiography↗
PubMed2007

The Ulcerated Leg Severity Assessment score for prediction of venous leg ulcer healing.

BACKGROUND: The aim of the study was to create a reliable scoring system for the prediction of venous ulcer healing in patients treated with compression. METHODS: A prospective baseline study to identify risk factors for venous ulcer healing was undertaken between March 1999 and August 2001. All patients were treated with multilayer compression. A number of variables were related to 24-week healing rates. A Cox regression model was used to identify risk factors that predicted ulcer healing, from which a scoring system was developed and validated prospectively between February 2004 and March 2005. RESULTS: In the baseline study of 229 patients, patient age, ulcer chronicity and venous refill time (VRT) of 20 s or less were identified as risk factors. Using these factors and hazard ratios from the Cox regression analysis, the following formula was devised: Ulcerated Leg Severity Assessment (ULSA) score=age+chronicity-50 (when VRT is greater than 20 s). Patients with an ULSA score of 50 or less had higher 24-week ulcer healing rates than those with higher scores in both the baseline study (P<0.001, log rank test) and the validation study performed in 86 patients (P=0.007, log rank test). CONCLUSION: The ULSA score may help to identify patients with venous ulcers unlikely to respond to conventional treatment who could be offered alternative therapy.

Adult↗