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PubMed2000

Lower extremity neuropathies associated with lithotomy positions.

BACKGROUND: The goal of this project was to study the frequency and natural history of perioperative lower extremity neuropathies. METHODS: A prospective evaluation of lower extremity neuropathies in 991 adult patients undergoing general anesthetics and surgical procedures while positioned in lithotomy was performed. Patients were assessed with use of a standard questionnaire and neurologic examination before surgery, daily during hospital stay in the first week after surgery, and by phone if discharged before 1 postoperative week. Patients in whom lower extremity neuropathies developed were observed for 6 months. RESULTS: Lower extremity neuropathies developed in 15 patients (1.5%; 95% confidence interval, 0.8-2.5%). Unilateral or bilateral nerves were affected in patients as follows: obturator (five patients), lateral femoral cutaneous (four patients), sciatic (three patients), and peroneal (three patients). Paresthesia occurred in 14 of 15 patients, and 4 patients had burning or aching pain. No patient had weakness. Symptoms were noted within 4 h of completion of the anesthetic in all 15 patients. These symptoms resolved within 6 months in 14 of 15 patients. Prolonged positioning in a lithotomy position, especially for more than 2 h, was a major risk factor for this complication (P = 0.006). CONCLUSIONS: In this surgical population, lower extremity neuropathies were infrequent complications that were noted very soon after surgery and anesthesia. None resulted in prolonged disability. The longer patients were positioned in lithotomy positions, the greater the chance of development of a neuropathy. These findings suggest that a reduction of duration of time in lithotomy positions may reduce the risk of lower extremity neuropathies.

Adult↗
PubMedDate not supplied

Effect of graft bed on long-term functional results of extremity skin grafts.

The purpose of the current study was to determine whether the long-term functional results of extremity burns grafted on fat were different from those grafted on fascia. Twelve patients (mean burn size, 38% TBSA) who had fascial excision of the majority of one or more extremities were examined a minimum of one year postinjury. Range of motion, motor strength, and sensation of the fascially excised extremities were measured. Twelve comparable patients with extremity burns (mean burn size, 35% TBSA) who had grafts placed on fat were used as positive controls. Patients whose burns were excised to fat had better joint mobility (P = 0.001) and sensory function (P = 0.001) than did patients whose burns were excised to fascia. Both groups had comparable muscle strength. These results indicate that patients with full-thickness burns of the extremities who have grafts placed on fat have significantly better long-term extremity function than do patients who have their skin grafts placed on fascia.

Adipose Tissue↗
PubMed1996

Abbreviated Injury Scale does not reflect the added morbidity of multiple lower extremity fractures.

OBJECTIVES: To determine if patients with multiple lower extremity fractures have worse outcomes than do patients with isolated femur fractures, and to determine if the Abbreviated Injury Scale (AIS) should distinguish between single and multiple lower extremity fractures. DESIGN: A retrospective study. MATERIALS AND METHODS: All blunt trauma patients at least 15 years of age treated at a level 1 trauma center from January 1990 through December 1993. Three groups of patients were selected. Group 1 included 50 patients whose only significant injury was a diaphyseal femur fracture. They had no other long bone fractures, minimal injuries to other body areas, and an Injury Severity Score (ISS) < or = 14. Group 2 was consisted of 29 patients with a femur fracture, at least one other diaphyseal lower extremity fracture, and also an ISS < or = 14. Group 3 consisted of 23 patients who had fracture patterns similar to those of group 2, but also had more severe nonextremity injuries (ISS > or = 15). Hospital morbidity and mortality rates were compared with t tests or chi-square analysis. Type 1 error probability was established at p < 0.05. MEASUREMENTS AND MAIN RESULTS: Compared with patients in group 1, patients in group 2 had an identical ISS (10.1 vs. 10.6, respectively), but had higher transfusion requirements (0.3 vs. 3.9 units), more days in the intensive care unit (ICU) (0.02 vs. 1.4), a higher incidence of adult respiratory distress syndrome (ARDS) (0 vs. 14%), longer hospital stays (6.0 vs. 14.8 days), greater disability at discharge (disability score 2.2 vs. 3.2), and a higher mortality rate (0 vs. 3.4%; p < 0.05 all variables). Patients in group 3 had worse outcomes than the other two groups: ISS = 30.1; transfusions = 11.9 units; ICU days = 9.1; ARDS incidence = 26%; hospital days = 29.9; disability score = 3.9; mortality = 26% (p < 0.05). CONCLUSIONS: Although AIS and ISS appropriately reflect the impact of extraskeletal injuries in patients with femur fractures, they do not adequately reflect the increased morbidity associated with multiple lower extremity fractures. The AIS-Extremity Score may need to be upgraded for multiple long bone fractures of the lower extremities.

Abbreviated Injury Scale↗
PubMed1989

Composite in situ vein bypass for upper extremity revascularization.

Chronic upper extremity arterial insufficiency is rare. Consequently, major reports specifically limited to the topic are scarce, and the clinical experience is small. In addition, symptomatology, diagnostic criteria, and guidelines for surgical management remain ill-defined. In the lower extremities, however, in situ vein bypass has been attempted for nearly three decades. This technique offers many advantages over traditional revascularization methods. Although the procedure has become popular for the lower extremity, no report of its use in the upper extremity is found in the literature. We report what may be the first case in which in situ bypass was used in the upper extremity for a threatened limb secondary to diabetic occlusive vascular disease complicated by a previous shunt used for hemodialysis. Revascularization of the upper extremity using the in situ vein bypass technique may offer a new alternative to traditional methods of revascularization.

Adult↗
PubMed2000

Limb salvage of lower-extremity wounds using free gracilis muscle reconstruction.

An extensive series reviewing the benefits and drawbacks of use of the gracilis muscle in lower-extremity trauma has not previously been collected. In this series of 50 patients, the use of microvascular free transfer of the gracilis muscle for lower-extremity salvage in acute traumatic wounds and posttraumatic chronic wounds is reviewed. In addition, the wound size, injury patterns, problems, and results unique to the use of the gracilis as a donor muscle for lower-extremity reconstruction are identified. In a 7-year period from 1991 to 1998, 50 patients underwent lower-extremity reconstruction using microvascular free gracilis transfer at the University of Maryland Shock Trauma Center, Johns Hopkins Hospital, and Johns Hopkins Bayview Medical Center. There were 22 patients who underwent reconstruction for coverage of acute lower-extremity traumatic soft-tissue defects associated with open fractures. The majority of patients were victims of high-energy injuries with 91 percent involving motor vehicle or motorcycle accidents, gunshot wounds, or pedestrians struck by vehicles. Ninety-one percent of the injuries were Gustilo type IIIb tibial fractures and 9 percent were Gustilo type IIIc. The mean soft-tissue defect size was 92.2 cm2. Successful limb salvage was achieved in 95 percent of patients. Twenty-eight patients with previous Gustilo type IIIb tibia-fibula fractures presented with posttraumatic chronic wounds characterized by osteomyelitis or deep soft-tissue infection. Successful free-tissue transfer was accomplished in 26 of 28 patients (93 percent). All but one of the patients in this group who underwent successful limb salvage (26 of 27, or 96 percent) are now free of infection. Use of the gracilis muscle as a free-tissue transfer has been shown to be a reliable and predictable tool in lower-extremity reconstruction, with a flap success and limb salvage rate comparable to those in other large studies.

Accidents, Traffic↗
PubMed1997

Degree of disc disruption and lower extremity pain.

STUDY DESIGN: Data were collected prospectively from patient-completed pain drawings, lumbar discographic pain responses, and computed tomographic-discographic images. OBJECTIVES: To determine if there were differences in pain location or the type of pain associated with the severity of symptomatic disc disruption. SUMMARY OF BACKGROUND DATA: Lower extremity pain related to spinal pathology was for a long time attributed primarily to nerve root compression. However, this simple model could not explain all lower extremity pain. Other mechanisms such as biochemical agents have been implicated. Also, nerve endings have been found in the outer layers of the anulus. Such endings could be associated with pain referred from the disc into the lower extremities. Pain drawings have been used in several studies to investigate various back pain origins and provide an easily administered method to document pain location. METHODS: Pain drawings were completed by 187 patients undergoing discography at the three lowest levels. The study group consisted of 118 men and 69 women with an average age of 37.2 years (range, 18-62 years). Computed tomographic discograms were scored using the Dallas discogram description, which assigns separate scores for discs with disruption of outer anular fibers (Grade 2) and those with disruption of the outermost anular layers associated with deformation or herniation of the outer anular well (Grade 3). The pain response provoked with each disc injection was recorded as pressure only or painless, pain dissimilar to clinical symptoms, similar to symptoms, or the exact reproduction of clinical pain, in this study, the similar and exact reproduction responses were combined and considered to be "symptomatic." The drawings were classified based on the presence or absence of pain in three regions: low back or buttocks, thigh, and leg. The drawings were also scored using the system described by Ransford, and those that were likely to be indicative of psychological problems were analyzed separately (N = 43). RESULTS: There was no significant difference in the distal location of lower extremity pain among patients whose most severe symptomatic disc disruption was a Grade 2 compared with those with symptomatic Grade 3 disruption (62.2% vs. 61.7%; P > 0.75; chi-square). The figure was similar for patients with both symptomatic Grade 2 and 3 disruption (72.7%). However, patients with symptomatic Grade 2 disruption used significantly more symbols to describe their pain, and in particular aching pain, than did those with symptomatic Grade 3 disruption. CONCLUSIONS: These results indicate that disc disruption passing into the outer layers of the anulus, but not resulting in deformation of the outer anular wall, was as frequently associated with lower extremity pain as were discs with more severe disruption deforming the outer anular wall; however, they were associated with a greater degree of aching pain. These findings support that lower extremity pain may be referred from the disc.

Adolescent↗
PubMed1998

Low back pain in college athletes. A prospective study correlating lower extremity overuse or acquired ligamentous laxity with low back pain.

STUDY DESIGN: A prospective evaluation of the incidence of low back pain in college athletes was undertaken. OBJECTIVES: To evaluate prospectively leg length discrepancy, hip flexor tightness, and lower extremity acquired laxity or overuse as predictive factors for low back pain in college athletes. SUMMARY OF BACKGROUND DATA: A pilot study found an association between low back pain and the factors to be studied. Several allusions to the kinetic chain theory appear in the literature, but little prospective research has been done in examining the effects of lower extremity involvement on the back. METHODS: Two-hundred fifty-seven college athletes representing nine varsity sports were screened during a preseason sports physical examination. Measures of flexibility, ligamentous stability, leg length discrepancy, and overuse syndromes were recorded. Athletes were observed throughout the ensuing year for low back pain requiring treatment by the athletic trainer. Those athletes with low back pain as the result of direct trauma to the region were excluded from the data. RESULTS: Twenty-four athletes (9.3%) received treatment for low back pain. Thirteen of 87 women (15%) compared with 11 of 170 men (6%) required treatment for low back pain (P = 0.048). Of 57 athletes with lower extremity acquired laxity or overuse, low back pain developed in 14 (P < 0.001). CONCLUSIONS: Athletes with lower extremity acquired ligamentous laxity or overuse may be at risk for the development of noncontact low back pain during athletic competition. Female athletes with lower extremity involvement appeared to have a higher incidence of low back pain treatment compared with their male counterparts. Inflexibility of the lower extremities or leg length discrepancy were not associated with future low back pain treatment.

Adult↗
PubMed1998

Lower extremity morphology and alignment and risk of overuse injury.

OBJECTIVE: Lower extremity alignment factors, including tibiofemoral angle, quadriceps angle (Q-angle), and limb length discrepancies, are commonly thought to be clinically relevant as contributing factors to overuse injuries of the lower extremities. To explore the scientific rationale for these clinical beliefs, we conducted a review of the available English language literature from 1966 to July 1997 relating overuse injury to lower extremity alignment. DATA SOURCES: MEDLINE was searched for medical subject headings and title key words to locate published works relating lower extremity morphologic characteristics to risk of overuse injury. Additional references were reviewed from reprint collections and reference lists of published work. DATA EXTRACTION AND SYNTHESIS: Relevant studies were reviewed for strengths and weaknesses in design, analysis, and conclusions. Synthesis across studies concentrated on commonalities and differences of methods in definition of exposure and outcome variables. MAIN RESULTS: Six population-based studies have been conducted evaluating some aspect of lower extremity alignment as a risk factor for overuse injury. Three of these studies evaluated military recruits in basic training, two studied mixed groups of athletes and one studied folk dancers. The time frame across studies ranged from 12 weeks to 52 weeks. A key finding was the considerable variation in the measure of lower limb alignment used as the exposure variable, as well as the method of measurement used to quantify the exposure. Some studies relied on visual examination, whereas others used digitized photographic techniques. Moreover, each study varied in the definition used for overuse injury; outcomes ranged from self-reported cases of shin splints to radiographic confirmation of stress fracture. Five of the six studies evaluated some aspect of foot morphology, whereas only one evaluated full leg alignment parameters. CONCLUSIONS: Results were conflicting but, in general, did not support clinical beliefs of the detrimental effects of decreased longitudinal foot arch and varus tibiofemoral alignment as risk factors for lower extremity overuse injury. Differences in methodologic rigor and outcome definition prevent a meaningful synthesis of existing work. Directions for future research are suggested.

Athletic Injuries↗
PubMed1999

Upper extremity stress fractures in athletes: clinical features of 44 cases.

PURPOSE: To review the clinical features of a large series of active patients with a stress fracture in a non-weight-bearing location of the upper extremity or ribs. DESIGN: Multicenter cross-sectional study. SETTING: Multiple academic medical centers. PARTICIPANTS: 44 patients with a diagnosis of upper extremity or rib stress fracture. MAIN OUTCOME MEASURES: Clinical features according to anatomic location, primary sport, and subdivided according to the nature of the sport-specific skills involved. RESULTS: A diagnosis of stress fracture was made in 44 patients based on history and physical examination, and confirmed by radiography, scintigraphy, magnetic resonance imaging (MRI), computed tomography (CT), or a combination of imaging techniques. Patients were subjectively divided into four categories based on the predominant type of upper extremity activity required for participation in their sport: 1) weight lifter (e.g., football, weight lifting, wrestling); 2) upper extremity weight bearer (e.g., gymnastics, diving, cheerleading); 3) thrower (e.g., pitcher, soccer goalie, javelin); or 4) swinger (e.g., golf, tennis). We noted that all fractures in the weight bearers occurred distal to the elbow, whereas in the throwers most fractures affected the shoulder girdle. Lower rib stress fractures predominated in the swingers group, whereas weight lifters had fractures located throughout the upper extremity. CONCLUSION: Stress fracture should be considered in the differential diagnosis of athletes presenting with upper extremity or rib pain of bony origin that is of insidious onset. Further study of the sport-specific patterns of injury described here may improve our ability to treat and prevent these injuries.

Adolescent↗
PubMed1999

Upper extremity deep vein thrombosis.

Upper extremity deep-vein thrombosis has recently been recognized as being a more common and less benign disease than previously reported. It arises generally in the presence of recognizable risk factors, such as central venous catheters and cancer. However, as many as 20% of patients present with apparently spontaneous episodes. The prevalence of inherited coagulation defects in patients with this disease ranges from 10% to 26%. The clinical picture of upper extremity DVT is characterized by pain, edema, and functional impairment, although it may be completely asymptomatic. Because the prevalence of this thrombotic disease is less than 50% among symptomatic subjects, objective diagnosis is mandatory prior to instituting an anticoagulant treatment. When available, compression ultrasonography (alone or associated with Doppler or color Doppler facilities) should be the preferred initial diagnostic test. However, contrast venography may be necessary before anticoagulants are withheld because of negative findings on compression ultrasonography. Pulmonary embolism complicates upper extremity deep-vein thrombosis in up to 36% of patients and may even be the presenting manifestation of this disorder. Its long-term clinical course is complicated by recurrent thromboembolism and post-thrombotic sequelae. Among the therapeutic options advocated for the therapy of upper extremity deep-vein thrombosis, unfractionated or low molecular weight heparin followed by at least 3 months of oral anticoagulants should be regarded as the treatment of choice. Thrombolysis and surgical procedures may be indicated in selected cases. The prevention of this disease requires the institution of appropriate pharmacologic measures (i.e., low-dose unfractionated or low molecular weight heparin or low-dose warfarin) whenever an indwelling central venous catheter is indicated. This review suggests that upper extremity deep-vein thrombosis is at least as serious a disease entity as deep-vein thrombosis of the lower extremities.

Acute Disease↗
PubMedDate not supplied

Upper extremity shortness in children with hemiplegic cerebral palsy.

OBJECTIVE: To evaluate upper extremity shortness in patients with hemiplegic cerebral palsy (HCP) and to investigate the association between extremity shortness, motor level, and muscle tone. DESIGN: Prospective, controlled study. SUBJECTS: Forty-two children with HCP and 29 healthy children. METHODS: Radiographs of the involved and the uninvolved humerus, forearm, and hands were obtained with a radiographic ruler placed adjacent to the extremity. The lengths and the diameters of both the diaphyses and metaphyses of the humerus, ulna, radius, and the second and the fifth metacarpal bones were measured in patients and the control group. The discrepancy was calculated as a percentage compared with the normal side. The Ashworth Scale was used in the evaluation of spasticity, and the Brunnstrom recovery staging was used in the motor evaluation. RESULTS: Children with HCP had significant differences in bone lengths and diameters compared with control children. There was no significant correlation between the upper extremity Brunnstrom stagings and the differences of bone length and diameter. A significant correlation was observed between the hand Brunnstrom staging and percentage difference of the bone length and diameter. The spasticity level showed no relation to the differences in bone length and diameter. CONCLUSIONS: Children with HCP have significant side-to-side limb-length discrepancy when compared with control children. The discrepancy increases with age. The extent of shortening did not appear to be related to upper extremity function and spasticity. The extremity shortness showed a relation to hand function.

Cerebral Palsy↗
PubMed2006

Multi-slice CT angiography for arterial evaluation in the injured lower extremity.

BACKGROUND: With the evolution of multi-slice helical computed tomographic angiography (MCTA), the optimal imaging modality for arterial injury in the traumatized lower extremity has been challenged. The objective of this study was to evaluate the ability of MCTA to detect arterial injury in the traumatized lower extremity. Our hypothesis was that MCTA is a sensitive and specific test for the non-invasive evaluation of lower extremity arterial injury. METHODS: After Institutional Review Board approval, we reviewed all patients at our Level I trauma center who sustained lower extremity trauma and underwent initial evaluation by MCTA over a 3-year period ending in February 2005. MCTA accuracy was tested against a gold standard of operative intervention, duplex ultrasonography, catheter-based angiography, or clinical follow-up. RESULTS: Sixty-three MCTAs were performed in 59 patients. MCTA was diagnostic in 62 of the 63 scans (98.4%). The mechanism was penetrating in 45.8%. Lower extremity fractures were present in 38.7% of patients studied. There were 22 positive studies. Out of this group, 19 were confirmed at operation and 3 were managed non-operatively. In the 19 injuries confirmed in the operating theater, there were 5 superficial femoral, 2 profunda, 10 popliteal, 1 posterior tibial, and 1 injury to all 3 mid-calf arteries. There were two injuries below the trifurcation managed non-operatively and there was one popliteal occlusion with distal reconstitution that was confirmed by duplex and managed non-operatively because of patient refusal of surgery. Forty studies were negative for arterial injury, with clinical follow up available in 89.5%, for a mean of 48.2 days (range, 5-287 days). No missed injuries were identified during the follow-up period. MCTA was non-diagnostic in 1 patient (1.6%), secondary to artifact from retained missile fragments. MCTA achieved 100% sensitivity and 100% specificity in detecting clinically significant arterial injury. CONCLUSION: MCTA is a sensitive and specific non-invasive imaging modality for arterial evaluation in the injured lower extremity that may replace catheter-based angiography in most patients.

Adolescent↗
PubMed2001

Outliers, extreme events, and multiscaling.

Extreme events have an important role which is sometimes catastrophic in a variety of natural phenomena, including climate, earthquakes, and turbulence, as well as in manmade environments such as financial markets. Statistical analysis and predictions in such systems are complicated by the fact that on the one hand extreme events may appear as "outliers" whose statistical properties do not seem to conform with the bulk of the data, and on the other hand they dominate the tails of the probability distributions and the scaling of high moments, leading to "abnormal" or "multiscaling." We employ a shell model of turbulence to show that it is very useful to examine in detail the dynamics of onset and demise of extreme events. Doing so may reveal dynamical scaling properties of the extreme events that are characteristic to them, and not shared by the bulk of the fluctuations. As the extreme events dominate the tails of the distribution functions, knowledge of their dynamical scaling properties can be turned into a prediction of the functional form of the tails. We show that from the analysis of relatively short-time horizons (in which the extreme events appear as outliers) we can predict the tails of the probability distribution functions, in agreement with data collected in very much longer time horizons. The conclusion is that events that may appear unpredictable on relatively short time horizons are actually a consistent part of a multiscaling statistics on longer time horizons.

Journal Article↗
PubMed2006

Archaeal habitats--from the extreme to the ordinary.

The domain Archaea represents a third line of evolutionary descent, separate from Bacteria and Eucarya. Initial studies seemed to limit archaea to various extreme environments. These included habitats at the extreme limits that allow life on earth, in terms of temperature, pH, salinity, and anaerobiosis, which were the homes to hyper thermo philes, extreme (thermo)acidophiles, extreme halophiles, and methanogens. Typical environments from which pure cultures of archaeal species have been isolated include hot springs, hydrothermal vents, solfataras, salt lakes, soda lakes, sewage digesters, and the rumen. Within the past two decades, the use of molecular techniques, including PCR-based amplification of 16S rRNA genes, has allowed a culture-independent assessment of microbial diversity. Remarkably, such techniques have indicated a wide distribution of mostly uncultured archaea in normal habitats, such as ocean waters, lake waters, and soil. This review discusses organisms from the domain Archaea in the context of the environments where they have been isolated or detected. For organizational purposes, the domain has been separated into the traditional groups of methanogens, extreme halophiles, thermoacidophiles, and hyperthermophiles, as well as the uncultured archaea detected by molecular means. Where possible, we have correlated known energy-yielding reactions and carbon sources of the archaeal types with available data on potential carbon sources and electron donors and acceptors present in the environments. From the broad distribution, metabolic diversity, and sheer numbers of archaea in environments from the extreme to the ordinary, the roles that the Archaea play in the ecosystems have been grossly underestimated and are worthy of much greater scrutiny.

Animals↗
PubMed1995

Bilateral lower extremity US in the patient with bilateral symptoms of deep venous thrombosis: assessment of need.

PURPOSE: To assess the frequency of lower extremity deep venous thrombosis (DVT) detected with ultrasound (US) in patients with bilateral symptoms suggestive of DVT. MATERIALS AND METHODS: Fifty patients with bilateral lower extremity symptoms suggestive of DVT were examined prospectively for predisposing factors and type of symptoms. Charts were reviewed for previous lower extremity disease or chronic illness that could explain the patient's symptoms. The frequency of DVT diagnosed with US in this patient group was determined. RESULTS: No DVT was identified in the patients with bilateral symptoms suggestive of DVT. Retrospective review demonstrated that 34 (68%) of the patients had a preexisting condition (cardiac disease, venous insufficiency, chronic swelling, cellulitis or thrombophlebitis, peripheral arterial disease). Because compression US has a greater than 90% sensitivity and specificity for the diagnosis of DVT, these results were statistically significant (P < .001). CONCLUSION: The likelihood of DVT in patients with bilateral lower extremity symptoms is extremely low. Alternative causes should be carefully explored before lower extremity US is considered.

Aged↗
PubMed1976

Differences in muscle blood flow in upper and lower extremities of patients after correction of coarctation of the aorta.

Using the method 133Xe clearance we investigated blood flow and calculated vascular resistances simultaneously in the muscles of the upper and lower extremities in 58 patients following successful surgical correction of aortic coarctation carried out at age 11.5 (+/- 2.9) years. The interval from operation to investigation was 11.5 (+/- 4.5) years. Resting and maximal ischemic exercise blood flows in the upper extremity were decreased and the duration of maximal blood flow was shortened. Values recorded from the lower extremities did not differ from normal controls. The difference between upper and lower extremities was statistically significant. Vascular resistance during maximal blood flow was higher in the upper extremities than in the lower. Differences between upper and lower extremities did not change after vasodilation elicited by amyl nitrite. The degree of differences was not dependent upon the age at operation, the age of the patients at investigation, or on the time interval between operation and investigation.

Adult↗
PubMedDate not supplied

Carotid and lower extremity arterial disease in elderly adults with isolated systolic hypertension.

The prevalence of carotid and lower extremity arterial disease was assessed in a healthy population of 56 elderly adults with isolated systolic hypertension. Duplex scans were performed to determine the extent of carotid disease, and postexercise ratios of ankle to arm systolic blood pressure were measured to assess lower extremity arterial disease. Internal carotid stenosis was found in 38% (21 of 56) of subjects and lower extremity arterial disease in 42% (23 of 55). The strongest predictor of internal carotid stenosis was lower extremity arterial disease. Independent risk factors for lower extremity arterial disease were smoking, internal carotid stenosis, and age. A measure of extent of carotid plaque was found to correlate with age, carotid stenosis, male sex, history of smoking, and total cholesterol. The high prevalence of peripheral vascular disease in this population may be related to their age and blood pressure. The high correlation between carotid stenosis and lower extremity arterial disease suggests that persons with peripheral vascular disease should be assessed and treated for atherosclerotic disease in general.

Aged↗
PubMedDate not supplied

The relationship between lower extremity functional strength and severity of peripheral arterial disease.

The purposes of this study were to (1) determine if peripheral arterial disease (PAD) severity is related to deficits in lower extremity functional strength, (2) identify covariates that might affect the relationship between lower extremity functional strength and severity of PAD, and (3) determine if the relationship between lower extremity functional strength and severity of PAD still persists after statistically controlling for significant covariates. A total of 144 patients were grouped into tertiles according to disease severity. Patients having an ankle-brachial index (ABI) of 0.76 to 0.90 were classified as having mild PAD (high ABI group), 0.51 to 0.75 classified as having moderate PAD (moderate ABI group), and 0.36 to 0.50 as having severe PAD (low ABI group). Lower extremity functional strength was assessed using the chair-stand test where the time to complete 5 consecutive stand-to-sit transfers was recorded. Patients were also characterized on ambulatory function and clinical characteristics. The moderate ABI group took significantly (p < 0.05) less time (13.49 +/- 0.49 s) to complete the chair-stand test than the low ABI group (15.86 +/- 0.63 s). Both daily physical activity level and total 6-minute walk distance were identified as significant covariates (p < 0.05) of lower extremity functional strength. After controlling for daily physical activity level and total 6-minute walk distance, no significant differences (p > 0.05) in the time to complete the chair-stand test existed between the ABI groups. These findings indicate that the greater impairment in lower extremity functional strength in patients with severe PAD is explained by their lower physical activity level and poorer overall walking ability.

Aged↗