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At least 505 records · Page 28Linked to original sources
PubMed1994

Cardiovascular responses of cardiac transplant patients to arm and leg exercise.

This investigation compares the cardiovascular responses of normal (n = 10) and cardiac transplant (n = 14) subjects to peak arm and leg exercise. It also tests the hypothesis that the higher heart rate (fc) in normal subjects during light (30 W) submaximal arm versus leg exercise is due to cardiac innervation. In cardiac transplant patients, power output, oxygen consumption (VO2), fc and rate pressure product were 54%, 28%, 7%, and 8% lower during peak arm than leg exercise, respectively. In normal subjects, power output, VO2, fc and rate pressure product were 61%, 33%, 8%, and 11% lower during peak arm than leg exercise, respectively. In cardiac transplant patients there was no significant difference in absolute fc during submaximal arm and leg exercise. In normal subjects, absolute fc during arm and leg exercise was [mean (SD)] 97 (4) beats.min-1 and 92 (4) beats.min-1, respectively (P = 0.07). Plasma noradrenaline was increased more during arm than leg exercise in both cardiac transplant and normal subjects. Maximal leg testing is useful when determining the capacity of cardiac transplant patients to perform arm work. The higher absolute fc reported by other investigators for normal subjects during submaximal arm versus leg exercise may be mediated by cardiac innervation.

Arm↗
PubMed1999

Venous function and delayed leg swelling following saphenectomy in coronary artery bypass grafting.

Some patients are troubled by leg swelling following saphenectomy long after CABG. Postsaphenectomy venous function in the leg has not, however, been well clarified. To determine whether venous dysfunction caused postsaphenectomy swelling, we measured the maximum venous outflow and time constant (tau) in the leg by venous occlusion strain-gauge plethysmography in 45 patients; a venous Doppler test was also conducted in 33 of the 45 at a mean 57.6 +/- 21.3 months after CABG. The saphenous vein was harvested unilaterally from the lower leg or from both the thigh and lower leg in all patients. Edema was seen in 4 patients (8.9%) and 8 reported leg swelling after saphenous vein harvest (17.8%). Legs were classified into three groups: group 1 consisted of 12 with edema or reports of swelling ipsilateral to the saphenous vein harvest site, group 2 consisted of 33 ipsilateral to the saphenous vein harvest without edema, and group 3 consisted of the 45 nonoperated-on, contralateral legs of the same patients as controls. No significant differences were seen in maximum venous outflow, tau, or the incidence of deep vein reflux among groups. No significant relationship was found between venous function and leg swelling occurring delayed after saphenectomy.

Aged↗
PubMed2005

Effects of the nitric oxide donor, sodium nitroprusside, on resting leg glucose uptake in patients with type 2 diabetes.

AIMS/HYPOTHESIS: Nitric oxide (NO) has been implicated as an important signalling molecule in the contraction-mediated glucose uptake pathway and may represent a novel strategy for blood glucose control. The current study sought to determine whether acute infusion of the NO donor, sodium nitroprusside (SNP), increases leg glucose uptake at rest in patients with type 2 diabetes. METHODS: Fifteen male patients with type 2 diabetes (aged 54+/-4 years, mean+/-SD) were entered into a randomised, cross-over design study, examining the effect of a 30-min intra-femoral infusion of SNP on leg glucose uptake. Comparison was made with a 30-min infusion of verapamil, titrated to elicit similar leg blood flow responses to SNP. Leg blood flow was measured by thermodilution in the femoral vein, and leg glucose uptake was calculated as the product of leg blood flow and the femoral arterio-venous (A-V) glucose concentration gradient. RESULTS: The two drugs increased leg blood flow to a similar extent (p=0.50). Both leg A-V glucose concentration gradient (SNP 0.12+/-0.05, verapamil -0.06+/-0.04 mmol/l; mean+/- SEM, p=0.03) and leg glucose uptake (SNP 0.17+/-0.09, verapamil -0.09+/-0.06 mmol/min; p=0.03) were higher with the SNP treatment than with verapamil. These results occurred independently of any significant difference in plasma insulin concentration between drugs (p=0.56). CONCLUSIONS/INTERPRETATION: Acute infusion of SNP resulted in greater glucose uptake relative to verapamil. NO may therefore be an important mediator of peripheral glucose disposal and a potential therapeutic target in patients with type 2 diabetes.

Blood Glucose↗
PubMed2006

Development of a strength test battery for evaluating leg muscle power after anterior cruciate ligament injury and reconstruction.

A more sports-specific and detailed strength assessment has been advocated for patients after anterior cruciate ligament (ACL) injury and reconstruction. The purpose of this study was to develop a test battery of lower extremity strength tests with high ability to discriminate between leg power development on the injured and uninjured sides in patients after ACL injury and in patients who have undergone ACL reconstruction. Twenty-three patients were tested 6 months after ACL injury and 44 patients were tested 6 months after ACL reconstruction. Twenty-four of the 44 patients were operated on using a hamstrings graft and 20 patients were operated on using a patellar tendon graft. All the patients performed a test battery of three strength tests for each leg in a randomised order. The three strength tests were chosen to reflect quadriceps and hamstring muscular power in a knee-extension and a knee-flexion test (open kinetic chain) and lower-extremity muscular power in a leg-press test (closed kinetic chain). There was a higher sensitivity for the test battery to discriminate abnormal leg power compared with any of the three strength tests individually. Nine out of ten patients after ACL reconstruction and six out of ten of the patients after ACL injury exhibited abnormal leg power symmetry using the test battery. Thus, this test battery had high ability in terms of discriminating between the leg power performance on the injured and uninjured side, both in patients with an ACL injury and in patients who have undergone ACL reconstruction. It is concluded that a test battery consisting of a knee-extension, knee-flexion and leg-press muscle power test had high ability to determine deficits in leg power 6 months after ACL injury and reconstruction. Only a minority of the patients had restored leg muscle power. The clinical relevance is that the test battery may contribute to the decision-making process when deciding whether and when patients can safely return to strenuous physical activities after an ACL injury or reconstruction.

Adult↗
PubMed2000

Limits of infrapopliteal bypass surgery for critical leg ischemia: when not to reconstruct.

The aim of this study was to identify the risk factors affecting the immediate 30-day postoperative outcome of infrapopliteal bypass grafts. A series of 511 revascularization procedures to the infrapopliteal arteries have been performed in 439 patients with critical leg ischemia. There were 306 crural bypasses and 205 pedal bypasses. The 30-day postoperative primary and secondary patency rates were 77.5% and 83.4%, respectively; the leg salvage rate was 89.8%; the survival rate was 94.7%; and 85.1% of patients were alive with a salvaged leg. A history of myocardial infarction, angina pectoris, or stroke had a great impact on the postoperative cardiac and cerebrovascular fatal and nonfatal complications. C-reactive protein arose as an important predictor of the length of hospital stay (p = 0.03), postoperative cardiac complications (p = 0.02), leg salvage (p = 0.009), amputation with patent graft (p = 0.009), and patients who survived with a salvaged leg (p = 0.006). Poor results were achieved in patients on long-term dialysis. Surgical experience had an influence on leg salvage (p = 0.02) and on patients alive with salvaged leg rates (p = 0.009). Infrapopliteal bypass surgery is a demanding procedure requiring high surgical skill and experience. Revascularization may be contraindicated when severe coronary disease, previous stroke, renal failure requiring long-term dialysis, diabetes, or high serum concentration of C-reactive protein coexist with critical leg ischemia, as these patients are at high risk for early postoperative leg or life loss.

Adult↗
PubMed2005

[Value of color-coded duplex sonography in preoperative visualization of lower leg arteries for microsurgical fibula transfer].

BACKGROUND: In patients being considered for a microsurgical fibular transfer, thorough examination of the vascular supply to the lower leg is indisputably necessary. The aim of this study was to evaluate the validity of color-coded duplex sonography (CCDS) in the assessment of the arteries of the lower leg. PATIENTS AND METHODS: In 13 patients needing bony reconstruction of the jaw 22 legs were examined using CCDS. The three arteries of the lower leg were visualized and traced from the ankle to the popliteal fossa. At every arterial segment Doppler sonographic examination was also performed. All 13 patients underwent digital subtraction arteriography (DSA) of the lower extremities, additionally. RESULTS: We were able to visualize and to assess all but one of the arteries using CCDS. In 13 extremities of 9 patients CCDS exhibited a normal vascular supply to the lower leg provided by three regular arteries. DSA confirmed this and the patients underwent fibular transfer. In the other 4 patients a regular vascular situation could not be shown by CCDS because of nonvisualization of arterial segments or pathological findings. Two of these patients received alternative bony transplants. In the remaining two patients angiography exhibited one leg to have a normal three vessel supply, respectively. Fibular transplants could be raised from this leg. In all patients CCDS was able to localize between 3 and 7 perforators branching off the peroneal artery. Their position determined the placement of the skin paddle to be raised with the bone. Further advantages of CCDS were the universal applicability to all patients and the possibility of performing it at our own department. The time required for the examination and the necessity of having adequate technical equipment were the disadvantages. CONCLUSION: In patients being considered for a microsurgical fibular transplantation, we recommend CCDS of the lower leg as a screening tool for the vascular supply of the lower leg. DSA and MRA are predominantly advocated for those patients, in whom CCDS reveals pathological or uncertain findings.

Adult↗
PubMed2006

Restless legs syndrome triggered by heart surgery.

This report presents the case of a 9-year-old child with a familial history of restless legs syndrome who began to complain of restless legs syndrome symptoms after heart surgery. Hypotheses on the potential interactions between genetic and environmental factors in the development of her restless legs syndrome are discussed. Increasing evidence supports reduced brain iron in the pathophysiology of idiopathic restless legs syndrome. It is possible that the child inherited a compromised brain and peripheral iron regulation, which predisposed her to restless legs syndrome. The interaction between her dysfunctional iron management and her intraoperatory blood loss may have led to a significant decrease in brain iron, triggering restless legs syndrome symptoms. Other factors, such as immobilization and sleep deprivation after surgery, may have contributed to trigger the restless legs syndrome symptoms. If confirmed by further evidence, this patient suggests the need to carefully monitor for restless legs syndrome symptoms in young surgical patients who present with a familial history of restless legs syndrome.

Child↗
PubMed1997

Interlimb interaction and stabilization of contralateral leg in isokinetic knee evaluation.

OBJECTIVE: To determine if peak torque (PT) production during isokinetic knee testing is affected by the stabilization and movement patterns of the contralateral leg. DESIGN: Repeated measure design. INTERVENTION AND MAIN OUTCOME MEASURE: Thirty subjects participated in comparing the force outputs in relation to the movement pattern of both legs. Another group of 45 subjects volunteered to perform five maximal isokinetic extension-flexion contractions in each of three different knee testing conditions: (1) without stabilization of the contralateral leg; (2) with a bar in front of the ankle joint of the contralateral leg; (3) with the contralateral leg strapped just above the level of the malleoli and the muscles of that leg induced reciprocally to perform isometric contractions with respect to the testing leg. PT was used to compare the strength of three different conditions. RESULTS: Significantly greater PT was measured when the contralateral leg of the subject was fixed and induced to contract reciprocally. CONCLUSION: More rigorous standardization of isokinetic strength testing procedures is needed due to differences in PT production of knee muscles according to the stabilization and movement pattern of the contralateral leg.

Adult↗
PubMed2003

A retrospective audit of long-term lower limb complications following leg vein harvesting for coronary artery bypass grafting.

OBJECTIVE: To evaluate the prevalence of leg complications following leg-vein harvest for coronary artery bypass grafting. METHOD: A questionnaire was sent to patients who had coronary artery bypass surgery between January 1993 and December 1998. Questions addressed pain, numbness, infection, swelling and general healing. The relationship between the risk factors of diabetes, peripheral vascular disease, previous fractures/injuries to legs, previous deep vein clots and arthritis affecting the legs with post operative symptoms of pain, numbness, swelling and general healing was explored with multivariate analysis. RESULTS: Of 700 questionnaires sent out 497 were returned, of which 422 (60%) were suitable for analysis. Numbness or tingling related to the wound was reported by 256 (61%), of whom 94 (37%) improved within 3 months. However, 105 (41%) had persistent numbness beyond 2 years. Pain in the wound was reported by 193 (46%), of whom 149 (77%) reported that this had improved by 3 months and only 19 (10%) had pain persisting beyond 2 years. A leg wound infection was reported by 126 (32%) patients, with 82 (65%) of these receiving antibiotics. A total of 336 (87% of 387 responses) described their wound as completely healed at 3 months. Unilateral leg swelling was reported by 175 (41%) with 98 of these (56% of those with swelling) improving by 3 months and 41 (23%) with swelling persisting beyond 2 years. There was no relation of wound problems to examined risk factors diabetes (P-values for numbness 0.31, wound healing 0.15, swelling 0.21, pain 0.22) and peripheral vascular disease (P-values for numbness 0.8, wound healing 0.21, swelling 0.18, pain 0.09). There was insufficient data to comment on the influence of fractures/injuries to legs, previous deep vein clots and arthritis affecting the legs. CONCLUSIONS: Wound complications are common following leg vein harvest. Prevalence of infection was higher than has previously been reported. Few people suffer long-term pain from saphenous nerve damage although paraesthesia and swelling were common long-term complications. We did not identify either diabetes or peripheral vascular disease as a risk factor for pain, numbness, swelling or problems with general healing. There is a need for a large multicentre prospective study.

Adult↗
PubMed2004

Anaerobic performance of arms and legs in male and female free style wrestlers.

The aim of the present study was to compare arm and leg anaerobic peak and mean power after normalisation for body mass (W/kg) and fat-free mass (W/kg FFM) of 12 female and 10 male wrestlers, members of the Polish Olympic team. Power outputs were assessed by 30 seconds leg cycling and 30 seconds arm cranking. It was determined that males had higher peak power (11.4 W/kg and 13.2 W/kg FFM for legs, 9.6 W/kg and 11.2 W/kg FFM for arms) as well as mean power (8.7 W/kg and 9.6 W/kg FFM for legs, 6.9 W/kg and 7.9 W/kg FFM for arms) than females (peak power 8.6 W/kg and 11.3 W/kg FFM for legs, and 5.9 W/kg, 7.8 W/kg FFM for arms, mean power 6.8 W/kg, 9.0 W/kg FFM for legs and 5.9 W/kg, 7.8 W/kg FFM for arms). Post-exercise maximal blood lactate concentration after 30 seconds leg cycling and 30 seconds arm cranking was also higher in male wrestlers (11.9 and 11.8 mmol/l, respectively) than in female wrestlers (10.4 and 9.1 mmol/l, respectively). However the ratios of lactate concentration to mean power expressed in W/kg FFM for males and females in leg cycling (1.18 and 1.17, respectively) and in arm cranking (1.48 and 1.50, respectively) were similar. These findings suggest that the amount of energy derived from glycolysis is not sex-dependent. Additionally it seems that the higher ratios for arms when compared to legs reflect closer relation of arm muscle energy metabolism to carbohydrate utilisation.

Adult↗
PubMed2002

Predilection of hemolytic anemia-associated leg ulcers for the medial malleolus.

BACKGROUND: Ischemic ulcers are usually found above the lateral, and venous stasis ulcers at the medial malleoli. Leg ulcers occur in at least 25% of sickle cell disease (SSD) patients in clinic populations, usually in the malleolar region. The function of the large leg veins in most SSD patients is unimpaired. PATIENTS AND METHODS: We determined leg ulcer location in 41 sickle cell anemia (SS), and 4 sickle-beta 0 thalassemic patients with longstanding chronic and/or recurrent leg ulceration, and reviewed published reports of leg ulcers in hereditary spherocytosis and thalassemias. RESULTS: Of the 57 legs of the 45 SSD patients with only 1 ulcer, 42 (74%) were medial and 15 lateral. The difference was significant (p < 0.001). Of patients with only a single ulcer, 22 were medial and 4 lateral. Of 15 reported patients with leg ulcers related to spherocytosis or thalassemia, 20/24 (83%) ulcers were medial. CONCLUSIONS: The medial malleoli are the most common site of leg ulceration in SSD and in other chronic hemolytic anemias. This suggests that stasis may play a role in the leg ulceration associated with chronic hemolytic anemia.

Adult↗
PubMed2003

Sex differences in peripheral arterial disease: leg symptoms and physical functioning.

OBJECTIVES: To compare lower extremity functioning and leg symptoms between women and men with peripheral arterial disease (PAD). DESIGN: Cross-sectional. SETTING: Three Chicago-area medical centers. PARTICIPANTS: One hundred eighty-seven women and 273 men with PAD identified consecutively in patients in the noninvasive vascular laboratories and a general medicine practice at the three medical centers. MEASUREMENTS: Walking speed, 6-minute walk, accelerometer-measured 7-day physical activity, and a summary performance score. The summary performance score combines data on walking velocity, time for five repeated chair rises, and standing balance to achieve a score on a 0 to 12 scale (12 = best). RESULTS: Women with PAD were older and had a lower prevalence of prior leg revascularization, a higher prevalence of spinal stenosis, and a lower prevalence of other cardiovascular disease than men with PAD. Mean ankle brachial index (ABI) values +/- standard deviation were similar in women and men with PAD (0.64 +/- 0.15 vs 0.66 +/- 0.14, P =.15). Women with PAD were significantly more likely than men with PAD to have exertional leg pain that sometimes begins at rest (27.8% vs 13.2%, P <.001). Women with PAD had slower walking speed (0.81 vs 0.92 m/s, P <.001), shorter 6-minute walk distance (1,047 vs 1,182 feet, P <.001), and a poorer summary performance score (8.9 vs 9.8, P <.001) than men with PAD, adjusting for age, race, height, comorbid disease, and leg symptoms. After adjusting for leg strength, sex differences in 6-minute walk performance and summary performance score were attenuated modestly (1,089 vs 1,177 feet for 6-minute walk, P =.022 and 9.2 vs 9.8 for summary performance score, P =.027). CONCLUSION: Women with PAD had a higher prevalence of leg pain on exertion and rest, poorer functioning, and greater walking impairment from leg symptoms than men with PAD. A higher prevalence of spinal stenosis in women may explain the observed sex differences in leg symptoms. Poorer leg strength in women may contribute to poorer lower extremity functioning in women with PAD than in men with PAD.

Aged↗
PubMed2002

High leg motor activity in sleep apnea hypopnea patients: efficacy of clonazepam combined with nasal CPAP on polysomnographic variables.

The association of sleep apnea hypopnea syndrome (SAHS) with high leg activity in the same patient is a dilemma for the physician, as clonazepam, used to treat periodic leg movement syndrome (PLMS) can aggravate apneas, while nasal continuous positive airway pressure (nCPAP) can exacerbate PLMS. The present study aimed to compare nCPAP alone (n), nCPAP combined with clonazepam (n+c) and clonazepam alone (c) in patients with mild to moderate SAHS associated with high leg activity. Fourteen patients with an apnea hypopnea index (AHI) between 10 and 50 h(-1) and a leg movement index with regard to time in bed [LMI (TIB)] > 15 h(-1) on baseline polysomnography (b) were recorded on three consecutive nights with n, n+c and c, respectively. Leg movements were detected, using actigraphy, and were subsequently categorized into periodic, apnea- or hypopnea-related and nonperiodic movements (defined as neither periodic nor related to a respiratory event). The three treatments were successful in improving breathing [AHI b 26.1 (3.2) n 11.8 (2.4) n+c 5.0 (0.7) c 14.9 (1.8) h(-1)], leg activity [LMI (TIB) b 391 (4.8) n 22.5 (4.4) n+c 23.9 (3.9) c 22.6 (3.7) h(-1)] and sleep fragmentation [stage shift index b 373 (2.6) n 28.6 (1.6) n+c 25.6 (1.8) c 26.6 (1.6) h(-1)]. All types of movements were reduced, the effect being significant for respiratory events related and nonperiodic movements. Combination therapy was more effective than nCPAP alone in reducing the AHI and in improving sleep efficiency. We conclude that in patients with mild to moderate SASH associated with high leg activity, nCPAP improves nocturnal breathing and clonazepam reduces leg activity. More unexpectedly nCPAP is beneficial on leg activity and clonazepam on breathing, probably through a decrease in sleep fragmentation. The best results are obtained with combination therapy.

Analysis of Variance↗
PubMed2003

Venous leg ulcer care: how evidence-based is nursing practice?

OBJECTIVES: The objectives of this study were to (1) determine how congruent community-provided leg ulcer care was with best practice for venous leg ulcers and (2) identify organizational and clinical factors associated with the provision of best practice for venous leg ulcers. DESIGN: The practice variation study group was an audit of nursing agency client records to determine the provision of care. SETTING AND SUBJECTS: The study population was a home care cohort of persons with venous leg ulcers (n = 66) who received care from one Ontario home care nursing agency between March 1999 and November 1999. INSTRUMENT: The audit tool was developed with a checklist reflecting the common recommendations from 3 international practice guidelines, as well as organizational and clinical factors that may influence or reflect best practice. RESULTS: Half of client records (35/66) included an identified etiology of the leg ulcer. An Ankle Brachial Pressure Index score was documented prior to the initiation of compression on fewer than half of the records (21/44). Regular ulcer measurement was done for 11% of the clients (7/64). Two thirds of the clients (44/66) were treated with compression. More than 60% of the clients (40/66) had been seen by either a dermatologist or a vascular surgeon. Topical antibiotics were prescribed for two thirds of clients (44/64). Fifteen percent of clients (10/66) were assessed for pain, and 17% (11/66) received some form of pain management. Documentation of client education specific to the leg ulcer was present on 3% of records (2/66). The mean number of different nurses providing leg ulcer care to each client was 19. A registered practical nurse was the classification of nurse assigned to 43.8% (29/66) of the clients. CONCLUSION: Several gaps were identified in the care provided. A standardized approach to care is needed that includes a comprehensive leg ulcer assessment to determine the ulcer etiology, determination of an Ankle Brachial Pressure Index score to screen for the presence of arterial disease, and compression for all clients who meet the criteria for venous disease. A reorganization of services is required, which includes an increased role for community nurses in leg ulcer assessment and management. Organizational and clinical factors influencing the delivery of best practice need to be identified and addressed.

Clinical Competence↗
PubMed1994

Sources of variation in back and leg dynamometry.

Three investigations were carried out to examine the concurrent validity and the reliability of a portable dynamometer (Takei Kiki Kogyo) for the measurement of back and leg strength. First, leg extension strength of 19 subjects was measured using the Takei dynamometer and compared to the isometric knee extension strength of the dominant (right) leg measured using a computer-controlled dynamometer (Lido Active, Davis, CA). The back extension strength of 18 subjects was also compared between the two dynamometers. Second, back and leg strengths of 36 subjects, aged 19-30 years, were measured twice using the Takei dynamometer. Six days separated the test and retest. Third, back and leg strengths of four subjects, aged 21-30 years, were measured at six different times of the solar day. Significant relations (p < 0.001) were obtained between the Takei and Lido dynamometers for leg strength (r = 0.90) and back strength (r = 0.79). Significant test-retest correlations (p < 0.001) were found for leg strength (r = 0.80) and back strength (r = 0.91). Group mean (+/- SD) leg strength values of test (1450.4 +/- 428.6 N) and retest (1432.8 +/- 449.1 N) did not differ ((p > 0.05). A small (4.5%) but significant difference was found between the test (1057.2 +/- 309.9 N) and retest (1106.2 +/- 334.4 N) mean values for back strength (p < 0.05). A time of day effect was evident for back and leg strength (p < 0.05); on average the peak times occurred at 16:53 h and 18:20 h, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1975

Effects of exercise therapy on total and component tissue leg volumes of patients undergoing rehabilitation from lower limb injury.

Anthropometric and X-ray data were collected on 20 young male patients undergoing a systematic programme of exercise therapy following fracture of the leg and consequent immobilization for 25--254 (mean 117) days. Estimates of total leg volume, calculated from X-ray or from anthropometric measurements, were essentially interchangeable in both the injured and uninjured legs. A procedure for estimating muscle volume from total leg volume is given. At the start of rehabilitation, muscle volume was significantly smaller (860 ml, 16 per cent) in the injured than in the uninjured leg. By the end of rehabilitation (mean 50 days) the injured leg had siginficantly increased by 360 ml (8 per cent) over its initial volume, and the uninjured one had increased but not significantly (120 ml, 2 per cent), so that the injured leg was still approximately 11 per cent (620 ml) small than the uninjured. The initial degree of atrophy and the period of immobilization were not significantly correlated, although the latter showed a negative relationship (P greater than 0.05) with the rate of increase of muscle volume in the injured leg. No significant correlation was found between the ratio of injured/uninjured leg volumes and muscle width measurements at 1/3 subischial, at 12.7 cm above the knee joint space or at the maximum calf. In systematic studies involving atrophy muscle volume must therefore be estimated either by anthropometry or by X-ray measurements.

Adult↗
PubMed2001

Treatment of leg and face veins with a cryogen spray variable pulse width 1064-nm Nd:YAG laser--a prospective study of 47 patients.

OBJECTIVE: Throughout the 1990s laser treatment of leg veins has been a challenge. Newer, longer wavelength lasers capable of delivering high fluences with larger spot sizes, with variable pulse width have shown promising preliminary results. Experience with these lasers for the treatment of facial telangiectasia and periorbital reticular veins is even more scant. To the authors' knowledge this is the first prospective study to evaluate a variable pulse width, cryogen spray-equipped 1064-nm Nd:YAG laser for the treatment of both leg and face veins, including larger periorbital reticular veins. METHODS: A total of 47 volunteers aged 32-67 years (30 skin type I-V with leg telangiectasia and reticular veins, and 17 skin type I-IV with face telangiectasia and reticular periorbital veins) were treated with the Nd:YAG laser. For leg vein patients, two to three sets of different leg veins were treated with a maximum of three treatments. Patients were examined 1 week after each treatment and at 1, 2, and 3 months after the last treatment. All face vein patients received one treatment and were examined at 1 month post treatment. Treatment parameters for both leg and face veins varied with the size of vessels being treated. Pre and post treatment 35-mm photographs were taken. Improvement was judged by two experienced physicians both visually on patients and by comparison of pre and post treatment photos. Results were graded as percentage resolution, in five groups: 0%, 0-25%, 25-50%, 50-75% and 75-100%. RESULTS: In all, 23 of 30 patients completed the leg vein segment of the study. A total of 41 leg vein sites were treated. Greater than 75% improvement was observed at 85% of the treated sites; greater than 50% improvement was observed at 95% of the treated sites; less than 25% improvement was observed at 5% of the treated sites. In all, 17 of 17 patients completed the face vein segment of the study. A total of 32 sites were treated (24 on cheeks, nose, and chin telangiectasia and eight periorbital reticular veins). Greater than 75% improvement was observed at 97% of the treated sites; greater than 50% improvement was observed at 100% of the treated sites. Notably, 100% of the facial reticular veins treated had essentially 100% resolution. Pain during treatment was variably perceived by patients, but occasionally was sufficient for patients to decline further treatment. Transient hemosiderin pigmentation, as seen with sclerotherapy, was common with larger vessels. CONCLUSION: The cryogen spray-equipped 1064-nm Nd:YAG laser was remarkably effective and safe for skin type I-V patients. Excellent results for leg veins, approaching sclerotherapy outcomes, were obtained for both 0.3-1.5-mm telangiectasia and larger 1.5-3-mm reticular veins. Furthermore, this laser is also an outstanding tool for treatment of facial telangiectasia with little if any risk of purpura. For the first time it appears that there is a safe and effective treatment for 1-2-mm periorbital reticular veins. However, the use of topical anesthesia may be needed for some patients.

Adult↗
PubMed2005

Speed and physiological cost index of hemiplegic patients pedalling a wheelchair with both legs.

OBJECTIVE: To determine whether hemiplegic patients can propel a leg-pedalling wheelchair and whether it is easier and faster for them to pedal the wheelchair using both legs alternately than to propel an ordinary wheelchair with their unaffected hand and leg. DESIGN: Within-subject comparison. SUBJECTS: Subjects comprised 10 hemiplegic in-patients (8 males, 2 females), aged 63.7 (SD 12.7) years with severe or moderate gait disturbance due to stroke. METHODS: Subjects were asked to practice propelling the leg-pedalling wheelchair and ordinary wheelchair on both slalom and rectangular courses for a period of 7-10 days. Once they had become skilled in this, the wheelchair speed and patient's heart rate were measured, and a physiological cost index was calculated. RESULTS: Subjects could pedal the leg-pedalling wheelchair using both legs alternately. The speed of this wheelchair was faster than that of the ordinary wheelchair, and the physiological cost index for pedalling it was lower than that for propelling the ordinary wheelchair. However, subjects needed some help in transferring to the leg-pedalling wheelchair. CONCLUSION: The hemiplegic patients could pedal the leg-pedalling wheelchair using both legs alternately faster and more effectively with regard to speed and physiological cost index.

Aged↗