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Early activation of arm and leg muscles following pulls to the waist during walking.

Many studies have investigated the compensatory reactions in humans elicited during walking when the support surface is perturbed. This has led to the description of characteristic responses generated in the muscles of the legs and torso, and recently the arms. The present study aimed to investigate the compensatory reactions elicited when balance was challenged by a perturbation applied to the waist, to determine to what extent balance corrective responses are generalized across perturbation modalities. A second aim was to characterize the arm responses elicited by the perturbations applied to the waist. We measured muscle activity of the left arm and leg following application of backward pulls of the waist while the subjects walked on a motorized treadmill. This resulted in robust activation of tibialis anterior and vastus lateralis, with co-activation of soleus and biceps femoris also evident when perturbations were applied at heel strike. These early responses occurred with a distal to proximal temporal organization. The responses in the leg muscles displayed a phase-dependent modulation in amplitude, decreasing in amplitude later in the stance phase. Leg muscle responses were not evident during the swing phase, except for the end of swing, just prior to heel strike. Arm muscle responses were observed in all subjects; however, the pattern of the arm responses varied considerably between subjects. Generally, shoulder muscles were more likely to respond than elbow muscles, at latencies consistent with the leg responses. Two important conclusions are drawn from the present study. First, the responses evoked in the legs with a pull to the waist are very similar to what has been reported for perturbations of the support surface, despite the very different locus of the perturbation. This suggests that balance control during walking may be achieved by preprogrammed reactions or synergies, which are triggered by multiple sensory cues. Second, rapid arm actions are integrated with these leg responses. However, the arm responses are more flexible, likely reflecting the fewer constraints imposed upon the actions of the arms, compared to the legs, during normal locomotion.

Abdominal Muscles↗

Early corrective reactions of the leg to perturbations at the torso during walking in humans.

The contribution of afferent feedback to the regulation of locomotion in humans is not well understood. Animal experiments have suggested that loading of the leg during the stance phase may enhance the magnitude of extensor burst activity and delay the onset of swing phase. The aim of the present study was to determine whether transient loading of the leg at the end of stance would enhance extensor-muscle activity and delay the onset of swing in walking humans. To test this hypothesis, we applied loads to the hips of subjects so that the load was applied along the long axis of the leg at the end of stance (down-back unsupported, DBU). This resulted in an unexpectedly complex reaction characterised by rapid co-contraction of antagonist pairs of muscles around the ankle and knee and a prolongation of the stance phase. We speculated that the complexity of the reaction was, in part, due to a disturbance in equilibrium. To address this possibility, two additional perturbation paradigms were tested: (1) subjects held a rail during the loading paradigm (down-back supported, DBS), or (2) subjects received only a posteriorly directed perturbation of the hips, which added no additional load to the leg (backward unsupported, BU). As predicted, the DBS perturbation resulted in an enhancement of the ongoing soleus-muscle activity, and the unexpected tibialis anterior burst that was observed during the DBU paradigm was absent. Allowing the subjects to hold a rail substantially reduced the change in the timing of the step cycle observed in the DBU paradigm. The BU perturbation prolonged the stance phase duration and, as expected, resulted in a burst of activity in tibialis activity. This was usually accompanied by a reduction in the ongoing soleus activity. Two important conclusions are drawn from the present study. First, loading of the leg at the end of stance phase enhances the ongoing extensor-muscle activity. We suggest that afferent feedback responding to the increase load supported by the leg leads to rapid enhancement of the active extensor muscles to compensate for the increased load and prevent collapse of the leg. Interestingly, the duration of the stance phase was only marginally increased when loading was applied without a postural disturbance (DBS). Second, posterior perturbation of the centre of mass at the end of stance phase evokes an "automatic postural response" in tibialis anterior. Of particular interest, this evoked postural response can occur simultaneously with an enhanced activation of soleus. This indicates that the DBU perturbation employed in this study elicited two responses, one to prevent the collapse of the leg and the other to stabilise the centre of mass.

Adult↗

Effect of single-leg resistance exercise on regional arterial stiffness.

To examine the effects of lower-limb unilateral resistance exercise on central and peripheral arterial stiffness, thirteen participants (7 male and 6 female, mean age = 21.5 +/- 0.7 years) performed leg press exercise using their dominant leg. Pulse wave velocity (PWV) was used to measure central (carotid to femoral) and peripheral (femoral to dorsalis pedis of both legs) arterial stiffness before, 5 min post, and 25 min post exercise. No change was found in central PWV. A leg-by-time interaction was found as peripheral PWV in the non-exercised leg did not change (7.9 +/- 0.3 m/s to 7.9 +/- 0.3 m/s to 8.0 +/- 0.3 m/s, P = 0.907) while peripheral PWV in the exercised leg significantly decreased from pre (8.7 +/- 0.4 m/s) to 5 min post exercise (7.5 +/- 0.3 m/s, P = 0.008) and 25 min post exercise (7.8 +/- 0.3 m/s, P = 0.031). Systolic blood pressure (BP) increased significantly from pre (126.9 +/- 3.4 mmHg) to 5 min post exercise (133.7 +/- 4.3 mmHg, P = 0.023) and was not different than resting values 25 min post exercise (123.2 +/- 3.1 mmHg). There was no change in diastolic BP. Compared to heart rate (HR) pre-exercise (55.4 +/- 1.4 bpm), HR was significantly increased 5 min post exercise (70.7 +/- 3.0 bpm, P = 0.001) and 25 min post exercise (69.1 +/- 2.0, P = 0.001). Acute resistance exercise appears to decrease arterial stiffness in the exercised leg while having no effect on central arterial stiffness or arterial stiffness of the non-exercised leg. These findings suggest that regional changes rather than systemic alterations may influence arterial stiffness following acute resistance exercise.

Adult↗

Lower leg fluid displacement during a simulated space shuttle launch.

Reductions in leg fluid volume of about 1/per leg or 10% of total leg volume have been reported during space flight. We wanted to test the hypothesis that a significant portion of these changes occur during the prelaunch and launch periods. Fluid volume changes in the lower leg were estimated in six men during a simulated Space Shuttle launch. After 2 h in the launch position, i.e. supine with elevated legs, the subjects were exposed to 500 s of two to three times increased g force in the anterio-posterior direction in a human centrifuge. During the prelaunch period one lower leg lost a mean of (113 SD 53) ml of fluid and there was little or no additional fluid reduction during the period of increased g force. This compares with the 178-ml reduction of lower leg volume that has been reported during the 1st day of Shuttle missions. We concluded that a significant portion of the fluid reduction observed in the lower leg during the early stages of space flight had already occurred before the launch.

Adult↗

Regulating exercise intensity using ratings of perceived exertion during arm and leg ergometry.

The purpose of this investigation was to examine the validity of regulating exercise intensity using ratings of perceived exertion (RPEs) during arm crank and leg cycle exercise at 50 and 70% peak oxygen consumption (VO2peak). Ten men and seven women [26 (1) years old; mean (SE)] participated in this study. Each subject completed a maximal estimation trial and two submaximal exercise bouts (production trials) on both an arm and leg ergometer. During each maximal estimation trial, subjects were asked to give a RPE for each stage of the exercise. RPEs, heart rates (HR), and power outputs (PO) equivalent to 50 and 70% VO2peak for each exercise mode were then estimated from plots of RPE versus oxygen consumption (VO2), HR versus VO2, and PO versus VO2, respectively. During the submaximal trials, subjects were instructed to select workloads on an arm and leg ergometer that produced the previously estimated RPEs. Comparisons were made for VO2, HR, and PO between the estimation and production trials for each mode at each exercise intensity. HR did not differ between the trials at either 50 or 70% VO2peak during arm and leg ergometry. In addition, VO2 and PO did not differ between the trials at either 50 or 70% VO2peak during arm ergometry and at 50% VO2peak during leg ergometry. However, these two parameters were lower (P < 0.05) during the production trial [1.88 (0.15) l x min(-1) and 89.1 (10.1) W, respectively] as compared to the estimation trial [2.08(0.14) l x min(-1) and 102.4 (6.5)W, respectively] during leg ergometry at 70% VO2peak. In conclusion, using RPEs to regulate exercise intensity is physiologically valid during arm ergometry at both 50 and 70% VO2peak and during leg ergometry at 50% VO2peak. However, this prescriptive approach remains questionable during leg cycle exercise at 70% VO2peak.

Adult↗

Architectural characteristics of dominant leg muscles in junior soccer players.

The preferential use of dominant over non-dominant limbs produces muscle hypertrophy in the dominant limb. The purpose of this study was to investigate the architectural characteristics of the muscle that are associated with dominant leg use in junior soccer players. Fascicle length, pennation angle and muscle thickness of the medial gastrocnemius (MG) were measured by B-mode ultrasound in 26 junior soccer players [mean (SD) age: 16.5 (0.6) years] and 20 control college students [age: 18.5 (0.5) years]. Lower leg circumference and MG muscle thickness were significantly (P < 0.05) greater in the soccer players than in the controls. The percent difference (dominant minus non-dominant legs) in muscle thickness and fascicle length were significantly (P < 0.01) larger in the soccer players than in the controls, but the percent difference in pennation angle was similar between groups. The difference (dominant leg minus non-dominant leg) in muscle thickness was significantly correlated (r = 0.55; P < 0.05) with the difference in muscle fascicle length in the soccer players, but not in the controls (r = 0.18). In conclusion, the preferential use of one limb over another, as seen in junior soccer players, results in a greater difference in muscle thickness between the dominant and non-dominant legs. This difference in muscle size was associated with longer fascicle lengths of the dominant leg. Thus, it appears possible that fascicle length may be further influenced by physical training in dominant legs.

Adolescent↗

The active straight leg raising test and mobility of the pelvic joints.

Objective signs to assess impairment in patients who are disabled by peripartum pelvic girdle pain hardly exist. The purpose of this study was to develop a clinical test to quantify and qualify disability in these patients. The study examined the relationship between impaired active straight leg raising (ASLR) and mobility of pelvic joints in patients with peripartum pelvic girdle pain, focusing on (1) the reduction of impairment of ASLR when the patient was wearing a pelvic belt, and (2) motions between the pubic bones measured by X-ray examination when the patient was standing on one leg, alternating left and right. Twenty-one non-pregnant patients with peripartum pelvic girdle pain in whom pain and impairment of ASLR were mainly located on one side were selected. ASLR was performed in the supine position, first without a pelvic belt and then with a belt. The influence of the belt on the ability to actively raise the leg was assessed by the patient. Mobility of the pelvic joints was radiographically visualized by means of the Chamberlain method. Assessment was blinded. Ability to perform ASLR was improved by a pelvic belt in 20 of the 21 patients (binomial two-tailed P = 0.0000). When the patient was standing on one leg, alternating the symptomatic side and the reference side, a significant difference between the two sides was observed with respect to the size of the radiographically visualized steps between the pubic bones (binomial two-tailed P = 0.01). The step at the symptomatic side was on average larger when the leg at that side was hanging down than when the patient was standing on the leg at that side. Impairment of ASLR correlates strongly with mobility of the pelvic joints in patients with peripartum pelvic girdle pain. The ASLR test could be a suitable instrument to quantify and qualify disability in diseases related to mobility of the pelvic joints. Further studies are needed to assess the relationship with clinical parameters, sensitivity, specificity and responsiveness in various categories of patients. In contrast with the opinion of Chamberlain, that a radiographically visualized step between the pubic bones is caused by cranial shift of the pubic bone at the side of the standing leg, it is concluded that the step is caused by caudal shift of the pubic bone at the side of the leg hanging down. The caudal shift is caused by an anterior rotation of the hip bone about a horizontal axis near the sacroiliac joint.

Adult↗

Infrainguinal endovascular and bypass surgery for critical leg ischemia in patients on long-term dialysis.

Lower limb revascularization has been shown to be worthwhile for treatment of critical leg ischemia in uremic patients, but poor results are expected in patients on long-term dialysis. We have retrospectively evaluated the results of a series of 21 consecutive patients on long-term dialysis who underwent 20 infrainguinal bypass graft and 5 endovascular procedures for critical leg ischemia to identify factors contraindicating any infrainguinal revascularization attempt in this patient population. At 2-year follow-up, the patency rate was 74%, leg salvage rate was 85%, and survival rate was 23%, whereas 23% of patients were alive with salvaged leg. Patients on hemodialysis achieved better survival outcome than patients on peritoneal dialysis (p = 0.02). Multivariate analysis showed that low serum level of albumin (p = 0.009; p = 0.005) and coronary artery disease (p = 0.0002; p = 0.001) had an adverse effect on the survival rate and on the rate of patients alive with salvaged leg, respectively. Patients without coronary artery disease achieved an alive-with-salvaged-leg rate at 1- and 2-year follow-up of 68% and 41%, respectively, whereas 12% of patients with coronary artery disease survived with salvaged leg after 1 year, but none of them survived with salvaged leg at 2-year follow-up (p = 0.003). In conclusion, infrainguinal revascularization for lower extremity ischemia in dialysis patients is hardly indicated in the presence of coronary artery disease and severe hypoalbuminemia.

Adult↗

Comparison of the results and reproducibility of arm and leg exercise tests in men with angina pectoris.

The results and reproducibility of arm and leg exercise tests were compared in 11 men with angina pectoris induced by both forms of testing. Leg testing was performed using a bicycle ergometer; arm testing was performed using the same apparatus modified to permit arm cranking. Subjects performed 2 days of arm and 2 days of leg testing over a 2 week period. Four tests were performed on each test day. The duration of exercise, oxygen uptake, heart rate, systolic and diastolic blood pressures and the rate-pressure product were determined at the onset of angina. Within day and between product were determined at the onset of angina. Within day and between day coefficients of variation were low and similar for arm and leg tests, indicating that both forms of testing are highly reproducible. Performing four tests on a single day did little to reduce variability. Oxygen uptake increased between the first and second arm or leg test on a single day, but there was little change after the second test. Repetition of the arm and leg tests did not affect performance over the study period. It is concluded that the reproducibility of arm exercise testing in men with angina pectoris is comparable with that of leg exercise. Subjects with angina induced by arm exercise who cannot perform leg testing can be evaluated and followed up with arm exercise tests.

Angina Pectoris↗

Obstruction of the swing phase during gait: phase-dependent bilateral leg muscle coordination.

We have investigated bilateral leg muscle activation following an obstruction of the forward swinging leg during gait. When the holding impulse was released at the beginning of the swing phase, weak gastrocnemius (GM) and biceps femoris (BF) responses appeared in the contralateral, standing leg. When the holding impulse was released at the end of the swing phase, strong tibialis anterior (TA) and rectus femoris (RF) responses appeared in the swinging leg, and GM and BF responses in the standing leg. In the latter condition the TA response was followed by a premature impact associated with a GM activation. The latency between onset of impulse and appearance of the responses was 65-70 ms in both legs. While in the first condition the duration of GM and BF response corresponded to the duration of the impulse, it was independent for the duration of GM and BF response in the latter. It is concluded that different strategies for compensation are at work. In the first condition, body stability is maintained during the obstruction by the standing leg. In the second condition, body support is provided by a premature touchdown of the swinging leg. It is suggested that the appropriate pattern is, in part, released by a spinal generator.

Adult↗

Leg muscle activation during gait in Parkinson's disease: adaptation and interlimb coordination.

Adaptation in leg muscle activity and coordination between lower limbs were studied during walking on a treadmill with split belts in one group of parkinsonian patients and one of age-matched healthy subjects. Four different belt speeds (0.25/0.5/0.75/1.0 m/sec) were applied in selected combinations to the left and right leg. While these walking conditions were easily tolerated by the healthy subjects, the parkinsonian patients usually reached the limits of their walking capabilities. Both groups adapted automatically to a change in belt speed within approximately 20 stride cycles. Healthy subjects adapted by reorganizing their stride cycle with a relative shortening of duration of support and lengthening of the swing phase of the "fast" leg and vice versa on the "slow" leg. The patients showed a restricted range of stride frequencies for the various belt speeds during normal and split-belt walking with consequent deviations in the reorganization of the stride cycle. In both healthy subjects and patients, ipsilateral gastrocnemius and contralateral tibialis anterior electromyographic (EMG) activity increased predominantly with an ipsilateral increase in belt speed. Two main differences were observed in the EMG patterns: (1) In the patients leg muscle EMG activity was less modulated and gastrocnemius EMG amplitude was small during normal and split-belt walking. However, there was no significant difference between the two groups in respect to the reorganization of the EMG pattern required for the various split-belt walking conditions. (2) The amount of co-activation of antagonistic leg muscles during the support phase of the stride cycle was greater in the patients compared to the healthy subjects during normal and split-belt walking. It is suggested that reduced EMG modulation and recruitment in the leg extensors may contribute to the impaired walking of the patients. This in turn is a result of an impaired proprioceptive feedback from extensor load receptors. This defective control is partially compensated for in parkinsonian patients by a greater amount of leg flexor activation which leads to a higher degree of co-activation. Visual input plays a role in the control of this increased activation.

Adaptation, Physiological↗

One-leg stance in healthy young and elderly adults: a measure of postural steadiness?

OBJECTIVE: To investigate postural steadiness during 30 s of one-leg stance in healthy young and elderly adults, by analysing the pattern of the ground reaction force variability. DESIGN: A laboratory set-up was used to analyse the variability of the ground reaction forces in relation to time as a measure of postural steadiness. BACKGROUND: The one-leg stance test is a measure considered to assess postural steadiness in a static position by a temporal measurement. The common notion is that a better postural steadiness, i.e. less force variability, allows for longer time standing on one leg. However, there is lack of evidence how postural steadiness during one-leg stance changes over time. METHODS: Twenty-eight healthy elderly and 28 healthy young adults were tested by means of force plates assessing ground reaction forces while performing one-leg stance. RESULTS: During one-leg stance, two phases could be identified in both groups: First a dynamic phase, a rapid decrease of force variability, and thereafter a static phase, maintaining a certain level of force variability. During the first 5 s of one-leg stance the force variability decreased significantly more in the young group resulting in a lower force variability level during the static phase than in the elderly. CONCLUSIONS: The difficulties in maintaining the static position in elderly seems dependent on the reduced initial decrease in force variability and/or musculoskeletal components. We suggest that the first 5 s are crucial when assessing balance during one-leg stance.

Adult↗

Erector spinae and quadratus lumborum muscle endurance tests and supine leg-length alignment asymmetry: an observational study.

OBJECTIVE: To determine if there is an association between supine leg-length alignment (LLA) asymmetry and the endurance of the erector spinae (ES) and quadratus lumborum (QL) muscles. METHODS: Forty-seven subjects (21 women; average age, 36 years old) were tested for ES endurance using the Biering-Sorensen (B-S) test, and 69 (31 women; average age, 34.5 years) were tested for QL endurance. Subjects were examined for supine LLA and tested for ES and QL muscle endurance. The muscle endurance times were compared against those who did and did not demonstrate LLA asymmetry and the side of the "short leg." RESULTS: In the B-S test, volunteers with LLA asymmetry (n = 27) had a mean endurance time of 89.7 seconds (SD, 43.3), and the no-LLA asymmetry group (n = 20) had a mean endurance time of 161.5 seconds (SD, 57.1), a significant difference (P < .001). In the QL test, after correction for the effects of sex and exercise, those with a right "short leg" (n = 22) had a right QL endurance time of 25.9 seconds (SE, 4.2) and a left QL endurance time of 34.7 seconds (SE, 4.3). The right QL endurance time was significantly different from those subjects with balanced legs (P = .001). Those with a left "short leg" (n = 20) had a left QL endurance time of 28.6 seconds (SE, 4.7) and a right QL endurance time of 38.1 seconds (SE, 4.5). Both QL endurance times were significantly different from those with balanced leg-length (P = .002 and .016, respectively). CONCLUSION: This study suggests that, using the B-S test, the group of volunteers who demonstrated a commonly used sign of subluxation/joint dysfunction, supine LLA asymmetry, had a decreased endurance times over those who did not. The QL endurance tests showed that the QL muscle ipsilateral to the supine short leg had significantly decreased endurance times over the same-side QL fatigue times in the no leg-length asymmetry group.

Adult↗

Exercise effect of modified contralateral stabilization bar during one-legged isokinetic exercise.

We compared the electrical activities recorded from the muscles of the unexercised leg with changing the position of the contralateral stabilization bar to determine whether the degree of muscle contraction was influenced by the position of the bar during one-legged isokinetic exercise using an isokinetic dynamometer. The root mean square (RMS) values recorded from the medial hamstring sites of the unexercised legs showed a significantly higher value when the bar was located behind and on both in front of and behind the unexercised leg during one-legged extension exercise. Results from the isokinetic knee flexion exercise test indicated that a significantly greater RMS value was recorded from the vastus lateralis sites when the bar was located in front of and on both sides of the unexercised leg. During one-legged isokinetic extension-flexion exercise, the mean values of RMS voltage were greater when the bar was positioned in front of and on both sides of the unexercised leg in the vastus lateralis site. At the medial hamstring site, a greater value was noticed when the bar was located behind or on both sides.

Adult↗

Transcutaneous oxygen measurement in stroke: circulatory disorder of the affected leg?

OBJECTIVE: To identify variances in the microcirculation of the affected leg of stroke patients and to correlate them with a number of variables that are clinically associated with a possible circulatory disorder ("cold leg"). DESIGN: Survey. SETTING: Large regional (tertiary care) rehabilitation center. PATIENTS: From 93 acute, first-ever stroke patients admitted for stroke rehabilitation, 10 individuals were selected. Patients with vascular or cardiopulmonary pathology and severe cognitive or speech impairments were excluded. MAIN OUTCOME MEASURES: A clinical assessment of the following variables was performed: subjective complaints of the affected leg, medication, walking performance, degree of lower-leg edema, trophic pathology, voluntary muscle activity of the dorsal flexors of the affected foot, and the degree of spasticity of the calf muscles. The microcirculation of the affected leg was registered via transcutaneous oxygen measurement (TcPO2). RESULTS: The clinical picture associated with a circulatory disorder ("cold leg") was partially and modestly present in seven patients. The TcPO2 values showed no differences between the paretic and nonparetic lower legs, nor did values change in the course of time after stroke: mean 77.9 mmHg (range 42-124) versus 86.1 (41-124) after 8 weeks (n = 10, p = .17); 76.9 (45-96) versus 73.1 (50-96) after 14 weeks (n = 9, p = .38); and 65.8 (44-88) versus 65.8 (37-78) after 20 weeks (n = 8, p = .48). The clinical symptoms could not be objectified in relation to the microcirculation. CONCLUSIONS: In selected stroke patients, no differences were established between microcirculation in both lower legs. TcPO2 measurement does not seem to be a suitable method for clinical research on this topic.

Adult↗

Exogenous nitric oxide increases basal leg glucose uptake in humans.

This study addressed the role of blood flow and nitric oxide in leg glucose uptake. Seven subjects (5 men, 2 women) were studied during conditions of resting blood flow and increased blood flow, achieved by infusion of the nitric oxide (NO) donor sodium nitroprusside (SNP) into the femoral artery. Femoral arterial and venous blood samples were obtained and blood flow was determined by infusion of indocyanine green dye. SNP infusion significantly increased leg blood flow (769 +/- 103 v 450 +/- 65 mL. min(-1). leg(-1), P <.001), but did not affect arterial (4.68 +/- 0.13 mmol/L control, 4.63 +/- 0.09 mmol/L SNP) or venous (4.60 +/- 0.14 mmol/L control, 4.54 +/- 0.10 mmol/L SNP) glucose concentrations. Glucose uptake was significantly (P <.01) higher during SNP infusion (65 +/- 6 micromol. min(-1). leg(-1)) than during the basal period (34 +/- 6 micromol. min(-1). leg(-1)), whereas lactate release was unaffected (rest, 45 +/- 11 micromol. min(-1). leg(-1); SNP, 42 +/- 14 micromol. min(-1). leg(-1)). We conclude that blood flow and/or NO increase basal leg glucose uptake.

Coloring Agents↗

A study of the impact of leg ulcers on quality of life: financial, social, and psychologic implications.

BACKGROUND: Leg ulcers affect probably 2.5 million persons in the United States, and their prevalence is likely to rise as the population ages. They cause considerable disability, and the cost of treating these chronic wounds is enormous. OBJECTIVE: The purpose of this study was to assess the financial, social, and psychologic implications of leg ulcers. METHODS: Data were collected by standardized personal interviews with 73 patients with chronic leg ulcers. The interview covered several domains that were selected to determine the impact of a leg ulcer on overall quality of life. RESULTS: A significant number of patients had moderate to severe symptoms, principally pain, related to the leg ulcer. Eighty-one percent believed that their mobility was adversely affected by the ulcer; the dominant predictor of impaired mobility was swelling of the leg (p < 0.001). For younger, working patients, leg ulceration was correlated with time lost from work (p < 0.001), job loss (p < 0.01), and adverse effects on finances (p < 0.02). Fifty-eight percent of patients found caring for the ulcer burdensome. There was a strong correlation between time spent on ulcer care and feelings of anger and resentment. Sixty-eight percent of patients reported that the ulcer had a negative emotional impact on their lives, including feelings of fear, social isolation, anger, depression, and negative self-image. CONCLUSION: Leg ulcers pose a substantial threat to a variety of dimensions of a patient's quality of life.

Adult↗

The concentration of high molecular weight compounds in interstitial tissue fluid: a study in patients with post-reconstructive leg oedema.

OBJECTIVES: To study whether relative changes in the concentration of different proteins of the subcutaneous interstitial tissue fluid in patients with postreconstructive leg oedema could give information on the integrity of the capillary wall following vascular reconstruction. MATERIALS: Sixteen patients developed ipsilateral leg oedema following femoropopliteal (n = 14) or femorotibial (n = 2) bypass surgery for intermittent claudication (n = 10) or critical lower limb ischaemia (n = 6) caused by obliterating atherosclerosis. METHODS: The leg volume increase was measured according to the formula of a truncated cone. The blister suction method was used for sampling of subcutaneous interstitial tissue fluid. The concentration of albumin, transferrin, immunoglobulin G and alpha 2-macroglobulin of serum and blister fluid was measured with nephelometry. RESULTS: Seven days postoperatively the mean leg volume increase was 32% (19.8%) in the operated leg compared to the contralateral side (p < 0.01). In the blister fluid each of the proteins had a significantly higher concentration in the operated leg compared to the control leg. This concentration difference was relatively larger for the proteins with the highest molecular weight, immunoglobulin G (p = 0.006) and alpha 2-macroglobulin (p = 0.002). CONCLUSIONS: A relatively larger concentration difference of the bigger molecules in the subcutaneous interstitial tissue fluid in patients with post-reconstructive leg ocdema suggests increased capillary permeability to plasma proteins following vascular reconstruction.

Aged↗