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PubMed1998

Blood flux and venoarteriolar response of the skin in legs with chronic venous insufficiency measured at two different depths by using a double-wavelength laser Doppler technique.

The laser Doppler flux (LDF) and the venoarteriolar response (VAR) of the skin in legs with chronic venous insufficiency (CVI) was measured by using a new double-wavelength probe technique (543 nm and 780 nm). The recordings were taken in a recumbent and in a sitting position. Ten patients with CVI and 20 control subjects with healthy legs were investigated. The LDF was found to be significantly enhanced in a recumbent position at 543 nm and in a sitting position at 780 nm in legs with CVI compared with healthy legs (P<0.05 and P=0.02, respectively). The authors could not find the VAR to be impaired in either wavelength in legs with CVI compared with healthy legs. The double-wavelength probe technique makes it possible to record simultaneously the LDF in the superficial and deep layers of the skin on the same place in the leg.

Aged↗
PubMed1998

Periodic limb movement disorder and restless legs syndrome in children with attention-deficit hyperactivity disorder.

Sleep disruption can lead to symptoms of attention-deficit hyperactivity disorder (ADHD) in children. Since periodic limb movement disorder and/or restless legs syndrome can cause sleep disruption, we assessed whether these two specific sleep disorders are likely to occur in children with ADHD. We asked a series of 69 consecutive parents of children with ADHD questions about the symptoms of periodic limb movement disorder. Based on a positive response to these periodic limb movement disorder queries, 27 children underwent all-night polysomnography. Eighteen children (aged 2 to 15 years) of the 27 (26% of the 69 children with ADHD) had 5 or more periodic leg movements in sleep per hour of sleep and had complaints of sleep disruption, thus fulfilling the criteria for periodic limb movement disorder. A comparably age- and sex-matched group of children referred to a sleep laboratory for sleep complaints but without ADHD showed only a 5% prevalence (2 of 38 subjects) of periodic leg movements in sleep (P=.017). Eight of the 18 children with ADHD and periodic limb movement disorder and one of the two control patients with periodic limb movement disorder had both a personal and parental history of restless legs syndrome symptomatology. This study further documents the occurrence of periodic limb movement disorder and restless legs syndrome in children and is the first large-scale study establishing a possible comorbidity between ADHD and periodic limb movement disorder. We propose that the sleep disruption associated with periodic limb movement disorder and restless legs syndrome and the motor restlessness of restless legs syndrome while awake could contribute to the inattention and hyperactivity seen in a subgroup of ADHD-diagnosed children.

Adolescent↗
PubMed1998

Assessment of rearfoot motion: passive positioning, one-legged standing, gait.

Earlier studies that address assessment of the subtalar joint (STJ) by measuring rearfoot motion used a goniometer to evaluate intertester reliability. Few investigations have determined how positions of the rearfoot, assessed manually (passive range of motion) or statically in one-legged standing, compare with those occurring during walking. The purpose of this study was to determine the following: (1) the intertester reliability of positioning the STJ in neutral, maximum inversion, and maximum eversion; (2) the reliability of the rearfoot position during relaxed one-legged standing; and (3) how these positions compare to rearfoot motion during walking. An electrogoniometer attached to the lateral aspect of the lower leg and heel was used to record the position of the rearfoot during testing procedures. Ten healthy volunteers participated. Rearfoot position was recorded during relaxed one-legged standing and during free and fast walking. Additionally, rearfoot position was recorded while each of three physical therapists positioned the STJ in neutral, maximum inversion, and maximum eversion. Intertester reliability for positioning the STJ in neutral, maximum inversion, and maximum eversion yielded intraclass correlation coefficients of 0.76, 0.37, and 0.39, respectively. Reliability of relaxed one-legged standing had an intraclass correlation coefficient of 0.92. The rearfoot position in relaxed one-legged standing and the maximum eversion position occurring during gait were not significantly different. These findings suggest that there is good intertester reliability in positioning the STJ in neutral. Additionally, the rearfoot position in relaxed one-legged standing may be used to approximate the maximum eversion position that occurs during gait.

Adult↗
PubMed1996

Racial differences in minimum lower leg vascular resistance in normotensive young adults with positive and negative parental histories of hypertension.

OBJECTIVE: To determine whether peripheral hemodynamic differences exist in young adult normotensive African Americans and white Americans with a positive and negative parental history of hypertension. METHODS: The participants were healthy men of whom 13 were African Americans and nine white Americans with a positive parental history and 19 were African Americans and 13 white Americans with a negative parental history. Lower leg blood flows were obtained at rest and during reactive hyperemia. Lower leg minimum vascular resistance (Rmin) was computed from reactive hyperemic blood flow measured by venous occlusion plethysmography, and mean arterial blood pressure was determined by auscultation of the brachial artery. RESULTS: Resting blood flow and mean arterial pressure were similar in all groups. A significant race x parental history interaction effect was observed for lower leg Rmin. In the white men the lower leg Rmin was significantly greater in the positive than the negative parental group (P < 0.05). Lower leg Rmin was significantly greater in African Americans than in white men without a parental histoy (P < 0.05). Mean arterial blood pressure and heart rate were similar among the groups. CONCLUSIONS: This study demonstrates that lower leg Rmin is greater in young white men with a positive parental history of hypertension than those with a negative parental history. In African Americans with either positive or negative parental histories, lower leg Rmin is not different. This finding suggests that heredity may have a greater influence in white populations than in African Americans on the structural changes in resistance vessels. The study also suggests that African Americans have an earlier structural change in the resistance vessels compared with white people, regardless of a parental history of hypertension. This suggests that factors other than heredity are of importance in changing the structure of the resistance vessels.

Adult↗
PubMed2003

Arm and leg impairments and disabilities after stroke rehabilitation: relation to handicap.

OBJECTIVES: (1) To examine the relationships between measures of impairment and disability for the arm and leg with a measure of handicap and (2) to identify the impairment or disability most strongly related to handicap situations. DESIGN: Prospective cohort study. SETTING: Intensive functional rehabilitation unit and community. PATIENTS: One hundred and two persons who had a stroke. MAIN OUTCOME MEASURES: Arm and leg impairments and disabilities were evaluated with reliable and valid tests at discharge from rehabilitation. Six months later, handicap situations were evaluated with the Assessments of Life Habits (LIFE-H). RESULTS: Arm and leg impairments and disabilities are correlated with handicap situations. Disability of the leg is more strongly associated with handicap than arm disability. Arm and leg disabilities are not statistically more strongly related to handicap than arm and leg impairments. CONCLUSIONS: The high correlations found between handicap situations and the impairment and disability measures of the leg provide new information that support the importance of mobility to promote integration after stroke.

Aged↗
PubMed2005

Mechanics and energetics of swinging the human leg.

We measured how much metabolic energy is expended to swing a human leg. A previous dynamical model of walking predicted that increasing metabolic costs for walking with step length and step frequency trade-off against each other to determine the optimum step combination at a given speed. Simple pendulum dynamics indicate that the cost of walking at high step frequencies could be associated with driving the legs back and forth relative to the body, at a rate increasing approximately with the fourth power of frequency, possibly due to the low economy of producing muscle force for short durations. A similar cost would be expected for isolated swinging of a leg at faster than its natural frequency. We constructed an apparatus to measure work performed on the leg, and measured metabolic cost as human subjects (N=12) swung one leg at frequencies 0.5-1.1 Hz and fixed amplitude. Rate of mechanical work ranged from 0.02-0.27 W kg(-1) over these frequencies. Net metabolic rate for leg swinging (subtracting that for quiet standing) increased from 0.41-2.10 W kg(-1), approximately with the fourth power of frequency (R(2)=0.92) and in proportion to a hypothesized cost of force production for short durations. The costs of producing force and work could account for the increase. In a crude comparison, moving the legs back and forth at a typical stride frequency of 0.9 Hz, might consume about one-third of the net energy (2.8+/-0.8 W kg(-1)) needed for walking at 1.3 m s(-1).

Biomechanical Phenomena↗
PubMed2004

Reductions in basal limb blood flow and lumen diameter after short-term leg casting.

PURPOSE: We tested the hypotheses that short-term casting immobilization of a leg would reduce basal blood flow and vascular conductance and induces structural alterations in femoral artery. METHODS: Right knee and ankle joints of eight healthy young men were immobilized with casting for 7 d. Before and immediately after casting, and 14 d after the cast was removed, femoral artery hemodynamics and structure were measured using a high-resolution ultrasound. RESULTS: Femoral artery lumen diameter in the immobilized leg decreased after the immobilization (P < 0.05) and returned to baseline during the recovery period, in which the subjects did not receive any special rehabilitation treatment. Femoral artery intima-media thickness (IMT) and IMT/lumen ratio in both legs did not show significant changes throughout the interventions. In the immobilized leg, femoral artery blood flow and vascular conductance decreased (-23 to 24%) after the immobilization (all P < 0.05). These parameters returned to the baseline during the recovery period, and there were no significant differences between the baseline and recovery values. In the control leg, femoral blood flow and vascular conductance did not change throughout the investigation. After 7 d of casting, femoral arterial distension, an index of arterial distensibility, tended to decrease in the immobilized leg but not in the control leg. CONCLUSION: We concluded that a short-term immobilization of lower limb decreases basal limb blood flow and arterial lumen diameter. These results suggest that basal limb blood flow and lumen diameter decrease rapidly upon the cessation of muscular weight bearing and locomotor activity, and may be modulated by an ordinary level of physical activity.

Adult↗
PubMed1975

Comparison of 125I-labelled fibrinogen uptake and venography in the detection of recent deep-vein thrombosis in the legs.

Both techniques were used to examine 72 legs, and agreed about the presence or absence of thrombus in 54 cases (72 per cent). In 41 legs both tests were positive and in 13 legs both tests were negative. In 16 legs the 125I fibrinogen test only was positive, and if the seven legs with clinical conditions known to increase fibrinogen uptake are excluded, there were nine legs (13 per cent) with an increased fibrinogen uptake in the calf and a normal venogram. In two legs the venogram only was positive, and in both cases there was evidence of clot retraction which suggested that the thrombus was more than a week old. The use of radio-opaque markers attached to the skin made it possible to compare the site of thrombosis detected by the two techniques and the results of this comparison indicate that the fibrinogen test underestimated the extent of femoral vein thrombosis in a significant proportion of cases. (p less than 0-001).

Adolescent↗
PubMed2004

Nurse-led education sets out to improve patient concordance and prevent recurrence of leg ulcers.

OBJECTIVE: This study evaluated the effects of a structured nurse-led education programme that aimed to improve patient concordance and prevent venous leg ulcer recurrence. METHOD: The design was quasi-experimental. Subjects (average age: 80) had venous leg ulceration that had healed within the previous two years, and were cared for at home by a district nurse. Data were available on 49 patients with 97 legs, 72 of which had had venous leg ulcers. Patients were divided into two groups: a control group, which received 'usual' care, and experimental group, which was exposed to the education programme. Recurrence rates, the effects of the education on patient behaviour and the effect on recurrence of having both ankle movement and general mobility were measured over one year. RESULTS: Patients in the experimental group experienced significantly less recurrence over the year (log rank test = 8.28, p = 0.004). To control for differences in mobility and ankle movement in the control and experimental groups at baseline, simultaneous logistic regression analysis was undertaken. This revealed a significant advantage for patients in the experimental group (p = 0.035; OR = 4.45, 95% CI = 1.11-17.74), who spent more time with their legs elevated each day. This difference was sustained throughout the 52 weeks (f = 2.88, p = 0.015). Those who had both full ankle movement (> 60 degrees) and full mobility (without aid) had significantly less recurrence (p = 0.042). Education had no significant effect on the amount of time patients wore compression hosiery (f = 2.1). CONCLUSION: A structured nurse-led patient concordance programme is effective in preventing venous leg ulcer recurrence and increasing the time patients spend with their legs elevated at heart level. Having both full ankle movement and full mobility reduces the risk of recurrence.

Activities of Daily Living↗
PubMed1993

Does crossing the legs decrease arterial pressure in diabetic patients with peripheral vascular disease?

OBJECTIVE: To evaluate the effect of crossing the legs at the knee and the ankle on peripheral arterial pressures. RESEARCH DESIGN AND METHODS: A prospective study of 6 diabetic patients with known peripheral vascular disease and 5 nondiabetic control subjects without peripheral vascular disease was conducted. Peripheral arterial pressures were taken at the ankle and at the great toe before and after crossing the legs at the knees and ankles. Comparisons were made of measurements obtained in the supine and sitting positions. All crossed leg measurements were taken in the sitting position. RESULTS: Ankle arm indexes and digital arm indexes pressures taken in the sitting position were equal to or higher than supine pressures, with the exception of one subject, GB. In this patient, ankle arm indexes and digital arm indexes on the right extremity were lower in the sitting position, but increased with the legs crossed at the knees and ankles compared with the uncrossed sitting position. In all patients, lower extremity pressures that decreased slightly with crossing the legs remained higher than pressures obtained in the supine position. Statistical analyses showed no significant differences. Wave forms did not change even when there was a slight decrease in ankle arm indexes or digital arm indexes. Control subjects without peripheral vascular disease showed no change in pressures with crossing the legs. CONCLUSIONS: Crossing the legs at the knees and ankles does not result in a significant decrease in peripheral arterial pressures in diabetic patients with peripheral vascular disease.

Analysis of Variance↗
PubMed2004

Trunk fat and leg fat have independent and opposite associations with fasting and postload glucose levels: the Hoorn study.

OBJECTIVE: Waist and hip circumferences have been shown to have independent and opposite associations with glucose levels. Waist circumference is positively associated with glucose levels, whereas hip circumference is negatively associated. It is unclear which tissues are involved in the pathophysiological mechanism causing these associations. The main goal was to determine which tissue in the trunk and legs, fat or lean tissue, is associated with measures of glucose metabolism. RESEARCH DESIGN AND METHODS: In 623 participants of the third examination of the Hoorn Study, whole-body dual-energy X-ray absorptiometry was performed to determine fat and lean soft-tissue mass in the trunk and legs. Fasting and 2-h postload glucose levels after 75-g oral glucose tolerance test (OGTT) were determined. After exclusion of known diabetic patients, cross-sectional analyses were performed in 275 men aged 60-87 years (140 with normal glucose metabolism, 92 with impaired glucose metabolism; and 43 with diabetes) and in 281 women (148 with normal glucose metabolism, 90 with impaired glucose metabolism, and 43 with diabetes). RESULTS: Greater trunk fat mass was associated with higher glucose levels after adjustment for age, trunk lean mass, leg lean mass, and leg fat mass. Standardized beta (95% CI) in men were 0.44 (0.25-0.64) for fasting and 0.41 (0.22-0.60) for postload glucose. For women, these values were 0.49 (0.35-0.63) and 0.47 (0.33-0.61), respectively. In contrast, in the same regression models, a larger leg fat mass was associated with lower glucose levels. Standardized beta in men were -0.24 (-0.43 to -0.05) and -0.12 (-0.31 to 0.07) and in women -0.24 (-0.37 to -0.10) and -0.27 (-0.40 to -0.13) for fasting and postload glucose, respectively. In these models, larger leg lean mass was also associated with lower glucose levels but was only statistically significant in men. CONCLUSIONS: If trunk fat is taken into account, accumulation of fat in the legs seems to be protective against a disturbed glucose metabolism, particularly in women. Further research is needed to unravel underlying pathophysiological mechanisms.

Absorptiometry, Photon↗
PubMed1992

Leg and foot ulcers. Nursing care in Malmö, Sweden.

Questionnaires concerning nursing care of leg and foot ulcer patients in three major care-giving sectors of the national health service, namely the Department of Dermatology, general hospital wards/clinics, and primary care, have been analysed. The overall response rate was 88% (primary care: 100%). Forms regarding 193 patients with leg ulcers and 64 patients with foot ulcers were analysed. Substantial differences in nursing care were noted between the three sectors. In 55% of the leg ulcers and 45% of the foot ulcers fibrin slough was present in the ulcer. Black, necrotic tissue was present in 8% of the leg ulcers and 22% of the foot ulcers. Profuse ulcer-exudation was most commonly reported for leg ulcer patients treated at the Department of Dermatology, while the majority of foot ulcers had only a mild exudation. Frequency of dressing changes varied between 1.4 times/week for leg ulcers at the Department of Dermatology and 9.2 times/week (foot ulcers 11.6) at general hospital clinics. Local wound dressings were exclusively chosen by physicians at the Department of Dermatology, mainly by physicians at general hospital clinics, and equally often by physicians and nurses in primary care. Time since last evaluation of the ulcer by a physician varied. At the general hospital clinics, 89% of the patients with leg ulcers had been seen by a physician within the last 2-month period. At the Department of Dermatology, 89% and in primary care 61% of the patients were examined within this period. 11% of the patients in primary care had never consulted a physician for their ulcers.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2000

Popliteal-to-distal bypass grafts for critical leg ischaemia.

BACKGROUND: To assess the value of revascularization to crural and pedal arteries using the popliteal artery as inflow source. METHODS EXPERIMENTAL DESIGN: Retrospective study with a mean follow-up period of 15.2 months (range, 0-46). SETTING: Academic referral center. PATIENTS: 62 patients with critical leg ischaemia and popliteal artery suitable as inflow source for infrapopliteal arterial revascularisation. INTERVENTIONS: 66 popliteal-to-distal bypass procedures, of which 18 popliteal-crural bypass grafts and 48 popliteal-pedal bypass grafts. MAIN OUTCOME MEASURES: Bypass graft patency, leg salvage, survival and success defined as patients alive with leg. RESULTS: At 1-month, 1-year, and 2-year follow-up, the primary patency rates were 87%, 58%, and 55%, secondary patency rates were 95%, 70%, and 67%, leg salvage rates were 97%, 88%, and 88%, while 88%, 70%, and 66% of patients were alive with legs at the same intervals. At 2-year follow-up the survival rate was 72%. Above-knee popliteal-to-distal bypasses achieved better primary patency (p=0.02) and corrected primary patency rates (p=0.01) than below-knee popliteal-to-distal bypasses. Diabetes and uraemia affected the survival and patients alive with leg rates. CONCLUSIONS: Popliteal-to-distal bypass surgery is worthwhile for the management of severe, isolated infrapopliteal atherosclerotic disease. Diabetic and uraemic patients are at high risk for both leg and life loss after revascularisation. Grafts originating from the above-knee popliteal artery may achieve better patency rates than those originating from the below-knee popliteal artery.

Adult↗
PubMed2001

[A patient with restless legs syndrome/periodic limb movement successfully treated by wearing a lumbar corset].

We report a 77-year-old woman with restless legs syndrome(RLS) and periodic limb movement(PLM). From 62 years of age, she was awakened by tingling and involuntary movement in her legs during sleep. There symptoms disappeared when she stood up and walked. She was treated with clonazepam (2.5 mg/day) and valproate (400 mg/day) at 77 years of age, and the symptoms clearly ameliorated. However, she developed mild truncal ataxia and was referred to our hospital. On admission, neurological examination revealed Babinski and Chaddock signs bilaterally with depressed tendon reflexes in the lower limbs, mild truncal ataxia and horizontal gaze nystagmus. She did not present with involuntary movement of the legs while taking the anti-epileptic drugs. Cessation of these drugs alleviated the truncal ataxia and nystagmus, but reexacerbated abnormal sensation with involuntary movement in her legs during sleep. The involuntary movements in her legs were slower than myoclonus and resembled a Babinski reflex (duration about 1 second), and they appeared periodically (around every 30 seconds) in I-II sleep stages. Neither brain MRI nor EEG detected any abnormality. Cervical MRI revealed focal compression of the spinal cord by osteophytes at C5-C6 (more severe on the left side). Motor evoked potentials with transcranial magnetic stimulation revealed a mild delay in the central conduction time (CCT), which was more prolonged on the left side. She was thus diagnosed as having RLS/PLM with involvement of the bilateral pyramidal tracts. Although nerve conduction studies did not detect any abnormality in the peripheral nerves, RLS/PLM of the left leg was induced by electric stimulation of the left tibial nerve. Because she did not want medication any more, we treated her with a lumbar corset, hoping that wearing a lumbar corset might induce contraction of the truncal muscles that would mimic standing and walking or might produce additional sensory input that would induce a 'sensory trick'. Consequently, her abnormal sensation and involuntary movement during sleep as well as the stimulation of the tibial nerve disappeared. Wearing a lumbar corset may inhibit the excitability of the spinal cord that generates RLS/PLM, though the level of sensory input by the corset was higher than the input level of abnormal sensation in her legs. A lumbar corset may be a useful alternative choice for patients with RLS/PLM, who cannot tolerate either anti-epileptic or dopaminergic drugs.

Aged↗
PubMed2002

Prediction of electrical impedance parameters for the simulated leg segment of an aircraft pilot under G-stress.

BACKGROUND: Blood accumulation in the lower extremities of fighter pilots has been known to induce loss of peripheral vision and consciousness. G suits and anti-G straining maneuvers applied to lower limbs do not work according to the actual status of blood accumulation. Therefore, the problem of blood accumulation in the legs requires further investigation. METHOD: The leg segment of an aircraft pilot has been modeled as a cylinder containing its anatomical structure of skin-fat layer, muscles, bones, and blood volume in the form of inner cylinders. Finite element analysis (FEA) was applied to the leg model with suitable boundary conditions. Predicted leg-segment electrical impedance (LEI) without blood accumulation has been compared with the measured experimental value using electrical impedance plethysmography (EIP). The effects of 7% blood pooling were analyzed by electrical impedance of the leg segment and its constituents by increasing the diameter of blood volume cylinder. RESULTS: The LEI has been predicted to be 46.7 omega, which corresponds well with experimental value of 46.0 omega and predicted value, being 1.58% higher. Predicted LEI was reduced to 44.2 omega during simulation of blood accumulation in FE model. The relative contributions of admittance for leg constituents fat, muscle, bones and blood volume are also found to be 2.96, 75.58, 0.33, and 11.13%, respectively. CONCLUSION: A computer simulation technique has been developed to predict electrical impedance parameters of the leg segment and its constituents with and without blood pooling. These results will be useful in further research and clinical applications for aircraft pilots under acceleration (G) stress.

Adipose Tissue↗
PubMed2002

Leg ulcers in New Zealand: age at onset, recurrence and provision of care in an urban population.

AIM: To describe the age at onset, recurrence rate, and provision of care for people with leg ulcers in New Zealand. METHODS: Between 1997 and 1998, people with current leg ulcers were identified from the North Auckland and Central Auckland health districts via notification from relevant health professionals and by self-referral. All ulcer types were investigated. Identified cases, aged between 40 and 99 years and on the general electoral roll, were interviewed as part of a case-control study. Descriptive information relating to interviewed cases is presented. RESULTS: 241 people with leg ulcers were interviewed. The average age was 75 years and almost 60% were women. The average age at ulcer onset was 65 years, 59% of people had recurrent ulcers, and 24% had been hospitalised in the last five years because of their leg ulcers. Those people with recurrent leg ulcers had lived with their condition for an average of fifteen years, with an average time to healing for their last ulcer of thirteen months. Treatment of this condition was largely community-based, with 136 different treatment options employed. CONCLUSIONS: Leg ulceration remains a chronic and recurring condition, with substantial practice variation in terms of treatment. Urgent attention needs to be given to the management of leg ulcer patients in this country, particularly given that New Zealand has a rapidly ageing population.

Adult↗
PubMed2002

Test-retest reliability of 4 single-leg horizontal hop tests.

The purpose of this study was to determine the test-retest reliability of 4 single-leg horizontal hop tests (i.e., single hop for distance, triple hop for distance, crossover hop for distance, and 6-m hop for time), with a time interval of approximately 4 weeks separating the 2 testing sessions. Eighteen healthy, young, adult men, all cadets enrolled at the U.S. Air Force Academy, Colorado, performed the single hop for distance, the triple hop for distance, the crossover hop for distance, and the 6-m hop for time during 2 testing sessions separated by 31.2 +/- 0.4 days. Reliability data for each of the single-leg hop tests were studied through a repeated measures analysis of variance, intraclass correlation coefficients (ICCs), and standard errors of measurement (SEMs). The ICCs ranged from 0.92 to 0.97 for the 4 single-leg hop tests. The SEMs for the single-leg hop tests that assessed the distance hopped ranged from 4.61 to 17.74 cm. The SEM for the 6-m hop for time test was 0.06 seconds. No significant differences were noted when the mean scores of the 2 test trials were compared by a repeated measures analysis of variance for any of the single-leg hop tests. These results indicate that the single-leg hop tests examined in this study offer strength and conditioning professionals a reliable method to assess the single-leg horizontal hopping capabilities of healthy, young, adult men, with intervals of approximately 4 weeks between testing sessions.

Adult↗
PubMedDate not supplied

Dialysis leg cramps. Efficacy of quinine versus vitamin E.

A controlled randomized double-blind study was done to determine the frequency and severity of leg cramps in 40 patients on dialysis with a history of leg cramps. All patients entered a 2 month placebo washout and were randomized into a 2 month double-dummy phase of quinine 325 mg at bedtime versus vitamin E 400 IU at bedtime. Of the 29 patients completing the study, 16 received quinine and 13 vitamin E. During placebo washout, the vitamin E group had a mean of 10.4 leg cramps per month, and the quinine group had a mean of 10.9. The vitamin E and quinine groups had a 1 month reduction in leg cramps to 3.3 and 3.6, respectively (p < 0.0005 for both groups combined); this was sustained at 2 months. A severity of pain index showed a statistically significant decrease for both groups. The 95% confidence interval for the difference between the number of leg cramps after vitamin E versus quinine treatment (95% confidence interval, -3.8, +3.2) suggests similar efficacy. Quinine and vitamin E were effective treatments for leg cramps in these patients. Considering the potential toxicity of quinine, vitamin E is recommended as the initial treatment of choice for patients on dialysis with leg cramps.

Adult↗