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At least 937 records · Page 52Linked to original sources
PubMed2006

The clinical importance of variations in the surgical anatomy of the superficial peroneal nerve in the mid-third of the lateral leg.

The superficial peroneal nerve (SPN) provides fundamental motor and sensory innervation to the leg and foot. A variety of surgical procedures is performed in the vicinity of this nerve, requiring that the surgeon be familiar with its specific anatomy. We dissected 111 legs to define the anatomic position of the SPN and found that the nerve had 4 distinct variations in location. In 77 (69.4%) specimens, the nerve coursed within the lateral compartment of the leg, while in 18 (16.2%) of the legs, the nerve split and contained branches in both the lateral and anterior compartments. The nerve in 7 (6.3%) legs was found within the intermuscular septum, and in 9 (8.1%) of the specimens, the SPN traveled only within the anterior compartment. These results confirm 4 anatomic variants of the SPN, which will aid surgeons in locating the nerve in the lateral aspect of the leg.

Decompression, Surgical↗
PubMed1996

FES standing: control by handle reactions of leg muscle stimulation (CHRELMS).

Many paraplegics can stand using functional electrical stimulation (FES) of their extensor muscles without any modulation of the stimulus intensity by feedback. This is possible because, using handles and the intact upper-body muscles, the position of the pelvis can be controlled and this determines the positions of the two legs. Nevertheless, it is highly desirable that some practical method of modulating the stimulus intensities is used to reduce muscle fatigue and improve posture. We propose that the goal of the controller should be the minimization of the handle reaction forces by referring these forces to the equivalent leg joint moments and, as far as possible, making corresponding changes to the stimulation of the leg muscles. If force sensors are used only at the handles, the joint moments in the two legs are indeterminate. We hypothesize that in some patients acceptable results may still be obtained if we treat the two legs as one. This method will control standing up, standing, and sitting down; the user will be able to "feel" that his leg muscles are tiring and will be able to "posture switch" without any explicit instruction to the controller to change mode.

Arm↗
PubMed1982

Release of hypoxanthine and phosphate from exercising human legs with and without arterial insufficiency.

Release of hypoxanthine and phosphate from exercising legs was studied in eight subjects without known obstructive arterial disease and in 20 claudicants. Lower leg blood flow was measured with a thermodilution catheter in the popliteal/distal femoral vein. The catheter allowed blood sampling from the calf before, during and after exhaustive exercise on a bicycle ergometer at a stepwise increasing load. Resting plasma hypoxanthine levels were higher in claudicants than in normal subjects (p less than 0.05). Hypoxanthine concentrations increased 2-4-fold during exercise, amounting to values ten times higher than the resting levels 5 and 10 min post exercise, in the venous effluent of the normal legs. A similar rise was found in the claudicants despite half the exercise intensity at exhaustion. Popliteal venous concentrations of phosphate increased by approximately 25% during exercise without significant differences between the two groups. During exercise the release of hypoxanthine increased 38-fold and of phosphate 21-fold in the normal lower legs, while a ten-fold increase in both metabolites was recorded in the claudicating legs. The study demonstrated a high release of hypoxanthine and phosphate from the human lower leg during rhythmic, exhaustive exercise (with maximal vasodilation). The result is compatible with the assumption that metabolites from the catabolism of adenine nucleotides (adenosine) play a role in the autoregulation of blood flow in human skeletal muscle. Increased plasma hypoxanthine concentrations at rest may indicate peripheral arterial insufficiency.

Adult↗
PubMed2006

Sickle cell leg ulcers: associations with haemolysis and SNPs in Klotho, TEK and genes of the TGF-beta/BMP pathway.

Cutaneous leg ulcers are common in sickle cell anaemia and their risk might be genetically determined. Sickle cell anaemia patients were studied to examine the relationship of leg ulcers with haemolysis and with single nucleotide polymorphisms (SNPs) in candidate genes that could affect sickle vasoocclusion. Leg ulcer patients had lower haemoglobin levels and higher levels of lactate dehydrogenase, bilirubin, aspartate transaminase and reticulocytes than did control patients with sickle cell anaemia but without leg ulcers. Age-adjusted comparisons showed that sickle cell anaemia-alpha thalassaemia was more frequent among controls than cases. These results strongly suggested that the likelihood of having leg ulcers was related to the intensity of haemolysis. 215 SNPs in more than 100 candidate genes were studied. Associations were found with SNPs in Klotho, TEK and several genes in the TGF-beta/BMP signalling pathway by genotypic association analyses. KL directly or indirectly promotes endothelial nitric oxide (NO) production and the TEK receptor tyrosine kinase is involved in angiogenesis. The TGF-beta/BMP signalling pathway modulates wound healing and angiogenesis, among its other functions. Haemolysis-driven phenotypes, such as leg ulcers, could be improved by agents that reduce sickle erythrocyte density or increase NO bioavailability.

Adult↗
PubMed1993

Effect of dihydroergotamine on leg blood flow during combined epidural and general anaesthesia and postoperative deep vein thrombosis after cholecystectomy.

The effects of dihydroergotamine (DHE) on the circulation of the leg during combined epidural and general anaesthesia were studied to determine if DHE would enhance leg blood flow and prevent postoperative deep vein thrombosis in a double-blind trial of 40 elderly female patients subjected to cholecystectomy. Central and big toe temperature, arterial blood pressure, heart rate, calf volume and arterial inflow of the leg by electrical impedance plethysmography and the venous outflow by Doppler method were measured. DHE 0.5 mg subcutaneously reduced the volume of the leg, i.e. increased the electrical impedance, probably due to venous vasoconstriction. Simultaneously the need for etilefrine hydrochloride was reduced. No significant changes in the pulsatile inflow of the leg or the outflow were detected. Deep vein thrombosis (DVT) was detected by fibrinogen uptake test in five patients (three in DHEH and two in the control group) and verified by ascending phlebography in four patients. Intraoperative characteristics in patients with postoperative DVT were tachycardia (P < 0.001), enhanced need for etilefrine (P < 0.01) and a more rapid increase in big toe temperature (P < 0.05) after induction of epidural analgesia, compared with patients without DVT. Femoral vein flow velocity remained at the preinduction level, whereas pulsatile arterial inflow slightly increased. Together with a low basal impendance of the leg, the changes were indicative of a more intense vasodilatation, probably leading to stagnant flow and development of postoperative deep vein thrombosis.

Aged↗
PubMed1998

Treatment of leg telangiectasias using a long-pulse frequency-doubled neodymium:YAG laser at 532 nm.

BACKGROUND: At the present time a large variety of vascular lesion lasers are available for the treatment of both congenital and acquired disorders of blood vessels. Although most vascular lesions lasers are variably effective in the treatment of facial telangiectasias, port-wine stains, hemangiomas, and other vascular anomalies, their use in the treatment of leg veins has been disappointing. Histologic, anatomic, and other variables have been associated with a poor response of leg veins to currently available vascular lesion lasers. OBJECTIVE: This study examines the use of a new long pulse frequency-doubled Neodymium (Nd):YAG laser emitting radiation at 532 nm for the treatment of leg veins. METHODS: Fifty patients with leg telangiectasias of varying diameters were treated using a variable pulse width frequency doubled Nd:YAG laser. This laser delivers energy through a novel water-cooled chill tip, which appears to limit epidermal damage during laser treatment. RESULTS: Sixty-two treatment sites were evaluated in 50 patients. Seventy-three percent of patients had greater than 50% improvement after one treatment. Eight-three percent were graded with clearances of better than 50% after two treatments, with 63% showing greater than 75% improvement. CONCLUSION: The VersaPulse variable pulse width laser appears to be an effective modality for the treatment of leg telangiectasias. The relative lack of patient discomfort combined with a high degree of patient satisfaction may indicate a fairly high level of patient acceptance of this new form of therapy for the treatment of leg telangiectasias.

Humans↗
PubMed2004

The "T" vein of the leg.

BACKGROUND: We frequently observe a tributary of the saphenous vein with the origin in the saphenous compartment of the medial aspect of the upper third of the leg. It runs transversally in the interfascial compartment toward the lateral aspect of the leg. Constantly it feeds by reflux varicose veins clinically visible in the paratibial region and/or in the lateral aspect of the leg. For the peculiarity of its anatomical shape as well as duplex appearance, we defined it as the "T" vein. OBJECTIVES: To assess how frequently the "T" vein of the leg is involved in varicose networks. METHODS: A total of 218 consecutive patients affected by primary varicose veins have been evaluated by the means of duplex scanning. We assessed both the presence of the above-mentioned tributary and the frequency of its hemodynamic involvement in the varicose network. RESULTS: In 15 of 218 cases (7%) we demonstrated the above-mentioned tributary with an interfascial length ranging between 5 and 12 cm involved in varicose networks. CONCLUSIONS: The anterior tributary of the saphenous vein of the anterolateral aspect of the leg is a neglected clinical entity, whose existence is important to know for the treatment of varicose veins of the lateral aspect of the leg.

Adult↗
PubMed1993

Quinine sulfate for leg cramps: does it work?

OBJECTIVE: To study the efficacy of quinine in the prevention of nocturnal leg muscle cramps. DESIGN: Double-blind, randomized, crossover trial with four periods of observation, each lasting 2 weeks. SETTING: General internal medicine outpatient clinic. PARTICIPANTS: Ambulatory outpatients who experienced an estimated two or more typical nocturnal leg cramps per week. INTERVENTION: 200 mg of quinine taken at bedtime. MAIN OUTCOME MEASURES: Self-reported ratings of leg cramp frequency, duration, and intensity. RESULTS: Sixteen patients completed the trial. During the 2 weeks patients used quinine, there was no statistically significant reduction in mean leg cramp number (quinine 3.5 vs placebo 4.2, P = 0.48), mean leg cramp duration (quinine 152 seconds vs placebo 163 seconds, P = 0.89), or patient ratings of severity using a 1 (low) to 10 (high) scale (quinine = 4.2 vs placebo = 4.0, P = 0.83). CONCLUSION: No significant reduction in nocturnal leg cramp frequency, intensity, or duration could be found using nightly quinine in this study. Since quinine is not without the potential for side effects and drug interactions, clinicians need to carefully consider the likelihood of modest benefit associated with quinine against the potential for side effects and drug-drug interactions.

Adult↗
PubMed1997

One-leg balance is an important predictor of injurious falls in older persons.

OBJECTIVE: To test the hypothesis that one-leg balance is a significant predictor of falls and injurious falls. DESIGN: Analysis of data from a longitudinal cohort study. SUBJECTS: Healthy, community-living volunteers older than age 60 enrolled in the Albuquerque Falls Study and followed for 3 years (N = 316; mean age 73 years). MAIN OUTCOME MEASURES: Falls and injurious falls detected via reports every other month. INDEPENDENT VARIABLES: Baseline measures of demographics, history, physical examination, Iowa Self Assessment Inventory, balance and gait assessment, and one-leg balance (ability to stand unassisted for 5 seconds on one leg). RESULTS: At baseline, 84.5% of subjects could perform one-leg balance. (Impairment was associated with older age and gait abnormalities.) Over the 3-year follow-up, 71% experienced a fall and 22% an injurious fall. The only independent significant predictor of all falls using logistic regression was age greater than 73. However, impaired one-leg balance was the only significant independent predictor of injurious falls (relative risk: 2.13; 95% CI: 1.04, 4.34; P = .03). CONCLUSION: One-leg balance appears to be a significant and easy-to-administer predictor of injurious falls, but not of all falls. In our study, it was the strongest individual predictor. However, no single factor seems to be accurate enough to be relied on as a sole predictor of fall risk or fall injury risk because so many diverse factors are involved in falling.

Accidental Falls↗
PubMed2005

One-legged bicycling as an assessment tool for patients with stroke.

OBJECTIVE: To assess whether one-legged bicycling correlates with muscle strength and thereby could work as an outcome measure for persons with stroke. METHODS: The study comprised 29 men (age 35-65) with a first occurrence of stroke 6-35 months earlier. Each leg was evaluated separately. A ramp protocol was used (10 W/min), with continuous recording of the ventilatory uptake (Vo(2)) and heart rate. An isokinetic dynamometer was used to assess strength and endurance. Enzyme assays were performed on muscle biopsy samples. RESULTS: The peak isometric strength and isokinetic strength of the paretic leg correlated with the max. W on the bicycle. The oxidative enzyme citrate synthase correlated with the workload for both legs on the bicycle and lactate dehydrogenase correlated with peak isometric strength in both legs. CONCLUSIONS: The one-legged bicycle exercise test can be used to assess endurance in persons with a previous stroke as it correlates with dynamometer testing and muscle biopsies.

Adult↗
PubMed2006

Single-leg hop testing following fatiguing exercise: reliability and biomechanical analysis.

A fatiguing exercise protocol was combined with single-leg hop testing to improve the possibilities of evaluating the effects of training or rehabilitation interventions. In the first test-retest experiment, 11 healthy male subjects performed two trials of single-leg hops under three different test conditions: non-fatigued and following fatiguing exercise, which consisted of unilateral weight machine knee extensions at 80% and 50%, respectively, of 1 repetition maximum (1 RM) strength. Intraclass correlation coefficients ranged from 0.75 to 0.98 for different hop test conditions, indicating that all tests were reliable. For the second experiment, eight healthy male subjects performed the fatiguing exercise protocol to investigate how fatigue influences lower-extremity joint kinematics and kinetics during single-leg hops. Hip, knee and ankle joint angles, moments and powers, as well as ground-reaction forces were recorded with a six-camera, motion-capture system and a force platform. Recovery of hop performance following the fatiguing exercise was also measured. During the take-off for the single-leg hops, hip and knee flexion angles, generated powers for the knee and ankle joints, and ground-reaction forces decreased for the fatigued hop conditions compared with the non-fatigued condition (P<0.05). Compared with landing during the non-fatigued condition, hip moments and ground-reaction forces were lower for the fatigued hop conditions (P<0.05). The negative joint power was two to three times greater for the knee than for the hip and five to 10 times greater for the knee than for the ankle during landing for all test conditions (P<0.05). Most measured variables had recovered three minutes post-exercise. It is concluded that the fatiguing exercise protocol combined with single-leg hop testing was a reliable method for investigating functional performance under fatigued test conditions. Further, subjects utilized an adapted hop strategy, which employed less hip and knee flexion and generated powers for the knee and ankle joints during take-off, and less hip joint moments during landing under fatigued conditions. The large negative power values observed at the knee joint during the landing phase of the single-leg hop, during which the quadriceps muscle activates eccentrically, indicate that not only hop distance but also the ability to perform successful landings should be investigated when assessing dynamic knee function.

Adult↗
PubMed1976

The nature of the training response; peripheral and central adaptations of one-legged exercise.

13 male subjects were studied and placed in 3 groups. Each group exercised one leg with sprint (S), or endurance (E) training and the other leg oppositely or not at all (NT). Oxygen uptake (Vo2), heart rate and blood lactate were measured for each leg separately and for both legs together during submaximal and maximal bicycle work before and after 4 weeks of training with 4-5 sessions per week. Muscle samples were obtained from the quadriceps muscle and assayed for succinate dehydrogenase (SDH) activity, and stained for myofibrillar ATPase. In addition, eight of the subjects performed after the training two-legged exercise at 70% Vo2 max for one hour. The measurements included muscle glycogen and lactate concentrations of the two legs as well as the blood flow and the a-v difference for O2, glucose and lactate.

Adaptation, Physiological↗
PubMed1997

Gait analysis in laying hens and broilers with and without leg disorders.

Selection of broiler strains for high body weight has changed the anatomical characteristics and in connection to that, the pattern of locomotion. In addition, rapid growing broilers show a high incidence of leg disorders which compromise the walking ability of the birds. Differences in the patterns of locomotion between laying hens and broilers and between broilers with and without leg disorders can be demonstrated and quantified by gait analysis. The gait pattern was recorded by videotracking. Three points of the body - the cloacal region and both feet joints - were marked by small patches of reflecting foils. The vertical and horizontal movements of the marked points were recorded by a camera in posterior position, while the bird was walking on a treadmill The camera was connected with a PC-operated videotracking system. The vertical and horizontal movements of the 3 marked points were recorded simultaneously and plotted against the time axis. Kinetograms show clearly the differences in the walking pattern between broilers and layers. Layers place the legs directly under the centre of gravity and, therefore, the body moves in a straight line. Broilers, in contrast, move the centre of gravity step by step laterally towards the position of the supporting leg. This pattern may be caused by the anatomical characteristics of broilers. Limping in broilers with leg problems can be measured by differences in the lateral and vertical movements of the right and left leg.

Animals↗
PubMed2005

Postprandial triacylglycerol uptake in the legs is increased during exercise and post-exercise recovery.

Six young, healthy male subjects were each studied in two experiments: (1) during resting conditions before and for 360 min after a meal (54% of energy as carbohydrate, 30% of energy as lipid, and 16% of energy as protein) comprising 25% of their total daily energy intake (M-->R); and (2) while exercising on a cycle ergometer for 60 min at 50% of the peak oxygen consumption commencing 60 min after the meal (M-->E) and then for another 240 min. Regional metabolism was measured by Fick's Principle in a leg and in the splanchnic tissue. The combination of food intake and exercise led to increased plasma triacylglycerol (TAG) uptake and clearance in the exercising legs immediately and for at least 4 h post-exercise, while food intake per se did not change leg plasma TAG uptake or clearance for up to 6 h. It is hypothesized that the effect of exercise on leg plasma TAG metabolism is a result of capillary recruitment leading to exposure of the plasma lipoprotein particles to a larger amount of active LPL. In spite of the increased TAG uptake in the exercising legs the arterial plasma TAG concentration had a tendency to increase faster during exercise after a meal than during rest, but it also decreased faster implying that the total lipaemic response was the same whether exercise was performed or not. The amount of lipid taken up in the legs was higher than could be accounted for by whole body lipid oxidation during post-exercise recovery, indicating accumulation of lipid in skeletal muscle in this period. Neither food intake alone nor the combination of food and exercise affected the splanchnic net balance of TAG. Finally, there is an additive effect of exercise and food intake on splanchnic net glucose balance.

Adult↗
PubMed2006

Energy absorption as a predictor of leg impedance in highly trained females.

Although leg spring stiffness represents active muscular recruitment of the lower extremity during dynamic tasks such as hopping and running, the joint-specific characteristics comprising the damping portion of this measure, leg impedance, are uncertain. The purpose of this investigation was to assess the relationship between leg impedance and energy absorption at the ankle, knee, and hip during early (impact) and late (stabilization) phases of landing. Twenty highly trained female dancers (age = 20.3 +/- 1.4 years, height = 163.7 +/- 6.0 cm, mass = 62.1 +/- 8.1 kg) were instrumented for biomechanical analysis. Subjects performed three sets of double-leg landings from under preferred, stiff, and soft landing conditions. A stepwise linear regression analysis revealed that ankle and knee energy absorption at impact, and knee and hip energy absorption during the stabilization phases of landing explained 75.5% of the variance in leg impedance. The primary predictor of leg impedance was knee energy absorption during the stabilization phase, independently accounting for 55% of the variance. Future validation studies applying this regression model to other groups of individuals are warranted.

Adult↗
PubMed2000

Management of leg ulcers.

Leg ulcer is a leading cause of morbidity among older subjects, especially women in the Western world. About 400 years BC, Hippocrates wrote, "In case of an ulcer, it is not expedient to stand, especially if the ulcer be situated on the leg". Hippocrates himself had a leg ulcer. The best treatment of any leg ulcer depends upon the accurate diagnosis and the underlying aetiology. The majority of leg ulcers are due to venous disease and/or arterial disease, but the treatment of the underlying cause is far more important than the choice of dressing. The aetiology, pathogenesis, treatment, and the future trends in the management of the leg ulcers are discussed in this review.

Angioplasty↗
PubMed1997

Acute lung injury after aortic surgery: the relation between lung and leg microvascular permeability to 111indium-labelled transferrin and circulating mediators.

BACKGROUND: Aortic surgery is a risk factor for acute lung injury and this may relate to ischaemia/reperfusion (I/R) of the lower body and release of inflammatory mediators. The aim of this study was to define the changes in microvascular protein permeability and circulating inflammatory mediators after aortic surgery. METHODS: In 11 consecutive patients who underwent elective aortic surgery microvascular permeability in lung and leg was measured before and a median of 2.8 hours after completion of surgery using 111indium (In)-labelled transferrin and 99mtechnetium (Tc)-labelled red blood cells, yielding a protein leak index (PLI) that is specific for protein permeability. Circulating leucocyte counts and levels of inflammatory mediators were determined. RESULTS: In the lung the PLI rose from a median of 0.6 (range -0.5 to 2.2) x 10(-3)/min before surgery to 5.4 (-2.3 to 33.5) x 10(-3)/min after surgery, and in the leg from 0.3 (-1.6 to 1.7) x 10(-3)/min to 5.0 (1.0 to 27.8) x 10(-3)/min. The increase in PLI in the lung was related to that in the leg. Levels of activated complement C3a and tumour necrosis factor-alpha did not change, but levels of interleukin (IL)-6, IL-8 and elastase-alpha 1-antitrypsin increased. After surgery there was slight neutrophilia and the leucocyte counts were inversely related to the IL-8 level. The rise in lung but not in leg PLI was greatest in patients with the highest IL-8 levels and the lowest leucocyte counts. CONCLUSIONS: Early after aortic surgery microvascular protein permeability increases in the leg and lung. Leg I/R injury may result in neutrophil activation and release of IL-8, which may induce neutrophil sequestration and subsequently increased pulmonary microvascular permeability. These findings may help to explain the occurrence of acute lung injury after I/R in man.

Adult↗
PubMed1986

Removal of infused amino acids by splanchnic and leg tissues in humans.

To compare the contributions of splanchnic and skeletal muscle tissues to the disposal of intravenously administered amino acids, regional amino acid exchange was measured across the splanchnic bed and leg in 11 normal volunteers. Postabsorptively, net release of amino acids by leg (largely alanine and glutamine) was complemented by the net splanchnic uptake of amino acids. Amino acid infusion via peripheral vein (0.2 g X kg-1 X h-1) caused a doubling of plasma insulin and glucagon levels and a threefold rise in blood amino acid concentrations. Both splanchnic and leg tissues showed significant uptake of infused amino acids. Splanchnic tissues accounted for approximately 70% of the total body amino acid nitrogen disposal; splanchnic uptake was greatest for the glucogenic amino acids but also included significant quantities of branched-chain amino acids. In contrast, leg amino acid uptake was dominated by the branched-chain amino acids. Based on the measured leg balance, body skeletal muscle was estimated to remove approximately 25-30% of the total infused amino acid load and approximately 65-70% of the infused branched-chain amino acids. Amino acid infusion significantly stimulated both the leg efflux and the splanchnic uptake of glutamine (not contained in the infusate). We conclude that when amino acids are infused peripherally in normal humans, splanchnic viscera (liver and gut) are the major sites of amino acid disposal.

Adolescent↗