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PubMed1999

Should people with nocturnal leg cramps drink tonic water and bitter lemon?

A literature search from 1993 to 1997 using MEDLINE and key-words beverages, muscle cramp, and quinine was performed. Three beverages containing quinine were examined in grocery stores. Analysis indicate that leg cramps are a common phenomenon associated with many comorbid disorders especially peripheral vascular and neurologic disorders. Thus, evaluation of a patient's complaining of leg cramps appropriately includes vascular, neurologic, and musculoskeletal examinations. Laboratory investigation of the symptom of leg cramps warrants as a minimum, assessment of thyroid function and determination of platelet counts and serum levels of electrolytes, calcium, and magnesium. A few small studies suggest that quinine is effective in decreasing the frequency of nocturnal leg cramps but not their severity or duration. Quinine consumed in commercial beverages has been reported to cause potentially fatal immunologically mediated hypersensitivity reactions. The concentration of quinine in commercial beverages varies greatly. Although commercial beverages containing quinine generally are labeled "Contains quinine," they typically lack both nutritional information about the amount of quinine and warnings of the health risks. It appears that 325 milligrams of quinine taken by mouth at bedtime typically relieves nocturnal leg cramps, but lower starting doses are appropriate for senior citizens and individuals with impaired renal function. In general, quinine in any form should be avoided by pregnant women and people with hepatic failure. Quinine consumed for the treatment of leg cramps should be prescribed and monitored by physicians, and people who consume quinine in commercial beverages must be warned of the health risks.

Carbonated Beverages↗
PubMed1997

Swell-preventing effect of intermittent exercise on lower leg during standing work.

This study investigated the effectiveness of several possible exercises for performance during standing work in order to prevent lower leg swelling and relieve subjective complaints. Volume changes in the lower leg were measured using bioelectrical impedance plethysmography in 13 healthy male subjects aged 23-36 years. Subjective complaints of leg pain, leg dullness and whole body fatigue were also recorded. Measurements were performed at two-minute intervals during a one-hour period of standing with insertions of one-minute of exercise every 10 min. The exercises were knee-bending, foot-stepping, walking, and heel-raising. The change rates of impedance over one hour were 2.2%, 4.0%, 4.6%, and 6.3%, respectively, indicating that leg volume was increased under all exercise conditions. Among exercises, the swell-preventing effect of knee-bending was strongest, and that of heel-raising was weakest. Heel-raising also yielded the highest number of subjective complaints. Knee-bending, which uses the thigh and calf muscles simultaneously, was considered the most effective for suppressing lower-leg swelling and minimizing subjective complaints.

Adult↗
PubMed1999

The effect of a tilting seat on back, lower back and legs during sitting work.

The purpose of this study was to examine the possible effects of a tilting seat on the back, lower back and legs. Ten healthy male subjects aged 22-28 performed word-processing operations while sitting on a chair for one hour under two different seating conditions: the rocking condition and the fixed condition. While the subjects were performing the task, measurements of lower leg swelling were taken using bioelectrical impedance plethysmography, and pain scores were recorded every five min for the neck, shoulders, back, lower back, hips and legs. Electromyograms (EMGs) of the back and lower back (at Th5-6, Th8-9, L1-2 and L3-4) were recorded every sec. In addition, the subjects were videotaped while using the rocking seat, in order to analyze the angle and frequency of seat tilting. At the end of the experiment, the subjects were asked to evaluate the two conditions with respect to localized fatigue and operational efficiency. There was no significant difference in lower leg swelling between the two conditions. EMGs were significantly different at Th5-6, Th8-9 and L1-2 between the two conditions. The rocking condition generated greater EMGs at Th5-6 and L1-2, whereas the fixed condition produced greater EMGs at Th8-9. The pain scores for the neck, shoulders, back and lower back were higher under the fixed condition, while those for the buttocks were higher under the rocking condition. The average tilting frequency was as low as 25.2 times per hour, with 15.6 times per hour for tilting angles ranging from 1 to 2 degrees, and 9.6 times per hour for tilting angles exceeding 2 degrees. As for the subjective evaluations of localized fatigue, seven of the ten subjects preferred the rocking condition, while two preferred the fixed condition and one subject had no preference. Thus, there was a significant difference in the subjective evaluations of the two chairs. These findings suggest that the rocking condition, in contrast to the fixed seating condition, reduced back and lower back pain as a result of its tilting capability. The results of EMGs suggest that the rocking condition reduced back and lower back pain by increasing the overall muscle activity of the back and lower back. The leg impedance measurements showed no effect of the rocking condition on the leg swelling, as compared with the fixed condition.

Adult↗
PubMed1978

Exercise-and post-exercise metabolism of the lower leg in patients with peripheral arterial insufficiency.

Exercise- and post-exercise metabolism were studied in the lower legs of six subjects without known arterial insufficiency and in sixteen claudicants. Lower leg blood flow was measured with a thermodilution catheter in the popliteal vein. The catheter allowed blood sampling from the calf before, during and after an exhaustive, stepwise increasing load exercise on a bicycle ergometer. A higher oxygen extraction and higher lactate release during exercise in claudicants than in normal subjects persisted in the post-exercise period (P less than 0.05). Leg arteriopoplitealvenous differences of free fatty acids (FFA) showed an inverse intergroup relationship to that of glucose. Being higher in claudicants than in normal subjects during exercise (P less than 0.05). However, net uptake of FFA was not significantly different in the groups of legs although it appeared increased relative to glucose in claudicants both during and after the exercise. Thus no statistically significant substrate preference was detected although the results suggests a preference for FFA relative to glucose in legs with arterial insufficiency. The study furthermore demonstrated the lag of exercise metabolism into the post-exercise period in such legs and a close relationship between this metabolic delay and the severity of the disease.

Adult↗
PubMed1983

The repair of soft tissue defects in the lower leg. A comparison of different flap techniques.

The results following reconstruction of soft tissue defects in the lower leg in 102 patients with 19 cross-leg flaps, 49 muscle flaps, 17 dorsalis pedis island flaps and 26 free composite island flaps were compared regarding the pattern of primary healing, time taken to heal and costs. The cross-leg flap appeared to be the least dependable method of reconstruction and most expensive way of reestablishing stable soft tissue coverage. Muscle flaps and dorsalis pedis island flaps appeared to be preferable and equal alternatives to cross-leg flaps in the proximal and distal part of the lower leg, respectively. Free composite island flaps also appeared advantageous compared to cross-leg flaps, and seem to be indicated when simpler means of reconstruction are inadequate or would yield a similar result at higher overall costs.

Adolescent↗
PubMedDate not supplied

Approach to leg edema of unclear etiology.

A common challenge for primary care physicians is to determine the cause and find an effective treatment for leg edema of unclear etiology. We were unable to find existing practice guidelines that address this problem in a comprehensive manner. This article provides clinically oriented recommendations for the management of leg edema in adults. We searched on-line resources, textbooks, and MEDLINE (using the MeSH term, "edema") to find clinically relevant articles on leg edema. We then expanded the search by reviewing articles cited in the initial sources. Our goal was to write a brief, focused review that would answer questions about the management of leg edema. We organized the information to make it rapidly accessible to busy clinicians. The most common cause of leg edema in older adults is venous insufficiency. The most common cause in women between menarche and menopause is idiopathic edema, formerly known as "cyclic" edema. A common but under-recognized cause of edema is pulmonary hypertension, which is often associated with sleep apnea. Venous insufficiency is treated with leg elevation, compressive stockings, and sometimes diuretics. The initial treatment of idiopathic edema is spironolactone. Patients who have findings consistent with sleep apnea, such as daytime somnolence, loud [corrected] snoring, or neck circumference >17 inches, should be evaluated for pulmonary hypertension with an echocardiogram. If time is limited, the physician must decide whether the evaluation can be delayed until a later appointment (eg, an asymptomatic patient with chronic bilateral edema) or must be completed at the current visit (eg, a patient with dyspnea or a patient with acute edema [<72 hours]). If the evaluation should be conducted at the current visit, the algorithm shown in Figure 1 could be used as a guide. If the full evaluation could wait for a subsequent visit, the patient should be examined briefly to rule out an obvious systemic cause and basic laboratory tests should be ordered for later review (complete blood count, urinalysis, electrolytes, creatinine, blood sugar, thyroid stimulating hormone, and albumin).

Algorithms↗
PubMed1980

Curled toes and perosis-like leg abnormalities in cage reared broilers.

A high incidence of perosis-curled toe type of leg disorder has consistently developed in both cage- and floor pen-reared male broiler chicks of two different genetic strains within 5 to 7 days when fed a nutritionally complete corn-soybean meal diet. Postmortem analysis of affected birds indicate classic perosis as seen in dietary manganese (Mn) deficiency. Ration modifications, such as inclusion of 50 ppm additional Mn or .5 mg/kg vitamin B-2 did not prevent or reduce the development of this leg problem. Birds reared in floor-pens had a reduced incidence (12 to 13%) of perosis-curled toe problem compared with incidence of leg disorders of battery-reared birds (20 to 60%). In most instances, a positive relationship between rate of weight gain and severity of leg abnormalities was apparent. Reduction in photoperiod from 24 hr/day to 12 hr/day substantially reduced incidence of leg disorders; however, growth rate was also reduced. The practical basal diet employed in all experiments promotes satisfactory rate of growth and feed efficiency and may be an excellent assay diet for experimentation into perosis-like broiler leg problems.

Animal Nutritional Physiological Phenomena↗
PubMed2006

General practitioners' experiences of managing patients with chronic leg ulceration.

OBJECTIVE: To understand general practitioners' experiences of managing patients with chronic leg ulceration, thus informing future strategies to improve leg ulcer care in general practice, Australia. DESIGN: Qualitative study using phenomenology and in-depth interviewing. PARTICIPANTS AND SETTING: Maximum variation sample of 12 GPs working in the Perth and Hills Division of General Practice between September and December 2004. MAIN OUTCOME MEASURE: Themes in participants' experiences of leg ulcer care. FINDINGS: Participants regarded leg ulcer management as an integral part of general practice. They expressed a desire to maintain their involvement, yet relied on nursing assistance. They perceived that ulcer care was usually straightforward and successful. Approaches to management appeared to differ significantly from that outlined in current guidelines. Instead, participants valued accessibility of care for the patient, awareness of patient context and regular review. Occasional problems with non-healing ulcers were experienced, and, in these situations, specialist opinion was appreciated. CONCLUSION: This study highlights fundamental differences between GP and specialist conceptualisation of leg ulcer care. For GPs, it identifies key areas of ulcer management that could be improved. For specialists, it suggests that widespread implementation of traditional guidelines may not be appropriate or acceptable. New approaches to leg ulcer management in general practice are likely to need a combination of education, human resources and practical support.

Attitude of Health Personnel↗
PubMed1992

A demographic survey of leg and foot ulcer patients in a defined population.

By means of a questionnaire sent to all medical units in Malmö, including primary care, homes for the elderly, and industrial health clinics, 275 patients with leg and foot ulcers were identified. With a population of 232,908 in Malmö, this corresponds to a prevalence of 0.12%, which is lower than reported by others. Since the response rate was high (88% total, Primary Care: 100%), the prevalence of 0.12% is, however, believed to be real and might be explained by the urban area investigated, with easy access to care and proximity to one somatic hospital. 50% of the patients with leg and foot ulcers were treated in Primary Care, and 30% of the leg ulcer patients were treated at the Department of Dermatology. 88% of leg and foot ulcer patients were over 75 years of age. Median age was 79.5 years, with 80 for women and 76.5 for men. In Primary Care the median age was 82. There was a predominance of women in the study population with an overall sex ratio of 3:1. A higher proportion of patients living alone was found in Primary Care. The etiology of the ulcers was considered to be "unknown" or "other" or else no statement was given in 36% of the leg ulcer- and 22% of the foot ulcer patients. This might reflect an overall uncertainty about the underlying etiological cause. Medially and laterally located leg ulcers were reported equally often, but there was also a great proportion of wholly or partially circumferential ulcers. 76% of the foot ulcers were located on the toes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Prostanoids for chronic critical leg ischemia. A randomized, controlled, open-label trial with prostaglandin E1. The ICAI Study Group. Ischemia Cronica degli Arti Inferiori.

BACKGROUND: No effective pharmacologic intervention is available for critical leg ischemia, a severe clinical condition associated with high morbidity and mortality. OBJECTIVE: To assess the safety and efficacy of prostaglandin E1 in improving the prognosis and quality of life in patients with critical leg ischemia. DESIGN: Multicenter, centrally randomized, controlled, open-label trial. SETTING: 56 vascular surgery and angiology departments of the Italian National Health Service. PATIENTS: 1560 patients with chronic critical leg ischemia. INTERVENTIONS: In addition to routine treatments practiced in each center, patients were randomly assigned to receive either a daily intravenous infusion of 60 microg of prostaglandin E1 in the form of alprostadil-alpha-cyclodextrine (n = 771) or no prostaglandin E1 (n = 789) during their hospital stay. The treatment period lasted for up to 28 days. MEASUREMENTS: A combined end point consisting of death and peripheral and cardiocerebrovascular illness (major amputation or persistence of critical leg ischemia, acute myocardial infarction, or stroke) evaluated at hospital discharge and during 6 months of follow-up. RESULTS: The incidence of the combined outcome measure was lower in the alprostadil group than in controls at hospital discharge (493 [63.9%] patients compared with 581 [73.6%] patients; relative risk, 0.87 [95% CI, 0.81 to 0.93]; P < 0.001) but differed only modestly at 6 months (348 of 661 [52.6%] patients compared with 387 of 673 [57.5%] patients; relative risk, 0.92 [CI, 0.83 to 1.01]; P = 0.074). Most of the observed benefit was due to recovery from critical leg ischemia. CONCLUSIONS: Short-term treatment with alprostadil-alpha-cyclodextrine provides patients with critical leg ischemia clinical benefit that is apparent in the short term but decreases over time.

Aged↗
PubMedDate not supplied

[The use of ropinirol ++ as a treatment for restless leg syndrome].

INTRODUCTION: Restless legs is an unpleasant sensation in the calves that occurs when the individual is sitting or laying down, with an irresistible urge to move the legs. It has been know as a cause of insomnia. We have been using various drugs with a variety of effectiveness. Levodopa is now considered the drug of choice but drug tolerance is likely to develop the risk of drug dependence. Recently, a new drug was developed by Smithkline Beecham called ropinirol which principal indication is the treatment of initial phase of Parkinson's disease. PATIENTS AND METHODS: Base on the idea of the efficacy de la levodopa in patients with restless legs we administered 0.25 mg of ropinirol at bedtime to 15 of our patients diagnosed with restless legs syndrome. None of them had received positive results using the classic treatments during more than five years since they had developed this syndrome. Before the treatment was begun, we discontinued any medications relating to this illness. RESULTS: Beneficial effects were observed after the first administration and has continued until this time, 12 months after the initial treatment. Efficacy was measure by using sleep questionnaires (Spiegel). With only a pill (0.25 mg) at the moment of laying down at bedtime reports a clear improvement in the symptoms, including reducing the periodic leg movements. CONCLUSION: That improvements continue without any secondary side effects and without appearing to have built up any tolerance for the medication. Further research is needed to investigate the long term efficacy and side effects of this new treatment, but at this moment is a valuable and satisfactory tool to treat restless legs syndromes.

Adult↗
PubMed1999

[Delineation of calf arteries using 2D-TOF MR angiography without contrast medium: efficacy of cardiac gating and leg warming].

We evaluated the image quality of non-contrast enhanced 2D-TOF MRA of the calf and the efficacy of cardiac gating and leg warming. In 10 healthy volunteers, MRA was carried out under the following four conditions: (a) usual MRA, (b) MRA with cardiac gating, (c) MRA after leg warming and (d) MRA with cardiac gating after leg warming. Although MRA with cardiac gating was not suitable, MRA after leg warming was well suited to the imaging of calf arteries. The image quality of MRA with cardiac gating after leg warming was the same as that of MRA after leg warming.

Arteries↗
PubMed1999

Does saphenous vein arterialisation prevent major amputation in critical leg ischaemia? A comparative study.

BACKGROUND: Arterialisation of the great saphenous vein has been suggested to improve distal circulation in patients with critical leg ischaemia not accessible for reconstructive surgery. As the technique has been a matter of controversy the aim was to assess the outcome of a series of own patients treated with arterialisation and compare them with conservatively treated patients. METHODS EXPERIMENTAL DESIGN: a retrospective cohort study. SETTING: an academic referral centre (Department of Surgery, Helsinki University Central Hospital) together with a district hospital (Peijas-Rekola Hospital). PATIENTS AND INTERVENTIONS: 14 consecutive patients with critical leg ischaemia treated with arterialisation of the great saphenous vein in the district hospital were compared with 14 age, sex, diabetes and symptom severity-matched controls with critical leg ischaemia treated conservatively in the academic referral centre. MEASURES: major amputations and patient survival. RESULTS: The leg salvage rate was 57% at one year in the arterialisation group and 54% in the conservative group (NS) but the survival rate at one year was 92% in the operative group and 64% in the control group (NS). CONCLUSIONS: Arterialisation did not have any effect on leg salvage. The results of this study do not support the use of arterialisation as a treatment for critical leg ischaemia

Aged↗
PubMed2000

Risk factors for leg wound complications following endoscopic versus traditional saphenous vein harvesting.

BACKGROUND: Risk factors for leg wound complications following traditional saphenectomy have included: obesity, diabetes, female gender, anemia, age, and peripheral vascular disease. Use of an endoscopic saphenectomy technique may modify the risk factor profile associated with a traditional longitudinal incision. METHODS: From September 1996 to May 1999, 276 consecutive patients who underwent elective isolated coronary artery bypass grafting performed by a single surgeon (K.B.A.) had their greater saphenous vein harvested endoscopically. During the period from January 1999 to May 1999, the surgical records of 643 patients who underwent the same operation and had a traditional longitudinal saphenectomy were reviewed for postoperative leg wound complications. Group demographics were similar regarding preoperative risk stratification and traditionally identified wound complication risk factors (diabetes, gender, obesity, preoperative anemia, and peripheral vascular disease). Leg wound complications were defined as: hematoma, dehiscence, cellulitis, necrosis, or abscess requiring dressing changes, antibiotics and/or debridement prior to complete epithelialization. Follow-up was 100% at six weeks. RESULTS: Leg wound complications following endoscopic harvest occurred in 3% (9/276) of patients versus 17% (110/643) of traditional harvest patients (p < 0.0001). No univariate risk factors for wound complications were associated with endoscopic saphenectomy. Univariate predictors of wound complications following traditional saphenectomy included: diabetes (p = 0.001), obesity (p = 0.0005), and female gender (p = 0.005). Multivariable risk factors for leg wound complications following saphenectomy were traditional harvest technique (OR 7.56, CI 3.8-17.2, p < 0.0001), diabetes (OR 2.10, CI 1.4-3.2, p = 0.0006) and obesity (OR 1.82, CI 1.2-2.8, p = 0.007). CONCLUSIONS: Traditional longitudinal saphenectomy is a multivariable risk factor for development of leg wound complications. Endoscopic saphenectomy modifies the risk factor profile for wound complications and should be the standard of care, particularly for obese and/or diabetic patients who require venous conduit during coronary artery bypass grafting.

Aged↗
PubMedDate not supplied

A clinico-radiological survey of deep venous thrombosis of the leg.

In a clinico-radiological survey of 150 cases of varicose veins of the leg, 44 had primary varicosities with no dermal complications; their venograms showed patency of the deep veins of the leg. In 106 cases presenting dermal complications, venographic evidence of deep venous occlusion was present. The dermal complications of varicosities are, therefore, always secondary to deep venous occlusion. Deep venous occlusion of the leg was confined to the lower 1/3 of the leg in 58% of the cases occurring as a complication of silent varices. In 15% it involved the upper 1/3. This lesion complicated trauma and surgical operations. In 5% thrombosis occurred in the muscular sinusoids as a complication of septicaemia. In 22%, deep venous occlusion in lower 1/3 of the leg extended to the middle and upper thirds with a corresponding ascending aggravation of the clinical picture. The underlying factors in the pathogenesis of dermal complications are discussed as well as the role of the lymphatics. The reported classification of deep venous occlusion of the leg may prove of value if a venographic study is not feasible. A review of the various types of treatment is presented in the light of these informations.

Humans↗
PubMedDate not supplied

["Difficult" venous ulcers of the legs].

The aim of the study was to analyze the diagnostic and surgical criteria in cases of "critical" venous leg ulcers. This report describes the management of 200 patients with trophic lesions of the lower limbs. Patients with venous leg ulcers were identified with the aid of ultrasonography and echocolor Doppler. Among these patients, according to the chronic evolution of the lesions, we identified all those with critical venous leg ulcers. The management of the lesions involved both medical and fairly aggressive surgical treatment with the use of general anaesthesia and deep surgical toilette of the ulcer. In the cases with poor epithelialisation we adopted oxygen therapy and skin grafts using the "mesh graft" technique. Critical venous leg ulcers were identified in 23 patients (19%). After surgical treatment, we observed complete epithelialisation of the lesion only in 5 cases (21.7%). In 13 patients (56.6%) the use of oxygen therapy was necessary and epithelialisation occurred on postoperative day 12. Skin grafts were used in 5 cases (21.7%). Only one recurrence was observed one year after operation in an area adjacent to the site of the graft. The "golden goal" of critical venous leg ulcer management is to establish a correct aetiological diagnosis, distinguishing between venous leg ulcers and other trophic lesions of the lower limbs. The medical and surgical treatment described in this report reduce healing time and the social costs of the disease, without any significant complications for the patient.

Humans↗
PubMedDate not supplied

Leg ulcer presenting in a patient with congenital afibrinogenaemia.

Congenital afibrinogenaemia is a rare hemorrhagic disorder characterized by the absence of fibrinogen. We report a case of congenital afibrinogenaemia presented with leg ulcer. A 30-year-old man presented with a history of prolonged bleeding from birth. His parents are cousins. He repeatedly showed haematoma after traumas on his leg. He was diagnosed as having congenital afibrinogenaemia because of plasma fibrinogen deficiency. Because his leg ulcer gradually increased in size, he was admitted to our department for treatment. Laboratory examinations revealed prolonged bleeding time, prolonged coagulation time, prolonged prothrombin time, prolonged activated partial thromboplastin time and plasma fibrinogen was not measurable. Histological examination revealed hyperkeratosis, acanthosis and severe fibrotic change in the whole dermis. Severe hemosiderin deposit was found in the middle dermis. His leg ulcer cured 2 months after the beginning of fresh frozen plasma administration (FFP), but recurrence of the leg ulcer after FFP treatment was found. This is the second reported case of congenital afibrinogenaemia presented with leg ulcer.

Adult↗
PubMed2002

Leg and trunk length at 43 years in relation to childhood health, diet and family circumstances; evidence from the 1946 national birth cohort.

BACKGROUND: This is a study of the associations of adult leg and trunk length with early life height and weight, diet, socioeconomic circumstances, and health, and parental height, divorce and death. METHOD: The data used were collected in a longitudinal study of the health, development and ageing of a British national birth cohort (N = 2879 in this analysis) studied since birth in 1946. Multiple regression models were used to investigate the relationships. RESULTS: Adult leg and trunk length were each positively associated with parental height, birthweight, and weight at 4 years. Leg length was associated positively with breastfeeding and energy intake at 4 years. Trunk length was associated negatively with serious illness in childhood and possibly also parental divorce, but not with the dietary data. CONCLUSION: Adult leg length is particularly sensitive to environmental factors and diet in early childhood because that is the period of most rapid leg growth. Trunk growth is faster than leg growth after infancy and before puberty, and may be associated with the effects of serious illness and parental separation because of the child's growing sensitivity to stressful circumstances, as well as the result of the biological effects of illness.

Adult↗