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At least 109 records · Page 6Linked to original sources
PubMed1990

Quantitative evidence of peripheral conversion of angiotensin within the human leg: effects of local angiotensin-I administration and angiotensin-converting enzyme inhibition on regional blood flow and angiotensin-II balance across the leg.

The renin-angiotensin system relevantly contributes to the maintenance of systemic vascular tone and there is experimental evidence that large amounts of angiotensin-converting enzyme (ACE) are present in peripheral vascular tissues, including resistance vessels. To determine and quantify peripheral vascular conversion of angiotensin-I (ANG-I) to angiotensin-II (ANG-II) across the human leg, the response of regional blood flow to local regional intra-arterial infusion of ANG-I and change in associated ANG-II balance were evaluated during ANG-I infusion and following additional ACE inhibition. Ten sodium-loaded healthy men were enrolled in the study. Following cannulation of both femoral arteries and the right femoral vein, leg blood flow was determined (indocyanine-green dye-dilution method) at baseline conditions and during constant intra-arterial infusion of haemodynamically ineffective doses of ANG-I as well as following concomitant intra-arterial administration of low doses of the non-sulfhydril ACE inhibitor cilazapril. From the transfemoral arterio-venous differences in ANG-II plasma concentrations and the corresponding regional blood (plasma) flow, the ANG-II balance across the leg was calculated. Systemic blood pressure did not change throughout the trial, indicating that no major systemic effects were present during ANG-I infusion or concomitant ACE inhibition. Moreover, arterial ANG-II plasma concentrations were not significantly changed by ANG-I infusion. Leg blood flow decreased to below baseline values following ANG-I infusion, increasing again then in a dose-dependent manner during concomitant cilazapril administration. The calculated baseline ANG-II balance across the leg revealed a net extraction in 6 out of 10 subjects and a net ANG-II formation in 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Voluntary changes in leg cadence modulate arm cadence during simultaneous arm and leg cycling.

Although there is some evidence showing that neural coupling plays an important role in regulating coordination between the upper and lower limbs during walking, it is unclear how tightly the upper and lower limbs are linked during rhythmic movements in humans. The present study was conducted to investigate how coupling of both limbs is coordinated during independent rhythmic movement of the upper and lower limbs. Ten subjects performed simultaneous arm and leg cycling (AL cycling) at their preferred cadences without feedback for 10 s, and then were asked to voluntarily change the cadence (increase, decrease, or stop) of arm or leg cycling. Leg cycling cadence was not affected by voluntary changes in arm cadence. By contrast, arm cycling cadence was significantly altered when leg cycling cadence was changed. These results suggest the existence of a predominant lumbocervical influence of leg cycling on arm cycling during AL cycling.

Adult↗
PubMed1998

A neuro-mechanical model of legged locomotion: single leg control.

Most models of legged locomotion have concentrated on properties of either the mechanical or the neural system. Here a combined neuro-mechanical model of stepping in a single leg is presented, as the first step in the process of modeling and building a fast and dynamically stable quadruped. It is based on general principles of legged animals with special reference to vertebrates. The mechanical leg was first studied separately in order to take advantage of its inherent mechanical properties and avoid over-control during stepping generation. As a part of the design strategy it uses elastic actuators to increase shock tolerance and energy efficiency. The neural controller consists of a neural phase generator (NPG), a system of fast feedback pathways, and a single control neuron representing descending drive from higher centers in the brain. Sensory information directly influences the movements through the fast feedback pathways, but also entrains the NPG. The NPG has its own description of the state of the leg, which then enables it to set the feedback pathways so that only actions appropriate for the particular stage of the step cycle are undertaken. This preprogramming benefits from the NPG's ability to filter out any inconsistencies or gaps in the afferent input. In this way the model unites the use of central pattern generators and peripheral feedback systems for the generation of stepping movements. The neuro-mechanical system produced stable stepping patterns over a large velocity range and was adaptable to different body weights and landing from varying heights.

Animals↗
PubMed2005

Experimental evaluation of the effect of raised pressure in a single compartment in the lower leg on neighbouring compartments using fresh above knee amputated legs-a study of interstitial pressures with two case reports.

STUDY DESIGN: Experimental evaluation of intracompartmental pressures in a fresh above knee amputated human leg. OBJECTIVES: To determine what effect raised pressure in one compartment of the lower leg had upon its neighbour. SUMMARY OF BACKGROUND DATA: There has been no previous reports of isolated compartment pathology, following low velocity trauma, causing a compartment syndrome in all four compartments of the lower leg. METHODS: Immediately after leg amputation, the intracompartmental pressure in the deep posterior compartment was artificially raised to 100 mmHg with infused 0.9% sodium chloride solution. The resultant pressure changes in remaining compartments were recorded over 30 min. RESULTS: Five legs were evaluated. After 30 min, the mean maximum intracompartmental pressure increase found in the superficial posterior, anterior and peroneal compartments was 78.4 mmHg (range 65-94 mmHg), 25.2 mmHg (range 14-31 mmHg) and 24.8 mmHg (range 15-31 mmHg), respectively. CONCLUSIONS: This experimental data and case reports show that a compartment in which there is raised pressure may exert external pressure on a neighbouring compartment that can result in physiological changes to induce a compartment syndrome within that neighbour. The importance of assessing all compartments within a limb segment, even when associated with low velocity trauma, remains paramount.

Adult↗
PubMedDate not supplied

Adapting national and international leg ulcer practice guidelines for local use: the Ontario Leg Ulcer Community Care Protocol.

BACKGROUND: Because of growing resources devoted to individuals requiring community care for leg ulcers, the authority responsible for home care in Ottawa, Ontario, Canada, established and evaluated a demonstration leg ulcer service. In an effort to provide current and evidence-based care, existing leg ulcer clinical practice guidelines were identified and appraised for quality and suitability to the new service. PROCESS: The Practice Guideline Evaluation and Adaptation Cycle guided development of a local protocol for leg ulcer care, which included: (1) systematically searching for practice guidelines, (2) appraising the quality of identified guidelines using a validated guideline appraisal instrument, (3) conducting a content analysis of guideline recommendations, (4) selecting recommendations to include in the local protocol, and (5) obtaining practitioner and external expert feedback on the proposed protocol. Updating the protocol followed a similar process. RESULTS: Of 19 identified leg ulcer practice guidelines, 14 were not evaluated because they did not meet the criteria (ie, treatment-focused guidelines, written in English and developed after 1998). Of the 5 remaining guidelines, 3 were fairly well developed and made similar recommendations. The level of evidence supporting specific recommendations ranged from randomized clinical trial evidence to expert opinion. By comparing the methodologic quality and content of the guidelines, the Task Force reached consensus regarding recommendations appropriate for local application. Two additional guidelines were subsequently identified and incorporated into the local protocol during a scheduled update. CONCLUSIONS: Local adaptation of international and national guidelines is feasible following facilitation of the Practice Guidelines Evaluation and Adaptation Cycle.

Community Health Services↗
PubMed1974

Vertical leg drainage of odema in treatment of leg ulcers.

Since oedema of adjacent tissue is a major factor in preventing healing of leg ulcers conservative treatment should aim to dry out the ulcer area before bandaging and to keep it dry afterwards. A method of postural drainage of oedema is described in which the patient lies supine with the legs raised vertically for two days. Non-stretch Viscopaste bandages are then applied and the patient allowed to move about normally, but instructed to continue vertical leg drainage for a period each day. Out of 106 cases treated by this method the leg ulcer healed within a year in 82 (77.4%). Relapses were apt to occur when the patient neglected to continue the vertical drainage regimen after the ulcer had healed. These results compare well with those reported for other methods of treatment. Vertical leg drainage treatment is inexpensive and the patient can continue at work.

Adult↗
PubMed2000

Effect of hyperoxia and hypoxia on leg blood flow and pulmonary and leg oxygen uptake at the onset of kicking exercise.

The purpose of this study was to examine the interactions of adaptations in O2 transport and utilization under conditions of altered arterial O2 content (CaO2), during rest to exercise transitions. Simultaneous measures of alveolar (VO2alv) and leg (VO2mus) oxygen uptake and leg blood flow (LBF) responses were obtained in normoxic (FiO2 (inspired fraction of O2) = 0.21), hypoxic (FiO2 = 0.14), and hyperoxic (FiO2 = 0.70) gas breathing conditions. Six healthy subjects performed transitions in leg kicking exercise from rest to 48 +/- 3 W. LBF was measured continuously with pulsed and echo Doppler ultrasound methods, VO2alv was measured breath-by-breath at the mouth and VO2mus was determined from LBF and radial artery and femoral vein blood samples. Even though hypoxia reduced CaO2 to 175.9 +/- 5.0 from 193.2 +/- 5.0 mL/L in normoxia, and hyperoxia increased CaO2 to 205.5 +/- 4.1 mL/L, there were no differences in the absolute values of VO2alv or VO2mus across gas conditions at any of the rest or exercise time points. A reduction in leg O2 delivery in hypoxia at the onset of exercise was compensated by a nonsignificant increase in O2 extraction and later by small increases in LBF to maintain VO2mus. The dynamic response of VO2alv was slower in the hypoxic condition; however, hyperoxia did not affect the responses of oxygen delivery or uptake at the onset of moderate intensity leg kicking exercise. The finding of similar VO2mus responses at the onset of exercise for all gas conditions demonstrated that physiological adaptations in LBF and O2 extraction were possible, to counter significant alterations in CaO2. These results show the importance of the interplay between O2 supply and O2 utilization mechanisms in meeting the challenge provided by small alterations in O2 content at the onset of this submaximal exercise task.

Adult↗
PubMed2001

Validity of double- and single-leg vertical jumps as tests of leg extensor muscle function.

The purpose of this research was to determine if 5 weeks of resistance training for the shoulder and hip flexor muscles produces improvements in vertical jumping (VJ) performance. Twenty-eight men were assessed on tests of shoulder power, leg extensor muscle function, and VJ performance using jumps performed from a standing position, a 3-stride run-up, and double- and single-leg takeoffs. A shoulder and hip flexor training group (n = 14) improved significantly more than a nontraining control group (n = 12) in shoulder power and 2 VJ performance tests, but not in the tests of leg extensor muscle function. It was concluded that the arm swing and free-leg drive significantly influence VJ performance and, therefore, VJ tests are not valid for assessment of leg extensor muscle function.

Adolescent↗
PubMed2003

[Surgical correction of leg-length discrepancy using the method of leg-length equalization: report of 4 cases].

OBJECTIVE: To describe a method of leg-length equalization for the correction of leg-length discrepancy. METHOD: Osteotomy and femur inlay was performed in 4 cases. RESULT: Smooth bone healing was achieved within one year postoperatively and the function of the repaired legs was satisfactory. Transiently limited flexion extension movement of both knees was observed during the operation and recovered normal after 3 months. CONCLUSION: Leg-length equalization is a safe method for leg-length discrepancy.

Adult↗
PubMed1995

[Usefulness of the 201TlCl exercise leg perfusion scintigraphy inarteriosclerosis obliterans (ASO)--with evaluation of leg perfusion comparing before and after PTA].

Twenty-eight patients of arteriosclerosis obliterans (ASO) complaining of intermittent claudication or pain at rest underwent symptom limited exercise leg perfusion scintigraphy using 201TlCl (Tl). Regions of interest (ROI) were drawn around each buttocks, thighs, calves and feet in whole body image, and we calculated Lesion/Normal Index (LNI) which was the divided value of the average count per pixel of each ROI of the affected side by that of the normal side. The average LNI of the foot was 0.81 and was smaller than other regions (p < 0.05). Other region except foot showed Tl high uptake in affected side in some cases. Fifteen patients were compared after percutaneous transluminal angioplasty (PTA) with before PTA, and LNI of the foot was statistically improve after PTA (p < 0.005). The period suffer from disease of the group of Tl high uptake in the affected leg was statistically shorter than that of the group of Tl non-high uptake (p < 0.05). We supposed that the Tl uptake of the foot reflects ischemia of the leg sensitively, and high uptake of Tl in affected leg is concerned with compensatory change of microcirculation of ischemic leg in subacute period. This scintigraphy was thought to be useful to detect the ASO and to evaluate the effect of PTA, and was able to avail diagnosis and observation of the course of ASO patient.

Adult↗
PubMed1999

Long-term consequences of fracture of the lower leg: cross-sectional study and long-term longitudinal follow-up of bone mineral density in the hip after fracture of lower leg.

The purpose of this study was to investigate whether bone loss in the hip, occurring after a fracture of the lower leg, persists many years after the fracture. In a long-term follow-up we measured bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) of both hips and the lumbar spine in a group of 11 patients, 5 years after a fracture of the lower leg. These patients were part of an earlier study, evaluating bone loss in the hip, up to 1 year after fracture of the lower leg. In this follow-up study, 5 years after fracture, loss from baseline BMD in the trochanteric region of the ipsilateral hip was 4.7% (p=0.04), whereas after a year in this group there was a decrease of 12.5% from baseline. On the contralateral side, hardly any change occurred. In the ipsilateral femoral neck, 5 years after fracture, BMD decreased by 2.9% (p=0.10), after 1 year loss from baseline was 5.1%. In a cross-sectional study we examined the differences in BMD of both hips, measured by DXA, in a group of 19 elderly patients reporting a fracture of the lower leg, with a mean time of 9.3 years after fracture. In this study, we found a 4.7% lower BMD in the trochanteric region of the hip on the fractured side compared with the nonfractured side (p=0.006), and a 2.9% lower BMD in the femoral neck (p=0.25). We conclude that, after fracture of the lower leg, BMD in the ipsilateral hip decreases significantly, with maximal bone loss after 1 year. After 5 years recovery has occurred, but not to baseline. Thereafter, significant excess bone loss is still observed in the trochanteric region. This persisting lower BMD may lead to an increased risk of another fracture in later years.

Aged↗
PubMed2002

Contact sensitization in patients with leg ulcers and/or leg eczema: comparison between centers.

Patients with leg ulcers and/or eczema of the legs are at risk of contact sensitization. The aim of this retrospective study was to investigate the impact of some aspects of practice of leg ulcer treatment and availability of drugs and dressings in a university-based wound care center. These data were compared with those from the Information Network of Departments of Dermatology (IVDK), where patch test reactions of 3529 patients with leg ulcers and/or eczema of the lower legs were documented. Data analyses showed frequencies of sensitization for single and multiple allergens. The change of treatment modalities may have a positive impact on lowering sensitization rates, but the ongoing use of topical drugs outside wound care centers may be expected to limit the effects of modern wound treatment.

Journal Article↗
PubMed2005

An item response analysis of the international restless legs syndrome study group rating scale for restless legs syndrome.

BACKGROUND AND PURPOSE: Restless legs syndrome (RLS) is a common central nervous system disorder; however, there is currently a lack of well-validated and easily-administered measures of RLS severity available. The International Restless Legs Syndrome Study Group has recently developed a 10-item scale to meet this need. The International Restless Legs Severity Scale (IRLS) has been shown to have a high degree of reliability, validity, and internal consistency. In order to further demonstrate the validity of the IRLS, the present study examined the relationship between scores on individual IRLS items and overall RLS severity. PATIENTS AND METHODS: The 10-item IRLS was administered to 196 RLS patients. Option characteristic curves (the probability of scoring different options for a given item as a function of overall IRLS score) were generated in order to illustrate the scoring patterns for each item across the range of total RLS severity. Item characteristic curves (the expected score on an item as a function of overall IRLS score) were also generated to illustrate the relationship between scores on the individual items and total RLS severity. RESULTS: The IRLS items demonstrated excellent item response properties, with option and item characteristic curves closely approximating those of an ideal item. Item 3 (relief of arm or leg discomfort from moving around) was the most problematic item in that a 'floor' effect was evident; however, the item response characteristics for this item were still acceptable. CONCLUSIONS: Each IRLS item showed a good relationship between responses on that item and overall RLS severity, providing further evidence for the validity of the IRLS as a measure of RLS severity in RLS patients.

Adult↗
PubMed1999

The influence of sex, age and sleep/wake state on characteristics of periodic leg movements in restless legs syndrome patients.

Restless legs syndrome (RLS) patients experience periodic stereotyped leg movements while awake and during sleep. The aim of the present study was to measure the effects of sex, age and the sleep/wake state on several characteristics (frequency, duration and periodicity) of these periodic leg movements (PLM). One hundred unrelated patients diagnosed with primary RLS were studied. During wakefulness, frequency of PLM increased and the mean inter-movement interval decreased with advancing age. The modal value of inter-movement interval distribution was also altered suggesting that aging influences rhythm-generation mechanisms. Sleep/wake states had a profound effect on leg movement characteristics. Movements of longer duration were seen during wakefulness, while REM sleep was characterized by the shorter duration and the lowest frequency of PLM, due most likely to the inhibition of spinal motoneurons that prevails in REM sleep. States of vigilance also modulated the periodicity of PLM. Intervals were shorter during wakefulness and increased progressively from stage 1 to stage 2 sleep, and to slow wave sleep (SWS). During REM, the duration of sleep intervals returned to values obtained in stage 1 sleep; these two stages sharing similar patterns of EEG activity. These results indicate that a single state dependent mechanism may be responsible for the periodicity of PLM noted both during sleep and wakefulness.

Adult↗
PubMed1995

Versatility of a cross-leg free rectus abdominis flap for leg reconstruction under difficult and unfavorable conditions.

A cross-leg free rectus abdominis flap, anastomosing to utilized "carrier" vessels of the contralateral noninjured leg, was used for reconstruction in six cases of extensive traumatic defects and deformities of a lower extremity. This method provides great advantages in free-flap reconstruction of complicated and unfavorable cases in which utilization of what would be suitable recipient vessels in the injured leg is most difficult, but there is good blood circulation of the leg.

Adult↗
PubMed1993

[Treatment of chronic osteomyelitis of leg with free latissimus dorsi musculocutaneous flap anastomosed to contralateral leg vessels].

A free latissimus dorsi musculocutaneous flap was first anastomosed to dorsal vessels of the contralateral leg. It was then used to cover a large defect of the leg as a result of chronic osteomyelitis. The use of such a cross-leg flap was not affected by the poor circulatory condition of the diseased leg. It was done in 20 patients with satisfactory results. All of them could take part in the physical work.

Adolescent↗
PubMed1997

Restless legs and periodic leg movements in sleep syndromes.

Restless legs syndrome (RLS) is a common sensorimotor disorder with an estimated prevalence of between 1% and 5%. The symptomatology is characterized by unpleasant sensations experienced predominantly in the legs and rarely in the arms. The symptoms occur only at rest and become more pronounced in the evening or at night. In addition, the patients suffer from a strong urge to move the limbs, typically manifest as walking around, which leads to complete but only temporary relief of the symptoms. Most of the patients with RLS have periodic leg movements (PLMS) during sleep and relaxed wakefulness that are characterized by repetitive flexions of the extremities. PLMS can occur as an isolated phenomenon, but often they occur together with other sleep disorders including RLS, narcolepsy, sleep apnoea syndrome or REM sleep behaviour disorder. In all these disorders, PLMS, contribute considerably to disturbed sleep, as the movements may lead to brief arousals or repeated full awakenings. The aetiology of RLS and PLMS is unknown. It is hypothesized that periodic leg movements result from a suprasegmental disinhibition of descending inhibitory pathways. Based on the efficacy of the drugs listed below, the dopaminergic, adrenergic and opiate systems are thought to play a major role in the pathogenesis of RLS/PLMS. Since the cause is unclear, therapy of RLS and PLMS remains symptomatic except for some secondary forms. Studies on the pharmacological treatment of RLS have shown the efficacy of levodopa, dopamine agonists, benzodiazepines, opioids, clonidine and carbamazepine. With regard to the drug treatment of PLMS in other sleep disorders including their isolated occurrence, indications and efficacy have been poorly defined until now.

Humans↗
PubMed1990

Three anteromedial fasciocutaneous leg island flaps for covering defects of the lower two-thirds of the leg.

Three different fasciocutaneous island flaps based on the medial septocutaneous vessels of the leg have been successfully transferred in eight patients. The flaps are based on three segments of the anteromedial aspect of the leg where their feeding vessels were most frequently identified. These anteromedial fasciocutaneous leg island flaps are thin, reliable and safe. They are relatively easy to elevate and are useful for covering defects of the lower two-thirds of the leg.

Adolescent↗