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PubMed1992

Community clinics for leg ulcers and impact on healing.

OBJECTIVE: To evaluate the effectiveness of community clinics for leg ulcers. DESIGN: All patients with leg ulceration were invited to community clinics that offered treatment developed in a hospital research clinic. Patients without serious arterial disease (Doppler ankle/brachial index > 0.8) were treated with a high compression bandage of four layers. SETTING: Six community clinics held in health centres in Riverside District Health Authority supported by the Charing Cross vascular surgical service. PATIENTS: All patients referred to the community services with leg ulceration, irrespective of cause and duration of ulceration. MAIN OUTCOME MEASURES: Time to complete healing by the life table method. RESULTS: 550 ulcerated legs were seen in 475 patients of mean (SD) age 73.8 (11.9) years. There were 477 venous ulcers of median size 4.2 cm2 (range 0.1-117 cm2), 128 being larger than 10 cm2. These ulcers had been present for a median of three months (range one week to 63 years) with 150 present for over one year. Four layer bandaging in the community clinics achieved complete healing in 318 (69%) venous ulcers by 12 weeks and 375 (83%) by 24 weeks. There were 56 patients with an ankle/brachial arterial pressure index < 0.8, indicating arterial disease. The 50 patients with pressure index < 0.8 > 0.5 were treated with reduced compression, and 24 (56%) healed by 12 weeks and 31 (75%) by 24 weeks. The figures for overall healing for all leg ulcers were 351/550 (67%) at 12 weeks and 417/550 (81%) at 24 weeks, compared with only 11/51 (22%) at 12 weeks before the community clinics were set up. CONCLUSIONS: Community clinics for venous ulcers offer an effective means of achieving healing in most patients with leg ulcers.

Aged↗
PubMed1984

Tension development and muscle activation in the leg during gait in spastic hemiparesis: independence of muscle hypertonia and exaggerated stretch reflexes.

In 15 patients with spastic hemiparesis the development of tension of calf muscles in relation to their electrical activation and their stretching period was studied on both sides during locomotion. Only in the spastic leg did isolated small biphasic potentials appear in the gastrocnemius E.M.G. with monosynaptic latency at the beginning of the stance phase, while the remaining gastrocnemius activation was reduced compared to the unaffected side. Perturbations of gait were followed in the spastic leg by a large monosynaptic response, while the polysynaptic reflex response was reduced. In the unaffected leg only a strong polysynaptic response appeared, which suggests a reciprocal modulation of monosynaptic and polysynaptic reflex responses. Tension development paralleled the gastrocnemius E.M.G. in the unaffected leg, while in the spastic leg tension was more closely correlated to muscle stretch. It is concluded that in spasticity the exaggerated monosynaptic reflexes represent only a small part of leg extensor activation during gait and that the tension development does not depend on these reflexes.

Adult↗
PubMed1999

Simulation of genetic interaction for Drosophila leg formation.

The formation of Drosophila wings and legs are major research topics in Drosophila development, and several hypotheses, such as the polar-coordinate model and the boundary model, has been proposed to explain mechanisms behind these phenomena. A series of recent studies have revealed complex interaction among genes involved in establishing three principal axes (A-P, D-V, and P-D) of leg formation. In this paper, we present a simulation system for leg formation, simulating the genes interactions involved. We use this simulator to investigate a mathematical framework of leg formation which is otherwise well-founded from a molecular perspective. Particularly, we focus on the formation of the expression patterns of dpp, wg, dll, dac, al, en, hh and ci genes, which are involved in the development of the third instar Drosophila leg disc. The most interesting part of this research is showing how the coaxial gene expression patterns behind the P-D axis can be formed, and how positional information, as postulated in the polar-coordinate model, can be conveyed to each cell. Our results suggest that P-D axis can be formed by a set of genes with different activation thresholds; the process involves different chemical gradients of dpp and wg products, forming a bi-polar contour. Interestingly, this combination of chemical gradients can specify unique positions of cells for the hemisphere, leaving the A-P axis determiner to decide only whether the cells are anterior or posterior. All in all, our so-called Bi-Polar Model describes axial formation of the leg disc well.

Animals↗
PubMed2006

Pneumatic pump reduces leg wound complications in cardiac patients.

Leg wound complications at the site of vein harvest for coronary artery bypass graft, although infrequent, cause significant morbidity. Pneumatic pressure therapy is valuable in venous and lymphatic diseases, but its usefulness after leg vein harvest has not been determined. A prospective randomized controlled trial was conducted on 200 patients, half of whom had sequential pneumatic leg pump therapy postoperatively. Wound healing, extent of lower limb edema, patient satisfaction, and the financial implications of pneumatic pressure therapy were assessed. In the study group, 71 patients had satisfactory wound healing vs. 23 in the control group. The leg wound infection rate in the study group was 3% vs. 15% in the control group ( p = 0.003). Lower limb edema was significantly reduced in the study group in the early postoperative period ( p < 0.05), and the mean postoperative length of hospital stay was reduced by 2.6 days in patients given pneumatic pressure therapy ( p = 0.003). The sequential pneumatic leg pump is an effective, inexpensive, and convenient device that reduces leg wound complications after coronary artery bypass grafting.

Coronary Artery Bypass↗
PubMedDate not supplied

Drop leg Lachman test. A new test of anterior knee laxity.

We describe a new method of evaluating anterior cruciate stability that we call the drop leg Lachman test. This test is performed with the patient supine and the leg to be examined abducted off the side of the table and flexed 25 degrees. The thigh is stabilized to the examining table with one of the examiner's hands, and the patient's foot is held between the examiner's legs. The examiner's free hand provides the anteriorly directed force as done in the Lachman test. A prospective study of 52 patients who were identified as unilaterally anterior cruciate ligament deficient was conducted. Forty-two subjects were tested while conscious, and 40 subjects were tested under anesthesia. Each subject was examined with a KT-1000 arthrometer. In the conscious group, the drop leg Lachman test resulted in 1.8 mm greater average excursion than the Lachman test. In the anesthetized group, the drop leg Lachman test resulted in 2.4 mm more average translation than the Lachman test. In both groups, the difference between tests was statistically significant. The drop leg Lachman test is physically easier to perform than the Lachman test, and it is a sensitive method of demonstrating anterior laxity in an anterior cruciate ligament-deficient knee.

Adolescent↗
PubMed2006

A review of the correlation of tergites, sternites, and leg pairs in diplopods.

In some arthropods there is a discrepancy in the number of dorsal tergites compared to the number of ventral sternites and leg pairs. The posterior tergites of the Diplopoda (millipedes) each cover two sternites and two pairs of legs. This segment arrangement is called diplosegmentation. The molecular nature of diplosegmentation is still unknown. There are even conflicting theories on the way the tergites and sternites/leg pairs should be correlated to each other. The different theories are based either on embryological analyses or on studies of the adult morphology and turned out to be not compatible with each other. We have previously used the expression patterns of segmentation genes in the pill millipede Glomeris marginata (Myriapoda: Diplopoda) to study millipede segmentation. Here we review the existing models on the alignment of tergites and leg pairs in millipedes with special emphasis on the implications the gene expression data have on the debate of tergite and leg pair assignment in millipedes. The remarkable outcome of the gene expression analysis was that (1) there is no coupling of dorsal and ventral segmentation and, importantly, that (2) the boundaries delimiting the tergites do neither correlate to the embryonic boundaries of the dorsal embryonic segments nor to the boundaries of the ventral embryonic segments. Using these new insights, we critically reinvestigated the correlation of tergites, sternites, and leg pairs in millipedes. Our model, which takes into account that the tergite boundaries are different from the dorsal embryonic segment boundaries, provides a solution of the problem of tergite to sternite/leg pair correlation in basal milipedes with non-fused exoskeletal elements and also has implications for derived species with exoskeletal rings. Moreover, lack of coupling of dorsal and ventral segmentation may also explain the discrepancy in numbers of dorsal tergites and ventral leg pairs seen in some other arthropods.

Editorial↗
PubMed1998

Notch signalling mediates segmentation of the Drosophila leg.

The legs of Drosophila are divided into segments along the proximodistal axis by flexible structures called joints. The separation between segments is already visible in the imaginal disc as folds of the epithelium, and cells at segment boundaries have different morphology during pupal development. We find that Notch is locally activated in distal cells of each segment, as demonstrated by the restricted expression of the Enhancer of split mbeta gene, and is required for the formation of normal joints. The genes fringe, Delta, Serrate and Suppressor of Hairless, also participate in Notch function during leg development, and their expression is localised within the leg segments with respect to segment boundaries. The failure to form joints when Notch signalling is compromised leads to shortened legs, suggesting that the correct specification of segment boundaries is critical for normal leg growth. The requirement for Notch during leg development resembles that seen during somite formation in vertebrates and at the dorsal ventral boundary of the wing, suggesting that the creation of boundaries of gene expression through Notch activation plays a conserved role in co-ordinating growth and patterning.

Animals↗
PubMed2003

Rapid mechano-sensory pathways code leg impact and elicit very rapid reflexes in insects.

The temporal sequence of mechanoreceptor input arriving at the motoneuron level in the central nervous system (CNS) after distal mechanical contact was studied for the locust middle leg. Different types of afferent information from potential contact areas after selective stimulation showed propagation times of no less than 8 ms from mechanosensory hairs, campaniform sensilla (CS) and spurs of the distal leg segments. Impact of the same mechanical stimuli, even if very delicate, elicits strain that is transferred in less than 1 ms via the cuticle and stimulates proximal CS on the trochanter and femur. These propagate the afferents that code distal leg contact in about 1 ms to the CNS, where they connect mono- and polysynaptically to motoneurons of the depressor trochanteris system. The elicited excitatory postsynaptic potentials (EPSPs) contribute to rapid efferent commands, since single EPSPs already rise near firing threshold of the motoneurons. The short delays in this mechano-neuronal-muscular pathway from the tip of a leg to the neuromuscular synapses (5-7 ms) can very rapidly raise muscle tension in the trochanteral depressors at new leg contacts during locust landing and locomotion. At substrate contact, proximal leg CS contribute to very rapid motor responses supporting the body.

Afferent Pathways↗
PubMed2006

Morphology and action of the hind leg joints controlling jumping in froghopper insects.

The morphology and movements of key joints of the hind legs that generate the rapid jumping of froghoppers were analysed. The movements of an individual hind leg during a jump occur in three phases. First, the trochanter is slowly levated about the coxa so that the femur moves anteriorly and engages with a lateral protrusion on the coxa. Second, both hind legs are held in this fully levated (cocked) position without moving for a few seconds. Third, both hind legs depress and extend completely in less than 1 ms. The critical, power-generating movement underlying a jump is the rapid and simultaneous depression of the trochantera about the coxae. The lever arm of the hind trochanteral depressor muscle is smallest at the cocked position, but does not appear to go over the centre of the pivot. It then increases to a maximum after some 80 degrees of depression movement. By contrast, the lever arm of the trochanteral levator tendon is similar over the range of joint movements and is exceeded by that of the depressor only after 40 degrees of depression. Three prominent arrays of hairs on the trochantin, coxa and trochanter are appropriately positioned to act as proprioceptors signalling key movements in jumping. In the fully levated position, a protrusion on the dorsal, proximal surface of a hind femur engages with a protrusion from the ventral and lateral part of a coxa. These structures are not present on the front and middle legs. Both protrusions are covered with a dense array of small projections (microtrichia) that both increase the surface area and may interlock with each other. To depress rapidly in a jump these protrusions must disengage. If the hind leg of a dead froghopper is forcibly levated, it will lock in its cocked position, from which it can depress rapidly by movement of the coxo-trochanteral joint and disengagement of the femoral and coxal protrusions. A prominent click sound occurs at the start of a jump that results either from the initial movements of the coxo-trochanteral joint, or from the disengagement of the microtrichia on the coxa and femur. Larval Philaenus, which do not jump, lack a femoral protrusion and have no microtrichia in equivalent positions on either the coxa or femur.

Animals↗
PubMed1978

Intersegmental reflex coordination by a single joint receptor organ (CB) in rock lobster walking legs.

In the decapod Crustacea, Palinurus vulgaris and Fasus lalandii, the reflex influences of one particular proprioceptor organ, the coxo-basal chordotonal organ (CB), on all the muscles operating the proximal and distal joints of the same leg, have been analysed. The distal end of CB was clamped in fine forceps mounted on a servo-controlled stretcher, and CB length changes of 2 mm were applied. Motor unit activity of the different muscles was recorded as electromyograms (EMGs). 1. Two types of proprioceptive reflex evoked by CB length changes have been investigated: (a) resistance reflexes of the two levator and two depressor muscles of the same leg segment, the coxopodite, i.e. 'intrasegmental reflexes', (b) 'intersegmental reflexes' induced in the muscles operating the proximal (T-C) joint of the same leg, and in all eight muscles of the limb segments distat to CB. 2. Both levator muscles respond reflexly to imposed CB stretch (which normally occurs with limb 'depression'), while both depressors respond during CB shortening (or passive "elevation" of the leg). 3. Intersegmentally CB stretch reflexly activates the M-C extensor muscle, and sometimes facilitates the T-C remotor and C-P bender muscles. Shortening of the single CB organ of a leg excites one or two tonic motor units of the T-C promotor and M-C flexor muscles, and also facilitates the remotor, I-M reductor, and the single stretcher-opener excitatory motoneurone. 4. Some of the muscles, particularly the M-C flexor and extensor muscles, are also influenced intersegmentally by the resting length of CB, usually but not invariably in the same direction as for the corresponding dynamic reflexes. The role of the CB chordotonal organ is discussed, with particular consideration of its intersegmental reflex influence on the posture of the entire leg, and on the more complex motor behaviour of locomotion, where it may be specially significant in coordination of the limb in lateral walking. A complex picture of both tonic and dynamic, inra- and intersegmental reflex regulation of the positions and movements of the limb segments, thus emerges.

Animals↗
PubMed2005

Measuring the impact of venous leg ulcers on quality of life.

OBJECTIVE: To identify health-related quality-of-life (HRQoL) issues in patients with venous leg ulcers, with the aim of generating items for a treatment outcome measure. METHOD: Thirty-eight patients with venous leg ulcers were interviewed by a psychologist using a semi-structured guide; they also completed a HRQoL questionnaire (modified Skindex). Data from the questionnaire were examined to explore the impact of venous leg ulcers on patients' lives. Interview transcripts were analysed using qualitative methods to identify additional venous leg ulcer-specific HRQoL items. RESULTS: Skindex scores indicated that older patients had worse HRQoL (p<0.05), as did those with pain and non-healing ulcers. Ulcer duration and size did not correlate with HRQoL. Interviews revealed the following effects of ulceration: pain (80.5%); itching (69.4%); altered appearance (66.7%); loss of sleep (66.6%); functional limitation (58.3%); and disappointment with treatment (50%). Based on the interview transcripts, items were generated and discussed with an expert panel, with a view to including them in a venous leg ulcer-specific HRQoL questionnaire. CONCLUSION: Disease-specific HRQoL outcome measures should be considered when evaluating treatments for venous leg ulcers.

Activities of Daily Living↗
PubMed2006

A cost-effectiveness analysis of two community models of care for patients with venous leg ulcers.

AIM: To conduct a cost-effectiveness analysis based on data from a randomised controlled trial comparing traditional community home nursing with a community Leg Club model for chronic venous leg ulcer management in the south-east metropolitan area of Queensland, Australia. METHOD: Participants were randomised to the Leg Club (n=28) or home visits (n=28). Data were obtained on resources/related costs incurred by the service provider, clients and carers, and the community. RESULTS: From the collective perspective (service provider, clients and carers, and the community), at six months the incremental cost per healed ulcer was dollars AU515 (Euros 318) and the incremental cost per reduced pain score was dollars AU322 (Euros 199). For the service provider, Leg Club intervention resulted in cost savings and better health effects when compared with home nursing. CONCLUSION: On both clinical and economic grounds, the Leg Club model appears to be more cost-effective than traditional home nursing for the treatment of chronic venous leg ulcers. However, clients and the local community contribute substantial financial and in-kind support to the operation of both services.

Aged↗
PubMed2000

[A new optoelectronic measuring device for assessment of leg circumference in comparison with manual measurement].

For compression treatment to be effective in patients with chronic venous insufficiency, it is vital that leg circumference be measured accurately. If compression stockings are custom fit and appropriate for the medical indications, patient compliance will be high. Exact measurements of circumference and length are prerequisites for a good fit. The aim of the present study was to compare an opto-electronic device for the contact-free measurement of calf circumference with the conventional manual method using a tape measure. We investigated the differences between the results obtained with the two methods, and also their reproducibility. Circumferences were measured at defined heights on an anatomically shaped non-yielding leg model and on the leg of a healthy volunteer by 10 different experimenters both with the tape measure and with the opto-electronic device. The calf circumferences measured manually with the tape measure varied significantly more than those measured opto-electronically, both in the leg model and in the leg of the volunteer. A systematic error in the opto-electronic method appears unlikely, since the manual measurements on the leg model were both larger and smaller than those obtained with the opto-electronic device. Reproducibility was exceptionally high with the opto-electronic device (standard deviation 0.11-0.42 cm). The opto-electronic method yields rapid accurate measurements of circumference with excellent intra- and inter-operator reproducibility.

Anthropometry↗
PubMedDate not supplied

Four-legged broiler chicken with two cloacae and three ceca.

This case report examines an Arbor Acres female x Peterson male crossbred 6-wk-old female broiler chicken with four legs, two cloacae, and three ceca. The intestines occupied the caudodorsal portion of the abdominal cavity with three ceca attached to the terminal end of the ileum. The left lateral cecum was larger and had a divided distal end that terminated into 2-cm-long blind sacs. The rectum was dilated and divided into two cloacae that each opened on the dorsolateral aspect of both the right and left cloacal elevator muscles. The two extra legs were attached to the pygostyle by cartilage and skin tissue. Both femoral heads of the extraneous legs were fused together. The extra legs were smaller in size (approximately 17 cm in length) compared with the normal legs (approximately 22 cm). The femoral heads of the two normal legs were disarticulated from the acetabulum.

Animals↗
PubMed1985

Total colectomy, mucosal proctectomy, and an ileal reservoir to an anal anastomosis. A comparison of short and long efferent legs.

In a consecutive series of 46 possible candidates for total colectomy, mucosal proctectomy, and ileal reservoir to an anal anastomosis, we have compared the clinical outcome of group I, with a long efferent leg (12 cm), and group II, with a short efferent leg (3-5 cm). The surgical procedure was done in three steps: first, a total colectomy; second, mucosal proctectomy and construction of an 'S-shaped' ileal reservoir with a temporary loop ileostomy; and, third, closing of the ileostomy. Nine patients with a long efferent leg and eight patients with a short leg were observed for 2-51 months with a functioning ileal reservoir. The overall mortality was zero. The results showed that the short efferent leg was important for low fecal urgency, spontaneous evacuation of stools, minimal soiling, independence of reservoir catheterization, and use of antidiarrheal drugs. The length of the efferent leg did not influence the function of the anal sphincter itself. The postoperative sexual life was unchanged, and all patients in group II had a better resocialization than those in group I. The selection of candidates for ileal reservoir operations from among patients with ulcerative colitis or familiar polyposis is most important because of a relatively long postoperative course and high incidence of surgical complications.

Adolescent↗
PubMed1996

Leg and foot ulcer patients. Epidemiology and nursing care in an urban population in south Stockholm, Sweden.

OBJECTIVE: To study the prevalence, demography, perceived aetiology, level of care, treatment and nursing care of patients treated for leg and foot ulcers. DESIGN: Prospective survey of leg and foot ulcer patients, using a structured questionnaire consisting of 20 questions directed at nurses and doctors in 193 units, including both primary health care and hospital. SETTING: South Stockholm Medical Area, Stockholm, Sweden. PATIENTS: Two hundred and ninety-four patients with leg and foot ulcers were identified during the six-week study period. MAIN OUTCOME MEASURES: Demographic data of population, prevalence of leg and foot ulcers, level of care, economic aspects, treatment of ulcers, level of compression, characteristics of the ulcers, pain and analgesics. RESULTS: With a population of 241,804 in the area, the prevalence of leg and foot ulcer was 0.12%. The majority of patients (92%) were older than 65 years of age, median age 79.2 years. The commonest cause of leg ulceration, as estimated by the staff, was venous insufficiency (42%). The majority of patients were treated within the primary health care system, and only a minority were treated in hospital. Many different local wound dressings were used (n = 51). The majority of dressing changes were performed by auxiliary nurses (54%). Compression was practised in 86% of all cases diagnosed as venous ulcers. Pain was reported by staff in 47% of all patients with venous ulcers. No pain relief was given to 29% of all these cases.

Adult↗
PubMed2001

Insulin regulates milk production and mammary gland and hind-leg amino acid fluxes and blood flow in lactating goats.

We investigated the roles of insulin and amino acid (AA) in regulating milk production and the uptake of AA and blood flow (BF) by the mammary gland and hind-leg of goats (n = 4). During two periods, either saline or AA (65 g/d) was infused i.v. for 7.5 d, and, beginning on d 5, goats were subjected to a hyperinsulinemic-euglycemic clamp. The insulin clamp elevated plasma insulin levels threefold and insulin-like growth factor-1 by 27%, and euglycemia was maintained by the infusion of glucose. Arterial, mammary, and tarsal vein blood samples were obtained on d 4 and 8 of each period, and blood flow was monitored continuously by probes. Insulin and insulin plus AA infusions increased the yields of milk by 13 to 18% and protein by 10 to 21%, but AA infusion alone had no effect. The insulin clamp reduced milk fat content by 21 to 31% and yield by 8 to 19%, and reduced the yields of milk fatty acids >C16. The insulin clamp increased mammary blood flow by 42%, but insulin and AA infusions both increased hind-leg BF by 29 to 52% and by 25%, respectively. Net uptakes of most plasma AA by the udder were reduced by insulin, whereas AA infusion had no effect. For the leg, the uptake of His and Thr were decreased by insulin, whereas the infusion of AA stimulated the uptake of total essential AA. Insulin increased the uptake of glucose by the udder but not by the leg. This study suggests that the udder and leg tissues respond differently to infusions of insulin and AA; the udder was more responsive to insulin, while the leg was more responsive to AA concentralion (supply), at least in terms of AA uptake and net anabolism (protein gain or secretion).

Amino Acids↗
PubMed2006

Housing system, milk production, and zero-grazing effects on lameness and leg injury in dairy cows.

The aim of this study was to assess the effect of grazing (G) vs. zero-grazing (ZG), level of milk production, and quality and type of housing system [free stalls (FS) and straw yards (SY)] on the prevalence of lameness and leg injuries in dairy cows. Observations were made on 37 commercial dairy farms across Great Britain. A single visit of 5 d duration was made to each farm. During this visit, lameness scores and the incidence of swellings, rubs, and injuries to hocks and knees were recorded on all the peak- or mid-lactation cows. Aspects of the quality of housing and management that were likely to affect foot and leg health were recorded. There were more lame cows on ZG farms (39 +/- 0.02%) than on grazing (G) farms (15 +/- 0.01%), and lameness scores were higher on FS farms compared with SY farms (0.25 +/- 0.01 vs. 0.05 +/- 0.01). Cows on SY farms had fewer hock and knee injuries compared with FS farms. The frequency of knee swellings was higher on ZG farms (0.31 +/- 0.02) than on G farms (0.15 +/- 0.01). Aspects of the free-stall design affected foot and leg health. The number of hock swellings increased with increasing stall gradient (0.16 +/- 0.01 with no slope vs. 0.39 +/- 0.02 at a 0 to 1.5% slope). There was an interaction between the length of the free-stall lunging space and the hip width of the cow, indicating that the incidence of lameness is generally highest on farms with small free stalls and heavy cows. High levels of milk production did not affect lameness or leg injury. The results indicate that housing cows throughout the year potentially has a detrimental effect on foot and leg health. However, good free-stall design may reduce lameness and leg lesions.

Animal Welfare↗