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At least 1,153 records · Page 64Linked to original sources
PubMed2003

[Evaluation of the lower leg vessels before microsurgical fibula transfer. Magnetic resonance angiography versus digital subtraction angiography].

BACKGROUND: Since the introduction of the fibula flap by Taylor in 1975, and its first application in the lower jaw by Hidalgo in 1989, it has become an option of first choice in mandibular reconstruction of large oromandibular defects. Perfusion of the osteomyocutaneous fibula transplant is based on the peroneal artery. To avoid postoperative ischaemia of the lower leg after sacrificing this artery, especially in smokers, adequate perfusion must be guaranteed preoperatively by radiological evaluation. Progress in the field of magnetic resonance angiography (MRA) enables an increasing number of primary non-invasive evaluations of vessels. The aim of this prospective study was to answer the question of whether MRA enables a accurate representation of anatomical variation and pathological stenoses of the lower leg vessels and can therefore replace conventional digital subtraction angiography (DSA). MATERIALS AND METHODS: We carried out conventional DSA of the lower leg before raising a fibula transplant and postoperative MRA with contrast medium in a prospective study with 15 patients. Vessels were assessed for atherosclerotic, occlusive or hypoplastic changes and anatomical variations by three radiologists. RESULTS: High resolution of MRA enables a reliable judgement of the lower leg vessels. Hypoplastic vessels, stenoses, occlusion or atherosclerotic changes of the vessels could definitely be detected by MRA just as by DSA. Thus, all patients without these diagnosed contraindications could be operated successfully. CONCLUSION: MRA of the lower leg enables a definitive determination of the vessel quality and the site of preference for harvesting the flap. Because MRA is a low risk procedure, can be carried out on an outpatient basis and causes no radiation load, it should be preferred to conventional DSA.

Adult↗
PubMed1982

Effectiveness of leg compression in preventing venous stasis.

To compare the ability of intermittent calf compression with that of sequential leg compression to prevent venous stasis, the clearance time of radiopaque dye, as determined by sequential phleborheograms performed on anesthetized patients, were compared. Calf compression was superior to no compression in clearing the dye from the calf alone, but did not aid clearance from the rest of the leg. Sequential leg compression was superior to intermittent calf compression in clearing dye from the calf and popliteal areas. Since intermittent leg compression has been as effective as small-dose heparin therapy in preventing postoperative deep venous thrombosis [7], the use of sequential leg compression may prove to be more effective and have less complication than heparin administration.

Humans↗
PubMed1996

Mechanical output from individual muscles during explosive leg extensions: the role of biarticular muscles.

The main result of this study is that biarticular leg muscles contribute significantly to the work done at joints, due to transfer of power during explosive leg extensions. In particular, a net power transfer was shown from hip to knee joint during jumping and sprinting. Seven elite athletes performed explosive one legged jump and spring push offs. Kinematics, ground reaction forces and electromyography (EMG) of leg muscles were recorded. The mechanical output of six individual muscle groups was estimated by using Hill-based muscle models. The EMG and kinematics served as input to these models. For jumping as well as for sprinting, the model estimated similar results for the relative work contribution done about a joint due to transfer of power by the biarticular muscles. Rectus femoris showed a power transfer from hip to knee joint, while in contrast hamstrings showed a power transfer from knee to hip joint. Regardless of these opposite directions of power transfer, a net transfer occurred from the hip to the knee joint. The relative work contribution of hamstrings done in hip extension was 7% in jumping and 11% in sprinting. For rectus femoris, the relative work contribution done in knee extension was 21% in jumping and 31% in sprinting. Power transferring actions by gastrocnemius from knee to ankle contributed 25% in jumping and 28% in sprinting to the work done in plantar flexion. These results support the hypothesis that the action of biarticular muscles contributes to a net transfer of power from proximal to distal joints during explosive leg extensions. This action of the biarticular muscles causes an efficient conversion of body segment rotations into the desired translation of the body centre of gravity.

Adult↗
PubMed1994

Leg-crossing: incidence and inheritance.

Leg-crossing refers to the preferential tendency for individuals to sit with one leg crossed over the other. In this study about 62% of the population are right leg-crossers, 26% are left leg-crossers, and the remaining 12% report that they have no preference or are indifferent. Familial data suggest that leg-crossing may be under genetic control: although the data do not fit any straightforward recessive or dominant Mendelian model, they are compatible with the type of model invoking fluctuating asymmetry which has been used to explain the inheritance of handedness, hand-clasping and arm-folding.

Adult↗
PubMed1996

Leg blood flow, metabolism and exercise capacity in chronic stable heart failure.

OBJECTIVES: To assess the metabolic state of skeletal muscle during exercise in patients with chronic heart failure (CHF) and relate this to exercise capacity. BACKGROUND: During exercise in CHF, there is little relation between exercise capacity and central haemodynamic function. Skeletal muscle and limb blood flow are abnormal in CHF. We investigated the relationship between leg blood flow, metabolism and exercise capacity and ventilation in 10 patients (average age 63.3 +/- 6.0 years; 3 female) with stable CHF. METHODS: Patients undertook maximal exercise testing. Peak oxygen consumption (VO2) and the slope of the relationship between ventilation and carbon dioxide production (VE/CO2 slope) were derived. During a supine cycle exercise test, cardiac output (CO) by Doppler echocardiography, femoral blood flow (FBF) by thermodilution, pulse and blood pressure were recorded, and radial arterial and femoral venous blood samples taken for catecholamine, lactate and potassium estimation every 3 min. RESULTS: The average peak VO2 was 19.7 (+/- 5.2; range 11.3-29.0) ml/kg/min. The proportion of CO to the right leg increased from 0.08 (+/- 0.03) to 0.22 (+/- 0.06) (P < 0.001) at 3 min, with no further significant change thereafter. There was a liner increase in leg VO2 reaching a plateau towards peak. At peak, femoral venous saturation was 22.79% +/- 7.20%. Venous lactate and potassium were higher than arterial (P < 0.001 for each comparison). There was no correlation between exercise performance and any of the measured metabolites either in absolute measurements, expressed as change from rest to peak exercise or as arterio-venous difference. The closest correlate of leg VO2 was leg hydrogen ion production, V[H+]. Change in femoral venous lactate from rest to peak exercise correlated with VE/VCO2 slope even when calculated from before the anaerobic threshold (r = -0.80; P = 0.025). CONCLUSIONS: In CHF, exercise capacity is not determined by individual haemodynamic events, and does not seem to be determined by the possible humoral signals we investigated. Ventilation is abnormal before anaerobic threshold, and predicts subsequent lactate rise, suggesting that skeletal muscle is the origin of excessive ventilation.

Aged↗
PubMed1989

Understanding the pathogenesis of the restless legs syndrome at the level of the dopamine receptor. Are we about to identify the neurochemical deficiency causing schizophrenia?

According to a recent hypothesis, the restless legs syndrome is thought to be due to a caffeine-like substance produced by the human body (1). Some researchers have reported a case of familial restless legs that had high concentration of free dopamine in the cerebrospinal fluid (2). Other researchers have noticed the beneficial effect of opioids in the treatment of the restless legs syndrome (3). In this article, I am compiling information reconciling the findings of those researchers with the hypothesis that proposes that the restless legs syndrome is due to a caffeine-like substance produced by the human body. Also, I am addressing the pathogenesis of the restless legs syndrome at the level of the dopamine receptors in the central nervous system. Understanding this pathogenesis probably will help in identifying the neurochemical deficiency causing schizophrenia.

Brain↗
PubMed1996

Rhythmical leg movements in low-risk and brain-damaged preterm infants.

The characteristics of rhythmical kicking movements of preterm infants with documented brain damage (BD), who later showed a severe motor impairment, are described and compared with those of low-risk (LR) preterm infants. Spontaneous movements were videotaped for 60 min in the incubator or in a warmer. A first group of 6 BD and 6 LR infants was observed at 31-35 weeks of postmenstrual age (PMA) and a second group (6 BD, 6 LR) at 37-39 weeks. Bouts of rhythmical kicks, defined as leg movements repeated in the same form at least three times at regular short intervals, were analysed during periods of activity. The results indicated non-significant differences between BD and LR infants at 31-35 weeks of PMA. In contrast, some differences were observed at 37-39 weeks. These differences were not due to leg movement frequency, but to inter-leg coordination and to temporal organisation of the kicking cycles. LR infants exhibited more alternate-leg movements and fewer semi-both-leg movements (simultaneous flexion and non-simultaneous extension) than BD infants. In LR cases the duration of the pause between flexion and extension was shorter, whereas flexion and extension periods were similar for all infants. Although there were significant differences, quantitative analysis of kicking characteristics was not clinically useful because of the large overlap in findings between the two groups. On the other hand Gestalt evaluation of general movements of the same videorecordings showed a closer correlation with the presence of brain lesions and with neurological outcome.

Brain Diseases↗
PubMed2004

Development of exercise-induced arm-leg blood pressure gradient and abnormal arterial compliance in patients with repaired coarctation of the aorta.

Often, the lack of systemic arterial hypertension and the lack of a resting arm-leg blood pressure gradient are used to assess the adequacy of the anatomic result after intervention for coarctation of the aorta (CoA). Some patients with no arm-leg gradient at rest may develop a gradient with exercise, leading caregivers to question the success of the repair. It is not clear what the prevalence is of patients who have undergone a successful intervention for CoA and have no arm-leg gradient at rest but develop a significant gradient with exercise and which factors may predict the development of an arm-leg gradient with exercise. This study evaluates the prevalence and predictors of an exercise-induced arm-leg gradient in subjects who have undergone an apparently successful intervention for CoA.

Adolescent↗
PubMed2004

Leg length discrepancy after total hip arthroplasty.

Restoration of hip biomechanics, including femoral offset and leg length are desired goals in performing total hip arthroplasty. Minor leg length discrepancies, less than a centimeter, are common after total hip arthroplasty and usually well tolerated. However in some patients, even these small discrepancies are a source of dissatisfaction. In addition, more significant discrepancies can be a risk factor for nerve injury and are a relatively common cause of litigation. Although leg length discrepancy cannot be eliminated after hip arthroplasty, it can be minimized through a series of steps both preoperatively and intraoperatively. These include physical examination to determine true and apparent leg length, and radiographic evaluation to both assess leg length and to preoperatively template the surgical procedure. Finally, the preoperative plan needs to be executed in the operating room using appropriate intraoperative cues.

Arthroplasty, Replacement, Hip↗
PubMed2006

Versatility of the sural fasciocutaneous flap in the coverage of lower third leg and hind foot defects.

BACKGROUND: Reconstruction of soft tissue defects of the lower third of the leg, the heel and the hind foot remains a challenge. The distally based sural artery fasciocutaneous flap has been used effectively to resurface these defects. In many instances, it has obviated the need for free tissue transfer. OBJECTIVE: The objective of the study is to evaluate the efficacy of reverse sural artery fasciocutaneous flap for coverage of lower third leg, posterior heel, malleoli and hind foot. STUDY DESIGN: This is a descriptive study, which was conducted on 84 patients who presented with soft tissue defects in the area of lower third leg, heel, malleoli and hind foot. PLACE AND DURATION OF STUDY: The study was conducted at department of plastic and reconstructive surgery, Federal Postgraduate Medical Institute Shaikh Zayed Hospital Lahore, over a period of 7 years from February 1997 to February 2005. PATIENTS AND METHODS: Over a period of 7 years, a total of 84 patients with Soft tissue defect of lower third leg, heel, malleoli and hind foot were included. Preoperative data, the age and sex of each patient, cause and site of defect, dimension of flap, transposition of pedicle (through a tunnel or laid open and covered with a skin graft), postoperative results and complications were recorded. All patients were followed up in out patients department for 6 months. RESULTS: Out of 84 patients, 54 were males and 30 females. Their ages ranged from 8 to 55 years with a mean of 31 years. Road traffic accidents was the cause of the defects in 53 patients, wheel spoke injury in 12 patients, trophic ulcer in five patients, osteomyelitis in five patients, marjolin ulcer in seven patients and diabetic ulcer in two patients. The site of 84 defects comprised 52 distal tibia; 20 tendo-Achillis and posterior heel defects; seven-malleolar region; three-anterior ankle and two-foot amputation stumps. The dimension of flap ranged from 5 to 15 cm in length and 4 to 12 cm in width. Postoperatively 66 flaps survived completely while marginal necrosis was seen in six patients and infection in four patients. The complete flap necrosis occurred in eight patients. There was no considerable morbidity at donor site and all patients had satisfactory functional outcome. CONCLUSIONS: The distally based superficial sural artery flap is a versatile, reliable procedure, useful in reconstruction of lower third leg, heel, malleoli and hind foot defects. The surgical technique is safe, of short duration and provides alternative to microsurgical reconstruction.

Adolescent↗
PubMedDate not supplied

Leg ulcers: uncommon presentations.

Uncommon presentations like vasculitis or other immunologic causes and malignancy account for about 1% to 2% of patients suffering from leg ulcers. We focus on such uncommon leg ulcers including: cutaneous vasculitis causing cutaneous ulceration, other immunologic or metabolic cutaneous lesions such as pyoderma gangrenosum and necrobiosis lipoidica, and ulcers based on neoplastic etiology. A short description on leg ulcers in the tropics is also included. The described uncommon presentations of leg ulcers are typically difficult to diagnose and treat; it is a specialist's job to take care of patients with these types of ulcers. Multidisciplinary specialized wound healing concepts integrated in the national health care system, as an accepted expert function, is the ideal way to organize the wound healing area. Such a system would result in an earlier diagnosis and more sufficient treatment for patients with uncommon presentations of leg ulcers.

Adult↗
PubMed2006

Modulations of interlimb and intralimb cutaneous reflexes during simultaneous arm and leg cycling in humans.

OBJECTIVE: We investigated to what extent intralimb and interlimb cutaneous reflexes are altered while simultaneously performing arm and leg cycling (AL cycling) under different kinematic and postural conditions. METHODS: Eleven subjects performed AL cycling under conditions in which the arm and leg crank ipsilateral to the stimulation side were moved synchronously (in-phase cycling) or asynchronously (anti-phase cycling) while sitting or standing. Cutaneous reflexes following superficial radial or superficial peroneal nerve stimulation (2.0-2.5 times radiating threshold, 5 pulses at 333 Hz) were recorded at 4 different pedal positions from 12 muscles in the upper and lower limbs. Cutaneous reflexes with a peak latency of 80-120 ms were then analyzed. RESULTS: The magnitude of interlimb and intralimb cutaneous reflexes in the arm and leg muscles was significantly modulated depending on the crank position for the relevant limb (phase-dependent modulation). A significant correlation between the magnitude of the cutaneous reflex and background EMG was observed in the majority of muscles during static contraction, but not during AL cycling (task-dependent modulation). No significant difference was found in comparisons of the magnitude of intralimb and interlimb cutaneous reflexes obtained during in- and anti-phase AL cycling. Qualitatively, the same results were obtained during AL cycling while sitting or standing. In addition, the modulation of cutaneous reflexes in arm muscles was identical among in-phase, anti-phase and isolated arm cycling. Results were the same for leg muscles. CONCLUSIONS: Cutaneous reflexes in arm muscles are little influenced by rhythmic movement of the legs and vice versa during AL cycling. It is likely that neural components that control interlimb reflexes are loosely coupled during AL cycling while sitting or standing. SIGNIFICANCE: Our results provide a better understanding of the coordination between the upper and lower limbs during rhythmic movement.

Adult↗
PubMed2004

The clinical use of supine left lateral leg cycle ergometry for exercise electrocardiographic testing in women, as used in exercise echocardiography.

BACKGROUND: Two-dimensional exercise echocardiography is commonly performed in the supine (SUP) left lateral posture (SLL) to optimize imaging quality. OBJECTIVES: To assess the clinical use of SLL cycle ergometry, we determined the metabolic, cardiovascular, and hemodynamic responses during graded leg cycle ergometry in women, performed in SLL, commonly used during exercise echocardiography, and compared our findings with those obtained during upright (UP) and SUP leg cycle ergometry. METHODS: A total of 21 apparently healthy women performed leg cycle ergometry in 3 distinct postures (UP, SUP, and SLL). RESULTS: Peak oxygen consumption and peak achieved workload during SLL cycle ergometry were significantly lower compared with UP cycle ergometry, indicating that in SLL physical work capacity would be underestimated compared with that obtained for the UP and SUP postures. The peak heart rate was significantly lower in SLL and the peak systolic blood pressure higher, compared with UP. Maximal rate pressure product was not significantly different among the postures, indicating the equivalent value of SLL with regard to augmenting myocardial oxygen demand during exercise. Stroke volume (calculated from aortic Doppler flow integral) was higher at rest, and increased to a smaller extent during exercise, in the SUP posture and SLL compared with UP. Similar peak values were attained for the 3 postures. CONCLUSIONS: SLL is not a suitable modality for the assessment of functional status or for the derivation of target heart rates for exercise training in UP posture. However, SLL leg cycle ergometry exercise provokes a comparable stimulus for the detection of coronary artery disease, as it will increase myocardial oxygen demand to the same extent as UP leg cycle exercise.

Adult↗
PubMed2005

Behavioral outcomes following below-knee amputation in the coordination between balance and leg movement.

Lateral leg movement is accompanied by opposite movements of the supporting leg and trunk segments. This kinematic synergy shifts the center of mass (CM) towards the supporting foot and stabilizes its final position, while the leg movement is being performed. The aim of the present study was to provide insight in the behavioral substitution process responsible for the performance of this kinematic synergy. The kinematic synergy was assessed by the principal component analysis (PCA) applied to both hip joints and supporting ankle joint. Patients after unilateral below-knee amputation and control subjects were asked to perform a lateral leg raising. The first principal component (PC(1)) accounted for more than 99% of the total angular variance for all subjects (amputees and controls). PC(1) thus well represents the possibility to describe this complex multi-joint movement as a one degree of freedom movement with fixed ratios between joint angular time course. In control subjects, the time covariation between joints changes holds during all phases of the leg movement (postural phase, ascending and braking phases). In amputees, PC(1) score decreased during the ascending phase of the movement (i.e. when the body weight transfer is completed, while the movement is initiated). We conclude that a feedback mechanism is involved and discuss the hypothesis that this inter-joint coordination in amputees results from a failure in the pre-setting of the inter-joint coupling.

Adult↗
PubMed2005

Longitudinal assessment of leg motor activity and sleep patterns in infants with and without Down syndrome.

Whether infants with Down syndrome (DS) perform leg movements with the same frequency and quality as their typical development (TD) counterparts is equivocal. Furthermore, the relationship between these early leg movements and later onset of locomotor milestones has only been partially explored. The aims of this study were two-fold: (1) to describe the longitudinal leg activity in infants with and without DS (3-6 months), and (2) to examine sleeping patterns and leg activity during the night. In addition, the relationships between leg activities and sleep patterns with locomotor development were explored. An activity monitor was placed monthly on the infant's ankle for 48 h. Data were analyzed to separate day-night, high-low activity, and sleep fragmentation. The results indicate that infants with DS produced more low intensity activity and more fragmented sleep. These findings are discussed in relation to the influence of early motor activity on achievement of functional motor behavior.

Circadian Rhythm↗
PubMed2005

Short-term lower-leg growth rate and urine cortisol excretion in children treated with ciclesonide.

BACKGROUND: Measurement of short-term lower-leg growth rate in children by means of knemometry has become established as an integral part of the available measures of systemic activity of topical steroids in children. OBJECTIVE: We sought to determine the effects of clinically effective doses of the novel inhaled corticosteroid ciclesonide on lower-leg growth rate and hypothalamic-pituitary-adrenal axis function in children with asthma. METHODS: In a double-blind, placebo-controlled, 4-period crossover study, 24 children aged 6 to 12 years sequentially received ciclesonide (40, 80, and 160 microg) in randomized order once daily in the evening. Each 2-week treatment period was followed by a 2-week washout period. Knemometry was performed at the beginning and end of each treatment period. Cortisol levels in 12-hour overnight urine were measured at the end of each treatment period. RESULTS: No statistically significant differences were seen in lower-leg growth rates between any of the ciclesonide treatments and placebo. Lower-leg growth rates were 0.412 mm/wk for placebo, 0.425 mm/wk for 40 microg of ciclesonide, 0.397 mm/wk for 80 microg of ciclesonide, and 0.370 mm/wk for 160 microg of ciclesonide. There was no statistically significant dose-response effect. Likewise, no statistically significant differences or dose-response effects were found for urinary cortisol adjusted for creatinine. CONCLUSION: Short-term lower-leg growth rate and hypothalamic-pituitary-adrenal axis function are not affected by treatment with ciclesonide in doses intended for clinical use in children.

Administration, Inhalation↗
PubMed2004

Chiropractic management of patients with bilateral congenital hip dislocation with chronic low back and leg pain.

OBJECTIVE: To discuss conservative methods for treating patients with chronic low back and leg pain associated with the biomechanical and postural alterations related to bilateral congenital hip dislocation. CLINICAL FEATURES: This report describes the cases of 2 adult female subjects with bilateral congenital hip dislocation without acetabula formation who suffered from chronic low back and leg pain managed conservatively by chiropractic methods. The first subject is a 45-year-old woman with a 9-month history of right buttock pain and radiating right leg pain and paresthesia down to the first 2 toes, with a diagnosis of a herniated L4 intervertebral disk. The second subject is a 53-year-old woman who complained of chronic intermittent low back pain and constant unremitting pain on her right leg for the last 3 years. INTERVENTION AND OUTCOME: Chiropractic manipulation utilizing Logan Basic apex and double notch contacts, as well as sacroiliac manipulation on a drop table with a sacrum contact and with a posterior to anterior and superior to inferior (PA-SI) rocking thrust, together with a spinal stabilization exercise program, were used on these 2 patients. Both patients had significant clinical improvement, with reduction on the Visual Analogue Scale (VAS) of 67% and 84%, Oswestry Disability Index improvement of 73% and 81%, and an improvement on the Harris hip score of 71% and 44%, respectively. CONCLUSION: A conservative management approach, including specific chiropractic manipulation and a spinal stabilization exercise program, can help manage the treatment of adult patients with chronic low back and leg pain related to bilateral congenital dislocation of the hips.

Chronic Disease↗
PubMed2006

The active straight leg raising test (ASLR) in pregnant women: differences in muscle activity and force between patients and healthy subjects.

Pregnancy-related low back and pelvic pain (PLBP) is a frequent complication of pregnancy. Although pathological mechanisms underlying PLBP are obscure, dysfunction of the sacroiliac joints (SI-joints) seems to play an important role. A cross-sectional study was performed on 24 pregnant women with and without PLBP. The objective was to determine muscle activation patterns of trunk and leg muscles during the active straight leg raising test (ASLR) and static hip flexion, and to determine maximal hip flexion force at 0 and 20 cm leg raise height. Moreover, the effort to raise the leg was scored. The measurements resulted in several significant differences between the patients and healthy controls; among others (a) patients scored subjectively more effort during ASLR, (b) at both 0 and 20 cm leg raise height patients had less hip flexion force, and (c) patients developed more muscle activity during ASLR. Since pregnant women with PLBP developed a higher muscle activity during ASLR with a significantly lower output at 0 and 20 cm than healthy pregnant women, it could be proposed that the ASLR demonstrates a disturbed load transfer across the SI-joints in this population.

Abdominal Muscles↗