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PubMed2006

Effect of acute leg cycling on the soleus H-reflex and modified Ashworth scale scores in individuals with multiple sclerosis.

This study examined the effect of a single bout of unloaded leg cycling on the soleus H-reflex and modified Ashworth scale (MAS) in 27 individuals with multiple sclerosis (MS) who had spasticity of the leg muscles, but were not currently taking anti-spastic medications. The soleus H-reflex and MAS data were collected before and 10, 30, and 60 min after 20 min of unloaded leg cycling and a control condition. The acute bout of unloaded leg cycling resulted in concomitant and prolonged reductions in the soleus H-reflex and MAS scores compared with the control condition. This provides converging evidence for the anti-spastic potential of acute unloaded leg cycling in individuals with MS.

Adult↗
PubMed2000

Major leg wound complications after saphenous vein harvest for coronary revascularization.

BACKGROUND: Major leg wound complications after coronary artery bypass graft procedures are infrequent and few are reported in the literature. We present our experience in treating 23 patients with major leg wound complications after coronary revascularization procedures. METHODS: A retrospective review of 3,525 bypass procedures with saphenous vein grafts performed over a 10-year period was conducted. Ten potential risk factors for those who developed major leg wound complications were analyzed and compared with the entire cohort of patients undergoing similar bypass procedures during the same period. RESULTS: Lower extremity wound complications occurred in 145 patients (4.1%), 23 of whom (0.65%) required additional surgical interventions (62 total). There were 32 wound debridements, 8 skin grafts, 11 vascular procedures, 5 amputations, 3 fasciotomies, 2 free tissue transfers, and 1 fasciocutaneous flap. Of ten variables evaluated by multivariate analysis, female gender, peripheral vascular disease, and postoperative intraaortic balloon pump use were identified as significant independent predictors of major leg wound complications (p < 0.0001). CONCLUSIONS: The causes of major leg wound complications after saphenous vein harvest for coronary artery bypass graft procedures are multifactorial. To minimize these complications, we recommend vascular evaluations before saphenous vein harvest, attention to proper surgical technique, and careful harvest site selection.

Aged↗
PubMed1997

Changes in the lower leg moment of inertia due to child's growth.

During growth the size and shape of the child's body changes. It is not clear whether the shape of a body segment changes proportionally in children between the age 5 and 18 years. The aim of this study is to describe these changes for the lower leg moment of inertia in a population of children. The segment moment of inertia describes the mass distribution along the body segment axis. The moment of inertia of the lower leg (including the foot) was measured by the free oscillation technique in 90 healthy children (61 boys and 29 girls) between and 5 and 18 years of age. The period of free oscillation was measured with and without external mass loading. The moment of inertia was calculated using a relation between the mass and the period of oscillation. A two-cylinder model of constant body density was used to predict the moment of inertia. Anthropometric measurements of length of the lower leg and foot, the circumference of the knee, ankle and foot were made. Experimental and model data of the lower leg of inertia were described by a fifth power function of body height. The experimental and model data showed high degree of convergence, confirming that the segment growth of the human body can be treated like the volume growth of a cylindrical object of constant body density. Thus it was experimentally confirmed that the lower leg segment growth between age 5 and 18 years may be considered as proportional.

Adolescent↗
PubMed1999

Runners adjust leg stiffness for their first step on a new running surface.

Human runners adjust the stiffness of their stance leg to accommodate surface stiffness during steady state running. This adjustment allows runners to maintain similar center of mass movement (e.g., ground contact time and stride frequency) regardless of surface stiffness. When runners encounter abrupt transitions in the running surface, they must either make a rapid adjustment or allow the change in the surface stiffness to disrupt their running mechanics. Our goal was to determine how quickly runners adjust leg stiffness when they encounter an abrupt but expected change in surface stiffness that they have encountered previously. Six human subjects ran at 3 m s(-1) on a rubber track with two types of rubber surfaces: a compliant "soft" surface (ksurf = 21.3 kN m(-1) and a non-compliant "hard" surface (ksurf = 533 kN m(-1). We found that runners completely adjusted leg stiffness for their first step on the new surface after the transition. For example, runners decreased leg stiffness by 29% between the last step on the soft surface and the first step on the hard surface (from 10.7 kN m(-1) to 7.6 kN m(-1), respectively). As a result, the vertical displacement of the center of mass during stance ( approximately 7 cm) did not change at the transition despite a reduction in surface compression from 6 cm to less than 0.25 cm. By rapidly adjusting leg stiffness, each runner made a smooth transition between surfaces so that the path of the center of mass was unaffected by the change in surface stiffness.

Adult↗
PubMed2000

Short stature and delayed puberty in gymnasts: influence of selection bias on leg length and the duration of training on trunk length.

BACKGROUND: Delays in bone age, the onset of puberty, and skeletal growth in gymnasts could be, in part, the reason for an interest in gymnastics, rather than being the result of vigorous exercise. We hypothesized that short stature and delayed bone age are present at the start of gymnastics, and training delays growth, producing short stature, even after retirement. METHODS: Sitting height and leg length were measured in 83 active female gymnasts, 42 retired gymnasts, and 154 healthy control subjects. Results were expressed as age-specific SD scores (mean +/- SEM). RESULTS: In the cross-sectional data, active gymnasts had delayed bone age (1.3 +/- 0.1 years), reduced height -1.32 +/- 0.08 SD, sitting height -1.24 +/- 0.09 SD, and leg length, -1.25 +/- 0.08 SD (all P <.001). However, in those training for less than 2 years, the deficit was confined to leg length (-0.8 +/- 0.2 SD). During 2 years of follow-up of 21 gymnasts, only the deficit in sitting height worsened (by 0.4 +/- 0.1 SD). In 13 gymnasts followed up in the immediate 12 months after retirement, sitting height accelerated, resulting in a lessening of the deficit in sitting height by 0.46 +/- 0.14 SD (P <.01). Adult gymnasts who had been retired for 8 years had no deficit in sitting height, leg length, or menstrual dysfunction. CONCLUSIONS: Short stature in active gymnasts is partly due to selection of individuals with reduced leg length. Reduced sitting height is likely to be acquired but is reversible with cessation of gymnastics. A history of gymnastic training does not appear to result in reduced stature or menstrual dysfunction in adulthood.

Adolescent↗
PubMed1991

Methodology for restoring functional leg length in revision total hip arthroplasty.

Functional leg length was measured in 30 patients before and after revision total hip arthroplasty. The authors emphasize the importance of preoperative planning, and determination of adjustment of the leg length should be aimed at a balanced attitude of the entire pelvis and lower back. In order to correct the length inequality, the leg was lengthened in the revision in 25 cases, left unchanged in 2 cases, and shortened in 3 cases. The mean functional leg-length inequality was 13 mm before operation and 4 mm after operation. The mean radiographic inequality between the upper surfaces of the iliac crest was 13 mm before operation and 9 mm after operation. The side operated was more often functionally shorter than the other side before operation, and longer than the other side after operation. The authors emphasize the importance of functional leg length in revision hip arthroplasty. The functional length discrepancy can be corrected in revision, but there appears to be a risk of overlengthening.

Aged↗
PubMed1992

Microvascular reactivity differences between the two legs of patients with unilateral lower limb ischaemia.

Posturally induced microvascular constriction in the skin of the leg is disturbed in severe ischaemia. It is unknown whether this disturbance is of local or central origin and whether the stage of ischaemia at which this disturbance occurs differs when the nutritive and thermoregulatory flow levels are compared. We investigated the effect of posture on the skin microcirculation in 21 patients with unilateral severe ischaemia. The results were compared with those from the contralateral, asymptomatic leg and with results from 11 age-matched controls. Patients were investigated in supine and sitting positions, using capillary microscopy to measure nutritive flow, and laser Doppler fluxmetry (LDF) to measure thermoregulatory flow, of the big toes. In the supine position, capillary flow and LDF were lower in the diseased than in the asymptomatic and control legs. After changing from the supine to the sitting position, capillary perfusion decreased in all three groups, but was most pronounced in the controls. Laser Doppler flux decreased in the controls, but increased in the diseased legs, suggesting disturbed vasoconstriction mechanisms in the deeper skin microvessels. These findings indicate that in severe limb ischaemia, posturally induced microvascular reactivity is sustained at the nutritive level but not at the thermoregulatory level. This disturbed reactivity is considered a local phenomenon, as it is not observed in the contralateral leg.

Adult↗
PubMed1994

Falsely elevated ankle pressures in severe leg ischaemia: the pole test--an alternative approach.

Ankle-branchial pressure indices (ABPIs), measured by sphygmomanometer and Doppler probe, are an accepted index of chronic leg ischaemia. However, tibial artery sclerosis or calcification decreases compliance, producing falsely elevated cuff occlusion pressures. Arterial cannulation is invasive and impractical, but by elevating the foot and measuring the height at which the Doppler signal disappears, ankle systolic pressure in mmHg can be derived. Using an 8MHz Doppler apparatus and calibrated pole, ankle systolic pressures measured by sphygmomanometer and elevation were compared in 49 severely ischaemic legs (40 patients). ABPIs were derived by dividing ankle systolic pressure by brachial pressure. Median (interquartile range) ABPI assessed by sphygmomanometry was 0.46 (0.35-0.56). Median ABPI measured by leg elevation was significantly lower at 0.21 (0.14-0.30), p < 0.0001, Wilcoxon. In 20 patients undergoing in situ vein bypass grafting, direct transducer-derived pressure measurements were obtained. Median ABPI for this method was 0.15 (0.11-0.27). No significant difference was found when compared with ABPIs derived by elevation, median 0.2 (0.13-0.31), p = 0.324, however median ABPI measured by sphygmomanometry was significantly higher at 0.37 (0.27-0.6), p = 0.0008. Correlation of elevation with transducer-assessed pressure measurements (r = 0.88) was closer than with cuff-derived measurements (r = 0.69). Pressures derived by leg elevation provide a more accurate index of severe leg ischaemia than sphygmomanometry, although the technique is limited to assessing pressures of less than approximately 60 mmHg. Falsely elevated ABPIs may underestimate the extent of disease in patients assessed for vascular reconstruction.

Aged↗
PubMed1988

Epidural vs general anaesthesia and leg blood flow in patients with occlusive atherosclerotic disease.

Total leg blood flow (plethysmography), skin blood flow (laser-Doppler flowmetry), and haemodynamic stability (MAP, HR, RPP) were studied in vascular (ABI less than 1.0; n = 31) and in non-vascular (ABI greater than 1.0; n = 24) surgical patients during epidural or fentanyl-supplemented general anaesthesia. During epidural anaesthesia significant increases in total leg blood flow were observed in vascular (from 1.9 +/- 0.2 to about 3 ml/100 ml tissue/min) as well as in non-vascular (from 2.5 +/- 0.6 to about 7 ml/100 ml tissue/min) patients and leg blood flow remained high in the postanaesthetic period. During general anaesthesia total leg blood did not increase, either in vascular or in non-vascular patients, and in the postanaesthetic period blood flow values even lower than the initial ones were observed. Skin blood flow increased about 4-fold in vascular as well as in non-vascular patients following both types of anaesthesia. In the immediate postanaesthetic period low flow values were again observed but only in the general anaesthesia groups. In vascular patients no critical redistribution of blood flow within the limb was observed irrespective of the type of anaesthesia. Good haemodynamic stability could only be maintained in the epidural group. It is concluded that epidural anaesthesia seems to offer considerable advantages over general anaesthesia for high-risk vascular patients during arterial reconstructions since better haemodynamic stability and higher leg blood flow can be achieved.

Aged↗
PubMed2001

Case study methodology in tissue viability. Part 2: A study to determine the levels of knowledge of nurses providing care for patients with leg ulcers in an acute hospital setting.

One of the main components of the clinical governance framework is a comprehensive programme of quality improvement activity that includes the implementation of evidence-based, everyday clinical practice. This paper addresses the challenges surrounding the implementation of one area of evidence-based practice, the management of leg ulcers in an acute hospital trust. The aim of the study was to distinguish the levels of knowledge of nurses providing care for patients with leg ulcers within an acute hospital setting. The design used was that of a collective case study. Each 'case' was a patient with a leg ulcer and the nurses who cared for that patient. They were studied in order to provide insight into the nurses' understanding of leg ulcer management. A number of themes were identified as being common to all the cases. They are: evidence-based practice, nursing skills, quality of life, patient understanding of their ulcer and pain. Each of these themes identified areas of knowledge deficit in the nurses. As part of the implementation of a leg ulcer policy an education programme is being developed to address these deficits.

Bandages↗
PubMed2000

Rapid intermittent compression increases skin circulation in chronically ischemic legs with infra-popliteal arterial obstruction.

BACKGROUND: Intermittent pneumatic compression (IPC) has been shown, by duplex, to increase popliteal artery flow in normal legs and in legs with superficial femoral artery occlusion. The objective of this study was to see if IPC improves distal circulation in legs with severe infra-popliteal disease. PATIENTS AND METHODS: Sixteen chronically ischemic legs with arteriographically demonstrated crural or pedal disease were studied during compression with an ArtAssist compression-device. This device delivers rapid compression of the foot and calf. Cutaneous laser-Doppler flux was measured continuously at the dorsal aspect of the distal forefoot. The findings were compared to those in thirteen normal controls of similar age. RESULTS: In ischemic legs, the spontaneous changes in skin-flux are minimal: mean resting flux in sitting position was 0.87 +/- 0.46 AU (Arbitrary Units). Upon activation of the compression device the maximum flux increased to 4.55 +/- 1.35 AU. The difference was statistically significant (p < 0.001). This response was similar to that in normal controls. CONCLUSION: Arterial flow augmentation upon compression is associated with increased skin-flux. This response remains present in severe disease of the crural outflow-arteries. Further investigation to define the role of intermittent compression for management of chronic arterial disease is warranted.

Aged↗
PubMed2003

Allergic contact dermatitis in venous leg ulcer patients.

Our aim was to determine the frequency and nature of contact sensitivity in venous leg ulcer patients in Lanarkshire. We performed patch testing with the European standard series, antimicrobials and medicaments on 200 patients referred to our leg ulcer clinics. Positive patch tests were found in 136 (68%) patients. Multiple allergies occurred in 102 (51%). The most frequent allergen groups were fragrances (30.5%), antimicrobials (19.5%), topical excipients (19.5%), rubber accelerators (13.5%) and topical corticosteroids (8%). We also found a high prevalence of positive patch tests to Intrasite gel (9.5%) and Hioxyl cream (8.5%), medicaments which are commonly used to treat leg ulcers in our area. Contact sensitivity is common in venous leg ulcer patients and has important implications for patient management. The allergens involved vary depending on local nursing practice. We suggest that all venous leg ulcer patients be patch tested with a locally relevant patch test series.

Adult↗
PubMed2005

Opposite contributions of trunk and leg fat mass with plasma lipase activities: the Hoorn study.

OBJECTIVE: Lipoprotein lipase (LPL) and hepatic lipase (HL) are essential in hydrolysis of triglyceride-rich lipoproteins. LPL activity is negatively, whereas HL activity is positively, associated with total body fat. We determined the associations of trunk and leg fat mass with plasma LPL and HL activities in a cross-sectional study. RESEARCH METHODS AND PROCEDURES: LPL and HL activities were determined in post-heparin plasma in a sample of 197 men and 209 women, 60 to 87 years of age. A total body DXA scan was performed to determine trunk and leg fat mass. RESULTS: In women, but not in men, trunk fat mass was negatively associated with LPL activity, whereas leg fat mass was positively associated, after mutual adjustment and adjustment for age. Standardized betas (95% confidence interval) for trunk and leg fat mass were -0.24 (-0.41; -0.08) and 0.14 (-0.02; 0.31), respectively (interaction by sex, p = 0.03). Larger trunk fat mass was associated with higher HL activity in men [0.48 (0.28; 0.68)] and women [0.40 (0.24; 0.56)]. A negative association of leg fat mass and HL activity was observed in men, although not statistically significant [-0.13 (-0.33; 0.06)], and in women [-0.28 (-0.38; -0.18)]. DISCUSSION: Abdominal fat is associated with unfavorable and femoral fat with favorable LPL and HL activities in plasma.

Abdominal Fat↗
PubMed1977

Leg blood flow and central circulation at various blood volumes: a peroperative study of nine patients with varicose veins.

1. In a group of nine middle-aged patients undergoing varicose vein surgery, cardiac output, right atrial, pulmonary arterial and capillary pressures, and leg blood flow were measured after induction of general anaesthesia but before operation, and also during operation before and after blood substitution. 2. Under anaesthesia, the mean pre-operative blood flows in the superficial and common femoral arteries were 160 ml/min and 280 ml/min respectively. These flows are comparable with those obtained in other studies under similar conditions but lower than values obtained in conscious subjects. During the operation the leg blood flow decreased by 24%. As cardiac output remained unchanged, the fractional leg blood flow fell. After transfusion of 900 ml of blood the leg blood flow doubled. 3. It is concluded that anaesthesia, surgical trauma and variations in blood volume greatly influence the leg blood flow and that an adequate substitution of operative blood loss is of utmost importance to achieve an optimum peripheral circulation.

Adult↗
PubMed1978

Determination of human leg blood flow: a thermodilution technique based on femoral venous bolus injection.

1. A thermodilution method was developed for the determination of human leg blood flow. The method is based on bolus injection of an indicator distally into the femoral vein, at room temperature, and recording of the dilution curve in the same vessel at the level of the inguinal ligament. The blood flow was computed automatically with two thermistors and an integrator. 2. The leg blood flow determined by this method at rest and during exercise at work loads of 50, 100 and 150 W in six healthy subjects was found to agree closely with measurements by an intraarterial indicator-dilution technique. A linear relationship was found between leg blood flow and work. The reproducibility of the blood flow determinations, expressed as the coefficient of variation for a single determination, was 12.9 at rest and 5.3 or less during exercise. 3. The method was used in two patients with occlusive arterial disease of the leg. Extremely low leg blood flows were found in these patients when they were forced to interrupt the exercise by severe calf pain

Adult↗
PubMed1986

Changes in human plasma atrial natriuretic polypeptide concentration in normal subjects during passive leg raising and whole-body tilting.

The effect of central venous pressure on release of human atrial natriuretic polypeptide (hANP) was studied by measuring the plasma hANP levels during passive leg raising to 60 degrees and head up whole-body tilt at 60 degrees in normal volunteers. In ten subjects, after at least 1 h recumbency, both legs were raised passively 60 degrees for 20 min. While the legs were raised the plasma hANP level increased significantly from a basal level of 101 +/- 10 pg/ml (mean +/- SE) to a peak of 165 +/- 15 pg/ml after 10 min, and returned to the basal level 10 min after the legs were lowered. The blood pressure and pulse rate were not affected by raising the legs. The effect of head up whole-body tilt of 60 degrees from the supine position, for 20 min, was examined in nine normal subjects. Their plasma hANP decreased transiently at 5 min in five of them and at 10 min or later in the remaining four subjects. Their blood pressure did not change but their pulse rate increased significantly while their body was being tilted. These results suggest that secretion of hANP is regulated physiologically by changes in the central venous pressure.

Adult↗
PubMed1986

The exchange of blood-borne amino acids in the leg during abdominal surgical trauma: effects of glucose infusion.

The exchange of plasma amino acids and glucose, lactate, glycerol and 3-hydroxybutyrate in the leg was studied in otherwise healthy patients undergoing elective cholecystectomy. Seven patients were given a constant intravenous infusion of glucose at a rate of 1.1 mmol/min throughout the study. Seven other patients who received normal saline only served as a control group. Measurement of leg blood flow and arterio-femoral venous differences of amino acids and other energy metabolites were made on four occasions: (I) before surgery, (II) 10 min after skin incision, (III) at the end of surgery, and (IV) 30 min after the end of anaesthesia. The release of amino acids from the leg was comparable in the two groups before and during the early part of surgery. At the end of surgery the release of several individual amino acids, as well as the total release of amino acids, from the leg was higher in the patients given glucose infusion compared with the control patients. The infusion of glucose prevented the intraoperative rise in arterial levels and uptake of 3-hydroxybutyrate in the leg. A high release of amino acids at the end of surgery was thus associated with low arterial levels of 3-hydroxybutyrate while the reverse pattern was seen in the control patients. These effects of glucose infusion were qualitatively different from those seen in uninjured postabsorptive man.

3-Hydroxybutyric Acid↗
PubMed1992

Nocturnal variations in lower-leg subcutaneous blood flow in paraplegic men.

1. Lower-leg subcutaneous adipose tissue blood flow rates were measured over 12-20 h under ambulatory conditions by means of the 133Xe-washout technique in nine paraplegic men, all with complete spinal cord lesions at or below the Th 6 level, and in nine age-matched healthy men. Portable CdTe(Cl) detectors and data-storage units were used. 2. The central and local sympathetic vasoconstrictive activity at the lower leg was measured under laboratory conditions by means of the 133Xe-washout technique and a stationary NaI(Tl) detector system. 3. The paraplegic men were found to have intact central and local sympathetic vasoconstrictive activity in their lower legs. Moreover, they all had a nocturnal hyperaemic blood flow phase of the same magnitude and duration as the control subjects. 4. The possibility that the somaesthetic nerves play a role in the hyperaemic response could be excluded, as all the paraplegic men suffered from complete lower-leg somaesthetic denervation. 5. A significant correlation was found between the time of going to bed and the nightly hyperaemic response in the right and left lower legs (P less than 0.01). 6. It is concluded that the present data are in accordance with the concept of a central nervous or humoral elicitation of nocturnal hyperaemia, although local metabolic and other factors might participate as well. Paraplegic men have an intact regulation of the postural and nocturnal changes in peripheral blood flow whether of central sympathetic or humoral origin.

Adipose Tissue↗