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At least 1,207 records · Page 67Linked to original sources
PubMed2001

Duplex scanning allows selective use of arteriography in the management of patients with severe lower leg arterial disease.

PURPOSE: Until April 1997 we routinely performed intra-arterial digital subtraction angiography (iaDSA) in all patients with severe lower leg ischemia requiring intervention. After a comparative study of duplex scanning (DS), pulsegenerated runoff, and iaDSA of the lower leg arteries, we postulated that management could be based on DS/pulse-generated runoff in 59% of patients. We prospectively evaluated the safety of such a noninvasive workup strategy. METHODS: All consecutive patients referred with severe lower leg ischemia between April 1997 and September 1998 were eligible. Management was based on DS with iaDSA being performed only on indication. Complications within 30 days and 12- and 24-month patency, survival, and limb salvage rates were recorded and compared with historical controls. RESULTS: A total of 125 limbs in 114 patients were evaluated (74% rest pain or tissue loss). In 97 (78%) of 125 limbs, management was based on DS. It comprised conservative treatment (n = 33, 0% after iaDSA), percutaneous transluminal angioplasty (n = 25, 16% iaDSA), femoropopliteal bypass graft (n = 29, 17% iaDSA), femorotibial bypass graft (n = 29, 62% iaDSA), and other surgical procedures (n = 8, 4% iaDSA). Overall, the mortality within 30 days was 4% (5/114), and 2-year survival was 83%. Two-year primary and secondary patency and limb salvage rates were 75%, 93%, and 93% after a femoropopliteal bypass operation, respectively. One-year primary and secondary patency and limb salvage rates were 35%, 73%, and 74%, respectively, after a femorocrural bypass operation. There were no differences in patient characteristics, indication for specific treatment, and immediate and intermediate term outcome between the study and reference population. CONCLUSION: In a vascular unit with wide expertise in DS of the lower leg arteries, management of patients with severe lower leg ischemia can be based on DS in most patients without negative effects on clinical outcome within 30 days and at 2-years' follow-up.

Adult↗
PubMed2002

Leg gas exchange, release of glycerol, and uptake of fats after two minutes bicycling to exhaustion.

It is not known to what extent the muscles use fats and carbohydrates as substrate for oxidation after intense, anaerobic types of bicycling. Six healthy young men therefore bicycled at constant power for 2 min to exhaustion. Blood was drawn from indwelling catheters in the femoral artery and vein at intervals during the 1-h postexercise recovery. The blood samples were analysed for concentrations of O2 and CO2, and for free fatty acids (FFA), triacylglycerols (TG), and glycerol in plasma. The blood flow was also measured, and the rate of leg uptake of FFA, TG, and O2 and the release of CO2 and glycerol as well as its gas exchange ratio were calculated and integrated over the recovery period. The leg gas exchange ratio integrated over the exercise plus 1-h recovery period was 0.67 +/- 0.06 (mean +/- SEM ), suggesting pure fat oxidation. There was no statistically significant arterial-femoral-venous difference of FFA across the leg. The concentration of TG in plasma fell by 0.18 +/- 0.09 mmol L(-1) (32%) during the first 10 min of the recovery period, and the leg took up 18 +/- 8 micromol TG kg(-1) body mass (bm) during the whole 1-h recovery period. Free glycerol was released from the leg throughout the recovery period in excess of that released from hydrolysis of TG from plasma, suggesting that 30 +/- 10 micromol TG kg (-1) bm was hydrolysed, probably from intra-muscular stores. If fully oxidized, the triacylglycerols hydrolysed can account for 101% of the measured O2 uptake. Thus, muscle seems to use only triacylglycerols as substrate for its oxidative energy release after intense exercise.

Adult↗
PubMed2003

Bilateral leg extension power and fat-free mass in young oarsmen.

We evaluated the impact of bilateral leg extension power and fat-free mass on 2000 m rowing ergometer performance in 332 young oarsmen (age 21+/-2 years, height 1.76+/-0.05 m, body mass 62+/-6 kg; mean+/-s). The 2000 m rowing performance time was correlated with height (1.62-1.93 m; R2=0.23, P<0.001), body mass (53-95 kg; R2=0.53, P<0.001), fat-free mass (47-82 kg; R2=0.58, P<0.001) and bilateral leg extension power (1202-3302 W; R2=0.38, P<0.001). Multiple regression analysis selected fat-free mass and bilateral leg extension power as regressor variables. Fat-free mass explained 58% of the variability in rowing performance and the inclusion of bilateral leg extension power improved the power of prediction by 5%. The results suggest that rowing involves almost every muscle in the body and that bilateral leg extension power is very important during this activity.

Adult↗
PubMed1988

The muscle activity paradox during circular rhythmic leg movements.

A cyclist's legs make a simple 360 degrees circular and rhythmic movement, activated by a simple flexion-extension function in a sagittal plane. However, because of the simultaneous combination of leg rotation in the hip, knee and ankle joint with translation of the upper body, the general motion becomes quite complex. This complexity is increased by the anatomical interpretations of EMG readings taken during the pedalling cycle, indicating a high activity of 'flexor' muscles during the downward 'extension' of the leg (0-90 degrees propulsion phase of the pedalling cycle). This calls for an anatomical paradox. In order to verify these interpretations, the activity of six lower limb muscles was measured under field circumstances on nine elite cyclists using a portable EMG data acquisition system and active surface electrodes allowing remote (non-telemetric) monitoring of the cyclists' muscle activity patterns. Measurements were made during a 1000 m submaximal but constant effort and during a 200 m sprint. Confirmation of the anatomical paradox was found in both test circumstances. Analyses of the normalized EMG in combination with torque values of both hip and knee during the pedalling cycle indicate a zero torque at 135 degrees for the knee, while at this same angle the overall extensor activity ends in one leg and starts simultaneously in the other leg (at 315 degrees). Since the propulsion does not continue until 180 degrees, the flexor muscles have to be activated before the extension activity ends in order to generate the continuation of the circular motion until (and beyond) the bottom dead centre (180 degrees).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

Prevalence of non-healed and healed chronic leg ulcers in an elderly rural population.

OBJECTIVE: To estimate the prevalence of non-healed and healed chronic leg ulcers in an elderly rural population. DESIGN: All persons 70 years or older were asked about present and previous leg ulcers. SETTING: A rural village in mid-west Sweden with 4000 inhabitants. PARTICIPANTS: 541 persons aged 70 years and above. OUTCOME MEASURES: The prevalence of healed or non-healed chronic leg ulcers in the population aged > or = 70. RESULTS: Healed or non-healed leg ulcers were reported by 53 persons (9.8%). Examination of these patients and also 100 individuals who had negated present or previous leg ulceration, giving the total prevalence of 12.6%. CONCLUSION: The result indicates a certain risk for overestimation of prevalence, as well as underestimation and decreased reliability when basing the figures only on telephone interviews or posted questionnaires.

Aged↗
PubMed2005

Standardised method of surgical treatment of chronic leg ulcers.

Healing and recurrence rates were compared in leg ulcers of different aetiology in 385 patients with 406 chronic leg ulcers. Standard treatment was excision of the ulcer followed by meshed split-skin grafting and correction of superficial venous insufficiency in the area. The median age of the patients was 75 years (range 16-95). After one year 345 patients with 357 leg ulcers were alive. Overall healing rate was 64% (227 in 357 legs) after one year. The best results were achieved in traumatic ulcers (31 in 36 ulcers) and worst for the arterial ulcers (4 in 20 ulcers). Recurrence rate in venous and venous/ischaemic ulcers was 14% (33 in 235 legs) and 8% (n=3) in the traumatic ulcers. Vasculitic ulcers tend to recur 59% (n=10), but the graft does relieve pain.

Adolescent↗
PubMedDate not supplied

Linear growth of Zapotec schoolchildren: growth status and yearly velocity for leg length and sitting height.

The growth status and yearly growth velocity for sitting height and leg length of mild-to-moderately undernourished Zapotec schoolchildren from Oaxaca, Mexico, are described and compared with well-nourished black and white North American boys and girls. Zapotec children between 6 and 13 years of age are significantly smaller than their North American counterparts. Differences in sitting height between the three samples are maintained throughout the age range; their yearly growth increments are comparable. Yearly growth velocity in leg length of the Zapotec children is lower, which increases variation in growth status with age. Age-specific relative leg length (leg length/stature) for the Zapotec sample is 1-5% smaller than well-nourished North American children. The results show that statural growth differences between Zapotec and North American schoolchildren are accounted for by diminished growth rates of leg length.

Adolescent↗
PubMedDate not supplied

Knemometry in childhood: accuracy and standardization of a new technique of lower leg length measurement.

Recently, a new anthropometric method of accurate lower leg length measurement (knemometry) was introduced. The present study was performed to investigate rigorously its strengths and weaknesses for auxological purposes, and to promote a standardized method of use. The data are based on 6 x 2200 single estimations of the lower leg length in 90 children of both sexes with normal, tall or short stature aged between 2.4 and 17.1 years. The overall technical error of this measurement was found to be 0.16 mm, which is reduced to 0.13 mm if the first estimation within each series of six is ignored. The following sources of systematic error could be detected: intra-daily variation, dependency on physical pressure put on or removed from the leg, vigorous physical activity prior to the measuring procedure, and a slow but significant correlation between day-to-day variation of lower leg length and body weight (r = 0.299, b = 0.372 mm/kg). There was no covariation with atmospheric parameters such as outside temperature, barometric pressure and others. After elimination of a linear trend from the individual growth curves, there was a remaining day-to-day variation of SD = 0.697 mm. This represents real changes of lower leg length and cannot be explained by the technical error of measurement which contributes to less than 10% of the total variation. Some of this day-to-day variation may be explained by non-linearity of growth. Knemometry appears to be a robust and precise new tool for the investigation of short term kinetics of longitudinal growth. Proposals for a standardized use of this technique are given.

Adolescent↗
PubMed1998

Measurement of the volume of a leg ulcer using a laser scanner.

Effective management of leg ulcer healing depends on accurate and reliable measurements of wound size. Current techniques usually rely on estimates of surface area or circumference which do not fully describe the healing process. A novel instrument has been developed that is capable of measuring the variations in the surface contours (topography) of a solid object. Its primary application is to measure the size of a leg ulcer by scanning a laser displacement sensor over the affected area. There is no contact with the wound and scanning takes approximately 2 minutes to perform. Volume is calculated by subtracting the measured topography from one calculated using an algorithm to reconstruct a healthy leg surface. A study was carried out where patients had their ulcers scanned during their visits to the leg ulcer clinic. Data are presented from two venous leg ulcers showing the calculated volume reducing over time.

Humans↗
PubMed2005

Charcot-Marie-Tooth disease type 1A duplication: spectrum of clinical and magnetic resonance imaging features in leg and foot muscles.

MRI is an ideal method for identifying areas of muscle atrophy and fatty infiltration. Studies comparing clinical and MRI features of foot and leg muscle atrophy in Charcot-Marie-Tooth disease type 1A (CMT-1A) duplication are lacking. The aim of this study is to describe clinical and MRI patterns of lower limb amyotrophy in CMT-1A. A total of 10 secondary CMT-1A patients and 1 proband patient with de novo mutation were prospectively evaluated. Ages of patients ranged from 8 to 61 years (median, 24). Disease severity in terms of ability to walk and run was established using a nine-point functional disability scale (FDS). We administered the CMT neuropathy score (CMTNS), based on patient's symptoms, neurological examination and neurophysiological testing. Muscle strength of flexo-extensor ankle and toe muscles was assessed manually with the standard Medical Research Council scale. In all 11 patients, leg MRI study included T1- and T2-weighted spin-echo sequences in coronal and axial planes, and a T1-weighted spin-echo sequence with chemical sift fat suppression before and after paramagnetic contrast agent injection. In seven patients both feet were simultaneously studied in coronal and axial planes. Six patients had pes cavus, an FDS score of 0 (normal), mild CMTNS and normal muscle power of foot flexo-extensors. In these six patients, MRI showed muscle fatty infiltration of intrinsic foot muscles mainly involving the lumbricals, all four leg muscle compartments being preserved. The remaining five patients had FDS scores from 1 (cramps or fatigability) to 3 (walking difficulty), mild to moderate CMTNS and variable weakness of peroneal musculature. In these five patients MRI showed, besides intrinsic foot muscle involvement, variable and distally accentuated fatty infiltration of the lateral, anterior and superficial posterior leg muscle compartments and, to a lesser degree, of the deep posterior compartment. In four patients muscle oedema and post-contrast enhancement was noted. MRI demonstrated fatty infiltration of clinically normal muscles. We conclude that clinical-MRI patterns of lower limb muscle atrophy vary with evolution of semiology. Selective involvement of intrinsic foot muscles is the characteristic pattern of CMT-1A cases with minimal disease signs. Afterwards this pattern usually combines variable involvement of leg muscles. Our findings help to clarity the pathogenesis of pes cavus in the disease.

Action Potentials↗
PubMed2002

A community-based study of postmenopausal white women with back and leg pain: health status and limitations in physical activity.

BACKGROUND: The objective of this study was to determine the prevalence of lower back pain and associated leg pain/numbness in postmenopausal Caucasian women and the relationship of these symptoms to health status and function. METHODS: A convenience sample of 573 white women enrolled in the Observational Study of the Women's Health Initiative (WHI) in Pittsburgh completed a questionnaire on low back pain (LBP) and leg pain (LP) and its impact on their daily activity. For data analysis, this information was merged with that obtained under the standard WHI protocol. RESULTS: Almost half of the women (49%) reported having had LBP during the previous month: 8% had LBP only, while 41% had both LBP and LP. In 9% of women, the leg and back symptoms were alleviated by sitting. Among women with LBP during the previous month, those who also had leg pain were five times more likely to have had functional limitations, two to four times more likely to have consulted a clinician or taken medications, and more likely to have had prior spinal surgery or hospitalization than the women with no LP. Based on the Short Form-36, women with LBP/LP had significantly lower scores for physical function, physical role, and bodily pain than women with no LBP or with LBP alone. CONCLUSIONS: Low back pain that radiates into the hip, buttock, or leg is relatively common in postmenopausal Caucasian women living in the community and is associated with decreased physical health status and with physical limitations.

Activities of Daily Living↗
PubMed1998

Treatment of leg edema and wounds in a patient with severe musculoskeletal injuries.

This case report describes the application of a technique for the treatment of leg edema and wounds resulting from a severe distal tibiofibular fracture. Following injury and numerous fracture- and wound-related surgeries in the first year postinjury, this patient developed leg edema, required daily treatment of 2 leg wounds, and was unable to wear a shoe due to foot swelling. He was referred to the physical therapy clinic 1 year postinjury for ankle rehabilitation and to diminish the leg edema. Therapy consisting of manual lymph drainage, compressive bandaging, exercise, and skin care was provided for 7 weeks. A compression stocking was issued near the end of treatment, which the patient continued to wear daily thereafter. At the time of discharge from therapy, the leg edema had decreased 74% and the wound area of both wounds had decreased 89%. Improvements continued following discharge. By 10 weeks after the start of treatment, edema had decreased 80.9%, one wound had healed, and the second wound was 93% improved. The patient was able to wear a shoe and resume recreational activities. This case report provides insight into a treatment that may shorten rehabilitation and control the cost of caring for injuries complicated by prolonged edema.

Bandages↗
PubMed2004

Prevalence of leg ulceration in a London population.

BACKGROUND: Current prevalence estimates of chronic leg ulceration are frequently based on studies from the 1980s. During the last decade, major changes have occurred in the application of evidence-based practice to this condition. AIM: To determine the prevalence and cause of leg ulceration in a defined geographical population after 8 years of providing standardized evidence based protocols of care. DESIGN: Prospective survey. METHODS: Patients with leg ulceration of >4 weeks duration) within an integrated acute and community leg ulcer service were ascertained, interviewed and clinically assessed, using a standardized questionnaire on medical history, ulcer details and non-invasive vascular investigation to describe causes. Ulcers were classified by aetiology. RESULTS: We identified 113 patients in a population of 252 000, giving a crude prevalence of 0.45/1000 (95%CI 0.37-0.54/1000): 0.34/1000 in men, 0.54/1000 in women. Rates were highly dependent on age, increasing to 8.29 (men) and 8.06/1000 (women) in those aged >85 years. Of the responders, 62/113 (55%) had their ulcer for >1 year. Uncomplicated venous ulceration was observed in only 59/138 (43%) ulcerated limbs; a further 21 had ulceration primarily due to arterial disease. Complex causes were present in 48 (35%) limbs, mostly venous disease in combination with diabetes (35%), lymphoedema (42%) and rheumatoid arthritis (26%). DISCUSSION: Our prevalence of chronic leg ulceration is approximately one-third of that predicted by previous studies using similar methodologies in the 1980s. Patients with ulceration have more complex aetiologies than previously recognized, which may be a consequence of both increasing ulcer chronicity and age.

Adult↗
PubMed1999

An algorithm to assess stiff-legged gait in traumatic brain injury.

Spastic paretic stiff-legged gait is a frequently encountered gait problem in patients with traumatic brain injury, as well as in many other patients with upper motor neuron disease. Formerly, spasticity of the quadriceps was considered to be the sole cause of stiff-legged gait. Quantitative gait analysis, however, may implicate hip flexor weakness or poor ankle mechanics as the cause of stiff-legged gait. We discuss the use of an algorithm to evaluate stiff-legged gait in traumatic brain injury using a quantitative gait analysis system such that the specific etiology of stiff-legged gait can be identified and can serve as the basis of a treatment plan.

Algorithms↗
PubMed1992

Linearity and reliability of the IEMG v torque relationship for the forearm flexors and leg extensors.

The purpose of this investigation was to examine the linearity and reliability of the surface integrated electromyogram (IEMG) v isometric torque relationship for the leg extensors and forearm flexors. Nine men and four women (mean age +/- SD = 22 +/- 2 yr) volunteered for this investigation. Isometric testing was conducted on a Cybex II isokinetic dynamometer with the lever arm at 0.785 rad (45 degrees) below the horizontal plane for the leg extensors and in the vertical plane for the forearm flexors. Bipolar surface electrodes were used to record IEMG values from the vastus lateralis and biceps brachii. To examine test-retest reliability, two test sessions, separated by a minimum of 48 h, were performed. The test-retest linearity of the IEMG v torque relationship ranged from r2 = 0.77 to 0.96 and 0.55 to 0.94 for the forearm flexors and r2 = 0.81 to 0.98 and 0.83 to 0.98 for the leg extensors. The slope values were not significantly different (P > 0.05) between sessions and were correlated (intraclass correlation coefficients) at R = 0.86 (standard error of estimate (SEE) = 5.77 microV.Nm-1, 31% of the mean) and R = 0.97 (SEE = 0.27 microV.Nm-1, 12% of the mean) for the forearm flexors and leg extensors, respectively. The test-retest maximal torque values were 57.73 +/- 22.57 Nm and 58.14 +/- 22.81 Nm (R = 0.99; SEE = 2.39 Nm) for the forearm flexors and 187.79 +/- 55.98 Nm and 195.42 +/- 56.27 Nm (R = 0.96; SEE = 22.62 Nm) for the leg extensors (nonsignificant differences; P > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Accuracy of leg length prediction in children younger than 10 years of age.

In this study, the authors attempted to predict the ultimate leg length in normal children with normally growing legs, using Green-Anderson and Moseley techniques with chronologic and skeletal age. The predictions were based on serial growth studies of children between 5 and 10 years of age. Using skeletal age for prediction, the absolute mean error in predicting the ultimate leg length was 2.4 cm using the Green-Anderson method and 2.58 cm using the Moseley method. Using the Moseley method for length prediction in boys, the mean error was 3.8 cm using skeletal age and 1.5 cm using chronologic age. For girls, using the Moseley method of leg length prediction, the mean error was 1.55 cm with skeletal age and 2.46 cm with chronologic age. The significance of this study is that skeletal age, as determined by the Gruelich and Pyle Atlas, does not improve the accuracy of prediction of ultimate leg length in children younger than 10 years of age, except in girls with advanced bone age.

Age Determination by Skeleton↗
PubMed2003

Influence of height, leg and trunk length on pulse pressure, systolic and diastolic blood pressure.

OBJECTIVE: To compare the effects of height, leg and trunk length on pulse pressure (PP), systolic (SBP) and diastolic blood pressure (DBP) in men and women. DESIGN: Prospective, population-based, birth cohort study. SETTING: England, Scotland and Wales. PARTICIPANTS: A total of 1472 men and 1563 women aged 53 years and followed since their birth in 1946. MAIN OUTCOME MEASURES: PP, SBP and DBP at age 53 years. RESULTS: PP increased linearly with decreasing height and leg length in men and women [shortest compared with the tallest height (leg length) group, men 54.6 versus 51.0 mmHg (55.8 versus 50.7 mmHg), women 52.9 versus 48.4 mmHg (53.3 versus 48.6 mmHg); P for trend < or = 0.001 in each case]. Adjustment for adult confounding factors and childhood social class or birth weight only slightly weakened these results (P for trend < or = 0.01 in each case). SBP, but not DBP, showed similar but weaker trends in men and women, except for the association with height in men, which lost statistical significance after adjustment. Trunk length was not associated with any outcome measure in men or women. CONCLUSIONS: Short height and leg length are associated with increased PP and SBP, but not DBP, in middle-aged men and women. PP is a potential mediator between short height and leg length and increased risk of coronary heart disease. Future studies of the association between shortness and coronary heart disease should consider the role of arterial hemodynamics.

Blood Pressure↗
PubMed2002

Pedal trajectory alters maximal single-leg cycling power.

PURPOSE: Muscular power produced during in vitro cyclic contraction has been reported to vary with muscle-length trajectory. The purpose of this study was to determine whether maximal human single-leg cycling power could be similarly altered by manipulating pedal trajectory. METHOD: Seven trained cyclists performed maximal single-leg cycle ergometry. Pedal trajectory was manipulated by repositioning the ergometer drive sprocket off-center with respect to the crank axle, such that the leg-extension phase occupied 42, 50, or 58% of the cycle time (LEP42, LEP50, and LEP58, respectively). RESULTS: Maximum instantaneous power was 12% greater for LEP58 (1984 +/- 143 W) than LEP50 (1838 +/- 126 W), which was 8% greater than that for LEP42 (1645 +/- 112 W). Maximum power, averaged over a complete revolution of the crank, was 4% greater for LEP58 (636 +/- 59 W) than for LEP50 (613 +/- 53 W), which was 18% greater than that for LEP42 (520 +/- 43 W). CONCLUSIONS: These findings, paralleling those for an in vitro model, confirmed our hypothesis that maximal single-leg cycling power could be altered by manipulating pedal trajectory. Alterations in power were likely due to concomitant effects of muscle-shortening velocity, muscle excitation, and biomechanical constraints. Additional research is needed to determine whether greater leg-extension phase ratios can elicit further increases in power and whether similar results can be obtained during bilateral cycling.

Adult↗