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At least 1,225 records · Page 68Linked to original sources
PubMed1995

Whole-body 201Tl scintigraphy during one-leg exercise and at rest in normal subjects: estimation of regional blood flow changes.

To determine the effect of exercise intensity on regional blood flow in exercising and resting leg muscles and organs, we assessed relative changes in the regional distribution of 201Tl during one-leg ergometer exercise and at rest by whole-body scintigraphy as an estimate of regional blood flow changes in 10 healthy males. The regional 201Tl activity was expressed as a percentage of the whole-body activity, and relative changes in each region were compared to those at the anaerobic threshold (AT) and at peak exercise. In the legs, the distribution of 201Tl in the exercising thigh and calf increased significantly at the AT to 390.7 and 219.2% respectively of resting levels (both P < 0.01), but remained unchanged the resting thigh from rest to peak exercise. Conversely its distribution in the resting calf decreased significantly at the AT to 60.0% of the resting level (P < 0.01). However, there were no significant differences between AT and peak exercise. In the organs, the distribution of 201Tl in the lung, liver, spleen and kidneys decreased significantly at the AT to 88.4 +/- 10.4%, 67.0 +/- 11.5%, 62.4 +/- 11.8% and 67.0 +/- 8.6% respectively of resting levels (all P < 0.01). Redistribution of blood flow to the exercising leg occurs predominantly during mild to moderate exercise. Therefore, blood flow in the leg during strenuous exercise depends primarily upon an increase in cardiac output. The splanchnic organs are the major sources of redistribution.

Adult↗
PubMed1982

Juvenile leg ulceration in beta-thalassemia major and intermedia.

A series of 12 patients with beta-thalassemia who developed juvenile leg ulcers is described. The trophic skin changes and leg ulcers occurred after the age of 15 years. Usually the ulcer occurred after trauma over the predisposed medial aspect of the leg. In four out of seven females, the trophic changes deteriorated during or following pregnancy. The development of trophic changes and subsequent leg ulcers is not related to the severity of the anemia or to the patients' transfusion requirements, but may be related to high fetal hemoglobin concentration. The ulcers are slow to heal and tend to recur. Multiple skin-grafting operations are required in order to achieve satisfactory coverage of the ulcers. Since tissue hypoxia may be the underlying pathophysiology, the use of topical hyperbaric oxygen chamber may be beneficial in the treatment of thalassemic leg ulcers.

Adolescent↗
PubMed1994

How does a pure muscle cross-leg flap survive? An unusual salvage procedure reviewed.

An exceptional indication for a cross-leg gastrocnemius flap used as a pure muscle flap in the distal third of the lower leg is presented. The vascular status of the patient after the accident and extensive colonized wounds in the injured lower leg did not favor any microvascular reconstruction. Because no cross-leg muscle flap has been mentioned in the literature so far, technical details of the procedure are explained. This case report leads to a discussion of the principles of wound healing in cross-leg muscle flaps as an example for early loss of axial blood supply. Furthermore, it adds new variety to the numerous procedures that use the gastrocnemius flap.

Adult↗
PubMed1983

Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality.

A simple and reliable low dose radiologic method developed by the author was used to measure leg length inequality of 798 patients with chronic and therapy resistant low-back and/or unilateral hip symptoms and 359 symptom free subjects. Statistically highly significant correlations of the symptoms and leg length inequality were observed. In the majority (79 and 89%), the chronic or recurrent sciatic pain and unilateral hip symptoms occurred on the side of the longer lower extremity. When correcting the leg length inequality simply with an adequate shoe lift, a permanent and mostly complete alleviation of symptoms was achieved in the majority of the cases. The unilateral symptoms associated with mostly unrecognized leg length inequality of 5 to 25 mm were, at least in part, due to the biomechanical responses, like bending and rotational forces, needed for compensation of the lateral imbalance caused by leg length inequality.

Adolescent↗
PubMed2005

Spinal cord stimulation for chronic back and leg pain and failed back surgery syndrome: a systematic review and analysis of prognostic factors.

STUDY DESIGN: Systematic review. OBJECTIVES: To assess efficacy and safety of spinal cord stimulation in patients with chronic leg and back pain and failed back surgery syndrome and to examine prognostic factors that predict spinal cord stimulation outcome. SUMMARY OF BACKGROUND DATA: A previous systematic review of spinal cord stimulation in patients with chronic back and leg pain and failed back surgery syndrome by Turner et al in 1995 identified 39 case studies and no controlled studies. METHODS: A number of electronic databases were searched through January 2002. Citation searching of included papers was undertaken, and gray literature was sought through contact with clinical experts. No language restrictions were applied. All controlled and noncontrolled study designs were included. Study selection was carried out independently by two reviewers. Prognostic factors (age, sex, duration of pain, time post surgery, follow-up duration, publication year, data collection year, indication, data collection country, study setting, and quality score) responsible for pain relief outcome across case series were examined using univariate and multivariate metaregression. RESULTS: One randomized controlled trial, one cohort study, and 72 case studies were included. The randomized controlled trial reported a significant benefit (P = 0.047) in the proportion of patients with failed back surgery syndrome reporting 50% or more pain relief with spinal cord stimulation (37.5%) compared with patients undergoing back reoperation (11.5%). There was evidence of substantial statistical heterogeneity (P < 0.0001) in the level of pain relief following spinal cord stimulation reported across case series studies. The four principal prognostic factors found to be predictive of increased level of pain relief with spinal cord stimulation were poor study quality score, short follow-up duration, multicenter (versus single center) studies, and the inclusion of patients with failed back surgery syndrome (versus chronic back and leg pain). Overall, 43% of patients with chronic back and leg pain/failed back surgery syndrome experienced one or more complications following a spinal cord stimulation implant, although no major adverse events were reported. CONCLUSIONS: Despite an increase in the number of studies over the last 10 years, the level of evidence for the efficacy of spinal cord stimulation in chronic back and leg pain/failed back surgery syndrome remains "moderate." Prognostic factors found to be predictive of the level of pain relief following spinal cord stimulation were study quality, follow-up duration, study setting, and patient indication.

Back Pain↗
PubMed2007

Legs evolved only at the end!

Talking about legged locomotion often evokes the idea that animals using such devices are perfectly adapted to this kind of motion and should be copied by robotics. The aim of this contribution is to show that the evolution of legs comes late in phylogeny, be it in arthropods or vertebrates. Neural control of legs in vertebrates has to deal with conservative arrangements 'invented' for axial locomotion of metameric organisms. The structure of this paper is to show the importance of axial driven propulsion in vertebrates without legs, with legs and only at the end how limbs move the body in eutherian mammals.

Animals↗
PubMed1997

Costs of the treatment of leg ulcers: initiating a quality assurance process.

Reports on a study which aimed to initiate a quality assurance process among health care personnel in Sweden. An epidemiological survey concerning treatment of leg ulcers in a defined region in Sweden was conducted and the costs of treating leg ulcers at different levels of care were analysed. The epidemiological survey provided the data necessary to calculate the socio-economic costs for the treatment of leg ulcers. The weekly cost was found to be about 24 times higher for hospital inpatients than it was for patients treated at home. The quality assurance process has continued through an interdisciplinary regional consensus conference and the establishment of a consensus programme in the region, with targets and general suggestions for the care and treatment of leg ulcers. To maintain high quality in leg ulcer treatment in the region, an interdisciplinary reference group has been established with members from different clinics at the hospital and members from the primary health care.

Cost of Illness↗
PubMed2004

A high prevalence of sensitization still persists in leg ulcer patients: a retrospective series of 106 patients tested between 2001 and 2002 and a meta-analysis of 1975-2003 data.

BACKGROUND: Sensitization to topical treatments used in leg ulcers is common. Questioning and patch testing are used to identify causative drugs or dressings. OBJECTIVES: To study the current frequency of sensitization in our centre, to analyse previously published studies, and to compare sensitization in recent years with studies published before 1990. METHODS: A retrospective study was undertaken of all patients admitted with leg ulcers in 2001 and 2002. Of the files of 235 patients with leg ulcers reviewed, we identified 106 patients (group A) who had been patch tested in our institution between 2001 and 2002 with the European standard series and an additional series. The frequency of sensitization was compared with an earlier unpublished retrospective study in our centre of 36 leg ulcer patients tested in 1988 (group B), with a group of unselected contact dermatitis patients tested between 1 January 1997 and 31 December 2000 in our centre (group C), and with results published in the literature. We performed a computerized database search of MEDLINE and compared results obtained in recent years with those obtained before 1990 to obtain evidence of changing trends. RESULTS: Seventy-five per cent of the 106 patients had at least one positive reaction, and 57% had two or more positive reactions. Balsam of Peru was positive in 40% of cases, followed by lanolin (21%), fragrance mix (18%), trichlocarban (13%), colophony (11%), Cetavlon (cetrimide cream) (9%) and neomycin (9%). Thirty-five of the 36 group B patients had at least one positive reaction. Lanolin was the most frequent (31%), followed by balsam of Peru (22%), Cetavlon (19%), colophony (14%), terebenthene (14%), quinoline mix (11%) and benzocaine (8%). Two hundred and eighty-six of 526 patients of group C were positive in at least one test (54.4%). Three allergens gave a sensitization rate >10%: balsam of Peru (12.5%), fragrance mix (15.2%) and nickel sulphate (21.1%). Review of the literature and calculation of sensitization rates in a pool of 3043 patients extracted from 24 series, plus our own, showed persistence of high sensitization rates and a significant (8.5%) increase in sensitization between the two periods compared. There was a decrease in sensitivity to lanolin, constant sensitization to aminoglycosides, a slight increase in sensitivity to thiuram mix and glucocorticoids, and a marked increase in sensitivity to balsam of Peru in France. Newer topical treatments and dressings showed very low rates of sensitivity with the exception of hydrogels. CONCLUSIONS: Despite warnings, sensitization to topical treatments for leg ulcers is still frequent and, moreover, continues to increase, some variations reflecting local nursing practices and variations in topical treatment available. Although a decrease in sensitization rate with lanolin has been observed throughout the world, no decrease in sensitization rate has been demonstrated with aminoglycosides, and sensitization to glucocorticoids, thiuram mix and new products (hydrogels) is now increasingly being reported.

Administration, Cutaneous↗
PubMed2004

Implementation of a leg ulcer strategy.

BACKGROUND: The care of patients with leg ulceration has developed over the past 15 years, although there is little information available to determine how these changes have affected clinical and patient defined outcomes. OBJECTIVES: To describe and evaluate the implementation of a leg ulcer strategy. PATIENTS/METHODS: This study used a pre- and postimplementation evaluation within population-based services within the boundaries of community services providing leg ulcer care. Evidence-based leg ulcer services were developed, including standardized assessment using Doppler ultrasound, rationalization of treatment using multilayer elastic high compression, development of referral criteria and acute service support. Complete ulcer healing rates, health-related quality of life and use of health resources were evaluated after 12 weeks in both pre- and postimplementation cycles. RESULTS: A total of 955 patients were evaluated (518 preimplementation, 437 postimplementation). The levels of assessment and treatment were poor prior to the change in practice with just one patient having evidence of correct assessment and 49 (11%) receiving high compression therapy. Postimplementation, this improved to 412 of 437 (94%) having evidence of measurement of the ankle brachial pressure index, and 85% receiving compression. Twelve-week healing rates preimplementation ranged between 9% and 24%, and postimplementation rose from 19% to 39%. Combined overall healing rates improved from 71 of 518 (14%) to 160 of 437 (37%), odds ratio =3.53, P < 0.001. Frequency of treatment visits reduced from a mean (SD) of 24.0 (16.1) over 12 weeks to 13.5 (8.6), P < 0.001. Intervention led to major improvements in health-related quality of life (measured using the Nottingham Health Profile), with significant improvements for energy, pain, sleep and mobility (P < 0.01). CONCLUSIONS: Rationalization of leg ulcer services through a total service change results in improvements in professional practice, better patient outcomes, and efficient use of current resources. This study highlights the importance of a multifaceted approach to improve practice focused on the needs of individual organizational settings.

Aged↗
PubMed2006

Optimal parameters for the treatment of leg veins using Nd:YAG lasers at 1064 nm.

BACKGROUND: The treatment of large vessels such as leg veins is successfully performed in clinical practice using pulsed Nd:YAG lasers. However, it is still unclear how laser parameters such as wavelength, fluence and pulse duration influence vessel destruction in leg veins. OBJECTIVES: To elucidate the governing parameters in selective photothermolysis of large vessels. METHODS: A recently developed mathematical model for photothermolysis has been adapted for the treatment of leg veins. The model was used to analyse the effectiveness of the selective photothermolysis process in laser treatment of leg veins by Nd:YAG at 1064 nm. The efficiency of laser-induced vessel heating was defined as a ratio between the absorbed and delivered energy. RESULTS: The efficiency improved with increasing vessel diameter, in agreement with clinical findings in various studies. The pulse duration made a minor contribution for laser fluences of 100-400 J cm(-2), whereas the efficiency was better for a small spot. The use of moderate fluences of 100-200 J cm(-2) reduced excess dermis heating and pain. CONCLUSIONS: We provide reference parameters for optimal treatment of leg veins using Nd:YAG lasers at 1064 nm. Our model predicts a maximal efficiency of a range of fluences (100-200 J cm(-2)) and pulse durations (10-100 ms).

Computer Simulation↗
PubMedDate not supplied

Nocturnal subcutaneous hyperaemia in the lower leg and foot of type 1 diabetic patients.

Nocturnal fluctuations in subcutaneous blood flow in the lower leg and foot were measured during sleep in Type 1 diabetic patients without autonomic neuropathy. Subcutaneous blood flow was measured, simultaneously, 100 mm above the malleolus on the medial aspect of the right lower leg and at the dorsum of the left foot in 10 diabetic patients, and on the right lower leg only in 10 normal human subjects over 12-20 h. The 133Xe wash-out technique, portable CdTe (Cl) detectors and a portable data storage unit were used. The tracer depots were applied by means of the epicutaneous, atraumatic labelling technique. In diabetic patients, subcutaneous blood flow increased 102 +/- 68% in the lower leg and 111 +/- 98% in the foot at 113 +/- 32 min and 107 +/- 37 min, after going to sleep. The hyperaemic phase lasted 128 +/- 43 min and 150 +/- 42 min, respectively. The hyperaemic response was not different from that in the control subjects (89 +/- 61%). There was no significant correlation between the absolute hyperaemia in the leg and that in the foot. In conclusion, Type 1 diabetic patients without autonomic neuropathy have normal nocturnal hyperaemia during sleep.

Adipose Tissue↗
PubMed1993

High prevalence of diabetes in chronic leg ulcer patients: a cross-sectional population study.

In a cross-sectional survey, designed to detect all patients with current chronic leg ulcers, 27% of the patients had diabetes mellitus. The outcome for the 104 examined diabetic patients has been evaluated and compared with the 278 nondiabetic patients. The purpose was to establish the prevalence of leg ulcers among diabetic patients and to assess potential causes. The point prevalence was calculated by extrapolating the leg ulcer frequency to the total diabetic population in the studied area. The point prevalence for active leg ulcers (including foot ulcers) in diabetic patients was 3.5% (95% CI 2.8-4.2). Ulcers above the malleoli were almost as common as foot ulcers. Peripheral vascular disease was present in 67% of all ulcerated legs in patients with diabetes compared to 42% in nondiabetic patients (p < 0.001). In 72% of foot ulcers in diabetic patients arterial impairment was judged to be a contributing aetiological factor and in nondiabetic patients 45% (p < 0.001). Ulcers solely attributed to possible neuropathy were less common (15%). Ulcers with multifactorial causes were common above the malleoli. This survey has given the size of the problem and indicates macroangiopathy to be the dominating factor responsible for slow or nonhealing ulcers in diabetic patients. Objective assessment of arterial circulation is mandatory and signs of arterial impairment require consultation with a vascular surgeon.

Adolescent↗
PubMed2002

Does capture-recapture analysis provide more reliable estimates of the incidence and prevalence of leg ulcers in the community?

OBJECTIVE: To determine whether capture-recapture analysis provides more reliable estimates of the cumulative incidence and prevalence of leg ulcers in Auckland, New Zealand. METHODS: A population-based, cross-sectional study was conducted in the Central and North Auckland health districts of New Zealand in 1998. Cases were identified through health professional referral and by self-notification. All ages and ulcer types were investigated. Both traditional and capture-recapture methods of analysis were used to estimate the cumulative incidence and prevalence of leg ulcers in the study population. RESULTS: Four hundred and twenty-six people with current leg ulcers were identified during the 12-month study period. Using traditional methods of analysis, the annual cumulative incidence rate of leg ulcers in Auckland was 32 per 100,000, with a point prevalence of 39 per 100,000 and a period prevalence of 79 per 100,000 per year. Results from capture-recapture analysis, however, suggest an annual cumulative incidence rate of 252 per 100,000, with a point prevalence of 248 per 100,000 and a period prevalence of 530 per 100,000 per year. CONCLUSIONS: The traditional method of calculating cumulative incidence and prevalence clearly under-estimates the frequency of leg ulcers in the Auckland region. Capture-recapture analysis provides a more reliable estimate of disease frequency, since cases that remain unidentified in the population are considered.

Adolescent↗
PubMed2005

Successful treatment of a leg ulcer occurring in a rheumatoid arthritis patient under leflunomide therapy.

OBJECTIVE: We report the case of a leg ulcer in a rheumatoid arthritis (RA) patient under treatment with leflunomide, discuss the influence of the drug on the aetiopathogenesis of the ulcer and describe its successful treatment. CASE SUMMARY: A 68-year-old woman with a 12-year history of RA developed a leg ulcer after 4 months of leflunomide treatment. Other ulcerogenic factors were ruled out. There were some clinical hints for rheumatoid vasculitis. The ulcer was resistant to ambulant conservative phase adapted wound bed preparation and a split skin transplantation failed. After omission of leflunomide and washout procedure with cholestyramine a second split skin transplantation resulted in complete healing. DISCUSSION: Leflunomide inhibits the division of activated T cells and thus inhibits among others the production of proinflammatory cytokines and the adhesion of cells to the endothelium. These mechanisms may partly explain the possible influence of leflunomide on the perpetuation of the ulcer. Until now, occurrence of vasculitis and leg ulcers has been described in one case each for the novel immunomodulator leflunomide. No successful treatment of a leg ulcer under leflunomide has been described yet. Omission of leflunomide and a washout treatment in our case led to a complete healing. This may indicate a critical role of leflunomide in the maintenance of this slow healing ulcer. CONCLUSIONS: An association between leflunomide intake, occurrence of leg ulcers in RA patients and delayed wound healing should be considered.

Aged↗
PubMed2006

A retrospective review of 20 hypertensive leg ulcers treated with mesh skin grafts.

BACKGROUND: Few articles have been published about hypertensive leg ulcers and their surgical treatment. Since mid of the year 2000, it has been our policy to treat all hypertensive leg ulcers very early with mesh split-thickness skin grafts. The present series consists of 15 patients whose hypertensive leg ulcers, including five bilateral cases, were treated with 20 mesh grafts from 2000 to 2002. SUBJECTS AND METHODS: All patients, nine women and six men, had a long history of hypertension. The same surgical procedure was applied to all 15 patients: a complete mechanical debridement of all necrotic tissues, immediately followed by mesh skin grafting. RESULTS: Patients were discharged from the hospital after an average post-operative period of 16 days. Upon leaving the hospital, the patients had lesions completely healed in 14 of 20 cases. The graft take had been complete after an average period of 14 days. In six cases, one or two very small patches of skin graft had necrosed and complete healing required an additional period of 1 to 3 months. In all 20 cases, pain had disappeared within 1 week from surgery. DISCUSSION: All patients were on opioid therapy before surgery. With medical treatment only, hypertensive leg ulcers used to heal after a mean period of 15 months. After surgery, the average healing period was 2 weeks and opioids were stopped within 1 month after surgery. CONCLUSION: The review of the present series shows that early mesh grafting of hypertensive leg ulcers is beneficial, because healing is very quick and the pain will disappear quasi-instantly.

Aged↗
PubMed1983

Effects of externally applied compression on blood flow in the human dependent leg.

In healthy humans placed in a horizontal position, venous transmural pressure was increased from about 10 to 45 mmHg in the mid-calf region by lowering the leg below heart level. This increase in vascular transmural pressure evoked a vasoconstrictor response, as 133Xe-measured blood flow was reduced by 56% (P less than 0.01) in subcutaneous tissue and by 31% (P less than 0.01) in skeletal muscle, when recorded at the same mid-calf level. The tissue pressure in the dependent leg was elevated stepwise by inflation of a standard whole leg cuff. The vasoconstrictor response was still present when the cuff was inflated to 10 mmHg, but absent in both tissues when external pressures between 20-40 mmHg were applied. The results suggest that the observed absence of vasoconstriction can be ascribed to inhibition of the local veno-arteriolar reflex mechanism. External pressures exceeding 40 mmHg reduced blood flow in both tissues. External pressures of 60 mmHg reduced blood flow by 45% (P less than 0.01) in subcutaneous tissue and by 19% (P less than 0.02) in skeletal muscle. In conclusion, the vasoconstrictor response evoked in the dependent leg is qualitatively similar, but quantitatively different in the two tissues, possibly due to a difference in basal vascular tone. The vascular adjustments to external compression of the dependent leg is similar in the two tissues at low external pressures (0-40 mmHg), but different at high pressures, the latter probably due to a difference in vessel collapsibility in the compressed tissues.

Adipose Tissue↗
PubMed1986

Effect of adrenaline on exchange of free fatty acids in leg tissues and splanchnic area. A comparison with the metabolic response to surgical stress.

The present investigation was aimed at studying the acute effects of an adrenaline infusion on the exchange of free fatty acids in the leg and splanchnic bed. Seven healthy males participated in the study. Adrenaline (40 ng/(min X kg body weight)) (0.22 nmol/(min X kg body weight] was infused to produce a plasma concentration similar to that seen in connection with surgery (2.77 +/- 0.42 nmol/l). Leg and splanchnic blood flow were measured and the femoral and hepatic arterio-venous differences for the total fraction of FFA were determined. 1-14C-oleic acid was infused intravenously so as to determine uptake and release of FFA. Measurements were made before and between 30 and 40 min after the start of the adrenaline infusion. The FFA concentration rose by 140% and the FFA uptake in the leg and splanchnic region increased about three fold. For 3-hydroxybutyrate the arterial concentrations as well as leg uptake and splanchnic uptake increased about six fold, four fold and eight fold, respectively. Ketogenesis accounted for a large part of the FFA uptake in the splanchnic bed during adrenaline infusion. We conclude that adrenaline infusion results in pronounced changes in FFA and 3-hydroxybutyrate concentrations and in the exchange of these substrates in leg and splanchnic bed. The adrenaline-induced increases in FFA and 3-hydroxybutyrate metabolism were generally more marked than those seen during and immediately after surgery.

3-Hydroxybutyric Acid↗
PubMed1991

Regional variations in nocturnal fluctuations in subcutaneous blood flow rate in the lower leg of man.

The purpose of the study was to investigate possible regional variations in recently discovered nocturnal fluctuations in subcutaneous blood flow rates. Approximately 90 min after going to sleep, a 100% blood flow rate increment, lasting about 100 min, has been demonstrated in the distal and medial aspect of the right lower leg of normal human subjects. In the present study subcutaneous adipose tissue blood flow rates were measured simultaneously in the right and left lower legs of 16 normal human subjects over 12-20 h ambulatory conditions. The 133Xe wash-out technique, portable CdTe(Cl) detectors and a portable data storage unit were used. The tracer depots were applied on the medial aspects of the right lower leg and on the medial (series 1) and lateral (series 2) aspect of the left lower leg 10 cm proximal to the malleolar level by means of the epicutaneous, atraumatic labelling technique. A nocturnal hyperaemic response was demonstrated at both the medial and lateral aspect of the leg. As for the degree of hyperaemia and the absolute blood flow rates in the different phases, there were some deviations between the medial and the lateral locations. However, a highly significant positive correlation was observed in both series concerning the duration of the period from going to bed until the hyperaemia phase (P less than 0.001). The mechanisms involved in the nightly subcutaneous hyperaemia are at present unknown. The sudden, synchronized increase in nocturnal subcutaneous blood flow points to a central nervous or humoral elicitation, although local metabolic factors might participate as well.

Adult↗