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PubMed2000

[Comparison of the effectiveness and cost of treatment with humid environment as compared to traditional cure. Clinical trial on primary care patients with venous leg ulcers and pressure ulcers].

INTRODUCTION: The discovery of moist environment dressings as alternatives to the traditional treatments based on exposing wounds to air, opened new expectations for the care and treatment of chronic wounds. Over the years, these expectations have led to the availability of new moist environment dressings which have made it possible to improve the care provided to patients suffering this kind of wounds, as well as providing important reasons to weigh in terms of cost-benefit-effectiveness at the time of selecting which type of treatment should be employed. The lack of comparative analysis among traditional treatments and moist environment treatments for chronic wounds among patients receiving primary health care led the authors to perform an analysis comparing these aforementioned options of treatment on patients suffering venous leg ulcers or pressure ulcers. PATIENTS, MATERIALS AND METHODS: The authors designed a Randomized Clinical Trial involving patients receiving ambulatory care in order to compare the effectiveness and cost-benefit of traditional versus moist environment dressing during the treatment of patients suffering stage II or III pressure ulcers or venous leg ulcers. In this trial, variables related to effectiveness of both treatments, as well as their costs were analyzed. MAIN RESULTS: 70 wounds were included in this Randomized Clinical Trial, 41 were venous leg ulcers of which 21 received a moist environment treatment while 20 received traditional cure, the other 29 wounds were pressure ulcers of which 15 received moist environment dressings treatment and 14 received traditional dressings. No statistically significant differences were found among the defining variables for these lesions in either group under treatment. In the venous leg ulcer study group, the authors conclusions were an average of 18.13 days, 16.33 treatment sessions and a cost of 10,616 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with traditional treatment compared to an average of 18.22 days, 4.54 treatment sessions and a cost of 2409 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with moist environment dressings. In the pressure ulcers study group, the authors conclusions were an average of 12.18 days, 12.1 treatment sessions and a cost of 15,490 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with traditional treatment compared to an average of 7.12 days, 1.86 treatment sessions and a cost of 2610 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with moist environment dressings. COMMENTS: The results of this randomized clinical trial demosntrated that the moist environment treatment group was more effective and had a better cost-benefit ratio than the traditional treatment group in the treatment of pressure ulcers and venous leg ulcers on patients cared for by nursing personnel in primary health care centers all of which agrees with publications consulted by authors.

Chronic Disease↗

PubMedDate not supplied

[Activated protein C resistance and cardiolipin antibodies in leg ulcers].

BACKGROUND: We conducted a prospective study to determine the prevalence of activated protein C resistance and anticardiolipin antibodies in leg ulcers, whatever venous, arterial or arteriovenous. PATIENTS AND METHODS: One hundred fifteen patients hospitalized for leg ulcers, without antiphospholipid syndrome were included. The vascular abnormalities were studied by clinical examination, Doppler, duplex Doppler and, when required, arteriography. Activated protein C resistance was isolated by a "classic" test (normalized APTT ratio in PCa presence or absence) and by a "second generation test" (by preliminary dilution with deficient factor V plasma). All patients with abnormal results on the second test were screened for the factor V Leiden (by PCR amplication with use of restriction enzymes). Anticardiolipin antibodies were investigated with an ELISA method with Harris standards as reference, in which the positive threshold was established at 20 units. RESULTS: Among these 115 patients, 50 venous (43.5 p. 100), 23 arterial (20 p. 100), 42 arteriovenous (36.5 p. 100) leg ulcers were identified. Activated protein C resistance was isolated in 12 cases (10.4 p. 100) (heterozygous carriers): 7 venous ulcers, 3 arteriovenous, 2 arterial. Anticardiolipin antibodies were measured at significant level in 49 cases (42.6 p. 100): 21 venous ulcers, 18 arteriovenous, 10 arterial. DISCUSSION: In this study, there was no statistical difference between the activated protein C resistance prevalence in leg ulcers when compared with Lorraine population (p=0.27). Factor V Leiden or anticardiolipin antibodies abnormalities were isolated in 56 cases (48.7 p. 100) without statistical difference between the 3 types of ulcers. Finally, the pathophysiology of venous, arterial and arteriovenous leg ulcers remains complex, suggesting several coagulation perturbations.

Activated Protein C Resistance↗

PubMedDate not supplied

Restless legs syndrome.

BACKGROUND: Restless legs syndrome is a common but not well-recognized central nervous system disorder that leads to insomnia and daytime distress. METHODS: A MEDLINE search of the recent English language literature was undertaken with review of appropriate articles and references. RESULTS: A growing body of work has added to an understanding of the epidemiology, diagnostic criteria, appropriate evaluation, and effective management of restless legs syndrome. CONCLUSIONS: Restless legs syndrome occurs in about 6% of the adult population, more so in the elderly. Affected patients experience uncomfortable sensations in the legs with inactivity, more pronounced late in the day and at bedtime, which are temporarily relieved by moving the limbs. Affected patients can suffer from insomnia, disrupted sleep, daytime fatigue, and difficulty with sedentary activities. Most cases are idiopathic, although secondary causes, such as iron deficiency, should be excluded. Dopaminergic agents are highly effective in treating restless legs syndrome, but side effects can be problematic. Alternative medications include benzodiazepines, opioids, gabapentin, and clonidine.

Humans↗

PubMed2002

[Leg length changes after upper tibial osteotomy: analysis of different preoperative planning methods].

PURPOSE OF THE STUDY: The amount of change in the length of the lower limb resulting from upper tibial osteotomy depends on the type of osteotomy performed, the preoperative length of the limb, the degree of preoperative deformity and the amount of correction obtained. Wedge resection, for example, removes bone tissue and can lead to shortening. Inversely, a lengthening effect may result from correction of deformity. The purpose of this article was to present an analysis of the differences between different types of osteotomies and compare their effect on leg length. METHODS: Change in length of the lower limb was studied with a mathematical analysis in opening wedge osteotomy, closing wedge osteotomy, and dome osteotomy. Leg length was calculated for several preoperative deformity angles of the entire limb (hip-knee-ankle angle) and several values of planned correction. RESULTS: The theoretical mathematical model demonstrated that the greatest changes in leg length are obtained with opening wedge osteotomy, followed by dome, then closing wedge osteotomy. Tables were established showing calculated change in leg length. Tracings on radiographs or CT scans used to measure these changes are explained. Methods applicable in case of flexion contracture of the knee are presented. DISCUSSION AND CONCLUSION: Once the initial question regarding length changes is posed, many of the points become evident on image tracings. This work points out how quickly tables can be used to recognize significant differences in leg length changes produced by different osteotomies.

Anthropometry↗

PubMed1975

The mechanism of generation and transmission of forces in leg extension.

This paper deals with the mechanical and electromyographic evaluation of the mechanism generating and transmitting the resultant leg extension force by maximal isometric contraction in two directions, the knee and hip joint being kept at 90 degrees. The two directions were a) from the center of gravity of the body to the ankle joint and b) from a point near the knee to the ankle. Six male subjects in a supine position exerted a maximal leg extension force of 47-112 kg for a) and 51-73 kg for b). These values were close to the smaller values of two forces estimated at the knee and at the hip from maximal isometric forces at the corresponding joint of the same joint angle. It was thus suggested that the joint limiting the resultant leg extension force was the knee for a) and the hip for b). The single joint muscles exhibited almost maximal activities when they concerned the joint which limited the resultant leg extension force. The double joint muscles were often contracted only moderately during the maximal isometric leg extension, indicating a different role of double joint muscles even at the maximal force production at a particular joint.

Adult↗

PubMed1999

Effects of aging on leg vein filling and venous compliance during low levels of lower body negative pressure in humans.

To evaluate the fluid shift and leg venous compliance during orthostatic stress with advancing age, 12 aged and 5 young healthy males were subjected to graded lower body negative pressures (LBNP) of -5, -10, and -15 mmHg. Cardiovascular variables were monitored continuously, and leg venous compliance was determined by venous occlusion plethysmography. Neither heart rate nor mean arterial pressure changed significantly in any subject during LBNP. A progressive decrease in the thoracic fluid volume index and a gradual increase in the leg fluid volume index, indicating a fluid shift towards the lower body were observed significantly in the young group (p<0.05), while these changes were not significant in the aged group. A linear reduction in peripheral venous pressure could be seen during graded LBNP in all subjects, but the reduction rate was smaller in the aged group. Baseline leg venous compliance was reduced in the elderly (p<0.05). During LBNP, venous compliance decreased in all subjects, but the decrease was significantly smaller in the aged group (p<0.05). It is suggested that the smaller fluid shift and smaller decreased leg venous compliance in aged people during gravitational stress were mainly due to the vascular and ventricular stiffness induced by an age-related reduction in visco-elasticity of the peripheral venous and ventricular walls.

Adult↗

PubMed2002

Substrate utilization during arm and leg exercise relative to the ventilatory threshold in men.

BACKGROUND: The purpose of this study was to determine variations in substrate utilization in men during arm and leg exercise at 70 and 90% of mode specific ventilatory threshold (Tvent). METHODS: Ten males served as subjects. Limb total and muscle volumes were estimated in the right arm and leg with anthropometry. Ventilatory equivalence, excess CO2, and modified V-slope methods were used to determine Tvent. Subjects performed 15 min of exercise at 70 and 90%Tvent arm cranking (AC) exercise, and 70 and 90%Tvent leg cycling (LC) exercise. RESULTS: VO2, VE, and HR were higher during LC exercise at both intensities. However, arm and leg RPE were not different at 70 and 90%Tvent. There were no significant differences between modes at 70%Tvent in relative carbohydrate use (54.5+/-9.5 and 57.8+/-8.2% for AC and LC, respectively) and relative fat oxidation (45.5+/-9.5 and 42.2+/-8.2% for AC and LC, respectively). However, at 90%Tvent, relative carbohydrate oxidation was significantly higher during AC versus LC exercise (75.4+/-10.6 versus 68.6+/-9.0%, p<0.05). Energy expenditure (total kJ x min(-1) was significantly lower during AC exercise (14.5+/-2.9 and 18.4+/-3.4 for the 70 and 90%Tvent, respectively) versus LC exercise (27.1+/-3.3 and 34.8+/-4.1 for the 70 and 90%Tvent, respectively; p<0.05). CONCLUSIONS: These results indicate that substrate use during AC exercise is similar to LC exercise at 70%Tvent. However, as the exercise intensity increases, the smaller arm musculature becomes more dependent on carbohydrate utilization compared to the legs.

Adult↗

PubMedDate not supplied

Bone mineral decrease in the leg with unilateral chronic occlusive arterial disease.

OBJECTIVE: The links between osteoporosis and arteriosclerosis have been established by numerous epidemiological studies. Could arteriosclerosis induce bone mineral loss via ischemia or other pathological process? We carried out a comparative study of bone mineral density in both legs of patients with unilateral arterial disease of the lower limbs. METHODS: We studied 25 patients, 22 men and 3 women, whose mean age was 62.3 years (range 35-88 years). These patients had unilateral lower limb arterial disease of at least 3 months duration with a systolic index at least 50% lower on the affected than on the healthy side. Bone mineral content (BMC) and bone mineral densities (BMD) of the femoral neck, femur, tibia, foot and ankle of the affected and the unaffected legs were measured by dual x-ray absorptiometry (Lunar DPXL) and the results compared. RESULTS: Bone mineral density was significantly lower in the femur (-3.7%, p = 0.04), the foot and the ankle (-3%, p = 0.05) of the affected leg. There was a non-significant decrease in BMD of the whole femoral neck (-1.2%) and the trochanter (-4.4%, p = 0.08) on the affected side. Tibial bone mineral density was identical in both legs. Bone mineral content was lower on the affected side (-5.3%, p = 0.05) whereas fat mass and muscle mass were the same in both legs. CONCLUSION: The ischemia resulting from arterial disease of the lower limbs appears to have a direct deleterious effect on bone mineralization.

Absorptiometry, Photon↗

PubMed1960

Leg cramps.

Foot and leg cramps are among the most frequent complaints presented by patients of both sexes, especially older persons. Similar cramping may occur in the thighs or in other skeletal muscles of the extremities and trunk. Foot and leg cramps usually occur after unusual exertion or during sleep. "Nocturnal leg cramps" may be of sufficient intensity to prevent sleep. "Pregnancy cramps" are particularly distressing. Effective treatment of foot and leg cramps requires an understanding of the etiology, pathophysiology and diagnostic techniques. Weight reduction and improved diet are essential. Among the useful supplementary medications are calcium lactate or gluconate, vitamin-mineral supplements, sympathetic blocking agents, vasodilators, ataraxics, muscle relaxants, quinine, hydrochloride, antihistamines, and nonmercurial diuretics. Improved foot care and correction of foot imbalance is usually required. Edema and venous insufficiency are improved by elastic support, by repeated foot elevation for massages, by manipulations and exercises and by the use of diuretics. There may be need for operations on the veins and for sclerotherapy. Patients with arterial insufficiency are often benefited by lumbar sympathetic blocks with long-acting anesthetics and intra-arterial injections with relaxants, vasodilators, thrombolytic enzymes and anticoagulants. Sympathectomy, angiography and reconstructive arterial operations are indicated in only a small proportion of patients with foot and leg cramps.

Disease↗

PubMed1992

Isokinetic arm and leg strength of adults with Down syndrome: a comparative study.

This study compared isokinetic arm (elbow flexion and extension) and leg (knee flexion and extension) strength of individuals with Down syndrome (DS), with mental retardation without DS (NDS), and sedentary young adults with no mental retardation (NMR). Eighteen individuals with DS, NDS, and NMR (11 men and seven women in each group) performed strength tests on a Cybex 340 isokinetic dynamometer. Parameters measured were peak torque (ft/lb), peak torque percent body weight (%BW), average power (watts), and average power %BW. Subjects with mental retardation (ie, DS and NDS groups) performed the test on two separate days with best test results chosen for statistical comparisons. The NMR group performed the test once. In all isokinetic strength parameters measured for arm strength, the NMR group demonstrated significantly higher scores than subjects with DS and NDS. Subjects with DS and NDS displayed similar test results. Similarly, for all the isokinetic strength parameters measured for leg strength, NMR demonstrated significantly higher scores than subjects with DS and NDS. Subjects with NDS, however, averaged significantly higher test results than subjects with DS for leg strength. The results of this study indicate that both subject populations who were mentally retarded exhibited lower arm and leg strength than the NMR subjects. Additionally, subjects with DS demonstrated inferior leg strength when compared to their peers with NDS.

Adult↗

PubMedDate not supplied

Leg length inequality.

OBJECTIVE: The (Pacific) Consortium for Chiropractic Research has taken the initiative to research, investigate and provide information directed toward health care accountability, including evaluation of health care measures and practices. This article is a review of the literature pertaining to leg length inequality (LLI). Leg length measures are utilized by various health care providers as an indicator of biomechanical imbalance and necessity for care. Following the overview of the incidence, classifications and clinical significance, emphasis was placed on methods of evaluation, especially the visual "quick" leg length measurement procedure. Finally, a brief section on conservative care has been provided. DATA SOURCES: The information and studies reviewed were obtained from Medline, the Index to Chiropractic Literature, Chiropractic Research Archives Collection, Physiotherapy Index, Chiropractic Literature Analysis and Retrieval System, various technique manuals, personal communication with technique research advisors, proceedings and dissertations. REFERENCE SELECTION: In spite of the widespread use of leg length measures, there is still much controversy associated with LLI, its biomechanical significance and the reliability of the various measurement systems employed. Therefore, the 182 references utilized were selected on the basis of applicable information, especially studies that provided a detailed methodological design with statistical analysis regarding evaluation procedures. CONCLUSION: There appears to be a lack of agreement concerning incidence, classification and point of clinical significance. However, the manifestations or consequences of LLI demonstrate greater accordance. Of the three most commonly utilized evaluation methods, radiographic measures such as the scanograms are recognized as the most reliable procedure for the evaluation of anatomical LLI. Much controversy exists with some of the clinical orthopedic methods and the visual "quick" leg check. Because there is such a vast range in estimates of reliability, few if any definitive conclusions can be made regarding these methods. Given this, it is evident that more research is needed before the use of certain orthopedic and visual checks are considered reliable and valid.

Biomechanical Phenomena↗

PubMed2003

[La accumulation and microstructure change of leg bones of rats fed with La(NO(3))(3) in low dosage for a long term].

OBJECTIVE: To study La accumulation and microstructure change of leg bones of rats fed with La(NO(3))(3) in low dosage for a long term. METHODS: After the rats were fed by La(NO(3))(3) in dosage of 2 mg x (kg(-1) x d(-1)) for 6 months, the contents of La and Ca,P in the leg bones were determined by ICP MS and spectrophotometry; the microstructure changes of the leg bones were investigated by electron microscopy and X-ray powder diffraction. RESULTS: In the leg bones of tested rats, the contents of La and P increased greatly, and those of Ca did not change obviously, so that Ca/P ratio values decreased in comparison with the control group. CONCLUSION: La was accumulatied in the rat leg bones and the change of bone microstructure induced after the rats were fed with La(NO(3))(3) in low dosage for a long term.

Animals↗

PubMed1992

Venous thrombosis during pregnancy: leg and trimester of presentation.

In order to determine the relative frequencies of left and right leg venous thrombosis during pregnancy and the frequencies of venous thrombosis during the three trimesters, a cohort study of 60 consecutive patients with a first episode of venous thrombosis during pregnancy was performed. Fifty-eight women had isolated left leg thrombosis, two patients had bilateral venous thrombosis and no patient had isolated right leg venous thrombosis. Thirteen patients had venous thrombosis during the first trimester (21.7%), 28 during the second trimester (46.7%) and 19 during the third trimester (31.7%). These findings indicate that patients with symptoms in the right leg rarely have venous thrombosis. Because leg pain and swelling occur most frequently during the third trimester but venous thrombosis is relatively equally distributed during all three trimesters, patients presenting earlier during pregnancy are more likely to have venous thrombosis than patients presenting later during pregnancy.

Female↗

PubMed1992

Changes in leg volume during microgravity simulation.

Little published information exists regarding the magnitude and time course of cephalad fluid shift resulting from microgravity simulations. Six subjects were exposed to 150 min each at horizontal bed rest, 6 degrees head-down tilt, and horizontal water immersion. Fluid shift was estimated by calculating leg volumes from eight serial girth measurements from groin to ankle before, during, and after exposure. Results were compared with data from the first 3 h of spaceflight. By the end of exposure, total leg volume for the six subjects decreased by 2.6 +/- 0.8%, 1.7 +/- 1.2%, and 4.0 +/- 1.6% for horizontal, head-down, and immersion, respectively. Changes had plateaued for horizontal and head-down and had slowed for immersion. Relatively more fluid was lost from the lower leg than the thigh for all three conditions, particularly head-down. During the first 3 h of spaceflight, total leg volume decreased by 8.6%, and relatively more fluid was lost from the thigh than the lower leg. The difference in volume changes in microgravity and simulated microgravity may be caused by the small transverse pressures still present in ground-based simulations and the extremely nonlinear compliance of tissue.

Adult↗

PubMed2004

Changes in patient's quality of life comparing conservative and surgical treatment of venous leg ulcers.

Leg ulcers of different etiology disable up to 1% of total population, and up to 15% individuals over 70 years old. It is an old disease, which troubles the patients and medical personnel and is hard to cure. It might take several years to cure the ulcer fully. Most of the patients with leg ulcers are being treated at home, not in the outpatient departments or hospitals; therefore there is not much information on how the ulcer affects the patient's everyday life and its quality. The researchers often analyze only the financial part of this disorder forgetting its human part: pain, social isolation, and decreased mobility. There are many questionnaires and methods to analyze the quality of life of the patients with leg ulceration. It is often unclear if we should treat the ulcer conservatively for a long time or if part of resources should be used for operation (skin grafting) and the time of treatment should be shortened. To see the advantage of both methods and the influence of the ulcer treatment to the quality of life we decided to estimate the functionality of surgical and conservative treatment. We have analyzed the case histories and the data of special questionnaires of 44 patients, which were treated in Department of Plastic Surgery and Burns of Kaunas University of Medicine Hospital in the period of 2001 January-2004 February and had large trophic leg ulcers (m=254 cm2) for 6 months or more. Ten patients were treated conservatively and 34 patients were treated by skin grafting. All of them were interviewed after 3-6 months. We found that the pain in the place of the ulcers has decreased for the patients, who were treated surgically. By making the differences of the pain more exact we found out, that the patients have been feeling pain before the operation and when interviewing them the second time they told that they felt discomfort, not pain. The intensity of pain remained the same for the patients treated conservatively. The regression of pain also proves the decreased usage of painkillers in the group of the patients with the surgical treatment. All the patients (n=44) have had sleep disorders because of the ulcers. In the group of surgically treated patients, ulcers did not disturb the sleep after more than 3 months, and in the group, treated conservatively, the problem remained. We also found that after surgical treatment the patients were more optimistic and cried less. That shows the recovery of their emotional status. We have also found that the patients knew from the surgeon first than from the family doctor or other medical personnel about this disorder. We have made conclusions, that with the reduction of the ulcer area the pain is also reduced. Surgical treatment of ulcers (autodermoplasty) reveals a statistically reliable positive effect on patient life quality (sleep and emotions), but even 50% of patients are unaware of the real leg ulceration causes.

Aged↗

PubMed2005

Interexaminer reliability and validity for diagnosis of temporomandibular disorders of visual leg measurements used in dental kinesiology.

AIMS: To determine the reliability and the validity of visual leg measurements used in dental kinesiology, which suggests that a masticatory dysfunction, such as occurs in temporomandibular disorders (TMD), can influence the length and the internal rotation of lower limbs. METHODS: The leg-length inequality test and the internal foot-rotation test were performed independently by 3 different examiners on 41 subjects who were also screened for TMD. Data were analyzed by means of kappa statistics and by calculation of sensitivity and specificity values. RESULTS: Chance-corrected reliability was generally poor for both the leg-length inequality test (0.33 < or = k < or = 0.39) and the internal foot-rotation test (0.15 < or = k < or = 0.27). Sensitivity and specificity values of the tests to differentiate TMD and healthy subjects were below acceptable thresholds; they ranged from 0.41 to 0.57. CONCLUSION: Visual evaluations of leg-length inequality and internal foot rotation were unreliable and are not valid for TMD diagnoses. The results of chiropractic visual leg measurement procedures in dentistry should be interpreted with caution, particularly when clinical decisions may lead to nonreversible dental treatment.

Adult↗

PubMed2006

Effects of static stretching on leg power during cycling.

AIM: This study investigated the effects of warm-up involving static stretching on leg power. It was expected that the inclusion of static stretching in the warm-up would decrease leg power. METHODS: Twenty-seven healthy volunteers (16 male, 11 female) participated in the study. A prospective, repeated measures design was implemented where volunteers underwent 2 testing sessions at least 24 hours apart. One testing session involved a control warm-up (5 min submaximal cycling) followed by 4 10-s leg power tests at 5, 20, 40 and 60 min postwarm-up. For the other testing session, the subjects performed 5 min of submaximal cycling followed by 15 min of lower body static stretching and then the four leg power tests. Relative peak power, time to peak power and relative total work were measured for each leg power test. RESULTS: Peak power and total work were significantly greater after the static stretching warm-up compared to the control warm-up on all power tests. Peak power was achieved more quickly for the static stretching warm-up compared to the control warm-up on the 5 min test only. CONCLUSIONS: A warm up that includes static stretching has beneficial effects on anaerobic power events in comparison to submaximal cycling alone.

Adult↗

PubMed2006

Leg ulcers - causes and management.

BACKGROUND: A leg ulcer is not a disease but the manifestation of an underlying problem that requires a clear diagnosis. OBJECTIVE: This article outlines the assessment and management of patients with leg ulceration. DISCUSSION: The simple tag of 'leg ulcer' is not an adequate diagnosis. A comprehensive assessment of the patient, skin, vascular status, limb, and ulcer is required to determine the aetiology and to formulate an appropriate management plan. Most leg ulcers are caused by venous insufficiency and compression is required to successfully heal venous leg ulcers. Treatment must address oedema, infection and pressure. Managing peripheral oedema using compression bandages is often more important than the topical dressings. Success requires consistent adherence to a care plan designed to address the underlying pathology and contributing factors.

Family Practice↗