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PubMed2006

Ropinirole: new indication. Restless legs: disproportionate adverse effects.

(1) The restless legs syndrome consists of unpleasant sensory and motor symptoms of varying intensity in the lower limbs. Symptoms occur at rest, seated or lying down, are more intense in the evening and at night, and are relieved by moving the limb. This syndrome does not cause serious physical complications. When sleep disturbances occur, non drug methods should be tried first. (2) Ropinirole is a dopaminergic agonist initially marketed for the treatment of Parkinson's disease. It is the first drug to be approved for restless legs syndrome in France. (3) Three double-blind randomised placebo-controlled trials with similar designs showed minimal differences on a composite rating scale. After 12 weeks of treatment, ropinirole led to an improvement of about 3 points on a 40-point scale compared with placebo. (4) A 12-week double-blind randomised controlled trial and including patients who had "responded" to ropinirole showed a lower relapse rate in the group that continued to use ropinirole (32.6%) instead of switching to placebo (57.8%). However, we do not know if this was because of continued drug efficacy or a rebound effect in the placebo group. (5) The adverse effects of ropinirole in patients with restless legs syndrome had already been observed in the treatment of Parkinson's disease, and included nausea, vomiting, drowsiness, a sudden urge to sleep, syncope, hypotension, and hallucinations. (6) An increase in the severity of restless legs symptoms, typically seen with levodopa, was not evaluated in clinical trials of ropinirole. Some cases have nevertheless been reported. They describe the appearance of symptoms increasingly early in the evening, then in the afternoon, or as a rebound effect in the morning or the latter part of the night. Their intensity increases and can affect other parts of the body. (7) In practice, ropinirole has a negative risk-benefit balance in restless legs syndrome, which is a minor health disorder.

Cost-Benefit Analysis↗
PubMed1991

Transfer effects of endurance training with the arms and legs.

The purpose of this study was to examine whether endurance training in the form of arm or leg cycling resulted in significant transfer effects when exercise was performed with the untrained muscle group. Sixteen middle-aged male volunteers completed 24 training sessions over 8 wk on either an arm cycle ergometer (AG, N = 8, mean age = 35.2 +/- 6.6 yr) or a leg cycle ergometer (LG, N = 8, mean age = 41.0 +/- 4.7 yr). The two groups were initially equated for their pre-training peak oxygen uptake (pVO2) determined during leg cycling (44.5 +/- 5.0 and 43.8 +/- 7.7 ml.kg-1.min-1 for the AG and LG, respectively). Training was performed at an intensity that was mid-way between the pre-training ventilatory threshold (VT) and the pVO2 for both cycling methods. Significant increases (P less than .05) were observed in the relative values of the oxygen uptake at the VT and the pVO2 as a result of both these methods of training, but these elevations were specific to the muscle groups that were trained. This specificity of training was also evident in the cardiorespiratory and metabolic measurements obtained during submaximal steady state exercise performed at the power output corresponding to the pre-training VT during arm and leg exercise. Hence, it was concluded that improvements in exercise performance resulting from short-term aerobic training with the arms or legs in middle-aged males with relatively high aerobic powers are due primarily to peripheral adaptations in the trained muscles.

Adult↗
PubMed1990

[Pelvic tilt and leg length discrepancy].

Pelvic obliquity caused by leg length discrepancy is a problem facing patients with a wide variety of conditions. It is the degree of discrepancy and the growth pattern of the legs that usually govern treatment decisions, with the cause of the discrepancy having little influence. We analyzed the results recorded in 345 patients with pelvic obliquity caused by leg length inequality operated on between 1969 and 1989. In 146 patients a shortening procedure was done and in 199 patients a lengthening procedure. Biological bone growth stimulation did not prove to be predictable and effective in 65 cases. In 134 patients and 138 segments a distraction procedure was performed. In 26 segments the technique was according to Wagner; in 37 cases the Ilizarov fixator was used and in 75 the Orthofix device. Excellent results were obtained in 65% and good results in 23%; the condition became worse in 12%. Analysis of the results justifies the use of epiphysiodesis, shortening osteotomies and bone lengthening according to the biological principles investigated by Ilizarov in the presence of well-defined indications outlined in this report. Patients with a discrepancy of up to 2-3 cm are treated conservatively by shoe lift. For patients with a leg length inequality of 3-5 cm, epiphysiodesis or shortening osteotomy is still a good indication although lengthening procedures can also be performed. Discrepancies between 5 and 15 cm are treated mainly by lengthening operations. New lengthening techniques such as corticotomy and callus distraction, as well as new external fixation systems like Orthofix and Ilizarov, have made bone lengthening a less risky, easier, and more effective procedure. In a growing child, careful clinical and radiological assessment and repeated analysis of past growth in order to predict future growth can provide an exact plan for effective treatment, which often consists of bone lengthening, combined with shortening procedures on the contralateral side to establish leg length equality even in cases when there is 20 cm difference. Surgical treatment can be especially gratifying when anatomical, cosmetic and functional symmetry is restored and a lifetime of shoe lifts, braces or prostheses can be avoided.

Adolescent↗
PubMed1986

New parameters for evaluation of blood flow in patients with leg ulcers.

Three new parameters have been introduced to provide data for quantitative evaluation of peripheral cutaneous blood flow in patients with leg ulcers. Reactive hyperemia was induced by occlusion of the blood flow for four minutes at the thigh-level. Blood flow was subsequently measured by laser-Doppler velocimetry in an unselected group of 14 patients with leg ulcers and a matched control group. The parameters used for evaluation was: 1) "peak flow" f(p), 2) divided by time to "peak flow" t(p), rendering a rate constant k (k = f(p)/t(p)) expressing the ability to increase blood flow abruptly in case of need. These parameters were all significantly reduced in the patients with leg ulcers, indicating that this simple and atraumatic technique was useful for discriminating blood flow values that may be relevant for healing time and with a sensitivity comparable to the measurements of distal systolic blood pressure. Distal systolic blood pressure measurements can still be considered to be of value when screening for arterial insufficiency in patients with leg ulcers. The values obtained were significantly lower in 36 patients with leg ulcers compared with 9 age-matched control persons.

Adult↗
PubMed1985

[The vascularized cross-leg flap].

A better knowledge of the leg skin blood supply has recently revived interest in the cross-leg technique for skin grafts. It is now possible to delineate on each leg two flaps that contain arteries and veins. The internal saphenous flap, taken on the internal aspect of the leg is fed by the cutaneous branch of the greater anastomotic artery, satellite of the internal saphenous nerve, while the external saphenous flap, located on the postero-external aspect of the leg, is fed by 2 cutaneous branches of the popliteal artery or gemellar arteries. The length to width ratio of these flaps varies from 3 to 4, which is both safe and reliable and provides for supple handling of the pedicles and increased patient's comfort.

Humans↗
PubMed1988

Clinical assessment and treatment of leg length inequalities.

Controversy persists regarding the significance of leg length inequality, the diagnostic approach to the use of heel lifts, and the implementation of proper orthopedic support in treatment of anatomical leg length inequalities. The purpose of this paper is to review the literature and formulate a sequential examination for a patient with leg length discrepancy, then outline a formula for the treatment of the patient. The initial problem a practitioner faces in examining a patient with leg length inequality is to determine if a true (anatomical) leg deficiency exists. Through a series of measurements and pelvic assessments, an effective screening process can be accomplished before radiography (scanogram) is required. An understanding of the mechanics along the kinetic chain, anywhere from the foot to the lumbar spine, coupled with the information gained from radiographs, can provide a treatment plan detailing the size of the lift and location.

Algorithms↗
PubMed1988

Circulatory disturbances of the venous system of the legs after coronary bypass graft operation.

The alterations of 85 limbs of 69 patients were examined after aortocoronary bypass operation. The study was partly retrospective, partly prospective. The limbs were divided into two groups according to their severity grade. On 36 legs (42%) the site of operation was free of reaction (inflammation, oedema). Twenty-seven legs (32%) required treatment with diuretics and Venoruton (success rate, 89%). Because of alterations of 22 legs (26%) Venoruton, Glyvenol, Colfarit, intravenous Rheomacrodex and, at the site of the intervention, heparin were administered. The inflammation of 4 of the 22 legs required, besides these treatments, antibiotics. Amelioration was observed in 20 of the 22 legs. The authors call attention to a new type of venous circulatory disturbances which may be iatrogenic in some respect. It would be possible to prevent a considerable part of the alterations if heart-surgeons, in cooperation with the peripheral vessel specialists, made additional examinations before operation. The treatment of the venous circulatory disturbance should already be started at the surgical centers and continued during after-care.

Adult↗
PubMed1987

Significance of the straight-leg-raising test in the diagnosis and clinical evaluation of lower lumbar intervertebral-disc protrusion.

The cases of 113 patients who had protrusion of a lumbar intervertebral disc were analyzed to determine the relationship between the findings at operation and the location of the pain that resulted from the straight-leg-raising test. The study showed a close relationship between the location of the pain and the position of the protrusion of the disc. The degree of limitation of straight-leg raising was also found to have a direct relationship to the size and position of the protrusion and to its relationship to the spinal nerve. The protrusions were classified into three types according to position in relation to the dura mater and to the pattern of pain that was induced by passive straight-leg raising. On straight-leg raising, central protrusions tended to cause pain in the back, lateral protrusions caused pain in the lower extremity, and intermediate protrusions caused both. On this basis, the distribution of pain on straight-leg raising allowed an accurate prediction of the location of the lesion in 100 (88.5 per cent) of the 113 patients.

Adolescent↗
PubMed1987

Oral prostaglandin E1 as a therapeutic modality for leg ulcers in Behçet's disease.

Prostaglandin E1 (PGE1) has been generally given only by intravascular injection. Recently, an oral PGE1 named OP1206 has been developed. OP1206 is a potent inhibitor of platelet aggregation as well as a strong vasodilator, and its half-life in humans is extremely prolonged because it is not metabolized in the lungs. Leg ulceration is one of the cutaneous manifestations in Behçet's disease and sometimes is very difficult to treat. In this investigation five patients having Behçet's disease with leg ulcers were treated with OP1206. All of the patients had the leg ulcers for more than 2 months. Fifteen micrograms of OP1206 was given initially, and the dosage was increased to 30 micrograms whenever there were no adverse effects. All the patients were soon able to tolerate the drug and increased dosage. Within 2 weeks, regeneration of granulomatous tissues was observed in all cases. Furthermore, the leg ulcers healed within one year. Only one patient developed diarrhoea, but this symptom disappeared when he adjusted to the dosage. The findings strongly indicate that OP1206 is a safe and promising drug for the treatment of leg ulcers in Behçet's disease.

Administration, Oral↗
PubMed1987

Space shuttle inflight and postflight fluid shifts measured by leg volume changes.

This is a study of the inflight and postflight leg volume changes associated with spaceflight on Space Shuttle missions. The results of this study show an inflight volume loss of 2 L from lower extremities, 1 L from each leg, representing an 11.6% volume change. The vast majority of this change appears to be a shift in body fluids, both intravascular and extravascular. The fluid shift occurs rapidly on Mission Day 1 (MD-1), with it being essentially complete by 6 to 10 h. The regional origin of shift and leg volume change shows a far greater absolute volume (708 ml vs. 318 ml) and percentage (69% vs. 31%) of the total change coming from the thigh as compared to the lower leg. Postflight, the return of fluid to the lower extremities occurs rapidly with the majority of volume return complete within 1.5 h postlanding. At 1 week postflight there is a residual leg volume decrement of 283 ml or 3.2% that is probably due to tissue loss secondary to atrophic deconditioning and weight loss.

Body Fluids↗
PubMed1986

Late venous function in the leg after deep venous thrombosis occurring in relation to pregnancy.

The frequency of deep venous insufficiency was investigated in 23 patients 3-10 years (mean 7 years) after they had developed an objectively diagnosed deep venous thrombosis (DVT) during pregnancy or the first week after delivery. Investigations included clinical examination, listing of symptoms and plethysmography, venous pressure and Doppler ultrasound. At follow-up there were clinical signs or symptoms of venous insufficiency in 35% of the legs with earlier DVT but in none of the non-thrombosed contralateral legs. Objective evidence of venous insufficiency was present in 15 (65%) of the legs with earlier DVT and in only five (22%) of the non-thrombosed legs. The differences between thrombosed and non-thrombosed legs are statistically significant. There was no correlation between objectively measured venous insufficiency and extent of the DVT. It is concluded that a DVT during pregnancy often leads to venous insufficiency and the risk seems to be higher than after DVT occurring in other groups of patients.

Adolescent↗
PubMed1985

Primary lymphedema of the leg: relationship between subcutaneous tissue pressure, intramuscular pressure and venous function.

In eight patients with unilateral primary lymphedema, subcutaneous tissue and intramuscular pressure were measured in both legs using the slit-catheter technique. Venous function was assessed by venography, or Doppler or photoplethysmography. Both at rest and during exercise, subcutaneous tissue pressure was elevated in the lymphedematous leg (17.9 +/- 7.6 and 33.0 +/- 10.8 mmHg respectively) compared to healthy contralateral leg (0.4 +/- 2.6 and -0.6 +/- 3.6 mmHg; p less than 0.001). The intramuscular pressure in the anterior tibial compartment was also increased at rest and during exercise in the edematous leg (24.9 +/- 4.4 mmHg and 43.6 +/- 11.2 mmHg respectively) compared to control leg (9.6 +/- 5.6 and 25.8 +/- 10.00 mmHg). These findings suggest that derangements in both the superficial and deep lymphatic systems as well as venous dysfunction contribute to the clinical appearance of "primary lymphedema."

Adult↗
PubMed1985

[Oxygen pressure fields in ulcers of the lower leg].

Using a multi-wire surface electrode, oxygen pressure fields were determined in leg ulcers of 11 patients with chronic venous insufficiency (cvi). In three of them, cvi was combined with arterial occlusive disease. The histograms of all patients with very low PO2 values revealed microcirculatory disturbances of the ulcer tissue. The influence of leg position is reflected in the histograms. Patients with cvi showed higher PO2 values when the leg was raised in comparison with when it was in the hanging position. The patients with mixed ulcerations showed a significant increase in tissue PO2 when the leg was in the hanging position, which shows the importance of arterial perfusion pressure. After a compression bandage had been applied to the legs with cvi, the tissue oxygen pressure of the ulcers increased markedly, probably as a result of diminished blood stasis. These results can be explained either by a rarefaction of capillaries in the ulcer tissue or by fibrin diffusion barriers around the capillaries. The changes in the histograms after bandaging are thought to be caused by an improvement in venous circulation.

Adult↗
PubMed1979

Determination of muscle mass changes in legs from 40K measurements.

The 40K content of the upper legs was periodically measured in several subjects whose injured legs had been in a cast for 6 weeks or more. As the subjects began using the leg again, the 40K content increased as the muscle tissue was replaced. A 25% increase in 40K content in 6 months is typical for a normal leg use and recovery. This is equivalent to an original muscle mass loss of 20%. By measuring specific body regions, such as arms or legs, with a high-efficiency detector system, muscle mass changes which exceed a few percent can be measured. These methods could be used in space flight and bedrest studies, and in studying nutritional deficiencies due to disease or diet.

Anthropometry↗
PubMed1971

Studies in osteoarthritis of the hip. II. Osteoarthritis of the hip and leg-length disparity.

An x-ray method is described for the determination of leg-length inequality in the standing subject, Its precision is compared to that of other methods in current use. The geometrical considerations which are inherent in any radiographic method of leg-length determination are summarized. Sixty-seven patients with OA hip were studied; 62 were considered to be idiopathic and 36 of these idiopathic cases were superolateral in type. Measurements in these 36 patients showed significant leg-length disparity, most of the diseased hips being found on the side of the longer leg. If allowance is made for shortening due to disease, the frequency and bias of the disparity are highly significant. The strong association between OA hip of this type and a long leg suggests a causal relationship.

Female↗
PubMed1981

Leg haemodynamics during different forms of anaesthesia in patients undergoing reconstructive vascular surgery.

In the present study the effects of three different anaesthetics (halothane, n = 9, enflurane, n = 9, and neurolept, n = 11) on leg circulation were studied during vascular reconstruction with a reversed femoropopliteal saphenous vein bypass graft. Leg vascular resistance showed significant differences between the three anaesthetic groups. Thus, during the pretransfusion period, leg resistance in the neurolept group was significantly higher than in the halothane and enflurane groups, although the blood volume did not differ significantly between the groups. Though leg resistance after blood transfusion decreased significantly more in the neurolept group compared with the two other groups, the resistance after transfusion was still significantly higher in the neurolept group. Inducing pharmacological vasodilatation caused significant increases in common femoral arterial and bypass blood flows in all groups, but the increases were significantly more pronounced in the neurolept group. It is concluded that leg haemodynamics are influenced in different ways according to the anaesthetic agents used. This, in turn, might contribute to a better understanding and a more correct interpretation of the results of intraoperative flow and pressure measurements, and, consequently, to improvement of the reconstructive procedure.

Aged↗
PubMed1983

Femoral shortening by a step-cut osteotomy for leg-length discrepancy in adults.

The problem of leg-length discrepancy in the adult differs from that in children. The technique of shortening the femur by the step-cut osteotomy and Küntscher rod fixation to correct leg-length discrepancy in the adult was employed in 14 consecutive patients. There were seven male and seven female patients, ranging in age from 15 to 36 years (average, 22.7 years). The leg-length discrepancy ranged from 2.7 to 11.0 cm (average, 5.6 cm), and the shortening of the longer leg (and thus of the patient) ranged from 2.7 to 7.5 cm (average, 5.0 cm). There were no intraoperative or postoperative complications. All fractures were united clinically and radiologically three to four months after surgery (average, 3.6 months). The follow-up period ranged from two to 18 years (average, 8.9 years). The final leg-length discrepancy was 0 in six patients and ranged from 0.5 to 3.5 cm (average, 1.3 cm) under correction in seven. One patient was overcorrected by 0.5 cm. All patients were satisfied both cosmetically and functionally with the operation.

Adolescent↗
PubMedDate not supplied

Leg scanning with radioisotope-labeled fibrinogen in patients undergoing hip surgery. Comparison with contrast phlebography and lung scans.

To establish whether radioisotope-labeled fibrinogen leg scanning is of value in the context of hip surgery, we prospectively studied 21 consecutive patients undergoing either total hip replacement (14) or open repair of a hip fracture (seven) with leg scans, contrast phlebography, and ventilation and perfusion lung scans. We found that in eight patients (38%), venous thromboembolism developed postoperatively. Agreement between phlebographic and leg scanning results was excellent. In no patient was venous thrombosis limited to the thigh on the operated-on side, a vital consideration in application of fibrinogen leg scanning to this patient population. Two patients had lung scan changes indicative of embolism; both had thrombi extending into thigh veins. Leg scanning with radioisotope-labeled fibrinogen appears to be a useful method for monitoring patients undergoing hip surgery, if the upper three counting points on the operated-on side are excluded.

Adult↗