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At least 1,369 records · Page 76Linked to original sources
PubMed1997

Acute leg ischaemia in Gloucestershire.

BACKGROUND: Acute leg ischaemia is both life threatening and limb threatening. This audit was designed to determine the incidence and outcome of acute leg ischaemia in a single county. METHODS: Using multisource data collection for a 1-year interval in 1994 all patients with acute leg ischaemia were identified prospectively using hospital and general practice records in the county of Gloucestershire, population 540,000. RESULTS: Seventy-seven patients with 84 events of acute leg ischaemia were identified, giving an incidence of one per 7000 per year rising to one per 6000 per year when bypass graft occlusions were included. All but four patients were treated in hospital. Sixteen of 80 hospital events involved conservative treatment; after 30 days nine patients had died and two required amputation. The remaining five patients had borderline ischaemic rest pain and accepted their symptoms without intervention. Sixty-four of 80 events were managed by either primary surgery and angioplasty (n = 31) or thrombolysis (n = 33). The 30-day outcome in patients treated actively was: limb salvage in 50 (78 per cent), amputation in four (6 per cent) and death in ten (16 per cent). CONCLUSION: In Gloucestershire almost all cases of acute leg ischaemia are managed by, or discussed with vascular surgeons. A flexible integrated policy of surgery and peripheral thrombolysis has resulted in a limb salvage rate of 78 per cent in patients suitable for active treatment.

Acute Disease↗
PubMed1997

Restless legs syndrome in home healthcare.

Restless legs syndrome affects millions, but most healthcare providers don't know it exists. Its sleep-deprived victims are plagued by indescribable crawling sensations in their legs that occur at night and that are only relieved by moving the legs. Many home healthcare clients, already challenged by their primary illness, are also affected by the persistent symptoms of Restless Legs Syndrome. It is important that home care nurses learn about Restless Legs Syndrome-what it is, how to assess it, and what can be done about it.

Community Health Nursing↗
PubMed1997

Leg ulceration and ethnicity: a study in west London.

Little is known of the influence race has on the development of leg ulceration, with most studies being performed in almost exclusively white populations. As part of a wider audit of leg ulcer services, health care professionals were contacted to give details of age, sex and ethnic background of all patients who attended for treatment of leg ulceration over a one year period in an area of west London. West London Health Care Trust provides services to a population of 275,000 of whom 53,000 have an ethnic background from the Indian subcontinent (South Asian). In all, 280 patients were identified, of whom 264 (94%) had details of age and sex. This gave a crude ascertainment rate of 1.02 per 1000 population. Of the 264 patients, five were classified as South Asians, with one patient classified as Afro-caribbean. The Mantel Haenzsel test demonstrated a significantly higher proportion of whites suffering from leg ulceration than South Asians, giving an odds ratio of 4.43, with 95% confidence intervals between 1.94 and 10.13 (P = 0.0004). The expected frequency of South Asian patients should be 23, based on rates from the white population, of which 13 would be women and 10 men. Only five South Asian men were identified, and no Asian women with leg ulceration. Reasons for this low ascertainment are two-fold. Either there is a real difference between the white and South Asian populations, or South Asian patients are not presenting for treatment. Further work must be performed to determine whether this is an effect of low prevalence, or unmet need in the community.

Aged↗
PubMedDate not supplied

The road to developing standards for the diagnosis and treatment of venous leg ulcers.

In early 1996 the Venous Leg Ulcer Guideline was developed for the diagnosis and treatment of venous leg ulcers. In order to discuss the development of standards in general, and the Venous Leg Ulcer Guideline in particular, we first need to understand the difference between the following terms: Critical pathway, consensus statement, guideline, and standard. There are advantages and disadvantages to the use of guidelines. In the development of a guideline, endorsement by a respected colleague is important. Development of the Venous Leg Ulcer Guideline began with a consensus statement and then underwent review by a national advisory panel and national peer review through publication. A revised guideline has now been developed which will be tested in a pilot study for clinical efficacy, effect on cost, and impact on quality of life. Validation will require implementation in a prospective clinical trial. Diagnostic and Treatment Algorithm forms for the diagnosis and treatment of venous leg ulcers were developed as part of the preliminary testing of the guideline. Although guidelines do not substitute for good clinical judgement, they can encourage clinical judgement and help reduce fragmented care and the costs associated with inappropriate treatments.

Critical Pathways↗
PubMed1998

[Contact sensitization in leg ulcers].

BACKGROUND: The leading complication of leg ulcers is the development of peri-lesional eczema. The etiological diagnosis is often difficult due to the large number of topical agents used. PATIENTS AND METHODS: Fifty patients, 35 women and 15 men, mean age 67.8 years, range 37-91 years, with leg ulcers of variable duration (15 days to 32 years, median 2 years) underwent explorations using the standard EECDRG battery in search of contact allergies. Eighteen potential allergens and the topical agents employed were tested. Readings were made at 48, 72, 96 or 120 hours. RESULTS: Sensitization rate was 76 p. 100 (90 p. 100 of the patients with a history of contact dermatitis and 50 p. 100 in those without such history). The respective percentages of positive tests were: balm of Peru 40 p. 100, fragrance-mix 28 p. 100, Amerchol L101 18 p. 100, lanoline alcohols 14 p. 100, colophane 12 p. 100, glycol propylene and parabens-mix 8 p. 100, stearylic alcohol, thiomersal, clioquinol and sorbic acid 6 p. 100, cetyl-stearylic alcohol, cetylic alcohol, eosin, cetrimide, chlorocresol, budesonide, tixocortol pivalate, bufexamac, formaldehyde, nickel, thiuram-mix and P.P.D. 4 p. 100, hexamidine, chlorhexidine, neomycin, benzocaine, potassium bichromate and cobalt 2 p. 100, triethanolamine, ethanol and other allergens in the EECDRG battery 0 p. 100. Tests were positive in 29 cases with commercial formulations, Biafine (8 cases), Parfenac (7 cases), and Rifocine ampoules (3 cases). Among 13 of the 29 cases, tests were positive with one or more allergens common to the product and the complementary battery. DISCUSSION: Contact sensitization rate is high in leg ulcer patients. Most of the tests had a relationship with leg ulcers. The number one causal agent is balm of Peru. Thirty percent of all the patients are sensitized to at least one excipient, generally lanoline. Allergy tests are positive in 22 p. 100 for one or more antiseptics and in 18 p. 100 for preservatives. Allergy to latex and neomycin is unusual, but sensitization to steroid anti-inflammatory agents was not tested. The main active ingredient in a topical agent is not always the allergen and a detailed test must be performed, generally with a complementary battery adapted to common prescriptions for leg ulcers.

Adult↗
PubMed1998

Short-term effect of correcting leg length discrepancy on performance of a forceful body extension task in young adults.

In this study we assessed the short-term effect of correcting leg length discrepancy on a vigorously performed task of resisted full body extension in 10 men, 18 to 35 years old, who had estimated leg length discrepancies of 10-15 mm. Using a cable ergometer we examined work performed, initial peak tension exerted on the ergometer, second peak tension, time to first peak tension, and mean velocity of the whole task. Each subject performed the task both with and without a heel lift, introduced to equalize leg length. The interval between testing under these two conditions was 48 hr. In the task of pulling the cable upward, each subject began from floor level with knees and trunk flexed, progressing to full body extension with the arms pulling the cable overhead with maximal effort. For each trial the task was repeated 15 times, with intervals of 90 seconds between the repetitions. Use of the lift failed to have a statistically significant effect on any of the variables, although it clearly enabled three of the subjects to exert greater strength with the arms and trunk during the second peak tension. This suggests that 1) overall body extension is influenced by too many factors to be affected in a consistently predictable way by a heel lift to correct leg length discrepancy, and 2) the heel lift may aid certain subjects with leg length discrepancy specifically during extension of the trunk in this task.

Adaptation, Physiological↗
PubMed2006

Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg: a series with community follow-up.

BACKGROUND: Cellulitis of the lower leg is a common problem with considerable morbidity. Risk factors are well identified but the relationship between consequences of cellulitis and further episodes is less well understood. OBJECTIVES: To review risk factors, treatment and complications in patients with lower leg cellulitis, to determine the frequency of long-term complications and of further episodes, and any relationship between them, and to consider the likely impact of preventive strategies based on these results. METHODS: Patients with ascending, presumed streptococcal, cellulitis of the lower leg were identified retrospectively from hospital coding. Hospital records, together with questionnaires to both general practitioners and patients, were used to record subsequent complications and identifiable risk factors for further episodes. RESULTS: Of 171 patients, 81 (47%) had recurrent episodes and 79 (46%) had chronic oedema. The concurrence of these two factors was strongly correlated (P < 0.0002). Based on 143 completed questionnaires, oedema was apparently due to or persistently asymmetrical after the cellulitic episode in 52 (37%), and 19 (13%) had ulceration attributed to, rather than causing, cellulitis. Of those with three or more episodes, half did not lead to hospital admission. Toeweb maceration was reported in only 15% of questionnaires. Use of antibiotic treatment for more than 28 days was associated with a reduced risk of leg ulceration or of prolonged oedema compared with shorter courses, but neither difference was statistically significant. CONCLUSIONS: This study demonstrates that the true frequency of postcellulitic oedema, as well as that of further episodes, is probably underestimated. Furthermore, there is a strong association between these factors, each of which is both a risk factor for, and a consequence of, each other, and for which intervention (reduction of oedema or more prolonged antibiotic therapy) may reduce the risk of recurrent infection. By contrast, self-reporting of toeweb maceration is low, so attempts to reduce the risk of recurrent cellulitis by treatment of tinea pedis or bacterial intertrigo may fail.

Anti-Bacterial Agents↗
PubMed2006

Dressings for healing venous leg ulcers.

BACKGROUND: Venous leg ulcers, sometimes called varicose or stasis ulcers, are a consequence of damage to the valves in the veins of the legs, leading to raised venous pressure. Venous ulcers are characterised by a cyclical pattern of healing and recurrence. The main treatment is the application of compression, either in the form of compression bandages or hosiery. Dressings are usually applied beneath the compression to aid healing, comfort and to control exudate. Wounds heal quicker in a moist environment and dressings are used to absorb excess fluid or retain fluid in an otherwise dry wound in order to achieve a 'moist wound environment'. There are a large number of dressing products and types available. It is unclear whether particular dressings aid healing of leg ulcers. OBJECTIVES: To assess the effectiveness of wound dressings for the treatment of venous leg ulcers. SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Register (April 2006) and CENTRAL (issue 1, 2006) and several other electronic databases (up to April 2005). Manufacturers of dressing products were contacted for unpublished studies. SELECTION CRITERIA: Randomised controlled trials that evaluated dressings for the treatment of venous leg ulcers. There was no restriction in terms of source, date of publication or language. Ulcer healing was the primary endpoint. DATA COLLECTION AND ANALYSIS: Data from eligible studies were extracted and summarised using a data extraction sheet by two authors independently. MAIN RESULTS: 42 randomised controlled studies were identified that met the inclusion criteria. The main dressing types that were evaluated were hydrocolloids (n = 23), foams (n = 6), alginates (n = 4), hydrogel dressings (n = 6) and a group of miscellaneous dressings (n = 3). In none of the comparisons was there evidence that any one dressing type was better than others in terms of number of ulcers healed. Current evidence does not suggest that hydrocolloids are more effective than simple low adherent dressings used beneath compression (9 trials; relative risk for healing with hydrocolloid 1.09 (95% CI 0.89 to 1.34)). For other comparisons there was insufficient evidence. AUTHORS' CONCLUSIONS: The type of dressing applied beneath compression has not been shown to affect ulcer healing. For the majority of dressing types there was insufficient data to allow us to draw strong conclusions except for hydrocolloid compared with a low adherent dressing. The result of the meta-analysis indicate no significant difference in healing rates between hydrocolloid dressings and simple, low-adherent dressings when used beneath compression. Decisions regarding which dressing to apply should be based on local costs of dressings and practitioner or patient preferences.

Bandages↗
PubMed2001

Intermittent pneumatic compression for treating venous leg ulcers.

BACKGROUND: Intermittent pneumatic compression (IPC) is a mechanical method of delivering compression to swollen limbs. This technique has been used to treat venous leg ulcers and limb swelling due to lymphoedema. The effectiveness of IPC, and the appropriate duration and frequency of IPC therapy are unknown as are the differences between various types of IPC. This review analyses the evidence for the effectiveness of IPC as a treatment for venous leg ulcers. OBJECTIVES: To determine whether IPC increases the healing of venous leg ulcers. To determine the effects of IPC on health related quality of life of venous leg ulcer patients. SEARCH STRATEGY: The Cochrane Wound Group Trials Register was searched for RCTs of intermittent pneumatic compression in February 2001. Journals and relevant conference proceedings were searched by hand. Companies were also contacted for relevant unpublished data or ongoing studies. SELECTION CRITERIA: Randomised controlled studies either comparing IPC with control (sham IPC or no IPC) or comparisons between IPC treatment regimens, in venous ulcer management were included. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of study quality were undertaken by two reviewers independently. MAIN RESULTS: Four randomised controlled trials were identified. One small trial (45 people) found increased ulcer healing with IPC plus compression than with compression alone (relative risk for healing 11.4, 95% Confidence Interval 1.6 to 82). Two small trials with a total of 75 people found no evidence of a benefit for IPC plus compression compared with compression alone. One small trial (16 people) found no difference between IPC (without additional compression) and compression bandages alone. REVIEWER'S CONCLUSIONS: Further trials are required to determine whether IPC increases the healing of venous leg ulcers.

Air↗
PubMed1995

The making of a fly leg: a model for epithelial morphogenesis.

Epithelial development dictates the shape of an organism. The metamorphic development of a Drosophila leg precursor into an adult leg is a well-defined example of epithelial morphogenesis that can be analyzed from the perspectives of genetics and molecular and cell biology. The steroid hormone 20-hydroxyecdysone induces and regulates the entire process. Mutants affecting Drosophila leg morphogenesis characteristically have short thick legs (the malformed phenotype) resulting from a failure to execute normal cell shape changes at a specific stage of development. Mutations that cause the malformed phenotype have already led to the identification and cloning of genes encoding transcription factors, a transmembrane serine protease presumably required for modification of the apical extracellular matrix, and components of the contractile cytoskeleton and adherens junctions. All of these products are required for the execution of normal changes in leg cell shape.

Animals↗
PubMed1987

Myoblast differentiation is induced by nerve transplanted to chick embryo legs.

Chick embryos were denervated early in development in order to disrupt the normal inductive interactions between the nervous system and developing populations of mononucleated myoblasts and their precursors in the leg. Neural tissue, either spinal cord or ciliary ganglion, was transplanted to one leg of the denervated embryos; the other leg remained aneural. Clonal analysis of cell populations in the transplant-containing legs showed that ectopic nerve tissue can recapitulate some of the neuromuscular interactions that occur in normally developing embryos. Chief among these was the observation that transplantation induced the appearance of the CMR-III myoblast class in the leg muscle. Since the process by which CMR-III myoblasts are produced from a precursor is dependent on nerve both in vivo and in vitro (Bonner, P.H. and T.R. Adams, Dev. Biol., 90:175-184, 1982), it was concluded that transplanted nerve tissue can also induce myoblast differentiation.

Animals↗
PubMed1998

The effect of leg band symmetry on female-male association in zebra finches

Studies have shown that female zebra finches, Taeniopygia guttata, prefer to associate with males wearing symmetric leg band combinations. In this study, I used a four-choice chamber apparatus to investigate this preference, and to determine whether it is influenced by band coloration. I created band combinations by banding males with four leg bands. The symmetrical combinations consisted of two bands on each leg; the asymmetrical combinations consisted of three bands on one leg and one band on the other leg. For each of the symmetry treatments, all four bands were either light green or red. Females did not spend significantly more time associating with males wearing symmetrical bands or with males wearing red bands. The duration of male-female associations was not influenced by an interaction between symmetry category and band colour treatment. None of 10 females spent the most time with males with red symmetrical bands.Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1999

Notch-mediated segmentation and growth control of the Drosophila leg.

The possession of segmented appendages is a defining characteristic of the arthropods. By analyzing both loss-of-function and ectopic expression experiments, we show that the Notch signaling pathway plays a fundamental role in the segmentation and growth of the Drosophila leg. Local activation of Notch is necessary and sufficient to promote the formation of joints between segments. This segmentation process requires the participation of the Notch ligands, Serrate and Delta, as well as Fringe. These three proteins are each expressed in the developing leg and antennal imaginal discs in a segmentally repeated pattern that is regulated downstream of the action of Wingless and Decapentaplegic. Our studies further show that Notch activation is both necessary and sufficient to promote leg growth. We also identify target genes regulated both positively and negatively downstream of Notch signaling that are required for normal leg development. Together, these observations outline a regulatory hierarchy for the segmentation and growth of the leg. The Notch pathway is also deployed for segmentation during vertebrate somitogenesis, which raises the possibility of a common origin for the segmentation of these distinct tissues.

Aging↗
PubMed1995

Regulation of sex-specific feeding behavior in fiddler crabs: physiological properties of chemoreceptor neurons in claws and legs of males and females.

This study examined properties of chemoreceptor neurons in the claws and legs of the fiddler crabs Uca pugilator and U. pugnax. The primary goal was to establish the neural basis of previously observed greater female sensitivity to feeding stimulants, and secondarily to compare physiological properties of chemoreceptor neurons in these semi-terrestrial crustaceans with those of fully aquatic forms. Sensitivity of chemoreceptor neurons in claws and legs is sex-specific; individual neurons of females respond to lower stimulus concentrations than male chemoreceptor neurons, and equivalent concentrations elicit greater spiking in female vs male chemoreceptor neurons. Thus, the population of chemoreceptor neurons in females expresses lower thresholds and greater average sensitivity than in males. Greater sensitivity of claw neurons explains observations indicating that females continue to feed at food levels too low to stimulate males. Sensitivity differences in leg neurons of males vs females have no clear behavioral correlate, but suggest that females can orient to more dilute stimuli than males. Chemoreceptor neurons of fiddler crabs have low sensitivities and slow rates of adaptation compared to other crustaceans. Also, neurons in claws adapt less slowly than neurons in legs, which may reflect subtle differences in the chemical stimulus environment experienced by claws vs legs.

Amino Acids↗
PubMed1990

The development of the sensory organs of the legs in the blowfly, Phormia regina.

The development of the sensory neurons of the legs of the blowfly, Phormia regina has been described from the third instar larva to the late pupa using immunohistochemical staining. The leg discs of the third instar larva contain 8 neurons of which 5 come to lie in the fifth tarsomere of the developing leg. Whereas 2 neurons persist at least to the late pupa, the other cells degenerate. The first neurons of gustatory sensilla arise in the fifth tarsomere at about 1.5 h after formation of the puparium. Most of these sensilla, however, appear within a short time period beginning at about 18 h. The femoral chordotonal sensory neurons first appear at the time of formation of the puparium, as a mass of cells situated in the distal femur. During later pupal development 2 groups of these cells come to lie at the femur-trochanter border, where they become the proximal femoral chordotonal organ of the adult; the remaining cells become the distal femoral chordotonal organ. Other scolopidial neurons appear later in development. The nerve pathways of the late pupal leg are established either by the axons of the cells that are present in the larval leg disc or by new outgrowing processes of sensory neurons. In the tibia, the initial direction of new outgrowth differs in different regions of the segment: proximal tibial neurons grow distally, while distal tibial neurons grow initially proximally.

Animals↗
PubMed1987

Metabolic responses to light arm and leg exercise when sitting.

Seven male subjects performed progressive exercises with a light work load on an upper limb or bicycle ergometer in the sitting position. At any comparable work load above zero, arm exercise induced higher oxygen uptake, ventilation, heart rate, oxygen pulse, respiratory rate and tidal volume than leg exercise. At similar levels of VO2 above 0.45 1 X min-1, heart rate and ventilation were higher during arm exercise. A close linear relationship between carbon dioxide output and oxygen uptake was observed during both arm and leg exercises, the slope for arm work being steeper. The ventilatory equivalent for VCO2 (VE/VCO2) gradually decreased during both types of exercise. The ventilatory equivalent for VO2(VE/VO2) remained constant (arm) while it rose (leg) to a peak at 9.8 W and then gradually decreased. Ventilation in relation to tidal volume had a linear relationship with leg exercise, but became curvilinear with arm exercise after tidal volume exceeded 1100 ml. The observed differences in response between arm and leg exercises at a given work load appear to be influenced by differences in sympathetic outflow due to the greater level of static contraction of the relatively small muscle groups required by arm exercise.

Adolescent↗
PubMed1990

[Effects of different vitamin D metabolites on the leg weakness syndrome of turkeys].

In two experiments the influence of vitamin D metabolites on leg weakness in turkeys belonging to the Big 6 line was studied. The metabolites were given orally or intravenously in different dosages. There are no differences in vitamin-D-dependent parameters between healthy turkeys and turkeys with leg weakness. Additional oral application of 1,25 (OH)2D3 in dosages of 2, 5 or 10 micrograms per animal day and of 400 micrograms 25 (OH)D3 per animal day had no influence on leg weakness. Even after intravenous application of 2 or 5 micrograms 1,25(OH)2D3 per animal day there were no changes concerning the degree of leg weakness nor were any signs of hypervitaminosis D observed (increase of serum calcium level or increase of the activity of duodenal calcium binding protein). Our results indicate that this form of leg weakness in turkeys is not connected to a disturbance of vitamin D metabolism.

Administration, Oral↗
PubMed2004

Quantification of axial alignment of the lower extremity on conventional and digital total leg radiographs.

The purpose was to assess axial alignment of the lower limb using mechanical axis measurements on conventional and digital radiographs. Total-leg radiographs of 24 patients, 8 male and 16 female, with a mean age of 68.6+/-10.2 years, were performed in a standardized anterior-posterior projection and standing position using a conventional and digital phosphor storage film screen radiography system. Knee joint angulation was assessed by measuring the angle between a line drawn from the center of the femoral head to the middle of the femoral condyles and a line drawn from the middle of the tibial condyles to the midpoint of the malleolus. On conventional leg radiographs, line drawing and angle measurement were performed manually with a transparent goniometer. Angle measurement on digital leg radiographs was performed on a PACS workstation using computer-assisted measurement software (IMPAX, AGFA-GEVAERT, Belgium). Evaluation time for both measurements was recorded. We diagnosed 14 varus and 10 valgus angulations of the knee joint. The mean individual difference between axis deviation of conventional digital leg radiographs was 0.93+0.6 degrees (min 0 degrees, max 2 degrees), the mean difference in varus angulation was 1.13+/-0.45 degrees (min 0.3 degrees, max 2 degrees), and the mean difference in valgus angulation was 0.65+/-0.71 degrees (min 0 degrees, max 2 degrees). Angle measurements on conventional and digital radiographs did not show any statistically significant difference. Mean time exposure was 4.9 min/patient for manual and 1.08 min/patient for computer-assisted angle measurement (P<0.001). Computer-assisted angle measurement on digital total-leg radiographs represents a reliable method with no significant angle differences compared to conventional radiographic systems and offers a significantly lower evaluation time.

Aged↗