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PubMed2002

High frequency distraction improves tissue adaptation during leg lengthening in humans.

The present study investigates the effect of distraction frequency on the development of tensile force in the tissues during lengthening. Two patients with bilateral Ilizarov leg lengthening underwent distraction with high frequency in one leg and low frequency in the other. The clinical situation represented a unique model for investigating the effect of distraction frequency, as each individual served as its own control. Both patients had double level lengthening. Distraction frequency at the proximal lengthening zone was 0.25 mm x 4 in the first leg and 1/1440 mm once every minute in the other. Total diurnal distraction at the proximal metaphysis was 1 mm in both legs. In addition, a distal metaphyseal distraction of 0.25 mm x 3 daily was performed on each leg. The tissue's mechanical response was monitored by measuring the tensile force at the proximal osteotomy. Both patients experienced a significant lower level of force during the high frequency lengthening. The lower level of force was concluded to be due to improved soft tissue adaptation, rather than reduced bone regeneration. Accordingly, high distraction frequency was considered favourable to low frequency, and is recommended in large lengthenings where high force levels are expected.

Adaptation, Physiological↗
PubMed1999

Assessment of functional status, low back disability, and use of diagnostic imaging in patients with low back pain and radiating leg pain.

We analyzed data from outpatients with chronic low back pain (LBP) in the Veterans Health Study (n = 563) to examine the relationship between localized LBP intensity and radiating leg pain in assessing patient functional status, low back disability, and use of diagnostic imaging. Based on the localized LBP intensity, the study subjects were divided into tertiles (low, moderate, and high intensity). The study subjects were also stratified by the extent of radiating leg pain. Using analysis of variance and multiple regression analysis, we compared the relative importance of localized LBP intensity and radiating leg pain in explaining the variability in the means of the SF-36 scales and low back disability days, and in the proportion of patients who had used diagnostic imaging. The results of the study indicate that measures of localized LBP intensity and radiating leg pain contribute separately to the assessment of patient functional status, low back disability, and use of diagnostic imaging. These results suggest that localized LBP intensity and radiating leg pain may represent two different approaches in assessing back pain severity. Future epidemiological and health services research should consider both measures in assessing the impact of LBP on patient functional status, low back disability, and use of diagnostic imaging.

Adult↗
PubMed2002

Correlation of expression patterns of homothorax, dachshund, and Distal-less with the proximodistal segmentation of the cricket leg bud.

We describe the expression pattern of Gryllus homothorax (Gbhth) and dachshund (Gbdac), a cricket homologue of Drosophila homothorax and dachshund, together with localization of Distal-less or Extradenticle protein during leg development. We correlated their expression patterns with the morphological segmentation of the leg bud. The boundary of Gbhth/GbDll subdivision is correlated with the segment boundary of the future trochanter/femur at early stages. Gbdac expression subdivides the leg bud into the presumptive femur and more distal region. During the leg proximodistal formation, although the early expression patterns of GbDll, Gbdac, and Gbhth significantly differ from those of Drosophila imaginal disc, their expression patterns in the fully segmented Gryllus leg were similar to those in the Drosophila late third instar disc.

Animals↗
PubMed1997

Homeotic transformation of legs to mouthparts by proboscipedia expression in Drosophila imaginal discs.

The Drosophila homeotic gene proboscipedia (pb) specifies labial identify and directs formation of the adult distiproboscis from the labial imaginal discs. pb null alleles result in the homeotic transformation of the distiproboscis into prothoracic (T1) legs [Kaufman (1978) Genetics 90, 579-596; Pultz et al. (1988) Genes Dev. 2, 901-920]. Homology with other transcription factors, localization to the nucleus, and restricted embryonic and imaginal expression implicate the pb protein (PB) as a transcription factor. In order to examine the possible roles that PB may play in the specification of adult mouthparts, we have expressed PB in cells of wing, leg and eye-antennal imaginal discs and assayed for effects on the development of adult structures. We report here that the ectopic expression of PB in the imaginal discs under the control of the inducible GAL4 system [Brand and Perrimon (1993) Development 118, 401-415] alters the developmental program of adult legs into maxillary or labial palps. These homeotic transformations have an equal effect on all three sets of legs, indicating an activity that is not solely dependent upon the unique combinations of other homeotic genes present in each of the leg discs. Segment polarity genes required for establishing the AP compartment boundary were found to be undisturbed by ectopic PB. Furthermore, normal patterns of apoptosis are observed in animals expressing ectopic PB, indicating that PB does not alter or affect cell death. These results suggest that molecular events occurring downstream of the establishment of the compartment boundary are affected by ectopic PB expression in imaginal discs and point to a general role in 'palp' formation in addition to the specification of labial identity.

Animals↗
PubMed1998

Control of antennal versus leg development in Drosophila.

During the evolution of insects from a millipede-like ancestor, the Hox genes are thought to have promoted the diversification of originally identical body structures. In Drosophila melanogaster, antennae and legs are homologous structures that differ from each other as a result of the Hox gene Antennapedia (Antp), which promotes leg identities by repressing unknown antennal-determining genes. Here we present four lines of evidence that identify extradenticle (exd) and homothorax (hth) as antennal-determining genes. First, removing the function of exd or hth, which is required for the nuclear localization of Exd protein, transforms the antenna into leg; such transformations occur without activation of Antp. Second, hth is expressed and Exd is nuclear in most antennal cells, whereas both are restricted to proximal cells of the leg. Third, Antp is a repressor of hth. Fourth, ectopic expression of Meis1, a murine hth homologue, can trigger antennal development elsewhere in the fly. Taken together, these data indicate that hth is an antennal selector gene, and that Antp promotes leg development by repressing hth and consequently nuclear Exd.

Animals↗
PubMed2000

Intermittent pump versus compression bandages in the treatment of venous leg ulcers.

BACKGROUND: The purpose of the present paper was to compare healing rate and leg swelling with an intermittent compression pump versus compression bandages in the treatment of venous leg ulcers, and to also compare patient compliance and satisfaction with the two techniques. METHODS: A randomized cross-over study of patients attending an outpatient wound clinic (n = 16) was undertaken. A regular monthly follow-up with measurement of ulcer size and leg volume was carried out, as well as completion of a questionnaire. RESULTS: Assessment was possible in 11 of the 16 patients. There was no significant difference between treatment types with regards to ulcer healing rates or control of leg oedema. The survey revealed that patients found the pump easier and more comfortable to use, with a trend towards increased compliance. CONCLUSIONS: Although the present study was too small for generalizable conclusions, compression pumps and bandages are comparable in efficacy for the healing of venous leg ulcers. The compression pump is reported as being easier and more comfortable to use than bandages.

Aged↗
PubMed2001

Elderly persons' experiences of living with venous leg ulcer: living in a dialectal relationship between freedom and imprisonment.

The aim was to illuminate elderly persons' experiences of living with venous leg ulcer. Fifteen persons 74-89 years of age with active leg ulcer were interviewed. Data were analysed utilizing a phenomenological-hermeneutic approach inspired by Ricoeur. The analysis includes dialectic movement between understanding and explanation of the text as a whole and its parts. In the structural analysis four themes were identified: emotional consequences of altered body image, living a restricted life, achievement of well-being in connection with a painful wound and bandage, and struggle between hope and despair with regard to a lengthy healing process. The comprehensive understanding indicated that the meaning of living with venous leg ulcer can be understood as a dialectal relationship between, on the one hand the feeling of being imprisoned in the body, the bandage and the home, and on the other hand, hope of freedom from a burdensome body. The results indicate that the concept, body of image, is vitally relevant to the caring of elderly people with venous leg ulcer. The study shows the importance of recognizing the persons' perceptions of their leg ulcers and the impact of these perceptions on well-being. Nurses can thereby anticipate problems and provide more sensitive care.

Adaptation, Psychological↗
PubMed2002

Surrogate endpoints for the treatment of venous leg ulcers.

Surrogate markers are endpoints that occur early in the course of treatment and are intended to predict the true, meaningful clinical endpoint. Surrogate markers have been used to study treatments for a wide range of diseases in which the true outcome is delayed. The evaluation of therapies for venous leg ulcers is challenged by the prolonged observation period necessary to reach the endpoint of healing. We have performed a large cohort study to examine wound healing characteristics as candidate surrogate markers of venous leg ulcer healing using the Curative Health Services population. A total of 58,038 wounds met our definition of venous leg ulcer; however, 1550 wounds were excluded based on size, depth, site, and/or involvement of tendon or bone, leaving 56,488 wounds in 29,189 patients for analysis. The median wound size was 189 mm2, with a median wound duration of 3 mo. Using a large cohort of diverse venous leg ulcer patients, we demonstrate that after only 4 wk of treatment the wound parameters log healing rate, log wound area ratio, and percentage change in wound area can be valid surrogate markers of healing at 12 or 24 wk of care. Based on the area under the receiver operator characteristic curve log rate, log area ratio, and percentage change in area can discriminate which patients will heal at 12 or 24 wk of care (receiver operator characteristic 0.72-0.80). These surrogates were further validated by demonstrating that established risk factors for not healing such as wound size and wound duration are also important risk factors for not achieving the surrogate endpoint. These surrogate markers for venous leg ulcer healing may allow for early clinical trials to be more efficient, and can allow clinicians to identify patients unlikely to heal early in the course of treatment in order to expedite referral to specialty centers or for the selection of stepped treatment algorithms.

Biomarkers↗
PubMed1984

Effects of a 24-h CHO-poor diet on metabolic and hormonal responses during prolonged CHO-loaded leg exercise.

This study examined the effects of a pre-experimental period of arm exercise followed by a 24-h carbohydrate (CHO)-poor intake, intended to reduce initial hepatic glycogen levels, on substrate and endocrine responses during prolonged CHO-loaded leg exercise. Seven subjects pedaled a cycle ergometer for 60 min at 62% VO2 max in the two following conditions: 1) after leg CHO loading followed by a 60-min arm exercise and a 24-h CHO-poor diet (CHOL + P), and 2) after leg CHO loading only (CHOL). Greater blood concentrations of fatty acids (1.2 vs 0.9 mEq X L-1), glycerol (0.41 vs 0.20 mmol X L-1), norepinephrine (2.09 vs 1.14 ng X ml-1), and epinephrine (0.38 vs 0.19 ng X ml-1) were observed in the CHOL + P as compared to the CHOL condition at min 60 of exercise. Insulin concentration was significantly (P less than 0.05) lower in the CHOL + P condition at rest and during exercise. There were no significant differences during exercise between the two conditions in blood glucose, lactate, glucagon, and cortisol concentrations. It is concluded that changes in blood glucose concentration do not solely account for metabolic and hormonal adaptations during prolonged leg exercise and that a pre-experimental period of arm exercise and CHO-poor diet, in spite of an increase in leg muscle glycogen, may provide a stimulus for such adaptations. It is suggested that the liver glycogen content may be involved in the regulatory mechanism.

Blood Glucose↗
PubMedDate not supplied

[Problems in the surgical treatment of congenital pseudarthrosis of the lower leg].

The principal aim of this study was to describe the frequent errors that are being committed when treating congenital pseudarthroses of the lower leg. The authors studied this in 25 patients. 21 of these were referred to surgery, whereas 4 were presented by colleagues seeking counsel and were then subjected to further treatment at another location. One-half of the 21 congenital pseudarthroses had already been unsuccessfully operated on in other hospitals up to as often as four times. The method of "combined plate osteosynthesis" was employed with 19 of the 21 patients; this method was originally developed by W. Blauth and used for the first time in 1969. Witt and Refior reported on a similar technique at about the same time and independently thereof. 17 of our patients were cured; 2 failures cannot be blamed on the method. The main procedural error in the previously operated patients had been a misjudgement of the disease pattern which is characterised by "biological deficiency" and lack of load-bearing capacity of the bones of the lower leg in a circumscribed region at the transition from the median to the lower third of the lower leg. Another important factor was certainly the lack of knowledge of the pathogenetic significance of the pathologically affected periosteum. In this connection the failures were certainly also conditioned by faulty osteosyntheses resulting therefrom, without using autologous osseous material for grafting; by operating too early; by immobilising the limbs postoperatively for too short a period; and by insufficient relief of the limbs before a patent medullary cavity had formed. Another error consisted in omitting to perform autologous bone chip implantation at the same time when removing osteosynthesis material. The authors conclude that congenital pseudoarthroses of the lower leg can in all probability be remedied already in early childhood if the well-tried principles of treatment of "combined plate osteosynthesis" are observed. This, however will not result in normal lower leg bones, as can be concluded from the fact that spontaneous fractures have occurred partly even in the locomotor apparatus after the pseudarthroses had healed. In future, petiolated bone grafts performed by microsurgeons should be promising and competitive. Küntscher nail osteosyntheses should also offer good chances of healing if performed from the site of the sole. Their main drawbacks might be damage of the distal tibial epiphysis and of the functions of the ankle joint and talo-calcaneonavicular joint.

Adolescent↗
PubMed2002

Venous leg ulcer: incidence and prevalence in the elderly.

BACKGROUND: Venous leg ulcer is a disease most common in those aged 65 years and older. However, the incidence and prevalence have not been well established. OBJECTIVE: Our purpose was to estimate the prevalence and incidence of venous leg ulcers in the elderly. METHODS: We studied the General Practice Research Database, validated our case ascertainment strategy, and estimated the annual prevalence and incidence of venous leg ulcer. RESULTS: The positive predictive value of our ascertainment strategy was 98.3% (95% confidence interval [CI], 90.0, 100.0). The annual prevalence of venous leg ulcer among the elderly was 1.69 (95% CI, 1.65, 1.74). The overall incidence rate was 0.76 (95% CI, 0.71, 0.83) for men and 1.42 (1.35, 1.48) per 100 person-years for women. CONCLUSION: Venous leg ulcer is a significant problem in those aged 65 years and older. As compared with previous studies, because we used medical records from a population of known size, our results are precise and less biased.

Aged↗
PubMed1999

Cultured allogeneic skin cells are effective in the treatment of chronic diabetic leg and foot ulcers.

Diabetic ulcers on the lower extremities present a difficult treatment problem, and some ulcers respond poorly to conventional topical and cast treatment. The purpose of this study was to assess the effect of cultured allogeneic keratinocyte epithelium and fibroblast-gelatin sponge on the healing of chronic, refractory diabetic leg and foot ulcers. Non-diabetic chronic leg ulcers were treated for comparison. This open study comprised 22 patients with type I or type II diabetes and 16 patients with leg or ankle ulcers of different aetiologies. A total of 26 diabetic and 25 non-diabetic ulcers were treated mainly with keratinocyte epithelium and/or fibroblast-gelatin sponge once weekly until complete healing or until no further healing could be observed despite several repeated treatments. The duration of diabetic ulcers was 10.3+/-15.8 (mean+/-SD) months and the size 3.1+/-6.6 cm2. The diabetic ulcers were located in the heel (7), toe (7), sole (5), leg (6) and Achilles (1). The mean duration of non-diabetic ulcers was 6.8+/-6.0 months and the size 10.5+/-11.8 cm2. A total of 12+/-11 skin cell transplantations were performed for the diabetic ulcers. All but 1 diabetic ulcer healed during the study. The time for 50% reduction in ulcer area was 32+/-32 days, but 99+/-110 days were needed for complete ulcer closure. The longer the ulcer had existed the longer was the healing time. Heel ulcers showed significantly slower healing response than leg, sole and toe ulcers. Preliminary results suggest that both keratinocytes and fibroblasts are equally effective in the healing process. The time required for healing of the diabetic ulcers did not differ markedly from that of the non-diabetic ulcers. The results suggest that cultured allogeneic skin cells used once weekly are effective in the treatment of recalcitrant diabetic ulcers.

Adult↗
PubMed1981

Neuromuscular studies of turkeys with trienbolone acetate-induced and naturally occurring "leg weakness".

1. In vivo sciatic nerve gastrocnemius muscle preparations were made from 14- to 18-week-old normal turkeys and from those with naturally occurring or trienbolone acetate (TA)-induced "leg weakness". 2. Preparations from leg weakness cases displayed neither accelerated muscle fatigue nor decreased nerve conduction velocities as compared with control preparations. 3. The muscles of the TA-treated turkeys but not of those with naturally occurring leg weakness were hyperexcitable to those of controls. 4. Post-tetanic potentiation of preparations from both naturally occurring and experimentally-induced cases of leg weakness was less than that of control preparations, both before and after partial neuromuscular blockade, significantly so at the lower pulse frequencies used. 5. It is tentatively suggested that the last finding might be of significance in explaining the clinical signs of leg weakness and might be associated with a disordered calcium metabolism.

Animals↗
PubMed2006

Substrate oxidation during incremental arm and leg exercise in men and women matched for ventilatory threshold.

The aim of this study was to determine the variations in substrate utilization between men and women matched for ventilatory threshold (Tvent) during incremental arm cranking and leg cycling exercise at 70, 85, 100 and 115% of the mode-specific Tvent. Recreationally active men (n=12) and women (n=10) with similar values for percentage of peak oxygen consumption at Tvent participated in the study. Ventilatory equivalence, excess CO2 and modified V-slope methods were used concurrently to determine Tvent. The participants performed 5 min of exercise at each of 70, 85, 100 and 115% Tvent during both arm cranking and leg cycling exercise. The females were tested during the early follicular phase for all trials. A two-way mixed-design analysis of variance was performed to test for differences between the sexes. When carbohydrate and fat oxidation were expressed relative to total fat-free mass, carbohydrate oxidation during arm cranking and leg cycling was significantly higher in men than women at each percentage of Tvent. In contrast, women showed significantly higher fat oxidation across intensities during both arm cranking and leg cycling. Our results suggest that when substrate utilization is expressed relative to total fat-free mass, women appear to maintain a higher rate of fat and lower rate of carbohydrate oxidation than men during both incremental arm cranking and leg cycling exercise relative to Tvent.

Adult↗
PubMed1993

Radiofrequency capacitive heaters: the effect of coupling medium resistivity on power absorption along a mouse leg.

A capacitive radiofrequency source in conjunction with a temperature-controlled electromagnetic coupling medium has the potential of delivering uniform heating distributions in a mouse leg for experimental studies to investigate the use of hyperthermia as a treatment for cancer. The system has been adopted by a number of groups who have confirmed that uniform temperatures can be achieved in the presence of blood flow along a one-dimensional line which extends between the plates across the leg. In this paper, a simple mathematical model is presented and verified experimentally to demonstrate that parallel-plate capacitive radiofrequency heaters produce an inherent absorbed power distribution along the leg which is determined by the impedances across the loads. Hence, the thicker or thinner regions of the leg can be preferentially heated by using a coupling medium with lower or higher salinity, respectively. Uniform power absorption along the mouse leg required that the coupling medium had equivalent electrical properties to those of tissue.

Animals↗
PubMed2004

Lysis of adhesions and epidural injection of steroid/local anaesthetic during epiduroscopy potentially alleviate low back and leg pain in elderly patients with lumbar spinal stenosis.

BACKGROUND: Lumbar spinal stenosis causes various forms of back or leg pain, and is recognized with increasing frequency in elderly patients whose physical status is not always suitable for surgery. Epiduroscopy, a new, minimally invasive diagnostic and therapeutic technique, may be useful for pain relief in such patients. We investigated the epiduroscopic findings and immediate and long-term changes in back and leg pain after epiduroscopy in elderly patients with spinal stenosis. METHODS: Patients with degenerative lumbar spinal stenosis (n=58, median age 71 yr) were divided into two groups based on presenting symptoms: a monosegmental group (n=34) and a multisegmental group (n=24). Each patient underwent epiduroscopy, and the findings were evaluated using visual analogue scales for low back and leg symptoms. Epiduroscopy included breaking down adhesions in the epidural space by injections of saline, and injection of steroids/local anaesthetic. RESULTS: Epiduroscopy showed that the amount of fatty tissue and the degree of vascularity were greater in the monosegmental group than in the multisegmental group. Relief of low back pain was observed up to 12 months after epiduroscopy in both groups. Relief of leg pain was evident up to 12 months after epiduroscopy in the monosegmental group, and up to 3 months after epiduroscopy in the multisegmental group. None of the patients showed deterioration of motor or sensory deficits during follow-up. One patient was excluded from analysis because of accidental dural puncture during the procedure. CONCLUSIONS: The findings of epiduroscopy corresponded to the symptoms. Epiduroscopy may reduce low back and leg pain in elderly patients with degenerative lumbar spinal stenosis, particularly those with radiculopathy.

Aged↗
PubMed1996

A randomized controlled trial of electromagnetic therapy in the primary care management of venous leg ulceration.

OBJECTIVE: The aim was to establish the potential efficacy, tolerability and side-effect profile of electromagnetic therapy as an adjunct to conventional dressings in the treatment of venous leg ulcers. METHOD: A prospective, randomized, double blind controlled clinical trial was carried out in a dedicated leg ulcer clinic based in one urban general practice. Nineteen patients with leg ulcers of confirmed venous aetiology were assessed. The main outcome measures were rate and scale of venous leg ulcer healing, changes in patient-reported pain levels, quality of life, degree of mobility, side effect profile and acceptability to patients and staff. RESULTS: Sixty-eight per cent of patients attending this dedicated clinic achieved improvements in the size of their ulcer (4, 21%, healed fully) and in reduced pain levels (P < 0.05) during the trial, despite the chronicity of ulcer histories. Patients treated with electromagnetic therapy at 800 Hz were found at day 50 to have significantly greater healing (P < 0.05) and pain control (P < 0.05) than placebo therapy or treatment with 600 Hz. All patients reported improved mobility at the end of the study. The electromagnetic therapy was well tolerated by patients, with no differences between groups in reporting adverse events, and proved acceptable to staff. CONCLUSIONS: Despite the small numbers in this pilot study, electromagnetic therapy provided significant gains in the healing of venous leg ulcers and reduction in pain.

Adult↗
PubMed2000

An enhancer trap screen for ecdysone-inducible genes required for Drosophila adult leg morphogenesis.

Although extensive studies of Drosophila imaginal disc development have focused on proliferation and patterning, relatively little is known about how the patterned imaginal discs are transformed into adult structures during metamorphosis. Studies focused primarily on leg development have shown that this remarkable transformation is coordinated by pulses of the steroid hormone ecdysone and requires the function of ecdysone-inducible transcription factors as well as proteases and components of the contractile cytoskeleton and adherens junctions. Here, we describe a genetic screen aimed at expanding our understanding of the hormonal regulation of Drosophila adult leg morphogenesis. We screened 1300 lethal P-element enhancer trap insertions on the second chromosome for a series of sequential parameters including pupal lethality, defects in leg morphogenesis, and ecdysone-induced lacZ reporter gene expression. From this screen we identified four mutations, one of which corresponds to bancal, which encodes the Drosophila homolog of hnRNP K. We also identified vulcan, which encodes a protein that shares sequence similarity with a family of rat SAPAP proteins. Both bancal and vulcan are inducible by ecdysone, thus linking the hormone signal with leg morphogenesis. This screen provides new directions for understanding the hormonal regulation of leg development during Drosophila metamorphosis.

Amino Acid Sequence↗