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At least 145 records · Page 8Linked to original sources
PubMed2006

New approaches to the study of periodic leg movements during sleep in restless legs syndrome.

STUDY OBJECTIVES: To describe a new approach for the analysis of quantity, type, and periodicity of the leg motor activity during sleep in patients with restless legs syndrome (RLS) and periodic leg movements (PLM). METHODS: The following parameters were taken into account for LM: duration, amplitude, area under the curve, sleep stage, side, interval, and bilaterality. The analysis of inter-LM intervals was carried out by drawing their distribution graphs. A new index evaluated their periodicity and was validated by means of a Markovian analysis. The differences in inter-LM intervals, LM duration, and area under the curve between normal controls and patients and between the 3 patient subgroups identified on the basis of their periodicity were statistically analyzed. SETTING: N/A. PARTICIPANTS: Sixty-five patients with RLS and periodic LM and 22 young healthy controls. MEASUREMENTS AND RESULTS: The RLS patients' inter-LM interval distribution graph showed a wide peak with a maximum located at around 15 to 30 seconds and extending from 10 to 90 seconds, not present in controls, and another peak for intervals less than 8 seconds, higher than that of controls. Three patient subgroups were identified with different proportions of these 2 peaks, periodicity, and Markovian parameters. Periodicity was not dependent on the periodic leg movement index. Patients showing the peak mainly at around 15 to 30 seconds tended to show slightly longer and higher area under the curve LM than did the other 2 subgroups. CONCLUSIONS: Our new approach seems to be useful in a new qualitative differentiation among patients with PLM, which is not possible by using the simple PLM index.

Adult↗
PubMed1994

[A new procedure for determination of leg length and differences in leg length using sonography. I. Development and experimental studies].

The precise measurement of leg length and leg length discrepancies (LLD) plays an important role in the examination of lumbar spine and lower extremities. Those real LLD which may be posttraumatic or idiopathic, can sometimes hardly be differentiated from LLD caused by spinal scoliosis or malposition. Although there is no final agreement, to which extent a LLD becomes clinically significant, most authors state that clinical assessment of LLD by tape measure or lengthening of the short leg with blocks of known thickness is highly unreliable. Radiological methods are necessary for precise detection of LLD less than 10 mm. Since previously reported non-invasive, ultrasound-supported leg-length measurement methods proved to be complicated and unhandy, a new method was developed. To avoid radiation exposure accuracy and precision were tested on human cadavers and were compared to clinical assessments by tape measurement. A measurement device was constructed consisting of a wire rope meter and a length millimeter digital display. Measurements were taken with the examined person in supine position. The device was placed beyond their feet and the end of the rope was hinged with a metal brace to a convenient transducer in exact middle position. Thus the middle of the ultrasound monitor concords with the end of the rope. The medial knee joint and ventral hip joint were used as standardised sonographic landmarks. Ten not pre-selected mortants were measured in this manner and additionally clinical LLD was obtained with a tape measure (medial ankle to anterior superior iliac spine). Afterwards all distances were anatomically prepared and measured with a meter stick.(ABSTRACT TRUNCATED AT 250 WORDS)

Equipment Design↗
PubMed1998

["Painful legs and moving toes" and muscle cramps spreading to the bilateral legs in a patient with alcoholic polyneuropathy].

A 37-year-old man with alcoholic polyneuropathy showed involuntary movement as intermittent flexion-extension or abduction-adduction of his toes identical to "painful legs and moving toes (PLMT)" and muscle cramps. Regarding the sequential spreading of PLMT and cramps from unilateral to contralateral leg muscles and phasic discharges observed by a needle EMG in the foot muscles during PLMT, we suppose that a spinal or supraspinal mechanism was responsible for the production of those movements. This case showed novel aspects of PLMT which was induced by sensory stimulation of the left lower leg and subsequently initiated cramps. The destruction of the lumbar sympathetic ganglion remarkably ameliorated the spontaneous PLMT and cramps, whereas sensory stimulation of the left lower leg still induced those movements. Therefore, we think that sensory inputs from peripheral nerves played a critical role in the generation of PLMT and cramps, and abnormal activities of spinal sympathetic nerves exacerbated those involuntary movements. Sensory induced PLMT may be a subgroup of this movement disorder.

Adult↗
PubMed1980

Adrenocortical response to one-leg and two-leg exercise on a bicycle ergometer.

Twelve healthy male subjects exercised for 30 min on a bicycle ergometer, using only one leg, at a work load that was nearly exhausting. Nine subjects (group A) showed a marked rise in plasma cortisol concentration (240 +/- 50 nmol x l-1), but in three subjects no such rise occurred (group B). All group B subjects had elevated cortisol levels prior to the period of exercise, which may have inhibited the adrenocortical response. Seven subjects of group A also performed the same work load using both legs. Under this regime, increases in plasma cortisol and aldosterone levels, blood lactate level and heart rate, but not plasma potassium, were significantly smaller than for one-leg exercise. These findings are consistent with the hypothesis that activation of the hypothalamic-pituitary-adrenal (HPA) system during exercise could be mediated through the stimulation of chemoreceptors in the exercising muscles. This effect could be reinforced by HPA stimulation in response to the greater acceleration of heart rate in one-leg exercise. The marked rises in plasma potassium levels might be responsible for the elevation of plasma aldosterone concentration particularly in those experiments when this occurs earlier than, or in the absence of, rises in cortisol concentration.

Adult↗
PubMed2000

Proximal distal axis formation in the Drosophila leg: distinct functions of teashirt and homothorax in the proximal leg.

The proximal distal axis of the Drosophila leg is patterned by expression of a number of transcription factors in discrete domains along the axis. The homeodomain protein Homothorax and the zinc-finger protein Teashirt are broadly coexpressed in the presumptive body wall and proximal leg segments. Homothorax has been implicated in forming a boundary between proximal and distal segments of the leg. We present evidence that Teashirt is required for the formation of proximal leg segments, but has no role in boundary formation.

Animals↗
PubMed1999

Use of the leg-to-leg bioelectrical impedance method in assessing body-composition change in obese women.

BACKGROUND: There is little information on whether bioelectrical impedance analysis (BIA) accurately predicts changes in body composition associated with energy restriction, exercise, or both. OBJECTIVE: We had 2 objectives: to determine the validity of the leg-to-leg BIA system in 1) estimating body composition in obese and nonobese women, with a cross-sectional design, and 2) assessing changes in body composition in obese women in response to 12 wk of energy restriction, exercise training, or both. DESIGN: Subjects were 98 moderately obese women (43.2 +/- 0.6% body fat, 45.0 +/- 1.1 y of age) and 27 nonobese control subjects (24.0 +/- 1.5% body fat, 43.5 +/- 2.5 y of age). Obese subjects were randomly divided into 1 of 4 groups, with fat-free mass, fat mass, and percentage body fat estimated with BIA and underwater weighing before and after 12 wk of intervention. The 4 groups were diet only (4.19-5.44 MJ/d), exercise only (five, 45-min sessions/wk at 78.5 +/- 0.5% of maximum heart rate), both exercise and diet, and control (no diet or exercise). RESULTS: No significant difference was found between underwater weighing and BIA in estimating the fat-free mass of the obese and nonobese women (all subjects combined, r = 0.78, P < 0.001, SEE = 3.7 kg) or in estimating decreases in fat mass during 12 wk of energy restriction, exercise, or both in obese subjects (F[3.85] = 1.45, P = 0.233). CONCLUSIONS: The leg-to-leg BIA system accurately assessed fat-free mass in obese and nonobese women, and changes in fat mass with diet alone or when combined with exercise.

Adipose Tissue↗
PubMed2003

A comparison of skinfolds and leg-to-leg bioelectrical impedance for the assessment of body composition in children.

BACKGROUND: This field-based investigation examined the congruence between skinfolds and bioelectrical impedance in assessing body composition in children. METHODS: Subjects were 162 female and 160 male children 10-15 years of age. Skinfold measures obtained at the triceps and medial calf and a leg-to-leg bioelectrical impedance system were used to determine percent fat using child-specific equations. Pearson product moment correlations were performed on the percent fat values obtained using skinfolds and bioelectric impedance for the entire data set. Separate correlations were also conducted on gender and age/gender subsets. Dependent t tests were used to compare the two techniques. RESULTS: Percent fat did not differ between skinfolds and bioelectrical impedance for the total subject pool. Bioelectrical impedance overestimated percent fat in girls by 2.6% and underestimated percent fat in boys by 1.7% (p < 0.01). Correlations between skinfolds and bioelectrical impedance ranged from r = 0.51 to r = 0.90. CONCLUSIONS: Leg-to-leg bioelectrical impedance may be a viable alternative field assessment technique that is comparable to skinfolds. The small differences in percent fat between the two techniques may have limited practical significance in school-based health-fitness settings.

Journal Article↗
PubMed2005

Investigation into the correlation between sensation and leg movement in restless legs syndrome.

We evaluated rest effects on restless legs syndrome (RLS) sensory and motor symptoms. During two 60-minute Suggested Immobilization Tests (SIT) subject's signals of RLS leg sensations and periodic leg movements while awake (PLMW) were recorded. Sensations, PLMW, sensations preceding or after PLMW, sensations occurring without following PLMW, and PLMW occurring without preceding sensation were determined. The RLS patients were divided into equal-sized high and low PLMW groups for further analysis. Data from 46 subjects (28 RLS and 18 controls) revealed sensations increased linearly with rest in RLS patients and controls. Movement rate increased linearly with rest for controls but increased rapidly for the first 45 minutes for all RLS patients. PLMW/hour increased with further rest for low but not high PLMW patients. Sensations followed by PLMW and PLMW without preceding sensations followed similar patterns. Sensations without subsequent PLMW increased dramatically in the last 15 minutes of the SITs. Whereas both sensory and motor signs of RLS increase with rest, there is minimal increase for controls. Patients with higher but not lower PLMW rates reached a ceiling for PLMW after 35 to 40 minutes. The temporal dissociation between sensory and motor events supports viewing these motor and sensory events as separate but loosely linked manifestations of RLS.

Aged↗
PubMed1997

Cross-leg free flaps for difficult cases of leg defects: indications, pitfalls, and long-term results.

BACKGROUND: Cross-leg free flaps have been described for reconstruction of leg defects in cases of trauma with no suitable recipient vessels in the vicinity of the defect. The pitfalls, however, have not been well documented in the literature. The technique of transfer and the length of time required before pedicle division depend on the nature of the flap and the contact surface. METHODS: Eight cross-leg free flap reconstructions were performed on seven patients between 1986 and 1993. These included three latissimus dorsi muscle flaps, three fibula osteomyocutaneous flaps, one tensor fascia lata myocutaneous flap, and one posterolateral thigh flap. The important technical considerations are outlined. RESULTS: One latissimus dorsi flap failed, whereas the rest of the flaps completely survived. The morbidity of the recipient and donor sites are listed. CONCLUSION: We conclude that the technique offers the possibility of salvaging limbs that are, otherwise, nonreconstructable. It is useful for young patients. When the flap is long, it can function as a nutrient flap for the distal limb even though the pedicle has been divided. It is a backup procedure in an urgent situation of re-exploration in which reestablishment of circulation should take place as soon as possible.

Adolescent↗
PubMedDate not supplied

[Restless legs syndrome in a patient with amputation of both legs].

INTRODUCTION: We present the case of a patient who, after amputation of both legs, suffered restless legs syndrome (RLS). This syndrome is characterised by a feeling of agitation in the legs and an overwhelming need to move them. CASE REPORT: A 62-year-old male patient who visited because of sleep onset and maintenance insomnia. The aetiology of the insomnia was interpreted as being an anxiety-dysthymic syndrome, which improved with suitable medication. Five months later, the patient returned with the same symptoms (onset insomnia). On questioning the patient again, we noticed that he displayed clear symptoms of RLS, despite the absence of both lower limbs. The clinical features were resolved with the administration of ropinirole. CONCLUSIONS: We do not know of any similar cases, but the scarce amount of knowledge available about RLS makes it likely that many patients with amputations present this problem without any proper diagnosis.

Amputation, Surgical↗
PubMed1983

[Repetitive skin testing in patients with lower leg eczema and leg ulcer].

16 patients with lower leg dermatitis and venous ulcers had been subject to patch-testing during 1974 to 1977. When retested in 1982, the number of positive reactions per patient increased from 3.82 to 5.87 on an average. 54% of the positive epicutaneous test reactions could be reproduced in the repeated patch test. Meanwhile, 9 of 16 of patients were free of lower leg dermatitis and 8 of them were free of venous ulcers. This paper deals with the problematic nature as well as the likely causes of the apparent inconsistency of epicutaneous test reactions in patients with lower leg dermatitis and venous ulcers.

Allergens↗
PubMed1982

[Restless legs and nocturnal leg spasms--forgotten facts in diagnosis--new facts for therapy].

An angiologist's experience with the symptom of restless legs is reported. The condition was diagnosed in 103 patients presenting with pain in their legs occurring predominantly at rest and vanishing with walking. Organic lesions could not be identified (in 76%) or were not responsible for the discomfort (in 24%). A depressive state, most often masked, was recognized in 67%. In 42% anxiety was present alone, and in 49% frank depression was diagnosed. In 9% psychiatric treatment was mandatory. Patients with no depression were either not treated (33%) or were given type I-antiarrhythmic drugs (mostly disopyramide) with good results. These drugs were only transiently effective in depressed patients since anxiety was often intensified when the symptom of restless legs disappeared. Antidepressant agents, though ineffective when given alone, were most helpful when administered together with disopyramide.

Adult↗
PubMed1977

Distribution of intravenously injected 201thallium in the legs duging walking. A new test for assessing arterial insufficiency in the legs.

There is a multitude of method for assessing the efficiency of the arterial circulation in the legs. Most of these methods can give conclusive information about the patency of the main arteries in the leg; the level of an arterial obstruction can also be estimated. However, none of these methods provides a direct estimate of the functional importance of arterial lesions of light to moderate severity. The present report describes preliminary findings of the distribution of intravenously injected 201Thallium, a potassium analogue, in the legs during exercise provoking symptoms of ischemia. From this pilot study the general impression is that the thallium uptake pattern corresponds well with the clinical, physiologic, and angiographic picture.

Arterial Occlusive Diseases↗
PubMed1992

Effect of one-legged exercise on the strength, power and endurance of the contralateral leg. A randomized, controlled study using isometric and concentric isokinetic training.

The purpose of this investigation was to study the effect of one-legged exercise on the strength, power and endurance of the contralateral leg. The performance of the knee extensor and flexor muscle of 20 healthy young adults (10 men and 10 women) was first tested by Cybex II+ and 340 dynamometers. Then 10 subjects were chosen at random to train using one leg three times a week for 7 weeks whilst the other 10 served as controls. During the 8th week, the tests were repeated. Both quadriceps and hamstring muscles of the trained subjects showed a cross-transfer effect from the trained limb to the untrained side. This concerned the strength and power, as well as endurance characteristics of these muscles. The average change in peak torque of the quadriceps muscle was +19% (P less than 0.001) in the trained limb, +11% (P less than 0.01) in the untrained limb and 0% in the control limbs. In hamstring muscles the changes were +14% (P less than 0.01), +5% and -1%, respectively. Concerning muscle endurance (work performed during the last 5 contractions in the 25-repetition test) the corresponding changes were +15% (P less than 0.01), +7% (P less than 0.01), and -1% in quadriceps muscle, and +17% (P less than 0.05), +7%, and -3% in hamstring muscles. The average strength benefit in the untrained limb was +36% (hamstring muscles) and +58% (quadriceps muscle) of that achieved in the trained limb. Untrained hamstring muscle showed better benefits in the endurance parameters than in strength or power parameters, while in the quadriceps muscle this effect was reversed. A positive relationship was observed between the changes (greater improvement in the trained limb resulted in greater improvement in the untrained limb) (hamstring muscles: r = 0.83, P less than 0.001, quadriceps muscle: r = 0.53, P less than 0.001). In endurance parameters, this relationship was almost linear while in the strength and power parameters the results were more in favour of a curvilinear relationship with limited benefit.

Adult↗
PubMed2002

SPECT imaging of striatal pre- and postsynaptic dopaminergic status in restless legs syndrome with periodic leg movements in sleep.

Restless legs syndrome (RLS) is a common sleep-related disorder principally characterised by leg paresthesia associated with an irresistible urge to move. A majority of RLS patients experience periodic leg movements during sleep (PLMS) and wakefulness. Pharmacological evidence suggests that RLS-PLMS may be caused by a central nervous system dopaminergic (DA) dysfunction. The aim of the present study was to evaluate the striatal pre- and postsynaptic DA status in patients suffering from both RLS and PLMS, by means of [123I] beta-CIT and [123I]IBZM SPECT respectively. Ten drug-naïve patients and ten age-matched controls participated in this study. All participants were recorded for at least one night of polysomnography before the SPECT studies. No difference was seen in DA transporter ([123I] beta-CIT) binding between RLS-PLMS patients (MD=4.89) and controls (MD=4.81; p=0.81). The study of the striatal D2-receptor binding ([123I]IBZM) revealed a significantly lower binding in patients (MD= 1.72) compared with controls (MD=1.85; p=0.006). These results support the hypothesis that a central DA dysfunction is involved in the physiopathology of RLS-PLMS. Several mechanisms may be responsible for the decrease of the D2-receptor binding. However, since [123I] beta-CIT binding is normal, a decreased number of D2-receptors or a decreased affinity of D2-receptors for [123I]IBZM is more likely than an increased level of synaptic DA with attendant downregulation of D2-receptors.

Adult↗
PubMedDate not supplied

The wasted leg syndrome, a single fibre electromyographic study of arms and legs.

Single fibre electromyography (SFEMG) was performed on 11 patients with the wasted leg syndrome. Five were of South Asian origin and the others Chinese. In most cases the disorder progressed for about 5 yr before becoming static or very slowly progressive. The SFEMG fibre density was increased similarly in both the affected and less affected leg, but was normal in the arms except for a few longstanding cases. The limited extent of clinical and electrophysiological abnormalities suggests that the wasted leg syndrome is a distinct entity.

Adolescent↗
PubMed2005

Supporting adherence and healthy lifestyles in leg ulcer patients: systematic development of the Lively Legs program for dermatology outpatient clinics.

OBJECTIVES: The objective of our project was to develop a lifestyle program for leg ulcer patients at outpatient clinics for dermatology. METHODS: We used the intervention-mapping (IM) framework for systematically developing theory and evidence based health promotion programs. We started with a needs-assessment. A multidisciplinary project group of health care workers and patients was involved in all five IM steps; formulating proximal program objectives, selecting methods and strategies, producing program components, planning for adoption and implementation and planning for evaluation. Several systematic literature reviews and original studies were performed to support this process. RESULTS: Social Cognitive Theory was selected as the main theory behind the program 'Lively Legs' and was combined with elements of Goal-Setting Theory, the precaution adoption model and motivational interviewing. The program is conducted through health counseling by dermatology nurses and was successfully pre-tested. Also, an implementation and evaluation plan were made. CONCLUSION: Intervention mapping helped us to succeed in developing a lifestyle program with clear goals and methods, operational strategies and materials and clear procedures. PRACTICE IMPLICATIONS: Coaching leg ulcer patients towards adherence with compression therapy and healthy lifestyles should be taken on without delay. Systematic development of lifestyle programs for other patient groups should be encouraged.

Adolescent↗
PubMed2005

Night-to-night variability in periodic leg movements in patients with restless legs syndrome.

BACKGROUND AND PURPOSE: Although a night-to-night variability in periodic leg movements (PLM) occurrence has been described in patients with primary PLM disorder and sleep apnea syndrome, no study has apparently considered the inter-night effect on PLM index during wakefulness and sleep in patients with Restless Legs Syndrome (RLS). Moreover, no study has examined the night-to-night variability in PLM index according to sleep stage and time of night. We therefore examined changes in PLM index during wakefulness and sleep during two consecutive nights in a group of untreated RLS patients. PATIENTS AND METHODS: Twenty-eight drug-free RLS patients, aged 53.4+/-2.3 yr, with a mean International Restless Legs Syndrome Study Group (IRLSSG) severity score of 20.2+/-1.6, were studied during two consecutive nights. PLM duration and interval, PLM index during wakefulness (PLMWI), during total sleep time (PLMSI), as well as during each sleep stage were measured. Analysis was also extended to examine PLM occurrence during sleep cycles. RESULTS: In the group of patients as a whole, the PLMW and PLMS index, duration and interval did not show significant difference between nights, these measures being consistently similar for both nights. Comparison of PLMS index between different sleep stages did not reveal inter-night differences. Nocturnal variation in PLM number, duration and interval for total recording time and sleep period revealed a progressive decline across the night for PLM index (P</=0.0001) but no interaction, the changes being similar in first and second nights. However, a large intra-individual variability was present with a correlation coefficient between nights of 0.60 for the PLMWI (P=0.001) and 0.54 (P=0.003) for the PLMSI. The individual inter-night changes in PLM index were independent of age, IRLSSG severity score, duration of the disease and changes in sleep parameters. CONCLUSIONS: This study shows that the index and the nocturnal pattern of PLM occurrence are highly reliable across nights in RLS patients, suggesting that a single-night study may be sufficiently sensitive to confirm diagnosis and associated sleep disturbances in these patients. However, an individual inter-night variability is present, independent of age, severity and duration of the disease, which should be considered in the clinical evaluation.

Adult↗