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PubMed1995

Proprioceptive sensory neurons of a locust leg receive rhythmic presynpatic inhibition during walking.

Mechanosensory neurons from a proprioceptor (the femoral chordotonal organ) signal the movements and positions of the femorotibial joint of a locust leg. Intracellular recordings from these neurons during walking show that their spikes are superimposed on a depolarizing synaptic input generated near their output terminals in the CNS. The depolarization consists of a rhythmic synaptic input at each step, and a sustained input that begins before walking commences. In different sensory neurons, which signal particular features of the movement, the rhythmic depolarization occurs at distinct times during either the swing or stance phases of the step cycle. The depolarizing input is timed to coincide with the greatest spike response of a sensory neuron. The input is associated with a conductance change, appears to reverse just above resting potential, and thus has similar properties to the presynaptic inhibition in these same neurons during imposed joint movements (Burrows and Laurent, 1993; Burrows and Matheson, 1994). Three sources could contribute to these inputs: (1) interactions between sensory neurons of the same receptor signaling the same movement, (2) signals from different receptors in the same leg and other legs, and (3) outputs of central neurons involved in generating walking. When the leg, whose movements the sensory neurons signal is removed, both the sustained and rhythmic synaptic inputs persist. Sensory neurons in isolated ganglia treated with pilocarpine are also depolarized in phase with a rhythmic pattern expressed in leg motor neurons, indicating that central neurons must contribute. The maintained synaptic input to the terminals means that the overall effectiveness of the sensory spikes in evoking EPSPs in postsynaptic neurons will be reduced during walking, and the rhythmic component means that the spikes from particular sensory neurons will be further reduced at particular phases of the step cycle that they signal best.

Animals↗
PubMed1994

[Effect of nilvadipine on nifedipine-induced edema of the lower leg. Results of a double-blind randomized comparative study].

OBJECTIVE: Evaluation of the effects of nilvadipine on nifedipine-induced lower-leg edema. STUDY DESIGN: multicenter, randomized, double-blind study. PATIENTS: 61 outpatients suffering from essential hypertension with diastolic blood pressure adjusted to < or = 95 mmHg by nifedipine, and simultaneous lower-leg edema. MEDICATION: First phase: wash-out--placebo b.i.d.; Second phase: slow-release nifedipine 20 mg b.i.d.; Third phase: slow-release nifedipine 20 mg b.i.d. or nilvadipine 8 mg (mornings) and placebo (evenings). PARAMETERS: Lower leg volume, blood pressure, heart rate, weight, laboratory investigations, undesired effects, assessment of effectiveness and tolerability by the physician, subjective patient assessment. RESULTS: Patients treated with nilvadipine immediately following nifedipine therapy showed a significant decrease in lower-leg volume as compared with those continuing to receive nifedipine. In about half of the patients receiving nilvadipine, nifedipine-induced lower-leg edema disappeared completely. No differences were seen between the two substances in terms of effectiveness or tolerability.

Aged↗
PubMedDate not supplied

Local reaction and serological response in commercial layer chickens injected intramuscularly in the leg with oil-adjuvanted Mycoplasma gallisepticum bacterin.

The incidence of local vaccine reaction was investigated in three flocks of commercial layer chickens after they were vaccinated intramuscularly in the leg with oil-adjuvanted Mycoplasma gallisepticum (MG) bacterin by commercial crews. Local vaccine reaction typically involved swelling due to a granulomatous cellulitis in the connective tissue above the tibiotarsal joint of the vaccinated leg. Histopathology revealed that the inflammatory reaction was confined primarily to subcutis and muscle fascia and rarely extended into muscle fibers, tendons, or tendon sheaths. Movement of the vaccinated flocks from growing to laying houses was associated with a significant increase in the incidence and severity of leg swelling. Antibodies against MG as measured by the hemagglutination-inhibition test were significantly higher in chickens with severe leg swelling than in chickens without leg swelling.

Adjuvants, Immunologic↗
PubMed1996

Resistance to activated protein C: a common anticoagulant deficiency in patients with venous leg ulceration.

Patients with leg ulcers caused by venous insufficiency often show evidence of previous deep venous thrombosis. Resistance to activated protein C (APC resistance) is a newly identified, autosomal dominant inherited defect in the anticoagulant system which significantly predisposes affected individuals to develop venous thrombosis. To elucidate the significance of APC resistance in venous leg ulcer patients, APC resistance was determined in plasma samples obtained from 46 unselected, consecutive patients with venous leg ulcers, admitted to hospital during a 6-month period. Twelve of the 46 patients (26%: 95% confidence limits, 14-41%) had APC resistance. APC resistance is thus a common anticoagulant deficiency among patients with venous leg ulceration and should be considered a risk factor for the development of venous leg ulcer disease.

Aged↗
PubMed1997

Sensorimotor pathways involved in interjoint reflex action of an insect leg.

Coordination of motor output between leg joints is crucial for the generation of posture and active movements in multijointed appendages of legged organisms. We investigated in the stick insect the information flow between the middle leg femoral chordotonal organ (fCO), which measures position and movement in the femur-tibia (FT) joint and the motoneuron pools supplying the next proximal leg joint, the coxa-trochanteral (CT) joint. In the inactive animal, elongation of the fCO (by flexing the FT joint) induced a depolarization in eight of nine levator trochanteris motoneurons, with a suprathreshold activation of one to three motoneurons. Motoneurons of the depressor trochanteris muscle were inhibited by fCO elongation. Relaxation signals, i.e., extension of the FT joint, activated both levator and depressor motoneurons; i.e., both antagonistic muscles were coactivated. Monosynaptic as well as polysynaptic pathways contribute to interjoint reflex actions in the stick insect leg. fCO afferents were found to induce short latency EPSPs in levator motoneurons, providing evidence for direct connections between fCO afferents and levator motoneurons. In addition, neuronal pathways via intercalated interneurons were identified that transmit sensory information from the fCO onto levator and/or depressor motoneurons. Finally, we describe two kinds of alterations in interjoint reflex action: (a) With repetitive sensory stimulation, this interjoint reflex action shows a habituation-like decrease in strength. (b) In the actively moving animal, interjoint reflex action in response to fCO elongation, mimicking joint flexion, qualitatively remained the same sign, but with a marked increase in strength, indicating an increased influence of sensory signals from the FT joint onto the adjacent CT joint in the active animal.

Afferent Pathways↗
PubMed1998

[Polyneuropathy in patients with periodic leg movements during sleep].

INTRODUCTION: Periodic legs movements of sleep (PLMS) are rhythmic, standard and repetitive contractions of muscles of the extremities during the sleep. It is known that the patients with restless legs syndrome (RLS) have disorders during the sleep: increase in the latency of the sleep, increased number of arousal, etc.; most of them have also periodic movements of the legs during the sleep. OBJECTIVE: The relationship of the periodic movements of the legs during the sleep with polyneuropathy is not clear. Some authors have found evidence of electrophysiological and pathological of signs of axonal mild polyneuropathy in patients with restless legs syndrome. In this work, we evaluated nine patients that were diagnosed of PLMS, to determine the prevalence of neuropathy in such sample. METHOD: Polysomnography of nocturnal sleep of 7-8 hours was performed, including electromyographic recording of both anterior tibialis muscles; and electroneurographic study of peroneal, sural, ulnar and median nerves. DISCUSSION: Just in none of the nine studied cases were obtained electrophysiological signs of neuropathy; though it has been able to demonstrate the existence of mild alteration of the peripheral nervous system, fundamentally of sensory character; nevertheless, C we think that it would have to be studied the existence of polyneuropathy in all the patients with PLMS in order to discard potentially tractable organic causes.

Adult↗
PubMed1996

Comparison of venous reflux in the affected and non-affected leg in patients with unilateral venous ulceration.

In 54 patients with unilateral leg ulceration of purely venous aetiology the only difference in venous reflux between affected and non-affected legs was with respect to the popliteal and crural veins. Deep and superficial venous reflux is common in legs without the skin changes typical of chronic venous insufficiency. The significance of venous reflux in an ulcerated leg cannot therefore be determined without reference to the contralateral, clinically normal, limb. Surgery should be directed at correcting reflux present in the ulcerated limb but not in the unaffected limb. In a minority of patients this entails superficial venous surgery alone, but in the majority such an approach would, ideally, entail correction of deep venous incompetence.

Aged↗
PubMed1998

[Analysis of leg geometry--standard techniques and normal values].

The diagnosis of malalignments of the lower extremities includes analysis of the geometry of the whole leg. The first step in the diagnostic process is a standardized physical examination. It provides valuable background information for an effective radiological diagnosis. Even with a thorough standardized physical examination it is not possible to define exactly the deformity or decide on an operative procedure. The diagnosis of axis deviations in the frontal plane can be measured on a conventional plain X-ray of the whole leg. In this view it is very important that the knee joints are in a true a.p. view independent on torsional deformities of the lower legs. Today the gold standard to measure the torsion and length of the lower extremities is the CT scan. However, the multitude of analytical methods for CT measurements described in the literature do not lend themselves readily to comparison; thus, it is difficult to identify a clear method of choice. Not every CT measurement is better than a physical examination. Evidence of reproducibility and accuracy is a prerequisite for useful interpretation of the results. Up to this point in the literature there are only reference values for the Ulm CT Method. One alternative is the MR scan, which avoids radiological risks, but the reproducibility and accuracy of the MRI method are not as good as for the CT method. Another alternative is ultrasound, where recent advances in the measurement of torsion and length of the lower extremities have proven competitive with or superior to the accuracy of MRI. The three-dimensional determination of the torsion and length of the lower extremities by ultrasound has now assumed a leading role in the non-radiological diagnosis of malalignments of the lower extremities in children and adolescents. This method furthermore is increasingly being used in preoperative planning of leg deformities in adults.

Adolescent↗
PubMed1977

Predictability of healing of ischemic leg ulcers by radioisotopic and Doppler ultrasonic examination.

In a prospective study of twenty-six patients with ischemic ulcerations of the lower extremity, the predictive reliability with regard to spontaneous wound healing of diabetes, pedal pulses, ankle blood pressure (ABP) as measured by doppler ultrasound, and "leg ulcer scan" as performed by the intra-arterial injection of radioactive albumin was evaluated. The results suggest that only the leg ulcer scan is significantly reliable in predicting the likelihood of spontaneous healing. The following format for the evaluation of the ischemic leg ulcer is therefore suggested: (1) If pedal pulses are present, a three week trial of conservative therapy is indicated before further evaluation. (2) If the doppler ABP is 50 mm Hg or less, the ulcer will not heal spontaneously. (3) Leg ulcer scan is indicated: (a) in the absence of pedal pulses if ABP is less than 50 mm Hg; (b) in the presence of pedal pulses if there is no evidence of spontaneous healing after three weeks of conservative therapy.

Humans↗
PubMed1986

Reconstruction of the lower leg and foot with the reverse-pedicled anterior tibial flap: preliminary report of a new fasciocutaneous flap.

The blood supply to the skin of the anterior leg was studied in 10 fresh cadavers. Particular attention was paid to the intermuscular septal blood vessels, which emerge in the cleft between tibialis anterior and extensor hallucis longus and extensor digitorum longus muscles. With this anatomical knowledge, the reverse-pedicled anterior tibial fasciocutaneous flap was designed and transferred clinically to cover lower leg and foot defects in 6 patients. Three case reports are detailed. The factors which allow a distally based flap to be raised in the lower leg against the direction of venous valves are also described. The versatility of this new flap in the reconstruction of defects of the lower leg and foot is discussed.

Adult↗
PubMed1993

Altered muscle metabolism shown by magnetic resonance spectroscopy in sickle cell disease with leg ulcers.

We performed 31P magnetic resonance spectroscopy of gastrocnemius muscle at rest in 7 normal volunteers and 12 patients with sickle cell disease (7 with leg ulcers and 5 without leg ulcers but with painful crises). We measured intracellular pH and ratios of Pi to ATP, PCr to ATP and PCr to Pi (Pi = inorganic phosphate, ATP = adenosine triphosphate, and PCr = phosphocreatine). Magnetic resonance arteriograms were also performed. Significant differences were found for PCr/Pi ratios between normals and sickle cell disease patients with leg ulcers (p < 0.008). Magnetic resonance arteriograms were normal in volunteers and patients with sickle cell disease. The altered high energy phosphate metabolism in sickle cell disease with leg ulcers is consistent with muscle ischemia or hypoxia.

Adult↗
PubMed2006

A novel reconstruction technique for the knee and upper one third of lower leg.

Various reconstructive choices for the coverage of soft tissue defects around the knee joint or upper one third of lower leg are available depending on the location, size and depth of the defect. The authors have found the medial sural artery perforator island flap a useful method for reconstruction of the upper one third of lower leg and knee. From January 2003 to November 2005, medial sural perforator island flaps were used on six patients, five were men and one was a woman. The largest flap obtained was 16 x 7 cm. In three cases, defects were located on the upper one third of lower leg and in the other cases, on the knee. Four of them bone exposed, and two cases had a post-burn contracture. All six flaps survived completely, without even minor complications. Postoperative follow up of the patients ranged from 2 to 33 months. The main advantages of the medial sural perforator island flap are a constant location and reliable blood supply without sacrifice of any main source artery and underlying muscle. This procedure is a valuable extension of local flap for defect coverage with minimal functional deficit of donor site and good aesthetic result on the defect and is a useful method for reconstruction of the upper one third of lower leg and knee.

Accidents, Traffic↗
PubMed2006

Risk factors for leg length discrepancy in patients with congenital vascular malformation.

OBJECTIVES: This study was conducted to determine the clinical risk factors for the development of leg length discrepancy (LLD) in patients with congenital vascular malformation (CVM) affecting the lower extremity. METHODS: A retrospective analysis was conducted of a prospectively collected database that included 361 patients who underwent assessment of a CVM lesion from September 1994 to January 2005. We measured LLD using lower extremity scanograms of 229 patients who were suspected of having LLD on physical examination. The risk factor analysis for a clinically significant LLD (>2 cm) was performed with the variables of age, gender, features of CVM (type, extent and depth), and the deep vein status (agenesis, hypoplasia, phlebectasia) of the affected limb. Fisher's exact test and the chi(2) test were used for the univariate analysis, and a logistic regression test was performed for the multivariate analysis. Among the patients with LLD, we compared the overgrowth group and undergrowth group with the Fisher's exact test to identify differences between the two subgroups. RESULTS: The included patients were 153 males (42%) and 208 females (57%) with a mean age of 20 +/- 14 years (range, 1 to 62). There were 157 patients (43%) in the still growing age group (age <15 years) and 204 (57%) were in the finished growing age group (age >15 years). The types of CVMs included 215 venous (60%), 43 arteriovenous (12%), 46 lymphatic (13%), and 57 (16%) combined venolymphatic malformations. On the lower extremity scanogram, 26 patients (7%) had a LLD of >2 cm due to overgrowth (n = 20) or undergrowth (n = 6) of the affected limbs. The univariate analysis showed that a venolymphatic malformation (P = .003) and a whole leg CVM (P = .000) were significant risk factors for development of LLD. However, the multivariate analysis identified the whole leg CVM lesion as a single independent risk factor for LLD (P = .004; odds ratio, 6.512, 95% confidence interval, 1.788 to 23.713). On subgroup analysis, a whole leg CVM was also identified as a risk factor for overgrowth of the affected limb. In a comparison between two subgroups of LLD (overgrowth v. undergrowth), overgrowth was significantly (P = .022) more common in female than in male patients. CONCLUSIONS: As a clinical risk factor for development of LLD, the extent of the CVM lesion was a single independent risk factor regardless of the type or depth of the CVM lesion. In addition, our data suggest that overgrowth or undergrowth of the affected limb, as a cause of LLD, might be related to gender.

Adolescent↗
PubMed2005

[Long-term follow-up after leg replantation].

Leg replantation is generally considered to yield good results, particularly since the widespread use of progressive lengthening procedures. This optimism must be weighted against the very long and difficult operative program, the social and occupational implications, and the functional outcome of the replanted limb. We report a case of below knee leg replantation in a young patient whose operative program lasted 29 months. Occupational activities were interrupted for three years. The clinical result was satisfactory but with 14 degrees residual valgus suggesting a potential risk of osteoarthritis and difficult therapeutic decisions. The alternatives to replantation are controversial. Leg transplantation is not a valid option in our opinion. Amputation with orthesis should be considered more often because complications are rare and recovery much shorter. Indications for leg replantation should be considered with prudence.

Adult↗
PubMed2002

Hepatocyte growth factor may accelerate healing in chronic leg ulcers: a pilot study.

BACKGROUND: Hepatocyte growth factor (HGF) is a heparin-binding protein with mitogenic, motogenic and morphogenic activities for various cell types. The regenerative properties of HGF have been the object of several animal and in vitro studies in recent years. OBJECTIVE: To investigate the physiological and therapeutic effects of HGF on chronic leg ulcers. METHODS: HGF in gel form was locally applied, once daily for 7 days, to 15 of 19 chronic leg ulcers in 11 elderly patients. All patients had previously been treated by conventional methods and their leg ulcers had been in stable conditions for between 1 and 14 years. Any signs of allergy, discomfort or pain were reported daily. Microcirculation perfusion in the ulcers, compared to the intact contiguous skin, was determined by laser Doppler at the beginning of the study, after 1 week and again after 3 months (in seven patients). Ulcer size and characteristics were also documented. RESULTS: It was observed that microcirculatory perfusion, which might reflect the angiogenic effect of HGF, was statistically significantly correlated (r = 0.94, p < 0.002) to ulcer area reduction in the treated ulcers. Excellent (84-100% area reduction) or partial healing (58-59%) was seen in eight out of 11 patients. No control group was included in this pilot study, which must be completed by proper control studies. CONCLUSION: This study suggests that HGF may heal chronic leg ulcers, possibly by improving the microcirculation. Proper control studies need to be performed.

Aged↗
PubMed2001

Ankle to brachial pressure index in normal subjects and trained cyclists with exercise-induced leg pain.

PURPOSE: This study compared ankle to brachial pressure indices (ABPI) before and after maximal exercise in three groups in order to investigate maximal exercise testing and ABPI as a useful procedure for the differential diagnosis of exercise-induced leg pain (EILP) in athletes. METHODS: ABPI measurements were taken before and after cycle ergometer exercise to volitional exhaustion or reproduction of symptoms in three groups: 1) untrained individuals (N = 10, 3 female, 7 male; age 35 +/- 5 yr (mean +/- SD)); 2) trained cyclists (N = 10, 3 female, 7 male; age, 30 +/- 5 yr); and 3) symptomatic group of trained cyclists, complaining of EILP (N = 12, 2 female, 10 male; age, 35 +/- 9 yr). RESULTS: Resting blood pressure indices were similar in all groups. ABPI were reduced (P < 0.05) in all groups after exercise. No differences between left and right legs were noted in the elite and untrained groups; however, a significant difference (P < 0.05) was noted between the nonsymptomatic (0.79 +/- 0.10) and symptomatic (0.61 +/- 0.20) legs in the subjects with EILP. Despite these group results, only three subjects in the symptomatic group met the published criteria (index of < 0.5) for endofibrosis of the external iliac artery. All positive ABPI tests were subsequently confirmed via arteriogram. CONCLUSION: Maximal exercise testing combined with ABPI measurement is a simple noninvasive procedure that may be useful for the examination of EILP. The results of this study suggest that, in cases with unilateral symptoms, a between-leg ABPI difference of 0.18 (at the first minute of recovery) may be considered as a useful additional diagnostic criterion.

Adult↗
PubMed1991

Leg-length inequality in people of working age. The association between mild inequality and low-back pain is questionable.

Leg-length inequality was measured from radiographs at the level of the vertices of the femoral heads in 247 men and women aged 35-54 years. Of these, 53 had never had any low-back problem, but they had considerable variation in leg-length inequality (mean SD, 5.5 +/- 4.1 mm; range, up to 20 mm). This group of symptom-free individuals did not differ from a group of 78 persons who had disabling low-back pain (LBP) during the previous 12 months (mean SD, 5.3 +/- 4.0 mm; range, up to 17 mm). The adjusted relative risks (odds ratios) of having LBP ever and of disabling pain during the last 12 months were 0.78 (95% confidence interval, 0.43-1.17) and 1.02 (0.68-1.38), respectively, for an increase of 5 mm in leg-length inequality. The results from this study make an association between mild leg-length inequality and LBP questionable.

Adult↗
PubMed2002

Tennis leg: clinical US study of 141 patients and anatomic investigation of four cadavers with MR imaging and US.

PURPOSE: To evaluate the ultrasonographic (US) findings in patients with a referring diagnosis of tennis leg and to explore the relative importance of the plantaris tendon and gastrocnemius muscle in the pathogenesis of this condition. MATERIALS AND METHODS: A cadaveric study was performed to outline the normal anatomy of the posterosuperficial compartment of the calf. Magnetic resonance (MR) imaging and US were performed, followed by gross anatomic correlation. US findings in 141 patients referred with a clinical diagnosis of tennis leg were retrospectively reviewed by means of consensus of two radiologists. Images were analyzed with respect to the integrity of the lower-leg musculotendinous units, presence of fluid collection, and deep venous thrombosis. RESULTS: MR imaging and US enabled distinction of the musculotendinous unit of the plantaris from the remaining muscles of the lower extremity in cadaveric specimens. US findings in the 141 patients included rupture of the medial head of the gastrocnemius muscle in 94 patients (66.7%), fluid collection between the aponeuroses of the medial gastrocnemius and soleus muscles without muscle rupture in 30 patients (21.3%), rupture of the plantaris tendon in two patients (1.4%), and partial rupture of the soleus muscle in one patient (0.7%). Deep venous thrombosis was seen in isolation in 14 patients (9.9%). CONCLUSION: In patients with clinical findings of tennis leg who undergo US, abnormalities of the medial gastrocnemius muscle appear to be more common than those of the plantaris tendon.

Adult↗