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PubMed2006

Treatment effects of combined radio-frequency current and a 900 nm diode laser on leg blood vessels.

BACKGROUND AND OBJECTIVES: Effective laser treatment of leg veins remains a major challenge. The present study examined the safety and efficacy of a new technology for leg vein treatment combining 900 nm diode laser with radiofrequency (RF) current. STUDY DESIGN/MATERIALS AND METHODS: Forty patients, skin types II-IV, received a maximum of three treatments on 1-4 mm leg veins at 2-week intervals with a 900 nm diode laser (250 millisecond exposure time, average fluence 60 J/cm2) and RF (energy 100 J/cm3). Results were assessed after each treatment and at 2 and 6 months after the final session. Patients rated their satisfaction with the clinical outcome on a five-item scale. Clinician and computer analysis of the clinical photography was also performed, in addition to histological assessment. RESULTS: One or two sessions were required in the majority of patients. Shortly after treatment, histology revealed contracted vessels with perivascular edema. Side effects were extremely rare. The clinician 2- and 6-month assessments showed that 70% and 82.5% of subjects, respectively, achieved over 50% clearance, with patient and computer assessments lower and slightly higher, respectively. Treatments showed greater efficacy on thicker vessels and in the darker skin types. CONCLUSIONS: The success of the treatment, minimal side effects, and patient comfort suggest that this combination is an effective, safe technique for leg vein treatment. When compared to previous studies using diode laser alone, the very low fluence needed to achieve vessel clearance emphasizes the role of RF energy.

Adult↗
PubMed2005

Subacute reconstruction of lower leg and foot defects due to high velocity-high energy injuries caused by gunshots, missiles, and land mines.

The present study reviews 215 male patients suffering high velocity-high energy injuries of the lower leg or foot caused by war weapons such as missiles, gunshots, and land mines. They were treated in the Department of Plastic and Reconstructive Surgery at Gulhane Military Medical Academy (Ankara, Turkey) between November 1993-January 2001. Severe soft-tissue defects requiring flap coverage and associated open bone fractures that were treated 7-21 days (mean, 9.6 days) after the injury were included in the study. Twenty-three of 226 extremities (10.2%) underwent primary below-knee amputation. The number of debridements prior to definitive treatment was between 1-3 (mean, 1.9). Gustilo type III open tibia fractures accompanied 104 of 126 soft-tissue defects of the lower leg. Sixty-four bone defects accompanied 83 soft-tissue defects of the feet. Eighteen local pedicled muscle flaps and 208 free muscle flaps (latissimus dorsi, rectus abdominis, and gracilis) were used in soft-tissue coverage of 209 defects. Overall, the free muscle flap success rate was 91.3%. Bone defects were restored with 106 bone grafts, 25 free fibula flaps, and 14 distraction osteogenesis procedures. Osseous and soft-tissue defects were reconstructed simultaneously at the first definitive treatment in 94% of cases. The mean follow-up after definitive treatment was 25 (range, 9-47) months. The average full weight-bearing times for lower leg and feet injuries were 8.4 months and 4 months, respectively. Early, aggressive, and serial debridement of osseous and soft tissue, early restoration of bone and soft-tissue defects at the same stage, intensive rehabilitation, and patient education were the key points in the management of high velocity-high energy injuries of the lower leg and foot.

Adult↗
PubMed2001

Vascular complication in free tissue transfer to the leg.

The lower-extremity free flap has a high incidence of vascular complication. A retrospective study of 70 free flap transplants in 70 patients (1987-2000) was conducted to investigate factors leading to vascular complication and free flap failure. The overall success rate was 92% (64 of 70 flaps); the incidence of vascular complications was 22% (16 of 70 flaps). Among 16 complicated flaps, 7 were transferred in severely crushed legs, and 4 were in multioperated legs attributable to chronic osteomyelitis. Venous thrombosis occurred in 12 flaps (86%). The success rate of the patients operated on at Yamaguchi University Hospital was higher (96%) than at other hospitals tested. The key factors contributing to improved outcome in free tissue transplantation in the leg were careful preoperative planning for highly traumatized legs and proper selection of the recipient vein and of the hospital at which immediate reexploration can be performed for vascular complicated flaps.

Adolescent↗
PubMed2003

Acute leg-cycling exercise attenuates the H-reflex recorded in soleus but not flexor carpi radialis.

The amplitude of the Hoffman reflex (H-reflex) in the soleus muscle is attenuated after acute bouts of leg-cycling exercise. The attenuation has been interpreted as a "tranquilizing" effect of exercise controlled by the central nervous system and generalized beyond a single spinal segmental level. If so, the postexercise depression of the H-reflex should occur in both the soleus and the flexor carpi radialis (FCR) muscle, which is not actively involved during leg cycling. This experiment examined the effect of moderate-intensity cycling exercise on the H-reflex recorded in soleus and FCR among 16 men. The H-reflex was measured immediately before and 10 min after 30 min of either moderate-intensity leg cycling (60% VO(2peak)) or quiet rest. The acute bout of cycling exercise reduced the H-reflex in the soleus but not in the FCR. Thus, the attenuation of the H-reflex after leg cycling does not generalize beyond the spinal segmental level that modulates the involved locomotory muscles; it is likely the result of segmental processes associated with the repetitive stretching or activation of the soleus muscle.

Adult↗
PubMed1990

Comparison of distraction epiphyseolysis and partial metaphyseal corticotomy in leg lengthening.

We have used Ilazorov's method of distraction epiphyseolysis for leg lengthening since 1977 and his new method of corticotomy or compactotomy since 1983. The first method was carried out in 22 lower limbs with an average lengthening of 8.25 cm (range 4 to 18 cm); included in this group are 2 patients with achondroplasia in whom both legs were lengthened 12 cm. In the second method, a corticotomy is carried out at the metaphyseal-diaphyseal junction followed by distraction in Ilazorov's apparatus (4 x 0.25 mm a day). We lengthened 30 legs; included are 5 patients who had both legs lengthened from between 8 and 12 cm. In the remainder an average of 7.9 cm of lengthening was achieved (range from 4 to 15 cm). The index for the treatment time per cm achieved (time from operation until full weight-bearing per cm of lengthening) was shorter after distraction epiphyseolysis than after corticotomy. Complications were also a little less after the latter procedure. Distraction epiphyseolysis has to be limited to children from aged 12 years until growth ceases. The advantage with corticotomy is that it can be done at any age from 5 to 30 years. Care is needed in both cases to avoid complications.

Adolescent↗
PubMed1995

The hybrid mass-spring pendulum model of human leg swinging: stiffness in the control of cycle period.

Human leg swinging is modeled as the harmonic motion of a hybrid mass-spring pendulum. The cycle period is determined by a gravitational component and an elastic component, which is provided by the attachment of a soft-tissue/muscular spring of variable stiffness. To confirm that the stiffness of the spring changes with alterations in the inertial properties of the oscillator and that stiffness is relevant for the control of cycle period, we conducted this study in which the simple pendulum equivalent length was experimentally manipulated by adding mass to the ankle of a comfortably swinging leg. Twenty-four young, healthy adults were videotaped as they swung their right leg under four conditions: no added mass and with masses of 2.27, 4.55, and 6.82kg added to the ankle. Strong, linear relationships between the acceleration and displacement of the swinging leg within subjects and conditions were found, confirming the motion's harmonic nature. Cycle period significantly increased with the added mass. However, the observed increases were not as large as would be predicted by the induced changes in the gravitational component alone. These differences were interpreted as being due to increases in the active muscular stiffness. Significant linear increases in the elastic component (and hence stiffness) were demonstrated with increases in the simple pendulum equivalent length in 20 of the individual subjects, with r2 values ranging between 0.89 and 0.99. Significant linear relationships were also demonstrated between the elastic and gravitational components in 22 subjects, with individual r2 values between 0.90 and 0.99.(ABSTRACT TRUNCATED AT 250 WORDS)

Acceleration↗
PubMed1991

Activity and directional sensitivity of leg campaniform sensilla in a stick insect.

1. The mechanoreceptive campaniform sensilla, which are arranged in groups on insect legs, were studied in the stick insect Cuniculina impigra. In middle and rear legs, the most posterior trochanteral campaniform group (group 1) is oriented so as to be stimulated by compressional cuticular forces acting on the posterior articulation of the trochanter with the coxa. 2. Recordings from nerve Tr2, which innervates this campaniform group, confirmed that the sensilla were directionally sensitive to cuticular stress generated by imposed or active movements of the femur. Different individual sensilla had different thresholds of response, but all responded qualitatively in the same way to a given stimulus. 3. Posteriorward horizontal deflection of the femur-trochanter relative to the coxa (at right angles to the normal plane of movement) produced a strong excitation of the group 1 sensilla. Anteriorward horizontal deflection caused a sharp reduction of on-going background activity in the group. Imposed vertical movements of the femur usually had little effect on the activity of the campaniform sensilla. 4. Active depression of the femur-trochanter by the animal reduced on-going background activity in proportion to the strength of the depression movement. Elevation that simulated muscle-generated lifting of the leg strongly increased activity. 5. It is concluded that campaniform group 1 functions to signal passive horizontal and active vertical movements around the trochantero-coxal joint of the leg. This dual pattern of response means that the animal cannot interpret signals from this campaniform group without also having information about muscle activity.

Animals↗
PubMed1995

Kinematic analysis of wing and leg movements for type I motility in E9 chick embryos.

Based on studies using direct observation methods, type I motility, the first motility pattern to emerge in chick embryos, is characterized as random, uncoordinated movement. Yet, electromyographic (EMG) studies indicate that leg muscles are recruited in orderly patterns of alternating flexor and extensor activity during type I motility. It has been suggested that this apparent paradox may be attributable to perturbations arising during movement in ovo under buoyant conditions. It is also possible that direct observation methods are insufficient to detect the extent of coordination between body parts during type I motility. To address the apparent discrepancy between random features reported in observational studies and reliable features reported in EMG studies, embryos were video recorded continuously for 60 min at embryonic day 9 and criteria were established to obtain homogeneous samples of motility for kinematic analysis of synchronous wing and leg movements. Limited to a single camera attached to a stereomicroscope, methods were developed to correct for out-of-plane movements of the ipsilateral wing and leg. Also, amniotic fluid was extracted from the egg in some recordings to test the possibility that movement under buoyant conditions may mask coordinated movement. Extended sequences of activity were digitized and analyzed. Results indicated that within a limb (wing or leg), direction and timing of excursions at adjacent joints co-varied and limb excursions were characterized by reliable patterns of alternating flexion and extension consistent with EMG studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Activity Cycles↗
PubMed1987

Short- and long-latency tibial somatosensory evoked potentials in cerebral lesions affecting Rolandic leg areas.

Short- and long-latency tibial somatosensory evoked potentials (SEPs) were studied in nine patients with clinical presentation primarily involving one lower extremity. In group 1, with extensive infarcts in the territory of anterior cerebral artery, tibial cortical SEPs were uniformly absent. In group 2, with small infarcts involving Rolandic leg areas, tibial SEPs showed a decrease in overall response amplitude and attenuation of P40. In group 3, with discrete mass lesions compressing Rolandic leg areas, P40 was preserved but might be delayed. Late SEP components (N75, P100 and N135) tended to be preserved in the patients of group 2 and 3. The data suggest that Rolandic leg areas and the neighboring cortex are crucial for short- and long-latency tibial cortical SEPs and that small lesions affecting Rolandic leg areas tend to affect short- and mid-latency SEP components.

Adult↗
PubMed1986

Phase plane modeling of leg motion.

Phase plane analysis of dynamical systems, in which variables are plotted against their time derivatives, has been recently emphasized as a general method for reconstructing system dynamics from data. The purpose of this experiment was to develop a model of leg movement in a stepping task using the phase plane approach. In this model, the leg is represented as a three-body linkage and the motion of the leg is assumed to be planar with four degrees of freedom. Experimental data was collected on one subject stepping six times, using a two dimensional videomotion analysis system with reflective markers placed on the lower limb joints. A computer program able to solve the equations of motion and compute the state of the system for a given task was implemented. This computer program was written to generate the motion of the leg for a given task using inverse kinematics and a preplanned foot path. Foot trajectories with cycloidal, constant acceleration/deceleration and sinusoidal velocity profiles were studied. From the results, an attempt was made to identify the variables which are measured and to determine the motion characteristics during stepping. The preliminary results support the concept of a hierarchical control structure with open-loop control during normal operation. During routine activity there is no direct intervention of the Central Nervous System (CNS). The results support the existence of preprogramming and provide a starting point for the study of the development of control in multiarticulate movements.

Foot↗
PubMed1988

Effects of leg activity and ambient barometric pressure on foot swelling and lower-limb skin temperature during 8 h of sitting.

Prolonged immobilization in an upright position often leads to discomfort and oedema in the feet of otherwise healthy subjects. To determine the significance of leg activity and ambient pressure on oedema formation, skin temperature (Tsk) and discomfort, 6 volunteers sat for 8 h with one leg immobilized and the other spontaneously active; one day at "sea level" (750 mmHg) and one day at reduced barometric pressure (540 mmHg). Foot swelling was measured by water plethysmography. Leg movements were continuously monitored by a Vitalog computer, and foot discomfort was estimated by analog-visual scales. The 8 hour swelling averaged 5.7% in the inactive foot, and 2.7% in the active foot (p less than 0.001). Tsk of the inactive foot levelled off towards ambient temperature (21 degrees C) within 4 h. For the active foot this fall was reduced by 2-3 degrees C (p less than 0.025). The increase in foot discomfort during the day was lowest in the active foot (p less than 0.005). High foot Tsk was associated with a high foot swelling rate. Reduced ambient barometric pressure had no effects on foot swelling or Tsk. It is concluded that modest leg activity during 8 h of sitting has several effects on the circulation in the feet: some effects promote and some prevent oedema formation. However, the net result is a reduction in foot swelling.

Adult↗
PubMed1986

Sympathetic response to maximal bicycle exercise before and after leg strength training.

Plasma catecholamine concentrations at rest and in response to maximal exercise on the cycle ergometer (278 +/- 15 watts, 6 min duration) have been measured on seven young active male subjects (19 +/- 1 years old; 80 +/- 3 kg; 176 +/- 3 cm) prior to and after a eight week leg strength training program (5RM, squat and leg press exercise). Strength training resulted in a significant increase in performance on squat (103 +/- 3 to 140 +/- 5 kg) and leg press exercise (180 +/- 9 to 247 +/- 15 kg) associated with a small significant increase in lean body mass (64.5 +/- 2.2 to 66.3 +/- 2.1 kg) and no change in maximal oxygen consumption (47.5 +/- 1.3 to 46.9 +/- 1.2 ml X kg-1 X min-1). Plasma norepinephrine (NE) and epinephrine (E) concentrations (pg X mL-1) were not significantly different before and after training at rest (NE: 172 +/- 19 vs 187 +/- 30; E: 33 +/- 10 vs 76 +/- 16) or in response to maximal exercise (NE: 3976 +/- 660 vs 4163 +/- 1081; E: 1072 +/- 322 vs 1321 +/- 508). Plasma lactate concentrations during recovery were similar before and after training (147 +/- 5 vs 147 +/- 15 mg X dL-1). Under the assumption that the "central command" is reduced for a given absolute workload on the bicycle ergometer following leg strength training, these observations support the hypothesis that the sympathetic response to exercise is under the control of information from muscle chemoreceptors.

Adult↗
PubMed1994

Circumferential "intermediate" lipoplasty of the legs.

Circumferential intermediate lipoplasty of the thighs and lower legs is an expansion of the traditional lipoplasty technique. Rather than limiting the correction to defined bulges, the goal is to thin the thigh or the calves and ankles circumferentially. This procedure is not indicated for all patients. In selected patients with extremely heavy thighs, medial and lateral bulges, full anterior thighs, and a full posterior thigh in the upper third, circumferential liposuction improves the results and produces a slimmer thigh. In the calves and ankles, circumferential lipoplasty reduces the entire lower leg giving a more attractive result rather than just reducing the medial and lateral ankle bulges. The concept of intermediate lipoplasty is introduced. This technique has advantages over the superficial technique and the traditional deep lipoplasty. No special equipment, incisions, drains, or change in technique is needed. Using circumferential intermediate lipoplasty to contour the entire lower leg results in a slimmer looking leg. There has been no increase in complications. The author reviews his experience with this technique.

Adult↗
PubMed1993

Volume changes in the lower leg during quiet standing and cycling exercise at different ambient temperatures.

The purpose of this study was to investigate whether ambient temperature influences both the rate of leg swelling during orthostasis and the oedema-preventing effect of the skeletal muscle pump. Using mercury-in-rubber strain gauges, volume changes were measured in the calf (n = 34) and near the ankle (n = 24) in healthy volunteers aged 19-33 years. Measurements were performed during 12 min of motionless standing in an upright posture and during 17 min of cycle exercise at intensities of 50 W and a pedalling rate of 50 rpm. The experiments were done in an air-conditioned chamber at temperatures of 20, 28 and 36 degrees C and 50% relative humidity. The rate of leg swelling, which occurred while standing, did not differ significantly among the three temperatures. The mean increases in calf volume during 10 min (min 2-12) orthostasis were 1.6 (SEM 0.1)%, 1.9 (SEM 0.2)% and 2.0 (SEM 0.2)% at 20, 28 and 36 degrees C respectively. In the ankle region the mean values were 0.9 (SEM 0.1)%, 1.0 (SEM 0.1)%, and 1.0 (SEM 0.1)% at the three temperatures, respectively. Exercising at low temperatures continuously reduced the volume of the leg, but at 36 degrees C the leg volume did not change significantly either at the calf or near the ankle. The mean volume changes measured between min 2 and min 15 were, at the calf, -1.1 (SEM 0.1)%, -0.8 (SEM 0.2)%, and -0.02 (SEM 0.1)% at 20, 28 and 36 degrees C, respectively. Near the ankle the mean changes were -0.7 (SEM 0.1)%, -0.3 (SEM 0.1)%, and +0.2 (SEM 0.1)%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Cardiorespiratory response at the onset of passive leg movements during sleep in humans.

To examine the ventilatory response at the onset of passive leg movements during sleep in man and the concomitant changes in cardiac output (Qc), five healthy male subjects had their knee joints extended and flexed alternately at a frequency of about 60.min-1 for about 8 s. Minute ventilation (VI), respiratory frequency, tidal volume, end-tidal partial pressure of carbon dioxide and of oxygen, stroke volume (SV), heart rate (fc) and Qc were measured before, during and after passive leg movement during sleep stage III or IV (SLEEP). These values were compared with those of the awake condition (AWAKE). The VI increased significantly (P < 0.05) compared with the mean of five breaths preceding the movement (pre-movement) within one or two breaths at the onset of passive leg movements in both conditions. The difference between the mean of the first and second breaths after the onset of leg movement and pre-movement was 5.2 (SEM 1.9) l.min-1 for SLEEP and 2.7 (SEM 1.1) l.min-1 for AWAKE, respectively. Four of the five subjects showed a larger increase in ventilation during SLEEP compared with AWAKE. The fc increased significantly (P < 0.05) at the beginning of the passive movement in all cases, while SV showed an increase or decrease so that Qc showed no significant change in either condition. These results would suggest that afferent drive from moving limbs could produce an increase in ventilation without any change in Qc.

Adult↗
PubMed1990

A new method for measuring power output in a single leg extension: feasibility, reliability and validity.

A method is described for measuring the explosive power of the leg in extension which has been found safe and acceptable for all age groups and levels of physical capability. The extension movement takes 0.25-0.40 s in a push through 0.165 m against a flat pedal. At the end of the push the leg is fully extended. The movement is made seated so that the forces are contained between the buttocks and the foot. The seat position is adjusted for leg length and the push is transmitted by a lever and chain to spin a flywheel. The gearing is such that resistance to the movement remains velocity of the flywheel is measured by an optoswitch and used to calculated the average leg extensor power (LEP) in the push. The reliability of the power measurement was evaluated in 46 subjects ranging in age from 20 to 86 years; they included medical students and geriatric day patients. They were tested on two occasions separated by a week. The maximal values on the first occasion (best of at least five trials) ranged from 30 to 300 W (mean +/- 1 SD = 154 +/- 88 W). There was no significant difference on re-test and the coefficient of variation was 9.4%. In a subgroup of 9 non-naive subjects who were measured by an experienced observer it was 6.3%. As expected, power was lower in women than in men and declined sharply with age. The sex difference was less when the values were expressed as power per body mass; a sharp age-related decline remained.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1975

Effects of training on maximal working capacity and haemodynamic response during arm and leg-exercise in a group of paddlers.

Maximal oxygen uptake and circulatory adaptation to work with legs and arms were studied in a group of 5 paddlers members of the Belgian national squad and a control-group of 9 trained subjects. The results showed that the specific armtraining of paddlers induced changes in the arm-to-leg ration of physiological parameters at submaximal and maximal work. In the group of paddlers maximal oxygen intake and workload during arm-exercise averaged respectively 88.6% and 80.3% of the scores obtained with leg-exercise. In the control group the arm to leg ratio varied between 81.2% and 65.2%. At a submaximal load of 100 W the difference in heartfrequency was 21 beats/min in the canoe group and 35 beats/min in the control group. Oxygen consumption and ventilation during work with the arms was lower in the group of paddlers. The data of our study suggest that the specific training of paddlers do result in a effect on the haemodynamic adaptations to arm work.

Adaptation, Physiological↗
PubMed2001

Measuring lower leg swelling: optimum frequency for impedance method.

The optimum measuring frequency of the impedance plethysmograph is determined for the estimation of leg volume increase caused by a sitting work load. Ten subjects sit for 1 h without leg movement. Right calf impedance is measured by the four-electrode method. The detecting electrodes are fixed on the calf with an inter-electrode distance of 15 cm. The measuring frequencies are 5, 10, 50 and 100 kHz. As the indices of leg swelling, three values are calculated: percentage change in impedance, volume change and percentage change in volume. The mean, standard deviation and coefficient of variation (CV) are calculated from the mean values of indices for each subject and frequency. The CV of all three indices increases when measurements are taken at higher frequencies. Among the three indices across all measuring frequencies, the volume change shows the highest CV (0.42 at 5 kHz, 0.82 at 100 kHz), and the percentage change in impedance shows the lowest CV (0.32 at 5 kHz, 0.72 at 100 kHz). It is concluded that the measuring frequency of 5 to 10 kHz is the best to obtain accurate data for the evaluation of lower leg swelling.

Adult↗