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At least 1,603 records · Page 89Linked to original sources
PubMed1998

Leg ulceration in the sickle cell patient.

BACKGROUND: The purpose of this study was to determine cost of care for leg ulcers in sickle cell patients and suggest an improved modality in ulcer care. STUDY DESIGN: We performed a retrospective study of a group of sickle cell disease patients with leg ulcers. RESULTS: Eighteen patients with a leg ulcer (duration: mean, 53.7 months), sickle cell disease, and a mean of 20.7 years of age had various modalities of treatment with the only consistency in healing being a commercial moist-wound dressing. CONCLUSIONS: There is no consistency in the treatment of the sickle cell patient with a leg ulcer. Treatment with a moist dressing had the best results.

Adolescent↗
PubMed1998

Outcome of infrainguinal bypass surgery for critical leg ischaemia in patients with chronic renal failure.

OBJECTIVE: To determine whether infrainguinal bypass surgery is worthwhile in patients with critical limb ischaemia (CLI) and chronic renal failure. DESIGN: Longitudinal observational study. MATERIALS AND METHODS: Twenty-two patients with moderate renal failure indicated by serum creatinine level above 150 mumol/l, 10 patients with end-stage renal disease requiring dialysis, and three patients with functioning kidney transplant, underwent 39 bypass procedures for critical limb ischaemia. RESULTS: Six femoropopliteal, 14 femorocrural and 19 femoropedal bypasses were performed. The immediate, 1-month, and 1-year primary patency rates were 97%, 84% and 70%, respectively. The limb salvage was 93% at 1-month and 72% at 1-year follow-up. One-year patency and leg salvage rates were 81% and 79% in non-dialysis patients, and 47% and 37% in dialysis patients. At 1-year follow-up, 55% of surviving patients had salvaged limbs. None of the patients in dialysis was alive with salvaged legs 4 months after revascularisation. Among preoperative risk factors, only serum creatinine showed a statistical significance in predicting leg salvage and survival. CONCLUSIONS: As the outcome of patients on dialysis is very poor after infrainguinal bypass grafting, revascularisation is seldom indicated. On the contrary, leg salvage can achieve good results in patients not requiring dialysis.

Adult↗
PubMed2003

A wheelchair modified for leg propulsion using voluntary activity or electrical stimulation.

A commercially available wheelchair has been modified for propulsion by movements of the lower legs. The feet are attached securely to a foot rest that can rotate around the knee joint. Movement is generated either with residual voluntary activation of the quadriceps (knee extensor) and hamstring (knee flexor) muscles, or with electrical stimulation of these muscles, if voluntary control is absent. Either a chain or a lever can couple the movements through a gearbox to the wheel to propel the wheelchair forward. Control of a wheelchair with the legs is more efficient than using the arms and has the potential to increase the mobility and whole-body fitness of many wheelchair users, but there is considerable variability between subjects. To address this variability, we measured for individual subjects the passive properties of the legs and foot at rest (effective stiffness and viscosity), the length-tension (torque-angle) properties of the active muscle groups, as well as their force-velocity curve and their activation and fatigue rates. The measured values were then inserted into a model of the leg-propelled wheelchair. The purpose of this paper is to test whether the model could predict the performance of individual subjects accurately and could be used, for example, to optimize the speed of the wheelchair for a given subject.

Computer-Aided Design↗
PubMed2002

Oxygen uptake kinetics during high-intensity arm and leg exercise.

The purpose of the present study was to examine the oxygen uptake kinetics during heavy arm exercise using appropriate modelling techniques, and to compare the responses to those observed during heavy leg exercise at the same relative intensity. We hypothesised that any differences in the response might be related to differences in muscle fibre composition that are known to exist between the upper and lower body musculature. To test this, ten subjects completed several bouts of constant-load cycling and arm cranking exercise at 90% of the mode specific V(O(2)) peak. There was no difference in plasma [lactate] at the end of arm and leg exercise. The time constant of the fast component response was significantly longer in arm exercise compared to leg exercise (mean+/-S.D., 48+/-12 vs. 21+/-5 sec; P < 0.01), while the fast component gain was significantly greater in arm exercise (12.1+/-1.0 vs. 9.2+/-0.5 ml min(-1) W(-1); P < 0.01). The V(O(2)) slow component emerged later in arm exercise (126+/-27 vs. 95+/-20 sec; P < 0.01) and, in relative terms, increased more per unit time (5.5 vs. 4.4% min(-1); P < 0.01). These differences between arm crank and leg cycle exercise are consistent with a greater and/or earlier recruitment of type II muscle fibres during arm crank exercise.

Adult↗
PubMed2000

The pole-pressure test: an easy alternative in patients with ischemic legs and incompressible arteries.

BACKGROUND: Systolic ankle artery pressure measured classically by cuff-manometry and Doppler ultrasound in patients with severely ischemic legs may be falsely elevated because of impaired compressibility of the arteries. We evaluated a hydrostatic blood pressure or so-called pole pressure test by correlating the ankle artery pressure as well as tcpO2 with the pole pressure. PATIENTS AND METHODS: We enrolled 29 patients (18 male, 11 female, 10 diabetics) with critical leg ischaemia. The pole pressure was obtained by elevating the leg, and measuring the height at which the Doppler signal disappears by means of a calibrated pole (recalculating cm H2O for mmHg). We used an 8 MHz cw-Doppler device. Only pole pressure values up to 70 cm H2O were included. In addition tcpO2 at 45 degrees C was recorded at the forefoot of the same leg. RESULTS: When we included the values of the ten diabetic patients the pole pressure of 57.9 +/- 16.2 mmHg (mean +/- SD) was significantly lower by 40.7 mmHg than the ankle pressure of 98. +/- 38.4 mmHg, p < 0.0001 (paired t-test). Without the diabetics the difference was 33.7 mmHg. The correlation coefficient between pole pressure and ankle pressure was 0.546 including the patients with diabetes, and 0.609 excluding the diabetics. The correlation of tcpO2 with the pole pressure, however, was 0.624 regardless of the inclusion of diabetics, while that between tcpO2 and ankle pressure was only 0.250. CONCLUSIONS: The pole pressure test is an easy, inexpensive and fast method providing a meaningful, quantitative measure independent of the compressibility of the arteries.

Aged↗
PubMed1983

Hemodynamics and leg muscle metabolism at rest and during exercise in young healthy men after prenalterol.

In eight young healthy men the effects of short-term treatment with prenalterol, a new beta-adrenergic agonist, on peripheral hemodynamics and leg muscle metabolism were studied at rest and during exercise at a moderate and a heavy workload. At rest prenalterol treatment significantly increased pulmonary oxygen uptake, heart rate, rate pressure product, and leg blood flow and decreased leg arteriovenous oxygen content difference. During exercise fewer hemodynamic effects of prenalterol were observed. At the moderate workload there was a slight increase in heart rate, but at the heavy workload heart rate fell. Prenalterol raised the arterial concentrations of free fatty acids and glycerol at rest by 70% and 40%, but during exercise these alterations were not present. The plasma levels of epinephrine and dopamine in subjects at rest decreased significantly during influence of prenalterol, but these differences were also abolished during exercise. The leg exchange of metabolites and the concentrations of endogenous muscle metabolites were not influenced by prenalterol, although the lactate concentrations in muscle tended to be lower at rest and during exercise. The results at rest demonstrate that prenalterol in this situation acts predominantly as a stimulator of beta 1-adrenoceptors. During heavy exercise, however, when the endogenous sympathetic tone is high, the beta-stimulating effects are no longer overt and instead reduced heart rate indicates a blocking effect on beta-adrenoceptors. The hemodynamic and metabolic results are concordant with the hypothesis that prenalterol acts as a partial beta-receptor agonist.

Adult↗
PubMed2001

Martorell's hypertensive leg ulcer: case report and concise review of the literature.

Hypertensive leg ulcers (Martorell's ulcers) are a unique form of lower extremity ischaemic leg ulcer. First described by Martorell, and Hines and Farber in the 1940s, these ulcers are defined by pain disproportionate to the size of the ulcer, specific location on the lower extremity, female-to-male predominance, association with long-standing, often poorly, controlled hypertension, and healing response to specific antihypertensive agents. We present a case of Martorell's hypertensive ischaemic leg ulcer and a concise review of the 104 previous cases in the world's English literature. Hypertensive ischaemic leg ulcers will be more commonly recognised with a renewed appreciation of the existence of this clinical entity.

Aged↗
PubMed1981

Glycogen-depletion patterns with isometric and isokinetic exercise in patients after leg injury.

1. The glycogen-depletion patterns were studies as a measure of muscle-fibre recruitment in patients after leg injuries (fractures, ligament injuries). Intermittent isometric and dynamic isokinetic knee extension were performed with 30 and 50% of the maximal isometric torque of the injured leg. In a third group isokinetic and dynamic exercise with weights were compared by using maximal effort procedures. 2. The 30% maximal voluntary contraction programme, which corresponded to 16% of maximal voluntary contraction of the non-injured leg, resulted in glycogen depletion of type I fibres, which was significant only in the isometric exercise. In the 50% maximal voluntary contraction programme (41% of maximal voluntary contraction of the non-injured leg) depletion of type II fibres dominated and was significant with isometric exercises. In the maximal effort programmes there was a significant depletion of type II fibres. 3. Subjects with a relatively large reduction in strength or a small number of type I fibres demonstrated more depletion of these fibres than other subjects. 4. In patients with moderately reduced muscle strength and muscle fibre atrophy static or dynamic exercises using at least 50% of the actual maximal voluntary contraction can thus be used to recruit and train type II fibres.

Adolescent↗
PubMed1991

Posturally induced microvascular constriction in patients with different stages of leg ischaemia: effect of local skin heating.

1. Skin microcirculation was investigated in 12 asymptomatic subjects and 76 patients, grouped according to their ankle-to-brachial systolic blood pressure index, in order to evaluate to what extent posturally induced microvascular constriction is dependent on the stage of leg ischaemia at different local skin temperatures. 2. Skin microcirculation was assessed in the supine and sitting position by using laser Doppler fluxmetry at unheated skin temperature and at 36 degrees C, and transcutaneous oximetry at 37 degrees C and 44 degrees C. 3. Skin perfusion and oxygenation diminished with decreasing ankle-to-brachial systolic blood pressure index. In healthy control subjects, perfusion and oxygenation were reduced when changing from the supine to the sitting position, but were enhanced in patients with severe leg ischaemia (ankle-to-brachial systolic blood pressure less than 30%), indicating disturbed posturally induced vasoconstriction. 4. Increasing the local skin temperature resulted in a higher perfusion and masked the posturally induced vasoconstriction in healthy subjects. In patients with severe leg ischaemia, however, perfusion was unaltered by the temperature increase, apparently because the microvessels were already maximally dilated. The induction of reactive hyperaemia produced no additional increase in perfusion or oxygenation. 5. It is concluded that posturally induced microvascular constriction in the skin is disturbed in patients with severe leg ischaemia (ankle-to-brachial systolic blood pressure index less than 30%). Disturbed microvascular constriction upon dependency was also seen in healthy subjects after local skin heating. This suggests that posturally induced vasoconstriction is mainly regulated by local mechanisms.

Adult↗
PubMed1995

Glucose-induced thermogenesis in splanchnic and leg tissues in man.

1. Fourteen healthy subjects were investigated before and for 4 hours after oral intake of 75 g of glucose (n = 8) or tap water (n = 6). Whole-body energy expenditure was measured by an open-circuit ventilated hood system. Blood samples for determination of oxygen, carbon dioxide, glucose and lactate were taken from an artery, a hepatic vein and a femoral vein. Blood flow in the splanchnic region was measured by constant infusion of Indocyanine Green. Leg blood flow was measured by venous occlusion strain-gauge plethysmography. Oxygen uptake and carbon dioxide output in the splanchnic and leg tissues were calculated as the product of blood flow and arteriovenous differences in oxygen or carbon dioxide concentrations. Net exchanges of glucose and lactate across the splanchnic and leg tissues were calculated as the product of blood flow and arteriovenous differences in whole-blood glucose or lactate concentrations. 2. Splanchnic oxygen uptake had a biphasic course with an initial increase from 2.35 +/- 0.88 (SD) mmol/min to 2.85 +/- 1.20 mmol/min 30 min after the glucose intake (P < 0.005) and a later decrease below the basal value to around 2.02 mmol/min 90-180 min after the glucose intake (P < 0.05). The integrated increase in the splanchnic oxygen uptake during the 4 h after the glucose intake was -32.6 +/- 49.7 mmol/240 min. Leg oxygen uptake increased from 4.3 +/- 1.4 mumol min-1 100 g-1 to 7.0 +/- 3.2 mumol min-1 100 g-1 90 min after the glucose intake (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Differences in mouth occlusion pressure and breathing pattern between arm and leg incremental exercise.

The aim of the study was to compare breathing pattern, mouth occlusion pressure, mean inspiratory flow and the ratio of mouth occlusion pressure to mean inspiratory flow at the same power output and carbon dioxide output during arm and leg incremental exercise. Mouth occlusion pressure was used as an index of inspiratory neuromuscular activity and its ratio to mean inspiratory flow as an index of the 'effective' impedance of the respiratory system. Eight normal subjects performed two incremental exercise tests, one with arms, the other with legs, on different weeks and in randomized order, and on two identical cycle ergometers. The power output was increased by steps of 25 W for arms and 50 W for legs every 4 min until exhaustion. At the same power output, oxygen consumption, carbon dioxide output, ventilation, mean inspiratory flow, mouth occlusion pressure, 'effective' impedance (P < 0.001) and respiratory frequency (P < 0.01) were higher during arm exercise than during leg exercise, whereas inspiratory time (P < 0.05) and expiratory time (P < 0.01) were lower. At the same carbon dioxide output, mouth occlusion pressure, ventilation, 'effective' impedance (P < 0.001) and respiratory frequency (P < 0.01) were higher and expiratory time (P < 0.05) was lower during arm exercise. In conclusion, the higher inspiratory neuromuscular activity and impedance of the respiratory system during arm exercise and the differences observed in ventilation and breathing pattern at equal carbon dioxide output seem related to the differences in exercising muscle afferents and the presence of an increased load due to contraction of rib cage muscles to stabilize posture.

Adult↗
PubMed2002

Erosive pustular dermatosis of the leg: report of three cases.

Erosive pustular dermatosis of the leg is a distinct form of spongiform amicrobial pustulosis. The disorder typically affects the lower limbs of elderly patients presenting with chronic venous insufficiency and stasis dermatitis, and has a chronic course. Three elderly patients with chronic venous ulcers are described, who developed pustules and moist eroded lesions on the leg. The clinical and histological features were typical for erosive pustular dermatosis. The lesions rapidly responded to topical treatment with either tacrolimus or corticosteroids. Of note, this condition was associated with a diverticular disease in two patients, while in another patient an epidermoid carcinoma of the tongue was present. Erosive pustular dermatosis of the leg is an uncommon but distinct skin disorder typically associated with trophic changes of the lower limbs. Our observations raise the question of the relation of erosive pustular dermatosis of the leg with the group of neutrophilic dermatoses. Topical immunotherapy with tacrolimus may constitute a novel therapeutic option for this frequently recalcitrant condition.

Administration, Topical↗
PubMed2002

Potential role of endothelin 1 in ischaemia-induced angiogenesis in critical leg ischaemia.

BACKGROUND: Ischaemia-induced angiogenesis occurs in critical leg ischaemia (CLI) and endothelin (ET) 1 may be involved in this process. The aim of this study was to quantify microvessels and study ET receptor expression and distribution in critically ischaemic leg muscle. METHODS: Leg muscle biopsies were taken from 12 patients with CLI and 12 patients with no leg ischaemia. Microvessels were identified immunohistochemically on muscle sections, and the number of immunopositive cells was quantified. ETA and ETB receptor messenger RNA (mRNA) expression was studied using real-time quantitative reverse transcriptase-polymerase chain reaction, and receptor binding was localized and assessed by in vitro autoradiography. RESULTS: The number of microvessels in CLI muscle biopsies was 2.6 times higher than that in controls (P < 0.01). ETB receptor mRNA expression and binding were significantly increased in CLI tissue (P < 0.05), while ETA receptor levels were not significantly raised. High-resolution autoradiography showed that ET receptor binding was associated with microvessels. CONCLUSION: Angiogenesis occurs in CLI and raised ETB receptors within the muscle were associated with microvessels, suggesting that ET-1 may mediate angiogenesis via these receptors in critically ischaemic muscle.

Aged↗
PubMed2000

The risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg. The DURAC Trial Study Group.

OBJECTIVES: To investigate the risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg. DESIGN: An open prospective long term follow-up multicentre trial. Patients were followed by frequent outpatient visits at each centre during the first 12 months after inclusion and thereafter annually. SETTING: Sixteen hospitals in central Sweden. SUBJECTS: A total of 790 consecutive patients with objectively verified first episode of acute deep vein thrombosis and without diagnosed malignant disease were recruited from a randomized study comparing 6 weeks with 6 months of oral antivitamin K therapy as secondary thromboprophylaxis. MAIN OUTCOME MEASURES: Deep vein thrombosis in the contralateral leg was confirmed by venography or ultrasound. With regard to the ipsilateral leg, venography was required. RESULTS: A recurrent episode of venous thromboembolism was documented in 192 patients after a mean (+/-SD) period of 31(+/-29) months. In 26 additional patients with ipsilateral symptoms the diagnostic critera were not fulfilled. One hundred and eleven patients have deceased and 69 patients withdrew from the study. The 392 patients without recurrent episodes were followed for a median of 96 months with 90% for at least 48 months. An objectively verified recurrent contralateral and ipsilateral deep vein thrombosis occurred in 95 and 54 cases, respectively, and in 41 patients pulmonary embolism was documented. In two patients thromboses with unusual locations were registered. The risk of contralateral versus ipsilateral recurrence was significantly increased with a risk ratio of 1.6 (95% confidence interval 1.4-1.9) in a time to event model. In a multivariate analysis none of the investigated variables were significantly associated with the side of recurrent thrombosis. CONCLUSIONS: The risk of a recurrent deep vein thrombosis is increased in the contralateral leg. This brings into question the importance of an impaired venous flow for recurrent episodes of thrombosis.

Aged↗
PubMed1999

Older women's experience of living with chronic leg ulceration.

In this study the authors sought to gain insight into the lives of older women, to focus on the experience of living with leg ulcers and to explore women's views by talking to them about their experiences. Twelve English-speaking women aged over 70 years who had experienced leg ulceration for 3 years or more were interviewed. Analysis of the interview text revealed two overarching themes: (i) gaining and maintaining control over vulnerable limb(s); and (ii) lifestyle consequences of chronic leg ulceration and impaired mobility. These themes contained several subthemes including: (i) nagging pain; (ii) self-expertise and infection; (iii) leakage, smell and embarrassment; (iv) fighting for skin and limb integrity; (v) wearing non-preferred apparel; (vi) loneliness; and (vii) coping, determination and hope. The findings of this research show that elderly women who live with leg ulcers experience multiple consequences. While the everyday problems of living with an unhealed would are addressed by the community nurse, other more subtle consequences may be overlooked. Recognition of the complex and sometimes hidden concerns of these women could help to avert the sense of helplessness which currently exists.

Adaptation, Psychological↗
PubMed1998

Locomotor-like movements evoked by leg muscle vibration in humans.

We attempted to elicit automatic stepping in healthy humans using appropriate afferent stimulation. It was found that continuous leg muscle vibration produced rhythmic locomotor-like stepping movements of the suspended leg, persisting up to the end of stimulation and sometimes outlasting it by a few cycles. Air-stepping elicited by vibration did not differ from the intentional stepping under the same conditions, and involved movements in hip and knee joints with reciprocal electromyogram (EMG) bursts in corresponding flexor and extensor muscles. The phase shift between evoked hip and knee movements could be positive or negative, corresponding to 'backward' or 'forward' locomotion. Such an essential feature of natural human locomotion as alternating movements of two legs, was also present in vibratory-evoked leg movements under appropriate conditions. It is suggested that vibration evokes locomotor-like movements because vibratory-induced afferent input sets into active state the central structures responsible for stepping generation.

Electromyography↗
PubMed2000

Pramipexole in the treatment of restless legs syndrome: a follow-up study.

The restless legs syndrome (RLS) is a condition characterized by unpleasant limb sensations occurring at rest and associated with an irresistible urge to move. Several treatments are used to treat RLS including benzodiazepines, opioids, dopaminergic agents, clonidine and anticonvulsant drugs such as carbamazepine and gabapentine. Dopaminergic agents are now considered the treatment of choice for RLS. Levodopa is effective in treating RLS; however, several patients treated with levodopa at bedtime developed morning or late afternoon restlessness. Recently, more attention has been paid to dopamine receptor agonists. Ergoline derivatives, bromocriptine and pergolide were found effective, but require concomitant administration of domperidone, a peripheral dopamine antagonist. In a recent study, we studied the efficacy and innocuity of pramipexole, a new dopamine agonist with a higher affinity for the D3 receptor subtype of the D2 family, in a double-blind, placebo-controlled, randomized trial. Pramipexole had major effects on RLS symptoms without severe side-effects. The present study aimed to assess the long-term efficacy of pramipexole. Seven patients were treated with the drug for a mean follow-up duration of 7.8 months. Treatment was started at a dosage of 0.25 mg, and progressively increased until the optimal therapeutic effect was obtained. Home questionnaires were completed for 7 consecutive days, after one month and after a mean of 7.8 months of treatment with pramipexole, assessing leg restlessness during the daytime, in the evening, at bedtime and during the night. There was no evidence of a decrease in the therapeutic effect of pramipexole in these patients, even 7.8 months after the initiation of treatment. The optimal dosage was 0.25 mg for one patient, 0.5 mg for five patients and 0.75 mg for one patient. While there was a progressive increase in severity of leg restlessness from daytime to nighttime before treatment, a suppression of leg restlessness was observed throughout the 24 h with a single dose of pramipexole at bedtime. The remarkable efficacy of pramipexole raises the possibility that the D3 receptors of the mesolimbic system may be more specifically involved in the physiopathology of RLS.

Adult↗
PubMed2002

Local treatment of chronic cutaneous leg ulcers with recombinant human granulocyte-macrophage colony-stimulating factor.

AIM: To test the efficacy and safety of recombinant granulocyte-macrophage colony-stimulating factor (rHuGM-CSF) in the treatment of chronic cutaneous leg ulcers. METHODS: Five patients with chronic cutaneous leg ulcers were recruited for this 4-month study using only rHuGM-CSF to treat the ulcers. One patient had a neuropathic-diabetic ulcer, and four had long-standing vascular leg ulcers. RESULTS: The patient with the neuropathic diabetic ulcer showed complete healing after 1 month of treatment. The other four patients with vascular leg ulcers with a long history of ulceration had a poor prognosis for healing. The first, with three venous ulcerative lesions, presented complete resolution of one ulcer and stabilization of the other two; the second and third patients, with large vascular ulcers, improved with more then 50% reduction of the mean diameter of the ulcers; the fourth patient, with one large venous ulcer, did not show any improvement. CONCLUSIONS: Pathogenesis, size and duration of the ulcers seemed to be the most important parameters regarding wound repairing capability of rHuGM-CSF. None of the ulcers increased in size and none of the patients developed clinical side-effects or peripheral blood cell count abnormalities during the treatment. All the results described were stable after 6 months of follow up. The absence of peripheral leucocyte count variation and the size-dependent therapeutic effect indicate that the drug exercises local rather than systemic actions.

Aged↗