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At least 1,639 records · Page 91Linked to original sources
PubMed2003

The new 940-nanometer diode laser: an effective treatment for leg venulectasia.

BACKGROUND: The 940-nm diode laser has been shown to be an effective treatment for leg veins. OBJECTIVE: We sought to evaluate the effectiveness of the 940-nm diode laser on leg veins, depending on the size and morphologic aspect of the treated vessels. METHODS: A total of 60 patients (mean age: 44.4 years, Fitzpatrick skin types I-IV) underwent up to 3 treatment sessions at 4-week intervals using the 940-nm diode laser. Treatment parameters were: vessels < 0.4 mm in diameter, 0.5-mm spot, pulse duration of 10 milliseconds, fluence 306 J/cm(2); 0.4 to 0.8 mm in diameter, 1-mm spot, pulse duration of 30 milliseconds, fluence 306 J/cm(2); and 0.8 to 1.4 mm in diameter, 1.5-mm spot, pulse duration of 70 milliseconds, fluence 317 J/cm(2). Repetition rate was 2.5 Hz. Success rate was evaluated through double-blind observation. RESULTS: Only 13.33% of patients with telangiectases less than 0.4 mm in diameter had a percentage of vessel clearance superior to 75%. However, 88.24% of patients with vessels between 0.8 and 1.44 mm in diameter obtained more than 75% vessel clearance. CONCLUSION: The treatment of leg veins by the 940-nm diode laser strongly depends on the size of the target vessel. Better results were obtained with 0.8- to 1.4-mm leg venulectases.

Adult↗
PubMed2002

Current home care expenditures for persons with leg ulcers.

OBJECTIVE: The purpose of this study was to gain a better understanding of the home care expenditures incurred in providing care to the population with leg ulcers. DESIGN: The study was designed as a descriptive survey and was conducted over a 4-week period during March 1999. SETTING AND SUBJECTS: Persons in a large Ontario urban center with an ulcer below the knee, including the foot, who were receiving nursing services in the home, were eligible for inclusion in the study. INSTRUMENTS: A leg assessment tool, a supply usage form, and a visiting nurses log (all developed by the researchers for the study) were used to collect data. METHODS: Home care nurses visited all clients and completed an in-depth assessment of their social, medical, and leg ulcer history. Legs were inspected, an ankle brachial pressure index score was determined, and ulcers were examined and measured. For each nursing visit, supply usage, travel and treatment times, and mileage were tracked. RESULTS: During the study period, 2270 visits were made (mean treatment time = 26 minutes, mean travel time = 17 minutes) costing $80.62 (Canadian dollars). Supply costs were $21.06. The regional annual home care expenditures were conservatively estimated to be $1.3 million. CONCLUSION: Costs could potentially be reduced by cutting the 40% visit time attributed to travel, decreasing the visit frequency to clients with minimal drainage, and attention to "best practice."

Cohort Studies↗
PubMed2002

Incidence of foot rotation, pelvic crest unleveling, and supine leg length alignment asymmetry and their relationship to self-reported back pain.

OBJECTIVE: To determine the incidence of pelvic unleveling, foot rotation, and supine leg length alignment asymmetry in a nonclinical population and to examine the validity (sensitivity, specificity, positive and negative predictive values) of these visual tests and their relationship to self-reported back pain. DESIGN: Volunteers answered a questionnaire regarding back pain and were then examined by a chiropractor who was unaware of the status of their back pain. PARTICIPANTS: Seventy-four unscreened volunteers answered the questionnaire. MAIN OUTCOME MEASURES: The association of visual tests with back pain and their validity indices; Visual Analogue Scale ratings. RESULTS: Fifty-one percent (n = 74) of volunteers examined had supine leg length alignment asymmetry (LLA). Pain intensity on a Visual Analogue Scale was significantly higher (P <.001) for those demonstrating supine LLA than for those without LLA. Those with back pain and recurrent back pain were significantly (P <.001) more likely to have supine LLA. The validity indices of the supine leg check showed acceptable levels for sensitivity (74%), specificity (78%), and positive predictive value (82%) [corrected] in recurrent back pain. Findings also indicated a high incidence of supine LLA in volunteers with chronic back pain (85%). CONCLUSION: The results indicated that, in this group of volunteers, the supine leg length alignment check had clinical validity as a stand-alone test for recurring back pain. Further testing on a larger, statistically defined cross-section of the population is recommended.

Adolescent↗
PubMed2000

Management of leg ulcers in patients with rheumatoid arthritis or systemic sclerosis: the importance of concomitant arterial and venous disease.

PURPOSE: We assessed the etiology and the prevalence of peripheral arterial and venous disease in leg ulcers in patients with rheumatoid arthritis and systemic sclerosis and analyzed the outcome after treatment of macrovascular disease. METHODS: A clinical study on 15 consecutive patients with chronic leg ulcers in collagen vascular disease (nine patients with rheumatoid arthritis, six patients with systemic sclerosis) was carried out in a referral center. Angiography was used when the ankle-arm index was less than 0.8; venography was used when venous reflux was detectable by means of a hand-held Doppler examination. Therapies included percutaneous transluminal angioplasty (seven patients), femoropopliteal bypass grafting surgery (one patient), saphenectomy of the greater saphenous vein (six patients), and split skin graft (11 patients). RESULTS: All patients with rheumatoid arthritis exhibited a multifactorial etiology of their ulcers: four of nine patients had peripheral arterial disease, and five of nine patients had venous insufficiency. In one of these patients, arterial and venous disease was combined. Five of six patients with systemic sclerosis exhibited a multifactorial etiology of their ulcers: three of six patients had peripheral arterial disease, and three of six patients had venous insufficiency. One of these patients had both arterial and venous disease. In patients with rheumatoid arthritis, healing was achieved in six of nine patients, and marked improvement occurred in two of nine patients. A below-knee amputation was necessary in one patient with rheumatoid vasculitis. In patients with systemic sclerosis, healing was achieved in three of six patients, and marked improvement occurred in the other three patients. CONCLUSION: Most leg ulcers in patients with rheumatoid arthritis and systemic sclerosis disclose a multifactorial etiology. Relevant arterial and venous disease can be found in approximately half the patients. Our study suggests that revascularization and vein surgery improve the healing of leg ulcers in patients with collagen vascular disease. A prospective trial is now required to confirm these results.

Aged↗
PubMed2002

Color-flow duplex scanning of the leg arteries by use of a new echo-enhancing agent.

OBJECTIVE: This was a dose-finding and effectiveness study of a newly developed contrast-enhancing agent, sulphur hexafluoride (SF(6)), in patients with peripheral arterial disease in whom the therapeutic policy could not be established on the basis of standard color-flow duplex scanning of the leg arteries. METHODS: In this open-label, randomized, dose-ranging, crossover design, 14 patients in whom the assessment of vessel patency was difficult because of poor visibility (low-flow state) or extensive wall calcifications were studied. Contrast-enhanced duplex scanning was performed on the upper leg (n = 4), lower leg (n = 6), or pedal (n = 4) arteries after intravenous injection of four different dosages of SF(6). The results were compared with those from selective angiography of the vessel of interest. Contrast duration and agreement about the diagnosis and the confidence in the diagnosis were obtained before and after administration of the contrast agent. RESULTS: No adverse effects of the contrast agent were seen. Overall agreement was reasonable with regard to vessel patency between contrast-enhanced duplex scanning and angiography (71%). Nine of 14 vessels (64%) appeared open when contrast was applied. In four cases this could not be confirmed by angiography; in two of these cases this was due to the presence of collateral vessels. All vessels that appeared occluded with the contrast agent were also occluded on the angiogram. The confidence in the diagnosis increased from 56% to 91% after contrast administration (P <.0001). CONCLUSION: SF(6)-enhanced color-flow duplex scanning is a safe method that may improve the assessment of the patency of leg arteries, particularly in low-flow states. The visualization of collateral vessles during (enhanced) duplex scanning may be misleading because they may be regarded as the vessel of interest.

Aged↗
PubMed2004

Flavonoid supplement improves leg health and reduces fluid retention in pre-menopausal women in a double-blind, placebo-controlled study.

Flavonoid extracts derived from plant foods have been shown to benefit certain types of fluid retention. However, no studies have investigated these compounds for use in premenstrual fluid retention, a complaint common among women with otherwise normal menstrual cycles. Therefore, we conducted a double-blind, placebo-controlled, pilot study into the effect of a daily flavonoid extract (Colladeen, 320 mg oligomeric procyanidins) on premenstrual fluid retention. Fluid retention was assessed at baseline and throughout 4 menstrual cycles of the intervention using validated questionnaires. Leg girth was also measured at baseline and at the end of the study. Thirty subjects completed the study (n = 18 active treatment; n = 12 placebo). Although no significant changes in leg girth measurements were noted, there was a significant improvement in subjective "leg health" scores after flavonoid treatment compared to placebo (p = 0.013). Furthermore, this was accompanied by an improvement in reported premenstrual fluid retention nearing significance (p = 0.066). We conclude that flavonoids supplements may provide a new therapeutic direction to counter premenstrual fluid retention and improve leg health. A larger study is now warranted.

Adult↗
PubMedDate not supplied

Surgical removal of ulcer and lipodermatosclerosis followed by split-skin grafting (shave therapy) yields good long-term results in "non-healing" venous leg ulcers.

The purpose of this study was to evaluate the long-term effects of shave therapy in non-healing venous leg ulcers. Forty-one patients with 75 recalcitrant leg ulcers caused by primary deep vein incompetence or post-thrombotic syndrome were operated by shave therapy (removal of ulcer and surrounding lipodermatosclerosis with a Schink skin-grafting knife and covering of the wounds with meshed split-thickness skin grafts). After an average follow-up period of 2 years and 5 months all patients were evaluated for long-term results. The healing rate of ulcers classified as non-healing was 67% (50 of 75 ulcers). The healing rate was 76% for ulcers associated with primary deep vein incompetence and 58% for ulcers associated with post-thrombotic syndrome (p = 0.08). Even in cases with recurrence (33%) these ulcers were strikingly reduced by 80-90% of their original size. Hypaesthesia was noticed in 38% of the transplanted areas. In "non-healing" venous leg ulcers due to deep venous insufficiency shave therapy yields favourable long-term results. Because it is only a symptomatic treatment which does not reduce the pathological refluxes, continuous compression of the lower leg is important.

Aged↗
PubMed1998

The veno-arteriolar reflex in venous leg ulcer patients studied by laser Doppler imaging.

Posture-induced microcirculatory changes in the lower leg were studied in venous leg ulcer patients and in control subjects by means of laser Doppler imaging (LDI), a technique which allows almost real-time mapping of the perfusion from a distance, each perfusion value constituting the mean of a number of measurements at separate sites. LDI values for intact skin with the subject supine were 0.39 (0.32, 0.47) V [geometric mean (gm -SD, gm +SD)] and 0.32 (0.15, 0.70) V in two age groups of controls and 0.91 (0.66, 1.24) V in patients (NS). Values were 2.04 (1.25, 3.35) V for skin at the ulcer margin, and 1.44 (0.72, 2.88) V in the ulcer proper. With the lower leg passively dependent, lower LDI values were obtained at all sites in all groups, the reduction in intact skin value being 62 +/- 11% (arithmetic mean +/- SD) (p < 0.01) in the younger controls, 43 +/- 24% (p < 0.01) in the older controls and 62 +/- 19% (p < 0.001) in the patient group, and the reduction in ulcer values being 45 +/- 27% (p < 0.05) for the margin and 52 +/- 23% (p < 0.001) for the ulcer proper. Thus, a high degree of postural vasoconstriction was present overall, even in the ulcer itself. Vasomotor tone in the skin of the lower leg was assessed by topical application of methyl nicotinate, a vasodilator. The skin perfusion value (supine position, no stimulus) was 71 +/- 31% (p < 0.01) of the drug-induced (assumed peak) hyperaemia value [0.60 (0.30, 1.10) V] in patients and 24 +/- 25% (p < 0.001) of the hyperaemia value (1.30 (0.64, 2.62) V] in the controls. It would appear that in ulcer patients the veno-arteriolar reflex, despite being comparable in magnitude to that in controls, may nonetheless be insufficient to reduce tone during dependency to a level similar to that in healthy controls.

Adult↗
PubMedDate not supplied

Growth of sitting height, subischial leg length and weight in well-off northwestern Indian children.

This paper reports attained means and tempo unconditional 1-year velocities of sitting height, subischial leg length and weight of well-off northwestern Indians based on two time measurements taken by the same measurer. A 3-year difference is observed in reaching the peak sitting height velocity between girls (11 years) and boys (14 years) as in their peak height velocity. While in girls the peak subischial leg length velocity is reached a year earlier, at 10 years, than that of their peak sitting height velocity, in boys it is reached at the same time as in sitting height (14 years). Comparisons of the attained means with the British standards show that while sitting height is shorter throughout in the Indians, the subischial leg length is longer until 12 years in girls and 14 years in boys, after which it becomes equal to that of the British. This differential growth of the two segments comprising stature produces shorter adult height. Though the weight velocities are not dissimilar, the Indian children are lighter throughout. This body shape and size, with relatively longer legs, is a useful adaptation to the northwestern Indian climate.

Adolescent↗
PubMed2004

Effects of crossed leg on blood pressure.

It is known that many factors influence an individual's blood pressure measurement. However, guidelines for accurately measuring blood pressure inconsistently specify that the patient should keep feet flat on the floor. The purpose of this study was to examine the effects of a crossed leg position on blood pressure in a Turkish sample. A prospective study of 238 subjects with an unmedicated high-normal blood pressure, stage 1 or stage 2 hypertension was conducted. After obtaining informed consent, subjects positioned their feet flat on the floor while their blood pressure was being measured. After 3 min, the blood pressure was measured again with the subject's leg crossed at the knee. Mean values of blood pressure were compared by t-test between two measurements. Statistical significance for all analysis was taken at the 5% level. The results indicated that both systolic and diastolic blood pressure increased significantly with the crossed leg position. Crossing the leg at the knee results in a significant increase in blood pressure. When blood pressure is measured, subjects should be instructed to have feet flat on the floor to eliminate a potential source of error.

Adult↗
PubMedDate not supplied

A new approach in the management of chronic nonhealing leg ulcers.

Chronic leg ulcers are a major cause of mortality and morbidity. The efficacy of hyperbaric oxygen treatment is being evaluated in the management of nonhealing leg ulcers to improve skin graft survival. Twenty-seven patients with 36 chronic leg ulcers were examined. Each wound received 12 preoperative hyperbaric oxygen treatments, split-thickness skin grafting, followed by 12 postoperative hyperbaric oxygen treatments. Wound transcutaneous oxygen tension measurements (TCOM) were taken. The graft take was evaluated. At 18 months follow-up, 18 skin grafts (50%) showed complete take, 15 (41.7%) demonstrated partial take, and 3 (8.3%) failed. Hyperbaric oxygen treatment is an effective adjunct in the management of chronic leg ulcers, and its use resulted in increased graft take and survival.

Adult↗
PubMed1998

Surgical treatment of chronic critical leg ischaemia. A five-year follow-up of survival, mobility, and treatment level.

OBJECTIVE: To evaluate mobility and care level required after amputation and arterial reconstruction for chronic critical leg ischaemia. DESIGN: A 5 year follow up study in three hospitals serving a defined population. SETTING: One regional and two district hospitals, Finland. PATIENTS: 117 Consecutive patients. OUTCOME MEASURES: Survival, amputations, mobility, and care level required. MAIN RESULTS: 66 Primary reconstructions, 51 primary and 35 later major amputations were done. Preoperatively 27 (53%) of the patients who underwent a primary amputation were in permanent institutional care. Of 86 patients who were living outside an institution, 62 (72%) had a reconstruction. One and five year mortality were 43% and 84% after amputation, and 20% and 57% after reconstruction, respectively. Of the patients who had had an amputation 10% were able to walk and 25% could manage to live outside an institution. Mobility and treatment level after primary and secondary amputations were similar. Forty seven (71%) of the patients who had had a reconstruction did not have an amputation. All patients whose reconstructions were successful preserved their walking ability and independent living. CONCLUSION: To maintain mobility and an independent living in patients with chronic critical leg ischaemia it is necessary to do a reconstruction that can salvage the leg. In old, institutionalised patients chronic critical leg ischaemia is often the harbinger of approaching death and then amputation is the only possible solution.

Activities of Daily Living↗
PubMed2001

Restless legs syndrome and sleep disturbance during pregnancy: the role of folate and iron.

Restless legs syndrome (RLS) is a neurosensory disorder that typically begins in the evening and often prevents a person from falling asleep. It has been associated with iron deficiency anemia and dopaminergic pathways and is often treated with iron infusion or dopamine agonists. The purpose of this secondary analysis of longitudinal data collected on women before, during, and after pregnancy is to document the prevalence of RLS during pregnancy, contrast its effect on sleep and mood state, and explore the role of folate and iron in the expression of RLS, specifically during the third trimester when the syndrome is most distressing. The prevalence increased from 0 during preconception to 23% (n = 7) during the third trimester of pregnancy. Only 1 subject continued to experience RLS after delivery. Compared with those without complaints of restless legs, those with restless legs had low serum ferritin at preconception and significantly lower folate levels during preconception and at each trimester. In addition, time to sleep onset was significantly delayed and depressed mood was significantly higher in the RLS group. Rather than indicators of iron deficiency anemia (serum ferritin, serum iron, and hemoglobin) or pernicious anemia (vitamin B(12)), it was reduced serum folate level that was associated with RLS in this sample of pregnant women. Findings indicate a need to reconsider recommendations about the normal ranges of serum ferritin and serum folate levels during pregnancy to minimize the complaints of restless legs and promote more consolidated sleep and better daytime mood state during pregnancy.

Adult↗
PubMed2002

Explosive power and asymmetry in leg muscle function in frequent fallers and non-fallers aged over 65.

BACKGROUND: although low strength is a risk factor for falls, lower limb explosive power is more predictive of functional difficulties than strength. Power may be more predictive of a future fall than strength per se. OBJECTIVE: to compare leg muscle strength and explosive power and asymmetry of leg strength and power of women aged 65 or over living at home, with and without a history of falls. DESIGN: a case controlled study of self-reported 'fallers' versus 'non-fallers'. SUBJECTS: twenty women, aged 65 or over, with a history of at least three falls in the previous year were age matched with 15 women with no history of falls in the previous year. METHODS: lower limb explosive power, isometric strength of the quadriceps and hamstrings, isokinetic concentric strength (100 degrees/sec) of the quadriceps, hamstrings, ankle plantar- and dorsi-flexors and quadriceps eccentric strength (100 degrees/sec). Habitual physical activity was assessed using the self-completed Habitual Activity Profile Questionnaire. RESULTS: the women with a history of falls were less active but were not significantly weaker in any of the strength measurements, apart from ankle dorsiflexion adjusted for body weight. Both groups had significant asymmetry in all the leg muscles for both strength and power. Although both groups were asymmetrical in their lower limb power, the fallers demonstrated a significantly greater asymmetry. When the least powerful legs were compared, the women with a history of falls were 24% less powerful for their weight than those who did not fall (P=0.04). CONCLUSIONS: weakness and asymmetry is prevalent in women aged 65 and over, with and without a history of falls. Poor lower limb explosive power combined with asymmetry between limbs may be more predictive of future falls than more traditional measurements of strength in older women who live independently.

Accidental Falls↗
PubMed2004

Leg extensor power, cognition, and functional performance in independent and marginally dependent older adults.

BACKGROUND: physical and cognitive function must be integrated and optimised in performance of daily activities. Age-related loss of physical function can result in poor performance of necessary daily activities and possibly lead to increased dependency and a change of living status. OBJECTIVES: (1) to evaluate average differences in physiological, cognitive, and functional performance of older adults from two different levels of independence, (2) to examine contributions of leg power, cognition, and functional performance to level of independence. DESIGN: cross-sectional study of self-reported 'independent' versus 'marginally dependent' older adults. SUBJECTS: 35 older adults (77.2 +/- 6 years) were placed into independent (n = 18) or marginally dependent (n = 17) groups based upon the Medical Outcomes Study SF36 physical function scores (independent: SF36PF > or = 85, marginally dependent: SF36PF < 85) and living status. METHODS: assessment of physical function includes the dependent variable, SF36PF. Assessment of physical, cognitive, and functional performance include the independent variables of leg extensor power, reaction time, processing speed, memory, attention, and functional performance. Functional performance is assessed by the Continuous Scale Physical Functional Performance Test. RESULTS: independent older adults have greater performance on leg power, reaction time, processing speed, memory, and functional performance than marginally dependent older adults. Functional performance is an independent predictor of level of independence. Leg power and cognition were separate small but significant predictors of independence. CONCLUSIONS: independent older adults have greater physiological, cognitive and functional performance than marginally dependent older adults. Individuals with greater functional performance tend to remain independent.

Activities of Daily Living↗
PubMed2004

Leg ulceration and perceived health: a population based case-control study.

OBJECTIVES: To quantify the effect of leg ulceration on health-related quality of life and to estimate a health state value for leg ulceration. DESIGN: Population based case-control study. SETTING: Two New Zealand health districts (population 540,468 people). SUBJECTS: 241 people with a leg ulcer of any aetiology, and 224 controls randomly selected from the electoral roll using stratified sampling. MAIN OUTCOME MEASURES: health-related quality of life as measured by the eight domains of the Short Form 36 question Health Survey, adjusted for age, sex and confounding co-morbidities; the physical component summary and mental component summary scores of the Short Form 36 question Health Survey standardised for age and sex; preference-based health state value derived from the Short Form 36 question Health Survey. RESULTS: Completed Short Form 36 question Health Survey questionnaires were available for 230 cases (95%) and 218 controls (97%). Cases reported significantly lower mean scores than controls across all eight domains of the Short Form 36 question Health Survey (P < 0.0005). Mean domain scores for cases were also significantly lower than population norms. The mean physical component summary score for cases and controls was 45.2 versus 50.1 (P < 0.0001) and the mean mental component summary score was 48.1 for cases versus 51 for controls (P < 0.0001). The mean health state values (adjusted for age and sex) were 0.80 for cases and 0.89 for controls. CONCLUSION: Leg ulcers reduce quality of life to a similar extent as other common chronic conditions, such as arthritis and diabetes.

Adult↗
PubMed1987

Comparison of bleeding times performed on the arm and the leg.

The standardized bleeding time (SBT) is used to assess hemostatic function in patients suspected of having coagulation disorders. Because injury to the arm or the presence of intravascular cannulae often preclude the determination of SBTs on the upper extremity, the authors compared the SBT on the arm with the bleeding time on the leg to ascertain the efficacy of the lower extremity for this test. Thirty healthy volunteers were enrolled in the study. Bleeding times were performed on the forearm and on the medial aspect of the calf. The subjects then ingested 650 mg of aspirin, and the tests were repeated two hours later on the contralateral extremities. The mean preaspirin SBT (5.6 +/- 1.7 minutes did not differ significantly from the mean bleeding time on the leg (5.8 +/- 2.3 minutes) (P greater than 0.50), nor was there a significant difference between the mean postaspirin bleeding time on the arm (10.2 +/- 4.3 minutes) and that on the leg (9.9 +/- 3.7 minutes) (P greater than 0.50). On the basis of this study, the authors conclude that the arm and leg are equally reliable sites for determining bleeding times in normal persons and are equally sensitive for detection of aspirin-induced prolongation of bleeding.

Adult↗
PubMed1990

Prevention of hypotension following spinal anaesthesia for elective caesarean section by wrapping of the legs.

Twenty-four parturients undergoing elective Caesarean section were allocated randomly to have the legs wrapped with elasticated Esmarch bandages immediately following spinal anaesthesia or to serve as controls. Significant hypotension (systolic arterial pressure less than 100 mm Hg and less than 80% of baseline value) was treated with i.v. ephedrine in 5-mg boluses. Leg wrapped patients had a significantly (P = 0.0033) lower incidence (16.7%) of hypotension than controls (83.3%). Only two patients in the leg wrapped group required ephedrine compared with 10 in the control group. Systolic arterial pressure was significantly (P less than 0.05) less in control subjects at 4, 5 and 6 min following spinal injection. No patient in the leg wrapped group became hypotensive following removal of the elasticated bandages.

Anesthesia, Obstetrical↗