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At least 1,657 records · Page 92Linked to original sources
PubMed1995

Changes in blood volume distribution between legs and trunk during halothane anaesthesia.

To assess the influence of halothane anaesthesia on the distribution of blood volume in supine humans, we used albumin labelled with 99mTc to measure blood volume distribution along the craniocaudal axis. We studied 6 volunteers in the supine position before, during and after anaesthesia with 1% halothane and 66% nitrous oxide. Using collimated detectors above and below the subject, counts were obtained from the legs, pelvis, abdomen, rib cage and head, with the arms excluded. During anaesthesia, the proportion of counts detected in the legs increased, but failed to achieve significance (P = 0.059). On recovery from anaesthesia, leg counts decreased significantly. Counts in the abdomen and rib cage decreased significantly during anaesthesia and the abdomen counts increased again on recovery (P = 0.036 for all changes). These results confirm other studies of the vascular effects of halothane, and do not support the hypothesis that blood volume redistributes from the legs to within the chest wall during anaesthesia.

Abdomen↗
PubMed1983

Electromyographic study of the relationship between hamstring and abdominal muscles during a unilateral straight leg raise.

The purposes of this study were 1) to assess the relative participation of the hip extensor and abdominal musculature during unilateral straight leg raising in the naive subject and 2) to examine quantitatively alterations in the pattern of pelvic stabilization when the subject was instructed to relax the contralateral extremity. Surface electrodes were used to record bilaterally the electromyographic activity of the rectus abdominus, external oblique, and medial hamstring muscles. Each healthy subject performed a unilateral straight leg raise three times in each of two modes, Preferred and Relaxed. The electromyographic values for each muscle were normalized to a maximum isometric contraction and analyzed using a three-factor (2 X 2 X 2) mixed design analysis of variance. Results indicate that 9 of the 11 subjects used the tested medial hamstrings and abdominal muscles during a unilateral straight leg raise performed in the Preferred Mode. When instructed to relax the contralateral extremity for the Relaxed Mode, abdominal muscle activity increased significantly (p less than .01). The findings indicate that although most subjects normally stabilize with the contralateral extremity during a unilateral straight leg raise, they can consciously alter the pattern.

Abdominal Muscles↗
PubMed2001

Leg ulcers in patients with rheumatoid arthritis--a prospective study of aetiology, wound healing and pain reduction after pinch grafting.

OBJECTIVE: To study the aetiology of leg ulcers in patients with rheumatoid arthritis (RA) and to study healing and pain relief after pinch grafting. METHODS: Twenty patients with RA and leg ulcers were studied. Diagnosis of the ulcers was founded on the clinical picture and measurements of the ankle-brachial pressure index. To detect vasculitis, skin biopsies were taken for immunohistochemistry and histopathology. Pain severity was assessed pre- and post-operatively using a visual analogue scale. RESULTS: Ten of the 20 patients had ulcers with multifactorial aetiology. Fifteen had signs of venous insufficiency, 11 had histopathological evidence of vasculitis, four had reduced arterial circulation and two patients had diabetes. Healing after pinch grafting was found in eight patients, all of whom had an ulcer area less than 15 cm(2). Eleven out of 18 patients had pain reduction after pinch grafting. CONCLUSION: The causation of leg ulcers in patients with RA was found to be multifactorial, with vasculitis and venous insufficiency as the main determinants. Pinch grafting seems to be a good alternative to conservative treatment for minor leg ulcers for these patients, regarding both wound healing and pain relief.

Aged↗
PubMed1988

Peripheral vasoconstriction in patients with sleep related periodic leg movements.

Two patients complaining of insomnia had sleep-related periodic leg movements (nocturnal myoclonus) on polysomnographic evaluation. Both also complained of cold feet and had abnormal peripheral pulse examinations. Treatment with phenoxybenzamine, alpha-adrenergic blocker, normalized the peripheral pulse responses, reduced the complaint of insomnia, and reduced the sleep related leg movements but resulted in only mild sleep improvements. Peripheral pulse examinations of ten other patients with sleep-related periodic leg movements revealed abnormal responses in four. From these and other results, it is hypothesized that the sympathetic nervous system may mediate the periodicity of sleep related periodic leg movements.

Adrenergic alpha-Antagonists↗
PubMed2003

Analysis of CAG repeat expansions in restless legs syndrome.

STUDY OBJECTIVES: A relatively high prevalence of restless legs syndrome symptoms has been recently reported in a substantial proportion of patients affected with spinocerebellar ataxia type 3. Our aim was to investigate whether there is a common genetic etiology between restless legs syndrome and spinocerebellar ataxia type 3. DESIGN: Systematic differences in the number of spinocerebellar ataxia type 3 trinucleotide repeat were investigated by means of an association study. The relationship between the size of the expanded alleles and several clinical features was also considered. PARTICIPANTS AND SETTING: 125 extensively characterized restless legs syndrome patients compared with 188 healthy controls matched for ethnic background. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: No CAG repeat expansions in the pathologic or intermediate range were detected in any of the examined subjects, including patients and controls. A similar allelic distribution was observed in both groups (Mann-Whitney U test = 78406; P = 0.99). Moreover, stratification analyses of the patients' samples according to different clinical and polysomnographic variables disclosed no significant differences. CONCLUSIONS: These results do not provide evidence toward an involvement of large CAG trinucleotide expansions at the spinocerebellar ataxia type 3 locus in idiopathic restless legs syndrome.

Female↗
PubMed1993

Leg heat content continues to decrease during the core temperature plateau in humans anesthetized with isoflurane.

BACKGROUND: Sufficient hypothermia during anesthesia provokes thermoregulatory responses, but the clinical significance of these responses remains unknown. Nonshivering thermogenesis does not increase metabolic heat production in anesthetized adults. Vasoconstriction reduces cutaneous heat loss, but the initial decrease appears insufficient to cause a thermal steady state (heat production equaling heat loss). Accordingly, the authors tested the hypotheses that: 1) thermoregulatory vasoconstriction prevents further core hypothermia; and 2) the resulting stable core temperature is not a thermal steady state, but, instead, is accompanied for several hours by a continued reduction in body heat content. METHODS: Six healthy volunteers were anesthetized with isoflurane (0.8%) and paralyzed with vecuronium. Core hypothermia was induced by fan cooling, and continued for 3 h after vasoconstriction in the legs was detected. Leg heat content was calculated from six needle thermocouples and skin temperature, by integrating the resulting parabolic regression over volume. RESULTS: Core temperature decreased 1.0 +/- 0.2 degrees C in the 1 h before vasoconstriction, but only 0.4 +/- 0.3 degrees C in the subsequent 3 h. This temperature decrease, evenly distributed throughout the body, would reduce leg heat content 10 kcal. However, measured leg heat content decreased 49 +/- 18 kcal in the 3 h after vasoconstriction. CONCLUSIONS: These data thus indicate that thermoregulatory vasoconstriction produces a clinically important reduction in the rate of core cooling. This core temperature plateau resulted, at least in part, from sequestration of metabolic heat to the core which allowed core temperature to remain nearly constant, despite a continually decreasing body heat content.

Anesthesia, Inhalation↗
PubMed1987

Reconstruction of the pelvis using a composite island flap salvaged from the remaining leg.

The case of a patient who sustained horrific injuries resulting in the loss of his left leg and hemipelvis and damage to the right sacroiliac joint and leg is discussed. The remaining leg was paralyzed as a result of damage to the sacral plexus. As a salvage procedure, a right above-knee amputation was performed, preserving a large composite flap from the distal part of the limb. This flap, consisting of most of the skin and soft tissue of the lower leg, contained within it a 10 cm segment of tibia and fibula. By islanding the flap on a pedicle composed of the femoral vessels, saphenous, and sciatic nerves, it was possible to mobilize it sufficiently far proximally to reconstruct the bone and soft-tissue defect of the contralateral hemipelvis. Seven years after this appalling injury, the patient has achieved a remarkable psychological and functional rehabilitation. He is independent and is successfully pursuing a professional career. This case report is a dramatic illustration of what can be achieved in reconstruction following trauma using salvage techniques.

Adolescent↗
PubMed2000

Reverse fasciosubcutaneous flap versus distally pedicled sural island flap: two elective methods for distal-third leg reconstruction.

In case of soft-tissue injury to the distal third of the leg, a safe and effective repair technique should be adopted. The use of complex procedures such as free flaps and cross-leg flaps is not always advisable. The authors present two methods that have proved to be both reliable and effective in obtaining long-lasting satisfactory results: the reverse fasciosubcutaneous sural flap and the reverse fasciocutaneous island sural flap. Since 1992 the authors have operated on 25 patients affected by traumatic tissue loss of the distal third of the leg and the calcaneal region. They used the fasciosubcutaneous flap in 14 patients and the sural flap in 11. Both of these flaps are technically simple, safe, and effective, and cause minimal injury to the donor site. The sural flaps are more useful for moderate-size wounds, especially in the calcaneal region, whereas the fasciosubcutaneous flap is better for repairing larger lesions of the leg and the ankle.

Adolescent↗
PubMed2001

A modified technique for harvesting the reverse sural artery flap from the upper part of the leg: inclusion of a gastrocnemius muscle "cuff" around the sural pedicle.

In the upper part of the leg, the sural nerve and its accompanying median superficial sural artery are buried between the two heads of the gastrocnemius muscle. Several authors found that the reverse sural artery flap was safe only if it was taken from the lower leg along the suprafascial course of the sural pedicle. This author presents a modified technique of harvesting the reverse sural artery flap from the proximal part of the leg: A midline "cuff" of gastrocnemius muscle containing the buried sural pedicle is harvested with the flap. This modification allowed maintaining a "mesenteric" connection between the sural pedicle and the overlying fascia in the upper part of the leg. A comparison between the incidence of ischemic events that occur with reverse sural artery flaps harvested using the standard and the modified techniques confirmed a more stable blood supply with the latter technique. The arterial and venous drainage of the reverse sural artery flap is discussed.

Adult↗
PubMed1983

Venous function in the leg after postoperative thrombosis diagnosed with 125I-fibrinogen uptake test.

The 125I-fibrinogen uptake test (FUT) has been widely used in the past decade to detect postoperative thrombosis. FUT has been shown to correlate well with phlebography, and positive FUT is associated with a high frequency of pulmonary embolism. The long-term venous function of the leg after FUT-detected postoperative thrombosis, however, is inadequately documented. In 179 patients who had been studied after operation with FUT, a follow-up evaluation of FUT as an indicator of risk for development of deep venous insufficiency was made four to five years later. The patients replied to a questionnaire, were clinically examined, and underwent venous strain-gauge plethysmography, venous pressure measurement, and, in some cases, phlebography. No statistically significant differences were found in any of the parameters between legs that had been FUT-positive and those that were FUT-negative at the time of the operation. The frequency of deep venous insufficiency thus was equal in FUT-positive and FUT-negative legs. It was also independent of the site of FUT-detected thrombus in the leg.

Aged↗
PubMedDate not supplied

Sympathetic nervous system involvement in the syndrome of painful legs and moving toes.

The objective of this study is to investigate sympathetic nervous system involvement in 2 patients with painful legs and moving toes. The first case was studied several years after the initiating trauma produced a peripheral nerve lesion and demonstrated the characteristic sequence of progression of pain and moving toes from the injured leg to the contralateral leg. The second case was initially studied within 3 months of an injury that did not produce definitive signs of a peripheral nerve lesion. Pain increased when the patients were startled and subsided temporarily after sympathetic blockade. In the first patient, toe movements and allodynia to light tactile stimulation persisted during sympathetic blockade, and pain sometimes returned before the vascular effects of blockade disappeared. In the second patient, pain and toe movements could be provoked reproducibly by light tactile stimulation of the affected foot and by sympathetic arousal. These symptoms and signs disappeared after lumbar sympathectomy, and re-emerged when signs of sympathetic reinnervation were detected. We concluded that sympathetic neuronal discharge may provoke pain by activating an impulse generator in the affected limb. Sympathetic involvement in the painful legs and moving toes syndrome appeared to be greater in the second case than the first, presumably due to differences in the initial injury or stage of the condition.

Adult↗
PubMed1987

Nitroglycerin-induced decrease of carbon monoxide diffusion capacity in acute myocardial infarction reversed by elevating legs.

Hemodynamic and respiratory variables were measured in 18 supine patients with acute myocardial infarction uncomplicated by left ventricular failure. Measurements were done during a control period and then when pulmonary capillary bed filling was decreased by iv injection of 3 mg nitroglycerin (NTG) and finally when pulmonary capillary bed filling was increased by raising the patients' legs. Heart rate increased significantly (p less than .05) ventricular filling, and mean aortic pressures dropped significantly (p less than .001) after NTG injection. Heart rate and mean aortic pressure returned to control level and ventricular filling pressures increased significantly (p less than .001) after elevating patients' legs. Mean carbon monoxide diffusion capacity decreased significantly (p less than .01) from 9.8 +/- 3.4 to 8.5 +/- 2.9 ml/min X mm Hg after NTG injection and increased significantly (p less than .02) to 9.3 +/- 3.5 ml/min X mm Hg after elevating patients' legs. Pulmonary wedge pressure decreased significantly (p less than .001) from 15 +/- 5 to 8 +/- 4 mm Hg after NTG injection and increased significantly (p less than .001) to 10 +/- 4 mm Hg after elevating patients' legs. We conclude that NTG reduces pulmonary capillary filling and pulmonary diffusion by reducing the available pulmonary gas exchange surface.

Adult↗
PubMed1993

Effect of intermittent pneumatic leg compression on intracranial pressure in brain-injured patients.

OBJECTIVE: To evaluate the effect of intermittent pneumatic leg compression on intracranial pressure and cerebral perfusion pressure in brain-injured patients. DESIGN: Prospective, sequential patient study. SETTING: Surgical/trauma ICU of a community hospital providing regional trauma care. PATIENTS: Twenty-four adult, brain-injured patients (mean Glasgow Coma Scale score = 6) who required hemodynamic and intracranial pressure monitoring. INTERVENTIONS: Placement of intermittent sequential pneumatic leg compression devices for prevention of venous thrombosis. MEASUREMENTS: Mean arterial pressure (MAP), heart rate, central venous pressure, and intracranial pressure were measured at baseline, and at 0, 10, 20, and 30 mins of intermittent pneumatic leg compression. Cerebral perfusion pressure was calculated as the difference between MAP and intracranial pressure. RESULTS: No significant changes in MAP, central venous pressure, or intracranial pressure occurred during the study interval. Calculated cerebral perfusion pressure remained unchanged. A total of 23 of 24 study patients had intracranial pressure controlled by hyperventilation or pharmacologic measures within the normal range at the time of study. CONCLUSION: Intermittent pneumatic leg compression results in no significant changes in intracranial pressure or cerebral perfusion pressure in stable, brain-injured patients who have intracranial pressure controlled by medical means.

Blood Pressure↗
PubMed2000

A new anthropometric phantom for calibrating in vivo measurements of stable lead in the human leg using x-ray fluorescence.

A new anthropometric phantom has been developed for calibrating in vivo measurements of stable lead deposited in bone using x-ray fluorescence. The phantom reproduces the shape of the mid shaft of the adult human leg and is fabricated using polyurethanes and calcium carbonate to produce materials that exhibit the same density, energy transmission, and calcium content as cortical bone, bone marrow, and muscle. The phantom includes a removable tibia fabricated using simulants for cortical bone and bone marrow to which a precise amount of stable lead has been added to cortical bone. The formulations used in fabricating the new anthropometric phantom are much more uniform in density and composition than the conventional phantom made from Plexiglas cylinders filled with plaster-of-Paris. The energy spectrum from an x-ray fluorescence measurement of the phantom using a 109Cd source is indistinguishable from an in vivo x-ray fluorescence measurement of the human leg, demonstrating that the materials used in the phantom exhibit the same radiological properties as human tissue. Likewise, results from x-ray fluorescence measurements of the phantom exhibit the same positional dependency as the human leg and vary by approximately 36% when, for example, the phantom containing 54 ppm of stable lead in the tibia was rotated by only 15 degrees. The detection limit for a 30 min 109Cd K shell x-ray fluorescence in vivo measurement is approximately 20 ppm determined from a background measurement using the new phantom containing no added lead in the muscle, bone, or bone marrow. The new anthropometric phantom significantly improves in vivo x-ray fluorescence calibration measurements by (1) faithfully reproducing the anatomy of the human leg, (2) having components that exhibit radiological properties similar to that of human tissue, and (3) providing a realistic calibration standard that can be used for in vivo x-ray fluorescence intercomparison measurements.

Adult↗
PubMed1985

An anatomic study of the septocutaneous vessels of the leg.

The vascular anatomy of the skin and fascia of the leg were studied in 20 cadaver legs that were injected and dissected under magnification to identify the origin, course, and distribution of vessels from the subfascial level to the skin. In addition to the longitudinally oriented fasciocutaneous arteries and the musculocutaneous perforators, the study demonstrated a third and important system of blood supply: the septocutaneous vessels. These vessels arise directly from the posterior tibial, anterior tibial, and peroneal arteries, run along the intermuscular septum, pierce the crural fascia, and ramify radially in the subcutaneous tissue superficial to the fascia. Longitudinally oriented anastomotic arcades are formed along the leg between branches of adjacent septocutaneous vessels. Each septocutaneous vessel has one or two venae comitantes. Selected methylene blue injections of the septocutaneous vessels revealed rich staining of the superficial surface of the fascia, the subcutaneous tissue, and distinct longitudinally oriented skin territories. There was no injection of dye in the deep surface of the fascia. It is felt that the septocutaneous vessels constitute an important source of skin circulation in the leg and form the basis for various fasciocutaneous flaps that have useful clinical applications.

Adult↗
PubMed1990

Distal lower leg local random fasciocutaneous flaps.

Significant open wounds of the distal third of the lower leg that require some form of vascularized flap have historically been covered with distant cross-leg flaps or more appropriately with microsurgical tissue transfers. The rediscovery of the "random" fasciocutaneous flap as a reliable single-stage option for proximal lower leg defects has been extended distally to allow an expedient alternative in lieu of these more complicated procedures. Over the past 7 years, 17 selected patients had closure of distal leg and ankle wounds with 19 local antegrade-oriented fasciocutaneous flaps. All eventually healed without serious sequelae, although 5 (26 percent) had minor complications, except for one case that could only be salvaged with a free-tissue transfer in order to prevent limb amputation. For small- or moderate-sized, uncontaminated injuries, this approach warrants consideration under appropriate circumstances as a simpler option that may permit satisfactory healing and avoids the known risks of microsurgical tissue transfers.

Aged↗
PubMed1995

Donor leg morbidity and function after fibula free flap mandible reconstruction.

The purpose of this study was to determine the donor leg morbidity and function after removal of the fibula free flap for mandible reconstruction. In the past 24 months, 29 consecutive patients underwent a total of 30 fibula free flap mandible reconstructions. A muscle-sparing technique was used to harvest the fibula flap, and the proximal 6 cm and distal 8 cm of fibula were left intact. Patients included 20 men and 9 women; their mean age was 58.8 years (range 29 to 82 years); the mean length of fibula removed was 14.5 cm (range 8 to 25 cm); osteocutaneous flaps were used in 27 patients (90 percent); and 16 patients (53 percent) required skin grafts to the donor leg. Donor leg morbidity and function were determined by patient questionnaire, physical examination, and isokinetic testing, with the opposite, unoperated leg serving as a control. Immediate postoperative morbidity occurred in 5 patients (17 percent) (infection, wound separation, or partial graft loss); none required additional surgery for donor complications. Patient questionnaires were completed by all patients at an average of 7.3 months after surgery. Patients were able to ambulate pain-free an average of 5.1 weeks (range 2 to 32 weeks) postoperatively and were all fully able to engage in all daily and recreational activities. Most (21 patients, 72 percent) were free of any donor pain, and the remainder (28 percent) had only occasional mild discomfort. Other complaints included ankle stiffness (41 percent), mild ankle instability (10 percent), and transient peroneal motor (7 percent) or sensory (28 percent) loss, which resolved in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

Crossover replantation and fillet flap coverage of the stump after ectopic implantation: a case of bilateral leg amputation.

A successful case of crossover replantation of the left foot to the stump of the right leg and temporary ectopic implantation of the right amputated foot on the forearm is described. The ectopically implanted right foot was used as a free fillet flap for the late reconstruction of the left leg stump. At the latest follow-up examination, 18 months after the accident, the patient was able to walk independently with a prosthesis on the stump of the left leg. Both the cross-replanted foot and the free filleted foot flap, used for the reconstruction of the left leg stump, have maintained adequate protective sensation. The importance of utilization of amputated parts for functional reconstruction is stressed. Crossover replantations and ectopic implantations should be considered in bilateral amputations for the salvage of at least one extremity.

Adolescent↗