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PubMed2004

Comparisons of the skeletal muscle metabolic abnormalities in the arm and leg muscles of patients with chronic heart failure.

BACKGROUND: It has been suspected for some time that patients with chronic heart failure (CHF) have abnormal muscle metabolism, so in the present study the muscle metabolism of the arm and leg were compared by (31)P magnetic resonance spectroscopy ((31)P-MRS) to examine the relationship to exercise tolerance. METHODS AND RESULTS: The study group comprised 13 patients and 11 normal controls. Calf-plantar and forearm-wrist flexion were performed to evaluate the metabolic capacity assessed as the phosphocreatine breakdown rate (PCr-slope) and muscle pH at a submaximal (70% peak) work rate (submax-pH). Exercise of both the arm and leg resulted in an earlier decrease in PCr and muscle pH in patients with CHF compared with controls. There were significant correlations between peak oxygen uptake (peak V(O2)) and the PCr-slope in both limbs in patients with CHF (forearm: r=0.63, p<0.05; calf: r=0.60, p<0.05), but no correlations in normal controls. There was a close correlation between the ventilatory anaerobic threshold (AT) and the PCr-slope in the calf (r=0.85, p<0.01), but not in the forearm in patients with CHF. Submax-pH in both upper and lower limbs was not significantly correlated to peak V(O2) or AT in either patients with CHF or controls. CONCLUSIONS: Although metabolic abnormalities during exercise are seen in both arms and legs, leg muscle abnormalities, in particular, are closely related to systemic exercise intolerance in patients with CHF.

Arm↗
PubMed1999

Early occurrence of respiratory muscle deoxygenation assessed by near-infrared spectroscopy during leg exercise in patients with chronic heart failure.

The mechanisms of respiratory muscle deoxygenation during incremental leg exercise with expired gas analysis were investigated in 29 patients with chronic heart failure and 21 normal subjects. The deoxygenation and blood volume of the respiratory muscle and exercising leg muscle were assessed by near-infrared spectroscopy (NIRS). To evaluate the influence of the leg exercise on the blood volume of the respiratory muscle, 10 normal subjects also underwent a hyperventilation test with NIRS. The respiratory muscle deoxygenation point (RDP), at which oxygenated hemoglobin starts to decrease, was observed in both groups during exercise. The oxygen consumption (VO2) and the minute ventilation at the RDP in the patients was lower (p<0.01). At the same VO2, the respiratory rate was higher in patients (p<0.01). During exercise, the blood volume of the leg muscle increased, while that of the respiratory muscle decreased. During a hyperventilation test, the minute ventilation was higher than that of the RDP during exercise, the blood volume of the respiratory muscle did not decrease, and the RDP was not detectable. In conclusion, a limited ability to increase perfusion of respiratory muscles during exercise combined with the greater work of breathing results in early respiratory muscle deoxygenation in patients with chronic heart failure.

Blood Volume↗
PubMed2001

The pathophysiology of different types of leg ulcers.

Leg ulcers are wounds on the leg of 6 weeks or more duration, and may range in size from very small to very large. They are caused primarily by deterioration in the peripheral circulation of the affected individual, although this may arise from a number of conditions. This article discusses the major conditions leading to the formation of a leg ulcer, in order to improve understanding of the rationale for leg ulcer management techniques.

Arteries↗
PubMed2002

Community leg ulcer clinics vs home visits: which is more effective?

District nurses manage the care of the majority of patients with leg ulcers, but there have been reports of variations in the practice and effectiveness of treatment provided by district nurses (Audit Commission, 1999). Evidence-based health care aims to promote clinical and cost-effective care/treatment through the explicit, conscientious, and judicious use of the currently available best evidence from research to guide decisions (Sackett et al, 1996). Following the method of Griffiths (2002), a mini-systematic review was undertaken, to find out whether leg ulcer clinics provide more effective treatment to patients with leg ulcers than care provided in patients' homes by district nurses. Five databases were searched to find valid randomised controlled trials (RCTs) or systematic reviews to answer the question. The search was supplemented by hand searching of relevant publications. Only one trial met the inclusion criteria of the review. Although it concluded that leg ulcer clinics delivered improved outcomes the evidence provided was limited due to the comparison treatment being outdated, inadequate information regarding costs, and that as a relatively small isolated RCT it provided insufficient evidence to answer the question.

Clinical Trials as Topic↗
PubMedDate not supplied

Assisting patients to comply with leg ulcer treatments.

A great deal of work has been done in recent years to highlight and improve the leg ulcer problem in the UK. Leg ulcer clinic projects have resulted in effective treatments (Moffat, 1990), guidelines to assist in the appropriate management of leg ulcers (Nelson, 1996) and leg ulcer clinics that aim to prevent recurrence (Ruane-Morris et al, 1995). However, even with the best possible treatment strategies based on reliable research evidence, many patients do not comply with the recommended treatment and therefore have persistent non-healing or recurrent ulceration (Moffat and Franks, 1995). Patient education is vastly important in this area and can be supported by education leaflets to facilitate learning. Educational theories can also be drawn on to ensure that patient education is based on sound evidence.

Humans↗
PubMedDate not supplied

Treatments and healing rates in a community leg ulcer clinic.

Leg ulcer management is increasingly becoming a nurse-led specialty with practitioners implementing evidence-based care that is efficient, effective and resourceful. A large percentage of patients with leg ulceration are treated in the community. This article will discuss the healing rates and management of venous leg ulcers, many of which were longstanding problems, in a community leg ulcer clinic.

Community Health Centers↗
PubMed2004

Quality of life and leg ulceration from the patient's perspective.

Chronic leg ulceration can have a profound impact on a patient's quality of life. Studies have shown that pain, and general interference with normal activities of living, are the major themes emerging which are often not dealt with in a consistent manner by healthcare professionals. A literature review of this subject shows that although a number of studies have been carried out on quality of life related to chronic leg ulceration, there is little evidence that these findings are being addressed in daily management of these often complex leg ulcer patients. The aim of this article is to examine the research relating to quality of life and leg ulceration, and to attempt to determine what the most important issues are from the patient's perspective, in an effort to improve the way nurses manage their care.

Activities of Daily Living↗
PubMed1997

Pain in venous leg ulcers.

A prospective study was conducted to assess the prevalence, severity and diagnostic utility of pain in patients with venous leg ulcers. A semi-structured questionnaire was completed by 140 consecutive patients in two specialist centres caring for patients with leg ulcers. A high proportion (64%) of the 94 patients with ulcers of purely venous aetiology reported severe pain; 50% of these patients were taking either mild analgesia or none at all. In 10 of 72 cases, leg elevation made the pain worse. Venous ulcers are painful. Pain in three distinct locations was reported by patients-within ulcers, around ulcers and elsewhere in the leg. The presence of severe pain does not necessarily indicate arterial disease or infection. Pain is, in general, inadequately controlled in these patients.

Adult↗
PubMed2003

Errors and discrepancies: a patient perspective on leg ulcer treatment at home.

OBJECTIVE: This Norwegian study explored the treatment experiences of nine patients with a leg ulcer who lived at home. METHOD: The study was descriptive and exploratory, with open-ended interviews. Five women and four men aged 60-96 years who had a leg ulcer for more than six weeks participated. Most had a venous/arterial leg ulcer, lasting from between four months to 'my whole adult life'. RESULTS: Treatment was not always carried out in a correct and caring manner. The patients experienced trial and error in their treatment, delays in the arrival of the helpers, unhygienic methods and lack of information about the cause and treatment of their ulcer. Despite these problems, they had confidence in the treatment they received. CONCLUSION: The treatment, hygiene and organisation of the care of patients with leg ulcers living at home needs improving.

Aged↗
PubMed2003

An evaluation of the leg and foot ulcer treatment provided in Oslo.

OBJECTIVE: This study set out to gather more information about the treatment of leg and foot ulcers in the community in Oslo, Norway. METHOD: A structured questionnaire on leg and foot ulcer treatment was sent to 173 community nurses in Oslo, of whom 102 responded with data on 145 patients. RESULTS: Of the sample, 55.9% had leg ulcers, 32.2% had foot ulcers and 11.9% both; 26.2% had diabetes. Thirty-four per cent of the patients had not had a diagnosis of leg ulceration. Saline was the preferred cleansing solution. Compression therapy was used on all types of ulcer. Pain was a problem for 52.9% of the patients, of whom 9% did not receive analgesia. CONCLUSION: Nurses and doctors working in this community need to update their knowledge of wound treatments.

Aged↗
PubMed2006

Patients' perceptions of the impact of treatments and products on their experience of leg ulcer pain.

OBJECTIVE: Very little research has explored patients' experience of pain with different cleansing agents and dressings. We therefore undertook a longitudinal study of their impact on leg ulcer pain. METHOD: Patients with leg ulcers referred to community nurses were eligible to participate. They were followed up for six months, completing questionnaires about the impact on pain of each wound treatment used. A treatment episode was defined as the use of a wound cleansing agent, primary dressing and bandages. When one aspect of treatment changed, a new treatment episode began. RESULTS: There were 210 treatment episodes for 96 leg ulcer patients. In 206 episodes cleansing agents were used. Cleansing caused pain in 22% of episodes and relieved pain in 27%. Of the five most commonly used dressing types, low-adherent dressings were the least likely to cause pain. Only 56% of patients were able to tolerate full compression bandaging and pain was the most common reason for non-compliance. CONCLUSION: A substantial proportion of patients felt that leg ulcer treatments caused pain. A greater emphasis on the impact of treatment on pain and healing is warranted both clinically and in research.

Aged↗
PubMed2006

An exploration of current leg ulcer management practices in an Irish community setting.

OBJECTIVE: To establish the prevalence of leg ulceration in the Irish Health Service Executive (HSE) mid-western region and to determine the level of assessment and treatment patients have been receiving in the local community. METHOD: Before the introduction of a Doppler training programme, all public health and community health nurses working in the Irish HSE mid-western area were requested to complete an audit form on each patient being treated for leg ulceration during a predefined one-week period. This form recorded details on patient demographics, ulcer aetiology, assessment and treatment. Out of 97 nurses, 96 responded to this audit, giving a response rate of 98.9%. RESULTS: A total of 429 patients with 449 leg ulcers were identified. Mean age was 75.5 years (standard deviation 10.7). Overall prevalence was 0.12%, which increased to 1.2% in those aged 70 years and over. Women were almost twice as likely as men to be affected (ratio of 1.8:1). The main causes of ulceration were reported as venous incompetence accounting for 63.3% (284/449) and arterial insufficiency accounting for 8% (36/449) of all ulcers. Only 59.9% (269/449) of all ulcerated limbs had ABPI measurements performed. Of those reported as venous in origin, 71.8% (204/284) had ABPI measurements recorded. Evidence-based care was generally apparent in this group, with 47.5% (97/204) receiving high compression and 18.1% (37/204) receiving reduced compression. However, in venous leg ulcers where ABPIs were not recorded (n=80) care appeared haphazard and inappropriate. CONCLUSION: Our study has identified the benefit of ABPI Doppler assessment.This assessment could be done in local health centres by trained nurses who could provide more appropriate and timely care to patients, thereby improving outcomes and relieving pressure on acute hospital clinics.

Age Distribution↗
PubMed1983

The influence on the spine of leg-length discrepancy after femoral fracture.

We investigated the spines of 15 patients who had significant leg-length inequality as a result of femoral shaft fractures sustained after skeletal maturity but below the age of 21 years. The patients were examined at least 10 years after fracture. The spines were studied clinically and radiographically before and after correction of leg-length inequality with a shoe-raise. Lateral spinal flexion was measured from radiographs. The lumbar scoliosis associated with the leg-length inequality was compensatory: after equalisation of leg-length the overall curve and the axial rotation were corrected completely. There was also an equal range of lateral flexion to either side after correction. Minor malalignments of the whole spine remained despite correction of the compensatory scoliosis, and within the lumbar spine correction of the scoliosis had not occurred equally at all levels. No patients complained of significant discomfort and neither structural abnormalities nor degenerative changes were seen on the radiographs.

Adolescent↗
PubMed2003

Orthotopic and heterotopic lower leg reimplantation. Evaluation of seven patients.

Reimplantation is a well-established procedure in reconstructive surgery. This is especially so after amputation of the upper limb since prostheses provide limited function. In unilateral amputation of the lower leg orthotopic reimplantation is the treatment of choice. With bilateral amputation, in which orthotopic reimplantation is not possible because of the complexity of the trauma, heterotopic reimplantation is an option. We report five patients who received orthotopic and two who received heterotopic reimplantations of the lower leg. We assessed the functional outcomewith reference to cutaneous sensation, mobility, pain, and the cosmetic result. The functional outcome was good, as was the patients' satisfaction. Their mobility, stability, and psychological state were satisfactory. Patients with heterotopic reimplantations preferred the reimplanted leg to a prosthesis. Although reimplantation of the lower leg requires prolonged hospitalisation, delayed mobilisation and secondary operations, we conclude that there is an indication for this operation in order to improve the patient's quality of life.

Adolescent↗
PubMed2006

The effect of a neck-retaining femoral implant on leg-length inequality following total hip arthroplasty: a radiological study.

The aim of this study was to assess whether a femoral component which retained the neck reduced the incidence of leg-length inequality following total hip arthroplasty. A retrospective review was undertaken of 130 consecutive primary total hip arthroplasties performed between April 1996 and April 2004 using such an implant. There were 102 suitable patients for the study. Standardised pre- and post-operative pelvic radiographs were measured by an independent investigator to the nearest millimetre. The leg-length inequality was reduced from a mean pre-operative value of -0.71 cm to a mean of 0.11 cm post-operatively. Of the 102 patients 24 (23.5%) had an equal leg-length post-operatively, and 95 (93.1%) had a leg-length inequality between -1 cm and 1 cm.

Arthroplasty, Replacement, Hip↗
PubMed2006

Restless legs syndrome: manifestations, treatment and dental implications.

BACKGROUND: The authors reviewed the clinical features, epidemiology, pathogenesis and risk factors, medical management, dental findings and dental management of patients with restless legs syndrome (RLS). TYPES OF STUDIES REVIEWED: The authors conducted a MEDLINE search for the years 2000 through 2004 using the key terms "restless legs syndrome," "epidemiology," "pathophysiology," "treatment" and "dentistry." They selected articles published in English in peer-reviewed journals for further review, and they gave preference to articles reporting randomized controlled trials. CONCLUSIONS: RLS is a neurological disorder that is characterized by unpleasant sensations in the legs that occur at rest, especially at bedtime. These symptoms cause an irresistible urge to get out of bed and move the legs to relieve the discomfort, thereby delaying sleep onset and resulting in fatigue and dysphoria the next day. CLINICAL IMPLICATIONS: The prevalence of dental disease may be extensive in patients with RLS because of diminished salivary flow resulting from the medications used to treat RLS. Patient education, saliva substitutes and anticaries agents are indicated. Special precautions must be taken when prescribing or administering sedative-hypnotic agents that are likely to have adverse reactions with the medications used to treat RLS.

Analgesics, Opioid↗
PubMed1996

Importance of lipid peroxidation, protective enzymes and trace elements in chronic leg ischaemia.

The aim of this study was to assess the lipid peroxidation in chronic leg ischaemia by determining thiobarbituric acid reactants. Furthermore, Cu, Zn-superoxide dismutase and glutathione peroxidase activities as well as the trace element profile (Zn, Cu, Se, Mg) were determined. Fasting blood samples from the common femoral artery and vein were taken from both legs of 15 patients (57 +/- 7 years) with peripheral arteriosclerosis and 9 individuals (54 +/- 9 years) of the control group without chronic leg ischaemia. Patients with peripheral arteriosclerosis showed significantly decreased venous thiobarbituric acid reactant levels (2.01 +/- 0.37 vs. 2.39 +/- 0.59 mumol/l in controls, p < 0.05). Both arterial and venous samples from patients showed lower Cu, Zn-superoxide dismutase activities and higher glutathione peroxidase activities than controls. Venous activities of glutathione peroxidase were significantly higher than arterial activities in both groups (patients 0.52 +/- 0.18 vs 0.43 +/- 0.15 mukat/g Hb, p < 0.001, control group 0.51 +/- 0.12 vs 0.39 +/- 0.19 mukat/g Hb, p < 0.01). The trace element profile of the patients showed a highly significant decrease in magnesium levels (p < 0.001) and increased venous copper levels (p < 0.05). No significant changes were found in zinc and selenium levels. The results of this study show that during chronic leg ischaemia the production of free oxygen radicals at rest is well controlled, but the activity of antioxidant enzymes seems to be impaired.

Adult↗
PubMed2003

Rewarming index of the lower leg assessed by infrared thermography in adolescents with type 1 diabetes mellitus.

The aim of this study was to determine whether infrared thermography before and after challenge of the lower leg in cold water may be a useful tool to detect abnormalities in skin blood flow in adolescent asymptomatic patients with type 1 diabetes mellitus (DM1) and to assess the optimal setting of skin temperature measurements. Twenty-five adolescents (10 female, 15 male, mean age 21.2 +/- 6.2 years, body mass index [BMI] 23.0 +/- 2.1 kg/m2) with a duration of DMI of 13.8 +/- 5.4 years and mean HbA1c levels 8.5 +/- 1.3% were compared to age- and sex-matched controls (BMI 22.9 +/- 2.2 kg/m2). Seven defined sites of the lower leg were assessed by infrared thermography before and for 10 min after exposure of the leg to 14 degrees C cold water. As skin temperature before exposure to cold water differs from individual to individual and basal temperature was significantly warmer in patients at the tip of the first (p < 0.05) and fifth (p < 0.05) toe, the rewarming index was calculated in order to compare data. Rewarming indexes of skin temperature during the whole measurement procedure (0-10 min) were significantly lower at the tip of the first (p < 0.05) and fifth (p < 0.01) toes and from minute 2-10 also at the inner ankle (p < 0.05) in patients compared to healthy controls. Rewarming indexes of the other four sites were not significantly different between patients and controls. Infrared thermography of the lower leg after cold water exposure is an easily applicable method and a useful tool to detect abnormalities of skin blood flow in adolescents with DM1 especially at the tips of the first and fifth toes and the inner ankle.

Adolescent↗