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At least 307 records · Page 17Linked to original sources

PubMed2001

Venous gangrene of lower extremities and Staphylococcus aureus sepsis.

This is a study of the venous gangrene of lower extremities and Staphylococcus aureus sepsis. We report on a premature infant who developed phlegmasia cerulea dolens (PCD) in both lower extremities in association with S. aureus sepsis, resulting in gangrene of the right foot. Non-pitting edema and cyanosis of the digits of the right lower extremity were noted 48 hours after hypotension and severe shock due to S. aureus sepsis. Intravenous antibiotics, isotonic fluids, and heparin were administered. Twenty-four hours later, edema and ischemic changes of the first and fifth left toes were also noted. Doppler flow study showed flow signals in both right and left popliteal arteries. However, there were no Doppler signals in neither right nor left popliteal vein. Emergency fasciotomies were performed on both lower limbs. The progression of the gangrene was limited to the right foot. There was complete resolution of PCD in both lower extremities. To the best of our knowledge, the association of S. aureus sepsis with PCD and venous gangrene in an infant has not been reported previously. This case illustrates the need for early recognition of PCD and aggressive intervention.

Foot Diseases↗

PubMed2005

Foot orthoses affect frequency components of muscle activity in the lower extremity.

The purpose of this study was to quantify the effects of selected foot orthoses on muscle activity in the lower extremity during running. Nine male and 12 female recreational runners, clinically and functionally classified as 'pronators', volunteered for this study and performed over-ground running trials at 4m/s in each of four experimental conditions: control, posting, molding, and posting & molding. Electromyographic (EMG) signals were recorded from seven lower extremity muscles. Wavelet analysis was performed to obtain EMG intensities in two frequency bands that were averaged for the pre-heel-strike and post-heel-strike intervals and for 30-100% of stance phase. Posting and custom-molding of foot orthoses increased the global EMG intensity of most muscles of the lower extremity for the stance phase of running (P < 0.05). The increases in EMG intensity were greater in the high- than in the low-frequency bands for some lower extremity muscles (P < 0.05). The effects on muscle activity of posting and custom-molding of foot orthoses differed between the three phases of running gait. The three tested foot orthoses did affect lower extremity muscle activity differently and these effects were specific to the phases of running gait. Combinations of increased requirements of controlling joint motion and minimizing soft tissue vibrations may have led to greater increases in shank muscle activity for the posted condition. The substantial changes in EMG due to orthotic interventions found in this study documents the importance of the study of muscle activity as a reaction to shoe inserts and foot orthoses.

Adult↗

PubMed1999

Survival of patients with melanoma of the lower extremity decreases with distance from the trunk.

BACKGROUND: Early stage melanoma of the lower extremity is generally associated with a favorable prognosis. However, several retrospective studies have suggested that melanoma on the foot portends poor survival. The authors hypothesized that the region of the lower extremity has prognostic importance. METHODS: Between January 1, 1971, and December 31, 1991, 652 patients were seen at the John Wayne Cancer Institute for a primary melanoma on the foot (92 patients), calf (336 patients), or thigh (224 patients). All patients had clinically or histopathologically negative regional lymph nodes. The duration of follow-up after first diagnosis was 9 -302 months, with a minimum of 6 years for survivors. Survival curves were estimated by the Kaplan-Meier method. Pearson chi-square test was used to test differences associated with the regional site of the lower-extremity melanoma. The log rank test was used for univariate analysis, and Cox proportional hazards regression was used for multivariate analysis. RESULTS: Univariate analysis identified regional site, gender, Breslow depth, Clark level, and age at diagnosis as significant for both overall survival (OS) and disease free survival (DFS) (P = 0.0001). Multivariate analysis confirmed regional site as an independent prognostic variable for OS (P = 0.0002) and DFS (P = 0.0005). Ten-year rates of OS and DFS were 71% and 66%, respectively, for patients with foot melanomas, compared with 92% and 87% for those with calf melanomas and 95% and 94% for those with thigh melanomas. CONCLUSIONS: The prognosis for patients with primary melanoma of the lower extremity is affected by the distance of the lesion from the trunk. Thus, distal (foot) lesions carry a higher risk than thigh lesions. This difference should be considered as a covariate when stratifying patients in clinical trials.

Adult↗

PubMed2002

Effect of duration of upper- and lower-extremity rehabilitation sessions and walking speed on recovery of interlimb coordination in hemiplegic gait.

BACKGROUND AND PURPOSE: The effects of different durations of rehabilitation sessions for the upper extremities (UEs) and lower extremities (LEs) on the recovery of interlimb coordination in hemiplegic gait in patients who have had a stroke were investigated. SUBJECTS AND METHODS: Fifty-three subjects who had strokes involving their middle cerebral arteries were assigned to rehabilitation programs with (1) an emphasis on the LEs, (2) an emphasis on the paretic UE, or (3) a condition in which the paretic arm (UE) and leg (LE) were immobilized with an inflatable pressure splint (control treatment). The 3 treatment regimens were applied for 30 minutes, 5 days a week, during the first 20 weeks after onset of stroke. All subjects also participated in a rehabilitation program 5 days a week that consisted of 15 minutes of UE exercises and 15 minutes of LE exercises in addition to a weekly 11/2-hour session of training in activities of daily living. A repeated-measures design was used. Differences among the 3 treatment regimens were evaluated in terms of comfortable and maximal walking speeds. In addition, mean continuous relative phase (CRP) between paretic arm and leg (PAL) movements and nonparetic arm and leg (NAL) movements and standard deviations of CRP of both limb pairs as a measurement of stability (variability) were evaluated. RESULTS: Comfortable walking speed improved in the group that received interventions involving the LEs compared with the group that received interventions involving the UEs and the group that received the control treatment. No differences among the 3 treatment conditions were found for the mean CRP of NAL and PAL as well as the standard deviation of CRP of both limb pairs. DISCUSSION AND CONCLUSION: With the exception of an improved comfortable walking speed as a result of a longer duration of rehabilitation sessions, no differential effects of duration of rehabilitation sessions for the LEs and UEs on the variable we measured related to hemiplegic gait were found. Increasing walking speed, however, resulted in a larger mean CRP for both limb pairs, with increased stability and asymmetry of walking, indicating that walking speed influences interlimb coordination in hemiplegic gait.

Analysis of Variance↗

PubMed1994

How does provider and patient awareness of high-risk status for lower-extremity amputation influence foot-care practice?

OBJECTIVE: To assess whether patients with diabetes at high risk for lower extremity amputation received more intensive medical care or self-care instruction and to determine the association between foot care and risk of lower-extremity amputation. RESEARCH DESIGN AND METHODS: Patients with diabetes were seen at he Seattle Veterans Affairs Medical Center (VAMC) between October 1984 and April 1987; 67 patients were seen for initial non-traumatic amputation, and 236 consecutive control subjects were seen for non-traumatic but medically necessary surgery unrelated to diabetes. Data collection included patient interview and medical record review. High-risk status, defined as presence of peripheral neuropathy, peripheral vascular disease, or or prior foot ulcer, was temporally fixed at 2 years before study enrollment. RESULTS: Peripheral neuropathy, peripheral vascular disease, and prior foot ulcer were independently associated with risk of lower-extremity amputation: peripheral neuropathy odds ratio (OR) = 1.4 (95% confidence interval (CI) 0.7-2.7), peripheral vascular disease OR = 2.6 (95% CI 1.5-4.5), and prior foot ulcer OR = 10.9 (95% CI 4.6-25.5). Patients with a prior foot ulcer were significantly more likely to have seen a podiatrist and to have received outpatient diabetes education at the Seattle VAMC; their providers were more likely to prescribe clipping toenails, regular foot washing, and elevating feet during the day (chi 1(2) for proportions P < 0.05). However, for patients with a history of peripheral neuropathy or peripheral vascular disease, there was no statistically significant increase in medical care (podiatry visits, outpatient diabetes education) or self-care instruction (clip nails, elevate feet, or self-monitor blood glucose) compared with patients without either of these two conditions (chi 1(2) for proportions P > 0.20). CONCLUSIONS: When clinicians were aware of a patient's very elevated risk for lower-extremity amputation (evidenced by prior history of foot ulcer), they were more likely to prescribe preventive foot-care behaviors, but awareness of other risk factors (peripheral neuropathy or peripheral vascular disease) did not necessarily increase preventive care. Physicians and patients should receive periodic education and reinforcement of diabetes management skills to modify care delivered to individuals at highest risk for lower-extremity amputation.

Adult↗

PubMed2005

An unusual solution after bilateral lower extremity amputation.

The authors present a case of a 40-year-old male with devastating amputation trauma of both lower extremities. Reconstruction of the right lower extremity was solved by the unusual use of inserted vascularized bone-skin graft from the left crus with a simultaneous replantation of the right foot. The result after 3.5 years is preservation of one extremity with full knee mobility. The other lower extremity was fitted for thigh prosthesis.

Adult↗

PubMed1986

Neurilemoma of the lower extremity.

A series of 76 patients with 85 neurilemomas of the lower extremity was reviewed. The tumors were located throughout the lower extremity and had varied clinical presentations, which often posed problems in diagnosis. Pain, however, was a consistent symptom, and 63 (83%) of the patients presented with local or radiating (or both) pain. Electromyography was done in seven cases, but the results were abnormal in only two. When evaluating a painful mass or an atypical pain in the lower extremity, the clinician should have a high index of suspicion for neurilemoma.

Adult↗

PubMed2005

The lower extremity nerve injuries - own experience in surgical treatment.

The frequency of the lower extremity nerve injuries is assessed to about 20% of the overall lesions to the peripheral nerve system. Peroneal neuropathy is the most common lower extremity nerve palsy. In this study, results of the surgical treatment of the lower extremity nerve injuries have been presented. The clinical material consisted of 270 patients (192 males, 78 females aged from 3 months to 74 years) with injuries of the common peroneal nerve - 125, sciatic nerve - 93, common peroneal and tibial nerve - 21, tibial nerve - 17, femoral nerve - 10, others - 4. The following surgical procedures were performed: external neurolysis - 164, internal neurolysis - 27, reconstruction with sural nerve grafting - 63, direct neurorrhaphy - 12, neurotisation - 3, supplementary tenomioplasty - 23. Evaluation of the results with the use of BMRC scale (M0-M5) and Highet scale (S0-S4) included the group of 120 patients. After the surgical treatment a significant improvement was found in 63.3%. The efficacy of the treatment is strictly dependent on an early surgical intervention, mechanism and degree of the nerve injury as well as appropriate method of surgical therapy.

Adolescent↗

PubMed2000

Utility of lower extremity venous ultrasound scanning in the diagnosis and exclusion of pulmonary embolism in outpatients.

STUDY OBJECTIVE: Emergency physicians frequently rely on normal findings from a lower extremity venous ultrasound examination as a method to decrease the probability of pulmonary embolism (PE) in outpatients with a nondiagnostic ventilation-perfusion lung scan (V/Q scan). The objective of this study was to evaluate the diagnostic utility of bilateral lower extremity venous ultrasound scanning in the diagnosis of PE in emergency department patients with a low-, moderate-, or indeterminate-probability (nondiagnostic) V/Q scan. METHODS: This prospective, 2-center, descriptive study was conducted at the EDs of 2 large teaching hospitals. From an initial cohort of 570 nonreferred outpatients, a convenience sample of 156 patients who had both a nondiagnostic V/Q scan and a lower extremity venous ultrasound scan performed was selected as the study population. The sensitivity and specificity for a single lower extremity venous ultrasound scan and the posttest probability of PE were determined for the study population. RESULTS: In the study population, the best-case sensitivity of the lower extremity venous ultrasound scan for PE was 54% (95% confidence interval [CI] 37% to 71%) and the specificity was 98% (95% CI 94% to 100%). The likelihood ratio of a positive test result was 27. The likelihood ratio of a negative test result was 0.49, yielding a lowest possible posttest probability of PE of 12% (95% CI 6% to 17%). CONCLUSION: This study demonstrates that the combination of a nondiagnostic (low, moderate, or indeterminate) V/Q scan plus a single negative result from lower extremity venous ultrasound examination, even in a best-case scenario, does not exclude the diagnosis of PE.

Adult↗

PubMed2006

Prospective multicenter study of quality of life before and after lower extremity vein bypass in 1404 patients with critical limb ischemia.

BACKGROUND: Patients with critical limb ischemia (CLI) have multiple comorbidities and limited life spans. The ability of infrainguinal vein bypass to improve quality of life (QoL) in patients with CLI has therefore been questioned. Prospective preoperative and postoperative QoL data for patients undergoing lower extremity vein bypass for CLI are presented. METHODS: A validated, disease-specific QoL questionnaire (VascuQoL) with activity, symptom, pain, emotional, and social domains and responses scored 1 (lowest QoL) to 7 (best QoL) was administered before surgery and at 3 and 12 months after lower extremity vein bypass for CLI. Changes in QoL at 3 and 12 months after lower extremity vein bypass and multiple predetermined variables potentially influencing QoL after lower extremity vein bypass were analyzed to determine the effect of lower extremity vein bypass on QoL in CLI patients. RESULTS: A total of 1404 patients had lower extremity vein bypass for CLI at 83 centers in the United States and Canada as part of the PREVENT III clinical trial. Surveys were completed in 1296 patients at baseline, 862 patients at 3 months, and 732 patients at 12 months. The global QoL score (mean +/- SD) was 2.8 +/- 1.1 at baseline and was 4.7 +/- 1.4 and 5.1 +/- 1.4 at 3 and 12 months, respectively. Mean changes from baseline at 3 and 12 months were statistically significant (P < .0001). Improved QoL scores extended across all domains. Diabetes and the development of graft-related events were associated with decreased improvement in QoL scores, though the mean relative change from baseline remained positive. CONCLUSIONS: Patients with CLI have a low QoL at baseline that is improved at 3 and 12 months after lower extremity vein bypass. QoL improvements are lower in diabetic patients and those who develop graft-related events. Successful revascularization can be expected to improve QoL in patients with CLI, with benefits that are sustained to at least 1 year.

Aged↗

PubMed2006

An international comparison of lower extremity amputation rates.

The purpose of this report was to compare lower extremity amputation rates between areas of the United States and areas outside the United States using a standard format. Twelve U.S. counties similar in size, income, and land use were selected. The rate of amputation for each county was developed following the method and definitions described by the Global Lower Extremity Amputation Study (GLEAS). The data were compared to rates of amputation for non-U.S. areas that participated in the GLEAS. The U.S. counties generally had higher amputation rates than the non-U.S. areas in this standardized comparison. The United States suffers a high number of lower extremity amputations in comparison to other developed countries. The effectiveness of prevention strategies in the United States needs to be reevaluated and new strategies explored.

Amputation, Surgical↗

PubMed1996

Morphological analysis of the human lower extremity based on the relative muscle weight.

Morphological study of the muscles of the lower extremity is necessary for the analysis of the muscular function and its relation with locomotion. In this study, the muscle weight of the lower extremities from 11 adult Japanese cadavers (6 males and 5 females, aged from 50 to 91 years old) were measured. The morphological characteristic of the human lower extremity is discussed based on the relative muscular weight. The largest muscles were the gluteus maximus (the extensor at the hip joint), the vasti muscles (the extensor at the knee joint) and the soleus (the plantarflexor at the ankle joint). These results reveal that the muscles acting on one joint are developed in the human lower extremity and that these muscles have important roles in human locomotion.

Aged↗

PubMed1997

Single bone straight line graphs for the lower extremity.

Valuable information about growth and growth prediction in the lower extremity has been provided in the past by Anderson and Green, Moseley, and Menelans. Greater patient expectations and advanced techniques for lower extremity lengthening require more precise information regarding the growth characteristics of each long bone. A simple method for predicting growth is presented for the femur and tibia. Straight line graphs similar to one described previously by Moseley for the entire lower extremity have been drawn separately for the femur and tibia. Information from a contemporary population and new knowledge about growth plate activity have been included to provide more accurate predictions. By superimposing identically scaled growth remaining graphs on these single bone straight line graphs, a simple and accurate estimate is obtained for the timing and effect of epiphysiodeses or lengthening procedures.

Adolescent↗

PubMedDate not supplied

[Biomechanical air-vibration stimulation in the medical rehabilitation of patients with chronic venous insufficiency of the lower extremities].

Biomechanical pneumo-vibration stimulation of lower extremities was used in 146 patients with different forms and stages of chronic venous insufficiency of lower extremities during conservative treatment in preoperative preparation and the following early rehabilitation, in 106 patients with consequences of the trauma and diseases of the spinal cord as well as in 35 healthy people. The biomechanical pneumo-vibration stimulation is thought by the authors to be a promising noninvasive conservative method of medical rehabilitation. It can be recommended for clinical use with due regard for contraindications.

Adolescent↗

PubMedDate not supplied

Immediate ambulation of patients with lower-extremity grafts.

Immediate ambulation of patients who have had lower-extremity skin grafting has been practiced in our burn center since 1987. A retrospective review of patients who had lower-extremity skin grafting only and a survey of burn centers in which 109 centers responded were conducted. Average skin graft take in our burn center was 96.4%. Patients in our burn center walked 30 feet independently by postoperative day 1.7, whereas the survey response average was 7.2 days (p less than 0.001). Average length of stay was 12.6 days (p less than 0.012). This review demonstrated that although immediate ambulation after lower-extremity grafting is not a widely adopted procedure, it does not impair graft take and may decrease the average length of stay.

Adolescent↗

PubMed1995

Bilateral lower extremity US in the patient with bilateral symptoms of deep venous thrombosis: assessment of need.

PURPOSE: To assess the frequency of lower extremity deep venous thrombosis (DVT) detected with ultrasound (US) in patients with bilateral symptoms suggestive of DVT. MATERIALS AND METHODS: Fifty patients with bilateral lower extremity symptoms suggestive of DVT were examined prospectively for predisposing factors and type of symptoms. Charts were reviewed for previous lower extremity disease or chronic illness that could explain the patient's symptoms. The frequency of DVT diagnosed with US in this patient group was determined. RESULTS: No DVT was identified in the patients with bilateral symptoms suggestive of DVT. Retrospective review demonstrated that 34 (68%) of the patients had a preexisting condition (cardiac disease, venous insufficiency, chronic swelling, cellulitis or thrombophlebitis, peripheral arterial disease). Because compression US has a greater than 90% sensitivity and specificity for the diagnosis of DVT, these results were statistically significant (P < .001). CONCLUSION: The likelihood of DVT in patients with bilateral lower extremity symptoms is extremely low. Alternative causes should be carefully explored before lower extremity US is considered.

Aged↗

PubMed2005

[Management strategies in the first operative phase after long-bone injury of the lower extremity in multiple-injured patients. A systematic literature review].

OBJECTIVE: Lower extremity injuries make up a substantial proportion of the injuries in multiply injured patients. The aim of this systematic literature analysis was to give an overview of the levels of evidence for different management strategies in the first operative phase after long-bone injuries of the lower extremity in multiply injured patients to enable, in the presence of adequate evidence, the development of clinical management corridors or, if the evidence was found to be inadequate, to document the necessity for scientific proof. METHODS: Clinical trials were systematically collected (Medline, Cochrane and hand searches) and classified into evidence levels (EL 1 to 5 according to the Oxford system). RESULTS: The necessity for primary or secondary definitive osteosynthesis of femur/tibia shaft fractures is still a matter of discussion. Intramedullary nailing is the preferred operative procedure for definitive treatment of femur shaft fractures. Stabilization of proximal and distal femur and tibia fractures is predominantly based on expert opinion. According to the literature, perioperative antibiotic prophylaxis is essential in fracture treatment. CONCLUSION: Numerous comparative studies (EL 2) dealing with management strategies in the first operative phase after long-bone injuries of the lower extremity in multiply injured patients are available, but there are only a few randomized studies. Based on the available data, it is possible to develop a rational therapy for this patient population.

Clinical Trials as Topic↗

PubMed2006

Elevated C-reactive protein levels are associated with postoperative events in patients undergoing lower extremity vein bypass surgery.

OBJECTIVES: Inflammatory markers such as high-sensitivity C-reactive protein (hsCRP) are associated with an increased risk of cardiovascular events and with the severity of peripheral arterial disease. The effects of inflammation on the development of vein graft disease remain speculative. We hypothesized that high levels of inflammatory markers would identify patients at increased risk for adverse events (graft failure, major cardiovascular events) after lower extremity bypass surgery. METHODS: Patients (n = 91) scheduled to undergo lower extremity bypass using autogenous vein were enrolled into a prospective study at two institutions. Exclusion criteria included the presence of major infection. A baseline plasma sample was obtained on the morning of lower extremity bypass. Biomarkers for inflammation included hsCRP, fibrinogen, and serum amyloid A (SAA). Values between patients with and without critical limb ischemia were compared. Proportions of events among dichotomized populations (upper limit of normal of each laboratory assay) were compared by log-rank test. RESULTS: Of the patients undergoing lower extremity bypass, 69% were men, 53% were diabetic, 81% were smokers, and their mean ankle-brachial index was 0.51 +/- 0.19. The indication for lower extremity bypass was critical limb ischemia in 55%. There were no perioperative deaths and two early graft occlusions. During a mean follow-up of 342 days (range, 36-694 days) there were four deaths, 27 graft-related events, and 10 other cardiovascular events. No relationships were found between events and demographics, comorbidities, baseline ankle-brachial index, or statin use. High-sensitivity CRP (P = .005), fibrinogen (P < .001), and SAA (P = .0001) levels were associated with critical limb ischemia at presentation. Among patients with an elevated hsCRP (>5 mg/L) immediately before surgery, major postoperative vascular events occurred in 60% (21/35), compared with a 32% (18/56) rate in those with a baseline CRP <5 mg/L (P = .004, log-rank test). On multivariable analysis, only elevated hsCRP correlated with adverse graft-related or cardiovascular events (P = .018). CONCLUSIONS: The inflammatory biomarkers of hsCRP, fibrinogen, and SAA correlate with peripheral arterial disease severity at presentation in patients undergoing lower extremity bypass. Patients with elevated hsCRP are at increased risk for postoperative vascular events, most of which are related to the vein graft. These findings suggest a potential relationship between inflammation and outcomes after lower extremity vein bypass surgery.

Arterial Occlusive Diseases↗