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At least 361 records · Page 20Linked to original sources

PubMed2006

Lower-extremity muscle cross-sectional area after incomplete spinal cord injury.

OBJECTIVES: (1) To quantify skeletal muscle size in lower-extremity muscles of people after incomplete spinal cord injury (SCI), (2) to assess differences in muscle size between involved lower limbs, (3) to determine the impact of ambulatory status (using wheelchair for community mobility vs not using a wheelchair for community mobility) on muscle size after incomplete SCI, and (4) to determine if differential atrophy occurs among individual muscles after incomplete SCI. DESIGN: Case-control study. SETTING: University research setting. PARTICIPANTS: Seventeen people with incomplete SCI and 17 age-, sex-, weight-, and height-matched noninjured controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Maximum cross-sectional area (CSA) of individual lower-extremity muscles (soleus, medial gastrocnemius, lateral gastrocnemius, tibialis anterior, quadriceps femoris, hamstrings) as assessed by magnetic resonance imaging. RESULTS: Overall, subjects with incomplete SCI had significantly smaller (24%-31%) average muscle CSA in affected lower-extremity muscles as compared with control subjects (P<.05). Mean differences were highest in the thigh muscles ( approximately 31%) compared with the lower-leg muscles ( approximately 25%). No differences were noted between the self-reported more- and less-involved limbs within the incomplete SCI group. Dichotomizing the incomplete SCI group showed significantly lower muscle CSA values in both the wheelchair (range, 21%-39%) and nonwheelchair groups (range, 24%-38%). In addition, the wheelchair group exhibited significantly greater plantarflexor muscle atrophy compared with the dorsiflexors, with maximum atrophy in the medial gastrocnemius muscle (39%). CONCLUSIONS: Our results suggest marked and differential atrophic response of the affected lower-extremity muscles that is seemingly affected by ambulatory status in people with incomplete SCI.

Adult↗

PubMed2000

MRA of the abdominal aorta and lower extremities.

Atherosclerotic involvement of the aorta and lower extremity vessels is a common clinical problem, especially in developed countries. While x-ray angiography has been the method of choice for preoperative evaluation of patients with atherosclerotic disease, magnetic resonance angiography (MRA) is emerging as a powerful noninvasive tool that is capable of providing information critical to the care of these patients. The objective of this manuscript is to review the current state-of-the-art of MRA of the abdominal aorta and lower extremity vessels. The techniques are described, the clinical indications for MRA are discussed, and the diagnostic accuracy and pitfalls of the various methods are presented.

Aorta, Abdominal↗

PubMedDate not supplied

Two simple leg net devices designed to protect lower-extremity skin grafts and donor sites and prevent decubitus ulcer.

Burn therapists routinely are tasked to position the lower extremities of burn patients for pressure ulcer prevention, skin graft protection, donor site ventilation, and edema reduction. We developed two durable and low-maintenance devices that allow effective positioning of the lower extremities. The high-profile and low-profile leg net devices were simple to fabricate and maintain. The frame was assembled using a three-quarter-inch diameter copper pipe and copper fittings (45 degrees, 90 degrees, and tees). A double layer of elasticized tubular netting was pulled over the frame and doubled back for leg support to complete the devices. The devices can be placed on any bed surface. The netting can be exchanged when soiled and the frame can be disinfected between patients using standard techniques. Both devices were used on approximately 250 patients for a total of 1200 treatment days. No incidence of pressure ulcer was observed, and graft take was not adversely affected. The devices have not required repairs or replacement. Medical providers reported they are easy to apply and effectively maintain proper positioning throughout application. Neither device interfered with the application of other positioning devices. Both devices were found to be an effective method of positioning lower extremities to prevent pressure ulcer, minimize graft loss and donor site morbidity, and reduce edema. The devices allowed for proper wound ventilation and protected grafted lower extremities on any bed surface. The devices are simple to fabricate and maintain. Both devices can be effectively used simultaneously with other positioning devices.

Burns↗

PubMed1981

[Role of the musculovenous "pump" in draining the subcutaneous veins in varicose disease of the lower extremities].

The two-system phlebotonometry of lower extremities in 50 patients with varicose disease enabled the authors to make a conclusion about the great role of the duration of that phase of diastole when the blood runs from superficial veins into deep ones promoting the evacuation of the congested blood. This phase was found to be considerably shorter and even to disappear completely in patients at the decompensation stage. The drainage function of the musculo-venous "pump" is disturbed in patients with the varicose disease of the lower extremities and the degree of its insufficiency is in direct relation with the degree of the disease.

Adolescent↗

PubMed1992

Treatment of lower extremity infections in diabetics.

The infected diabetic lower extremity has enjoyed a surge in popularity in the medical literature. There have been numerous papers outlining classification systems for ulcer depth, surgical approaches, and microbiology. Discussions on antibiotic use have usually been directed toward therapy of the "diabetic foot infections" as a group, without regard to differences in severity and location of these infections. These infections can vary from the most superficial of processes to a severe life- and limb-threatening sepsis. The author presents a review of the processes involved in the diabetic lower extremity infection and suggests a classification system for selection of empiric antibiotic therapy based on the severity of the infection.

Algorithms↗

PubMed2006

Epidemiology of stress fracture and lower-extremity overuse injury in female recruits.

PURPOSE: The purpose of this prospective study was to examine rates and risk factors for overuse injuries among 824 women during Marine Corps Recruit Depot basic training at Parris Island, SC, in 1999. METHODS: Data collected included training day exposures (TDE), baseline performance on a standardized 1.5-mile timed run, and a pretraining questionnaire highlighting exercise and health habits. The women were followed during training for occurrence of stress fracture and other lower-extremity overuse injury. RESULTS: There were 868 lower-extremity overuse injuries for an overall injury rate of 12.6/1000 TDE. Rates for initial and subsequent injury were 8.7/1000 and 20.7/1000 TDE, respectively. There were 66 confirmed lower-extremity stress fractures among 56 (6.8%) women (1.0/1000 TDE). Logistic regression modeling indicated that low aerobic fitness (a slower time on the timed run (> 14.4 min)), no menses in six or more consecutive months during the past year, and less than 7 months of lower-extremity weight training were significantly associated with stress fracture incidence. Self-rated fair-poor fitness at baseline was the only variable significantly associated with other non-stress fracture overuse injury during basic training. CONCLUSIONS: Among this sample of women, the risk of lower-extremity overuse injury was high, with a twofold risk of subsequent injury. The results suggest that stress fracture injury might be decreased if women entered training with high aerobic fitness and participated frequently in lower-extremity strength training. Furthermore, women reporting a history of menstrual irregularity at their initial medical exam may require closer observation during basic training.

Adolescent↗

PubMed1992

Assessment of upper and lower extremity movements in hemiplegic children.

Upper and lower extremity movements were assessed in 26 children with spastic hemiplegia according to the modified Brunnstrom method. Of the upper extremity movements, supinating the forearm was most difficult, followed in order by pronating the forearm, flexing the shoulder to 90 degrees, flexing the shoulder to 180 degrees, abducting the shoulder to 90 degrees or putting the hand on the lumbar spine, putting the hand behind the ipsilateral ear (flexor synergy), and putting the hand on the contralateral knee (extensor synergy). The extensor and flexor synergies were easier than the other movements in the hemiplegic children as well as in hemiplegic adults, but the order of difficulty in the other movements in children was not the same as in adults. The difficulty in the lower extremity movements was uniform in the subjects. None of the children could dorsi-flex the ankles and many could not rotate the hips internally. A small number of the children could not flex the knees or perform straight leg raising. All children could flex the hips and knees, extend the hips and knees, and abduct the hips. The difficulty in isolated hip abduction and flexion was less prominent in the hemiplegic children, compared to in hemiplegic adults.

Adolescent↗

PubMed1990

Lower extremity revascularization via the lateral plantar artery.

Lower extremity bypass grafts to the tibial and crural arteries are commonly employed to treat patients with atherosclerotic limb-threatening ischemia. Although occasional series have mentioned bypasses to a plantar artery, few of these specifically examine the results of arterial reconstructions using these vessels. Six patients underwent femoral to lateral plantar artery (LPA) bypass within a 19-month period for gangrene of the forefoot. There was one early graft failure and in the five completely autogenous reconstructions, graft patency and limb salvage had been achieved during a follow-up ranging from three to 22 months. The LPA is an acceptable site for anastomosis of lower extremity bypass grafts and the early results presented herein support its more liberal use when proximal sites are unavailable.

Aged↗

PubMed2000

Neuroanatomic substrates of lower extremity somatosensory evoked potentials.

After stimulation of the lower extremity nerve (tibial nerve), N21 and N23 are recorded from L4 and T12 spine respectively. The far-field potentials of P31 and N35 are registered from Fpz-C5s (fifth cervical spine) or CPi (ipsilateral with respect to the side of stimulation)-ear derivation. Additional far-field potentials of P17 and P24 may be recorded from the scalp when a noncephalic (knee) reference is used. The major positive peak, P40, is registered at the vertex and the CPi. Preceding P40, there is a small negative peak, N37, recorded at the contralateral (CPc) hemisphere. Neuroanatomic substrates of these somatosensory evoked potential (SSEP) components are less well clarified compared with those of upper extremity (median nerve) SSEPs, primarily because clinical application of lower extremity SSEPs is more difficult, and all of the aforementioned potentials but one (P40) are not obligatory components. The concept of "paradoxical lateralization" complicates the issue further. Accumulating evidence, however, suggests that the far-field potentials of P17 and P31 arise from the distal portion of the sacral plexus and brainstem respectively. These correspond to P9 and P14 of the median nerve SSEPs respectively. The spinal potential of N23 is equivalent to the N13 cervical potential of the median nerve SSEP. N35 recorded from the ipsilateral hemisphere is analogous to N18 of the median nerve. Paradoxically lateralized P40 has been thought to represent the positive end of a dipole field, reflected by the negativity at the mesial surface of the contralateral hemisphere, and has commonly been considered to be equivalent to the first cortical potentials (N20) of the median nerve SSEP. However, more recent evidence suggests that the primary positivity is at the mesial cortical surface, and it more likely corresponds to P26 of the median nerve SSEP. Thus the first cortical potential corresponding to N20 is probably a small and inconsistent N37 recorded on the contralateral hemisphere. These assumptions need to be verified further by more extensive clinical studies applied to various neurologic disorders.

Afferent Pathways↗

PubMedDate not supplied

[The potentials of polarography in predicting the effect of a reconstructive operation in patients with severe ischemia of the lower extremities].

Possibilities to prognose the effect of reconstructive operation on the lower extremity vessels are shown on the basis of transcutaneous of oxygen on the dorsal surface of the foot in complex with ultrasonic Dopplerometry in patients with severe ischemia of lower extremities. Effectiveness of the test with the orthostatic growth of Po is proved. An examination of 60 patients with severe ischemia of lower extremities and 10 patients without pathology of main vessels (control group) was performed. Operations were performed on 48 patients, in 35 of them reconstructive operations were made. No correlation was found between preoperative value of Po and a result of the reconstruction. A correlation was found between the value of the orthostatic growth of Po and outcome of the reconstructive operation. The average growth of Po in the group of patients with a negative outcome of the reconstruction made up 9.93 + 2.78 mm Hg, with a positive outcome it was 14.137 + 2.30 mm Hg (p < 0.05). In patients with malleolus index of the regional systolic pressure > 0.3 with the orthostatic growth of Po > 20 mm Hg the probability of positive prognosis of the reconstruction made up 88.8%.

Acute Disease↗

PubMed2001

[Distal pedicled sural island flap-plasty for defect coverage of the distal lower extremity].

Soft tissue defects on the distal lower extremity often need extended reconstructive procedures, especially if tendinous, articular, or bony structures are exposed. The use of local flaps in the perimalleolar, pretibial and calcaneal area is limited, often free tissue transfer is required. The distally based sural island flap is a pedicled soft-tissue flap on the vascular axis of the sural nerve. It can be raised as a fasciocutaneous or a lipofascial flap. We report our experience of 16 cases, nine of these cases in the lipofascial technique. The aim of soft tissue coverage was reached in 15 cases. In one patient a partial necrosis of the flap occurred requiring a reoperation with free flap coverage. The main advantages of the technique are the extended arc of rotation in the problematic area of the ankle and the lower extremity, the easy and fast preparation and the stable flap perfusion. The lipofascial as well as the fasciocutaneous flap have some risk of loss or donor-site morbidity that can be avoided by adhering strictly to certain operative principles.

Adolescent↗

PubMed2005

Dermatologic conditions associated with use of a lower-extremity prosthesis.

OBJECTIVES: To document the frequency of skin problems among lower-limb prosthesis users and to assess for factors associated with skin problems among patients using a prosthesis. DESIGN: Six-year retrospective chart review. SETTING: An outpatient amputee clinic at a regional, referral rehabilitation hospital in Canada. PARTICIPANTS: Seven hundred forty-five subjects with a total of 828 lower-extremity amputations participated. Subjects were included if they had a lower-extremity amputation and used a prosthesis for ambulation or transfers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The presence or absence of a skin problem. Descriptive and nonparametric statistics were used to analyze data. RESULTS: Three hundred thirty-seven residual limbs (40.7%) had at least 1 skin problem. Adjusted odds ratios showed that amputation level, being employed, type of walking aid, and absence of peripheral vascular disease (as a comorbidity) were independently associated with the presence of at least 1 skin problem ( P <.05). CONCLUSIONS; Dermatologic conditions are a frequent complication for the lower-extremity amputee who uses a prosthesis. The results suggest that more active amputees have an increased risk for developing skin problems. Further study in this area is warranted.

Aged↗

PubMed2003

Depressive symptoms and lower extremity functioning in men and women with peripheral arterial disease.

OBJECTIVE: Factors associated with impaired functioning in patients with lower extremity peripheral arterial disease (PAD) are not fully understood. The purpose of this study was to determine the relationship between depressive symptoms and objective measures of lower extremity functioning in persons with PAD. DESIGN: Cross-sectional. PATIENTS/PARTICIPANTS: Four hundred twenty-three men and women with PAD identified from 3 Chicago area medical centers. MEASUREMENTS AND MAIN RESULTS: PAD was defined as ankle brachial index (ABI) <0.90. The Geriatric Depression Scale short form (GDS-S) (0-15 scale, 15 = worst) was completed by all participants. A clinically significant number of depressive symptoms was defined as a GDS-S score >or=6. Six-minute walk distance and usual-and fast-pace walking velocity were determined for all participants. A GDS-S score >or=6 was present in 21.7% of participants with PAD. Adjusting for age, increasing numbers of depressive symptoms were associated with an increasing prevalence of leg pain on exertion and rest (P =.004). Adjusting for age, sex, race, ABI, number of comorbidities, current smoking, and antidepressant medications, increasing numbers of depressive symptoms were associated with shorter 6-minute walk distance (P <.001), slower usual-pace walking velocity (P =.005), and slower fast-pace walking velocity (P =.005). These relationships were attenuated slightly after additional adjustment for presence versus absence of leg pain on exertion and rest and severity of exertional leg symptoms. CONCLUSIONS: Among men and women with PAD, the prevalence of a clinically significant number of depressive symptoms is high. Greater numbers of depressive symptoms are associated with greater impairment in lower extremity functioning. Further study is needed to determine whether identifying and treating depressive symptoms in PAD is associated with improved lower extremity functioning.

Aged↗

PubMed1996

Prospective study of safety of lower extremity phlebography with nonionic contrast medium.

BACKGROUND: Lower extremity deep venous thrombosis (DVT) following hig h osmolar ionic contrast phlebography has been reported to vary between 9% to 31%. The purpose of this study was to determine the incidence of minor and major adverse reactions and postphlebographic DVT when using nonionic contrast (iopamidol). PATIENTS AND METHODS: One hundred fifty-seven patients with clinically suspected DVT were studied prospectively. One hundred eleven patients had prephlebography duplex ultrasound, and 102 patients were examined in the vascular laboratory for delayed side effects 1 week after phlebography. The presence of phlebography induced DVT was assessed using color duplex ultrasound. The mean amount of contrast used 102 ml. RESULTS: Minor adverse reasons, including nausea, local pain, and dizziness, occurred in 11 (7%) of 157 patients; however, no major complications or postphlebographic DVT was found in the 102 patients who underwent postphlebography duplex ultrasound. Phlebography and pre- and postphlebography duplex ultrasound showed no acute DVT in 70 patients. The maximum hypothetical true rate of major complications (ie, postphlebography DVT) that would result in no detectable events in a population of 102 patients with follow-up (for a probability of P <0.05) is 2.9. CONCLUSION: lower extremity phlebography using nonionic contrast material is safe, with no incidence of postphlebography DVT in our series. Its utilization should be encouraged if duplex ultrasound is not available.

Adolescent↗

PubMed1995

Exercise performance of lower-extremity amputees.

A comparison of the literature quantifying the energy expended during ambulation of healthy individuals and those with amputation of the lower extremity is difficult as study parameters and methods are inconsistent. However, the energy cost of ambulation is greater for amputees than for nonamputees. Ascending level of amputation appears to be associated with increasing metabolic demand. There appears to be a difference in energy cost of ambulation following different surgical procedures. The literature regarding energy cost of ambulating with different lower-extremity prostheses is equivocal, with the exception of the contoured adducted trochanteric-controlled alignment method (CAT-CAM) socket for above-knee amputees and the new energy-storing (Proteor) foot for traumatic below-knee amputees, which may decrease energy expenditure during ambulation. Therefore, it is reasonable to recommend that energy cost of ambulation be considered when deciding on the most efficacious surgical procedure, and metabolic efficiency of gait be considered when selecting prostheses most suitable for lower-extremity amputees. Though limited research is currently available, it appears that training or physical conditioning for the lower-extremity amputee, particularly with cardiopulmonary or vascular insufficiency, may decrease the metabolic cost of ambulation. More research is needed regarding the benefits of aerobic exercise and the safest, most effective exercise regimens for reducing metabolic costs of ambulation in lower-extremity amputees.

Amputees↗

PubMedDate not supplied

Lower-extremity overuse injury and use of foot orthotic devices in women's basketball.

One hundred thirty-two female basketball players were observed for lower-extremity overuse injury between 1993 and 2004. Athletes studied between 1993 and 1996 did not receive foot orthotic devices and composed the control group. The treatment group comprised athletes studied between 1996 and 2004. Athletes in the treatment group were given a foot orthotic device before participation in basketball. Data analysis included lower-extremity overuse injury rates and the effect of foot orthotic devices on lower-extremity overuse injury rates by means of an incidence density ratio. The control group had a lower-extremity overuse injury rate of 5.37 per 1,000 exposures, and the treatment group had a rate of 6.44 per 1,000 exposures. The incidence density ratio was not significant (P = .44). This study rejects the concept that foot orthotic devices may assist in prevention of lower-extremity overuse injury in female basketball players.

Adult↗

PubMedDate not supplied

Characteristic trends of lower-extremity complex regional pain syndrome.

Complex regional pain syndrome (CRPS) is a multifaceted, progressive, and potentially devastating disorder generally affecting the extremities. In addition, scant information is available regarding the types of patients who develop lower-extremity CRPS. This is a retrospective chart review study of 64 patients who presented to a pain clinic with CRPS of the lower extremity. The study examined 23 variables broadly classified under demographic characteristics, CRPS characteristics, and healthcare utilization. The sample was found to consist of predominantly white, middle-aged women with CRPS I. Subjective complaints consisted of burning, sharp, throbbing, or aching pain with shooting symptoms. Initial presenting clinical findings included allodynia, edema, erythema, and hyperesthesia. The most common precipitating injuries were blunt trauma of the foot with or without fracture or ankle sprain. The most common inciting surgical events were bunionectomy, tarsal tunnel release, and heel-spur surgery. Referral to the pain clinic was delayed more commonly in trauma patients than in postsurgical patients, with a corresponding increase in pain clinic visits for treatment. This study may act as a guide for physicians treating the lower extremity to aid in the recognition of lower extremity complex regional pain syndrome and its characteristics.

Adolescent↗

PubMedDate not supplied

Early results of lower extremity infrageniculate revascularization with a new polytetrafluoroethylene graft.

When an autologous vein is not available for lower extremity revascularization, prosthetic grafts are often required. However, prosthetic bypass grafts have limited patency for infrageniculate reconstruction. To potentially improve patency, a new geometric modification of the polytetrafluoroethylene (PTFE) graft, Distaflo (Impra, Tempe, AZ), has been developed for lower extremity bypass. We reviewed our early experience with the Distaflo graft in patients who required infrageniculate bypass for lower extremity ischemia when no suitable autologous saphenous vein was available. All patients were maintained on warfarin anticoagulation postoperatively. All grafts were followed at 6- to 12-week intervals with duplex ultrasound evaluation. Patient characteristics, operative procedures, and graft surveillance information were maintained on a computerized registry. Thirty-two patients with limb-threatening ischemia underwent 35 infrageniculate reconstructions with a Distaflo graft between February 26, 1999, and August 24, 2000. Thirty-two of 35 bypasses were performed on extremities that had previously undergone a surgical procedure. Forty-eight previous revascularization procedures were done on these 25 extremities. Thirty grafts were constructed to the tibial outflow sites, whereas the remaining five grafts were placed to the below-knee popliteal artery. One patient died on the second postoperative day secondary to unrelated causes, and only one graft (3%) failed during the same hospitalization. Fifteen of 35 grafts (43%) remained patent 1 to 30 months later. Four patent grafts (6%) were ligated between 2 and 14 months for infectious indications. When considering the 20 failed grafts, 9 patients underwent major amputation, 5 patients remain with chronically ischemic limbs, and 6 patients underwent additional bypass grafts. Twenty-three patients (72%) maintained limb salvage. The Distaflo PTFE graft achieves promising early patency for complex infrageniculate revascularization and may be used as an alternative conduit in patients with critical limb ischemia who do not have an adequate vein for lower extremity revascularization.

Aged↗