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Results for “Lower Extremity”

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At least 613 records · Page 34Linked to original sources

PubMed2002

High-resolution sonography of lower extremity peripheral nerves: anatomic correlation and spectrum of disease.

OBJECTIVE: The value of sonography for the diagnosis of diseases of the peripheral nervous system is only little known. This image presentation is intended to raise the awareness of sonographers and clinicians of the potential of sonography by giving an anatomic-sonographic correlation of lower extremity peripheral nerves and an overview of commonly encountered diseases. METHODS: On 2 lower extremity cadaver specimens, peripheral nerves were imaged in typical locations such as the tarsal tunnel. During sonography the nerve was injected with blue dye, and thin-slice anatomic sections were obtained at the scan level with a chain saw. In addition, sonographic images of patients with typical diseases are shown. RESULTS: An excellent anatomic-sonographic correlation was obtained, which underlines the feasibility of sonography for imaging of lower extremity peripheral nerves. Reliable results may be obtained with sonography of typical disease processes of lower extremity peripheral nerves. CONCLUSIONS: Recent developments in sonographic technology such as the introduction of high-frequency linear array transducers, compound imaging, and extended field-of-view imaging strongly improve the applicability of transcutaneous sonography for the examination of peripheral nerve disease.

Cadaver↗

PubMed2004

Functional gait changes in patients with chronic lower extremity hemiplegia treated with a technology to induce movement (TIM)-type system.

BACKGROUND AND PURPOSE: The purpose of this study was to examine changes in gait and ankle motor performance in a group of patients with chronic lower extremity hemiplegia associated with treatment using a surface electromyography (SEMG)-based technology to induce movement (TIM)-type system. PARTICIPANTS: Thirteen adult (average age, 44.8 years) volunteer participants with chronic lower extremity hemiplegia (average, 9.2 years) participated in this study. METHOD: A single cohort, repeated measure design was used with each participant assessed initially and after a 6-week intervention of twice weekly SEMG-TIM-type treatments. Patients were assessed by measures of functional gait (free walking velocity and the Tinetti test of gait and balance) and by measures of ankle motor performance (number of standing heel lifts, standing toe lifts, or seated toe taps performed in 1 minute). RESULTS: Patients with chronic lower extremity hemiplegia demonstrated a statistically significant improvement (p < .05) in all measures of functional gait and ankle motor performance. DISCUSSION AND CONCLUSION: Patients with chronic lower extremity hemiplegia demonstrated improvement in measures of functional gait and ankle motor performance after treatment with an SEMG-based TIM-type system. This study should be replicated in randomized controlled, larger, and multicentered clinical studies.

Adult↗

PubMed2006

Walking barefoot decreases loading on the lower extremity joints in knee osteoarthritis.

OBJECTIVE: To evaluate the effects that modern shoes have on gait and lower extremity joint loads in osteoarthritis (OA). METHODS: Gait analyses were performed on 75 subjects with knee OA while they were wearing their everyday walking shoes and while they were walking barefoot. The trials involved optoelectronic detection of external markers during ambulation over a multicomponent force plate, and were matched for speed. Comparisons were made of gait parameters and joint loading during trials in which the subjects walked while wearing shoes and while barefoot. RESULTS: Peak joint loads at the hips and knees significantly decreased during barefoot walking, with an 11.9% reduction noted in the knee adduction moment. Stride, cadence, and range of motion at the lower extremity joints also changed significantly, but these changes could not explain the reduction in the peak joint loads. CONCLUSION: Shoes may detrimentally increase loads on the lower extremity joints. Once factors responsible for the differences in loads between with-shoe and barefoot walking are better delineated, modern shoes and walking practices may need to be reevaluated with regard to their effects on the prevalence and progression of OA in our society.

Adult↗

PubMedDate not supplied

Lower extremity amputations in diabetic Mexican American elders: incidence, prevalence and correlates.

This study was designed to determine the incidence and prevalence of amputations in diabetic Mexican American elders and to identify correlates of lower extremity amputations. Data for this study came from baseline and two follow-up interviews of the Hispanic Established Population for the Epidemiological Study of the Elderly (EPESE) conducted in five southwestern states (Texas, California, New Mexico, Colorado and Arizona) in 1993-1994. Of the 3050 subjects aged 65 and older, 690 reported diabetes, and from these, 60 (8%) reported having at least one lower extremity amputation. Losing a leg was the most common type of amputation (53%). Twelve percent of respondents reported a new amputation and 40% of amputees reported a second amputation during follow-up. Mortality among amputees was 46% during a 5-year follow-up. Multiple logistic regression analysis showed that being male and having eye problems, hip fracture and diabetes for 10 or more years were significantly associated with lower extremity amputations at baseline, whereas obesity, stroke and 10 or more years with diabetes were significantly associated with new amputations at 5-year follow-up. Gender and disease history were associated with lower extremity amputations at baseline and follow-up. These variables may be useful in developing patient education and intervention programs.

Aged↗

PubMedDate not supplied

Lower extremity management in patients with diabetes.

Foot ulcers are a major cause of disability, morbidity, and mortality in people with diabetes. The three major etiological factors for diabetic foot ulcers are peripheral neuropathy, peripheral vascular disease, and infection. Tight control of blood glucose and proper foot care are essential for prevention of foot ulcers and lower extremity amputations. Treatment of lower extremity diabetic ulcers typically includes surgical debridement of the wound and appropriate oral or intravenous antibiotics. Becaplermin gel, a prescription, recombinant wound-healing therapy, may be used to promote healing of diabetic foot ulcers in select patients. Pharmacists can make a significant contribution to the prevention of diabetic foot ulcers and lower extremity amputations.

Amputation, Surgical↗

PubMed2004

[The lower extremity amputation in vascular diseases].

There were examined 78 patients, to whom the lower extremity amputation on the hip level was performed. Complex examination, using the nuclear magnet resonance relaxation and arteriography, was performed. Introduction of method of the lower extremity amputation on the hip level, the apparatuses for the cutaneo-fascial flaps cutting out had permitted to reduce the purulent-septic complications frequency from 34.1 down to 7.8% and postoperative mortality--from 13.1 to 5.3%.

Adult↗

PubMed1986

Lower extremity nerve injuries.

The surgical and anatomic features pertinent to lower extremity nerve injury are reviewed. The common problems associated with specific nerve lesions are discussed and reparative recommendations are offered. A more informed, aggressive approach to lower extremity nerve repair is suggested.

Adult↗

PubMed2000

Pelvic and lower extremity arterial imaging: diagnostic performance of three-dimensional contrast-enhanced MR angiography.

OBJECTIVE: The diagnostic performance of a three-dimensional MR angiography-based strategy was assessed with regard to its ability to characterize the arterial vasculature from the aortic bifurcation to the lower extremity runoff vessels. A single-injection, two-station protocol in combination with a lower-extremity vascular coil was used. SUBJECTS AND METHODS: Both conventional digital subtraction angiography and three-dimensional contrast-enhanced MR angiography with a dedicated peripheral vascular coil were performed in 61 patients with suspected peripheral vascular disease. In a prospective analysis, one reviewer evaluated the digital subtraction angiographic images and a second reviewer evaluated the MR angiographic images; both were unaware of the results of the other imaging technique. Each vascular segment (29 segments per patient) was evaluated for the presence of occlusive vessel disease. The following grading system was applied: 0, normal; 1, vessel irregularity with a luminal reduction of less than 10%; 2, mild stenosis (lumen reduction, 10-49%); 3, severe stenosis (lumen reduction, 50-99%); and 4, occlusion (lumen reduction, 100%). In 11 patients surgical graft patency was assessed. RESULTS: MR angiography provided an image quality comparable with that of digital subtraction angiography. Overall sensitivity and specificity for MR angiography were 92% and 96.6%, respectively, for the detection of hemodynamically significant disease and 92.3% and 99.4%, respectively, for the detection of occlusions. CONCLUSION: Two-station contrast-enhanced three-dimensional MR angiography with a dedicated lower-extremity vascular coil proved effective enough to consider it as a noninvasive alternative to digital subtraction angiography in the assessment of the pelvic and lower extremity arterial vasculature.

Adult↗

PubMed2002

A dual wavelength approach for laser/intense pulsed light source treatment of lower extremity veins.

BACKGROUND: Consistent reproducible aesthetic results are a desired component of laser/intense pulsed light (IPL) treatment of lower extremity blood vessels. In this regard, shorter wavelengths may be used to treat fine red telangiectases, whereas longer wavelengths may be used to treat larger diameter blue venulectasia and small reticular veins. OBJECTIVE: The purpose of the present study was to demonstrate that a bimodal wavelength approach to laser/IPL source treatment for lower extremity vessels up to 8 mm in diameter produces results superior to previously described photothermolytic approaches for eradication of unwanted lower extremity blood vessels. METHODS: Fifty female patients (mean age, 37 years) were treated in a private practice setting with class I-III red telangiectasia, blue venulectasia, and reticular veins (0.1-4.0 mm in diameter) on the inner or outer thighs. A combined approach of laser/IPL treatment was used; patients had up to 3 treatments at 6-week intervals on a 5-cm2 surface area of vessels with the use of an IPL source wavelength of 550 nm, fluence of 40 J/cm2, for treatment of red telangiectases less than 1 mm in diameter, while a 1064-nm Nd:YAG laser at a fluence of 140 J/cm2 was used to treat venulectases and reticular vessels that were 1.0 to 4.0 mm in diameter. Results were analyzed by macrophotographic imaging, double-blinded observer evaluation, optical chromatography, and a patient evaluation scale. RESULTS: An average of 2(1/2) patient sessions produced significant clearing (75%-100%) in 80% of patients. The mean erythema index showed significant lightening (35.3+dl) in the study population. Finally, 76% of patients reported great satisfaction with the treatment results. CONCLUSION: A bimodal wavelength approach utilizing both short and long wavelengths produces significant clearing of the variably colored, multiple-diameter/depth array of vessels, which commonly presents a therapeutic challenge to the vascular laser surgeon.

Adult↗

PubMed2006

Blisters associated with lower-extremity fracture: results of a prospective treatment protocol.

OBJECTIVES: To evaluate patient outcomes after treatment of lower-extremity fractures associated with blister formation and to assess complications after soft-tissue treatment using a prospective protocol. DESIGN: Retrospective evaluation of prospectively collected data. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Between September 1999 and September 2003, 47 patients who had sustained a closed lower-extremity fracture with early development of fracture blisters in the zone of injury were followed. Blisters were characterized as either avoidable or unavoidable with respect to surgical incisions, and characteristics such as number, size, blood filled or clear filled, and the presence of an intact roof were documented. INTERVENTION: All blisters were unroofed, and antibiotic cream (silver sulfadiazine, Silvadene, King Pharmaceuticals Inc.) was applied twice daily until the blister bed had re-epithelialized. MAIN OUTCOME MEASUREMENTS: Fracture union and the development of wound or skin complications. Patient satisfaction with the cosmetic outcome of the treatment regimen was assessed through telephone survey at 23-month minimum follow-up. RESULTS: Twenty-eight patients presented with a single blister, and 19 had multiple blisters. Blister size averaged 9.7 cm. Twenty-two patients had blood-filled blisters, 20 had clear-filled blisters, and five had a combination of the two. Fracture patterns included 17 ankle fractures (OTA 44), 13 tibial plateau fractures (OTA 41), five tibial-shaft fractures (OTA 42), eight calcaneus fractures (OTA 45), and four pilon fractures (OTA 43). Mean delay in definitive surgical care was 7.7 days (range 0 to 20 days). The average delay of surgery for ankle fractures was 6 days (range 0 to 18 days), which was significantly less than the delay for calcaneus fractures (12 days, range 4 to 19 days, P < 0.02) and tibial plateau fractures (11 days, range 0 to 20 days, P < 0.02). Thirty-seven of the 45 patients (82.3%) available for follow-up at a mean of 27 weeks (range 14 to 35) had an uncomplicated postoperative course, and fracture union was achieved in 43 of 45 cases (95.6%). The soft-tissue complication rate associated with the standardized treatment regimen was 13.3% (6/45 cases), with three cases of minor soft-tissue breakdown, one superficial infection, and two major complications directly related to the presence of fracture blisters. Both major complications involved full-thickness skin breakdown occurring directly at the base of fracture blisters in patients with diabetes. The skin breakdown required further surgery in both cases. Including the two patients who developed nonunion, the overall complication rate for the treatment cohort was 17.7% (8/45 cases). At a mean follow-up of 51.9 months (range 23 to 73), three patients in the cohort had expired. Of the 42 patients available for evaluation, 28 patients (67%) were reachable for a telephone survey to assess satisfaction with the outcome of the fracture and soft-tissue management. Patients rated their satisfaction with the cosmetic appearance of their lower extremities after the standardized treatment regimen on a scale of 1 to 10 (with 10 representing very satisfied), with a mean of 9.07 (range 5 to 10). Six patients reported scarring at the sites of previous fracture blisters, all of which occurred after blistering of the blood-filled subtype. The presence of scarring significantly decreased patient satisfaction with cosmesis and overall treatment (P < 0.0001 and P < 0.01, respectively). CONCLUSIONS: Treatment of fracture blisters with a silver sulfadiazine (Silvadene) regimen proved to be successful in minimizing soft-tissue complications by promoting re-epithelialization in all nondiabetic patients. At long-term follow-up, patients were generally satisfied with the cosmetic outcome of the treatment regimen. Postoperative scarring, which was more common with blood-filled blisters, significantly impacted patient satisfaction. We urge caution when planning to make a surgical incision around an area of both full-thickness (blood-filled) and partial-thickness (clear-filled) fracture blisters in diabetic patients because the zone of injury might extend beyond the borders of the fracture blister.

Adult↗

PubMed2004

Autologous transplantation of peripheral blood stem cells as an effective therapeutic approach for severe arteriosclerosis obliterans of lower extremities.

Treatment of severe arteriosclerosis obliterans of lower extremities (ASOLE) remains a clinical challenge. To develop a more effective approach, we evaluated the clinical efficacy of autologous transplantation of mobilized peripheral blood stem cells (PBSCs) in 5 patients with ASOLE. The patients received recombinant human granulocyte colony-stimulating factor (rhG-CSF, 600 micro g/day) for 5 consecutive days. On day 5, PBSCs were collected, sorted from blood circulation of patients, and then intramuscularly injected into their ischemic lower limbs. A significant improvement of clinical manifestations including severe pain, skin temperature and ulcer, was observed, without obvious adverse effect. The patient's limb was successfully saved. Satisfactory remission was obtained 3 months after transplantation as shown by significant improvement in ankle-brachial pressure index (ABI), blood flow in personal vascular laboratory (PVL), laser Doppler blood perfusion, and the angio-graphic scores. Our data suggest for the first time that autologous transplantation of mobilized PBSCs provides a practical, safe, and effective method of treatment for lower limb ischemia.

Aged↗

PubMed1989

[Surgical treatment of primary varices of the lower extremities using the I.K.E.M. method].

This report reviews our two years experience of the surgical treatment of the lower extremities primary varix by I.K.E.M.- method. Since March 1985 to September 1988., 75 patients have been operated upon at our surgical clinic. Sexual ratio was 4:1 in favour of female sex. The operations on both lower extremities were performed in one stage on 2/3 of patients. Operation indication were based on clinical research and a generally known tests. No phlebography has been done as it is considered unnecessary for diagnoses on the lower extremities primary varix. Main tactics and technology for this method is retrograded saphenectomy against application of Klapp's and Smetanas knite for varix elimination. Operation period is approximately 45 for both extremities. It is recommended for patients to get up early in the morning. Average staying at the hospital was two days. Occasional wearing of elastic bandages is for six weeks.

Female↗

PubMed2004

[Erythrocyte concentrations of adenosine triphosphate (ATP) and magnesium, before and after conservative therapy of lower extremities atherosclerosis].

37 patients with atherosclerosis of lower extremities and the mean claudication distance of 300-500 m (Fontaine 11 degrees) were subjected to pharmacotherapy with pentoxyfilline 600 mg twice daily, and walking exercise tests on a treadmill. The concentrations of ATP and magnesium ions in erythrocytes were assessed in the patients in resting condition, and after standardized walking exercise tests, 6 and 12 weeks since the beginning of therapy. Applied treatment proved beneficial in protecting the patients against depletion of ATP in their erythrocytes. Hypomagnesemia and accompanying lowered concentrations of ATP were observed in 1/3 of the cases. As the deficiency of ATP can cause functional changes and structural alterations in the erythrocytes and deterioration of the clinical condition of these patients supplementing magnesium ions in these cases seems justified.

Adenosine Triphosphate↗

PubMedDate not supplied

The fetid foot: lower-extremity infections in patients with diabetes mellitus.

Infections of the lower extremities in patients with diabetes mellitus have been attributed to Staphylococcus aureus and other facultatively anaerobic bacteria. However, a review of 30 consecutive diabetics who required surgery for lower-extremity infections revealed that 17 had mixed infections due to both obligate and facultative anaerobes; only six had infections due to S. aureus. Mixed infections often had characteristics of anaerobic suppuration and responded poorly to therapy. Patients with mixed infections required more operations than did those with staphylococcal infections, and their surgical wounds healed more slowly. Seven patients had infections with mixed enteric bacteria (neither anaerobes nor S. aureus), and their response to therapy was intermediate between that of the patients with mixed anaerobic infections and those with staphylococcal infections. Nine additional patients with mixed anaerobic infections were treated with cefoxitin; three required amputations at a level above the ankle, but six patients improved and required only limited surgery that preserved foot function. Bacteroides fragilis was the anaerobe isolated most often. Cefoxitin (less than or equal to 20 micrograms/ml) inhibited all of the anaerobes isolated from the nine patients and 97% of an additional 135 consecutive clinical isolates of B. fragilis; 98% of 54 strains of Bacteroides oralis and all of 34 strains of Bacteroides melaninogenicus were also inhibited. These in vitro results and the results of our clinical study show that cefoxitin is a promising antibiotic for therapy of foot infections due to a mixed flora of anaerobes in diabetics.

Aged↗

PubMed1992

Quantification of skeletal muscle necrosis in the lower extremities using 99Tcm pyrophosphate with single photon emission computed tomography.

No non-invasive quantitative method is currently available for measuring the amount of regional skeletal muscle necrosis in humans. A threshold method using 99Tcm pyrophosphate (PPi) with single photon emission computed tomography (SPECT) has been reported to quantify muscle necrosis successfully in a canine model. This method has been modified to measure muscle necrosis in the lower extremities of human patients. Modifications include adding background subtraction and using the contralateral unaffected lower extremity as background region. A region of interest was also manually drawn around the affected lower extremity muscle to exclude the tibia. In order to identify the group of patients with no significant necrosis and with diffuse hyperaemia, nine control subjects were studied. The variance of the counts within the pixels of the lower extremities was 132 (S.D. = 27). A variance of greater than 159 was considered as being significant for necrosis. Thirteen patients were studied. Six patients had significant muscle necrosis (462 ml, S.D. = 280 ml). All except one patient (who had a small amount of muscle necrosis) developed foot drop. Seven patients had no significant necrosis. All patients had normal ankle dorsiflexion. It is possible to quantify regional muscle necrosis using PPi with SPECT. Volume of necrosis determined by this method can also predict clinical outcome.

Aged↗

PubMed2002

Industrial medicine and acute musculoskeletal rehabilitation. 4. Evaluation and management of the injured worker with a lower-extremity injury.

UNLABELLED: This self-directed learning module highlights the importance of recognizing the relationships between multiple, concurrent joint injuries in the lower extremity of an injured worker. This chapter focuses on evaluating the lower extremity and devising a rehabilitation program that incorporates the entire kinetic chain. Further recommendations for return to work are discussed. OVERALL ARTICLE OBJECTIVES: (a) To accurately recognize and diagnose coexisting injuries in the lower extremity and (b) to devise an evaluation and treatment program enabling the worker to return to work.

Acute Disease↗

PubMed2004

Minimally invasive subcutaneous fasciotomy for chronic exertional compartment syndrome of the lower extremity.

Chronic exertional compartment syndrome of the lower extremity can be debilitating in the active population. Open fasciotomy typically provides a cure or significant improvement in up to 90% of patients, provided that the compartments are adequately released. Cosmetic deformity from the surgery may be a major concern, especially in the young female athlete. A technique for minimally invasive subcutaneous fasciotomy is described that allows adequate compartment release and a favorable cosmetic result.

Chronic Disease↗

PubMedDate not supplied

The application of Aquaplast Thermoplastic as a bolus material in the radiotherapy of a patient with classic Kaposi's sarcoma at the lower extremity.

BACKGROUND: The classic Kaposi's sarcoma (KS) patients usually present with progressive skin lesions over the lower extremities, following an indolent course. Although radiotherapy is an effective treatment for KS, radiation over these lesions is not without difficulty. The intrinsic difficulty resides in how a homogenous radiation dose over superficial lesions involving large areas and irregular surface is properly delivered. Several bolus techniques have thus been invented. MATERIALS AND METHODS: The Aquaplast RT Thermoplastic is a new type of bolus material that can be easily molded and conformed to the curvature of skin, with the equivalence to soft tissue in radiation interaction. RESULTS: This material was applied as the bolus for the irradiation of a classic KS patient, whose disease involved multiple skin areas over the right heel and ankle. Large parallel-opposed irradiation fields delivered by 60Co were used. Computed tomography demonstrated a close conformity of the bolus built-up by Aquaplast RT Thermoplastic to the surface of the ankle and foot. A dosimetry measurement further confirmed an adequate and homogenous distribution of desired dose around the lesions of the lower extremity. After a total dose of 39 Gy, divided in 13 fractions, the lesions remitted completely. CONCLUSION: Our data suggest that the use of Aquaplast RT Thermoplastic as a bolus material is helpful in delivering adequate dose to skin lesions of the lower extremities.

Aged↗