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At least 73 records · Page 4Linked to original sources

PubMed1978

Lower limb angiography in leprosy.

Bilateral lower limb angiography was performed on 58 patients with leprosy and compared with bilateral lower limb angiography performed on 63 non-leprosy patients. The vessels in leprosy were narrow and constricted. Decreased blood flow through arteries in the distal third of the lower limb was present. Abnormal AV fistula formation in the thigh and calf muscles and in trophic ulcers of the feet was also seen. Deep inflammatory granulomatous reaction surrounding the arteries as a result of leprosy is a possible explanation for these angiographic findings and is felt to be related to trophic ulceration. These findings were specific for leprosy, precede clinical manifestations, and are helpful in management.

Adult↗

PubMed2006

Minimally invasive revascularization strategies for chronic lower limb ischemia.

Lower extremity wounds resulting from ischemia are increasingly becoming a common indication for surgical revascularization. Techniques in minimally invasive vascular surgery for the treatment of lower extremity chronic ischemia have expanded rapidly in recent years. The current standard of care with which all new modalities should be compared is the restoration of arterial flow via direct arterial revascularization using the autogenous reversed saphenous vein that can yield limb salvage rates of approximately 95%. Percutaneous transluminal angioplasty and stenting (PTA/S), cryoplasty, catheter-directed atherectomy, laser-assisted PTA/S, drug-eluting stents, and subintimal angioplasty are emerging minimally invasive modalities used for the treatment of lower extremity ischemia. Early success rates using many of these techniques have been promising. The outcomes of randomized controlled trials with long-term follow-ups are needed to make confident remarks about the effectiveness of these techniques.

Angioplasty↗

PubMedDate not supplied

Preventing cellulitis in older people with persistent lower limb oedema.

Persistent lower limb oedema is an underestimated problem in the elderly population. Oedematous tissue predisposes the individual to the development of bacterial infections. Accurate assessment of the underlying aetiology and application of compression hosiery could prevent cellulitis and reduce the risk of recurrent episodes. Awareness of the complications of leg oedema needs to be raised in the general population. Healthcare professions require education to enable the provision of safe, effective treatment to reduce morbidity relating to chronic oedema and cellulitis. The 'National Service Framework for Older People' and the 'British Lymphology Society's Framework for Education' could facilitate the development of national service provision to meet the needs of the population with chronic oedema.

Aged↗

PubMed2005

Prevention of major amputations in nonischemic lower limb lesions.

BACKGROUND: Major lower limb amputations continue to be performed at an increasing rate, the major cause being the rising prevalence of adult onset diabetes. It can be demonstrated that a reduction in amputation rate can be achieved at institutes with a higher level of academic and specialty interest, by avoiding errors of management and by newer technical innovations in wound closure. STUDY DESIGN: A simpler method of wound closure that is easily taught and learned and is readily available to the medical community and the patient population can play a substantial role in reducing the number of amputations. Satisfactory closure of open lesions by full-thickness skin and subcutaneous tissue carries with it a lower incidence of recurrence, reduces costs by avoiding or reducing length of hospitalization, and minimizes use of general anesthesia, a serious matter in immunocompromised older patients. Avoiding errors of technique will additionally reduce amputation rate. RESULTS: In the last 10 years, 125 patients, mostly diabetic and elderly, with major and recurrent lesions of the lower extremities, have been treated by closure of the debrided wound with a combination of external tissue expansion and wound toilette. Major lower limb amputations have been avoided. CONCLUSIONS: Experience confirms that the relationship between high hospital volume, specialty interest, higher level of academic care; avoiding technical errors; and simplifying the methodology, lead to a reduction in need for major amputations. A lower mortality in the patient population at risk is achieved and a reduction in costs, which have risen beyond the 132 billion dollars level, can be expected.

Adult↗

PubMedDate not supplied

[The risk of general anesthesia in surgery of the veins of the lower limbs].

Venous surgery on the lower limbs does not involve specific problems for the anaesthetist. General anaesthetic is still indicated in particular cases, even though techniques of locoregional anaesthetic are being more and more widely used in venous surgery of the lower limbs. Certain authors have found that the indications for general anaesthetic are limited to the counterindications or failures of local anaesthetic; others give general anaesthetic a wider application when surgery is to be carried out on a patient in the ventral decubitus position. The aim of general anaesthetic for venous surgery of the lower limbs is simply to facilitate a purely functional surgery. In this context, injury or fatality directly connected with the anaesthetic seems unacceptable. However, the accident rate is far from being low, as various inquiries have revealed. In France, the inquiry set up by INSERM found that serious accident related wholly or partially to the anaesthetic occurs once in every 3,000 operations. Of course, the accident rate increases with age and depends on the previous pathological condition. But, quite apart from cardio-vascular accidents, which have multiple causes and usually involve high-risk patients, these studies show that respiratory accidents involve every type of patient, whatever their medical history. Moreover, the majority of such accidents could have been avoided had there been adequate monitoring to detect any anomaly before the occurrence of the accident. It is thus appropriate to recall the recommendations of the American Society of Anesthiologists for standard pre-operative monitoring: monitoring of ventilation (spirometry, capnometry, debrancher alarm), monitoring of oxygenation, circulation (continuous ECG and pulse assessment) and monitoring of temperature.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents↗

PubMed2004

[Imaging of the lower limb arteries: when, how and why?].

Noninvasive screening of lower limb arterial disease has long been performed using color Doppler ultrasonography, whereas surgical or endovascular treatment planning relied on conventional angiography. With continued improvements of noninvasive imaging modalities, it is now possible to image the entire lower limb vasculature without arterial catheterization. Multidetector row helical CT angiography has the advantage of visualizing the arterial lumen and arterial wall calcifications, and nephrotoxicity is reduced by decreasing amounts of contrast medium. Three-dimensional MR angiography is a safe procedure, with high contrast sensitivity, and has recently benefited from step table technology that allows a single injection of contrast medium. The literature shows that both helical CT and MR angiography have high levels of accuracy, but outcome studies of their respective role in the setting of acute and chronic lower limb ischemia are lacking. These noninvasive techniques should play a major role in two main situations: first, in critical ischemia where therapeutic planning should ideally be achieved non invasively; second, in the follow-up of treated patients presenting with recurrent ischemia.

Angiography↗

PubMed2005

The "interfascial" veins of the lower limbs.

The veins of the lower limb are commonly divided in deep and superficial ones according to their position with respect to the Muscular Fascia (MF). Anatomical textbooks affirm that all superficial veins are thin walled vessels that run in a yielding layer of fat. Accordingly, no differences between saphenous Veins (SVs) and their tributaries (TVs) are reported by physiologists and pathophysiologists. On the contrary, the SVs do not correspond to the classic anatomic, physiologic and clinical descriptions of the "superficial" veins. In fact, the SVs: 1) are not superficial because they course between the SF and the MF; 2) they are not thin vessels, being their wall thick and rich in muscular cells; 3) they actively contribute to the complex mechanisms of venous return from the lower limbs; and finally, 4) they are quite resistant to hypertension and usually afflicted with limited varicose changes. As a consequence, the SVs should not be longer considered "real" superficial veins and the venous bed of the lower limb would be better represented by a three-layered model.

Adipose Tissue↗

PubMed2005

Does a balance deficit persist in Australian Football players with previous lower limb ligament injury?

A history of lower limb ligament injury is a commonly-cited risk factor for another similar injury. During the acute phase of injury, there is a balancing skill deficit in the injured limb. It has been unclear as to whether this deficit persists in the medium-to-long term for previously injured Australian footballers, contributing to the risk of re-injury. This study compared the balance ability of footballers with and without previous lower limb ligament injury and, for previously injured players, the balance ability of the previously injured limb to the opposite uninjured limb. A total of 216 players from 6 teams from the Australian Football League were tested. The balance task comprised stepping on to a foam mat on top of a force plate and maintaining one-legged balance. The subjects were divided into 4 groups based on their injury history: all ankle injuries to only one limb, recent ankle injuries to only one limb (within the last 12 months), knee ligament injury only to one limb, and no previous ankle or knee ligament injury. Statistical analysis revealed that there was no significant difference between the balance scores of any of the previously injured players and those with no previous lower limb ligament injury. There was no significant difference between the balance score of the previously injured limb with the opposite uninjured limb. It appears that a balance deficit does not persist in Australian Football players with previous lower limb ligament injury.

Adolescent↗

PubMed2000

Influence of upper- and lower-limb exercise training on cardiovascular function and walking distances in patients with intermittent claudication.

PURPOSE: The effects of upper-limb (arm cranking) and lower-limb (leg cranking) exercise training on walking distances in patients with intermittent claudication was assessed. METHODS: Sixty-seven patients (33 to 82 years old) with moderate to severe intermittent claudication were recruited, and the maximum power generated during incremental upper- and lower-limb ergometry tests was determined, as were pain-free and maximum walking distances (by using a shuttle walk test). Patients were randomly assigned to an upper-limb training group (n = 26) or a lower-limb training group (n = 26). An additional untrained group (n = 15) was recruited on an ad hoc basis in parallel with the main trial by using identical inclusion criteria. This group was subsequently shown to possess a similar demographic distribution to the two exercise groups. Supervised training sessions were held twice weekly for 6 weeks. RESULTS: Both training programs significantly improved the maximum power generated during the incremental upper- and lower-limb ergometry tests (P <. 001), which may reflect an increase in central cardiovascular function that was independent of the training mode. More importantly, pain-free and maximum walking distances also improved in both training groups (P <.001). The improvements in the training groups were similar; there were no changes in the untrained control group. These findings suggest that the symptomatic improvement after upper-limb exercise training may result, in part, from systemic cardiovascular effects rather than localized metabolic or hemodynamic changes. CONCLUSION: Carefully prescribed upper-limb exercise training can evoke a rapid symptomatic improvement in patients with claudication, while avoiding the physical discomfort experienced when performing lower-limb weight-bearing exercise.

Adult↗

PubMed2006

Sonography and risk factors for lower limb deep venous thrombosis at Mulago Hospital, Uganda.

BACKGROUND: Lower limb deep venous thrombosis (DVT), and its sequelae (lower limb chronic venous insufficiency and pulmonary embolism) are now well acknowledged as major haematological problems in the world, for which appropriate and accurate means of diagnosis is necessary. Developments in ultrasound have made it the imaging modality of choice in the diagnosis of lower limb DVT. OBJECTIVES: To determine the sonographic pattern, and identify the risk factors of lower limb DVT. DESIGN: Cross sectional, descriptive study carried out between April 2002 and March 2003. SETTING: Mulago Hospital, Uganda. SUBJECTS: Eighty six consecutive patients (92 limbs), with clinically suspected DVT, were studied by duplex sonography after a thorough risk factor evaluation. RESULTS: Out of a total of 86 patients clinically suspected to have lower limb DVT, 38 (44.2%) were found to have DVT after sonography. The gender incidence was similar. The left limb was affected in 60% of cases and the right in 40%. Bilateral DVT was noted in two patients. Most of the patients had acute and extensive DVT. CONCLUSION: Duplex ultrasonography is a very useful modality for assessing lower limb DVT, even in a low resource country like Uganda. It demonstrates the wealth of information obtained from sonography.

Adolescent↗

PubMed2004

Neural coupling between upper and lower limbs during recumbent stepping.

During gait rehabilitation, therapists or robotic devices often supply physical assistance to a patient's lower limbs to aid stepping. The expensive equipment and intensive manual labor required for these therapies limit their availability to patients. One alternative solution is to design devices where patients could use their upper limbs to provide physical assistance to their lower limbs (i.e., self-assistance). To explore potential neural effects of coupling upper and lower limbs, we investigated neuromuscular recruitment during self-driven and externally driven lower limb motion. Healthy subjects exercised on a recumbent stepper using different combinations of upper and lower limb exertions. The recumbent stepper mechanically coupled the upper and lower limbs, allowing users to drive the stepping motion with upper and/or lower limbs. We instructed subjects to step with 1) active upper and lower limbs at an easy resistance level (active arms and legs); 2) active upper limbs and relaxed lower limbs at easy, medium, and hard resistance levels (self-driven); and 3) relaxed upper and lower limbs while another person drove the stepping motion (externally driven). We recorded surface electromyography (EMG) from six lower limb muscles. Self-driven EMG amplitudes were always higher than externally driven EMG amplitudes (P < 0.05). As resistance and upper limb exertion increased, self-driven EMG amplitudes also increased. EMG bursts during self-driven and active arms and legs stepping occurred at similar times. These results indicate that active upper limb movement increases neuromuscular activation of the lower limbs during cyclic stepping motions. Neurologically impaired humans that actively engage their upper limbs during gait rehabilitation may increase neuromuscular activation and enhance activity-dependent plasticity.

Adult↗

PubMed1989

[Flowmetry in the evaluation of hemodynamics of the lower limbs in chronic ischemia].

Regional hemodynamics in the lower limbs was studied in 250 patients (480 lower limbs) with obliterative lesions of the abdominal aorta and lower limb arteries. Six levels of blood circulation were examined: the iliac segment, the femoral segment, the popliteal and tibial segments, the circulatory channels of the foot and toes. The suggested complex method of ultrasonic measurement of the blood flow in the lower limbs makes it possible to evaluate the hemodynamic significance of the collaterals and the adverse effect of the pathologically changed arterial segment on the regional hemodynamics. The conducted noninvasive study of hemodynamics allows the initial stages of the lesion to be detected (which physical examination fails to do in some cases) and adequate tactics of stage-by-stage treatment by surgery to be elaborated. The outcome of the reconstructive operation can be prognosed by determining the patency of the arterial arch of the foot and the leg arteries.

Collateral Circulation↗

PubMedDate not supplied

Comparison of somatosensory evoked potentials recorded from the scalp and dorsal column nuclei to upper and lower limb stimulation in the rat.

Responses from the dorsal column nuclei (DCN) in the rat to stimulation of the upper limbs (median nerve) and lower limbs (sciatic nerve) showed a difference in the wave forms of the two responses. These results support results of earlier studies in the cat, monkey, and man that showed that only slow-conducting cutaneous afferents from the lower limbs travel in the dorsal column, while all afferents from the upper limbs travel in the dorsal column and synapse in the DCN. A comparison between the response from the DCN and that from the vertex to stimulation of the upper limbs showed correspondence between short-latency peaks, while no clear earlier waves could be discerned in the response from the vertex to stimulation of the lower limbs. Even when the dorsal column was transected on one side, the correspondence between the early peaks in the scalp and the DCN responses to stimulation of the upper limbs was maintained. The effect of the dorsal column lesion on the response recorded from the surface of the DCN to stimulation of the sciatic nerve was mainly a reduction in the number of peaks. Transection at the midbrain level resulted in elimination of the long-latency response in the scalp recording, but the initial negative peak was maintained, which corresponded to the initial negative peak of the DCN response to stimulation of the upper limbs.

Animals↗

PubMed1999

Venous thromboses of upper limbs are more frequently associated with occult cancer as compared with those of lower limbs.

Three hundred and forty-three consecutive patients with deep vein thrombosis (DVT) were investigated for the possible presence of occult or undiagnosed cancer, of whom 305 patients had DVT of the lower limbs whereas 38 had DVT of the upper limbs. Cancer was diagnosed during a 12-month follow-up in nine patients with DVT of the upper limbs (23.7%) and in 34 patients with DVT of the lower limbs (11.1%). The difference was statistically significant. Furthermore, it was shown that the majority of cancers (seven of nine) in the case of DVT of the upper limbs were discovered during the first week of hospital admission. In contrast, in the case of DVT of lower limbs, only eight of 34 cancers were discovered during the initial investigation. Lung cancer and lymphomas represented the majority of cancers associated with upper limb venous thrombosis (seven of nine). In the case of DVT of the lower limbs, cancers were heterogeneous; however, 12 of 34 were cancers of the colon or prostate.

Arm↗

PubMed2006

Forearm vascular responses to combined muscle metaboreceptor activation in the upper and lower limbs in humans.

Our previous studies showed that venous occlusion or passive stretch of the lower limb, assuming a mechanical stimulus, attenuates the vasoconstriction in the non-exercised forearm during postexercise muscle ischaemia (PEMI) of the upper limb. In this study, we investigated whether a metabolic stimulus to the lower limb induces a similar response. Eight subjects performed a 2 min static handgrip exercise at 30% maximal voluntary contraction (MVC) followed by 3 min PEMI of the upper limb, concomitant with or without 2 min static ankle dorsiflexion at 30% MVC followed by 2 min PEMI of the lower limb. During PEMI of the upper limb alone, forearm blood flow (FBF) and forearm vascular conductance (FVC) in the non-exercised arm decreased significantly, whereas during combined PEMI of the upper and lower limbs, the decreases in FBF and FVC produced by PEMI of the upper limb was attenuated. Forearm blood flow and FVC were significantly greater during combined PEMI of the upper and lower limbs than during PEMI of the upper limb alone. When PEMI of the lower limb was released after combined PEMI of the upper and lower limbs (only PEMI of the upper limb was maintained continuously), the attenuated decreases in FBF and FVC observed during combined PEMI of the upper and lower limbs was not observed. Thus, forearm vascular responses differ when muscle metaboreceptors are activated in the upper limb and when there is combined activation of muscle metaboreceptors in both the upper and lower limbs.

Adult↗

PubMed1977

Effects of postural changes of the upper limb on reflex transmission in the lower limb. Cervicolumbar reflex interactions in man.

The influence of passive changes in upper limb position on the excitability of three myotatic arc reflexes (soleus, quadriceps, and biceps femoris) of the lower limb has been explored on 42 volunteers. The results indicate that the excitability of the three myotatic arcs can be influenced at a distance by postural modifications of the upper limb. When the ipsilateral upper limb is forwards or the contralateral backwards, a facilitation of both soleus and quadriceps tendon reflexes is observed while the biceps femoris reflexes are reduced. This pattern of facilitation and inhibition is reversed when the ipsilateral upper limb is backwards or the contralateral forwards. The facilitations as well as inhibitions of proximal myotatic arc reflexes are quantitatively more marked than that of the soleus reflex. Facilitation and inhibition are not linearly related to the angle of the arm with the trunk. Effects begin at a considerable angle, become maximal at 45 degrees, and progressively disappear for greater values. It is suggested that the distinct pattern of facilitation and inhibition which is exerted in reciprocal fashion on extensor and flexor motor nuclei might depend on the long propriospinal neurones connecting cervical and lumbar enlargements.

Achilles Tendon↗

PubMedDate not supplied

Lower limb amputation. 1: indications and treatment.

Lower limb amputation is performed predominantly to alleviate acute and chronic limb ischaemia caused by vascular disease, poorly controlled diabetes or, occasionally, infection. Atherosclerosis is the primary cause of chronic arterial ischaemia and the most common reason for amputation. The vascular nurse has an important role in reducing the need for amputation, by providing information on health promotion and illness prevention to patients with vascular insufficiency to halt progression to amputation. This is the first of four articles focusing on lower limb amputation. It examines the indications for lower limb amputation in detail, and briefly outlines other treatment options including revascularization techniques.

Algorithms↗

PubMed2007

Disinhibition of upper limb motor area by voluntary contraction of the lower limb muscle.

It is well known that monosynaptic spinal reflexes and motor evoked potentials following transcranial magnetic stimulation (TMS) are reinforced during phasic and intensive voluntary contraction in the remote segment (remote effect). However, the remote effect on the cortical silent period (CSP) is less known. The purpose of the present study is to determine to what extent the CSP in the intrinsic hand muscle following TMS is modified by voluntary ankle dorsiflexion and to elucidate the origin of the modulation of CSP by the remote effect. CSP was recorded in the right first dorsal interosseous while subjects performed phasic dorsiflexion in the ipsilateral side under self-paced and reaction-time conditions. Modulation of the peripherally-induced silent period (PSP) induced by electrical stimulation of the ulnar nerve was also investigated under the same conditions. In addition, modulation of the CSP was investigated during ischemic nerve block of the lower limb and during application of vibration to the tibialis anterior tendon. The duration of CSP was significantly shortened by phasic dorsiflexion, and the extent of shortening was proportional to dorsiflexion force. Shortening of the CSP duration was also observed during tonic dorsiflexion. In contrast, the PSP duration following ulnar nerve stimulation was not altered during phasic dorsiflexion. Furthermore, the remote effect on the CSP duration was seen during ischemic nerve block of the lower limb and the pre-movement period in the reaction-time paradigm, but shortening of the CSP was not observed during tendon vibration. These findings suggest that phasic muscle contraction in the remote segment results in a decrease in intracortical inhibitory pathways to the corticospinal tract innervating the muscle involved in reflex testing and that the remote effect on the CSP is predominantly cortical in origin.

Adult↗