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PubMedDate not supplied

Segmental volume plethysmography in the diagnosis of lower extremity arterial occlusive disease.

Over a 24 month period, segmental limb systolic pressures (SLP), pulse volume recordings (PVR) and bi-planar arteriograms were obtained for 202 lower extremities. The SLPs proved unsatisfactory for the localization of arterial disease and are presently employed only to assess the extent of limb ischemia. Bases on simple, qualitative criteria, the thigh PVR was graded as "normal" or "abnormal" and correctly predicted the presence or absence of hemodynamically significant aortoiliac disease in 95% of limbs. It there was a greater than 25% increase in the amplitude of the calf PVR relative to he thigh, patency of the superficial femoral artery was correctly identified in 97% of lower extremities. The limited accuracy of SLP alone in differentiating iliac and femoral artery occlusive disease, especially when present in combination, emphasizes the necessity of including some type of waveform analysis in the routine evaluation of patients with lower extremity arterial insufficiency.

Aorta↗

PubMed1987

Lower extremity burns related to sensory loss in diabetes mellitus.

A chart review of 37 hospitalized patients with diabetes mellitus who received burn therapy showed that ten (27 percent) had preventable lower-extremity burns related to sensory loss. Most of these ten burns occurred from heat applied for self-care of diabetes, namely, from hot tap water, a hot moist compress, or a heating pad. These ten patients, compared with the other 27 diabetic burn patients, were more likely to be men younger than 45 years old, to have insulin-dependent diabetes, and to have been burned during self-treatment. These findings underscore the importance of injury-prevention educational efforts by physicians in cautioning their diabetic patients, especially those with lower-extremity sensory losses, about potential burns from heat applied to the lower extremities for self-care.

Adult↗

PubMed1982

Sciatic nerve block by the anterior and posterior approach for operations on the lower extremity. A comparative study.

The results of the analgesic block of the lower extremity by means of an anterior (150 patients) or a posterior (114 patients) approach to the sciatic nerve, associated to a "3 in 1 block" were compared. The anterior approach technique was associated with a higher incidence of failures, insufficient analgesia and hence a higher demand for intraoperative analgesic and sedative drugs. Also tolerance to a pneumatic tourniquet over the proximal thigh was less than with the posterior approach. However, the sciatic nerve block by anterior approach granted a more prolonged analgesia. This technique was suitable for trauma patients immobilized in the supine position, for patients with skeletal traction on Zupinger frame, both for surgery and for closed reduction of lower extremity fractures.

Adolescent↗

PubMed1986

Extraperitoneal iliac endarterectomy in the treatment of multilevel lower extremity arterial occlusive disease.

The traditional approach to the surgical correction of lower extremity ischemia resulting from combined aortoiliac and femoropopliteal disease has consisted of aortofemoral bypass as the initial step. This operation is of considerable magnitude, mandates the use of prosthetic material, and may not adequately relieve distal ischemia. Extraperitoneal iliac endarterectomy is an operation of lesser magnitude and does not require the use of prosthetic material. When applied to selected patients with multilevel disease, it can be conveniently and expeditiously combined with distal bypass and deep femoral repair, femorofemoral bypass, or both for the simultaneous and complete correction of multilevel disease. In the past 10 years, 65 patients underwent simultaneous extraperitoneal iliac endarterectomy in combination with an outflow procedure for the correction of multilevel lower extremity arterial occlusive disease. Using a two-team approach, operative time averaged 3 hours. Operative mortality was 5 percent. The procedure was combined with femoral endarterectomy in 60 patients, with femoropopliteal-to-tibial bypass in 30 patients, and with femorofemoral bypass in 10 patients. The life table patency for iliac endarterectomy was 100 percent at 6 years, whereas patency for the associated outflow procedures was 87 percent at 6 years. These results indicate that extraperitoneal iliac endarterectomy is uniquely suited for combination with distal procedures to permit the simultaneous repair of combined aortoiliac and femoropopliteal disease in a single operation of reasonable magnitude.

Adult↗

PubMed1999

Digital subtraction angiography of the abdominal aorta and lower extremities: carbon dioxide versus iodinated contrast material.

PURPOSE: To compare the diagnostic value of carbon dioxide to that of iodinated contrast material for digital subtraction angiography of the abdominal aorta and lower extremities. MATERIALS AND METHODS: Thirty-five patients underwent comparative CO2 and iodinated contrast material arteriography of the abdominal aorta and lower extremities. For each contrast study, three independent observers evaluated the degree of opacification and percentage of stenosis of each vessel, the degree of certainty of their observations, and the overall quality of the study. Data of CO2 and iodinated studies were compared using analysis of variance for repeated measures. Interobserver and intertechnique agreements were estimated with Cohen's kappa and intraclass correlation coefficient. RESULTS: Iodine-based vascular opacification was superior to that with CO2 in the central and distal arteries (P = .02). The degree of certainty and overall quality score were higher for iodine than for CO2-based contrast studies (P = .00001). The interobserver agreement for categorizing stenoses was higher for iodine as compared to CO2-based angiography. No significant difference was observed between the mean stenosis values obtained with CO2 and iodine-based angiography in any segment. Intraclass correlation coefficient demonstrated a high degree of convergence of the two techniques for assessing the percentage of stenosis. CONCLUSION: CO2 can be used as an alternative to iodinated contrast material for obtaining arteriograms of the abdominal aorta and lower extremities for investigating atherosclerotic disease.

Aged↗

PubMed2003

FDG-PET imaging of lower extremity muscular activity during level walking.

We analyzed muscular activity of the lower extremities during level walking using positron emission tomography (PET) with (18)F-fluorodeoxyglucose ((18)F-FDG). We examined 17 healthy male subjects; 11 were assigned to a walking group and 6 to a resting group. After (18)F-FDG injection, the walking group subjects walked at a free speed for 15 min. A whole-body image was then obtained by a PET camera, and the standardized uptake ratio (SUR) was computed for each muscle. The SUR for each muscle of the walking group was compared with that for the corresponding muscles in the resting group. The level of muscular activity of all the muscles we examined were higher during level walking than when resting. The activity of the lower leg muscles was higher than that of the thigh muscles during level walking. The muscular activity of the soleus was highest among all the muscles examined. Among the gluteal muscles, the muscular activity of the gluteus minimus was higher than that of the gluteus maximus and gluteus medius. The concurrent validity of measuring muscular activity of the lower extremity during level walking by the PET method using (18)F-FDG was demonstrated.

Adult↗

PubMed1994

Nonrecurrent primary basal cell carcinoma of the lower extremity with late metastasis.

BACKGROUND: Metastatic basal cell carcinoma (MBCC) is rare, with most cases of head and neck origin and from large multi-recurrent tumors. MBCC is very rare from lower extremities and even more rare from primary tumors that were small and treated without local recurrence. OBJECTIVE: This paper presents a case of MBCC in a 78-year-old woman who had previously undergone resection without local recurrence of a small lower extremity basal cell carcinoma. CONCLUSION: MBCC can present atypically with site of origin on lower extremities, initial tumor size small, and nonrecurrence of the primary tumor site. The clinician should be aware of this as well as understand that prompt and aggressive surgical therapy to localized metastases may extend survival.

Aged↗

PubMed2003

High prevalence of asymptomatically poor muscle perfusion of lower extremities measured in systemic lupus erythematosus patients with abnormal myocardial perfusion.

Patients with systemic lupus erythematosus (SLE) may develop premature atherosclerosis, notably peripheral vascular disease (PVD) presenting with intermittent claudication or gangrene. Therefore, it is important to investigate if high prevalence of poor muscle perfusion of lower extremities in SLE patients with abnormal myocardial perfusion is related to more cardiovascular risk factors. We used a well-established and noninvasive radionuclide method (xenon 133 muscle washout) to evaluate objectively the anterior tibial muscle perfusion of 34 SLE female patients without symptoms/signs of PVD in the lower extremities. The patients were separated into two groups according to myocardial perfusion imaging results. Meanwhile, 30 normal female controls with matched age distribution were also included for comparison. The muscle perfusion differed significantly ( P <0.05) between patients (1.90+/-0.41 ml/100 g per min) and controls (2.91+/-0.50 ml/100 g per min), as well as between 18 SLE patients with abnormal myocardial perfusion (1.33+/-0.43 ml/100 g per min) and 16 with normal myocardial perfusion (2.26+/-0.45 ml/100 g per min). Based on the xenon 133 muscle washout method, we conclude that muscle perfusion in the lower extremities of SLE patients without symptoms/signs of PVD is significantly decreased and related to abnormal myocardial perfusion.

Adult↗

PubMed1987

The lesser saphenous vein: autogenous tissue for lower extremity revascularization.

From December 1980 to December 1985, 54 patients underwent 56 lower extremity arterial procedures with the use of lesser saphenous vein (LSV) as graft material. LSV was used in all cases because a satisfactory greater saphenous vein (GSV) was unavailable to accomplish the proposed revascularization. Indications for operation were rest pain, ulceration, and gangrene (74%), and 26% had claudication alone. Fifty of the 56 procedures were femorotibial and femoroperoneal bypasses. Three graft combinations were used: LSV alone (29), lesser saphenous vein and other autogenous vein composites (LSV/AUTO) (14), and lesser saphenous vein with synthetic composite grafts (LSV/SYN) (13). Graft patency rates were determined by life-table analysis. The 3-year patency rate for LSV was 60% and for LSV/AUTO was 38%. LSV/SYN graft composites had a graft patency rate at 18 months of 21%. These data suggest that the LSV may function as an autogenous venous graft for lower extremity revascularization when sufficient GSV is not available.

Arteriovenous Shunt, Surgical↗

PubMed2002

Altering muscle activity in the lower extremities by running with different shoes.

PURPOSE: To provide evidence that lower-extremity muscle activity during running is tuned in response to the loading rate of the impact forces at heel-strike. METHODS: Six runners ran two 30-min trials per week for 4 wk. The trials tested two shoes which differed only in the material hardness of the midsole. The shoes were tested in a randomized sequence. Bipolar surface EMG was recorded from the muscles of the rectus femoris, biceps femoris, medial gastrocnemius, and tibialis anterior. EMG was resolved into time-frequency space using wavelet techniques. EMG was analyzed for the 150 ms time window immediately before heel-strike. RESULTS: The intensity of the EMG and the ratio of the EMG intensity between high and low frequency components both showed significant changes between shoes, subjects, and muscles. Additionally, the intensity ratio showed a significant change over the course of each 30-min run. CONCLUSIONS: Lower-extremity muscle activity used to tune the muscles for the impact task can be altered by changing the material hardness of the shoe. The changes in the EMG frequency ratio suggest that muscle fiber-type recruitment patterns can also be altered by the choice of midsole material.

Adult↗

PubMed2004

[Management of severe postburn scar contracture in the lower extremities].

OBJECTIVE: To summarize the clinical experience in the management of severe postburn scar contracture in the lower extremities. METHODS: The scars in popliteal fossa and ankle joint were excised. Traction and skin grafting were employed in the management of contracture deformity in these areas. RESULTS: Severe postburn scar contracture deformity in sixty postburn patients could be corrected by constant traction and skin grafting. CONCLUSION: Scar excision and lysis with constant traction might be an optimal method in the management of severe postburn scar contracture deformity of joints in the lower extremities and satisfactory results could be obtained without tendon grafting and elongation.

Adolescent↗

PubMed1997

Influence of inertia on intersegment moments of the lower extremity joints.

The calculation of three-dimensional intersegment moments of the lower extremity modelled as a system of rigid bodies-during human locomotion with the help of an inverse dynamics approach is one of the main strategies to describe the local kinetics of a human motion. From the numerical point of view, the resultant intersegment moment consists of different contributions; the moment of ground reaction force, the moment dependent on the weights of the segments and two inertia dependent parts, the moment of inertia force and the rate of change of angular momentum (with respect to the segments centre of gravity). For running with a horizontal velocity of 5 m s(-1), the calculation of the moment of inertia force can be neglected for the ankle but is important for the hip. Looking at the knee, this contribution is needed if the touch down phase is of special interest. The rate of change of angular momentum-with respect to the segments centre of gravity-can be neglected for all joints of the lower extremity.

Adult↗

PubMed1998

Aortic and lower-extremity arterial disease: evaluation with MR angiography versus conventional angiography.

PURPOSE: To compare magnetic resonance (MR) angiography with conventional angiography in evaluation of the aorta and lower-extremity arterial system. MATERIALS AND METHODS: Fifty-seven patients were evaluated with femoral conventional and MR angiography. Iliac artery segments were evaluated with two-dimensional and contrast material-enhanced three-dimensional time-of-flight MR angiography. Infrainguinal regions were evaluated with two-dimensional time-of-flight MR angiography with a dedicated lower-extremity coil. Arteries depicted on femoral images were separately interpreted as 20 anatomic segments. Disease classification included normal to moderate disease (0%-50% stenosis), severe stenosis (> 50% stenosis), diffuse disease (more than one severe stenosis), and occlusion. Four readers interpreted the images and rendered treatment recommendations. RESULTS: Substantial to almost perfect interobserver agreement (kappa, 0.66-1.00) was achieved in most cases for MR angiogram interpretation. The three most experienced readers achieved substantial to almost perfect intraobserver agreement (kappa, 0.61-1.00) between conventional and MR angiogram interpretation in most cases. Among three readers, moderate agreement (kappa, 0.43-0.53) was found between treatment recommendations based on conventional versus MR angiographic findings; for the most experienced reader, this agreement was almost perfect (kappa, 0.90). CONCLUSION: For experienced readers, there was substantial to almost perfect agreement between conventional and MR angiographic image interpretations of the aorta and lower-extremity arterial system.

Aged↗

PubMed1994

The significance of perioperative cultures in open pediatric lower-extremity fractures.

The value of perioperative cultures in 86 open pediatric lower-extremity fractures was assessed. Thirteen infections were identified, for an incidence of 15%. The predebridement culture was positive in 63% of wounds, and the postdebridement culture was positive in 40%. In the 13 wounds with infection, the infecting pathogen was found among the organisms grown on positive predebridement cultures 29% of the time, and on 60% of post-debridement cultures. Neither culture was of value in predicting the identity of a potential subsequent infecting pathogen. There was no significant difference in the rate of infection for negative cultures versus positive cultures; however, a negative predebridement culture was associated with a 94% chance of avoiding infection, and a negative postdebridement culture correlated with a 79% probability that infection would not occur. A positive culture result was less useful, however, because the infection rate remained low in these instances. Predebridement cultures were highly sensitive (88%) in identifying wounds that developed infection; however, the false positive rate was high, resulting in a specificity of only 43%. Postdebridement cultures, although somewhat more specific (63%), lacked sensitivity (50%). Clearly the routine use of perioperative cultures in open pediatric lower-extremity fractures must be questioned. Further prospective study is needed to confirm the validity and general applicability of the results of this retrospective review.

Bacteria↗

PubMed1988

Management of failed prosthetic grafts at the time of major lower extremity amputation.

During a 2-year period 75 patients underwent 77 major lower extremity amputations for arterial insufficiency deemed untreatable by reconstruction (36 primary and 41 after failed infrainguinal arterial bypass). Patients with nonfunctional prosthetic grafts were randomized prospectively to either partial graft removal or complete graft removal, performed simultaneously with amputation, to determine which technique more effectively reduces delayed wound healing, stump infection, operative revision, and process-related death. Patients with known graft and deep wound infection were excluded from this review, as were patients who had positive graft cultures at the time of amputation. Partial graft removal resulted in an increased rate of delayed wound healing (47.8% vs 7.7%; chi 2 5.9, p less than 0.025) and secondary stump infection (39.1% vs 7.7%; chi 2 4.4, p less than 0.05), when compared with complete graft removal. The operative revision and process-related mortality rates were also higher in limbs that had partial graft removal, although not statistically significant. The operative morbidity and mortality rate was no greater in the group with complete graft removal, although the mean operative time was nearly doubled (1.4 vs 2.6 hours). Therefore we recommend that all nonfunctional prosthetic graft material be removed concomitant with major lower extremity amputation to avoid the excessive number of wound healing and suppurative complications that are encountered when residual graft material is present in the amputation stump.

Amputation, Surgical↗

PubMed2004

Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or =60 y.

BACKGROUND: Vitamin D may improve muscle strength through a highly specific nuclear receptor in muscle tissue. OBJECTIVES: We investigated whether there is an association between 25-hydroxyvitamin D [25(OH)D] concentrations and lower-extremity function in ambulatory older persons, whether that association differs by activity level, and, if so, whether there is an identifiable threshold in the association. DESIGN: The study was a population-based survey of the ambulatory US population aged 60 to > or =90 y (n = 4100). Lower-extremity function according to serum 25(OH)D concentrations was assessed by linear regression analyses and regression plots after control for activity level (inactive or active) and several other potential confounders. Separate analyses were performed for the timed 8-foot (ie, 2.4 m) walk test and a repeated sit-to-stand test. RESULTS: The 8-foot walk test compared subjects in the lowest and highest quintiles of 25(OH)D; the latter group had an average decrease of 0.27 s [95% CI: -0.44, -0.09 s (or 5.6%); P for trend < 0.001]. The sit-to-stand test compared subjects in the lowest and highest quintiles of 25(OH)D; the latter group had an average decrease of 0.67 s [95% CI: -1.11, -0.23 s (or 3.9%); P for trend = 0.017]. In the 25(OH)D reference range of 22.5-94 nmol/L, most of the improvement occurred in subjects with 25(OH)D concentrations between 22.5 and approximately 40 nmol/L, and further improvement was seen in the range of 40-94 nmol/L. Stratification by activity level showed no significant effect modification. CONCLUSION: In both active and inactive ambulatory persons aged > or =60 y, 25(OH)D concentrations between 40 and 94 nmol/L are associated with better musculoskeletal function in the lower extremities than are concentrations < 40 nmol/L.

Aged↗

PubMed2006

Core strength and lower extremity alignment during single leg squats.

INTRODUCTION/PURPOSE: Muscles of the trunk, hip, and knee influence the orientation of the lower extremity during weight bearing activities. The purpose of this study was threefold: first, to compare the orientation of the lower extremity during a single leg (SL) squat among male and female athletes; second, to compare the strength of muscle groups in the trunk, hips, and knees between these individuals; and third, to evaluate the association between trunk, hip, and knee strength and the orientation of the knee joint during this activity. METHODS: Twenty-four male and 22 female athletes participated in this study. Peak isometric torque was determined for the following muscle actions: trunk flexion, extension, and lateral flexion, hip abduction and external rotation, and knee flexion and extension. The frontal plane projection angle (FPPA) of the knee during a 45 degrees SL squat was determined using photo editing software. RESULTS: Males and females moved in opposite directions during the SL squat test (F(1,42) = 5.05, P = 0.03). Females typically moved toward more extreme FPPA during SL squats (P = 0.056), while males tended to move toward more neutral alignment (P = 0.066). Females also generated less torque in all muscle groups, with the exception of trunk extension. The projection angle of the knee during the SL squat test was most closely associated with hip external rotation strength. CONCLUSION: Using instruments suitable for a clinical setting, females were found to have greater FPPA and generally decreased trunk, hip, and knee isometric torque. Hip external rotation strength was most closely associated with the frontal plane projection angle.

Adolescent↗

PubMed1981

Hemodynamic assessment of transluminal angioplasty for lower extremity ischemia.

The results of percutaneous transluminal angioplasty (PTA) for 56 ischemic lower extremities in 51 patients were analyzed. Indications for balloon catheter dilatation were intermittent claudication in 46 limbs (82.1%), rest pain in five (8.9%), and ischemic ulceration in five (8.9%). Balloon dialation was technically successful in 16 of 17 iliac segment lesions (94.1%) with symptomatic improvement in each instance. Nine of the 16 limbs were hemodynamically improved with a significant increase (less than 0.15) in ankle systolic pressure index. Four additional limbs had improvement in the thigh index. The remaining three limbs were hemodynamically unimproved. During average follow-up of 7.1 months, the 13 initially improved limbs remained hemodynamically improved. Thirty-one of 42 femoropopliteal dilatations (73.8%) were technically successful, with uniform symptomatic improvement. Of these 31 limbs, 26 had a significant initial increase in ankle index, one had improvement in distal thigh index only, and the remaining four limbs were hemodynamically unimproved. During mean follow-up of 8.4 months in the 27 limbs that initially were improved after femoropopliteal dilation, the pressure index returned to the pre-PTA level in 12 instances (44.4%). These results indicate that PTA is useful in selected short-segment iliac lesions. Balloon dilation of femoropopliteal lesions was less successful and its application requires further evaluation. This study demonstrates the need for close monitoring of the objective hemodynamic response, as well as symptomatic and angiographic results, in establishing the proper role of PTA in the treatment of lower extremity ischemia.

Adult↗