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PubMed1995

MR and spiral/helical CT imaging of lower extremity occlusive disease.

Magnetic resonance (MR) angiography and spiral CT angiography are promising new imaging modalities for evaluating patients with lower extremity arterial occlusive disease. Both techniques are less invasive than conventional angiography, and MR angiography has the additional advantages of not requiring iodinated contrast media or ionizing radiation. The basic principles of MR angiography and spiral CT angiography are reviewed with an emphasis on three-dimensional display techniques. This is followed by a discussion of their clinical applicability toward the diagnosis and treatment planning of lower extremity arterial occlusive disease.

Angiography↗

PubMed1999

Evaluating functional outcome in patients with lower extremity sarcoma.

The Short Form 36, The Toronto Extremity Salvage Score, and the 1987 and 1993 Musculoskeletal Tumor Society Rating Scales were compared as measures of functional status for patients with lower extremity sarcoma. The study included 97 patients with lower extremity sarcoma and evaluated each measure on the following measurement properties: conceptual framework; statement of the purpose; feasibility; breadth of content; depth of measurement; cross sectional and longitudinal reliability; and validity and responsiveness. The Short Form 36 represents patients' perceptions of their physical and mental health and is practical to use. However, the validity of the measure is questionable for the patients with sarcoma because the subscale structure could not be reproduced in the current data. The Toronto Extremity Salvage Score meets all standards of measurement with the exception of breadth of content as it measures only physical function. The 1987 and 1993 Musculoskeletal Tumor Society scales do not meet the standards of measurement. In choosing an outcome measure for the extremity sarcoma population, the Toronto Extremity Salvage Score has superior measurement properties when compared with the Short Form 36 or the 1987 and 1993 Musculoskeletal Tumor Society scales. The Toronto Extremity Salvage Score is a reliable and efficient measure for monitoring patients and for use in clinical trials.

Adolescent↗

PubMedDate not supplied

[Duplex sonography in the diagnosis of ischemic disease of the lower extremity. Comparative study with angiography].

The aim was to study possibilities of duplex sonography in evaluation of ischemic diseases of the lower extremities. The results obtained were compared with angiographic findings and high correlation of the results was obtained. Duplex sonography is a simple, safe, noninvasive method in diagnosing the site and degree of stenotic changes on the arteries of the lower extremities.

Angiography↗

PubMed2004

Condition-specific Western Ontario McMaster Osteoarthritis Index was not superior to region-specific Lower Extremity Functional Scale at detecting change.

OBJECTIVE: We determined whether the sensitivity to change of the Western Ontario McMaster Osteoarthritis Index (WOMAC) physical function (PF) subscale, a condition-specific measure for persons with osteoarthritis of the hip or knee, was superior to a lower extremity region-specific measure, the Lower Extremity Functional Scale (LEFS), in persons with osteoarthritis of the hip or knee undergoing total joint arthroplasty. METHODS: The WOMAC and LEFS were administered to 102 patients with osteoarthritis preoperatively, within 16 days of surgery, and >20 days after the first postoperative assessment. These time points enabled the assessment of deterioration and improvement. Two timed performance measures (40 m walk test and the timed-up-and-go test) were also assessed. Change was quantified by the standardized response mean (SRM). RESULTS: WOMAC PF SRMs were not greater than the LEFS SRMs. Performance measures' times increased significantly over the deterioration interval and decreased over the improvement interval. The WOMAC PF and LEFS demonstrated significant improvement over the second assessment interval; only the LEFS showed significant deterioration over the first assessment interval. WOMAC PF scores seem to be strongly influenced by pain. CONCLUSION: The findings do not support the hypothesis that the WOMAC PF subscale is superior to the LEFS in detecting change.

Aged↗

PubMedDate not supplied

Types of psychological reactions in patients with lower-extremity amputations.

The aim of this study was to establish types of psychological reactions and conditions in patients with lower-extremity amputations. Apart from using psychological interviews, detection was performed using psychometric tests: Minnesota Multiphasic Personality Inventory and Beck Depression Inventory. Psychometric parameters were analyzed in a group of 20 examinees treated at the Medical Rehabilitation Clinic in Novi Sad. Out of the whole sample, 45% of patients presented with adaptive reactions to amputation and consequent disability, whereas 55% presented with maladaptive responses. The registered psychopathological symptoms included nosologic categories: reaction to stressful events and adjustment disorder (predominantly affecting other emotions; mixed disorder of conduct and emotions; prolonged depressive reaction) and dysthymia. When working with lower-extremity amputees, apart from adaptive, nonpathological forms of behavior, one also encounters maladaptive responses with predomination of mood disorders due to severe somatic stress.

Adaptation, Psychological↗

PubMed2002

Angiographic distribution of lower extremity atherosclerosis in patients with and without diabetes.

AIMS: To determine differences in the anatomic site of atherosclerosis in the lower extremity between patients with and patients without diabetes. DESIGN: Cross-sectional study of patients who underwent angiography of both legs because of symptoms of intermittent claudication, rest and/or night pain, ulceration or gangrene. METHODS: The angiographies of 37 patients with diabetes and 37 patients without diabetes, matched for age, sex and smoking behaviour, were evaluated using the Bollinger scoring system. RESULTS: The mean (sd) Bollinger score in the upper leg (from the abdominal aorta to and including the superficial femoral artery) was higher (P = 0.01) for patients without diabetes (35.3 (22.8)) than for patients with diabetes (23.3 (16.1)). In the lower leg (from the popliteal artery to the posterior tibial artery) patients with diabetes tended to have a higher score than patients without diabetes: 47.4 (34.2) and 37.6 (32.9), respectively (P = 0.22). CONCLUSION: This angiographic study confirms the clinical notion that lower limb atherosclerosis in diabetes is more severe in distal segments of the lower extremity, while the proximal segments remain less attenuated compared with patients without diabetes.

Aged↗

PubMed1998

Physical examination and chronic lower-extremity ischemia: a critical review.

OBJECTIVE: To determine the clinical utility of physical examination in patients with suspected chronic ischemia of the lower extremities. DATA SOURCES: MEDLINE search (January 1966 to January 1997), personal files, and bibliographies of textbooks on physical diagnosis, surgery, and vascular surgery. STUDY SELECTION: Both authors independently graded the studies as level 1, 2, or 3, according to predetermined criteria. Criteria deemed essential for analysis of sensitivity, specificity, and likelihood ratios were (1) clear definition of study population, (2) clear definition of physical examination maneuver, and (3) use of an acceptable criterion standard test for comparison. RESULTS: The following positive findings help clinicians diagnose the presence of peripheral arterial disease: abnormal pedal pulses, a unilaterally cool extremity, a prolonged venous filling time, and a femoral bruit. Other physical signs help determine the extent and distribution of vascular disease, including an abnormal femoral pulse, lower-extremity bruits, warm knees, and the Buerger test. The capillary refill test and the findings of foot discoloration, atrophic skin, and hairless extremities are unhelpful in diagnostic decisions. Mathematical formulas, derived from 2 studies using multivariate analysis, allow clinicians to estimate the probability of peripheral arterial disease in their patients. CONCLUSION: Certain aspects of the physical examination help clinicians make accurate judgments about the presence of peripheral arterial disease and its distribution.

Aged↗

PubMed1989

[Myoglobin level in patients with occlusive diseases of the lower extremities].

Serum myoglobin (MG) concentration was measured in 25 patients with obliterating atherosclerosis of the aorta and main arteries of the lower extremities and in 30 normal subjects. Serum MG levels were also measured repeatedly following aortofemoral bifurcation shunting. An original one-step enzyme (immunoassay technique was used to determine serum MG concentration. Serum MG was increased in patients with obliterating diseases of the lower extremities. There was marked myoglobinemia, reaching its peak within 8 to 10 hours after the reconstructive operations on the aorto-iliac segments.

Adult↗

PubMed2005

[Osteogenesis imperfecta--operative treatment on lower extremities in children with osteogenesis imperfecta].

The group of 141 children with osteogenesis imperfecta was treated in Orthopaedic Department of the University Children Hospital in Krakow, Poland. In 77 (54.6%) children from this group, we operated on lower extremities. Prophylactic operations, that were intramedullary Rush rodding, we performed in 19 cases (14 femurs and 11 tibias). Sofield-Millar procedures we performed in 58 children. We operated 321 times - there are 4 operations on average in one child. Average follow-up period was 6.7 years. We operated 473 long bones: 234 femurs and 239 tibias. We did 479 osteotomies. First operations were done at the age of 9 years on average (1.5-21 years). Further operations, 3 in each patient on average, we performed in period 37 months from one to another on tibias and 49 months on femurs. In all operated children we achieved full axis correction and their activity after operation improved. In order to assess that, we used the Bleck scale. In general, before operation, 54 (70%) children did not walk, and, in contrast, after operations 53 (69%) started walking. Operative treatment of the lower extremities in children with osteogenesis imperfecta improves their clinical physical abilities, quality of life and allows increase in activities.

Adolescent↗

PubMed1999

Diabetes-related lower-extremity amputations disproportionately affect Blacks and Mexican Americans.

BACKGROUND: We sought to identify the age-adjusted incidence of lower-extremity amputation (LEA) in Mexican Americans, blacks, and non-Hispanic whites with diabetes in south Texas. METHODS: We summarized medical records for hospitalizations for LEAs for 1993 in six metropolitan statistical areas in south Texas. RESULTS: Age-adjusted incidence per 10,000 patients with diabetes was 146.59 in blacks, 60.68 in non-Hispanic whites, and 94.08 in Mexican Americans. Of the patients, 47% of amputees had a history of amputation, and 17.7% were hospitalized more than once during 1993. Mexican Americans had more diabetes-related amputations (85.9%) than blacks (74.7%) or non-Hispanic whites (56.3%). CONCLUSIONS: This study is the first to identify the incidence of diabetes-related lower-extremity amputations in minorities using primary data. Minorities had both a higher incidence and proportion of diabetes-related, LEAs compared with non-Hispanic whites. Public health initiatives and national strategies, such as Healthy People 2000 and 2010, need to specifically focus on high-risk populations and high-risk geographic areas to decrease the frequency of amputation and reamputation.

Black or African American↗

PubMed1990

Combined orthopedic and vascular injury in the lower extremities: indications for amputation.

A retrospective review was undertaken to determine risk factors associated with amputation after open fractures of the lower extremity that were complicated by vascular injury. During an 11-year period ending in December 1987, we observed open fractures in 31 patients and injuries to the popliteal artery in 16 patients, to the tibial arteries in eight patients, to the femoral artery in five patients, and to the dorsal artery of the foot in two patients. Vascular repair was accomplished in 25 patients; 12 patients had primary end-to-end anastomosis, 12 patients had reverse saphenous vein grafts, and one patient had a bovine graft. Of these 25 patients, five patients required amputation because of infection and three patients required amputation because of continued ischemia. Three patients with irreparable damage had immediate amputation, and three patients without distal ischemia had vessel ligation only. The risk factors associated with amputation were shock on admission (10 of 19 patients [p less than 0.02]) and a crushed extremity (10 of 18 patients [p less than 0.01]). The overall amputation rate, which included three immediate amputations and eight late amputations, was 35.2%. The data suggest that limb salvage is possible in two thirds of patients with combined orthopedic and vascular injuries of the lower extremity, but a history of shock or crush injury with vascular compromise is an unfavorable prognostic sign.

Accidents, Traffic↗

PubMed2004

[Effects of dyslipoproteinemia on long-term results of surgical treatment of patients with obliterating atherosclerosis of the lower extremity vessels].

The investigation included 120 patients who had undergone different revascularizing operations more than 10 years ago for obliterating atherosclerosis of the lower extremity vessels. Dyslipoproteidemia was diagnosed in 88 of them. It was established that in patients with dyslipoproteidemia the symptoms of ischemia of lower extremities were developed in younger age. Within 5 years after the first revascularizing operations there appear reliable differences in the course of the disease in patients with dyslipoproteidemia and normal levels of lipids in blood. More than 90% of patients with dyslipoproteidemia in the distant period of time have symptoms of generalized atherosclerosis, and the survival is mainly predetermined by cardiac and cerebral complications of atherosclerosis. The life of dyslipoproteidemia patients operated upon is 8 years shorter than of subjects with the normal-level of lipids in blood.

Arteriosclerosis Obliterans↗

PubMed1993

Incidence and course of symptomatic deep venous thrombosis of the lower extremities in a black Caribbean population.

During a 5-year period 131 patients with symptomatic deep venous thrombosis of the lower extremities (DVT) were identified in a black Caribbean population. Eighty-one patients (61%) had objective evidence (ascending venography), while in 39% the diagnosis was based on clinical findings only. The overall annual incidence rate for definite DVT was 11 per 100,000 person years; there was a steep increase with age in both sexes. Proximal DVT was present in 69% of patients. Swelling (92%), pain on palpation (89%) and tenderness (87%) were the most frequent symptoms, while immobilization (43%) and varicosities (42%) were the most frequent risk factors; DVT was rare during pregnancy (1 in 15,000 deliveries). Seventeen patients (21%) developed pulmonary embolism and five patients (6.2%) died during the hospital stay (four of fatal pulmonary embolism, one due to toxic epidermolysis after venography). We conclude, that symptomatic DVT of the lower extremities has a low incidence in this black Caribbean population, but is nonetheless associated with considerable morbidity and mortality due to pulmonary embolism.

Adult↗

PubMed2004

Core stability measures as risk factors for lower extremity injury in athletes.

INTRODUCTION/PURPOSE: Decreased lumbo-pelvic (or core) stability has been suggested to contribute to the etiology of lower extremity injuries, particularly in females. This prospective study compares core stability measures between genders and between athletes who reported an injury during their season versus those who did not. Finally, we looked for one or a combination of these strength measures that could be used to identify athletes at risk for lower extremity injury. METHODS: Before their season, 80 female (mean age = 19.1 +/- 1.37 yr, mean weight 65.1 +/- 10.0 kg) and 60 male (mean age = 19.0 +/- 0.90 yr, mean weight 78.8 +/- 13.3 kg) intercollegiate basketball and track athletes were studied. Hip abduction and external rotation strength, abdominal muscle function, and back extensor and quadratus lumborum endurance was tested for each athlete. RESULTS: Males produced greater hip abduction (males = 32.6 +/- 7.3%BW, females = 29.2 +/- 6.1%BW), hip external rotation (males = 21.6 +/- 4.3%BW, females = 18.4 +/- 4.1%BW), and quadratus lumborum measures (males = 84.3 +/- 32.5 s, females = 58.9 +/- 26.0 s). Athletes who did not sustain an injury were significantly stronger in hip abduction (males = 31.6 +/- 7.1%BW, females = 28.6 +/- 5.5%BW) and external rotation (males = 20.6 +/- 4.2%BW, females = 17.9 +/- 4.4%BW). Logistic regression analysis revealed that hip external rotation strength was the only useful predictor of injury status (OR = 0.86, 95% CI = 0.77, 0.097). CONCLUSION: Core stability has an important role in injury prevention. Future study may reveal that differences in postural stability partially explain the gender bias among female athletes.

Adolescent↗

PubMed1990

[Is the measurement of the pulse wave rate useful in the diagnosis of the early stages of arterial atherosclerosis of the lower extremities in type I diabetics?].

The authors examined the rate of the pulse wave (RPW) on the arteries of the lower extremities in a group of 60 type I diabetics and in a control group of 60 subjects without diabetes. The aim of the examination was to find out whether in diabetes threatened by early development of atherosclerosis preclinical signs of stiffening of the arteries with a fast spread of the pulse wave are present. The authors found in diabetics significantly higher values of RPW, as compared with non-diabetics, starting from the fourth decade. In subjects under 30 years the RPW in the two groups did not differ. In diabetics significant linear correlations were revealed between RPW values and age and RPW values and the duration of diabetes--i.e. with advancing age and longer duration of diabetes RPW rises. In diabetics with peripheral neuropathy significantly higher RPW values were recorded, as compared with diabetics without this complication. Assessment of the RPW by ultrasound is a non-invasive useful examination which makes it possible to detect among type I diabetics subjects with preclinical signs of stiffening of the arteries of the lower extremities which is considered an initial stage of atherosclerosis.

Adult↗

PubMed1982

Efficacy of balloon catheter dilatation for lower extremity atherosclerosis.

Since there are few data regarding complications and long-term efficacy of balloon catheter dilatation for advanced lower extremity atherosclerosis, we are reporting our experience with 132 attempted dilatations in 88 patients. Dilatation was attempted on 51 aortoiliac-common femoral lesions, 80 superficial femoral-popliteal lesions and 1 peroneal lesion. Twenty procedures were technically unsuccessful and led to urgent surgery in three patients. Thirty-one complications in the 109 technically successful dilatations led to emergency surgery in only one, but another required closure of an arteriovenous fistula at the site of catheterization. There were three episodes of embolism, but none required operation. In 109 dilatations monitored for 1 month, there was significant hemodynamic improvement in 52 and mild to moderate improvement in 37; 10 had no change; 10 occluded at the site of dilatation. Of the 42 patients observed 6 months or longer, 11 maintained a significant increase, and 15 had mild to moderate improvement; 11 reverted to predilatation levels; 1 had progressive worsening; 4 occluded. Sixteen patients who had significant increases in flow after dilatation and were followed longer than 6 months showed a trend to restenosis as the length of follow-up increased. We conclude that dilatation is a useful adjunctive procedure in treating lower extremity atherosclerosis, that the early results are good, and that the incidence of recurrent stenosis is high. Indications for dilatation and its complications are similar to those for operations. It should not be done without hemodynamic monitoring.

Aged↗

PubMed2004

[Reconstruction of posttraumatic bony defects of the lower extremity: callotaxis or free vascularized fibula graft?].

PURPOSE/BACKGROUND: Several methods have been established for the treatment of bony defects of the lower extremity. The purpose of this paper is to evaluate the use of a free vascularized fibula graft for these defects in comparison to callotaxis and segmental transport. METHOD AND CLINICAL MATERIAL: Retrospective analysis of data from 32 patients treated between 1981 and 1999 at the University Hospital in Zurich, Switzerland with bony defects of the lower extremity. RESULTS: The reconstruction of the bony defect was successful in 80 % with fibula graft, in 94 % with callotaxis and in 83 % with segmental transport. In the group with the fibula transplantation 2.6 re-interventions due to complications had to be performed, in the callotaxis group there were 3.6 and in the segmental transport group 5.2 surgical re-interventions. The time between primary intervention and full weight bearing was 16 months in the fibula transplantation group, 7.6 months in the callotaxis group and 10.7 months in the segmental transport group. CONCLUSION: The results show that these three options can be used for different indications. Reconstruction can be planned according to the following rules: Segmental bony defects of the entire circumference of up to 5 cm are best treated by initial shortening followed by callus distraction. Bony defects from 5 to 12 cm are best treated by segmental transport while maintaining limb length. Defects > 12 cm are best treated by reconstruction with a vascularized free fibula graft.

Accidents, Traffic↗

PubMed1997

Scintigraphy of lower extremity cadaveric bone allografts in osteosarcoma patients.

PURPOSE: To describe scintigraphic characteristics of bone allografts used in limb salvage reconstruction after resection of lower extremity osteosarcoma. MATERIALS AND METHODS: The authors reviewed 85 skeletal scintigrams of 20 pediatric patients followed up for 0.5-5.7 years after resection of lower extremity osteosarcoma and allograft reconstruction. Uptake in the allograft and adjacent host tissues was assessed visually. RESULTS: Lack of tracer uptake in the allografts was seen in 99% of the studies and a faint rim of tracer localization outlining the allograft's periphery was seen in 95% of the studies. Increased uptake was noted at the allograft-host bone junction in 78% of the studies. Uptake was increased in the joint surfaces of native bones articulating with allografts (97% of studies), including the patella (93% of studies) when the knee was involved. These findings were stabilized as time passed. CONCLUSION: Cadaveric bone allografts have a characteristic scintigraphic appearance in this selected patient group that reflects the physiology of their incorporation process.

Adolescent↗