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At least 127 records · Page 7Linked to original sources
PubMed2002

Lower limb replantations: indications and a new scoring system.

The need for reconstruction of lower limb amputations is increasing, due to high-energy trauma in road accidents and work-related injuries. The indication for lower limb replantation is still controversial. Compared with upper limb replantations, indications are more select due to the frequent complications in lower limb salvage procedures, such as severe general complications or local complications such as necrosis, infections, nonunions, the need for secondary lengthening, or other reconstructive procedures. The satisfactory results given by artificial prosthesis, such as quicker recovery time and fewer secondary procedures, also contribute to the higher degree of selection for lower limb replantation candidates. Since 1993, we have replanted 14 amputations of the lower limb in 12 patients, including 2 bilateral cases. Although survival of the replanted segment was obtained in all patients, 5 cases were subsequently amputated for severe secondary complications. Of the remaining 9 cases, evaluated by means of Chen criteria, 7 had good results (3 Chen I and 4 Chen II), 1 sufficient (Chen III), and 1 poor (Chen IV). The best results were obtained in young patients. Our experience led us to examine the necessity for careful, objective patient selection. We developed a score evaluation system by modifying the international classifying method for severe limb traumas (mangled extremity severity score, or MESS system). This relatively simple system, based on the retrospective study of our cases, considers several parameters (patient's age, general conditions, level and type of lesion, time of injury, and associated lesions), giving each one a score. The total score gives the indication for replantation, predicts the functional outcome, and facilitates decision-making.

Adolescent↗
PubMed1997

Correlating clinical indicators of lower-limb ischaemia with quality of life.

The objectives of the study were to analyse the impact of increasing lower-limb ischaemia upon quality of life and to assess the correlation between clinical indicators of lower-limb ischaemia and such quality. A prospective observational study of a consecutive series of 235 patients (144 men and 91 women; median age 68 (range 41-87) years presenting with varying degrees of lower-limb ischaemia graded according to ISCVS criteria was performed. Data was collected at interview before any intervention. Clinical indicators of lower-limb perfusion included: intermittent claudication and maximum walking distance on standardized treadmill testing; ankle:brachial pressure indices and isotope limb blood flow. Quality of life analysis was performed using the EuroQol (EQ) questionnaire. This is a standardized generic instrument for describing health-related quality of life and consists of a descriptive system of five dimensions, each measured on three levels. Thus, a profile and two single indices of quality of life were derived using different methods. Increasing lower-limb ischaemia results in a statistically significant deterioration in both global quality of life and in all EQ-measured quality of life dimensions (P < 0.01 Kruskal-Wallis, ANOVA). The correlation between clinical indicators and quality of life is statistically significant but not sufficiently close (correlation coefficients < 0.6) to assume that variations in clinical indicators result in reciprocal variations in quality of life. In conclusion, as might be expected, a significant correlation exists between clinical indicators of lower-limb ischaemia and health-related quality of life. However, the low correlation coefficients emphasize how tenuous the association is. Thus, a significant improvement in the clinical indicators of lower-limb ischaemia cannot be assumed to impart a similar benefit on quality of life. The latter concept must therefore be analysed independently.

Activities of Daily Living↗
PubMed2003

Efficacy of pulsed dye laser treatment of port wine stain malformations of the lower limb.

BACKGROUND: There is relatively little information about treatment of port wine stains (PWS) of the lower limb. Few studies have specifically addressed the efficacy of pulsed dye laser (PDL) treatment of a PWS on the lower limb and there is no information on the relative efficacy at different sites on the lower limb. It has been suggested that treatment is not as successful when compared with the face and postinflammatory hyperpigmentation has been reported to be a significant problem. OBJECTIVES: To review retrospectively patients who attended for PDL treatment of PWS affecting the lower limb and assess the efficacy and adverse effects with particular reference to skin site. METHODS: A retrospective review was carried out of patients attending the Leeds Dermatology Laser Centre for treatment of a PWS on the lower limb with a 585-nm PDL. RESULTS: A total of 52 sites in 39 patients were treated: 17 on the thigh, 31 on the lower leg and four on the foot. The mean number of sessions per patient was 14, with an excellent outcome in seven treatment sites (13.5%), good in 13 (25%), moderate in 21 (40.4%) and poor outcome in 11 (21.1%). Patients were generally pleased with their results with a mean improvement of 7 on a scale of 0-10. Perifollicular persistence of the PWS was observed in six sites (11.5%). Adverse effects occurred in 36 patients (92.3%), most commonly hyperpigmentation (87%). Six patients (15.4%) developed atrophic scarring and four (10.3%) hypopigmentation. Atrophie blanche-like changes were seen in four patients on the lower leg. Hypertrophic scarring was not seen. CONCLUSIONS: Although physician-assessed good or excellent responses of 38.5% are lower than frequently reported for other skin sites and adverse effects may be more frequent, patient satisfaction with treatment was generally high. Patients with PWS on the lower limb merit a trial of PDL treatment.

Adolescent↗
PubMed2006

Radionuclide assessment of lower limb perfusion using 99mTc-MIBI in early stages of atherosclerosis.

BACKGROUND: The aim of the work was a scintigraphic evaluation of regional blood supply of thigh and calf muscles using 99mTc-MIBI as a radiopharmaceutical, in early stages of atherosclerosis revealed during ultrasonographic examination of lower limbs, in patients without typical clinical symptoms of chronic ischaemia of lower limbs and with preserved normal Doppler spectrum of blood flow. Moreover, basic relations between early signs of lower limb atherosclerosis and abnormal myocardial perfusion, as well as asymptomatic hypoperfusion of lower limbs, were analysed. MATERIAL AND METHODS: Stress and rest radionuclide study of lower limb muscles and myocardium using 99mTc-MIBI was performed in 47 men, who were divided into two groups based on ultrasonography results. The first group (group I) comprised 22 patients with early atherosclerotic changes in peripheral vessels and the second (group II) comprised 25 people with normal arteries. For the purposes of quantification of study results normal values of regional blood supply and indices of asymmetry at levels of thighs and calves, as proposed by Segall et al., were applied. Myocardial scintigrams were evaluated according to widely accepted rules (visual and semi quantitative--normative analysis). RESULTS: Mean values of stress and rest perfusion indices of thighs as well as calves in gr. I were statistically significantly lower (p < 0.001) than in gr. II. Incidence of asymmetry in the stress perfusion of calves and thighs was statistically significantly higher (p = 0.04) in patients with atherosclerotic changes as compared with the control group. Abnormal myocardial perfusion was found in 77% of patients from group I and in 28% from group II (p = 0.001). Reversible, stress induced ischaemia was found in 59% and 16%, resp. (p = 0.01). CONCLUSIONS: 1. Radionuclide study revealed a reduced stress as well as rest perfusion of lower limb muscles in clinically asymptomatic patients with atherosclerotic changes of lower limb vessels of low degree and a preserved normal Doppler blood flow spectrum. 2. Presence of early atherosclerotic changes in lower limb vessels implies a higher probability of asymptomatic hypoperfusion of lower limbs as well as coronary artery disease.

Atherosclerosis↗
PubMedDate not supplied

The effect of lower limb length on the energetic cost of locomotion: implications for fossil hominins.

The consequences of the relatively short lower limbs characteristic of AL 288-1 have been widely discussed, as have the causes and consequences of the short limbs of Neanderthals. Previous studies of the effect of limb length on the energetic cost of locomotion have reported no relationship; however, limb length could have accounted for as much as 19% of the variation in cost and gone undetected (Steudel and Beattie, 1995; Steudel, 1994, 1996). Kramer (1999) and Kramer and Eck (2000) have recently used a theoretical model to predict the effect of the shorter limbs of early hominids, concluding that the shorter limbs may actually have been energetically advantageous. Here, we took an experimental approach. Twenty-one human subjects, of varying limb lengths, walked on a treadmill at 2.6, 2.8, 3.0 and 3.2m.p.h., while their expired gases were analyzed. The subjects walked for 12 minutes at each speed and their rates of oxygen consumption (VO2) over four minutes were averaged to estimate VO2. We also measured each subject's height, weight and lower limb length. Lean body mass and % fat were determined using dual-energy x-ray absorptiometry. ANCOVA with total VO2 at either speed as the dependent variable and total lean mass, % fat and lower limb length as covariates resulted in all three covariates having a significant positive effect on VO2 at p<0.01. Subjects with relatively longer lower limbs had lower locomotor costs. Thus the short lower limbs characteristic of some hominid taxa would have resulted in more costly locomotion, barring some physiological anomaly. The magnitude of this effect is substantial; Neanderthals are estimated to have had locomotor costs 30% greater than those of contemporary anatomically modern humans. By contrast the increase in lower limb length seen in H. erectus would have mitigated the increase in locomotor costs produced by the increase in body size.

Adolescent↗
PubMed1993

[HTLV-I associated myelopathy presenting with profound atrophy of unilateral lower limb].

A 63-year-old woman had suffered from progressive weakness and wasting of the right lower limb for seven years. In the lower limbs, there were profound muscular atrophy and weakness on the right, and mild weakness with spasticity on the left. Muscle strength of the upper limbs was normal. Sensory examination was normal except for paresthesias below the right knee. Anti-HTLV-I antibody titer was raised both in serum and in the CSF. Motor nerve conduction studies of the lower limbs showed small compound muscle action potentials and somewhat slow conduction velocities, more evident in the right side. F-wave was evoked only in the left tibial nerve and its latency was increased. Sensory nerve conduction studies were normal in the lower limbs. Somatosensory evoked potentials (SEPs) after tibial nerve stimulation at the ankles showed increased interpeak latencies between lumbar N20 and scalp P37. Nerve conduction studies in the upper limb were normal. Single fiber electromyography suggested anterior horn involvement not only in the lumbosacral cord but also in the cervical cord. Weakness and spasticity improved after oral administration of prednisolone. The SEPs findings and a favorable response to prednisolone excluded the possibility of amyotrophic lateral sclerosis. This case is a clinical variant of HTLV-I-associated myelopathy presenting profound atrophy of unilateral lower limb.

Female↗
PubMed1982

New perspectives on nursing lower limb amputees.

New perspectives on nursing lower limb amputees arise from the author's researches into amputee rehabilitation and a summary of other recent research findings. These are dealt with in the context of basic amputee treatment and the nursing process. There is new material on the psychological and neurological sequelae of amputation, the practical problems of loss of a limb and the prosthetic dimension of treatment. The patients' reactions to lower limb amputation were found to vary from intense grief to intense relief, many noting it to be of minor or moderate consequence. The model of sudden and shocking loss is largely incorrect. Attention is drawn to an unrecognized ordinariness which should become part of amputee nursing. Patients have many practical problems. These are social and economic, personal and domestic. The ward environment is unsuited to these needs but, working closely with therapists, nurses can do much to facilitate amputee rehabilitation. The modern purpose of amputation surgery is prosthetic replacement. Nurses should be working with some urgency towards uniting patient and prosthesis. Pain and discomfort are underestimated and research shows them to be a major characteristic of amputation continually and for many years after surgery. A variety of pain syndromes are involved.

Adaptation, Psychological↗
PubMed1983

Isometric muscle force response of the human lower limb.

This paper deals with isometric muscle force response of the human lower limb when the leg is subjected to various external forces applied on the knee and ankle joints. The major components of the research apparatus are a subject restraint system, a force application device which employs three sonic emitters, and an upper leg cuff with four sonic emitters. The sonic emitters are used to determine the direction and the location of the force application on the lower limb and the orientation of the upper leg with respect to the torso. The numerical results are presented from experiments conducted on three male and three female subjects to determine their isometric muscle resistance against external forces trying to dislodge their lower limbs from several initial configurations. Quantitative results on the isometric muscle force capability of the subjects, when their lower limbs are dislodged from the initial stowed position, are also presented. It is concluded that, although there are intra- and inter-subject variations for the maximum values of the resistive muscle forces of the lower limb, there are some trends in the behavior of their magnitudes. Incorporating the results of the present research into multi-segmented models of the human body should improve the long-time response capabilities of these models so that they can simulate more realistically the biodynamic events which take place when the human body is subjected to high magnitudes of external forces lasting more than a fraction of a second.

Adult↗
PubMed2001

Mobility of people with lower limb amputations: scales and questionnaires: a review.

OBJECTIVE AND DESIGN: A systematic literature review to compare mobility scales used for lower limb amputees. A literature search was carried out by computerized search of biomedical literature including Medline and Embase. The studies included were published between 1978 and 1998 and including the following keywords: amputation, artificial limbs, prosthesis, lower limb, activities of daily living, mobility. RESULTS: Thirty-five studies were identified; 19 had a measurement of separate levels of mobility comparable to each other. Sixteen studies used ordinal and ratio scales without separate levels of mobility. The widest range of measurement found was the scale from 'walking with prosthesis without a walking aid' to 'totally confined to bed'. The Stanmore Harold Wood mobility scale was published most frequently. None of the 35 studies presented give a continuous measurement of mobility. CONCLUSION: A multitude of measurement scales and questionnaires are available for differ in methods and measuring range. Measuring mobility by a scale has been shown to have limitations. Several authors did extensive research but they all measure only a number of aspects of mobility. Consensus about the measurement of mobility of lower limb amputees is not available in the recent literature.

Activities of Daily Living↗
PubMed1986

Intravascular shunts in complex lower limb trauma.

Vascular injuries of the lower limb in the presence of extensive soft tissue loss, fractures, or other life-threatening injuries are associated with a high amputation rate. Five patients underwent temporary intravascular shunting during the period of treatment of such injuries. Rapid reperfusion of the limb via such shunts permitted more comprehensive evaluation and management of the lower limb and other associated injuries than would have been possible in the presence of prolonged ischemia.

Adolescent↗
PubMed1975

Thermography in diagnosing deep venous thrombosis of the lower limb.

Phlebography and thermography of the lower limbs were performed on 58 patients suspected on the basis of clinical examination to have deep venous thrombosis of the lower limb. Both thermography and phlebography were consistently positive in 34 and negative in 17 cases. The skin temperature was lowered in four cases evidently because of an arterial spasm caused by deep venous thrombosis. No significant temperature elevation was established in three anamnestically and phlebographically older cases.

Humans↗
PubMed2004

Response preparation and stimulus-response congruence to fractionating reaction time of upper and lower limbs.

We measured the fractionating reaction time for upper and lower limbs of 18 young men, using an electromyogram to clarify the interaction of response preparation and stimulus-response congruence on premotor and motor time. The reaction time was divided into two periods with respect to the onset of the electromyogram, premotor and motor components. Manipulating the probability of the Go versus NoGo signals varied three different amounts of response preparation. Prior to the imperative stimulus, precue information about the position of a stimulus was presented. In the stimulus-response congruent task, subjects were required to release a key on the same side of the body using either an upper or lower limb in response to an imperative Go stimulus. In the stimulus-response incongruent task, subjects were required to act in a reverse manner. Subjects were not supposed to respond to the NoGo stimulus. The premotor time of the upper and lower limb responses was affected by the respective effects of response preparation and stimulus-response congruence. The motor time of the upper and lower limb responses increased as the probability of the Go signal decreased but not in relation to stimulus-response congruence. These results suggest that response preparation affects not only information processing time but also peripheral motor activity due to motor programming, and that the stimulus-response congruence effect on motor time disappears when information about the position of the imperative stimulus is precued.

Adolescent↗
PubMed2006

[Lower-limb amputations and diabetes].

BACKGROUND: A reduced incidence of lower-limb amputations in diabetic patients is a highly prioritised goal. The frequency and prognosis of amputations in our hospital area was recorded in the present study. MATERIAL AND METHODS: All patient records from 1990 to 1999 from the hospitals in Hamar and Elverum, with operation codes for lower-limb amputations, were examined. Known diabetes, smoking status, previous angiography or vascular surgery, and survival until January 31st 2002 were recorded. RESULTS: 412 amputations in 270 patients were recorded. 118 patients (44%) had diabetes, 96% of them had diabetes type 2. Diabetic patients were subject to 51% of the amputations. On average, 0.31% of known diabetic patients in our hospital area had amputations of lower-limb(s) annually during the study period. The mean annual incidence of amputations in diabetic persons was 550 per 100,000 and in non-diabetics 17 per 100,000. The mean age at the first amputation was 77 years. Multiple and distal operations were more frequent in diabetics. Mortality 30 days after the first amputation was 11% in diabetics and 24% in non-diabetics and after one year it was 32% for diabetics and 51% for non-diabetics. INTERPRETATION: The amputation frequency in our hospital area is similar to that in other parts of Norway. About one half of lower-limb amputations are performed in diabetic patients. Most amputees are old and mortality after amputation is high.

Aged↗
PubMedDate not supplied

The experience of lower limb lymphedema for women after treatment for gynecologic cancer.

PURPOSE/OBJECTIVES: To describe women's experiences with lower limb lymphedema to inform both preventive and management clinical practices. DESIGN: A retrospective survey. SETTING: The gynecology/oncology unit of a tertiary referral women's hospital in Australia. SAMPLE: 82 women who developed lower limb lymphedema after surgical and radiation treatment for gynecologic cancers. METHODS: Structured interviews. MAIN RESEARCH VARIABLES: Psychosocial and emotional impact, physical effects, knowledge, support, treatment modalities. FINDINGS: Women identified changes in appearance and sensation in the legs and the triggers that both preceded and exacerbated symptoms. Women described seeking help and receiving inappropriate advice with as many as three assessments prior to referral to lymphedema specialists. Many women implemented self-management strategies. Lower limb lymphedema had an impact on appearance, mobility, finances, and self-image. CONCLUSIONS: Increasing longevity after gynecologic oncology treatment requires all practitioners to be aware of known or potential triggers of lower limb lymphedema and the appropriate referral and management strategies available. Women at risk need to know early signs and symptoms and where to seek early care. IMPLICATIONS FOR NURSING: The role of nursing in acute and community care of women at risk for developing lower limb lymphedema includes (a) engaging women in protecting their legs from infection or trauma pre- and postoperatively, (b) providing nursing care and education during the pre- and postoperative phases, and (c) ensuring that women being discharged are aware of early signs and symptoms of lower limb lymphedema and how to access qualified, specialized therapists so that early and effective management can be initiated.

Adaptation, Psychological↗
PubMed1997

Diagnostic imaging of lower limb deep venous thrombosis.

Lower limb deep venous thrombosis is a common clinical disorder that can lead to fatal pulmonary emboli and postphlebitic syndrome. The clinical evaluation for deep venous thrombosis has been found to be useful in nonhospitalized patients, but a low-cost, easily available technique to confirm the presence of lower limp thrombi is still needed. Doppler ultrasound examination with compression has emerged as the diagnostic imaging study of choice for most patients. Contrast venography, magnetic resonance imaging or radionuclide scintigraphy may be useful in selected patients.

Algorithms↗