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Results for “Lower Extremity”

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PubMed2006

Lower-extremity arterial calcification as a correlate of coronary artery calcification.

Coronary artery calcification (CAC) has been used as a testing modality for coronary atherosclerosis burden. In diabetes, arterial calcification in the tunica media is common and predicts renal and cardiovascular mortality. It is unknown whether the 2 calcification processes are related. We identified risk factors associated with lower-extremity arterial calcification (LEAC) and determined its relationship to the presence of CAC 6 years later and the incidence of complications in type 1 diabetes mellitus. A random sample of 190 participants from the Pittsburgh Epidemiology of Diabetes Complications Study, a prospective cohort of childhood-onset type 1 diabetes mellitus, received radiographs of their ankles and feet at the 4-year follow-up examination (1990-1992) and was followed up for approximately 6 years. At the 10-year examination, 121 of these individuals received an electron beam tomography scan. Male sex (odds ratio [OR] = 12.72, P < .0001), diabetes duration (OR = 4.53, P < .0001), and autonomic neuropathy (AN; OR = 5.92, P = .007) independently increased the odds of LEAC. Controlling for other known risk factors (duration and high-density lipoprotein cholesterol), we found that LEAC correlated with the presence of CAC 6 years later (OR = 1.12, P = .03), although adjusting for neuropathy attenuated this relationship (P = .08). LEAC also independently predicted AN but not the onset of other diabetes complications. Although arterial calcification in the lower extremities and the heart share many of the same risk factors, LEAC is an independent correlate of the later presence of CAC and AN. Thus, factors related to the calcification process in addition to vascular risk factors may play a role in determining the extent of CAC.

Adult↗

PubMed2000

Lower extremity compensations following anterior cruciate ligament reconstruction.

BACKGROUND AND PURPOSES: Several studies have demonstrated that patients with knee injury scored within a normal range during one-legged hop tests, yet showed quadriceps femoris muscle weakness with non-weight-bearing isokinetic testing. This study evaluated lower-extremity kinetics while subjects performed a single-leg vertical jump (VJ) and a lateral step-up (LSU) in an attempt to explain this phenomenon. SUBJECTS AND METHODS: Using a motion analysis and force platform system, hip, knee, and ankle extension moments of 20 subjects with anterior cruciate ligament (ACL) reconstructions and 20 matched subjects were measured while they performed an LSU and a VJ. RESULTS: An analysis of variance revealed that the knee extension moment of the ACL-reconstructed extremity was lower than that of the uninjured and matched extremities during the LSU, VJ take-off, and VJ landing. However, there was no difference in summated extension moment (hip + knee + ankle) among extremities during the LSU and VJ take-off. The summated extension moment of the ACL-reconstructed extremity during VJ landing was less than that of the uninvolved and matched extremities. CONCLUSION AND DISCUSSION: These results suggest that the hip or ankle extensors may compensate for the knee extension moment deficit. The decrease in summated extension moment in the ACL-reconstructed extremity during VJ landing represents inadequate attenuation of landing forces, which may expose the skeleton and joint structures to injury.

Adult↗

PubMed1978

[Pulmonary embolisms as a complication of acute arterial obstruction of the lower extremities].

This is an analysis of 130 cases with embolism of the pulmonary artery with a lethal outcome, which had developed in patients suffering from occlusion of the lower extremities. It is noted that the origin of embolism of the system of the pulmonary artery depends on the severity of ischemia of the tissues of the affected extremity and pointed out that this menacing complication develops both in the stage of ischemia and in the postischemic period. For the prevention of pulmonary embolism in patients with severe ischemia or gangrene of the lower extremities, it is recommended that operative treatment (corrective operations on the arteries or amputation) should be combined with inspection of the major veins.

Acute Disease↗

PubMed2002

Lower extremity compartment syndrome following a laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Bariatric surgery has the potential for serious complications. A case is presented of unilateral lower extremity compartment syndrome after a laparoscopic Roux-en-Y gastric bypass performed in the modified lithotomy position. CASE REPORT: A 38-year-old female (weight 134.5 kg, BMI 49.6) underwent a laparoscopic Roux-en-Y gastric bypass (operating time 375 min). Postoperatively, she complained of bilateral lower extremity pain that gradually subsided over the course of the day. However, on the 1st postoperative day she developed numbness on the dorsum of the foot and compartment syndrome was diagnosed (anterior compartment pressure 71 mmHg). She underwent emergency fasciotomy, which resulted in a reduction of the pain and numbness on the dorsum of the foot. The next day she ambulated without difficulty and was discharged home on the 5th postoperative day. 12 days after her operation, delayed primary closure of the fasciotomy wound was done with the assistance of a novel device (Proxiderm) that applies constant tension to the wound edges. Subsequent recovery was uneventful, and at 4-month follow-up the patient had a weight loss of 28 kg without any right leg motor or sensory deficits. CONCLUSION: Bariatric surgeons should be aware of compartment syndrome as a rare but serious complication. Prevention, early recognition, and prompt fasciotomy are crucial for a favorable outcome.

Adult↗

PubMed2002

Reteplase infusion in the treatment of acute lower extremity occlusions.

PURPOSE: Reteplase, a recombinant tissue plasminogen activator, has been used in the treatment of acute coronary occlusion. Experience is accumulating regarding its use in the treatment of peripheral vascular disease. Increased experience with this thrombolytic agent may show that it can be an appropriate alternative agent to currently employed plasminogen activators. MATERIALS AND METHODS: Over the course of six months, reteplase was used to treat 18 patients with peripheral arterial occlusions, confined to the lower extremities. The agent was infused via "pulse-spray" catheters. Fifteen patients were started on 0.5 U/h. Concurrent heparin therapy was used at 500 U/h in 16 of 18 patients. RESULTS: The average total dose of reteplase infused was 13.3 units. It ranged from 6.2 to 41.5 units. The average duration of infusion was 26.9 hours with a range of 12-44 hours. Clinical success, defined as restoration of sufficient patency to reestablish limb function and resolution of pain in the symptomatic extremity was 89% (16 out of 18). Hemorrhagic complications occurred in five patients and were major in one patient (5%). No patient experienced intracranial hemorrhage. CONCLUSION: Increased experience with the use of reteplase in the treatment of acute lower extremity occlusions is accumulating. The safety and efficacy profile in our group appears satisfactory and compares to other studies. However, definite conclusions must await the results of controlled comparisons of different reteplase infusion regimens and controlled comparison to other thrombolytic agents.

Arterial Occlusive Diseases↗

PubMed1995

Subjective outcome following surgical management of lower-extremity neuromas.

This study evaluated the long-term subjective outcomes of 19 patients (13 females, six males), following surgical resection and proximal transposition of lower-extremity neuromas. The patient mean age was 49 years (S.D.: 18), with a mean post-injury time of 8 years and post-surgery follow-up of 4 years. Thirteen patients reported symptomatic improvement in pain, and six reported no improvement. Of ten subjects who were unemployed prior to surgery, two returned to work and four retired postoperatively. Preoperatively, 13 patients used analgesic medication and postoperatively, eight reported taking less medication; four had completely stopped taking pain medication. Symptomatic pain relief apparently can be achieved with surgical management of lower-extremity neuromas.

Adult↗

PubMedDate not supplied

Lower extremity manifestations of Vibrio vulnificus infection.

Vibrio vulnificus is a potentially lethal marine bacterium that has not been previously described in podiatric literature. A review of the microorganism's characteristics, susceptible patient population, and lower extremity manifestations of infection is presented. V. vulnificus is found as part of the normal flora of the Gulf of Mexico, Atlantic, and Pacific coastal waters and is often isolated from the filter feeding shellfish of these regions. Its pathogenicity is generally reserved for the immunocompromised host, and is specifically related to disease states which exhibit high serum iron levels. V. vulnificus infections present in two distinct clinical syndromes: primary sepsis secondary to raw oyster ingestion, or localized infection from wound exposure to V. vulnificus-inhabited salt water. Both syndromes demonstrate characteristic skin lesions of the trunk and extremities that present as hemorrhagic bullae and progress to necrotic ulcerations. Although V. vulnificus infection is rare, its extreme virulence in patients suffering from a chronic disease process and its manifestation of characteristic lower-extremity lesions require the podiatric physician to be able to recognize and treat such a condition.

Combined Modality Therapy↗

PubMed1978

Lower extremity forces and torques during systematic variation of non-weight bearing motion.

Component and resultant external forces and torques at ankle, knee, and hip joints of unrestrained lower extremity motion were computed as resultant limb velocities were systematically changed. Cinematographic and modeling techniques were used to analyze 45 trials of five skilled soccer players who performed slow, medium and fast velocity kicks. A model of the lower extremity was incorporated, with kinematic data and segment mass estimates, into computer programs to quantify the mechanical variables. Monotonic increases in magnitudes of all kinetic elements occurred as the velocity of kicking was increased. Significant differences were also observed in the maximum values of the net parallel and perpendicular external force actions, and resultant torques at the joints with changes in limb velocity.

Ankle↗

PubMed2004

Gemcitabine-associated scleroderma-like changes of the lower extremities.

Gemcitabine is a nucleosid analog approved for use in the treatment of metastatic urothelial carcinoma of the bladder. We describe an unusual case of scleroderma-like changes of the lower extremities after treatment by gemcitabine for metastatic carcinoma of the bladder. The patient developed initial inflammatory edema (3 kg) restricted to the lower extremities and subsequent scleroderma-like changes after 2 cycles of gemcitabine. Cutaneous biopsy specimen revealed diffuse sclerosis without involvment of the fascia or muscle. Discontinuation of gemcitabine resulted in dramatic removal of the edema, softening of the skin, and partial reversibility of the fibrotic process. This is the first case report of a scleroderma-like reaction associated with gemcitabine. This antineoplastic agent must be added to the very limited number of cytostatic agents capable of giving rise to scleroderma-like features.

Acetaminophen↗

PubMed2000

A comparative study of alternative conduits for lower extremity revascularization: all-autogenous conduit versus prosthetic grafts.

PURPOSE: In the absence of an adequate ipsilateral greater saphenous vein, various alternative conduits have been used for the performance of lower extremity revascularization. In this study we compared the effectiveness of all-autogenous arm vein bypass grafts with that of prosthetic grafts. METHODS: Seven hundred forty lower extremity revascularization procedures (506 arm vein, 234 prosthetic) performed between 1990 and 1999 were followed prospectively by means of a computerized vascular registry. RESULTS: Bypass graft configurations were femoro-above-knee-popliteal (26 arm vein, 100 prosthetic); femoro-below-knee-popliteal (38 arm vein, 29 prosthetic); femorotibial (174 arm vein, 55 prosthetic); femoropedal (23 arm vein, 2 prosthetic); popliteotibial/pedal (101 arm vein, 1 prosthetic); and extension "jump" grafts (144 arm vein, 47 prosthetic). The indications for surgery were limb salvage (98.0% arm vein, 89.7% prosthetic) and disabling claudication (2.0% arm vein, 10.3% prosthetic). The mean follow-up was 23.4 months (range, 1 month-7.4 years). Overall patient survival at 4 years was 54% (arm vein) and 69% (prosthetic). Cumulative patency varied with graft configuration. The 1-year primary patency rates for femorotibial grafts were 81.6% +/- 3.6% (arm vein) and 58.0% +/- 8.4% (prosthetic); the 3-year rates were 68.3% +/- 6.1% (arm vein) and 41.1% +/- 9.8% (prosthetic) (P<.01). The 1-year limb salvage rates for femorotibial grafts were 91.1% +/- 2.8% (arm vein) and 69.1% +/- 8. 8% (prosthetic); the 3-year rates were 81.4% +/- 5.6% (arm vein) and 63.2% +/- 10.3% (prosthetic) (P =.02). The 1-year primary patency rates for femoro-below-knee-popliteal grafts were 92.9% +/- 5.1% (arm vein) and 83.4% +/- 8.0% (prosthetic); the 3-year rates were 72.8% +/- 10.1% (arm vein) and 55.5% +/- 12.1% (prosthetic) (P=.05). The 1-year limb salvage rates for femoro-below-knee-popliteal grafts were 100% (arm vein) and 91.3% +/- 7.0% (prosthetic); the 3-year rates were 94.7% +/- 7.3% (arm vein) and 75.3% +/- 14.6% (prosthetic) (P = NS). CONCLUSION: In this study autogenous arm vein grafts demonstrated increased patency and limb salvage, compared with prosthetic grafts. These increases achieved statistical significance in the femoro-below-knee-popliteal and femorotibial configurations. An effort to use an all-autogenous vein conduit is justified on the basis of these results; however, if no autogenous vein is available, prosthetic grafts provide a reasonable alternative to primary amputation.

Aged↗

PubMed1991

[Diagnosis of concomitant ischemic heart disease and selection of surgical tactics in arteriosclerosis of major arteries of the lower extremities in relation to heart function in patients with extensive arteriosclerosis].

The results of examination of 74 patients treated in the clinic for ischemia of the lower extremities with concomitant ischemic heart disease (IHD) diagnosed by the data of clinico-instrumental investigations are presented. In 10.8% of the patients, IHD was diagnosed in clinical examination, in 89.2%--in performing the loading test. The authors consider that the volume of intervention on the aorto-iliac segment should correspond to a functional state of the myocardium, on the femoro-popliteal segment--to severity of a lesion at this region and is not restricted by functional state of the myocardium. To the patients with a functional reserve corresponding to a functional class IV, the performance of coronarography for definition of the expediency to perform one-stage intervention on the coronary bed and major arteries of the lower extremities is indicated.

Adult↗

PubMed2004

Skin diseases of the lower extremities in the elderly.

Routine care of the legs and feet in the elderly is important in helping to prevent infections, malignancies, and further deterioration. The lower extremities are of particular interest because of the increasing amount of diseases and disorders involving the legs and feet. Foot disorders in the elderly are associated with poor choices in footwear, structural changes, brought on by aging, and inadequate knowledge about prevention and treatment. Conservative treatments along with gait modification provide positive long-term results, although sometimes surgery is necessary for severe foot disorders. Onychomycosis and other nail disorders commonly infect the elderly despite the wide variety of treatment options. The increase in malignancy formation in the elderly is caused by the increase in the elderly population and inadequate treatment of leg ulcers and other chronic lesions. Aging is associated with many dermatologic changes; many of the disorders and diseases of the lower extremities can be managed if detected and treated early. Proper awareness of the signs, symptoms, and care is important.

Aged↗

PubMed2004

Deforming lipoblastomatosis of the lower extremity.

OBJECTIVE: Lipoblastomatosis is a rare disorder in infants and children and nonexistent in adults. We discuss a case of a newborn child with lipoblastomatosis extensively involving the pelvis and lower extremities. The clinical and radiological characteristics of the disorder are discussed. CLINICAL FEATURES: A 2-month-old male had an enlarging deformity of the pelvis and lower extremities with progression of the condition from birth. There was no family history related to the disease. No other clinical abnormalities were present. INTERVENTION AND OUTCOME: Lipoblastomatosis is initially treated with surgical excision of the lipomatous neoplastic tissue. The postsurgical outcome is satisfactory; however, the likelihood of recurrence has been reported. CONCLUSION: We present the features of lipoblastomatosis, an uncommon disorder affecting infants and children. The clinical and radiologic manifestations of the disease are assessed with emphasis on magnetic resonance imaging.

Humans↗

PubMed1989

Combined non-invasive diagnostics of deep vein thrombosis of the lower extremities.

Application of a combined non-invasive diagnostic approach to screening examination of a high-risk group of patients made it possible to detect phlebothrombosis on 34 lower extremities in 31 patients with absent clinical manifestations of the disease. Combined use of Doppler ultrasound flowmetry and occlusive venous plethysmography increases the accuracy of the diagnosis of deep vein thrombosis of the lower extremities up to 96%.

Adult↗

PubMed1987

Imipenem/cilastatin treatment of lower extremity skin and soft tissue infections in diabetics.

The efficacy and safety profile of imipenem/cilastatin was investigated in 94 patients with diabetes mellitus with infections of the lower extremity. Ninety-eight percent of the pathogens were susceptible to imipenem; this was higher than to other antibiotics tested. Ninety-two percent of the patients were cured (47%) or improved (45%). Bacterial eradication was achieved for 79% of the pathogens. Adverse experiences were similar to those reported previously. Imipenem-cilastatin proved to be a very effective antibiotic with a good safety profile for use in diabetic patients with lower extremity infections.

Anti-Bacterial Agents↗

PubMed1993

[Arterial "crossover" reconstruction in ischemic disease of the lower extremities].

The authors present a group of 20 patients where in the course of a 15-year period (1978-1992) a crossover bypass was made to save a lower extremity with advanced ischaemia. Based on their own experience which they compare with results of physicians abroad they submit an analysis of indications for this type of extra-anatomical reconstruction. In the authors' opinion crossover bypasses have their place in reconstruction surgery of the arteries of the lower extremities if they are perceived as extra-anatomical reconstructions and thus are subjects to strict criteria for indication.

Aged↗

PubMed2004

Comparison of continuous epidural and intravenous analgesia for postoperative pain control in pediatric lower extremity surgery.

In recent years epidural anesthesia and analgesia techniques were used in pediatric surgery owing to the development of pediatric epidural catheter needles. And the need of postoperative pain control in pediatric patients is also increasing. We compared combined general-epidural anesthesia and analgesia technique with intravenous fentanyl analgesia after general anesthesia for postoperative analgesic effect and complications in these pediatric patients. We randomly allocated 91 pediatric patients undergoing lower extremities surgery into epidural lidocaine group (n=61) and IV fentanyl group (n=30). During the operation, end-tidal sevoflurane concentration (ET(sev)) was controlled to maintain the blood pressure and heart rate within 10% of preoperative value. At the postoperative period, Parent Visual Analog Scale (PVAS), Objective Pain Score (OPS) and the incidence of nausea/ vomiting were checked immediately, 6 hours and 24 hours after the patient's arrival at general ward. ET(sev) was significantly low in epidural lidocaine group (p < 0.05). Compare to IV fentanyl group, epidural lidocaine group had significantly lower OPSs at 6 hours after arrival. Epidural lidocaine group had significantly lower PVASs immediately, 6 hrs and 24 hours after arrival. There was no significant difference in the incidence of postoperative nausea and vomiting. A combined general-epidural anesthesia technique significantly reduces intraoperative end-tidal sevoflurane concentration compared to general anesthesia alone. And continuous patient-controlled epidural analgesia reduces postoperative pain scores significantly more than continuous patient-controlled IV fentanyl analgesia without any serious complications in pediatric lower extremity surgery.

Analgesia, Epidural↗

PubMed1993

The role of limb torque, muscle action and proprioception during closed kinetic chain rehabilitation of the lower extremity.

This paper defines the differences between open and closed kinetic chain exercise and explains the role of limb torque, muscle action, and proprioception during rehabilitation of the lower extremity. Closed kinetic chain rehabilitation is shown to decrease shear forces, increase proprioception, and increase muscle group coordination through examples of progressive exercises. The authors conclude that closed kinetic chain rehabilitation is an economical, efficient, and effective means of rehabilitation, with the ultimate goal of enhancing proprioception, thus gaining lower extremity joint stability.

Journal Article↗