Evaluation of the long-pulse dye laser for the treatment of leg telangiectasias

BACKGROUND: Leg telangiectasias are common visible ecstatic dermal capillaries, arterioles, or veins. Multiple methods of treatment have been reported for this entity. A long-pulse (1500 microsecond) dye laser has been developed to treat leg veins ranging in size from 0.1 to 1.0 mm in diameter. OBJECTIVE: To determine the effectiveness of this novel device on treating leg veins with varying wavelengths and fluences. METHODS: Eight patients with more than 250 sites of leg telangiectasis were treated with the long-pulse dye laser. RESULTS: Clearance of 100% was achieved after one or two treatments by vessels with diameters up to 0.5 mm. Vessels with diameters between 0.5 and 1.0 mm faded in about 80% of treatments. Transient adverse affects were observed in a low incidence. CONCLUSIONS: The long-pulse dye laser is a safe and effective tool in the treatment of leg telangiectasias.     

Determinants of isogravimetric capillary pressure in the isolated dog hindlimb

The hindlimb of the dog was rapidly isolated and carefully perfused in an attempt to prevent transcapillary fluid shifts into the interstitium which may occur during normal surgical isolation and perfusion. In the control preparation before weight was allowed to increase, isogravimetric capillary pressure (Pci) averaged 8 mmHg lower than colloid osmotic pressure of the plasma (IIp). As the weight of the leg was increased, Pci increased and IIp - Pci decreased. When weight was increased by 5.8%, IIp - Pci averaged 3 mmHg; with a 9.8% increase in weight, IIp - Pci averaged 1.3 mmHg. The calculated value of compliance of the interstitial space averaged 0.50 ml/mmHg per 100 g of tissue and increased approximately 10-fold as the weight of the leg was increased. Since IIp - Pci has always been reported to be approximately 2 mmHg when the hindleg was isolated with standard surgical techniques, these data suggest that the procedures normally used to isolate and perfuse the hindlimb caused the weight of the limb to increase by 6% or more before Pci was determined. Furthermore, it appears that most of the variation in the reported value of Pci is due to variation in the value of IIp since IIp - Pci has always been reported to be very close to 2 mmHg in the isolated hindlimb.     

Nutrition, tissue oxygenation, and healing of venous leg ulcers

Little research has examined the healing and pain associated with saphenous vein (SV) harvest incisions, and no literature has addressed the associated distress and cosmetic result. The purpose of this study was to determine whether dry sterile gauze dressings, transparent film dressings or no dressings were more effective in hospitalized patients undergoing coronary artery bypass graft (CABG), in terms of minimizing leg incisional pain, minimizing the distress of a leg scar and improving the cosmetic appearance of the leg incision scar. Patients were randomized to dressing type on postoperative day (POD) 1, completed a pain and distress visual analogue scale (VAS) on PODs 1, 3 and 5, and a cosmetic result VAS upon discharge. Overall, leg incisional pain decreased over time (p < 0.05). Females reported decreasing pain between PODs 1 and 3, while males reported increasing pain between PODs 1 and 3 (p < 0.05). The film-dressing group reported decreasing pain from PODs 1 to 3, while the no-dressing and gauze-dressing groups reported increasing pain from PODs 1 to 3 (p < 0.05). Pain on POD 5 was positively correlated with an unfavorable cosmetic result (r = 0.42, p < 0.05), and distress on POD 5 was positively correlated with an unfavorable cosmetic result (r = 0.44, p < 0.05). The results of this study are encouraging and support the continued testing of dressings to minimize pain and distress, as well as enhancing cosmetic result.     

Compatibility of Stainless Steel 316L with Lead-17?at.% Lithium with Reference to Indian-TBM

Corrosion of SS316L steel in flowing lead?Clithium eutectic alloy melt has been investigated with respect to eutectic melt velocity and temperature gradient in a thermal buoyancy loop. Preferential dissolution of major constituent elements namely, Fe, Ni, Cr from the tube walls with the formation of a porous corroded layer has been observed in the hot leg maintained at 773?K. Nickel and chromium rich deposits were found on the cold leg surface which was at 673?K. However, no porous corroded layer has been observed in the cold leg. Chemical analysis of the eutectic showed a substantially high concentration of Ni.     

Thoracic arachnoid cyst presenting incomplete features of Brown-Séquard syndrome: a case report

Spinal intradural arachnoid cyst presenting incomplete features of Brown-Séquard syndrome is very rare. Only 6 cases have been reported. We report one in a thoracic lesion. A 42-year-old man noticed thermohypesthesia in his right leg, and monoparesis in his left leg. On admission, he presented incomplete features of Brown-Séquard syndrome below the Th7 level. MRI showed the spinal cord to be displaced antero-laterally to the right at Th6-7 level. Myelography and CT myelography failed to show the cyst wall, but an arachnoid cyst was totally removed with T5-8 osteoplastic laminotomy. Sensory disturbance has not changed postoperatively, but motor weakness in his left leg recovered within one month after the operation. No cystic lesion has been detected by MRI during the ten months since the operation. We investigated all seven cases in the literature including our case which showed incomplete features of Brown-Séquard syndrome. As regards to the location of the cyst, all cases were at the mid-thoracic level. And four cases were at the midline. These results suggest that the mechanism of Brown-Séquard syndrome associated with spinal arachnoid cyst may be related not only to the laterality of the lesion but also to the asymmetrical circulation in the watershed area.     

Control of industrial noise and hearing loss at work--are we making progress?

STUDY DESIGN: A case report. OBJECTIVE: To document the occurrence of hematocolpos causing sciatica and leg weakness in an adolescent girl. SUMMARY OF BACKGROUND DATA: Low back pain resulting from hematocolpos has been reported previously but not associated with symptoms of sciatica or neurologic weakness. METHODS: The authors were involved in the care of this patient, and all medical records, radiologic investigations, and related literature were reviewed. RESULTS: After being checked for longstanding symptoms of sciatica and leg weakness, the patient underwent a computed tomographic examination of lumbar spine, which showed a large collection in the pelvis consistent with hematocolpos. Surgical drainage of the collection was associated with complete resolution of her symptoms. CONCLUSIONS: Awareness of hematocolpos as a possible cause for sciatica and neurologic symptoms in the lower limbs may lead to earlier diagnosis and, therefore, reduced morbidity in the investigation of the adolescent girl.     

Current management of acute leg ischaemia: results of an audit by the Vascular Surgical Society of Great Britain and Ireland

BACKGROUND: Management of acute leg ischaemia has changed in recent years. This study aimed to elucidate current practice throughout the UK and Ireland. METHODS: Surgeons and audit departments were asked to return a questionnaire about every episode of acute leg ischaemia seen in the hospital between 1 January and 31 March 1996. RESULTS: A total of 539 episodes were reported in 474 patients (248 men) aged 19-96 (median 73) years. Common causes were thrombosis in situ (41 per cent), embolism (38 per cent) and graft or angioplasty occlusion (15 per cent). Vascular surgical advice was requested in 95 per cent of cases. Initial management was: immediate embolectomy in 21 per cent, anticoagulants in 13 per cent and no vascular intervention in 10 per cent. Arteriography was done in 56 per cent, followed by 186 endovascular and 165 surgical interventions. At 30 days, 70 per cent of limbs were definitely viable and 16 per cent had been amputated. The mortality rate was 22 per cent. Cases were reported by 86 of 182 hospitals contacted, but some referred no patients, and a supplementary audit of 54 cases (10 per cent size of the original sample) from non-contributing hospitals showed no important differences. CONCLUSION: Patients with acute leg ischaemia are generally treated by vascular specialists, with modern methods and acceptable results. This is being achieved despite insufficient vascular surgeons and radiologists for formal emergency rotas in most hospitals.     

Effect of low-power He-Ne laser on fracture healing in rats

BACKGROUND AND OBJECTIVE: Helium-Neon (He-Ne) laser radiation has been found to accelerate fracture healing in laboratory animal models as well as in cultures of cells involved in this process. We investigated the radiological, biomechanical, and histological effects of He-Ne radiation on fracture healing in a rat model. STUDY DESIGN/MATERIALS AND METHODS: Sixty-two rats underwent bilateral open osteotomies of the tibiae followed by internal fixation with intramedullary wires. The right leg received He-Ne laser radiation of 0, 2, or 4 Joules every other day for 2 to 6 weeks while the left leg served as a control. RESULTS: Radiological and histological examinations of the osteotomy sites failed to show any enhancing effect of He-Ne laser radiation on the bone healing process. Biomechanically, the irradiated bones of two of the six test groups were significantly weaker than the controls. CONCLUSION: These results fail to support the previously reported enhancing effect of He-Ne laser radiation on fracture healing.     

Pain in venous leg ulcers

A prospective study was conducted to assess the prevalence, severity and diagnostic utility of pain in patients with venous leg ulcers. A semi-structured questionnaire was completed by 140 consecutive patients in two specialist centres caring for patients with leg ulcers. A high proportion (64%) of the 94 patients with ulcers of purely venous aetiology reported severe pain; 50% of these patients were taking either mild analgesia or none at all. In 10 of 72 cases, leg elevation made the pain worse. Venous ulcers are painful. Pain in three distinct locations was reported by patients-within ulcers, around ulcers and elsewhere in the leg. The presence of severe pain does not necessarily indicate arterial disease or infection. Pain is, in general, inadequately controlled in these patients.     

A case of lumbosacral lipoma-associated adult onset tethered cord syndrome with initial symptoms of sensory disturbance and intractable foot ulcers]

A 63-year-woman who complained of sensorimotor disturbance of the lower extremities and urinary disturbance was presented. She noted loss of superficial sensation in both feet and foot ulcers at the age of 20 years. Her illness was initially diagnosed as hereditary sensory neuropathy type 1 (HSN1). The foot ulcers were so intractable that she had to have her right leg amputated at the age of 48 years. She had a severely impaired superficial sensation in the lower extremities and buttock, distal weakness of the left leg, and dysuria at the age of 60 years. The neurological examination revealed that she had segmental sensorimotor disturbance below the levels of the 5th lumbar segment. MRI demonstrated tethered cord with a lumbosacral lipoma. Adult onset tethered cord syndrome (TCS) that presents with HSN 1-like symptoms as initial clinical features has not yet been reported. Foot ulcers are often seen in child onset TCS in which the degree of tethered cord is severer than adult onset cases. It is reported that release of the tethered cord promotes healing of the foot ulcers. We recommend MRI for the study of the lumbosacral cord of patients with HSN 1-like symptoms, because there is a possibility that such patients may have TCS and early surgical treatment is effective for TCS.     

The roles of the homeobox genes aristaless and Distal-less in patterning the legs and wings of Drosophila

In the leg and wing imaginal discs of Drosophila, the expression domains of the homeobox genes aristaless (al) and Distal-less (Dll) are defined by the secreted signaling molecules Wingless (Wg) and Decapentaplegic (Dpp). Here, the roles played by al and Dll in patterning the legs and wings have been investigated through loss of function studies. In the developing leg, al is expressed at the presumptive tip and a molecularly defined null allele of al reveals that its only function in patterning the leg appears to be to direct the growth and differentiation of the structures at the tip. In contrast, Dll has previously been shown to be required for the development of all of the leg more distal than the coxa. Dll protein can be detected in a central domain in leg discs throughout most of larval development, and in mature discs this domain corresponds to the distal-most region of the leg, the tarsus and the distal tibia. Clonal analysis reveals that late in development these are the only regions in which Dll function is required. However, earlier in development Dll is required in more proximal regions of the leg suggesting it is expressed at high levels in these cells early in development but not later. This reveals a correlation between a temporal requirement for Dll and position along the proximodistal axis; how this may relate to the generation of the P/D axis is discussed. Dll is required in the distal regions of the leg for the expression of tarsal-specific genes including al and bric-a-brac. Dll mutant cells in the leg sort out from wild-type cells suggesting one function of Dll here is to control adhesive properties of cells. Dll is also required for the normal development of the wing, primarily for the differentiation of the wing margin.     

Gait analysis of adult patients with complete congenital dislocation of the hip

Comprehensive gait analysis is valuable in understanding the performance of patients with lower limb disorders. The gait pattern of adult patients with untreated congenital dislocation of the hip (CDH) has not yet been reported. We studied the gait pattern in nine women (mean age 31.4 years) with Crows group IV CDH. Six had unilateral and three had bilateral involvement. They were not treated during childhood and had no pain at the time of study. A control group comprised 15 normal female subjects of the same age group. Gait was studied using a motion-analysis system, force plateforms, and computer calculation during level walking. Common abnormal gait patterns seen in patients with both unilateral and bilateral CDH were slower walking velocity, which was due to a shorter stride length, less forward tilting of the pelvis, insufficient flexion, and excessive internal rotation of the hips. The patients with unilateral CDH had a shorter step length, lower pelvis, a lateral shift of the ground reaction force, decreased maximum adduction moments of the hip and knee on the diseased side, and increased maximum adduction moments of the hip and knee on the unaffected side. This asymmetry may have been due to leg length inequality. Thus, correlation of the leg length discrepancy may be important for unilateral CDH patients in improving their gait.     

Immunohistochemical study of epithelioid hemangioendothelioma in the leg: a case report

Epithelioid hemangioendothelioma is a relatively rare lesion. Although its histogenesis has been well described, its immunohistochemical characteristics remain controversial. A case of epithelioid hemangioendothelioma of the soft tissue of the right leg in a 67-year-old Chinese woman is reported. Histologic findings of intracytoplasmic lumina in the tumor cells and positive immunostaining for vimentin, factor VIII-related antigen. CD34 and Ulex europaeus agglutinin 1 (UEA-1) were obtained, demonstrating differentiation of the tumor cells to endothelial cells, although staining for antibodies to cytokeratins AE1/AE3 and CAM5.2 was weak. CD34 as well as Factor VIII-related antigen is a useful marker of endothelial differentiation in this tumor. A review of the literature is also presented.     

Leg temperature and heat content in humans during immersion hypothermia and rewarming

Core temperature afterdrop following cold water immersion has previously been shown to be greater during treadmill exercise than shivering (J. Appl. Physiol. 1987; 63:2375-9). To test the hypothesis that this results from increased transfer of heat from the core to exercising muscles, we quantified the changes in leg temperature and heat content during cooling and exercise/shivering protocols. Upper and lower leg muscle temperatures were measured at multiple depths in five thin healthy male subjects immersed in 8 degrees C water until core temperatures reached 32.8-34.9 degrees C. In these thin subjects there was a significant but small difference between exercise and shivering afterdrop (approximately 0.2 degrees C), and total leg heat content was unchanged during this period with both protocols. Subsequent heat gain was similar in both treatments but, in the lower leg, was greater during exercise than shivering, suggesting that shivering is less effective than exercise in increasing lower leg heat content.     

Clinical review 43: Treatment of hypertension: focus on prevention of coronary heart disease

A case of immediate stump reconstruction following proximal leg amputation below the knee is reported. Additional length and sensation are conferred to the stump by free autotransplantation of a composite flap taken from the unsalvageable amputated leg. This flap provided 13 cm of vascularized tibia invested in the skin of the foot. This operative procedure facilitated the fitting of a prosthesis and preserved knee function despite an initial very proximal amputation.     

Spontaneous epidural hematoma as a cause of sciatic pain in a schoolboy

A previously healthy 13-year-old boy began to manifest radiating pain in his left leg after heavy physical exertion during judo training. He also had a sensation of numbness in his left buttock and leg. Initially, the patient was treated conservatively with a clinical diagnosis of disc herniation. However, following 3 months of conservative treatment, there was no relief of pain. Magnetic resonance imaging of the lumbar spine demonstrated an epidural mass causing compression of the dural sac at the L4-L5 disc level. During surgery, the L5 nerve root was found to be severely compressed in the spinal canal because of a chronic epidural hematoma. Following microsurgical removal of this hematoid mass, the patient had a good recovery. Spontaneous epidural hematomas in the lumbar region are rare, and only a few cases presenting with features simulating those caused by a disc herniation have been reported. Our patient represents the first such case described in a child.     

Actinomyces meyeri cutaneous actinomycosis with pulmonary localization

Infections due to Actinomycosis species are located in the cervico-facial region in 50 to 65 percent of the cases. Extra-cervical cutaneous lesions are exceptional. The most frequently encountered germ is Actinomyces israeli, observed in 85 percent of the cases. We report the case of an Actinomyces meyeri infection which presented as a leg abscess and a pulmonary lesion. There was no cervico-facial localization. There was however a chronic parodontitis. A second germ, Capnocytophaga sp. was isolated from the abscess. This case is of particular interest because of the extracervical localization and the rare species isolated (17 other cases of Actinomyces meyeri infection have been reported). The mechanism of the infection can be better understood in light of pulmonary lesions in the lower right lobe due to inhalation and the coexistence of a buccodental germ in the culture of the leg abscess: buccodental origin of the germ, pulmonary lesion secondary to inhalation, septicaemic dissemination with cutaneous metastases.     

Treatment of restless leg syndrome with pergolide--an open clinical trial

Dopaminergic treatment with levodopa (L-dopa) has been proven as the treatment of first choice in patients with restless leg syndrome (RLS). Augmentation of symptoms and end-of-dose rebound phenomena under L-dopa/decarboxylase inhibitor treatment present major problems in some patients. To evaluate the efficacy of pergolide in RLS, we treated 15 patients suffering from severe RLS, who had previously experienced an augmentation of symptoms under long-term treatment with L-dopa, in an open clinical trial with pergolide. All patients reported an improvement of their RLS symptoms. Our study shows that pergolide, if administered at a mean dose of 0.4 mg in combination with domperidone, is a very effective drug in the treatment of sleep disturbances and daytime symptoms associated with RLS, and does not cause any serious side effects during the observation period of 6 months.     

Leg injuries and shin guards

Soccer players have a high risk of soft-tissue injuries to their legs. Fractures of the tibia and fibula represent a serious potential injury; despite this, the incidence of these fractures in soccer players is unknown. Shin guards have become the only protective devices that are required by international and collegiate soccer associations. Nonetheless, the protective ability of shin guards has only been studied to a limited extent. Shin guards are assumed to be most effective at reducing leg abrasions and contusions. The role of shin guards in protecting against fractures has yet to be determined. Further analysis of the clinical effectiveness and biomechanical properties of shin guards is necessary to reduce the rate of leg fractures.     

An unusual cause of sciatica. A case report

STUDY DESIGN: This case report illustrates the need to be aware of extraspinal causes of sciatica. A patient with a strangulated sciatic hernia showed the clinical features of sciatic leg pain, intestinal obstruction, and a left gluteal abscess. OBJECTIVE: To highlight the need to examine the course of the sciatic nerve for local pathology when the cause of sciatica is not obvious. SUMMARY OF BACKGROUND DATA: Sciatic herniae are rare. The coexistence of sciatica and a gluteal abscess, caused by a strangulated sciatic hernia, does not appear to have been reported previously. METHODS: A 66-year-old woman with preexisting low back pain and left leg pain was admitted to the hospital with intestinal obstruction and a left gluteal mass. Results of needle aspiration suggested the diagnosis, which was confirmed by laparotomy. The sciatic hernia was repaired via a transabdominal approach. RESULTS: The symptoms of sciatic nerve compression and intestinal obstruction resolved fully after surgery. CONCLUSION: The possibility of local pathology causing sciatic nerve compression should be considered when a patient reports sciatic leg pain, particularly if the presentation is atypical. Intestinal obstruction or the presence of a gluteal mass should suggest the possibility of a sciatic hernia.