scholarly journals La valutazione delle ulcere vascolari degli arti inferiori attraverso la Wound Trend Scale: l’esperienza dell’Azienda USL di Piacenza/Assessment of vascular ulcers of the lower limbs through the Wound Trend Scale: the experience of the LHA of Piacenza

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Fabio Mozzarelli ◽  
Sara Gaetti
Keyword(s):  
Vascular Surgery ◽  
Health Authority ◽  
Lower Limb ◽  
Predictive Ability ◽  
Lower Limbs ◽  
Convenience Sample ◽  
Venous Ulcers ◽  
Appropriate Care ◽  
Depth Analysis ◽  
Type Of Injury

Le ulcere cutanee vascolari degli arti inferiori, siano esse di origine venosa, arteriosa o mista, rappresentano una patologia diffusa che colpisce dallo 0,3 al 5% della popolazione, consumando fra l'1 ed il 3% del fondo sanitario Nazionale. La cura delle persone con questo tipo di lesioni deve avvalersi di strumenti idonei alla valutazione delle caratteristiche delle ulcere in modo che possa innescare il trattamento clinico/assistenziale più adeguato. Il presente studio intende verificare l'appropriatezza nella descrizione delle lesioni e la capacità predittiva sull’evoluzione delle stesse della Wound Trend Scale (WTS). La ricerca è stata condotta presso l’unità operativa di chirurgia vascolare e nell’ambulatorio di vulnologia dell’Azienda USL di Piacenza; ha coinvolto 11 pazienti con 12 lesioni vascolari degli arti inferiori. Il campione di convenienza utilizzato era composto per la maggior parte da pazienti di sesso femminile (73%) con un’età media di 79,2 anni (DS±0,7). È emersa una maggiore frequenza di ulcere venose (58%) prevalentemente localizzate in sede perimalleolare (50%). La WTS composta da 14 items, oltre ad informare rispetto alle caratteristiche delle lesioni, permette di indicare l’evoluzione delle stesse attraverso tre misurazioni seriate con intervalli stabiliti in base alla gravità della ferita. Dallo studio è emerso che l’83% delle ulcere ha mostrato un’evoluzione verso la guarigione, mentre il restante 17% è stato connotato da un peggioramento della lesione. La WTS si pone come un valido strumento per la descrizione delle ulcere con caratteristiche di predittività rispetto all’evoluzione delle stesse ma necessita di maggiori approfondimenti per testarne l’appropriatezza. Vascular ulcers of the lower limbs, be they venous, arterial or mixed, represent a widespread pathology affecting from 0,3 to 5% of the population, consuming between 1 and 3% of the National health fund. The care of people with this type of injury must use tools that are suitable for assessing the characteristics of ulcers so that it can trigger the most appropriate care treatment. The present study intends to verify the appropriateness in the description of the lesions and the predictive ability on the evolution of the same ones of the Wound Trend Scale (WTS). The research was conducted at the vascular surgery ward and in the volnology service of the Health Authority of Piacenza; involved 11 patients with 12 lower limb vascular ulcers. The convenience sample used was mostly composed of female patients (73%) with a mean age of 79,2 years (DS±0.7). A greater frequency of venous ulcers (58%) has emerged, mainly located in the perimalleolar site (50%). The WTS consists of 14 items, in addition to informing the characteristics of the lesions, premise to indicate the evolution of the same through three measurements with intervals established based on the severity of the wound. The study found that 83% of ulcers showed an evolution towards healing, while the remaining 17% was characterized by a worsening of the lesion. The WTS stands as a valid tool for the description of ulcers with predictive characteristics with respect to their evolution but needs more in-depth analysis to test their appropriateness.

Changes in Skin Microcirculation at Periulcerous Sites in Patients with Chronic Venous Ulcers during Leg Elevation

1992 ◽  
Vol 7 (1) ◽  
pp. 36-39 ◽  
Author(s):  
M. D. Barnes ◽  
R. Mani ◽  
D. F. Barrett ◽  
J. E. White
Keyword(s):  
Lower Limb ◽  
Laser Doppler ◽  
Lower Limbs ◽  
Patient Treatment ◽  
Venous Ulceration ◽  
Transcutaneous Oxygen ◽  
Venous Ulcers ◽  
Laser Doppler Fluximetry ◽  
Transcutaneous Oximetry ◽  
Oxygen Measurements

Objective: To investigate the effect of limb elevation on the microcirculation of the skin in patients with venous ulceration of the leg. Design: Prospective study in patients receiving in patient treatment for venous ulceration. Setting: Health Service teaching hospital. Patients: Thirteen patients with venous ulceration of the lower limb for more than two years were investigated. Interventions: Patients were admitted to hospital and treated by bedrest with elevation of the lower limbs by 10° above the horizontal. Main outcome measures: Laser Doppler fluximetry and transcutaneous oximetry of the skin surrounding the venous ulcers was undertaken. Results: The laser Doppler fluximetry in the periculcerous region increased by 10.8 A.U. (95% CI 17 to 4.54). However, the transcutaneous oxygen measurements did not change during the period of treatment. Conclusions: Admission to hospital with elevation of the limb for patients with venous ulceration results in ***microcirculatory changes which are probably attributable to reduction in lower limb oedema.

EPIDEMIOLOGY OF PRIMARY VARICOSE VEINS OF LOWER LIMB IN A TERTIARY CARE HOSPITAL.

2021 ◽  
pp. 30-32
Author(s):  
Praveen Kumar Nookala ◽  
Sandeep Mahapatra ◽  
Anusha Arumalla ◽  
Muneer Ahmad Para ◽  
Venu Gopal Mustyala ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Lower Limb ◽  
Varicose Veins ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Lower Limbs ◽  
Venous Disease ◽  
Care Hospital ◽  
Study Results ◽  
Primary Varicose Veins

Introduction: Epidemiological studies plays an important role in providing information on the spectrum and frequency of venous disease distribution in a population. In India, study encompassing the clinical evaluation and surgical management of varicose veins on the conventional lines seems a necessity to improve the quality care with the available resources. We have undertaken an epidemiological study on inuence of age, sex, body mass index, posture on clinical manifestations and complications of varicose veins of lower limbs in patients attending the Department of Vascular Surgery . Materials and Methods: A prospective observational study was conducted in Department of vascular surgery on patients with primary varicose veins of lower limb. Patients with secondary varicose veins, recurrent varicose veins, patients less than 18 years, deep vein thrombosis& peripheral arterial disease were excluded from the study. Results: In the present study 88.89% of ulcer patients had combined saphenofemoral(SFJ) and perforator incompetence, while 11.11% of ulcer patients had combined saphenofemoral, saphenopopliteal (SPJ)and perforator incompetence.14% patients present with combined SFJ, SPJ and perforator incompetence. The patients with higher CEAP classication had combined SFJ and SPJ valvular incompetence. Most commonly, the disease affected the males in the age group of 40-50 years. Conclusion: The present study shows that prolonged standing , obesity ,increasing age are the common risk factors for development of varicose veins.

scholarly journals Tratamento cirúrgico de varizes de membros inferiores em paciente hemofílico: relato de caso / Surgical treatment of lower limb varicose veins in a hemophiliac patient: case report

2019 ◽  
Vol 64 (3) ◽  
pp. 258
Author(s):  
Camila Teixeira Campos ◽  
Romulo Teixeira de Oliveira ◽  
Wanderley De Paula ◽  
Ygor Minassa Alves
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Vascular Surgery ◽  
Factor Viii ◽  
Varicose Vein ◽  
Lower Limb ◽  
Varicose Veins ◽  
Lower Limbs ◽  
Vein Resection ◽  
Hemophiliac Patient

Objetivo: Relatar uma situação rara na especialidade cirúrgica vascular, aparentemente ainda sem documentação de experiência semelhante e que consiste no tratamento cirúrgico de varizes de membros inferiores em paciente hemofílico e com sintomatologia venosa. Relato de caso: Procedimento cirúrgico realizado no Hospital Evangélico de Vila Velha, no setor de Cirurgia Vascular no ano de 2018, em paciente hemofílico e portador de veias varicosas primárias sintomáticas em membros inferiores. Realizado intervenção cirúrgica convencional com safenectomia bilateral e ressecção de varizes tronculares com infusão endovenosa de fator VIII no pré-operatório e nos 10 dias subsequentes. Necessitou de acompanhamento multidisciplinar incluindo hematologista e apresentou evolução satisfatória, sem intercorrências hemorrágicas. O paciente retornou no 14º de pós-operatório sem complicações. Concluímos que é perfeitamente possível a realização de cirurgia venosa de varizes com técnica convencional em paciente portador de doença hemofílica, bastando para isso a recomendada infusão de fator VIII.Descritores: Hemofilia A, Varizes, Procedimentos cirúrgicos vascularesAbstractObjective: To report a rare situation in the vascular surgical specialty, apparently still without documentation of similar experience, which consists in the surgical treatment of lower limb varicose veins in a hemophiliac patient with venous symptomatology. Case report: Surgical procedure performed at the Evangelical Hospital of Vila Velha, in the Vascular Surgery sector in 2018, in a hemophilic patient with symptomatic primary varicose veins in the lower limbs. Conventional surgical intervention was performed with bilateral saphenous vein resection and trunk varicose vein resection with intravenous factor VIII infusion preoperatively and in the 10 subsequent days. It was required multidisciplinary follow-up including hematologist and presented satisfactory evolution, without hemorrhagic complications. The patient returned in the 14th postoperative period without complications. It was concluded that to perform varicose vein surgery with conventional technique in a patient with hemophilic disease is perfectly possible with the recommended factor VIII infusion.Keywords: Hemophilia A, Varicose veins, Vascular surgery procedures 

Design of a Human Knee Reeducation Mechanism

2019 ◽  
Vol 11 (1) ◽  
pp. 42-53
Author(s):  
Allaoua Brahmia ◽  
Ridha Kelaiaia
Keyword(s):  
Lower Limb ◽  
Mechanical Design ◽  
Kinematic Chain ◽  
Lower Limbs ◽  
Kinematic Structure ◽  
Robotic Device ◽  
Human Knee ◽  
Kinematic Study ◽  
Rehabilitation Exercise ◽  
New Machine

Abstract To establish an exercise in open muscular chain rehabilitation (OMC), it is necessary to choose the type of kinematic chain of the mechanical / biomechanical system that constitutes the lower limbs in interaction with the robotic device. Indeed, it’s accepted in biomechanics that a rehabilitation exercise in OMC of the lower limb is performed with a fixed hip and a free foot. Based on these findings, a kinematic structure of a new machine, named Reeduc-Knee, is proposed, and a mechanical design is carried out. The contribution of this work is not limited to the mechanical design of the Reeduc-Knee system. Indeed, to define the minimum parameterizing defining the configuration of the device relative to an absolute reference, a geometric and kinematic study is presented.

scholarly journals Effects of Dominant and Nondominant Limb Immobilization on Muscle Activation and Physical Demand during Ambulation with Axillary Crutches

2021 ◽  
Vol 6 (1) ◽  
pp. 16
Author(s):  
Kara B. Bellenfant ◽  
Gracie L. Robbins ◽  
Rebecca R. Rogers ◽  
Thomas J. Kopec ◽  
Christopher G. Ballmann
Keyword(s):  
Lower Limb ◽  
Muscle Activation ◽  
Weight Bearing ◽  
Lower Limbs ◽  
Medial Gastrocnemius ◽  
Bipedal Walking ◽  
Lower Limb Muscle ◽  
Limb Muscle ◽  
Physical Demand ◽  
Limb Dominance

The purpose of this study was to investigate the effects of how limb dominance and joint immobilization alter markers of physical demand and muscle activation during ambulation with axillary crutches. In a crossover, counterbalanced study design, physically active females completed ambulation trials with three conditions: (1) bipedal walking (BW), (2) axillary crutch ambulation with their dominant limb (DOM), and (3) axillary crutch ambulation with their nondominant limb (NDOM). During the axillary crutch ambulation conditions, the non-weight-bearing knee joint was immobilized at a 30-degree flexion angle with a postoperative knee stabilizer. For each trial/condition, participants ambulated at 0.6, 0.8, and 1.0 mph for five minutes at each speed. Heart rate (HR) and rate of perceived exertion (RPE) were monitored throughout. Surface electromyography (sEMG) was used to record muscle activation of the medial gastrocnemius (MG), soleus (SOL), and tibialis anterior (TA) unilaterally on the weight-bearing limb. Biceps brachii (BB) and triceps brachii (TB) sEMG were measured bilaterally. sEMG signals for each immobilization condition were normalized to corresponding values for BW.HR (p < 0.001) and RPE (p < 0.001) were significantly higher for both the DOM and NDOM conditions compared to BW but no differences existed between the DOM and NDOM conditions (p > 0.05). No differences in lower limb muscle activation were noted for any muscles between the DOM and NDOM conditions (p > 0.05). Regardless of condition, BB activation ipsilateral to the ambulating limb was significantly lower during 0.6 mph (p = 0.005) and 0.8 mph (p = 0.016) compared to the same speeds for BB on the contralateral side. Contralateral TB activation was significantly higher during 0.6 mph compared to 0.8 mph (p = 0.009) and 1.0 mph (p = 0.029) irrespective of condition. In conclusion, limb dominance appears to not alter lower limb muscle activation and walking intensity while using axillary crutches. However, upper limb muscle activation was asymmetrical during axillary crutch use and largely dependent on speed. These results suggest that functional asymmetry may exist in upper limbs but not lower limbs during assistive device supported ambulation.

scholarly journals COVID-19 era in long-term cardiac rehabilitation programs: how was muscle strenght and lean mass affected in cardiovascular patients?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Borges ◽  
M Lemos Pires ◽  
R Pinto ◽  
G De Sa ◽  
I Ricardo ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Cardiac Rehabilitation ◽  
Lean Mass ◽  
Lower Limb ◽  
Lower Limbs ◽  
Phase Iii ◽  
Face To Face ◽  
Home Based ◽  
Lower Limb Strength

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Exercise prescription is one of the main components of phase III Cardiac Rehabilitation (CR) programs due to its documented prognostic benefits. It has been well established that, when added to aerobic training, resistance training (RT) leads to greater improvements in peripheral muscle strength and muscle mass in patients with cardiovascular disease (CVD). With COVID-19, most centre-based CR programs had to be suspended and CR patients had to readjust their RT program to a home-based model where weight training was more difficult to perform. How COVID-19 Era impacted lean mass and muscle strength in trained CVD patients who were attending long-term CR programs has yet to be discussed. Purpose To assess upper and lower limb muscle strength and lean mass in CVD patients who had their centre-based CR program suspended due to COVID-19 and compare it with previous assessments. Methods 87 CVD patients (mean age 62.9 ± 9.1, 82.8% male), before COVID-19, were attending a phase III centre-based CR program 3x/week and were evaluated annually. After 7 months of suspension, 57.5% (n = 50) patients returned to the face-to-face CR program. Despite all constraints caused by COVID-19, body composition and muscle strength of 35 participants (mean age 64.7 ± 7.9, 88.6% male) were assessed. We compared this assessment with previous years and established three assessment time points: M1) one year before COVID-19 (2018); M2) last assessment before COVID-19 (2019); M3) the assessment 7 months after CR program suspension (last trimester of 2020). Upper limbs strength was measured using a JAMAR dynamometer, 30 second chair stand test (number of repetitions – reps) was used to measure lower limbs strength and dual energy x-ray absorptiometry was used to measure upper and lower limbs lean mass. Repeated measures ANOVA were used. Results Intention to treat analysis showed that upper and lower limbs lean mass did not change from M1 to M2 but decreased significantly from M2 to M3 (arms lean mass in M2: 5.68 ± 1.00kg vs M3: 5.52 ± 1.06kg, p = 0.004; legs lean mass in M2: 17.40 ± 2.46kg vs M3: 16.77 ± 2.61kg, p = 0.040). Lower limb strength also decreased significantly from M2 to M3 (M2: 23.31 ± 5.76 reps vs M3: 21.11 ± 5.31 reps, p = 0.014) after remaining stable in the year prior to COVID-19. Upper limb strength improved significantly from M1 to M2 (M1: 39.00 ± 8.64kg vs M2: 40.53 ± 8.77kg, p = 0.034) but did not change significantly from M2 to M3 (M2 vs M3: 41.29 ± 9.13kg, p = 0.517). Conclusion After CR centre-based suspension due to COVID-19, we observed a decrease in upper and lower limbs lean mass and lower limb strength in previously trained CVD patients. These results should emphasize the need to promote all efforts to maintain physical activity and RT through alternative effective home-based CR programs when face-to-face models are not available or possible to be implemented.

Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?

2021 ◽  
pp. 1-9
Author(s):  
Lucas Sousa Macedo ◽  
Renato Polese Rusig ◽  
Gustavo Bersani Silva ◽  
Alvaro Baik Cho ◽  
Teng Hsiang Wei ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Upper Limb ◽  
Computed Tomography Angiography ◽  
Lower Limb ◽  
High Energy ◽  
Lower Limbs ◽  
Added Value ◽  
Vascular Lesions ◽  
Limb Injuries ◽  
Significant Difference

BACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA–). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.

scholarly journals Motor disability in patients with multiple sclerosis: transcranial magnetic stimulation study

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Anssam Bassem Mohy ◽  
Aqeel Kareem Hatem ◽  
Hussein Ghani Kadoori ◽  
Farqad Bader Hamdan
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Lower Limb ◽  
Magnetic Stimulation ◽  
Motor Evoked Potential ◽  
Invasive Procedure ◽  
Single Pulse ◽  
Lower Limbs ◽  
Control Group ◽  
Conduction Time ◽  
Motor Disability

Abstract Background Transcranial magnetic stimulation (TMS) is a non-invasive procedure used in a small targeted region of the brain via electromagnetic induction and used diagnostically to measure the connection between the central nervous system (CNS) and skeletal muscle to evaluate the damage that occurs in MS. Objectives The study aims to investigate whether single-pulse TMS measures differ between patients with MS and healthy controls and to consider if these measures are associated with clinical disability. Patients and methods Single-pulse TMS was performed in 26 patients with MS who hand an Expanded Disability Status Scale (EDSS) score between 0 and 9.5 and in 26 normal subjects. Different TMS parameters from upper and lower limbs were investigated. Results TMS disclosed no difference in all MEP parameters between the right and left side of the upper and lower limbs in patients with MS and controls. In all patients, TMS parameters were different from the control group. Upper limb central motor conduction time (CMCT) was prolonged in MS patients with pyramidal signs. Upper and lower limb CMCT and CMCT-f wave (CMCT-f) were prolonged in patients with ataxia. Moreover, CMCT and CMCT-f were prolonged in MS patients with EDSS of 5–9.5 as compared to those with a score of 0–4.5. EDSS correlated with upper and lower limb cortical latency (CL), CMCT, and CMCT-f whereas motor evoked potential (MEP) amplitude not. Conclusion TMS yields objective data to evaluate clinical disability and its parameters correlated well with EDSS.

scholarly journals Unilateral and Bilateral Strength Asymmetry among Young Elite Athletes of Various Sports

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 683
Author(s):  
Maros Kalata ◽  
Tomas Maly ◽  
Mikulas Hank ◽  
Jakub Michalek ◽  
David Bujnovsky ◽  
...  
Keyword(s):  
Lower Limb ◽  
Elite Athletes ◽  
Lower Limbs ◽  
Knee Extensors ◽  
Young Athletes ◽  
Lower Limb Muscles ◽  
Significant Difference ◽  
Strength Asymmetry ◽  
Main Factor ◽  
Objective Type

Background and objective: Type of physical activity may influence morphological and muscular asymmetries in the young population. However, less is known about the size of this effect when comparing various sports. The aim of this study was to identify the degree of bilateral asymmetry (BA) and the level of unilateral ratio (UR) between isokinetic strength of knee extensors (KE) and flexors (KF) among athletes of three different types of predominant locomotion in various sports (symmetric, asymmetric and hybrid). Material and methods: The analyzed group consisted of young elite athletes (n = 50). The maximum peak muscle torque of the KE and KF in both the dominant (DL) and non-dominant (NL) lower limb during concentric muscle contraction at an angular velocity of 60°·s−1 was measured with an isokinetic dynamometer. Results: Data analysis showed a significant effect of the main factor (the type of sport) on the level of monitored variables (p = 0.004). The type of sport revealed a significant difference in the bilateral ratio (p = 0.01). The group of symmetric and hybrid sports achieved lower values (p = 0.01) of BA in their lower limb muscles than those who played asymmetric sports. The hybrid sports group achieved higher UR values (p = 0.01) in both lower limbs. Conclusions: The results indicate that sports with predominantly symmetrical, asymmetrical, and hybrid types of locomotion affected the size of the BA, as well as the UR between KE and KF in both legs in young athletes. We recommend paying attention to regular KE and KF strength diagnostics in young athletes and optimizing individual compensatory exercises if a higher ratio of strength asymmetry is discovered.

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