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BACKGROUND: Edema caused by orthostasis is a common clinical picture in the medical and occupational context. Medical compression therapy with compression stockings (CS) is considered a conservative therapeutic standard in edema therapy. The effect of CS on leg discomfort and the increase of the lower leg volume during a standing load still remains questionable. In addition, it is not entirely known whether there is a correlation between volume increase and discomfort in these individuals. METHOD: A timed, controlled standing load of 15 min was conducted by the participants in this non-randomized controlled study to analyze the change in and correlation between lower leg volume increase and the occurrence of lower leg discomfort under compression therapy. Below-knee CS with an interface pressure of 23–32 mmHg were used. The lower leg volume was measured following previous studies using an optical three-dimensional volume (ml) measurement system, and sensations of discomfort and the urge to move were asked about using a numerical rating scale (NRS) of 0–10. The subjects conducted a leg movement for 15 s immediately after the standing period; the data were collected again subsequently. A correlation was calculated between the lower leg volume and the data regarding the discomfort and urge to move for each participant. The experiments had already been performed as part of a previous study including the same subjects who did not wear CS. The results of the study conducted here were compared with those of the participants who did not wear CS to investigate the effect of the CS. RESULTS: Lower leg volume increased by an average of 27 ml (p

Introduction: Prolonged sitting causes leg discomfort. We evaluated shear wave velocity (SWV) of leg muscles, leg circumference, and leg discomfort associated with 2 h sitting. Methods: Twenty-one middle-aged men and 19 middle-aged women participated in the study. SWV and leg circumference was measured just after sitting, 60 min, 120 min, and after 3 min of leg raising. Leg discomfort was assessed before sitting and 120 min. Results: SWV was significantly greater in men than women and increased over time, and decreased with leg raising. The percentage increase in lower leg circumference was significantly greater in women than in men, and it increased over time. Leg discomfort significantly increased after 120 min in both men and women. Discussions: Because SWV is proportional to an increase in intramuscular compartment pressure in the lower leg, intramuscular compartment pressure increased over time with sitting and decreased with leg raising. Considering the changes in SWV and leg circumference, it was inferred that prolonged sitting causes an increase in intramuscular compartment pressure and intravascular blood volume, as well as an increase in water content in the leg subcutaneous tissue. Leg discomfort was estimated to be due to increased intra-leg fluid. Brief leg raising may resolve leg edema and discomfort.

Nicola Ielapi,1,2,&ast; Michele Andreucci,3,&ast; Umberto Marcello Bracale,4 Davide Costa,1,5 Egidio Bevacqua,6 Nicola Giannotta,1,6 Maria Grazia Bevacqua,7 Giuseppe Filiberto Serraino,7 Pasquale Mastroroberto,7 Michele Provenzano,6 Raffaele Serra1,6 1Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology” at the Department of Surgical and Medical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy; 2Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy; 3Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy; 4Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, Naples, Italy; 5Department of Law, Economics and Sociology, University Magna Graecia of Catanzaro, Catanzaro, Italy; 6Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy; 7Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy&ast;These authors contributed equally to this workCorrespondence: Raffaele SerraDepartment of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy, Email rserra@unicz.itBackground: Venous return in the circulatory system of lower limbs results from the interaction of several mechanisms and reflects the balance between blood inflow and outflow. Blood outflow improves during the lying position especially with leg elevation both in patients with chronic venous disease (CVD) and in healthy subjects in sedentary settings with short-term immobilization. This study evaluated the level of comfort of hospital inpatients, without CVD, lying with a moderate leg elevation during hospital stay.Methods: This was a clinical trial examining 60 consecutive patients referred to vascular surgery, cardiac surgery, and nephrology units. After inclusion, patients were randomly assigned to two groups: A (leg elevation) in which patients were made to lie in the hospital bed with moderate elevation of the legs, and B (no leg elevation) in which patients were made to lie in the hospital bed without leg elevation.Results: The whole population consisted of 40 patients undergoing leg elevation (group A) and 20 without leg elevation (group B). During each day of hospitalization, measurements such as ankle and calf circumference, heart rate, blood pressure, and body temperature were collected. Subjective data such as perceived heaviness in the lower limbs, comfort perception and hours of sleep were also collected. In this study, patients of group A recorded a decrease in calf and ankle circumference (delta in ankle and calf circumference (difference between end of study visit and baseline visit) were significantly decreased in group A vs group B (p< 0.001 for both sides), and patients perceived less leg heaviness and even reported more leg comfort compared to patients of Group B (p< 0.001)). Among patients of group A, the bigger advantage in terms of comfort perception was recorded in patients with 15° leg elevation.Conclusion: Moderate leg elevation during hospital stay seems to effectively improve leg comfort in hospitalized patients.Keywords: venous system, lower limb, circulation, leg elevation, hospital stay, vein symptoms, leg discomfort

© 2019 Sociedade Portuguesa de Pneumologia. Published by Elsevier Espana, ˜ S.L.U. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/)., Chronic and progressive dyspnea, the most characteristic symptom of chronic obstructive pulmonary disease (COPD), is often associated with physical activity reduction, not only because of the symptom itself but also because of the anticipation of discomfort caused by physical exertion. Fatigue is also one of the main symptoms, described as the second most prevalent. Therefore, relief of these symptoms is one of the primary goals in the management of patients with COPD.

Summary. Background: Vein symptoms (VS) entail diffuse leg discomfort and pain coinciding with a perception of weighty or swollen legs. Their traditional classification as a form of venous disease may be inaccurate as they occur in patients with no or any venous disorder. We hypothesized that VS would emerge from a primordially standing associated perturbation in the lower limbs which is not necessarily connected with a venous disorder. Patients and methods: Patients were sorted into groups according to the CEAP classification, VS only (C0s), primary varicose veins (C2p), varicose veins plus oedema (C2p and C3), and venous dermatopathy (C4). Patients completed questionnaires before and one week after they were exposed to a test of stationary standing. Results: Patients (N = 127) in the four groups differed by sex, age and body weight. The VS experienced in the preceding week scored the same in all groups at 3.1 on a numeric rating scale (range 0–10; SD 1.6). During standing, lower leg volume increased and symptoms emerged to the same extent across patient groups and were reduced similarly by compression (volume by 1.7 %, symptoms by 41.7 %). The emergence of symptoms was neither correlated with leg volume increase per se, nor with limiting this increase by compression. Symptoms recorded at baseline correlated with the symptoms provoked by the stress test with bare legs while the symptoms reported at follow-up, when stockings were worn regularly, correlated with the stress test with compression. Conclusions: VS, in terms of neuropsychology, reflect a homeostatic disturbance experienced in the presence and absence of venous disease. Thus, VS are not distinctive for the presence of venous disease insofar as they may reflect dynamic homeostatic feelings resulting from a standing-related disequilibrium in the legs’ internal environment.

To evaluate the acute effects of expiratory positive airway pressure (EPAP) on exercise tolerance, dyspnea, leg discomfort, and breathing pattern in patients with COPD.Fifteen patients with COPD were assessed with the following three different protocols: EPAP of 7.5 cmHExercise tolerance was lower in protocol 1: 108 ± 45 seconds compared to protocols 2: 187 ± 99 seconds (A reduction on exercise tolerance and an increase in dyspnea were found with EPAP of 7.5 cm H

Assessment of dyspnoea severity during incremental cardiopulmonary exercise testing (CPET) has long been hampered by the lack of reference ranges as a function of work rate (WR) and ventilation (V̇E). This is particularly relevant to cycling, a testing modality which overtaxes the leg muscles leading to a heightened sensation of leg discomfort.Reference ranges based on dyspnoea percentiles (0–10 Borg scale) at standardised WRs and V̇E were established in 275 apparently healthy subjects aged 20–85 (131 men). They were compared with values recorded in a randomly selected “validation” sample (N=451, 224 men). Their usefulness in properly uncovering the severity of exertional dyspnoea were tested in 167 subjects under investigation for chronic dyspnoea (“testing sample”) who terminated CPET due to leg discomfort (86 men).Iso-WR and, to a lesser extent, iso-V̇E reference ranges (5th–25th, 25th–50th, 50–75th and 75th–95th percentiles) increased as a function of age, being systematically higher in women (p0.05). Submaximal dyspnoea-WR scores lied within the 75th–95th or >95th percentiles in 108/118 (91.5%) subjects of the “testing” sample who showed physiological abnormalities known to elicit exertional dyspnoea i.e., ventilatory inefficiency and/or critical inspiratory constraints. In contrast, dyspnoea scores typically lied in the 5th–50th range in subjects without those abnormalities (pThis frame of reference might prove useful to uncover the severity of exertional dyspnoea in subjects who otherwise would be labeled as “non-dyspneic” while providing mechanistic insights into the genesis of this distressing symptom.

We tested the hypothesis that patients with chronic obstructive pulmonary disease (COPD) who stop exercise due to breathlessness (B) vs. leg discomfort (LD) have greater pathophysiological abnormalities in dynamic respiratory mechanics & pulmonary gas exchange efficiency at end-exercise. We compared physiological and perceptual responses at the symptom-limited peak of cycle exercise testing between 61 patients reporting B (43M; mean±SD FEV1, 42±22%pred) and 26 patients reporting LD (24M; FEV1, 60±27%pred, p

Background: Restless legs syndrome (RLS) is misdiagnosed due to a variety of clinical presentations and lack of a diagnostic biomarker. Sociocultural differences in patients' reporting of symptoms further contribute to this under diagnosis. We developed an expanded diagnostic tool for RLS, incorporating all International RLS Study Group (IRLSSG) diagnostic criteria with a number of additional questions mainly focusing on specific sociocultural influences in RLS symptom reporting among Indians. The purpose of this study was to examine the change in the diagnostic yield of RLS, if any, through administration of this expanded questionnaire. Materials and Methods: The AIIMS RLS questionnaire for Indian patients (ARQIP) was developed in English language, and then translated into Hindi. All consecutive patients attending Neurology and sleep disorders clinic with complaints of leg discomfort were recruited in the study. Two examiners evaluated all patients with complaints of leg discomfort seen by a senior Sleep Medicine expert, one using only IRLSSG diagnostic criteria and the other using the ARQIP. Patients were categorized as RLS or “no-RLS” by the expert, and this was considered as the “standard” for analysis. Results: A total of 155 participants (78 males, 50.3%) with a mean age of 44.1 ± 14.5 years were enrolled. A total of 105 patients were diagnosed as having RLS (group 1) and the rest as having “non-RLS” (group 2). The ARQIP was found to have a much higher sensitivity (100% vs 73%), specificity (44% vs 32.7%), negative predictive value (100% vs 36.4%), and positive predictive value (79% vs 70%) compared to the standard questionnaire. The diagnostic yield of this tool was 26.7% (Confidence interval = 100–73.3). Conclusions: The ARQIP for RLS diagnosis, validated in this study, has been observed to have a high sensitivity and a negative predictive value with a high diagnostic accuracy.

Most diagnostic tests assess the function of a single organ or organ system at rest. Conversely, exercise requires the integrated function of multiple systems under stress, including the cardiovascular, pulmonary, and musculoskeletal systems. The physical stress of exercise can expose physiological limitations not otherwise apparent at rest. This is particularly relevant for patients with respiratory and/or heart diseases in whom the increased physical demands of exercise quickly exhaust their reduced functional reserves, leading to the disabling symptoms of dyspnea, leg discomfort, and fatigue. The present chapter provides a framework for CPET performance and interpretation aimed at maximizing its clinical relevance. This approach underscores the principle that measurement of exertional symptoms, using validated scales and parameters of ventilatory control and dynamic respiratory mechanics, should be routinely used to optimize clinical CPET interpretation.

Although simple characterization of discomfort as cramps, heaviness, shooting pains, and so forth can be misleading, history and examination are key to accurate diagnosis. Absence of both dorsalis pedis and posterior tibial pulses strongly suggests peripheral arterial disease (PAD), and the presence of either pulse makes PAD less likely. Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are a common cause of lower extremity myalgias. Restless legs syndrome causes nocturnal discomfort but must be distinguished from confounding“mimics." Neurologic causes of leg symptoms include lumbar spinal stenosis, radiculopathy, distal symmetric polyneuropathy, and entrapment neuropathy. Many common causes of leg discomfort can be managed conservatively.

There has been no previous side-by-side comparison of the diagnostic criteria for restless legs syndrome (RLS) (Willis–Ekbom disease) and growing pains. In our review, we explore this comparison emphasizing overlaps and disconnects, summarize recent literature exploring the relationship between the 2 entities, and make suggestions for future research. There is considerable overlap in the diagnostic criteria for childhood RLS and growing pains. The literature also indicates that RLS and growing pains more commonly occur together than one would expect based on chance alone, and the family histories of RLS and growing pains often are overlapping. Leg rubbing to obtain relief from leg discomfort is common to both disorders, though walking to obtain relief seems unique to RLS. Childhood RLS also has been reported to be painful in up to 45% of cases. The development of standard diagnostic criteria is necessary to move forward in the field of growing pains research. A quantitative and validated rating scale for growing pains severity already exists. Because of the clinical and genetic similarity between RLS and growing pains, studies that parallel those previously performed in RLS patients are recommended for growing pains patients. For example, a genome wide association study in growing pains patients of all possible genes with particular attention to those identified as related to RLS and a therapeutic trial of medications known to be effective in RLS would be welcome. Abnormalities in vitamin D metabolism also may be common to both disorders.

Restless legs syndrome (RLS) is an under-recognized neurologic sensorimotor disorder, affecting approximately 2% of male and female adolescents. It is characterized by an urge to move the legs, usually associated with leg discomfort. The symptoms occur at rest, are relieved by movement, and are most severe in the evening and at night. RLS varies in severity, with some adolescents experiencing mild, infrequent symptoms and others having severe, daily symptoms.

Objective: This study aims to survey the prevalence of musculoskeletal disorders(MSD) among Korean hospital workers and to analyze the relationship of MSD symptoms and workload perceived by workers. Background: Despite of high exposure to the MSD risk factors and high MSD symptom prevalence among health care workers, there were not enough studies of MSD prevalence among the hospital workers. Method: This study designed a survey based on Nordic questionnaire to obtain MSD symptoms and the degree of four perceived workloads: work repetition, urgency, physical exertion and satisfaction. In this survey, 1,846 workers in a hospital participated. The prevalence of MSD was analyzed for each body part, and MSD cases, which were predetermined in this study, were identified. The relationship between the MSD cases and each perceived workload was analyzed using chi-square test. Results: The pain in the shoulder was the most prevalent among the workers as 52%, and the low back(37%) and leg discomfort(36%) followed. The MSD cases, in which degree of pain was more than severe, were also the most prevalent in the shoulder(13%). Female workers had higher rate of MSD cases than the males. Among the four workload variables, the physical exertion was the statistically related to MSD cases for all the body parts. In addition, the others also had significant relation to MSD cases except one or two body parts. Conclusion: This study found that Korean hospital workers had MSD symptoms mainly in the shoulder, low back and legs in order, and the perceived workload surveyed in this study was highly correlated with MSD symptoms. Application: This study provides another evidence that subjective physical exertion perceived by workers is an important factor to explain MSD cases as same as the objective one.

Many occupations require workers to stand for prolonged periods, which can cause both discomfort and pain. This study examines the effects of different shoe and floor conditions on standing discomfort in the workplace and laboratory. Two experiments were conducted. Experiment 1 enrolled 10 subjects who performed a computer task under two floors and shoe conditions while standing for 4 h in a laboratory. Experiment 2 involved 14 subjects who stood for 4 h throughout their shift on two different floors in a real work situation (i.e., a field experiment). Analytical results demonstrate that floor type and time standing significantly affected subjective ratings for leg discomfort and circumferential shank measurements in both the laboratory and field studies. Shoe condition significantly affected subjective ratings for leg discomfort. We conclude that shoe/floor conditions and prolonged standing influence worker lower extremity discomfort during prolonged standing. These analytical findings suggest that common ergonomic interventions, such as modifying the flooring on which workers stand might some what alleviate leg edema for workers standing for 4 h shifts in laboratory and field settings. Nevertheless, prolonged standing for even 1 h without rest showed negative effects and should be avoided when possible.

The core symptoms of venous disease include leg discomfort or pain accompanied by sensations of heavy, weighty, or swollen legs. This suggests the presence of a cause and effect relationship between swelling and pain, resulting in the assumption that a venous disorder is responsible. The aim of this study was to investigate the relationship between leg volume increase and symptoms provoked by a period of stationary standing and also to investigate the effect of medical compression stockings (MCS).Healthy volunteers were subject to stationary standing. Lower leg volume and the intensity and nature of the emerging symptoms were assessed seven times during 10 minutes.Of 46 subjects analyzed after an initial test with bare legs, 18 (39%) developed no or few symptoms (≤2 on a Numeric Rating Scale [NRS] of 0 to 10). However, their leg volume increased as much as in the 28 subjects who experienced more symptoms. Oligosymptomatic subjects scored lower in a baseline questionnaire on leg symptoms of somatic and psychic origin than did volunteers with more symptoms. The oligosymptomatic subjects were excluded from the tests with MCS. In the 24 subjects who completed the whole study, the lower leg volume increased in two phases, reaching an increment of 44 mL (standard deviation [SD], 18) or 1.73% (SD, 0.65) after 10 minutes. Symptoms emerged and increased in a linear fashion, reaching a mean score of 2.93 NRS points (SD, 1.52) at 10 minutes. The most prominent symptom was tingling (NRS, 5.07; SD, 3.05), followed by feelings of pressure and tension (NRS, 2.17; SD, 1.87). No correlation was found between volume increase and symptoms. MCS exerting an ankle pressure of 10 to 15 mm Hg reduced the volume increase to 32 mL (SD, 20), and MCS exerting 23 to 32 mm Hg reduced it to 24 mL (SD, 20; both P .001; difference between stockings, P = .06). Symptom intensity was reduced to NRS 2.06 (SD, 1.52) and 2.21 (SD, 1.23; both P .001), respectively. Both MCS reduced the symptoms equally (P = .38). Symptom reduction was not correlated with the prevention of volume increase.On prolonged stationary standing, leg volume increase and symptoms occur independently. MCS reduce volume increase according to the pressure they exert. Symptoms are reduced independent of the pressure exerted and the volume increase prevented. This suggests that MCS act in more ways than by a simple reduction in volume.

A 22-year-old professional football player presented to a preparticipation physical examination with a 2-week history of left leg discomfort extending from the groin to the knee over the previous 2 weeks. He was found to have superficial vein thrombophlebitis (SVT) of the left great saphenous vein extending from the knee to within approximately 1.6 cm of the saphenofemoral junction. There is paucity in the literature regarding the management of SVT, particularly in actively training athletes. This case addresses the considerations of anticoagulation management for SVT as well as the unique challenge of managing anticoagulation therapy in an athlete that is actively training.

Purpose The present study was an attempt to investigate the effect of unstable footwear on lower leg muscle activity, volume change and subjective discomfort during prolonged standing. Methods Ten healthy subjects were recruited to stand for 2 h in three footwear conditions: barefoot, flat-bottomed shoe and unstable shoe. During standing, lower leg discomfort and EMG activity of medial gastrocnemius (MG) and tibialis anterior (TA) muscles were continuously monitored. Changes in lower leg volume over standing time also were measured. Results Lower leg discomfort rating reduced significantly while subjects standing on unstable shoe compared to the flat-bottomed shoe and barefoot condition. For lower leg volume, less changes also were observed with unstable shoe. The activity level and variation of right MG muscle was greater with unstable shoe compared to the other footwear conditions; however regarding the left MG muscle, significant difference was found between unstable shoe and flat-bottomed shoe only for activity level. Furthermore no significant differences were observed for the activity level and variation of TA muscles (right/left) among all footwear conditions. Conclusions The findings suggested that prolonged standing with unstable footwear produces changes in lower leg muscles activity and leads to less volume changes. Perceived discomfort also was lower for this type of footwear and this might mean that unstable footwear can be used as ergonomic solution for employees whose work requires prolonged standing.

Minimally invasive surgery (MIS) offers cosmetic benefits to patients; however, surgeons often experience pain during MIS. We administered an ergonomic questionnaire to 176 Korean laparoscopic gynecological surgeons to determine potential sources of pain during surgery. Logistic regression analysis was used to identify factors that had a significant impact on gynecological surgeons’ pain. Operating table height at the beginning of surgery and during the operation were significantly associated with neck and shoulder discomfort (P

SummaryThis paper presents two women who visited the phlebology surgery in the opinion that varices would be responsible for their symptoms. Patient 1 complained of nocturnal pain that radiated from the posterior surface of the left thigh to the anterior and lateral surfaces of the knee and lateral aspect of the calf. This pain occurred whenever she changed position. Patient 2 felt numbness in her right foot and an annoying burning sensation in her right heel. She was known to have lumbar discopathy and stenosis of the spinal canal which however, according to neurological diagnosis, could not explain the symptoms. On clinical examination neither had visible nor palpable varices, nor any recognisable dermal signs of venous hypertension. However, it was conspicuous that the left foot of patient 1 barely reached the floor when she was sitting down. In patient 2 the circumference of the right calf was increased by 2 cm.In both cases a coarse, circumscribed thickening was palpable deep in the posterior surface of the thigh (patient 1) and the proximal calf (patient 2). This was responsible for the asymmetrical posture in sitting of patient 1. Doppler/duplex sonography did not reveal any pathological findings in either patient. Thanks to MRI scans the cause in both cases was found to be a subfascial tumour that was displacing the musculature, thus compressing nervous structures; once in the thigh (patient 1: 600 g), once in the calf (patient 2: 200 g). In both women the symptoms disappeared after surgical extirpation of the clinically and histologically verified lipomas.

Diagnosis of restless leg syndrome (RLS) in Parkinson's disease (PD) is difficult because of clinical confounds. The suggested immobilization test (SIT) is validated for diagnosis of primary RLS. This study evaluated the usefulness of the SIT for diagnosis of RLS in PD. We compared SIT scores, as well as polysomnography measures in 50 patients with PD (25 with RLS, 25 without), 25 patients with primary RLS, and 25 age/sex matched controls. Mean leg discomfort score was increased in patients with PD and RLS compared to PD without RLS, and also in patients with primary RLS compared to controls. Leg discomfort was significantly higher at the end of the test in patients with RLS compared to patients without RLS. Intensity of leg discomfort was similar between patients with RLS, with or without PD. Using a mean leg discomfort cutoff of 11, we showed sensitivity of 91% and specificity of 72% for RLS diagnosis in PD during symptomatic time intervals. Periodic leg movements index during the SIT did not differ between groups. Periodic leg movements index during sleep and wakefulness was increased in patients with primary RLS compared to controls, but did not differ between patients with PD, with and without RLS. The sensory SIT is a simple test that may help diagnose RLS in patients with PD.

Aim: To test the hypothesis that obese individuals may either hyperinflate or deflate the lung when exercising. In both cases breathlessness is an inescapable consequence. Methods: Ventilatory variables, end-expiratory lung volume and end-inspiratory lung volume, and dyspnoea score (Borg scale) were studied in 20 class II-III obese subjects and 14 healthy controls during incremental symptom-limited cycle exercise. Results: Ventilation increased with increasing work rate, in obese and in control subjects; most obese subjects had to increase end-expiratory lung volume to escape from flow limitation; in contrast, like controls, a few subjects deflated the lung on heavy-to-peak exercise. Dyspnoea was equal in degree at anaerobic threshold and peak exercise in obese as in control subjects, and in obese who hyperinflated as in those who deflated the lung. In particular, end-expiratory lung volume at baseline (r = −0.84, P = 0.04) was negatively correlated with changes in Borg score in obese who did not hyperinflate: the lower the former the higher the latter. On the other hand, tidal volume (r = 0.54, P = 0.045) and decrease in inspiratory reserve volume (r = 0.59, P = 0.028) were positively correlated with the Borg score in obese subjects who hyperinflated. No other independent variable correlated with the Borg score. Conclusions: We conclude that not all obese subjects had to increase end-expiratory lung volume on heavy-to-peak exercise. Changes in dyspnoea for unit changes in ventilation were similar in obese who did hyperinflate as well as in those who did not, suggesting that the increase in respiratory neural drive, associated with an increase in ventilation, is an important source of dyspnoea in obese as well as in control subjects.

Restless legs syndrome (RLS) is a common disorder that is estimated to affect 10% of Americans. However, it remains largely undiagnosed and untreated by clinicians. The primary symptoms of this condition are leg discomfort or an urge to move that is temporarily relieved by movement and is worse at rest and at bedtime. RLS impacts the quality of life of the sufferer by disrupting sleep and disturbing or curtailing work and social activities. Approximately 80% of RLS sufferers also have periodic limb movements during sleep, in which repetitive leg movements fragment sleep and may result in daytime drowsiness. RLS may be treated by dopaminergic agents, benzodiazepines, anticonvulsants and opiates; dopamine agonists are currently considered first-line therapy for this condition. Pramipexole has been studied in the treatment of RLS since 1998. This article reviews the role of this medication in the management of this serious neurological disorder.

Publisher Summary This chapter discusses restless legs syndrome (RLS) and periodic limb movements in sleep. Sleep disturbance is the main complaint that brings RLS patients in for treatment, but sleep disturbance is not necessary for the diagnosis of RLS. The leg discomfort and periodic leg movements in wakefulness in RLS may cause difficulty in initiating and maintaining sleep. Patients may experience daytime drowsiness because of the insomnia. The periodic limb movements in sleep usually do not cause conscious awareness of sleep disturbance in the patient, but spousal sleep disruption because of such leg kicks is common. The neurological examination is normal in the idiopathic and familial forms of the disorder. Cases associated with peripheral neuropathy and radiculopathy are also seen. There is an increased frequency of RLS in cases of renal failure and RLS may be temporarily exacerbated during pregnancy. Iron deficiency makes the symptoms of RLS worse and every patient should be screened for deficiency of the iron-binding protein, ferritin.

Sigitas Urbonavicius, Mindaugas Trumpickas, Arūnas Grinkevicius Kauno medicinos universiteto Kardiochirurgijos klinikos Angiochirurgijos skyrius, Eivenių g. 2, LT-50009 Kaunas El. pastas: sigisu@takas.lr , sigisu@one.lt Tikslas Įvertinti Cyclo 3 Fort poveikį, gydant lėtinį venų nepakankamumą ir jo klinikinius simptomus. Ligoniai ir metodai Cyclo 3 Fort yra palyginti neseniai Lietuvoje pasirodes preparatas, kuris susideda is Ruscus aculeatus ekstrakto, flavonoido hesperidino bei askorbo rūgsties. Užsienyje jis gerai įvertintas gydant galūnių edemą, kai ji atsiranda dėl venostazės ar limfostazės. Pateikiama retrospektyvinė 35 ligonių tyrimo duomenų analizė. Dvidesimt ligonių keturias savaites buvo gydomi Cyclo 3 Fort (po 2 kapsules per dieną), o kiti 15 jokių venotonikų nevartojo. Kojos edema buvo vertinama matuojant blauzdos ir kulksnies perimetrą bei tūrio kitimus. Skausmas ir galūnės diskomfortas buvo vertintas pagal sudarytą klausimyną. Rezultatai Sio tyrimo rezultatai parodė, kad po 4 savaicių ligoniams, kurie vartojo Cyclo 3 Fort, visi tirtieji veiksniai (kojos edema, skausmas, dienos ir nakties mėslungis, diskomfortas, kojų sunkumas, parestezijos) buvo ženkliai mažesni negu jokių venotonikų nevartojusiems ir tik venine kraujotaką gerinancius fizinius pratimus dariusiems ligoniams. Isvados Venotonikas Cyclo 3 Fort ženkliai mažina kojos edemą bei lėtinio venų nepakankamumo klinikinius simptomus. Reiksminiai žodžiai: lėtinis venų nepakankamumas, kojos edema, venotonikai The treatment of chronic venous insufficiency and it’s clinical symptoms with phflebotonic Cyclo 3 Fort Sigitas Urbonavicius, Mindaugas Trumpickas, Arūnas Grinkevicius Objective To evaluate the effectiveness of the phlebotonic Cyclo 3 Fort for the outpatient treatment of chronic venous insufficiency and its clinical symptoms. Patients and methods Cyclo 3 Fort is a quite new in Lithuania composite medicine containing Ruscus aculeatus, hesperidin and ascorbic acid. In some western countries it had a good approvement in the treatment of leg edema. There are retrospective data on 35 patients with chronic venous insufficiency (CVI). Twenty patients were treated with Cyclo 3 Fort for 4 weeks, and the other 15 patients for various reasons underwent physical examinations for venous circulation improvement in the same period. Leg edema was assessed by measuring the calf and ankle perimeters. Pain and leg discomfort was estimated by asking special questions. Results After four weeks all the study parameters (edema of legs, day and night cramps, discomfort, heaviness and parasthesias) were significantly better in the Cyclo 3 Fort group vs. the control group. Conclusion The use of phlebotonic Cyclo 3 Fort statistically significantly reduced the volume of the legs and symptoms of CVI. Keywords: chronic venous insufficiency, phlebotonics, oedema of the leg

Polysomnographic recordings and the Suggested Immobilization Test (SIT) are frequently used to support the clinical diagnosis of restless legs syndrome (RLS). The present study evaluated the discriminant power of 5 different parameters: (1) index of periodic leg movements during sleep (PLMS), (2) index of PLMS with an associated microarousal (PLMS-arousal), (3) index of PLM during nocturnal wakefulness (PLMW), (4) SIT PLM index and (5) mean subjective leg discomfort score during the SIT (SIT MDS) in 100 patients with idiopathic RLS and 50 healthy control subjects. Both groups differed significantly on each parameter studied. Furthermore, while the SIT PLM, the PLMS and the PLMS-arousal indices revealed a poor ability to discriminate patients from controls, the PLMW index and the MDS both showed high sensitivity (87 ± 7 and 82 ± 8, respectively) and specificity (80 ± 11 and 84 ± 10, respectively) for diagnosing RLS. The combination of these 2 parameters correctly classified 88% of all subjects with a sensitivity of 82% and a specificity of 100%.

This study examined the effect of customized insoles in relieving postwork discomfort in healthy individuals whose jobs require long periods of standing and walking. CompuSole insoles were worn by 122 New York City Police Department officers for up to 5 weeks for an average of 7 hours per day. The officers walked an average of 3 miles per day. Before the study, one-fifth of the police officers in this study experienced foot pain or discomfort at the end of their workday; 15% had calluses, corns, or athlete’s foot; 18% had sought treatment for a foot problem in the past; and 20% had worn foot orthoses. There was a significant reduction in tiredness in the feet at the end of the day after wearing the insoles, but no improvement in back or leg discomfort. At the end of the workday, 68% had less foot discomfort and 60% were more comfortable at work when wearing the insoles. (J Am Podiatr Med Assoc 91(10): 515-520, 2001)

A 20-year-old man had a 2-month history of progressive gait abnormality, leg discomfort, and “coldness.” He had immigrated 5 years earlier and worked at a meat-packing plant. There was a chin-on-chest deformity. MRI of the cervical spine showed a destructive process affecting multiple vertebral segments (figure …

Restless legs syndrome (RLS) is a common neurological sleep disorder in adults characterized by the following diagnostic criteria: an urge to move that is usually associated with unpleasant sensations and symptoms that are worse at rest, relieved by movement, and most severe at night. The definite diagnosis of RLS in children is stricter and consists of self-description of leg discomfort or the presence of 2 of 3 supportive criteria combined with 4 essential criteria for diagnosis in adults. RLS in childhood has often been misdiagnosed as growing pains or a part of normal development. As a result, physicians have often missed the chance for proper management. We diagnosed a case of RLS in a 5-year-old boy presenting with growing pains, whose mother was found to have had RLS since childhood. We confirmed RLS by using a polysomnograph, in which the indices of periodic limb movement syndrome (PLMS) and periodic limb movement during wakefulness (PLMW) were recorded to be compatible with RLS criteria. The patient‘s ferritin level was low normal, and his symptoms improved after taking iron supplements.

An unusual case of bilateral popliteal arteriovenous fistulas is reported. The patient reported right leg discomfort and swelling 1 month after multiple gunshot wounds to both legs; the left leg was asymptomatic. Arteriography demonstrated AV fistulas in both popliteal arteries. The importance of a high index of suspicion in making the diagnosis is emphasized.

A methodology of chair evaluation developed earlier was applied to a novel, forward-sloping chair. Two groups of six subjects each were trained to use the chair and then given an evaluation session of 2 1 2 h . The chair elicited mixed responses, with complaints of leg discomfort from terminal users and of entry and egress from typists. Overall, the chair was no better than conventional chairs and could be worse than well-designed conventional office chairs.

✓ Two cases of entrapment of the superficial peroneal nerve are presented. This is an unusual cause for leg discomfort and should be considered in the differential diagnosis of leg pain.