Lower Limb Symptoms Research Articles

Percutaneous endoscopic lumbar discectomy: clinical and quality of life outcomes with a minimum 2 year follow-up

BackgroundPercutaneous endoscopic lumbar discectomy is a relatively new technique. Very few studies have reported the clinical outcome of percutaneous endoscopic discectomy in terms of quality of life and return to work.Method55 patients with percutaneous endoscopic lumbar discectomy done from 2002 to 2006 had their clinical outcomes reviewed in terms of the North American Spine Score (NASS), Medical Outcomes Study Short Form-36 scores (SF-36) and Pain Visual Analogue Scale (VAS) and return to work.ResultsThe mean age was 35.6 years, the mean operative time was 55.8 minutes and the mean length of follow-up was 3.4 years. The mean hospital stay for endoscopic discectomy was 17.3 hours. There was significant reduction in the severity of back pain and lower limb symptoms (NASS and VAS, p < 0.05) at 6 months and 2 years. There was significant improvement in all aspects of the Quality of Life (SF-36, p < 0.05) scores except for general health at 6 months and 2 years postoperation. The recurrence rate was 5% (3 patients). 5% (3 patients) subsequently underwent lumbar fusion for persistent back pain. All patients returned to their previous occupation after surgery at a mean time of 24.3 days.ConclusionPercutaneous endoscopic lumbar discectomy is associated with improvement in back pain and lower limb symptoms postoperation which translates to improvement in quality of life. It has the advantage that it can be performed on a day case basis with short length of hospitalization and early return to work thus improving quality of life earlier.

Clinical and Radiological Outcomes of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion

Prospective study. Comparison of clinical and radiologic outcomes of minimally invasive (MIS) versus Open transforaminal lumbar interbody fusion (TLIF). Open TLIF has been performed for many years with good results. MIS TLIF techniques have recently been introduced with the aim of smaller wounds and faster recovery. From 2004-2006, 29 MIS TLIF were matched paired with 29 Open TLIF. Patient demographics and operative data were collected. Clinical assessment in terms of North American Spine Society, Oswestry Disability Index, Short Form-36, and Visual Analogue scores were performed before surgery, 6 months and 2 years after surgery. Fusion rates based on Bridwell grading were assessed at 2 years. The mean age for MIS and Open procedures were 54.1 and 52.5 years, respectively. There were 24 females and 5 males in both groups. Fluoroscopic time (MIS: 105.5 seconds, Open: 35.2 seconds, P < 0.05) and operative time (MIS: 216.4 minutes, Open: 170.5 minutes, P < 0.05) were longer in MIS cases. There was less blood loss in MIS (150 mL) versus Open (681 mL) procedures (P < 0.05). The total morphine used for MIS cases (17.4 mg) was less compared to Open (35.7 mg, P < 0.05). MIS (4 days) patients have shorter hospitalization compared to Open (6.7 days, P < 0.05). Both MIS and Open groups showed significant improvement in Oswestry Disability Index (P < 0.05), back pain and lower limb symptoms (North American Spine Society and Visual Analogue scores, P < 0.05), and Quality of Life scores (Short Form-36, P < 0.05) at 6 months and 2 years, but there was no significant difference between the 2 groups. Eighty percent of MIS and 86.7% of Open TLIF levels achieved grade 1 fusion (P > 0.05). MIS TLIF has similar good long-term clinical outcomes and high fusion rates of Open TLIF with the additional benefits of less initial postoperative pain, early rehabilitation, shorter hospitalization, and fewer complications.

Iliac Artery Compression in Cyclists: Mechanisms, Diagnosis and Treatment

To review the mechanisms, diagnosis and treatment options for symptomatic iliac artery compression in cyclists. Pubmed, Medline, Embase and Google were searched using combinations of the terms 'iliac artery disease', 'iliac artery compression', 'iliac artery stenosis', 'cyclists' and 'athletes'. Tethering of the iliac artery by the psoas arterial branch and fibrous tissue, and muscular hypertrophy predispose the vessel to kinking and compression during cycling. Symptoms may only be present on maximal exercise in the cycling position. Provocative exercise tests using a cycling ergometer with ankle brachial pressure index measuring has a sensitivity of 85% to detect arterial insufficiency. Magnetic resonance imaging is increasingly being used as the investigation of choice to confirm the diagnosis, although digital subtraction angiography and colour duplex ultrasonography may also help. Conservative measures including adjustments to the cycling posture and bicycle setup should be recommended to all patients. The evidence for surgical and endovascular treatments is limited and the use of prosthetic graft should be avoided. Iliac artery compression should be recognised as an important differential diagnosis in competitive cyclist presenting with lower limb symptoms. Although the optimal treatment strategy remains unclear, early diagnosis may reduce unnecessary investigations, and enable the cyclist to make appropriate adjustments and decisions in treatment management.

Deep venous thrombosis in gynecological oncology: Incidence and clinical symptoms study

Objective Cancer patients have increased risks of leg deep venous thrombosis (DVT). We studied the incidence, risk factors and most predictive symptoms of leg DVT in gynecologic oncology patients. Study designs Gynecologic oncology patients with any leg DVT symptoms were recruited and screened using Doppler sonogram. All hospitalized surgery and non-ambulating patients received thigh-high sequential compression devices (SCDs) without heparin as a prophylactic method against thrombosis. Statistical analysis was done using chi-square or Fisher's exact tests. Results Out of 1974 patients, 134 complained of lower limb symptoms. Doppler studies found 38 patients with leg DVT. Incidence of leg DVT was 36/853 (4.2%) in patients with cancer and 2/1121 (0.2%) in patients without cancer (odds ratio 2.8 with a diagnosis of cancer). Leg edema, erythema, fever, and warm leg were significant symptoms in diagnosing leg DVT ( p < 0.01). The cost of finding a leg DVT was $747.54. Conclusions Clinical exam is less accurate than Doppler sonogram in diagnosing leg DVT. The incidence of leg DVT using SCD seems to be comparable with other studies. Finally, the cost of identifying leg DVT seems reasonable.

Analysis in related factors of deep vein thrombosis formation in diabetic patients and the nursing strategy

Objective To study the related factors in diabetic patients with lOwer extremital deep vein thrombosis(DVT) and the nursing strategy. Methods 58 diabetic cases underwent lower limbs 99mTc-MAA veins imaging and/or ultrasunography. The related laboratory data such as fasting plasma glucose(FPG),blood cholesterol, blood triglycerides and clinic informations such as age, disease courses, lower limbs symptoms (swelling, erooted veins and diabetic foot) and acute complication (diabetic ketoacidosis and hyperosmolar non ketotic diabetic coma) were collected simultaneously. The relationship of each factors with DVT incidence were analyzed. Results 28 patients (48.3%) complicated with lower limbs DVT. The DVT incidence was signifi-cantly different among patients with different age, disease courses, FPG, blood cholesterol, blood triglycerides, lower limbs symptoms and acute complication, respectively. No significant difference was seen in patients with different blood pressure, body weight index, diabetes type. Conclusions Various dangerous factors accumu-lating in DM such as old age, long disease courses, high FPG, high blood cholesterol and high blood triglyc-erides contribute to the high incidence of lower limbs DVT. Early intervention, comprehensive treatment and in-tensive nursing should be applied to reduce the incidence of DVT. Key words: Diabetes mellitns; Deep vein thrombosis; Related factors; Nursing strategy

A mass in the fourth ventricle

A 53-year-old man with a history of testicular carcinoma treated by orchidectomy presented with a sudden onset left facial droop and left upper limb weakness that lasted for 4 days. He denied any speech difficulty, lower limb symptoms, seizures, urinary or bowel symptoms. On examination he was alert and orientated, with an occasional head-bobbing tremor. There was mild flattening of the left nasolabial fold, with the remainder of his neurological examination normal. Basic blood investigations were unremarkable. His MRI is shown in Fig. 1, Fig. 2. The tumour was completely removed by a posterior fossa craniotomy. Fig. 2T2-weighted fast spin echo axial MRI showing 1.3 cm hyperintense lobulated lesion in the inferior aspect of the fourth ventricle compressing the posterior aspect of the medulla oblongata. The lesion did not enhance with contrast. View Large Image Figure Viewer Download Hi-res image A mass in the fourth ventricleJournal of Clinical NeuroscienceVol. 16Issue 3PreviewB. Subependymoma. Full-Text PDF

The Effect of Electrical Stimulation of the Pudendal Nerve on Sciatic Nerve Blood Flow in Animals

To investigate the mechanism of the clinical effect of electroacupuncture of the pudendal nerve on the lumbar and lower limb symptoms caused by lumbar spinal canal stenosis, we studied changes in sciatic nerve blood flow during electrical stimulation of the pudendal nerve in the rat. METHODS Using rats (n=5), efferent electrical stimulation to the pudendal nerve was performed and sciatic nerve blood flow was measured with laser Doppler flowmetry. Simultaneously, changes in the blood pressure and cardiac rate were measured. Furthermore, the effect of atropine on these responses to the stimulation was also studied. Electrical stimulation of the pudendal nerve significantly increased blood flow in the sciatic nerve transiently without increasing heart rate and systemic blood pressure. The significant increase in the sciatic nerve blood flow disappeared after administration of atropine. Electrical stimulation of the pudendal nerve causes a transient and significant increase in sciatic nerve blood flow. This response is eliminated or attenuated by administration of atropine, indicating that it occurs mainly via cholinergic nerves.

Pudendal Nerve Electroacupuncture for Lumbar Spinal Canal Stenosis – a Case Series

To investigate the effectiveness of pudendal nerve electroacupuncture for lumbar and lower limb symptoms in patients with lumbar spinal canal stenosis for whom acupuncture of the lumbar and lower limb muscles had been ineffective. Nine patients with lumbar spinal canal stenosis for whom conventional acupuncture at the lumbar and lower limb muscles had no effect. Pudendal nerve electroacupuncture was performed eight times (once per week). VAS scores and continuous walking distance were used to evaluate changes in symptoms. The following changes in symptoms occurred after pudendal nerve electroacupuncture: low back pain was improved from 45.3+/-17.4mm (mean +/- SD) to 39.2+/-14.0mm, lower limb pain was improved from 61.1+/-5.6mm to 35.4+/-11.9mm, lower limb dysaesthesia was improved from 63.9+/-8.4mm to 46.9+/-16.2mm, and continuous walking distance was improved from 100.0+/-35.4m to 250.0+/-136.9m. Conclusion Pudendal nerve electroacupuncture may be an effective treatment for lumbar and lower limb symptoms due to spinal canal stenosis, and is potentially useful in patients who have not responded to conventional acupuncture.

'Idiopathic' torticollis: have you ruled out a spinal tumour?

A 70-year-old woman presented with a 6-month history of progressive torticollis accompanied by low back pain and mild lower limb weakness (Figure 1). Apart from grade IV power and diminished reflexes in the lower limbs, her neurological examination was normal. Plain X-rays and magnetic resonance scan of the cranio-cervical junction and cervical spine did not detect any significant abnormality apart from age-related degenerative changes. The torticollis was thus thought to be idiopathic in aetiology. However, in view of her lower limb symptoms, a magnetic resonance scan of the lumbar spine was performed which revealed an intradural extramedullary tumour opposite the L1 and L2 vertebrae (Figure 2). Following excision of the tumour (schwannoma), her symptoms improved gradually. Nine months later, not only was she pain free and walking independently, but the torticollis had also reversed remarkably (Figure 3).

Degenerative Lumbar Spinal Stenosis – Current Strategies in Diagnosis and Treatment

Although the aging of the population is causing a dramatic rise in the incidence of lumbar spinal stenosis, the indications and options for surgical treatment are not clearly defined. In an attempt to aid clinical decision making, a selective literature review was conducted, taking into account the guidelines of the Association of the Scientific Medical Societies in Germany (AWMF). In degenerative lumbar spinal stenosis hypertrophy of the facet joints and yellow ligaments brings about constriction of the spinal canal, leading to back pain and activity-dependent lower limb symptoms (neurogenic claudication). If conservative treatment fails, an imaging study, usually magnetic resonance imaging, is required. In the case of severe symptoms the progressive underlying degeneration necessitates surgical treatment. Minimally invasive fenestration techniques are usually employed to decompress the spinal canal; in the presence of instability, fusion is indicated. Despite the proven superiority of surgery in the management of refractory lumbar spinal stenosis, there is a lack of evidence-based data regarding the different surgical treatment options. The evaluation of modern, minimally invasive techniques is thus difficult.

Musculoskeletal Disorders in Referrals for Suspected Lumbosacral Radiculopathy

An electrodiagnostic evaluation is often requested for patients with suspected lumbosacral radiculopathy. Although musculoskeletal disorders can produce lower-limb symptoms, their prevalence in this referral population is unknown. The purpose of this study was to determine the prevalence of common lower-limb musculoskeletal disorders in patients referred for lower-limb electrodiagnosis and determine whether these findings predict study outcome. Subjects undergoing an electrodiagnostic study for lower-limb symptoms and suspected lumbosacral radiculopathy constituted the sample. A standardized clinical and electrodiagnostic evaluation was performed for all patients. There were 170 subjects included. The mean age was 52 (SD = 17), and 45% were males. The total prevalence of musculoskeletal disorders in the sample was 32%. The prevalence in those with a normal study was 55% as compared with 21% in those with lumbosacral radiculopathy (P < 0.0001). Musculoskeletal disorders are common in patients suspected of having lumbosacral radiculopathy. The high prevalence among both patients with normal studies and those with radiculopathy and other disorders limits the usefulness of this information in predicting study outcome. In particular, it is common for patients to have two or more problems and the presence of a musculoskeletal disorder should not preclude such testing.

Effect of Chronic Venous Insufficiency on Activities of Daily Living and Quality of Life: Correlation of Demographic Factors With Duplex Ultrasonography Findings

The study evaluates to what extent symptoms of chronic venous insufficiency (CVI) and functional venous incompetence as investigated using color-coded duplex ultrasonography may interfere with activities of daily living (ADLs). This study comprises a cross-sectional survey conducted in urban areas surrounding 24 Italian cities. A spontaneous sample of 5,187 subjects (4,457 women [mean age, 54 years] and 730 men [mean age, 61 years]), selected by advertising on television and in newspapers, underwent a clinical examination that included duplex ultrasonography in 3 vein segments in both legs to determine the presence and severity of venous reflux. Subjective perception of lower limb symptoms of CVI and the effect of leg problems on the ability to perform normal ADLs are assessed by means of a self-administered questionnaire. Most of the respondents have some CVI symptoms, with women being 1.5 to 3 times as likely as men to report leg symptoms. The risk of developing the most frequent subjective symptoms such as heaviness and tiredness in the legs is not statistically significantly different for younger subjects compared with older subjects. Advanced age is considered to be a relevant risk factor only for heat sensation and swollen legs. Persons living in southern Italy are at higher risk of almost all lower limb symptoms. Results of duplex ultrasonography performed on 3875 subjects show that fewer than 1 in 5 young persons, regardless of sex, manifest some degree of venous reflux (primarily mild symptoms). The risk of developing venous incompetence increases rapidly with age until it triples among subjects 50 years and older. Adjusting for all other factors, men are on average 1.5 times as likely as childless women to have venous reflux, and the risk increases in the case of family history of CVI or (among women) in the case of past pregnancies. More women than men report that their leg problems affect their ADLs. Pregnancy and living in the south contribute to a reduction in the ability to perform most heavy housework. Although milder lower limb symptoms such as evening heaviness and tiredness in the legs may begin early in life, venous reflux and related symptoms of heat sensation and swollen legs become more pronounced with age, and their severity can be disabling for those afflicted.

A clinical longitudinal evaluation of pre-fabricated, semi-rigid foot orthoses prescribed to improve foot function

Background Custom-made foot orthoses whilst effective can be expensive and time-consuming to manufacture making ready made devices an attractive option. This study, with follow up after 12 months provides longitudinal data not frequently available. Objectives Longitudinal evaluation of the efficacy of a slim, ready made, 3/4th length semi-rigid foot orthosis. Method Data was collected from 21 participants at baseline, at 4 weeks and via postal questionnaire after 12 months. Powerstep orthoses (Cuxson-Gerrard & Co Ltd., Oldbury, UK) were given to participants with the therapeutic aim of resolving or reducing their lower limb symptoms. Results Participants reported an initial marked decrease in foot pain, found the orthoses fitted in footwear readily, had a sense of increased foot stability and a significant improvement in comfort ( p < 0.0001). Some increase in pain levels reported after 4-weeks ( p = 0.01), was accompanied by an equally significant increase in mobility ( p = 0.01) which triangulated closely against diary records. After a mean of 15.1 months, 73% of participants still found the orthoses beneficial. Conclusion Participants found ready made orthoses enhanced sense of stability and generally reduced symptoms over a period of at least 1 year.

Acupuncture Treatment for Low Back Pain and Lower Limb Symptoms—The Relation between Acupuncture or Electroacupuncture Stimulation and Sciatic Nerve Blood Flow

To investigate the clinical efficacy of acupuncture treatment for lumbar spinal canal stenosis and herniated lumbar disc and to clarify the mechanisms in an animal experiment that evaluated acupuncture on sciatic nerve blood flow. In the clinical trial, patients with lumbar spinal canal stenosis or herniated lumbar disc were divided into three treatment groups; (i) Ex-B2 (at the disordered level), (ii) electrical acupuncture (EA) on the pudendal nerve and (iii) EA at the nerve root. Primary outcome measurements were pain and dysesthesia [evaluated with a visual analogue scale (VAS)] and continuous walking distance. In the animal study, sciatic nerve blood flow was measured with laser-Doppler flowmetry at, before and during three kinds of stimulation (manual acupuncture on lumber muscle, electrical stimulation on the pudendal nerve and electrical stimulation on the sciatic nerve) in anesthetized rats. For the clinical trial, approximately half of the patients who received Ex-B2 revealed amelioration of the symptoms. EA on the pudendal nerve was effective for the symptoms which had not improved by Ex-B2. Considerable immediate and sustained relief was observed in patients who received EA at the nerve root. For the animal study, increase in sciatic nerve blood flow was observed in 56.9% of the trial with lumber muscle acupuncture, 100% with pudendal nerve stimulation and 100% with sciatic nerve stimulation. Sciatic nerve stimulation sustained the increase longer than pudendal nerve stimulation. One mechanism of action of acupuncture and electrical acupuncture stimulation could be that, in addition to its influence on the pain inhibitory system, it participates in causing a transient change in sciatic nerve blood blow, including circulation to the cauda equine and nerve root.

Chronic Venous Insufficiency in Italy: The 24-cities Cohort Study

ObjectiveTo assess the relationship between sex, age, geographical region, lower limb symptoms and the presence of trunk varicose veins and venous incompetence. DesignCross-sectional population study in 24 cities in the North, centre and South of Italy. ParticipantsFive thousand two hundred and forty-seven people were selected during spring and summer 2003 by advertising on television, in newspapers, and by leaflets in 24 Italian cities. In all 5187 (4457 [85.9%] women and 730 men [14.1%]) volunteers were assessed. The median age was 54 (range: 18–90) years for the women and 61 (range: 18–89) years for the men. MethodsSelf-administered questionnaire on subjective symptoms of chronic venous insufficiency (CVI) in the lower limbs, and clinical examination, including colour duplex ultrasonography to assess the presence and severity of varicose veins. ResultsOverall only 22.7% of the subjects examined were free of visible signs of venous disease, with approximately 53% of the population over 50 years of age showing some venous reflux. People living in Southern Italy were more severely affected than those living in the North. Varicosities and telangiectases were the most frequent objective signs in both sexes. Trunk varicosities (27%) and saphenous reflux (41%) increased with age and were more common in men; in contrast, minor objective symptoms such as telangiectases (70%), as well as subjective symptoms such as heavy (79%) and tired legs (78%), were more common in women and were not age-related. ConclusionsVenous disease is very common in Italy, in particular in people living in the South. A correlation between varicose veins and venous incompetence is more marked in men, while minor objective and subjective symptoms prevail in women. The findings from this non-random sample closely match results from previous studies, in which random sampling was used.

IS SYMPTOMATOLOGY USEFUL IN DISTINGUISHING BETWEEN CARPAL TUNNEL SYNDROME AND CERVICAL SPONDYLOSIS?

Hand paraesthesia is a common symptom found in patients either with carpal tunnel syndrome or cervical spondylosis. To differentiate between the two conditions, it is important to identify additional diagnostic symptoms. Ninety-two patients with operated carpal tunnel syndrome and 138 patients with spinal surgery for cervical spondylosis were reviewed. After exclusion of cases co-morbid with both cervical spondylosis and carpal tunnel syndrome or other neurological disorders, 44 patients with carpal tunnel syndrome and 41 patients with cervical spondylosis were compared. There were significant differences in the symptomatology between the two groups. In carpal tunnel syndrome, 84% had nocturnal paraesthesia, 82% hand paraesthesia were aggravated by hand activity, and hand pain occurred in 64%. The incidences were only 10%, 7% and 10%, respectively in cervical spondylosis. Neck pain was present in 76% of cervical spondylosis but only in 14% of carpal tunnel syndrome, and lower limb symptoms were present in 44% of cervical spondylosis and only 9% in carpal tunnel syndrome.

Skin denervation in type 2 diabetes: correlations with diabetic duration and functional impairments.

Sensory neuropathy is a prominent component of diabetic neuropathy. It is not entirely clear how diabetes influences skin innervation, and whether these changes are correlated with clinical signs and laboratory findings. To investigate these issues, we performed skin biopsies on the distal leg of 38 consecutive type 2 diabetic patients with sensory symptoms in lower limbs (25 males and 13 females, aged 56.2 +/- 9.4 years) and analysed the correlations of intraepidermal nerve fibre (IENF) densities in skin with glycaemic status (duration of diabetes, HbA1C, and fasting and post-prandial glucose levels), and functional parameters of small fibres (warm and cold thresholds) and large fibres (vibratory threshold and parameters of nerve conduction studies). Clinically, 23 patients (60.5%) had signs of small-fibre impairment, and 19 patients (50.0%) had signs of large-fibre impairment. IENF densities were much lower in diabetic patients than in age- and gender-matched controls (1.794 +/- 2.120 versus 9.359 +/- 3.466 fibres/mm, P < 0.0001), and 81.6% (31/38) of diabetic patients had reduced IENF densities. IENF densities were negatively associated with the duration of diabetes (standardized coefficient: -0.422, P = 0.015) by analysis with a multivariate linear regression model. Abnormal results of functional examinations were present in 81.6% (warm threshold), 57.9% (cold threshold), 63.2% (vibratory threshold) and 49% (amplitude of sural sensory action potential) of diabetic patients. Among the three sensory thresholds, the warm threshold temperature had the highest correlation with IENF densities (standardized coefficient: -0.773, P < 0.0001). On nerve conduction studies in lower-limb nerves, there were abnormal responses in 54.1% of sural nerves, and 50.0% of peroneal nerves. Of neurophysiological parameters, the amplitude of the sural sensory action potential had the highest correlation with IENF density (standardized coefficient: 0.739, P < 0.0001). On clinical examination, 15 patients showed no sign of small-fibre impairment, but seven of these patients had reduced IENF densities. In conclusion, small-fibre sensory neuropathy presenting with reduced IENF densities and correlated elevation of warm thresholds is a major manifestation of type 2 diabetes. In addition, the extent of skin denervation increases with diabetic duration.

Abstracts of the 8th Meeting of the Italian Peripheral Nerve Study Group: 60

Brachial amyotrophic diplegia (BAD) is defined the isolated upper limb weakness attributed to neurogenic atrophy, sparing lower extremity, respiratory and bulbar muscles. Although such phenotypes may be seen in number of conditions, previous reports pointed out that the label of BAD should refer to any patient with slowly and nonprogressive neurogenic atrophy of upper limbs remaining stable at least 18 months after initial presentation 50 year old man with unremarkable past history noticed after minor cervical spine trauma progressive weakness and wasting of left shoulder and arm which was followed within few months by gradual involvement of contralateral in relatively symmetric pattern. There were no symptoms in lower limbs, neck, bulbar muscles nor sphincter disturbances. On examination, patient exhibited a peculiar posture of both hands hanging loosely at his sides. There were fasciculations and atrophy of upper limb muscles. Reflexes could not be elicited in upper extremities but they were normal in the lower. Cranial nerves and sensory examination were unremarkable. Routine blood tests and search for GM1 antibodies were negative, whereas CK was found mildly elevated ( 361 mU/ml). Test for HIV‐1 was positive with RNA level of 144.920 copies/ml and CD4 count 403/mm3. Electrophysiology showed in both sides low amplitude of compound muscle action potentials, mildly reduced velocity without evidence of conduction block or of temporal dispersion. Sensory conduction study was normal. On EMG, there was loss of motor units, acute and chronic neurogenic changes. Cervical MRI was normal. Patient neurological disability did not show progression. The case reported exhibits the following notable aspects: clinical and electrophysiological abnormalities fully restricted to upper limbs, lack of significant demyelinating features as well as of GM1 antibodies, absence of clinical signs related to immunosuppression due to HIV‐1 infection.

Effects of Compression Hosiery in Female Workers with a Standing Profession

Objective: To evaluate the effect of compression hosiery during standing work. Design: An open study, comparing symptoms and plethysmographic findings before and after treatment. Setting: University hospital, vascular surgery. Subjects: Forty-eight female volunteers with a standing profession. Methods: Visual analogue scale to evaluate symptoms and foot volumetry to study venous function before and after 4 weeks use of compression hosiery (20–30 mmHg). Result: All scores for symptoms were significantly reduced after treatment. Only 21% of the study subjects had minor abnormalities on foot volumetry. The expelled volume was significantly higher after work at 4 weeks than at the first measurement at inclusion, while the refilling rate was significantly lower after work at 4 weeks than at the corresponding measurement at inclusion. Conclusion: Symptomatic improvement was recorded after compression treatment. Limited effects were seen with the objective measurement, although the most important factor, the refilling rate, diminished significantly during the treatment period. Compression treatment reduces lower limb symptoms following standing work.

Early symptom progression rate is related to ALS outcome: a prospective population-based study.

To define the factors related to ALS outcome in a population-based, prospective survey. The 221 patients (120 men and 101 women) listed in the Piemonte and Valle d'Aosta ALS Register between 1995 and 1996 were enrolled in the study. The patients were prospectively monitored with a standard evaluation form after diagnosis. Mean age at onset was 62.8 (SD = 11.2) years. According to El Escorial diagnostic criteria (EEDC), 112 patients had definite ALS, 85 probable ALS, 18 possible ALS, and six suspected ALS. The median survival time from symptom onset was 915 days (95% CI = 790 to 1065). The median survival time from diagnosis was 580 days (95% CI = 490 to 670). In univariate analysis, outcome was significantly related to age, onset site, EEDC classification, and symptom progression rate (i.e., the rate of decline of muscle strength and bulbar and respiratory function in the 6 months after diagnosis). In the Cox multivariate model, age, progression rate of respiratory, bulbar, and lower limb symptoms, EEDC classification, percutaneous endoscopic gastrostomy, and treatment with riluzole were significantly related to outcome. The rate of progression of symptoms in early ALS is predictive of disease outcome.