Lower Limbs

MDMA overdose as well as the concomitant consumption of selective serotonin reuptake inhibitors (SSRI) with other dmgs that exert serotoninergic effects (such as inhibitors of monoamine oxidase) can rapidly lead to the serotonin syndrome. Its symptoms, which are reversible upon cessation, of the drug include confusion, muscle rigidity in the lower limbs, and hyperthermia suggesting an acute reaction to serotonin overflow in the CNS. Blocking the function of SERT outside the brain causes side effects (e.g., nausea), which may be due to elevated 5HT however , impairment of transporter function is not equivalent to direct activation of 5HT recqrtors in causing adverse effects such as fibrosis and pulmonary hypertension. 

Diabetes mellitus is a complicated, chronic disorder characterized by either insufficient insulin production by the beta cells of die pancreas or by cellular resistance to insulin. Insulin insufficiency results in elevated blood glucose levels, or hyperglycemia As a result of the disease, individuals with diabetes are at greater risk for a number of disorders, including myocardial infarction, cerebrovascular accident (stroke), blindness, kidney disease, and lower limb amputations. 

Location Trunk in men Legs in women Upper back Trunk, head, neck Sun-exposed areas, face Palms of the hands, soles of feet, nail beds Head/neck trunk/lower limbs Backs of the hand, bare scalp, lips, ears... 

Acute exposure to certain organophosphate esters produces a slowly developing neuropathy in humans, OPIDN, that is functionally characterized by initial weakness and subsequent ataxia and paralysis in the lower limbs (8-14 days or longer, following exposure) (Ecobichon 1991 Johnson 1975 Murphy 1986). 

Signs and Symptoms High fever coughing thick nasal discharge rapidly spreading, deep ulceration of the nasal mucosa submaxillary lymph nodes swollen and painful nodules on the skin, abdomen, and lower limbs death in 1-2 weeks. In the cutaneous form, the lymphatics are enlarged and nodular abscesses ("buds") of 0.5-2.5 cm develop, which ulcerate and discharge yellow oily pus. 

Podoleanu C, Maggi R, Brignole M et al. (2006) Lower limb and abdominal compression bandages prevent progressive orthostatic hypotension in elderly persons a randomized single-blind controlled study. J Am Coll Cardiol 48(7) 1425-1432... 

Abe S, Tokizaki T, Miki Y, Tateishi A, Ogawa K, Nakano H, Matsushita T (2005) Hyperthermic isolated regional perfusion with CDDP for bone and soft-tissue sarcoma of the lower limb pharmacokinetics, thermal dose, toxicity, and feasibility. Cancer Chemotherapy and Pharmacology 56 55-62. 

Fig. 29. Thirteen-year-old boy with Duchenne Dystrophy, (a) The fat selective image shows a fatty degeneration of all muscles in a cross-section of the lower limb. The fat tissue is orientated in the direction of the muscle fibres, and is present between the fibres and in the septa, (b, c) The spectra from both volume elements indicated in (a) reveal signals from EMCL. Muscle specific metabolites (TMA and creatine) are clearly reduced and not visible in the proton spectra due to the reduction of muscle tissue in favour of adipose tissue.

Fig. 31. Twenty-year-old woman with glutaric aciduria type I. (a) The Ti weighted image shows normal findings for the cross-section of the lower limb. The volume element for spectroscopy was chosen in the soleus muscle, (b) The 7-fold magnification depicts a reduction of TMA. Although no fatty degeneration is visible on the image, the spectrum is dominated by EMCL.

Necrosis of cells may be the cause of other conditions that may be less obvious and less severe than the heart attack, bnt can still be the cause of considerable damage and pain. These include frostbite, in which blood supply to part of the lower limbs (especially fingers and toes) is restricted by extreme cold (vasoconstriction) so that oxygen supply is not snfficient to maintain normal rate of ATP generation in the cells in the skin and, in severe cases, the... 

Strychnine poisoning may also occur from dermal exposure. In one recent case report a women experienced marked pain in the lower limbs, dermal sensitivity, and stif iess in her jaw 24 hours after cleaning up a strychnine spill. Strychnine was confirmed in the plasma and urine by gas chromatography-mass spectrometry. ... 

With severe intoxication, lesions of the anterior horn cells and the pyramidal tracts may also occur. Muscular weakness may increase over a period of several weeks or months recovery may take months or years and in 25-30% of cases, permanent residual effects remain, usually confined to the lower limbs. Gait impairment, characterized by high steps and footdrop and permanent in some, was called Jake Walk. ... 

Even when administered by intramuscular or subcutaneous injection the rate of absorption of drugs from their site of administration varies, not only from individual to individual, but from site to site in the same subject (B13). For the few drugs studied in this way absorption and distribution was quicker and higher blood levels achieved when injections were given into upper rather than lower limbs and proximal to the trunk than distally. 

Then bring the entire lower limbs into attention, and after fixing them firmly in consciousness, let the Neophyte realize that these limbs are but instruments for physical progress—useful and important, but not indispensable to the being and reality of the... 

Type B effects are rare but should be recognized. They include oedema of the lower limbs (bromocriptine, amantadine), livedo reticularis (amantadine), diarrhoea (tolcapone, entacapone), paroxysmal hypertension and dysregulation of blood pressure control (selegiline), narcoleptic phenomena (pramipex-ole), and insomnia (all dopaminergic agonists). 

Aspirin and ticlopidine are used for their antiplatelet effect. They lower the risk of vascular recurrence by 27%. Asasantine (aspirin 50 mg - - dipyridamole 400 mg) lowers the risk by 37% (ESPS2). Clopidro-gel (75 mg) lowers the risk of recurrent vascular events after cerebral, cardiac or lower limb infarction by 8.7%. 

The first series of femoro-popliteal shunts, including 15 patients suffering a severe lower limb arterite (level III, even IV) and for whom the saphenous vein could not be used, was reported by Campbell in 1976 [20] the patency rate at 8 months was 87%. These ePTFE prostheses made surgeons very enthusiastic and at least one of them, Veith [21], argued in their favour through an impressive... 

Sauvanier, M., J. Constans, S. Sko-pinski et al. Lower limb occlusive arteriopathy retrospective analysis of 73 patients with onset before the age of 50 years. J Mai Vase 2002 27(2) 69-76. 

In veterinary medicine, isoxsuprine is used to treat navicular disease, which is a debilitating disease affecting the lower limbs of horses [45]. 

The structure of trauma injuries is given in Table 20.1. There were on average 1.5 injuries per injured person. The most common localization of injuries was in the lower limbs - 59.4%, of which shin - 47.4%, upper limbs and head - 25.0% each. The injuries with high lethality included injuries of the chest and abdominal cavities, and also pelvis, which were accompanied by a deep shock condition. 

Gracies JM, Singer BJ, Dunne JW The role of botulinum toxin injections in the management of muscle overactivity of the lower limb. Disabil Rehabil 2007 29 1789 [PMID 18033604]... 

---