scholarly journals Maintenance of the Results of Stage II Lower Limb Lymphedema Treatment after Normalization of Leg Size

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Jose Maria Pereira de Godoy ◽  
Henrique Jose Pereira de Godoy ◽  
Renata Lopes Pinto ◽  
Fernando Nestor Facio ◽  
Maria de Fatima Guerreiro Godoy
Keyword(s):  
Lower Limbs ◽  
Stage Ii ◽  
Volume Control ◽  
Compression Stockings ◽  
Elastic Compression ◽  
Custom Made ◽  
Elastic Stockings ◽  
Baseline Values ◽  
Post Hoc ◽  
Better Than

Objective. The aim of this study was to identify strategies to transfer responsibility of the maintenance of the results of lymphedema treatment to the patient. Methods. Maintenance of the reduction of edema was evaluated in a prospective clinical trial in patients with Stage II leg lymphedema. Twenty-one lymphedematous lower limbs were evaluated in Clínica Godoy in 2014 and 2016. The evaluation was done by volumetry at baseline and weekly thereafter for volume control. Patients wore Venosan® cotton 20/30 and 30/40 mmHg elastic compression stockings followed by a custom-made inelastic stocking made of grosgrain fabric. The Friedman test for multiple comparisons and Conover post hoc test were used for statistical analysis with an alpha error of 5%. Results. On comparing leg volume changes using the different types of stockings, the 20/30 mmHg elastic compression stockings failed in the first week to maintain the volume reductions but the 30/40 mmHg compression stockings did not allow significant increases in volume (p value > 0.05). During one week, the grosgrain stocking reduced leg volumes to baseline values (p value = 0.24). Conclusion. Higher compression of elastic stockings is better than lower compression but the inelastic grosgrain stocking is even better than both to maintain the results.

scholarly journals Elastic compression treatment of chronic superficial venous insufficiency of the lower limbs based on Doppler venous pressure index measurements

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Leonardo Corcos ◽  
Daniele Pontello ◽  
Tommaso Spina
Keyword(s):  
Venous Insufficiency ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Lower Limbs ◽  
Compression Stockings ◽  
Elastic Compression ◽  
Pressure Index ◽  
Counter Pressure ◽  
The Difference ◽  
Compression Treatment

Ineffectiveness or discomfort from graduated elastic compression stockings (GES) in patients with chronic venous insufficiency (CVI) and/or varicose veins of the lower limbs (VVLL) can depend of inappropriate counter pressure applied. Counter pressure was calculated by Doppler venous pressure index (VPI). The aim of this study was to verify the value VPI in the choice of GES. A total of 1212 LL of 606 patients subjected to VPI measurements VPI correlated with the various sites of reflux (R) and C of Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification. The difference between standing VPI the and normal values=counter pressure to be applied by GES. Questionnaire to 96 patients with CVI/VVLL wearing GES. Mean VPI values: greater saphenous (GSV)>smaller saphenous; GSV with isolated venous reflux (R) at the leg>GSV at the thigh; additional R in perforators increases VPI in all the districts; superficial R increases VPI in PT. Relation between VPI/C of CEAP: P<0.05-0.0001; 81/83/96 (97.5%) patients improved; 0 complained. R in GSV at the leg and in perforators increases VPI in deep veins. Few discrepancies VPI/CEAP can be expected. Standing VPI is highly predictive. The best choice of GES can be based on the VPI measurement.

scholarly journals Synergistic Effect of Adjustments of Elastic Stockings to Maintain Reduction in Leg Volume after Mechanical Lymph Drainage

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
José Maria Pereira de Godoy ◽  
Renata Lopes Pinto ◽  
Ana Carolina Pereira de Godoy ◽  
Maria de Fátima Guerreiro Godoy
Keyword(s):  
Clinical Trial ◽  
Synergistic Effect ◽  
Randomized Clinical Trial ◽  
Compression Stockings ◽  
Lymph Drainage ◽  
Elastic Compression ◽  
Elastic Stockings ◽  
Grade Ii

The objective of the present study was to evaluate the effect of elastic compression stockings on volumetric variations of lymphedematous limbs between mechanical lymph drainage sessions. Eleven patients with Grade II leg lymphedema, regardless of etiology, were evaluated in a randomized clinical trial. The ages ranged from 47 to 83 years old with a mean of 62.4 years. Participants were submitted to mechanical lymph drainage (RAGodoy) associated with adjusted and unadjusted knee-high elastic compression stockings (20/30 Venosan). The effect of these stockings on the maintenance of volumetric reductions between sessions of lymph drainage was assessed. In all, 33 evaluations were carried out, 18 of patients using well-adjusted stockings and 15 with badly-adjusted stockings. The differences in volumes were significant (unpairedt-test;P-value < 0.0001). Adjusting the compression provided by elastic stockings according to the size of the leg has a synergistic effect in reducing volume during mechanical lymph drainage.

Compression Therapy: European Regulatory Affairs

2000 ◽  
Vol 15 (3-4) ◽  
pp. 182-187 ◽  
Author(s):  
H. A. M. Neumann
Keyword(s):  
Medical Devices ◽  
Medical Profession ◽  
University Hospital ◽  
Residual Pressure ◽  
Elasticity Coefficient ◽  
Compression Stockings ◽  
Durability Test ◽  
Elastic Compression ◽  
Regulatory Affairs ◽  
Custom Made

Objective: Updating the status of the European standardisation for medical elastic compression stockings, including custom-made stockings (class 030606, EN29999), knitted from threads made of natural fibres or synthetic fibres and elastic threads. Design: Review of the literature. Setting: Department of Dermatology at the University Hospital of Maastricht (The Netherlands). Methods: Systematic review of the European regulations within the European Committee for Standardisation (CEN), by a special committee researching non-active medical devices (CEN/TC205). A special working group was set up for medical elastic compression stockings (CEN/TC205/WG2) and for anti-embolism stockings (CEN/TC205/WG2/P1) linked to the scientific background and literature on medical elastic compression stockings. Results: CEN/TC205 formalised a European prestandard (prEN12718) for medical elastic compression stockings. The pre-standard describes five compression classes, instructions for measurement, instructions for residual pressure and instructions for knitting. Still lacking is a good instrument for the comparison of laboratory measurements and a durability test. The problem of the elasticity coefficient is neglected in the standard. Conclusions: Normalisation of non-active medical devices is an important quality instrument. The medical profession should give attention to adequate compression classes, a good understanding of the elasticity coefficient and the durability of stockings.

Compression therapy and pressure in the deep venous system

2003 ◽  
Vol 18 (4) ◽  
pp. 192-197 ◽  
Author(s):  
J C J M Veraart ◽  
T K Oei ◽  
H A M Neumann
Keyword(s):  
Venous Insufficiency ◽  
Venous Pressure ◽  
Venous System ◽  
Rank Test ◽  
Class Iii ◽  
Compression Stockings ◽  
Elastic Compression ◽  
Deep Venous System ◽  
Strong Compression ◽  
Elastic Stockings

Objectives: To evaluate the effect of five different elastic compression stockings on the venous pressure in the deep venous system in the supine and standing positions. Methods: Setting: Departments of Dermatology and Radiology, University Hospital Maastricht, The Netherlands. Patients: A total of eight limbs of seven subjects (five patients and two healthy volunteers) with a mean age of 53 years (range 33-79) were measured. The patients were known to have severe venous insufficiency and recurrent leg ulceration. A catheter connected to an external pressure transducer was placed in one of the deep veins of the lower leg after puncturing the popliteal vein. The position of the catheter was established with contrast medium. Venous pressure recordings were made in the supine and standing positions while wearing an anti-embolism stocking and while wearing four different compression stockings (class II and III). Results: All stockings worn in the supine position caused a significant increase in pressure when compared with no compression at all ( P <0.05; Wilcoxon rank test). Only the strong compression class III stockings caused a significant and clinically relevant pressure increase, compared with the other four elastic compression stockings ( P <0.05; Wilcoxon rank test). In the standing position no differences in pressure were found between the elastic stockings, or when any stocking was compared with the use of no stocking at all. Conclusions: The results demonstrate that only strong compression class III stockings (>40 mmHg at the ankle) increase the pressure in the deep venous system in the supine position. Because of this, these elastic stockings may be the only stockings that have a positive influence on the pathologic deep venous system in patients with deep venous insufficiency, such as after deep venous thrombosis. The study confirms earlier clinical observations that in the treatment of patients with post-thrombotic symptoms and deep venous insufficiency only strong elastic compression stockings are effective.

Clinical effectiveness of bioflavonoids in the treatment of secondary lower limb lymphedema

2021 ◽  
Vol 29 (2) ◽  
pp. 245-250
Author(s):  
Roman E. Kalinin ◽  
Igor A. Suchkov ◽  
Denis A. Maksaev
Keyword(s):  
Lower Limb ◽  
Adverse Reactions ◽  
Clinical Effectiveness ◽  
Lower Limbs ◽  
Compression Stockings ◽  
Secondary Lymphedema ◽  
Elastic Compression ◽  
Positive Clinical Effect ◽  
Micronized Purified Flavonoid Fraction ◽  
Flavonoid Fraction

AIM: This study aimed to investigate the effectiveness of the application of a combination of the preparation of micronized purified flavonoid fraction (MPFF) and elastic compression in patients with acquired lymphostasis. MATERIALS AND METHODS: Sixty patients with stage II secondary lower limb lymphedema according to М. Foeldi were included. The patients were divided into two groups through randomization with the envelope method. The first group (n = 30) was subjected to a conservative treatment (MPFF, 1000 mg/day) coupled with elastic compression (3rd class compression stockings). The second group was given compressive therapy (third-class compression stockings). The patients were physically examined through the measurement of the circumference of the limb at different levels. RESULTS: In the first group, the circumference of the lower third of the shin decreased by 8.15% (p = 0.005) after 1 month and by the end of treatment by 10.6% (p 0.001), of the middle third of shin by 3.15% (p = 0.001) and 4.78% (p 0.001), and of the upper thirdby 4.08% (p 0.001) and 5.99% (p 0.001). By the end of the observation period (3 months), the circumference of the lower third of the shin in the second group (29.68 4.67 cm) was significantly greater than that in the first group (26.65 2.92 cm, p = 0.035). No adverse reactions were observed in the MPFF group. CONCLUSIONS: The volume of the lower limbs of patients with acquired lymphedema decreased after using a combination of MPFF and elastic compression to a larger extent than after the isolated use of elastic compression. Patients taking MPFF had a positive clinical effect without adverse reactions. Therefore, MPFF could be used in the pharmacotherapy of secondary lymphedema of the lower limbs.

Evaluation of a Novel Class 2 Graduated Elastic Compression Garment Compared to a Gold Standard Compression Garment

2020 ◽  
Author(s):  
Katerina Morgaenko ◽  
Aditya Sharma ◽  
Nishaki Mehta ◽  
Daniel Quinn
Keyword(s):  
Patient Compliance ◽  
Standing Position ◽  
Attractive Alternative ◽  
Application Time ◽  
Compression Garment ◽  
Compression Stockings ◽  
Elastic Compression ◽  
Qualitative Feedback ◽  
Elastic Stockings ◽  
And Control

Abstract Background: Graduated elastic compression stockings are a frequently prescribed therapy for cardiovascular conditions with established benefit. However patient compliance remains low owing to significant difficulty donning the device, discomfort and poor fit. Based on end-user feedback, a novel compression device (CompressRite CR) to facilitate one handed application with minimal use of upper extremity strength was compared to Jobst stocking (Control). Methods: An open, prospective, single-center study was done in in volunteers and in-patients. Study subject’s lower extremities were clinically classified by a blinded vascular specialist. Pressure readings were obtained using a pressure sensor in standing position every 5 minutes during two 30-minute sessions using CR and Control. Results: Ninety study subjects (82 healthy volunteers, 8 in-patients, 34% males, 66% females, 70% White, 22% African American, %7 Asian, 1% Hispanic) completed the study. Clinical vascular classification revealed 31% C0, 18% C3, 16% C1, 7% C2, 4% C4 and 22% unclassified. CR performed similar to Control in terms of pressure delivery. Calf circumference was not impacted by pressure sessions in both groups. Application time of CR was higher but removal times were similar. Qualitative feedback collected showed that CR was superior to conventional garment. Conclusion: CR appeared to be equally effective to Control graduated elastic stockings with a longer application time on first attempt but consistently higher scores for satisfaction. This may represent an attractive alternative with higher patient compliance rates.

scholarly journals Distress disclosure and psychological Distress among men: the role of feeling understood and loneliness

2021 ◽  
Author(s):  
Brian TaeHyuk Keum ◽  
John L. Oliffe ◽  
Simon M. Rice ◽  
David Kealy ◽  
Zac E. Seidler ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Group Analysis ◽  
Mediation Model ◽  
Adult Men ◽  
Path Analyses ◽  
Asian Men ◽  
Race Ethnicity ◽  
Post Hoc ◽  
Distress Disclosure ◽  
Better Than

AbstractWe examined whether men’s distress disclosure would be indirectly associated with psychological distress through feeling understood by others and loneliness as serial or parallel mediators. We conducted path analyses (N = 1827 adult men; mean 37.53 years, SD = 14.14) to test the mediators while controlling for race/ethnicity. Post-hoc multi-group analysis was conducted to examine differences across White and Asian men. The serial mediation model fit the data better than the parallel mediation model. Controlling for race/ethnicity, a significant partial indirect association was found between greater distress disclosure and lower psychological distress through greater feelings of being understood and lower feelings of loneliness. Post-hoc multi-group analysis suggested that the hypothesized paths fit equivalently across White and Asian men, and the direct effect was not significant for Asian men. Our hypothesized serial model also fit the data significantly better than alternative models with distress and the mediators predicting disclosure. Distress disclosure may be a socially conducive strategy for men to feel understood and socially connected, a process that may be associated with lower psychological distress.

scholarly journals Potential of different fluoride gels to prevent erosive tooth wear caused by gastroesophageal reflux

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Philipp Körner ◽  
Luca Georgis ◽  
Daniel B. Wiedemeier ◽  
Thomas Attin ◽  
Florian J. Wegehaupt
Keyword(s):  
Gastroesophageal Reflux ◽  
Artificial Saliva ◽  
In Vitro Study ◽  
Tooth Wear ◽  
Control Group ◽  
Erosive Tooth Wear ◽  
Custom Made ◽  
Post Hoc ◽  
Bovine Enamel

Abstract Background This in-vitro-study aimed to evaluate the potential of different fluoride gels to prevent gastroesophageal reflux induced erosive tooth wear. Methods Surface baseline profiles of a total of 50 bovine enamel specimens [randomly assigned to five groups (G1–5)] were recorded. All specimens were positioned in a custom made artificial oral cavity and perfused with artificial saliva (0.5 ml/min). Reflux was simulated 11 times a day during 12 h by adding HCl (pH 3.0) for 30 s (flow rate 2 ml/min). During the remaining 12 h (overnight), specimens were stored in artificial saliva and brushed twice a day (morning and evening) with a toothbrush and toothpaste slurry (15 brushing strokes). While specimens in the control group (G1) did not receive any further treatment, specimens in G2–5 were coated with different fluoride gels [Elmex Gelée (G2); Paro Amin Fluor Gelée (G3); Paro Fluor Gelée Natriumfluorid (G4); Sensodyne ProSchmelz Fluorid Gelée (G5)] in the evening for 30 s. After 20 days, surface profiles were recorded again and enamel loss was determined by comparing them with the baseline profiles. The results were statistically analysed using one-way analysis of variance (ANOVA) followed by Tukey`s HSD post-hoc test. Results The overall highest mean wear of enamel (9.88 ± 1.73 µm) was observed in the control group (G1), where no fluoride gel was applied. It was significantly higher (p < 0.001) compared to all other groups. G2 (5.03 ± 1.43 µm), G3 (5.47 ± 0.63 µm, p = 0.918) and G4 (5.14 ± 0.82 µm, p > 0.999) showed the overall best protection from hydrochloric acid induced erosion. Enamel wear in G5 (6.64 ± 0.86 µm) was significantly higher compared to G2 (p = 0.028) and G4 (p = 0.047). Conclusions After 20 days of daily application, all investigated fluoride gels are able to significantly reduce gastroesophageal reflux induced loss of enamel.

scholarly journals Baseline Interleukin-6 and -8 predict response and survival in patients with advanced hepatocellular carcinoma treated with sorafenib monotherapy: an exploratory post hoc analysis of the SORAMIC trial

2021 ◽  
Author(s):  
Osman Öcal ◽  
Kerstin Schütte ◽  
Juozas Kupčinskas ◽  
Egidijus Morkunas ◽  
Gabija Jurkeviciute ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Objective Response ◽  
Advanced Hepatocellular Carcinoma ◽  
Sorafenib Treatment ◽  
Post Hoc Analysis ◽  
Y90 Radioembolization ◽  
Baseline Values ◽  
Post Hoc

Abstract Purpose To explore the potential correlation between baseline interleukin (IL) values and overall survival or objective response in patients with hepatocellular carcinoma (HCC) receiving sorafenib. Methods A subset of patients with HCC undergoing sorafenib monotherapy within a prospective multicenter phase II trial (SORAMIC, sorafenib treatment alone vs. combined with Y90 radioembolization) underwent baseline IL-6 and IL-8 assessment before treatment initiation. In this exploratory post hoc analysis, the best cut-off points for baseline IL-6 and IL-8 values predicting overall survival (OS) were evaluated, as well as correlation with the objective response. Results Forty-seven patients (43 male) with a median OS of 13.8 months were analyzed. Cut-off values of 8.58 and 57.9 pg/mL most effectively predicted overall survival for IL-6 and IL-8, respectively. Patients with high IL-6 (HR, 4.1 [1.9–8.9], p < 0.001) and IL-8 (HR, 2.4 [1.2–4.7], p = 0.009) had significantly shorter overall survival than patients with low IL values. Multivariate analysis confirmed IL-6 (HR, 2.99 [1.22–7.3], p = 0.017) and IL-8 (HR, 2.19 [1.02–4.7], p = 0.044) as independent predictors of OS. Baseline IL-6 and IL-8 with respective cut-off values predicted objective response rates according to mRECIST in a subset of 42 patients with follow-up imaging available (IL-6, 46.6% vs. 19.2%, p = 0.007; IL-8, 50.0% vs. 17.4%, p = 0.011). Conclusion IL-6 and IL-8 baseline values predicted outcomes of sorafenib-treated patients in this well-characterized prospective cohort of the SORAMIC trial. We suggest that the respective cut-off values might serve for validation in larger cohorts, potentially offering guidance for improved patient selection.

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