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.

scholarly journals Study of the antioxidant status in patients with secondary lymphedema of the lower extremities under conservative treatment

2021 ◽  
Vol 102 (3) ◽  
pp. 277-283
Author(s):  
Roman E. Kalinin ◽  
Igor A. Suchkov ◽  
Denis A. Maksaev ◽  
Yulia V. Abalenikhina
Keyword(s):  
Superoxide Dismutase ◽  
Glutathione Peroxidase ◽  
Healthy Volunteers ◽  
Antioxidant Status ◽  
Lower Extremities ◽  
Compression Therapy ◽  
Secondary Lymphedema ◽  
Elastic Compression ◽  
Micronized Purified Flavonoid Fraction ◽  
Flavonoid Fraction

Aim. To assess the antioxidant status in patients with secondary lymphedema of the lower extremities who undergo different types of conservative treatment. Methods. The study included 90 patients with secondary lymphedema of the lower extremities and 30 healthy volunteers. Group 1 participants (n=30) received compression therapy and Vitamin E at a dose of 400 IU/day, group 2 participants (n=30) compression therapy and a micronized purified flavonoid fraction 1000 mg/day, group 3 (n=30) compression therapy alone. Group 4 (n=30) comprised healthy volunteers. The level of malondialdehyde, the activity of superoxide dismutase, glutathione peroxidase, catalase, and the level of non-protein thiols (SH-groups) were determined at inclusion in the study and then after 1 and 3 months. Results. In patients with secondary lymphedema, the initial level of glutathione peroxidase was higher by 768.22%, catalase by 420.5%, malondialdehyde by 60%, and the level of SH-groups was lower by 65,71% compared with the group of volunteers. In the first group, there was a significant decrease of 36.1% in the level of superoxide dismutase and a significant increase of 89.9% in the level of glutathione peroxidase at the end of therapy when compared with the level after 1 month. In the second group, catalase level significantly increased by 33.3%, superoxide dismutase by 17.6%, and glutathione peroxidase by 61.3% compared to baseline values. The biochemical indicators of the endothelium significantly increased when using a combination of micronized purified flavonoid fraction and elastic compression in comparison with elastic compression alone and a combination with Vitamin E. In the third group, there were no significant differences in the levels of biochemical indicators of endothelial function. Conclusion. Increased formation of lipid peroxidation products along with a decrease in the activity of antioxidant systems was revealed in patients with lower extremity secondary lymphedema compared with healthy volunteers; the most effective therapy aimed at correcting endothelial cell dysfunction is the use of micronized purified flavonoid fraction and elastic compression.

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 MUFFIN-PTS trial, Micronized Purified Flavonoid Fraction for the Treatment of Post-Thrombotic Syndrome: protocol of a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e049557
Author(s):  
Jean Philippe Galanaud ◽  
Jameel Abdulrehman ◽  
A Lazo-Langner ◽  
Grégoire Le Gal ◽  
Sudeep Shivakumar ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Compression Stockings ◽  
Level Of Evidence ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Registration Number ◽  
Venoactive Drugs ◽  
Micronized Purified Flavonoid Fraction ◽  
Flavonoid Fraction ◽  
Randomised Controlled

IntroductionAfter deep vein thrombosis, up to 50% of patients develop post-thrombotic syndrome (PTS). PTS is a chronic condition that reduces quality of life (QOL). Cornerstones of PTS treatment include the use of elastic compression stockings but this treatment is usually incompletely effective and is burdensome. Venoactive drugs have been reported to be effective to treat chronic venous insufficiency (CVI). However, the level of evidence supporting their use in CVI in general and in PTS in particular is low.Methods and analysisThe MUFFIN-PTS trial is an academic, publically funded, multicentre randomised placebo-controlled trial assessing the efficacy of micronised purified flavonoid fraction (MPFF, Venixxa), a venoactive drug, to treat PTS. Eighty-six patients with PTS (Villalta score (VS) ≥5) and experiencing at least two of the following PTS manifestations among daily leg heaviness, cramps, pain or oedema will be randomised to receive 1000 mg of oral MPFF or a similar appearing placebo for 6 months, in addition to their usual PTS treatment. Total study follow-up will be 9 months, with visits at inclusion/baseline, 3, 6 and 9 months. Primary outcome is the proportion of patients with improvement in VS in each group, where improvement is defined as a decrease of at least 30% in VS or a VS <5 in the PTS-affected leg. Main secondary outcomes include QOL and patient satisfaction.Ethics and disseminationPrimary ethics approval was received from Centre intégré universitaire de santé et de services sociaux (CIUSSS) West-Central Montreal Research Ethics Board. Results of the study will be disseminated via peer-reviewed publications and presentations at scientific conferences.Trial registration numberClinicalTrials.gov Registry (NCT03833024); Pre-results.

Long-term treatment of chronic venous insufficiency of the leg with micronized purified flavonoid fraction in the primary care setting of India

2004 ◽  
Vol 19 (4) ◽  
pp. 179-184 ◽  
Author(s):  
R K Pinjala ◽  
T K Abraham ◽  
S K Chadha ◽  
A A Hai ◽  
S A Hussain ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Venous Insufficiency ◽  
Care Setting ◽  
Primary Care Setting ◽  
Compression Stockings ◽  
Symptom Intensity ◽  
Micronized Purified Flavonoid Fraction ◽  
Flavonoid Fraction

Objective: This study investigates whether micronized purified flavonoid fraction (MPFF) is effective and acceptable without compression or surgical intervention for the management of chronic venous insufficiency of the leg (CVIL) in the primary care setting of a tropical country such as India. Methods: A prospective observational study on patients with early CVIL drawn from the clinical practice of randomly selected physicians distributed across India. Patients received MPFF 1000 mg/day for six months without compression stockings or surgery. The primary outcome was a change in their CEAP (clinical, aetiological, anatomical, pathophysiological) classification of CVIL severity. Secondary outcomes were changes in leg oedema, symptom intensity and quality of life. Results: Of the 308 patients recruited by 72 physicians, 166 (53.9%, 95% confidence interval (CI) 48.3-59.5) had regression in the CEAP severity stage. Mean leg circumference in those with oedema decreased by 2 cm (95% CI 1.7-2.3, P <0.05). Patient-assessed mean percentage decrease in symptom intensity was 32.3 for cramps (28.9-35.7, P <0.01); 32.4 for heaviness (29.8-35.7, P <0.01); 28.2 for pain (25.6-30.8, P <0.01); and 21.5 for swelling (18.7-24.3, P <0.01). Quality of life improved by 21.7% (16.9-26.5, P <0.01) in the physical domains, 25.9% (20.8-31.0, P <0.01) in the social domains, and 19.2% (14.7-23.7, P <0.01) in the psychological domains. Conclusions: When used alone, MPFF was effective and acceptable for the management of CVIL in primary care. This may be useful in tropical climates where compliance with compression stockings is poor and access to surgery limited.

Do Compression Stockings Potentiate the Fibrinolytic Capacity of the Lower Limbs?

1989 ◽  
Vol 4 (3) ◽  
pp. 161-166 ◽  
Author(s):  
D.C. Berridge ◽  
J.C. Westby ◽  
G.S. Makin ◽  
B.R. Hopkinson
Keyword(s):  
Hydrostatic Pressure ◽  
Lower Limb ◽  
Fibrinolytic Activity ◽  
Varicose Veins ◽  
Bed Rest ◽  
Lower Limbs ◽  
Clot Lysis ◽  
Compression Stockings ◽  
Occlusion Time ◽  
The Right

Patients with varicose veins and liposclerosis have been shown to have impaired fibrinolytic activity1. Furthermore, fibrinolytic activity is much reduced in the lower than in the upper limbs, probably due to the difference in hydrostatic pressure. After 2–10 days bed rest a significant increase in potential is observed2. Compression support stockings can exert 30–40 mmHg of pressure which is 50% of the normal hydrostatic pressure. Therefore does the long term use of such stockings cause a significant increase in fibrinolytic potential? Seventeen patients (10 male, 7 female; mean age 52.8 +/— 9.8 yrs) with features of liposclerosis were studied. Pre- and post-euglobulin clot lysis times (ELT) were measured in the right arm and both legs using a 10 min occlusion time. The patients contralateral leg served as the control. Sigvaris stockings were made for each patient to wear on the designated leg only. Measurements were repeated after 1 and 3 months of use with the stocking in situ and after 30 min bed rest. Patients were instructed to wear the stockings at all times during the day. There were no significant differences in the pre-occlusion values between the arm or the lower limb groups throughout the study. Lower limb post occlusion ELT values were significantly higher in both the affected limb ( p < 0.002) and the patients control limb ( p < 0.002), than in the arm. This relationship was constant throughout the study period. No significant potentiation was seen after either 1 or 3 months of use. There were no new areas of ulceration throughout the study period. Thus any clinical benefit arising from the use of compression stockings is not from potentiation of local fibrinolysis.

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.

Design of a Human Knee Reeducation Mechanism

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

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

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

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

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

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

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

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

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

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

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

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