Hydrocephalus treated by compressive head wrapping.
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A simple method of applying compressive cranial wrapping for neonatal hydrocephalus is described and its beneficial use in one patient is described. (+info)
Usefulness of an insole with subtalar strapping for analgesia in patients with medial compartment osteoarthritis of the knee.
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OBJECTIVE: To assess the effect of an insole with subtalar strapping on patients with medial compartment osteoarthritis (OA) of the knee. METHODS: Novel lateral wedged insoles with elastic subtalar strapping (the subtalar strapping support group) and ankle supporters with a lateral wedged heel insert (the sock-type ankle support group) were prepared. Eighty-eight female outpatients with knee OA were treated with 1 of the 2 insoles for 8 weeks. Femorotibial angle was assessed by standing radiographs with and without unilateral insole use for each subject. Symptoms of knee OA were evaluated according to the severity index of Lequesne et al at baseline and at the final assessment. RESULTS: Participants wearing the insole with subtalar strapping (n = 42) demonstrated significantly decreased femorotibial angle (an average of change: -3.1 degrees +/- 2.5 degrees, P < 0.0001), but a significant difference was not found in the sock-type ankle support group (n = 46; -0.4 degrees +/- 1.1 degrees, P > 0.05). In the subtalar strapping support group, pain during bed rest with full extension of the knee (P < 0.0001), pain after getting up (P = 0.04), pain on getting up from a seated position (P = 0.021), maximum distance walked (P = 0.009), and aggregate severity score (P < 0.0001) were significantly improved compared with baseline. In contrast, significant symptomatic improvement was detected only in the aggregate score (P = 0.016) in the sock-type ankle support group, but not in any of the 10 specific categories. CONCLUSION: The lateral wedged insole with subtalar strapping induces correction of the femorotibial angle and symptomatic relief in patients with varus-deformity knee OA. (+info)
Kinesthesia at the knee: the effect of osteoarthritis and bandage application.
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OBJECTIVE: To investigate whether osteoarthritis (OA) of the knee or bandaging of the knee affects movement detection. METHODS: Movement detection levels were determined in 10 women aged > 65 years with moderate to severe knee OA and 10 healthy women matched for age, body mass index, and activity levels. Movements were imposed at 0.5 degrees /second, 1.0 degrees /second, and 2.5 degrees /second. Additionally, detection levels were compared with and without the knee bandaged at a single velocity, (0.5 degrees /second). RESULTS: Controls perceived significantly smaller movements than OA subjects at all test velocities (P < 0.01). However, the bandage did not affect movement detection (P > 0.05). CONCLUSIONS: Detection of movement at the knee was impaired in subjects with severe knee OA, and a bandage did not improve detection. Thus, considering previous findings that position sense is impaired, a generalized proprioceptive deficit appears to be associated with OA. This deficit could result from loss of receptors, altered muscle function, or the consequent joint instability. (+info)
Postthrombotic syndrome after isolated calf deep venous thrombosis: the role of popliteal reflux.
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OBJECTIVE: The purpose of this study was to evaluate the long-term clinical and hemodynamic outcomes after isolated first-time calf deep venous thrombosis (cDVT). METHODS: This retrospective clinical study was set in an academic referral center. From 1990 to 1994, 617 patients were seen with acute DVT. This number included 82 patients with phlebographically confirmed cDVT. Of those patients, 50 attended the clinical assessment 6 to 10 years (mean, 8.4 years) after the acute event. All patients with cDVT underwent treatment with anticoagulant therapy (96% heparin and warfarin, 4% only warfarin). The duration of the heparin treatment was 4.0 to 8.0 days (mean, 6.4 days), and warfarin was given for 2.0 to 7.5 months (mean, 3.4 months). Compression stockings were used regularly (mean, 9.2 months; range, 0.25 to 64 months) in 30% of the patients after acute cDVT. The initial ipsilateral phlebograms were reevaluated to confirm the diagnosis of cDVT without popliteal involvement. The clinical assessment included evaluation of both legs according to CEAP clinical classification C0-6. Bilateral color-flow duplex scan imaging was performed to assess reflux in deep popliteal segments. Photoplethysmographic measurement of venous refilling time was conducted in both legs to observe deep reflux. RESULTS: The mean age was 57 years (range, 30 to 76 years) at the time of the clinical assessment. Cause of acute cDVT was idiopathy in 52%, coagulopathy in 2%, trauma in 10%, immobilization in 22%, and postoperative in 14% of the cases. During the follow-up period, seven recurrent DVTs (14%) were seen. In the clinical assessment, 17 legs (34%) with previous cDVT had skin changes (CEAP C4-6). No active ulcers were found. Contralaterally, the frequency of C4-6 was 10% (n = 5; P <.05). After exclusion of recurrent DVTs, the distribution of the clinical classification still remained the same. Deep popliteal reflux was detected in 20 legs (40%) with previous cDVT. Contralaterally, popliteal reflux was seen in nine cases (18%; P <.05). Plethysmography showed deep reflux in 16 legs (33%) with cDVT and in nine cases (18%) contralaterally (P >.05). A significant association was found between deep popliteal reflux and skin changes (P <.05). CONCLUSION: In the long-term follow-up, cDVT may lead to significant postthrombotic disease. Reflux in the primarily uninvolved popliteal vein is frequent and may be associated with more severe disease. (+info)
Does thigh compression improve venous hemodynamics in chronic venous insufficiency?
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OBJECTIVE: The aim of this study was to investigate the hemodynamic effects of thigh compression in patients with deep venous incompetence. PATIENTS AND METHODS: This diagnostic test study was set in a municipal general hospital. Twelve patients with venous leg ulcers (CEAP classification, C6 Es Ad Pr; four men and eight women), with a mean age of 56.5 +/- 16.8 years, with popliteal venous reflux of more than 1 second detected with duplex scan, underwent investigation with the following methods: 1, the pressure exerted under thigh-length compression stockings class II and short-stretch adhesive compression bandages was measured with an MST tester (Salzmann, Switzerland) and a CCS 1000 device (Juzo, Germany), respectively; 2, the great saphenous vein and the femoral vein on the thigh were compressed with a pneumatic cuff (0, 20, 40, and 60 mm Hg) containing a window through which the diameters of these veins could be measured with duplex ultrasonography; and 3, with the same thigh-cuff occlusion procedure, the venous filling index (VFI) for each experiment was measured with air plethysmography. These values reflected the presence and extent of venous reflux in each experiment depending on the degree of venous narrowing. RESULTS: The mean pressure of a class II compression stocking was about 15 mm Hg at the thigh level, and adhesive bandages achieved a pressure of more than 40 mm Hg in the same location. A statistically significant reduction of the diameters of the great saphenous vein and the femoral vein could be obtained only when the cuff pressure on the thigh was equal to or higher than 40 mm Hg (P <.001). A reduction of the venous reflux (VFI) was achieved only with a thigh pressure of 60 mm Hg (P <.001). No significant reduction was seen of VFI with a thigh pressure in the range of the class II stockings. Previous investigations have shown that, in patients with deep venous incompetence, a pressure cuff on the thigh with 60 to 80 mm Hg is able to reduce ambulatory venous hypertension. CONCLUSION: Thigh compression as exerted with class II thigh-length compression stockings is not able to significantly reduce venous diameter or venous reflux. However, with a pressure of 40 to 60 mm Hg on the thigh that can be achieved with strongly applied short-stretch bandages, considerable hemodynamic improvement, including reduced venous reflux, can be obtained in patients with severe stages of chronic venous insufficiency from deep vein incompetence. The practical value of these preliminary findings should be investigated with further clinical trials. (+info)
Radial artery pseudoaneurysm successfully treated by compression bandage.
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In children, surgery for radial artery pseudoaneurysm (PA) may be followed by growth retardation of the hand because of inadequate blood flow. We believe this is the first report of a child with PA of the radial artery cured by compression bandage. Conservative management is a safe and valuable initial treatment option for uncomplicated radial PA. (+info)
Effect of elastic compression stockings on venous hemodynamics during walking.
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PURPOSE: Venous hemodynamics evaluated during walking better reflect changes that occur under active physiologic conditions than do conventional static modes of exercise such as tip-toe exercise, knee bending, or dorsiflexion. We prospectively studied the efficacy of air-plethysmography (APG) in monitoring venous hemodynamics during ambulation, and with this method we determined the hemodynamic effects of graduated elastic compression stockings on the lower limb during walking at various speeds. METHODS: The residual volume fraction (RVF%) during treadmill walking was monitored with APG in 10 limbs with primary chronic venous insufficiency (CVI)(CEAP(2-4)) at four speeds (1.0, 1.5, 2.0 and 2.5 km/h consecutively), with and without elastic compression (21 mm Hg at the ankle). The method was validated in comparison with standard APG, which is based on tip-toe exercise. RVF obtained during treadmill walking at 1.5 km/h was correlated with RVF measured with standard APG in 30 subjects: 12 healthy volunteers, 11 patients with primary CVI, and 7 postthrombotic limbs. Data were analyzed with nonparametric statistics. RESULTS: RVF measurements during walking were reproduced with an intra-day coefficient of variation of 5.1% to 16.5%. RVF during walking correlated well with RVF during standard APG (tip-toe) (r = 0.5, P =.004). At each of the investigated walking speeds, stockings improved venous hemodynamics by decreasing RVF, from a median of 50.5% without stockings to 40.5% with stockings at 1.0 km/h (19.8% decrease), from 49% to 39.5% at 1.5 km/h (19.4% decrease), from 50.5% to 41% at 2.0 km/h (18.8% decrease), and from 53% to 45.5% at 2.5 km/h (14.2% decrease) (all speeds, P <.02). Efficacy of the stockings in decreasing RVF (percent change in RVF) was similar across the spectrum of examined speeds (P =.47). During walking with elastic stockings, nominal RVF values were also similar across the spectrum of walking speeds, except at 2.5 km/h (P =.012). During walking without stockings, RVF did not change with treadmill speed, nor did it differ from that obtained with conventional APG (tip-toe) (P =.46). The percentage decrease in RVF generated with elastic stockings correlated with the venous filling index (r = 0.73, P =.017) at 1.0 km/h. CONCLUSIONS: APG is a reproducible and valid method for monitoring venous hemodynamics during walking. Graduated elastic compression stockings significantly improved venous hemodynamics by reducing RVF in limbs with primary CVI at all examined walking speeds (1.0 to 2.5 km/h). The effect was linearly correlated with the amount of reflux (1.0 km/h). The modified application of APG during walking offers a new noninvasive method for assessment of venous hemodynamics in limbs with CVI, enabling quantification of the actual effect of elastic compression therapy during ambulation. (+info)
Minimally invasive surgical management of primary venous ulcers vs. compression treatment: a randomized clinical trial.
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OBJECTIVES: to compare minimally invasive surgical haemodynamic correction of reflux (CHIVA) with compression in the treatment of venous ulceration. DESIGN: prospective randomised study. MATERIALS AND METHODS: from a cohort of 80 patients with 87 venous leg ulcers, 47 were randomised to either surgery or compression. RESULTS: at a mean follow-up of 3 years, healing was 100% (31 days) in the surgical and 96% (63 days), in the compression group (p<0.02). The recurrence rate was 9% in the surgical and 38% in the compression group (p<0.05). In the surgical group, all plethysmographic parameters except ejection fraction, had improved significantly at 6 months in the surgical group, and at 3 years residual volume fraction remained in the normal range. Finally, quality of life significantly improved in the operated group. CONCLUSIONS: this study supports the effectiveness of surgical therapy for leg ulceration secondary to superficial venous reflux. (+info)