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[Compression stockings in treatment of lower leg venous ulcer].

AIM: of the study was to evaluate the efficiency of medical compression stockings, which do not require special application techniques, compared with short stretch bandages for treating leg-ulcers. STUDY-DESIGN AND PATIENTS: Prospective trial on a total of 50 out-patients with leg-ulcers randomly allocated into two therapy-groups: 25 patients got firm compression bandages using short stretch material (Rosidal K), 25 patients were treated by medical compression stockings (Thrombo+Sigvaris 503). Due to the statistically significantly lower mean age and longer duration of the ulcers in the Sigvaris-group only restricted comparison of the treatment groups is possible. Local dressings in both groups consisted of a nonadherent, absorbing material (Vliwin) with an individually modelled rubber foam pad on top. The end-point was complete ulcer-healing, in a period of 3 months. METHODS: The following parameters were measured: area of ulceration, compression-pressure, tcPO2 and Laser-Doppler-Fluxmetry at the ulcer border before and after 3 minutes of arterial occlusion, venous volume and venous filling index by air plethysmography (APG) with and without compression. RESULTS: After 3 months 21 cases (84%) were healed in the Sigvaris-group and 13 (52)% in the Rosidal-group. This significant difference may be partly explained by the more favorable starting condition of the stocking-patients. However, one major advantage of stockings over short stretch bandages is the maintenance of an adequate pressure if they are not renewed for several days. CONCLUSION: Therapy of venous ulcers by medical compression stockings may be an effective approach for fit and cooperative patients.

Adult↗

Diapers and underpads, Part 2: Cost outcomes.

A randomized clinical trial was conducted at three acute care facilities between August and December 1993 to compare cost outcomes between patients managed with diapers or with underpads. The 166 patients were divided into five groups: polymer or nonpolymer underpads, polymer or nonpolymer diapers, and cloth underpads. Among other results, the average number of nonpolymer underpads used (3.4) compared to other products used (1.4 polymer underpads, 1.1 cloth underpads, 1.0 nonpolymer diapers, 1.0 polymer diapers) quantified nurses' perceptions that nonpolymer pads were not as effective as their polymer counterparts in absorbing incontinence. The nonpolymer underpad was, however, the least expensive of the products studied, even taking into account the volume of product used. The nonpolymer underpad group also took the most time for cleanup. The cloth underpad group consistently used all of the linen items, suggesting that complete bed changes were necessary. The polymer underpad group consistently used the least linen, suggesting that the incontinence episodes were successfully contained by the product. When all costs were combined for time (at $13.50 hourly aide wage), linen use and product type, there was a statistically significant difference between the five treatment groups (F 9.3, p < 0.0000). Total costs (product, linen and staff time) for diaper products were higher than either the polymer or cloth underpad groups. Recommendations, based on both parts 1 and 2 of this study are that the polymer diaper is the product of choice for the ambulatory patient, and the polymer underpad is the product of choice for the bedridden patient. The nonpolymer underpad should no longer have a place in incontinence management.

Adult↗

Mapping liquid distribution in absorbent incontinence products.

This paper reviews methods available for mapping the distribution of fluid in incontinence pad materials to assist with evaluating existing products and developing new ones, and to provide data for building and validating predictive models. Specifically, the following technologies are considered and their strengths and limitations described: discrete sensors based on conductance, temperature or optical measurements, optical imaging, gravimetric methods, X-ray imaging and magnetic resonance imaging. It is suggested that the ideal method would enable fluid distribution to be mapped in three dimensions with good spatial and time resolution in single materials and composite structures of simple and complex geometries under static and dynamic mechanical loading. It would also allow liquid to be mapped in products when worn by users. It is concluded that, although each existing method meets some of these requirements, and each requirement is met, at least reasonably well, by at least one method, improved techniques are needed. The particular need for methods that can provide some measurement of liquid saturation within absorbent products, both in the laboratory and in real use, is highlighted. In many cases, simple methods used appropriately are sufficient to elicit the important aspects of liquid transport and storage within absorbent products.

Absorption↗

[Polyglycolic acid mesh in surgery of the liver and spleen].

Since 1987 absorbable PGA-mesh (Dexon) has been used as a pad for mattress sutures and as remaining tamponade in surgery of the liver and spleen. In 25 cases atypical resections of liver tumors have been performed using PGA-mesh to secure mattress sutures. Blood loss was below 500 cm3 in all cases, operating time was decreased and no infection was seen. Six times this technique was also used in cases with splenic trauma. In all patients the organ could be preserved. In 10 patients with severe trauma of the liver PGA-mesh was successfully used as a remaining tamponade. Also in these cases no infection occurred although 50 mesh had been implanted in one case.

Humans↗

Force attenuation properties of various trochanteric padding materials under typical falling conditions of the elderly.

The purpose of this study was to determine and compare the force attenuation properties of various external trochanteric padding materials under in vitro conditions simulating characteristic falling of the elderly. The selected materials had to be practically suitable for external hip padding so that the main criteria for the materials were good energy absorbing capacity, good durability, low weight, good recovery after compression, easy availability, and reasonable price. Eight materials met these requirements. The first six were flexible cross-linked polyethylene foams with densities from 30 to 200 kg/m3. The seventh material was Plastazote polyethylene foam, and the eight foam was made of ethylene-vinyl acetate (EVA) copolymer. With a pendulum effective mass of 39 kg, impact velocity of 3.0 m/s, and impact force of 8.2 kN, the force attenuation provided by the 20 mm thick hip-padding materials was quite small, ranging from 22 to 38%. With all these materials the peak femoral force remained above 5 kN, more than two times above the femoral fracture threshold (2 kN). In the second set of experiments, the impact force was gradually reduced until the tested materials lowered the impact force below the fracture threshold. With the most efficient material this critical falling velocity was found to be 1.6 m/s. To go below the fracture threshold with the realistic impact velocity of 3.0 m/s, the padding materials had to be 100-140 mm thick.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗

Congenital dysplasia of the heel fat pad: a case report of a previously undescribed entity.

We describe a 13-year-old girl who was born with a congenital anomaly of her left heel fat pad. We call this anomaly congenital dysplasia of the heel pad, due to under development of all elements of the heel fat pad. In the case presented the vertical fibrous septa were missing and the amount of fat and its distribution were abnormal. As a result, the abnormal biomechanical shock absorber mechanism caused a painful callosity formation. A surgical procedure aiming to produce adhesions between the fat pad and the calcaneous in order to decrease the shear of the heel pad was only partially successful. Different types of orthotic devices did not resolve the clinical problem of the painful heel. Such a congenital anomaly has never been described in the English literature, and we coined the term congenital dysplasia for the previously undescribed entity.

Adipose Tissue↗

A new double-layered launderable bed sheet for patients with urinary incontinence.

In a skilled nursing facility, 36 patients (chiefly elderly) with persistent urinary incontinence were the subjects of this study. In their management, the usual disposable pads were compared with a new launderable bed sheet (Kylie) which absorbs urine in the second layer while maintaining a dry surface next to the patient's skin. There was a 42 percent reduction in the frequency of bedding changes with the new bed sheets. The patients experienced increased comfort due to decreased skin wetness and decreased creasing of the sheets. The reduced frequency of bed linen changes permitted longer undisturbed periods for the patient. Management costs were reduced by 40 percent with the launderable bed sheets. There were no adverse effects on the condition of the patients or in the quality of care.

Adult↗

Paracellular water uptake and molecular sieving by the foot epithelium of terrestrial slugs.

A paracellular pathway in the foot epithelium of Lehmannia valentiana can be opened by dehydrating the slug. Movement of water from a wet pad through the opened pathway into the haemolymph of this terrestrial slug is rapid. The sieving properties of this paracellular pathway have been determined using the reference isotope 3HOH and various 14C-labelled solutes. Paracellular uptake of 14C-insulin (Fig. 1) and 3HOH (Fig. 2) is initial rate for at least 3 min. If the wet pad contains 1,000 cpm of 14C per ml of 3HOH, slugs absorb only about 400 cpm of 14C with each ml of 3HOH absorbed representing a sieving ratio of 0.4 for insulin. The sieving ratio of 14C-inulin does not change when the concentration is increased from 0.1 to 2.5 mmol/l. Moreover, the sieving ratio of 14C-inulin was not affected significantly by the nature of the labelling, i.e., 14C-carboxyl vs 14C-methoxy. Sieving ratios for 14C-mannitol (182 Da), 14C-polyethylene glycol (4,000 Da), and 14C-inulin (5,250 Da) were 0.92, 0.63, and 0.39, respectively (Table 1), indicating that sieving is dependent on molecular size. 14C-Dextran (70,000 Da) and blue dextran (200,000 Da) were excluded from the paracellular pathway (Fig. 4). The effective pore size of the paracellular pathway was estimated using the relationships between sieving ratio and molecular weight of 3HOH and the various solutes that can pass through the pathway. The extrapolated pore size is equivalent to that of a sieve having a molecular weight cutoff of about 10,000 Da (Fig 3).

Animals↗

Fingertip reconstruction with a palmar advancement flap and free dermal graft: a report of six cases.

The palmar thumb advancement flap was first described by Moberg in 1964. It was further utilized for the thumb and defined by Posner and Smith in 1971. In 1980, Macht and Watson favorably reported their technique of palmar advancement that was applicable not only for the thumb, but also for all five digits with soft tissue tip losses. A further refinement of their technique is to augment the digital tip with an autogenous dermal graft. This dermal "padding" is placed directly over the bony tuft to act as a "shock absorber," add bulk and contour to the distal tip of the finger, increase soft tissue stability, eliminate direct percussive tenderness of the bone, and decrease disability for specific occupations such as those requiring typewriting. Six cases are reported.

Adult↗

Purification of staphylocidal beta-lysin from rabbit serum.

A cationic protein of rabbit serum bactericidal for Staphylococcus aureus was purified. The specific activity per unit of protein of the purified staphylocidal preparation was approximately 37,000 times greater than that of the serum from which it was isolated. Similar techniques were used to purify serum beta-lysin active against Bacillus subtilis approximately 24,000 times. The staphylocidal activity cannot be attributed to the same beta-lysin active against B. subtilis, lysozyme, or antibody-complement systems. The concentrations of staphylocidal beta-lysin in the sera of the five mammalian species studied did not correlate with their beta-lysin activities against B. subtilis. The two beta-lysins are similar in that both were heat-stable, sensitive to trypsin digestion, had molecular weights near 6,000, and were found in higher concentrations in serum than in plasma. Furthermore, similar techniques can be used to absorb and elute both substances in highly purified forms using cellulose asbestos filter pads and ion exchange chromatography on carboxymethyl cellulose. In contrast to the beta-lysin against B. subtilis, the staphylocidal beta-lysin was not released from blood platelets, and it was inactive in the presence of heparin, sodium citrate, sodium oxalate, ethylenediaminetetraacetic acid, acidic phospholipids, and acid pH values. A variety of proteins, including those of normal serum, preferentially inhibited the bactericidal activity of staphylocidal beta-lysin but not the beta-lysin against B. subtilis.

Animals↗

Managing faecal incontinence or leakage: the Peristeen Anal Plug.

Incontinence can be a devastating problem to many individuals. It is embarrassing and limiting socially, and prevents those with the problem from going about their day-to-day activities. People adopt coping strategies to manage the problem and those with urinary incontinence often look for containment products such as disposable pads or nappy-style products. These products have been developed using different absorbent materials and are accessible to sufferers in local supermarkets. Absorbency of the products has improved so that once wetted, they hold urine more easily. However, the same cannot be said for faecal incontinence management products and there are few that can be called upon to manage this devastating condition. The Peristeen Anal Plug, developed originally as the Conveen Anal Plug, stands alone in the search for a device to manage faecal incontinence or leakage.

Activities of Daily Living↗

Incontinence pads: clinical performance, design and technical properties.

The paper describes the functional requirements of urinary incontinence pads and reviews the results of several studies which seek to relate the clinical performance of pads to their design and the technical properties of their constituent materials. Pad designs covered include: simple rectangular (for use with conventional pants or marsupial pants containing a pouch); wing-folded; shaped; and all-in-one infant-style diapers. Data on the clinical and technical properties of fluff wood pulp and hydrogel absorbents, and viscose rayon, polyester, polypropylene and polyethylene coverstocks are presented. Attention is focussed on four major aspects of pad function: freedom from leakage; freedom from discomfort and skin damage; ease of application and removal; and aesthetic properties. The relationships established between clinical and technical data will be of interest to health care professionals selecting products; organizations seeking to create standards; and pad designers.

Clothing↗

A continuous spectrophotometric assay method for peptidylarginine deiminase type 4 activity.

A simple, continuous spectrophotometric assay for peptidylarginine deiminase (PAD) is described. Deimination of peptidylarginine results in the formation of peptidylcitrulline and ammonia. The ammonia released during peptidylarginine hydrolysis is coupled to the glutamate-dehydrogenase-catalyzed reductive amination of alpha-ketoglutarate to glutamate and reduced nicotinamide adenine dinucleotide (NADH) oxidation. The disappearance of absorbance at 340nm due to NADH oxidation is continuously measured. The specific activity obtained by this new protocol for highly purified human PAD is comparable to that obtained by a commonly used colorimetric procedure, which measures the ureido group of peptidylcitrulline by coupling with diacetyl monoxime. The present continuous spectrophotometric method is highly sensitive and accurate and is thus suitable for enzyme kinetic analysis of PAD. The Ca(2+) concentration for half-maximal activity of PAD obtained by this method is comparable to that previously obtained by the colorimetric procedure.

Buffers↗

Optical structure and function of the white filamentary hair covering the edelweiss bracts.

The optical properties of the inflorescence of the high-altitude Leontopodium nivale subsp. alpinum (edelweiss) is investigated, in relation with its submicrometer structure, as determined by scanning electron microscopy. The filaments forming the hair layer have been found to exhibit an internal structure which may be one of the few examples of a photonic structure found in a plant. Measurements of light transmission through a self-supported layer of hair pads taken from the bracts supports the idea that the wooly layer covering the plant absorbs near-ultraviolet radiation before it reaches the cellular tissue. Calculations based on a photonic-crystal model provide insight on the way radiation can be absorbed by the filamentary threads.

Asteraceae↗

Analysis of the heel pad fat in rheumatoid arthritis.

The heel fat pad is organized, both in structure and in composition, to bear the stresses and strains of normal activities and to permit pain-free weightbearing. The fatty acid composition of heel pads in 11 patients with rheumatoid arthritis, a disease process frequently associated with heel fat pad atrophy, was analyzed using gas-liquid chromatography and was compared with that of patients without systemic disease. The heels of patients with rheumatoid arthritis demonstrated a significant change in the composition of saturated fatty acids when compared with heels of nonrheumatoid patients. This composition reflects an increased fat viscosity, which decreases the ability of the heel to absorb and dissipate the energy generated during ambulation. This factor could cause degeneration of the heel septal system, with resulting fat pad atrophy.

Abdomen↗

Disposable pull-ups versus disposable nappies for children with a disability.

Most children are expected to be dry by the age of three years (Lukeman, 1997). However, children with physical and/or learning disabilities may have difficulty achieving continence and will have an ongoing need for absorbent products. Historically these were disposable nappies. In recent years, the disposable pull-up style pad (Fig 1) has proved popular as an alternative design.

Child↗

Absorbable versus nonabsorbable graft: outcome of bone anchored male sling for post-radical prostatectomy incontinence.

PURPOSE: We determined the outcome of the bone anchored male sling procedure for stress urinary incontinence in men regarding the graft material used. MATERIALS AND METHODS: A total of 39 men with post-radical prostatectomy incontinence received a perineal bone anchored male sling. Patients with previous salvage external beam radiotherapy and high serum prostate specific antigen, incontinence due to neurogenic or posttraumatic etiology, or previous benign prostatectomy were excluded. Urodynamic evaluation was performed preoperatively. The number of pads daily used by patients was recorded preoperatively and during postoperative visits. To compress the urethra 2 types of materials were used. Absorbable biomaterials were used in the first 12 patients and nonabsorbable material was used in the following 27. RESULTS: Mean patient age +/- SD was 67.3 years (range 50 to 79). The mean duration between radical prostatectomy and male sling surgery was 57.9 +/- 40.4 months (range 5 to 135). The procedure was successful in 26 patients (96.2%) in the nonabsorbable group and in 1 (8.3%) in the absorbable group at a mean followup of 18.9 and 28.8 months, respectively. CONCLUSIONS: The absorbable sling materials that were used for the bone anchored male sling demonstrated disintegration of the material. Autolysis of these absorbable materials removed active compression forces on the urethra after a short period. Nonabsorbable graft is associated with the best outcome following the perineal bone anchored male sling procedure.

Absorbable Implants↗

Photoelectron angular distributions from above threshold ionization of hydrogen atoms in strong laser fields.

We apply a scattering theory of nonperturbative quantum electrodynamics to study the photoelectron angular distributions (PADs) of a hydrogen atom irradiated by linearly polarized laser light. The calculated PADs show main lobes and jetlike structure. Previous experimental studies reveal that in a set of above-threshold-ionization peaks when the absorbed-photon number increases by one, the jet number also increases by one. Our study confirms this experimental observation. Our calculations further predict that in some cases three more jets may appear with just one-more-photon absorption. With consideration of laser-frequency change, one less jet may also appear with one-more-photon absorption. The jetlike structure of PADs is due to the maxima of generalized phased Bessel functions, not an indication of the quantum number of photoelectron angular momentum states.

Journal Article↗