[Ambulatory treatment of leg ulcers by permanent compression by elastic stockings. Technic, protocol, illustration, results in 100 cases].
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Adult↗
SEARCH · PubMed Health
Results for “Stockings, Compression”
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A new method for measuring the effective compression of medical stockings.
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Clothing↗
Acute pulmonary embolism.
Prevention of deep venous thrombosis is fundamental in the prevention of pulmonary embolism. Deep venous thrombosis is common after all surgical procedures, but the frequency differs, as does the effectiveness of various methods of prevention. Low-dose heparin, low molecular weight heparin, graduated compression elastic stockings, intermittent pneumatic compression, and oral anticoagulants have a role in the prevention of deep venous thrombosis, depending on the risks of deep venous thrombosis and their demonstrated effectiveness (or lack of effectiveness) in the particular circumstance. The optimal method of prophylaxis is specific to the predisposing condition. Heparin continues to be a mainstay of anticoagulant therapy. Major bleeding is rare in patients treated with low doses of heparin to prevent deep venous thrombosis. With therapeutic doses, however, major bleeding occurs in about 5% of patients. The optimal dose of warfarin and the method of evaluating the anticoagulant effect of warfarin have undergone modifications in recent years. It is now recognized that the prothrombin time ratio depends on the activity of the thromboplastin used for measuring the prothrombin time. An International Normalized Ratio, which relates to a standardized thromboplastin, has been developed, thus avoiding differences of the prothrombin time ratio that occur from batch to batch of thromboplastin reagent from the same manufacturer and that occur with different thromboplastin reagents from different animal sources and different manufacturers. The bedside diagnosis of pulmonary embolism is useful in helping a physician determine the extent to which diagnostic tests should be pursued. A sound bedside impression also contributes strongly to the formulation of a noninvasive diagnosis of pulmonary embolism. The clinical manifestations of pulmonary embolism form a recognizable constellation of findings that often lead to a correct diagnosis or exclusion of pulmonary embolism. Important clues to the diagnosis of pulmonary embolism relate to the initial syndrome. The presentation of pulmonary embolism is most often in the form of the pulmonary hemorrhage-pulmonary infarction syndrome. The next most common presentation is unexplained dyspnea, unaccompanied by pulmonary hemorrhage or infarction. Least common, but most severe, is the syndrome of circulatory collapse. Immobilization, usually caused by surgery, is the most frequent predisposing factor. Most patients with clinically recognizable pulmonary embolism have dyspnea or tachypnea. Dyspnea or tachypnea or pleuritic pain occurs in nearly all patients who have clinically apparent pulmonary embolism (97%). Ordinary tests such as the electrocardiogram and chest radiograph are helpful if the physician is attentive to nonspecific abnormalities.(ABSTRACT TRUNCATED AT 400 WORDS)
Acute Disease↗
Postmastectomy lymphoedema. Treatment and a five-year follow-up study.
BACKGROUND: Lymphoedema of the arm is a common problem after mastectomy and radiotherapy of mammary cancer. In a prospective 5-year follow-up study we investigated the development of arm oedema and the effect of conservative compression treatment. METHODS: Two hundred and twenty-six patients who had undergone mastectomy were investigated. Oedema formation was estimated by recording displaced water volume of both arms preoperatively and six times post-operatively. One hundred fifty-seven patients (70%) could be followed for five years. An inter-arm difference of 100 ml or more was defined as oedema. Three types of treatment were given: (1) Compression with stockings in 28 patients, (2) intermittent compression (Flowtron) in 8 and (3) intermittent compression (Lympha-Press) and compression sleeves in 19 patients. RESULTS: A total of 46 patients (20%) developed post-operative oedema, 17 within six months and 29 one year postoperatively. The average oedema volume was 418 ml. Most patients with a moderate or severe oedema had irradiation therapy. Severe lymphoedema (750 ml or more) occurred in patients with irradiation postoperatively and lymph node engagement. There was no correlation between patient age and oedema formation. Compression therapy with stockings reduced oedema in 15 out of 28 patients (54%) and prevented further swelling. Therapy with stockings and Lympha Press reduced the arm volume in 13 out of 19 patients (68%). Four out of eight patients treated with Flowtron showed oedema reduction. In most patients cessation of treatment resulted in relapse of swelling to the same degree as before. CONCLUSIONS: Compression therapy is beneficial to control postmastectomy arm swelling. This applies to different modalities and prolonged periods of treatment are required to check progression. Application of stockings is the simplest way to treat postoperative oedema. In most cases postoperative oedema appeared during the first year after surgery and the most severe cases occurred after irradiation.
Adult↗
Vascular ultrasonography for deep venous thrombosis after total knee arthroplasty.
Screening vascular ultrasonography was performed postoperatively on 164 consecutive patients being treated with total knee arthroplasty (203 total knee prostheses). This consisted of examination of the femoral and popliteal veins of the operative extremity with color flow and duplex ultrasonography one week postoperatively. All patients received deep venous thrombosis (DVT) prophylaxis with sequential compressive pneumatic stockings, low-dose warfarin, continuous passive motion, and early mobilization. All patients were observed prospectively for thromboembolic sequelae for a minimum of six months postoperatively. The screening study was significantly limited in six (3%) of the 203 total knee prostheses. The overall incidence of sonographically detected proximal DVT or symptomatic calf vein thrombosis was 3% (6/203), and the incidence of symptomatic pulmonary embolism was 2% (4/203). Four of the ten thromboembolic complications occurred after hospital discharge. Results of this study suggest that duplex ultrasonography can be a useful screening method for identification of venous thrombosis after TKA. Patients with asymptomatic proximal DVT can be identified and appropriately treated before development of serious thromboembolic complications. Routine screening for DVT after TKA can avoid the considerable expense, inconvenience, and potential risk of complications associated with prolonged postoperative prophylactic anticoagulation. The combination of sequential compressive stockings, early mobilization, and low-dose warfarin appears to be a safe and effective prophylactic regimen against venous thromboembolic disease in these high-risk patients.
Adult↗
The prevalence of venous thromboembolism after hip and knee replacement surgery.
OBJECTIVE: To determine the prevalence of venous thromboembolism (VTE) after total hip replacement (THR), total knee replacement (TKR) or bilateral TKR in a large sample of patients in a major hospital orthopaedic unit. DESIGN, SETTING AND PATIENTS: The Mater Misericordiae Hospital, North Sydney, NSW, a 195-bed private hospital. All patients who had THR, TKR or bilateral TKR at the hospital between 1 April 1995 and 31 December 2001 had physical prophylaxis (graduated compression elastic stockings or intermittent pneumatic compression, or both) and chemical prophylaxis (anticoagulant) against VTE. All underwent ultrasonography of both legs before discharge, with a small, symptomatic group also undergoing a ventilation/perfusion lung scan (V/Q scan) and computed tomographic pulmonary angiography. MAIN OUTCOME MEASURES: Prevalence of deep-vein thrombosis (DVT) and symptomatic pulmonary embolism (PE) before discharge. RESULTS: Among a total of 5999 patients, the pre-discharge prevalence of DVT after THR, TKR or bilateral TKR was 8.9%, 25.6% and 36.9%, respectively. The prevalence of symptomatic non-fatal in-hospital PE was 1.9%, while the prevalence of fatal in-hospital PE was 0.05%. CONCLUSIONS: Despite short-term chemical and physical thromboprophylaxis, the prevalence of DVT after lower-limb joint replacement, measured by pre-discharge ultrasonography, was high. The rate of symptomatic non-fatal in-hospital PE was moderate, but fatal in-hospital PE was rare.
Adolescent↗
Calf pump function in patients with healed venous ulcers is not improved by surgery to the communicating veins or by elastic stockings.
Calf muscle pump function was assessed in 41 limbs after venous ulcers had healed. Treatment was then randomized either to ligation of incompetent lower leg communicating veins and ablation of incompetent superficial veins combined with permanent graduated compression elastic stockings, or to graduated compression elastic stockings only. Half volume refilling time (TV1/2) and relative expelled volume (EVrel) measured on foot volume plethysmography were used to assess calf muscle pump function. This was repeated after 12 months. The initial TV1/2 and EVrel were significantly lower than for normal limbs. There was no significant improvement in TV1/2 in either treatment group (Student's t test, P = 0.78, P = 0.19). EVrel did not improve significantly in limbs treated with elastic stockings alone (P = 0.94), but there was a slight but significant improvement in EVrel in limbs treated with surgery and elastic stockings (P = 0.048); however, this was still significantly below the normal range (P less than 0.001). In limbs without phlebographic evidence of post-thrombotic changes, treated with the combination of surgery and elastic stockings, there was a significant improvement in EVrel (P = 0.035), but no improvement was found in limbs with post-thrombotic changes. This small but significant improvement in EVrel in limbs without post-thrombotic changes treated by surgery and elastic stockings may explain the reduced incidence of reulceration that has been found following surgical eradication of the superficial and communicating veins.
Adult↗
The use of thromboembolic deterrent stockings and a sequential compression device to prevent spinal hypotension during caesarean section.
Hypotension is a common side effect of spinal anaesthesia for caesarean section. We have performed a randomised, controlled study to determine the efficacy of a sequential compression device (SCD) (Kendall) in combination with thromboembolic deterrent (TED) stockings (Kendall) to reduce the incidence of hypotension in this setting. Within 20 min of spinal injection, there was no statistically significant difference in the incidence of hypotension (defined as less than 100 mmHg and less than 80% of baseline blood pressure) (TED/SCD group 65%, control 80%, P = 0.12). However, there was a trend for those receiving TED/SCD prophylaxis to require less ephedrine to maintain normotension than the control group (median TED/SCD 3 mg, control 6 mg, P = 0.08). The administration of ephedrine deviated from protocol on a total of 46 occasions (2.3% of recordings). To try to reduce the influence of this, we reinspected our data using time to first episode of hypotension with a Kaplan-Meier survival analysis. This showed that the instantaneous risk (hazard) of developing hypotension was 1.8 (95% CI: 1.1-2.9) times higher in controls than those receiving TED/SCD prophylaxis (P = 0.02). Despite demonstrating some benefit of TED/SCD prophylaxis to prevent hypotension, we do not consider that the magnitude of this benefit warrants their routine use.
Clinical Trial↗
Compression for preventing recurrence of venous ulcers.
BACKGROUND: Up to 1% of adults will suffer from leg ulceration at some time. The majority of leg ulcers are venous in origin and are caused by high pressure in the veins due to blockage or weakness of the valves in the veins of the leg. Prevention and treatment of venous ulcers is aimed at reducing the pressure either by removing / repairing the veins, or by applying compression bandages / stockings to reduce the pressure in the veins. The vast majority of venous ulcers are healed using compression bandages. Once healed they often recur and so it is customary to continue applying compression in the form of bandages, tights, stockings or socks in order to prevent recurrence. Compression bandages or hosiery (tights, stockings, socks) are often applied for ulcer prevention. OBJECTIVES: To assess the effects of compression hosiery (socks, stockings, tights) or bandages in preventing the recurrence of venous ulcers. To determine whether there is an optimum pressure/type of compression to prevent recurrence of venous ulcers. SEARCH STRATEGY: Searches of 19 databases including the Cochrane Wounds Group trials register and the Cochrane Controlled Trials Register, handsearching of journals, conference proceedings, and bibliographies up to June 2000. SELECTION CRITERIA: Randomised controlled trials evaluating compression bandages or hosiery for prevention of venous leg ulcers. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of study quality were undertaken by two reviewers independently. MAIN RESULTS: No trials compared recurrence rates with and without compression. One trial (300 patients) compared high (UK Class 3) compression hosiery with moderate (UK Class 2) compression hosiery. A intention to treat analysis found no significant reduction in recurrence at five years follow up associated with high compression hosiery compared with moderate compression hosiery (relative risk of recurrence 0.82, 95% confidence interval 0.61 to 1.12). This analysis would tend to underestimate the effectiveness of the high compression hosiery because a significant proportion of people changed from high compression to medium compression hosiery. Compliance rates were significantly higher with medium compression than with high compression hosiery. One trial (166 patients) found no difference in recurrence between two types of medium (UK Class 2) compression hosiery (relative risk of recurrence with Medi was 0.74, 95% confidence interval 0.45 to 1.2). Both trials reported that not wearing compression hosiery was strongly associated with ulcer recurrence and this is circumstantial evidence that compression reduces ulcer recurrence. No trials were found which evaluated compression bandages for preventing ulcer recurrence. REVIEWER'S CONCLUSIONS: No trials compared compression with vs no compression for prevention of ulcer recurrence. Not wearing compression was associated with recurrence in both studies identified in this review. This is circumstantial evidence of the benefit of compression in reducing recurrence. Recurrence rates may be lower in high compression hosiery than in medium compression hosiery and therefore patients should be offered the strongest compression with which they can comply. Further trials are needed to determine the effectiveness of hosiery prescribed in other settings, i.e. in the UK community, in countries other than the UK.
Adult↗
[Prophylactic strategies for perioperative pulmonary embolism: the second report; reevaluation of usefulness of combination of elastic stockings and intermittent pneumatic compression].
BACKGROUND: The incidence of perioperative pulmonary thromboembolism (PTE) has increased in Japan. As the mortality rate of PE is very high, its prophylaxis is important. METHODS: From January 1998 to December 1999 no prophylactic strategies were employed. From May 2000 to December 2004, elastic stockings (ES) for prevention of perioperative deep vein thrombosis were worn from the morning of the operation until the beginning of ambulation. Intermittent pneumatic compression (IPC) apparatuses were used in combination with ES right after the induction of anesthesia until leaving ICU. Sixty percent of patients stayed in ICU until the next morning after the operation and the other patients for a few hours after the end of surgery. RESULTS: We managed 4,511 patients without any preventing method and 11,688 patients with the combination of ES and IPC. Seven patients developed PTE without any prophylaxis and one with preventative methods. The incidence of PTE was significantly decreased from 15.51 persons/10,000 cases to 0.86 person/10,000 cases. Symptomatic deep vein thrombosis occurred in 3 cases in spite of preventative methods. CONCLUSIONS: Our preventive strategies with the combination of ES and IPC seem to be useful to decrease the incidence and severity of perioperative PTE.
Aged↗
Perioperative morbidity of intracavitary gynecologic brachytherapy.
PURPOSE: To define the incidence and severity of perioperative morbidity and its subsequent management with standard tandem and ovoid insertions and to evaluate pretreatment and treatment factors associated with an increased risk of perioperative morbidity. METHODS AND MATERIALS: Ninety-five tandem and ovoid insertions were performed at the Fox Chase Cancer Center between 1985 and 1992 for cervical (n = 91) and endometrial (n = 4) cancer. Patients were placed on antibiotics in 19%, usually for a positive routine preoperative urine culture, but no patient was given prophylactic antibiotic therapy. Deep-vein thrombosis prophylaxis was practiced for 70% of implants and included subcutaneous heparin (40%), graduated compression elastic stockings (16%), and external pneumatic calf compression (14%). All patients were placed on prophylactic diphenoxylate hydrochloride, with doses ranging from three to eight tablets/day. RESULTS: Intraoperative complications were seen in 3% of implants and included two perforations and a vaginal laceration in two patients. Twenty-four percent of implants (16 patients) developed temperatures of > 100.5 (range 100.6 to 103), although only one patient required implant removal because of fever. Management of fever included antibiotics in 35% and acetaminophen only in 65%. Five implants (5%) were removed emergently secondary to presumed sepsis (n = 1), exacerbation of chronic obstructive pulmonary disease, hypotension, change in mental status (n = 3), and myocardial infarction/congestive heart failure (n = 1). No patient developed a deep-vein thrombosis, pulmonary embolism, gastrointestinal obstruction, or died of a postoperative complication. Univariate analysis of pretreatment and treatment factors revealed older age (p < 0.005) and spinal/epidural anesthesia (p < 0.02) to be associated with increased perioperative morbidity, and older age (p < 0.05) and higher ASA classification (p < 0.02) to be associated with severe complications requiring removal of implant. Multivariate analysis revealed only older age (p < 0.01) to be significantly related to perioperative morbidity. CONCLUSIONS: Fever of > 100.5 was seen in 24% of implants and can be managed successfully without removal of the implant in 96% of cases. Use of antibiotics preoperatively and intraoperatively did not reduce the risk of perioperative temperature elevation. Use of routine diphenoxylate hydrochloride prophylaxis was tolerated without ileus or gastrointestinal obstruction clinically. Although routine deep-vein thrombosis prophylaxis is reasonable, our data would support a low risk of deep-vein thrombosis for untreated patients. Severe perioperative morbidity necessitated premature implant removal in only 5% of cases and was related to older age in multivariate analysis.
Adult↗
Improving the treatment of leg ulcers.
Treatment of leg ulcers is often inadequate, with delayed diagnosis, overuse of antibiotics, and insufficient or inadequate use of compression therapy. Ulcers caused by arterial insufficiency will not heal unless the blood flow is improved. Ulcers caused by venous insufficiency will usually heal within a few months with appropriate compression therapy. Compression can be applied with stockings, bandages, or a pump. Class 2 compression stockings are required for treatment of ulcers; TED stockings and Class 1 stockings do not provide adequate compression. A four-layer compression bandage can be used if a patient cannot manage stockings. Applying the bandage with the correct pressure is a skill developed from practice. A pump can be used if neither stockings nor bandages are suitable. However, it must be used for six hours a day, which precludes use by active patients. An ulcer that does not heal with three months of adequate compression therapy requires further investigation.
Adult↗
[Formation of compressive bandage after sclerotherapy for lower limb varices].
Invention concerns compressive sclerotherapy as a treatment modality for lower limb varices. Technical result of investigation is the development of compressive bandage that creates and maintains adequate level of limb compression both in supine position (during bed rest) and standing or walking. Technical result is achieved by formation of two compressive layers of elastic bandage. Highly expansible elastic bandage is used for the first layer aimed for fixation and compression of latex or foam pads at injection sites to create local compression of variceal nodes. Open toe elastic stocking (I compression class) is placed over the bandage to maintain adequate compression during bed rest. The second external layer consists of elastic bandage with moderate expansion (II compression class). It is placed over the first one from toes to thigh upper third and creates optimal compression in patient's vertical position. The patient is permitted to take it off or loose exclusively in supine position, to wash or refresh foot with wet towel, to change it with a new one.
Bandages↗
Graded compression for preventing deep venous thrombosis.
The physiological effects of static compression of the leg have recently been reinvestigated. Graded compression extending from the ankle to the upper thigh produces the maximum increase in velocity of femoral vein blood flow and the maximum decrease in clearance times of contrast media and radioisotopes from the deep veins of the calf. This type of compression may be easily produced by a specially designed elastic stocking. Graded compression was used in a controlled clinical trial of 98 patients undergoing major operations to assess its effect on isotopically diagnosed deep vein thrombosis. The incidence of deep vein thrombosis was 49% in the control group and 23% in the treated groups. No complications were caused by the stockings. Carefully designed and correctly applied static compression is a safe and effective method of reducing the incidence of deep vein thrombosis.
Adult↗
Type of compression for reducing venous stasis. A study of lower extremities during inactive recumbency.
Determination of the optimal compression to reduce venous stasis was studied in terms of the amount of pressure and manner of application (graded or uniform pressure). Both lower extremities of seven inactive recumbent subjects were tested using transcutaneous Doppler ultrasonic measurement of femoral vein blood flow velocity. Optimal compression was defined as the externally applied pressure that produced the greatest increase in femoral vein flow velocity consistent with safety and the practicality of hospital use of elastic stockings. Optimal compression for elastic stockings to be used by hospitalized patients who spend substantial time in bed should be 18 to 8 mm Hg (ankle to midthigh). At this compression, average femoral vein blood flow velocity is increased to 138.4% of base line. Gradient compression at this level was found to produce a greater femoral vein flow velocity than the same amount of compression distributed uniformly over the lower extremity.
Adult↗
[Secondary malignant lymphedema].
The diagnosis of a secondary malignant lymphoedema which is caused by tumor infiltration or tumor compression is a very important sign for an unknown primary, but also for a tumor relapse. It is a big challenge, because it is often associated with a long story of woe, severe pain and a big reduction in mobility. Only an early diagnosis and introduction of a tumor-specific therapy is able to prevent the progress of this disease. As the secondary lymphedema is a chronic progressive disease, the early beginning of the "Complex physical Oedematherapy" is necessary, which consists of a combination of manual lymph drainage, compression by the use of bandages and special stockings for compression, physical training to improve mobility, dermatological care and drug therapy. Lymphedema is a chronic incurable disease. Therefore the therapeutic goal is to reach a stable disease without symptoms, which means reducing the lymphedema to "Stadium 0, latent stage".
Breast Neoplasms↗
[Computer-assisted evaluation of the compressive force of antithrombosis stockings].
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Bandages↗
[Compression therapy using elastic stockings].
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Bandages↗