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At least 613 records · Page 34Linked to original sources
PubMed1999

The influence of oral anticoagulation therapy on deep vein thrombosis rates four weeks after total hip replacement.

PURPOSE: The purpose of this study was to assess the rate of postoperative deep vein thrombosis (DVT) as a function of oral anticoagulation therapy after total hip replacement surgery. METHODS: A total of 125 patients completed the study. All the patients received sequential gradient pneumatic compression over elastic stockings until hospital discharge. In addition, all the patients underwent postoperative heparin therapy followed by oral warfarin therapy, adjusted in dose to maintain a goal international normalized ratio (INR) level of 2.0 to 3.0. Warfarin therapy and compression stockings were continued for 1 month after surgery. Bilateral duplex scanning was performed 1 and 4 weeks after surgery to assess the rate of DVT. RESULTS: Nineteen of the 125 patients had DVT develop (15.2%). Of those thromboses, six (31.6%) and 13 (68%) were detected 1 week and 1 month after surgery, respectively. The rate of proximal DVT was 2.4% (3 of 125) 1 week after surgery and rose to 8.2% (10 of 122) 1 month after surgery. Most DVT cases (64%; 12 of 19) were asymptomatic. The patients in whom DVT developed had significantly lower INR values during the second to fourth postoperative weeks than did those patients without thrombosis, and no differences in INR values were found during the first postoperative week. CONCLUSION: The risk of the development of DVT extends beyond hospital discharge in patients who undergo total hip replacement, despite a regimen of prolonged oral anticoagulation therapy. This is particularly true in patients whose INR values did not reach therapeutic range during the first postoperative month. Therefore, thrombosis prophylaxis regimens on the basis of the administration of warfarin should try to maintain INR values within therapeutic range during the entire first postoperative month to minimize the incidence of DVT.

Administration, Oral↗
PubMedDate not supplied

[Pressure therapy using elastic stockings].

Elastic stockings raise problems of two types: prescribing for the physician and compliance for the patient. The prescription must contain five pieces of information: the name of the stocking, its compression strength, its size, its height and its length. Compression strength should be noted either in mmHg, corresponding to the type of disease requiring treatment, or directly in terms of the suffix of the stocking. A table listing the majority of elastic stockings available in France and showing their compression strength facilitates prescribing. It is equally important to take the time to convince each patient of the value of this type of compression, to review the technical difficulties associated with the putting on and taking off of the stockings and the possibilities of superimposition. Compliance with prescribed treatment is the key to success.

Bandages↗
PubMed1977

Effectiveness of elastic stocking decompression.

The compression effectiveness of the five leading brands of antiembolism stockings was compared and related to criteria previously described (pressure gradient diminishing from 18 mm Hg at the ankle to 8 mm Hg at the thigh). Tests were conducted using a standard leg form in common use within the hosiery industry, fitted with specially developed sensors. All of the stockings achieved pressures higher than recommended-some substantially. Elastic stockings from two manufacturers demonstrated tourniquet effects at the calf. Several brands ceased to preserve a continuously diminishing pressure gradient above the knee. Deviation of leg diameter from standard geometry was accompanied by a substantial increase (decrease) in pressure with increasing (decreasing) girth. Reproducibility of pressure effects produced by identical-sized stockings varied among the brands tested.

Adult↗
PubMed2006

National survey in the United Kingdom of prophylaxis of deep vein thrombosis for patients with fracture of the neck of the femur.

Thromboprophylaxis continues to be a contentious issue because of a lack of clear answers to pertinent questions. Hence, a survey is helpful in identifying current practices. A national survey in the UK in January 2004 investigated the use of thromboprophylaxis following fracture of the neck of the femur. Responses from 723/1648 (44%) orthopaedic consultants to a postal questionnaire showed that 623 (86%) regularly undertook trauma surgery and 625 (87%) had protocols for prophylaxis of deep venous thrombosis. In all, 555 (89%) consultants followed these protocols routinely and, of these, 276 (50%) regularly used both chemical and mechanical prophylaxis, 235 (42%) used chemoprophylaxis only and 44 (8%) used mechanical prophylaxis only. Among consultants using chemoprophylaxis, 238 (46%) used low-molecular-weight heparin, 148 (30%) used aspirin, 75 (15%) used low-molecular-weight heparin and aspirin, 35 (6%) used unfractionated heparin and 15 (3%) used warfarin. However, 68 (11%) did not use any thromboprophylaxis at all for patients with fractured neck of the femur.

Femoral Neck Fractures↗
PubMed2007

Immediate hemodynamic effect of the additional use of the SCD EXPRESS Compression System in patients with venous ulcers treated with the four-layer compression bandaging system.

OBJECTIVES: To test the hypothesis that the SCD EXPRESS intermittent pneumatic compression applied in combination with a four-layer bandage in patients with venous ulcers increases popliteal vein volume flow and velocity. DESIGN: Twenty limbs of 18 patients with venous leg ulcers were studied, median age 76 years. The Total Volume Flow (TVF) and the Peak Systolic Velocity (PSV) were recorded in the popliteal vein using duplex ultrasonography. Measurements were made (i) without bandage, (ii) with four layer bandage and (iii) following the application of the SCD Compression System on top of a four-layer bandage for at least 15 minutes. RESULTS: The median VCSS was 17 (range, 12-22) while the median VSDS for reflux was 4.5 (range, 1-7.5). The median TVF was 71 mL/min (inter-quartile range 57-101) without bandage, 112 (IQR 89-148) with four-layer bandage and 291 (IQR 241-392) with the addition of the SCD System (P<.001, Wilcoxon signed ranks test). The median PSV was 8.4 cm/sec (IQR 6.8-14) without bandage, 13 (9.0-19) with four-layer bandage and 27 (21-31) with the addition of the SCD System (P<.001, Wilcoxon signed ranks test). Both TVF and PSV increased slightly with the addition of the four-layer bandage. However, with the addition of the SCD System these parameters increased three fold. CONCLUSIONS: The SCD EXPRESS Compression System accelerates venous flow in the legs of patients with venous ulcers already treated with a four-layer bandage. The combination of four-layer compression with the SCD System on healing venous ulcers needs to be tested by a clinical effectiveness study.

Aged↗
PubMed1996

A study of the advantages of elastic stockings for leg lymphedema.

To assess the efficacy of compression therapy alone, we report herein the long-term results of leg lymphedema using elastic stockings. Between January 1965 and March 1993, 41 primary lymphedema and 74 secondary lymphedema of the lower extremities have been treated at our hospital. Ten patients had recurrence of cancer, and 5 patients had surgical therapy. The remaining 100 patients were analyzed for the clinical results following treatment with elastic stockings. During the follow-up period of 5 +/- 0.2 years, 3 of 39 limbs (8% or 30 patients) with primary lymphedema wearing elastic stockings experienced enlargement of limb circumference and 36 limbs (92% or 27 patients) showed decrease or no change. Without elastic stockings, 1 out of 13 limbs (8% or 8 patients) with primary lymphedema showed worsening of their symptoms. In contrast, only 1 of 61 limbs (1.7%) in 46 patients with secondary lymphedema who wore elastic stockings showed deterioration of their symptoms. Although elastic stockings did not influence the incidence of the lymphangitis, their effect in maintaining limb circumference was apparent in all the patients with inflammation caused by secondary lymphedema. Among 20 patients with secondary lymphedema who had recurrent lymphangitis, only 1 out of 19 limbs (5%) in 16 patients experienced deterioration of the symptom with the use of elastic stockings while 1 out of 4 limbs (25%) in 4 patients showed improvement or no change without elastic stockings. Our data demonstrate that compression stockings are associated with long-term maintenance of reduced limb circumference, especially in secondary lymphedema regardless of the association with recurrent lymphangitis.

Adolescent↗
PubMed2006

Leg ulcers - causes and management.

BACKGROUND: A leg ulcer is not a disease but the manifestation of an underlying problem that requires a clear diagnosis. OBJECTIVE: This article outlines the assessment and management of patients with leg ulceration. DISCUSSION: The simple tag of 'leg ulcer' is not an adequate diagnosis. A comprehensive assessment of the patient, skin, vascular status, limb, and ulcer is required to determine the aetiology and to formulate an appropriate management plan. Most leg ulcers are caused by venous insufficiency and compression is required to successfully heal venous leg ulcers. Treatment must address oedema, infection and pressure. Managing peripheral oedema using compression bandages is often more important than the topical dressings. Success requires consistent adherence to a care plan designed to address the underlying pathology and contributing factors.

Family Practice↗
PubMed2007

[Deep venous thrombosis--epidemiology, diagnosis and treatment].

The pathogenesis of deep vein thrombosis (DVT) involves vascular changes or injury, stasis and alterations in the blood composition. The risk increases with age; however, important risk factors are cancer, surgery, immobilisation and hormone therapy. DVT most often appears in the crural veins. The diagnosis is based on ultrasound, d-dimer and clinical examination. Correct treatment requires gradient compression hosiery, low-molecular heparins and anticoagulant therapy. Duration of treatment depends on the individual risk of recurrence.

Anticoagulants↗
PubMed2006

Traction-compression-closure for exomphalos major.

PURPOSE: We present our experience with traction-compression-closure (TCC) for exomphalos major (EM) to achieve a safe and embryologically correct midline supraumbilical aesthetic closure with preservation of the umbilicus. METHODS: Nineteen neonates with EM were paralyzed and ventilated. The abdominal domain was increased by upward cord traction to assist liver-bowel reduction by gravity and sac ligation, followed by circumferential elastic body binder compression. The supraumbilical abdominal wall anomaly cicatrized spontaneously or was closed surgically as a midline scar, with preservation of the umbilicus. RESULTS: Over 7 years (1998-2004), 19 patients with EM were treated by TCC, 18 of whom survived. The patients' median gestational age was 36 weeks (range, 24-40 weeks); their median birth weight was 2312 g (range, 890-3000 g). The median time to reduction was 4 days (range, 3-5 days), whereas that to full enteral feeds was 6 days (range, 4-6 days). Mechanical ventilation for 7 days (range, 6-8 days) was not associated with any morbidity, and the time to home discharge was 11 days (range, 8-12 days). Five patients did not require any surgery. There was no episode of sac rupture or infection. CONCLUSION: Abdominal expansion by vertical cord traction followed by compression reduction (TCC) under muscle relaxation and ventilation is time well spent toward a safe and aesthetic midline abdominal wall closure without tension for EM.

Abdominal Wall↗
PubMed2007

Professional footwear evaluation for clinical nurses.

Epidemiological investigations indicate that nursing professionals experience a higher prevalence of musculoskeletal disorders (MSDs) than most other occupational groups. Most nursing activities require standing and walking for prolonged periods. Such job requirements may contribute to MSD problems in the lower extremities. Thus, wearing comfortable nursing shoes is essential to reduce the lower-extremity discomfort for clinical nurses. The objectives of this study are: (1) to evaluate three brands of commercially available nursing footwear and identify the important shoe features for adequate shoe support during nursing activities, and (2) to assess the effect of wearing compression hosiery by measuring the biomechanical, physiological, and psychophysical responses of test participants. The method of this study involved two phases. First, field observations were conducted to collect job demand data, including walking speed, and the ratios of walking, standing, and sitting. Second, an experiment was conducted to evaluate the functions of professional nursing footwear and examine the influence of compression hosiery on lower extremity discomfort relief. Measurements included electromyography (EMG) of the lower leg, joint range of motion (ROM) in the lower extremity, foot pressure, ground reaction force (GRF), and subjective discomfort ratings for the lower body and feet. Summarizing the findings of this study, comfortable footwear for nursing professionals should emphasize a footbed with arch support outside with 1.5 cm thickness of EVA materials in the metatarsal zone and heel height between 1.8 and 3.6 cm; this can minimize foot pressure distribution, impact force, and increase shin and ankle comfort. In addition, wearing compression hosiery is recommended to alleviate lower body and foot discomfort for clinical nurses.

Adult↗
PubMed1976

Elastic compression in the prevention of venous stasis. A critical reevaluation.

The effect of elastic compression on venous flow in the legs provided by carefully fitted stockings has been measured by a venographic technic. The stocking used provides a gradually decreasing compression from ankle to groin. Clearance of stagnant blood from behind venous valves is clearly improved and the differences observed are statistically highly significant. These data suggest that the routine use of carefully fitted compression stockings will result in a decreased incidence of deep vein thrombosis (DVT) and provide a singularly safe, convenient, and noninvasive method of prophylaxis. Evidence presented suggests that at least two investigators have failed to show a decreased incidence of DVT in limbs subjected to elastic compression because the method of compression was inadequate .

Adult↗
PubMedDate not supplied

Compression modalities and dressings: their use in venous ulcers.

Among the standard of care for venous ulcer treatment are the use of compression therapy to reverse the effect of venous hypertension and the use of occlusive dressings to maintain a moist wound-healing environment and for treatment of abnormalities of the ulcer bed. The use of multilayered elastic bandages for compression in patients with normal arterial flow currently provides the treatment with the highest level of evidence for treatment of venous ulcers. Additionally, treatment of the ulcer bed, especially with cadexemer iodine dressings, is also supported by evidence from randomized controlled trials, whereas newer dressings provide less well proven alternative opportunities to speed the healing of venous ulcers.

Humans↗
PubMed2006

[What to do if incompressible bleeding from a stab wound occurs in EMS and ER? Temporary control with a Foley catheter].

Exsanguination plays a key role in avoidable prehospital deaths. As some bleedings from deep stab wounds cannot be stopped with direct compression, the insertion of a Foley catheter can prevent ongoing bleedings. A case report of bleeding from a stab wound in the supraclavicular region is given. The simple measure of careful insertion and blocking of a Foley catheter proved to be a key resuscitative procedure which can be done under any suitable circumstances.

Adult↗