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At least 811 records · Page 45Linked to original sources

PubMed2002

Tibio-calcaneo-naviculo-cuboidale arthrodesis: 6 patients followed for 1-8 years.

As a salvage procedure for patients with irreparable damage to the peritalar anatomy, we used a new method, the Ilizarov ring fixator, to stabilize a tibio-calcaneo-naviculo-cuboideal (TCNC) arthrodesis after resecting the talus in 6 patients with an average follow-up of 3 years. The tibia was lengthened by callus distraction, mean 6 (3.5-10) cm. Patients with exacerbation of a chronic talar osteomyelitis, symptomatic posttraumatic changes, and those with extremely unstable club feet and talar deformity preventing an adequate reduction of the joint, were successfully treated with the TCNC-fusion. The method permits early weight bearing, while providing stability and compression of the fusion, thereby avoiding further loss of bone stock.

Adult↗

PubMed1988

Local treatment of venous leg ulcers.

At present the following guidelines for treatment of venous leg ulcers from our department are: Check the patients' general health--special attention to heart incompensation with oedema of the legs and the peripheral circulation. The most relevant laboratory tests are haemoglobin and urine-glucose. Routine bacterial cultivation is not necessary in non-diabetic patients as the result will generally not influence diagnosis, treatment or prognosis. Furthermore, treatment with topical antibiotics should be avoided. It is not only unnecessary, wasteful and sensitizing, but it also involves a risk of causing antibiotic resistance. Systematic antibiotic therapy is indicated only when obvious inflammatory signs in the tissues surrounding the ulcer are present, e.g. erysipelas or cellulitis. Non-sensitizing topical remedies should be applied. Avoid wool, alcohols, parabens, topical antibiotics and oxiquinolines. When eczema occurs use a hydrocortisone preparation in an inert base. Epicutaneous testing might be indicated. Bandages to be recommended are double-layer bandages consisting of an inner zinc oxide impregnated stocking and an outer elastic bandage and hydrocolloid dressing plus compression bandage.

Anti-Bacterial Agents↗

PubMed2006

Compartment syndrome of the lower leg after surgery in the modified lithotomy position: report of seven cases.

PURPOSE: Acute compartment syndrome is known to develop after trauma or after postischemic revascularization. It also can occur when a patient has been lying in the lithotomy position during prolonged surgery. Methods were searched for the prevention of this iatrogenic complication after a series of seven patients who developed compartment syndrome after surgery at our hospital. METHODS: A series of seven consecutive patients who developed compartment syndrome of the lower leg(s) after abdominoperineal surgical procedures from 1997 to 2002 is presented and so are the lessons learned to prevent this problem. RESULTS: When comparing our experiences with data from literature, the seven patients had the usual risk factors for development of a compartment syndrome: lengthy procedure (>5 hours); decreased perfusion of the lower leg because of Trendelenburg positioning combined with the lithotomy position; and external compression of the lower legs (because of positioning, stirrups, or antiembolism stockings). Measures have been taken to prevent compartment syndrome from developing after prolonged surgery in the lithotomy position. This complication has not occurred again after the introduction of these measures two years ago. CONCLUSIONS: Acute compartment syndrome can be prevented if adequate measures are taken, but after lengthy surgery, maximum alertness for emerging acute compartment syndrome remains indicated. Early diagnosis and treatment by four-compartment fasciotomy is still the only way to prevent irreversible damage.

Acute Disease↗

PubMed1990

[Treatment of lymphedema in institutions. Two weeks of in-hospital intensive lymphatic drainage followed by maintenance treatment with a pulsator].

54 patients were admitted to The Norwegian Radium Hospital (hotel ward) for treatment of secondary lymph drainage in the arm or the leg. The treatment consisted of 14 days intensive lymph drainage, including massage and physical exercises, and intermittent compression with pulsator and bandaging. Information/instruction was given continuously. Good elastic stockings were supplied before the patients left the hospital. The treatment was succeeded by a maintenance programme, which the patients carried out themselves at home. The patients were closely followed up and reported on for six months, and were rechecked after another four and 12 months. We present the results after 14 days of intense treatment, followed by a 12-month maintenance programme.

Bandages↗

PubMed1997

Thromboembolism prophylaxis during laparoscopic cholecystectomy.

BACKGROUND: The aim of this study was to determine current UK practice with regard to thromboembolism prophylaxis during laparoscopic cholecystectomy. METHODS: Postal questionnaires were sent to 800 members of the Association of Surgeons; replies were received from 551 surgeons (69 per cent) of whom 417 practised laparoscopic cholecystectomy. RESULTS: Heparin was prescribed to all patients by 74 per cent, and selectively by 20 per cent, of respondents. Surgeons who performed fewer than ten laparoscopic cholecystectomies per annum were significantly less likely to use heparin (P < 0.001) and more likely to believe that heparin produces significant adverse bleeding (P < 0.01). Thirty per cent of respondents used low molecular weight heparin. Stocking to deter thromboembolism were used by 74 per cent, and pneumatic compression by 37 per cent. Indications for heparin varied considerably and were not influenced by Thromboembolic Risk Factors (THRIFT) guidelines. Only 20 per cent of respondents considered that thromboembolism was a problem; 91 per cent reported that they had never experienced a thromboembolic complication following laparoscopic cholecystectomy. CONCLUSION: The rate of thromboembolism after laparoscopic cholecystectomy is unknown but most surgeons believe the risk is very low. Surgeons' attitudes towards thromboembolism prophylaxis are variable, but most experienced surgeons use low-dose heparin.

Adult↗

PubMed2005

[Reorientational arthrodesis of the ankle joint using four screws].

BACKGROUND: Arthrodesis of the ankle has gained wide acceptance as a first-line treatment option for painful posttraumatic osteoarthritis. The technique using four to five lag screws for internal osteosynthesis is a safe and biomechanically stable method to obtain a sound ankle fusion with good to excellent long-term results in the majority of patients. Malalignment hazards are minimized by preservation of the ankle mortise. METHODS: The meticulous resection of all cartilage and sclerotic bone as well as an atraumatic surgical technique are essential for preventing major complications. The need for revision surgery is minimized by correction of talar malalignment, fusion with the foot in a 90 degrees position and preoperative evaluation of the subtalar joint. In a series of 40 ankle fusions fixed with the lag screw technique, 82.5% good to excellent results were obtained after 5.6 (4.8-7.6) years. No infection, stress fracture or non-union was seen. RESULTS: In cases of osteitis, osteonecrosis, osteoporosis, and poor soft-tissue condition, external fixation techniques are preferred. In the presence of severe loss of bone stock at the distal tibia, stability can be achieved by using a compression nail for tibiotalar fusion without additional subtalar arthrodesis.

Adult↗

PubMed1991

Compression volume in adult ventilator circuits: a comparison of five disposable circuits and a nondisposable circuit.

UNLABELLED: Although the concept of ventilator circuit compression is well known, it is not fully appreciated clinically. We compared the compression volume of five adult disposable ventilator circuits and a nondisposable circuit. METHODS: Five brands of disposable circuits (Inspiron, Intertech, Marquest, Seamless, and U-Mid) and one nondisposable brand (Bennett) were used. The circuits were attached to the outlet of a Bennett MA-1 ventilator in the standard manner, and the filter and humidifier were bypassed to eliminate their contribution to compression volume. The ventilator delivered 1 L of gas to a Michigan Instruments Test Training Lung at a flow of 60 L/min and a rate of 12/min. A valve system was placed between the Y-connector and the TTL to partition circuit compression volume from the volume delivered to the test lung. The compression factor was calculated by dividing the compression volume by the ventilating pressure. Five compliance settings were used on the TTL (0.1, 0.05, 0.03, 0.02, and 0.015 L/cm) to simulate different ventilating pressures. Pressure at the Y-connector, compressible volume, and volume delivered to the TTL were measured using a calibrated Timeter RT200 volume-pressure analyzer. Five measurements were made with each brand. A new circuit was used for each run with a disposable circuit, and a different circuit from the respiratory care department stock was used for each run with a nondisposable circuit. RESULTS: There were significant differences between the compression factors at different TTL compliance settings (p less than 0.001), and brands of circuits evaluated (p less than 0.001). There was a significant interaction effect for compression factors between TTL compliance setting and circuit brands (p less than 0.001). The compression factors for all disposable circuits were greater than the compression factors for the nondisposable circuits (p less than 0.05). CONCLUSIONS: There were differences in circuit compression factors as a function of the ventilating pressure and the brand of circuit. Although these differences are too small to be clinically important in many cases, they may be important during ventilation with low tidal volumes and high pressures.

Adult↗

PubMed1986

Comparison of two occlusive bandages in the treatment of venous leg ulcers.

A randomized controlled study was performed in 34 patients with venous leg ulcers. No difference was found in the healing rate between a new hydrocolloid dressing plus compression, and a double layer bandage, consisting of an inner paste bandage (i.e. a stocking impregnated with zinc oxide paste) and an outer elastic bandage. The parameters chosen for objective evaluation were stereophotogrammetric measurement of ulcer area and volume, and bacterial counts.

Aged↗

PubMed2005

[Postoperative venous thrombosis in general surgery patients and perioperative prophylaxis].

In a population of general surgery patients in Western countries, there was a 19% incidence of deep vein thrombosis (DVT) and a 1.6% incidence of pulmonary embolism (PE), with 0.9% of patients experiencing fatal PE. In Japan, there was a 15.8% incidence of DVT and a 0.34% incidence of PE, with 0.08% of patients experiencing fatal PE in a population of abdominal surgery patients. The incidences of PE and fatal PE in our department were 0.11% and 0.03%, respectively. We started to use intermittent pneumatic compression (IPC) for the prophylaxis of postoperative PE in 1999 and then added elastic stockings in 2002 and low-dose unfractionated heparin (LDUH) in 2003 for prophylaxis. The incidence of PE has dropped and that of fatal PE has become 0% with the use of such prophylactic measures. When the risk of venous thromboembolism of the 15 patients who experienced PE in our department were assessed using the Japanese Guidelines for Prevention of Venous Thromboembolism, 13 patients were assessed as high risk and 2 as low risk. The mean age and mean body mass index of the 15 patients were 54 yeas old and 24.8, respectively, and PE was not limited to obese or elderly patients. Such findings appear to indicate the difficulty of risk assessment for PE. Therefore we started to use IPC, elastic stockings, and LDUH for the prophylaxis of PE and DVT for all general surgery patients from April 2004. These prophylactic measures are recommended for the highest-risk patients in the Japanese Guidelines for Prevention of Venous Thromboembolism. There have so far been no serious bleeding complications with the administration of LDUH. We will continue to observe the effects of prophylaxis and the risk of bleeding.

Female↗

PubMed2006

Micromechanical response of mineral and collagen phases in bone.

We report the first simultaneous quantification of Young's modulus in the separate material phases of bone: collagen and carbonated hydroxyapatite. High-energy X-ray scattering and in situ loading revealed macroscopic, mineral, and collagen Young's moduli (90% confidence limit) for a canine fibula equaled 24.7(0.2) GPa, 38.2(0.5) GPa {for 00.4 and 43.6(1.4) GPa for 22.2}, and 18(1.2) GPa, respectively. The mineral contained compressive residual stresses on the order of -60 to -80 MPa before loading and had a stress enhancement (ratio of internal to applied stress) between 2.0 and 2.3. The diffraction peak width increased with increasing applied stress, mainly along the bone's longitudinal direction, and peak widths returned to pre-deformation values when load was removed. In a second fibula section from the same animal, the mineral's internal stress changed from -50 MPa (22.2 reflection) to -75 MPa (00.4) just after removal from formalin to -10 MPa after eight hours immersion in phosphate-buffered saline; the corresponding change in collagen D-spacing DeltaD/D equaled 4.2x10(-3).

Animals↗

PubMed2005

Effects of elastic stocking on quality of life of patients with chronic venous insufficiency. An Italian pilot study on Triveneto Region.

AIM: Even though compression therapy is the most recommended treatment for chronic venous insufficiency (CVI) in the national and international guidelines, its application, at least in Italy, is lower than the estimated need from the prevalence of CVI in the epidemiological studies. Since we believe that the measurement of the impact of compression therapy on quality of life (QoL) could improve the compliance for this precious treatment, we carried out this study on 50 patients with CVI. METHODS: Fifty patients (23 CEAP C2 and 27 C(3-4-5), selected within a larger study on QoL in CVI), received a prescription for compression therapy. Before treatment and 4 months afterwards, the patients received the instrument for QoL assessment (MOS SF-36; CIVIQ-2; Euro-QoL 5D and a visual analogue scale). The score scales have been adjusted to poorest QoL as 0 and best QoL as 100. RESULTS: Baseline QoL of patients in class C2 did not show significant difference with the healthy Italian Population, except for the physical role item. The patients in class C(3-4-5) showed significant reduction of QoL. After 4 months all the items of the utilized instrument showed significant improvement (from P<0.01 to P<0.04 for SF-36; from P<0.099 to P<0.006 for other instruments) in all CEAP classes. CONCLUSIONS: The study unquestionably shows that the compression therapy improves the QoL of patients with CVI, and should be included in the CVI treatment covered by the Public National Health Insurance. Finally, the QoL measurement could be utilized as the scientific method to assess the effectiveness and efficacy of different therapeutic devices.

Bandages↗

PubMed2005

Internal strains and stresses measured in cortical bone via high-energy X-ray diffraction.

High-energy synchrotron X-ray diffraction was used to study internal stresses in bone under in situ compressive loading. A transverse cross-section of a 12-14 year old beagle fibula was studied with 80.7 keV radiation, and the transmission geometry was used to quantify internal strains and corresponding stresses in the mineral phase, carbonated hydroxyapatite. The diffraction patterns agreed with tabulated patterns, and the distribution of diffracted intensity around 00.2/00.4 and 22.2 diffraction rings was consistent with the imperfect 00.1 fiber texture expected along the axis of a long bone. Residual compressive stress along the bone's longitudinal axis was observed in the specimen prior to testing: for 22.2 this stress equaled -95 MPa and for 00.2/00.4 was between -160 and -240 MPa. Diffraction patterns were collected for applied compressive stresses up to -110 MPa, and, up to about -100 MPa, internal stresses rose proportionally with applied stress but at a higher rate, corresponding to stress concentration in the mineral of 2.8 times the stress applied. The widths of the 00.2 and 00.4 diffraction peaks indicated that crystallite size perpendicular to the 00.1 planes increased from t=41 nm before stress was applied to t=44 nm at -118 MPa applied stress and that rms strain epsilon(rms) rose from 2200 muepsilon before loading to 4600 muepsilon at the maximum applied stress. Small angle X-ray scattering of the unloaded sample, recorded after deformation was complete, showed a collagen D-period of 66.4 nm (along the bone axis).

Animals↗

PubMed2006

Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality.

STUDY DESIGN: Retrospective follow-up of patients over the age of 65 with a minimum of five-level fusions. OBJECTIVE: To determine the effect on outcomes of long constructs in patients with poor bone stock, and to review surgical techniques used in patients with poor bone stock. SUMMARY OF BACKGROUND DATA: Scoliotic deformities in patients with poor bone stock require alterations in both the surgical technique and preoperative planning. To our knowledge, complications of long constructs in poor bone stock have not been specifically reported. METHOD: Patients over the age of 65 that underwent a minimum of five-level fusion over a 5-year period were reviewed. We reviewed both operative reports and clinic notes and recorded both early and late complications. RESULTS: Early complications included pedicle fractures and compression fractures with an overall rate of 13%. Late complications included pseudarthroses with instrumentation failure, adjacent level disc degeneration with herniation, compression fractures, and progressive kyphosis. Progressive junctional kyphosis occurred in 26% of patients. CONCLUSIONS: Spinal stabilization surgery in patients with poor bone stock is associated with high complication rates. Complications such as progressive kyphosis adjacent to the fusion are difficult to address with instrumentation alone.

Age Factors↗

PubMed1982

Salvage of painful total ankle arthroplasty.

Revision of painful total ankle arthroplasties with reinsertion of a prosthetic device has been unsatisfactory. After removal of the prosthetic components, generally, the remaining bony stock is insufficient to allow adequate fixation with methylmethacrylate. Revision with arthrodesis by the modified Chuinard compression technique has been successful. Ankle arthrodesis is the only available surgical alternative to prosthetic ankle arthroplasty. Consequently, should a total ankle arthroplasty fail, a reliable salvage procedure is available that leaves the patient with minor, if any, additional functional impairment compared to that with an ankle arthrodesis done initially.

Ankle Joint↗

PubMed2007

[Lymphedema].

It is necessary to do treatment that centered on the compression therapy after examining the condition closely enough to treat the lymphedema (so-called malignant lymphedema) that developed by the progress of cancer. As the compression method, the method of using the elastic bandage is general, and, according to circumstances, the elastic stocking is used. Moreover, not only the patient but also the family feels and self care what is important. It is thought that the manual lymph drainage to affected limbs is also effective to think about the symptom reduction of affected limbs as palliative medicine because of the purpose is not to improve the edema.

Female↗

PubMedDate not supplied

Knee fusion with intramedullary rods for failed total knee arthroplasty.

Knee fusion was obtained after failed total knee arthroplasty with the aid of internal fixation by use of intramedullary rods. The method has been used in eight cases, including difficult situations characterized by morbid obesity, segmental fractures, and loss of bone stock. In these cases, stability would have been difficult to obtain with conventional methods of external fixation, compression, or casting. Stability was achieved quickly with an intramedullary rod in eight cases; fusion was obtained in seven.

Aged↗

PubMed1992

The effect of elastic compression on the venous tone in patients with varicose veins.

The long term effect of elastic compression, with an emphasis on the changes in venous wall elasticity, was studied in 10 limbs with varicose veins. By simultaneously measuring venous volume, using the air plethysmograph (APG), and venous pressure, while the venous outflow was occluded, the pressure/volume (P/V) relationship of the venous system of the leg could be studied and the elastic modulus calculated. These measurements were performed prior to the application of elastic stockings and 6 weeks later, one day after the stockings had been removed. Statistically significant improvements were noted in the APG parameters studied and in the P/V curve derived elastic modulus calculations. The limbs could be divided into two groups based on the response of the P/V curves to elastic stockings and the severity of disease. Those limbs with milder disease tended to shift their P/V curves downward and to the right after compression (giving them a more normal pattern). Limbs with more severe disease showed evidence of a similar pattern of improvement at low but not at high venous pressures.

Bandages↗

PubMed1987

Legging orthosis for venous and lymphatic insufficiency.

Presented are the description and advantages of a unique compression device in the form of a legging for the treatment of venous and lymphatic insufficiency. It consists of a number of pliable, unyielding, adjustable compression bands, from the knee to the instep. The bands are easily closed, tightened, and opened, which is particularly useful for the physically handicapped patient for whom the commonly prescribed elastic stocking is inappropriate because of the difficulty in putting it on and removing it. The effectiveness of the legging is enhanced by its nonelasticity, as has been long proven by the Unna boot, and its ability to maintain an unreduced compression level throughout its lifetime, regardless of edema changes.

Equipment Design↗