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PubMed1981

[Methods of determining pressure on tissues from elastic stockings used for the prevention and treatment of chronic venous diseases of the lower limbs].

The authors discuss methods and devices for determination of the compressive properties of elastic products in prophylaxis and treatment of the disease of lower extremity veins. The majority of the discussed methods is tedious, and the devices used are characteristic of high measurement error and frequently can be used in laboratories only. The authors designed a portable device for the measurement of the pressure exerted on every part of the body by the elastic products. This device can be applied both in standard and in clinical conditions. It is simple and easy to handle, and the results obtained reflect the real pressure exerted by the elastic products on extremities. Moreover, the authors presented a new method of measurement of elastic products pressure on human extremity.

Biomechanical Phenomena↗

PubMed2002

Supracondylar fractures of the femur above total knee arthroplasties with cortical allograft struts.

Ten supracondylar fractures of the femur above a total knee arthroplasty were treated with open reduction and internal fixation using a metal plate and cortical allograft struts. Failure with nonunion of previous operative treatments was seen in 5 patients. The other 5 patients had either severe osteopenia or comminution of the fracture above the knee prosthesis. At an average of 38 months' follow-up, all the fractures healed with an average union time of 17.6 weeks. The postoperative knee alignment averaged 5.1 degrees valgus. Infection occurred in 1 patient, which resulted in a poor outcome. The remaining 9 patients were functioning well at the most recent follow-up examination. The use of cortical allograft struts combined with a compression plate provided satisfactory results for supracondylar fractures above knee prostheses with severe osteopenia or loss of bone stock after initial failure of internal fixation.

Aged↗

PubMed2003

[Thrombosis prophylaxis in orthopaedic surgery: considerations and uncertainties].

As it is not always possible to identify patients at extra risk of deep-venous thrombosis after major orthopaedic surgery, it is considered advisable to prescribe prophylactic treatment. Prophylaxis with a low dose of unfractionated heparin is more effective than no prophylaxis at all but less effective than low molecular-weight heparin or cumarine derivatives. Acetylsalicylic acid does not appear to have a place in the prevention of venous thromboemboli in elective total-hip and total-knee surgery. Its usefulness in the operative treatment of hip fractures has not been established. Starting prophylaxis postoperatively has not been shown to be less safe or effective than starting it preoperatively. The incidence of thrombosis is lower if the course of prophylactic treatment is lengthened to 4-6 weeks following arthroplasty of the hip or knee. The optimal period of medicinal prophylaxis has yet to be ascertained. Intermittent pneumatic compression appears to be effective after total-knee arthroplasty but in practice is difficult to deliver. Support stockings, a foot pump and rapid mobilization have little effect on the incidence of proximal deep-venous thrombosis. There are insufficient data regarding the use of thrombosis prophylaxis in day surgery.

Anticoagulants↗

PubMed2005

[Prophylaxis of perioperative pulmonary thromboembolism in a patient with anti-phospholipid antigen syndrome].

A 68-year-old woman with anti-phospholipid antigen syndrome (APS) was proposed to undergo partial pulmonary resection for lung cancer. She suffered from mild cerebellar ataxia. Exercised 201Tl myocardial scintigraphy was performed due to abnormal Q wave in preoperative electrocardiography and showed old myocardial infarction in inferior-to-posterior area without myocardial ischemia. Cardiac function was marginally decreased in cardiac echographic evaluation. Arterial thrombosis by APS might cause cerebellar ataxia and myocardial infarction. Low molecular weight heparin (LMWH) was continuously infused from 1 hour prior to arrival in an operation room. Elastic stockings (ES) were worn from the morning of the operation in combination with the use of intermittent pneumatic compression apparatus (IPC). Significant bleeding was not observed perioperatively. Hypothermia was avoided by forced-air-warming therapy. She was transferred to ICU after the end of the operation. She was returned to her ward without IPC on the first postoperative day. Warfarin was given with the beginning of ambulation on the second postoperative day to keep PT-INR about 2. On the third postoperative day LMWH was discontinued and ES were taken off. The postoperative course was uneventful.

Aged↗

PubMedDate not supplied

Evaluation of the effects of elastic compression in patients with postphlebitic limbs by laser-Doppler flowmetry.

Laser-Doppler flowmetry has been used to study the skin microcirculation in 20 normal limbs and 80 limbs of patients with venous hypertension and leg ulceration due to deep venous reflux. It was found that limbs with venous hypertension had a high skin resting blood flow (BRF) and an impaired veno-arteriolar reflex (VR). There was a marked improvement in both BRF and VR after elastic compression for three weeks and an association between this improvement and the rate of healing of the leg ulcers. The results indicate that elastic compression may affect the microcirculation even though it does not alter the venous pressure measurements when the elastic stockings are removed.

Adult↗

PubMed1986

Knee arthrodesis.

Thorough excision of all scarred and infected tissues with careful contouring of the bone ends to ensure adequate bone apposition should be performed. Cancellous bone grafts placed about the periphery of the arthrodesis should be considered in the case of loss of bone stock to improve the surfaces for bone apposition. Rigid biplanar external fixation should be used to obtain a compression arthrodesis combined with prolonged immobilization. Unfortunately, some patients will require permanent bracing.

Aged↗

PubMed2001

Effect of crosslinking UHMWPE on its tensile and compressive creep performance.

The in vitro quasi-static tensile and compressive creep properties of three sets of GUR 1050 ultra-high-molecular-weight polyethylene (UHMWPE) specimens were obtained. These sets were: control (as-received stock); "low-gamma" (specimens were crosslinked using gamma radiation, with a minimum dose of 5 Mrad); and "high-gamma" (specimens were crosslinked using gamma radiation, with a minimum dose of 15 Mrad). The % crystallinity (%C) and crosslink density (rho(x)) of the specimens in the three sets were also obtained. It was found that, in both tension and compression, crosslinking resulted in a significant depreciation in the creep properties, relative to control. The trend in the creep results is explained in terms of the impact of crosslinking on the polymer's %C and rho(x). The present results are in contrast to literature reports that show that crosslinking enhances the wear resistance of the polymer. The implications of the present results, taken together with the aforementioned literature results, are fully discussed vis-a-vis the use of crosslinked UHMWPE for fabricating articular components for arthroplasties.

Biocompatible Materials↗

PubMed2003

Temporal trends in prevention of venous thromboembolism following primary total hip or knee arthroplasty 1996-2001: findings from the Hip and Knee Registry.

BACKGROUND: The Hip and Knee Registry is an observational database comprising data on practices of US orthopedic surgeons during 1996 to 2001. We examined trends in the use of prophylaxis for venous thromboembolism (VTE) among patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS: Data on 9,327 THA and 13,846 TKA patients were submitted between 1996 and 2001 by 464 orthopedic surgeons from 319 hospitals in 42 of the United States. RESULTS: During 1996 to 2001, 44% of THA patients and 38% of TKA patients were male, and 93% and 92% were white, respectively. The median age of THA and TKA patients increased from 66 to 68 years and 68 to 69 years, respectively, between 1996 and 2001 (p < 0.001), while the mean length of hospital stay decreased from 4.7 to 3.7 days and 4.5 to 3.7 days, respectively (p < 0.001). Use of spinal or epidural anesthesia increased from 34 to 46% for THA and 43 to 54% for TKA patients (p < 0.001). One or more types of thromboprophylaxis were administered to 99% of patients. The following were the most common types of thromboprophylaxis: elastic stockings (61% and 58%), warfarin (56% and 53%), low-molecular-weight heparin (38% and 40%), and intermittent pneumatic compression (35% and 32%) in THA and TKA patients, respectively. Aspirin was used for thromboprophylaxis in 4% of THA and 7% of TKA patients. One or more type of in-hospital prophylaxis matching the 2001 American College of Chest Physicians (ACCP) recommendations were administered to 89% of THA and 91% of TKA patients between 1996 and 2001. During this period, in-hospital use of ACCP prophylaxis recommendations increased from 88 to 94% following THA (p < 0.001). This increase was also observed for prophylaxis administered to TKA patients, although this did not reach statistical significance. CONCLUSIONS: Recent trends in the management of patients undergoing THA and TKA in the United States, including shorter lengths of hospital stay and increased use of spinal/epidural anesthesia, present a challenge to orthopedic surgeons who wish to provide their patients with effective prophylaxis for VTE. Despite these challenges, nearly all surgeons participating in the Hip and Knee Registry are providing types of prophylaxis consistent with evidence-based consensus recommendations. Although there are concerns regarding increased bleeding risk due to the use of anticoagulants in patients receiving spinal/epidural anesthesia, there was a significant increase in the use of spinal/epidural anesthesia between 1996 and 2001. During this same period, the proportion of patients receiving spinal/epidural anesthesia who were also administered anticoagulants as prophylaxis increased significantly.

Aged↗

PubMed1993

[Prevention of thromboembolism with drugs].

Prophylaxis of thrombosis during and after surgery reduces the incidence of deep vein thrombosis and lung embolism in patients at risk. The kind of therapy applied is related to the individual risk of each patient. Antithrombotic stockings together with low-dose heparin or dextran, is recommended in low-risk patients. Alternatively intermittent pneumatic compression can be applied in these patients. In patients at high risk (hip or knee surgery) a prophylaxis regimen that has been proven efficient in this patient group must be used. Unfractionated and low-molecular-weight heparin (both also in combination with DHE), dextran and oral anticoagulants have been shown to be effective, but LMW heparin seems to be the best. Prophylaxis of thrombosis is also recommended in outpatients whose lower extremities are immobilized. The initiation of therapy, choice of medicament duration of therapy is ultimately the decision of the responsible physician, who must consider it for each individual patient.

Anticoagulants↗

PubMed1979

[Graduated and constant compression of the lower extremities in the prevention of postoperative deep venous thrombosis and of pulmonary thromboembolism. Clinical trial].

The authors report their experience with graded-pressure elastic hose (TED Stockings) for the prevention of deep venous thrombosis of the lower limbs and pulmonary embolism in high-risk, bedridden postoperative patients. The trial was designed according to a closed sequential program and gave positive, statistically significant results in terms of preventing pathology with this type of hose.

Bandages↗

PubMed1982

Venous thromboembolism prophylaxis: a survey of its use in the United States.

Despite controversy about their effectiveness, low-dose heparin therapy and elastic stockings were the methods most frequently selected by surgeons in a national survey on thromboembolism prophylaxis. These methods were selected even for patients with an extremely high risk of thrombosis. Surgeons responding to this survey apparently did not discriminate between degrees of patient risk, did not recognize the limitations of low-dose heparin and elastic stockings in protecting high-risk patients, and were unfamiliar with more effective methods of prophylaxis, ie, warfarin, dextran, and intermittent pneumatic compression. There is clearly a need for more specific data regarding the safe use of effective thromboembolism prophylaxis in surgical patients.

Anticoagulants↗

PubMedDate not supplied

Measuring units for elastic stockings: priority to mmHg rather than classes.

Seven incontrovertible arguments show that the only valid measurement unit for elastic stockings is the millimetre of mercury and not a grading system. The mmHg is an international measurement unit; a new European grading system will make prescribing much more difficult; the degree of arterial insufficiency is calculated by taking systolic pressures by Doppler and is expressed in mmHg; in case of superimposition of elastic stocking, pressure add together but not grades; the unit used for pressure instruments is the mmHg; a clinical situation may require a compression force straddled between two grades; finally, new materials will certainly provide increasingly precise forces.

Bandages↗

PubMed1998

Compressive creep characteristics of extruded ultrahigh-molecular-weight polyethylene.

The static compressive creep behavior of ultrahigh-molecular-weight polyethylene (UHMWPE) was studied under physiologic conditions. Specimens were machined from the center and periphery of extruded GUR 4150HP rod stock and were subjected to constant pressures of 2, 4, or 8 MPa for intervals as long as 10(4) min. The creep strain (creep divided by initial thickness) was compared to the pressure and duration of loading by using analysis of variance and linear regression analysis. The amount of creep strain increased rapidly in the early period of testing and was followed by a reduced rate of creep, which reached a steady state after approximately 4000 min. The amount and rate of creep strain increased linearly with pressure. Surprisingly, the rate of creep strain varied with the radial position in the rod stock: specimens obtained from the periphery had 8-19% larger creep strain rates than did specimens obtained from the center (p = 0.1 to p < 0.001). These results advance the characterization of creep's contribution to the in vivo penetration of the metallic component into the UHMWPE component, thereby facilitating the measurement of true in vivo wear. These data also help explain the azimuthally nonuniform deformation observed in retrieved acetabular cups.

Compressive Strength↗

PubMed1990

A functional and radiographic analysis of the total condylar knee arthroplasty.

Twenty-one knees in 14 patients were studied during walking, in clinical follow-up, and radiographically. The purpose was to examine the relationship between dynamic loading at the knee joint during level walking in the early postoperative period (1-2 years) and longer-term (4 years) prosthetic performance. Joint kinematics and kinetics were measured while patients were walking in the laboratory. The results were compared with an age-matched control group of healthy normal subjects. Patients were analyzed when grouped according to original diagnoses of rheumatoid or osteoarthritis. After total knee arthroplasty, patients with rheumatoid arthritis walked with a significantly lower magnitude peak adduction moment (force tending to thrust the knee into varus) about the knee than patients with osteoarthritis. The osteoarthritic group had an increased varus axial alignment when compared to the rheumatoid group. There was a strong correlation between postoperative varus alignment and the magnitude of the adduction moment. These results suggest that dynamic loading at the knee is greatly affected by static alignment of the joints in patients with total knee arthroplasty. In spite of the lower adduction moment during level walking and its associated effects on lower compressive loads at the knee, the patients with rheumatoid arthritis had a significantly higher radiolucency index. Thus, it appears that quality of bone stock may be a more important factor in determining prosthetic loosening than dynamic loading at the knee joint following total knee arthroplasty.

Arthritis, Rheumatoid↗

PubMed1986

Complicated deep venous insufficiency: conservative management.

An understanding of venous pathophysiology is helpful in managing deep venous insufficiency. Examination of the patient after standing for 10 minutes by searching for perforator tenderness and milking away the edema will reveal incompetent perforators. A sponge pump improves calf pumping and reduces local tissue damage from the systolic peak pressures of walking. It is an invaluable aid in treatment. The combination of high ligation of the superficial system and compression sclerotherapy for the perforators gives excellent control. Compression sclerotherapy can be readily repeated as necessary. Patients with severe deep venous insufficiency should always be advised to wear a surgical support stocking indefinitely.

Clothing↗

PubMed1988

[Radiological diagnosis of chronic spinal cord compressive lesion at thoraco-lumbar junction].

Radiological findings in five cases with chronic spinal cord compressive lesion at thoraco-lumbar junction were reported. Three cases had spondylosis and two cases had ossification of yellow ligament (OYL). The levels of the lesions were T12/L1 in three cases and T11/12 in two cases. Two out of three spondylotic patients had also OYL at the same level. The five cases consisted of three men and two women. The ages ranged from 42 to 60 years old with a mean age of 53 years old. Neurologically, every patient showed flaccid paresis and sensory disturbance of the legs. Two cases had sensory disturbance of stocking type. The intervals from the onset of the symptoms to the final diagnosis were 6 months, 7 years, 8 years, 11 years and 12 years. Myelography showed anterior spinal cord compression by bony spur in spondylotic patients, and posterior compression by OYL in other cases. Myelography in flexion posture disclosed the cord compression by bony spur more clearly in two out of three spondylotic patients. Delayed CT-myelography showed intramedullary filling of contrast material in two cases, which indicated degenerative change or microcavitation due to long term compression of the spinal cord. MRI was taken in three spondylotic patients and could directly show compression of the spinal cord. Difficulty in detecting abnormality at thoraco-lumbar junction on plain roentgenogram, and similarity of the symptoms to peripheral nerve disease often lead to a delay in diagnosis. The significance of dynamic myelography and delayed CT-myelography when dealing with such a lesion was discussed here.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1999

Fatal case of dichloromethane poisoning.

A 47-year-old man was found dead in a factory where dichloromethane (DCM) tanks were stocked. He was making an inventory of the annual stock of DCM contained in several tanks (5- to 8000-L capacity) by transferring the solvent into an additional tank with the help of compressed air. During this operation, one of the tanks overflowed and the man, who was not wearing any protection, was intoxicated. Autopsy showed digestive, suprarenal, and liver bleeding. Blood was also found in the trachea. DCM was identified by headspace gas chromatography-mass spectrometry (GC-MS). A headspace gas chromatography-flame ionization detection technique (GC-HS-FID) optimized for quantitation in biological fluids, organs and viscera was established at autopsy. The following concentrations of DCM were found: blood (150 mg/L), urine (2.0 mg/L), gastric content (5.6 mg/L), brain (122 mg/kg), fat (99 mg/kg), liver (44 mg/kg), lung (20 mg/kg), and kidney (15 mg/kg). A study of the storage stability of DCM was carried out on these samples. Ethanol production was measured in some organs. The results are discussed in light of the rarity of existing literature.

Fatal Outcome↗

PubMedDate not supplied

Prevention of edema, flight microangiopathy and venous thrombosis in long flights with elastic stockings. A randomized trial: The LONFLIT 4 Concorde Edema-SSL Study.

UNLABELLED: The LONFLIT1/2 studies have established that in high-risk subjects after long (> 10 hours) flights the incidence of deep venous thrombosis (DVT) is between 4% and 6%. The LONFLIT4 study has been planned to evaluate the control of edema and DVT in low-medium-risk subjects. The aim of this study was to evaluate edema and its control with specific flight stockings, in long-haul flights. In the first part of the study 400 subjects at low-medium risk for DVT were contacted; 28 were excluded for several nonmedical problems; 372 were randomized into 2 groups to evaluate prophylaxis with stockings in 7-8-hour flights; the control group had no prophylaxis. Below-knee, Scholl, Flight Socks, producing 14-17 mm Hg of pressure at the ankle, were used in the treatment group. The occurrence of DVT was evaluated with high-resolution ultrasound scanning (femoral, popliteal, and tibial veins). Edema was assessed with a composite score based on parametric and nonparametric measurements. Part II: In this part of the study 285 subjects at low-medium risk for DVT were included and randomized into 2 groups to evaluate edema prophylaxis in 11-12-hour flights; the controls had no prophylaxis while the prevention group had below-knee, Scholl, Flight Socks (comparable to part I). RESULTS: Part 1: DVT evaluation. Of the 184 included subjects in the stockings group and 188 in the control group, 358 (96.2%) completed the study. Dropouts were due to compliance or connection problems. Age/sex distributions were comparable in the groups. Stockings Group: of 179 subjects (mean age 49; SD 7; M:F = 101:78), none had DVT or superficial thromboses. CONTROL GROUP: of 179 subjects (mean age 48.4; SD 7.3; M:F = 98:81), 4 (2.2%) had a DVT. There were also 2 superficial thromboses. In total, 3.35% (6) subjects had a thrombotic event. The difference (p<0.002) is significant. Intention-to-treat analysis detects 15 failures in the control group (9 lost + 6 thromboses) out of 188 subjects (7.9%) versus 5 subjects (2.7%) in the stockings group (p <0.05). All thrombotic events were observed in passengers sitting in nonaisle seats. The tolerability of the stockings was very good and there were no complaints or side effects. Thrombotic events were asymptomatic. No difference was observed in the distribution of events between men and women. The 3 women who had a thrombotic event were taking low-dose, oral contraceptives. Edema evaluation: The level of edema at inclusion was comparable in the 2 groups. After the flight there was a score of 6.7 (3.1) in controls; in the stockings group the score was 2.9 times lower (p<0.05). The control of edema with stockings was clear considering both parametric (circumference, volume) and nonparametric (analogue scale lines) data. Part II: DVT evaluation. Of the 285 included subjects, 271 (95%) completed the study. Dropouts were due to low compliance or connection problems. Age/sex distributions were comparable in the groups. Stockings Group: of 142 subjects (mean age 48; SD 8; M:F = 89:53), none had DVT or superficial thromboses. CONTROL GROUP: of 143 subjects (mean age 47; SD 8; M:F = 87:56), 3 had a popliteal DVT and 3 a superficial thrombosis. In total, 4.2% (6) subjects had a thrombotic event. The difference (p<0.02) between groups is significant. Intention-to-treat analysis detects 14 failures in the control group (8 lost + 6 thromboses = 9.7%) versus 6 (all lost = 4.2% in the stockings group) (p<0.05). Four of 6 events (3 DVT + 1 SVT) were observed in non-aisle seats. The tolerability of the stockings was very good. No difference was observed in the distribution of events between men and women. Edema evaluation: The level of edema at inclusion was comparable in the 2 groups. After the flight there was a score of 8.08 (2.9) in controls while in the stockings group the score was 2.56 (1.5) (p < 0.005). In conclusion. Scholl Flight Socks are very effective in controlling edema. Also this type of compression is effective in significantly reducing the incidence of DVT and thrombotic events in low-medium-risk subjects, in long-haul flights. CONCLUSIONS: Considering these observations, Flight Socks are effective in controlling edema and in reducing the incidence of DVT in low-medium-risk subjects, in long-haul flights (7-11 hours).

Aerospace Medicine↗