Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy is a surgical procedure for patients who want to lose weight. An acute porto-mesenteric vein thrombosis is an infrequent but not rare complication in patients who undergo laparoscopic sleeve gastrectomy. In this article, we present a 40-year-old male patient with body mass index of 47 kg/m² was admitted for laparoscopic sleeve gastrectomy. The surgery took about 130 minutes without any hemorrhage. Full enoxaparin prophylaxis, early and full mobilization, and intermittent pneumatic compression stockings were all applied to prevent venous thrombosis. Unfortunately, he applied to our emergency department and diagnosed to have porto-mesenteric vein thrombosis. There was an approximately 60 cm necrotic jejunal segment between 10th and 70th cm after Treitz ligament and was resected. He was discharged on sixth post operative day with prescription of oral warfarin.

Recent Updates of the Diagnosis and Prevention of Venous Thromboembolism in Patients with a Hip Fracture / 대한고관절학회지

Venous thromboembolism (VTE) is a potentially fatal complication that is relatively common after hip surgery. Since patients with a hip fracture have a higher risk of preoperative VTE due to an inability to ambulate after injury and aggravation of underlying age-related conditions, it may be difficult to effectively prevent VTE using only conventional approaches. Very few studies have been published reporting on the prevalence and prevention of VTE in patients with a hip fracture compared to those with hip arthroplasty. For this reason, we aimed to share recent updates on the diagnosis and prevention of VTE in patients with a hip fracture. Preoperative screening tests to diagnose VTE need to be performed more actively following hip fracture and indirect multidetector computed tomography venography is considered the most effective test for this purpose. As the risk of VTE appears to increase with time following a hip fracture, preventive measures should be taken as soon as possible in patients with a hip fracture. A wide variety of mechanical and pharmacological options are available for prophylaxis. When considering patient compliance and preventive impact, intermittent pneumatic compression devices and foot pumps are recommended as mechanical modalities. Of the available preventive medications for patients with a hip fracture, low molecular weight heparin seems to be the most appropriate option because of its short half-life and fast onset of action. Surgery should be performed as soon as possible in patients with hip fractures, and we recommend mechanical and pharmacological methods as active interventions immediately after injury to prevent VTE.

Prevention, diagnosis and treatment of perioperative complications of bariatric and metabolic surgery / 中华胃肠外科杂志

Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy. The treatment of pulmonary artery embolism includes remittance of pulmonary arterial hypertension, anticoagulation, thrombolysis, operative thrombectomy, interventional therapy and extracorporeal membrane oxygenation (ECMO). Hemorrhage is a rarely occurred but relatively serious complication after bariatric surgery. The primary cause of anastomotic bleeding after laparoscopic gastric bypass is incomplete hemostasis or weak laparoscopic repair. The common bleeding site in laparoscopic sleeve gastrectomy is gastric stump and close to partes pylorica, and the bleeding may be induced by malformation and weak repair technique. Patients with hemodynamic instability caused by active bleeding or excessive bleeding should timely received surgical treatment. Anastomotic fistula in gastric bypass can be divided into gastrointestinal anastomotic fistula and jejunum-jejunum anastomotic fistula. The treatment of postoperative anastomotic fistula should vary with each individual, and conservative treatment or operative treatment should be adopted. Anastomotic stenosis is mainly related to the operative techniques. Stenosis after sleeve gastrectomy often occurs in gastric angle, and the treatment methods include balloon dilatation and stent implantation, and surgical treatment should be performed when necessary. Marginal ulcer after gastric bypass is a kind of peptic ulcer occurring close to small intestine mucosa in the junction point of stomach and jejunum. Ulcer will also occur in the vestige stomach after laparoscopic sleeve gastrectomy, and the occurrence site locates mostly in the gastric antrum incisal margin. Preoperative anti-HP (helicobacter pylorus) therapy and postoperative continuous administration of proton pump inhibitor (PPI) for six months is the main means to prevent and treat marginal ulcer. For patients on whom conservative treatment is invalid, endoscopic repair or surgical repair should be considered. Different surgical procedures will generate different related operative complications. Fully understanding and effectively dealing with the complications of various surgical procedures through multidisciplinary cooperation is a guarantee for successful operation.

Adaptation and Effects of the Evidence-based IPC Nursing Protocol on Prevention of Postoperative Venous Thromboembolism / 간호행정학회지

PURPOSE: This study was conducted to adapt the standardized evidence-based nursing protocol using the IPC (intermittent pneumatic compression) intervention to prevent venous thromboembolism in surgical patients. Further, an investigation was done to measure knowledge on prevention of venous thromboembolism, surrogate incidence of venous thromboembolism and to assess IPC compliance in the study patients compared with those in surgical patients who underwent IPC intervention due to previous clinical experience. METHODS: An analysis was done of the nine modules suggested by National Evidence-based Healthcare Collaborating Agency (NECA) in the adaptation manual of the clinical practice guideline for protocol adaptation. A nonequivalent control group post test design as a quasi-experiment was used to verify the effect of the IPC protocol. RESULTS: There was a significant difference in knowledge of prevention of venous thromboembolism, IPC application time after intervention and the number of IPC applications between the experimental group (n=50) using the IPC nursing protocol and the control group (n=49). However, the symptoms of deep vein thrombosis and pulmonary thromboembolism were not observed in either the experimental group or the control group after the intervention. CONCLUSION: Results confirm that the standardized IPC nursing protocol provides effective intervention to prevent venous thromboembolism in surgical patients.

Avaliação linfocintilográfica qualitativa de pacientes com linfedema de membros inferiores tratados com compressão pneumática intermitente por quatro semanas / Qualitative lymphoscintigraphic evaluation of patients with lower limb lymphedema, treated with sequential intermittent pneumatic compression for four weeks

Introdução: O tratamento conservador do linfedema periférico consta de drenagem linfática manual, exercícios terapêuticos, contenção elástica e inelástica e também a compressão pneumática intermitente sequencial. Objetivo: Avaliar o efeito da compressão pneumática intermitente sequencial associada ao uso de contenção inelástica e elástica e exercícios miolinfocinéticos, durante quatro semanas, em pacientes com linfedema das extremidades inferiores, utilizando a análise qualitativa da linfocintilografia e a perimetria. Material e métodos: Dez pacientes portadores de linfedema das extremidades inferiores selecionados por conveniência, totalizando 14 membros acometidos, foram submetidos a quatro semanas de tratamento com compressão pneumática intermitente sequencial, contenção inelástica e elástica e exercícios miolinfocinéticos. Para a avaliação dos membros realizou-se a análise qualitativa da linfocintilografia e também a perimetria dos membros antes e após o tratamento proposto. Resultados: Não foi encontrada diferença estatisticamente significativa nos achados linfocintilográficos pré e pós-tratamento. Contudo, encontrou-se redução significativa da perimetria dos membros (p < 0,01) cuja redução máxima encontrada foi de 5,9% na perimetria do tornozelo e a mínima de 1,8% na perimetria da coxa. Conclusão: O tratamento realizado foi eficaz na redução da perimetria do membro tratado, porém não foi observada alteração significativa nos padrões linfocintilográficos qualitativos para estes pacientes. (AU)

Introduction: Conservative treatment of peripheral lymphedema consists of manual lymphatic drainage, therapeutic exercises, elastic and inelastic compression and sequential intermittent pneumatic compression. Objective: The objective of this study was to evaluate the effect of four weeks of sequential intermittent pneumatic compression combined with elastic and inelastic compression and lymphokinetic exercises on patients with lymphedema of the lower extremities by means of qualitative analysis with lymphoscintigraphy and circumference measurements. Methods: Ten people with lymphedema of the lower limbs, totaling 14 limbs treated, selected by convenience, underwent lymphoscintigraphy before and after four weeks of treatment with sequential intermittent pneumatic compression, elastic and inelastic sleeves and lymphokinetic exercises. For evaluating limbs, were carried out qualitative analysis of lymphoscintigraphy and also circumference measurements before and after the proposed treatment. Results: No statistically significant differences were detected in lymphoscintigraphic findings before and after treatment. However, there was a significant reduction in the circumference measurements (p <0.01) of the limbs. The maximum reduction was found 5.9% in the ankle circumference and the minimum was 1.8% thigh circumference. Conclusion: The treatment was effective at reducing limb circumference, however, no significant changes were observed on the qualitative lymphoscintigraphic analysis for these patients. (AU)

Preventing Venous Thromboembolism with Use of Intermittent Pneumatic Compression after Total Hip Arthroplasty in Korean Patients

Intermittent Pneumatic Compression (IPC) device has been used to prevent venous thromboembolism (VTE). This study investigated the effectiveness of IPC device. We evaluated incidences of deep vein thrombosis (DVT) and pulmonary embolism (PE) in total hip arthroplasty (THA) patients after use of IPC device, and compared with historical incidences from our institution. We applied IPC device in 741 patients who underwent 870 elective primary THAs from January 2010 to December 2013, DVT was detected in 3 patients (0.3%) by sonography, and one (0.1%) of them was symptomatic. Symptomatic PE occurred in 1 patient (0.1%) and there were no cases of fatal PE. The incidence of symptomatic DVT was significantly lower than the historical control (P = 0.042). The IPC is a safe and effective prophylaxis of VTE after primary THA in Korea.

Preventing Venous Thromboembolism with Use of Intermittent Pneumatic Compression after Total Hip Arthroplasty in Korean Patients

Intermittent Pneumatic Compression (IPC) device has been used to prevent venous thromboembolism (VTE). This study investigated the effectiveness of IPC device. We evaluated incidences of deep vein thrombosis (DVT) and pulmonary embolism (PE) in total hip arthroplasty (THA) patients after use of IPC device, and compared with historical incidences from our institution. We applied IPC device in 741 patients who underwent 870 elective primary THAs from January 2010 to December 2013, DVT was detected in 3 patients (0.3%) by sonography, and one (0.1%) of them was symptomatic. Symptomatic PE occurred in 1 patient (0.1%) and there were no cases of fatal PE. The incidence of symptomatic DVT was significantly lower than the historical control (P = 0.042). The IPC is a safe and effective prophylaxis of VTE after primary THA in Korea.

Thromboembolism in pregnancy

Pregnancy-related venous thromboembolism (VTE) is one of the leading causes of maternal morbidity and mortality, developed in the antenatal and postpartum periods of pregnancy. The incidence of VTE during normal pregnancy is four- to six-fold higher than in the general reproductive aged female population. Physiologic changes such as hypercoagulable state, decreased venous capacitance, and reduced venous blood flow due to mechanical obstruction from gravid uterus compromise this condition. The prominent risk factors for VTE are thrombophilia, history of circulatory disease and previous VTE, preeclampsia and related disorders, and Cesarean section. In case of suspicion of VTE, prompt diagnosis and management are needed with the caution of potential adverse effects on the fetus. Low molecular weight heparin treatment is preferred due to better safety, more consistent bioavailability, ease of administration, lower risk of drug-related osteoporosis and thrombocytopenia and easier monitoring. For pregnant women with acute VTE, adjusted-dose subcutaneous low molecular weight heparin should be administrated antenatally and continued for at least 6 weeks postpartum. For prevention of VTE, mechanical prophylaxis such as physiotherapy, exercise, compression stockings, and intermittent pneumatic compression devices could be used. Thromboprophylaxis should also be considered for pregnant subjects with certain risks such as carriers of molecular thrombophilia or previously experienced VTE.

Terapias compressivas no tratamento de úlcera venosa: estudo bibliométrico / Terapias compresivas en el tratamiento de úlcera venosa: estudio bibliométrico / Compressive Therapy in the Treatment of Venous Ulcers: Bibliometric Study

Introdução: Úlceras de origem venosas são lesóes cutâneas que geralmente acometem o terço inferior das pernas. O tratamento dessas feridas é dinâmico e depende da evolução das fases da reparação tecidual. Esse tratamento inclui métodos clínicos e cirúrgicos, sendo a terapia compressiva o método não cirúrgico mais frequentemente utilizado. Dentre as terapias compressivas, destacam-se as bandagens inelásticas e elásticas, meias elásticas e pressão pneumática intermitente. Objetivo: O presente estudo pretendeu identificar o perfil da produção científica nacional e internacional que descrevesse terapia compressiva e úlcera venosa classificando-o de acordo com: cronologia de publicação, procedência, periódicos em que estão publicadas, avaliação do "Qualis" - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes), distribuição da abordagem metodológica, análise do conteúdo das publicaçóes e comparar, quando possível, os dados apresentados nessa revisão. Método: Estudo bibliométrico realizado nas bases de dados Medline, Lilacs e CINAHL no qual se utilizaram os descritores "Varicose Ulcer/therapy", "Compression Bandages", "Wound Healing" e o operador booleano AND entre os anos de 2009 a 2013. Resultados: Foram selecionados 47 artigos; a maioria publicada em 2012 (n = 12; 25,53%), nos Estados Unidos (n = 14; 29,78%) e Reino Unido (n = 14; 29,78%), em revistas de especialidade vascular (n = 19; 40,42%), com avaliaçóes A2 (n = 13; 27,65%) e B1 (n = 13; 27,65%). A maior parte da metodologia utilizada nos estudos selecionados era tipo "estudos clínicos" (n = 30; 63,82%). Dentre os estudos clínicos e metanálises, apenas 30% (n= 14) apresentavam como objetivo principal avaliação da terapia compressiva e pretenderam estudar comparativamente eficácia de bandagens elásticas, inelásticas, meias elásticas, pressão pneumática intermitente e ausência de terapia compressiva no tratamento de úlceras venosas. Conclusão: Há preocupação da comunidade científica com a busca do tratamento eficaz para as úlceras venosas, porém a distribuição mundial de publicaçóes é desigual. Evidenciou-se que a terapia compressiva não é o objeto principal na maioria dos trabalhos selecionados, o que leva ao interesse em terapias adjuvantes ou complementares a essa. Ficou evidente a necessidade da terapia compressiva, porém não há consenso sobre qual pressão deva ser utilizada para se obter melhores resultados na cicatrização; portanto, são necessários mais estudos que avaliem as interferências das diversas pressóes sobre o processo de reparo tecidual. Também há carência de estudos que comprovem a ação da pressão pneumática intermitente com associaçóes ou não de bandagens elásticas.

Introducción: úlceras de origen venosas son lesiones cutáneas que generalmente acometen el tercio inferior de las piernas. El tratamiento de estas heridas es dinámico y depende de la evolución de las fases de la reparación del tejido. Este tratamiento incluye métodos clínicos y quirúrgicos, y la terapia compresiva es el método no quirúrgico más utilizado. Entre las terapias compresivas, se destacan los vendajes inelásticos y elásticos, medias elásticas y presión neumática intermitente. Objetivo: este estudio buscó identificar el perfil de la producción científica nacional e internacional que describiera la terapia compresiva y la úlcera venosa para clasificarla de acuerdo con: cronología de publicación, procedencia, periódicos en que están publicadas, evaluación del "Qualis" - coordinación de perfeccionamiento de personal de nivel superior (Capes), distribución del abordaje metodológico, análisis del contenido de las publicaciones y comparar, cuando fuera posible, los datos presentados en esta revisión. Método: estudio bibliométrico realizado en las bases de datos Medline, Lilacs y CINAHL en el que se utilizaron los descriptores "Varicose Ulcer/therapy", "Compression Bandages", "Wound Healing" y el operador booleano AND entre los años de 2009 a 2013. Resultados: se seleccionaron 47 artículos; la mayoría de ellos publicados en 2012 (n = 12; 25,53%), en Estados Unidos (n = 14; 29,78%) y Reino Unido (n = 14; 29,78%), en revistas de especialidad vascular (n = 19; 40,42%), con evaluaciones A2 (n = 13; 27,65%) y B1 (n = 13; 27,65%). La parte más grande de la metodología utilizada en los estudios seleccionados fue tipo "estudios clínicos" (n= 30; 63,82%). Entre los estudios clínicos y metanálisis, apenas 30% (n= 14) presentaban como objetivo principal evaluación de la terapia compresiva y estudiaban comparativamente eficacia de vendajes elásticos, inelásticos, medias elásticas, presión neumática intermitente y ausencia de terapia compresiva en el tratamiento de úlceras venosas. Conclusión: hay preocupación de la comunidad científica sobre la búsqueda del tratamiento eficaz para las úlceras venosas; sin embargo, la distribución mundial de publicaciones es desigual. Se evidenció que la terapia compresiva no es el objeto principal en la mayoría de los trabajos seleccionados, lo que lleva al interés en terapias adyuvantes o complementarias a esta. Quedó evidente la necesidad de la terapia compresiva, pero no hay consenso sobre cuál presión deba ser utilizada para obtener mejores resultados en la cicatrización; por lo tanto, son necesarios más estudios que evalúen las interferencias de las diversas presiones sobre el proceso de reparación del tejido. También hay carencia de estudios que comprueben la acción de la presión neumática intermitente con asociaciones o no de vendajes elásticos.

Introduction: Venous ulcers are skin lesions, which usually affect the lower third of the legs. The treatment of these wounds is dynamic and depends on the tissue repair process. Clinical and surgical procedures are included among those therapies, and the therapeutic compressive most often used non-surgical method. Inelastic and elastic bandages, elastic stockings and intermittent pneumatic pressure are the most common compressive therapy used. Objective: This study aimed to identify the national and international scientific literature profile describing compression therapy and venous ulcers and classify that profile according to: chronology of publication, country, periodicals that are published review of 'Qualis' - CAPES, distribution of the methodological approach, analysis of the publications content and compare, where possible, the data presented. Method: bibliometric study conducted in the Medline, Lilacs and CINAHL databases using the keywords "Varicose Ulcer / therapy", "Compression Bandages", "Wound Healing" and boleyn word AND between the years 2009-2013. Results: 47 articles were selected, the major part was published in 2012 (n = 12, 25.53 %), the United States (n = 14, 29.78 %) and the United Kingdom (n = 14, 29.78%), in vascular surgery specialized magazines (n = 19, 40.42%), Qualis A2 (n = 13, 27.65 %) and B1 (n = 13, 27.65 %). Much of the methodology used in the selected studies was "clinical studies" type (n = 30, 63.82 %). Only 30 % ( n = 14 ) had as main objective assessment of compressive therapy and intended study compared the effectiveness of elastic bandages, inelastic, elastic stockings , intermittent pneumatic pressure and absence compression therapy for the treatment of venous ulcers. Conclusions: There is a concern, in the scientific community, about the research for effective treatment for venous ulcers. However, the worldwide distribution of publications is uneven. It was evident that compression therapy is ...

Prevention Effects of Graduated Compression Stockings and Intermittent Pneumatic Compression on Deep Vein Thrombosis in SICU Patients: Pilot Study / 기본간호학회지

PURPOSE: The purpose of this pilot study was to investigate the effects of mechanical interventions for deep vein thrombosis (DVT) prophylaxis in surgical intensive care unit (SICU) patients. METHODS: The participants were assigned to the intermittent pneumatic compression (IPC) and graduated compression stocking (GCS) intervention. Patients who met the criteria were selected for comparison from our previous study. Data for 140 patients were included in the final analysis. RESULTS: The mean age was 57.5 (+/-15.7) and 61.4% were men. About forty-seven percent of the participants were 61 years or over. In the second duplex scan, 3, 2 and 1 critically ill patients developed deep vein thrombosis in the control, GCS, and IPC groups, respectively. Incidences of DVT were 6.0%, 5.0%, and 2.0% for the control, GCS, and IPC groups, respectively. This difference was not significant. Relative risks of no intervention were 3.0 and 1.2 compared with IPC and GCS application. There were no significantly different variables among the three groups before the intervention except for diagnosis on admission. CONCLUSION: Although it may difficult to conclude that mechanical prophylaxis effectively prevents DVT among SICU patients because there was no statistical significance in this study, but incidence rates among the three groups differed greatly. The findings reveal that further study should be conducted with larger samples and randomized controlled trial for SICU patients.

Non-pharmacological Prophylaxis of Venous Thromboembolism in Acutely Ill Medical Patients.

Venous thromboembolism (VTE) represents one of the leading causes of mortality and morbidity in acutely ill medical patients. VTE prophylaxis can be assured by pharmacological strategies and, when contraindicated, by non pharmacological measures, such as early mobilization, graduated compression stockings (GCS), intermittent pneumatic compression (IPC) or inferior vena caval filters. Literature evidence on non pharmacological VTE prophylaxis lacks and guidelines are not standardized for hospitalized ill medical patients. Much recently randomized clinical trials in patients with stroke and other medical diseases, seem to increase doubts and reduce certainties in this context. In this review we provide information about non pharmacological thromboprophylaxis in acutely hospitalized ill medical patients.

Comparison of Clinical and Physiological Efficacies of Different Intermittent Sequential Pneumatic Compression Devices in Preventing Deep Vein Thrombosis: A Prospective Randomized Study

BACKGROUND: There are few comparative studies about the optimal method of pneumatic compression to prevent deep vein thrombosis (DVT). The aim of this prospective randomized study was to compare venous hemodynamic changes and their clinical influences between two graded sequential compression groups (an alternate sequential compression device [ASCD] vs. a simultaneous sequential compression device [SSCD]). METHODS: In total, 34 patients (68 limbs) undergoing knee and spine operations were prospectively randomized into two device groups (ASCD vs. SSCD groups). Duplex ultrasonography examinations were performed on the 4th and 7th postoperative days for the detection of DVT and the evaluation of venous hemodynamics. Continuous data for the two groups were analyzed using a two-tailed, unpaired t-test. Relative frequencies of unpaired samples were compared using Fisher exact test. Mixed effects models that might be viewed as ANCOVA models were also considered. RESULTS: DVT developed in 7 patients (20.6%), all of whom were asymptomatic for isolated calf DVTs. Two of these patients were from the ASCD group (11.8%) and the other five were from the SSCD group (29.4%), but there was no significant difference (p = 0.331). Baseline peak velocity, mean velocity, peak volume flow, and total volume flow were enhanced significantly in both device groups (p < 0.001). However, the degrees of flow and velocity enhancement did not differ significantly between the groups. The accumulated expelled volumes for an hour were in favor of the ASCD group. CONCLUSIONS: Both graded sequential compression devices showed similar results both in clinical and physiological efficacies. Further studies are required to investigate the optimal intermittent pneumatic compression method for enhanced hemodynamic efficacy and better thromboprophylaxis.

Extensive Bullous Complication Associated with Intermittent Pneumatic Compression

Intermittent pneumatic compression (IPC) device is an effective method to prevent deep vein thrombosis. This method has been known to be safe with very low rate of complications compared to medical thromboprophylaxis. Therefore, this modality has been used widely in patients who underwent a hip fracture surgery. We report a patient who developed extensive bullae, a potentially serious skin complication, beneath the leg sleeves during the use of IPC device after hip fracture surgery.

Effect of intermittent pneumatic compression on coagulation function and deep venous hemodynamics of lower limbs after rectal cancer resection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of intermittent pneumatic compression (IPC) on coagulation function, deep venous hemodynamics and prevention of deep venous thrombosis (DVT) of lower limbs in patients after rectal cancer resection.</p><p><b>METHODS</b>A total of 120 patients undergoing rectal cancer resection were randomly divided into non-IPC group (control group, n=60) and IPC group (n=60). The control group received routine treatment after resection and the IPC group received IPC based on the routine treatments. Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), international normalized ratio (INR) and volume of D-dimer (D-D) were detected before operation and 1-, 3-, 5- and 7-day after operation. Meanwhile, blood flow velocity and caliber of external iliac vein, femoral vein and popliteal vein were examined by color Doppler ultrasound, then the average blood flow velocity and blood flow volume were calculated.</p><p><b>RESULTS</b>Incidence of lower limb DVT was 13.3% (8/60) and 1.7% (1/60) in control group and IPC group respectively with significant difference (P<0.05). The differences in PT, APTT and INR were not significant (P>0.05) at 1-day after operation as compared to the preoperative level, while FIB and D-D both increased (P<0.05), all presented no significant difference among the two groups (P>0.05). PT shortened gradually (P<0.05), APTT and INR did not change significantly (P>0.05), FIB and D-D increased gradually (P<0.05), and no significant differences were found between the two groups at the same time point (all P>0.05). All the above parameters in the control group were significantly lower than those in IPC group (all P<0.05).</p><p><b>CONCLUSIONS</b>IPC can improve hemodynamics indexes of deep veins of lower limb in patients after rectal cancer operation, and prevent the lower limb DVT. IPC is a safe, simple and convenient physical therapy.</p>

Common Peroneal Nerve Palsy by the Use of Intermittent Pneumatic Compression Device after Hartmann's Operation

Intermittent pneumatic compression device is a standard component for prevention of deep venous thrombosis in immobile patients. This method has been known to be safe with very low rate of complications compared to medical thromboprophylaxis. Therefore, this modality has been used widely in patients who underwent a general surgery. We report a patient who developed common peroneal nerve palsy during the use of intermittent pneumatic compression device after Hartmann's operation.

Case-control study on ultra-early application with intermittent pneumatic compression to prevent postoperative deep venous thrombosis of intertrochanteric femoral fracture in elderly patients / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of ultra-early application with intermittent pneumatic compression (IPC) in preventing postoperative lower limbs deep venous thrombosis (DVT) of intertrochanteric fractures in elder patients.</p><p><b>METHODS</b>From May 2008 to May 2010, 80 patients with intertrochanteric fractures were randomly divided into ultra-early group and postoperative group. In ultra-early group, there were 21 males and 19 females, ranging in age from 67 to 86 years with an average of (76.4 +/- 13.27) years; in postoperative group, there were 26 males and 14 females, ranging in age from 68 to 89 years with an average age (75.8 +/- 12.71) years. IPC was respectively used at the 3rd day before operation (ultra-early group) and postoperative that day (postoperative group). Serum D-dimer of all the patients were measured at the 3rd day before operation and at the 3rd, 7th,14th days after operation. Lower limbs DVT were observed by ultrasound at the 3rd, 14th days postoperatively. Perioperative bleeding volume of patients were compared between two groups.</p><p><b>RESULTS</b>There was no statistical difference in the serum D-dimer concentration and lower limbs DVT between two groups at the 3rd day before operation (P > 0.05). There was no statistical difference in perioperative bleeding volume between two groups (P > 0.05). In ultra-early group, Serum D-dimer concentration at the 3rd, 7th days after operation was respectively (351.00 +/- 104.34), (412.31 +/- 106.95) microg/ml; and in postoperative group, the item was respective (419.34 +/- 145.38), (509.16 +/- 146.05) microg/ml; serum D-dimer concentration in ultra-early group was lower than postoperative group (P < 0.05). There was no significant differences in serum D-dimer concentration at the 14th day after operation between two groups (P > 0.05). Incidence of DVT in postoperative group was 22.5%, which was higher than that of ultra-early group at the 14th day after operation (P < 0.05). There was no significant differences at the 3rd day after operation between two groups (P > 0.05).</p><p><b>CONCLUSION</b>Compared with postoperative application with IPC, ultra-early application with IPC could reduce the level of serum-dimer and the incidence of DVT without increase perioperative blood of intertrochanteric fracture in elder patients.</p>

Two mechanical methods for thromboembolism prophylaxis after gynaecological pelvic surgery: a prospective, randomised study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Venous thromboembolism is known to be an important social and health care problem because of its high incidence among patients who undergo surgery. Studies on the mechanical prophylaxis of thromboembolism after gynaecological pelvic surgery are few. The aim of our study was to evaluate the effect of mechanical thromboembolism prophylaxis after gynaecological pelvic surgery using a combination of graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) or GCS alone.</p><p><b>METHODS</b>The study was performed on 108 patients who were randomly assigned to two groups. The first group received GCS before the operation and IPC during the operation (IPC + GCS group). The second group received GCS before the operation (GCS group). To analyze the effect of the preventive measures and the laboratory examination on the incidence of thrombosis and to compare the safety of these measures, the incidence of adverse reactions was assessed.</p><p><b>RESULTS</b>The morbidity associated with DVT was 4.8% (5/104) in the IPC + GCS group and 12.5% (14/112) in the GCS group. There were significant statistical differences between the two groups. There were no adverse effects in either group.</p><p><b>CONCLUSIONS</b>The therapeutic combination of GCS and IPC was more effective than GCS alone for thrombosis prevention in high-risk patients undergoing gynaecological pelvic surgery, and there were no adverse effects in either group.</p>

effect of combined decongestive therapy and pneumatic compression pump on lymphedema indicators in patients with breast cancer related lymphedema

Lymphedema treatment is difficult and there is no consensus on the best treatment. This study evaluated the effect of combined decongestive therapy [CDT] and pneumatic compression pump on lymphedema indicators in patients with breast cancer related lymphedema [BCRL]. Twenty one women with BCRL were enrolled. The volume difference of upper limbs, the circumference at 9 areas and shoulder joint range of motion were measured in all patients. CDT was done by an educated nurse in two phases. In first phase, CDT was accompanied by use of a compression pump for 4 weeks, 3 days per week. In second phase, CDT was performed daily without compression pump for 4 weeks by patients at home. At the end of each phase, the same primary measurements were done for patients. The mean volume difference of the upper limbs and mean difference in circumference in all areas at different phases decreased significantly. Mean flexion, extension, abduction and external rotation [in degrees] at different phases increased significantly. CDT significantly reduced mean volume and mean circumference of the affected limb, and significantly increased shoulder joint range of motion. The findings support the optimal effects of CDT in the treatment of secondary lymphedema of upper extremity

Effects on Changes in Femoral Vein Blood Flow Velocity with the Use of Lower Extremity Compression for Critical Patients with Brain injury

PURPOSE: This study was done to evaluate the mean venous velocity (MVV) response with knee and thigh length compression stockings (CS) versus intermittent pneumatic compression (IPC) devices in immobile patients with brain injuries. METHODS: We carried out a randomized controlled study. We analyzed both legs of a randomly chosen sample of 43 patients assigned to one of 4 groups (86 legs). The patients were sequentially hospitalized in the intensive care unit (ICU) in "S hospital" from November 2005 to December 2006. The base line and augmented venous velocity was measured at the level of the common femoral vein. We applied leg compression 42 times over 7 days (for 2 hours at a time at 2 hour intervals). RESULTS: There was a statistical difference among the 4 groups. The difference for the "IPC" group was more significant than the "CS" group. CONCLUSION: These results indicate that the application of IPC can be considered as an effective method to prevent deep vein thrombosis for immobile patients with brain injury.

Compressão pneumática intermitente como cuidado intensivo de enfermagem no pós-operatório de clientes de cirurgia bariátrica: revisão sistemática / Intermittent pneumatic compression: an intensive care in postoperative of customers of bariatric surgery: the systematic review

O presente trabalho teve o objetivo de realizar uma revisão sistemática, trazendo evidências científicas acerca do uso da compressão pneumática intermitente nos membros inferiores como cuidado recomendado para prevenir trombose venosa profunda nos clientes de cirurgia bariátrica. A busca eletrônica dos artigos foi feita nasbases de dados do Medline, Lilacs, Pubmed, Capes e Cochrane, utilizando-se os descritores: gastroplastia e cirurgia bariátrica combinadas com os termos cuidados de enfermagem, intervenção de enfermagem, trombose venosa profunda, enfermagem ecompressão pneumática intermitente. A intervenção de interesse, portanto, foi o uso da compressão pneumática intermitente e o desfecho foi trombose venosa profunda. O total de artigos encontrados e selecionados para leitura integral foi 88, sendo incluídos noestudo 7 artigos. A análise qualitativa dos estudos permitiu concluir que o uso da compressão pneumática intermitente no pós-operatório de um cliente de cirurgia bariátrica como meio profilático para trombose venosa profunda é uma ação recomendada de nível 2B, ou seja, a evidência para recomendação deste cuidado está baseada em estudos prospectivos não ramdomizados...