Venous tonus enhancement after a short cycle of intermittent pneumatic compression.

OBJECTIVES: To test if intermittent pneumatic compression (IPC) used with a short cycle could reproduce and confirm the 30 min vasoconstriction effect observed after a long cycle of pressure. METHODS: Eighteen subjects took part in the study, 12 with venous insufficiency (VI) and six without VI (NonVI). Duplex scanner was used to evaluate the diameter of six sites of veins on each of both lower limbs before and after the treatment. The IPC was applied to only one limb. RESULTS: The control limb showed no change in venous diameter. The treated limb, showed in the NonVI group one vasoconstriction: the greater saphena at the knee level (GS) (P < 0.05). In the VI group, four sites out of six showed a vasoconstriction: the common femoral (P < 0.005), the GS at its cross (P < 0.001), the GS (P < 0.001) and the lesser saphena (P < 0.05). CONCLUSIONS: Both long and short cycle of IPC are suitable to enhance the venous tone in VI patients for at least 30 min after the end of the treatment.

Reliability and limits of agreement of circumferential, water displacement, and optoelectronic volumetry in the measurement of upper limb lymphedema.

We conducted a reliability comparison study to determine the intrarater and inter-rater reliability and the limits of agreement of the volume estimated by circumferential measurements using the frustum sign method and the disk model method, by water displacement volumetry, and by infrared optoelectronic volumetry in the assessment of upper limb lymphedema. Thirty women with lymphedema following axillary lymph node dissection surgery for breast cancer surgery were enrolled. In each patient, the volumes of the upper limbs were estimated by three physical therapists using circumference measurements, water displacement and optoelectronic volumetry. One of the physical therapists performed each measure twice. Intraclass correlation coefficients (ICCs), relative differences, and limits of agreement were determined. Intrarater and interrater reliability ICCs ranged from 0.94 to 1. Intrarater relative differences were 1.9% for the disk model method, 3.2% for the frustum sign model method, 2.9% for water displacement volumetry, and 1.5% for optoelectronic volumetry. Intrarater reliability was always better than interrater, except for the optoelectronic method. Intrarater and interrater limits of agreement were calculated for each technique. The disk model method and optoelectronic volumetry had better reliability than the frustum sign method and water displacement volumetry, which is usually considered to be the gold standard. In terms of low-cost, simplicity, and reliability, we recommend the disk model method as the method of choice in clinical practice. Since intrarater reliability was always better than interrater reliability (except for optoelectronic volumetry), patients should therefore, ideally, always be evaluated by the same therapist. Additionally, the limits of agreement must be taken into account when determining the response of a patient to treatment.

Does retrojugular route for carotid endarterectomy increase the risk of internal jugular vein thrombosis?

Two different approaches are available to perform carotid endarterectomy: the traditional antejugular or the retrojugular route. With retrojugular route, direct access to the carotid arteries necessitates median retraction and often collapse of the internal jugular vein (IJV). Therefore, we have prospectively evaluated the potential incidence of IJV thrombosis.

Actuación fisioterapéutica en patología linfática / Lymphoedema physical treatment

El tratamiento de los linfedemas de las extremidades está dirigido por la fisioterapia. La descongestión del edema se consigue asociando drenaje linfático manual, vendajes funcionales no adhesivos y presoterapia neumática intermitente. La prevalencia del resultado se mantiene gracias a las de medidas de contención y al respeto de ciertas normas de vida

Physiotherapy dominates the treatment of limb lymphoedema. Its decongestion is mainly carried out by combination of manual lymphatic drainage, pneumatic drainage and bandages with or without an increased muscular pump effect. The decongestive result is maintained by two complementary elements: the wearing of elasto-rigid socks and the respect of certain rules of living

Hook phlebectomy versus transilluminated powered phlebectomy for varicose vein surgery: early results.

OBJECTIVES: to compare Transilluminated Powered Phlebectomy (TIPP) (TriVex System) with Muller's hook phlebectomy. MATERIALS AND METHODS: between January and April 2001, 40 patients (group 1) undergoing TIPP were non-randomly compared to 40 patients undergoing Muller's hook phlebectomy (group 2) in the course of conventional vein stripping and perforator ligation. All patients had at least C2 CEAP disease. RESULTS: hospital stay averaged 2 days (range 1-3 days; median 2 days) and was similar for the two groups. TIPP took significantly longer (56+/-12 vs 45+/-10 min, p<0.001) but was associated with significantly fewer incisions (6 [2-8] vs 8 [4-21], p<0.001). The mean pain score (out of 10) at 2 and 7 days and 6 weeks was 5, 2 and zero after TIPP and 4, 2 and zero after hook phlebectomy. The incidence of postoperative haematoma formation was significantly higher after TIPP (45 vs 25%, p=0.06), especially in the calf region (25 vs 2.5%,p =0.003). CONCLUSION: TIPP was slower (although speed increased with practice) associated with more haematoma (although this reduced with practice) and fewer incisions. In other respects (pain, cosmetic satisfaction, other complications, residual varices) it was not significantly different from hook phlebectomy. Greater clinical experience with the technique and randomized studies are required to determine whether TIPP is a valuable addition to our armamentarium.

Protective effect of glove on median nerve compression in the carpal tunnel.

OBJECTIVES: To determine the protective effect of gel padded glove on median nerve compression in the carpal tunnel. METHODS: Median nerve conduction parameters, skin temperature, laser Doppler flowmetry and pain modifications were measured during and after a 30-min carpal tunnel external compression protocol performed with and without glove in a random order on six healthy volunteers. RESULTS: Compression induced a rapidly reversible increase in sensory and motor distal latencies, a decrease in sensory amplitude, finger laser Doppler flowmetry and hand skin temperature supporting the hypothesis of a reversible conduction block of ischemic origin. There was no statistical difference between the tests (with or without glove) except for pain that was significantly reduced by glove protection. CONCLUSION: Gel padded glove does not seem to have a protective effect on the carpal tunnel syndrome induced by compression but provides significant comfort.

Transilluminated powered mini-phlebectomy: early clinical experience.

We report our preliminary experience with a new surgical endoscopic technique, the Transilluminated Powered Phlebectomy (TriVex System, Smith + Nephew) to remove varicose veins. TriVex System combined an irrigated illuminator device and a powered vein resector. There were 15 patients with a mean age of 50 years, nine were women and six were men. We evaluated prospectively the safety, efficacy and clinical benefits of this new surgical device.

Intraoperative hemodynamic assessment of gastroepiploic artery and saphenous vein bypass grafts: a comparative study.

OBJECTIVE: Blood flow characteristics of right gastroepiploic artery and saphenous vein conduits were compared during bypass surgery. METHODS: This study is based on a consecutive series of 97 patients undergoing a bypass graft to the right coronary artery, posterior descending artery, or posterolateral branch using either a pediculated right gastroepiploic artery (n = 52) or a saphenous vein (n = 45) bypass graft. Flows and velocity profiles were measured with an 8-MHz pulsed-wave Doppler ultrasound flowmeter. Thorough flow measurements were made (1) after cessation of cardiopulmonary bypass and (2) before chest closure. RESULTS: At the end of cardiopulmonary bypass, flow in the right gastroepiploic artery (59. 0 +/- 6.7 mL/min) did not differ (P =.08) from flow in the saphenous vein (46.1 +/- 2.7 mL/min). Mean trace velocity was 11.9 +/- 0.7 cm/s in the right gastroepiploic artery and 11.6 +/- 0.8 cm/s in the saphenous vein (P =.80), but peak systolic velocity was 29.4 +/- 1.2 cm/s for the right gastroepiploic artery and 23.1 +/- 1.3 cm/s for the saphenous vein (P <.001). Likewise, before chest closure, flow was 57.1 +/- 4.7 mL/min in the right gastroepiploic artery and 46.5 +/- 4.0 mL/min in the saphenous vein (P =.10), mean velocity was 12. 9 +/- 0.7 and 11.6 +/- 0.8 cm/s, respectively (P = .22), and systolic peak velocity was 30.0 +/- 1.2 and 22.3 +/- 1.2 cm/s, respectively (P < .001). CONCLUSIONS: There were no flow differences between right gastroepiploic artery and saphenous vein grafts implanted into the same coronary bed in comparable groups of patients. Waveform shape of the right gastroepiploic artery grafts was characterized by a wider spectral dispersion resulting in a higher maximal frequency.

Ligation of the superficial femoral vein in prevention of pulmonary embolism: an old fashion procedure?

From 1974 to 1988, interruption of the superficial femoral vein (SFV) was performed to prevent pulmonary embolism (PE) in 73 patients. The mean age of the patients was 62 years. Phlebography showed thrombi in the following localizations: calf veins (67.3%), superficial femoral or popliteal veins (56.6%), common femoral veins (19.5%) and iliac veins (2.7%). A floating thrombus in the popliteal or femoral vein was the main indication for surgery in 97.3% of patients. Pulmonary embolism had occurred in 76.7% and was associated with neoplasm in 13.7%. Ligation of the SFV was performed in 93 limbs and completed iliac or femoral thrombectomy in 32.3%. The procedure was performed under locoregional anesthesia in 82.9% of the cases. Hospital mortality was 1.4% and 3 year survival, considering only PE related deaths was 95.3 +/- 2.7%. Follow-up was complete for all patients and averaged 3.0 years, for a 3 years PE-free rate of 90.8 +/- 3.6%. Persistent symptoms included increased limb tenseness in 12.5% and mild ankle edema in 25%. Bilateral strain-gauge plethysmography (SGP) was obtained in 65 limbs. The time necessary to obtain a 50, 75 and 100% decrease in calf volume (respectively T1/2, T3/4 and TT) was calculated for the operated limb and compared with the untreated limbs used as controls. A prolongation of T1/2 from 2.5 +/- 0.3 sec in controls to 4.3 +/- 0.4 sec in the operated limb (p less than 0.01) was found. Thus, our experience with ligation of the superficial femoral vein is favourable since long-term ill effects have been minimal and strain gauge plethysmography (SGP) showed only mildly altered venous drainage.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in serum and intestinal diamine oxidase (DAO) activity after proximal enterectomy in rats. Correlation of DAO activity with mucosal mass parameters.

To determine whether serum and mucosal DAO activity reflects quantitative changes in the small bowel mucosal mass, we have chosen an experimental model of mucosal hyperplasia which is known to occur in the rat after enterectomy. A 50% proximal enterectomy or a single transection was performed in 20 growing rats weighing 145-160 g. Ten days following surgery, we determined mucosal mass parameters (weight, protein, and DNA content), sucrase activity, and DAO activity in the duodenum (segment A), proximal ileum (segment B), and distal ileum (segment C) of the remaining small intestine. Mucosal hyperplasia was demonstrated by the finding that in each segment, mucosal weight, protein, and DNA content per centimeter of gut length were significantly (P less than 0.01) higher (+38 to + 78%) in the resected group than in transected controls. In segments B and C of resected rats, the changes in DAO activity expressed per gram of mucosa paralleled the changes in mucosal mass, the activity being increased by +69% and +49% (P less than 0.05) compared to the values recorded in transected controls. Expressed per centimeter of gut length, total DAO activity was also enhanced by +141% in segment B (P less than 0.05 vs controls) and by +87% in segment C (P less than 0.01 vs controls) of resected rats. In the duodenum, the changes in DAO activity were small (+36%) and not significant.(ABSTRACT TRUNCATED AT 250 WORDS)