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PubMed1991

The characteristics and theoretical basis of the Qigong maneuver.

We have made a systematic experimental study since we proposed the Qigong (Q-G) maneuver in 1986. The purpose of this article is to summarize our 5-year research project. It describes the theoretical problems of the Q-G maneuver, including the mechanism of blood pressure elevation induced by the Q-G maneuver, analysis of the maneuver elements and their respective contribution, the theory and method of muscular contraction in the Q-G maneuver, and the theory and practice of seated posture in the anti-G maneuver. We also describe the characteristics of the Q-G maneuver in five aspects.

Abdominal Muscles↗
PubMed1991

Intermittent pneumatic compression versus coumadin. Prevention of deep vein thrombosis in lower-extremity total joint arthroplasty.

One hundred forty-nine consecutive patients requiring lower extremity total joint arthroplasty were randomized to either coumadin (52 patients) or intermittent pneumatic compression (48 patients) as prophylaxis against deep vein thrombosis (DVT). Forty-nine patients were excluded. When fully ambulatory, the presence or absence of DVT was diagnosed by ascending venography (90% of patients), nuclear venography, venous dopplers, or impedence plethysmography. The two groups were similar in average age (64 years), indication for arthroplasty (pain because of arthritis in 90%), gender (98% male), and average number of risk factors (2.4). Twenty-five percent of patients on coumadin and 25% of patients on intermittent pneumatic compression (IPC) developed DVT. IPC was more effective than coumadin following primary total hip arthroplasties (THAs) (16% versus 24% incidence DVT); coumadin was more effective than IPC following primary total knee arthroplasties (TKAs) (19% versus 32% incidence of DVT). DVT developed in 36% of patients following revision arthroplasty. Seventy-five percent of all thrombi were proximal. Both IPC and coumadin were found to be safe; there was no increased perioperative bleeding in the coumadin group. Of three postoperative deaths, one was possibly due to pulmonary embolism (PE).

Adult↗
PubMed1991

The autotransfusion effect of external leg counterpressure in simulated mild hypovolemia.

We examined the cardiovascular response of external leg counterpressure in healthy volunteers at 100 mm Hg compression pressure. To stimulate mild hypovolemia, measurements were made with the subjects in a 60 degrees head-up tilt position. Left ventricular end-diastolic volume (LVEDV) and cardiac output (CO) were calculated from two-dimensional echocardiography. Flow through the inferior vena cava (IVC) below the origin of the hepatic veins was determined by the Doppler ultrasound technique. The application of counterpressure significantly increased LVEDV, CO, and arterial blood pressure over that seen with tilting without the device. These responses were accompanied by a small but significant increase in IVC flow. We therefore concluded that external leg counterpressure transferred blood to the central circulation by compression of the venous capacitance vessels (an autotransfusion effect) in mild hypovolemia, but such an effect may not benefit patients in a hypovolemic shock state because of the small amount of translocated blood.

Adult↗
PubMed1991

Pneumatic antishock garment decreases hemorrhage and mortality from splenic injury.

The effect of the pneumatic antishock garment (PASG) in controlling hemorrhage and death from splenic injury was studied in a canine model. Twelve (two groups of 6) anesthetized dogs had their spleens crushed. Carotid blood pressure, carotid blood flow, splenic artery flow and abdominal aortic flow, as well as the death rate and blood loss, were measured. Group 1 dogs did not have PASG inflation, but group 2 dogs had PASG inflation to an intraperitoneal pressure of 60 mm Hg. All group 1 dogs died within 27 to 58 minutes, but all group 2 dogs survived. Blood loss was 9.4 +/- 1.4 mL/min in group 1 and 1.6 +/- 0.9 mL/min in group 2. In group 1 carotid artery blood pressure, carotid artery flow, splenic artery flow and abdominal aortic flow fell from 120 +/- 10 mm Hg, 284 +/- 12 mL/min, 194 +/- 18 mL/min and 285 +/- 10 mL/min respectively to 0 with death of the animals. By 2 hours in group 2 dogs the carotid artery blood pressure had dropped from 116 +/- 12 to 99 +/- 12 mm Hg, and over the same period carotid artery flow, splenic artery flow and abdominal aortic flow fell from 296 +/- 8 mL/min, 190 +/- 26 mL/min and 279 +/- 16 mL/min respectively to 259 +/- 14 mL/min, 39.0 +/- 6 mL/min and 45 +/- 11 mL/min respectively. Thus, inflation of the PASG maintained carotid artery blood pressure wh ile decreasing splenic, abdominal and aortic flow as well as splenic hemorrhage, with a decrease in the death rate, over a 2-hour period.

Abdomen↗
PubMed1991

Prevention of deep vein thrombosis after total knee arthroplasty. Coumadin versus pneumatic calf compression.

The rate of deep vein thrombosis (DVT) after total knee arthroplasty (TKA) without prophylaxis has been reported as high as 84%. Coumadin anticoagulation and pneumatic calf compression (PCC) boots are two current therapies that have been thought to be effective in reducing this high rate of DVT. To investigate these two methods, a nonrandomized prospective study was designed. The first group involved treating 48 consecutive knee arthroplasties with a regimen of coumadin anticoagulation. The second group involved 81 consecutive knee arthroplasties treated with sequential PCC boots. Bilateral lower extremity venography was performed between the eighth and tenth hospital postoperative days. The overall incidence of DVT in the coumadin group was 33%, with 29% having calf thrombi and 6% having thigh thrombi. The overall incidence of DVT in the boot group was 31%, with 27% having calf thrombi and 6% having thigh thrombi. In both groups, there were no treatment-related complications. Cost analysis of the administration of each type of therapy showed coumadin to be approximately 50% more expensive than PCC boots. Although coumadin and PCC boot therapy are safe and effective in reducing the incidence of DVT after TKA, there are economic factors that make the latter a more favorable option.

Female↗
PubMed1991

The role of the pneumatic antishock garment in penetrating cardiac wounds.

UNLABELLED: OBJECTIVE--To determine the impact of the pneumatic antishock garment on survival in patients with cardiac wounds. DESIGN--A retrospective review of a 6.5-year experience in a population of patients with gunshot or stab wounds to the heart (N = 70). SETTING--The city and county of Denver, Colo, where all patients were transported by paramedic ambulances to Denver General Hospital, an urban, level 1 trauma center. PATIENTS--All patients were analyzed, including those transported to the emergency department with no vital signs at the trauma scene. Only patients with definite penetrating cardiac injuries were included. METHODS--Paramedic trip sheets and emergency department, operating room, in-hospital, and autopsy records were reviewed. Demographic, clinical outcome, and treatment data were collected. A multiple logistic regression model was developed to determine which characteristics and treatment variables were independently predictive of patient outcome. The ability of each independent variable to predict outcome was determined by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS--Seventy patients (31 gunshot and 39 stab wounds) had a revised trauma score of 2.8 +/- 4.0 (mean +/- SD; range, 0-12; median, 0). Thirty-two (46%) had cardiac tamponade. Overall, 21 (30%) of the patients survived. In the logistic model, the presence of cardiac tamponade (OR, 9.1; 95% CI, 1.5 to 56.1) and a higher revised trauma score were associated with higher survival. Inflation of the pneumatic antishock garment was associated with sevenfold lower survival (adjusted OR, 0.14; 95% CI, 0.02 to 0.86); the effect was negative across all trauma score groups. CONCLUSION: --Survival in patients with penetrating cardiac wounds is highly associated with anatomic and physiologic factors, while application of the pneumatic antishock garment appears to be detrimental.

Adolescent↗
PubMedDate not supplied

The effect of intraabdominal pressure and saline infusion on abdominal aortic hemorrhage.

Blood loss, survival, and hemodynamics were monitored for 1 hour or until death in 30 anesthetized pigs with a 0.5 cm abdominal aortic laceration. Eight animals (Group I) had no treatment; 7 animals (Group IA) had saline infusion at a maximum rate of 200 mls/min to maintain carotid artery pressure (CP); 8 animals (Group II) had intraabdominal pressure increased to 60 torr by pneumatic antishock garment (PASG) inflation; and 7 animals (Group IIA) had PASG inflation with saline infusion to maintain CP. Groups I and IA survived 9.5 +/- 4.2 minutes and 28.0 +/- 5.5 minutes, respectively (p less than 0.05). Groups II and IIA survived the 1 hour. Saline infusion (5400 +/- 120 mls in Group IA and 535 +/- 180 mls in Group IIA, p less than 0.05) increased blood loss without PASG inflation (1289 +/- 49 mls in Group I vs. 4840 +/- 1350 mls in Group IA, p less than 0.05) as well as with PASG inflation (438 +/- 64 mls in Group II vs. 1235 +/- 68 mls in Group IIA, p less than 0.05). CP could not be maintained in spite of saline infusion in Group IA but in Group IIA CP was maintained with saline infusion. In an otherwise fatal abdominal aortic laceration, increasing intraabdominal pressure improves survival and decreases hemorrhage. While saline infusion may prolong survival it increases hemorrhage both in the presence and absence of increased intraabdominal pressure.

Animals↗
PubMedDate not supplied

Surgical correction of recurrent venous ulcer.

Seventy-six limbs from 46 patients with comparable superficial and deep venous valve incompetence underwent surgical correction for recurrent venous ulcers of the leg that were refractory to various modes of nonsurgical and surgical treatments. A follow-up of 10 to 73 months (mean = 37 months), revealed the venous ulcer healed with perforator ligation and saphenous vein stripping in 14 of 33 (44%), stripping plus valvuloplasty 17 of 21 (80%), stripping plus vein transposition 11 of 14 (78%) and stripping plus valve transplantation 6 of 8 (75%). In patients with incompetent deep venous valve and perforators, the disassociation of the superficial from the deep venous system (stripping) plus correction of the deep venous valvular incompetence (valvuloplasty, transposition or valve transplant) produced superior results in the treatment of recurrent venous ulcer when compared to perforator ligation and saphenous vein stripping alone (p less than 0.005). Adjunctive usage of elastic stockings and intermittent compression pneumatic boots in the perioperative period was helpful in controlling leg swelling and promoting wound healing.

Bandages↗
PubMed1991

The changes in intramuscular pressure and femoral vein flow with continuous passive motion, pneumatic compressive stockings, and leg manipulations.

Intramuscular pressure was measured continuously in the deep compartment of the calf and anterior thigh of volunteers while their legs were cyclically moved from 0 degrees to 90 degrees back to 0 degrees (angle of knee flexion) in an anatomic continuous passive motion (CPM) device and a nonanatomic CPM device. Femoral venous flow was measured continuously using a thermodilution technique in volunteers while their legs were moved in both CPM devices, during inflation of a pneumatic stocking, and during several leg manipulations. Baseline intramuscular pressures in the deep calf and anterior thigh were 10.0 +/- 1.9 mmHg and 4.9 +/- 1.9 mmHg, respectively (mean +/- standard error). Both the anatomic and nonanatomic CPM devices produced a statistically significant maximal increase in pressure in the calf. By contrast, only a decrease in pressure occurred in the thigh with both devices. Baseline femoral vein flow measured by the thermodilution technique was 311 +/- 38 ml per minute. Significant increases in femoral vein flow were seen with both CPM devices. The maximal flow produced by the anatomic CPM was 1199 ml per minute and was approximately four times higher than baseline flow and approximately 1.4 times the maximal flow change seen with the nonanatomic CPM (836 ml per minute). The greatest net increase in flow was observed between 60 degrees and 90 degrees of knee flexion with both devices. Overall, passive straight-leg elevation produced the largest flow (1524 ml per minute), followed by the anatomic CPM and nonanatomic CPM, and then by active ankle dorsiflexion(640 ml per minute), pneumatic stocking inflation (586 ml per minute), manual calf compression (532 ml per minute), and passive dorsiflexion (385 ml per minute)(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Advances in pediatric emergency department procedures.

Pediatric procedures in the Emergency Department typically involve techniques for stabilization, evaluation, and treatment of the child. This article considers indications and techniques for vascular access, lumbar puncture, arterial lines, pulse oximetry, and urine collection. Multiple routes of medication administration and pain management modalities also are reviewed.

Catheters, Indwelling↗
PubMed1990

Effectiveness of intermittent pneumatic leg compression for preventing deep vein thrombosis after total hip replacement.

A randomized trial was performed in consecutive patients undergoing total hip replacement to evaluate the effectiveness of sequential intermittent calf and thigh compression for preventing venous thrombosis compared with a control group given no prophylaxis. Both groups underwent case finding for deep vein thrombosis using combined fibrinogen I 125 leg scanning, impedance plethysmography, and venography. Deep vein thrombosis by venography was present in 77 (49%) of 158 control patients compared with 36 (24%) of 152 patients given intermittent compression. Proximal vein thrombosis was present in 42 controls (27%) compared with 22 patients (14%) given intermittent compression. Combined impedance plethysmography and leg scanning was insensitive in this patient group (sensitivity, 46%); venography was required to detect more than half the patients with venous thrombosis. Sequential intermittent leg compression clinically and statistically significantly reduced the frequency of both proximal vein and calf vein thrombosis. Case finding resulted in early detection and treatment of patients with venous thrombosis.

Female↗
PubMed1990

[Hemodynamic impact of pressotherapy].

We study the hemodynamic effects of pressotherapy in 11 patients (mean age : 68 +/- 10 years) with uncomplicated acute myocardial infarction (n = 6) or with chronic ischemic heart failure (n = 5). We measure the right auricular pressure (RAP), the mean pulmonary arterial pressure (MPAP) and the pulmonary wedge pressure (PWP), before, during pressotherapy (MPAP) and the pulmonary wedge pressure (PWP), before, during pressotherapy (T 20 min) and 30 minutes after the end of pressotherapy (T 30 min). We use five-chambered leg garments with 80 mm Hg pressure during 20 minutes. The wavelike action (from the bottom to the top) is intermittent: the compression time is 10 second (sec); compression is maintained during 60 sec; deflation time is 15 sec. After 20 minutes pressotherapy (t 20) the 3 variables increase: RAP: from 3.6 +/- 5 to 7 +/- 7 mm Hg (P less than 0.001), MPAP: from 25 +/- 14 to 29 +/- 17 mm Hg (p less than 0.01) and the PWP from 10 +/- 8 to 17 +/- 11 Hg (p less than 0.01). This rise is particularly important in heart failure patients: from 18 +/- 8 to 29 +/- 8 mm Hg for the PWP, with cough in one patient. At T 30 these 3 variables decrease and return nearly to initial values: respectively 2.7 +/- 4.7 (RAP), 24 +/- 14 (MPAP), 12 +/- 8 mm Hg (PWP). In conclusion pressotherapy increases RAP and pulmonary pressures.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[A survey of the French-speaking Association of Lymphology on the use of pressotherapy in France during the treatment of lymphedema].

116 physicians out of the 1000 who were questioned use pressure-therapy in the treatment of lymphedema of the extremities. Another 170 are interested in the technique and await this report before possibly adopting it. Overall, the devices utilized are compartmented and use discontinued pressure that is asynchronous in relations to heart beat; each session lasts 30 minutes, on average, with compression and resting phases lasting 45 seconds and 15 seconds, respectively. The usual schedule is one session daily, three days per week, in two series clustered within a single year. Although manual drainage of lymphatics is combined with pressure-therapy in 71.55% of the times, only 43.47% of physicians use elastic support following the treatment. Results are good or very good in 64.4% of cases, and the incidence of post-therapeutic events is rather low (polyuria, pain recrudescence of lymphangitis, etc.). Aside from lymphedema, venous insufficiency, hypodermitis and leg ulcers may also benefit from pressure-therapy.

Clinical Protocols↗
PubMed1990

[Mercury pressotherapy in the treatment of lymphedema].

Increasingly growing pressure gradients impressed upon a limb maintained vertically positioned in mercury (metal) have been used as an individually-adjusted compressive, evacuating and atraumatic mould in lymphatic or venolymphatic disease of the limbs. We studied this new so-called mercury pressure-therapy applied to 100 cases of lymphedema of the upper extremity, 100 cases of lymphedema of the lower extremity, 150 cases of inflammatory hypodermitis of the leg and 50 refractory venous ulcers. During the first trials, the patients were treated with a prototype, then with a model of the latest version of the Gradient-1000 device (fig. 1), allowing for mercury displacement along the limb controllable by 6 parameters. During experimentation, we used the following methodology: 1) Each patient's treatment consisted in 3 to 4 compression sessions at 3 to 8 day intervals. Later, the patient was followed up for 3 to 6 months and received 1 to 2 additional pressure treatments, as deemed necessary. 2) Each session comprised 30 minutes of actual compression by several rising mercury waves falling back to the zero level each time, using the following criteria: slow velocities (1 to 2 cm/second), progressively higher rising levels (45 to 70, even 80 cm), each level upheld for 3 to 5 minutes, few repeated up and down phases (6 to 10, depending upon the duration of each phase). 3) In between the compression sessions, the patient wore a compressive elastic bandage permanently. 4) The first 3 to 4 compression sessions constituted the initial treatment; the patient was then fit with a removable elastic bandage to be worn 12/24 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Arm↗
PubMed1990

[ A comparative lympho-scintigraphic evaluation of manual lymphatic drainage and pressotherapy in edema of the arm following treatment of a breast tumor].

Manual lymphatic drainage (MLD) and pressure-therapy are part of the therapeutical gears used in physiotherapy for reducing edema. The solution to the problem of the reduction fo lymphedema of the extremities rests with the evacuation of the liquid phase and the resorption of the stagnant proteins in the interstitial compartment not being collected by the lymphatic system. The injection of a 99 Technetium-labelled colloid substance provides a functional approach to the problem of lymphatic stasis.

Arm↗