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At least 1,297 records · Page 72Linked to original sources
PubMed2005

Haemodynamic study examining the response of venous blood flow to electrical stimulation of the gastrocnemius muscle in patients with chronic venous disease.

OBJECTIVES: The aim of this study was to explore the option of stimulating calf muscle contraction through externally applied neuromuscular electrical stimulation (NMES) and to measure venous blood flow response to this stimulation. METHODS: Ten patients with class 6 chronic venous disease (CEAP clinical classification) were recruited. Measurements of peak venous velocities in the popliteal vein were recorded by Duplex scanning in response to six test conditions; 1. Standing, 2. Voluntary calf muscle contraction, 3. Standing with NMES applied, 4. Standing with compression bandaging applied to the leg, 5. Voluntary calf muscle contraction with compression bandaging applied to the leg, 6. Stationary with compression bandaging applied to the leg and NMES applied. Comfort assessment was completed using visual analogue scales at each test stage and on study completion each patient completed a short structured interview to determine comfort and acceptability of NMES. Statistical analyses were carried out using SPSS, Version 9. Non-parametric testing was used in all analyses using the Wilcoxon Signed Ranks Test for paired samples. RESULTS: There was a significant increase in venous velocities on voluntary contraction of the calf muscle (median resting vel 7.3 cm/s; voluntary contraction median 70 cm/s) and with the introduction of NMES, both with compression (median velocity 15 cm/s, p = 0.005 Wilcoxon) and without compression (median velocity 13 cm/s, p = 0.005 Wilcoxon). The greatest increase with NMES was when combined with compression bandaging. All patients reported the stimulus as an acceptable treatment option with 90% reporting NMES as comfortable. CONCLUSIONS: Healing rates in venous ulceration with the application of compression bandaging remain between 50 and 70%. This study shows a positive haemodynamic response to NMES. Further research is needed to quantitatively measure the effect of NMES on ulcer healing.

Chronic Disease↗
PubMed1997

Ulcerative keratitis in bullous keratopathy.

PURPOSE: The authors review a large series of patients with bullous keratopathy (BK) to analyze the frequency of ulcerative keratitis, and determine the contributory roles of bullae, bandage soft contact lenses, steroids, and prophylactic antibiotics. METHODS: A retrospective review of all cases of pseudophakic or aphakic bullous keratopathy presenting to the cornea service between January 1, 1986 and September 1, 1995 was performed. The influence of time, bullae, bandage contact lenses, steroids, and prophylactic antibiotics was evaluated by actuarial methods and multivariate analysis. RESULTS: Nine hundred eighteen patients were included in this study, 44 (4.7%) of whom had infectious or inflammatory complications; 813 cases were available for statistical analysis. Steroids (P < 0.0001), bandage soft contact lens use (P = 0.004), and bullae (P = 0.01) had statistically significant independent effect on the risk of developing ulcerative keratitis, and the combination of steroids and bandage lenses yielded the highest risk (P < 0.001). Propylactic antibiotic use paradoxically had a statistically significant association with ulcerative keratitis in these patients (P = 0.01). Increasing BK time was also associated with ulcer development, and the risk remained relatively constant over the 60 months of the study. Streptococcus was the most frequent organism cultured. CONCLUSIONS: Ulcerative keratitis developed in 4.7% of patients with bullous keratopathy. Prolonged BK time alone was a risk factor for infection. The strongest single additional risk factor for ulcer development was steroid use, followed by bandage soft contact lens use, and their simultaneous use had the greatest effect. The presence of bullae was also a risk factor for infection, and prophylactic antibiotic use did not prevent ulcer development.

Aged↗
PubMedDate not supplied

Analysis of therapy-resistant venous leg ulcers. Can triple-layer treatment initiate healing?

Chronic leg ulcers represent a major health-care problem with considerable socioeconomic impact. Patients with seemingly therapy-resistant leg ulcers are common to all clinics. The purpose of the present study was to (1) examine a group of patients with nonhealing venous leg ulcers treated with a double-layer bandage and (2) evaluate whether the addition of an interactive hydrocolloid wound dressing could initiate healing in these patients. Twenty-two patients with ulcers caused by venous insufficiency were included. The patients had a mean ulcer duration of 27.6 years. Duration of the present ulcer was at least 1 year (mean >/= 4.1 years). Twenty of the 22 patients showed massive lipodermatosclerosis. Before inclusion, all patients had used double-layer bandage consisting of a zinc-impregnated bandage or stocking and a self-adhesive compression bandage for 1 year or longer without improvement. The new regimen was a triple-layer treatment with the hydrocolloid water applied over the ulcer and the traditional double-layer bandage unchanged. Three patients were dropped from the study. Nineteen patients were followed until healing or for 10 months. Nine of the 19 patients who completed the study healed. Ulcer area was reduced by 70% or greater in 7 patients and by 30% to 40% in two patients. One ulcer did not respond to the treatment and worsened slightly. The results of this study were encouraging and indicate that the triple-layer treatment with the hydrocolloid dressing applied to the ulcer should be evaluated in a randomized, controlled study in patients with less pessimistic prognoses.

Journal Article↗
PubMed2006

[Pneumatic tourniquet occlusion of circulation in distal bypass surgery].

The femoral-popliteal or distal bypass requires as a rule exact isolation and dissection of the arteriosclerotic and calcified artery. The tourniquet is an effective substitute for vascular occlusion especially in case of seriously calcified vessels. As opposed to the Esmarch bandage, the sterile Löfquist-bandage has a lot of advantages. Starting the bypass operation as usual procedure the Löfquist-bandage can be used for interruption of circulation just before opening the vessels. Positive experiences in varicose vein surgery induced us to perform this tourniquet procedure in distal bypass surgery by using the special Löfquist-bandage. Meanwhile we operated on 74 patients between 1999 and 2003. We treated 29 patients with primary distal bypass reconstruction and 45 patients who suffered from bypass occlusion. In addition to bypass thrombectomy, these patients underwent PTA, reconstructions of the distal anastomosis and bypass prolongations. The advantages were both a short clamping time and an economic dissection of the vessels. The complications were haematomas, re-occlusion, wound infections and major amputations in only few patients. Operative complications with the bandage were not observed. Indications, important technical details and the results are critically discussed.

Anastomosis, Surgical↗
PubMed1998

Use of esmolol to attenuate hemodynamic responses during cataract extraction.

Esmolol attenuates hemodynamic responses to tracheal intubation and extubation in young patients, but has less well documented pharmacokinetics and efficacy in older patients. Following cataract surgery, application of pressure on the eye during eye bandaging may have vasomotor effects. The present study of older patients having cataract surgery investigated 1) the effects of normal saline 1.0 ml. 10kg(-1) or esmolol 4.0 mg.kg(-1) IV given 90 secs prior to tracheal intubation and of normal saline 0.5 ml.10 kg(-1) or esmolol 2.0 mg.kg(-1) IV given 60 sec prior to each of eye bandaging and tracheal extubation; 2) the time to onset and duration of action of esmolol; 3) the cardiovascular effects of eye bandaging. Esmolol attenuated the cardiovascular effects of tracheal intubation, eye bandaging and tracheal extubation, but caused relative bradycardia and hypotension after induction and hypotension after extubation. Its effect occurred within 60-90 secs and lasted about 6 mins. Pressure on the eye during bandaging in those not given esmolol caused hypertension without tachycardia.

Adrenergic beta-Antagonists↗
PubMed2000

Oral pentoxifylline for treatment of venous leg ulcers.

BACKGROUND: Healing of venous leg ulcers is improved by the use of compression bandaging but some venous ulcers do not respond to compression therapy. Pentoxifylline, a drug which helps blood flow, has been used to treat venous leg ulcers but to date there has been no systematic review. OBJECTIVES: To assess the effects of pentoxifylline ('Trental 400') for treating venous leg ulcers, when compared with placebo, or in comparison with other therapies, in the presence or absence of compression therapy. SEARCH STRATEGY: We searched the Cochrane Peripheral Vascular Diseases and Wounds Groups specialised registers (date of search August 1999), and reference lists of relevant articles. We hand searched relevant journals and conference proceedings, and contacted Hoechst (the manufacturer of the drug) and experts in the field. SELECTION CRITERIA: Randomised trials comparing pentoxifylline with placebo or other therapy in the presence or absence of compression, in patients with venous leg ulcers. DATA COLLECTION AND ANALYSIS: Details from eligible trials were extracted and summarised by one reviewer using a coding sheet. Data extraction was independently verified by one other reviewer. MAIN RESULTS: Nine trials involving 572 adults were included. The quality of trials was variable. Eight trials compared pentoxifylline with placebo; in five of these trials patients received compression therapy. In one trial pentoxifylline was compared with defibrotide in patients who also received compression. By pooling eight trials that compared pentoxifylline with placebo (with or without compression) it was found pentoxifylline was more effective than placebo in terms of complete healing or significant improvement (relative risk for healing with pentoxifylline compared with placebo 1.41, 95% confidence interval 1.19 -1.66). Pentoxifylline and compression was more effective than placebo and compression (relative risk for healing with pentoxifylline 1.30, 95% confidence interval 1.10-1.54). Combination of similar trials using compression obtained a number needed to treat (NNT) of 7 (95%confidence interval 4-17). A comparison between pentoxifylline and defibrotide found no difference in healing rates. More adverse effects were reported in the pentoxifylline group, although this was not statistically significant (relative risk for adverse effects with pentoxifylline 1. 25, 95% confidence interval 0.87-1.80). Nearly half of the adverse effects were reported to be gastro-intestinal. REVIEWER'S CONCLUSIONS: Pentoxifylline appears to be an effective adjunct to compression bandaging for treating venous ulcers. There was no cost effectiveness data available and healthcare commissioners may therefore conclude that it not be considered a routine adjunct. Pentoxifylline in the absence of compression may be effective for treating venous ulcers in the absence of compression, although the evidence should be cautiously interpreted. The majority of adverse effects are likely to be tolerated by patients, and gastrointestinal disturbances (indigestion, diarrhoea and nausea) are the most frequent adverse effect.

Administration, Oral↗
PubMed1995

Change of central venous catheter dressings twice a week is superior to once a week in patients with haematological malignancies.

Thirty-two consecutive patients with haematological disorders, in need of a permanent central venous catheter (CVC) were randomly allocated to have their CVC bandages (Tegaderm) changed once (OAW, n = 20) or twice (TAW, n = 19) a week. The two randomization arms were balanced in respect of age, sex, and underlying disease. The exit site of the CVC was inspected daily through the transparent bandage and erythema was noted. If severe erythema occurred, daily wet gauze dressings were applied. Samples for bacterial cultures were taken from the exit site of the CVC at every change of bandages. There was no difference in complications leading to removal of the CVC between the two groups (7/20 OAW vs. 7/19 TAW) or in CVC survival-time (P = 0.4). However, the OAW group had more positive CVC tip cultures (OAW 11/14 vs. TAW 2/9; P < 0.05) and a tendency to: (i) more extra dressings (P = 0.08); (ii) more cultures from the exit skin site showing high numbers of colony forming units (P = 0.07); (iii) shorter time to first exit site infection (P = 0.09); and (iv) more Gram-positive septicaemias (P = 0.08). Both clinical and bacteriological data in this study indicate that changing transparent polyurethane CVC bandages twice a week is superior to once a week.

Adolescent↗
PubMed1994

Facilitation of peripheral intravenous access: an evaluation of two methods to augment venous filling.

STUDY OBJECTIVE: To evaluate two methods of augmenting venous filling as potential aids to i.v. cannulation. DESIGN: Comparative study of cross-sectional areas of preselected antecubital fossa veins. SETTING: Vascular laboratory of a British university teaching hospital. PARTICIPANTS: Thirty healthy, normotensive, adult volunteers. INTERVENTIONS: Vessel cross-sectional areas measured noninvasively using a color flow duplex ultrasound scanner. Measurements were taken at rest, after application of a venous tourniquet, with tourniquet and Esmarch bandage, and with tourniquet and Rhys-Davies exsanguinator. RESULTS: Mean (+/- SD) cross-sectional area at rest was 0.18 +/- 0.094 cm2 and after tourniquet was 0.28 +/- 0.14 cm2. Application of an Esmarch bandage produced an increase to 0.33 +/- 0.14 cm2, and Rhys-Davies exsanguinator produced an increase to 0.32 +/- 0.15 cm2 (P < .0001 for all comparisons except Rhys-Davies exsanguinator versus Esmarch bandage). CONCLUSION: Application of either the Esmarch bandage or the Rhys-Davies exsanguinator caused significant filling of antecubital fossa veins in excess of that produced by a venous tourniquet alone in normovolemic, normotensive volunteers.

Adult↗
PubMed2000

Non-elastic compression: an alternative in management of chronic venous insufficiency.

Non-elastic compression has been used to treat venous insufficiency of the lower extremities for more than 150 years. The best and most recognized example is the Unna boot. When compared with other dressings, the Unna boot has performed as well as or better than other forms of compression. While the Unna boot is used worldwide, a 3- or 4-layer dressing has emerged as the dressing of choice in treating severe chronic venous insufficiency in the United States and English-speaking European countries. In the United States, non-elastic compression can also be applied as a CircAid legging. This semirigid support has been compared with heavyweight class 3 below-knee medical stockings. At 2 and 6 hours after application, inelastic compression maintained limb size and reduced venous volume better than did stockings. At 6 hours, the ejection fraction of the calf muscle pump was increased and venous filling index significantly improved with inelastic compression compared with stockings. Comparison of elastic stockings with short-stretch bandages has also been completed. The short-stretch bandage was found to be similar but not identical to the semirigid inelastic support device. The studies have shown that venous filling index improved by short-stretch bandaging and that venous reflux time was prolonged more by the short-stretch bandages than by stockings. The findings of these studies demonstrate that the inelastic support dressing mimics the action of the Unna boot in providing counter-pressure to perforating vein outflow. This may improve cutaneous and subcutaneous microcirculation in a manner similar to perforating vein surgery, which has been shown to accelerate leg ulcer healing.

Bandages↗
PubMed2000

Elastic adhesive dressing treatment of bleeding wounds in trauma victims.

Conventional methods for hemorrhage control in the trauma patient fall short of providing a full solution for the life-threatening bleeding injury. The tourniquet is limited specifically to injuries of the distal limbs. Local pressure or tight bandaging with military bandages is cumbersome and often insufficient. Therefore, we sought a superior method to stop bleeding in emergency situations. Our objective is report and description of our experience with this method. Since 1992 our trauma team repeatedly encountered multiple trauma victims presenting with bleeding wounds. We achieved hemorrhage control by means of an adhesive elastic bandage applied directly over a collection of 4 x 4 gauze pads placed on the wound surface. The roll is then wrapped around the body surface, over the bleeding site, until sufficient pressure is reached to terminate ongoing hemorrhage. Three typical cases are described in detail. Adhesive elastic dressing compression was successful in fully controlling bleeding without compromise of distal blood flow. Our method corresponded to the demand for an immediate, effective and lasting form of hemorrhage control without complications. Furthermore, this technique proved successful even over body surfaces normally recognized as difficult to compress. We experienced equal favorable success while working during transit by either ambulance or helicopter transportation. We find our preliminary experience using elastic adhesive dressing for bleeding control encouraging and suggest that this may substitute existing practices as the selected treatment when indicated. This method is presently underrecognized for this purpose. Development of a single unit bandage may further enhance success in the future.

Adhesives↗
PubMed2002

Exsanguination of lower limbs in healthy male subjects.

Gamma camera technique was used to assess the effectiveness of various exsanguination methods in 12 healthy male volunteers given an autologous injection of 99mTc-labeled erythrocytes. The methods used included elevation alone, Esmarch bandage, gauze bandage, and the Pomidor roll-cuff. The median times spent on use of these methods were: Esmarch 85 sec, gauze 104 sec, and Pomidor roll-cuff 18 sec. The various exsanguination methods caused a median percentage reduction in regional blood volume of the lower limbs: elevation 1/2 minute 45%, 1 minute 45%, 2 minutes 42%, 4 minutes 44%, 6 minutes 43%, 10 minutes 44%, Esmarch bandage 64%, gauze bandage 62%, and Pomidor roll-cuff 61%. No statistically significant differences were found between the elevation procedures. The external methods were more effective than elevation alone (p < 0.001).

Adult↗
PubMed2005

The static stiffness index: a simple method to assess the elastic property of compression material in vivo.

BACKGROUND: The efficacy of compression therapy depends mainly on the exerted pressure and on the stiffness of the material. OBJECTIVE: To propose a simple method by which pressure and stiffness can be assessed in the individual patient. MATERIAL AND METHODS: Using a pressure transducer (Kikuhime small probe, MediTrade, Soro, Denmark) the sub-bandage pressure is measured on the medial aspect of the lower leg at the transition of the gastrocnemius muscle into the Achilles' tendon. The pressure difference between active standing and lying is defined as the static stiffness index (SSI). RESULTS: The accuracy and precision of the probe are good. Unna boot bandages (Lohmann-Rauscher, Vienna, Austria) and multilayer short-stretch bandages show a significantly higher SSI than long-stretch bandages and round-knitted class II stockings. The SSI values are lower than 10 mm Hg for elastic, long-stretch material and higher than 10 mm Hg for inelastic, short-stretch material. CONCLUSION: In future compression trials, pressure and stiffness measured in vivo should be declared.

Bandages↗
PubMed2004

Lower limb wrapping prevents hypotension, but not hypothermia or shivering, after the introduction of epidural anesthesia for cesarean delivery.

The decrease of arterial blood pressure and body temperature after epidural or spinal anesthesia is thought to be the result of sympathetic block, which could cause pooling and redistribution of blood into the lower extremities. Studies have demonstrated that leg wrapping with elastic bandages may reduce the incidence of hypotension after spinal anesthesia. We tried to extend these previous observations to epidural anesthesia by testing the hypothesis that leg wrapping with elastic bandages should decrease the incidence of hypotension in patients receiving epidural anesthesia. Moreover, we evaluated the effect of this maneuver as regards hypothermia and shivering. Sixty parturients were randomly allocated to receive either leg wrapping with tight elastic bandages (leg-wrapped group) or not (control group) before anesthesia. Sublingual temperature was observed at five periods: baseline, immediately after epidural anesthesia, abdominal skin disinfection, skin incision, and delivery. Hypotension and shivering during the observation periods were also recorded. The incidence of hypotension was significantly less frequent (P = 0.03) in the leg-wrapped group (23%) compared with the control group (50%). Shivering incidences were similar in both groups (70% versus 70%). Sublingual temperature decreased significantly (P < 0.001) throughout the procedure in each group. However, no differences were found between the two groups at each designated observation, even if compared by the magnitude of temperature decrease. We conclude that although leg wrapping with elastic bandages prevents maternal hypotension after epidural anesthesia, it does not reduce the incidence or magnitude of hypothermia or prevent shivering.

Adult↗
PubMedDate not supplied

Comparison of Rosidal K and SurePress in the treatment of venous leg ulcers.

Fifty-two patients (26 in each group) were recruited into this randomized, comparative, controlled trial of Rosidal K short-stretch compression bandage and SurePress long-stretch compression bandage in the treatment of venous leg ulcers. Patients were monitored for a maximum of 12 weeks. Each patient was seen weekly by a research nurse, who recorded the study variables. The mean percentage reduction in the wound bed surface area during the study period was 52% in the SurePress group and 73% in the Rosidal K group. Eight patients in each group saw their ulcers heal within the study period. The average limb volume reduction, based on the first 4 weeks of data collection, was 2.3 cm for those in the Rosidal K group and 3.9 cm in the SurePress group. Ulcer size increased in six patients allocated to SurePress bandages and in four patients allocated to Rosidal K bandages.

Aged↗
PubMed1999

The use of proteases as prognostic markers for the healing of venous leg ulcers.

Abnormally high levels of some proteases are associated with pathological changes in the wound bed of venous leg ulcers. This study involved two experiments which measured proteases in wound fluid harvested from leg ulcers in order to predict healing. In the first experiment, neutrophil elastase, a protease, was harvested from wound fluid extracted from the bandages of seven patients with leg ulcers. This was undertaken once a week over a period of up to six weeks. The amount of elastase recovered from the bandages showed wide variation between patients and there was no consistent correlation between the activity of elastase and healing of the ulcers, as determined nine months after sampling for the enzyme. The second experiment determined the stability of neutrophil elastase that was added to bandages for one week. The stability was found to vary from approximately 50% to 100%, depending on the type of bandage used. In addition to the possibility of using protease measurements to predict healing, the procedure was found to be simple, non-invasive and relatively inexpensive, and could be performed routinely in the clinic.

Bandages↗
PubMed2001

Improving the treatment of leg ulcers.

Treatment of leg ulcers is often inadequate, with delayed diagnosis, overuse of antibiotics, and insufficient or inadequate use of compression therapy. Ulcers caused by arterial insufficiency will not heal unless the blood flow is improved. Ulcers caused by venous insufficiency will usually heal within a few months with appropriate compression therapy. Compression can be applied with stockings, bandages, or a pump. Class 2 compression stockings are required for treatment of ulcers; TED stockings and Class 1 stockings do not provide adequate compression. A four-layer compression bandage can be used if a patient cannot manage stockings. Applying the bandage with the correct pressure is a skill developed from practice. A pump can be used if neither stockings nor bandages are suitable. However, it must be used for six hours a day, which precludes use by active patients. An ulcer that does not heal with three months of adequate compression therapy requires further investigation.

Adult↗
PubMed2000

[Compression therapy of leg ulcers].

The authors present a group of 76 patients with chronic venous insufficiency in the stage or crural ulceration. After staging of the disease (C 6, E prim, E sec, A sup. pr. ref., P re) in the first stage they used a conservative approach, the method of compressive bandages: either an elastic bandage or zinc-glue bandage (Varolast). 49 patients were cured by conservative treatment (64.5%) in the course of 5 months. 12 patients were indicated for surgery (15.8%). Thus the authors cured finally 80.2% patients. A relapse was recorded in 6 patients (7.8%) and in 9 patients treatment failed (11.8%). For treatment with zinc-glue bandages they recommend patients without obstruction in the deep venous system, with large chronic ulcers and associated oedema of the whole leg.

Bandages↗
PubMed1959

Crushing injury of the hand; prevention of ischemic contracture.

Crushing injury of the hand usually causes "explosive" damage. Subsequent swelling of the palmar structures further impairs venous outflow, and hemorrhage into structural spaces increases the pressure. The arterial system and the large dorsal veins, however, are seldom obstructed and provide adequate circulation unless hampered by improper bandaging. A bandage that compresses the dorsal veins causes back-pressure, which increases the swelling further and brings about ischemia. Swelling and pain cause the patient to restrict exercise of the injured hand, which permits contractures to develop. The author has averted this sequence in more than 100 cases by preserving integrity of veins during debridement, arresting hemorrhage, bandaging the hand with compression dressings in functional flexion, and reducing swelling with hyaluronidase. In these cases, on removal of bandages in 24 hours, swelling was reduced and continued to diminish. All patients exercised the hand at this time without discomfort and only a few required aspirin for pain.

Bandages↗